While many people enjoy the apparent healthy glow of a good tan, the long-term consequences of looking ‘bronzed’ are far less glorious. Like smoking from many decades ago, most people know it is not good for you but just can not resist doing it. This is particularly true amongst teens and young people who are infused with an understandable perception of immortality.

The Food and Drug Administration (FDA) has now proposed that indoor tanning beds be labeled with consumer warnings about the risks of developing skin cancer from their use. This is just a warning and does not preclude anyone, even a minor, from using them. But it will have in the warning a recommendation that warns young people not to use them. If approved, and I have no doubt it eventually will, this would reclassify sunlamps from a Class 1 device to a Class 2 device signifying the increased health risk with their use.

Despite the position of the tanning industry that indoor tanning beds do not pose any health risks, the reality is that sunlamps do damage your skin and increase your risk of developing skin cancer. According to the American Academy of Dermatology, the use of tanning beds increases the risk of developing the most severe form of skin cancer, melanoma, by a striking 75 percent.

Elective plastic surgery done for cosmetic gain always take a careful look at the patient’s general health beforehand. With some notable exceptions (morbid obesity, diabetes, smokers) it is fair to say that any person under the age 50 is unlikely to have medical problems that would exclude them from having almost any type of plastic surgery safely. Most certainly, the most athletic and fit individuals would seem to be ideal candidates to undergo a surgical experience without incident. Recent reports have pointed out, however, that there is one unique athletic patient that is at risk of the heart stopping (asystole) during surgery. Several cases have now emerged in young women who were endurance trained (marathon runners) with presurgical slow heart rates below 60 (bradycardia) that are at risk for cardiac arrest during surgery. The exact mechanism is not fully understood why this can potentially happen. Ironically the most very fit, perhaps unnaturally fit, patient has an increased cardiac risk for surgery in general if they have a low heart rate. While no deaths have been reported from these events happening in surgery, plastic surgeon and anesthesiologist need to be on guard in the athletic patient with a slow heart rate.

Eyebrows, particularly for women, play an important part of facial attractiveness. Most think of beautiful eyebrows as their shape and degree of and location of their arch. But recent studies show that eyebrow shape is not the only feature that makes them attractive. Eyebrow projection may be just as important as shape. Eyebrows that have high walls, a slight prominence below the brow bone, helps frame the eye like a frame for a picture. Higher walls allow for greater projection of the eyebrow which correlates to perceived facial attractiveness. The area between the eyelid and the brow bone, known as the oblique frame, is what helps frame the eye not necessarily the brow bone itself. Studies show that women with higher oblique frames are consistently rated as more attractive. What is the best way to have a more prominent oblique frame…fat injections. A few ccs of fat judiciously and carefully placed in the oblique frame area may do as much for eyebrow attractiveness as its shape.

Breast implants have now been with us for over fifty years and they are likely to be with us for at least another fifty years and longer Their popularity has never been higher in the U.S. with over 300,000 breast augmentations performed in 2012, making it the number one cosmetic procedure performed. Women who get breast implants range from all walks of life from the topless dancer to the soccer mom. Despite their popularity, they have always been a source of social controversy, creating debate from psychologists to the media. In a recent published survery one-third of younger women, ages 18 to 25 years old, said they would swap their intelligence for bigger breasts. Nearly two-thirds surveyed said that they thought men would be more romantically interested in them if they were more endowed. The survey responses are likely a reflection of their young age and limited perspective on life. But these responses no doubt indicate that many women seek to increase breast size because they think it will make them more atttractive…and perception can become reality as we all know.

While the media and the internet is filled with plastic surgery ‘problems’ and apparent unfulfilled expectations, what occurs in the typical plastic surgery patient? Like most stories that are newsworthy, a normal happy patient is not very interesting or of much interest. Thus the public’s perception of plastic surgery can become a little skewed. In a new European study just released, researchers found that most plastic surgery patients report a boost in self-confidence and more fulfilled lives after their surgery. They examined at regular intervals after plastic surgery 550 patients and found that they had higher self-confidence afterwards if they had reasonable expectations before surgery. Only a little over 10% (12% to be exact) seemed to have unrealistic expectations for how their surgery would improve their life. What this demonstrates is that one should research thoroughly their plastic surgery procedure(s) of interest and make sure they understand what it can and, of equal importance, which it can not do. Like most things in life perception can become reality… if that perception has a reasonable basis. As a result, most plastic surgery patients are satisfied and do feel better about themselves afterwards which is the primary goal of the operation in the first place.

A woman’s hormones are well known to change as they age. Women over age 40 will have a decrease in such hormones as estrogen and oxytocin while testoterone increases. This can lead to an increase in one’s sex drive. But the post-pregnancy bodies of many women over 40 leave them feeling very self-consicous with loose abdominal skin and saggy and smaller breasts. This may partially account for why up to 15% of married couples report that they have not had sex in the past six months or even a year. This is where the Mommy Makeover can be of benefit. By combining several body reshaping procedures in a single operation a dramatic improvement in a woman’s body altered by pregancy can occur. The most common Mommy Makeover combines a breast augmentation often with a breast lift and a tummy tuck. By putting these two procedures together one can reduce not only cost but recovery time by as much as one month than if they were done separately. But if cost and recovery is not enough, almost three-quarters of Mommy Makeover patients report that they noticed an improvement in their frequency and pleasure of their sex life after the surgery.

A lot of attention has been paid to how to create more attractive and sensuous lips. From injectable fillers to lipsticks and lip plumpers, enhancing the lips has much to do with altering the appearance of the pink portion of the lip. (vermilion) But an often overlooked area of the lip is what lies above it…the amount of skin between the nose and the upper lip. If this distance is too long, which often happens with aging, the lip looks smaller and less perky. While there are some dental strategies to help the lip look fuller (tooth lengthening), this produces at best a minimal improvement. The most aesthetic skin distance along the philtral columns of the upper lip (Upper Lip Length, ULL) is anywhere between 11 to 13mms for most women. (for men it can be a few millimiters longer) If you do not have an aesthetic ULL, it can be made by a procedure known as a subnasal lip which actually removes a strip of skin right underneath the nose. Shortening this distance also lifts up and makes the cupid bow’s area more full.

While large numbers of cosmetic procedures are performed in the United States, including invasive surgeries, there are some smaller countries that have an unlikely number as well. The Islamic Republic of Iran is known for many things including being the world’s oldest civilization, having large amounts of natural gas and petroleum reserves and being one of the most mountanious countries in the world. With a population of over 75 million, there is a surprising number of cosmetic procedures performed. According to a recent report in the Tehran newspaper Etemad, Iran has the highest rate of rhinoplasty surgery in the world. As many as 200,000 Iranians, most women, have the procedure every year to remove a nasal hump and lift and slim the tip of their noses. An Iranian nasal research society (Rhinology Research Society of Iran) conducted a joint study with Johns Hopkins University that discovered that the rate of rhinoplasties done in Iran was 7X that of the U.S. What accounts for such a rate of rhinoplasty in a country where few would think of it as so common? Due to fashion restrictions imposed by religion, the face makes a very important personal statement. Having an attractive nose is considered extremely important in Iranian society. Influenced by Western culture and Hollywood, smaller noses with more Western proportions is considered beautiful. The ethnic Persian nose with a large hump and a downturned tip is no longer in style.

Despite the relatively weak state of the U.S. economy, the number of cosmetic procedures continue to increase. According to the American Society of Plastic Surgeons, there was a 5% increase in the number of aesthetic procedures from 2011 to 2012. With over 14 million procedures performed, this is the third year in a row that an increase in these procedures occurred. But the procedure increase is not related to actual surgery but in minimally invasive procedures such as Botox, skin treatments and laser hair removal. Actual invasive surgery number have remained stable but with no real increase.There are a number of reasons why minimally invasives have increased from less discretionary income for surgery, a growing number of middle-aged group of patients who are beginning to show their age to an expanding number of non-surgical treatment options. Leading the way in minimally invasive therapies is Botox injections by a wide margin with over 6 million treatments in 2012. Botox treatments continue to increase because they not only work, are quick and easy to do but an increasing number of people of all ages are at least trying this aesthetic therapy that has worked its way into the fabric of modern American society.

While over 14 million plastic surgery procedures were performed in 2012, the types of procedures differed considerably across the various age groups. The age group of 35 to 50 year-olds makes up the highest percentage (43%) with efforts being made to slow down the effects of aging which are now unavoidable to overlook. This is why this age group accounts for almost 50% of Botox and injectable filler use. Concomitantly, the use of laser, chemical peels and light therapies are also prevalent in an effort for skin improvement and wrinkle reduction. Reversing the effects of childbearing are seen in the high number of  breast augmentations, tummy tucks and liposuction in this age group as well. The age group 51 to 64 year olds are the next highest users at 28% of the cosmetic pie. As 60 is the new 50, facial surgical procedures dominate with nearly two-thirds of all eyelid lifts, browlifts and facelifts occurring in this group. The 19 to 34 year-old age group accounted for 20% of procedures done with breast augmentation, liposuction and rhinoplasty being common surgeries and laser hair removal and microdermabrasion being the most commonly done non-surgical procedures. At the opposite ends of the age groups, the 65 and older group (9%) and under the age of 19 (1%) made up the rmaining 10% of the procedures performed.