Los Angeles plastic surgeon Dr. Tarick Smaili said the singer has probably changed her cosmetic regimen.  Over the past couple of years, she was branded as “pillow face” because of overuse of facial fillers.

“I think that she has now realized that too much of a good thing is bad.  Facial dermal fillers such as Juvederm and Restylane can do great wonders because they can soften or even remove wrinkles, and also correct the gaunt appearance common among aging individuals.  However, over-injection can lead to the puffy or what we call pillow face,” Smaili said.

Previous photos of the singer also shed light to her cosmetic regimen.  Aside from too much fillers, sometimes the singer also seemed to have too much Botox injection to the point that she looked “stone face.”

With her recent appearance, Smaili thinks the singer has received just the right amount of facial dermal fillers which are important to correct her gaunt face (probably because of her low body fat and also due to natural aging).

Showbiz bloggers believe that Madonna previously had multiple cosmetic procedures—both surgical and non-invasive in nature—including brow lift and facelift, laser skin treatment, injectable fillers, and Botox injection.  However, the 53-year-old star neither confirmed nor denied having cosmetic any procedure.

Despite the fact that cosmetic procedures in the US have skyrocketed over the past couple of years, many celebrities still remain mum even if the result looks somewhat obvious.  According to data released by the American Society of Plastic Surgeons, about 13.1 million aesthetic procedures (both surgical and minimally invasive treatments) were performed in 2010.

“Perhaps celebrities like Madonna remain silent about having cosmetic procedures because they want their fans to think that their beauty is somewhat natural.  Much like winning in a gene lottery,” Smaili said.

Despite countless of hours in the gym, some people will not achieve the much coveted six-pack because of genetic predisposition.  Also the excess fats in the abdominal area tend to be stubborn that no matter how some individuals perform rigorous exercises, the bulges seem not to go away.

Abdominal etching is a special type of liposuction in which the plastic surgeons use a cannula (pen-like device) that is smaller than the one used during the traditional technique.  With this instrument, doctors strategically remove the excess fats to create grooves which in turn results to the appearance of six-pack.

(Taylor Lautner and his much coveted six-pack abs.)

Usually, doctors create several small incisions (about 1-2mm in length) which can heal quickly without causing visible scars in most cases.

Abdominal etching through liposuction surgery is typically conducted under general anesthesia, though some plastic surgeons prefer using “twilight” anesthesia which can sedate the patients but they will still remain awake.  And as a relatively simply procedure, most patients can return just a few hours following their operation.

Of course, the small incision and removal of excess fats can still lead to pain and discomfort which is the most pronounced during the first to second day following liposuction.  To control this symptom, doctors recommend over-the-counter or prescribed pain medications.

To further minimize the pain, plastic surgeons recommend compression garments wrapped around the abdomen.  By wearing them, the skin will also retract and heal closer to the body and the patients can shorten their recovery.

Ideally, compression garments are worn three to six weeks at all time even during sleep (except when bathing), depending on the surgeon’s instruction.

Because of the swelling, the grooves that create the six-pack abs will not be apparent within the first few weeks.  In most cases, it takes about six months before the patients see the muscular appearance.

But as with any cosmetic surgery, abdominal etching through liposuction has its own limitations and disadvantages.  First and foremost, it cannot create a muscular appearance for patients who are 25 pounds heavier than their ideal weight; another consideration to make is that significant weight fluctuations can totally reverse the result.

Since maintaining normal weight is the most important thing after abdominal etching, plastic surgeons consider a patient’s willingness to stick to a healthier way of life—e.g., regular exercise and moderate diet.

The celebrity mom, who was featured in MTV’s reality show 16 and Pregnant, tweeted: “Thank you USWeekyly for including me on 2011 BEST: Plastic surgeries.”

After giving birth, Abraham underwent breast augmentation surgery to increase her bust size from cup size A to C.  Despite criticism for having the procedure at a relatively young age, she said that she is happy with her decision.

Los Angeles leading plastic surgeon Dr. Tarick Smaili, who did not treat Abraham, said that she is a good example of natural-looking breasts after plastic surgery.

“The good thing about her breast implant size is that it complements her body and perfectly fits her small frame.  She did not go overboard as some celebrities have done in the past by using large implants that often result to the heavy top look,” Smaili said.

During the 1990s, the cosmetic surgeon said the trend in breast augmentation was the “bigger the better,” despite the unnatural look it gave to some patients, particularly those with small frame.

But nowadays, Smaili said that he is seeing more patients asking for revisions to “downsize their breast implant and achieve a more natural look.”

“I think the trend today is the natural bust size.  Just enough volume especially in the upper poles of the breasts to create more cleavage.  People should know that not all patients who ask for breast augmentation solely want to enlarge their breasts; in fact, a significant number of my patients just want to regain the lost volume caused by pregnancy,” Smaili said.

The cosmetic surgeon added that 300 to 350 cubic centimeter (cc) of breast implant size is often enough to create the natural look, although he warned that factors such as waistline, chest width, natural fat and tissue, and overall body frame should also be considered when deciding for the “right” implant size.

Citing Abraham’s breast augmentation, Smaili lauded her decision to stick “to a realistic size considering her small frame and thin arms.”

“Patients like her are easy to work with.  They know their body and consider its limitation.  While we always remind our patients that going for extremely large implants have many disadvantages, there are some who are still persistent about this.  But any self-respecting and ethical surgeons would have to turn these women down because we should not push the body’s limit—that’s my rule,” Smaili said.

During the show, even River’s plastic surgeon Norman Leaf was surprised when she showed up for consultation; this was probably because the TV personality has too much done on her face that it looks as if it was blown by a strong gust of wind.

Despite the overdone appearance, River seems to crave cosmetic plastic surgery as years go by.  Unfortunately, her seemingly unhealthy obsession with the procedure resulted to a windswept appearance and squinty eyes.

Because of too much work done on River’s face, even her daughter Melissa and some of her colleagues beg her to stop having cosmetic procedures.  However, the dissuasion ended when she offered them to pay all their aesthetic treatments.

In a previous interview, the 78-year-old TV personality was quoted saying, “My body is my temple, and my temple needs redecorating.”

Leading cosmetic surgeon Dr. Tarick Smaili, who did not treat Rivers, said that she have had too many procedures, including facelift surgery, that resulted to the unnatural appearance.

“Facelift surgery, because it cannot stop the aging process, still needs some revisions after 10 years or so.  However, repeating the procedure should be carefully done as the skin becomes thinner as people age,” Smaili said.

The cosmetic surgeon said the disadvantage of repeating facelift surgery more than twice is the higher risk of losing the “fundamental” shape of the face, resulting to an unnatural look.

“Also, pulling the skin over and over again can result to the squinty eyes or fish eyes.  That look is very unflattering so plastic surgeons have to be extra careful when doing revisions,” he added.

Smaili said that while the number of facelift surgery performed on a patient should be limited, this is not the case for soft tissue fillers and most injectable treatments designed to remove or minimize the signs of aging.

“Soft tissue fillers like Juvederm and Restylane should be performed every six months to two years, depending on the absorption rate of the body and treated areas.  Botox should also be repeated every couple of months in order to maintain the youthful appearance,” Smaili added.

The 59-year-old actor, who started his boxing career in 1991 after his acting career failed, is not new from plastic surgery.  In fact, he admitted to have five rhinoplasty surgeries to repair his nose due to sports-related injuries in addition to one operation to fix his smashed cheekbones.

Aside from facial injuries, Rourke also suffered from neurological problems which forced him to leave the boxing and return to his acting career.

Going back to Rourke’s rumored plan to undergo plastic surgery, some say that the actor probably wants to look like his movie character Thomas, a rugby player who in 2009 revealed that he’s gay.

Because Thomas is 22 years younger than Rourke, the actor would likely have facelift to make himself look younger.  This procedure, which is increasingly becoming popular in the US, involves the removal of sagging skin and wrinkles by going deeper into the facial tissue.  If done correctly, it can erase 10 to 15 years off from one’s face.

Whether Rourke will push through with the plastic surgery or not, he should be more careful in choosing his plastic surgeon.  In 2009, the actor said in an interview that he regretted having facial cosmetic procedures because of the unnatural result.

“Most of it [plastic surgery] was to repair facial injuries because of the boxing, but I went to the wrong guy to put my face back together,” Rourke said.

Facial plastic surgery is a complex procedure that combines science and art; for this reason, a patient should always choose a board-certified plastic surgeon who has an extensive experience in this specific surgery.

Dr. Tarick Smaili, a cosmetic plastic surgeon who did not treat Rourke, believes that interviewing previous patients can help a person determine if his doctor is able to deliver “great and natural results.”

“A doctor who has no medical malpractice suit and has good records would in fact advise you to talk to his previous patients.  By contrast, if your doctor discourage you to make some background check, this is already a red flag,” Smaili said.

But much to the disappointment of celebrity bloggers and showbiz reporters, Jenner’s scar is not caused by facelift or any cosmetic procedure.  The former Olympian had surgery to remove a cancerous growth on his face, according to a report published in Us Weekly.

The magazine cited an unnamed source although Jenner had not yet confirmed if his scar is really from a cancer surgery.

Perhaps those people who jumped into a conclusion that Jenner’s scar is from plastic surgery cannot be blamed as the reality tv star had admitted to have some nips and tucks in the past—a mini facelift when he was 35 years old and then followed by rhinoplasty or “nose job.”

Because the result of Jenner’s mini facelift was not as natural as it should be, he has been criticized for his “wind-swept” look and squinty eyes—clear manifestations of bad plastic surgery.

In an effort to “correct” the not-so-natural result of Jenner’s initial facelift, his wife and stepdaughters convinced him to get a revision plastic surgery several years ago.

Dr. Tarick Smaili, a cosmetic surgeon who did not treat Jenner, said that facelift is not only about removing the sagging skin and wrinkles.

“For me, the most important thing aside from making the face more youthful is also maintaining the natural shape of the eyes and face.  No one would like to have squinty eyes or a face that looks like it was blown by a strong wind.  With this in mind, I am very carefully when it comes to removing the sagging skin although I prefer going deeper into the facial muscle so the result will last 10 to 15 years,” Smaili said.

To avoid botched results, Smaili advised patients to carefully choose their plastic surgeons and make sure that they have been certified by the American Board of Plastic Surgery.

Smaili added that patients considering facelift surgery should make sure that their doctors have expertise in facial rejuvenation.

“People should remember that not because their doctors provide them great breast augmentation result does not necessarily mean that they are also good in facelift.  First and foremost, two procedures are very different from each other,” Smaili said.

The 39-year-old actress was spotted on the Hawaiian beach during the holiday with a more toned and shapelier body.  Some experts have said that she may have increased her bust size by a cup.

While Diaz’s body appears to be shapelier than the previous years, some people are really not convinced if she had the procedure as the increase in her bust size was not as significant as compared to other celebrities who have gone under the surgical knife.  In fact, some bloggers even said that a slight weight gain may be the primary reason for the actress’ improved figure.

During previous interviews, Diaz was quoted saying that she would love to have a curvier figure, something she said she was not “naturally gifted.”

Meanwhile, the actress was not a first-timer in plastic surgery.  In 2006, she had rhinoplasty or nose surgery after sustaining injuries; however, the Hollywood star said she would rule out cosmetic surgery.

Whether Diaz has gone under the knife or just gained some weight that resulted to a shapelier figure, it is really hard to tell since the increase in her bust size was not dramatic.  And because the actress has brushed off rumors of her alleged breast augmentation surgery, the only thing people can do is speculate.

But assuming that Diaz had breast implant surgery, her decision to choose smaller implants is commendable as it resulted to a very natural appearance rather than looking “heavy” on top.

Meanwhile, Dr. Tarick Smaili said that he is seeing more and more women opting for the natural look.

“I see that the growing trend is having smaller implants so the results will be natural that it would be hard or even impossible to tell if a woman has undergone plastic surgery or not.  In fact, we’ve seen Hollywood celebrities such as Denise Richards and Pamela Anderson downsizing their bust size with another augmentation surgery,” the leading cosmetic surgeon said.

During the previous years, the actress has been accused of yoyo dieting that left her with a very thin frame and flat chest.  But after she gained some weight, she now looks healthier and shapelier than the previous years.

The British tv personality, who has appeared topless on numerous tabloid newspapers, was quoted saying that her large implants seem out of proportion with her smaller body-frame.  In fact, she even admitted to “lifting her breasts” during body-building competitions because they hide the “first couple of rows of her abs.”

Meanwhile, Dr. Tarick Smaili, a cosmetic surgeon who did not treat Marsh, said that he is seeing more patients wanting to downside their breasts in order to achieve a more natural look.

“In general, very large breast implants lead to the heavy top look which often looks unnatural, especially if you have a small frame and limited chest width.  Surprisingly, this was a trend during the previous years although I am now seeing that many patients are opting to replace their implants with smaller ones to look natural,” Smaili said.

Another concern with extremely large breast implants, Smaili said, is that the patients are at higher risk of rippling, which is more of a problem if they have a limited amount of breast tissue and fats to cover the implant shell.

Citing the body-builder’s recent photo, Smaili said that her upper and medial cleavage has some visible rippling, which the doctor explained is caused by implants that are too large for her body.

Marsh is not the only celebrity who is shifting to the natural look.  In fact, Denise Richards and Pamela Anderson have been reported to undergo a revision breast augmentation to downsize their implants.

Another good example is Kate Hudson who has been reported to have plastic surgery in 2010 to receive small breast implants that no one would even be able to tell she have them if not for her previous videos and photos.

Going back to Marsh, she previously said that she was concerned if she had the controversial PIP breast implants which have been pulled out in the UK market and other countries after findings suggest the devices have a very high failure rate.

However, she did not mention if her decision to replace her breast implants with smaller ones has also something to do with the controversial PIP devices.

While the movie has made Dolly’s plastic surgery a butt of joke, with some of the characters’ tacky reference to her “overdone” appearance, not everyone is laughing.  Many people—especially movie critics—believe the actress deserves better than the slapstick, loud film that undermines her talents.

Going back to her acting, some movie bloggers said it was “painful” seeing the actress with overdone plastic surgery especially on the big screen.  This is more of a problem with the emergence of high definition technology that can emphasize any facial flaws.

In fact, one writer at the Chicago Tribune has described Dolly’s plastic surgery “as if she did her last work in a drive-through.”  But despite the harsh comment, he noted the actress’ vocal prowess and her charm.

To digress from the movie and Dolly’s impeded acting skills, facelift surgery is not just about removing the facial aging—e.g., wrinkles and sagging—but more importantly is maintaining the normal appearance and fundamental shape of the face.  This is the rule of thumb followed by board-certified cosmetic surgeons.

“The goal of facial plastic surgery is to create a natural appearance and not a windblown face and squinty eyes,” said Dr. Tarick Smaili, one of the leading Los Angeles plastic surgeons.

To create a natural appearance, Smaili said the most important thing is to remove the right amount of skin.  By contrast, he said that excising too much facial tissue can result to the “dreaded windswept look and squinty eyes.”

Another technique is to go deeper into the facial tissues, the cosmetic surgeon added, so the result of facelift surgery can last 10 to 15 years without the need for revision procedures.

However, Smaili warned that facelift does not stop the aging of the face and so the need for “minor tweaks” after 10 years will be needed in order to maintain the youthful appearance.  Revisions may include “isolated facelift,” Botox injection, eyelid lift, and even nose job (particularly for aging patients whose nasal tip becomes too drooping and elongated).

Citing Dolly’s appearance, Smaili said the actress probably had “too invasive” secondary facial rejuvenation procedures that resulted to her lack of expression.

This is a list of best and worst celebrity cosmetic surgery of 2011:

• Lil’ Kim

She used to look naturally beautiful, but with bad plastic surgery, she ended up having too prominent cheeks and a too pointy nose that almost resembles that of the late King of Pop Michael Jackson.

Another notable change is her bust size.  However, it seems that the 4’11” singer has gone overboard with her outrageously large breast implants.  It could have been better if she chose smaller ones to fit her petite frame.

• Kate Hudson

Kate Hudson is a perfect example of a good breast augmentation surgery.  She only asked for small breast implants to better fit her petite frame, giving her a nice B cup from a “double A.”  Because of the natural look she has achieved, not everyone is even convinced that she had plastic surgery, with some even saying that she might have started using “good” push-up bras.

While Kate has not yet confirmed if she went under the knife, her previous photos show the “subtle” improvements.

• Ashlee Simpson

Her previous nose was too large.  But with a good rhinoplasty surgeon, she now has a smaller, delicate-looking nose that complements her face.  However, the singer is still denying having plastic surgery.

• Joan Rivers

Over the past several years, television personality Joan Rivers has always been included in the list of worst plastic surgery.  But despite the notoriety of her obsession, she still continues to make some “tweaks” here and there that it is hard to tell how many cosmetic surgeries she had and is planning to have.

• Jane Fonda

Joan Rivers should learn from Jane Fonda who had facelift, eyelid lift, and neck lift.  The actress looks younger and refreshed nowadays, without looking like a wind just blew her face—a manifestation of bad facial plastic surgery.

• Donatella Versace

The Italian fashion designer may be talented in making fashionable clothes but is probably clueless when it comes to “ideal beauty.”  With her swollen, stretched out lips and her unflattering tan, or sometimes orange complexion, she definitely looks “unglamorous.”

• Megan Fox

While the sultry actress has repeatedly denied having plastic surgery, it is really hard to refute that her looks are solely from good genes.  Some doctors claim that she had nose job and eyelid surgery to make herself one of the most gorgeous celebrities in Hollywood.  But even if the cosmetic procedures are just plain rumors or real—and her appearance is just created by talented makeup artists and good photoshop skills—she looks stunningly beautiful.

• Heidi Montag

The reality tv star admitted to have had 10 plastic surgeries in one day.  In 2010, she had buttock augmentation, breast implant surgery, brow lift, Botox injection on her forehead, liposuction on her midsection, neck liposuction, fat injection on her face, chin reduction, ear pinning, and nose job.

But just after several months of her extreme makeover, she said during an interview that she regretted her surgeries.

• Jennifer Aniston

The actress has previously admitted to have had nose surgeries, although she claimed that these were done to correct her deviated septum, which is the strip of tissue separating the two nostrils.  But whether she had the procedures for cosmetic or reconstructive reasons, she looks more gorgeous these days.

• Nadya Suleman

The “Octomom” had tummy tuck surgery after giving birth to octuplets.  However, her plastic surgeon had probably gone overboard as her abdomen now appears too flat that it has no definition or contour.  Plus, her navel looks like it was created by making a vertical slit, making it hard to deny that she had the procedure.

• Lisa Rinna

The television host and actress had definitely joined the bandwagon of celebrities with a larger-than-life lip.  While this is a growing trend among famous people, any self-respecting plastic surgeon would definitely not agree with the swollen, stretched out lips.

Also, Lisa’s multiple facial plastic surgeries left her with an unnaturally smooth, windswept appearance.  Meanwhile, she was quoted saying in 2009 that she regretted going overboard with cosmetic procedures.

• Jocelyn Wildenstein

The wealthy socialite, dubbed as the “Lion Queen” and the “Cat Lady,” has been reported to spend a whopping $4 million just to look like a feline.  For several years, she has managed to make it to the list of worst plastic surgery.

• Ellen DeGeneres

While Ellen has not yet confirmed if she had plastic surgery, it is hard to deny that she looks younger and refreshed nowadays.  Some cosmetic surgeons assume that she may have had facelift, eyelid lift, laser skin resurfacing, Botox, and/or neck lift.

Ellen is a perfect example of “natural look” after facial plastic surgery.