Download Regular folks get the star treatment Cosmetic surgery and other

Regular folks get the star treatment Cosmetic surgery and other procedures are no
longer the stuff of celebrities
USA TODAY
July 8, 2004
Katie Maslanka
Did he or didn't he?
He did, and retired industrial engineer Bill Mullen is not only thrilled he got an eyelid lift at age
60, he's not afraid to talk about how much better he feels about his appearance.
"To say I'm happy is an understatement -- I'm tickled pink," Mullen says six weeks after having
the operation near his home in Prospect, Conn. "I not only have no regrets, I wish I had done it
earlier."
Now cut to U.S. Sen. John Kerry, the presumed Democratic nominee for president. Did he get
Botox injections to smooth out his famously craggy visage? Wife Teresa Heinz Kerry readily
says she gets Botoxed, but the senator's staff denies that he does -- as if Botoxing were an
automatic disqualifier for the presidency.
If so, millions of Americans such as Bill Mullen can never run for president -- about 8.2 million
Americans in 2003 alone. According to medical statistics, that's how many surgical and nonsurgical cosmetic procedures were performed last year in the USA, including 2.2 million Botox
treatments. That doesn't count an unknown number administered by non-physicians at salons,
spas and parties.
Nor does it count the millions of other new cosmetic procedures Americans have each year to
improve their appearance, such as UV and sunless tanning, teeth whitening, laser hair removal,
Brazilian waxing and color contacts to dramatically change eye color.
Call it the L.A.-ing of America. Once this sort of thing was the exclusive province of the rich and
famous in Los Angeles and New York -- and only then on the QT. Phyllis Diller may have joked
about her plastic surgeries, but almost nobody else talked about it openly. Now everybody
everywhere does it, and everybody blabs. (Except politicians.) New Jersey is even going to tax
cosmetic procedures -- a first -- at 6%.
High schoolers get their faces scraped (microdermabrasion) for the prom; some even get bigger
breasts for graduation gifts. Brides have so many ways to "improve" themselves before the
wedding that they can take their pick of "something new": Botox, bikini wax or bleached teeth.
Cosmetic transformation is Topic A in fashion magazines and beauty salons and now on national
TV, on shows including ABC's Extreme Makeover and MTV's I Want a Famous Face.
Multitudes of non-famous, middle-class Americans are no longer satisfied with what God and
DNA gave them. In the beauty-obsessed, instant-gratification culture that now prevails, they've
embraced the idea that they can look better, so why not?
For Peter Fodor, a Los Angeles plastic surgeon and president of the American Society for
Aesthetic Plastic Surgery, the change in attitudes is summed up in what he saw on the street
the other day: Three people, not together, strolling around nonchalantly with plastic surgery
bandages on different parts of their body. Even Fodor, in practice for 20 years, was shocked,
and not just at the sight of people walking in Los Angeles.
"It's getting to the point that (surgery) is like going to the gym -- it's a normal part of life," he
says. "These days I see mail-delivery people, policemen, schoolteachers, even prison guards."
Surgical beautification has permeated "every strata of society," says plastic surgeon Paula
Moynahan, who operated on Bill Mullen at her Waterbury, Conn., practice and has a busy New
York office. "The idea of improving inside and outside is totally acceptable, whereas in the past
it was seen as vain and self-serving and selfish."
How did it change?
It's the baby boomers, of course. They hate to age and hate even more looking their age.
"They want to look good, feel good, no matter what it costs, and damn it, they're worth it,"
says William Dorfman, the dentist on Extreme Makeover.
Here's the formula: Take a huge population of aging consumers with plenty of disposable
income, which is crucial because most cosmetic transformations are not covered by insurance.
Add a thriving or at least a stable economy, because most surgical procedures are luxury items.
Sprinkle growing numbers of plastic surgeons, cosmetic dentists and salon aestheticians. Throw
in expanded and improved surgical techniques and increasingly affordable delivery systems,
such as lasers and spray-on tanning machines. Whomp up the national advertising, while the
glare of celebrity spotlight spreads the news even further to the unbleached, untucked,
unwaxed masses. Then put it all on TV.
The result: Wichita grandmother Marilyn Neifert getting $15,000 worth of cosmetic surgery.
Two years ago, Neifert, then 59, spent eight hours on the table for a chin tuck, face lift, eyelid
tuck, chemical peel and liposuction. Is she an outcast in conservative Wichita? Not a bit, and
she's more than happy to chat about it -- after all, what's there to be embarrassed about?
"I just knew (the surgery) would make me look nicer," she says. "I always hated my double
chin, ever since I was a teen, and I figured I might as well do the whole nine yards. To look the
way I want is a dream come true for me."
Waxing is less risky and cheaper. The Brazilian bikini wax, named for seven Brazilian sisters
who introduced it to New York in the late 1980s, leaves very little hair in the pubic area -- for
women and men -- and can hurt like the dickens.
"I tried it a couple of times, mostly out of curiosity," says Melinda Burns, 42, a hairstylist and
mother of three who got hers at A Morning Star Day Spa, where she works in Lubbock, Texas.
"Summer's coming, a lot of (college) girls were getting it, so I thought, 'Let's be 10 again!' I'm
adventurous."
Clearly, adventurousness is not just an L.A. thing, says Melissa Yamaguchi, 40, president of the
Salon Association and owner of six California day spas, where the latest fad is the Playboy wax,
which leaves genitalia totally bare.
"Trends used to trickle slowly to the Midwest, but nowadays people aren't waiting," says
Yamaguchi, originally from Oklahoma. "People are picking up magazines, watching TiVo, getting
everything instantly. When I grew up, if a girl had a tattoo, she was from the wrong side of the
tracks. Now everyone has one, and you can't make a judgment call based on it."
Almost a spiritual experience
Indeed, there has been a sharp decline in coyness. Why else would dozens of people agree to
be sliced and diced, and in their underwear, on national television?
For DeShante Hall, 23, of Pittsburg, Calif., it was almost a spiritual experience -- indeed "a
miracle" she was picked for Extreme Makeover, back in September. "I have no regrets about
sharing with America because it was a blessing to me," says Hall, whose makeover included
reconstructing a cleft lip and mouth muscles, straightening her septum, grafting ear cartilage to
her right nostril, reshaping her nose and having a tummy tuck, liposuction, an inner thigh lift, a
chemical peel, a tooth porcelain veneer, gum augmentation and an upper bridge. "After the
experience, you are less afraid of change and actually welcome change."
Especially if change isn't so expensive or public. Disposable color contact lenses have been
around for nearly two decades, but only in the last two years have manufacturers begun to
market them as fashion accessories. The result: about 2.6 million wearers.
"People really notice. They say, 'Wow, your eyes are gorgeous,' " says Alexis Rodriguez, 25, a
New Yorker in fashion public relations who wears green FreshLook lenses that enhance her
green eyes.
Teeth and body hair, too
Cosmetic dentistry, on the other hand, is almost as expensive as plastic surgery, and it is
booming: Estimates put the cosmetic segment of the $70-billion-a-year U.S. dental industry at
about $15 billion. Surveys of members of the American Academy of Cosmetic Dentistry show a
300% increase in tooth-whitening treatments in the last five years. Sales of Invisalign -invisible, removable plastic, night-guard-like braces to straighten teeth that can cost up to
$5,000 -- grew 75% in 2003.
Aesthetic dentistry has grown because "people go to dentists not just to fix or maintain healthy
teeth, they go for the sole purpose of maintaining a better-looking smile," says David Thrower,
vice president for Align Technologies, which makes Invisalign.
A perfect smile has become the new beauty standard -- and never mind the one you inherited
from Mom and Dad, adds Lawrence Addleson, a San Diego dentist and president of the
cosmetic dentists academy, which had 60 founding members in 1984 and now has 6,300. "I
have young patients who want a specific celebrity's smile or they bring in magazines and say, 'I
want that smile,' " he says.
Another thing men and women want is less body hair. Even though the human race has grown
steadily less hirsute since caveman days, we are still obsessed with plucking every stray hair
from brows, backs, lips, legs, underarms, wherever. Thus, the spreading popularity of
permanent hair removal by lasers, which use high-intensity pulsed light to attack hair follicles at
the roots. In 2003 there were nearly1 million laser hair-removal procedures conducted by
physicians, a 25% jump from the year before, according to the American Society for Aesthetic
Plastic Surgery.
"It's the times we're living in: There's an ideal appearance, and it's not a hairy man or woman,"
says Leonard LaCivita, a doctor and medical director of American Laser Centers, a chain of
physician-supervised laser clinics that has grown to 34 locations in two years.
That's why waxing has been big business for years, says Tina Alster, director of the Washington
(D.C.) Institute of Dermatologic Laser Surgery, so it's no surprise that a procedure to zap hair
permanently and less painfully than waxing or electrolysis would be attractive to consumers and
entrepreneurs.
But dermatologists such as Alster are alarmed about the unknown (but probably growing)
number of laser treatments performed by non-physicians in mall salons and day spas. Used
improperly, lasers can burn and scar skin or leave it hyperpigmented. In 2001 nearly half the
2,400 members of the American Society for Dermatologic Surgery reported an increase in
patients seeking treatment for botched laser treatments by non-physicians. Different states
have different regulations about who can perform laser treatments.
Why would people put themselves in the hands of non-physicians? It's cheaper, for one thing.
Alster says removing hair from the upper lip would cost about $250 a treatment in her clinic.
Prices at a salon might be a fraction of that.
People want cosmetic transformation at reduced rates? Shocking. But at least they're not
ashamed and hiding.
Cut back to John Kerry. He went to the dentist recently and came out with two new pearly
white crowns on his front teeth. But, his aides insisted, he did not get his teeth whitened. Just
cleaned.
Very presidential.
Press Enterprise (Riverside, CA)
June 29, 2004, Tuesday
A little touch-up; Wrinkle relaxers and volume fillers give people non-surgical
options to face lifts
LAURIE LUCAS; THE PRESS-ENTERPRISE
Charlene Ellen Smith of Bloomington has given up on growing old
gracefully.
Her lipstick runs uphill above her top lip into tiny
tributaries. Crevices known as nasolabial folds stretch from
nose to mouth, bracketing her smile. Two vertical lines carve
themselves into a scowl between her brows.
Smith wanted a facsimile of her former self without spending big
bucks on an overhaul. So she turned to the fastest-growing
segment of the booming cosmetic-surgery business - a combination
of wrinkle relaxers and soft-tissue fillers.
Known as minimally invasive procedures, they accounted for
nearly half of the 7 million non-surgical treatments performed
last year, according to the American Society of Plastic
Surgeons.
Dr. Keith LaFerriere, president of the American Academy of
Facial Plastic and Reconstructive Surgery, says more patients
are women younger than 40 who are influenced by the popularity
of cosmetic transformations glorified on prime-time TV shows.
"Most people need a little touch-up, not the extreme makeovers
they see on TV," maintains Dr. Abel Torres, chief of the
division of dermatology at Loma Linda University Medical Center.
He says today's facial tune-ups tend to be safer and more
natural looking than ever before - and less costly than nips and
tucks.
But doctors point out that for some patients, soft-tissue
augmentation and wrinkle reductions are steppingstones to cosmetic
surgery.
"I've thought about a face lift," says Smith, 37, an
animal-cruelty investigator for Riverside County. "I'm not
afraid to have one. It's the money." For now, however, she's
delighted that the stopgaps work their magic.
More than Botox
Like millions of other women seeking "facial rejuvenation"
without a scalpel's touch, Smith looked hard at the bottom line.
A face lift typically costs $ 5,000 to $ 10,000 and lasts five to
10 years. Injectable volume fillers and muscle relaxants run
from $ 300 to more than $ 1,000 per syringe, and they usually last
three months to several years, depending on the treatment.
Smith consulted a dermatologist in Riverside that she had
found online: Sorin Eremia, director of cosmetic surgery in the
division of dermatology at UCLA Medical Center.
"The big news is that now we have more choices," he says.
Several months ago, Smith opted for two of the most popular
injectable fountain-of-youth phials: Botox - a muscle relaxant for
her forehead wrinkles - and Restylane, a new filler that knocked
out her laugh lines and puffed up her lips.
Smith is delighted with the results: Her smackers are fuller
without looking like inflated inner tubes, her expression is softer
and her smile indentations are shadows of themselves. What's more,
Restylane will keep her pucker plumped up and her wrinkles at bay
for six months to a year, twice as long as the original bovine
collagen shots first popularized more than 20 years ago.
Eremia says he's almost completely stopped using bovine
collagen, so-called because it's made from purified cows' skin.
Restylane, the new darling of dermatologists and cosmetic
surgeons since its recent FDA approval, is genetically
engineered. It's identical to hyaluronic acid, a natural
component of the body's connective tissue.
Eremia hails Restylane as "a far better product than collagen at
the same cost with long-lasting results. And (Restylane) does
absolute wonders for the lips."
Although you can't prevent the hourglass from running out, you
can sure slow it down. Here's a guide to some anti-aging
treatments:
Wrinkle relaxers
Botox is the brand name for purified botulinum toxin type A. It
has become the gold standard for achieving a kinder, gentler
expression: In 2003, board-certified doctors administered
2,891,390 injections of Botox.
It's injected in minute quantities to relax frown lines between
brows, worry lines on foreheads, crow's feet around the eyes and
thick bands in the neck. The toxin blocks the nerve impulses,
temporarily paralyzing the muscles that cause wrinkles while
giving the skin a smoother, more refreshed appearance.
Studies have also suggested that Botox is effective in relieving
migraine headaches, excessive sweating and muscle spasms in the
neck and eyes. Results take a few days to appear fully and last
three to six months.
Average cost for an entire forehead and around the eyes is $ 400
to $ 600. Rare, temporary side effects include small bruising at
injection sites, dry or watery eyes, headache, and droopy
eyelids.
Volume fillers
Bovine collagen, sold under various brand names, is made from
purified from cows' skin.
Zyderm I is thin and used for fine lines, hollows under the eyes
and shallow scars. Zyderm II is thicker and effective for deeper
lines and scars. Zyplast, the thickest, is the choice for deep
furrows, scars and lip enhancement.
Last year, the FDA approved two types of human-based collagen,
CosmoDerm and CosmoPlast. Results are immediate and last three to
six months. Average cost: $ 400 to $ 500 per injection.
The biggest risk of bovine collagen is allergic reaction. Two
skin tests spaced at least two weeks apart could determine this
condition. No allergy test is required for human collagen.
Other rare but reported risks include infection, abscesses, open
sores, skin peeling, scarring and lumpiness, which may persist
throughout the treated area.
Autologous fat transplantation or microlipoinjection extracts
fat cells from the patient's abdomen, thighs, buttocks or
elsewhere and re-injects them beneath the facial skin.
Fat is most often used to fill in "sunken" cheeks or laugh
lines, to correct skin depressions or indentations, to minimize
forehead wrinkles and to enhance the lips. Surgeons can freeze
fat up to two years and re-inject it. There's no chance of an
allergic reaction, but with most patients, about a third to of
the original injection disappears within three to six months,
requiring two to three more injections.
The initial fat extraction and facial injection costs $ 800 to
$ 1,200; each subsequent injection runs $ 200 to $ 300.
Restylane is a clear gel based on a non-animal, synthetic
hyaluronic acid. It's injected to erase wrinkles and plump up
lips. No pre-test is necessary because hyaluronic acid occurs
naturally in the body, providing moisture and elasticity in the
skin. A syringe costs about $ 400 and lasts six to 12 months.
Prior mini-injections of a local anesthetic or a regional "nerve
block" will ease pain caused by the procedure.
Hylaform gel is hyaluronic acid extracted from rooster combs.
Its uses, longevity and cost are similar to Restylane's.
However, because it's an animal byproduct, there's the potential
for an allergic reaction.
Radiance is made from ground calcium hydroxylapatite, an element
found in bone and teeth. Currently FDA-approved to treat human
vocal-cord paralysis and some types of incontinence, it's being
used "off label" by some doctors as injectable wrinkle filler
around the lips and in deep laugh lines and acne scars.
A syringe costs $ 1,000 or more and some doctors report results
lasting two to three years. One major drawback is that Radiance
can lump easily and form granulomas - small, sometimes itchy
bumps under the skin.
Studies show the problem can last months or years. The lumps can
also migrate to other parts of the body with a potential for
complications, according to the American Society of Plastic
Surgeons.
STOP BEAUTY SHOP SET FOR EXTREME MAKEOVERS A FULL-BODY SALON CONCEPT
ENVISIONS EVERYTHING FROM TUCKS TO FACIALS.
Booth Moore,
Los Angeles Times
7 July 2004
Forget watching them on TV. Extreme makeovers will soon be available at
one-stop beauty shops offering everything from pedicures to tummy tucks,
highlights to Botox injections.
Richard Rakowski is the venture capitalist behind the Advanced Aesthetics
Institute, the West Palm Beach flagship clinic he says will be the model
for the next revolution in beauty. He announced recently that he has
acquired the Georgette Klinger spas and salons in Beverly Hills, Costa Mesa
and seven other California cities, which will be the vehicles for the
expansion of his concept.
Two years ago, Rakowski woke up on his 50th birthday, got an eyelift and
decided to open AAI, the first network of total body salons and spas.
In December, the company caught the attention of Moet Hennessy Louis
Vuitton, which invested $20 million in the new aesthetics/medical services
sector.
Georgette Klinger, who died in January, opened her first spa on Madison
Avenue in 1941.
Her pioneering approach to facials was to treat the skin as a living organ
that could be affected by diet, exercise and herbal treatments.
"With over 5 million facials done to date, they have a strong name and they
are known for quality," Rakowski says. "It's a terrific entry point. And
they are open in our exact cities. What we did was identify vanity markets,
where there is a heavy concentration on appearance, so this is not a
coincidence."
At least a handful of the facilities will offer skin-care assessment and
cosmetic surgery, cosmetic dentistry and dermatology.
All procedures would be coordinated by an aesthetic concierge, and a full
makeover could cost as much as $40,000.
AAI has a medical board of directors to oversee clinical activities.
Some might find streaking hair magenta irreconcilable with trusting a
doctor with liposuction in the same shop.
To make it work, Rakowski said, there must be three distinct environments.
"The medical side has to be credible and safe. It needs to look like the
Four Seasons merging with a Swiss clinic. The reason is that Sharpie boxes
and fluorescent lights are frightening for clients. They don't want
messages of fear.
"The facial studio must be unique," he said, "with Enya music and
aromatherapy.
"The hair salon has to be more high energy. But our model is not `God, you
look gorgeous,' because we are taking a more scientific approach to the
business."
Rakowski's idea of the future is a world populated with Adonises more
beautiful than ever imagined on any silver screen.
"The everyday person now has access to tools that Hollywood never had
access to," Rakowski said. "What I think is the big story now is
after-Hollywood. There's a lot of talent, both in makeup and hair, and
bringing that talent together from around the world is exciting. Beauty is
not fashion-oriented now, it's science-oriented."
So where's the next capital of beauty? "Wherever I decide to put my
research facility," Rakowski said. "Palm Beach or Dallas."
Take it on the chin
6 July 2004
Chicago Tribune
Never mind the sincere blue tie, men. Forgo the hair transplants. The chin
is the new power player in today's world.
More men are trotting off to plastic surgeons to have chins augmented to
look strong or trimmed down with liposuction to look younger, The Wall
Street Journal reports. It has become one of the fastest-growing procedures
for men--up 70 percent in 2003 over 2002, according to the American Society
of Plastic Surgeons. Almost 60 percent of the chin work is done on men.
One reason for the increase is that the procedures have been refined.
Changes are subtle; implants have been developed that make the chins look
more natural; and scars are less visible.
Chin up
Last year, 9,583 surgeries were performed on chins at a cost of about
$2,000 to $3,000 each.
PHOTO: Some men go in for a faux cleft to have a Robert Mitchum-like
dimple, while others get injections of Restylane and other fillers to
smooth out the chin
UNDER THE MICROSCOPE Thanks To Rooster Combs, It Can Afford To Crow; Anika
Therapeutics Inc.
By Peter Benesh
6 July 2004
Investor's Business Daily
Rooster combs are rich in hyaluronic acid. But let's not get technical.
Let's call it HA, as the folks at Anika Therapeutics do.
HA is a natural, biocompatible polymer. The human body makes it and needs
it, especially as it ages. It protects and lubricates soft tissues,
maintains the structural integrity of tissues and transports molecules to
and within cells.
You can do a lot with HA. Anika is looking for as many uses as it can find.
Its new product, OrthoVisc, won Food and Drug Administration approval in
February. Three injections can relieve arthritic knee pain for six months.
Johnson & Johnson's Ortho Biotech Products subsidiary began marketing
OrthoVisc on March 1.
For the uninformed, rooster combs are those large fleshy crests you see on
the heads of roosters and other fowl.
Roosters with supercombs are specially bred for Anika, says Chief Financial
Officer William Knight.
"Some (combs) are as large as the palm of my hand," he said.
Each comb produces one gram of HA. That's enough for 30 syringes of
OrthoVisc, says Nollenberger Capital Partners analyst William Gibson, who
owns Anika shares.
Anika has another product in pivotal clinic trials to fight the aging
effect. It's a cosmetic HA treatment that could knock out collagen and even
eat into the botox market.
"HA has largely replaced collagen in Europe, and the same model could
unfold in the United States," Gibson said.
THE FINANCIAL.
Anika returned to profitability last year after losing money in 2001 and
2002. It earned 7 cents a share during this year's first quarter, up from a
5-cent loss the prior year. Sales rose 82% to $6.1 million.
OrthoVisc contributed 41% of product revenue during the quarter. Sales of
Hyvisc, an HA product to treat arthritic horses, made up 16.4% of product
sales.
Anika's gross margin on product revenue rose to 51% from 42% the year
before.
Gibson, the only analyst watching Anika, expects full-year earnings to hit
27 cents a share, up from 6 cents in 2003. He sees 2005 profit rising 85%
to 50 cents a share.
THE COMPANY
Anika has made HA products since 1983. A decade later it went public after
being spun out from a now-defunct company.
It sells most of its ophthalmic surgery products through Bausch & Lomb.
Last year Bausch & Lomb accounted for more than 51% of overall revenue.
Anika also produces HA ophthalmic products for Advanced Medical Optics,
STAAR Surgical and privately held Cytosol Ophthalmics.
There's plenty of competition.
In the ophthalmic HA business, Alcon controls 50% of the market. And
Genzyme is the "800-pound gorilla" of the osteoarthritis sector, CFO Knight
said.
Still, analyst Gibson says Anika has three strong cards in its hand.
One is J&J's huge marketing power. Another is the fact that OrthoVisc has
the highest HA concentration of any osteoarthritis product. Third, Anika's
product -- unlike some rivals -- causess no allergic reactions.
LOOKING AHEAD
Advanced Medical's April buy of Pfizer's ophthalmology business might cost
Anika some business. Pfizer makes a competing line of HA products for
cataract surgery.
Meanwhile, Anika has launched pilot clinical trials for Incert, an HA
product to prevent internal tissue adhesion and scarring from spinal
surgery.
Some 680,000 spinal surgeries are performed in the U.S. each year. The
FDA's OK won't come until 2006, Gibson says.
As the population ages and joints wear out, demand for relief will grow.
J&J's Ortho Biotech will fund clinical trials for OrthoVisc treatment of
hips, shoulders and ankles. Knight says the potential market for OrthoVisc
is now $300 million and growing 10% to 20% a year.