Does Heidi Montag—who had 10 plastic surgery procedures in one day—now have “buyer’s remorse” following her procedures? According ABC News, the reality TV star is looking to get a breast reduction after her most recent breast augmentation surgery made her a G cup.

Patients who have buyer’s remorse after plastic surgery typically are troubled by deeper issues, according to Ann Kearney-Cooke, a psychologist who specializes in weight and body image issues. “[The surgery] changes the look, but if you have a problem that you haven’t resolved, you’ll have a temporary positive feeling, but then something else is the problem,” says Kearney-Cooke.

Some surgeons, like Chicago plastic surgeon Dr. Julius Few, feel buyer’s remorse after plastic surgery is becoming more common.  “I think [plastic surgery remorse] is actually increasing, and I think in part it’s increasing because of the drop in reimbursement by insurance companies, which is driving doctors in other specialties into the plastic surgery market,” he says.

However, other surgeons disagree. Dr. Timothy Miller, chief of plastic surgery at the David Geffen School of Medicine at UCLA, says, “Maybe I’ve seen it a few times in my practice, but it’s very rare.”

Most plastic surgeons do agree that buyer’s remorse can potentially be avoided if patients and doctors recognize and address a patient’s underlying problem.

“I have a therapist who works in my practice,” says Dr. Few. “We know in plastic surgery that if somebody has undue stress, the risk of complication is higher.”

Dr. Miller agrees that some patients need to speak to someone before undergoing surgery. “Most plastic surgeons will tell patients to work out their problems—go talk to a psychiatrist or confide in somebody else,” he says.

To avoid buyer’s remorse, communication between the doctor and doctor is critical. “It’s really important that both the patient and the physician understand what the motivation is behind the surgery,” said Dr. Malcolm Roth, a plastic surgeon in Brooklyn, N.Y.

The state of New York has passed a new law that requires its hospitals to inform breast cancer patients about the availability of and insurance coverage for breast reconstruction before they undergo “mastectomy surgery, lymph node dissection or a lumpectomy.”

While breast reconstruction after a mastectomy is covered by insurers, some women—often poor, minority women—do not seek out the procedure, as they may be unaware of coverage. The Women’s Health and Cancer Rights Act, passed by Congress in 1998, guaranteed universal coverage for breast reconstruction after cancer surgery.

“A disproportionate number of women who are at a socioeconomic disadvantage do not get breast reconstruction surgery after a mastectomy for one of several reasons. Either they are unaware of it as an option, they do not know it is covered by Medicaid and Medicare insurance programs, they do not know where to gain access to the procedures, or it is never mentioned to them by their other doctors,” said Evan Garfein, MD, the New York plastic and reconstructive surgeon who authored the bill.

There are several breast reconstruction options for cancer patients; the two primary methods are tram-flap reconstruction and latissimus reconstruction. Tram-flap reconstruction uses muscle, fat and skin from the abdomen to create a new breast, and latissimus reconstruction uses muscle and skin from the upper back to create a new breast mound after a mastectomy.

“Breast reconstruction has been repeatedly shown to improve the quality of life and overall well-being of women who have been treated for breast cancer,” said Dr. Garfein. “This new law will ensure that breast cancer patients from all socioeconomic groups are informed about their options regarding breast reconstruction and about where to get the procedure.”

A breast cancer patient’s decision to have reconstruction should involve input from both the cancer surgeon and the plastic surgeon, so the surgical team and the patient can then decide together if reconstruction should be performed and when.

Dr. Leff performs breast reconstruction in Bellevue, Washington.

The first reliable international plastic surgery statistics revealed that the most popular surgical procedure in the world is liposuction and the most popular non-surgical procedure is toxins or neuromodulators injections, which includes Botox and Dysport.

The International Society of Aesthetic Plastic Surgery (ISAPS) conducted the survey with plastic surgeons throughout the world; the data was obtained and analyzed by independent statistical specialists.

Liposuction accounted for 19 percent of all plastic surgery procedures in 2009. It was followed by breast augmentation (17%); eyelid lift (13.5%); rhinoplasty (9.4%); and tummy tuck (7.3%).

The number of non-surgical procedures actually topped the number of surgical procedures performed last year. According to ISAPS, this finding reflects “both advances in cosmetic surgery innovation and the desirability of less expensive treatments.”

Rounding out the top five non-surgical procedures were hyaluronic acid injections (20.1%); laser hair removal (13.1%); autologous fat injections (5.9%); and IPL laser Treatment (4.4%). Botox/Dysport accounted for about 32 percent of all non-surgical procedures. However, the top procedures do vary among countries. For instance, injectables are not yet as popular in other countries as they are in the U.S., says ISAPS President and Atlanta plastic surgeon Foad Nahai, MD.

The United States topped the list as the country with the most procedures performed compared with any other country in 2009. The top five countries were:

1. United States (17.5% of total procedures)
2. Brazil (14.3%)
3. China (12.7%)
4. India (5.2%)
5. Mexico (4.8%)

“It is no surprise to me that the United States has the largest number of aesthetic procedures, and same with Brazil,” says Dr. Nahai. “But countries like China and India with emerging economies are generating a lot wealth and as that wealth is passed around, people are choosing to their spend discretionary income on aesthetic procedures.”

For a more details on the statistics, visit the ISAPS website.

A new botulinum toxin, XEOMIN, has been approved by the FDA. It joins Botox and Dysport as the third botulinum toxin to be approved for use in the U.S. Its approval is for the treatment of adults with cervical dystonia or blepharospasm.

Cervical dystonia is a neurological movement disorder characterized by twisting of the neck, and blepharospasm is characterized by excessive eyelid spasms.

FDA approval of XEOMIN, a product of Merz Pharmaceuticals, was based on the results of two U.S. clinical trials. A study cited in the Journal of Neurological Sciences on the efficacy and safety of XEOMIN found it showed “non-inferiority” to Botox when used in the same doses to treat cervical dystonia. It concluded that XEOMIN is a safe and effective treatment for the disorder.

Compared to Botox and Dysport, XEOMIN is the only botulinum toxin that doesn’t require refrigeration prior to reconstitution. Merz believes this may be beneficial and could “simplify product distribution and storage and help ensure product integrity at the time of injection.”

In addition to its botulinum toxin product, Merz also joined the dermal filler market when it announced earlier this year that it would be acquiring BioForm Medical, maker of  Radiesse dermal filler. After the acquisition is complete, Merz and will be renamed “Merz Aesthetics.”

While more players are joining the botulinum toxin market, Botox shows no signs of weakening. Botox sales rose 7 percent in this quarter to $360.5 million, according to Allergan earnings report released last week. Allergan said it now believes the drug will post sales of $1.36 billion to $1.39 billion this year, which compares with a forecast in February for $1.33 billion to $1.37 billion.

Could the future hold a Botox cream? That’s the goal of Revance Therapeutics, a privately held bio-pharmaceutical company in California that is exploring a Botox product that could be applied to the skin in cream form, reports WCBS-TV in New York City.

Patients in the early trials tended to see a moderate reduction in wrinkles around their eyes after using the product for a month. The product is being tested on crow’s feet because the skin around the eyes is thin and susceptible to bruising when Botox is injected.

While there are still about two years before clinical trials on the product, called RT001, are complete, plastic surgeons and dermatologists are already weighing in.

Potential Black Market?

Dr. David Colbert, a New York City dermatologist, told WCBS-TV that he worries that a Botox cream would be so popular that black market versions would be sold online without oversight and that the potential muscle paralyzing effects could be dangerous.

“I think it’s a brilliant idea, but I’m more concerned about the welfare of people who would use it irresponsibly,” he says.

The Holy Grail?

Dr. Scott Newman, a New York City plastic surgeon, feels the potential benefit is worth the risk. “It’s like the holy grail. If you can get a wonderful result with less downside, why wouldn’t that be an attractive option?”

For more than just wrinkles?

Dr. Anthony Youn, a plastic surgeon in Michigan, shared his thoughts about the product on his website: “I think a huge application of this topical botulinum toxin is in sweat reduction. Could you imagine an antiperspirant stick with this product that lasts several months with each application and leaves no residue? I’d buy it!”

To watch the WCBS-TV segment, go to http://wcbstv.com/video and search for “Botox cream.”

(before & after use of RT001 for 28 days; image via WCBS-TV)

A study found that breast surgery patients spent less time at the surgery facility when they had their operation at an ambulatory surgery center (ASC) vs. a hospital. The study, published in the American Journal of Surgery, found  that on average the total time was 69 minutes shorter at the ASC; most significant was the 55-minute difference in the preoperative time period.

The authors were able to do a comparison of 92 patients who underwent breast surgery at the ASC and 92 who underwent surgery at the hospital because they had an ASC that was closed in 2005, and then breast operations were moved to a hospital.

The study analyzed anesthetic techniques; recovery room events; and the patient’s total duration of stay, pre- through post-op.

Results found that age and recovery times were similar and complications were negligible at both, but the preoperative and total facility time increased for breast operations done in the hospital setting.

“Findings support a common perception, namely, that outpatient surgery can be more efficiently performed at a dedicated outpatient center rather than at a hospital setting,” according to the study’s authors.

Reasons for the efficiency of the ASC include:

• Nurses at the ASC only prep outpatients, whereas hospital nurses may process both outpatients and critically ill patients.
• The ASC was limited to a relatively small and uniform set of cases, whereas the hospital has a more varied and complex case mix, which can cause surgery delays.
• The preoperative area in the ASC was physically closer to the OR compared with the hospital setting.

The study conclusion states that “the potential efficiency advantage of an ASC over a hospital has implications for patient and staff satisfaction, facility expense, and surgeon productivity.”

While both the ASC and hospital are safe places for plastic surgery, the ASC may have the advantage in efficiency.

A new special report called the “The Beauty Advantage” on Newsweek.com says that the quest to look good isn’t just “a vain pursuit” and that beauty can affect your career and life.

In today’s economy looking good is something that can’t be dismissed as frivolous, according to the article.

“Economists have long recognized what’s been dubbed the ‘beauty premium’—the idea that pretty people, whatever their aspirations, tend to do better in, well, almost everything,” writes Jessica Bennett in the online article. Economist Daniel Hamermesh says a good-looking man will make some $250,000 more during his career than his least-attractive counterpart.

Here are a few other statistics the article cites to make this point:

• Handsome men earn, on average, 5 percent more than their less-attractive counterparts (good-looking women earn 4 percent more)
• Attractive people get more attention from teachers, bosses, and mentors
• Babies stare longer at good-looking faces

It’s not a surprise then that some may turn to plastic surgery. According to the American Society of Plastic Surgeons, 13 percent of women (and 10 percent of men, in a Newsweek survey), say they’d consider cosmetic surgery if it made them more competitive at work.

Newsweek also surveyed 202 corporate hiring managers and found that 56 percent of them said that qualified but unattractive candidates are likely to have a harder time getting a job. Over 50 percent advised spending as much time and money on “making sure they look attractive” as on perfecting a résumé.

Hiring managers also rated nine character attributes from one to 10 (with 10 being the most important). The results? Looks came in third, below experience and confidence, but above where an applicant went to school and five other attributes.

You can find a variety of online essays, photo galleries, and interactive features on the “beauty advantage” at Newsweek.com.

Last week Botox was approved for use as a tool for preventing chronic migraine headaches in the U.K. The country’s drug regulator became the first in the world to approve Botox for this use, Allergan announced last week. While it’s best known as a cosmetic wrinkle treatment, Botox can now be used on migraine patients in the U.K. who have headaches at least 15 days a month, including migraines on 8 days.

In the United States, the FDA may decide later this month if it will allow Botox to be used for migraines, according to Aaron Gal, a Sanford C. Bernstein & Co. analyst in New York.

In the United States, in addition to treating wrinkles, Botox can be used to treat eye muscle spasms and muscle stiffness in the elbow, wrist, and fingers in adults with upper limb spasticity. There are also several off-label uses for Botox, such as treatment of excessive sweating.

Allergan’s clinical trial involved 1,384 adults who had a history of migraines and experienced 15 or more headache days of which at least 50 percent were migraine or probable migraine during the 28-day period. At the end of the baseline period, patients were randomized to receive either Botox injections or placebo.

By week 24 following treatment, those who received Botox averaged 8.2 fewer migraine days, compared to the placebo group, who averaged 6.2 fewer migraine days.

“We have been following these studies really closely and the evidence is really pretty solid. These people spend half their lives in pain. Even if they get half the attacks, it can really improve their quality of life,” said Lee Tomkins, director of Migraine Action in the U.K. She stressed it is not a cure but does offer hope for those who suffer from migraines.

Botox was the number one minimally-invasive cosmetic procedure in 2009, during which the procedure was performed 4.8 million times in the U.S., according to the American Society of Plastic Surgeons’ most recent statistics. Overlake Plastic Surgeons offers Botox to Bellevue and Seattle patients and is often able to schedule evening and same day appointments for the procedure.

Project Beauty, a new website  by the American Society for Aesthetic Plastic Surgery, launched today and its aim is to help consumers “cut through the clutter” and help them answer beauty-related questions,  including: “What treatments work? Which don’t? How can we tell if a product is legitimate or just marketing hype?”

The new consumer website will be inclusive about all things beauty and not just focus on cosmetic surgery. It will cover a variety of topics, including hair, makeup, staying fit, fashion trends, and plastic surgery.

Billing itself as a “video news magazine,” Project Beauty will be updated on a weekly basis and features experts on topics such as fashion and skin care as well as news and first person accounts on all things related to aesthetic surgery.

To celebrate the launch, the site is holding a month-long giveaway contest called “30 Days of Beauty.” Each day from July 6, 2010 to August 4, 2010, Project Beauty will offer one prize—such as a Sonicare toothbrush, Mederma Stretch Marks Therapy, or SmashBox cosmetics—per day. To win, you must join the Project Beauty Community and enter daily to win the prize of the day.

Videos on the site include a teenager who shares her reasons for getting rhinoplasty at fifteen; a step-by-step guide to applying makeup for daytime; summer fashion ‘must-haves’ for men; and a young professional on her decision to have a breast augmentation.

Project Beauty also launched a social media campaign on Facebook, Twitter, and YouTube to promote the website and share videos from ProjectBeauty.com.

To join the Project Beauty community, sign up at www.projectbeauty.com.

Beware if you’re looking for discounted plastic surgery—there is usually a catch, according to a recent posting on AOL’s Stylelist website. The article warns consumers of bargain plastic surgery, citing everything from billboards advertising “bargain boob jobs” in California to an ad near Clearwater, Florida touting “$8 Botox” injections.

While some are just marketing ploys other “bargains” could be at the cost of safety. “To get the cost down, they could be cutting back on things like general anesthesia. They make you feel like the procedure must be easier and not so serious if you’re just getting local sedation. Nothing could be further from the truth,” says Long Beach, Calif., plastic surgeon Dr. Marcel Daniels.

Another cosmetic surgery trend, according to Stylelist, is that doctors who studied a different branch of medicine, such as gynecology, are performing plastic surgery procedures.

“Many physicians not trained as plastic surgeons can legally perform a surgical procedure in their office. These people often claim that they can do the same procedure as a plastic surgeon under local anesthesia and may even claim they are more scientifically advanced,” says Beverly Hills plastic surgeon Dr. John Anastasatos. “The truth is that they don’t have surgical privileges at hospitals and surgery centers because they simply are not surgeons and never trained as surgeons.”

How do you avoid these plastic surgery pitfalls? Research your doctor to make sure he or she has plastic surgery training. Consumers can check any doctor’s board certification for free at the American Board of Plastic Surgery website. Another red flag, according to the article: a lack of before-and-after photos.

Dr. Leff is a board certified plastic surgeon who practices in the Bellevue, Washington area. His website contains a before and after photo portfolio of his work.

The full article, “‘Free’ Plastic Surgery: The Dangers of Bargain Breasts and Botox” is available on Stylelist.com. (Photo by Aaron Gruenert, courtesy of Stylelist.com)