Any cosmetic surgeon with "before" and "after" photos worth a second glance has a story about the celebrity who needs "a little work" and needs to get back to work -- quickly. Those whose livelihoods depend on their looks want to tinker with their various parts enough to turn back the clock, but not enough to make the adoring masses suspect anything
other than clean living.
Thankfully, then -- for the stars, as well as for us civilians -- advances in plastic surgery now make it possible to tweak rather than perform a drastic overhaul.
So here goes: a list of small changes that might make a big difference.
The wrinkle eraser
Minute amounts of diluted botulism virus (yes, the stuff of dented cans your mother warned you about) are injected into your forehead and around your eyes to smooth out deep wrinkles and crow's-feet. "It paralyzes the muscle that allows you to furrow your brow," explains Dr. Lawrence Koplin, a Beverly Hills, Calif., plastic surgeon.
Even though the U.S. Food and Drug Administration approves Botox only for eye-muscle disorders, its use is spreading. One reason for the popularity of Botox injections could be that the procedure breaks plastic surgery recovery-time records: You walk out with nothing to show for it (no bruises, no red skin) except, within a few days, fewer creases in your forehead or eye area.
The five-minute procedure costs $400 to $800, depending on where you live and the physician's specialty (dermatologists usually charge less than plastic surgeons).
Furrows reappear three to six months after an injection, so a longer-lasting brow lift may be more cost-effective. And, cautions Dr. Bernard Raskin, an Encino, Calif., dermatologist, "if the toxin diffuses to the eyelid area, it can cause temporary drooping" -- although this rarely happens.
Another caveat: In rare cases, people are allergic to Botox.
The brow lift
To raise sagging foreheads, surgeons make half-inch incisions in the scalp above the hairline, then remove bits of muscle between the eyebrows with surgical instruments
threaded through a camera-equipped tube called an endoscope. Patients receive local anesthesia and intravenous sedatives, which block pain but are less risky than general anesthesia.
"People want brow lifts because the eyes and forehead tend to age faster than the lower half of the face," says Dr. Gerald Pitman, a New York City plastic surgeon.
When frown lines become less intense, Pitman continues, "eyebrows move up to a more natural position." The end result? "A more alert, less sinister appearance," as one patient puts it.
This two-to-three-hour surgery costs $3,000 to $6,000.
The aftermath can be traumatic, with swelling and bruising around the eyes lasting two weeks at the absolute minimum.
The eye lift
Doctors call what time does to the eyes "hooding," a rather grisly-sounding term to capture the sleepy look humans get when the upper eyelids lose elasticity and fat pushes forward. To correct it, surgeons use local anesthesia and remove the fat pads with either lasers or the traditional scalpel -- a procedure known as an "upper blepharoplasty."
"Even patients' closest friends can't figure it out," boasts Dr. Michael Rabkin, a Los Angeles oculoplastic surgeon.
The one-hour procedure costs $2,000 to $3,500.
Although it's the most common plastic surgery, recovery is distinctly uncomfortable. Eyes are swollen for about a week and, in occasional cases, feel dry and itchy for a few months. Though the laser technique coats more, its boosters say it's worth it because scars are less noticeable and there's less bleeding.
But not everyone agrees: "It doesn't offer any advantages over the scalpel," scoffs one Beverly Hills, Calif., surgeon.
The cheek lift
To give cheekbones more prominence, surgeons perform what's known as a "transconjunctival cheek lift." That means they make an incision in the lower eyelid, then, through that cut, pull up cheek tissue and fat pads and stitch the more angular face into place.
"There are also facial implants on the market than can replace fat and tissue, for even more definition of the cheeks," says Dr. Ronald E. Iverson, president of the American Society of Plastic and Reconstructive Surgeons.
Major facial swelling (think about looking like a chipmunk) for at least two to three months. And the implants carry extra risks: They increase the chances of infection, and though it happens infrequently, can slide from their proper position.
Collagen, Autologen (made from your own collagen cultivated in a lab) or fat from your back end or another capacious body part is injected into less endowed places: backs of hands, wrinkles around the edges of lips, deep facial wrinkles caused by sun exposure, for example.
Recovery is quick: Patients may experience light swelling for a day or so.
The five-minute procedure is $350 to $500.
"Fat is a little unpredictable," Raskin says: The body may absorb it, making any "lift" disappear. Other doctors, however, say that compared to autologous collagen, fat has a better chance of staying put, since it can develop its own blood supply and thus better integrate with your body. And again, as with all types of injections, there's a risk of infection.
Excess neck fat is suctioned out of double chins, and sagging skin is tucked up. Different combinations of procedures are used, depending on the problem. In one common approach, the surgeon puts the patient under a light anesthesia and then makes an incision under the chin, so as to conceal any scarring. Next, "fat is suctioned out of the neck, and the sagging platysma (neck) muscle is tightened," explains Dr. Robert Kotler, a Beverly Hills, Calif., facial plastic surgeon.
The 1 1/2 -to-2-hour procedure costs $3,500 to $5,000.
Your neck can feel tight and sore for up to six weeks. The technique usually works best for those 45 and under; their skin is still relatively elastic.