ASAPS 2010: some science on Mesotherapy

One of the most interesting presentations at the recent ASAPS meeting was the long-awaited results of the lipodissolve / mesotherapy study. Dr. V. Leroy Young, who is an extremely careful and thoughtful researcher, presented the findings.

The study used volunteers with a BMI < 30 and without significant skin laxity, who had a series of injections into their abdomen in an attempt to reduce their subcutaneous fat deposits. There was no dieting, no other drugs, lasers or surgery used. The typical grid pattern of injections was used to one-half of the abdomen, with a pre-mixed combination of mesotherapy agents (PPC/DC). The patient had a series of up to four treatments into the same area, at intervals of 8 weeks. This method was chosen to mimic what is done at many mesotherapy clinics. Careful monitoring was done with a multitude of measurements, photos, lab tests, and CT scans - before, during and after the series of injections. By only treating one-half of the abdomen, each patient served as their own control.

There were no significant changes in BMI or skin-fold thickness, and no blood test changes as a result of the treatments.

In reviewing the photos, the before and after "result" photos looked very similar to me. Not much of a change. If there were changes in body shape, I thought that they looked pretty subtle. If I were the patient, I would be pretty disappointed in these results!

There were a couple of CT scans where I could really see a difference in thickness of the fat layer - so something was happening, at least in some patients, some of the time. According to Dr. Young's numbers, there was an average reduction of 7% in the subcutaneous fat thickness.

There were no major adverse effects reported in the mesotherapy study group, but patients' post-op complaints included pain, swelling and nodule formation. Despite that, most of the patients wanted to go ahead and treat the opposite side!

Bottom line: It's good to finally see this kind of non-biased, carefully controlled research being done. Personally, I was not impressed with the changes, but it might have some application for small areas where a little further refinement of a result might be desired following real liposuction. Too early to tell on that idea, though.

When the final report is issued in the Aesthetic Surgery Journal, I will be able to comment on it in more detail.

ASAPS 2010: Project Beauty website launches

An exciting new consumer-oriented website from ASAPS, with engaging video featurettes, Project Beauty is sure to be a hit. It features stories on health & wellness, beauty and style tips, and news about plastic surgery trends and procedures.

Just the kind of thing that readers of PSB: the plastic surgery blog love!

Click here for the link.

ASAPS 2010: the Laser Lipo Backlash

I just returned from the Aesthetic Society's annual meeting, held just outside Washington, D.C. As usual, ASAPS put on another top quality, well-organized session, with a wide selection of first-rate surgeons from around the world. The next series of blog posts will feature new stories from the meeting.

Up first: The Disappointment of Laser Liposuction.

Despite the marketing hype by the laser manufacturers, surgeons are now coming forward saying that they're just not seeing the hoped-for improvement in results with laser liposuction, compared to standard liposuction methods. The excitement phase, seen when any new technology comes along, is probably over - to be replaced by a more honest, pragmatic assessment phase.

Dr. Jeff Kenkel, laser guru from UT Southwestern, probably said it best with a very honest assessment, "I really wanted to believe in the lasers, and I kept on trying them...", but then he showed us his clinical results, which showed very little, if any, skin tightening. He admitted there wasn't a single surgical result obtained with the laser that he couldn't have been obtained with standard liposuction.

So far, there's very little good science at this point in 2010 to back up the claims that the manufacturers were making in 2007. That's not to say that laser lipo is without some merit - it's just not the magic wand that many promoters have claimed it is. Research is still ongoing, and surgeons like Dr. Barry diBernardino are working hard to present scientifically valid data, not just opinion and "hand-waving", like we've seen in the past.

Many surgeons in the audience felt like the manufacturers really need to show more solid scientific research, before making sales claims. Others of us felt it was really up to us not be conned by preliminary results and sub-standard studies, and to demand better from the manufacturers and the news media.

Of interest, the best lipo results I saw at the whole meeting were done by Dr. Simeon Wall, Jr., of Louisiana. His secret: a three-step liposuction method done with... power-assisted liposuction. No laser, no magic gadget - just a great technique with the tools we already have.

Once again, it's the carpenter, not the hammer used.

ASAPS 2010: stay tuned

Yes, readers - it's that time of year again, when the best aesthetic plastic surgeons in the world congregate for their annual meeting.

ASAPS 2010 will be held in Washington, D.C., starting in about a week. The latest and greatest, what's hot and what's not, and what actually works in cosmetic plastic surgery will be up for discussion....just the sort of stuff we love here at PSB: the plastic surgery blog!

I'll be attending, listening, learning and questioning. When I get back, I'll have a full report for everyone....stay tuned.

Laser liposuction: the Emperor's New Clothes?

Just this week, the American Society for Aesthetic Plasic Surgery (ASAPS) put on an educational webinar for Plastic Surgeons, talking about various recent advances in liposuction. A variety of devices, including Power-assisted Liposuction, VASER, and SmartLipo and the related laser-assisted liposuction devices were reviewed and discussed by the experts.

All of these were compared against the traditional "gold standard" liposuction method of tumescent liposuction, which has been proven to be safe and effective in many published studies. (This is where a thin tube, called a cannula, is hooked to a vacuum, and is used to suction out fat that has been previously injected with a good volume of medication-containing fluid.)

Here are the results:

Power-assisted Liposuction (PAL) got the "thumbs-up" from the panel, as good scientific trials showed that it was as effective as tumescent liposuction, and less fatiguing for the surgeon.

VASER, the latest form of ultrasonic liposuction, was also well received. The panelists liked it for secondary liposuction (i.e. touch-ups) and areas of the body that are fibrous. Some surgeons used it as their primary liposuction tool. Good scientific data was presented to show that this is effective, and safe, as long as the ultrasonic energy applied is not excessive.

Laser-assisted liposuction, such as SmartLipo or CoolLipo, received a veritable beating during the discussions by the experts. Marketing claims by the manufacturers, such as "less invasive", "safer", "more skin tightening", "quicker recovery" and "better results" were each individually addressed and debunked, until not a single one of these claims was left standing. (Cue sound effects: Wham! Biff! Pow!!) Higher laser power machines actually increased the percentages of patients with complications from skin burns.

Essentially, we learned that there was no good scientific proof for any of the laser lipo claims. While these laser lipo machines do remove fat, here's the key point - they haven't been shown to do it any better than the other liposuction devices we already have. And there's been little to no convincing evidence of significant skin tightening in any reputable journal in a double-blinded comparison.

The more honest surgeons in the panel agreed: you can get the same results with any of the current technologies, without spending big bucks for the laser system.

In other words - It's not the hammer, it's the carpenter using it.

A skilled, experienced surgeon will get good liposuction results by using good patient selection and appropriate technique. Other than the questionable marketing to technology-obsessed patients who demand the "latest", there appears to be no additional merit to the laser liposuction methods.

I realize that it may seem hard to believe for those that like to think that the latest laser gadget must be the best. It's a bit of the old story of the "Emperor's New Clothes". Laser liposuction, no matter what smart name you call it, has not been proven to be better than standard liposuction in any controlled scientific trials after several years on the market....and if it were really as marvellous as everyone claimed, we would have had plenty of scientific proof by now.

WSJ: Plastic Surgery decreased in 2009

Nice summary of 2009 plastic surgery trends in the Wall Street Journal, showing the effect of hard economic times on elective plastic surgery volume.

I've reproduced it, below. I've added some editorial comments in parentheses.

In addition, you can see the latest ASAPS statistics on plastic surgery, by clicking the link here.

***************

By ANJALI ATHAVALEY, Wall Street Journal

The number of cosmetic-surgery procedures in the U.S. sagged for the second year in a row in 2009, according to an annual survey released Tuesday by a plastic surgeons' association.

There were 10 million surgical and nonsurgical procedures last year, down 2% from 2008, according to a survey of 928 board-certified physicians by the American Society for Aesthetic Plastic Surgery, a Garden Grove, Calif., group of plastic surgeons specializing in cosmetic surgery. (ASAPS is the largest, most important group of cosmetically-oriented plastic surgeons.)

Driving the decline was a 17% drop in surgical procedures, to 1.5 million surgeries. "People just couldn't go for the big items," said Renato Saltz, the association's president.

Tummy tucks, rhinosplasty and other surgical procedures can cost thousands of dollars more than nonsurgical measures, and they require a longer recovery. (But of course, the surgeries do much more than any non-surgical alternative.)

Indeed, fear of job loss is the main reason people are putting off their surgeries, says Phil Haeck, president-elect of the American Society of Plastic Surgeons, a separate group that has yet to release its annual survey. Dr. Haeck, a plastic surgeon in Seattle, said that marks a shift from last year when consumers cited cost as a primary hurdle. This year, "job priority is number one, cosmetic surgery is number two," he said.

Breast augmentation beat out liposuction as the most popular surgical procedure for the second year in a row. Dr. Saltz attributes renewed popularity of breast augmentation to the 2006 Food and Drug Administration decision to lift the ban on cosmetic use of silicone breast implants. Breast augmentations numbered 311,957 last year, down 12% from 2008; liposuctions numbered 283,735, down 17%.

Nonsurgical procedures, such as injections of Botox or hyaluronic acid to fill facial wrinkles, were flat, inching up 0.6% to 8.5 million.

Two surgeries are surging in popularity. Buttock lifts, which involve reshaping of the bottom, increased 25% to 3,024 procedures, and buttock augmentations increased 37%, to 4,996. Increasingly, people want to reshape their rears after losing weight, Dr. Saltz said.

The procedures, costing from $4,000 to $5,000, are fairly new, with both benefiting from recent technique improvements, he added. As the economy recovers, more baby boomers are expected to seek procedures, and more physicians will likely offer nonsurgical options. Surgical procedures have increased by 50% since 1997, while non-surgical procedures grew 231%. Places like health clubs and spas are already offering minimally invasive procedures. (Not recommended!) Cosmetic-surgery associations recommend that consumers seek out procedures that are conducted under the supervision of a board-certified physician.

They should also do research before going overseas for cheaper rates for surgical procedures, which physicians say is a growing trend. "Right now, there is not an association that verifies that the physician is appropriately trained to do what they are doing," said Dr. Haeck. "Very few of the countries where these are being offered have anything that approximates the rigorous boards in the United States." (Canada is one exception - their training standards are equivalent to the U.S.)

Study Shows Women Are More Prone to Facial Wrinkles Than Men

Findings from a study published in the November/December issue of Aesthetic Surgery Journal (ASJ) suggest that gender-specific differences in the perioral skin (skin surrounding the mouth) account for more and deeper skin wrinkling in women than in men.

“The aim of this study is to obtain new insight into the perception that women wrinkle earlier and more severely than men,” said the study’s lead author, Emma C. Paes, M.D., from the Department of Plastic, Reconstructive and Hand Surgery at the University Medical Center in Utrecht, Netherlands. “If we understood the reasons for differences in wrinkling between women and men, then we might be able to develop better strategies for the treatment of perioral wrinkles.”

The study found that all of the following could explain the presence of more and deeper perioral wrinkles in women:

Women’s perioral skin contains fewer sweat glands and sebaceous glands (microscopic glands in the skin that secrete an oily/waxy matter, called sebum, to lubricate skin and hair), which could influence the natural filling of the dermis (skin).

Women’s perioral skin contains fewer blood vessels and, therefore, is less vascularized compared to men, which could accelerate the development of wrinkles.

In women, the closer attachment of the muscular fibers surrounding the mouth to the dermis may cause an inward traction, thereby creating deeper wrinkles.

Current treatments for perioral wrinkles include the use of lasers & chemical peels, Botox injections, and injectable or implantable wrinkle fillers. Despite these many options, the effective treatment of wrinkles in the perioral region still remains a challenging problem.

“We think it's important to consider the reasons why a particular treatment may or may not be effective,“ said Dr. Paes. “Sometimes one has to go back to the basics... In the end, having more basic knowledge about a problem can speed up the process of finding the right solution.”

Source: ASAPS

Are you the typical Botox & Filler patient?

Here's an interesting press release from ASAPS (American Society for Aesthetic Plastic Surgery), discussing a new survey in which Botox Cosmetic and fillers like Restylane and Juvederm were now "mainstream" topics of discussion amongst patients, and not any big "secret". This matches with our experience - our female patients openly discuss their treatments, much like they were sharing make-up tips! What I find interesting in this survey is that 7 of 10 Botox users also have HA fillers done.


Survey Shows Majority of Respondents Openly Discuss Use of BOTOX® Cosmetic and Hyaluronic Acid Dermal Fillers

NEW YORK, NY (June 1, 2009) — Despite what some may think, people aren’t hiding their use of BOTOX® Cosmetic and hyaluronic acid dermal fillers. In fact, according to survey statistics released today by The Aesthetic Surgery Education & Research Foundation (ASERF), the research arm of the American Society for Aesthetic Plastic Surgery (ASAPS), nearly nine out of 10 respondents (87 percent) openly discuss their BOTOX® Cosmetic and hyaluronic acid dermal filler treatments with others, with seven out of ten (70 percent) receiving support from the people they told.

“In a similar survey issued four years ago, we dispelled the myth that Hollywood and corporate wives were the typical BOTOX® Cosmetic patient,” says ASERF President Laurie Casas, MD, a plastic surgeon practicing in suburban Chicago. “Now, demographic and perception data trends show us that aesthetic injectable treatments have continued to evolve into mainstream and accepted options for the everyday woman.”

Survey results found that the typical aesthetic injectable patient is a married, working mother between 41-55 years of age with a household income of under $100,000. The survey also found that women receiving aesthetic injectable treatments are health-conscious and philanthropy minded, with the majority incorporating exercise (95 percent) and healthy eating habits (78 percent) into their lives, and many volunteering with charitable organizations that matter to them (32 percent). In addition, nearly seven out of 10 respondents believe that BOTOX® Cosmetic (72 percent) and hyaluronic acid dermal fillers (65 percent) are important parts of their aesthetic routine.

“Interestingly, among BOTOX® Cosmetic patients, nearly seven out of 10 respondents also received treatment with hyaluronic acid fillers with the majority of respondents being treated with JUVÉDERM®,” says Dr. Casas. “Most people have great success with BOTOX® Cosmetic and dermal fillers; however, we need to make patients aware that even though injectables are not ‘surgery,’ their administration is a medical procedure with risks that depend on the training and experience of the clinician, the clinical setting and the technique used.”

Additional findings of the survey found that 72 percent of respondents received BOTOX® Cosmetic injections to treat their glabellar lines – the frown lines in between the brows, while 63 percent of those surveyed received hyaluronic acid dermal filler injections to treat their nasolabial folds – also known as the “parentheses” – the lines around the nose and mouth. A few of the most frequently cited reasons to receive treatment with BOTOX® Cosmetic was “to look more relaxed, less stressed” while patients reported choosing treatment with hyaluronic acid dermal fillers to “look more rejuvenated.”

ASAPS 2009: new technologies in body contouring

At the recent ASAPS meeting, a number of breakthrough new technologies were presented, as potential alternatives / improvements on the standard liposuction technique. Bear in mind that most of these wonder gadgets are still in the developmental phase, and do not yet have FDA approval.

But some of the before & after photos looked pretty exciting! Definitely something to watch for over the next few years!

The techniques presented included:

Focused external ultrasound for fat reduction: "Liposonix", "UltraShape"
Radio-frequency assisted liposuction: "BodyTite"
Water-assisted liposuction: "BodyJet" - which is FDA approved.

The BodyTite before and afters seemed to show some clinically significant skin shrinkage effects. Their built-in skin temperature monitoring system may offer a better degree of protection and higher effectiveness than competiting laser lipo machines. But the UltraShape and Liposonix machines have the advantage of being external, non-surgical treatments with minimal "downtime", even though the results are more subtle than traditional liposuction surgery.

It's too early to tell which horse will win this race....

ASAPS 2009: breast implants & biofilms

One of the big topics of discussion at ASAPS this year was biofilms. Biofilms are a type of bacterial contamination that loves to form on solid, implanted devices like man-made heart valves, contact lenses, orthopedic implants, and yes...breast implants. There is a growing body of research that suggests that these biofilms are linked to the #1 unsolved problem of breast implants - capsular contracture.

Implant-associated biofilms don't cause fevers, redness or typical infection issues. They are difficult to detect without specialized testing. They are resistant to standard antibiotic treatment, and are virtually impossible to clean off from the implanted device. But when the sepcialized tests are done, there is a much higher incidence of these bacterial biofilms in women who have capsular contracture, compared to the tissue around soft, "normal" breast implants. Most commonly, the bacteria involved is Staph. epidermidis - the common bacteria that lives on our skin, and is also found inside the normal breast gland.

So, what does this mean? Well, taking this concept to its logical conclusion would suggest:

1. At the time of the initial surgery, take steps to reduce the chance of implant contamination. This can be done through technical measures such as using an antibiotic irrigation (or betadine) to rinse the implant and the implant pocket. Consider using the infra-mammary incision (more direct) rather than the peri-areolar incision (more contact with breast tissue).

2. At the time of a capsulectomy operation, consider using a brand-new implant (no biofilm), rather than re-using the old implant. Perform total capsulectomy (removing all of the capsule) rather than capsulotomy (cutting the capsule, but leaving it in place.)

3. After surgery, treat the breast implant just like a artificial heart valve, and take antibiotics whenever you have a procedure that might cause bacteria in the bloodstream, like dental cleanings, endoscopy, or minor surgery.

4. Researchers are investigating anti-bacterial coatings for implants, and other longer-lasting antibacterial delivery systems. One promising method involves a compound called Ageliferin, which disperses biofilm, and re-sensitizes the bacteria to antibiotics.

So far, most of the research is lab stuff. There haven't yet been large clinical studies giving us the answers that we need to make day-to-day decisions. But, it's hopeful that we're getting closer to finding an answer for the problem of capsular contracture.

Best new concept at ASAPS 2009 - Revance therapeutics

Sounds like science fiction, right? - a wrinkle-fighter that works without needles...

One of the coolest products in development that I heard about at the ASAPS meeting belongs to a company called Revance therapeutics, based in Palo Alto, California. They seem to be the first ones to have cracked the problem of getting large molecules into the skin. Usually, large molecules can not be absorbed transdermally, so relatively few medications can be compounded in a gel or patch formula.

While there are countless applications for this drug-delivery technology, their first commercial application using this technology is with botulinum toxin (aka Botox), creating a gel that you put on the surface of the skin, in the area of the animation wrinkles, and presto! - you get the expected Botox-like relaxation effect - no needles involved.

It's still in clinical testing, and is not yet FDA approved, but the presentation I saw of their phase I results for wrinkles in the lateral canthal (crow's feet) area were impressive. The stuff works! Applying the gel in the armpit area also works to reduce excessive sweating, again without the multiple injections we currently use.

Besides working for Botox, the same technology could be applied to a number of other drugs. Imagine, for example, using this idea with insulin - diabetics wouldn't need to use needles.

This could be a real game changer, folks.

The 2009 Aesthetic Meeting

The most important educational meeting for aesthetic plastic surgeons, in my opinion, is the ASAPS annual meeting. It's happening next week - and yours truly will be there. We'll hear "what's hot", "what's new" and "what's not working". All of the "major league" players of aesthetic plastic surgery will be there, discussing the best ways to do facelifts, rhinoplasty, eyelid surgery, breast surgery, body lifts, as well as fillers, peels and lasers. A huge vendor display area allows attendees to see many new products as well.

My favorite sessions are the panels, where experts - often with conflicting opinions - debate the merits of their particular approach.

I'll be taking my notebook with me - and should have plenty of hot & juicy plastic surgery news to blog about!

Marketing hype in cosmetic surgery

Hype. Spin. Puffery. Exaggerated claims. Call it what you will - there is a lot of it out there in the world of cosmetic surgery. Unlike most other fields of medicine, the commercial influences on cosmetic surgery and aesthetic medicine have changed the traditional doctor-patient-medical supplier relationship - and not for the better.

Where does the hype come from?

1. Marketers of new technologies: Claims of wonderful new technology that works "better than anything that has come before" should always be viewed with caution. Most progress is evolutionary, not revolutionary. Laser-assisted liposuction is a great example of marketing hype getting way ahead of what has been scientifically proven. For example, is there any solid data that has been published in a reputable journal showing that laser-assisted liposuction tightens the skin? Nope. Yet, claims of skin tightening are all over the internet.

2. Marketers of "new procedures": It's become fashionable for physicians to put their name on a variation of a standard surgical technique. This is especially true for the various forms of mini-facelifts. Call it a "fill-in-the-blank" lift using some cutesy name, and market the heck out of it - and patients will seem to flock to the door. But, as we've discussed in earlier chapters of this blog, mini operations usually have mini results - and subsequent disappointment for the patient.

3. Commercial Media: Take for example, the various websites that claim to be give lists of the "best surgeon in town" or "top cosmetic surgeons in the state". Usually these are paid listings. The only qualification required is that the physician pays the bills for this marketing exposure!

The same is true with many of the local lifestyle magazines. Did you ever notice that the surgeons that are awarded "best surgeon" or who are featured on the cover by these magazines are typically the ones with the biggest advertising budgets? Hmmm....

And don't even get me started on some of the over-the-top hyperbole seen on some surgeons' websites. The descriptions make it sound like they could part the Red Sea, or walk on water! Take it with a grain of salt, people!

So, what's a consumer to do?

It boils down to old-fashioned research.

1. Ask around - get referrals from people you trust - your own doctor, OR nurses, close personal friends that have had a good experience with a local plastic surgeon. See who has good "word of mouth" endorsements.

2. Check out the ASAPS website (www.surgery.org), the ASPS (www.plasticsurgery.org) or the Florida Society of Plastic Surgeons (www.fsps.org) website to see some of the possible people you should interview in your neighborhood.

3. Interview several highly experienced, Board-certified Plastic Surgeons who do your procedure of interest routinely. Make notes and compare.

4. Look at plenty of "before and after" photos with a critical eye - we've discussed how to do this in an earlier chapter of this blog.

5. Has the staff had surgery by that surgeon? Do you like how their results look?

6. Does the surgeon have a list of actual patients that you can speak with?

7. Do you like the "feel" or "vibe" of the office? Do you feel sure that these people will look after you if you should happen to have a complication from your procedure?

8. While price is important to many people, don't always be tempted by the lowest price. If it seems too good to be true, it probably is.

"We Fix Cheap Haircuts"

True story: I was walking around downtown Orlando recently, and I came across an old-time barber shop. "Haircuts for men and boys", the sign said, "eight dollars". Seemed like quite a deal.

About a block further down the same street, I came across another barber shop. This one had a sign in the window, "We fix cheap haircuts".

I laughed at the sly reference to their low-cost competition down the street. If you think about it though, the world of plastic surgery is not that different.

Sometimes the "cheap haircut" is surgery that has been performed outside of the U.S., usually in South or Central America, with the patient returning to Florida with an infection, an open incision, thick scars, or a crummy-looking result. (I've seen all of these issues!)

Sometimes the "cheap haircut" is cosmetic surgery that was performed locally, by people that advertise ridiculously low-cost liposuction or breast augmentation surgery.

These patients with complications from inexpert surgery all tell the same sad story: "It seemed like a good idea at the time. I was hoping to get a deal on cosmetic surgery....and look what happened".

Either way, the total price for the initial surgery PLUS the required fix-up procedures is far more expensive than having it done right the first time, by a real board-certified plastic surgeon in an accredited surgery facility with U.S. level standards of quality. Worse yet, sometimes the problems can't be undone.

It's unwise to gamble with cheap cosmetic surgery....or cheap haircuts, for that matter. While some patients are satisfied with their discount surgery, why spin the roulette wheel with your health? Like that old slogan, "It may cost a little more, but I'm worth it!"

Reloxin - a potential challenger to Botox Cosmetic?

"Reloxin", a form of botulinum toxin, and potential competition for Botox, could go on sale in the U.S. soon.

The FDA is currently evaluating the product, which has been sold in Europe for approximately 15 years under the name Dysport. It's a wrinkle-fighter, similar to Botox, and it also has a good track record of success and a good record of safe use.

Medicis, the U.S. distributor, said it is hoping for FDA approval of their application in early 2009.

It will be interesting to see how this situation works out. Will the newcomer try to under-cut the price of Botox? Will patients be willing to try the newcomer, or stick with the original? The dosing of Dysport and Botox is not directly comparable - so it wouldn't be a simple 1:1 substitution - but both have been shown to be effective for dynamic facial wrinkles.

Botox, made by Allergan, has been the No. 1 cosmetic medical treatment in the United States for the last few years, according to the American Society for Aesthetic Plastic Surgery (ASAPS) procedural statistics.

2008 ASAPS Procedural Statistics

Every year, ASAPS - the pre-eminent organization for aesthetic plastic surgeons - compiles statistics on common plastic surgery operations and trends in surgery. The latest report, on last year's surgical activity, was released today, and includes figures from Board-certified Plastic Surgeons, Dermatologists and Otolaryngologists (Ear, Nose & Throat).

Here are some of the highlights:

- In 2008, over 10 million cosmetic procedures (both surgical and nonsurgical) were performed. This was divided into 1.7 million surgical procedures and 8.4 million non-surgical procedures (botox, fillers, etc.)

- Not unexpectedly given the economy, these numbers are down somewhat compared to the previous year - by about 12 percent overall.

- The top 5 surgical procedures in 2008 were: breast augmentation (355,000), liposuction (341,000), eyelid surgery (195,000), rhinoplasty (152,000) and abdominoplasty (147,000).

- The top 5 non-surgical procedures in 2008 were: Botox injection (2.4 million), laser hair removal (1.2 million), hyaluronic gel fillers like Juvederm and Restylane (1.2 million), chemical peel (591,000) and laser skin resurfacing (570,000).

- Women had 92% of the total, men 8%.

- The most popular operation for women overall was breast augmentation, while the most popular for men was liposuction.

- 62% of women and 51% of men approve of cosmetic surgery. Forty percent of women would consider surgery for themselves, either now or in the future.

The full report can be viewed at www.surgery.org.

How to choose a Plastic Surgeon

If you've been doing your research prior to coming in for a consultation, you've probably come across one of those checklists that many of the plastic surgery advice websites seem to have. While I don't mind those lists, there's probably an easier way:

choose a member of ASAPS (the American Society for Aesthetic Plastic Surgery) as a first step.

Right away, you've automatically selected a Board-certified Plastic Surgeon with significant experience and interest in cosmetic / aesthetic plastic surgery. All members of ASAPS have been in practice for at least 5 years, must operate in accredited surgical facilities, must adhere to the ASAPS' Code of Ethics, and have been approved by their peers. Only about one-quarter of all plastic surgeons are ASAPS members - the specialists in aesthetic (cosmetic) plastic surgery.

Then, look for a ASAPS surgeon who has an aesthetic sense that matches yours. I often use the analogy of choosing an interior decorator - if you are redecorating your home, you might get three designers to give you suggestions on how to do it. While all 3 might offer competent designs, one will match your personal tastes better than the others. That's the one to go with. The same applies when choosing your aesthetic plastic surgeon.

Make sure your surgeon explains things well, and that his/her approach makes sense to you. Do they have lots of before and after photos for your procedure? Do the photos look the way you want to look?

Do you "bond" with the surgeon and the office staff? Do you feel comfortable there? Will they look after you, without a big hassle, should there be a complication?

If you can answer "yes" to these questions, then you've found your surgeon. :)