Bergman Cosmetic Surgery

DR. BERGMAN» Pageantry Articles by Dr. Bergman

Dr. Bergman is Pageantry Magazine's International Plastic Surgery Consultant, and writes quarterly articles for the magazine.

Pageantry is considered "The Bible" of the pageant, fashion and talent industries. Dr. Bergman has worked with numerous beauty pageant winners in perfecting their looks. He is also an expert pageant judge.

Summer 2010
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Fall 2007 - Fall 2005

Summer 2010 - Pageantry Magazine

Lifetime of Regret
For some, tattoos are a form of art, but for others they are a reminder of a costly career mistake.

We all have regrets. But in pageants, and fashion modeling, a tattoo can be a glaring distracting regret when it comes to your confidence and appearance.

Tattoos, if carried out on a whim or for the wrong reasons, can result in "ink regret". This is quite common and seen in my practice every day. Even the most meaningful tattoos can become career-limiting in a competitive industry such as modeling. According to a 2008 Harris poll, 14 percent of all Americans have at least one tattoo, and 17 percent of those experience regret. So how do we get rid of them?

It's important to realize that removing the tattoo will be more expensive and painful than the original "inking" process. Also, darker colors are more completely removed than lighter or brighter colors - a fact that doesn't make sense to most patients. There are three main categories of removal options: Masking, topical substances and laser treatment.

MASKING
To "mask" a tattoo, you can either:
a) use makeup; or
b) cover one tattoo with another.

Several products are available for makeup-style concealment. This is often sufficient for most tattoos if cover-up is only required for a short time such as a runway show, photo shoot or pageant. Covering one tattoo with a new one requires planning with your tattoo artist, and the new tattoo must be darker in color. The old ink will require some form of removal process to first lighten the area in order to cover the unwanted tattoo effectively.

TOPICAL SUBSTANCES
Common topical kits will include a cream or gel, as well as an exfoliator and moisturizer (tip: exfoliators and moisturizers are available separately at the drug store for significantly less). Most topicals take a long time - some up to a year - to face the tattoo. While expensive, these topicals are cheaper than lasers and are not painful. Do not use products that contain TCA (trichloroacetic acid) unless you have spoken to your plastic surgeon. These are cream versions of a chemical peel and can cause significant scarring or pigmentation changes when not used properly.

A slightly more invasive topical technique includes mixing saline with a gel and actually tattooing it into the area. The gel binds to the ink molecules and brings them to the surface, forming a scab that falls off as the area heals. This process is repeated 3-5 times over 4-6 weeks until the ink is gone. The risk of scarring and skin discoloration from this process is the same as for laser treatments.

LASER TREATMENTS
Lasers are quicker than topicals, but are more expensive and painful. They are used to react with and break down ink. The ink can then be absorbed by your body in the same manner that natural ink-fading occurs due to sunlight and environmental exposure. This is also why it requires multiple visits in order to gradually break down the ink. Be warned - this process can result in scarring. The thinner the skin, the more likely it is to scar. Pain-relief creams can be applied to the area to help with the discomfort. Some physicians will use injections to provide pain relief during the procedures, but use of these injections will require more treatments during the removal process. There are several types of lasers, which all provide similar results. Consult your plastic surgeon for his/her experience with each machine.

Laser removal will typically take 8-12 treatments, 8 weeks apart, with each session lightening the ink. The number of sessions required will depend on skin type, tattoo location, color, amount of ink, etc. Sometimes a combination of topicals and lasers can be utilized to lower the number of laser sessions required, or to target more "stubborn" tattoos. Patients with a healthy immune system and/or who do not smoke will have more successful results with lasers. The most common side effects of laser treatments are scarring and skin pigmentation changes, and should be immediately discussed with your physician, as these side effects can sometimes be reduced if detected early and treated when they have occurred. As with any procedure involving the skin... always wear sunscreen, especially when undergoing the treatments.

SURGERY
If none of the above procedures have worked, the only option remaining is surgery - literally "cutting out" the tattoo. Depending on the size, this can include anything from cutting out the tattoo and stitching the skin back together, to a skin graft to cover the area. In either case, scarring is quite common. However, depending on how badly you want the ink gone, sometimes pain and a little scarring is worth it.

Of course, any time you consider making a permanent change to your body it is important to think of long-term consequences. But should you find yourself suffering from "ink regret," consult your plastic surgeon to find the appropriate option for your situation and budget.

Dr. Ronald Bergman is a board-certified plastic surgeon practicing in Des Moines, Iowa, for 28 years. He specializes in breast augmentation, liposuction, and tummy tucks. His patients include many local, national, and international pageant winners. Dr. Bergman is also a highly qualified pageant judge.
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Spring 2010 - Pageantry Magazine

Saving Your Skin
The cold weather months are the perfect time to prep for summer's warm glow
A competing woman's body is perfected during the winter. Those are my favorite cold weather words every year. Winter brings holidays, stress and often new resolutions for your personal trainers. While most people slack after they've unpacked the sweaters, those who continue to stay focused really shine on the competitive stage.
Cosmetic surgery is well-timed for most competitors with time off over the holidays, as there is plenty of time for a full recovery. However, it is very important to remember that the skin is best treated during the frosty months. Most skin treatments require no tan before or no immediate sun exposure after the application. My recommendation is to bring on your high quality skin care reigns like Obagi, do those chemical peels, and say hello to laser procedures.

Obagi's skin care regimen has remarkable results by combining both hydroquinone and tretinion active ingredients with a high quality line of products. Hydoquinone evens the skin tone that has been influenced by sun damage and tretinion treats wrinkles and acne. These ingredients both require limited sun exposure, making the treatment off limits in the summer or with tanning bed use. Sunscreen is included in the daily regimen.
Chemical peels are offered in a wide variety. The goal of a chemical peel is to slough off layers of skin to treat sun damage, wrinkles and acne, or to provide a more youthful overall appearance. They vary in types of chemicals used, the concentration of the chemicals, and how deeply the chemicals penetrate the skin. These treatments are typically done on the face but can also be done on the decollete (chest area).
Laser hair removal, skin rejuvenation and spider vein treatments are the most popular of all winter procedures and have benefits for all competitors of almost every age. One cannot have a tan at the time of a laser procedure, as the pigment in your skin can increase the chance of complications, and limited sun exposure afterward is also often recommended depending on the nature of your procedure.

The benefits of laser hair removal are obvious - no shaving. There is also no downtime and it is particularly beneficial for those who get bumps from shaving. It is important to remember that is does require several treatments to get the full benefit, as it is only effective against the hairs in the growth phase. Monthly hair cycles and the treatments not done during the growth phase of the hair cycle will not be effective. Anywhere from five to 10 treatments can be required depending on your skin type, the type of laser and timing of treatments.
Laser skin rejuvenation is very effective for spot treatments or for overall skin quality. Spot treatments are typically for sun damage and wrinkles, whereas overall skin quality focuses on texture and tightening. There are several of these treatments that can be done over the lunch hour with no downtime. As with chemical peels, depending on the depth of the skin layer targeted, very dramatic results can be achieved with deeply penetrating laser resurfacing that can either be done in your plastic surgeon's office or, if deep enough, even as an outpatient surgical procedure.

Laser vein treatments are becoming more and more requested among competitors in their 20s and 30s. Treatment of small spider veins when first noticed is much more simple. They can often be easily "zapped," usually with only one quick laser treatment. It can cause mild bruising that goes away in a few days. Lasers can also be used to treat some of the lesser varicose veins but offer quite amazing results for those small, unsightly spider veins, especially when treated early.
With the proper skin care products, chemical peels and laser procedures, you are on the right path to your quest for your title. Do not let the cold weather suppress your motivation. Remain focused on your treatment regimens, and achieve body perfection this winter.

Dr. Ronald Bergman is a board-certified plastic surgeon practicing in Des Moines, Iowa, for 28 years. He specializes in breast augmentation, liposuction, and tummy tucks. His patients include many local, national, and international pageant winners. Dr. Bergman is also a highly qualified pageant judge.
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Winter 2009- Pageantry Magazine

Getting Your Fill
There are plenty of things to consider before taking the ultimate plunge with breast augmentation
Prepping for next Spring's competitions is now in full swing. A question I am asked every year is: "Are breast implants for me?" Picking out the perfect dress and having it not quite fit on top while looking at last year's pageant photos, wondering if more fullness would have helped in the swimsuit competition. These are common concerns, especially considering that when most women lose weight or begin an intense toning-up regimen for a pageant, they often lose volume in their breasts. This situation leaves my patients with questions and sometimes only a small window of opportunity.

Looking at Lingerie
My caveat to all surgical procedures is that prior to considering a permanent change to your body, it is important to explore all non-surgical options first. Local lingerie stores are often able to provide several options, including bras and adhesive silicone products.

Breast Augmentation
Breast augmentation is the name given to the surgical procedure that involves placing an implant either on top of or below the chest muscle (pectoralis major muscle) for the purpose of increasing breast volume. This is done by your plastic surgeon for cosmetic or reconstructive purposes.

Implant Choices
There are two major types of shell implants: saline or silicone. From here, there are several subtypes. They vary in size based on volume (how many milliliters), although that does not relate to cup size, but rather to the amount of volume being added to existing breast tissue. The different sizes come in different profiles (width and height) and shell textures (smooth or textured). So many choices to make it is very important to discuss with your plastic surgeon what options would work best for your lifestyle and natural canvas. Saline is approved for cosmetic use in patients over the age of 18, whereas silicone is not approved until page 22. Both implants are approved for patients of any age for the purpose of reconstruction.

Things to Consider
The risks of your particular procedure should be discussed between you and your surgeon. Risks specific to breast implant surgery include: the need for further surgery, capsular contractor (hardening of the implant), changes in nipple sensation and implant rupture, which is a very low risk. Implants do not last forever, as most patients need additional surgery at some point in their lifetime. If you decide to have your implants taken out, the changes to your breasts cannot be undone. If you have implants on top of the chest muscle or implanted around the nipple area, breast tissue can be affected and decrease your ability to breast-feed. Mammograms to screen for breast cancer can be more difficult with implants. Because of these risks and the mild swelling that can happen after surgery, I recommend trying to plan for at least three months between your surgery and the big event to provide adequate time for healing.

Is It Right For Me?
This is never a question I can answer for anyone else. I can provide all of the information to make an informed decision, but breast augmentation, like any elective procedure, is an individual choice. I warn patients not to have unrealistic expectations and to make sure that this is something you really want to do for you. That being said, most women make the decision to get implants after a long, well-thought out process and truly enjoy their new figure.

More information is always available thorough our office as well as the FDA website at www.FDA.gov/medicaldevices.

Dr. Ronald Bergman is a board-certified plastic surgeon practicing in Des Moines, Iowa, for 28 years. He specializes in breast augmentation, liposuction, and tummy tucks. His patients include many local, national, and international pageant winners. Dr. Bergman is also a highly qualified pageant judge.
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Fall 2009 - Pageantry Magazine

Saving Your Skin
While your complexion's number one enemy is bacteria, there are plenty of good weapons at your disposal.

One of the biggest fears I'm asked to face is the surprise big day breakout. Acne is often considered a pre-competition taboo to even discuss. However, due to constant improvements in the treatment of acne, it deserves to be revisited along with a few friendly reminders.

Every girl will experience at least one breakout in her lifetime. Most commonly this will occur during times of hormonal change - the teenage years, late 20s to early 30s and late 40s to early 50s. This surge in hormones can leave us with acne's dreaded pustules and scars. Also, depending on the severity, it can cause real psychological damage by decreasing confidence, self-esteem, competition and work performance.

Oil production is influenced by hormones, stress and genetics. When all, or even some, of these forces work together it can spell disaster.

KNOW YOUR ENEMY
Many superstitions exist, but the one true cause is bacterial infection of clogged pores. The most commonly diagnosed bacteria is Propionibacterium acnes, or P. acnes. Bacteria live on your skin and can cause infections when pores become clogged or when oil production is increased. Pores may become clogged from improper face washing, product residue and environmental exposures. Oil production in influenced by hormones, stress and genetics. When all, or even some, of these forces work together it can spell disaster.

SEEKING SOLUTIONS
The best treatment always starts with a well-balanced diet, drinking plenty of water and getting at least eight hours of sleep each night. Of course, nothing can replace a visit to your physician for appropriate diagnosis and treatment of your acne.

A high quality face wash and sunscreen should always be the first and last steps of any skin care regimen. Wash your face twice daily to clean away makeup, dirt and oil. The best soaps are unscented and leave little residue. This can be tested by washing the back of your hand and patting it dry-if your skin becomes irritated or doesn't feel clean, it's not a good soap. I recommend over-the-counter products like Neutrogena or Aveeno and prescription products like Obagi.

FIGHT YOUR BATTLE
After the face is clean, the next step is to fight bacteria. There are three main categories of treatments for bacteria: topical benzoyl peroxide, topical antibiotics and oral antibiotics. Topical benzoyl peroxide is available at the drug store but in lower concentrations than are usually needed to get results . When combined with alcohol, as found in many products, these solutions can be very drying to the skin and worsen the acne over time. It can also bleach clothing, towels and bedding if you're not careful. Clindamycin and erythromycin are examples of topical antibiotics or antibiotics available as creams. Unlike pills these creams are applied directly to the infected pores and can provide faster results th an pills.

Oral antibiotics are pills like doxycycline or minocycline and are taken every day to either treat or prevent breakouts. While they are effective, it can take a while to see results and they are usually reserved for more severe cases.

Once you have defeated the bacteria, there is still one more step before the application of sunscreen and that's a topical retinoid product, like Retin-A Micro, Differin or generic tretinoin. This is my favorite step because these products really bring your overall skin texture and appearance to the next level. Unfortunately, it is also the hardest therapy to start and maintain. Retinoids increase the rate at which your body builds new layers of skin. The downside is that it can take your body at least 28 days to catch up. During th e beginning of this catching up process, patients can go through a shedding phase. The appearance is similar to that of a peeling sunburn and can cause patients to stop using the product. Thankfully, this period is short and the results are worth it.

ADDITIONAL RESOURCES
Some of the other treatments you may hear about include birth control pills, Accutane, injections and laser treatments. "The Pill" works by regulating hormones to decrease the ups and downs that can trigger a hormonally-induced breakout. Accutane is a very strong medication taken as a daily pill that decreases oil production throughout the body. It requires regular doctor check-ups frequent blood work and two forms of birth control as it can cause liver and triglyceride problems, as well as devastating birth defects. It sounds scary, but in the right patient, and when used and monitored correctly, it can be a miracle treatment. Injections work well for an individual, deep, painful, cystic or nodular acne lesion. Finally, laser therapies, once only used to treat acne scars, can now be used as an additional tool in long-term management of acne prone skin and even during breakouts.

In your next quest for stardom, remember that your skin doesn't have to suffer the dreaded competition jinx. Acne, when properly diagnosed and treated by your plastic surgeon, can be a very manageable part of your event preparations and every title holder's best accessory.
Dr. Ronald Bergman is a board-certified plastic surgeon practicing in Des Moines, Iowa, for 28 years. He specializes in breast augmentation, liposuction, and tummy tucks. His patients include many local, national, and international pageant winners. Dr. Bergman is also a highly qualified pageant judge.
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Summer 2009 - Pageantry Magazine

Sun, Smart & Beautiful
Avoid the Top 5 mistakes in preparing for your competition by keeping your skin gorgeous and safe

As we approach this summer's long-awaited competition season, I realize I see the same mistakes every year. This year,
my staff and I compiled our Top 5 mistakes we see on a regular basis. Consider this your insider advice on how to avoid these ill-fated trends.

These mistakes have a common theme-expecting too much in too short of a time period. When this happens the desired results are not always achieved and problems tend to arise. Planning ahead and having good communication with your surgeon can prevent most of these mishaps and leave you prepared in plenty of time for your next debut.

Mistake #1 - TOO MUCH SUN.
I realize that a dark, olive or bronzed tan is glamorous in the spotlight. But as a physician, I am obligated to tell you that skin cancer is a real risk. One bad sunburn or prolonged tanning session is all it can take to increase your risk of skin cancer. You must have sunlight for your body to make Vitamin D, but this amount of sunlight is obtained in normal everyday activities like going for a walk outside. A UV-ray-free option like spray tanning is a good alternative. There is not much of a difference between the do-it-yourself kits and professional sessions in how they work, only in the application process. These products fade over time and are considered safe for short-term use. The best way to avoid damage to your skin and to keep your skin appearing youthful only requires one product - a quality moisturizer with SPF.

Mistake #2 - LAST MINUTE COSMETIC SURGERY.
The perfect time for your long-awaited breast augmentation or liposuction is not one week prior to the Main Event. While we all want to look our best and exude the most confidence, last minute surgery can compromise results and your satisfaction. Recovery time after any surgery can often take two to four months for you to be 100 percent. Considering these procedures are often expensive and involve permanent changes to your body, your goal should be to maximize the outcome. This means take your time, plan ahead and follow your surgeon's advice. This will give you plenty of time to heal properly and to feel at ease in your new physique.

Mistake #3 - CRASH DIETING.
Most of us are well aware of eating disorders. However, crash diets-during which significant weight loss is obtained in a short amount of time-can walk the line of an eating disorder and even result in similar serious side effects. Healthy weight loss is two pounds per week unless otherwise monitored by a physician. The word "diet" implies that you are missing something. My advice is always just the opposite-focus on what you're putting into your body and not what you're taking away. There is no substitute for a long term, well-balanced nutrition plan and exercise program . If you can do that year-round, you'll not only be healthier, but you'll feel more prepared inside and out.

Mistake #4 - NEW SKIN TREATMENTS PRIOR TO COMPETITION OR TANNING.
Getting a chemical peel, laser treatment or starting a new intense skin care regimen may be just what the doctor ordered. These therapies do provide great results with very little down time. However, summer is simply not the season to start. Most patients are spending more time outside in addition to tanning for events, which most skin care treatments and products do not allow. The high yield ablative procedures remove layers of dead skin and stimulate collagen production. The results are younger, healthier skin, but it also removes your skin's natural protection and makes it very sensitive to sunlight. Not only can you damage the treatment, but you can also increase your risk of skin cancer. On top of this, most summer schedules are simply too irregular to stay faithful to your skin care regimen. I encourage most of my patients to schedule these therapies in the fall, winter and early spring. If summer is a must, talk to your surgeon, purchase a high-quality SPF, keep the treatment area covered and break out a hat that provides full facial shade.

Mistake #5 - ASSUMING THAT LOOKING GREAT TAKES SPENDING A LOT OF MONEY.
Too often the assumption in cosmetic enhancement is that just because something costs more, it's better. I argue that the first three steps toward any cosmetic enhancement are simple: research, budget and plan. This will give you the most realistic goals within a reasonable timeline. You will know your options, budget and plan that includes your surgeon and aesthetician. Following this plan will lead you toward the desired results with in a budget you are comfortable with, all on your own watch. You will not only be happier with the results, but also with your experience.

The best result any surgeon can aspire to is enhancing your natural beauty. This enhancement starts with good lip care. Lip care is simple and there are only two important steps:
1) Drink plenty of water (dry, cracked lips are never appealing); and
2) Utilize daily lip product s that include both a moisturizer and sunscreen. This product does not need to be expensive. Drug store lip balm will meet these criteria and can easily mix with your favorite lipstick or lip gloss. Adversely, two big no-no's of lip care include: 1) applying dry skincare products, chemical peels or performing microderm abrasion procedures on the lips; and 2) licking or picking at dry skin, or nervously nibbling on the lips - trust me, it only makes matters worse.

LIP SHAPES
The most desirable lip shape by far is the heart. A full upper lip with well-defined Cupid's bow (the arched M-shape in the center) paired with a plump, perfectly balanced bottom lip. Lip augmentation can balance almost any other combination, including: thin lips, small upper lip, smaller bottom lip, lips with irregular borders, smoker's lines or lack of a Cupid 's bow. Lip reduction and reconstruction procedures are available for those who would like a more permanent change or for those who would like to reduce the size of their lips.

TOPICALS
Topical lip plumpers are available everywhere, in the forms of generic drug store products to the top of the line plumpers, such as Physician's Complex, available only at your surgeon's office. These products provide short-term results by temporarily increasing blood flow to the lips. The drawback is that constant use of any lip plumper will never lead to permanently fuller lips.

MANUAL LIP PLUMPERS
These are vacuum devices, like the product made by Luscious Lips, made to go over the lips and increase blood flow. These provide only minutes of results and I typically do not recommend these products to my patients.

TEMPORARY INJECTABLES
There are many, many injectables on the market. However, there are two main implants requested at my office - Juvederm and Restylane. Juvederm and Restylane are hyaluronic acid fillers that are excellent plumpers. This is perfect for the patient who simply wants more volume and lasts up to one year. These products provide very reproducible, relatively long-lasting results. There are several other products on the market, and it is very important to discuss the right product for you with your surgeon. These injections are safe procedures when performed by qualified injectors.

PERMANENT INJECTABLES
I typically do not initially recommend these procedures to my patients. if you are interested in permanent solutions, be sure that you have tried the temporary injectables for a significant length of time - at least two years - and are sure that this is the desired look you want long term.

LASER RESURFACING
This the the most exciting area of facial care in cosmetics. There are not currently any laser treatments beneficial for the lips. However, for patients who have discolorations or deep lines around the lips - smoker's lines, laugh lines, etc. - lasers that can provide dramatic results are available. I have recently seen very exciting results from newer fractional lasers for softening deeper smoker's lines that we had previously only been able to fill.

Remember, the best results are often obtained with combining treatments. However, it all starts with lip care. Moisturizers and sunscreens combined with a careful selection of the right topical plumper or injectable will assure your readiness for your next stage appearance as well as your next kiss.

The issue of celebrity plastic surgery is so intriguing. Curiosity causes us all to want to know who had implants, liposuction and injected too much collagen into their lips.

Many stars have publicly come out and admitted to their surgery and even promote it, including Cher and Joan Rivers. According to Celebrity Cosmetic Surgery, a blog devoted to news involving celebrities and plastic surgery, even beautiful supermodel Cindy Crawford has admitted to work, including Botox and collagen. Other stars who have confirmed plastic surgery include Ashlee Simpson and Ashley Tisdale.

There are also many guesses as to which celebrities have had surgery, although they either won't comment or deny it. Michael Jackson barely has a nose. Some plastic surgeons estimate he's probably had numerous Rhinoplasty procedures. His nose, as a result of too much surgery, has literally collapsed. Others rumored to have had surgery include Hillary Clinton, Victoria Beckham and Madonna.

So why are some celebrities so willing to admit they've had a little work and others who have obviously had work downright lie about it? There is still a small stigma that is slowly being overcome that plastic surgery equates to a vain or shallow person. This is often farther from the truth. Most women have surgery to fix areas that personally bother them.

A great role model and celebrity, who has had plastic surgery and has since come out against it, is Jamie Lee Curtis. The 49-year old actress underwent surgery on her lower eyes at age 35 and has admitted to Botox and liposuction. However, Jamie Lee regrets these decisions and wishes she would have just let herself age as so many other people choose to do naturally. She once said, "I did it all, but you know what? It doesn't work. The fraud is it doesn't work; it doesn't work because you still look in the mirror and you see the fraud of what you were trying to do."

For every celebrity who opposes or supports plastic surgery, there are millions of everyday women without the luxury of the millions of dollars these celebrities have, and many of those women are in the pageant industry.

Iowa patient Terri Wilson had a tummy tuck procedure done and says, "After having children, I always had a 'pooch' on my lower abdomen. Even with exercise and dieting it wouldn't go away. After surgery, my clothes fit better and I feel more confident ." In fact, women who are realistic about what is achievable are the best and only patients I'll work with.

Another one of my patients, Cindy Johnson says, "Before my augmentation, I already felt good about myself. But after the augmentation I feel more beautiful and complete."

It seems whether you're a celebrity or the girl next door, whatever surgery you decide to have performed is a very personal decision, and quite frankly it isn't anybody's business what you decide about your body. One 27-year old told me she thought about having breast augmentation surgery for six years before finally having it done . Thinking out your decision is the best thing you can do. There are risks to any plastic surgery and it 's very important that you discuss this with your surgeon. Good luck in making an informed decision on whether or not to have plastic surgery and please call our office if we may be of any assistance.

Hello, friends. Before we give you this issue's tips on gimmicks and tricks, there is one topic we need to address. The most recent revelation in plastic surgery involves questions about the safety of Botox injections after 16 reported deaths resulting from Botox injections. Four of the deaths involved usage of Botox in people less than 18 years of age.

One U.S. advocacy group claims 180 reports of serious Botox complications have been sent to the Food and Drug Administration. As a result, some are calling for a warning label - "Death Risk" - to be put on all vials of the drug. Does this mean women should put a halt to getting these injections for cosmetic purposes? Not necessarily. Botox is made from the same toxin that causes botulism. It has been used to successfully treat a number of medical conditions for many years and is considered safe when administered properly. We promise we will continue to watch the FDA's stance on Botox injections and keep you posted in the pages of future issues of Pageantry.

Now that Botox is being questioned, it opens the door to thoroughly scrutinize the practices of the industry, something we should do. There are many tricks and gimmicks on the market that encourage consumers to spend billions upon billions of dollars per year.

One U.S. advocacy group claims 180 reports of serious Botox complications have been sent to the Food and Drug Administration.

The first gimmick used in plastic surgery is unqualified physicians, even non-physicians calling themselves cosmetic surgeons, cosmetic specialists or laser specialists administering laser treatments, chemical peels and injections. Unfortunately, the FDA has done little to crack down on non-qualified individuals performing procedures that should be left in the hands of qualified plastic surgeons and dermatologists. A white lab coat and official-looking office do not make one qualified to perform cosmetic procedures, or even minor procedures. Beware of clinics running under the guidance of a "medical director" who may or may not be a practicing physician, and in many cases is not a plastic surgeon or dermatologist.

In many states, doctors who have had no experience with plastic surgery and those who have never even performed a surgery are directing clinics offering cosmetic procedures. The best thing to do is ask; "Is this clinic under the direction of a plastic surgeon?"; "Who is the plastic surgeon and is his or her state license current?"; "How often does the doctor visit the clinic and personally perform the procedures being advertised?". If you are unable to get the answers to these questions, then do not use that clinic.

WHY ARE THESE ESTABLISHMENTS SUCCESSFUL?
This brings us to our second gimmick, or in this case, trick. The power of advertising. At one time it was considered unethical for doctors to advertise their services. Now the advertising niche for plastic surgeons and non-plastic surgeons alike is extremely competitive. Most of us have websites; some opt for billboards and dramatic newspaper ads to lure uninformed consumers. Now, just because someone is advertising does not make that person unqualified to perform, but the bottom line is that you must ask questions. If someone is unable or unwilling to answer tough questions, it is not a person you want working on your face or body.

Finally, the number one cosmetic surgery gimmick is a doctor who offers procedures that do not work. Just a few years ago, the FDA approved the contour thread lift, a procedure touted as an alternative to a facelift. Many doctors are now finding that the threads break, cause infections and are short-acting. The best thing you can do for your face in your teens, 20s and 30s is to use a good skin care regimen. You can even use an over-the-counter line that includes a cleanser, moisturizer and, most importantly, sunscreen. Peels, lasers and injections can offer subtle improvements but should rarely be used in young women. A full surgical facelift is the only proven method to correct a sagging face and is often performed on women, beginning in their 40s and 50s. Beware of anything that sounds too good to be true. If it promises to change your life or permanently alter your looks, it is most likely a bogus claim.

As we conclude, it's also important to remember that any cosmetic procedure, whether it's Botox injections or breast augmentations, are not permanent. Most procedures need to be redone, ranging from every few months to 10 or 15 years down the line. Plastic surgery requires a commitment from both the patient and the surgeon, and should be entered into with serious thought and careful consideration.

What pageant queen hasn't dreamed of making her grand entrance–brilliantly walking into the spotlight, beautiful and confident, in a bathing suit–knowing every muscle in her body is smoothly trim, perfectly shaped, and toned?

As we head back to reality, those of us in the industry know that Swimsuit competition is usually the area of much anxiety for contestants. Makeup, false eyelashes, and a great hairdo can work wonders during an Evening Gown showdown, and a little practice on how to genuinely communicate in sound bites can help ace the Interview. But "fixing" the body itself is very difficult, and not something that can be simply primped or practiced.

When facing this reality, it should be comforting for delegates to know you are not alone. Ninety percent of women have cellulite to some degree, and most women tend to carry fat in their outer thigh (otherwise known as saddlebags), lower stomach, and buttocks areas. Diet and exercise is the first and most important way that you can combat overall body fat. However, you cannot remove fat from specific areas through diet or exercise; you can only tone specific spots. So, what is a hard working pageant contestant to do? First, I recommend seeing a nutritionist and personal trainer, but if specific fat removal is what you are looking for, you need a plastic surgeon.

UNPROVEN SOLUTIONS
Buyer beware! There are a number of new products on the market that are being touted as advancements in fat removal and reduction. These products are marketed under the name lipodisolve or mesotherapy. The product, a combination of vitamins, minerals, and various medications, is injected into the fatty areas with the promise that it dissolves fat after several treatments.

Mesotherapy, which can cost upwards of $1,500, has been popular in Europe for years, and is more recently being used in the United States. You will find physicians' assistants and even some plastic surgeons using these promising potions. According to the American Society of Plastic Surgeons, however, "there are no published scientific studies demonstrating the effects are permanent, why or if certain ingredients work, or how safe mesotherapy is for patients."

In addition, the type of drugs varies just as much as the practitioners using them, as do the quantity and frequency of recommended mesotherapy treatments. Many plastic surgeons have chosen not to use mesotherapy, because there is not sufficient evidence that it works and there is the risk it could be harmful with long-term use. Most plastic surgeons also avoid recommending creams that claim to reduce cellulite and aid in fat loss, on the grounds that those results are probably bogus.

THE TRIED AND TRUE
Liposuction is the only scientifically proven method that can target fat reduction in a specific part of the body. In liposuction, a surgeon using a thin instrument, called a cannula, carefully contours the shape of a specific area of the body while removing fat. Results are dependent upon the experience and artistic abilities of the individual surgeon. "Lipo," as the treatment is commonly called, can be expensive. The price can range from $3,000 to $15,000, depending on the number of areas a patient has targeted as well as which part of the country you live in.

As with any surgical procedure, liposuction comes with risks that are unusual but can occur, which range from a potential rippling of the skin to death. If a surgeon does not explain the risks associated with any procedure, find a new surgeon! You should thoroughly discuss the decision to undergo liposuction with your plastic surgeon.

On the positive side, liposuction usually has moderate to dramatic results in fat reduction on specific areas of the body. Keep in mind that this procedure is not intended for weight loss, and a patient must continue a healthy diet and exercise program after surgery in order to enhance muscle definition arid maintain the result that was realized through liposuction.

Whatever choices you make, please do keep in mind: Even with plastic surgery, perfection is impossible. Your body type and fat deposits are determined mostly by your genes. Concentrate on developing your confidence while wearing your swimsuit. A beautiful smile goes a long way in "hiding" what you may think are figure flaws.

Dr. Ronald Bergman is a board-certified plastic surgeon practicing in Des Moines, Iowa, for 28 years. He specializes in breast augmentation, liposuction, and tummy tucks. His patients include many local, national, and international pageant winners. Dr. Bergman is also a highly qualified pageant judge.
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