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.

According to the American Society of Plastic Surgeons (ASPS), men accounted for about 10 percent of all cosmetic plastic surgeries performed in the US.  But while women still make up for the vast majority of patients, experts believe that males may catch up sooner with the growing number of middle-aged workers.

Over the past couple of years, nose job has been the most popular cosmetic procedures for men.  The procedure typically involves manipulating and reshaping the cartilage, which is the flexible tissue inside the nose, to reduce or increase the projection, correct nostril flare, and address other aesthetic problems.

Aside from nose jobs, Smaili says he sees a growing number of male patients seeking liposuction, a procedure to remove the excess fats underneath the skin.  This is not surprising since the surgery was the third most popular cosmetic procedure for men in 2010, according to ASPS data.

“Contrary to popular belief, most men, especially those working in the corporate industry, are conscious with the way they look.  This doesn’t surprise me as several studies have shown that male bosses who are pleasing to the eyes—not necessarily those drop-dead-gorgeous superiors—appear to be more credible and trustworthy,” Smaili says.

And with the growing number of baby boomers and middle-aged men, some experts suggest that facial rejuvenation procedures such as facelift, Botox injection, and eyelid lift will continue their popularity.

In fact, a survey released by ASPS showed that eyelid lift was the third most popular cosmetic plastic surgery in 2010.

Employment is often the primary reason of men seeking cosmetic procedures, particularly that more workers these days postpone their retirement, in addition to the fact that older people are living longer and healthier.

But when treating older patients, Smaili says that most of them simply want to regain their youthful appearance, even those who are asking for nose jobs.

“Older men have a well-imprinted body image.  They do not want to drastically change their appearance, for instance, those who are asking for nose jobs just want to correct their drooping nasal tip to make it youthful.  On the other hand, younger patients are more focused on changing the fundamental shape of their nose,” he says.

Because of the stiff job competition and the growing number of men postponing their retirement, leading Los Angeles plastic surgeon Dr. Tarick Smaili sees more male patients going to his office to ask for cosmetic procedures.

“Contrary to popular belief, I think men nowadays are as conscious as women in terms of physical appearance.  In fact, a 2010 data from the American Society of Plastic Surgeons (ASPS) has shown that the number of middle-aged men seeking medical enhancement is on the rise,” Smaili added.

Meanwhile, another survey shows men’s growing enthusiasm with plastic surgery.  UCLA has found that 23 percent of US men were interested with the procedure, although only a fraction will push through with their plans.  By contrast, women were about eight times more likely than male patients to go under the knife.

Smaili noticed that many men still view plastic surgery as the last resort to their problems.

“Based on my experience, men will more likely prefer non-invasive procedures such as Botox injection and dermal fillers while women are more willing to go under the knife to achieve the best result possible,” the cosmetic surgeon said.

A significant number of men seeking cosmetic surgery undergo facial rejuvenation procedures such as facelift and eyelid lift.  And with the aging baby boomers who are living longer and healthier, plastic surgeons across the US believe in one thing: more eager patients will fall in line outside their office.

In fact, a 2010 data from ASPS shows that facelift performed on male patients increased by 14 percent.

Aside from employment reasons and Americans’ obsession to looking young, Smaili believes that the increasing number of patients seeking cosmetic procedures is caused by the changing attitude.

“In the past, cosmetic surgery was almost considered taboo, but now, many people would admit it without batting an eyelash.  More men are also open to treatments that would improve their appearance; this is proven by the invention of the term metrosexual, which is used to describe men who spend a lot of time and money for their appearance,” Smaili said.

Aside from facial rejuvenation procedures such as facelift and Botox, Smaili has also noticed an increase in number of male patients seeking liposuction especially in the chest area and abdomen.

In 2010, 13.1 million cosmetic procedures were performed in the country, with about 88 percent accounting to non-invasive treatments.  Meanwhile, almost half of the patients were in their 40s and 50s, a clear manifestation of Americans’ obsession to youthful beauty.

One advantage of non-invasive cosmetic procedures over surgical ones is that they involve no recovery or require little downtime.  However, one consideration is that they often need maintenance so the patients can preserve their youthful appearance; for instance, Botox and collagen injection must be repeated at least every six months.

The International Association for Physicians in Aesthetic Medicine (IAPAM) is expecting that non-invasive cosmetic procedures especially those treating the signs of aging will increase in numbers.  Botox and Dysport, which both uses neurotoxin in small dosage, will continue their popularity.

Dermal fillers such as Restylane and Juvederm will also continue their popularity.  These treatments are used to “fill in” hollowed facial areas such as the cheeks although certain types can also used in lip augmentation.

In addition, non-surgical body contouring procedures such as VelaSmooth and Zerona will continue their popularity.

Over the past couple of years, liposuction has been one of the most popular cosmetic surgeries in the US.  But nowadays, new technologies have made it possible to perform the procedure without using incisions; in fact, some doctors simply inject a concoction of drugs to the fatty areas to melt these away, allowing the body to naturally flush these out.

These are the advantages of minimally invasive procedures over cosmetic plastic surgery:

• The treatments are performed quickly.
• Most procedures are relatively painless or at least the discomfort can be minimized by local anesthesia.
• Bed rest is not required because there is little or no downtime.
• Side effects are minor.  But in case the patients develop some swelling, redness, and bruising, these symptoms will likely subside a day or two.
• The procedures are ideal for patients who do not want the idea of going under the knife.
• Most non-invasive treatments provide instantaneous results because there is little or no symptom such as swelling and bruising.
• The non-invasive cosmetic procedures are much cheaper than plastic surgery.

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.

While many studies have already proven the countless benefits of acupuncture, I am quite doubtful with its effectiveness in terms of removing the wrinkles, fine lines, and sagging skin.  First and foremost, these signs of aging are caused by many factors including sun damage, tissue laxity, and pull of gravity.

But despite some critics, one doctor who offers facial acupuncture still insists that by creating a “little scar formation, it would be possible to lift the sagging skin and address other signs of facial aging.”

Some also claim that the acupuncture needles can encourage the body to produce natural collagen, which is a type of protein responsible for making the skin youthful and plump.

The cost of acupuncture for the removal of facial aging is almost the same, if not more expensive, than most traditional non-surgical facial rejuvenation treatments such as laser, soft tissue fillers, and Botox injection.  Also, patients should consider that it requires monthly maintenance that costs around $150.

Meanwhile, the average cost for the first few sessions of facial acupuncture is $1,000.

Whether facial acupuncture really works—or it is just another media hype—patients should remember that facelift surgery is often the most ideal solution to the signs of aging because it provides a longer lasting effect.  By contrast, non-surgical treatments (e.g., laser skin resurfacing, Botox, and soft tissue fillers) must be repeated every six months to two years in order to maintain the youthful appearance.

But regardless if facelift surgery or non-surgical treatment is used, all facial rejuvenation treatments do not stop the aging process.

Traditional facelift surgery can remove 10 to 15 years off from face, with its result lasting a decade or so.  After this period, a patient may need some kind of revisions such as “isolated” facelift including brow lift, eyelid lift, etc.

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.

By contrast, cosmetic rhinoplasty surgery requires patients to be at least 14 years old or slightly older when dealing with males (as their nasal structure takes longer than girls to become fully matured).  In this way, the results after surgery are less likely to change as the years pass by.

Aside from physical issues, patients younger than 14 are not yet emotionally mature to fully understand the ramifications of cosmetic plastic surgery, which in turn makes them a bad candidate in the first place.

According to a previous study, teenagers have a different view of cosmetic.  While adults see this as a way to stand out from the rest of their peers, younger people seek this to fit into their crowd.

It is safe to say that 16 is already an ideal age to have nose jobs as long as the teenagers are emotionally mature and they have realistic goals and expectations.  As any self-respecting doctor would say, “there is no point of conducting aesthetic surgery if it would not elicit a smile from a patient.”

But as mentioned earlier, reconstructive rhinoplasty does not have an age requirement especially if a patient is experiencing breathing problems and severe deformities. In fact, most doctors will likely address the issues as soon as possible so an individual can live a more normal life.

Either performed for reconstructive or cosmetic reasons, nose surgery is a relatively safe procedure because it does not involve major blood vessels and organs.  However, there are still some risks, although usually minor or at least can be easily treated.

While most teenagers can return to school just a week to 10 days after their nose surgery, some residual swelling and bruising (which can be covered up with make-up) can last for a couple of months.  Also, they can resume most of their daily life’s activities within four to six weeks.

Meanwhile, older patients can also enjoy the benefits of rhinoplasty surgery; but unlike teenagers and young adults, they often seek to regain the youthful appearance of their nose rather than change it dramatically.  This is not surprising since those in their 40s and 50s already have a well-imprinted body image.

However, a recent study has proven what plastic surgeons have always been telling their patients: nose jobs, if correctly performed on the right candidates, can result to a more youthful appearance.

In a study conducted by the researchers from the University of Toronto, young and middle-aged patients on average looked 1.5 years younger after rhinoplasty surgery.

The study, which is published in the January-February issue of Archives of Facial and Plastic Surgery, suggests that patients will achieve a more youthful appearance—whatever their age—after their nose jobs.

“The age of the patients at the time of surgery had only a small effect on the age reduction,” according to the report, which involved 53 individuals who had nose surgery; their pictures were taken prior to the procedure and one year afterward.

The pre- and post-surgical photos—which were taken at the same angle, lighting, and camera—were examined by 50 “untrained” lay observers in two sessions.  Half of the respondents were asked to first look at the pre-operative pictures before the “after” photos; the remaining half examined the images in the reverse order.

Each respondent was asked to guess the patients’ age from the paired frontal and lateral images.

Meanwhile, the age of patients at the time of their surgery was between 15 and 61, with a mean of 35.  Most of them were from the 20-30 age bracket, with about three-quarters were women.

As people reach the age of late 30s or early 40s, it is not uncommon to experience visible changes in the nose especially with its tip drooping.  Also, the skin thickens around the nostrils as the nasal tip becomes elongated because of the aging and pull of gravity, resulting to an unpleasant appearance.

Aside from making the face look older, age-related changes in the nose may also lead to breathing difficulties particularly if the drooping tip is severe.  To correct this problem, most plastic surgeons will manipulate the flexible nasal tissue, or graft cartilage behind the ear and then transfer it to the nose.

Grafting cartilage behind the ears, which is to be transferred to the nose, does not affect the organ’s appearance or hearing of a patient.

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.