Building a Better You

Botox parties, celebrities like Patricia Heaton and “Dr. 90210” have all helped cosmetic surgery go mainstream. Here’s the latest on how to do it locally–and how to do it most affordably.

Botox parties, candid celebrities like Patricia Heaton and the reality show “Dr. 90210” have all helped cosmetic surgery go mainstream. Not only are more people seeking consultations, they willingly admit they’ve “had a little work” done.

In some cases, that confession is necessary. Gone are the days when a face lift was as obvious as Joan Rivers on the red carpet. Today’s rejuvenation procedures leave you looking renewed—not redone. Yet cosmetic surgeries can also improve your self-image and quality of life.

Many procedures are surprisingly affordable, and if you have a larger budget, you can combine procedures for discounts.

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We asked area doctors for the hottest procedures for men and women at three price points: $2,500, $5,000, $5,000-plus. (For procedures in the $10,000-plus range, see the sidebar on page 97.) Many procedures apply to both sexes.

Prices fluctuate. Many physicians base their fees on the patient’s particular need. Liposuction for a heavier patient, for instance, will cost more than for a person of average size. The prices below take both the hospital and anesthesiologist’s fees into account, which is known as the “global fee.” Always ask if a quoted price is comprehensive.

There is a risk with any medical procedure. Investigate your options and be realistic. Pouty lips won’t make you look like Angelina Jolie. But they might make you look mah-va-lous.



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$2,500 and less

Smooth That Brow
If the furrow between your brows makes everyone think you’re always angry, consider Botox. “It’s a wonderful, extremely successful procedure that’s on the less-expensive side,” says Dr. Christopher Saunders, who has offices in Newark, North Wilmington and Chadds Ford. Among the leading cosmetic treatments, the procedure involves tiny injections of Botulinum toxin, which reduces the muscle activity that causes frown lines. Many doctors charge by the unit, typically $10 to $15. The area between the brows requires 18 to 25 units. Results last for about four months.


Wax On, Wax Off
When your girlfriend called you Sasquatch, it wasn’t a term of endearment. A hairy back is a bummer. Laser hair reduction can leave you smooth as a baby’s behind. Anesthesia isn’t usually required. You’ll feel a slight sting, and there will be some redness. Because the laser targets pigment, it works best on people with dark hair and light skin. It does not work well with gray hair. Since your hair grows at varying rates, you’ll need multiple treatments—in some cases, as many as nine. Most practices offer packages, but there is no guarantee that you’ll be hair-free in that many treatments, says Dr. Susan Kirchdoerffer of Reflections Medical Spa in North Wilmington, which shares space with her family practice. Expect to pay between $750 and $1,000—or more—for large areas such as the back.


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Eyes on the Prize
It might be eye-opening to learn that upper-eyelid surgery can be performed for about $2,500, though the price can jump to $3,500 if you want general anesthesia. To remove fat, the surgeon will make incisions following the natural lines of your eyelids in the creases of your upper lids, then close them with fine sutures. (The surgeon may also remove excess skin.) Dr. Ari Abel, a Newark ophthalmologist who performs facial surgery, often makes incisions inside the lid, then closes them with dissolving sutures.

 Afterward, cold compresses and elevation can ease the swelling, which can last two weeks or more. If puffy lower lids make you appear tired even after a good night’s sleep, consider tackling all your eyelids at once for a cost reduction. Blepharoplasty on all four lids runs $3,500 to $5,000, again, depending on the anesthesia.



$2,500 and less

Down with Hair
When it comes to laser hair reduction, the bikini line, legs, armpit, forearms and chin are on the female hit list. The laser’s high-energy light zaps the hair follicle, causing it to become dormant. Patients at Dr. Neil deLeeuw’s practice in Wilmington frequently seek the treatment for unsightly hairs on their chins. The fee for the chin alone is $229 for three sessions. The chin and jaw line is $399 for three sessions. Because hair grows at varying rates, you may need more than three.


Peeling Out
Chemical peels encompass both the lighter peels available in many salons and the heavy-duty peels applied in doctors’ offices and hospitals. The chemical breaks up the top layers of skin (epidermis). Depending on the nature and concentration of the chemicals, the peels can strip off superficial layers, or they can go deep into the skin.

Attitudes Medical Spa in Ocean View combines micro peels—alpha hydroxy acids and beta hydroxyl acids in various percentages—with micro-dermabrasion in the same treatment. (The micro-dermabrasion, which exfoliates the skin, comes first.) It’s $150 per treatment. A series of six is $800.

Like many area doctors, Dr. Paul Sabini in Newark uses trichloroacidic acid—TCA for short—to treat moderately deep wrinkles and improve the skin’s overall texture. During the 15-minute treatment, your skin might feel hot and sting. “Some people have had these procedures before and can tolerate them,” Sabini says. “Others want sedation.” Afterward, you may experience swelling. You’ll need at least a week before going out in public. Avoid sun exposure.

Dr. Mehdi Balakhani utilizes the Blue Peel, part of the Obagi skincare line developed by Dr. Zein Obagi. The solution includes ingredients reported to hasten healing. “It neutralizes the TCA peel,” Balakhani says. Generally, peels run between $500 and $1,000, depending on the depth of the peel. You may need multiple applications.


Lose Those Veins
Sclerotherapy requires injection of saline solution to erase unsightly varicose and spider veins. At Attitudes Medical Spa, the charge is $75 per syringe. The average is two syringes. You may need to wear compression stockings for several weeks after the treatment.


Fill ’er Up
Some creases and folds—especially those running from the nostrils to the mouth—are too deep for Botox. They respond better to fillers, such as Restylane, Juvéderm, Radiesse and Sculptra, which are injected into the target areas, including the lips. Restylane is made with hyaluronic acid, a substance that occurs naturally in the human body. Juvéderm, also made with hyaluronic acid, is a smooth gel. Radiesse is made of calcium-based micro-spheres suspended in a natural gel.

The newer Sculptra is a synthetic Poly-L-lactic acid material commonly used in dissolvable stitches and soft-tissue implants. “Sculptra is a filler I’m using with excellent success,” Saunders says. “It’s shown to have lasting benefits for multiple years.” Dr. Joseph Danyo in Greenville uses Sculptra to fill in hollow cheeks and augment the cheekbones.

Most practices price by the syringe. The hyaluronic acids run bout $500 a syringe, Radiesse is about $750 and Sculptra is $1,500. Most people require just one syringe to treat the nasal-labial folds.


No More Bulges
For a poochy belly and saddlebags, check out the Alma Accent XL radiofrequency energy device, available in Danyo’s office. Circled on the skin for 20 to 30 minutes, a hand piece sends energy into the skin, prompting collagen to shrink, thus reducing the appearance of wrinkles, cellulite and fatty bulges. It also works on the face. Some compare the sensation to a hot stone massage, though your response will depend on your pain threshold. “Results can be visible within days,” Danyo says. The cost is $500 per zone.


What a Face
Thermage is another device that uses radiofrequency energy to tighten the skin. In theory, the heat causes tightening of existing collagen and stimulates production of new collagen. Skin may be red for a few days and you might experience blistering. Some say results last from six months to two years, though it will vary from person to person. The cost is about $2,000 for one area or $3,500 for the full face and neck.


Removing Age Spots
Non-ablative procedures that treat fine lines and uneven pigmentation cover a wide spectrum of products. Danyo uses the Pixel Fractional Erbium laser. “Fractional means the laser fires tiny dots, separated by untreated skin, in a grid pattern,” Danyo says. “Since the tiny dots of treated skin are surrounded by normal skin, they heal very quickly.” Only 30 percent of the total skin surface area receives treatment during any one session. The cost for a full face is $750. “There is minimal downtime, no anesthesia, minimal risk, and it’s done in the office,” he says. The chest and hands can also undergo treatment.

Similarly, deLeeuw uses the Fraxel laser, which treats deep but microscopic zones in your skin to eliminate old epidermal pigmented cells. Fraxel treatments trigger the body’s own natural production of new collagen and skin cells, improving the dark discoloration known as melasma, acne scars, wrinkles around the eyes and pore size. The fee is $3,200 for three sessions that treat the entire face.


Light Makes Right
Intense pulsed light is another non-ablative technique. Unlike a laser, which emits light at a specific wavelength, IPL emits a broad spectrum with each pulse to treat a variety of skin imperfections at once. You might see IPL advertised as a FotoFacial or PhotoFacial, which addresses sun damage (redness and brown spots), wrinkles, pore size and flushing. An entire zone, such as the face, is treated during each session. You’ll use a numbing cream, and the procedure will cause some stinging. Afterward, there will be some redness and swelling, which ice can alleviate. The cost is $1,500 to $2,000, and many patients pair IPL with micro-dermabrasion, Kirschdoerffer says.


Neck and Neck
Liposuction can address a host of problem areas, including an ill-defined chin and a loose neck, says Dr. Abdollah Malek of Newark. The cost is about $3,500.




No More Dumbo
Nicknames like Jughead and Dumbo make children self-conscious about their large ears. To avoid damaging their self-images, many doctors recommend that children undergo ear reshaping, known as otoplasty, at age 8 or younger. “Ninety-five percent of the ear growth is complete by age 6,” says Dr. Katheryn Warren in Newark. The cost is about $4,000. Adults can also undergo the procedure, but because big ears are so linked to poor self-esteem, doctors recommend that children are treated early.


Ahead by a Nose
Putting your best face forward is difficult when the bump on your nose is the center of attention. Rhinoplasty, one of the most common cosmetic surgery procedures, can reduce or increase the nose’s size, change the shape of the tip or bridge, and narrow the nostrils’ span.

The surgery—which Danyo says involves knives, scissors, sutures and a “meticulous technique”—is usually performed under general anesthesia. The trend is toward a less obvious result, says Malek. “You cannot distinguish that they’ve had surgery. A good rhinoplasty is natural and soft.” Healing takes time. Expect bruising and swelling. The cost usually runs from $4,000 to $5,000, but can exceed $5,000, depending on how much work is involved.


Ditch the Dunlop
Liposuction can target a spare tire that won’t deflate—even with rigorous exercise. Through a tiny incision, a narrow tube is inserted to vacuum out fat layers deep beneath the skin. The tube also breaks up fat cells. Doctors can work on the flank and abdomen for about $3,500, depending on the amount of fat that must be removed. Higher-volume liposuction runs between $4,000 and $5,000. “It’s a case of time equals money,” says Warren. “The more fat you need removed, the more time it takes, the more it costs.”

You may need to wear a snug elastic garment to control swelling, and you could experience some pain, burning, bleeding and temporary numbness.


Perfect Pecs
Gynecomastia (an abnormal enlargement of one or both breasts) affects 40 percent to 60 percent of men. A male breast reduction, which runs from $4,000 to $5,000, may involve liposuction to reduce the fat and-or excision to remove tissue. “Some men have true breast tissue, and you can’t liposuction that,” Warren says. There will be swelling and bruising, and you’ll need to limit activity. “It heals up beautifully,” says Dr. Lawrence Chang. “There is a very high satisfaction rate.”




Thanks to endoscopic brow lifts, raising your eyebrows is downright popular. After making incisions near the hairline, the surgeon uses endoscopic tools to reposition the skin. “It puts the eyebrows in a more youthful, elevated position,” Malek says.

To keep skin in place during healing, surgeons might use suture-based and percutaneous screw fixation devices or absorbable devices. Brow lifts run about $3,500.

Abel combines brow lifts with upper eye lifts by doing the brow lift through the incision made above the upper eyelid. “It’s a great procedure for a temporal brow lift,” he says. (The temporal area elevates the tail of the brow.) The procedure can be performed under local anesthetic, and it’s good for older patients who don’t want the risk of damaging the facial nerves.


More Beautiful Breasts, Part I
Breasts are intrinsically linked with femininity and, therefore, self-image, Malek says. In a breast augmentation, doctors enhance the natural breast with inflatable implants filled with saline solution (sterile saltwater) or elastic silicone gel. Potential incision areas include underneath the armpit, beneath the nipple, underneath the breast or in the abdomen. Ask your doctor which is best for you.

The procedure is typically performed under general anesthesia. To minimize downtime, Dr. deLeeuw uses electrocauterization instead of traditional medical instruments or his hands to separate tissue and make room for the implants. “There is very little blood,” he says. “It is very precise.”

Some women experience so little discomfort, they go out to dinner that night, back to work after the weekend.

Depending on the woman’s anatomy and the implant material, the cost is about $5,000, though it can run higher. Silicone is almost double the price.




The Magic of the Mini
Too young for a full face lift but too young for sagging jowls? Consider a mini face lift, which involves smaller incisions that run along the hairline by the ear. While the definition of a “mini” often varies from doctor to doctor, it generally addresses the neck and lower part of the face. “You can get significant results,” says Dr. Jonathan Pontell, who has a practice in Media, Pennsylvania.

There is no technical definition for a mini face lift, so ask the doctor exactly what is included. Because of the variations, the price runs from $3,000 to $5,000.


No More Comb-over
Donald Trump might have made a signature look out of his comb-over, but most men don’t have the attitude or big bucks to carry it off. Shaving your head his one solution. A hair transplant is another. During the procedure, which is performed under local anesthetic, hair is removed from a donor site along the back of the head near the neck, then transplanted in bald or balding areas.

Doctors take about 1,000 grafts at a time. A single graft may include one to three hairs. Dr. Paul Sabini charges $3 a graft. A session involving 1,000 grafts can take six to seven hours. “They watch a movie. Some sleep,” Sabini says. Many patients can undergo up to four sessions, though you must allow time between each for the incision area to heal and loosen.

Another option to baldness is a scalp reduction, during which a bald area is removed and the sides stitched together. Depending on anesthesia and hospital costs, the price is around $3,500. There is the risk of scarring, and if the treated area is on top of the head, you could wind up with an ear lift. Patients with tight scalps can first undergo a scalp expansion. An envelope is inserted under the skin and, over weeks, filled with successive injections of saline solution to gradually stretch the skin. You will look noticeably different during the lengthy treatment time, which is why most men don’t opt for the procedure, Sabini says. The price can range from $5,000 to $8,000 and up.




More Beautiful Breasts, Part II
If your nipples are dropping below the crease beneath your breasts, you may need a breast lift, either with or without augmentation. Some doctors make an anchor-style incision that circles the areola and extends downward to follow the curve of the infra-mammary fold. DeLeeuw makes a lollipop incision that circles the areola and just moves downward, so there is no incision in the crease. Either way, the nipple and areola move to a higher position. (They remain attached during the procedure.) The cost is about $6,600 for a breast lift alone, about $7,000 with an augmentation.


Love that Tummy
Childbearing combined with gravity can pull your belly down over your bikini. A tummy tuck (abdominoplasty) eliminates that Shar-Pei effect. The surgeon makes a long incision from hipbone to hipbone above the pubic area. The naval is freed to allow for repositioning. Surgeons generally use a knife and electrocautery, which minimizes bleeding.

The surgeon will tighten the muscles and skin, then remove excess skin. Instead of inserting a drain to remove fluid from swelling, Danyo stitches the skin flap down to the muscle, creating a seal. Surgeon Peter Coggins of Greenville recently began using a German suture that better tightens the abdominal wall. “It does not cut through muscle,” he says. As a result the wall is held tightly in place. Another type of new suture leads to less notable scars, which are easily hidden by a string bikini.

A full recovery can take weeks, so plan accordingly. The cost is between $5,000 and $7,000. Prices go up if you’re heavier than average. Most women pair the procedure with breast lifts, breast augmentation or liposuction.

(A mini tummy tuck only addresses the area between the belly button and the pubic hair line. If you have loose skin and rolls above the belly button, the mini is not for you. “It’s very rare to see a patient who is a good candidate,” Warren says.)


Laser-like Precision
Traditional ablative laser resurfacing can improve skin texture, the appearance of wrinkles, scars and discolorations. The procedure can also remove unwanted tissue. These treatments are far more intense than IPL and some other lasers, and they typically involve the Erbium YAG laser or the CO2 laser, one of the first cosmetic lasers.

There is significant downtime. “As you get into stronger lasers—which produce more rejuvenation—there is a longer recovery period,” Saunders says. Your skin will be lobster red for a few weeks, and still rosy up to four.

Because of the downtime, Warren only uses laser resurfacing for medical conditions such as rhinophyma, which is characterized by a thick, bulbous nose. (Picture W.C. Fields.) Able uses a laser on puffy lower eyelids during an eye lift. “I can use the ablative to tighten the skin,” he says. The cost is about $3,500.

Laser resurfacing for the full face, performed in the hospital under general anesthesia, can run from $5,000 to $7,000.


Combining Procedures
Most people recognize the term “face lift,” but may not know what one entails. In the old days, a face lift addressed the jowls and neck, which many doctors now call a mini face lift. These days, a face lift is typically comprised of a combination of procedures.

Dr. Katheryn Warren targets the neck, mid-face and lower face. Many add an eye lift and brow lift. Dr. Jonathan Pontell’s full facial rejuvenation includes the brow, eyelids, face and neck. The various combinations explain why face lifts can run between $8,000 and $15,000.

Eyelid, brow and face lifts are not the only procedures performed simultaneously. Many patients elect to combine treatments, not only to get it all over with in one fell swoop but also to get a discount. Anesthesia and hospital costs are reduced when you double up instead of undergoing a lower face lift one year and eyelid surgery the next. Moreover, doctors often negotiate price when it comes to multiple procedures. “Sometimes you give patients discounts—10 percent to 20 percent—which makes it easier for them,” says Dr. Mehdi Balakhani.

Many women opt for both a tummy tuck and breast augmentation, which can cost about $11,000 to $12,000. Women also combine tummy tucks with liposuction of the stomach and thighs.

Body contouring procedures after massive weight loss often involve multiple procedures, but the amount of lifting involved might mean dividing those multiple procedures into several surgeries. Thighs, back, arms, legs, the trunk—everything could need a lift.

“You take 10 people who’ve lost 200 pounds, and they’ll each need a different procedure,” Warren says. Some men have excessive skin around the breasts. Some women have great legs but fluttery arms and a sagging neck. Depending on what the patient needs, a lift can run up to $20,000. Insurance might cover some of it.

When several procedures are involved, patients often stay in the hospital at least one night to monitor pain management, Malek says. Surgeries involving multiple procedures require caution. “You have to weigh the benefits, the risk factors and the time under anesthesia,” says Dr. Lawrence Chang.

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