Vanity? No, most people – celebrities notwithstanding — are not vain.

The desire to be the most beautiful or most handsome? No, most just want to look like a rested, refreshed version of themselves.

Over and over, plastic surgeons hear: “Doctor, people always ask me why I’m so angry; but I’m hardly ever angry!”

Or, “Friends always ask why I’m so sad or if I got enough sleep last night. Actually, I sleep just fine and I’m rarely sad or depressed.”

By now you get our drift:  facial expressions cause many to see cosmetic plastic surgeons.

It’s because some of the natural effects of aging quickly mark our key facial expressions to various negative moods that aren’t really there at all.

For instance, when the deep lines at the sides of the mouth, the marionette lines, start pointing south, many may assume you are sad.

When bags form under your eyes, others think you’re tired. Add drooping upper eyelids to the picture  and people assume you are so worn out you’re likely to drop in your tracks.

That’s not good for job interviews or even keeping the job you’ve got.

Wrinkles on the forehead and between the eyebrows can indicate anger and disgust.

Writing in this month’s Aesthetic Surgery Journal, board-certified Virginia plastic surgeon George Weston, MD, and colleagues, tell how Dr. Weston has preformed about 3,000 surgical lip lifts since 1980.

Writes Dr. Weston: “The mouth ages along with the face, but is frequently ignored when performing facial rejuvenation.”

In the procedure, the right and left edges and middle of the lips are lifted. The surgeons may also excise, or remove, some excess skin at the corners of the lips.

While tons of information is available about lip augmentation via Restylane or other hyaluronic acid fillers, you rarely hear about lip or mouth surgery.

But it may be worthwhile. Hyaluronic acid fillers dissolve and other materials inserted into the lips almost always cause future problems.

The surgery does leave a faint facial scar. However, Dr. Weston writes the mark can barely be discerned from inches away.

Other expression surgery includes upper and lower eyelid lifts, along with the removal of heavy wrinkles and lines on the forehead.

View lip and mouth surgery before and after pictures.

Already, athletes at all levels are looking forward to the release of the new substance to treat the Achilles heel of sport injuries, torn cartilage.

In plastic surgery, experts predict the substance will be used as an all-purpose clay to mold new cartilage outside the body for use in building new ears and noses through injections.

Here’s how it works, according to researchers at MIT and Harvard Universities: physicians extract the patient’s own cartilage-producing cells and mix them into a newly developed and patented gel which is based on hyaluronic acid. Then, they inject the mixture into an injury site or wherever it’s needed for plastic surgery.

Hyaluronic acid is the prime ingredient in Juvederm and Restylane.

So far, the engineered cartilage injectable has been tested on animals.

In one experiment, cells from cartilage structures inside the human nose were mixed with other types of growth cells and then injected into mice.

The researchers then harvested the injected areas at various times from 14 to 38 weeks and studied the samples, using several types of biochemical analysis. Results? 93 percent resembled natural cartilage.

Printed in the January-February 2008 issue of Archives of Facial Plastic Surgery, a professional journal for plastic surgeons, the researchers concluded: “Injected, autologous cartilage may be the answer to the long search for the ideal implant in facial plastic surgery.”

“Autologous” means the donor tissue comes from the patient’s own body. Read more about the research for this possible facial injectable.)

Michael Jackson, are you paying attention? Can you hang on just a couple more years until this marvelous substance is widely available?

Back then, there were many movie stars who complained about shaving behind their ears – because so much beard-bearing skin had been moved higher.

And many starlet face lift patients – who found themselves in middle age – had such tight facial skin, they sported a windblown or surprised look. Some had faces so tight they just no longer looked their former selves.

But as more thinking, discussion and research went into the mix, the next wave in surgical facelifts became replacing lost volume. Because, as aging progresses, the face loses collagen and some facial muscles shrink, leading to sagging skin and other marks of advancing age.

The slogan became, “To duplicate the look of youth, restore the fullness of youth.”

Hence, the popularity of facial fillers like Juvederm and Restylane. But, alas, those substances are temporary so the rejuvenated look must be maintained by repeat visits to the plastic surgeon.

Now, rising higher on the radar is a minimally invasive procedure that replaces – for the long term — lost facial volume with your own donated fat. But it’s not just fat injections; the substance doing the work is rich in adult stem cells.

Widely known as Fat Augtograft Muscle Injection, just FAMI or the “stem cell face lift,” the procedure takes some of your own fat and connective tissue, prepares it and then injects a stem-cell rich substance into the main facial muscles.

Stem cells are so named because they are the body’s basic building block; everything else can grow from stem cells.

Results?  Badly wrinkled foreheads, sagging cheeks, hollow places under eyes, thinned lips and drooping jaw lines are rejuvenated.

Some patients, like those with sagging jowls and neck, may need a facelift to remove excess skin. (A basic facelift treats the area of the face from just below the eyes to the jaw and neck.)

The benefit of a FAMI  facial procedure includes:

• No risk of damaging facial nerves, arteries or veins
• No allergies in your own donated fat
• Less recovery time
• Also being available to rejuvenate for bony, aged hands

View a before and after picture of a FAMI procedure.

Only, nobody has fully defined “stress.”

Now, scientists have closely studied at least one form of stress — divorce. And to quote the late George Carlin, “it ain’t good for ya!” Ditto, use of too many anti-depressants and being too fat.

Here’s how the survey was done:

Using pictures of 186 identical female twins, researchers at Case Western Reserve University in Ohio asked an independent panel to study the pictures and affix an age to each.

The study used identical twins because twins are genetically exactly the same; given all other things being equal, twins should age at the same rate.

When the results were tabulated, researchers found that a twin who had been divorced looked two years older than her sibling who may have been married, single or even widowed. They also found that twins who used mood elevators looked older.

For subjects under age 40, overweight twins looked older than their sibling, too. But in twins over 40, the heavier twin looked younger.

The many rigors of divorce (sleeplessness, arguments, constant anger and worry along with financial woe) often lead to:

• Crow’s feet near the eyes
• Bags under the eyes
• Fine “smoker’s” lines around the mouth
• Sagging facial skin

One plastic surgeon researcher reckons that continued relaxation of the facial muscles due to antidepressant use can account for the sagging facial flesh.

The study did not include any male twins. (Read more about the research on divorce.)

So, who are you going to call when you are over 40, divorced and looking older than your true age?

That’s right, a board-certified plastic surgeon! Possible procedures that can turn back the clock a little include:

• Face lift
• Microdermabrasion
• Chemical and laser peel
• Facial fillers

The lead researcher, Bahaman Guyuron, M.D., professor and chairman, department of plastic surgery at University Hospitals Case Medical Center observed the findings have put some science behind the idea that volume replacement (using Juvederm, Restylane and other hyaluronic acid fillers) rejuvenates the face.

Have you ever been divorced? Did you see extra wrinkles?

If you didn’t already know, Cindy holds the record for most cosmetic surgeries in the 2009 Guinness Book of World Records.

Among other procedures, she’s already had:

• Breast augmentation
• Face lift
• Rhinoplasty
• Liposuction
• Cheek implants

CSI: Cindy, we must ask about Body Dysmorphic Disorder (BDD). As you know, these people seek endless plastic surgery.

Cindy: BDD sufferers are normally obsessed with one particular feature they change constantly. And they shun attention, are suicidal recluses and really believe they are ugly. And that ain’t me, Hoss!

CSI: The 2009 Guinness Book says your record is spending $100,000 on more than 50 minor procedures, including 9 full scale operations since 1988. Is that complete?

Cindy: The total is now 13 major procedures under general anesthetic and hundreds of minor procedures. But, looking back with 20-20 hindsight, I should have not done three of them and two were revisions. So I could have been in the same place with eight! I’ve held the record since 2000.

CSI: And the minor procedures?

Cindy: Hundreds! That includes tooth bleaching, filler injections, vein removal, face peels and microdermabrasion repeated over and over during 20 years. If you’re really curious about how a girl from Ohio came to be me, get Living Doll, my autobiography or Image and Cosmetic Surgery Secrets, available at the Cindy Jackson website.

CSI: How do you make a living in London?

Cindy: I have appeared in films. I’m a musician and model and do some writing and television appearances here.

I also do in-person consultations with people who are looking for cosmetic plastic surgery and surgeons. I also offer face and body microdermabrasion and moisturizer products on my website.

CSI: What is your current top goal?

I’m going for a total Brigitte Bardot look. Some think I’m already there!

To see the changes cosmetic plastic surgery can make, just visit my website where you can see my before and after plastic surgery pictures since 1988.

CSI: Thank you, Cindy.

NEXT: Cindy tells how to find bargain beauty and cosmetic rejuvenations treatments during hard times.

Las Vegas plastic surgeon Goesel Anson, M.D., says that many Americans are getting plastic surgery to stay on top their game during a tough economy.

O.K., doctor, but what procedures?

While you may need to update your resume, you also must consider your appearance. A tired, haggard or unrested look does not put your name at the top of the hiring list!

At the same time, budget is a big concern. Just where do you allocate any dollars you can allocate to rejuvenation surgery? Which procedures produce the most noticeable change?

Here are the results of a quick, impromptu and totally unofficial phone survey of board-certified Beverly Hills plastic surgeons who recommend what to do first:

• Fix the neck and jaw line

Aging is most noticeable when the neck becomes loose and jowls sag from your jaw.

• Next, consider eyelid surgery

If the upper eyelids sag, your eyes look hidden. If lower eyelids are baggy, you look unrested.

• Consider your  skin quality

If your facial skin is wrinkled and covered with age spots, you might try dermabrasion or an acid or laser peel as the ticket to a new job. Women usually need skin care first because men tend to have thicker skin.

• Think about facial injectables

More injectables are added to the marketplace as time goes on. For six months to a year, you can correct and plump up sagging facial features with substances like Restylane, Prevelle and Radiesse.

• Perhaps a breast augmentation?

Women with breast enhancements certainly get more attention, but first, consider the field in which you work.

A breast enlargement will probably go over well in the entertainment industry, among marketing and sales professionals and others. But what would happen in a more conservative industry, like banking, accounting or academics?

Think rejuvenation surgery would help your job hunt?

A rhinoplasty can change the following nasal features, among others:

• Make your nose bigger or smaller
• Change the shape of the bridge
• Narrow the span of the nostrils
• Relieve breathing problems
• Remove humps and bumps on the nose

However, there’s no hiding the after effects of a surgical rhinoplasty. You’ll be bruised, wear a thick bandage over your nose, have some swelling and should take some time away from your normal schedule for healing.

But there’s another way.

If the corrections you want on your nose are just minor, you can also have a non-surgical nose job with facial fillers like Restylane, Juvederm, Radiesse or Perlane.

Benefits? No recovery or time off for healing needed, little or no pain (anesthetic cream is spread on the skin before starting) and the results show much quicker.

Plus, the cost of a nose job with facial fillers is performed in the surgeon’s office and is priced far lower than a surgical rhinoplasty.

What’s the catch, you ask?

All these fillers eventually dissolve back into the body after about a year, leaving your nose in its uncorrected state.

Conditions on and around your nose that make you a candidate for a non-surgical rhinoplasty include:

• Straightening nasal humps and bumps
• Raising the bridge of a ski jump nose
• Repairing divots, depressions or troughs in the skin of the nose.

Some cosmetic surgeons give patients a mirror and ask them to watch and take part in the process as the doctor works.

Here’s a YouTube segment showing a patient getting facial fillers.

Speaking of which: the results of any facial filler or Botox wrinkle remover are known in plastic surgery as “provider dependent.”

That means it takes a lot of practice with many years experience with injectables to deliver good results. So be sure and ask your surgeon how often he or she has been delivering facial fillers.

When done correctly, the result can be very pleasing. Read more in the New York Times Magazine about how faces look when they are not pulled tight but pushed out and plumped up from the inside.

What would you like to have filled on your face?

• Quick
• Effective
• Inexpensive
• Require no “downtime” for healing

In 2007, , a little over 1.4 million injectable procedures were performed by plastic surgeons to:

• Erase wrinkles
• Plump up facial folds and creases
• Flesh out hollow facial areas
• Augment lips

Because the injectables are being delivered to so many people, an independent panel of top plastic surgery experts urged the Federal Food and Drug Administration (FDA) to make the risks of facial injectables more widely known.

While facial injectables like Juvederm, Restylane and Prevelle have been thoroughly studied and rarely cause medical woes, the panel had in hand 823 reports of dermal fillers causing medical problems. (Read more about the facial injectable panel.) In almost all cases, the Botox, Restylane or other injectable is not at fault for the complication.  This is why it is so important that you do your research, even if it is “only a little Botox”.

Here are the top 10 questions to ask your practitioner before going ahead.

1. How many injectables have you given?
2. In my case, is shock or difficulty breathing possible?
3. Am I likely to have an allergic reaction?
4. Will I have swelling afterwards? Will the substance move elsewhere in my face?
5. Can I expect sores or facial redness?
6. Is the substance painful during or after the procedure?
7. Is it likely to cause blisters, cysts, bumps or scarring?
8. How long will the injectable have the intended effect?
9. Are you using this substance off-label?
10. What is the officially approved indication for this substance?

Patients are best safeguarded, they say, by using a board certified plastic surgeon with many years experienced giving facial injectables.

Have you ever tried a facial injectable? Botox, for instance?

Of course, Madonna can afford any type of surgery she wants.

But for we ordinary mortals who earn less than bazillions of dollars yearly, the more common situation is finding yourself at age 55 and settling for the appearance you had at 40.

There are a few more affordable plastic surgery procedures that can have an impact on making you look younger and more refreshed.

Before plastic surgery, however, take preventive measures like:

• Forsake sun bathing – it ages the skin.
• Ditto for smoking – it ages facial skin while adding lines and wrinkles.
• Always use sun block.

Here are a few cosmetic plastic surgery procedures that may stretch your dollar.

• Ask about the nasolabial fold

The deep creases that run from the corners of your nose to the corners of your mouth, the nasolabial folds, make you look older.  Some surgeons make the mistake of performing a facelift and pulling the facial skin too tight when trying to lessen those lines. A better way: consider using facial fillers like Restylane to fill in and plump up those creases.

• Want to get rid of wrinkles?

If your only complaint is wrinkled facial skin, consider getting a younger look via a chemical peel or a laser peel to resurface the facial skin.

• Consider just an eyelid surgery

Rather than having a whole face lift, consider an upper eyelid lift for sagging eyelids. If your lower eyelids are bagging, surgical correction there can be less costly while making you look younger.

• Think about your neck

Flabby jowls and a drooping neck also add to an aged appearance. A neck lift is often done by using a little liposuction and then tightening the stretched neck muscle that creates a double chin. (Read more about neck surgery on a previous post.)

What features would you change? Leave a comment!

Does plastic surgery have a McBotox or a Starbucks-like future in the greater Los Angeles area? Only time will tell. But the Botox clinic in the Big Apple looks good to people who are pinching their pennies.

The clinic, SmoothMed, is staffed by two plastic surgeons. One told the New York Times he doesn’t think of the clinic as a McBotox but “Botox-on-the-go.”

Patients can make an appointment but the doors are also open to passersby who were shopping at nearby Bloomingdale’s and decided to stop in to eliminate a few facial wrinkles. (Read more about Botox.) Appointments usually last a little under half an hour with follow up sessions taking about 15 minutes.

However, wrinkle removal is not the be-all and end-all of speedy rejuvenation procedures.

Smoothmed is also cashing on another noteworthy trend in plastic surgery as more patients put off plastic surgery in favor of facial injectables. So the clinic also offers shorter, less pricey treatments like:

• Restylane
• Perlane
• Radiesse

But there may be danger in the glitter!

A successful outcome for an injectable procedure is something plastic surgeons know as “highly provider dependent.” That means it requires years and years of experience working with tiny needles and injectables to be effective and safe. You may not find that at a shopping or mini mall.

So be sure and ask the person who actually wields the needle about his or her level of training and experience.Your best bet? A board certified plastic surgeon!

Ever tried Botox? Leave a comment and tell us about it!