Lynn Shapiro, 59, of Bridgeton, N.J., has no idea how much she has spent on twice-a-year facial injectables in the past few years, and she’s not interested in finding out. She just knows that she likes the way she looks and is thrilled about the way she feels. “Whatever I’m spending,” she says, “it’s worth it.”
Baby boomers received more than 1.1 million injections of Botox and hyaluronic acid in 2009, a 15 percent increase over the year before, according to the American Society of Aesthetic Plastic Surgery, and the trend shows no signs of slowing.

The generation whose mantra could be “50 is the new 30” does not intend to grow old gracefully. It doesn’t want to age the way its parents did, and it doesn’t have to. In the past eight years, a new field of cosmetic medicine has emerged, focused on fillers and injections and giving anyone with a credit card the option of looking younger and more refreshed without going under the knife.

But it can be costly. Injectables such as Restylane, Juvederm and Radiesse range from $345 to $800 a syringe, depending on the doctor. And they last only six to nine months before a redo is needed.

“When you add it up over time, it can be more than the cost of a surgical procedure,” says Scott Bartlett, professor of surgery at the University of Pennsylvania and chief of pediatric plastic surgery at the Children’s Hospital of Philadelphia.

In Shapiro’s case, the desire for facial rejuvenation arose in 2002, shortly after she recovered from a serious operation to remove a growth from her spine.

“When I learned it was not malignant, I began to look at life differently,” she says. “I wanted to do the things that would make me feel better and enjoy myself more.”

Since then, she has had countless injections with facial fillers to treat depressions under her eyes and chin, and with Botox to erase the lines in her forehead. In February, she had blepharoplasty to remove excess fat from her upper eyelids.

“The skin over my eyes was droopy and made me always look tired or angry,” Shapiro says. “I was neither.”

Blepharoplasty is the most common cosmetic surgical procedure performed on baby boomers, ahead of face-lifts and liposuction. There were 70,218 done last year, down from 91,806 in 2008, according to ASAPS. Experts say the trend is due to the dismal economy and the rising use of fillers, injections and skin-tightening lasers.

“In today’s times, when people can’t afford to be away from work for long, alternatives to blepharoplasty are more attractive,” plastic surgeon Kevin Cross says.

Still, eyelid surgeries are here to stay, he says.

Cross is medical director of Deme, a glitzy aesthetic center with locations in Center City and Devon that assembles specialists in cosmetic surgery, dentistry, skin care, nutrition and mental health.

But it is not just plastic surgeons who specialize in injecting facial fillers and Botox. Dermatologists, internists, general practitioners and ophthalmologists do it, too. The administering of fillers is a lucrative business that caters to men and women who crave instant youth. They are willing to pay for it out of pocket, as insurance rarely covers the procedures. Shapiro’s fillers and eye surgery were done by Marc Cohen, who is board-certified in ophthalmology and cosmetic surgery. Cohen has offices in Voorhees and Bala Cynwyd.

“Eyelids are the most complicated and challenging part of the face on which to work,” Cohen says. “They are delicate structures, and the key is to achieve a look that is natural, attractive and preserves function.”

Over the years, Cohen says, the approach has changed significantly. “Pick up any magazine and you’ll see that people look younger when they have fairly full upper eyelids, not the hollowed-out Marilyn Monroe look that people used to envision when they considered cosmetic eye surgery. So we remove less tissue than we used to and we use fillers – both under the brow and beneath the lower lids – to add volume and create those more youthful, sweeping curves.”

Fillers do not replace surgery, but they can often postpone it. Meanwhile, the plumping up of wrinkles and lines, creating cheekbones and voluptuous lips, can restore the sought-after look of days gone by. And for those without the sagging necks and bulging jowls that beg for face-lifts, fillers may be enough to satisfy them.

Twenty-five years ago, Penn’s Bartlett could not have imagined how dramatically the field of facial rejuvenation would change, he says. With the arsenal of techniques available today, he suggests consulting someone with “more than one club in his bag.”

“If you go to someone who does nothing but inject, that’s all he’ll be able to offer you,” he says. “A plastic surgeon who uses many different strategies and understands the anatomy of the face can tell you what’s best for you.”

Marianne Daria of Bryn Mawr is not quite a baby boomer, but at 43 she wants to get a head start against aging. Several times a year, she visits the Havertown office of internist Norbertus Robben, whose practice now is only cosmetic medicine. Patients say they receive pleasing results and modest prices.

Daria receives treatments with Botox and fillers and has had nonsurgical laser skin tightening. Fillers such as Restylane, Juvederm and Radiesse can range from $345 a syringe (Robben’s price) to $650 to $750 (Cross’ price) or even more. Skin-tightening treatments generally begin at over $1,000 depending on the type of treatment and who’s giving it.

Robben asks his patients to prioritize what bothers them most, and typically they’re on target, he says. Most often, they point out the nasal labial folds, the marionette crevices that run from the corners of the lips to the chin, the hollows under the eyes and the “smoker’s” lines above the lip – which all can be addressed with fillers. “If they are looking for more than what I can offer them, I’ll suggest they see a plastic surgeon,” Robben says.

Toni Rosen, 52, a French and Spanish teacher who lives in Bryn Mawr, doesn’t think she’s ready for plastic surgery and likes the results of the fillers she gets from Cross a couple of times a year. She has had the lines above her lips treated, as well as the depressions under her eyes and the deep folds between her nose and mouth.

If she remembers to stop taking her once-a-day baby aspirin a week before the procedure, she says, she experiences no bruising. Otherwise, she may have a minimal black-and-blue marking that lasts for three or four days. The numbing cream that is applied a half-hour before the procedure keeps her pain-free while Cross is injecting her.

“Every doctor has a different aesthetic sense,” Rosen says, “and Dr. Cross is a perfect fit for me.”

When Rosen first came to Deme in April 2008, she was also seen by Betsy Rubenstone, a licensed aesthetician and director of Deme’s medical skin-care division. Since then, she has seen one of Rubenstone’s aestheticians for microdermabrasion and a laser treatment. Every day, she cares for her skin by using brightening exfoliation pads, a hydrating mask, a peel/bleach cream and a tinted moisturizer, all products Rubenstone prescribed for her.

“I like having healthy-looking skin,” she says, “but I won’t go to extremes. I’m putting my money into the fillers because I think they make such a difference. The guy behind the counter at the pizza place used to tell me I looked tired when I felt peppy and full of energy. Now I realize it was just that my face was losing volume and my cheeks were beginning to sink in. I’m going to go back there and see what he says now.”
By GLORIA HOCHMAN
For the Inquirer

Thinking of a little nip tuck? A new survey reveals the perfect age for plastic surgery is 52 years, 41 weeks and four days.

That’s right. Not only are more and more women considering plastic surgery — 1 in 3, in fact — the average woman now thinks 52 is the ideal age for cosmetic procedures ranging from face lifts to eye lifts, Botox and tummy tucks.

In a survey conducted by London’s beauty and health retailer, Superdrug, 3,000 women aged 40 to 65 were found to be increasingly image conscious when asked about their willingness to undergo plastic surgery.

Some of their responses included:

– If money were no object, a fifth of women would get a face lift.

– 25 percent would opt for an eye lift.

– 29 percent would get a tummy tuck.

And even among those who wouldn’t undergo the knife, 29 percent would choose Botox or chemical peels.

On the shocking side, it seems that many women favor looks over money: Almost 29 percent would rather look 20 years younger than be a millionaire. And when asked who the perfect aging role model is, the overwhelming choice was Twiggy.

Dr. Darren McKeown, a London-based cosmetic doctor told the Daily Mail that the popularity of certain treatments is not only celebrity driven, but career driven as well.

“When you’ve been in a company for a long time and have younger colleagues snapping at your heels the last thing you want to do is look tired. The average age of my client is in their forties.”

Plastic surgery is not the only way women over 40 are fighting the aging process. Men and women over 50 are now ten times more likely to use fake tanning lotion or tanning beds and 14 times more likely to use anti-wrinkle cream. And 15 percent of women over 50 admit to still wearing padded bras (five times as many as their mothers at the same age).

Why all the fuss to look younger? Sixty-two percent believe they are more likely to be judged on their appearance than previous generations.

by Deborah Dunham

On February 17, 2002, Devin was on his way to becoming a suicide statistic. Due to a variety of family issues, the then-twenty-three year-old took the Winchester 12-gauge shotgun given to him on his 16th birthday, checked then closed the barrel, and placed it under his chin. He never heard the blast.

Whether due to the shotgun’s extended barrel or other factors, Devin was not destined to end his life on that day. Rather, he became one of the 80,000 patients of ASPS Member Surgeons who undergo maxillofacial surgery each year.

Devin’s suicide attempt left him without his nose, the lower third of his jaw, both lips and all but six of his teeth. In the following two-and-one-half months, Devin endured multiple surgeries: muscle flaps transplanted from his chest to provide blood supply and restore bulk to his face; bone and tissue relocated from his ribs to rebuild his nose and from his leg to reconstruct his jaw.

In 2006, ASPS Member Surgeons performed over 1.6 million reconstructive plastic surgeries, restoring function and appearance to patients with degenerative disorders, birth defects, and severe injuries of the body.

While recovering from his multiple surgeries, Devin underwent a transformation – his primary focus became other people, beginning with his mother. Unable to speak, Devin communicated by using a writing board, and one day he scribbled, “Sorry. I didn’t mean to hurt you. I’ll never do anything like that again.”

He began to realize that there must be others like him—that there were likely other high-school aged kids who were contemplating suicide, as he had long before his attempt.

Devin shared his thoughts with his surgeon, who put him in touch with a suicide prevention group called the Yellow Ribbon Program and Community for Hope. Shortly, thereafter, Devin began speaking to middle- and high school groups.

Devin’s presentations begin by passing around a photo of himself before the suicide attempt, while telling students about his mohawk, tattoos, piercings, and desire to enjoy his “new” life. His goal? To draw attention away from his face, allowing students to “see” his personality.

However, the most important lesson, Devin tells them, is that they should never be afraid to ask for help, that the Yellow Ribbon Program makes getting help easy.

“The program is a godsend,” Devin says. “I didn’t know about it, or I wouldn’t have attempted suicide. I wouldn’t be here talking about my life.”

Occasionally, a student in crisis will reach out after a presentation. One student took the time to write: “I used to have so much to deal with and it was hard and sometimes I would get scared and wonder why I was here? And it might be better if I run away or hurt myself or maybe commit suicide. . . And then I heard your story and I realized who else I would have been hurting and what I almost did.”

It is just this type of response that fuel’s Devin’s desire to continue helping others in need.

Former Denver Broncos tight-end Reggie Johnson was playing with his 5-year-old son, Reggie ll, in May, when he suddenly found himself gasping for breath.

“I could barely get up the steps,” says Johnson, 42, who weighed 307 at the time. “I was huffing and puffing. I knew I had to do something.”

And he did. Johnson went from eating 3,000 calories a day to about 1,800. “I stopped playing football, but I still ate like a football player,” he says.

Johnson began a medical weight loss program, began walking, and lost 40 pounds in three months.

But there were some stubborn pockets of fat around his abdomen he just couldn’t lose.

So Johnson, now a sales consultant for Coastal Wine and Spirits, decided to get SmartLipo, a laser-assisted cosmetic surgery procedure designed to be less invasive than traditional liposuction, but with the same results and less downtime.

“I’m just enhancing myself,” says the Florida State University graduate, who now weighs 268. “I don’t see anything wrong with a man that wants to look better.”

A growing number of men are turning to plastic surgery to help them look and feel better about themselves. Some are looking for an edge in the job market. Others have found themselves back in the dating pool, or they’ve been inspired by wives who had their own cosmetic procedures.

While women still account for most cosmetic procedures, last year, 200,000 men had something “done.” That’s about 13 percent of all cosmetic procedures, according to the American Society of Plastic Surgeons. And there was a whopping 42 percent increase in minimally invasive cosmetic procedures among men from 2000 to 2009, according to the ASPS.

“I don’t think its taboo anymore,” says Khalid Saeed, a doctor of osteopathic medicine who practices at Clarity MedSpa√ in Land O’ Lakes. “More and more you see it out in the news, (male) Hollywood figures who are openly talking about their procedures and how they’re keeping up. The technology is there, there’s no need to be shy anymore.”

Saeed says women start visiting the plastic surgeon’s office in their 30s and 40s with a plan to enhance their looks. Men usually start showing up in their 40s and 50s.

Most of his male clients choose procedures like SmartLipo and Botox (to help smooth wrinkles) because they don’t cause a lot of bruising or require a long recovery time, and you can see results quickly. Botox continues to be the most popular noninvasive cosmetic procedure for both men and women. Other top surgical procedures for men include rhinoplasty (nose reshaping), eyelid surgery; breast reduction surgery for enlarged male breasts, and hair transplants.

“Most of the men we see in our practice are athletes or previous athletes,” Saeed says. “Back in the day, they played professionally or had athletic prowess. And now, you get a little older and Father Time is catching up with you. They want to freshen their look, stay competitive and just feel better about themselves. But they don’t want to spend a lot of time doing it.”

After doing some research, Johnson settled on SmartLipo because he could resume normal activities the next day. He was awake listening to music during his Oct. 6 procedure.

SmartLipo is similar to traditional liposuction, but less invasive. The incisions are smaller, which leaves little scaring; it doesn’t require general anesthesia and there is little bleeding, which makes recovery quicker.

Johnson’s SmartLipo cost $6,000; the price can vary from $2,000 to $6,000 depending on the area covered. Most men opt to have their abdomen, flanks and “love handles” worked on.

The procedure takes about three to four hours. Patients go home with a bandage covering the small incisions, but no stitches. And they must wear a compression belt for at least three weeks.

Recovery time varies, but most patients can show off their new bod after about two weeks. It takes about three months to see optimum results and skin tightening, Saeed says.

The best candidates are men and women who, like Johnson, have a body mass index under 30, exercise regularly and are in good health.

“The procedure really isn’t for debulking,” Saeed says. “It’s for sculpting areas of fat that just won’t go away because of genetics.”

Two days after his procedure Johnson was impressed with the results. He’s not ruling out more surgical procedures in the future.

“I want to look good for me and for my wife,” he says. “I didn’t like the way I looked, and I did something about it. I’m not shamed. I feel better about myself, and its going to show.”

Reporter Cloe Cabrera

SmartLipo is a brand of equipment and is not less invasive than traditional liposuction. A great result does not come from a particular brand or technology, but a great Board Certified Plastic Surgeon. Only plastic surgeons receive training in cosmetic procedures during their specialized residency. Physicians who are not plastic surgeons have usually received a few hours of training from the manufacturer of the equipment.

An Afghan woman whose ears and nose were cut off by her abusive husband as punishment for running away – and whose mutilated face featured on the front of an international magazine – has undergone extensive plastic surgery.
The 18-year-old, Aisha, was featured by Time magazine in an article that revealed how her husband, a commander in the Taliban, had disfigured her and left her to die.
The magazine also helped arrange for her to travel to the US for the reconstructive surgery.
The young woman displayed her new face at a fund-raising event held in Los Angeles for the Grossman Burn Foundation, which performed eight months of surgery.
She was presented with an “Enduring Heart” award by Maria Shriver, the wife of California’s Governor Arnold Schwarzenegger, who told her: “This is the first Enduring Heart award given to a woman whose heart endures and who shows us all what it means to have love and to be the enduring heart.”
The young woman replied in English: “Thank you so much.”
Aisha, who asked that her family name not be used, was married to a Taliban fighter when she was aged just 12 when she and her sister were handed over in order to settle a family debt according to local custom known as baad. The girls reportedly endured many years of abuse, and were forced to sleep in a stable with the fighter’s family’s animals.
Aisha was often beaten and her in-laws treated her and her sister like slaves.
Eventually Aisha ran from the house but her husband – who returned from fighting inside Pakistan in order to find her and restore “family honour” – tracked her down in Kandahar. He took her back to Oruzgan district where he lived and on the way he cut off her nose and ears.
Essentially left for dead, she managed to crawl to the house of her uncle but he refused to help her. Eventually a relative took her to a US-operated hospital.
“Aisha is only one example of thousands of girls and women in Afghanistan and throughout the world who are treated this way. Aisha is reminded of that enslavement every time she looks in the mirror,” Rebecca Gray Grossman, the foundation’s chairwoman, said in a statement. “But there are still times she can laugh. And at that moment you see her teenage spirit escaping a body that has seen a lifetime of injustice.”
There is a lot more work ahead for Aisha. Experts say the reconstruction of her mutilated face is to continue and she is to stay on in California with host families who are providing her with accommodation.

By Andrew Buncombe, Asia Correspondent
Thursday, 14 October 2010