As cosmetic surgery advances, physicians become increasingly skilled at creating a youthful appearance.

The essential component allowing this progress has been the development of a greater understanding of what actually happens to the face as it ages.

A leader in this area has been Dr. Val Lambros, a plastic surgeon. He has collected old photos, youthful photos, from patients.

He then took new comparable photos and superimposed the new photo over the old photo, so that he could switch back and forth between the two. Many previous assumptions were found to be completely or partially untrue. For example, the eyebrows don't descend much in most people.

What is very important is the loss of deeper tissues creating hollows and sagging skin. This emphasizes the importance of replacing the lost volume. In the old days, cosmetic surgeons performed procedures that made people look different, but not necessarily younger.

At a recent meeting of cosmetic surgeons, a photo of Nancy Pelosi was projected with the comment "This is what my patients don't want to look like, the deer in the headlights look."

Now, cosmetic surgeons are developing more tools and techniques to make people actually look younger. Usually this requires a blend of techniques.

There have been some reports about the use of blue light alone in the treatment of acne. Multiple treatments, often several times weekly, have been required.

The reported improvement has been mild, at best. We've tried it and while eventually it is possible there might be improvement, from a practical standpoint this is not a worthwhile treatment.

Cosmetic surgery has become a popular solution to self confidence when the root of the issue is based on physical appearances. We look at our bodies and see flaws and hide them for fear that others will see us as inferior.

When self-confidence plummets, it can have a negative effect on every area of your life. You may not feel suitable for a potential love interest, or as pretty as your best friend. You might even fail to go after a promotion because you don't feel as good about yourself as you should.

Cosmetic surgery can help repair your self-esteem. While inner confidence is something you have to work on from the inside out, it's hard to feel secure in your own skin if you keep focusing on its flaws.

Your inner strength can be compromised by acne scars, a tattoo you wish you'd never gotten, sagging breasts, or an area plagued with fat that you just can't get rid of - regardless of how much spot training you do.

A cosmetic surgeon will help guide you through the steps that could be taken to fix the problem, but they can also be a pillar of support. They want to make sure that the whole person is healed and not just the area that they work on.

Because they've seen all types of disfigurements and flaws, they understand what you're going through and be sympathetic to your feelings without judging you for your decision to move forward with cosmetic surgery.

Because cosmetic surgery is a fast-rising industry, there are more medical students pursuing this path by specializing in different areas of the field.

You don't want someone who has a general understanding, but a specialist instead. Choose someone who has extensive experience in dermatology, facioplastic surgery, opthamoplastic and plastic surgey.

There are excellent cosmetic surgeons who not only do quality work, but also have a good bedside manner. Unfortunately, as with any field, there are the bad apples in the barrel. You can prevent the possibility of having a bad experience by evaluating your cosmetic surgeon before opting to have them perform the treatment.

Your health can be at risk if you don't take time to investigate. Ask for references from potential cosmetic surgeons. A good reputation in the community can mean a world of difference in your final results.

Find out what their credentials are and where they got their medical degrees.

• How much experience do they have in the type of surgery you want done to your body?

• Do they provide before and after pictures of previous patients?

• Were the results good?

Don't do any type of surgery until you feel comfortable enough to trust your cosmetic surgeon. A reliable cosmetic surgeon will be upfront about possible risks and side effects. You'll want to rest assured that he'll know what to do in case anything goes wrong.
You want a cosmetic surgeon who has been around for a while, and has a track record. Check with other physicians, such as your family doctor, about the cosmetic surgeon's reputation in the medical community.

Levulan is aminolevulinic acid, a chemical that is normally present in the body in small amounts as a result of hemoglobin synthesis.

When Levulan is applied to the skin, it is converted to protoporphyrin IX which is a photosensitizer. This chemical, when exposed to certain wavelengths of light, particularly blue light, sets off a reaction that is toxic to cells.

Because the Levulan is preferentially absorbed by sun damaged cells, these are destroyed and replaced by more normal cells.

Originally Levulan was released to treat thickened areas of sun damage known as actinic keratoses. The Levulan was to be placed on the rough areas of skin only.

With time, physicians began putting the chemical on the entire face, and also on other areas such as the arms, legs and chest. The treatment was also applied to other conditions, such as acne.

Currently we use Levulan plus light to good effect in treating diffuse sun damage and in rejuvenating older skin. Many of the skin changes we associate with age are really sunlight related, and we get good improvement in discolorations and fine lines and wrinkles with this therapy.

Typically people get some redness and peeling after the treatment, similar to a sunburn. Usually more than one treatment is necessary. Sometimes we'll combine blue light with intense pulsed light for added benefit.

Blue light plus Levulan helps in acne. Other light sources, including the intense pulsed light and the pulsed dye laser have also been used. In our hands the blue light has seemed to be more effective than the intense pulsed light.

The degree of response varies, as does the number of treatments required. The studies seem to indicate that between one and six treatments are necessary. We have had some patients who had dramatic long term clearing with one or two treatments. We have had other patients who have had partial improvement. In my view this is a useful adjunctive treatment for acne.

iposuction was successfully performed in1974 by Dr. Georgio Fischer, an Italian gynecologist in 1974 and it was further refined by several French surgeons. The next major advance was made by a US dermatologist, Dr. Jeff Klein, who developed tumescent liposuction in 1985. Dr. Klein's advances allowed liposuction to be performed under local anesthesia. This resulted in a major advance in the safety of the procedure, and moved it out from the hospital operating room to an outpatient or office facility. Dr. Klein also pioneered the use of microcannulas which allow for more precise fat removal.

Tumescent liposuction is still the procedure of choice, and a number of studies have shown that this is the safest way to go. The microcannulas are thin tubes that break up the fat and suck it out. Initially liposuction was performed with larger cannulas that required bigger skin incisions which left larger scars. Also, with the larger cannulas, there was a greater risk of producing some dimpling or lumpiness.
Although liposuction can be performed in many areas of the body, the most common areas are the abdomen, chin/jowls and the saddle bags. We recently have begun adding limited liposuction of the cheek folds to some of our MACS-Lift (short scar facelift) procedures.
Some recent additions to fat removal procedures have been the use of laser assisted liposuction (SmartLipo) and the injection of bile acids to dissolve the fat (Lipodissolve). We don't perform either of these procedures due to safety considerations