Pageantry Articles

Summer of 2010- Pageantry Magazine

Lifetime of Regret
For some, tattoos are a form of art, but for others they are a reminder of a costly career mistake.

 

We all have regrets. But in pageants, and fashion modeling, a tattoo can be a glaring distracting regret when it comes to your confidence and appearance.

 

Tattoos, if carried out on a whim or for the wrong reasons, can result in “ink regret”. This is quite common and seen in my practice every day. Even the most meaningful tattoos can become career-limiting in a competitive industry such as modeling. According to a 2008 Harris poll, 14 percent of all Americans have at least one tattoo, and 17 percent of those experience regret. So how do we get rid of them?

 

It’s important to realize that removing the tattoo will be more expensive and painful than the original “inking” process. Also, darker colors are more completely removed than lighter or brighter colors – a fact that doesn’t make sense to most patients. There are three main categories of removal options: Masking, topical substances and laser treatment.

 

MASKING
To “mask” a tattoo, you can either:
a) use makeup; or
b) cover one tattoo with another.

 

Several products are available for makeup-style concealment. This is often sufficient for most tattoos if cover-up is only required for a short time such as a runway show, photo shoot or pageant. Covering one tattoo with a new one requires planning with your tattoo artist, and the new tattoo must be darker in color. The old ink will require some form of removal process to first lighten the area in order to cover the unwanted tattoo effectively.

 

TOPICAL SUBSTANCES
Common topical kits will include a cream or gel, as well as an exfoliator and moisturizer (tip: exfoliators and moisturizers are available separately at the drug store for significantly less). Most topicals take a long time – some up to a year – to face the tattoo. While expensive, these topicals are cheaper than lasers and are not painful. Do not use products that contain TCA (trichloroacetic acid) unless you have spoken to your plastic surgeon. These are cream versions of a chemical peel and can cause significant scarring or pigmentation changes when not used properly.

 

A slightly more invasive topical technique includes mixing saline with a gel and actually tattooing it into the area. The gel binds to the ink molecules and brings them to the surface, forming a scab that falls off as the area heals. This process is repeated 3-5 times over 4-6 weeks until the ink is gone. The risk of scarring and skin discoloration from this process is the same as for laser treatments.

 

LASER TREATMENTS
Lasers are quicker than topicals, but are more expensive and painful. They are used to react with and break down ink. The ink can then be absorbed by your body in the same manner that natural ink-fading occurs due to sunlight and environmental exposure. This is also why it requires multiple visits in order to gradually break down the ink. Be warned – this process can result in scarring. The thinner the skin, the more likely it is to scar. Pain-relief creams can be applied to the area to help with the discomfort. Some physicians will use injections to provide pain relief during the procedures, but use of these injections will require more treatments during the removal process. There are several types of lasers, which all provide similar results. Consult your plastic surgeon for his/her experience with each machine.

 

Laser removal will typically take 8-12 treatments, 8 weeks apart, with each session lightening the ink. The number of sessions required will depend on skin type, tattoo location, color, amount of ink, etc. Sometimes a combination of topicals and lasers can be utilized to lower the number of laser sessions required, or to target more “stubborn” tattoos. Patients with a healthy immune system and/or who do not smoke will have more successful results with lasers. The most common side effects of laser treatments are scarring and skin pigmentation changes, and should be immediately discussed with your physician, as these side effects can sometimes be reduced if detected early and treated when they have occurred. As with any procedure involving the skin… always wear sunscreen, especially when undergoing the treatments.

 

SURGERY
If none of the above procedures have worked, the only option remaining is surgery – literally “cutting out” the tattoo. Depending on the size, this can include anything from cutting out the tattoo and stitching the skin back together, to a skin graft to cover the area. In either case, scarring is quite common. However, depending on how badly you want the ink gone, sometimes pain and a little scarring is worth it.

 

Of course, any time you consider making a permanent change to your body it is important to think of long-term consequences. But should you find yourself suffering from “ink regret,” consult your plastic surgeon to find the appropriate option for your situation and budget.

 

Dr. Ronald Bergman is a board-certified plastic surgeon practicing in Des Moines, Iowa, for 28 years. He specializes in breast augmentation, liposuction, and tummy tucks. His patients include many local, national, and international pageant winners. Dr. Bergman is also a highly qualified pageant judge.

Spring 2010 – Pageantry Magazine

Saving Your Skin
The cold weather months are the perfect time to prep for summer’s warm glow
A competing woman’s body is perfected during the winter. Those are my favorite cold weather words every year. Winter brings holidays, stress and often new resolutions for your personal trainers. While most people slack after they’ve unpacked the sweaters, those who continue to stay focused really shine on the competitive stage.
Cosmetic surgery is well-timed for most competitors with time off over the holidays, as there is plenty of time for a full recovery. However, it is very important to remember that the skin is best treated during the frosty months. Most skin treatments require no tan before or no immediate sun exposure after the application. My recommendation is to bring on your high quality skin care reigns like Obagi, do those chemical peels, and say hello to laser procedures.

Obagi’s skin care regimen has remarkable results by combining both hydroquinone and tretinion active ingredients with a high quality line of products. Hydoquinone evens the skin tone that has been influenced by sun damage and tretinion treats wrinkles and acne. These ingredients both require limited sun exposure, making the treatment off limits in the summer or with tanning bed use. Sunscreen is included in the daily regimen.
Chemical peels are offered in a wide variety. The goal of a chemical peel is to slough off layers of skin to treat sun damage, wrinkles and acne, or to provide a more youthful overall appearance. They vary in types of chemicals used, the concentration of the chemicals, and how deeply the chemicals penetrate the skin. These treatments are typically done on the face but can also be done on the decollete (chest area).
Laser hair removal, skin rejuvenation and spider vein treatments are the most popular of all winter procedures and have benefits for all competitors of almost every age. One cannot have a tan at the time of a laser procedure, as the pigment in your skin can increase the chance of complications, and limited sun exposure afterward is also often recommended depending on the nature of your procedure.

The benefits of laser hair removal are obvious – no shaving. There is also no downtime and it is particularly beneficial for those who get bumps from shaving. It is important to remember that is does require several treatments to get the full benefit, as it is only effective against the hairs in the growth phase. Monthly hair cycles and the treatments not done during the growth phase of the hair cycle will not be effective. Anywhere from five to 10 treatments can be required depending on your skin type, the type of laser and timing of treatments.
Laser skin rejuvenation is very effective for spot treatments or for overall skin quality. Spot treatments are typically for sun damage and wrinkles, whereas overall skin quality focuses on texture and tightening. There are several of these treatments that can be done over the lunch hour with no downtime. As with chemical peels, depending on the depth of the skin layer targeted, very dramatic results can be achieved with deeply penetrating laser resurfacing that can either be done in your plastic surgeon’s office or, if deep enough, even as an outpatient surgical procedure.

Laser vein treatments are becoming more and more requested among competitors in their 20s and 30s. Treatment of small spider veins when first noticed is much more simple. They can often be easily “zapped,” usually with only one quick laser treatment. It can cause mild bruising that goes away in a few days. Lasers can also be used to treat some of the lesser varicose veins but offer quite amazing results for those small, unsightly spider veins, especially when treated early.
With the proper skin care products, chemical peels and laser procedures, you are on the right path to your quest for your title. Do not let the cold weather suppress your motivation. Remain focused on your treatment regimens, and achieve body perfection this winter.

Dr. Ronald Bergman is a board-certified plastic surgeon practicing in Des Moines, Iowa, for 28 years. He specializes in breast augmentation, liposuction, and tummy tucks. His patients include many local, national, and international pageant winners. Dr. Bergman is also a highly qualified pageant judge.

Winter 2009- Pageantry Magazine

Getting Your Fill
There are plenty of things to consider before taking the ultimate plunge with breast augmentation
Prepping for next Spring’s competitions is now in full swing. A question I am asked every year is: “Are breast implants for me?” Picking out the perfect dress and having it not quite fit on top while looking at last year’s pageant photos, wondering if more fullness would have helped in the swimsuit competition. These are common concerns, especially considering that when most women lose weight or begin an intense toning-up regimen for a pageant, they often lose volume in their breasts. This situation leaves my patients with questions and sometimes only a small window of opportunity.

Looking at Lingerie
My caveat to all surgical procedures is that prior to considering a permanent change to your body, it is important to explore all non-surgical options first. Local lingerie stores are often able to provide several options, including bras and adhesive silicone products.

Breast Augmentation
Breast augmentation is the name given to the surgical procedure that involves placing an implant either on top of or below the chest muscle (pectoralis major muscle) for the purpose of increasing breast volume. This is done by your plastic surgeon for cosmetic or reconstructive purposes.

Implant Choices
There are two major types of shell implants: saline or silicone. From here, there are several subtypes. They vary in size based on volume (how many milliliters), although that does not relate to cup size, but rather to the amount of volume being added to existing breast tissue. The different sizes come in different profiles (width and height) and shell textures (smooth or textured). So many choices to make it is very important to discuss with your plastic surgeon what options would work best for your lifestyle and natural canvas. Saline is approved for cosmetic use in patients over the age of 18, whereas silicone is not approved until page 22. Both implants are approved for patients of any age for the purpose of reconstruction.

Things to Consider
The risks of your particular procedure should be discussed between you and your surgeon. Risks specific to breast implant surgery include: the need for further surgery, capsular contractor (hardening of the implant), changes in nipple sensation and implant rupture, which is a very low risk. Implants do not last forever, as most patients need additional surgery at some point in their lifetime. If you decide to have your implants taken out, the changes to your breasts cannot be undone. If you have implants on top of the chest muscle or implanted around the nipple area, breast tissue can be affected and decrease your ability to breast-feed. Mammograms to screen for breast cancer can be more difficult with implants. Because of these risks and the mild swelling that can happen after surgery, I recommend trying to plan for at least three months between your surgery and the big event to provide adequate time for healing.

Is It Right For Me?
This is never a question I can answer for anyone else. I can provide all of the information to make an informed decision, but breast augmentation, like any elective procedure, is an individual choice. I warn patients not to have unrealistic expectations and to make sure that this is something you really want to do for you. That being said, most women make the decision to get implants after a long, well-thought out process and truly enjoy their new figure.

More information is always available thorough our office as well as the FDA website at www.FDA.gov/medicaldevices.

Dr. Ronald Bergman is a board-certified plastic surgeon practicing in Des Moines, Iowa, for 28 years. He specializes in breast augmentation, liposuction, and tummy tucks. His patients include many local, national, and international pageant winners. Dr. Bergman is also a highly qualified pageant judge.

Fall 2009 – Pageantry Magazine

Saving Your Skin
While your complexion’s number one enemy is bacteria, there are plenty of good weapons at your disposal.

 

One of the biggest fears I’m asked to face is the surprise big day breakout. Acne is often considered a pre-competition taboo to even discuss. However, due to constant improvements in the treatment of acne, it deserves to be revisited along with a few friendly reminders.

 

Every girl will experience at least one breakout in her lifetime. Most commonly this will occur during times of hormonal change – the teenage years, late 20s to early 30s and late 40s to early 50s. This surge in hormones can leave us with acne’s dreaded pustules and scars. Also, depending on the severity, it can cause real psychological damage by decreasing confidence, self-esteem, competition and work performance.

 

Oil production is influenced by hormones, stress and genetics. When all, or even some, of these forces work together it can spell disaster.

 

KNOW YOUR ENEMY
Many superstitions exist, but the one true cause is bacterial infection of clogged pores. The most commonly diagnosed bacteria is Propionibacterium acnes, or P. acnes. Bacteria live on your skin and can cause infections when pores become clogged or when oil production is increased. Pores may become clogged from improper face washing, product residue and environmental exposures. Oil production is influenced by hormones, stress and genetics. When all, or even some, of these forces work together it can spell disaster.

 

SEEKING SOLUTIONS
The best treatment always starts with a well-balanced diet, drinking plenty of water and getting at least eight hours of sleep each night. Of course, nothing can replace a visit to your physician for appropriate diagnosis and treatment of your acne.

 

A high quality face wash and sunscreen should always be the first and last steps of any skin care regimen. Wash your face twice daily to clean away makeup, dirt and oil. The best soaps are unscented and leave little residue. This can be tested by washing the back of your hand and patting it dry-if your skin becomes irritated or doesn’t feel clean, it’s not a good soap. I recommend over-the-counter products like Neutrogena or Aveeno and prescription products like Obagi.

 

FIGHT YOUR BATTLE
After the face is clean, the next step is to fight bacteria. There are three main categories of treatments for bacteria: topical benzoyl peroxide, topical antibiotics and oral antibiotics. Topical benzoyl peroxide is available at the drug store but in lower concentrations than are usually needed to get results . When combined with alcohol, as found in many products, these solutions can be very drying to the skin and worsen the acne over time. It can also bleach clothing, towels and bedding if you’re not careful. Clindamycin and erythromycin are examples of topical antibiotics or antibiotics available as creams. Unlike pills these creams are applied directly to the infected pores and can provide faster results than pills.

 

Oral antibiotics are pills like doxycycline or minocycline and are taken every day to either treat or prevent breakouts. While they are effective, it can take a while to see results and they are usually reserved for more severe cases.

 

Once you have defeated the bacteria, there is still one more step before the application of sunscreen and that’s a topical retinoid product, like Retin-A Micro, Differin or generic tretinoin. This is my favorite step because these products really bring your overall skin texture and appearance to the next level. Unfortunately, it is also the hardest therapy to start and maintain. Retinoids increase the rate at which your body builds new layers of skin. The downside is that it can take your body at least 28 days to catch up. During th e beginning of this catching up process, patients can go through a shedding phase. The appearance is similar to that of a peeling sunburn and can cause patients to stop using the product. Thankfully, this period is short and the results are worth it.

 

ADDITIONAL RESOURCES
Some of the other treatments you may hear about include birth control pills, Accutane, injections and laser treatments. “The Pill” works by regulating hormones to decrease the ups and downs that can trigger a hormonally-induced breakout. Accutane is a very strong medication taken as a daily pill that decreases oil production throughout the body. It requires regular doctor check-ups frequent blood work and two forms of birth control as it can cause liver and triglyceride problems, as well as devastating birth defects. It sounds scary, but in the right patient, and when used and monitored correctly, it can be a miracle treatment. Injections work well for an individual, deep, painful, cystic or nodular acne lesion. Finally, laser therapies, once only used to treat acne scars, can now be used as an additional tool in long-term management of acne prone skin and even during breakouts.

 

In your next quest for stardom, remember that your skin doesn’t have to suffer the dreaded competition jinx. Acne, when properly diagnosed and treated by your plastic surgeon, can be a very manageable part of your event preparations and every title holder’s best accessory.
Dr. Ronald Bergman is a board-certified plastic surgeon practicing in Des Moines, Iowa, for 28 years. He specializes in breast augmentation, liposuction, and tummy tucks. His patients include many local, national, and international pageant winners. Dr. Bergman is also a highly qualified pageant judge.
 
Summer 2009 – Pageantry Magazine

Sun, Smart & Beautiful
Avoid the Top 5 mistakes in preparing for your competition by keeping your skin gorgeous and safe

 

As we approach this summer’s long-awaited competition season, I realize I see the same mistakes every year. This year,
my staff and I compiled our Top 5 mistakes we see on a regular basis. Consider this your insider advice on how to avoid these ill-fated trends.

 

These mistakes have a common theme-expecting too much in too short of a time period. When this happens the desired results are not always achieved and problems tend to arise. Planning ahead and having good communication with your surgeon can prevent most of these mishaps and leave you prepared in plenty of time for your next debut.

 

Mistake #1 – TOO MUCH SUN.
I realize that a dark, olive or bronzed tan is glamorous in the spotlight. But as a physician, I am obligated to tell you that skin cancer is a real risk. One bad sunburn or prolonged tanning session is all it can take to increase your risk of skin cancer. You must have sunlight for your body to make Vitamin D, but this amount of sunlight is obtained in normal everyday activities like going for a walk outside. A UV-ray-free option like spray tanning is a good alternative. There is not much of a difference between the do-it-yourself kits and professional sessions in how they work, only in the application process. These products fade over time and are considered safe for short-term use. The best way to avoid damage to your skin and to keep your skin appearing youthful only requires one product – a quality moisturizer with SPF.

 

Mistake #2 – LAST MINUTE COSMETIC SURGERY.
The perfect time for your long-awaited breast augmentation or liposuction is not one week prior to the Main Event. While we all want to look our best and exude the most confidence, last minute surgery can compromise results and your satisfaction. Recovery time after any surgery can often take two to four months for you to be 100 percent. Considering these procedures are often expensive and involve permanent changes to your body, your goal should be to maximize the outcome. This means take your time, plan ahead and follow your surgeon’s advice. This will give you plenty of time to heal properly and to feel at ease in your new physique.

 

Mistake #3 – CRASH DIETING.
Most of us are well aware of eating disorders. However, crash diets-during which significant weight loss is obtained in a short amount of time-can walk the line of an eating disorder and even result in similar serious side effects. Healthy weight loss is two pounds per week unless otherwise monitored by a physician. The word “diet” implies that you are missing something. My advice is always just the opposite-focus on what you’re putting into your body and not what you’re taking away. There is no substitute for a long term, well-balanced nutrition plan and exercise program . If you can do that year-round, you’ll not only be healthier, but you’ll feel more prepared inside and out.

 

Mistake #4 – NEW SKIN TREATMENTS PRIOR TO COMPETITION OR TANNING.
Getting a chemical peel, laser treatment or starting a new intense skin care regimen may be just what the doctor ordered. These therapies do provide great results with very little down time. However, summer is simply not the season to start. Most patients are spending more time outside in addition to tanning for events, which most skin care treatments and products do not allow. The high yield ablative procedures remove layers of dead skin and stimulate collagen production. The results are younger, healthier skin, but it also removes your skin’s natural protection and makes it very sensitive to sunlight. Not only can you damage the treatment, but you can also increase your risk of skin cancer. On top of this, most summer schedules are simply too irregular to stay faithful to your skin care regimen. I encourage most of my patients to schedule these therapies in the fall, winter and early spring. If summer is a must, talk to your surgeon, purchase a high-quality SPF, keep the treatment area covered and break out a hat that provides full facial shade.

 

Mistake #5 – ASSUMING THAT LOOKING GREAT TAKES SPENDING A LOT OF MONEY.
Too often the assumption in cosmetic enhancement is that just because something costs more, it’s better. I argue that the first three steps toward any cosmetic enhancement are simple: research, budget and plan. This will give you the most realistic goals within a reasonable timeline. You will know your options, budget and plan that includes your surgeon and aesthetician. Following this plan will lead you toward the desired results with in a budget you are comfortable with, all on your own watch. You will not only be happier with the results, but also with your experience.

 

Dr. Ronald Bergman is a board-certified plastic surgeon practicing in Des Moines, Iowa, for 28 years. He specializes in breast augmentation, liposuction, and tummy tucks. His patients include many local, national, and international pageant winners. Dr. Bergman is also a highly qualified pageant judge.

Spring 2009 – Pageantry Magazine

Picking the Perfect Pout

It takes the right consideration and choice to achieve dazzling stage presence with kissably soft results

Voluptuous lips- natural or enhanced are a sign of beauty and youth. As we age, we lose volume in our faces, and as early as 1900, surgeons began the search for an answer to this dilemma. The perfect pout can provide a youthful, dazzling stage presence every pageant queen or model desires, as well as the kissably soft sexiness every woman desires. A good lip augmentation can add an edge of natural sexiness and balance to your face in a way that no other procedure can. Celebrities like Marilyn Monroe, Angelina Jolie and Scarlett Johansson are known for having beautifully full lips and are frequently requested celebrity assets in my office.

 

The best result any surgeon can aspire to is enhancing your natural beauty. This enhancement starts with good lip care. Lip care is simple and there are only two important steps:
1) Drink plenty of water (dry, cracked lips are never appealing); and
2) Utilize daily lip product s that include both a moisturizer and sunscreen. This product does not need to be expensive. Drug store lip balm will meet these criteria and can easily mix with your favorite lipstick or lip gloss. Adversely, two big no-no’s of lip care include: 1) applying dry skincare products, chemical peels or performing microderm abrasion procedures on the lips; and 2) licking or picking at dry skin, or nervously nibbling on the lips – trust me, it only makes matters worse.

 

LIP SHAPES
The most desirable lip shape by far is the heart. A full upper lip with well-defined Cupid’s bow (the arched M-shape in the center) paired with a plump, perfectly balanced bottom lip. Lip augmentation can balance almost any other combination, including: thin lips, small upper lip, smaller bottom lip, lips with irregular borders, smoker’s lines or lack of a Cupid ‘s bow. Lip reduction and reconstruction procedures are available for those who would like a more permanent change or for those who would like to reduce the size of their lips.

 

TOPICALS
Topical lip plumpers are available everywhere, in the forms of generic drug store products to the top of the line plumpers, such as Physician’s Complex, available only at your surgeon’s office. These products provide short-term results by temporarily increasing blood flow to the lips. The drawback is that constant use of any lip plumper will never lead to permanently fuller lips.

 

MANUAL LIP PLUMPERS
These are vacuum devices, like the product made by Luscious Lips, made to go over the lips and increase blood flow. These provide only minutes of results and I typically do not recommend these products to my patients.

 

TEMPORARY INJECTABLES
There are many, many injectables on the market. However, there are two main implants requested at my office – Juvederm and Restylane. Juvederm and Restylane are hyaluronic acid fillers that are excellent plumpers. This is perfect for the patient who simply wants more volume and lasts up to one year. These products provide very reproducible, relatively long-lasting results. There are several other products on the market, and it is very important to discuss the right product for you with your surgeon. These injections are safe procedures when performed by qualified injectors.

 

PERMANENT INJECTABLES
I typically do not initially recommend these procedures to my patients. if you are interested in permanent solutions, be sure that you have tried the temporary injectables for a significant length of time – at least two years – and are sure that this is the desired look you want long term.

 

LASER RESURFACING
This is the most exciting area of facial care in cosmetics. There are not currently any laser treatments beneficial for the lips. However, for patients who have discolorations or deep lines around the lips – smoker’s lines, laugh lines, etc. – lasers that can provide dramatic results are available. I have recently seen very exciting results from newer fractional lasers for softening deeper smoker’s lines that we had previously only been able to fill.

 

Remember, the best results are often obtained with combining treatments. However, it all starts with lip care. Moisturizers and sunscreens combined with a careful selection of the right topical plumper or injectable will assure your readiness for your next stage appearance as well as your next kiss.

 

Dr. Ronald Bergman is a board-certified plastic surgeon practicing in Des Moines, Iowa, for 28 years. He specializes in breast augmentation, liposuction, and tummy tucks. His patients include many local, national, and international pageant winners. Dr. Bergman is also a highly qualified pageant judge.

Fall 2008 – Pageantry Magazine

Knowing Your Role Models
Some celebrities prefer plastic surgery and some don’t, but it’s still your body and ultimately your decision

 

The issue of celebrity plastic surgery is so intriguing. Curiosity causes us all to want to know who had implants, liposuction and injected too much collagen into their lips.

 

Many stars have publicly come out and admitted to their surgery and even promote it, includingCherand Joan Rivers. According to Celebrity Cosmetic Surgery, a blog devoted to news involving celebrities and plastic surgery, even beautiful supermodel Cindy Crawford has admitted to work, including Botox and collagen. Other stars who have confirmed plastic surgery include Ashlee Simpson and Ashley Tisdale.

 

There are also many guesses as to which celebrities have had surgery, although they either won’t comment or deny it. Michael Jackson barely has a nose. Some plastic surgeons estimate he’s probably had numerous Rhinoplasty procedures. His nose, as a result of too much surgery, has literally collapsed. Others rumored to have had surgery include Hillary Clinton, Victoria Beckham and Madonna.

 

So why are some celebrities so willing to admit they’ve had a little work and others who have obviously had work downright lie about it? There is still a small stigma that is slowly being overcome that plastic surgery equates to a vain or shallow person. This is often farther from the truth. Most women have surgery to fix areas that personally bother them.

 

A great role model and celebrity, who has had plastic surgery and has since come out against it, is Jamie Lee Curtis. The 49-year old actress underwent surgery on her lower eyes at age 35 and has admitted to Botox and liposuction. However, Jamie Lee regrets these decisions and wishes she would have just let herself age as so many other people choose to do naturally. She once said, “I did it all, but you know what? It doesn’t work. The fraud is it doesn’t work; it doesn’t work because you still look in the mirror and you see the fraud of what you were trying to do.”

 

For every celebrity who opposes or supports plastic surgery, there are millions of everyday women without the luxury of the millions of dollars these celebrities have, and many of those women are in the pageant industry.

 

Iowapatient Terri Wilson had a tummy tuck procedure done and says, “After having children, I always had a ‘pooch’ on my lower abdomen. Even with exercise and dieting it wouldn’t go away. After surgery, my clothes fit better and I feel more confident .” In fact, women who are realistic about what is achievable are the best and only patients I’ll work with.

 

Another one of my patients, Cindy Johnson says, “Before my augmentation, I already felt good about myself. But after the augmentation I feel more beautiful and complete.”

 

It seems whether you’re a celebrity or the girl next door, whatever surgery you decide to have performed is a very personal decision, and quite frankly it isn’t anybody’s business what you decide about your body. One 27-year old told me she thought about having breast augmentation surgery for six years before finally having it done . Thinking out your decision is the best thing you can do. There are risks to any plastic surgery and it ‘s very important that you discuss this with your surgeon. Good luck in making an informed decision on whether or not to have plastic surgery and please call our office if we may be of any assistance.

 

Dr. Ronald Bergman is a board-certified plastic surgeon practicing in Des Moines, Iowa, for 28 years. He specializes in breast augmentation, liposuction, and tummy tucks. His patients include many local, national, and international pageant winners. Dr. Bergman is also a highly qualified pageant judge.
 

Summer 2008 – Pageantry Magazine

Getting Past the Gimmicks
There are specific things you should look for to make sure you’re not being fooled by an unscrupulous “plastic surgeon.”

 

Hello, friends. Before we give you this issue’s tips on gimmicks and tricks, there is one topic we need to address. The most recent revelation in plastic surgery involves questions about the safety of Botox injections after 16 reported deaths resulting from Botox injections. Four of the deaths involved usage of Botox in people less than 18 years of age.

 

OneU.S.advocacy group claims 180 reports of serious Botox complications have been sent to the Food and Drug Administration. As a result, some are calling for a warning label – “Death Risk” – to be put on all vials of the drug. Does this mean women should put a halt to getting these injections for cosmetic purposes? Not necessarily. Botox is made from the same toxin that causes botulism. It has been used to successfully treat a number of medical conditions for many years and is considered safe when administered properly. We promise we will continue to watch the FDA’s stance on Botox injections and keep you posted in the pages of future issues of Pageantry.

 

Now that Botox is being questioned, it opens the door to thoroughly scrutinize the practices of the industry, something we should do. There are many tricks and gimmicks on the market that encourage consumers to spend billions upon billions of dollars per year.

 

OneU.S.advocacy group claims 180 reports of serious Botox complications have been sent to the Food and Drug Administration.

 

The first gimmick used in plastic surgery is unqualified physicians, even non-physicians calling themselves cosmetic surgeons, cosmetic specialists or laser specialists administering laser treatments, chemical peels and injections. Unfortunately, the FDA has done little to crack down on non-qualified individuals performing procedures that should be left in the hands of qualified plastic surgeons and dermatologists. A white lab coat and official-looking office do not make one qualified to perform cosmetic procedures, or even minor procedures. Beware of clinics running under the guidance of a “medical director” who may or may not be a practicing physician, and in many cases is not a plastic surgeon or dermatologist.

 

In many states, doctors who have had no experience with plastic surgery and those who have never even performed a surgery are directing clinics offering cosmetic procedures. The best thing to do is ask; “Is this clinic under the direction of a plastic surgeon?”; “Who is the plastic surgeon and is his or her state license current?”; “How often does the doctor visit the clinic and personally perform the procedures being advertised?”. If you are unable to get the answers to these questions, then do not use that clinic.

 

WHY ARE THESE ESTABLISHMENTS SUCCESSFUL?
This brings us to our second gimmick, or in this case, trick. The power of advertising. At one time it was considered unethical for doctors to advertise their services. Now the advertising niche for plastic surgeons and non-plastic surgeons alike is extremely competitive. Most of us have websites; some opt for billboards and dramatic newspaper ads to lure uninformed consumers. Now, just because someone is advertising does not make that person unqualified to perform, but the bottom line is that you must ask questions. If someone is unable or unwilling to answer tough questions, it is not a person you want working on your face or body.

 

Finally, the number one cosmetic surgery gimmick is a doctor who offers procedures that do not work. Just a few years ago, the FDA approved the contour thread lift, a procedure touted as an alternative to a facelift. Many doctors are now finding that the threads break, cause infections and are short-acting. The best thing you can do for your face in your teens, 20s and 30s is to use a good skin care regimen. You can even use an over-the-counter line that includes a cleanser, moisturizer and, most importantly, sunscreen. Peels, lasers and injections can offer subtle improvements but should rarely be used in young women. A full surgical facelift is the only proven method to correct a sagging face and is often performed on women, beginning in their 40s and 50s. Beware of anything that sounds too good to be true. If it promises to change your life or permanently alter your looks, it is most likely a bogus claim.

 

As we conclude, it’s also important to remember that any cosmetic procedure, whether it’s Botox injections or breast augmentations, are not permanent. Most procedures need to be redone, ranging from every few months to 10 or 15 years down the line. Plastic surgery requires a commitment from both the patient and the surgeon, and should be entered into with serious thought and careful consideration.

 

Dr. Ronald Bergman is a board-certified plastic surgeon practicing in Des Moines, Iowa, for 28 years. He specializes in breast augmentation, liposuction, and tummy tucks. His patients include many local, national, and international pageant winners. Dr. Bergman is also a highly qualified pageant judge.
 


Spring 2008 – Pageantry Magazine

Taking Target Practice
Despite some newly introduced product promises, liposuction remains at the top of the list of effective, site-specific figure-trimming treatments.

 

What pageant queen hasn’t dreamed of making her grand entrance–brilliantly walking into the spotlight, beautiful and confident, in a bathing suit–knowing every muscle in her body is smoothly trim, perfectly shaped, and toned?

 

As we head back to reality, those of us in the industry know that Swimsuit competition is usually the area of much anxiety for contestants. Makeup, false eyelashes, and a great hairdo can work wonders during an Evening Gown showdown, and a little practice on how to genuinely communicate in sound bites can help ace the Interview. But “fixing” the body itself is very difficult, and not something that can be simply primped or practiced.

 

When facing this reality, it should be comforting for delegates to know you are not alone. Ninety percent of women have cellulite to some degree, and most women tend to carry fat in their outer thigh (otherwise known as saddlebags), lower stomach, and buttocks areas. Diet and exercise is the first and most important way that you can combat overall body fat. However, you cannot remove fat from specific areas through diet or exercise; you can only tone specific spots. So, what is a hard working pageant contestant to do? First, I recommend seeing a nutritionist and personal trainer, but if specific fat removal is what you are looking for, you need a plastic surgeon.

 

UNPROVEN SOLUTIONS
Buyer beware! There are a number of new products on the market that are being touted as advancements in fat removal and reduction. These products are marketed under the name lipodisolve or mesotherapy. The product, a combination of vitamins, minerals, and various medications, is injected into the fatty areas with the promise that it dissolves fat after several treatments.

 

Mesotherapy, which can cost upwards of $1,500, has been popular in Europe for years, and is more recently being used in theUnited States. You will find physicians’ assistants and even some plastic surgeons using these promising potions. According to the American Society of Plastic Surgeons, however, “there are no published scientific studies demonstrating the effects are permanent, why or if certain ingredients work, or how safe mesotherapy is for patients.”

 

In addition, the type of drugs varies just as much as the practitioners using them, as do the quantity and frequency of recommended mesotherapy treatments. Many plastic surgeons have chosen not to use mesotherapy, because there is not sufficient evidence that it works and there is the risk it could be harmful with long-term use. Most plastic surgeons also avoid recommending creams that claim to reduce cellulite and aid in fat loss, on the grounds that those results are probably bogus.

 

THE TRIED AND TRUE
Liposuction is the only scientifically proven method that can target fat reduction in a specific part of the body. In liposuction, a surgeon using a thin instrument, called a cannula, carefully contours the shape of a specific area of the body while removing fat. Results are dependent upon the experience and artistic abilities of the individual surgeon. “Lipo,” as the treatment is commonly called, can be expensive. The price can range from $3,000 to $15,000, depending on the number of areas a patient has targeted as well as which part of the country you live in.

 

As with any surgical procedure, liposuction comes with risks that are unusual but can occur, which range from a potential rippling of the skin to death. If a surgeon does not explain the risks associated with any procedure, find a new surgeon! You should thoroughly discuss the decision to undergo liposuction with your plastic surgeon.

 

On the positive side, liposuction usually has moderate to dramatic results in fat reduction on specific areas of the body. Keep in mind that this procedure is not intended for weight loss, and a patient must continue a healthy diet and exercise program after surgery in order to enhance muscle definition arid maintain the result that was realized through liposuction.

 

ne

Lifetime of Regret
For some, tattoos are a form of art, but for others they are a reminder of a costly career mistake.

 

We all have regrets. But in pageants, and fashion modeling, a tattoo can be a glaring distracting regret when it comes to your confidence and appearance.

 

Tattoos, if carried out on a whim or for the wrong reasons, can result in “ink regret”. This is quite common and seen in my practice every day. Even the most meaningful tattoos can become career-limiting in a competitive industry such as modeling. According to a 2008 Harris poll, 14 percent of all Americans have at least one tattoo, and 17 percent of those experience regret. So how do we get rid of them?

 

It’s important to realize that removing the tattoo will be more expensive and painful than the original “inking” process. Also, darker colors are more completely removed than lighter or brighter colors – a fact that doesn’t make sense to most patients. There are three main categories of removal options: Masking, topical substances and laser treatment.

 

MASKING
To “mask” a tattoo, you can either:
a) use makeup; or
b) cover one tattoo with another.

 

Several products are available for makeup-style concealment. This is often sufficient for most tattoos if cover-up is only required for a short time such as a runway show, photo shoot or pageant. Covering one tattoo with a new one requires planning with your tattoo artist, and the new tattoo must be darker in color. The old ink will require some form of removal process to first lighten the area in order to cover the unwanted tattoo effectively.

 

TOPICAL SUBSTANCES
Common topical kits will include a cream or gel, as well as an exfoliator and moisturizer (tip: exfoliators and moisturizers are available separately at the drug store for significantly less). Most topicals take a long time – some up to a year – to face the tattoo. While expensive, these topicals are cheaper than lasers and are not painful. Do not use products that contain TCA (trichloroacetic acid) unless you have spoken to your plastic surgeon. These are cream versions of a chemical peel and can cause significant scarring or pigmentation changes when not used properly.

 

A slightly more invasive topical technique includes mixing saline with a gel and actually tattooing it into the area. The gel binds to the ink molecules and brings them to the surface, forming a scab that falls off as the area heals. This process is repeated 3-5 times over 4-6 weeks until the ink is gone. The risk of scarring and skin discoloration from this process is the same as for laser treatments.

 

LASER TREATMENTS
Lasers are quicker than topicals, but are more expensive and painful. They are used to react with and break down ink. The ink can then be absorbed by your body in the same manner that natural ink-fading occurs due to sunlight and environmental exposure. This is also why it requires multiple visits in order to gradually break down the ink. Be warned – this process can result in scarring. The thinner the skin, the more likely it is to scar. Pain-relief creams can be applied to the area to help with the discomfort. Some physicians will use injections to provide pain relief during the procedures, but use of these injections will require more treatments during the removal process. There are several types of lasers, which all provide similar results. Consult your plastic surgeon for his/her experience with each machine.

 

Laser removal will typically take 8-12 treatments, 8 weeks apart, with each session lightening the ink. The number of sessions required will depend on skin type, tattoo location, color, amount of ink, etc. Sometimes a combination of topicals and lasers can be utilized to lower the number of laser sessions required, or to target more “stubborn” tattoos. Patients with a healthy immune system and/or who do not smoke will have more successful results with lasers. The most common side effects of laser treatments are scarring and skin pigmentation changes, and should be immediately discussed with your physician, as these side effects can sometimes be reduced if detected early and treated when they have occurred. As with any procedure involving the skin… always wear sunscreen, especially when undergoing the treatments.

 

SURGERY
If none of the above procedures have worked, the only option remaining is surgery – literally “cutting out” the tattoo. Depending on the size, this can include anything from cutting out the tattoo and stitching the skin back together, to a skin graft to cover the area. In either case, scarring is quite common. However, depending on how badly you want the ink gone, sometimes pain and a little scarring is worth it.

 

Of course, any time you consider making a permanent change to your body it is important to think of long-term consequences. But should you find yourself suffering from “ink regret,” consult your plastic surgeon to find the appropriate option for your situation and budget.

 

Dr. Ronald Bergman is a board-certified plastic surgeon practicing in Des Moines, Iowa, for 28 years. He specializes in breast augmentation, liposuction, and tummy tucks. His patients include many local, national, and international pageant winners. Dr. Bergman is also a highly qualified pageant judge.

Spring 2010 – Pageantry Magazine

Saving Your Skin
The cold weather months are the perfect time to prep for summer’s warm glow
A competing woman’s body is perfected during the winter. Those are my favorite cold weather words every year. Winter brings holidays, stress and often new resolutions for your personal trainers. While most people slack after they’ve unpacked the sweaters, those who continue to stay focused really shine on the competitive stage.
Cosmetic surgery is well-timed for most competitors with time off over the holidays, as there is plenty of time for a full recovery. However, it is very important to remember that the skin is best treated during the frosty months. Most skin treatments require no tan before or no immediate sun exposure after the application. My recommendation is to bring on your high quality skin care reigns like Obagi, do those chemical peels, and say hello to laser procedures.

Obagi’s skin care regimen has remarkable results by combining both hydroquinone and tretinion active ingredients with a high quality line of products. Hydoquinone evens the skin tone that has been influenced by sun damage and tretinion treats wrinkles and acne. These ingredients both require limited sun exposure, making the treatment off limits in the summer or with tanning bed use. Sunscreen is included in the daily regimen.
Chemical peels are offered in a wide variety. The goal of a chemical peel is to slough off layers of skin to treat sun damage, wrinkles and acne, or to provide a more youthful overall appearance. They vary in types of chemicals used, the concentration of the chemicals, and how deeply the chemicals penetrate the skin. These treatments are typically done on the face but can also be done on the decollete (chest area).
Laser hair removal, skin rejuvenation and spider vein treatments are the most popular of all winter procedures and have benefits for all competitors of almost every age. One cannot have a tan at the time of a laser procedure, as the pigment in your skin can increase the chance of complications, and limited sun exposure afterward is also often recommended depending on the nature of your procedure.

The benefits of laser hair removal are obvious – no shaving. There is also no downtime and it is particularly beneficial for those who get bumps from shaving. It is important to remember that is does require several treatments to get the full benefit, as it is only effective against the hairs in the growth phase. Monthly hair cycles and the treatments not done during the growth phase of the hair cycle will not be effective. Anywhere from five to 10 treatments can be required depending on your skin type, the type of laser and timing of treatments.
Laser skin rejuvenation is very effective for spot treatments or for overall skin quality. Spot treatments are typically for sun damage and wrinkles, whereas overall skin quality focuses on texture and tightening. There are several of these treatments that can be done over the lunch hour with no downtime. As with chemical peels, depending on the depth of the skin layer targeted, very dramatic results can be achieved with deeply penetrating laser resurfacing that can either be done in your plastic surgeon’s office or, if deep enough, even as an outpatient surgical procedure.

Laser vein treatments are becoming more and more requested among competitors in their 20s and 30s. Treatment of small spider veins when first noticed is much more simple. They can often be easily “zapped,” usually with only one quick laser treatment. It can cause mild bruising that goes away in a few days. Lasers can also be used to treat some of the lesser varicose veins but offer quite amazing results for those small, unsightly spider veins, especially when treated early.
With the proper skin care products, chemical peels and laser procedures, you are on the right path to your quest for your title. Do not let the cold weather suppress your motivation. Remain focused on your treatment regimens, and achieve body perfection this winter.

Dr. Ronald Bergman is a board-certified plastic surgeon practicing in Des Moines, Iowa, for 28 years. He specializes in breast augmentation, liposuction, and tummy tucks. His patients include many local, national, and international pageant winners. Dr. Bergman is also a highly qualified pageant judge.

Winter 2009- Pageantry Magazine

Getting Your Fill
There are plenty of things to consider before taking the ultimate plunge with breast augmentation
Prepping for next Spring’s competitions is now in full swing. A question I am asked every year is: “Are breast implants for me?” Picking out the perfect dress and having it not quite fit on top while looking at last year’s pageant photos, wondering if more fullness would have helped in the swimsuit competition. These are common concerns, especially considering that when most women lose weight or begin an intense toning-up regimen for a pageant, they often lose volume in their breasts. This situation leaves my patients with questions and sometimes only a small window of opportunity.

Looking at Lingerie
My caveat to all surgical procedures is that prior to considering a permanent change to your body, it is important to explore all non-surgical options first. Local lingerie stores are often able to provide several options, including bras and adhesive silicone products.

Breast Augmentation
Breast augmentation is the name given to the surgical procedure that involves placing an implant either on top of or below the chest muscle (pectoralis major muscle) for the purpose of increasing breast volume. This is done by your plastic surgeon for cosmetic or reconstructive purposes.

Implant Choices
There are two major types of shell implants: saline or silicone. From here, there are several subtypes. They vary in size based on volume (how many milliliters), although that does not relate to cup size, but rather to the amount of volume being added to existing breast tissue. The different sizes come in different profiles (width and height) and shell textures (smooth or textured). So many choices to make it is very important to discuss with your plastic surgeon what options would work best for your lifestyle and natural canvas. Saline is approved for cosmetic use in patients over the age of 18, whereas silicone is not approved until page 22. Both implants are approved for patients of any age for the purpose of reconstruction.

Things to Consider
The risks of your particular procedure should be discussed between you and your surgeon. Risks specific to breast implant surgery include: the need for further surgery, capsular contractor (hardening of the implant), changes in nipple sensation and implant rupture, which is a very low risk. Implants do not last forever, as most patients need additional surgery at some point in their lifetime. If you decide to have your implants taken out, the changes to your breasts cannot be undone. If you have implants on top of the chest muscle or implanted around the nipple area, breast tissue can be affected and decrease your ability to breast-feed. Mammograms to screen for breast cancer can be more difficult with implants. Because of these risks and the mild swelling that can happen after surgery, I recommend trying to plan for at least three months between your surgery and the big event to provide adequate time for healing.

Is It Right For Me?
This is never a question I can answer for anyone else. I can provide all of the information to make an informed decision, but breast augmentation, like any elective procedure, is an individual choice. I warn patients not to have unrealistic expectations and to make sure that this is something you really want to do for you. That being said, most women make the decision to get implants after a long, well-thought out process and truly enjoy their new figure.

More information is always available thorough our office as well as the FDA website at www.FDA.gov/medicaldevices.

Dr. Ronald Bergman is a board-certified plastic surgeon practicing in Des Moines, Iowa, for 28 years. He specializes in breast augmentation, liposuction, and tummy tucks. His patients include many local, national, and international pageant winners. Dr. Bergman is also a highly qualified pageant judge.

Fall 2009 – Pageantry Magazine

Saving Your Skin
While your complexion’s number one enemy is bacteria, there are plenty of good weapons at your disposal.

 

One of the biggest fears I’m asked to face is the surprise big day breakout. Acne is often considered a pre-competition taboo to even discuss. However, due to constant improvements in the treatment of acne, it deserves to be revisited along with a few friendly reminders.

 

Every girl will experience at least one breakout in her lifetime. Most commonly this will occur during times of hormonal change – the teenage years, late 20s to early 30s and late 40s to early 50s. This surge in hormones can leave us with acne’s dreaded pustules and scars. Also, depending on the severity, it can cause real psychological damage by decreasing confidence, self-esteem, competition and work performance.

 

Oil production is influenced by hormones, stress and genetics. When all, or even some, of these forces work together it can spell disaster.

 

KNOW YOUR ENEMY
Many superstitions exist, but the one true cause is bacterial infection of clogged pores. The most commonly diagnosed bacteria is Propionibacterium acnes, or P. acnes. Bacteria live on your skin and can cause infections when pores become clogged or when oil production is increased. Pores may become clogged from improper face washing, product residue and environmental exposures. Oil production is influenced by hormones, stress and genetics. When all, or even some, of these forces work together it can spell disaster.

 

SEEKING SOLUTIONS
The best treatment always starts with a well-balanced diet, drinking plenty of water and getting at least eight hours of sleep each night. Of course, nothing can replace a visit to your physician for appropriate diagnosis and treatment of your acne.

 

A high quality face wash and sunscreen should always be the first and last steps of any skin care regimen. Wash your face twice daily to clean away makeup, dirt and oil. The best soaps are unscented and leave little residue. This can be tested by washing the back of your hand and patting it dry-if your skin becomes irritated or doesn’t feel clean, it’s not a good soap. I recommend over-the-counter products like Neutrogena or Aveeno and prescription products like Obagi.

 

FIGHT YOUR BATTLE
After the face is clean, the next step is to fight bacteria. There are three main categories of treatments for bacteria: topical benzoyl peroxide, topical antibiotics and oral antibiotics. Topical benzoyl peroxide is available at the drug store but in lower concentrations than are usually needed to get results . When combined with alcohol, as found in many products, these solutions can be very drying to the skin and worsen the acne over time. It can also bleach clothing, towels and bedding if you’re not careful. Clindamycin and erythromycin are examples of topical antibiotics or antibiotics available as creams. Unlike pills these creams are applied directly to the infected pores and can provide faster results than pills.

 

Oral antibiotics are pills like doxycycline or minocycline and are taken every day to either treat or prevent breakouts. While they are effective, it can take a while to see results and they are usually reserved for more severe cases.

 

Once you have defeated the bacteria, there is still one more step before the application of sunscreen and that’s a topical retinoid product, like Retin-A Micro, Differin or generic tretinoin. This is my favorite step because these products really bring your overall skin texture and appearance to the next level. Unfortunately, it is also the hardest therapy to start and maintain. Retinoids increase the rate at which your body builds new layers of skin. The downside is that it can take your body at least 28 days to catch up. During th e beginning of this catching up process, patients can go through a shedding phase. The appearance is similar to that of a peeling sunburn and can cause patients to stop using the product. Thankfully, this period is short and the results are worth it.

 

ADDITIONAL RESOURCES
Some of the other treatments you may hear about include birth control pills, Accutane, injections and laser treatments. “The Pill” works by regulating hormones to decrease the ups and downs that can trigger a hormonally-induced breakout. Accutane is a very strong medication taken as a daily pill that decreases oil production throughout the body. It requires regular doctor check-ups frequent blood work and two forms of birth control as it can cause liver and triglyceride problems, as well as devastating birth defects. It sounds scary, but in the right patient, and when used and monitored correctly, it can be a miracle treatment. Injections work well for an individual, deep, painful, cystic or nodular acne lesion. Finally, laser therapies, once only used to treat acne scars, can now be used as an additional tool in long-term management of acne prone skin and even during breakouts.

 

In your next quest for stardom, remember that your skin doesn’t have to suffer the dreaded competition jinx. Acne, when properly diagnosed and treated by your plastic surgeon, can be a very manageable part of your event preparations and every title holder’s best accessory.
Dr. Ronald Bergman is a board-certified plastic surgeon practicing in Des Moines, Iowa, for 28 years. He specializes in breast augmentation, liposuction, and tummy tucks. His patients include many local, national, and international pageant winners. Dr. Bergman is also a highly qualified pageant judge.
 
Summer 2009 – Pageantry Magazine

Sun, Smart & Beautiful
Avoid the Top 5 mistakes in preparing for your competition by keeping your skin gorgeous and safe

 

As we approach this summer’s long-awaited competition season, I realize I see the same mistakes every year. This year,
my staff and I compiled our Top 5 mistakes we see on a regular basis. Consider this your insider advice on how to avoid these ill-fated trends.

 

These mistakes have a common theme-expecting too much in too short of a time period. When this happens the desired results are not always achieved and problems tend to arise. Planning ahead and having good communication with your surgeon can prevent most of these mishaps and leave you prepared in plenty of time for your next debut.

 

Mistake #1 – TOO MUCH SUN.
I realize that a dark, olive or bronzed tan is glamorous in the spotlight. But as a physician, I am obligated to tell you that skin cancer is a real risk. One bad sunburn or prolonged tanning session is all it can take to increase your risk of skin cancer. You must have sunlight for your body to make Vitamin D, but this amount of sunlight is obtained in normal everyday activities like going for a walk outside. A UV-ray-free option like spray tanning is a good alternative. There is not much of a difference between the do-it-yourself kits and professional sessions in how they work, only in the application process. These products fade over time and are considered safe for short-term use. The best way to avoid damage to your skin and to keep your skin appearing youthful only requires one product – a quality moisturizer with SPF.

 

Mistake #2 – LAST MINUTE COSMETIC SURGERY.
The perfect time for your long-awaited breast augmentation or liposuction is not one week prior to the Main Event. While we all want to look our best and exude the most confidence, last minute surgery can compromise results and your satisfaction. Recovery time after any surgery can often take two to four months for you to be 100 percent. Considering these procedures are often expensive and involve permanent changes to your body, your goal should be to maximize the outcome. This means take your time, plan ahead and follow your surgeon’s advice. This will give you plenty of time to heal properly and to feel at ease in your new physique.

 

Mistake #3 – CRASH DIETING.
Most of us are well aware of eating disorders. However, crash diets-during which significant weight loss is obtained in a short amount of time-can walk the line of an eating disorder and even result in similar serious side effects. Healthy weight loss is two pounds per week unless otherwise monitored by a physician. The word “diet” implies that you are missing something. My advice is always just the opposite-focus on what you’re putting into your body and not what you’re taking away. There is no substitute for a long term, well-balanced nutrition plan and exercise program . If you can do that year-round, you’ll not only be healthier, but you’ll feel more prepared inside and out.

 

Mistake #4 – NEW SKIN TREATMENTS PRIOR TO COMPETITION OR TANNING.
Getting a chemical peel, laser treatment or starting a new intense skin care regimen may be just what the doctor ordered. These therapies do provide great results with very little down time. However, summer is simply not the season to start. Most patients are spending more time outside in addition to tanning for events, which most skin care treatments and products do not allow. The high yield ablative procedures remove layers of dead skin and stimulate collagen production. The results are younger, healthier skin, but it also removes your skin’s natural protection and makes it very sensitive to sunlight. Not only can you damage the treatment, but you can also increase your risk of skin cancer. On top of this, most summer schedules are simply too irregular to stay faithful to your skin care regimen. I encourage most of my patients to schedule these therapies in the fall, winter and early spring. If summer is a must, talk to your surgeon, purchase a high-quality SPF, keep the treatment area covered and break out a hat that provides full facial shade.

 

Mistake #5 – ASSUMING THAT LOOKING GREAT TAKES SPENDING A LOT OF MONEY.
Too often the assumption in cosmetic enhancement is that just because something costs more, it’s better. I argue that the first three steps toward any cosmetic enhancement are simple: research, budget and plan. This will give you the most realistic goals within a reasonable timeline. You will know your options, budget and plan that includes your surgeon and aesthetician. Following this plan will lead you toward the desired results with in a budget you are comfortable with, all on your own watch. You will not only be happier with the results, but also with your experience.

 

Dr. Ronald Bergman is a board-certified plastic surgeon practicing in Des Moines, Iowa, for 28 years. He specializes in breast augmentation, liposuction, and tummy tucks. His patients include many local, national, and international pageant winners. Dr. Bergman is also a highly qualified pageant judge.

Spring 2009 – Pageantry Magazine

Picking the Perfect Pout

It takes the right consideration and choice to achieve dazzling stage presence with kissably soft results

Voluptuous lips- natural or enhanced are a sign of beauty and youth. As we age, we lose volume in our faces, and as early as 1900, surgeons began the search for an answer to this dilemma. The perfect pout can provide a youthful, dazzling stage presence every pageant queen or model desires, as well as the kissably soft sexiness every woman desires. A good lip augmentation can add an edge of natural sexiness and balance to your face in a way that no other procedure can. Celebrities like Marilyn Monroe, Angelina Jolie and Scarlett Johansson are known for having beautifully full lips and are frequently requested celebrity assets in my office.

 

The best result any surgeon can aspire to is enhancing your natural beauty. This enhancement starts with good lip care. Lip care is simple and there are only two important steps:
1) Drink plenty of water (dry, cracked lips are never appealing); and
2) Utilize daily lip product s that include both a moisturizer and sunscreen. This product does not need to be expensive. Drug store lip balm will meet these criteria and can easily mix with your favorite lipstick or lip gloss. Adversely, two big no-no’s of lip care include: 1) applying dry skincare products, chemical peels or performing microderm abrasion procedures on the lips; and 2) licking or picking at dry skin, or nervously nibbling on the lips – trust me, it only makes matters worse.

 

LIP SHAPES
The most desirable lip shape by far is the heart. A full upper lip with well-defined Cupid’s bow (the arched M-shape in the center) paired with a plump, perfectly balanced bottom lip. Lip augmentation can balance almost any other combination, including: thin lips, small upper lip, smaller bottom lip, lips with irregular borders, smoker’s lines or lack of a Cupid ‘s bow. Lip reduction and reconstruction procedures are available for those who would like a more permanent change or for those who would like to reduce the size of their lips.

 

TOPICALS
Topical lip plumpers are available everywhere, in the forms of generic drug store products to the top of the line plumpers, such as Physician’s Complex, available only at your surgeon’s office. These products provide short-term results by temporarily increasing blood flow to the lips. The drawback is that constant use of any lip plumper will never lead to permanently fuller lips.

 

MANUAL LIP PLUMPERS
These are vacuum devices, like the product made by Luscious Lips, made to go over the lips and increase blood flow. These provide only minutes of results and I typically do not recommend these products to my patients.

 

TEMPORARY INJECTABLES
There are many, many injectables on the market. However, there are two main implants requested at my office – Juvederm and Restylane. Juvederm and Restylane are hyaluronic acid fillers that are excellent plumpers. This is perfect for the patient who simply wants more volume and lasts up to one year. These products provide very reproducible, relatively long-lasting results. There are several other products on the market, and it is very important to discuss the right product for you with your surgeon. These injections are safe procedures when performed by qualified injectors.

 

PERMANENT INJECTABLES
I typically do not initially recommend these procedures to my patients. if you are interested in permanent solutions, be sure that you have tried the temporary injectables for a significant length of time – at least two years – and are sure that this is the desired look you want long term.

 

LASER RESURFACING
This is the most exciting area of facial care in cosmetics. There are not currently any laser treatments beneficial for the lips. However, for patients who have discolorations or deep lines around the lips – smoker’s lines, laugh lines, etc. – lasers that can provide dramatic results are available. I have recently seen very exciting results from newer fractional lasers for softening deeper smoker’s lines that we had previously only been able to fill.

 

Remember, the best results are often obtained with combining treatments. However, it all starts with lip care. Moisturizers and sunscreens combined with a careful selection of the right topical plumper or injectable will assure your readiness for your next stage appearance as well as your next kiss.

 

Dr. Ronald Bergman is a board-certified plastic surgeon practicing in Des Moines, Iowa, for 28 years. He specializes in breast augmentation, liposuction, and tummy tucks. His patients include many local, national, and international pageant winners. Dr. Bergman is also a highly qualified pageant judge.

Fall 2008 – Pageantry Magazine

Knowing Your Role Models
Some celebrities prefer plastic surgery and some don’t, but it’s still your body and ultimately your decision

 

The issue of celebrity plastic surgery is so intriguing. Curiosity causes us all to want to know who had implants, liposuction and injected too much collagen into their lips.

 

Many stars have publicly come out and admitted to their surgery and even promote it, includingCherand Joan Rivers. According to Celebrity Cosmetic Surgery, a blog devoted to news involving celebrities and plastic surgery, even beautiful supermodel Cindy Crawford has admitted to work, including Botox and collagen. Other stars who have confirmed plastic surgery include Ashlee Simpson and Ashley Tisdale.

 

There are also many guesses as to which celebrities have had surgery, although they either won’t comment or deny it. Michael Jackson barely has a nose. Some plastic surgeons estimate he’s probably had numerous Rhinoplasty procedures. His nose, as a result of too much surgery, has literally collapsed. Others rumored to have had surgery include Hillary Clinton, Victoria Beckham and Madonna.

 

So why are some celebrities so willing to admit they’ve had a little work and others who have obviously had work downright lie about it? There is still a small stigma that is slowly being overcome that plastic surgery equates to a vain or shallow person. This is often farther from the truth. Most women have surgery to fix areas that personally bother them.

 

A great role model and celebrity, who has had plastic surgery and has since come out against it, is Jamie Lee Curtis. The 49-year old actress underwent surgery on her lower eyes at age 35 and has admitted to Botox and liposuction. However, Jamie Lee regrets these decisions and wishes she would have just let herself age as so many other people choose to do naturally. She once said, “I did it all, but you know what? It doesn’t work. The fraud is it doesn’t work; it doesn’t work because you still look in the mirror and you see the fraud of what you were trying to do.”

 

For every celebrity who opposes or supports plastic surgery, there are millions of everyday women without the luxury of the millions of dollars these celebrities have, and many of those women are in the pageant industry.

 

Iowapatient Terri Wilson had a tummy tuck procedure done and says, “After having children, I always had a ‘pooch’ on my lower abdomen. Even with exercise and dieting it wouldn’t go away. After surgery, my clothes fit better and I feel more confident .” In fact, women who are realistic about what is achievable are the best and only patients I’ll work with.

 

Another one of my patients, Cindy Johnson says, “Before my augmentation, I already felt good about myself. But after the augmentation I feel more beautiful and complete.”

 

It seems whether you’re a celebrity or the girl next door, whatever surgery you decide to have performed is a very personal decision, and quite frankly it isn’t anybody’s business what you decide about your body. One 27-year old told me she thought about having breast augmentation surgery for six years before finally having it done . Thinking out your decision is the best thing you can do. There are risks to any plastic surgery and it ‘s very important that you discuss this with your surgeon. Good luck in making an informed decision on whether or not to have plastic surgery and please call our office if we may be of any assistance.

 

Dr. Ronald Bergman is a board-certified plastic surgeon practicing in Des Moines, Iowa, for 28 years. He specializes in breast augmentation, liposuction, and tummy tucks. His patients include many local, national, and international pageant winners. Dr. Bergman is also a highly qualified pageant judge.
 

Summer 2008 – Pageantry Magazine

Getting Past the Gimmicks
There are specific things you should look for to make sure you’re not being fooled by an unscrupulous “plastic surgeon.”

 

Hello, friends. Before we give you this issue’s tips on gimmicks and tricks, there is one topic we need to address. The most recent revelation in plastic surgery involves questions about the safety of Botox injections after 16 reported deaths resulting from Botox injections. Four of the deaths involved usage of Botox in people less than 18 years of age.

 

OneU.S.advocacy group claims 180 reports of serious Botox complications have been sent to the Food and Drug Administration. As a result, some are calling for a warning label – “Death Risk” – to be put on all vials of the drug. Does this mean women should put a halt to getting these injections for cosmetic purposes? Not necessarily. Botox is made from the same toxin that causes botulism. It has been used to successfully treat a number of medical conditions for many years and is considered safe when administered properly. We promise we will continue to watch the FDA’s stance on Botox injections and keep you posted in the pages of future issues of Pageantry.

 

Now that Botox is being questioned, it opens the door to thoroughly scrutinize the practices of the industry, something we should do. There are many tricks and gimmicks on the market that encourage consumers to spend billions upon billions of dollars per year.

 

OneU.S.advocacy group claims 180 reports of serious Botox complications have been sent to the Food and Drug Administration.

 

The first gimmick used in plastic surgery is unqualified physicians, even non-physicians calling themselves cosmetic surgeons, cosmetic specialists or laser specialists administering laser treatments, chemical peels and injections. Unfortunately, the FDA has done little to crack down on non-qualified individuals performing procedures that should be left in the hands of qualified plastic surgeons and dermatologists. A white lab coat and official-looking office do not make one qualified to perform cosmetic procedures, or even minor procedures. Beware of clinics running under the guidance of a “medical director” who may or may not be a practicing physician, and in many cases is not a plastic surgeon or dermatologist.

 

In many states, doctors who have had no experience with plastic surgery and those who have never even performed a surgery are directing clinics offering cosmetic procedures. The best thing to do is ask; “Is this clinic under the direction of a plastic surgeon?”; “Who is the plastic surgeon and is his or her state license current?”; “How often does the doctor visit the clinic and personally perform the procedures being advertised?”. If you are unable to get the answers to these questions, then do not use that clinic.

 

WHY ARE THESE ESTABLISHMENTS SUCCESSFUL?
This brings us to our second gimmick, or in this case, trick. The power of advertising. At one time it was considered unethical for doctors to advertise their services. Now the advertising niche for plastic surgeons and non-plastic surgeons alike is extremely competitive. Most of us have websites; some opt for billboards and dramatic newspaper ads to lure uninformed consumers. Now, just because someone is advertising does not make that person unqualified to perform, but the bottom line is that you must ask questions. If someone is unable or unwilling to answer tough questions, it is not a person you want working on your face or body.

 

Finally, the number one cosmetic surgery gimmick is a doctor who offers procedures that do not work. Just a few years ago, the FDA approved the contour thread lift, a procedure touted as an alternative to a facelift. Many doctors are now finding that the threads break, cause infections and are short-acting. The best thing you can do for your face in your teens, 20s and 30s is to use a good skin care regimen. You can even use an over-the-counter line that includes a cleanser, moisturizer and, most importantly, sunscreen. Peels, lasers and injections can offer subtle improvements but should rarely be used in young women. A full surgical facelift is the only proven method to correct a sagging face and is often performed on women, beginning in their 40s and 50s. Beware of anything that sounds too good to be true. If it promises to change your life or permanently alter your looks, it is most likely a bogus claim.

 

As we conclude, it’s also important to remember that any cosmetic procedure, whether it’s Botox injections or breast augmentations, are not permanent. Most procedures need to be redone, ranging from every few months to 10 or 15 years down the line. Plastic surgery requires a commitment from both the patient and the surgeon, and should be entered into with serious thought and careful consideration.

 

Dr. Ronald Bergman is a board-certified plastic surgeon practicing in Des Moines, Iowa, for 28 years. He specializes in breast augmentation, liposuction, and tummy tucks. His patients include many local, national, and international pageant winners. Dr. Bergman is also a highly qualified pageant judge.
 


Spring 2008 – Pageantry Magazine

Taking Target Practice
Despite some newly introduced product promises, liposuction remains at the top of the list of effective, site-specific figure-trimming treatments.

 

What pageant queen hasn’t dreamed of making her grand entrance–brilliantly walking into the spotlight, beautiful and confident, in a bathing suit–knowing every muscle in her body is smoothly trim, perfectly shaped, and toned?

 

As we head back to reality, those of us in the industry know that Swimsuit competition is usually the area of much anxiety for contestants. Makeup, false eyelashes, and a great hairdo can work wonders during an Evening Gown showdown, and a little practice on how to genuinely communicate in sound bites can help ace the Interview. But “fixing” the body itself is very difficult, and not something that can be simply primped or practiced.

 

When facing this reality, it should be comforting for delegates to know you are not alone. Ninety percent of women have cellulite to some degree, and most women tend to carry fat in their outer thigh (otherwise known as saddlebags), lower stomach, and buttocks areas. Diet and exercise is the first and most important way that you can combat overall body fat. However, you cannot remove fat from specific areas through diet or exercise; you can only tone specific spots. So, what is a hard working pageant contestant to do? First, I recommend seeing a nutritionist and personal trainer, but if specific fat removal is what you are looking for, you need a plastic surgeon.

 

UNPROVEN SOLUTIONS
Buyer beware! There are a number of new products on the market that are being touted as advancements in fat removal and reduction. These products are marketed under the name lipodisolve or mesotherapy. The product, a combination of vitamins, minerals, and various medications, is injected into the fatty areas with the promise that it dissolves fat after several treatments.

 

Mesotherapy, which can cost upwards of $1,500, has been popular in Europe for years, and is more recently being used in theUnited States. You will find physicians’ assistants and even some plastic surgeons using these promising potions. According to the American Society of Plastic Surgeons, however, “there are no published scientific studies demonstrating the effects are permanent, why or if certain ingredients work, or how safe mesotherapy is for patients.”

 

In addition, the type of drugs varies just as much as the practitioners using them, as do the quantity and frequency of recommended mesotherapy treatments. Many plastic surgeons have chosen not to use mesotherapy, because there is not sufficient evidence that it works and there is the risk it could be harmful with long-term use. Most plastic surgeons also avoid recommending creams that claim to reduce cellulite and aid in fat loss, on the grounds that those results are probably bogus.

 

THE TRIED AND TRUE
Liposuction is the only scientifically proven method that can target fat reduction in a specific part of the body. In liposuction, a surgeon using a thin instrument, called a cannula, carefully contours the shape of a specific area of the body while removing fat. Results are dependent upon the experience and artistic abilities of the individual surgeon. “Lipo,” as the treatment is commonly called, can be expensive. The price can range from $3,000 to $15,000, depending on the number of areas a patient has targeted as well as which part of the country you live in.

 

As with any surgical procedure, liposuction comes with risks that are unusual but can occur, which range from a potential rippling of the skin to death. If a surgeon does not explain the risks associated with any procedure, find a new surgeon! You should thoroughly discuss the decision to undergo liposuction with your plastic surgeon.

 

On the positive side, liposuction usually has moderate to dramatic results in fat reduction on specific areas of the body. Keep in mind that this procedure is not intended for weight loss, and a patient must continue a healthy diet and exercise program after surgery in order to enhance muscle definition arid maintain the result that was realized through liposuction.

spring 2007 cover

The latest advances in facial beautification feature eyelashes made lavish with extensions and transplants. Also: a silicone breast implant update.     (spring 2007)

The science of body shaping seems to progress at an ever increasing rate. It behooves us to maintain a close watch on such developments, to not only stay on top of beauty trends but also to arm ourselves with the facts to make informed decisions about potential beauty enhancements. Here are two new developments in plastic surgery, and a third tip based on body chemistry from which every competition beauty can benefit.

LONGER EYELASHES
The next big thing on the beauty market is the surge in eyelash extensions. Forget about your run-of-the mill glue-on lashes of pageant years past! Beauty salons and estheticians are hopping on this bandwagon all over the country. We first saw this trend on the West Coast, and it has made its way to the Midwest and back East in recent months.

There are two methods for placing extensions. The most common involves the gluing of synthetic lashes with tweezers. It takes a professional about two hours to complete and costs approximately $500. The lashes will last a couple of months.

In addition, a second option is transplants. Surgeons are now able to transplant eyelashes in the same manner as traditional hair transplants, where actual eyelash hair follicles are grafted along the edge of the eyelid to permanently create longer, thicker, more pronounced lashes.

The surgical route should be embarked on with caution. The potential side effects and risks associated with surgery make this method a good option for those undergoing reconstruction from burns or prior eye surgery that resulted in loss of lashes. It is quite invasive for a strictly cosmetic enhancement.

FDA SILICONE APPROVAL
In my last “Body Shaping” column, I covered a host of health issues regarding cosmetic breast enhancement surgery. Since the Winter 2006 issue of Pageantry went to press, news media coverage has widely broadcast the announcement that silicone breast implants have been approved by the FDA, giving breast-enlargement patients a new choice in effecting that body-shaping change. Silicone breast implants were taken off the market in 1992 after patients reported health problems associated with their use.

Plastic surgeons have long known that the incidence of health conditions for women with silicone implants were no different than the incidence of health issues in women without implants. Now that accurate information is out there and silicone is once again an option, many patients wonder what is the best choice.

Saline implants have worked well for the past 14 years. However, some patients and their surgeons may prefer silicone because they feel more natural. Saline can look very natural, but does not have the same feel as silicone. There is also a lower incidence of wrinkling in the silicone implants compared to the saline-filled alternatives. However, there are downsides to silicone implants, too. It is much more difficult to tell when silicone is ruptured as opposed to a saline implant, which deflates quite obviously. While the material in the silicone implant will not harm you, it will be more difficult and time-consuming to repair.

Doctors will be sending their silicone breast implant patients in for magnetic resonance imaging (MRI) every other year after surgery. This procedure will allow medical professionals to fully examine implants and to ensure no ruptures have occurred. Patients will have to absorb the costs of their MRI , which will add up quickly after a few years with the implants. In addition, the implants themselves are more costly. Silicone implants could boost the cost for breast augmentation by $1,000 dollars.

As with saline, silicone implants are not permanent. A patient will have to replace breast implants due to the effects of time. And, even with implants, as time goes by a person will see the effects of gravity. Patients should clearly weigh the pros and cons of silicone vs. saline with their plastic surgeon. Both types of implants can result in improved appearance and satisfied patients.

GOOD HYDRATIONS
Finally, did you know your body is 50 to 70 percent water (depending on your age), and you can lose up to three liters of water daily through the simple processes of sweating, breathing, and urinating (you can lose up to three liters an hour when you exercise!)? Replenishing our bodies with water is an absolute priority for both greater beauty and good health, so my advice is to drink 64 to 80 ounces of water or herbal tea throughout the day, which is easy to do by carrying a water bottle.

 Dr.Ronald Bergman

Pageantry Magazine

spring 2007,  volume 28, issue 1

 

winter 2006 cover

Breast Augmentation & Health      (winter 2006)

The latest available information indicates that surgical enhancement is safe, though the procedure will require special post-op care to monitor breast health.

The number of women participating in competitions for those with married status or Ms. divisions is increasing, and often these contestants are well into their 30’s and 40’s. Many of these women have breast implants, or have questions about implants in relation to breast health. Such concerns are more common than ever, since the number of breast cancer cases increases yearly and now are showing up more often in younger women.

Breast augmentation surgery is the second most popular plastic surgery performed in the United States. It is estimated that 4 million women have undergone breast augmentation surgery and a half million are expected to have the procedure this year. If you are considering breast implants, there are a few things you should know when it comes to screening for breast cancer. Here are the answers to the most commonly heard questions.

How do implants affect the diagnosis of cancer?

 First, and foremost, it is possible that an implant can obscure early breast cancer detection through a mammogram. The good news is that for patients who have implants radiology technicians will take more views of the breast compared to patients without implants, thus improving the chances that an early occurrence of the disease will be found. In addition, technology has become more advanced, and radiologists now have more experience in dealing with implants. It is very likely that cancer will still be detected in a woman with implants during a routine mammogram.

What is the latest evidence regarding implants and breast cancer?

Women with implants do not experience higher incidences of breast cancer. In fact, there are no known modern studies that show any connection between implants and the onset of auto-immune diseases or any other types of diseases. Studies done years ago that claimed breast implants were dangerous have proven to be false, and this applied to both silicone and saline implants. When cancer is found in women with implants, the disease has not necessarily progressed to a later stage and cancer treatment is very successful.

What about the integrity of the implants themselves?

Many women are concerned about possible damage to the implant during the mammogram examination itself. The pressure of the mammogram should not cause an implant to rupture, although, as with any medical procedure, there is always a potential danger of complications, and rupture is one possibility. Implant companies have informed plastic surgeons that the man-made implants should last 10 years before replacement is necessary. In my practice, I have found numerous women who have had implants successfully in place for 20 years or more.

Will I be able to compete in pageants after breast cancer surgery?

Women who must undergo breast reconstruction due to cancer may still compete in Swimsuit competitions. The breast can be reconstructed so that other contestants and the judges would not be able to tell that implants are in place even with the affected contestant wearing a swimsuit. However, reconstruction is different in the sense that the reconstruction, unlike augmentation, requires some sort of material to be covering the breast in order for it to appear natural. I have found that most breast reconstruction patients are happy just to be alive and to have breasts again.

These patients must be counseled honestly about what the outcome of surgery will be and must have realistic expectations. Although reconstruction patients will never look 100 percent natural, fortunately today we are able to get them very close. Medical insurance will cover implants for patients who undergo reconstruction following a mastectomy.

The breast is a very private and sensitive part of a woman’s anatomy. We have made great strides in recent years in allowing women to talk about their bodies and, in particular, about what improvements might be available to improve this part of a women’s body from an aesthetic vantage point. And yet, make no mistake – the most important facet in this and any other area of plastic surgery is a women’s health. Neither doctors nor patients should ever put appearance ahead of personal well-being.

 

Dr. Ronald Bergman

Pageantry Magazine

Winter 2006, Volume 27, Issue 4

fall 2006 cover

Advantage: Plastic Surgery Patients      (fall 2006)

In a land where beauty pays, many now consider nips ‘n’ tucks as inexpensive insurance on the way up the ladder of success.

Let’s face it. We live in a country where looks matter. The clothing, cosmetics, and plastic surgery markets are booming as women, and now even men, are hopping on the beauty-is-better bandwagon.

While we try to teach our youth that beauty comes from within, the adults among us are spending billions of dollars trying to look better, and those who do say they have a reason… career advancement. A better career equates to more long-term earning power, hence a few thousand dollars on plastic surgery is seen as an investment in one’s livelihood.

Does looking good really advance career opportunities? According to a recent Monster.com poll, of the 22,000 people who answered the question, “Do you think having plastic surgery or cosmetic dental work would help advance your career?” 53 percent said “yes”.

Ms. U.S. World 2006 Annastasia Anderson is open about the fact that looks indeed make a difference in career advancement as well as in the pageant world. “Society is harsher on women, especially when they age,” she said. “I think society expects women to look forever young.” Moreover, this long-time beauty queen feels certain that beauty can be the tiebreaker in a tight job market. “If you and one other person are equally qualified for a job position the better-looking person is going to get the job.”

Miss West Chicago USA 1998 Rachel Conradt agrees to an extent. “It’s a yes-no question,” she said. Rachel believes that “plastic surgery as a way of career advancement depends on the industry.” She believes that in the world of modeling, pageants, and television that better looking women who’ve had “aesthetic improvements” are a step ahead of their colleagues. However, Rachel also believes that “falling into stereotypes can hurt a person in fields such as accounting and law enforcement.”

According to a recent LA Business poll, more than half of the readership said they would not go under the knife for the mere sake of getting a better job. One reader commented, “I value myself more than that.”

Whenever we talk about plastic surgery, it really comes down to each our own. For many patients, a little work equates to a big boost with advanced self-esteem and career opportunities. But there are still many in the world who wouldn’t be paid to alter their looks. It is very much an individual, personal decision. The real beauty in this debate is that we all have the opportunity to choose.

 

Dr. Ronald Bergman

Pageantry Magazine

Fall 2006, Volume 27, Issue 3

summer 2006 cover

In Support of a ‘Rational’ Approach                (summer 2006)

The term “irrational exuberance” has its origin in a speech that former chairman of the Federal Reserve Board Alan Greenspan gave on December 5, 1996, and in the following decade often has been used to describe a heightened state of speculative fervor in financial markets. Something akin to irrational exuberance has affected the world of aesthetic plastic surgery as well in recent years.

Let me explain. Plastic surgery ought to be a carefully considered procedure that, when done correctly on qualified patients, should be barely detectable. However, a visit to numerous websites showing poor outcomes makes it obvious that too many patients in recent years are ending up looking worse when leaving the surgeon’s office than they did before entering. Even some well-known celebrities appear to have been obviously “done”. This is a sad state of affairs for the majority of plastic surgeons, who truly believe that their work, while appreciably improving a person’s appearance, should be invisible to the naked eye

There are several reasons for the appearance of irrational exuberance in the world of plastic surgery. First and foremost, TV news and reality programming exposure that sets unrealistic goals for plastic surgery is sending a flood of patients who are not qualified into plastic surgery offices across the country. Not everyone is a candidate for plastic surgery; a patient must meet certain physical and psychological criteria before undergoing plastic surgery.

Due to over-exuberance in meeting this demand for services, we have seen patients wind up in the hands of surgeons who are too aggressive or under-trained, or both. They may pull the skin on a face-lift too tight, or make breast implants too large, or improperly administer Botox injections. These unqualified surgeons are nip ‘n’ tucking for their own financial gains, often without taking the proper safeguards to ensure a proper outcome, and their patients are suffering as a result.

Also, the greater number of men and women submitting to the surgical knife is, in itself, driving up the annual number of return-visit procedures, because any single operation is not a permanent solution to a person’s aesthetic improvements. For example, the average face-lift will start to fall after 10 years; breast implants need to be replaced about 15 years after the initial operation; for Botox, the effects fade away in months. Patients may be left unaware of this, if their doctors fail to fully apprise them of these facts.

One concurrent change in the public’s perception of plastic surgery is that it is no longer considered taboo. The majority of patients are completely willing to tell others about their surgery and even show it off. Back in the 1950’s, the same procedures were being performed, but you never heard about them. Even as recently as the 1980’s, it was not acceptable to talk about plastic surgery in polite company. Today, openness abounds. As an example, an acquaintance of mine tells of a female friend who, when asked about her vacation plans this summer, confided that she’s taking her week off for a visit to her plastic surgeon’s office!

Every society is different when it comes to what constitutes normal beauty, and even within one country the “ideal look” often changes. For example, in some African cultures, it is beautiful to have rings placed around the neck, so that after a period of years the neck is nearly a foot long. In the United States, wrinkle-free faces, large breasts, full lips, and tight tummies are trendy. Such preferences change over the years, depending on what types of movies, music, and fashion icons are popular and what high-profile celebrities look like. Remember the 1960’s model known as Twiggy? At that time, “incredibly thin” was in. A decade earlier, Marilyn Monroe’s size 12 voluptuous figure was all the rage.

There are rare instances when a patient wants to look “done”. For example, there are documented cases of a person asking for the features of a cat or a Barbie doll. In these cases, it is the surgeon’s responsibility to seek approval from board-certified psychiatrists before proceeding with such drastic, unconventional procedures. An ethical plastic surgeon will not usually want his or her name associated with bizarre-looking transformations.

Whatever tomorrow’s trends, the plastic surgery growth phenomenon we are witnessing today says much about our culture. The fact that plastic surgery is expensive (often between $5,000 and $25,000 for one procedure) is evidence to how much we have become a disposable-income-driven society. Looking good has a higher priority to many people than saving thousands of dollars for retirement. Some patients view their plastic surgery expenditures as an investment in their personal and professional future.

As we arrived at the new millennium, high-profile celebrities, society women, and TV personalities have been open about having undergone plastic surgery, and the general public is now following suit. There are pros and cons about this newly relaxed acceptance of aesthetic plastic surgery, but as always, the bottom line is that such a procedure is nothing to take lightly – it is, after all, a life-altering occurrence. It must result from a well-thought-out decision between a patient and his or her physician. While that may seem obvious in this era of irrational exuberance, adopting such a rational approach is more necessary than ever.

 

Dr. Ronald Bergman

Pageantry Magazine

Summer 2006, Volume 27, Issue 2

spring 2006 cover

Nature vs. Sutures: Pageants and Plastic Surgery               (spring 2006)

Not too long ago, a woman in an Asian beauty pageant sued the pageant organizer for removing her from the pageant after it was learned the contestant had plastic surgery – in violation of the competition’s written rules. The lawsuit was rejected, because the judge in the case ruled it was well within the pageant organizer’s right to promote “natural beauty”.

This leaves us to consider the question of whether plastic surgery should be banned from pageants. A growing number of teenagers are having plastic surgery, including rhinoplasty (nose jobs) and breast implants. Is a ban on plastic surgery for teen competitions desirable? With millions of people undergoing cosmetic procedures around the world every year, would enforcing a plastic surgery ban even be feasible?

I doubt it, and most competition event organizers recognize this. The official position of the Miss Universe Organization regarding this issue, posted on the pageant’s web site, is this: “Although contestants are discouraged from altering their own natural beauty, no restrictions are placed on cosmetic surgery; it is impossible to enforce such a rule. In fact, since 1990 the organization has allowed the use of padding in an effort to discourage participants from permanently altering their bodies for the competition.”

The reasoning behind allowing plastic surgery is best expressed by former Miss Illinois USA contestant and law student Rachel Conradt, who says, “I don’t see anything wrong with plastic surgery at all. A pageant is like an art competition to see who can mold the best body. It shouldn’t be an issue if a doctor is determining a patient is ready and wants it for the right purpose, that purpose being she wants it for herself.”

As a plastic surgeon, I would not perform certain procedures, including breast augmentation or liposuction, on a woman under the age of 18, as her body may still be growing. However, at the age of 18, many contestants are still competing in teen division pageants and, particularly with breast augmentation, may be seen to have an advantage over the younger contestants due to surgical enhancement. Such fairness issues could be handled with enlightened instructions to the competition’s judges.

A pageant organizer in China last year took another tack in dealing with the issue by holding the first official “Miss Plastic Surgery” pageant. All of the pageants contestants were required to have “gone under the knife” for various procedures. Organizers said the contest encourages people to accept the choices of women who decide to have cosmetic procedures.

Here in the United States, the television show The Swan actually recruits candidates for plastic surgery and pays for the procedures, and in turn hosts a season-ending pageant in which a winner is chosen. The danger of such “reality” shows in blatantly encouraging plastic surgery is that they set up unrealistic expectations when it comes to what women believe such surgery can accomplish. Such TV exposure also may encourage those who should not be candidates for plastic surgery to pursue having it despite arguments to the contrary.

Still, many observers today would argue that the discreet use of plastic surgery obviates the need for pageant regulations. Dr. Sam Gershenbaum, a Miami, Florida-based plastic surgeon, believes pageant contestants should be allowed to compete even when they’ve had plastic surgery because, once procedures are properly planned and completed, there is no obvious evidence of them. “Cosmetic surgery should be something that, when done right, nobody can tell it’s been done anyway,” he says.

As cosmetic surgery becomes more accepted in the mainstream of society, it appears even traditional pageants are taking heed. Miss Universe Organization’s stance proves that event producers can skirt this issue while also encouraging “natural beauty”. After all, while it is important for contestants to feel confident in their bodies, plastic surgery for the sole purpose of winning a beauty pageant is something I highly discourage. Plastic surgery is a life changing event and should never be taken lightly. When done in a responsible manner, under well thought-out circumstances, plastic surgery can boost a person’s self-esteem and change a person’s life in a very positive manner.

 

Dr. Ronald Bergman

Pageantry Magazine

Spring 2006, Volume 27, Issue 1

winter 2005 cover

Targeting the Bulges That Won’t Budge            (winter 2005)

Daily workouts are part of most entertainers and contestants’ lives. The combination of the treadmill, squats, and weight training exercises often pays off in the form of a flattering and fit figure. However, nearly 90 percent of women will find that even with a faithful exercise regimen, trouble spots still remain – stubborn places where the excess fat just won’t disappear no matter how rigorous the training sessions are.

What are the trouble spots most often cited by women of all ages? Usually these dedicated women are concerned about the inner and outer thighs, gluteal folds, lower abdomen, and – although less often a concern – the chin line and neck area. If a contestant or performer has tried a trainer-approved exercise program and followed a healthy diet but continues to struggle with these common complaints, cosmetic surgery often is the only effective option to remove the bulges that won’t budge from these stubborn areas.

The most common approach for removing fat in the stubborn problem areas is liposuction. During liposuction, a narrow tube called a cannula is inserted through a tiny incision, and small amounts of fat are literally vacuumed out of the body. A trained surgeon will be able to sculpt a beautiful, natural look.

One misconception about liposuction is that it aids in weight loss. In fact, liposuction is intended to sculpt and shape, not to serve as an instant-thinning procedure. It should be used when the body is already at its ideal weight, not when a person is looking for a quickie substitute for a professionally managed weight-loss program. Another common misconception relates to cellulite: Liposuction will not eliminate cellulite, which is a common problem in women and is genetically linked.

Loose abdominal skin is another complaint women often have, especially as they advance in age and are raising families. The area between the abdominal muscles is often left permanently weakened after childbirth. All of the crunches in the world won’t eliminate this problem area. An abdominoplasty, or “tummy tuck”, can tighten and tone the stomach area. To accomplish this, a surgeon will literally cut out excess skin and pull the muscles in the abdomen tight. This surgery results in a flat stomach, but also winds up leaving a large scar near the pelvic region.

As for areas around the face that defy the slimming effects of exercise programs, liposuction may also be used to sculpt a youthful jaw line on patients under the age of 40. Those over 40, however, may have to resort to a full face-lift.

Even after having a successful liposuction or tummy tuck, you will still need to implement or resume a long-term regular exercise program. The rule seems to be: What comes off can come back. It is possible to regain the fat removed through surgery; your results are only permanent if you continue to adhere to a healthy lifestyle.

Depending on which part of the country you live in, these procedures can come with a very hefty price tag, ranging from$5,000 to $15,000 per procedure. Before you make such an investment, though, it pays to exercise some caution. Any type of surgery has serious risks associated with it, and before you make the investment, you should talk with your plastic surgeon about the downside as well as the benefits of the procedure you are considering.

After making such an informed assessment, tens of thousands of women choose to undergo these procedures every year, and usually do so with beautiful and successful results. Through the ability to take aim at very specific areas of the body, cosmetic surgery is one tool in the beauty arsenal that has the potential to mold an already fine physique into a living, breathing artistic statement.

 

Dr. Ronald Bergman

Pageantry Magazine

Winter 2005, Volume 26, Issue 4 

fall 2005 cover

Preserving Youth: It All Starts With Facing the Facts  fall 2005

Did you know that nearly 24,000 teenagers undergo some type of cosmetic procedure every year? The numbers provided by the American Society of Plastic Surgery alert us to a cold, hard fact: the quest to maintain a youthful appearance is beginning at a very young age.

A traditional face-lift is the invasive surgical route for women who already see the effects of gravity.  The majority of face-lift patients range from 40 to 60 years old.  A fairly new procedure called a feather lift is less invasive than a face-lift. A surgeon literally uses threads (almost like sewing) to lift the underlying tissue and contour the face. Since this is a new procedure, we truly don’t know the long-term effects or long-term complications of a feather lift, but it is becoming increasingly popular in younger patients who are not quite ready for a face-lift.

Pageant and modeling contestants typically compete in their teens, 20’s, and 30’s, and for these women there is an array of less-invasive procedures to tighten the face and reduce the appearance of wrinkles. The single most important thing you can do to preserve facial beauty is to use a doctor-prescribed skin care program. I recommend the Obagi Nu Derm program. Obagi skin care uses a combination of ingredients, including hydroquinone, which drastically reduces the appearance of freckles and other dark spots caused by sun damage. You will also use Retin-A or Renova in conjunction with the Obagi system. While originally formulated to treat acne, both Retin-A and Renova have proven to diminish and prevent wrinkles. Good skin care should start in your teen years.

Beyond great skin care, there are “filler” products that can be used to replace the collagen in your skin. These include human-based collagen Cosmoderm and Cosmoplast. These injections require a quick visit to your plastic surgeon, and literally fill in unwanted lines and wrinkles, such as crow’s feet, forehead lines, and vertical lip lines. Restylane is another product commonly used to fill in lines. Botox can be used to eliminate the frown lines between your eyebrows.

These procedures typically cost between $300 and $600 per area being treated. The results are not permanent. They should last three to six months, and then you will need to repeat the process. There are currently dozens of other filler products being used in Europe and in the testing phase, but they have yet to be approved by the Food and Drug Administration for use in the United States.

A chemical peel is another option for sun-damaged, wrinkled, or blotchy skin. There are minor peels and deep peels, which require sedation and extensive recovery time. Trichloroacetic acid and phenol are typically used in a peel. The result is much more toned, smooth, even-textured skin. As with any procedure, there are risks to peels and fillers, including droopy eyes, severe allergic reactions, and permanent facial damage. It is best to proceed with caution and be sure that your doctor is an experienced practitioner whose track record of success can be ascertained.

While these procedures can offer a marked improvement in a contestant’s general appearance, nothing will stop the aging process. A healthy diet, smoke-free lifestyle, and genetics are the most important indicator of how long you’ll hold on to your youth.

 

Dr. Ronald Bergman

Pageantry Magazine

Fall 2005, Volume 26, Issue 3

summer 2005 cover

Not Just a Matter of Inches  summer 2005

A woman who will be competing in pageants or pursuing a career in the entertainment industry and who is thinking about breast augmentation is obviously looking for an ideal size and shape that will be pleasing to the public. Getting that perfect look is a true form of artistry, and breast surgery for celebrities differs slightly from the typical breast augmentation patient.

The first concerns – and the most important concerns, are the choices relating to size and body proportion. The size of the appropriate enhancement will depend completely on the person’s body frame, bone structure, height, and the amount of body fat she has and where that fat is located. Pageant contestants tend to be of smaller size than the average woman and, therefore, will most likely require smaller sized implants so that she does not look “done”. The more natural the implant, the better chance a contestant has of winning the Swimsuit competition. Judges are not fond of giant, round, obvious breast implants. Patients need to know that if it is obvious to other people that implants are in place, the surgeon did a poor job. When in place, the breast implants should truly look and feel as though you were born that way.

Breast augmentation should match the waist-to-hip ratio. In other words, the implants should be in balance with the size of your waist, hips, and thighs. There is no set method for determining this ratio; rather, a surgeon that has a trained eye will be able to determine by examining each individual patient how large each patient’s breasts could be on their body without resulting in a fake-look. If a patient shows her doctor a photo of a size “double-D” model, but is a size “A” cup with small hips, the doctor will have to explain that she is not being realistic about the potential results, and will discuss with the patient which is a more appropriate course of action for her.

Among the types of breast implants are the round and contoured varieties. Many plastic surgeons will advertise that the contoured implants will create the more natural looking result. However, the more traditional round type of implants are just as natural looking and effective if the surgeon is careful, uses sizers before the permanent implants are put in place, and accurately fills the implants with the correct amounts of saline, keeping in mind that often each breast may need a different amount of fluid.

Often women will have breasts that are spaced too far apart and are looking to reposition them with implants. This is also possible to a small degree. The procedure requires advanced skill and technique, and the patient will not get a perfect result when it comes to repositioning, although often there is improvement in bringing the breasts closer together and creating a very natural looking cleavage.

Other personalities may be interested in breast reductions. If a woman is severely overweight, or has pain due to the size of her breasts, insurance may cover the procedure. However, because most of the competition participants aren’t overweight, a reduction for them is usually deemed to be an elective cosmetic procedure. These reductions can also result in beautifully proportioned breasts that will help many candidates look fabulous in the Swimsuit competition. However, one downside to reductions is the unavoidable scar tissue that results – which the augmentation procedures minimize and that often has disappeared within a year.

It is important to discuss with your plastic surgeon all of your breast enhancement or reduction options before making any decision regarding surgery. As always, be sure your board-certified plastic surgeon gives you access to “before” and “after” photos of patients (particularly pageant contestants). When done correctly, perfecting the look of a woman’s breasts can give her a definite advantage over the other contestants, particularly in Evening Gown and Swimsuit competition.

 

Dr. Ronald Bergman

Pageantry Magazine

Summer 2005, Volume 26, Issue 2

spring 2005 cover

The New Reality of Nip ‘n’ Tuck  spring 2005

No doubt by now you’ve heard about invasive cosmetic surgeries, including breast augmentation and liposuction, but as much as 80 percent of a plastic surgeon’s business can be non-invasive. Procedures such as Botox, Restylane, and collagen injections are quickly becoming the most popular cosmetic options. Much of the reason behind this is the low cost and lack of patient down time. Plastic surgeons’ clients can walk into the doctors’ office during their lunch hour for microdermabrasion or Botox and walk out an hour later looking 10 years younger for less than one might think.

The popularity of “plastic-surgery TV”, including shows such as Extreme Makeover and The Swan, has also made the concept of plastic surgery more appealing and acceptable. Women are no longer embarrassed about having “work done”, and often go public regarding how they obtained their new look. Celebrities and other well-known people coming out in public about their own plastic surgeries have given the industry a tremendous boost as well.

According to a published celebrity article, Patricia Heaton, Pam Anderson, Joan Rivers, Cher, and many more have all gone public about their surgeries. “We all have been nipped, butt pulled, do Botox, do collagen, lipo, starving all the time, and exercising,” says Patricia Heaton. “That’s why everybody looks that way.” Joan Rivers admitted having a number of procedures, and often jokes publicly about her “young but done” face.

The non- or low-invasive procedures such as lip injections and Botox make some women feel as if they’re just getting a little help, as opposed to full-blown surgery. I’ve found these relatively simple procedures often lead to women wanting an even bigger improvement, such as larger breasts or smaller thighs.

While the plastic surgery community welcomes the newly found star status of non-invasive procedures, there is risk to the craze. First, an attractive 30 year-old receiving Botox to correct a slightly wrinkled forehead is still going to be an attractive woman when she walks out of the plastic surgeon’s office. A 65 year-old will not look 30 no matter how much Botox you inject into her face. The reality is that non-invasive procedures can only slightly improve a person’s look. If you don’t have the basic canvas to begin with, we can’t make you gorgeous with a chemical solution.

In addition, there are still risks to non-invasive procedures, such as droopy eyes or even burns. Do not trust someone in a hair salon or manicure shop to laser, peel, or inject your face. We see a number of patients every week hoping we can fix a mistake made by an unqualified person.

“A lot of plastic surgery makes you feel fine, and now I feel fine,” said celebrity Sharon Osbourne in an interview late last year. As a surgeon, I must cringe a bit upon hearing these words, because plastic surgery should not make you feel fine. You should feel fine long before you walk in my door. If it is obvious a patient has self-esteem problems or other possible emotional distress, I will not perform surgery – invasive or non-invasive – on that particular patient.

Of course, I’m a huge supporter of plastic surgery and the choice for a woman to have work done. Just make sure you’re seeking Botox or fuller lips because you want a little improvement, not a new identity. The true star power lies within your own heart and soul. The most beautiful women I’ve ever seen are genuinely gorgeous on the inside first.

 

Dr. Ronald Bergman

Pageantry Magazine

Spring 2005, Volume 26, Issue 1

winter 2004 cover

When is Liposuction Contouring the Right Choice? winter 2004

Liposuction is a procedure intended for individuals who are already in good physical shape who wish to sculpt their body. It is not intended for weight loss or weight control. During the procedure, unwanted fat is removed from specific areas, including the abdomen, buttocks, thighs, knees, and upper arms. To be a good candidate for liposuction, you must have realistic expectations about the procedure. The best candidates are normal weight people with firm, elastic skin who have pockets of excess fat.

Liposuction may be performed in a surgeon’s office-based facility, in an outpatient surgery center, or in a hospital. Smaller-volume liposuction is usually done on an outpatient basis for reasons of cost and convenience. However, if a large volume of fat will be removed, or if the liposuction is being performed in conjunction with other procedures, a stay in a hospital may be required. The average cost of the procedure is between $5,000 and $15,000, depending on how many areas are being treated, and where the surgery is being performed.

Liposuction is a procedure in which localized deposits of fat are removed to recontour one or more areas of the body. Through tiny incisions, a narrow tube, or cannula, is inserted and used to vacuum the fat layer that lies deep beneath the skin. The cannula is pushed and pulled through the fat layer, breaking up the fat cells and suctioning them out. The suction action is provided by a vacuum pump or large syringe, depending on the surgeon’s preference. If many sites are being treated, your surgeon will then move on to the next area, working to keep the incisions as inconspicuous as possible.

Fluid is lost along with the fat, and it’s crucial that this fluid be replaced during the procedure to prevent shock. For this reason, patients need to be carefully monitored and receive intravenous fluids during and immediately after surgery.

While this is the basic technique in liposuction, several refined variations have been introduced in the past 10 years. These include fluid injections, a technique in which a medicated solution is injected into fatty areas before surgery in order to remove the fat more easily. There is also ultrasound-assisted lipoplasty (UAL). This technique requires the use of a special cannula that produces ultrasonic energy. As it passes through the areas of fat, the energy explodes the walls of the fat cells, liquefying the fat, which is then removed with the traditional liposuction technique.

After the procedure, the patient is fitted with a snug compression garment, which is worn for several weeks. Improvement will become apparent after about six weeks, when most of the swelling has subsided.

Liposuction is normally safe, as long as patients are carefully selected, the operation facility is properly equipped, and the board-certified plastic surgeon is adequately trained. Your doctor must have advanced surgical skills to perform procedures that involve the removal of large amounts of fat.

It is important to keep in mind that, even though a well-trained plastic surgeon is your best bet, there is no guarantee of a perfect result. Though they are rare, complications can and do occur. Imperfections in the final appearance are possible after liposuction. The skin surface may be irregular, asymmetric, or even “baggy”. Numbness and pigmentation changes may occur.

There is the possibility of infection, the formation of fat and blood clots, excessive fluid loss (which can lead to shock), friction burns or other damage to the skin or nerves, or perforation injury to vital organs. This is why it is critical to have a good surgeon. Steer clear of dermatologists and others who are not specifically trained to perform liposuction.

Once the fat cells have been removed by liposuction, these same cells do not grow back. The fat cells are gone forever. However, neighboring fat cells can grow to a tremendous size and make up for the missing cells removed by the surgery. In other words, if you gain weight and do not follow a healthy lifestyle, you will, in all likelihood, gain your fat back.

If your expectations are realistic, you will most likely be very happy with your liposuction results. You may find that you are more comfortable in a wide variety of clothes, and more at ease with your body. By eating a healthy diet and getting regular exercise, you will be able to maintain your new shape.

 

Dr. Ronald Bergman

Pageantry Magazine

Winter 2004, Volume 25, Issue 4

fall 2004 cover

With Breast Surgery, The Operative Word Is ‘Precaution’  fall 2004

Breast augmentation is the second-most-popular plastic surgery procedure in the United States, next to the rhinoplasty, or nose job. The best candidates for breast surgery are women who are looking for improvement – not perfection – in the way they look. Augmentation will enhance the bust line, creating a fuller, rounder, and more feminine silhouette.

Breast implants are often used to correct a reduction in breast volume after pregnancy, and the procedure also may be called on to balance a difference in breast size. Many women involved in the pageant, modeling, and entertainment industries choose to have augmentation in order to enhance their already fit figures. Most women report a renewed sense of confidence after the surgery, and successful augmentations result in improved satisfaction with how one looks in swimwear and other clothing.

First and foremost, creams and pills claiming to enhance breast tissue simply do not work; surgery is the only option for larger breasts. Breast augmentation is an outpatient procedure, and most surgeons can complete the operation in approximately one hour. The patient will spend an hour or so in the recovery room before going home.

The method of inserting and positioning an implant will depend on the woman’s anatomy and her surgeon’s recommendation.  An incision can be made either in the crease where the breast meets the chest, around the areola, in the armpit, or in the navel. Every effort is made to assure that the incision is placed so resulting scars will be as inconspicuous as possible. If she has a skilled surgeon, the woman may barely notice a scar one year after the operation.

Working through the incision, the surgeon will lift the breast tissue and skin to create a pocket, either directly behind the breast tissue or underneath the chest wall muscle, then each implant will be centered beneath the nipple. It is preferable for the surgeon to use sizers during this portion, and sit the patient up during surgery to make sure her implants do not look artificial. The implants chosen by the surgeon should fit as perfectly as possible. If it is obvious to others that breast implants are in place, the surgeon did not do a good job.

Implant Choices

There are many different types of implants, with saline implants being mandatory for first-time implant insertion and silicone implants, available for women participating in approved silicone implant studies. Implant styles vary as well, and can include smooth rounds, textured rounds, and anatomically shaped implants, among others. They vary in size as well, depending on the manufacturer.

 With the implants in place, the surgeon then determines how many cubic centimeters (cc) of fluid to place in the implant for the desired result. Some women will need as few as 120 cc, but there are implants available that may accommodate as much as 850 cc. A skilled surgeon will know whether the left and right breast are not of equal size, and will introduce different amounts of saline at this time to ensure an even appearance.

The patient is likely to feel tired after surgery. Some report a great deal of pain, while others take a Tylenol and go to dinner the following evening. Working women may return to work within two to three days, depending on their occupation. The stitches will be removed approximately on the 10th day following the procedure, and it can take several weeks or months for the swelling to disappear.

 

Considering Complications

Breast augmentation is relatively straightforward, but as with any operation, there are risks associated with surgery and specific complications may result from this procedure. The most common problem is capsular contracture, which occurs when the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or “scoring” of the scar tissue, or perhaps removal or replacement of the implant.

 As with any procedure, excessive bleeding following the operation may occur, requiring another operation to control the bleeding and remove the accumulated blood. Other rare complications include infection, uneven size, and scarring. Some women report that their nipples become oversensitive, undersensitive, or even numb. You may also notice small patches of numbness around your incisions. This is permanent in some patients. Occasionally, breast implants may break or leak. As with any surgery, there are other severe and unusual complications that can result in permanent injury or death. The surgeon should go over all of the possible complications with his patient prior to doing the procedure.

Choosing a Practitioner

There are many surgeons out there, and some will use snappy advertising and promotional gimmicks to lure patients. The best way to find a surgeon is by word-of-mouth; ask someone who has had the surgery what she thought of her surgeon. Ask for pre operative and post operative pictures; beware of a surgeon who won’t show his or her work. Ask a plastic surgeon to provide contact information for his last five to 10 patients who would be willing to speak about their experience with a potential client. Choose a board certified plastic surgeon who specializes in breast augmentation.

Once those qualifications are met, beware of discount breast implant and liposuction centers. The average cost of an entire augmentation – including surgeon fees, hospital fees, and anesthesia fees – runs between $4,000 and $10,000 nationally.

A woman’s decision to have her breasts surgically enhanced is a very personal decision, one that not everyone will understand. The important thing is how the woman feels about it. Breast surgery is most often a decision women are thrilled with.

 

Dr. Ronald Bergman

Pageantry Magazine

Fall 2004, Volume 25, Issue 3

 

Facial Rejuvenation without Surgery 2004

 The search for a youthful appearance is a multi-century quest. The Romans had bath houses (spas), and the ancient Egyptian women were the first to use alpha and beta hydroxy acids. They did so by applying milk, grape, and fruit extracts to their faces with the ultimate goal of improving the skin. Today, we have much more highly sophisticated options: lasers, intense pulse light, radio frequency, micro dermabrasion, filler products, and Botox, as well as oxygen and collagen creams and other over-the-counter products. So what really works on which wrinkles?

Through scientific studies, we know the only topical that can stimulate collagen and elastin to prevent and help with lines in tretinoin (marketed as Retin A and Renova), so our advice is: Save your money on over-the-counter products. They can help for dry skin or minimize the appearance of very fine lines, but they do nothing at the cellular level. Instead, see your doctor for some tretinoin. The alpha and beta hydroxy acids, at prescription strength, can also make the skin softer and healthier appearing, but offer no help for lines and wrinkles.

The lines of the upper face (crows feet, frown lines, and forehead lines) are caused by the action of facial movement, with heredity, smoking, and sun exposure also being contributing factors. Ablative laser procedures (which, by definition, are surgeries that require a recuperation period) and deep peels can stimulate collagen and elastin and improve lines, laxity, and wrinkles, but at increased risk. The non-ablative lasers, intense pulse light, and radio-frequency modalities give minimal improvements at best.  Micro dermabrasion improves only the very fine lines and will give the skin a softer, more youthful appearance, but it does not stimulate collagen and elastin.

That leaves us with Botox treatments, using botulinum toxin type A to temporarily paralyze the muscle, causing a significant reduction (if not resolution) of these lines. Contrary to some articles on the subject, Botox does not leave the face without animation. Initially, the effects last about three to four months. As the procedure is consistently performed, Botox will last longer and may be needed only one to two times per year. The complication of Botox that raises the most concern is the possibility of a lid or brow droop, which does not commonly occur if the treatment is performed by a skilled practitioner knowledgeable in the anatomy of the facial muscles. If a droop happens to occur, it typically lasts only a few weeks.

The lines around the mouth – that start at the side of the nose and extend to the corners of the mouth, and those that appear from the corner of the mouth and extend down to the chin – can be treated with Botox, but doing so is more risky than treating the upper facial lines, because a mouth droop could occur, causing the patient to look like he or she has experienced a stroke. A mouth droop can last for many months.

A better option for eliminating lines in the lower face is the use of filler products – Zyplast (bovine collagen), Cymetra and Cosmoplast (human collagen and elastin), and Restylane (hyaluronic acid) – which serve to fill in and plump up the areas under the surface of the skin where lines appear. The filler products are also used to treat acne scarring and to plump the lips. After the area to be treated has been anesthetized, the specialist uses a small needle to inject these creamy products with minimal discomfort. The procedures take about 15 to 30 minutes to perform in the doctor’s office, with touch-ups possibly required about one month later. After the desired correction is achieved, these products last an average of six to nine months, while some patients metabolize these products more rapidly and may require more frequent procedures.

The most common side effects of using filler products are bruising and swelling, lasting from 24 to 48 hours. Unevenness can be corrected with subsequent procedures. Rarely, filler products can enter a blood vessel, causing a loss of blood supply to a small area and resulting in a breakdown of tissue and potential scarring.

Nothing can replace a face-lift to correct certain problems – jowling, laxity, or baggy eyes – but these non-surgical options give us choices for facial rejuvenation before or after any other surgical intervention.

 

Dr. Ronald Bergman

Pageantry Magazine

Volume 25, Issue 2, Summer 2004

 

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