April 7, 2008 -- A recent report suggests that despite worries over an economic downturn, Americans are still spending money on procedures intended to make them look better. The annual report, issued last week by the American Society of Plastic Surgeons, showed that the number of cosmetic procedures performed continued its steady rise last year to a total of nearly 12 million.
"The report tells me Americans are devoted to looking and feeling their best," ASPS president Dr. Richard A. D'Amico said in a statement on the report. "High demand continues for less invasive and relatively less expensive procedures, but there were also promising rebounds in some surgical procedures."
But while consumers continue to flock to doctors in the hopes of improving their appearance, plastic and cosmetic surgeons and dermatologists say there are a number of procedures of which consumers should be especially wary.
The entries listed here represent 10 cosmetic procedures that -- for most people, at least -- are least likely to offer results that justify their risks.
A Jab to Dissolve Fat? Mesotherapy and Lipodissolve
Several cosmetic surgeons and dermatologists agree that if there is one procedure to avoid when shopping for a slimmer look, it's one called lipodissolve -- a shot that is purported to dissolve away stubborn fat deposits.
This shot is often part of "mesotherapy" -- a shallow injection of a cocktail of substances using a fine needle.
"There is really not a single scientific study to show that it definitely works," said Dr. Malcolm Roth, director of plastic surgery at Maimondes Medical Center in Brooklyn, N.Y. "Are these chemicals safe when injected into fat? And what happens to this fat? Where does it go?
And Dr. Carolyn Jacob, a board certified dermatologist in Chicago, calls lipodissolve the most ill-advised treatment available today.
"This is a non-FDA approved use of a material called lipostabil, which can dissolve fat and other structures," she said. "However, it can cause pain, swelling, hard lumps, ulceration of the skin, and contour irregularities."
"None of the pharmaceuticals used for injection are FDA approved," said Dr. Susan Kaweski at the Aesthetic Arts Institute of Plastic Surgery in San Diego. "There have been no double-blinded studies revealing the mechanism of diffusion of solutions following injection, the precision and control of fat destruction by the chemicals or the long- and short-term effects of the drugs."
Despite the dangers of the procedure, the growing number of clinics offering lipodissolve is a testament to its continued legal status in the United States. Still, the procedure is banned for cosmetic purposes in Brazil and other countries.
"Most physicians performing this procedure do not have training in liposuction, plastic surgery or dermatologic surgery," Jacob says. "Even dentists are doing it."
A Sexier Step: Cosmetic Foot Surgery
Those who desire cosmetic surgery from top to toe should be no strangers to cosmetic foot surgery -- a collection of surgical and minimally invasive procedures designed to yield a sexier foot.
Despite the continued popularity of these procedures, which involve everything from filler injections to round out angles to total surgical reshaping of the foot, doctors have been warning consumers away from cosmetic foot surgery for years.
"The public needs to be aware of the risks associated with these procedures," said the American Orthopaedic Foot and Ankle Society President Dr. Glenn B. Pfeffer. "Women need to know what they are getting into."
He noted that the trend toward the practice of cosmetic surgery raises serious concern when one considers the risks of surgery on painless feet. "Complications can include infection, nerve injury, prolonged swelling of a toe, and even chronic pain with walking," Pfeffer said.
Not surprisingly, the sector of consumers that tends to be the most enthused at the prospect of better-looking feet are women who hope to adorn their feet with the latest in strappy, high-heeled fashions.
And the procedures involved run the gamut from filler injections to full-blown surgery to reshaping the foot. The American Orthopaedic Foot and Ankle Society noted that surgery to shorten the toes or narrow the feet are favorite options in this category. Some practitioners will also inject the fat pad of the feet with collagen or other substances -- again, solely to change the appearance of the feet.
Permanent Filler Injections
Injectable fillers, simply put, are special gels that are injected into the skin to plump up lips, push out wrinkles and fine lines -- in short, "fill out" spaces in the face where a bit of extra volume is needed.
Most of the fillers that are on the market today are temporary -- that is, after a certain amount of time they are absorbed into the body and the results are lost. This group of fillers includes the natural filler collagen, as well as a number of newer gels such as hyaluronic acid.
But some fillers are designed to stick around in the body for longer periods of time. These fillers, appropriately termed permanent fillers, include liquid silicone and the product known as Aquamid.
Though tantalizing to some consumers who would prefer to pay for fillers once rather than shell out for repeat procedures, such fillers have also been known to lead to a number of complications, including irreversible binding with tissues and a tendency to "drift," which can lead to a distorted appearance.
Roth said that the problems become even more severe in the event of a botched job.
"I do not do permanent fillers," Roth said. "Even with temporary fillers, once it's injected, even though it's going to go away, you're stuck with unsatisfactory results until it goes away. Permanent fillers don't go away."
But despite widespread disapproval among cosmetic surgeons and dermatologists, many consumers still seek out permanent filler injections.
"Silicone is still being used by some practitioners," Roth said. "I have seen three people in the last year who had silicone injections administered by nonphysicians."
Injection for Breast Augmentation
What if getting bigger breasts was as simple as getting a shot?
The idea is not a new one, and it stands to reason that pumping the breasts full of fat or fillers would offer an alternative to breast implant surgery -- all without the scars.
Traditionally, doctors performing such procedures have used the fat harvested from other areas of the body, such as the buttocks and thighs. By purifying this fat and reinjecting it into the breasts, they say, they can offer their patients a safe enhancement using the body's own spare materials.
But in reality, the procedure is not nearly as simple as it appears.
"On the surface, the concept of using liposuction to remove unwanted fat from one's own thighs and buttocks, and then injecting it into the breasts to make them larger, has appeal," the American Society for Aesthetic Plastic Surgery noted in a past statement on the procedure. "However, aesthetic surgeons certified in plastic surgery have long maintained that injection of fat, or any substance, into or behind the breast tissue can be potentially dangerous."
Dangerous, because there exists the potential for the reinjected fat to calcify, creating a scarred mass buried within the breast tissues. These calcifications can either mask or mimic the presence of breast cancer. And since between 7 and 14 ounces of fat are needed for the enlargement of a breast, there is no shortage of relocated fat to make the detection of breast cancer difficult, or even impossible.
More recently, a procedure referred to as the "boob jab" has made headlines by using artificial fillers to accomplish the same goal of bigger breasts. Specifically, the procedure requires the injection through the armpit of a temporary filler called Macrolane directly into the breast.
The procedure costs $4,000, and the results are temporary. And some doctors worry that this technique, too, could make it more difficult for current screening tests to detect breast cancer.
Cosmetic Leg Lengthening Surgery
How far would you go for a few more inches of height? For some, the quest for a more impressive stature leads them to a painful procedure that involves breaking both legs -- and using devices with screws attached to their legs to gradually extend their bones.
It's an extreme procedure to be sure. Yet, the technique is widely known in China and other Asian countries, where young professionals seek out the procedures to give themselves an edge in the business world.
But the procedure is also well known in the United States. Robert Rozbruch, the director of the Institute for Limb Lengthening and Reconstruction in New York, told ABC News that he does not approve of leg lengthening for cosmetic purposes as a new cosmetic surgery trend. And the patients who come to his center can only receive the surgery after extensive psychological testing.
"Orthopedic surgeons don't do cosmetic surgery," Rozbruch told ABC News. "It's not in our normal routine. We do this for a guy who is maybe [5 foot 2] or [5 foot 3] and well adjusted but being short is something that is very disturbing to them. When you talk to them you can feel the pain they go through."
But the results don't come cheap. Costs of the procedure generally top out at $120,000. For an average height gain of 3 inches, that's $40,000 per inch.
For those of a very short stature, the results may be worth the price tag and the pain. But Roth said the procedure is a poor choice if vanity is the main motivation.
"For purely cosmetic surgery purposes, I certainly would never let somebody in my family have that done," Roth said.
While many people hit the gym and suffer through crash diets to attain a smaller behind, there are others who actually seek out surgical solutions for a larger, rounder butt.
For these people, cosmetic surgery can offer buttock implants. Unlike breast implants, which are filled with either silicone gel or saline, buttock implants are solid slabs of silicone, positioned beneath the fibrous lining of the buttock muscles.
The result is a rounder, more voluminous rear end. But this result comes at a price for many patients.
"We don't really have the same demand for buttock implants in our part of the world as you see elsewhere," Roth noted. "And that may be a good thing. There is a high rate of problems with these implants."
Among these problems is an increased risk of infection. This is because in order to hide the incision from plain view, surgeons will often place it between the buttocks, perilously close to the anus and the germs that reside there.
And even after the incisions have healed, the implants are situated in an area of the body that endures its share of daily abuse.
"Just logically, if you think about what you're doing -- putting an implant into an area that you sit on -- it stands to reason that there is a very significant rate of problems with these devices," Roth said.
Made Up for Life: Tattooed Makeup
While many women may dream of skipping their makeup routine in the morning, for those who opt for permanently tattooed makeup, the reality can be more like a nightmare than anything else.
"I have had more than my share of patients who ask me to remove the permanent makeup tattoo that someone else gave them, and I will tell you that they're difficult to take away," Roth said.
Much of this difficulty in removing these tattoos is owed to the fact that the areas that are tattooed are some of the most delicate tissues of the face -- namely, the inner folds of the eyelids and the lips. And even with today's complement of high-tech tattoo removal lasers, there is never a guarantee that the tattoos will disappear completely.
This is especially bad news for those who have received botched jobs from untrained practitioners. But even for those who get what they want in the short term, their long-term satisfaction with the job may still be in question.
"If you don't like the results, you may still be stuck with them. And even though you might like the result in the short term, fashions change."
Extreme Facial Procedures
As the images of more than a few celebrities can attest, extreme facial procedures can have a dramatic impact on one's appearance -- and not always in a good way.
Dr. Gregory H. Branham, associate professor and chief of facial plastic and reconstructive surgery at Washington University in Saint Louis, said he treats a number of patients who want a revision of previous work done on their faces. Sometimes, he said, this previous work involved facial liposuction in which the natural fat pads of the face are sucked out. While these patients likely hoped for a sexier, more angular appearance, what they usually got was a hollow, "Cruella deVille" kind of look.
Another procedure he sees regularly is the skin lift -- a relic of 1970s-era cosmetic surgery in which the skin was pulled taut to eliminate wrinkles.
"While I do not perform these procedures I have seen patients come into my practice with broken or failed sutures that are extruding and need to be retrieved," Branham said. "I have not seen good long-term results with these, and they are generally quite expensive when you compare them to a conventional face-lift or even a mini-lift that is a surgical procedure with more promise of a longer lasting result."
But the ravages of bad facial procedures are not confined to surgery alone. Another extreme facial procedure, the CO2 laser peel, leaves patients with a scabby, red face that takes weeks to heal. While these patients eventually enjoy a smoother complexion once the healing is over, there are a number of alternative procedures available today that can give much the same result -- without the intense pain and downtime.
Combination Mastopexy/Breast Implant
What do you get when you combine two tried-and-true plastic surgery techniques in a single operation?
If the procedures in question are a breast lift, or mastopexy, and a breast augmentation, the chances are decent that you could get more complications than you bargained for.
"A mastopexy, or breast lift, with simultaneous breast augmentation [has] one of the highest sources of malpractice suits," said Dr. Henry Kawamoto, clinical professor of plastic surgery at UCLA and director of the UCLA Craniofacial Clinic.
The reason for all the problems is clear when the aim of each procedure is considered. While mastopexy is often aimed at breast reduction -- essentially tightening up the tissues of the breast to eliminate a flabby, loose appearance -- the aim of breast augmentation is the exact opposite.
So while surgeons performing both procedures may start by removing the excess skin on the breasts during the mastopexy operation, they may find themselves stretching the remaining skin in order to accommodate the breast implants that they put in later.
Aside from the complications that arise due to the combination of the two procedures, patients also face the normal risks that go with each individual surgery -- risks that include the possibility of infection, implant exposure, asymmetry of the breasts, loss of nipple sensation, the inability to breast-feed, healing problems and other complications.
Any Procedure by Untrained Hands
With the explosion in the popularity of cosmetic surgery in the past two decades has come another explosion in the number of people who are willing to perform these operations.
But not every doctor has the training necessary to perform these procedures. Indeed, many of the proprietors for whom cosmetic procedures represent a lucrative part of their business do not even hold a medical degree.
"Probably everyone has heard of the itinerant practitioner who performs procedures in a hotel room for bargain basement prices and then is nowhere to be found when complications arise," Branham said.
So what is the key to avoiding such practitioners? Do your homework, said Branham -- and don't rush into surgery before you know everything you need to about your surgeon.
"You should see the doctor ahead of time and not the day of the procedure except in unusual circumstances," Branham said. "This allows you the time and opportunity to check out the doctor and his or her credentials and see the facility for yourself without the stress of an imminent procedure."
And when in doubt, don't go through with the procedure.
"We have a saying," Roth said. "You never regret the operation you don't do."