Attaining a firmer face, thinner thighs and captivating cleavage through cosmetic surgery has long come with one undeniable wrinkle: painful recovery and more downtime than busy Americans want to surrender. But now, from Botox to laser treatment and a host of "injectibles," fighting aging has never been easier.


"The non-surgical approaches and injectibles, over the last five years, have really taken off," observes Dr. W. John Kitzmiller, chief of the Division of Plastic, Reconstructive and Hand Surgery at the University of Cincinnati. In fact, traditional cosmetic surgical procedures such as the full facelift were down 5 percent from 2000 to 2005, while minimally invasive procedures were up 53 percent, according to the American Society of Plastic Surgeons.


With aging and sun exposure come wrinkles and brown spots. Procedures such as Fraxel laser treatment treat this as well as scars and stretch marks. Injected fillers counteract lipoatrophy, which is the loss of fat beneath the skin of the face. Such loss occurs with age, and can result in sunken cheeks, indentations and hollow eyes. These fillers include Restylane, a synthetic dermal filler injected to plump the skin and smooth wrinkles. It lasts four to six months, Kitzmiller says.


There's also autologous fat, or living cells, which are also injected, a procedure that often needs to be repeated for lasting results. Sculptura, which has been called the "liquid facelift," is injected deeper than Restaylane and lasts longer. It works by filling in lines and wrinkles and by stimulating the body to produce new collagen and underlying tissue, resulting in a more youthful appearance.


But the most popular choice is Botox, a toxin that is injected into the face and paralyzes muscles that cause frown lines and "crow's feet." It's quick, minimally painful, and requires no recovery"”but each treatment only lasts up to about three months.


"The number-one procedure we perform here is Botox, hands down," says Dr. Mark Mandell-Brown, who with his wife, Marianne, operates a popular cosmetic surgery center near Bethesda North Hospital. And the Botox popularity they see isn't a local phenomenon. According to the American Society of Plastic Surgeons, Botox was the number one minimally invasive cosmetic procedure in 2005, with 3.8 million treatments"”a whopping 388 percent growth from 2000 to 2005. In the same time frame, eyelid surgery and traditional facelifts were down 30 and 19 percent, respectively.


Dr. Mark Grosinger, D.O., of the Montgomery ENT (Ear, Nose and Throat) Clinic, a certified specialist in otolaryngology as well as facial plastic and reconstructive surgery, sounds a note of caution. "Everyone's doing Botox, but not everyone is doing it well," he remarks. "Don't run to just anyone. You want someone who has a thorough knowledge of the anatomy of facial muscles."


Beyond Botox, the chemical peel and microdermabrasion are among the top three procedures. Of the surgical procedures, breast augmentation was one that increased"”up 37 percent from 2000 to 2005. Among women, this is the most popular surgery, while men are looking for more subtle changes such as rhinoplasty (nose job) and eyelid lifts. "(Men) don't want people to notice something's obviously different," Dr. Mandell-Brown notes.


Cosmetic procedures have become part of a lifestyle for some people, incorporating other measures to look and feel better. One growing trend is medi-spas, facilities that combine spa services such as massages and styling with cosmetic procedures such as Botox injections.



Not all cosmetic procedures are created equal. "Reconstructive surgery is designed to restore a person back to a normal state" such as after an accident, devastating disease or birth defects, Dr. Kitzmiller explains. Cosmetic surgery, on the other hand, is taking something that's normal and making it closer to an ideal. Sometimes, plastic surgery encompasses both, such as fixing a wound from a dog bite on the face, or even fixing wrinkles around the eyes. "A lot of this involves components from both," he says.


Remember that various surgical specialists also perform plastic surgery. Dr. Grosinger, for example, may perform sinus surgery and rhinoplasty (the cosmetic "nose job") on the same patient, and otoplasties for kids, to pull back protruding ears. "We do a lot of eyelid surgery," he adds. "Most ophthalmologists are uncomfortable with [operating on] anything outside the globe of the eyeball."


Cosmetic surgery is heavily marketed, but consumers shouldn't lose sight of the fact that these are medical procedures. "We have a comfortable, inviting area," Kitzmiller notes. "But we're clear that we are a medical practice."


Experts say that choosing what's right for you depends on what you want to achieve and how much time and money you can spend. It's critical that you feel comfortable talking to your doctor, so you can both arrive at the best option.


 Sometimes, that might not be what you initially intended. Take liposuction. Dr. Mandell-Brown often consults patients away from surgical options when it comes to weight. Proper diet and exercise are essential first. "We don't see liposuction as a substitute for weight loss"”especially with radical weight loss," he explains. "It's more for sculpting and fine tuning."



Educating patients is the doctor's job, and you should carefully consider a physician's credentials, training and experience when choosing. "Be cautious about promises that sound too good to be true. Get a second opinion if you're uncomfortable," Kitzmiller advises. He's certified by the American Board of Surgery and the American Board of Plastic Surgery. Dr. Mandell-Brown is certified by the American Academy of Cosmetic Surgery and the American Board of Facial Plastic and Reconstructive Surgery.


Dr. Grosinger acknowledges doctors will claim some board or academy credentials are better than others, but "most certification boards are pretty stringent," he says. "Being board certified doesn't guarantee great results."


When considering cosmetic surgery or procedures, examine the doctor's facilities, too. They should be clean, professional"”and accredited. It's especially important to discuss whether a procedure will be performed on site, at an outpatient surgical center or at a hospital. Get details on how anesthesia will be administered and who is supervising that critical function. If you have concerns, ask to talk with the anesthesiologist.


Most important in preparing for any cosmetic procedure is knowing what to expect, whether it's surgery or quick injections. Beauty sometimes, well, hurts. "We spend a lot of time educating our patients," Kitzmiller says. "Scheduling the procedure is inconvenient, but it's the recovery that's the hard part."