Surfside Summer Makeovers

WebMD experts tell you the cosmetic secrets people are using to stay looking good on the beach.

From the WebMD Archives

Try as we might, most of us will probably never achieve Jessica Simpson's new bikini bod or rhythm and blues star Usher's finely chiseled abs -- at least not the old fashioned way with a low-fat, low-calorie diet, and regular exercise.

While nipping, tucking, zapping, and suctioning are certainly no substitute for a healthy lifestyle, they can definitely augment one, experts tell WebMD. For better or worse, here's what the inhabitants of the cabana next store may be up to this summer.

Breast in Show

Adjustable breast implants may make some waves at the beach this summer. Here's why: "About 90% of breast augmentation patients are very happy with the results immediately after surgery and then at six weeks, they say 'I could have gone bigger,'" explains Ben Lee, MD, a plastic surgeon in Englewood, Colo. "They come in terrified that they will end up looking like Dolly Parton and opt for smaller implants."

To the rescue: the Spectrum Expandable saline implant. "It has a port that is placed in at the time of surgery either underneath the breast or nipple and after surgery, if a woman decides to go bigger, they can add about 70 ccs of volume or so," he tells WebMD. They can also be downsized, he says, but that is rarely done.

"Some of the best breast augmentations that I have seen are done with this method," he says.

Cohesive gel implants may also make a splash this summer, says Barry DiBernardo, MD, director of New Jersey Plastic Surgery in Montclair, N.J., and spokesman for the American Society for Aesthetic Plastic Surgery (ASAPS).

Although they are not fully approved yet for initial breast augmentation, cohesive gel implants are as safe as saline and feel as natural as silicone, he says.

"If you cut one of these implants in half, the gel doesn't spill, so it is much safer and feels so good that you don't want to put it down when it's in your hand," says DiBernardo, also the president of the New Jersey Society of Plastic Surgeons.

As it stands, "women who are exchanging implants or who are having a breast lift at the same time can use these new implants," he says.

Adds Donald W. Kress, MD, a plastic surgeon in Frederick, Md., "It's a phenomenal implant that looks like it grew there and feels like it, too."

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Tightening and Tucking in Time for Independence Day

So you want to get rid of some of the extra skin before you don your new bikini? A new type of liposuction may be just what the doctor ordered. Called liposelection, the new technology uses ultrasound energy to break up fat before it is removed via liposuction. It can be used in the abs, arms, back, hips, knees, love handles, neck and chin, saddlebags, and thighs. "It has less potential to burn the skin and is potentially more precise than traditional liposuction and can be used anywhere in the body," Lee says.

Lasers, too, can trim some unwanted flab. "People with loose skin that's not terribly loose on the abdomen, inner thighs, or arms who don't want and don't need major surgery may benefit from the Titan laser," DiBernardo says. "The Titan laser tightens the skin without downtime and can be used in any color skin," he says. "It takes anywhere from one to six treatments that are given at least one month apart." he says. It uses infrared light to cause the collagen in the skin's dermis to contract and tighten. But the Titan tightening treatment is not for everyone, he notes. "If it's there's too much fat or too much skin, we need to jump to something more aggressive" such as a tummy tuck or liposuction.

Thermage, which uses radiofrequency to tighten and lift skin, may also flatten unwanted flab, says Ariel Ostad, MD, a dermatologist in private practice in New York City and a clinical assistant professor of dermatology at the New York University Medical Center.

"For people with loose skin on their abdomen from delivery, pregnancy, or childbirth, or creepy skin on their abdomen or under their arms, Thermage can tighten the skin," Ostad says. It's FDA approved for the face, but Thermage can be used on other areas, he says. And "for people very self-conscious about wearing bikinis, Thermage involves no scars and provides minimal lifting and tightening."

Still want those six-pack abs? Now you can have them etched in … skin.

"Ab-etching is a cheaters way of making six-pack or eight-pack abs," Kress says.

"If you are 40 pounds overweight, you will look ridiculous, but if you are slim and attractive and want to emphasize it, this may be a worthwhile procedure," he says. Ab-etching involves the removal of excess fat in between the abdominal muscles and in doing so, creates scars that give the appearance of a defined stomach ala Usher.

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Mommy Makeovers

"My all-time favorite procedure for this time of year is the mom body tune-up," DiBernardo says. "It's a huge category and always very gratifying." It's aimed at women between the ages of 38 to 45 who have had all their children. "These pregnancies have taken a toll on their abdomen and breasts," he says. "They have tried going to gym and are so depressed that they have lost their body," he says.

But in one session, "we will do their breast and abs at the same time -- whether combining liposuction, a mini or full tummy tuck with a breast augmentation with lift or a lift only," he tells WebMD.

"In a few hours, they get their body back and sometimes it's better than what they started with," he says. "It's a 180-degree turnaround that fits the extreme beach makeover title to a T." For best results, always to choose a board-certified plastic surgeon. To find one near you, visit the ASAPS web site at www.surgery.org/public/findasurgeon.php.

Dream Cream or Snake Oil?

Many women and men may be tempted by the dozens of creams that promise to get rid of cottage cheese thighs, but "I have not seen a cream that works yet, so I don't waste my time with them," DiBernardo says.

Ostad echoes these sentiments: "There are lots of creams that say they improve cellulite, but they are really just moisturizers that may contain collagen and they have very transient effects for about an hour," he says. "In terms of long-term effectiveness, they don't offer any."

He is equally cynical about lasers and cellulite. "There is a lot of hype from laser companies, but before we jump in and offer it to patients, we want to make sure there are studies out there that show these really work," Ostad says. "At the present time, I don't think they are good enough."

Hair Today, Gone Tomorrow

"Laser hair removal is not new, but it is going well," DiBernardo says. "For men, a big area is the back because you can't shave there, and for women it is more the bikini line and areas of convenience," he says.

"We do know that they will need at least three treatments and that could be upward of six or eight treatments depending on the machine, part of the body treated, and skin type," he says. Still, "some people will come in June and get a full treatment and know that their hair will not grow back until September -- so they are set for the summer," he says.

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'Backne' Be Gone

"Some people have backs full of terrible acne and the most effective treatment for acne -- whether on the face or back -- is called photodynamic therapy," DiBernardo says. "We coat the skin with a material that's activated by a laser, wait 30 minutes, and hit it with the laser and it activates the molecules to kill acne bacteria and dry up the oil glands," he says. "Nothing else does that other than pills like Accutane," a controversial acne drug linked to depression and possibly suicide.

Photodynamic therapy typically involves two to four treatments, and patients must wait a week to go in sun (with sunblock), he says.

Doin' Da Butt

When J-Lo first burst on the scene, there was some demand for buttock implants, and although "it has little spurts, there is not such a high demand," DiBernardo says. "These can become infected or shift," he says, adding that he is not a big fan. Fat injection involving grafting fat from one body part and adding it to another may be an option for someone looking to be bootylicious this summer. But with this technique, it's difficult to predict how much fat the body will reabsorb and multiple procedures may be necessary. According to the ASAPS, Americans had more than 2,100 buttock augmentation procedures and nearly 6,000 buttock lifts last year.

Fat transfer or lipostructure can also help boost leg size in men trying to go from skinny to studly.

"Some people have very skinny legs below the calves and want it built up," DiBernardo says. The problem? "The skin is so thin not a good place to put implants, so we can harvest fat from other areas and transfer and build up those skinny legs to a more plump desirable appearance."

Putting Your Best Foot Forward

In a new survey of 2,012 men and women, 22% of people said they were not happy with the way their feet look. In fact, 9% rarely go barefoot because they don't like the look of their feet and 8% won't wear open shoes. The poll was conducted by PediFix foot care products.

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"Before strappy sandals, people didn't reveal their feet as much, and now there is an awareness about the aesthetic appearance of the foot," says Stuart J. Mogul, DPM, a podiatric surgeon in New York and author of Perfect Feet.

"From a strictly cosmetic standpoint, one of the things that we do are surgical corrections of hammer toes and toes with corns or bunions," Mogul says. Other sandal-worthy operations include shortening the second toe, which if it sticks out enough, can make it difficult to fit into shoes. "The results can be pretty dramatic," he says. "There is a dual benefit to most of these surgeries as surgery relieves pain but leaves a foot without corns, and toes look more normal."

What's more, some foot doctors are using collagen and fat injections to build up cushioning on the foot. But "this is temporary and displaced with weight bearing," he says. "I don't think it's an effective treatment."

The Heat Is On

Many women are concerned about the appearance of varicose and spider veins on their legs. The good news is that a new procedure can help banish unsightly varicose veins. Called Closure, a doctor first uses ultrasound to map the vein, then numbs the area with local anesthesia. The doctor then nicks the skin behind the knee and threads a small tube into the vein. Using ultrasound, the doctor guides the tip of the tube until it reaches the point near the groin where the saphenous vein starts. The saphenous vein, which runs along the thigh, is one of the major veins of the leg. Then, a tiny, heated probe is threaded through the tube, shrinking the inner walls of the vein until it collapses. Once the diseased vein is shut, other healthy veins take over its job. "The majority of veins disappear within a month," Ostad says.

Traditionally, varicose veins have been removed with surgery. The surgery may involve tying off the saphenous vein, then partially or completely removing its branches, a procedure known as vein stripping. This type of surgery is usually performed under general anesthesia, and the patient must rest the leg for about a week afterward. Another option for varicose vein removal is called sclerotherapy, or injection therapy. In this procedure, a solution is injected into the vein to force it to clot. Unlike with the new heat therapy, varicose veins often return after sclerotherapy.

WebMD Feature Reviewed by Charlotte E. Grayson Mathis, MD

Sources

Published June 13, 2005.

SOURCES: Ben Lee, MD, plastic surgeon, Englewood, Colo. Barry DiBernardo, MD, director, New Jersey Plastic Surgery, Montclair, N.J.; spokesman, American Society for Aesthetic Plastic Surgery (ASAPS). Ariel Ostad, MD, clinical assistant professor of dermatology, New York University Medical Center. Stuart J. Mogul, DPM, podiatric surgeon, New York; author, Perfect Feet. Donald W. Kress, MD, plastic surgeon, Frederick, Md.
© 2005 WebMD, Inc. All rights reserved.

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