Sometimes is seems there is no limit to the new uses doctors will find for Botox (and its Johnny-come-lately-cousin, Dysport).

On ABC's medical talk show yesterday, Dr. Drew (the show's resident plastic surgeon) demonstrated a technique that can minimize an overly "gummy" smile. With this method, Botox is injected into the muscle responsible for lifting the lip into a smile. The nerve impulses that tell the lip to lift are weakened, and voila--less gum showing!

The side-by-side before and after photos showed what I personally felt was little difference. Yet of course, the patient treated on the show was very happy with her results. (Otherwise I'm guessing they might have opted to skip the segment altogether.)

If you have a too-gummy smile and feel you would be happy with a slight-moderate improvement that lasts 3-6 months, then this procedure may be worth looking into. However, it is important to understand that Botox injections are not without risk, especially when used in the area around the mouth.

If you choose to go for it, be very careful to choose a doctor who has extensive experience using Botox for this specific procedure. If you make the wrong choice, and the doctor over-injects or injects in the wrong place (which could be within just a couple millimeters of the right place), and you could be left unable to smile at all until the Botox wears off in about 3-6 months.

See plastic surgery before and after photos.

Life isn't fair. Especially if you're a woman. We are expected to be the "fairer" sex -- to get our bodies right back into shape after pregnancy, a la celeb super-moms like Heidi Klum and Jessica Alba. We compare our faces to the plump, smooth, impossibly even-toned visages of perpetually youthful stars like Demi Moore and Nicole Kidman. We bemoan the perception that men become more "distinguished" with age, while we simply get older.

To add insult to injury, a recent study has just proven that, yes, women are more likely than men to have more (and deeper) wrinkles at least in one area of the face -- around the mouth. These wrinkles (known in medical terms as perioral wrinkles) are believed to be more severe in women for several reasons:

• Compared to men, women's perioral (around the mouth) skin contains fewer sweat and sebaceous (oil) glands. The presence of these glands is believed to provide some protection and lubrication to the outer layers of the skin, as well as natural plumping of the deeper layers of skin.
• Compared to men, women's perioral skin contains fewer blood vessels. More blood vessels mean more oxygen and other nutrients are delivered to the skin. More oxygen and nutrients = more resilient, youthful skin.
• Compared to men, the muscular fibers surrounding a woman's mouth have a closer, tighter attachment to the dermis. It is believed that this may cause a downward pull on the skin's surface, thereby creating more pronounced wrinkles.

Treating wrinkles in this area of the face is challenging, because the use of Botox in this area is generally not recommended. Currently, the only ways of treating this area are the use of injectable dermal fillers, chemical peels, and laser resurfacing. Although not unheard of, it is interesting to note that attempting to correct perioral wrinkles through surgical means (like a face lift) can result in an odd-appearing, "pulled" look around the mouth.

The results of this study are important to cosmetic medicine because we are constantly striving to come up with better ways to prevent and treat perioral wrinkling. To this end, we must develop a better understanding of why women wrinkle more in this area. Ergo, this study's findings, while depressing for women everywhere, are nonetheless useful.

It seems there is a new "breakthrough" in cosmetic medicine every day. Introducing Zerona---one of the latest, most-hyped entrants into the non-invasive cosmetic procedure market. If you haven't heard of it yet, you haven't been paying attention while Zerona was making the rounds on such popular  TV shows as Extra and Rachel Ray, among others.

Zerona is a laser device that looks like something straight out of a science fiction movie, with multiple laser-emitting "tentacles" projecting this way and that from a dark and ominous-looking base. The treatment is applied externally to fatty areas of the body (no incisions required). The claim is that Zerona's low-light lasers emit targeted energy which penetrate through the skin and cause the fat cells to release their fatty contents into the space between the cells, where they are then swept away by the body's own waste elimination mechanisms.

Physicians using the device claim that their patients are losing, on average, a total of 3-6 inches (measured at multiple sites) in a 2 week-long series of 40-minute treatments. This is the equivalent of losing 1-2 liters of fat. Treatments are given every other day during the 2-week period, and the average cost for a series is $2,000-$3,000. 

The results are undoubtedly more subtle than with surgical liposuction. Moreover, in many cases the cost isn't significantly less. However, for a person who is wary of going under the knife (not to mention anesthesia) to achieve her body contouring goals, Zerona could be quite appealing. Zerona is also touted as imparting a subtle skin-smoothing effect on treated areas.

Like any other emerging technology, one must weigh the pros and cons. The upside: no scalpel, no anesthesia, no pain, no downtime.

On the other hand, the biggest downside of any brand new procedure is that it is essentially unproven. There are no long-term studies to indicate how long the results from this procedure may last or what other long-term effects it may produce. In addition, there is no guarantee of the extent of your results with Zerona (although some doctors are offering a partial credit up to $1,000 toward surgical liposuction for patients who don't lose at least 3 inches with their Zerona treatments).

What do Tampa, the Bronx, and Argentina have in common? All boast recent tragic headlines about deaths related to large-volume injection of permanent filler substances used to enhance the buttocks.

The injections in question involved the use of large amounts of synthetic substances such as polymethylmethacrylate (PMMA), silicone, and polyacrylimide to augment areas of the body like the buttocks and breasts. The Physicians Coalition for Injectable Safety warns that this practice can cause disfigurement, serious permanent injuries, and even death, as has been shown in real cases both in the U.S. and overseas.

In the U.S., the PMMA-based filler Artefill is the only permanent filler which is approved for use as a cosmetic injectable. However, it is not approved for injection into the buttocks or breasts. As of this writing, the only methods of buttocks augmentation which are accepted by the medical community (and supported by studies on safety and effectiveness) are the injection of the patient's own (autologous) fat and the use of FDA-approved implants.

While there are legitimate off-label uses for a variety of dermal fillers, any ethical cosmetic surgeon or dermatologist will tell you that large-volume injection of permanent synthetic fillers is a dangerous practice. The risks range from things like infection and granulomas to necrosis, kidney failure, and pulmonary embolism.

In short, for the sake of your looks, your health, and possibly even your life, it is exceedingly important to seek out a well-qualified physician who understands what types of injection procedures are unproven at best, potentially fatal at worst.

See plastic surgery before and after photos.

Last night at a children's birthday party, I was (once again) asked one of my least favorite questions: "Are they real?"

Don't get me wrong---I am not the least bit ashamed of the fact that my breasts have been enhanced by modern medicine. I have been known to share the information unsolicited if the time (and the audience) is right. In fact, it occurs to me that I have just "outed" myself to a whole lot of people reading this blog. However, let me be clear: I do think it's rude to ask, especially in a crowd of people, even more so if you really don't know the person.

I was still thinking about the rudeness of this question this morning, and I remembered that I had posted a poll about it a few months back. I decided to search and revisit that poll so I could get an idea of the general consensus: Is one's breast augmentation status fair game for casual party conversation? The results? 42% say it depends on how well you know the person, while 36% say it's rude no matter what.

That settles that. But as I was perusing my own poll results, I came across another interesting breast-related poll and related article posted by About.com's Guide to Urban Legends. Find out if ogling women's breasts really increases life expectancy in men.

More Ta Ta-Tastic Polls:

• What's The "Perfect" Breast Size?
• Real or Fake: Can You Tell?
• What Do Men Really Think About Fake Breasts?

See plastic surgery before and after photos.

Cosmetic surgery. It isn't just for vanity any more.

Recently, ABC's medi-centric talk show, The Doctors, featured a story about emerging technology that allows liposuctioned fat to provide medical benefit for patients with a variety of diseases and disorders. This benefit comes in the form of stem cells.

After being suctioned from parts of the body where it is unwanted, the fat is purified and the stem cells isolated. The idea is that these valuable cells can then be "programmed" to become any type of cells, including brain, heart, or spinal cord cells.

The technology is brand new, so don't expect miracles just yet. However, the potential is huge. Advantages of using body fat for stem cells are clear:

• Fat carries none of the controversy associated with other stem cell sources such as embryonic stem cells.
• Using a patient's own fat cells means that a "match" between recipient and donor is certain.
• Most patients have a plentiful (and renewable) supply of fat cells for harvesting. (no need for banking)
• The technique makes good use use of something that would otherwise be disposed of. (think green!)

See plastic surgery before and after photos.

Dear Santa,

I have been a very good girl this year. And so, I am writing you this letter to give you my Christmas wish list. If it's not too much trouble, I would like:

1. a higher brow and more "wide-awake" eyes
2. smoother skin
3. perkier breasts
4. a tighter, firmer mid-section

If you can make this happen, I promise I'll be even better next year!

Sincerely,

Saggy in Seattle

PS Since I plan to eat a lot of cookies over the holidays, maybe you could throw in some lipo too? I heard that Smart Lipo is excellent!

In this season of gift-giving, I'm sure there are more than a few people putting cosmetic surgery on their wish list. Or not?

Would you be offended if a loved one offered, as your Christ-sol-hanu-kwanzaa gift, to pay for your cosmetic procedure? Or would you be overjoyed? Is it akin to a gym membership present (okay for a few, a risky choice for most)? Is it appropriate only if explicitly asked-for by the recipient? Is it too much to ask for?

What do you think? Is cosmetic surgery a good gift for the holidays?

My 7 year old son went to his school's "Holiday Shop" yesterday and came home with presents for loved ones, along with one he got for himself: a money jar with the words "Facelift Fund" emblazoned on the side. No, my child is not saving for a face lift. (He just liked the color of the jar, and plans to use it to hold the overflow from his extensive rock collection.) But it got me thinking. In these fiscally challenging times, how are people paying for plastic surgery?

Do you have a face lift jar? A special account where you save for "me" purchases (separate from your retirement savings or kids' college funds)? Are you planning to put it on a credit card? Does your surgeon offer a financing plan? Or are you hoping your insurance plan will pay for your procedure, at least in part?

Weigh in on the poll: How are you paying for your cosmetic procedure?

Most people in the U.S. agree that we need some sort of health care reform. It's how we go about -- and more importantly, how we fund it -- that is the big question dividing us into separate camps.

One revenue source currently on the table is adding a 5% tax on all cosmetic surgery. Such a tax has been proposed in numerous states over the years and rejected after examining the feasibility. The only state to approve such a tax has been New Jersey (which boasts the highest overall tax burden per capita in the nation). Critics in the state say the tax has failed to realize expected profits, and point out that the bill now faces opposition from the same legislators who approved it in the first place.

Not surprisingly, the American Academy of Cosmetic Surgery (AACS) has issued a press release opposing the new tax. "Activating a cosmetic surgery tax is not the solution to funding a health care overhaul," states AACS Immediate Past President Dr. Steven Hopping.  AACS arguments against the cosmetic surgery tax include the following points:

• A tax on elective cosmetic procedures is an unreliable, risky revenue source that has no proven record of raising projected revenues.
• The difficulty of defining elective vs. medically-necessary cosmetic surgery. There is a blurry line between what procedures are considered medically-necessary and those that are elective.
• Retention of highly-skilled physicians is at risk. Physicians face many challenges in operating their practices on a day-to-day basis.  Turning them into tax-collectors is an additional burden on these doctors.
• Cosmetic surgery is not a specialty for only the wealthy or the vain. In fact, the median income for those electing to have cosmetic surgery is dropping.
• Despite the fact that more men are seeking cosmetic procedures than ever, the largest portion of patients are still working women, who would be unfairly targeted by such taxes.
• A large portion of those being taxed would be the baby-boomer generation. And as this age group continues to age, the more interest will be generated in cosmetic procedures. It is important to note that the age bracket are most likely to vote in elections is the same as those who are electing to have cosmetic procedures.

Personally, I'm not sure if I buy into all of those arguments. On one hand, cosmetic surgery is not a necessity. On a $10,000 face lift, 5% is an extra $500. The tax on a new pair of breasts, on average, would be about $300. If you can't afford the new tax, the answer is simple: Don't have the surgery. But ah, there's the rub. If fewer people end up having cosmetic surgery due to the tax, then both the anticipated revenue and the economy pay the price.

What do you think? Is is a risky move to burden an already-flailing business (and current statistics do say that the business of cosmetic surgery is having trouble in this economy) with a brand new tax? Is an extra $500 going to make a difference to those who who have been saving up to pay a doctor to turn back the hands of time? Do you worry that doctors might start cutting corners to be able to keep their fees the same and stay competitive? Does patient care suffer? Or do you think anyone who is having surgery for vanity's sake should be willing to chip in to help pay for reform that will help people with legitimate medical needs?

Weigh in on the poll and share your reasons for your answer.

First, let's just say that any Atheists and/or Agnostics may feel free to replace the word "God" with "nature" throughout this article.

Second, I am going to play devil's advocate - pardon the irony - to those who believe plastic surgery is somehow morally wrong because "Who are we to mess with what God made?"

If God brought you into this world in poverty, do you owe it to Him to stay there?

If you were born with webbed fingers, is it an insult to God (and therefore, a sin) to have your deformity corrected so your hands can be fully functional?

If God decided you were meant to lose your eyesight (even when there's a laser surgery that could preserve it), do you think He would be offended if you had the surgery?

Now you may be thinking that these questions are not relevant to cosmetic surgery because these things are all related to health and function, not vanity. Okay then. I have to ask you now: Did God give you pierced ears? Did God give you cut, styled, and colored hair? Did He make you with colored eyelids and glossy lips and painted nails and powdered skin? Were you born with clothes on?

Of course I'm not implying that everyone should run out and have plastic surgery. I'm not speculating that God likes plastic surgery, or saying that vanity is a good thing (although I don't believe a little vanity is necessarily a bad thing either). I'm just saying, if you believe in God, you must also believe that He gave us each certain gifts that we can use to improve our health, our station in life, our base of knowledge, and yes, even our appearance. When someone gives you a gift, isn't it fair to assume they want you to use and enjoy it?

Still others disparage cosmetic surgery as a selfish act. Well, yes...and no. To keep this post from getting too long, I'm going to refer you to another post about the morality of having plastic surgery in these trying times. Maybe it will help you see things from a new perspective.

Agree with me? Disagree? Let your feelings be heard by taking part in this related poll on the morality of plastic surgery.

To sum it up, I never read anything in the Bible (and I don't believe it is in any other Holy books either) that says "Thou shalt not have plastic surgery". I have, however, read the part where it says, "Judge not, lest ye be judged." And that's good enough for me.