Ten Ways to Become a 10

Herein, the experts describe the top five invasive and top five noninvasive cosmetic procedures and how they rate in the First State.

Technological advances, the economy and changing lifestyles influence a cosmetic procedure’s popularity.

Liposuction currently ranks first on the list of top procedures, according to a survey by the International Society of Aesthetic Plastic Surgery. At the same time, many people are still investing in such tried-and-true procedures as the tummy tuck.

Here’s a look at the ISAPS survey’s top five invasive and top five noninvasive procedures worldwide and how they rate in Delaware. (Note: Costs vary according to the type of anesthesia, the physician and whether you are combining procedures.)

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Invasive Procedures


Also known as lipoplasty, liposuction involves the removal of excess fat deposits.

How it’s done A small, hollow tube is inserted into the body through tiny incisions. Dislodged fat is suctioned out via a surgical vacuum or syringe.

Why it rates Liposuction removes the excess baggage left behind when you lose weight. Yet even thin people carry some unwanted fat that dieting and exercise won’t cure. “There is not a human alive—including myself—who wouldn’t enjoy a little bit of liposuction, perhaps in the stomach or neck,” says Dr. Christopher Saunders, who has practices in Wilmington, Newark and Chadds Ford, Pennsylvania.

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Many Delaware practices follow the international trend. “Liposuction seems to be the most popular year after year,” says Dr. Joseph Danyo, who has a Greenville office. The belly and outer thighs are hotspots.

Liposuction is not just for the torso. Dr. Jonathan Pontell, who has an office in Media, Pennsylvania, performs liposuction exclusively on the neck and chin.

New technologies include SmartLipo, a laser-assisted system that heats the fat to make it easier to remove. Radio frequency-assisted procedures use electrical energy to both disrupt the fat cells and tighten the skin.

Dr. Abdollah Malek, who has a practice in Newark, has seen a 15 percent improvement in the skin’s tightness by using laser-assisted procedures. Dr. Ian Lonergan, who has a Wilmington office, is equally impressed with radio frequency-assisted liposuction.

Risks Uneven contours, rippling or loose skin, blood clots, fat clots, scarring, burns from laser-assisted or ultrasound techniques, bleeding, pain.

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Recovery You’ll likely wear compression garments for up to three weeks after the procedure, and you may have drains inserted in the surgical area to reduce fluid.

Cost $1,600 for small, single areas to $5,900 and up for multiple areas.

Page 2: Breast Augmentation


Breast Augmentation

Implants make breasts larger and-or fuller.

How it’s done There are three incision options: around the nipples, in the crease under the breasts, and near the armpit. The implant goes under the pectoral muscle or behind the breast tissue.

Why it rates “Breast cosmetic surgery remains popular because of cultural standards of beauty that favor firm, full breasts,” says Dr. Peter Coggins, a surgeon in Greenville. In Delaware, the procedure is still going strong. Lonergan and Dr. Jonathan Saunders, who has a practice in Newark, say breast augmentation is their leading service.

Most women want to be a full C or a small D, Saunders says. Your anatomy, body type and skin elasticity will dictate the size you should handle. Silicone implants, taken off the market in 1991 after reports of ruptures, are back. Today’s version is gel-like and more natural looking, Saunders says. Danyo says about three-quarters of his clients opt for it.

Risks Scarring, changes in nipple or breast sensation, scar tissue around the implant, implant leakage or rupture, wrinkling or rippling over the implant.

Recovery You may need to wear a special bra for up to six weeks. Many women can manage pain with ibuprofen, Lonergan says. Dr. Christopher Saunders’ patients receive a continuous infusion of Lidocaine for about three days. The primary recovery period is 24 to 48 hours, then a few days of reduced activity. Expect pain and swelling for a few weeks.

Cost $5,000 for saline implants, $6,000 for silicone.

Page 3: Blepharoplasty (eyelid surgery)


Blepharoplasty (eyelid surgery)

Eyelid surgery improves the appearance of the upper and lower eyelids by removing excess skin and fat deposits and tightening muscles and tissue.

How it’s done Surgeons make incisions in areas that will conceal the scar, such as the natural crease of the upper eyelid, the lower lash line or inside the lower eyelid.

Why it rates “We look in each other’s eyes when we talk,” says Dr. Christopher Saunders. “And when we age, we see it in this area first.” The procedure is second in popularity to mini-facelifts for Pontell.

The upper eyelids are a “slam dunk,” Danyo says. “You look great and it’s simple to do. The lower eyelids are more complicated.” Sometimes, a patient may look better with volume restoration under the eye, which involves using a filler to plump up the trough that emphasizes eye bags.

Risks Temporary blurred or impaired vision, difficulty shutting your eyes, a temporary droop in the lower lid, fluid accumulation, eyelid disorders and eye dryness.

Recovery Surgeons agree that most people have little pain, but they will experience discomfort from swelling and bruising.

Cost $1,500-$3,000

Page 4: Rhinoplasty



Nose surgery improves the appearance of the nose and may correct impaired breathing caused by structural abnormalities.

How it’s done Surgery is performed either using a closed procedure, where incisions are hidden inside the nose, or an open procedure, where an incision is made across the tissue that separates the nostrils. The soft tissues that cover the nose are gently raised, allowing access to reshape the structure of the nose.

Why it rates The United States ranks No. 1 in countries performing rhinoplasty, but its popularity in Delaware is not as strong as it once was. “My father used to do three rhinoplasty procedures a week for years,” says Dr. Jonathan Saunders.

That said, there are still folks who decide to lose the bump, correct a crooked proboscis or take a little off the top while undergoing surgery to fix a deviated septum.

The satisfaction level is high. “I had a man say to me that [rhinoplasty] was the second-best investment he’d made after his education,” says Dr. Mehdi Balakhani, who has offices in Wilmington and Newark.

Risks Rupture of small surface vessels, nose asymmetry, nasal airway alteration and, rarely, a hole in the septum develops.

Recovery The doctor will place a splint, internal tubes or packing inside your nose and a splint or bandages outside your nose to support and protect it during initial healing. Swelling will subside in up to three months.

Cost $3,000-$6,000 and up

Page 5: Abdominoplasty (tummy tuck)


Abdominoplasty (tummy tuck)

A tummy tuck removes excess fat and skin and restores weakened or separated muscles to create a smoother, firmer stomach profile.

How it’s done A full tummy tuck requires a horizontal incision between the pubic hairline and navel. The surgeon will repair weakened abdominal muscles and remove excess fat, tissue and skin.

Why it rates Liposuction will likely not meet the expectations of a mother of three whose skin and muscles were stretched during her pregnancies. “We need to talk before surgery about whether she needs a tummy tuck instead of liposuction,” Saunders says. “The results will be different. Tummy tucks are popular because it delivers what you’re trying to achieve.”

Malek agrees. He often combines a tummy tuck with liposuction to create a contoured waist. The rewards have a price. “Of all the [listed] procedures, it’s the most painful, with the longest recovery,” Saunders says. Recovery can take two weeks or more. Mini-tummy tucks, once highly publicized, are rare, Lonergan says. “Most patients are better off with a full procedure.”

Risks Scarring, wound separation, asymmetry and recurrent skin looseness.

Recovery You may wear a compression garment to minimize swelling and to support your abdomen. Doctors may place a temporary small, thin tube under the skin to drain excess blood or fluid. Balakhani uses compression boots during and 48 hours after surgery to help prevent blood clots.

Cost $3,000 to $8,000, depending on hospital fees and how much work is performed.

Page 6: Noninvasive Procedures – Botulinum (Botox, Dysport)


Noninvasive Procedures

Botulinum (Botox, Dysport)

Tiny injections of Botulinum toxin reduce the muscle activity that causes frown lines in the forehead and near or between the eyes.

How it’s done You’ll receive the injections in the office. No anesthesia is required.

Why it rates Botox has also proven that it’s safe and effective, Malek says. Dysport is similar to Botox. “Generally, they do the same thing,” Malek says. Because Dysport is new, the manufacturer has offered discounts, but doctors like Danyo and Balakhani prefer to stick with the familiar Botox.

Risks Incorrect application can result in droopy eyelids and dry eyes.

Recovery You may have redness and some swelling, which will subside quickly. There is no downtime.

Cost $280 to $650, depending on the amount of coverage.

Page 7: Hyaluronic Acid (Juvederm, Restylane)


Hyaluronic Acid (Juvederm, Restylane)

Hyaluronic acid occurs naturally in connective tissue, some cartilage and joint fluids. It’s used to plump up lips and fill deep eye wrinkles and the nasolabial folds.

How it’s done Malek has had Juvederm without numbing and quickly opted for numbing. Some doctors use injections to numb the area. Others go for topical treatments. The material is then injected into the site. Lonergan gives a mirror to his patients and together they decide how much is needed to achieve the desired effect.

Why it rates Complication rates are relatively few. Results last for up to six months.

Risks Temporary lumps, clumping caused by facial movement that creates nodules, acne-like eruptions.

Recovery There may be swelling, redness or bruising at the injection site for a few days. An over-filled area should resolve in a matter of hours or days.

Cost $650 to $850 a syringe.

Page 8: Laser Hair Removal


Laser Hair Removal

Laser hair removal reduces the amount of hair in the treated areas.

How it’s done The procedure relies on an intense, pulsating beam of light to remove unwanted hair by damaging the follicle and inhibiting future hair growth. It’s best for people with light skin and dark hair. It does not guarantee permanent hair removal. You’ll need several treatments.

Why it rates Less fuzz on the legs? A smooth back? “There’s been no reduction in its popularity,” Danyo says.

Risks Blisters, scarring, changes in skin tone or texture.

Recovery Some redness and swelling.

Costs Total cost of the lip alone is $600 and up because some people need 12 treatments. Lip and chin could run $800 and up.

Page 9: Fat Grafting


Fat Grafting

The surgeons remove fat from one area of the body, where it’s typically unwanted, and put it in an area that needs volume.

How it’s done Fat is removed from a donor site and implanted into the cheek or lips. It takes best when fat is inserted into muscle, Balakhani says.

Why it rates “One of the beauties of fat transfer to the face is that not only can it be a quick fix—because there are no incisions to heal—but it’s a long-lasting one too,” says Coggins. About 80 percent of his patients undergo the procedure. Many patients select the procedure while undergoing liposuction. “We’ve seen a huge increase this year,” says Danyo. Technique is vital. “I use fat judiciously, which makes all the difference in the world,” Coggins says.

Risks Asymmetry, infection, fatty cysts, hematoma, fat embolism, permanent discoloration from the bruises.

Recovery Possible bruising, soreness and swelling for up to 10 days.

Cost Starting with the face, fat grafting starts at about $1,950 and moves to $6,000.

Page 10: Intense Pulsed Light


Intense Pulsed Light

IPL is not a laser, which uses one continuous wavelength. Instead, the device offers multiple wavelengths to treat redness, dark patches and broken capillaries.

How it’s done Patients receive a topical anesthetic, then the doctor or technician zaps the targeted area with the device.

Why it rates Though multiple treatments are often required, it is still an affordable way to treat skin imperfections.

Risks Improper technique can cause burns. It might not work on all areas.

Recovery Redness and swelling for a day or so. Cold compresses and elevation help.

Cost $250 to $300 for the face. You’ll likely need multiple treatments, so the total cost could exceed $1,200.

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