Fall 2007 - Pageantry Magazine

Looking Laser Sharp
For women 30 and older, new techniques in laser resurfacing can take years off the face or otherwise hide small imperfections. Here's what you need to know to get it done safely.

Q: I've heard a lot about lasers being used to improve skin. Do they really work?
A. Yes and no. There are certain lasers on the market that are more effective than others. The technology is always changing, which is why many offices will lease lasers as opposed to purchasing a laser. This way a physician can stay on top of the latest technology without making a huge investment in a laser machine that will soon be outdated. Proper treatment by a qualified physician is essential to your success. There are numerous people who call themselves "laser certified." These people do not necessarily have any medical background and should be approached cautiously. If you are interested in laser treatments for your skin, you should see a board-certified dermatologist or plastic surgeon.

Q: So is there more than one type of laser available for skin treatments?
A. Yes. It's important to understand that not all lasers are equal. This is the reason why there are so many different lasers on the market. Each type has its strengths and weaknesses. A pre-procedure consultation with your doctor is essential. Understanding the credentials of the laser operator is also very important. This will reduce the chances of any complications.

Q: What is laser resurfacing?
A. Laser resurfacing, also known as a laser peel, is used when a carbon dioxide (C02) or Erbium laser removes areas of damaged or wrinkled skin. The laser is a beam of energy that vaporizes the top layers of damaged skin. This procedure can minimize fine lines and also treat minor facial scars or areas of uneven skin coloring, called pigmentation. This procedure can be performed on portions of the face or the entire surface.

Q: Who should and who should not use laser treatments for their skin?
A. The treatment is appropriate for a woman over age 30. It is not something that would be appropriate for a younger woman, who typically shows no evidence of tissue aging. This is why a consultation performed by a board-certified plastic surgeon or dermatologist is necessary. Maintaining a very good skin regimen with a medical-grade skin-care line will help to keep the skin staying fresh and young. Also, patients with olive or black skin may be at increased risk for changes in pigmentation. In addition, any patient who has taken Accutane within the past two years should avoid laser treatment.

Q: What is the Fraxel laser? I've heard a lot about this.
A. The Fraxel laser uses a "fractional" approach to laser skin resurfacing. This treatment allows skin to heal more quickly than traditional lasers, because the entire skin surface is not being treated at once. The Fraxel laser is useful for fine lines, wrinkles, and sun damage. It is used with topical anesthesia, as to sedation. Fraxel is a regimented treatment, requiring four to five sessions with approximately four to six days of social downtime.

Q: What will I look like immediately after a laser treatment?
A. Your skin will vary in its appearance, depending on the treatment, ranging from slight redness immediately following the procedure to bright pink to red in the weeks following treatment . Depending on which laser your physician uses, you will experience a certain amount of swelling and discomfort. Your skin may be sensitive, and you should not wear stage makeup immediately following the procedure. You must avoid the sun following laser treatment something we recommend at all times anyway. Maintaining a medical-grade skin-care regimen with sunscreen is absolutely essential.

Q: How much does it cost?
A. Laser resurfacing costs an average $2,400 - the national average physician's fee for one treatment session. You may need several treatments to receive your desired look. Due to the price, the decision to pursue laser resurfacing is not an issue to be taken lightly.

Q: I know there are risks with anything. What are the risks with lasers?
A. It is true that any cosmetic procedure, no matter how small it may seem, carries risk. When performed by a qualified experienced surgeon, complications are rare and usually minor. However, even with the best surgeon, a patient can suffer burns, scarring, or infection.

Q: What should I ask a laser specialist before having a procedure?
A. Ask about medical training - if the person is a board-certified dermatologist or plastic surgeon. Laser skin resurfacing is typically performed by a doctor who is specially trained to use a CO2 laser. Make sure the person performing any laser procedure on you has privileges at a fully accredited hospital in your area. Find out the type of equipment that will be used, where the procedure will be performed, and the extent of each procedure.

Q: What will I look like when treatment is complete?
A. This is going to vary from patient to patient and treatment to treatment. Your doctor can give you a realistic view of how improved your skin will look. Many patients look refreshed, invigorated, and younger.

Q: Can lasers be used for other things besides skin care?
A. Yes. Lasers can help remove or improve scars, tattoos, hair, veins, and acne. With the ever-changing advancement of laser technology, we will be able to treat more skin conditions in the future. Again, it is important to speak with your doctor about which type of laser is best for you.

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 2007- Pageantry Magazine

Botox & Beyond

Facial fillers are proving to be this year's newest wrinkle in the fight against those early signs of aging. You're probably wondering: Are they worth the expense and bother, or is Botox still "the bomb"? Read on...

You're looking in the mirror one morning and you see it-your first facial wrinkle. Sudden panic sets in, and then, like the proactive competitive person
you are, you jump on the Internet and start reading all about wrinkle solutions. Or, here's another example: You're looking at an album of photos of yourself, and over time, you notice your face losing some of its fullness, your lower cheeks are beginning to sag, and your lips may be starting to thin. You resolve to take action, only to discover that reversing these signs of aging isn't accomplished with a face-lift. What you're looking for is a facial rejuvenation.

There is a lot of hype surrounding lasers, creams, and other products marketed to treat the early signs of aging, but which of these products really work and which are a waste of your time and money? Glad you asked.

Q: Why do I get these lines or wrinkles in the first place?
A. We get wrinkles for two reasons: 1.) genetics (thanks,Mom and Dad!) and 2.) environmental exposure. Genetics will give you your skin type, your level of hormones, and determine what muscles you use to make facial expressions.

Different types of skin are more resilient in resisting the aging process, with a thicker layer of collagen helping to keep wrinkles at bay. As we age, our body's natural decline in hormones will gradually decrease the amount of collagen in the skin, making it thinner and, therefore, more susceptible to wrinkle formation.

The muscles used in facial expression will determine whether you develop wrinkles such as smile lines, forehead lines, crow's feet, and the famous "ll's" between your eyebrows. Exposure to such environmental influences as smoke, dry air, wind, and pollution doesn't help, either, but the worst external skin damage of all is caused by the sun! That great tan may look marvelous in competition, but exposure to the sun and its ultraviolet rays can actually speed up the aging process.

Q: What skin care products really work?
A. The best advice here is to take part in a good skin-care regime. For younger women, this does not need to be expensive-simply use pure soap, toner, and over-the-counter moisturizer everyday... even in the winter.

You can minimize long-term damage from the sun by reducing exposure at peak daylight hours, wearing a hat, never using a tanning bed (apply tanning products to add facial skin color instead), and apply a sunblock daily — the most valuable beauty cream you can purchase.

For those who may not have taken as good of care of their skin as they should have, prescription product lines, such as Obagi, a registered trademark of Obagi Medical Product s, are some of the best ways to go. Obagi is a top-of-the-line skincare treatment that can cost $250-400 for a 3-to-4-month starter kit. Once prescribed by a plastic surgeon or dermatologist, Obagi will put you on the right track with a daily regimen that really delivers results.

Q: Does Botox stack up?
A. Botox Cosmetic, a registered trademark of Allergan, is injected in small doses into the muscles of the face from the nose up. It is very effective in treating wrinkles in the forehead, crow' s feet , and the "Il 's" between the eyebrows. Botox works by relaxing the muscle so that you can't form the crease in the skin that causes the wrinkle. When Botox is injected correctly, you can eliminate the wrinkles while still being able to show animated facial expressions.

Botox is safe for anyone between the age of 18 and 65, and typically lasts 3 to 4 months at first; in subsequent treatments, the results will last longer. Botox can cost anywhere from $300 to $1,000 per treatment. Save your money on over-the-counter products that promise similar results to Botox but have no credible clinical studies proving their effectiveness. It is best to invest in treatments, such as Botox, that are approved by the Food and Drug Administration (FDA).

Q: How do filler products work, and are they effective in restoring fullness to the face?
A. Several filler products are making the news this year, with national magazines focusing on celebrities who have used them. A wide variety of filler products are available right now, ranging from the hyaluronic acid-based and collagen-based to calcium-based formulas. The biggest difference between them is how long they last and on which part of the face they are most effective. Thicker, calcium-based products like the new FDA-approved Radiesse, registered trademark of BioForm Medical, are great for smoker's lines around the lips and smile lines on either side of the mouth, which are usually deeper. Typically, Radiesse costs $700 per treatment and lasts one to two years.

Juvederm, registered trademark of Allergan, is another new product approved in 2007 that is a hyaluronic acid-based filler and can be used for the same areas as Radiesse. Juvederm, which has shown itself to be even more effective in plumping up the lips, costs $500 to $600 per treatment and lasts six to nine months.

Warning: Several lip gloss-style "lip plumpers" are promising the same results, and while it's true their effects may last a couple of hours, none of them have been shown to mimic the dramatic long-term results available with the FDA-approved filler products.

Beyond all these anti-wrinkle and filler treatments, the real secret to fighting the aging process is to take care of yourself early on and continue to do so as the years pass. If you eventually want to make those inevitable wrinkles disappear for a while or to restore facial fullness, consult a plastic surgeon who can help you cut through the confusing competing product claims and rumors you may have heard. One final bit of advice: Save your money for what works.

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 2007 - Pageantry Magazine


The latest advances in facial beautification feature eyelashes made lavish with extensions and transplants. Also: a silicone breast implant update.

The science of body shaping seems to progress at an ever increasing rate. It behooves us to maintain a close watch on such developments, to not only stay on top of beauty trends but also to arm ourselves with the facts to make informed decisions about potential beauty enhancements. Here are two new developments in plastic surgery, and a third tip based on body chemistry from which every competition beauty can benefit.

LONGER EYELASHES
The next big thing on the beauty market is the surge in eyelash extensions. Forget about your run-of-the mill glue-on lashes of pageant years past! Beauty salons and estheticians are hopping on this bandwagon all over the country. We first saw this trend on the West Coast, and it has made its way to the Midwest and back East in recent months.

There are two methods for placing extensions. The most common involves the gluing of synthetic lashes with tweezers. It takes a professional about two hours to complete and costs approximately $500. The lashes will last a couple of months.

In addition, a second option is transplants. Surgeons are now able to transplant eyelashes in the same manner as traditional hair transplants, where actual eyelash hair follicles are grafted along the edge of the eyelid to permanently create longer, thicker, more pronounced lashes.

The surgical route should be embarked on with caution. The potential side effects and risks associated with surgery make this method a good option for those undergoing reconstruction from burns or prior eye surgery that resulted in loss of lashes. It is quite invasive for a strictly cosmetic enhancement.

FDA SILICONE APPROVAL
In my last "Body Shaping" column, I covered a host of health issues regarding cosmetic breast enhancement surgery. Since the Winter 2006 issue of Pageantry went to press, news media coverage has widely broadcast the announcement that silicone breast implants have been approved by the FDA, giving breast-enlargement patients a new choice in effecting that body-shaping change. Silicone breast implants were taken off the market in 1992 after patients reported health problems associated with their use.

Plastic surgeons have long known that the incidence of health conditions for women with silicone implants were no different than the incidence of health issues in women without implants. Now that accurate information is out there and silicone is once again an option, many patients wonder what is the best choice.

Saline implants have worked well for the past 14 years. However, some patients and their surgeons may prefer silicone because they feel more natural. Saline can look very natural, but does not have the same feel as silicone. There is also a lower incidence of wrinkling in the silicone implants compared to the saline-filled alternatives. However, there are downsides to silicone implants, too. It is much more difficult to tell when silicone is ruptured as opposed to a saline implant, which deflates quite obviously. While the material in the silicone implant will not harm you, it will be more difficult and time-consuming to repair.

Doctors will be sending their silicone breast implant patients in for magnetic resonance imaging (MRI) every other year after surgery. This procedure will allow medical professionals to fully examine implants and to ensure no ruptures have occurred. Patients will have to absorb the costs of their MRI , which will add up quickly after a few years with the implants. In addition, the implants themselves are more costly. Silicone implants could boost the cost for breast augmentation by $1,000 dollars.

As with saline, silicone implants are not permanent. A patient will have to replace breast implants due to the effects of time. And, even with implants, as time goes by a person will see the effects of gravity. Patients should clearly weigh the pros and cons of silicone vs. saline with their plastic surgeon. Both types of implants can result in improved appearance and satisfied patients.

GOOD HYDRATIONS
Finally, did you know your body is 50 to 70 percent water (depending on your age), and you can lose up to three liters of water daily through the simple processes of sweating, breathing, and urinating (you can lose up to three liters an hour when you exercise!)? Replenishing our bodies with water is an absolute priority for both greater beauty and good health, so my advice is to drink 64 to 80 ounces of water or herbal tea throughout the day, which is easy to do by carrying a water bottle.

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 2007 - Pageantry Magazine

Too Much of a Good Thing?

An obsession with personal beauty and a supply of too-willing-to-please doctors have fed a growing addiction to plastic surgery in some segments of society. The question is: Can patients and practitioners rein in the habit before the epidemic turns dangerous?

Plastic surgery is a serious life decision that is, sadly, taken to the extreme by some. While we don't have precise numbers relating to plastic surgery addition, plastic surgeons are seeing a surge of repeat customers in their offices. In fact, two-thirds of plastic surgery patients are repeat patients.

Plastic surgery is often a good thing. Facial and body deformities are easily corrected through reconstructive procedures, and cosmetic procedures can give great boost to self-esteem. But, indeed, there comes a point when plastic surgery is the result of deep-seated emotional problems. More often than not, repeat patients are females. Not everyone who has repeat surgery is addicted. The addiction comes to light when a patient equates beauty with happiness. To achieve the "high" of being happy, a person addicted to plastic surgery will not stop her obsessive behavior, constantly finding fault with her body and seeking corrective measures. The medical profession calls this body dysmorphic disorder.

CELEBRITY WORSHIP
Plastic surgery addicts are usually easy for a doctor to detect. Addicts typically obsess about specific body parts of another person, often a celebrity. For example, a person may want Angelina Jolie's lips, Jennifer Aniston's nose, or Brad Pitt's "six-pack" abs. Plastic surgery addicts do not understand the concept of individual results; instead, for them plastic surgery is the means to a perfect end. The severe problem develops when addicts try over and over again to look "perfect." Perfection is impossible in the world of plastic-surgery. Slight to moderate improvement is a more realistic goal

In this regard, reality TV shows have done little to help the cause of plastic surgery. These very quick radical makeovers encourage people to think that having several procedures at once is acceptable. In reality, it would take years and multiple procedures to receive some of the results seen on TV, not to mention a team of great hair and makeup artists.

Addiction to surgery is disheartening to most plastic surgeons, but there are surgeons who will go against their own standards and ethical standards in the industry in order to make a quick buck. A good plastic surgeon will turn down patients who do not need surgery, or he or she will ask the patient for clearance by a psychiatrist before proceeding with any course of treatment that may be considered questionable. Recently, a number of addicts have made news by purposely trying to look like a cat or a Barbie doll. These people have often had hundreds of surgeries to achieve a nonhuman look.

BOTOX WITHOUT LIMITS
Aside from addiction to invasive procedures, there is a growing concern of addiction to Botox, Restylane, collagen and other filler products meant to fill areas on the face that have lines due to aging or genetic composition. Botox is so appealing because its results are so dramatic, and very often as a result patients can't stop after one or two treatments. The typical treatment lasts three to six months, after which the effects of Botox fade; people who want to have a long-term result decide they must be treated continuously. A recent study in Great Britain found that 50 percent of Botox users said they were unable to achieve a youthful appearance without getting Botox. Although the long-term use on humans for relaxing frown lines still needs further study and an increasing number of patients are requesting the "frozen" look that comes with an intensive Botox treatment, the good news is that there is no known adverse health affects due to long-term Botox use. Nevertheless, the administration of Botox should be very subtle, as with any invasive procedure. It should not make a person completely wrinkle-free and unable to move his or her face.

If we are to achieve reasonable results that avoid extreme measures, the responsibility lies with our nation's plastic surgeons. We must recognize the fine balance between the benefits of surgery and the dangers of overdoing it, and we must refuse patients who are addicted. Sadly, too often today, the patients who are refused treatment find another physician to give them what they want. The only real solution will be a shift in cultural standards regarding beauty. In an age when a large portion of our society wants to defy aging, that shift does not appear to be on the immediate horizon.

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 2006 - Pageantry Magazine

Advantage: Plastic Surgery Patients

In a land where beauty pays, many now consider nips 'n' tucks as inexpensive insurance on the way up the ladder of success.

Let's face it. We live in a country where looks matter. The clothing, cosmetics, and plastic surgery markets are booming as women, and now even men, are hopping on the beauty-is-better bandwagon.

While we try to teach our youth that beauty comes from the within, the adults among us are spending billions of dollars trying to look better, and those who do say that they have a reason... career advancement. A better career equates to more long-term earning power, hence a few thousand dollars on plastic surgery is seen as an investment in one's livelihood.

Does looking good really advance career opportunities? According to a recent Monster.com poll, of the 22,000 people who answered the question, "Do you think having plastic surgery would help advance your career," 53 percent said "yes."

Ms. U.S. World 2006 Annastasia Anderson is open about the fact that looks indeed make a difference in career advancement as well as in the pageant world. "Society is harsher on women, especially when they age," she said. "I think society expects women to look forever young." Moreover, this long-time beauty queen feels certain that beauty can be the tiebreaker in a tight job market. "If you and one other person are equally qualified for a job position, the better-looking person is going to get the job."

Miss West Chicago USA Rachel Conradt agrees to an extent. "It's a yes-no question," she said. Rachel believes that "plastic surgery as a way of career advancement depends on the industry." She believes that in the world of modeling, pageants, and television that better looking women who've had "aesthetic improvements" are a step ahead of their colleagues. However, Rachel also believes that "falling into stereotypes can hurt a person in fields such as accounting or law enforcement."

According to a recent LA Business poll, more than half of the readership said they would not go under the knife for the mere sake of getting a better job. One reader commented, "I value myself more than that."

Whenever we talk about plastic surgery, it really comes down to each our own. For many patients, a little work equates to a big boost with advanced self-esteem and career opportunities. But there are still many in the world who wouldn't be paid to alter their looks. It is very much an individual, personal decision. The real beauty in this debate is that we all have the opportunity to choose.



History lesson - Ms. U.S. World 2006 Annastasia Anderson receives a personal tour from Pageantry "Body Shaping" columnist, Dr. Ronald Bergman, during her visit to the historical Bergman Mansion, the plastic surgeon's recently restored Des Moines, Iowa offices, built in 1883.

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 2006 - Pageantry Magazine

In Support of a 'Rational' Approach

Since plastic surgery's taboos have faded in recent years, society has seen a spike in patients, opportunistic practitioners, and TV exploitation. In navigating today's tricky territory, our expert explains what the art of body shaping ideally should be all about.

The term "irrational exuberance" has its origin in a speech that former chairman of the Federal Reserve Board Alan Greenspan gave on December 5, 1996, and in the following decade often has been used to describe a heightened state of speculative fervor in financial markets. Something akin to irrational exuberance has affected the world of aesthetic plastic surgery as well in recent years.

Let me explain. Plastic surgery ought to be a carefully considered procedure that, when done correctly on qualified patients, should be barely detectable. However, a visit to numerous web sites showing poor outcomes makes it obvious that too many patients in recent years are ending up looking worse when leaving the surgeon's office than they did before entering. Even some well-known celebrities appear to have been obviously "done." This is a sad state of affairs for the majority of plastic surgeons, who truly believe that their work, while appreciably improving a person's appearance, should be invisible to the naked eye.

There are several reasons for the appearance of irrational exuberance in the world of plastic surgery. First and foremost, TV news and reality programming exposure that sets unrealistic goals for plastic surgery is sending a flood of patients who are not qualified into plastic surgery offices across the country. Not everyone is a candidate for plastic surgery; a patient must meet certain physical and psychological criteria before undergoing plastic surgery.

Due to over-exuberance in meeting this demand for services, we have seen patients wind up in the hands of surgeons who are too aggressive or under-trained, or both. They may pull the skin on a face-lift too tight, or make breast implants too large, or improperly administer Borox injections. These unqualified surgeons are nip 'n' tucking for their own financial gain, often without taking the proper safeguards to ensure a proper outcome, and their patients are suffering as a result.

Also, the greater number of men and women submitting to the surgical knife is, in itself, driving up the annual number of return-visit procedures, because any single operation is not a permanent solution to a person's aesthetic improvements. For example, the average face-lift will start to fall after 10 years; breast implants need to be replaced about 15 years after the initial operation; for Botox, the effects fade away in months. Patients may be left unaware of this, if their doctors fail to fully apprise them of these facts.

One concurrent change in the public's perception of plastic surgery is that it is no longer considered taboo. The majority of patients are completely willing to tell others about their surgery and even show it off. Back in the 1950s, the same procedures were being performed, but you never heard about them. Even as recently as the 1980s, it was not acceptable to talk about having plastic surgery in polite company. Today, openness abounds. As an example, an acquaintance of mine tells of a female friend who, when asked about her vacation plans this summer, confided that she's taking her week off for a visit to her plastic surgeon's office!

Every society is different when it comes to what constitutes normal beauty, and even within one country the "ideal look" often changes. For example, in some African cultures, it is beautiful to have rings placed around the neck, so that after a period of years the neck is nearly a foot long. In the United States, wrinkle-free faces, large breasts, full lips, and tight tummies are trendy. Such preferences change over the years, depending on what types of movies, music, and fashion icons are popular and what high-profile celebrities look like. Remember the 1960s model known as Twiggy? At that time, "incredibly thin" was in. A decade earlier, actress Marilyn Monroe's size 12 voluptuous figure was all the rage.

There are rare instances when a patient wants to look "done." For example, there are documented cases of a person asking for the features of a cat or a Barbie doll. In these cases, it is the surgeon's responsibility to seek approval from board-certified psychiatrists before proceeding with such drastic, unconventional procedures. An ethical plastic surgeon will not usually want his or her name associated with bizarre looking transformations .

Whatever tomorrow's trends, the plastic surgery growth phenomenon we are witnessing today says much about our culture. The fact that plastic surgery is expensive (often between $5,000 and $25,000 for one procedure) is evidence to how much we have become a disposable-income-driven society. Looking good has a higher priority to many people than saving thousands of dollars for retirement. Some patients view their plastic-surgery expenditures as an investment in their personal and professional future.

As we arrived at the new millennium, high-profile celebrities, society women, and TV personalities have been open about having undergone plastic surgery, and the general public is now following suit. There are pros and cons about this newly relaxed acceptance of aesthetic plastic surgery, but as always, the bottom line is that such a procedure is nothing to take lightly - it is, after all, a life-altering occurrence. It must result from a well-thought-out decision between a patient and his or her physician. While that may seem obvious in this era of irrational exuberance, adopting such a rational approach is more necessary than ever.

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 2006 - Pageantry Magazine

Nature vs. Sutures: Pageants and Plastic Surgery

Should plastic surgery be banned from pageants? Although an argument could be made for imposing such a ban, doing so would be unenforceable. Besides, with today's subtle and sophisticated surgical techniques, who's to know?

Not too long ago, a woman in an Asian beauty pageant sued the pageant organizer for removing her from the pageant after it was learned the contestant had plastic surgery - in violation of the competition's written rules. The lawsuit was rejected, because the judge in the case ruled it was well with in the pageant organizer's right to promote "natural beauty."

This leaves us to consider the question of whether plastic surgery should be banned from pageants. A growing number of teenagers are having plastic surgery, including rhinoplasty (nose jobs) and breast implants. Is a ban on plastic surgery for teen competitions desirable? With millions of people undergoing cosmetic procedures around the world every year, would enforcing a plastic surgery ban even be feasible?

I doubt it, and most competition event organizers recognize this. The official position of the Miss Universe Organization regarding this issue, posted on the pageant 's web site, is this: "Although contestants are discouraged from altering their own natural beauty, no restrictions are placed on cosmetic surgery; it is impossible to enforce such a rule. In fact, since 1990 the organization has allowed the use of padding in an effort to discourage participants from permanently altering their bodies for the competition."

The reasoning behind allowing plastic surgery is best expressed by former Miss Illinois USA contestant and law student Rachel Conradt, who says,"I don't see anything wrong with plastic surgery at all. A pageant is like an art competition to see who can mold the best body. It shouldn't be an issue if a doctor is determining a patient is ready and wants it for the right purpose, that purpose being she wants it for herself"

As a plastic surgeon, I would not perform certain procedures, including breast augmentation or liposuction, on a woman under the age of I8, as her body may still be growing. However, at the age of 18, many contestants are still competing in teen division pageants and, particularly with breast augmentation, may be seen to have an advantage over the younger contestants due to surgical enhancement. Such fairness issues could be handled with enlightened instructions to the competition's judges.

A pageant organizer in China last year took another tack in dealing with the issue by holding the first official "Miss Plastic Surgery" pageant. All of the pageant's contestants were required to have "gone under the knife" for various procedures. Organizers said the contest encourages people to accept the choices of women who decide to have cosmetic procedures.

Here in the United States, the television show The Swan actually recruits candidates for plastic surgery and pays for the procedures, and in turn hosts a season-ending pageant in which a winner is chosen. The danger of such "reality" shows in blatantly encouraging plastic surgery is that they set up unrealistic expectations when it comes to what women believe such surgery can accomplish. Such TV exposure also may encourage those who should not be candidates for plastic surgery to pursue having it despite arguments to the contrary.

Still, many observers today would argue that the discrete use of plastic surgery obviates the need for pageant regulations. Dr. Sam Gershenbaum, a Miami, Florida based plastic surgeon, believes pageant contestant s should be allowed to compete even when they've had plastic surgery because, once procedures are properly planned and completed, there is no obvious evidence of them. "Cosmetic surgery should be something that, when done right , nobody can tell it's been done anyway," he says.

As cosmetic surgery becomes more accepted in the mainstream of society, it appears even traditional pageants are taking heed. Miss Universe Organization's stance proves that event producers can skirt this issue while also encouraging "natural beauty." After all, while it is important for contestants to feel confident in their bodies, plastic surgery for the sole purpose of winning a beauty pageant is something I highly discourage. Plastic surgery is a life-changing event and should never be taken lightly. When done in a responsible manner, under well thought-out circumstances, plastic surgery can boost a person's self esteem and change a person's life in a very positive manner.

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 2006 - Pageantry Magazine

Breast Augmentation & Health

The latest available information indicates that surgical enhancement is safe, though the procedure will require special post-op care to monitor breast health.

The number of women participating in competitions for those with married status or Ms. divisions is increasing, and often these contestants are well into their 30s and 40s. Many of these women have breast implants, or have questions about implants in relation to breast health. Such concerns are more common than ever, since the number of breast cancer cases increases yearly and now are showing up more often in younger women.

Breast Augmentation surgery is the second most popular plastic surgery performed in the United States. It is estimated that 4 million women have undergone breast augmentation surgery and a half million are expected to have the procedure this year. If you are considering breast implants, there are a few things you should know when it comes to screening for breast cancer. Here are the answers to the most commonly heard questions.

HOW DO IMPLANTS EFFECT THE DIAGNOSIS OF CANCER?
First, and foremost, it is possible that an implant can obscure early breast-cancer detection through a mammogram. The good news is that for patients who have implants, radiology technicians will take more views of the breast compared to patients without implants, thus improving the chances that an early occurrence of the disease will be found. In addition, technology has become more advanced, and radiologists now have more experience in dealing with implants. It is very likely that cancer will still be detected in a woman with implants during a routine mammogram.

WHAT IS THE LATEST EVIDENCE REGARDING IMPLANTS AND BREAST CANCER?
Women with implants do not experience higher incidences of breast cancer. In fact, there are no known modern studies that show any connection between implants and the onset of auto-immune diseases or any other types of diseases. Studies done years ago that claimed breast implants were dangerous have proven to be false, and this applied to both silicone and saline implants. When cancer is found in women with implants, the disease has not necessarily progressed to a later stage and cancer treatment is very successful.

WHAT ABOUT THE INTEGRITY OF THE IMPLANTS THEMSELVES?
Many women are concerned about possible damage to the implant during the mammogram examination itself. The pressure of a mammogram should not cause an implant to rupture, although, as with any medical procedure, there is always a potential danger of complications, and rupture is one possibility. Implant companies have informed plastic surgeons that the man-made implants should last 10 years before replacement is necessary. In my practice, I have found numerous women who have had implants successfully in place for 20 years or more.

WILL I BE ABLE TO COMPETE IN PAGEANTS AFTER BREAST CANCER SURGERY?
Women who must undergo breast reconstruction do to cancer may still compete in Swimsuit competitions. The breast can be reconstructed so that other contestants and the judges would not be able to tell that implants are in place even with the effected contestant wearing a swimsuit. However, reconstruction, unlike augmentation, requires some sort of material to be covering the breast in order for it to appear natural. I have found that most breast reconstruction patients are happy just to be alive and have breasts again.

These patients must be counseled honestly about what the outcome of the surgery will be and must have realistic expectations. Although reconstruction patients will never look 100 percent natural, fortunately today we are able to get them very close. Medical insurance will cover implants for patients who undergo reconstruction following a mastectomy.

The breast is a very private and sensitive part of a woman's anatomy. We have made great strides in recent years in allowing women to talk about their bodies and, in particular, about what improvements might be available to improve this part of a woman's body from an aesthetic vantage point. And make no mistake - the most important facet is this, and any other, area of plastic surgery is a woman's health. Neither doctors nor patients should ever put appearance ahead of personal well-being.

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 2005 - Pageantry Magazine

Preserving Youth: It All Starts With Facing the Facts

By now everyone's heard of Botox. But many other less-invasive wrinkle-reducing choices are now available. Following a doctor-prescribed skin-care regimen as a teen should also help put off the effects that are, ultimately, inevitable with age.

Did you know that nearly 24,000 teenagers undergo some type of cosmetic procedure every year? The numbers provided by the American Society of Plastic Surgery alert us to a cold, hard fact: the quest to maintain a youthful appearance is beginning at a very young age.

A traditional face-lift is the invasive surgical route for women who already see the effects of gravity. The majority of face-lift patients range from 40 to 60 years old. A fairly new procedure called a feather lift is less invasive than a face-lift. A surgeon literally uses threads (almost like sewing) to lift the underlying tissue and contour the face. Since this is a new procedure, we truly don't know the long-term effects or long-term complications of a feather lift, but it is becoming increasingly popular in younger patients who are not quite ready for a face-lift.

Pageant and modeling contestants typically compete in their teens, 20s, and 30s, and for these women there is an array of less-invasive procedures to tighten the face and reduce the appearance of wrinkles. The single most-important thing you can do to preserve facial beauty is to use a doctor-prescribed skin-care program. I recommend the Obagi Nu-Derm program. Obagi skin care uses a combination of ingredients, including hydroquinone, which drastically reduces the appearance of freckles and other dark spots caused by sun damage. You will also use Retin-A or Renova in conjunction with the Obagi system. While originally formulated to treat acne, both Retin-A and Renova have proven to diminish and prevent wrinkles. Good skin care should start in your teen years.

Beyond great skin care, there are "filler" products that can be used to replace the collagen in your skin. These include human-based collagen Cosmodern and Cosmoplast. These injections require a quick visit to your plastic surgeon, and literally fill in the unwanted lines and wrinkles such as crow's-feet, forehead lines, and vertical lip lines. Restylane is another product commonly used to eliminate the frown lines between your eyebrows.

These procedures typically cost between $300 and $600 per area being treated. The results are not permanent. They should last three to six months, and then you will need to repeat the process. There are currently dozens of other filler products being used in Europe and in the testing phase, but they have yet to be approved by the Food and Drug Administration for use in the United States.

A chemical peel is another option for sun-damaged, wrinkled, or blotchy skin. There are minor peels and deep peels, which require sedation and extensive recovery time. Trichloracetic acid and phenol are typically used in a peel. The result is much more toned, smooth, even-textured skin. As with any procedure, there are risks to peels and fillers, including droopy eyes, severe allergic reactions, and permanent facial damage. It is best to proceed with caution and be sure that your doctor is an experienced practitioner whose track record of success can be ascertained.

While these procedures can offer a marked improvement in a contestant's general appearance, nothing will stop the aging process. A healthy diet, smoke-free lifestyle, and genetics are the most important indicators of how long you'll hold onto your youth.

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 2005 - Pageantry Magazine

Not Just a Matter of Inches

Paying close attention to the subtleties of breast enhancement surgery can lead to a desirable difference that's almost indistinguishable from what Mother Nature would provide.

A woman who will be competing in pageants or pursuing a career in the entertainment industry - and who is thinking about breast augmentation is obviously looking for an ideal size and shape that will be pleasing to the public. Getting that perfect look is a true form of artistry, and breast surgery for celebrities differs slightly from the typical breast augmentation patient.

The first concerns - and the most important concerns, are the choices relating to size and body proportion. The size of the appropriate enhancement will depend completely on the person's body frame, bone structure, height, and the amount of body fat that she has and where that fat is located. Pageant contestants tend to be of smaller size than the average woman, and, therefore, will most likely require smaller sized implants so that she does not look "done." The more natural the implant, the better chance a contestant has of winning the Swimsuit competition. Judges are not fond of giant, round, obvious breast implants. Patients need to know that if it is obvious to other people that implants are in place, the surgeon did a poor job. When in place, the breast implants should truly look and feel as though you were born that way.

Breast augmentation should match the waist-to-hip ratio. In other words, the implants should be in balance with the size of your waist, hips, and thighs. There is no set method for determining this ratio; rather, a surgeon that has a trained eye will be able to determine by examining each individual patient how large each patient's breasts could be on their body without resulting on a fake-look. If a patient shows her doctor a photo of a size "double-D" model, but is a size "A" cup with small hips, the doctor will have to explain that she is not being realistic about the potential results, and will discuss with the patient which is a more appropriate course of action for her.

Among the different choice of types of breast implants are the round and contoured varieties. Many plastic surgeons will advertise that the contoured implants will create the more natural-looking result. However the more traditional round type of implants are just as natural-looking and effective if the surgeon is careful, uses sizers before the permanent implants are put in place, and accurately fills the implants with the correct amounts of saline, keeping in mind often each breast may need a different amount of fluid.

Often women will have breasts that are spaced too far apart and are looking to reposition them with implants. This is also possible to a small degree. The procedure requires advanced skill and technique, and the patient will not get a perfect result when it comes to repositioning, although often there is improvement in bringing the breasts closer together and creating a very natural-looking cleavage.

Other personalities may be interested in breast reductions. If a woman is severely overweight, or has pain due to the size of her breasts, insurance may cover the procedure. However, because most of the competition participants aren't overweight, a reduction for them is usually deemed to be an elective cosmetic procedure. These reductions can also result in beautifully proportioned breasts that will help many candidates look fabulous in the Swimsuit competition. However, one downside to reductions is the unavoidable scar tissue that results - which the augmentation procedures minimize and that often has disappeared within a year.

It is important to discuss with your plastic surgeon all of your breast enhancement or reduction options before making any decision regarding surgery. As always, be sure your board-certified plastic surgeon gives you access to "before" and "after" photos of patients (particularly pageant contestants). When done correctly, perfecting the look of a woman's breasts can give her a definite advantage over the other contestants, particularly in Evening Gown and Swimsuit competition.

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 2005 - Pageantry Magazine

The New Reality of Nip 'n' Tuck
Though it is a refreshing trend for patients (including celebrities) to admit to their quick fixes via plastic surgery, it's still critical that patients be candid about their own motivations.

No doubt by now you've heard about invasive cosmetic surgeries, including breast augmentation and liposuction, but as much as 80 percent of a plastic surgeon's business can be non-invasive. Procedures such as Botox, Restylane, and collagen injections are quickly becoming the most popular cosmetic options. Much of the reason behind this is the low cost and lack of patient down time. Plastic surgeons' clients can walk into the doctors' office during their lunch hour for microdermabrasion or Botox and walk out an hour later looking 10 years younger for less than one might think.

The popularity of "plastic-surgery TV," including shows such as Extreme Makeover and The Swan, has also made the concept of plastic surgery more appealing and acceptable. Women are no longer embarrassed about having "work done," and often go public regarding how they obtained their new look. Celebrities and other well-known people coming out in public about their own plastic surgeries have given the industry a tremendous boost as well.

According to a published celebrity article, Patricia Heaton, Pam Anderson, Joan Rivers, Cher, and many more have all gone public about their surgeries. "We all have been nipped, butt pulled, do Botox, do collagen, lipo, starving all the time, and exercising," says Patricia Heaton. "That's why everybody looks that way." Joan Rivers admitted having a number of procedures, and often jokes publicly about her "younger but done" face.

The non- or low-invasive procedures such as lip injections and Botox make some women feel as if they're just getting a little help, as opposed to full-blown surgery. I've found these relatively simple procedures often lead to women wanting an even bigger improvement, such as larger breasts or smaller thighs.

While the plastic surgery community welcomes the newly found star status of non-invasive procedures, there is risk to the craze. First, an attractive 30-year-old receiving Botox to correct a slightly wrinkled forehead is still going to be an attractive woman when she walks out of the plastic surgeon's office. A 65-year-old will not look 30 no matter how much Botox you inject into her face. The reality is that non-invasive procedures can only slightly improve a person's look. If you don't have the basic canvas to begin with, we can't make you gorgeous with a chemical solution.

In addition, there are still risks to non-invasive procedures, such as droopy eyes or even burns. Do not trust someone in a hair salon or manicure shop to laser, peel, or inject your face. We see a number of patients every week hoping we can fix a mistake made by an unqualified person.

"A lot of plastic surgery makes you feel fine, and now I feel fine," said celebrity Sharon Osbourne in an interview late last year. As a surgeon, I must cringe a bit upon hearing these words, because plastic surgery should not make you feel fine. You should feel fine long before you walk in my door. If it is obvious a patient has self-esteem problems or other possible emotional distress, I will not perform surgery - invasive or non-invasive - on that particular patient.

Of course, I'm a huge supporter of plastic surgery and the choice for a woman to have work done. Just make sure you're seeking Botox or fuller lips because you want a little improvement, not a new identity. The true star power lies within your own heart and soul. The most beautiful women I've ever seen are genuinely gorgeous on the inside first.

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 2005 - Pageantry Magazine

Targeting the Bulges That Won't Budge
Losing the last inch is often the hardest - especially in those perennially protruding trouble spots. When no amount of exercise will do the job, liposuction often is the only effective option.

Daily workouts are a part of most entertainers and contestants' lives. The combination of the treadmill, squats, and weight-training exercises often pays off in the form of a flattering and fit figure. However, nearly 90 percent of women will find that even with a faithful exercise regimen, trouble spots still may remain - stubborn places where the excess fat just won't disappear no matter how rigorous the training sessions are.

What are the trouble spots most often cited by women of all ages? Usually these dedicated women are concerned about the inner and outer thighs, gluteal folds, lower abdomen, and - although less often a concern - the chin line and neck area. If a contestant or performer has tried a trainer-approved exercise program and followed a healthy diet but continues to struggle with these common complaints, cosmetic surgery often is the only effective option to remove the bulges that won't budge from these stubborn areas.

The most common approach for removing fat in the stubborn problem areas is liposuction. During liposuction, a narrow tube called a cannula is inserted through a tiny incision, and small amounts of fat are literally vacuumed out of the body. A trained surgeon will be able to sculpt a beautiful, natural look.

One misconception about liposuction is that it aids in weight loss. In fact, liposuction is intended to sculpt and shape, not to serve as an instant-thinning procedure. It should be used when the body is already at its ideal weight, not when a person is looking for a quickie substitute for a professionally managed weight-loss program. Another common misconception relates to cellulite, which is a common problem in women and is genetically linked.

Loose abdominal skin is another complaint women often have, especially as they advance in age and are raising families. The area between the abdominal muscles is often left permanently weakened after childbirth. All of the crunches in the world won't eliminate this problem area. An abdomnioplasty, or "tummy tuck," can tighten and tone the stomach area. To accomplish this, a surgeon will literally cut out excess skin and pull the muscles in the abdomen tight. This surgery results in a flat stomach, but also winds up leaving a large scar near the pelvic region.

As for areas around the face that defy the slimming effects of exercise programs, liposuction may also be used to sculpt a youthful jaw line on patients under the age of 40. Those over 40, however, may have to resort to a full face-lift.

Even after having a successful liposuction or tummy tuck, you will still need to implement or resume a long-term regular exercise program. The rule seems to be: What comes off can come back. It is possible to regain the fat removed through surgery; your results are only permanent if you continue to adhere to a healthy lifestyle.

Depending on which part of the country you live in, these procedures can come with a very hefty price tag, ranging from $5,000 to $15,000 per procedure. Before you make such an investment, though, it pays to exercise some caution. Any type of surgery has serious risks associated with it, and before you make the investment, you should talk with your plastic surgeon about the downside as well as the benefits of the procedure you are considering.

After making such an informed assessment, tens of thousands of women choose to undergo these procedures every year, and usually do so with beautiful and successful results. Through the ability to take aim at very specific areas of the body, cosmetic surgery is one tool in the beauty arsenal that has the potential to mold an already fine physique into a living, breathing artistic statement.

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 2004 - Pageantry Magazine

Facial Rejuvenation

Women today have many options in the battle against lines and wrinkles. Here are the ones that actually work. Without surgery.

The search for a youthful appearance is a multi-century quest. The Romans had bath houses (spas), and the ancient Egyptian women were the first to use alpha and beta hydroxy acids. They did so by applying milk, grape, and fruit extracts to their faces with the ultimate goal of improving the skin. Today, we have much more highly sophisticated options: lasers, intense pulse light, radio-frequency, micro dermabrasion, filler products, and Botox, as well as oxygen and collagen creams and other over-the-counter products. So what really works on which wrinkles?

Through scientific studies, we know the only topical that can stimulate collagen and elastin to prevent and help with lines and wrinkles is tretinoin (marketed as Retin A and Renova), so our advice is: Save your money on over-the-counter products. They can help for dry skin or minimize the appearance of very fine lines, but they do nothing at the cellular level. Instead, see your doctor for some tretinoin. The alpha and beta hydroxy acids, at prescription strength, can also make the skin softer and healthier appearing, but offer no help for lines and wrinkles.

The lines of the upper face (crows feet, frown lines, and forehead lines) are cause by the action of facial movement, with heredity, smoking, and sun exposure also being contributing factors. Ablative laser procedures (which, by definition, are surgeries that require a recuperation period) and deep peels can stimulate collagen and elastin and improve lines, laxity, and wrinkles, but at increased risks. The non-ablative lasers, intense pulse light, and radio-frequency modalities give minimal improvements at best. Micro dermabrasion improves only the fine lines and will give the skin a softer, more youthful appearance, but it does not stimulate collagen and elastin.

That leaves us with Botox treatments, using botulinum toxin type A to temporarily paralyze the muscle, causing a significant reduction (if not resolution) of these lines. Contrary to some articles on the subject, Botox does not leave the face without animation. Initially, the effects last about three to four months. As the procedure is consistently performed, Botox will last longer and may be needed only one to two times per year. The complication of Botox that raises the most concern is the possibility of a lid or brow droop, which does not commonly occur if the treatment is performed by a skilled practitioner knowledgeable in the anatomy of the facial muscles. If a droop happens to occur, it typically lasts only a few weeks.

The lines around the mouth - that start at the side of the nose and extend to the corners of the mouth, and those that appear from the corner of the mouth and extend down to the chin - can be treated with Botox, but doing so is more risky than treating the upper facial lines, because a mouth droop can last for many months.

A better option for eliminating lines in the lower face is the use of filler products - Zyplast (bovine collagen), Cymetra and Cosmoplast (human collagen and elastin), and Restylane (hyaluronic acid) - which serve to fill in and plump up the areas under the surface of the skin where lines appear. The filler products are also used to treat acne scarring and to plump the lips. After the area to be treated has been anesthetized, the specialist uses a small needle to inject these creamy products with minimal discomfort. The procedures take about 15 to 30 minutes to perform in the doctor's office, with touch-ups possibly required about one month later. After the desired correcting is achieved, these products last an average of six to nine months, while some patients metabolize these products more rapidly and may require more frequent procedures.

The most common side effects of using filler products are the bruising and swelling, lasting from 24 to 48 hours. Unevenness can be corrected with subsequent procedures. Rarely, filler products can enter a blood vessel, causing a loss of blood supply to a small area and resulting in a breakdown of tissue and potential scarring.

Nothing can replace a face-lift to correct certain problems - joweling, laxity, or baggy eyes - but these non-surgical options give us choices for facial rejuvenation before or after any other surgical intervention.

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 2004 - Pageantry Magazine

When is Liposuction Contouring the right choice?

Liposuction is a procedure intended for individuals who are already in good physical shape who wish to sculpt their body. It is not intended for weight loss or weight control. During the procedures, unwanted fat is removed from specific areas, including the abdomen, buttocks, thighs, knees, and upper arms. To be a good candidate for liposuction, you must have realistic expectations about the procedure. The best candidates are normal weight people with firm, elastic skin who have pockets of excess fat.

Liposuction may be performed in a surgeon's office-based facility, in a outpatient surgery center, or in a hospital. Smaller-volume liposuction is usually done on an outpatient basis for reasons of cost and convenience. However, if a large volume of fat will be removed, or if the liposuction is being performed in conjunction with other procedures, a stay in the hospital may be required. The average cost of the procedure is between $5,000 and $15,000, depending on how many areas are being treated, and where the surgery is being performed.

Liposuction is a procedure in which localized deposits of fat are removed to recontour one or more areas of the body. Through tiny incisions, a narrow tube, or cannula, is inserted and used to vacuum the fat layer that lies deep beneath the skin. The cannula is pushed and pulled through the fat layer, breaking up the fat cells and suctioning them out. The suction action is provided by a vacuum pump or large syringe, depending on the surgeon's preference. If many sites are being treated, your surgeon will then move on to the next work area, working to keep the incisions as inconspicuous as possible.

Fluid is lost along with the fat, and it's crucial that this fluid be replaced during the procedure to prevent shock. For this reason, patients need to be carefully monitored and receive intravenous fluids during and immediately after surgery.

While this is the basic technique in liposuction, several refined variations have been introduced in the past 10 years. These include fluid injection, a technique in which a medicated solution is injected into fatty areas before surgery in order to remove the fat more easily. There is also ultrasound-assisted lipoplasty (UAL). This technique requires the use of a special cannula that produces ultrasonic energy. As it passes through the areas of fat, the energy explodes the walls of the fat cells, liquefying the fat, which is then removed with the traditional liposuction technique.

After the procedure, a patient is fitted with a snug compression garment, which is worn for several weeks. Improvement will become apparent after about six weeks, when most of the swelling has subsided.

Liposuction is normally safe, as long as patients are carefully selected, the operation facility is properly equipped, and the board-certified plastic surgeon is adequately trained. Your doctor must have advanced surgical skills to perform procedures that involve the removal of large amounts of fat.

It is important to keep in mind that, even though a well-trained plastic surgeon is your best bet, there is no guarantee of a perfect result. Though they are rare, complications can and do occur. Imperfections in the final appearance are possible after liposuction. The skin surface may be irregular, asymmetric, or even "baggy." Numbness and pigmentation changes may occur.

There is a possibility of infection, the formation of fat and blood clots, excessive fluid loss (which can lead to shock), friction burns or other damage to the skin or nerves, or perforation injury to vital organs. This is why it is critical to have a good surgeon. Steer clear of dermatologists and others who are not specifically trained to perform liposuction.

Once the fat cells have been removed by liposuction, these same cells do not grow back. The fat cells are gone forever. However, neighboring fat cells can grow to a tremendous size and make up for the missing cells removed by the surgery. In other words, if you gain weight and do not follow a healthy lifestyle, you will, in all likelihood, gain your fat back.

If your expectations are realistic, you will most likely be very happy with your liposuction results. You may find that you are more comfortable in a wide variety of clothes, and more at ease with your body. By eating a healthy diet and getting regular exercise, you will be able to maintain your new shape.

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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