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Gone are the days when having plastic surgery meant long weeks, sometimes months, of recovery and was the domain of aging movie stars. Cosmetic surgery has evolved with new and safer procedures, many with shorter recovery times and little, if any, post-operative pain. Today's goal is to have patients look as if they haven't had a procedure. People from all walks of life are having cosmetic surgery at much younger ages, with a marked increase in the number of men. Today 25 percent of my patients are male.

Men tend to have cosmetic surgery later than women, having eyelids done in their 40s (women will do this as early as their 30s) and facial procedures in their 50s. Eyelid surgery and minimal-incision neck lifts are both extremely popular. Men elect to have cosmetic surgery to maintain a more vital appearance in an increasingly competitive job market or often just to keep up with their younger-looking wives.

Liposuction has been used for years to remove fat, but it has evolved to become a sophisticated surgical accessory, shortening or eliminating scars resulting from traditional procedures. For many, entire lower-abdomen or tummy-tuck scars can now be replaced with a much shorter one. For some women, breast reductions are being performed with liposuction only - eliminating the traditional anchor-shaped scar.

Liposuction of "love handles," the neck, the abdomen and large breasts Is increasingly popular for men due to minimal incisions and faster recov-ery times. Breast enlargement is in fashion again. I have been testing a new implant for the past year, which is pre-filled with saline and has no valve. "Rippling" or waviness common to standard implants has not been noted thus far. For a surgeon participating in this study in your area, contact Silimed Corporation at (800) 832-8102.

Best Face Forward
Face-lifts today are longer lasting and more natural because we now tighten the deep tissue overlying the muscles of the face and the platysma muscle of the neck along with the skin itself, Recently, with the aid of video cameras (endoscopy), we have been lifting soft tissues in the center of the face as well. The sagging of this fatty tissue causes deep smile lines and jowls. Endoscopy has recently made other minimal incision procedures available-namely, eyebrow, forehead and neck lifts.

Eyelid surgery can be performed with removal of fat through a small incision inside the lid and a skin peel, if excessive tissue does not exist. This eliminates the traditional incision under the lash lines and in the crease of the upper lid. Improvements in nasal surgery mean that in some cases, filing of small bumps and refining the nasal tip can be performed without breaking any bones.

Laser and chemical peels are both extremely effective for improving age-related lines and discolorations. Newer chemical peels with a neutralized acid have the advantages of reduced post-operative pain and shorter recovery times.

Injectable filling materials for smile lines, scars and lips, and Botox treatments, have become "lunch-hour" procedures, making them the most common procedures for both men and women, Collagen (a bovine- or cow-derived skin component) is effective but short-lasting, usually three to five months; plus, it requires an allergy test. Alloderm (derived from purified hurnan skin) is my treatment of choice. It is injected as a liquid (lasting months) or a solid placed under the skin (may last years). It has a natural feel and is non-allergenic.

With an injection of Botox (derived from a specific bacteria), the muscles in the forehead and around crow's feet on the sides of the eyes are temporarily weak-ened. Lines disappear within 48 hours. Botox is very effective and lasts five to 10 months, after which it can be re-injected.

For the name of a board-certified plastic surgeon who specializes in cosmetic surgery in your area, contact the American Society for Aesthetic Plastic Surgery at (800) 4PLASTIC (800 475-2764). My staff and I can be reached at (212) 249-7000, or at www.stevenhermanmd.com

Dr. Herman has a private practice in Now York City and in Norwalk, CT. He is on the staff at Albert Einstein College Hospital and New York Eye & Ear Infirmary, both in Now York City.

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