Friday, December 23, 2016

Big boobs are over

Two years ago, Gwen Welborn was in a rough spot. The middle-age single mom had recently divorced, was dealing with her child’s cystic fibrosis and had just lost both her parents in quick succession. “I just wanted to do something good for myself,” says the 52-year-old Wantagh, LI, resident. So she decided to get breast implants.

Yet despite her friends urging her to go big, Welborn decided on a more subtle enhancement.

“I was always small-chested, and I wanted to stay small,” says Welborn, who owns a beauty salon in Seaford, LI. “I wanted to continue to run and bike and work out. In my mind, I was looking at someone like Cameron Diaz, someone I had heard had a small implant but you would never look at her and say, ‘Oh, she had surgery.’ ”

Now, Welborn is thrilled with her new boobs, which she says are a 32C but look more like a B-cup. “At first I thought they were a little big, because they get swollen after the surgery,” she says. “But now I like them just the way are.”

Breast augmentation is the most popular type of cosmetic surgery in the US, with more than 279,000 women getting boob jobs in 2015, according to the American Society of Plastic Surgeons. But if you’re envisioning buoyant Playboy Bunnies or “Baywatch”-era Pamela Anderson, think again. Today, women are ditching the DDs in favor of a more natural-looking B-cup — a trend bolstered by since denied rumors that willowy celebs like Taylor Swift have gotten “mini” boob jobs, barely noticeable augmentations to help them fill out their clothes better.

“Five years ago, I never saw this,” says Alexes Hazen, M.D., associate professor at the Hansj√∂rg Wyss Department of Plastic Surgery at NYU Langone Medical Center. “Now, it’s around 40 percent of patients who come in [who are] requesting a B-cup.”

Hazen says many women now know that bigger breasts can cause neck pain or back aches, which is why they’re straying away from larger sizes — and in some cases getting reductions or revisions of old implants. “Obviously, a smaller cup size is much more comfortable, but most women don’t want an A-cup,” she says. “It just doesn’t fill most dresses or women’s clothing in the right way a B cup generally does.”

“If you wear a size B you can wear anything,” says Leesa Rowland, a 50-year-old author who lives in Midtown East and just had her last of two breast-reduction surgeries — from a D to a B — a few weeks ago. “It’s the perfect size. I can wear things that are low-cut and look sexy, not matronly. And if you do want to look bigger, you can just wear a push-up bra.

“I didn’t tell anybody. I didn’t think anybody would really notice because I covered [my chest] up, but it was the funniest reaction, because people would ask, ‘Wow! How’d you lose so much weight?’ ”

It helps that fashion trends now tend to favor looks that require the wearer to go braless, adds Hazen, like handkerchief tops, backless dresses, and tight leotards and bodysuits. “If you’re anything bigger than a B, you can’t wear that stuff,” she says.

That was why Madison, an elementary school teacher who prefers not to use her last name for professional reasons, decided to get small implants in December. “I wanted to fill out my clothes, not get new clothes,” says the 28-year-old Upper East Side resident, who had wanted to get a boob job since high school. “When after the first week I took off my bandages, I looked amazing. I just kept staring at myself because my mind needed to get used to my new body. Now, people don’t look at me different, but I feel different. I look better in my clothes and feel more confident.”

Another reason women are opting for smaller cup sizes: They want to work out.

“Women are very athletic now and physically fit,” says Tracy Pfeifer, a board-certified plastic surgeon and adviser for RealSelf.com, a Web site devoted to cosmetic procedures. Pfeifer estimates that 40 to 50 percent of clients at her Upper East Side practice request a full B-cup — up from 25 percent five years ago. “They understand that larger breasts are going to interfere with their exercise.”

That was important to Welborn, an avid runner and biker who wanted to work out easily in a sports bra and maintain her level of exercise. “It hasn’t affected it at all,” she says.

But more important than the cup size, says Pfeifer, is proportion. “It has to do with the body frame and how wide their hips are. Women will come in and say a cup size, but they don’t really know what that cup size actually is. When they say B, they [mean they] don’t want to look out of proportion. I want it to look natural.”

Cassie Cohen, who lives in Westchester, ended up getting between a full B and small C when she got her surgery two weeks ago with Pfeifer. “I didn’t want to have boobs just for the sake of really big boobs,” says the 20-year-old Boston University student, who admits her parents would have never agreed to let her go through with the operation had she wanted DDs. (The surgery was a gift from her mother.) “I was sort of bigger on the bottom so it looked a little strange to be so small at the top. I just wanted more of a curve, more definition. They’re really comfortable and flattering — most people would never guess I had gotten surgery.”

And while smaller implants have long been a trend in tony Manhattan, says Dr. Daniel Maman, of 740 Park Plastic Surgery, it is becoming a national trend. “I think there’s a shift in mentality from women just wanting larger breasts to wanting to go back to the size that they were prior to bearing children and breast-feeding,” says Maman, who adds that about 95 percent of his clients — “very sophisticated, in very good shape and avid exercisers” — ask for more covert enhancements. “There’s a higher percentage of women who work now, and they want something discreet,” he says.

“The artificial augmented look is no longer desirable.”



Botulinum Neurotoxin in Plastic Surgery—What's the Evidence for Effectiveness?

(Photo : Michael Buckner / Staff)

Botox and other botulinum neurotoxin (BoNT) products are widely known for their use in treating facial wrinkles but did you know they can also be used to treat a wide range of non-cosmetic problems? Eight conditions with good evidence of effective treatment with BoNT are identified in a special review in the August issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

The international review analyzed the research evidence on plastic surgery procedures using BoNT. "The use of botulinum neurotoxins has revolutionized the treatment of several different problems seen in the plastic surgeon's office, from facial wrinkles to painful conditions with limited treatment options," comments lead author Marie E. Noland, MD, of Dalhousie University in Halifax, Nova Scotia, Canada. Her coauthors were Donald H. Lalonde, MD, of Dalhousie University in Saint John, New Brunswick; G. Jackie Yee, MD, of Baker Plastic Surgery, Miami; and Rod J. Rohrich, MD, of University of Texas Southwestern Medical Center at Dallas.

Evidence and Experience Show Benefits of BoNT: A purified protein derived from bacteria, BoNT acts as a "neuromodulator"-it interferes with communication between nerves and muscles, causing local paralysis in the areas where it's injected. Two types of BoNT are available: BoNT-A (with brand names including Botox and Dysport) and BoNT-B (Myobloc).

The review identifies eight conditions treated by plastic surgeons with high-quality evidence of good responses to BoNT. The evidence is strongest for minimally invasive treatment of facial wrinkles (rhytides). The FDA has approved BoNT-A for treatment of forehead lines or wrinkles, while Botox specifically is approved for treatment of "crow's feet" at the corner of the eyes.

Studies support the use of BoNT for other types of facial aging problems as well. Cosmetic injection of BoNT-A is by far the most common plastic surgery procedure, with more than 6.5 million procedures performed in 2015, according to ASPS statistics.

Botulinum neurotoxin is also effective for some types of facial movement disorders (dystonias)-for example, tics caused by benign essential blepharopasm. It can also be used to treat issues related to facial nerve palsy and abnormal facial nerve regeneration, which can cause problems such as abnormal tears or sweating.

Two studies have reported that Botox can reduce hand tremors in patients with essential tremor, although hand function may not improve. Both BoNT-A and BoNT-B show evidence of effectiveness in patients with chronic, excessive sweating, especially of the hands (palmar hyperhidrosis).

Botulinum neurotoxin is a safe and effective treatment for upper limb spasticity of the arm and hand in adults. It also shows promise for treatment of muscle spasticity in children with cerebral palsy.

Neuromodulator therapy with BoNT has emerged as a useful new treatment for migraine headaches. This benefit was discovered coincidentally when patients undergoing cosmetic BoNT injection for forehead wrinkles reported decreased migraines. Based on three large studies, Botox has been approved for treatment of chronic migraine headaches.

More recently, studies have supported BoNT for treatment of neuropathic (nerve-related) pain-a common problem with few effective treatments. Injection is effective for the treatment of some important causes of neuropathic pain, including diabetes and surgical nerve damage.

The review includes figures and online videos illustrating proper BoNT injection technique for plastic surgeons. In a featured video on the Plastic and Reconstructive Surgery website, Editor-in-Chief Dr. Rohrich comments: "Neuromodulators are safe, but they must be done appropriately-in the right dose, in the right area, in the right way.

" Plastic and Reconstructive Surgery® is published by Wolters Kluwer.