Fix Me: Nips and Tucks Soar

Liposuction. Boob jobs. Lip-plumping Botox. Pec implants to die for. These are a few of our favorite beauty enhancers.

Sure, cosmetic procedures go awry, as seen lately with Priscilla Presley whose botched silicone injections have sent her jaw and lower face sagging. And people have died from minor plastic surgeries or reactions to higher-risk procedures such as liposuction.

Nonetheless, beauty-upgrades are "skyrocketing," said Dr. Angelo Volandes of Massachusetts General Hospital, whose specialty is internal medicine. His research focuses on contemporary ethical issues in medicine. Requests for cosmetic enhancements are "really hitting our offices all around the country. It's not just this rare occurrence you get once in a blue moon." Often the plastic surgeon needs clearance from a primary doctor, he said.

In 2007, Americans spent more than $13 billion for nearly 11.7 million cosmetic procedures, according to the American Society for Aesthetic Plastic Surgery. That's up from nearly 8.5 million procedures in 2001.

Women and men are flocking to doctors' offices to get rid of "ugly" features and improve the "so-so" ones. They are driven by self-esteem issues, the desire to fit into an image-conscious society, perhaps vanity and even career and romance opportunities.

Of course body modifications date back thousands of years. From head reshaping and neck elongating to body painting and tattooing, body enhancements are a part of every culture. They can signal an individual's place in society, mark a special moment, or simply fit in with the latest fashion.

The jury is out on whether the latest nips and tucks, when done to climb social ladders, gain access to better jobs or better mates, actually work. But in a society focused on image, scientists have established that looks matter:

• Shoppers buy more from attractive salespeople, according to a study published in the Journal of Consumer Research.
• A study last year found attractive people capture our attention in a snap, keeping our eyes glued to the beauty bunch.
• Skinny people might have a leg up when promotion time comes around: A study being presented this month at a psychology conference found that being obese or overweight can hinder a person's opportunity of getting a job or moving up the work ladder.

Cosmetic must-haves

Since 1997, surgical and non-surgical cosmetic procedures have increased more than 450 percent in the United States.

While women have been the most typical connoisseurs of tummy tucks and facelifts, men have jumped on the vanity train, as the figures below from the American Society for Aesthetic Plastic Surgery indicate.

Women's top-five cosmetic surgical procedures for 2007:

• Breast augmentation: 399,440 procedures
• Liposuction: 398,848
• Eyelid surgery: 208,199
• Tummy tuck: 180,457
• Breast reduction: 153,087

Men's top-five cosmetic surgical procedures for 2007:

• Liposuction: 57,980 procedures
• Eyelid surgery: 32,564
• Nose reshaping: 31,713
• Breast reduction: 20,280
• Hair transplantation: 16,491

The No. 1 non-surgical cosmetic procedure for U.S. men and women last year was Botox injection, with more than nearly 3 million procedures overall.

The latest twists

While liposuction is one of the chart toppers for cosmetic surgeries, Volandes said gastric bypass surgeries are becoming increasingly popular for a new set of dieters. "It is a procedure that was intended for people who are very, very morbidly obese, and now we're seeing it in people who are in the high 100's and who might be 5 foot 2." He added, "There are real risks here."

Another alarmingly popular and invasive procedure these days could be called a Jimmy-Choo fix. Cosmetic toe modification is a solution chosen by some women who want to squeeze into high heels with narrow toes and heels. The majority of women that podiatric surgeon Suzanne Levine sees at her Manhattan office come in with hammertoes in which the foot curves inward. The answer can be Botox injections to loosen up the muscles pulling on the toe or, more dramatically, a surgical shaving down of the bones of the second and third toes.

Many women wear spike heels in spite of the pain for the overall slenderizing effect of wearing heels; they make a woman look more petite and feminine. "It's more aesthetically appealing when wearing certain clothes," Levine said.

Toe cleavage, in which the pinky toe gets severed off, can also help women slide into snazzy stilettos. This procedure can alleviate the pain from too many hours in heels, which place most of your body weight onto the ball of the foot and squeeze the toes together. Shoes aside, the long-term result can be inward- or outward-pointing toes and arthritis in the feet, Volandes said.

Another option would be to ditch the heels, of course. "But fashion tastes are what they are," Volandes told LiveScience, "and people are willing to go through extremes, and this is just one additional extreme to be quite honest."

He refers to this as a Cinderella-type phenomenon. "If you are born an envious stepsister with a wide foot, medicine can surgically enhance you into a Cinderella so that your newly trimmed foot fits a narrow glass slipper," Volandes wrote in a 2006 issue of the journal Medical Humanities.

The new you?

Body embellishments are nothing new to human societies. What's in and what's out, however, has changed throughout human history with big breasts or small breasts, tiny waists or rolls of fat being prized or scorned as the ultimate in beauty.

Today's cosmetic surgery can give a person a cuter nose and sexier thighs. Research has shown people feel better about the body part they had fixed, said psychologist Diana Zuckerman, president of the National Research Center for Women & Families. But, she added, there isn't as much hard evidence for whether self-esteem or even a career get a boost.

One past study found that nearly 90 percent of patients reported satisfaction a year after receiving cosmetic surgeries, including boosted overall body image.
 
"There's this idea that if you look better you'll be happier. You'll feel better about yourself," Zuckerman said, "and logically that makes so much sense because we live in a society where people do care what you look like." But there are limits to what surgery can do.

While physical attractiveness could woo a hot guy, for instance, Zuckerman points out the difference between a "7" and an "8" on the looks scale is not so noticeable to the eye. "Most people getting cosmetic surgery don't go from being a 3 to being a 10," Zuckerman said during a telephone interview. "People do have these unrealistic expectations about how this is going to change their life and how it's going to change how they feel about themselves."

Why do they do it?

It's easy to be shocked by the accelerating market for cosmetic surgeries and enhancements, but the larger question is why people do it. The reason is simple: The fairest of them all, at least by advertising and marketing standards, is today's big celebrity on the covers of glossy magazines and featured on "Entertainment Tonight."

"We are bombarded with images of people who've had plastic surgery," Zuckerman said, "and our sense of the ideal of what we're supposed to look like is so unrealistic that you really can't achieve it without plastic surgery." She noted, for instance, these ideals include a "Barbie-doll body, which just about nobody has naturally, or a 60-year-old woman who looks 35."

Not even the stars can achieve perfection, hence the need for the pit-crew of make-up and other stylists, the ideal lighting and then the digital enhancements. Zuckerman calls this the trickle-down effect, because it's the finished product seen by the everyday TV watcher.

Back at the body level, not only aspiring actors or rich socialites sign up for a boob job or pectoral implants. Psychological problems, such as low self-esteem, depression and body-image disorders play a role, say scientists.

Many people getting cosmetic procedures have an exaggerated sense of their flaws and their appearance, a medical diagnosis called body dysmorphic disorder (BDD), according to Zuckerman. "There's a tendency that, now their hips are too big, their ears stick out or their chin is too small," Zuckerman said.

Perhaps the most extreme case of BDD, she said, is Michael Jackson.

"There's a large psychological component, as you can imagine, to this," Volandes said. "The toll that body image disorders can have on people, this truly can be just as traumatic to people as physical ailments."

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