Can cosmetic surgery help you maintain a firm, slender body throughout life? Which treatments available today are worth investing in, and which ones should send you running - with your hand firmly on your wallet?

I Hear It Every Day
Here are some of the body questions I get in my consulting room:

• If I do Pilates or yoga all my life, will I still have to get a Tummy Tuck when I'm older?
  
  
• How can I keep the skin on my chest from getting thin and spotted like my mother's?
  
  
• Will my hands always give away my age, or are there treatments to rejuvenate them too?
  
  
• Do all women who have children end up needing breast lifts?

While I can't answer all of your questions in one newsletter, let me touch on some main points from each decade of life. If you have further questions, you know where to find me.

It's not for nothing that liposuction is the most popular plastic surgery procedure. Most bodies don't fit the slender ideal promoted by our culture.

One question I hear a lot:

When is it "too early" to seek liposuction?

Answer: I've done liposuction on young women in their teens and twenties - but only if their bodies warranted it. Liposuction is ideal for people with basically normal weight but with specific areas of resistant fat, such as on the outer thighs (saddlebag deformity) or the "pooch" just under the belly button for women. For men, it would be the so-called "love handles" or gynecomastia (enlarged breasts).

Healthy Habits Come First
But liposuction is not a substitute for healthy habits. That's why a full history, evaluation and consultation are necessary for people who feel overwhelmed by their bodies' tendency to store fat.

Unfortunately, we've seen ALL ages of people who go through what we call the "chasing your tail" syndrome. They get liposuction early in life. They believe it may permanently re-set their body's fat storage system.

It doesn't. But they keep trying it instead of looking for a lifestyle solution.

Judgment Call
So, if I were asked, is liposuction appropriate for my 18-year-old? - I'd have to say that it would be a judgment call. We'd consult with you and your child and give you the benefit of our professional overview.

You wouldn't be just guessing, and we'd never subject anyone to unnecessary trauma for beauty's sake. It is typical to decide on a non-surgical option for at least 10 percent of my consultations. When surgery is the better option, we will let you know!

Can liposuction work as a jump-start to a healthier lifestyle?

Yes! We've seen it happen again and again. This is the inverse to the early-lipo issue. Mature women who have tried every diet on the planet and stayed more than that "extra ten pounds" overweight for years often get a fantastic jump-start from liposuction.

For them, getting even a few pounds of fat off their bodies makes exercising easier. Better yet, it awakens a "fire in the belly" motivation that erases past failures and puts them over the top.

The Weight They've Dreamed Of
We've seen these patients push through months of strict regimens to arrive at the weight they dreamed of all their lives. Sometimes - and again, this is a judgment call -there can be a tremendous psychological value in giving yourself a head-start. We can advise you on this issue, too.

Above illustrations are cross sections of skin showing fat distribution in subcutaneous tissue with cellulite on the left diagram and normal fat cells on the right diagram.

Here's where the majority of scams take place. There is no way to remove those fibrous connections under the skin that result in dimpled skin. At least not yet. But some people will take your money and give you treatments. These treatments mostly just cause swelling that smoothes the surface of your skin temporarily. It does not solve the underlying problem.

• There are laser treatments that are somewhat successful, and the future of cellulite treatment will probably be a laser skin tightening solution. This technology is evolving rapidly and will be a huge advance. SmartLipo laser lipolysis has shown some promise in reducing mild to moderate cellulite. The laser disrupts the fibrous connections under the skin. The laser energy and heat cause the skin to shrink and tighten.
  
  
• Our advice about cellulite, which mainly affects legs, is to make the muscles underneath the skin firmer. When you increase muscle mass, your skin stretches over a firmer surface, and often this reduces the appearance of cellulite. Good skin care, moisturization and hydration also help.

Most women are well-informed about breast surgery. There is, however, one misconception I come across often, and that's the idea that breast implants can be used to "lift" sagging breasts.

That simply isn't true. If your breasts have lost significant altitude because of pregnancy, breast-feeding, weight loss, or simply through aging, you will need a breast lift. (If they haven't sagged significantly, you won't.)

Increasing volume is a separate issue, and if you desire that, we can certainly add implants.

Don't Look Matronly
Using implants alone to "fill" the saggy and deflated breasts DOES produce larger breasts; but they are often large, saggy breasts, which tend to look matronly. Often, we will replace volume with implants and also uplift the breasts at the same operation (a mastopexy-augmentation).

This is one of the most satisfying procedures I perform. Many women finished with childbearing feel heightened sexual desire when their breasts are restored and enlarged. The combined breast augmentation and lift (mastopexy) is one of the key elements of a "mommy makeover"

Tummy Tuck deserves its own newsletter, but let me address just one question here - the skin-only Tummy Tuck.

Young women in their 20s often finish pregnancy with loose skin on their abdomens. Perhaps they don't have loose muscles (yet), or excess fat, but the skin on their abdomens may not contract fully following pregnancy (this depends on how damaged the skin is from the stretching, how much weight was gained and on pure genetics).

"Stretch marks" are actually a sign that the skin has stretched too fast for the dermis to withstand (the deeper layers of the skin where the collagen resides). The dermis "tears" apart, leaving the thin epidermis, and a scar in the form of a stretch mark.

Skin-Only Tummy Tuck
The way to restore a tight-skinned belly for these women is with a skin-only Tummy Tuck. It leaves a scar across the bottom of the belly. Many women struggle with the idea of undergoing the procedure because of this scar, but we tailor the scar to hide under your bikini line.

For those with loose skin AND some excess adipose, we can recontour the abdomen through the tummy-tuck WITH some Smart Lipo liposuction at the same time.

I've got good news for everyone concerned with loose skin and/or fat deposits on any part of the body. New skin tightening lasers have finally hit the market. External ultrasound machines can dissolve small areas of extra fat (diminish girth by approximately 2 centimeters). This is a huge step forward. It will affect all body parts and be applied to dozens of problem areas. See our special monthly offer for information about nonsurgical ultrasonic fat reduction!!

Today's cosmetic surgery is solving problems from every decade of life, as bodies morph from those of young girls to mature women. But the right information is essential to using it wisely.

We're committed to giving you state-of-the-art information, freshly minted and accurate, as this exciting medical specialty progresses.