Tonya Jones slips on her skin-tight Michael Kors dress and examines herself in the mirror, turning to look over her shoulder at her back and behind. She is still healing from surgery that removed fat from her back and waist area and put it exactly where she wanted it — in her buttocks for a more rounded, Brazilian look. But she immediately loves what she sees.
So far, Jones has told only her sister about the surgery, so we've changed her name. She's even kept it a secret from her boyfriend. "I did it for me," says Jones, 56. "Just looking at how gravity takes over, my figure wasn't looking the same."
She chose to have the surgery on the Friday before Memorial Day weekend to have an extra day for recovery. By that Tuesday, she had the eight small stitches removed and returned to work, where she walks about 3 miles a day in a manufacturing plant.
Jones is not alone in wanting a fuller behind. In 2014, more than 11,500 people had buttock augmentation using their own fat, a 15 percent increase from 2013, according to the American Society of Plastic Surgeons. During that same time, buttock implants increased by a whopping 98 percent — although still fewer than 2,000 people had it done — and buttock lifts grew by 44 percent with about 3,500 people undergoing that procedure, according to the ASPS.
"Fat has an abundance of stem cells, and when transplanted elsewhere in the body, the success rate is excellent," says Dr. Mark Foglietti of the Cosmetic Surgery Institute in Beachwood who performed Jones' surgery. "It is safer than buttock implants, which have many known complications."
In fact, buttock implants tend to be uncomfortable to sit on, which is why plastic surgeons prefer fat transfer for enhancements.
"Buttock enhancement is more about contour than size," says Dr. Steven Goldman of the Beachwood Plastic Surgery and Medical Spa.
Even with the increase in buttock procedures, the No. 1 cosmetic surgery procedure last year was breast augmentation. Last year, surgeons completed more than 286,000, a 1 percent drop from the year before.
Goldman says that rapid recovery techniques are one reason breast augmentation remains popular.
"Patients are typically active, fitness-conscious women who want to restore youthful fullness," Goldman says, "as well as young professional women who want to enhance volume and contour."
Volume — whether in the breasts, buttocks or face — seems to be the biggest trend in cosmetic procedures today.
"The old-fashioned nip and tuck is less and less. We're now doing more plumping, more augmentation procedures," says Dr. Faisal Quereshy of the Visage Surgical Institute in Medina. "It's 3-D volume replacement. Think of a baby's skin that is nice and round and you see all the contours. But in an older person, the skin dries up. You get laxity, and that causes wrinkles."
In fact, the ASPS reports that the number of face-lifts performed in the United States dropped by 4 percent in 2014, although surgeons still did more than 128,000 of them.
Many surgeons believe the drop may be because of the number of nonsurgical options that can refresh a face or even delay aging. There are three big nonsurgical categories in cosmetic procedures: neurotoxins, such as Botox; hyaluronic acid fillers for volume; and treatments to resurface the skin or boost collagen.
With more than 6.6 million people getting Botox or Dysport injections last year, it is by far the most popular nonsurgical cosmetic procedure on the market today. Botox and its competitors Xeomin and Dysport temporarily freeze muscles to prevent movement and smooth the area. They are most frequently used on forehead wrinkles and frown lines between the eyebrows and crow's-feet.
In fact, many surgeons believe that neurotoxins are driving younger people to seek procedures much earlier. When muscles are weakened and can't be used, they also can't create wrinkles in the first place.
"People are asking for stuff to be done at a younger age, like a prophylactic," says Quereshy. "They're getting forehead lines treated before they even start."
"At 35, I can take the lines away completely [with a neurotoxin]. I cannot do that at 65 or 70," says Dr. Bahman Guyuron, a plastic surgeon in Lyndhurst. "The earlier rejuvenation starts, the more successfully we can serve patients to retain a youthful appearance."
And stay tuned for a new neurotoxin that is currently in clinical trials, says Dr. Brian Harmych of Harmych Facial Plastic Surgery in Pepper Pike.
"Revance will be a topically applied neurotoxin," Harmych says. In other words, the patient wouldn't even need a needle stick. But with trials still underway, it could be years before it reaches the market.
In keeping with the trend to add volume, new fillers treat different areas of the face. The two standby products, Restylane and Juvederm, are hyaluronic acid fillers that physicians inject — usually in the lines around the mouth and nose or mouth and chin's "marionette lines" — to fill in and add volume. Two new products recently on the market are thinner versions specifically tailored to the small "smoker's lines" around the mouth: Restylane Silk and Belotero Balance.
Most hyaluronic acid fillers last about eight months before the patient's body breaks it down and gets rid of it. But one of the newest ones, Juvederm Voluma, lasts much longer.
"This product is injected deep in the fatty tissue of the cheekbone or directly on top of the bone," Foglietti explains. "It plumps and elevates the cheekbone area. The product takes a minute to inject and will last approximately two years."
But perhaps the longest-lasting volume — and gaining in popularity — is the technique Foglietti used with Jones' buttock augmentation: the patient's own fat.
Once fat is harvested from another part of the body, it is processed and separated into pure fat through a filtration system before transferring it to another part of the body.
"Fat injection and augmentation has been around for a long time, but it definitely has been getting more popular," says Dr. Gregory M. Fedele of the Art of Plastic Surgery in Beachwood. "The advantage of fat is that it has the ability to be permanent,
because some of the fat cells will survive and be in the area that you injected for the long term. The other advantage is that it tends to be more cost-effective because you can use a lot more volume."
In fact, Fedele estimates that 50 to 60 percent or more of the fat will stay in the area permanently.
Yet surgery is still the gold standard for a longer-lasting result, says Dr. Michael Wojtanowski of the Ohio Clinic for Aesthetic and Plastic Surgery in Westlake.
"In the old days there was one face-lift, and everybody got the same thing," Wojtanowski says. "But now we know how to customize a patient's face-lift based on what their issues are, what their goals are. They're really tailored to the individual very precisely."
In fact, many surgeons now combine the traditional face-lift with a fat transfer for an overall facial rejuvenation.
"The results are exponentially better when you combine the procedures," says Harmych.
Guyuron says fat transfer serves the central facial area while a face-lift rejuvenates the sides. "[Fat transfer] really gives the face a glow," he says.
The overall goal for face-lifts, especially in the Midwest, is to keep the look very natural, say many board-certified plastic surgeons.
"Some people have the misconception that doing a face-lift is going to really change their appearance and they're not going to look like themselves," Fedele says. "With good plastic surgery, you should not be able to tell. You should just look more youthful."
While surgery offers a longer-lasting result, achieving a rested look doesn't have to require downtime.
"Thermage uses radiofrequency to tighten the collagen microscopically and [results] in tighter skin with no downtime," explains Wojtanowski. "Thermage is a really nice process for someone who is younger and doesn't need surgery or someone who is a little older and doesn't have the downtime to do a surgical procedure."
Venus Legacy also uses radiofrequency, and Ulthera employs focused ultrasound to stimulate collagen in the skin, says Goldman.
"Both involve no needles or cutting and increase skin firmness," he says. "They cannot achieve the results of a face-lift but have no downtime and high satisfaction rates."
Guyuron says a new laser on the market for skin resurfacing and wrinkle reduction, Halo by Sciton, is the first hybrid delivering both ablative and nonablative laser at the same time. It provides both surface and deeper skin ablation with less downtime.
While fat injections help boost volume in some areas where aging has deflated the face, though, patients may still want fat to go away in others.
recently, the food and drug Administration announced approval of a new product called Kybella to get rid of a double chin. Kybella may be on the market later this summer. Injected into the fat, Kybella destroys the fat cells. "This is probably the most exciting thing in the pipeline," says Harmych.
Some surgeons are waiting for more results before praising Kybella, worried that the skin left behind after the fat dissolves might still need attention.
Currently, Wojtanowski says double chins are usually treated with contouring through liposuction of the neck.
But, as Jones found out with her buttock augmentation surgery, the beauty of cosmetic surgery is being able to remove fat from one area and put it to good use in another — and to look great as a result.
If anyone happens to ask about her new shape this summer?
Code Blue
Summer is the time for dresses, shorts and bathing suits. But many people with varicose veins often are willing to sweat it out in long pants rather than display the bulging purple knots in their legs.
Beyond the appearance, however, varicose veins often cause leg fatigue, swelling, aching, heaviness and cramping.
"Some people have varicose veins on both sides, so they just get used to the fact that their legs feel a certain way," says Dr. Patricia Duggan, a board certified vascular surgeon with Vascular Interventions and Venous Associates in Mayfield Village. "We'll treat one leg and they'll call the office back and say, 'You know, I never realized how bad my legs felt until I got this leg treated.' "
Duggan also says many still fear getting varicose veins treated because they knew someone who had them "stripped" long ago and don't want to go through the same crude procedure.
But in 1999, the Food and Drug Administration approved a treatment for varicose veins called endovenous laser treatment, which can be done in the vascular surgeon's office with a single needle stick of the vein and the patient returning to work the next day.
"It has revolutionized the way we treat varicose veins," Duggan says.
Duggan uses ultrasound to look for reflux in the vein — blood flowing backward through the vein's valve. To treat the vein, Duggan uses a needle to thread the laser into the vein where it gently heats the vein and seals it from the inside. Once she has sealed off the refluxing vein, she says she often sees nearby veins lightening from blue to pink.
"Everything is connected, like a tree and branches, so you have to treat the trunk before you could treat the smaller vessels that were feeding from there," she explains.
Sometimes, smaller "spider veins" remain. Duggan treats those with sclerotherapy — a foam solution — a newer treatment that lightly irritates the lining of the vein with a detergent and causes it to disappear or a procedure called VeinGogh that uses radiofrequency to collapse the vessel wall.
Picture Perfect
Smile confidently with dental procedures spanning full sets of new teeth to more conservative cosmetic options.
Maria Pulling Buehner has a lot to smile about. She got married this year, turned 40, and her daughter just graduated from high school.
But she has another reason for showcasing her pearly whites: a full set of new teeth.
"I never smiled," Buehner says. "I love posing for pictures and smiling."
Buehner has had lifelong health issues that impacted her teeth. She was diagnosed with juvenile rheumatoid arthritis as an infant and had her baby teeth pulled during the course of her treatment. Lacking calcium because of a milk allergy, her adult teeth grew in weak and began to deteriorate. A blood-clotting disorder and years of medical treatment also contributed to her poor dental health.
But now she has a full set of implants that are as permanent and functional as real teeth thanks to Case Western Reserve University's School of Dental Medicine. Implants give her the natural look, since they go into the gumline, held by screws in the jawbone.
Creating new smiles through crowns, veneers or implants is becoming more popular. Approximately 3 million people have implants, and that number is growing each year by half a million, according to the American Academy of Implant Dentistry.
"Over 50 percent of Americans age 50 and older are missing at least one tooth due to trauma, gum disease or decay," says Dr. John Pyke, a dentist in Avon Lake. "Implants have an extremely high success rate, and today's implants are easier to place and restore than 25 years ago."
The technique of placing implants has advanced through the years, says Dr. Fady Faddoul, director of the advanced education in general dentistry and faculty practice programs at CWRU.
"It used to be that you had to place the implant where the bone is. Now we can place the implant where we need to place the implant and then bring the bone to it by bone grafting," says Faddoul, who worked with Buehner. "There are a lot of techniques that allow us to place the implant in the perfect position to give us the best aesthetic result."
Materials used for teeth have also become stronger and more lifelike. "White filling used to be monochromatic," says Dr. Hussein Assaf, associate director of advanced education in general dentistry at CWRU. "Now you have shades for enamel, shades for dentin."
Dr. John Heimke actually color maps each replacement tooth. Heimke, who is certified in digital dentistry and has offices in Rocky River and Sandusky, says flat, stock colors may be cheaper but not as natural looking.
"Most people don't have really white teeth. They have a shade of yellow or gray, and as they get older, it gets darker," Heimke says. "It's white at the bottom, transitions, and near the top of the tooth is a different color. We actually map it out. It relates to skin tone, eye color and the actual tooth color."
Heimke uses both still pictures and video taken at varying angles to examine facial, muscle and lip dynamics. He then sends the video and photos to the laboratory.
"What we're able to do is really fine-tune a smile and customize it for a specific patient," Heimke says. "It's really a revolution."
A different type of technology allows Solon-based dentist Dr. Scott L. Rose to do what he refers to as "face-lift dentistry" to aesthetically improve the patient's smile.
Using neuromuscular diagnostic and treatment technology such as joint ultrasound and transcutaneous electrical neuromuscular stimulation, Rose uncovers the patient's proper bite to relax the facial muscles prior to replacing or restoring the teeth.
"When the bite is in the correct position, facial muscles relax, including the muscles that hold the lips open and closed, so that the whole one-third of the face looks much more natural, much more relaxed and much prettier," Rose explains. "You're also helping relieve a lot of head and neck pain and jaw joint pain."
Whole-body health is another reason cosmetic dentistry is growing in popularity. Eighty-nine percent of people turn to cosmetic dentistry to improve their overall physical attractiveness and self-esteem, according to the American Academy of Cosmetic Dentistry.
"We're seeing more baby boomers invest in their dental health," says Pyke. "They realize that good oral health affects their entire body."
In fact, there are many conservative techniques people can try before replacing teeth with crowns, veneers or implants. Bleaching can brighten a smile, and invisible braces can straighten adult teeth without drawing attention.
"Sometimes limited reshaping, bleaching or bonding can drastically improve a smile," says Pyke.
But patients also need to have realistic expectations, warns Case Western's Faddoul.
Commercials, for example, might have patients believe that getting implants is quick. Since the temporaries can be placed in a day, the smile is improved rapidly. But the gums and bones where the dentist places the screws need months to heal. Meanwhile, the patient must remain on a soft diet.
For Buehner, the process took even longer. She received her upper temporaries in October 2013 because she didn't initially plan to do her entire mouth. When she liked the result, she had her lower teeth extracted for the implants in July 2014. Finally, her permanent teeth were placed last month.
"Any advice I can give would be to go for it," she says. "I smile at everybody now."
