Are Those Real?

By Leslie Marcus / Photography by Kristina Yamamoto / Styled by Simone Perloff / Photographer's assistant: Lisa Costigan

Breasts. Who doesn't love 'em? I love mine, but that wasn't always the case. My first boob job was a rite of passage: finish finals at USC, get a pair and graduate from girl to woman. "Do you want a Mercedes Benz or a Toyota Camry in your chest?" L.A. Doctor to the Stars* asked me. To be or not to be wasn't the question. Saline or silicone implants was. The answer? I sprung for the Benz.

I awoke from surgery with a pair of silicone Ds sitting in my nosebleed section. My new breasts were perched so high and pushed so close together, my neck disappeared. The doctor promised my boobs would drop, but they never did. My confidence did, however, and my new quest was to hide my chest.

Mine is a cautionary tale, so I offer this advice: before opting for Double-Ds, know the ABCs - of the risks, the rewards and your doctor's credentials. Not all plastic surgeons are created equal (my guy in L.A. certainly wasn't), so be certain you're making an informed decision prior to going under the knife.

These days, there's a new face of plastic surgery, a more lifelike face enhanced by Botox and other injectables. Bigger used to be better, but now the Holy Grail is natural-looking results. Guys, you're coming along for the ride, too, and I don't mean as a backseat driver.

*"L.A. Doctor to the Stars" is the name news outlets gave my first plastic surgeon, Lance Wyatt, M.D., after he was arrested last summer for allegedly filming his patients undress without their knowledge. I wasn't involved in all that, but I did receive one of his botched boob jobs. Scott Miller, M.D. fixed me three years ago.

 

Breast Intentions

Patients want a breast that can do multiple things, meaning you can dress them up or dress them down depending on the circumstances," says board certified plastic surgeon Vince Marin, M.D. of Marin Aesthetics in Del Mar.

Marin performs roughly 150 breast augmentations (that's 300 boobs) a year in San Diego, with the lion's share of his patients falling in the 25-to-30 age range. Gone are the requests for huge implants, he says. The most requested size today is a C cup.

"The biggest regret we always get is the patient feels like they went too small," Marin says. "So we always try to push them a little bit and find happy medium."

In 2011, 69 percent of women used silicone for breast implants; the rest used saline. Today, women have another option."Gummy Bear implants are the latest thing to hit the market," Marin says. But new doesn't necessarily mean better. These puppies, make that "bears," have a thicker, more cohesive gel (think Gummy Bear vs. marshmallow), but there's no evidence that they're safer or longer-lasting.

Marin points out that these new implants are supposed to appear more natural when a woman is standing, but they don't flatten like a natural breast does (or as well as silicone) when a woman lies down.

Breast implants average $5,000 to $6,500, depending on the type you choose. If you're spending a lot less, please make sure you're using a reputable doc. Say no to Groupon for this one, and plan to be out of commission for about a week following the procedure.

 

Butt, of Course

Jeans are getting tighter, bathing suits are getting smaller, and the booty is a bigger star than ever before. If your backside is falling behind, it may be time to shop for a new one.

BOARD CERTIFIED PLASTIC SURGEON Paul Chasan, M.D. says beautiful butts are so popular these days that some weeks he performs as many derriere as breast augmentations.

"The biggest trend right now is contouring the buttock and making it look better using your body's own fat," says Chasan, who begins the two-stage procedure (commonly referred to as the Brazilian Butt Lift) by first performing liposuction of the hips, love handles and outer thighs. "Then you have that fat to inject into the buttock. It's kind of like taking a deflated balloon and filling it with air."

Silicone implants are another option for people who have flat butts, but not enough of their own fat to harvest. Implants are surgically implanted in the center of the glute muscle.

"A newer thing I've been doing is called the 'Thong Lift,'" Chasan says. "I can keep the scar right along where the thong would be, pulling the skin right to the center so the scar is completely hidden."

Chasan also performs what he calls the "Del Mar Butt Tuck," which involves removing the hanging skin from the lower part of the butt crease. This one's more for cougars who've been prowling North County for a while, so there's still time to save up.

Like what you see after shelling out the roughly $9,000 it takes to buy a butt augmentation? Give yourself a standing ovation, because you won't be sitting down for up to two weeks after surgery.

 

Skin in the Game

As a TV producer for FOX 5 San Diego, I've come face-to-face with heartthrobs from 90210 to Baywatch, all of whom seem to maintain that youthful glow. But it's not camera tricks, face creams or dryer sheets that keep them wrinkle-free. It's a skilled injector armed with Botox and fillers.

"If you start young enough, say in your late twenties or early thirties, you can keep wrinkles at bay for 20 years, using just Botox," says board certified dermatologist William Groff, M.D. of Cosmetic Laser Dermatology in La Jolla.

Groff calls this "preventative maintenance." I call it "fitness for your face," but instead of building muscles, you're paralyzing them to keep wrinkles from forming. After enjoying 20 years of wrinkle-free bliss, however, the dream (and your face) may come crashing down.

"In your late thirties and early forties, you start to lose volume in your face, the facial bones begin to shrink, and you lose fat in your face - so things start to cave in," says Groff. "If you can maintain the volume of the face using fillers, you can prevent the need for facelifts and surgical procedures for many years."

Hyaluronic acid fillers (like Restylane, Perlane and Juvederm) are most commonly used to add volume to, among other indentations, the "parentheses" that form around the mouth. Results can last from six to nine months; the next generation of fillers is expected to last longer.

 

Lip Service

Hyaluronic fillers are also used to plump lips. Used incorrectly, they create the infamous "trout pout" that makes women look like they've been kissing a vacuum hose. "I think, 'Oh, my gosh! Who did their lips?'" Groff says. "I wonder if these patients did their research or just went to the cheapest place they could find in town. It doesn't look good and just throws out a red flag to everyone that says, 'Hey, look at me. I got my lips done.'"

 

Now Ear This

A new technology that can delay or even reverse aging is called Laviv, a procedure that involves removing a small piece of skin from behind the ear and sending it off to a laboratory. From that sample, scientists can grow millions of new, living cells. "These fibroblast cells are injected into acne scars, stretch marks or fine lines, and they produce collagen, which fills in these defects in the skin," says Groff. Laviv requires three treatments, has no downtime, and costs around $3,000. Results begin to appear within three to six months.

 

Beam Me Up

"Lasers have very specific jobs. They're not one size fits all," says Groff. Signs of sun damage can appear in one's early twenties in the form of dark brown spots. "The gold standard, if you want to get the best results, is the q-Switched Alex Laser. We can easily get 90 to 100 percent clearance of sunspots in one treatment. The second best option would be Intense Pulsed Light, or IPL." Prices range from $150 for a few spots to $750 for an area peppered with them. There is relatively no downtime, and it takes about five days for the spots to slough off the skin.

The real key to keeping youthful skin is basic: sun protection. That means religiously putting on sunblock every time you step outside. If you're still going to a tanning bed, Google "Tanning Lady."

Mother Always Nose

The whittled-down ski-slope noses of the 1980s are gone. (Well, mostly gone - Michelle Pfeiffer still has hers.) Today's nose job is all about finding a natural fit to complement the face.

"When a person's nose works with their face, you notice their eyes, their cheekbones. You don't notice their nose," says La Jolla-based BOARD CERTIFIED PLASTIC SURGEON Scott Miller, M.D. "Jessica Biel, she's got a great nose, but you have a hard time picturing it because you didn't really notice it. You just know that she's beautiful."

In addition to looking good, a nose actually has to work. A good nose job, Miller points out, addresses form and function.

There haven't been noteworthy advances in rhinoplasty in recent years. The supposed "Five-Minute Nose Job" garnered some
media attention, but the procedure (which uses fillers like Juvederm to plump up nooks and fill in crannies) has limited use.

"Most people who don't like their nose - it's not something that can be solved with a little filler," Miller says. "It's something that
requires modification of the structure underneath the skin."

A majority of Miller's rhinoplasty patients are in their early to mid-twenties, which is in line with the national average.

"It's always bugged them, but now they're adult and have the resources," he says. "They do it at life-changing events - before
they start a new job, before meeting a new peer group. They do it before they're knee-deep into their adult life, so they can move forward with this new confidence and new presentation to the world."

 

Battle of the Bulge

According to the American Society for Aesthetic Plastic Surgery, liposuction was the most popular cosmetic surgical procedure in the U.S. in 2011. The future of fat loss, however, may lie in non-surgical solutions.

Case in point: CoolSculpting by Zeltiq is an FDA-cleared and clinically established method of fat removal. The relatively new procedure freezes fat with a vacuum-like device that's placed on top of the skin. You can get it done during lunch break and still make it to the gym the same evening.

"Fat is more susceptible to cold than skin, so you can kill 20 percent of fat cells in a given area, through the skin, without injuring the skin," says Scott Miller, M.D. of Miller Plastic Surgery in La Jolla, a BOARD CERTIFIED PLASTIC SURGEON.

Each area takes about an hour to treat and costs about $600. A full abdominal treatment costs about $1,200. Results become evident in two to three months as "frozen" fat cells are metabolized and flushed from the body.

Despite advances in non-invasive techniques, liposuction remains the most effective solution for removing fat from various areas of the body. Miller uses an innovation called the "Body Jet" in conjunction with the traditional suctioning of fat.

"It's basically like doing a breast stroke - the water does a breast stroke through the fat, loosening it and breaking it up," he says.

When it comes to results, Miller says finding a realistic diet and exercise program is key.

"What doesn't make sense is to go to Navy S.E.A.L. boot camp, get down to a certain weight, have liposuction on that last little bulge and at some point go back to real life and wonder why that area got full again, because that eight percent body fat wasn't something you were able to maintain," he says.

 

Cellu-Lighten The Load

A new weapon in the fight against women's biggest enemy, cellulite, is Cellulaze, recently approved by the FDA as a solution for cottage-cheese thighs. "We think this is probably one of the Holy Grails of cosmetic surgery," says Jeffery Umansky, M.D., a BOARD CERTIFIED PLASTIC SURGEON who practices alongside his brother William at Umansky Medical Center in La Jolla. The procedure involves making small incisions in the skin and shooting a laser at the internal structures that cause dimpling. Treating one area, like the outer thighs, costs around $3,000. The technology is too new (studies have followed patients for only two years) to predict how long results will last, but judging from the "after" pics I've seen at doctors' offices, the immediate aftereffects are evident: extreme bruising, so don't plan to unveil that new bikini right away.

Guise, and Dolls

Looking for Barbie (or for another Ken), men are getting in on the nip/tuck action. Many of us first got acquainted with the metrosexual man when he took up a seat at our nail salon for a pedicure. (We thank you for that, Dude, and so do your feet.) These days, we see them putting in long hours at the gym, wearing Lululemon gear and sipping on protein shakes.

It makes sense these guys would begin to get face and body "tune-ups" like some of us girls do. Despite freaking out at the sight of blood, men have been embracing Botox (Brotox?) to erase fine lines and wrinkles.

"Men used to make up a very small percent of our patients, but I'd say now it's approaching about 15 to 20 percent of our patient population," says BOARD CERTIFIED DERMATOLOGIST William Groff, M.D. "As the workforce gets older, and jobs become harder to get, people see youthfulness as an advantage."

When it comes to surgical cosmetic procedures for men, liposuction reins king, followed by rhinoplasty and eyelid surgery, according to statistics compiled by the American Society of Aesthetic Plastic Surgery.

"Men are most commonly getting lipo of the love handles and their chin or neck, so they can define a masculine jawline," says BOARD CERTIFIED PLASTIC SURGEON Vince Marin, M.D.

CoolSculpting by Zeltiq is an option for guys wanting to shed a beer belly without going under the knife. The FDA-approved, non-surgical procedure freezes fat, using a vacuum-like device that can reduce up to 20 percent of fat in a particular area of the body over the course of three to six months. The manufacturer now offers a larger, tire-shaped attachment that wraps around the entire abdomen and love handles.


AB-solutely

Want to look like the Situation from The Jersey Shore? A procedure called Ab Etching might get you there by using targeted liposuction to carve out spaces between the abdominal muscles to create a six-pack. "It does run the risk of scarring, because you're taking away so much of the fatty tissue that it could cause problems where the skin sticks down in odd ways, a la Tara Reid," says BOARD CERTIFIED PLASTIC SURGEON Vince Marin, M.D. "If you sculpt or etch in abs in someone who is a little overweight, that can look odd as well. It's sculpted fat rather than thin skin over hard muscle, so it can get more of a marshmallow appearance rather than that rock-hard ab look." The procedure costs around $3,000.


Hair Apparent
Combatting the inherited genes that comprise a half-dome, or less

Male Pattern Baldness is genetic, and men who want to fight it often have to endure painful, timely and expensive procedures. There are a number of different ways to perform hair-replacement surgery, but many can yield unsightly scars and poor results.

"What we're doing now is game- changing technology," says BOARD CERTIFIED PLASTIC SURGEON Richard Chaffoo, M.D. "The system is called Neo-Graft."

The procedure involves harvesting small grafts from the back of the head in a process that prevents the scarring often
correlated with archaic hair-transplant techniques. Chaffoo says Neo-Graft eliminates the doll-like appearance of yesteryear's hair plugs, and that the transplanted hair looks natural.

"In a single session, we are able to transplant up to 3,500 grafts," he says, "which means you can essentially recreate the entire frontal hairline, the top of the head and the crown area all in one setting."

One session can take four to eight hours, depending on the number of graphs. The average cost of the procedure is around $16,000.

THANK YOU, REAL DOLL!

If having a girlfriend or boyfriend seems too expensive (or chatty), find quieter and more affordable companionship at realdoll.com, based in San Marcos.

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