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American Society for Aesthetic Plastic Surgery (ASAPS) Releases it’s 2013 Plastic Surgery Statistics – Check out the Highlights Below!

March 24th, 2014


* There were over 11 million surgical and nonsurgical cosmetic procedures performed in the United States in 2013.

* From 2012 to 2013, there was a 6.5% increase in the total number of cosmetic surgical procedures, with almost 1.9 million surgical procedures performed this past year.

* The most popular surgical procedure in 2013 was liposuction with 363,912 procedures performed; a 16% increase compared to 2012. Breast augmentation was the second most popular procedure with 313,327 procedures performed, down 5.2% from 2012.

* Bottock augmentation and labiaplasty, which have not previously been considered ‘popular’ took the top spots for the most significant increases in number of procedures performed over the course of a one-year period – with buttock augmentations in the lead at 58% and labiaplasty coming in second at 44%.

* Top 5 Procedures of 2013:
1. Liposuction
2. Breast augmentation
3. Blepharoplasty
4. Abdimnoplasty
5. Rhinoplasty

* Top 5 Nonsurgical procedures of 2013:
1. Botox
2. Hyaluronic Acid
3. Hair removal
4. Microdermabrasion
5. Photorejuvenation

* Women had more than 10.3 million cosmetic procedures, 90.6% of the total.

* Men had more than 1 million cosmetic procedures, 9.4% of the total.

* Americans spent more than $12 billion on cosmetic procedures .

* People age 35-50 had the most procedures in 2013 – over 4.7 million and 42% of the total.

* The most common surgical procedure for people age 35-50 was liposuction.


The data listed above is a portion of the statistics reported by ASAPS.  This report gives an overall view of cosmetic procedures in the United States.

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Doctor Radio Q&A: Are Brazilian Butt lifts safe and do they last? What are the consequences?

March 5th, 2014


Brazilian butt lifts are safe and they do last.  However the complication rate with butt lifts is higher then with other cosmetic procedures. Brazilian butt lifts are performed using Autologous fat injections, where the fat has been harvested or removed from another part of the body.  Silicone buttocks implants can be used when the individual does not have an adequate amount of fat to use for the augmentation. Some patients receive a combination of the silicone implants and Autologous fat to give the best contour and fullness. As with all aesthetic surgery procedures, it needs to be performed by someone with a great deal of experience.

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More Q&A from Doctor Radio: What is a forehead/brow lift? Is it a separate procedure from a Facelift?

February 28th, 2014


A forehead /brow lift is not part of a facelift procedure. A facelift procedure essentially lifts from the collarbone to the corner of the eyes. A forehead /brow lift is a separate procedure.

There are different ways to perform a forehead/brow lift:
1.) Endoscopic Brow Lift: Several small incisions are used and the work is done under the skin with an endoscope.

2.) Coronal Brow Lift: Requires an incision across the top of the scalp.

3.) Anterior Hairline Incision: Which is useful when lowering of the hairline is indicated.

The surgeon evaluates each patient and determines which technique will give the best result for the individual. With the variations in technique that are available it’s not necessary to have a major distortion of a hairline. Most people who have a forehead/brow lift that is performed correctly do not show obvious signs of having had the procedure.

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More Q&A from Doctor Radio!

February 25th, 2014


What are the consequences and changes on the breast after breast augmentation: Following breast augmentation, the breast will continue to age just as they would normally age. There is no evidence of breast implants that cause cancer or any other breast disease. One can breast feed following most breast augmentations if one is in the breast-feeding age range. Mammograms require special x-ray views in order for the radiologist to get the maximum visualization of the breast tissue. This is a normal process for most radiologists performing mammograms, as there are millions of women with breast implants. Fibrous capsular contracture is a possibility following breast augmentation, although the incidence is very low with the silicone gel implants and saline breast implants that are used today. It’s appropriate that the breast implants be an appropriate size for the individuals body frame and their breast tissue. Excessively large implants can cause thinning and distortion of the breast tissue.

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SiriusXM 81 Radio Show Q & A from the February 11th Show

February 24th, 2014


A number of topics were discussed on my SiriusXM Doctor Radio Show on Tuesday, February 11th, which I think making interesting content for this blog. The show started with an article from The London Observer, by writer Eva Wiseman on February 8, 2014, addressing the question, “IS COSMETIC SURGERY NOW A NORMAL PART OF MODERN LIFE”? Cosmetic surgery has become a part of everyday life for a huge number of people around the world. Cosmetic procedures are no longer just limited to celebrities and those who are finically well off. Lasers, fillers, nueromodulators and other non-invasive procedures help people long before they need a surgical treatment. The age range of people undergoing cosmetic procedures has dropped significantly with more individuals interested in maintenance of their appearance and prevention of the more obvious signs of the aging process. For many seeking help, a surgical procedure is the only way to get a significant improvement. Many surgical procedures today are minimally invasive with faster recovery times.

The following slightly paraphrased questions are from callers listening to the show:
Question: I HAVE SOME FAT UNDER MY CHIN AND LOOSE SKIN HANGING BUT I DON’T WANT A FACELIFT. CAN THIS BE CORRECTED WITHOUT A FACELIFT? Answer: If there is a significant amount of loose skin under the skin it will require a facelift for a great result. Some males who have a large, turkey gobbler neck will benefit from local excision of skin and fat on the front of the neck, but this will leave a vertical scar that is visible on close observation. Some men are only concerned about the heaviness of the front of their neck and are willing to have an incision if the excess fat and skin is eliminated. This is usually not a good procedure for a female.

Answer: If a patient has large muscle bands on the front of the neck an incision is necessary under the chin in the transverse skin crease in order to work directly on the muscle bands. With the direct approach to the muscle bands (very large cords on the front of the neck) can be eliminated. Individuals without muscle cords on the front of the neck do not need an incision under the chin. When an incision is made under the chin, it is made in the skin crease in such a way that is usually not visible.

Answer: Patients having bariatric surgery should loose all of the weight that is indicated in their particular case and be stable in that weight for approximately six months prior to having surgery to eliminate loose and hanging skin. The sequence of body contouring procedures to remove loose and hanging skin following massive weight loss will depend on the needs and desires of the patient and the order in which the plastic surgeon thinks its best for the individual.

Answer: Patients with large pendulous breasts often receive significant improvement in pain and discomfort in the upper back. The pressure from heavy breasts on bra straps can be significantly reduced. Of course not all back pain is caused by heavy breasts, but it’s a frequent symptom and complaint of those requesting breast reduction surgery.

Answer: A single isolated stent in a coronary artery is not a contraindication to elective surgery. However a complete workup and evaluation is mandatory in order to determine there is no underlying cardiac disease and there is no further coronary artery narrowing. The person needs to be evaluated and cleared by their cardiologist. The overall lifestyle and activity level of the individual as well as a number of other factors are important in the final decision making process. Essentially a single coronary artery stent with no indication of any further heart disease, in my opinion, is not a contraindication to an elective surgical procedure.

Answer: Breast lift and abdominoplasty is part of the combination of procedures that plastic surgeons call the, “mommy-makeover.” 55 years of age or earlier is an excellent time to these procedures for the motivated individual. Sagging breasts can be lifted and shaped to a much more youthful appearance. Elimination of hanging abdominal skin and repairing bulging abdominal muscles can significantly change the clothes an individual wears and elevate their self-esteem.

Answer: No. It’s impossible to gain weight if one burns up as many calories as consumed. Following liposuction it is possible to gain weight if one is eating too much. A significant number of fat cells are removed from an area undergoing liposuction. If one is gaining weight and there are a large number of fat cells in other areas then those fat cells can expand in size. It is possible to enlarge an area that has undergone liposuction if one eats too much. Liposuction is not a weight reduction procedure; it is a body contouring procedure. It is excellent at getting rid of genetically determined fat pockets. It’s also useful for removing fat in areas where an individual has gained weight due to an increase in calorie consumption. It is important that a person undergoing liposuction maintain a diet where the calorie load taken equals that burned.

Answer: In general it is not a good idea to create dimples in the cheeks. Unfavorable healing or scarring or changes with animation can result in a contour that can be unattractive and not considered an appropriate aesthetic result.

Tune in Tuesday, March 11th from 6-8PM for my next SiriusXM Channel 8 Show!

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August 27th, 2013




There are articles and advertisements online, in print and on television everyday talking about the latest device, product or technique that will get you fast results for cheap. This extends from the more extensive surgeries, like a facelift to smaller treatments like a facial or noninvasive laser. Most of the claims should be taken with at least a grain of salt, but some shortcuts and claims could lead to more serious complications like scars and the need for corrective surgery. If it sounds too good to be true, it probably is not true – exercise caution.

Beware of  “New” Facials, creams and potions

Snails, bird poop and gold are just a few things that have made headlines on ingredients for anti-aging treatments that focus on good skincare recently.  Does any of that make sense to you?

Lunchtime Facelifts?

There are many ways to lift a face and some patients do well with a mini-lift with shorter incisions and a quick recovery, but most of this cannot be achieved over an hour lunch. Injectables and skin resurfacing treatments is more appropriate for that time frame.

Illegal injections!

Perhaps the most alarming trend is the increase in illegal injections of potentially toxic and unverified products from unlicensed individuals due to the popularity of buttock augmentations and Botox. It seems like there’s a news story every week about the arrests of these unscrupulous criminals who prey on vulnerable patients who do not have the resources and information to make better decisions.  Make sure you see a surgeon that is certified by the American Board of Plastic Surgery.


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I’ve got to do something about my face, but what?

July 12th, 2013


I’ve got to do something about my face, but what?









Years ago, it was easy. You chose from a menu of forehead lift, eyelift, midface lift, cheek implants, rhinoplasty, facelift, chin implants and liposuction, which might be coupled with a skin resurfacing treatment. But now, almost each surgical procedure has a noninvasive counterpart to treat the same problem.

The marriage of technology and imagination has spawned a supermarket of noninvasive procedures that claim to iron out wrinkles, lift, chisel, plump and remodel. With a less expensive price tag and less downtime, the issues related to noninvasive procedures boil down to: “What results and how much longevity can I get from noninvasive treatments?”

Though the surgical options are more expensive, the nonsurgical treatments will need to be repeated, so it is up to you to do the math. Here is a sampling of some of the surgical facial procedures and their noninvasive counterparts that are currently available:

Brow Lift or Botox?

Surgical. A brow lift, also called a forehead lift, corrects skin wrinkling and drooping that causes your eyebrows to sag and excess skin to hood your upper eyelids. It can soften the deep creases across your forehead and reduce the horizontal frown lines at the top of your nose and the vertical lines between your brows.

Nonsurgical. Botox and Dysport are neurotoxins that relax the muscles underneath the skin to prevent wrinkle formation. They are FDA-approved to treat the “elevens,” – those lines that form between your brows. They have also been successfully used to treat horizontal forehead lines, crow’s feet, tiny bunny lines on the side of the nose and can give your eyebrows a gentle lift.

Eyelift, Soft Tissue Fillers or Your Own Fat?

Surgical. Upper eyelid blepharoplasty removes the excess fat and sagging skin of the upper eyelids that can make you look tired or sad and corrects a puffy upper eyelid appearance. 

Lower eyelid blepharoplasty eliminates under eye bags, excess lower eyelid skin and fine crepe-paper type wrinkles, dark under eye circles and lower eyelid droopiness. The result is a more alert and rested appearance.

Nonsurgical. Injections of Botox, Dysport or Xeomin can minimize Crow’s feet. When injected above the eyebrows, Botox or Dysport can also provide a ten-degree lift to the arch and a slight lift to the tail. To get rid of under eye depressions (bags), your plastic surgeon can inject your own fat or a hyaluronic acid, such as Restylane, into the area. An autologous fat injection (your own fat) usually lasts longer than hyaluronic acid, which will last up to a year.

Cheek Implants, Fillers, or Your Own Fat?

Surgical. Cheek implant surgery can make your cheekbones more pronounced and attractive, replace lost cheek volume (due to aging and weight loss) and fill in hollowed-out cheeks. Cheek implants vary widely in material, size and shape and can be custom made to suit you.

Nonsurgical.  Autologous fat is commonly used to build-up the cheeks. Your plastic surgeon can take fat from areas such as the belly or thighs and meticulously inject it into the cheek area. This is commonly used as an adjunct to facelift. Filler injections (Restylane, Perlane or Juvederm), or a collagen stimulator (Sculptra or Radiesse) are also great cheek enhancement options. In addition to balancing your face, injectable facial fillers will lift your cheeks to create a youthful appearance.

Rhinoplasty or Injectables?

Surgical. Rhinoplasty can reshape your nose to remove a nasal hump and reduce an enlarged tip. It can also improve the angle between your nose and upper lip. If your nose has drooped with age, rhinoplasty can lift it.

Nonsurgical. A Botox or Dysport injection in the divider between the nostrils can also lift the tip of your nose. Bumps on the nose can be minimized with injections of soft tissue fillers. In some patients, tissue fillers are added to increase nasal volume where desired.

Facelift or Injectables?

Surgical. A facelift can reverse the effects of gravity, tightening deeper tissues, firming up excess loose skin and addressing the volume changes that occur with aging. Liposuction can remove excess fat under the neck.

Nonsurgical. Injectable soft tissue fillers can be used to lift and diminish jowls, lift corners of the mouth, and minimize wrinkles, folds and lines. Injections of Botox or Dysport can be used to make neck cords recede. Necklines can be softened with mini doses of hyaluronic acid fillers in combination with Botox or Dysport.

It is important to know what’s available, so you can get more out of your plastic surgery consultation.  Call 212-249-6000 for a consultation with Dr. Aston to discuss your options.


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Why People Put Themselves Under the Knife: Psychologists Confirm Long-Term Positive Effects Of Plastic Surgery

May 24th, 2013


The article below just came to my attention and I thought it would be worthwhile to share with my patients.  The findings in this study are consistent with my experience of taking care of thousands of patients.  I think readers will find this very interesting…

Why people put themselves under the knife: Psychologists confirm long-term positive effects of plastic surgery

March 11, 2013

Psychology & Psychiatry In a long-term study, Prof. Dr. Jürgen Margraf, Alexander von Humboldt Professor for Clinical Psychology and Psychotherapy at the RUB, investigated the psychological effects of plastic surgery on approximately 550 patients in cooperation with colleagues from the University of Basel. Patients demonstrated more enjoyment of life; satisfaction and self-esteem after their physical appearance had been surgically altered.

The results of the world’s largest ever study on this issue are reported by the researchers in the journal Clinical Psychological Science. The aim of the research The researchers examined whether patients who undergo plastic surgery are systematically different from other people, what goals they set themselves before the surgery, and whether they achieve these afterwards. The researchers compared 544 first-time surgery patients with two other groups: on the one hand with 264 people who had previously wanted plastic surgery and then decided against it, and on the other hand, with around 1000 people from the general population who have never been interested in such operations. The desire for a better appearance for aesthetic reasons usually occurs in younger people with slightly above-average incomes.

Women represent 87 % of all patients who opt for cosmetic surgery. Overall, there were no significant differences among the three groups studied in terms of psychological and health variables, such as mental health, life satisfaction and depressiveness. Most patients do not expect the impossible from surgery using a psychological instrument, the so-called “Goal Attainment Scaling”, the researchers examined what goals the patients wanted to achieve with cosmetic surgery. Alongside open questions, ten standard goals were offered, also including two, which were clearly unrealistic: “All my problems will be solved” and “I’ll be a completely new person”. Only 12 % of the respondents specified these unrealistic standard goals. In the open questions, the patients answered on the whole more realistically, expressing wishes such as to “feel better”, “eliminate blemishes” and “develop more self-confidence”.

Long-term improvements in psychological variables after surgery the psychologists tested the patients before surgery, as well as three, six and twelve months afterwards. On average, the participants claimed to have achieved their desired goal, and to be satisfied with the results in the long-term. Compared to those who had chosen not to have plastic surgery, the patients felt healthier, were less anxious, had developed more self-esteem and found the operated body feature in particular, but also their body as a whole, more attractive. No adverse effects were observed. Thus, the researchers were able to establish a high level for the average treatment success of the cosmetic surgery, also in terms of psychological characteristics.


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Check out the latest article from the Daily Mail Featuring Dr. Aston!

May 9th, 2013


“Nip-tuck’s Extreme New Face Unveiled: With Britons Spending £2.3bn a Year on Plastic Surgery, Our Health Editor Heads to America to Discover the Latest Bizarre Procedures”

When anyone in New York high society feels the need for a little nip and tuck, they see Sherrell Aston.  As one of his slightly envious sounding peers explains: ‘It’s a status thing to name-drop him as your surgeon.

‘You eat in the best restaurants, get your couture from Paris and, when it’s time, Sherrell does your facelift.’

Of course, Sherrell is terribly discreet, but he has been linked to ‘work done’ on Vogue editor Anna Wintour and actress Catherine Deneuve. In his four-decade career, he has performed more than 6,000 facelifts, technically known as a rhytidectomy. Is it a record?

‘It could be… I wouldn’t like to say,’ he replies modestly.

Read more:

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Silicone-gel breast implants: What’s the fuss about?

April 1st, 2013


“No implantable device on planet has been more thoroughly studied than silicone gel implants.”

If you’ve been following plastic surgery news lately, you know that silicone-gel breast implants are back, big time. When they returned to the market in 2006 after the FDA ban was lifted only 19 percent of breast augmentation procedures used silicone. In 2012, according to new statistics released by the American Society for Aesthetic Plastic Surgery (ASAPS), 72 percent of the 330,631 breast augmentation procedures in the U.S. used silicone implants, while only 28 percent used saline.

Further, one can speculate that the total increase in breast augmentation procedures in 2012 (330,631 compared with 316,848 in 2011), and the comeback of breast augmentation as the number one plastic surgery procedure in the U.S., is because women can choose silicone, which, according to patients and surgeons, feels and looks more natural.

But if you’re considering breast implants, to know that they’re popular is not enough. Breast augmentation is surgery and implants take up permanent residence in your body. You are probably asking, “What was so wrong with silicone-gel implants in the first place that they were taken off the market for years?” In a recent live interview, the Huffington Post got together prominent plastic surgeons to answer these questions:

Why were silicone-gel breast implants taken off the market?

The FDA banned the use of these devices in cosmetic procedures in 1992 after complaints that the devices ruptured. At that time there were concerns that once released in the body, the implant material could lead to health problems, including connective-tissue diseases like rheumatoid arthritis. Plastic surgeons did not believe this to be true, but manufacturers at the time had no long-term data at this point, so they agreed to the ban to collect more information. During the ban, silicone implants continued to be used for breast reconstruction.

Why were they put back on the market?

The efforts of scientific studies made by 2,000 institutions exploring 1,200 data points showed that silicone-gel breast implants were not associated with breast cancer, autoimmune disease or any other systemic diseases.

Even though a scientific advisory committee recommended that the ban be lifted in 2003, the FDA recommended even more studies. It was not until 2006, after three more years of studies, that the FDA decreed these implants “safe and effective.”

Why are silicone-gel breast implants more popular than saline implants?

Water is not compressible. Women want a breast implant that is soft and compressible like silicone. Most women think the silicone implants feel more like a natural breast.

What are the dangers of silicone breast implants?

Silicone-gel breast implants were not banned because things went wrong but because, at the time, there weren’t scientific studies to refute claims that were made. The concern in the early 1990s was that these implants could make you systemically ill, i.e., cause disease. Now we have studies that show that neither silicone nor saline implants cause disease.

However, both these implants can have local complications. The most common local complications associated with both are capsular contracture (hardening), reoperation, implant removal and rupture or implant deflation.

Is there a higher complication rate with silicone than saline?

Studies since 2006 show an equal complication rate between saline and silicone. With saline implants, you can tell immediately if there is deflation. When it ruptures it deflates and the saline is absorbed by the body. With silicone implants, you sometimes need additional tests.

Saline implants are more prone to rippling and can sometimes be seen through the skin, but an advantage is that they can be adjusted by small increments at the time they are implanted.   This is helpful when adjusting volumes to improve asymmetry in breast size.  Saline implants require a much smaller incision, meaning less scarring. The shell of the implant is inserted and then is it filled with saline. Removing it is also easier.

On the other hand, the new silicone-gel breast implants have the virtue of being firm enough that if you cut one of these in half and squeeze it, the silicone protrudes from the open end, but when you release the pressure, it goes right back in. This ability to retain its integrity takes away the concerns, to a large degree, that in the event of rupture, there may be free silicone in the body. Additionally, breast implants create a pocket or capsule once implanted into the body, which prevents it from moving or sliding out, even in case of rupture.

Why do studies show that 20 percent of patients need their silicone gel breast implants removed after 10 years?

This removal rate is not due to implant failure, i.e., a broken implant. Most reoperations are because women want to change their breast size, have breasts that droop, or chose an implant that is too large. In other words, the reoperation rate is due to the way patients and surgeons select and use implants, rather than implant failure. Another consideration is that not every doctor performing breast augmentation is a skilled board-certified plastic surgeon; poor surgery will certainly lead to reoperation.

So, what’s the fuss about?

The fuss about silicone breast implants is because breast augmentation is politically and sociologically loaded and makes great fodder for news stories. For lawyers, it became their new ‘asbestos’ and for feminists breast implants became a symbol for bad values. Though Pamela Anderson is a poster child for breast implants, most patients are young women with underdeveloped breasts who feel inadequate or women with deflated breasts following pregnancy that just want a ‘natural look.’

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