But there are other often heard requests that hint things may not go well.

 Here are the top five:

1. Doc, I’m 65 and want to look 20 again!

Sure, plastic surgery turns the clock back some, but ten years is about it.  You’ll be very lucky if you look 15 years younger after surgery. Asking for three and one-half decades is not realistic.

2. Don’t bother checking my cholesterol level!

Sorry, cosmetic plastic surgery is only for those who are healthy enough to undergo surgery. You’ll need a physical in California and a few other states. If you’re close to 50, your surgeon may require a physical even if your state does not.

3. I want liposuction because I don’t like dieting or exercise!

Any plastic surgeon worth his or her salt will tell you liposuction is not a means of weight control but a way to lose troublesome spots – like love handles – that just won’t go away otherwise.

(And, yes, the fat can come back! Liposuction removes fat cells permanently. But the few left behind have no limit on how large they can become. To keep up the svelte look after liposuction, you must watch what you eat and work out.)

4. I want a face lift because my husband has gone to live with the baby sitter!

Other than making you feel better about a body part – a big nose, big breasts on a man or small breasts on a woman — that causes you embarrassment, plastic surgery will not make you feel better about the big speed bumps you encounter while traveling the road of life.

5. I want to leave the operating room and go back to the office right after surgery!

If you want surgery, you must show your surgeon you’ll take time out for recuperation and healing. That’s basically the reason your surgeon handed you a to-do laundry list about follow up care after cosmetic surgery. Follow the instructions for a good outcome.

(Read our blog post about breast implants as body armor.)

When Ebay, the huge online market and auction site first appeared, very few people ever imagined it would be a place to obtain breast implants. (Make that used breast implants!)

Case in point: Sharon Osbourne, TV star and mate of mumbling rockstar Ozzy Osbourne, has announced she does not like her current breast augmentation because the implants are too round and too big.

Actually, Sharon falls into a trend of midlife woman who once had breast enhancement and then decide to go back under the knife for a reduction in size.

Many decide larger breasts are uncomfortable and get in the way. Plus, they no longer need large “girls” because they are no longer trolling for a mate.

Said Ozzy: “Ah’m shu Sha don madaupa ‘er mind ‘cause, Sha always knowz whaa Sha wanndo wiff ‘er fac…”

Anyhow, Sharon has already forked over about $600,000 for cosmetic plastic surgery including:

• Face lift
• Buttocks lift and augmentation
• Weight loss surgery
• Tummy tuck

But where does Ebay fit in?

Sharon wants to eventually have her DD implants removed and exchanged for smaller implants.

And, get this: she wants to sell them on Ebay.

Wonder where Sharon got that idea?

Perhaps from entertainer and former California gubernatorial candidate Mary Carey who listed her old breast implants on Ebay in 2007. The starting bid was about $2200. But, hey, the implants were autographed!

Back in 2005, an exotic dancer who appeared under the name Tawny Peaks had her somewhat unwieldy 69-HH implants removed after her dancing career. GoldenPlace.com reportedly paid $13,000 for one of the implants as a publicity stunt. (Read more about the breast implant sale.)

Yet another celebrity – at least in the U.K. – made the news for almost selling her implants in Ebay.

British pop princess Kerry Katona placed an autographed 34GG implant on Ebay – with all profits going to charity — but the site removed the listing because the paperwork relating to charities was not listed correctly.

Nonetheless, if you look on Ebay, you’ll find somewhere around 12, not-for-surgery breast implants ranging in size from 275 to 650 cc’s.

Of course, for a measly 80 bucks, nobody famous has autographed them!

Case in point: police vehicles in donut parking lots.

One would assume that the ingestion of donuts — and a subsequent weight gain — would also be under way.

Down Under in Australia, the police may not be loading up on donuts but biscuits (“cookies” in the U.S.) and other fattening foods.

According to The Perth Sunday Times, taxpayers are helping to pay for overweight police officers to have Lap Band surgery. The police union is contributing the equivalent of $2000 toward each officer’s surgery; the cost of Lap Band surgery in Australia is about $6000. The idea is to combat chronic illness, lowering other health costs.

As any Lap Band doctor can tell you, chronic illnesses that are usually resolved after weight loss surgery include:

• Hypertension, or, high blood pressure
• Type II diabetes
• Sleep apnea

But the Lap Band help is being criticized Down Under because the police are undergoing a general belt-tightening ( financial belt tightening, unfortunately) and have already cut back on mobile phones, motorcycles and even patrol cars.

Australian researchers writing in Obesity Journal, surveyed 323 Lap Band patients three years after their surgery and found 91 percent would have the weight loss surgery again. (Read the Lap Band doctor article.)

In the U.S., police officers are often required to stay in shape. After all, a cop never knows when he or she must chase a bank robber on foot!

So news about overweight cops is constantly being made.

For instance, a five-foot-nine Bellevue, Nebraska, policeman, Chris Parent, was fired back in 2007 at 350 pounds because he just was not nimble enough.

The crunch? Parent took a combat course test requiring him to kneel, fire his sidearm at a target, move to another location and fire again. But the officer could not stand again after kneeling without grabbing onto something for support.

Parent battled his case through the Nebraska Supreme Court who ordered the officer reinstated in 2009 with full back pay.

In Thailand, 340 portly traffic cops are told to hit the gym, lose at least 10 pounds and get into shape within three months. A survey found 57 percent of the force is overweight, with high cholesterol and triglyceride levels.

The day might come when Lap Bands are as common as badges to police forces.

It happens like this:

For many reasons – inactivity, bad eating habits, genetics – some people gain 100 to 150 and more pounds. Such a huge weight gain stretches the skin of the arm, legs, stomach, chest, neck and face far beyond its ability to rebound.

After weight loss surgery – like via a Lap Band  – the result is still “plus sized,” skin hanging in sheets.

That’s a problem because the movement in almost any exercise causes the excess skin to painfully flap and rub against still other sheets of skin. That, in turn, often creates pain, infections and embarrassment.

Lap Band doctors have reported patients with enough loose skin hanging from their stomachs to reach the knees.

Due to massive weight loss (MWL), one of the most popular body shaping procedures to remove that excess skin is the tummy tuck, or abdominoplasty.

Plastic surgeons in Pittsburgh studied 490 MWL patients who had tummy tucks.

A regular tummy tuck just won’t remove enough skin. So the doctors and patients can choose from:

• A circumferential, or belt, abdominoplasty

The scar goes all the way around the body.

• A Fleur-de-lis abdominoplasty

The scar — only on the abdomen — is shaped like an inverted “T”.

Because the scars are longer and a few more complications could exist, the plastic surgeons, working at the University of Pittsburgh Medical Center, studied the results of 154 patients who had the Fleur-de-lis version.

Results? The doctors found the overall abdominal complication rate of all tummy tuck patients is about the same as the Fleur-de-lis group only.

The usual, expected complications in abdominoplasty include:

• Infections along the incision
• Seroma, a pocket of clear fluid that sometimes develops after surgery.
• The incision breaking open, known in medicine as dehiscence
• Being male is also a risk factor.

Concluded the surgeons:

• Fleur-de-lis can do a better job of removing excess skin on MWL patients who are left with a lot of hanging, loose skin on the upper abdomen.
• Complication rates are about the same as with traditional tummy tucks that use only one incision along the lower abdomen.

(Read the University of Pittsburgh plastic surgery study.)

• 3000 women
• 1000 men

to discover that 50 percent of male study subjects look at a woman’s breasts before her face.

That’s no great shock to any woman who knows the feeling of a guy talking, not to her face, but to her breasts. Some even advise the man: “Hey, I’m up here!”

But here’s the unusual part of the study: many women are just as obvious, with 90 percent of the study group admitting they stare at and evaluate “the girls” of their friends, co-workers and relatives. Half the group of women surveyed also said they have “breast envy” when they spot a healthy and attractive bust line.

 About 40 percent men of men said, of the women they are usually around, they, the men, check out the ladies’ cleavage at least ten times daily.

British plastic surgeons say that about half of English women are unhappy with their breasts, with 63 percent wanting breast augmentation.

 Guys, however, would not to touch that question.  Half said they would not want their partner to have breast enlargement or a breast lift.

 But it’s not to say that men are mindless beasts. For, given human nature, men are just beasts.

 Let us explain more.

 Researchers at the University of Wellington in Australia performed a similar study and found 47 percent of men first looked at a woman’s décolletage while only 20 percent of first glances were on her face. Moreover, the glances at breasts lasted longer.

 The move is hard wired into the brain – men are not responsible. Whether we realize it or not, virtually all of human attraction is due to the possibility of  mating.

 To prove it, the Australian scientists noted male subjects’ glances fell to the aspects of the hourglass figure within 0.2 seconds of the breast peep. Larger breast sizes and a slim waist indicate the woman has higher levels of estrogen and, thus, greater fertility. ll this may have been a good thing when very few humans dwelled on Earth.

And because our brains can actually overtake libido – given a little effort – wouldn’t it be a wonderful social lubricant if more men worked on developing their peripheral vision so they could look a lady in the eyes while admiring her nether regions?

For 2009, the rate of male breast reduction increased 80 percent over the previous year. And for 2008, that rate had increased over 2007.

According to the British Association of Aesthetic Plastic Surgeons (BAAPS), 581 gynecomastia surgeries were counted in 2009 while 2008 saw 328.

Compare that with half a decade ago, when only 22 such surgeries were performed.

By comparison, male breast reduction in the U.S. was down 5.7 percent for 2008 when compared to the number of similar surgeries done in 2007. The American Society of Plastic Surgeons (ASPS) –believe it or not! – says the decline was due to the economy.

Actually, readers of the CSI blog were already clued into some of the story. Back in January, 2009, the CSI blog reported on some suspected causes. (Read our blog about why gynecomastia has increased.)

The BAAPS also points out that, for British men, the following procedures increased 21 percent over last year’s rates, including:

• Rhinoplasty
• Eyelid lift surgery
• Liposuction
• Pinning back of large ears (otoplasty)

What could be going on?

According to some plastic surgery analysts and prognosticators, it’s the “Sarkozy effect” – a mini boom in male plastic surgery.

Sarkozy? (In New Orleans, they would say “Who dat?”)

 Nicolas Sarkozy, the 50-ish president of France, married former supermodel Carla Bruni who is 13 years his junior.

Meanwhile, back in England, a cosmetic plastic surgery chain, The Harley Medical Group claims 50 percent more men than last year between 35 and 55 coming in for Botox.

Also, male microdermabrasion – a procedure much loved by women – is up 43 percent.

Face lifts are up 17 percent while chin lifts have increased 43 percent.

The new group of patients are being called FAMs (Forty or Fifty-year-old Alpha Males) by British plastic surgeons.

In addition to looking good, another trend is working when a FAM marries a woman young enough to be his daughter: he must be willing to start another family!

He is then known as a “Recycled Father”.

After a few years of diaper changing and the terrible twos, our FAM will then be ready for every rejuvenation procedure known to plastic surgeons!

The problem: Too much Botox froze some facial features so the directors could not get the right emotions onto actors’ faces. But, hey, that was a strictly a Tinsel-town “problem” that didn’t play well in Peoria, so nobody paid much attention, Southern California plastic surgeons notwithstanding.

It turns out there is more to the story that first met the eye.

When Bloody Mary sang “Happy, happy, happy, happy-Talk” in South Pacific, she could have been talking of our future where Botox injections became the single most popular procedure

Here’s why: Psychologists have pretty well nailed down that you can feel somewhat better if you force a smile onto your face. And the reverse is true, too. Run around with a sour expression and things will feel more bleak.

The professional magazine Psychological Science will soon carry an article on people who had their positive and negative emotions tested before and after Botox injections.

Results? Botox injections may do more than just remove crow’s feet near your eyes or worry lines on your forehead. The substance may indeed change your reactions to bad, sad or unhappy news while making happy times brighter.

The test: Forty volunteers who were having Botox injections in two weeks were given three highly emotional statements designed to trigger either a sad, angry or happy response. The testers asked each participant to press corresponding buttons, indicating they had read and understood the messages.

Then, two weeks after the Botox injections, the same subjects were shown the same messages and asked to push the three buttons again.

Results? All took longer to push the sad and unhappy buttons. But they all jumped on the happy button in nothing flat. (Actually, the delay for the sad and unhappy buttons was about a second.)

The researchers say that indicates Botox may affect the ability to understand the emotional content of language.

And here’s the meaningful application for plastic surgery that turns out well: a happy expression can affect the emotions to also be more joyful.

The old saw, “Smile and the world smiles with you” seems to be more important than we ever thought.

(Read more about the Botox study.)

But many plastic surgeons (including California Surgical Institute) already offer email and phone consultations to potential cosmetic surgery patients and others coming to the Golden State from afar.

The usual scenario usually takes place like this:

• A patient, doing research likes the website and emails the surgeon.
• The surgeon answers the patient’s questions and invites him or her to send current pictures for a preliminary look.
• If the patient wants to pursue a possible surgery with that doctor, the surgeon then asks for the patient’s medical history and other health information.
• The patient is given an approximate quote and information about lodging and other vacation possibilities. Many offer an airport pickup service for out-of-town plastic surgery patients.
• When the patient arrives, surgeon and patient start from the beginning with a full hands-on exam and review the cost of the plastic surgery. Some surgeons start with the concept that the patient has never been seen before.

We looked at SurgeonHouseCall.com and see a few red warning flags.

For one, you are asked to fill an online form with your medical conditions, your medical history and the medications you take.

That information has value to various marketers so you may start getting spammy email and telemarketing calls offering cheap drugs, cures, medical supplies and so on.

With SurgeonHouseCall.com, only 55 plastic surgeons are available; you only know the responding surgeon is interested in doing business.

But just by going to your home computer, you can surf the websites of hundreds of cosmetic surgeons in dozens of locations. Moreover, you can find out all about a surgeon long before ever emailing or speaking to the doctor .

Any good plastic surgery website should contain:

• Many, many before and after plastic surgery pictures of the procedure you want.
• Information about where the surgeon trained.
• The specialty of the board certification. (Only the American Board of Plastic Surgery and the American Board of Otolargyngology (head and neck surgery) can certify surgeons to perform cosmetic plastic surgery.)
• Patient testimonials.
  • Many plastic surgeons allow you to speak to a former patient who had the procedure you want.

Like many things in life, a lot depends on you!

Lifestyle can determine the life span of major invasive plastic surgery like:

• Face lift
• Breast lift and augmentation
• Male and female breast reduction surgery

But first, the good news: if your enhancement involves cartilage or bone, you should be good to go for life. These procedures include:

• Otoplasty, the ear pinning operation
• Nose jobs
• Cheek and jaw implants

Cosmetic plastic surgeries that depend the most on the patient’s lifestyle include:

• Face and neck lift
• Liposuction
• Breast augmentation
• Body shaping

A breast enhancement is protected with a bra that gives good support.

Given a skilled, well-trained plastic surgeon, a face and neck lift should be good for about ten years. Staying off cigarettes, using sun block while forsaking sun bathing and – yes, we get tired of hearing it, too! – watching your weight are also important.

Because so many people are having weight loss surgery via a Lap Band, body shaping procedures and liposuction are affected by the patient’s ability to keep the weight off.

Here’s the deal with liposuction: the procedure  removes fat cells which do not regrow. But – and it’s a big but — every liposuction leaves behind a few fat cells.

Why should that be important?

Any fat cell has the ability to store an almost endless amount of fat. Thus, couch potatoes are almost sure to undo a liposuction without a thoughtful  eating and an exercise plan.

Finally, the facial fillers which last anywhere from three to 12 months include:

• Botox
• Juvederm
• Restylane
• Prevelle

On the plus side of fillers: you can immediately return to your usual activities with no time taken out for healing while showing almost immediate results.

The way to prolong and protect your tummy tuck or your “mommy makeover” (a tummy tuck plus a breast lift or augmentation) is:

• Make sure your family is complete

Childbirth will certainly part the stomach muscles again – allowing the contents of the abdomen to bulge out in a pot belly. Nursing may cause the breasts to deflate and droop.

Gynecomastia

It’s especially tough on teens who, above all, want to fit in with their friends. But with breasts can that can rival those of prepubescent girls, a lot of cruel teasing takes place.

One of the first questions teen boys ask plastic surgeons when they arrive to ask what can be done about their growing breast  is “Do I have cancer?”

Usually not. Statistics reveal that for every 100 cases of female breast cancer, about one teen or man is stricken with the same malady.

Teens then want to know why they have enlarged breasts. Most cosmetic plastic surgeons will explain that the lad:

• Has too much female hormone, estrogen
• Is too sensitive to the amount of estrogen in his system
• Has obesity as a contributing factor.

Many pediatricians and family doctors suggest waiting until the lad’s 18th or 19th birthday before considering gynecomastia surgery. Sometimes, the condition  just goes away on its own.

But many plastic surgeons think teens should be allowed to have gynecomastia surgery – given a proper diagnosis – because a lot of what happens in the teen years determines the type of men patients become.

Just read the concerned letter from a very worried mom of a teen gynecomastia patient.

Overall, the cruelest remarks are: “No girl wants to go out with a boy who has bigger breasts!”

Later in life, the grown gynecomastia sufferer will hear remarks about his “man boob” or “moobs.”

Other patients ask why the excess tissue can’t just be liposuctioned away.

While some fat in the chest can be liposuctioned, the actual fibrous breast tissue formed in the guy’s breast is far too dense to be taken out with suction.

Male breast reduction must be surgically removed. (Read more about gynecomastia surgery.)

For guys who are concerned about the Big C in their chests and breasts, the tell-tale symptoms to look for include:

• Being over 40
• Having growth on one side only
• Breast cancer in women relatives
• Discomfort in a breast
• Anything leaking from a nipple
• A nipple that retracts

That man would then have a very tiny piece of internal tissue taken from the affected breast and then biopsied by a lab.