Since each person has a unique facial structure and characteristic, this niche plastic surgery requires a great deal of skills on the surgeon’s part to achieve a more natural and feminine appearance.  Aside from the facial structure, the changes should also depend on a patient’s expectations and degree of masculine features.

Cheekbone augmentation surgery is one of the most popular FFS procedures since having prominent cheeks can create a more feminine look.  Among women, this is a prized feature as this usually connotes patrician look and youthful beauty, according to some plastic surgeons.

This procedure is generally performed using solid silicone implant which comes in different sizes and shapes and can be custom-made to fit into a specific facial structure.  This approach is more preferred by transgender as it provides a permanent result unlike the facial fillers which only last a couple of months.

There is no visible scarring following a cheekbone augmentation since plastic surgery specialists make the incisions inside the mouth.  But if performed with other facial surgery, the incisions may be placed within the hairline or inside the lower eyelid, which also results to hidden scars.

Jaw reduction is another popular FFS procedure in which plastic surgeons make the lower portion of the face narrower, a common feminine look.  With this procedure, they turn a square-shaped jaw to an inverted triangle or a round shape gently sloping with the chin as its lower point.

Plastic surgeons perform this procedure by making an incision on the lower gums to access the jaw bone and reduce its ridges using a special electric drill.  In most cases, they also trim the back corners to reduce the jaw’s height and give it a soft, feminine shape.

To further create a more feminine look, jaw reduction may be performed in conjunction with chin feminization surgery.  In some cases, additional surgery such as face lift and/or neck lift are also done to tighten the excess skin and further highlight the feminization of the lower facial region.

Most plastic surgeons believe that FFS can increase the self-esteem and confidence if performed on patients who are emotionally stable and have realistic expectations and goals.

Just take a gander at the many sites featuring celebrity bad plastic surgery and see who is bravely facing the world with a set of overfilled or unbalanced kissers — commonly known as “trout pouts,” “fish lips” and “duck lips.”

Until now, the various ways lips could be augmented included:

• Restylane
• Juvederm
• Living body tissue

Some surgeons remove fat from the patient and reinject it into the lips.

• Inserts

         A type of Gore-Tex is often implanted into scanty lips.

         Another insert works like a breast augmentation — a thin implant  is inserted into the lips and filled with saline.

But problems inevitably cropped up because: 

• Facial fillers are reabsorbed back into the body within six months
• Replanted fat often dies if it cannot find a blood supply
• GoreTex becomes hard after a few years and must be surgically removed
• Fluid filled inserts implants can extrude, or pop out through the skin

Additional woes include crooked lips, bad reactions, unnatural feeling and appearance along with the formation of cysts.

So what are the lips challenged supposed to do?

It’s a universal and continuing problem because, with normal aging, sexy, lush lips on both men and women thin, becoming less plump and attractive.  As a person ages, grooves on the upper lip also flattens while the red area, the vermillion, diminish and make the mouth not quite as kissable as in its salad days.

The latest wrinkle is removing neck muscle and grafting that tissue into lips.

The current issue of Journal of Facial Plastic Surgery, professional magazine for rejuvenation surgeons, tells of a two year test on 25 patients whose lips were augmented with muscle taken from the sides of their necks. Some connecting tissue, known as fascia, was also added.

The surgeons who came up with the technique examined their patients one and two years after the lip surgery.

Results? The amount of lip vermillion area had increased by 20 to 24 percent while the lips had become larger, too. A survey showed 24 patients were satisfied, with one patient requesting a little more augmentation with an injectable gel.

(Read about the new lip augmentation procedure in Science Daily.)

Until now, most consumers — and quite a few doctors — believed that lips become thinner as we age because the volume inside the lips had diminished.

Solution? Lip augmentation, big time! Fill those kissers with collagen, Juvederm, Radiesse and whatever works.

There is even a lip augmentation procedure that implants strips of Gore-Tex to make lips seem fuller. Another procedure – verafil — inserts a small, saline-filled implant inside the lips.

And what happens?

Too often, some of Hollywood’s most beautiful faces wind up gracing bad plastic surgery websites, labeled with non-sexy attributes like:

• Duck lips
• Trout pout
• Sausage Lips
• Fish lips

For ordinary patients, plumping up the lips is risky, at least according to realself.com where only 54 percent of 67 lip augmentation patients said the procedure was worth it.

That’s about the same odds as a coin toss for having a good outcome.

So let’s go back to square one and see what the doctors found about how the lip ages, the first such study.

During autopsies, the researchers took 20 lip samples of a group with an average age of 40 and from another group who averaged 80.

While the study was done on upper lips only, the doctors found the aging was mostly caused by the shrinking of some muscles around the lips and sagging due to loss of elasticity, “…rather than the often-postulated but unproven total volume loss.”

Lessons learned? Go easy with volume replacement! Ask your plastic surgeon to consider the balance of your lips in relation to the rest of your face.

For instance, the upper lip should be about one-half to two-thirds the size of the lower, to appear natural. The distance from the top lip to the nose is also important.

Too much plumping can ruin the vermilion border, the line where the red of the lip meets the surrounding normal skin of the face.

To augment your lips, your own particular face structure may call for:

• Corner lip lifts
• Augmentation of the marionette lines
• Expression surgery

Like most procedures in plastic surgery, your surgeon should have an artistic eye and lots of experience with lips.

Look for a doctor who has pages and pages of before and after lip augmentation pictures.

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.

• Eyelid lifts
• Hair transplants
• Neck lifts

If  your favorite actress is about the same age, she has most likely had:

• Forehead lift
• Face lift
• Breast augmentation
• Lip augmentation

Somehow, TV film and movie stars, along with other celebrities seem to change appearance from one week to the next – with no hints of surgery like bruising or bandages.

If you haven’t guessed, celebrities go to great lengths to have plastic surgery in secret.
According to the British documentary, Hollywood Knives, film legend Gary Cooper wanted a face lift and checked into a New York City hospital under an assumed name for an operation on a cyst.

The next day, the hospital arranged for Cooper to leave at five in the morning and denied any plastic surgery took place.

Before that, one Beverly Hills plastic surgeon took a famous actor to his own home for recovery. But one of the surgeon’s youngsters let the cat out of the bag when he bragged at school the actor was staying at his house with a bandaged head.

News photographers were soon on the surgeon’s front yard.

But all that was in the mid-1950s, long before rejuvenation surgery became so common.

Today, with so many famous people wanting to keep their plastic surgery under wraps, top plastic surgeons offer the following safeguards from prying eyes:

• Separate waiting rooms
• Private entrances
• Assumed names so that clerks, parking lot attendants and others will be none the wiser
• Procedures taking place at 4 a.m.
• Procedures taking place on weekends
• Staying incognito at recovery centers
• Plastic and cosmetic surgeons will visit the celebrity at home or somewhere private rather than back at the practice.
• Plastic and cosmetic surgeons and their staff are committed to total secrecy

It’s a cat-and-mouse game between the news media – who often station photographers on the sidewalks outside surgeons’ offices – and the actors and actresses who want the public to think they are just blessed with natural good looks.

Which celebrity do you think has had the best plastic surgery? The worst?

You probably already know how a buttocks augmentation is done. The surgeon takes fat from areas of your body where you have plenty, purifies the fat cells and then injects it throughout the layers of the buttocks.

Fat injection for breast augmentation seems to present more problems.

Some surgeons use it successfully, but others say it’s not a good idea because if any of the transferred fat dies, it can block breast mammograms and X-rays. (Expired fat eventually calcifies.)

However, an American Society of Plastic Surgeons (ASPS) member did a study that shows injecting some fat after performing a breast reconstruction with implants may be a good idea.

Gregory Scott, M.D., examined the medical records of 21 mastectomy and breast reconstruction patients who had 42 fat transfers for contour deformities or wrinkling in the breast after breast reconstruction.

Although the injections were done about 10 months after the breast enhancements, the fat injections were shown to be safe while improving breast shape and hiding any wrinkling.

The injected fat covers breast wrinkling or dimpling in the implant that may show through the skin. (Read more about the breast enhancement study.)

• Fat transfer is also used in:
• Lip augmentation
• Smoothing aged hands
• Filling the sunken places under eyes
• Plumping up the nasolabial folds, the deep creases running from the nose to the corners of your mouth.

A similar procedure trademarked as “Live Fill” removes whole but tiny strips of healthy fat and replants them to augment thin lips or the facial folds that make you look older.

Read more about fat transfer in plastic surgery.

What would you like to do with your excess fat?

• Brad Pitt
• Angelina Jolie

Mind you, it took the input of 20,000 plastic surgeons in 84 nations to decide on the above couple!

Here are a few more famous body parts patients all over the world ask cosmetic plastic surgeons to copy.

First, the women’s choices:

• Breasts

Leader Pamela Anderson (who has openly discussed her breast augmentations), followed by runners up Brazilian beauty, Gisele Bundchen, Britney Spears and Xuxa, a Brazilian entertainer.

• Lips.

Hands-down favorite: Angelina Jolie followed by Julia Roberts.

• Buttocks

Another overwhelming choice: Jennifer Lopez with Halle Berry and Sandra Bullock
bringing up the rear.

• Nose

Nicole Kidman takes this slot among women followed by Demi
Moore and Britney Spears (both of whom are moms and have had breast lifts and
tummy tucks,) along with Mexican singer and actress Thalia.

• Eyes

Angelina Jolie again, followed by Catherine Zeta-Jones, Demi Moore,
Michelle Pfeiffer and Salma Hayek.

• Legs

A three-way tie among Tina Turner, Sharon Stone and Cameron
Diaz, followed by Jennifer Lopez.

• Forehead

Nicole Kidman, Madonna and Oprah Winfrey. Some patients also
asked for their forehead lifts to look like Elizabeth Taylor’s.

• Chin

Mentioned were Sonia Braga, Nicole Kidman, Julia Roberts
and Charlize Theron.

• Cheeks

The most requested cheeks belong to Sophia Loren, followed by
Michele Pfeiffer, Nicole Kidman, Angelina Jolie and screen legend
Marilyn Monroe. (Read more about cheek augmentation.)

For plastic surgery, whose body part would you request?

NEXT: The stars male plastic surgery patients want to copy.

All eight were born on January 26, 2009, and were surviving in early February.

The latest wrinkle: Even though Nadya was living with her mother, some are beginning to think she’s had plastic surgery.

The Extratv.com website turned up Nadya’s high school graduation picture taken in 1992. (View the before picture.)

Despite the blurriness of the picture, it appears Nadya had a much wider nose and a thinner upper lip 17 years ago.

Here is Nadya’s current look.

“It is hard to make a certain observation without proper before and after plastic surgery pictures but I think she most likely has had a lip augmentation, most probably with fat grafting or an implant,” says Tarick Smaili, M.D. a board-certified plastic surgeon and medical director of California Surgical Institute.

“Her nose does show signs of rhinoplasty work.  She does have a nice supratip, plus the shape of the nose does not fit the profile of her face,” Dr. Smaili says.  “It is too thin and sloped, compared to her round full face.”

Other plastic surgery bloggers are wondering if Nadya is going for a total Angelina Jolie imitation with large lips, flowing dark hair and a penchant for having many children.

When a patient first comes in for initial consultation about plastic surgery, the surgeon takes a full history to find out if the inquiring patient is right for plastic surgery.

If the person’s history reveals the potential patient is:

• A single mom to six
• A parent to three disabled children
• Herself disabled
• Unemployed
• Receiving state and federal welfare

A reasonable surgeon might raise his or her eyebrows about not only that patient’s ability to pay for plastic surgery, but her judgment for wanting to have it at all.

The latest octuplet news came from NBC’s Today show: they added the total bill for raising 14 children to age 18. It comes to $1.55 million!

Don’t worry taxpayers; No allowance was provided in that budget for rejuvenation surgery!