Botox is already a controlled substance, but in practice this means that only someone with a medical license can order the product. There are very few limitations on who can administer the shots, and while the injections are not particularly dangerous except in rare instances, a poorly placed injection can cause undesirable side effects.

Botox has made waves across the country and around the world. In China, it is frequently and openly administered by beauty parlors with no training or qualifications, which has led to widespread calls for stricter controls. Last year, the UK considered implementing tighter regulation on Botox, but this was ultimately dismissed for being too expensive to enforce.

Stateside, Botox regulation has become a hot topic in Texas and New Jersey, as politicians, doctors, and concerned citizens worry that the lack of controls is endangering many patients. The Texas Medical Board has considered making changes to the rules about who can perform cosmetic procedures involving prescription medications. This would include injectable fillers.

In New Jersey, legislators have introduced a bill that would ban Botox for minors, except in cases where a doctor affirms that the treatment is medically necessary. Before it became a popular cosmetic procedure, Botox was (and continues to be) used for a variety of medical purposes, including the treatment of certain migraines and cerebral palsy symptoms.

Botox regulation is supported by many people who fear that unscrupulous providers are capitalizing on the treatment’s rising popularity without taking into account the safety and ethical issues involved. You should always make sure that your Botox is being administered by an accredited professional with years of experience. Only these providers are qualified to target specific facial muscles and deliver predictable results with consistency.

For Lindsay, who graduated ten years ago, breast augmentation fit the bill. Though her father was hesitant, her mother sympathized with Lindsay’s struggle to find clothing that fit well. After some research, Lindsay’s parents gave in to her request.

While Lindsay said it was was the right time in her life, even looking back, some parents are more reluctant to allow their children to undergo cosmetic surgery.

Though her mom suggested laser hair removal, Lexy, 14, was unsure of the necessity at first and did not mind shaving. But after experiencing irritation, Lexy decided to undergo the $900 series of treatments and is now interested in more cosmetic surgery. Her mom, however, does not feel the same way and refuses to let her daughter dramatically change her body.

Though Lexy’s mom resisted more involved procedures, plenty of teens around the country are choosing more than laser hair removal. Skin resurfacing and injection treatments like Botox are also a hit among teens. Teens also have a high interest in breast augmentation and liposuction.

Even with all this interest, and her own cosmetic surgery success story, Lindsay urges teens to think about why they want the procedure.

Lindsay said each person must first be happy with themselves before surgery and told prospective teen patients to “think it through and make sure you’re doing it for the right reasons.”

Dr. David R. Neal, a psychology professor at the University of Southern California said that, “If you have a poker face because your facial muscles are paralyzed, you can’t read others emotions as well.”

Oftentimes, Neal said, we read the emotions of others by mimicking their facial expressions using a sort of “sixth sense.” Under the effect of too much botulinum toxin, the main component in Botox and Dysport, we lose that sense, he said.

Despite the decreased ability of some Botox users to read the facial expressions of others, Neal maintains that the effect is subtle and says patients need to weigh the aesthetic benefits with the possible psychological effects the treatments may have.

Conversely, the study found that patients who received treatments of the dermal filler Restylane did not experience a change in their ability to read facial expressions.

Though both Botox and Dysport are hugely popular non-surgical options for diminishing many facial lines and wrinkles, new alternatives are often being researched. This treatment, which is called cryoneuromodulation, “appears to have the same clinical efficacy and safety comparable to the existing techniques,” according to Francis Palmer, director of facial plastic surgery at the University of Southern California School of Medicine in Los Angeles, who co-authored the study.

Rather than paralyzing the underlying muscle to smooth out the wrinkle as Botox and Dysport do, this new method freezes specific nerves in the forehead using small needles. This stops the nerve from communicating with the muscle, which causes it to relax. The smoothing effect is almost immediate and lasts about as long as botulinum toxin-based methods—three to four months.

The procedure takes about 15 minutes to complete while the patient is under a local anesthetic. Patients said the level of discomfort was similar to that experienced with Botox.

Though you may want to jump at the chance to try this new wrinkle-fighting treatment, it is still in the early stages of trails and has only been tested on forehead wrinkles. In the meantime, Botox is known to beautifully treat forehead lines, frown lines and crow’s feet.

Plastic surgeons in the Phoenix area say they are seeing a dramatic uptick in the number of individuals who are coming in during tax season, using their tax refund check to cover all or part of a procedure.

Kristy Harris in Phoenix chose to use her tax refund to pay for part of her breast lift surgery and used some savings to cover the rest of the $8,400 procedure (cost based on patient-reported averages on RealSelf.com). The mother of two said that raising children took a toll on her body and she wanted to do something to help herself achieve a “different look.”

Another popular procedure for the breasts is breast augmentation, which costs approximately $6,600. This surgery can improve shapeliness and body proportion.

Liposuction remains one of the most sought-after body procedures and costs about $5,600. Liposuction is often performed to remove stubborn fat deposits nearly anywhere on the body.

Even if your tax refund check is a bit smaller than you would hope, non-surgical treatments are available at a fraction of the cost of surgery. The ever-popular Botox, is used to reduce lines and wrinkles on the face. Chemical peels are also non-invasive and remain one of the key facial rejuvenation treatments and work to reduce many skin imperfections like a dry, dull complexion, blemishes and pigmentation issues. Botox and chemical peels cost about $472 and $610 for full treatments, respectively.

Botox, produced by Allergan and Dysport, produced by Medicis, contain similar components of the botulinum toxin, which controls muscle movement when injected between the brows and diminishes glabellar lines and wrinkles. On top of this cosmetic use, botulinum toxin-based products have been used to treat excessive sweating and migraines and now the makers are taking the next steps in making their products widely available to those averse to injections.

So far, the news is good for consumers. The second phase in trials for topical Botox, which was completed in October, was successful. While no market date has been set for the topical version of Botox, nor for its Medicis-produced rival Dysport, needle-shy individuals can still test the possible effects of Botox by using Allergan’s Treatment Visualizer.

To learn more about injectable treatments as well as other skin care options, we encourage you to join the mailing list of Portland based plastic surgeon Dr. Workman and to call to schedule a consultation.

“I do see a fair amount of parents coming in with their child because of bullying and teasing and feelings of self-consciousness,” says cosmetic surgeon Dr. Michael Fiorillo.

Erica Morgo was one such child, who sought a nose job at 15 after being taunted for years by her classmates because of her large nose.

“I felt helpless. I felt like a loser,” said Morgo about the effects of the bullying. “I tried breaking my nose once. I was so fed up with the bullying that I tried banging my face against the door.”

In addition to acting in self-harm, Erica Morgo also reported missing about a month of school in an effort to avoid facing her tormentors, and finally her mother, Dana Manzella, decided enough was enough and allowed her daughter to have plastic surgery.

“I think that was definitely a good decision, because it brought her back — her self-esteem back up to be able to do activities that she did before, with comfort,” Manzella said.

Manzella also allowed her younger daughter, Breanna Morgo, to start having Botox injections a few times a year to correct her droopy smile at age 5.

“We only do it twice a year — in September for school pictures, and then again in June for her birthday,” Manzella said of Breanna Morgo’s Botox regimen.

Although Manzella has no qualms about her daughters’ cosmetic procedures, child psychiatrist Dr. Ned Hallowell thinks that Manzella and parents like her may be putting their children at unnecessary physical and psychological risk.

“The idea of someone getting plastic surgery to avoid bullying seems to me as crazy and worrisome as if a black person were to go to a doctor and say, ‘I wanna become white to avoid racism,’” Dr. Hallowell said. “The problem is clearly with the phenomenon of bullying, and not with the person’s nose.”

Still, despite the objections of Hallowell and other teen plastic surgery critics, nearly 90,000 teenagers had cosmetic surgery in 2007. The procedures most commonly sought were rhinoplasty, breast reduction, breast augmentation, ear surgery and Botox.

While many plastic surgeons will decline to operate on teens unless they present a serious or pronounced physical deformity, other surgeons believe that some teens are mature enough to make the decision to undergo cosmetic procedures (with parental consent).

“My preference is, of course, to work out the issues first, the bullying, the teasing. But there are certain situations where people are mature enough. And surgery is a final resort,” said Dr. Fiorillo.

In general, the issue of whether to operate on a particular patient, regardless of age or emotional maturity, is a decision left entirely up to each individual surgeon, so it is important to consult with a Lake Oswego plastic surgeon whose ethics and judgment you trust before you (or your teen) pursue elective surgery.

Plastic Surgery

Facial rejuvenation surgeries such as facelift and brow lift procedures are expected to become increasingly popular in 2011, as many consumers rebound from economic hardship and seek treatments for sagging skin and wrinkles they’ve been putting off for the past year or two.

ASAPS anticipates that increased awareness of obesity risks and dramatic weight loss awaits many patients in 2011, thus ushering in the need for more thigh lift and tummy tuck procedures, as well as others designed to remove loose, excess skin after weight loss.

Buttock augmentation procedures such as the butt lift, which is designed to give patients a plumper, shapelier posterior a la Kim Kardashian or Beyonce, will also continue to increase in popularity in 2011, according to ASAPS.

In addition, baby boomers with aging breast implants are also likely to need maintenance procedures, such as breast implant replacement surgery to exchange aging implants and breast lift surgery to lift drooping or sagging breasts.

Non-surgical Cosmetic Treatments

Injectable wrinkle relaxers and fillers, such as Botox, Restylane and Juvederm became some of the most popular cosmetic treatments in 2010 and will continue to be widely used in 2011, according to ASAPS. The organization also noted that injectable treatments will continue to evolve over the next year, as scientists bring new wrinkle smoothing treatments to the U.S. market.

Non-invasive and minimally invasive cosmetic treatments will continue to increase in popularity as doctors and pharmaceutical and medical manufacturing companies work to give consumers new body contouring and skin rejuvenation options that don’t require surgery in 2011.

ASAPS predicts non-surgical fat-zappers like Zerona and CoolSculpting will only continue to increase in popularity over the next year, and technological improvements will likely make these and other non-invasive fat reduction procedures more effective.

However, the organization reminds consumers that for the foreseeable future, surgical liposuction, which is coincidentally less invasive than ever, will remain the most effective method for permanent fat reduction.

Brandon Alleman and his team of researchers at the University of Iowa surveyed 45 companies that facilitate medical tourism for U.S. patients and found that these companies have referred only about 13,500 U.S. residents to healthcare and cosmetic surgery facilities outside the country.

These companies represent about 70 percent of the market serving U.S. medical tourists, so if, say 23,000 American patients traveled abroad for medical treatments, that makes up only a tiny fraction of the number of patients treated in the U.S. each year.

This is good news to Portland plastic surgeon Dr. Michael Workman, as he and many of his colleagues, as well as respected plastic surgery organizations like the American Society of Plastic Surgeons, discourage American patients from traveling abroad for cosmetic procedures like liposuction, breast augmentation and even injectables for a number of reasons.

For instance, countries outside the U.S. where plastic surgery is less expensive often do not have adequate standards of care and official oversight designed to prevent avoidable complications and poor outcomes.

There is also concern over whether medical tourists actually receive treatment with the products or devices they think they are getting, and that they paid for. Many patients think they’re getting Botox or Restylane, but end up getting cheap knock-offs of the real thing, along with poor results.

In addition, most plastic surgeons agree that it is important to receive follow-up care from the physician who performed the procedure, which is not usually possible weeks or months after surgery, when patients have returned to their homes in the U.S.

In fact, the study results showed that 93 percent of companies brokering medical tourism packages expect follow-up care to be performed by U.S. physicians.

Given the fact that many physicians are uncomfortable providing follow-up care to patients on whom they did not perform the initial surgical procedure, it can be not only difficult to find a physician who will provide post-surgical follow-up care for patients who have traveled abroad for cosmetic surgery, but costly to hire a new physician as well, especially if complications arise and revision surgery is needed.

To avoid the potential risks and difficulties with follow-up care that can arise from medical tourism, it’s best to first choose an accessible, board-certified plastic surgeon who performs surgery and other cosmetic procedures in appropriately accredited U.S. facilities.

Let cost be your final consideration in choosing a surgeon, as paying slightly more for a great outcome the first time can end up being much less expensive than paying separately for follow-up care and multiple revision procedures down the road.

There are also a number of financing options available to Americans who do not have the cash in-hand needed to pay for plastic surgery, so there is little reason to travel abroad when some of the world’s best surgeons are in your own backyard.

Each of the women questing for the ‘Bridalplasty’ prize has a wish list of cosmetic procedures they would seek should they beat out the competition, in addition to ideas for their wedding cake, dress, invitations and more.

According to an article in the Chicago Sun-Times, the show’s oldest contestant, Allyson, is a 33-year-old who plans to claim a wedding suited to her “old-school rocker chick” tastes and other prizes in the form of liposuction, a breast lift, a breast reduction and Botox, as well as some cosmetic dentistry, if named the show’s victor.

Before I was pregnant with my son, I was in the best physical shape of my life,” Allyson says. “I would love to get back to that and I’m sure [my fiance] would NOT mind some smaller perky boobies on me. I’m 33 and they sag down to my belly. What will happen when I’m 50? Will I have to roll them up and tuck them in my bra?”

Allyson’s sentiments reflect how many women feel after undergoing the physical rigors of pregnancy and childbirth, and although many plastic surgeons may not agree with the show’s blend of reality TV chaos and medical procedures for ethical reasons, they can certainly see where Bridalplasty contestants are coming from.

“Mixing reality TV and plastic surgery has always made me uncomfortable. However, I do appreciate that there is a lot of excitement and anticipation when planning a wedding and everyone wants to look their best,” says Boston plastic surgeon Dr. Fouad Samaha.

Dr. Samaha specializes in the breast enhancement and body contouring procedures that he says many women seek before their wedding day.

“Our brides-to-be who planned ahead have had mostly breast enhancement and liposuction procedures, allowing enough time for healing so that they look great on the big day. We have also performed a lot of procedures on mothers-of-the-bride (including breast procedures, abdominoplasty, liposuction, etc.) and getting the right injectables always adds the finishing touch,” says Dr. Samaha.

An important point from Dr. Samaha that Bridalplasty contestants and other women planning surgical makeovers before their weddings would do well to consider is that plastic surgery requires brides to plan ahead.

If Allyson gets everything on her extensive plastic surgery wish list, she would need every minute of the four-month recovery period allotted after the show to bounce back from surgery before her big day, provided there are no complications.

As the contestants of Bridalplasty work toward trumping their opponents in the quest for the wedding and body of their dreams, viewers may find themselves wondering where the future grooms are in all of this. If they are like Dr. Samaha’s patients, they’re probably not standing idly by while their fiancées do all the work and get all the work done.

“Many grooms get Botox,” says Dr. Samaha, “to make sure that they lose any frown lines and look as happy to be there as they feel.”