It's been said that the grass is always greener on the other side of the fence. Just ask any woman about her body and she will find a fault with it. Of course many "faults" can be fixed with lifestyle intervention, undergarments and cosmetics.

However, for those who need a little more, there is plastic surgery. This is a multi - billion dollar business. There is nothing wrong with changing/improving that which is not in keeping with the desired body image . In general, the problems begin when the boundaries between reality and delusion are breached and procedures are performed by inexperienced or overenthusiastic health professionals.

Statistics released by the American Society for Aesthetic Plastic Surgery have revealed that nearly 11.5 million cosmetic surgical and non-surgical procedures were performed in the United States in 2005.

In 2005 the top five surgical cosmetic procedures were Liposuction, breast augmentation, Blepharoplasty (eyelid surgery), Rhinoplasty (nose reshaping ) and Abdominoplasty (tummy tuck). The top five non-surgical cosmetic procedures were Botox injections, Laser hair removal, Hyaluronic acids (Hylaform, Restylane), Microdermabrasion and Chemical peels.

Botox ® is the cosmetic form of botulinum toxin. Given by injection , this toxin temporarily reduces or eliminates frown lines, forehead creases, crow's feet near the eyes and thick bands in the neck. It blocks the nerve impulses, temporarily paralysing the muscles that cause wrinkles while giving the skin a smoother, more refreshed appearance. Botox ® is also effective in relieving migraine headaches, excessive sweating and muscle spasms in the neck and eyes .The most common side effects include headache, respiratory infection, flu syndrome, temporary eyelid droop and nausea .

LIPOSUCTION is particularly well suited for women and men who are of relatively normal weight but have isolated pockets of exercise-resistant fat that cause certain areas of their body to appear disproportionate. The procedure improves body shape by removing deposits with a tube and vacuum device. There are a variety of techniques . With the tumescent technique, targeted fat cells are infused with a saline and local anaesthetic solution before liposuction . This reduces post-operative bruising and swelling.

For larger volumes of fat or for fibrous body areas, ultrasound-assisted lipoplasty may be used. During this procedure, ultrasound waves are used to assist in breaking up the fat to make it easier to remove. Once the fat is treated with ultrasonic waves, a suction cannula is used to remove the fat. Common locations for liposuction include chin, cheeks, neck, upper arms, above breasts, abdomen, buttocks, hips, thighs, knees, calves and ankles.

The best results will be achieved if the skin still has enough elasticity to achieve a smooth contour following fat removal. When skin is inelastic, as in some older patients, it may not redrape well and a skin-tightening procedure may be necessary.

Tummy Tuck (Abdominoplasty) is usually performed under general anaesthesia. The muscles of the abdominal wall are flattened by removing excess fat and skin. Persons who have loose abdominal skin and fat that is concentrated in the abdomen can benefit from this procedure. Loose skin can be inherited or may be caused by substantial weight loss.

Abdominoplasty can tighten muscles that have been separated and weakened by pregnancy. In addition, there may be improvement in the appearance of stretch marks, especially those located below the navel.

BREAST LIFT raises and reshapes sagging breasts by removing excess skin and repositioning remaining tissue and nipples. Loss of skin elasticity, gravity and other factors such as weight loss, pregnancy and breast-feeding ultimately affect the shape and firmness of the breasts. For those who may be unhappy with the loss of breast volume over time, implants can be inserted as part of the procedure - resulting in an increase in breast size at the same time as the shape and position of the breasts are enhanced. The duration of results are variable as gravity, pregnancy, aging, and weight changes may cause new sagging.

Cosmetic procedures underscore one of the advantages of living in modern society - the relative ease with which the body can be changed. If one is fat, one can diet. If the breasts are too small, they can be enlarged; if they are drooping, they can be lifted. Wrinkles can be smoothed away and tummies can be sucked or flattened away.

Dr Jacqueline Campbell is a family physician in private practice. Comments are welcome at drjcampbell14@yahoo.com

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