After her tummy tuck, Joan was ready to shop for a bathing suit (every woman’s darkest hour). She was feeling confident that her makeover was beginning to take form and that this experience would be different than the ones she had had in the past.
Unfortunately, the minute Joan got into a cute little rhinestone-accented tankini, she became aware of the multicolored patterns on her calves. In the past, Joan had thought her veined legs added character, and she had actually spent one summer putting the intricate web to good use by tutoring history students. Joan found that when she put her legs side by side, they actually resembled the map that Lewis and Clark used to mount their expedition across the United States.
Unfortunately, standing in the dressing room looking at herself in the bathing suit, Joan realized that the vein that represented the Missouri River had recently forked, and she knew this summer it would give students the mistaken impression that Sacagawea had led Lewis and Clark not to Oregon but rather to Brooklyn. Fearful that the entire class would flunk their make-up exams because of her, Joan slid out of the tankini, called the doctor, and decided to have the distorted and incorrect veins removed.
I’ve had liposuction twice. The first time, it was on my thighs, in the saddle-bag area. This was eons ago, when liposuction was brand-new, and women were willing to trade their firstborn children to try it. Back then, we didn’t know the downsides about lipo: that you can’t take too much fat at once, or the blood loss could bring on a heart attack.
So I went in, had my thighs vacuumed, and thank God, it worked, in that it took away the fat from my legs. But six months later, I developed funny lumps around my waist. No one in those days knew that could happen.
When you do liposuction, you really have to commit to keeping your weight down, otherwise it comes back in weird places, in strange ways.
The best lipo procedures I’ve seen on anyone are under the chin on women who are born with necks that go right into their chests. Neck lipo can make a huge difference even though so little fat is taken out.
I didn’t try lipo again until a few months ago, when I decided to have my upper arms done. I was especially motivated to get rid of new pockets of grandma flab that had formed around my elbow in the back. Couldn’t wear short-sleeved shirts or sleeveless dresses. A terrific doctor named Lisa Cassileth did it for me.
If you are in your seventies and have a body part lipo’ed without a skin lift, be prepared to be scared to death of the result. Mine worked. My arms looked skinny, and that was great. They weren’t flabby at all, but they were still wrinkled. So the next step was a minor pull-up in my armpits. This lift left small scars, but my arms, for my age, look just fine, and I don’t have to go swimming in a blouse.
What’s driven me to have both my legs and my arms attended to is the beauty ideal of the long, lean-limbed woman. It’s a fairly recent development, this obsession with slender stems. In the nineteenth century, plump arms and chubby legs were considered delectable and precious. Now, they’re considered a disgrace.
I think the giraffe aesthetic started in the Fifties, when Grace Kelly and Audrey Hepburn became the most envied actresses on screen. It was the era of models turning into actresses. Real actresses just couldn’t compete. Rita Hayworth was slim, but she had some meat on her bones. Marilyn Monroe was a hog in comparison to Audrey Hepburn, as were Jayne Mansfield and Jane Russell. They were voluptuous, large-boned beauties, even in their day. In ours, they’d be playing the fat girl/best friend parts in movies …or providing the voices of animated hippopotami in the latest Disney film.
Normal women who would dream of comparing their gams to Cameron Diaz’s—and who’d dare, really?—aren’t grasping to achieve a beauty ideal. Your limbs are only as long as they are already. The under-six-feet crowd (i.e., 99 percent of human females) know they can’t do anything about their height. But they can do something to make their limbs lithe, and appear taller, in the process.
So many women walk around self-conscious about their upper arms. “Hadassah hunks,” by the way, is my official medical term to describe the fat and skin that hang from your upper arm. All of us have a memory of a grandma in a sleeveless dress with big, fat arms. Once you hit sixty, the skin gets so loose that normal sleeve sizes don’t fit. When you do wear arm-showing clothes, you feel exposed and embarrassed if you—God forbid—have to wave at anyone or raise your hand to signal the waiter. Big arms that flap like you’re about to take flight, or suffocate someone in a clench, aren’t attractive or feminine.
Men have big arms. They call them “guns.” Women with “guns” want to shoot themselves.
If you’re under thirty-five and have fat arms and resilient skin, you’d be better off with arm lipo than a lift. It’s less expensive, and you’ll have no visible scars. Arm lipo, which I had, takes an hour under local anesthesia and sedation. You’ll go in and get drugged and numbed. The doctor will make small incisions in your armpit to insert a small cannula—a metal tube—to infuse the area with a tumescent solution of lidocaine (a painkiller), saline, and epinephrine (to constrict blood vessels).
Once your arm is pumped up with fluid, the doctor then inserts another cannula, which is hooked up to a suction machine, and proceeds to hoover out the saline solution as well as the fat. Then your incision will be closed with a stitch or two. And you’re done.
You’ll have some swelling and bruising to deal with for a couple of weeks, decreasingly so. You’ll also have to wear a compression sleeve on each arm for a week to hold off the worst of the swelling and to help contour your new arms.
Pain? Some, for a couple of days, easily held at bay by medication. When the compression garments come off, so will the sleeves of your dresses and shirts. The only scars are teeny and in your armpit. No one will ever see them. Arm lipo is relatively inexpensive. Expect to pay between $2,000 and $3,000.
The over-thirty-five-year-olds who have loose hanging skin due to the demands of gravity, age-related skin laxity, and/or the stretching out of having gained and lost a lot of weight need an arm lift, also called brachioplasty. Fourteen thousand had this done in 2007.
As most doctors explain it, the arm lift trades one aesthetic problem for another. The first problem is “bat wings.” The second problem is significant, permanent scars either on the inside of the arm, from pit to elbow, or on the outside, like a seam, also from pit to elbow. A mini-brachioplasty scar is just a semi-circular crescent that spans the armpit.
The choice is yours. Big arms or big scars? If you decide to go for it and live with scars, the procedure is described below.
For an arm lift, you’ll have either general anesthesia or local numbing with sedation. Whenever possible, take the local and sedation, just to avoid the scary risks of being put under. It’s not like you’re going to be watching the doctor slice into you. If you don’t have to see it, and you won’t feel it, you might as well be awake, and enjoy the Valium for the hour or two of the procedure.
The doctor will make the incision—depending on the state of your arm, it’ll be on the inside, along the outside, or across the armpit. Once the incision is made, the doctor may use sutures to stitch the arm muscles tighter so your arms will be firmer and more toned-looking.
Then, if liposuction is also called for, he’ll do that next, removing excess fat.
Last, he’ll pull the skin around the arm tighter—not too tight, or you won’t have a full range of motion—trim the excess skin, and sew the remaining skin envelope closed. Those lucky enough to get by with a mini brachioplasty will only have their skin yanked tighter toward the armpit, like tugging up your sleeve. A smaller flap of skin will be excised.
With either a full or a mini, you might have a drainage tube put in, which will come out in a few days. You’ll be bandaged, and put in a compression sleeve for support and to prevent swelling.
Then the surgeon will do the whole thing all over again, on the other side.
Drawbacks? You’ll bruise and swell, but only for a couple of weeks. You’ll have pain for several days, but again, drugs will hold that at bay.
Whenever you’re cut with a scalpel, you run the risk of infection, but you’ll probably be on antibiotics before and after surgery to prevent it.
There’s also the risk of bleeding from a nicked vessel, but this usually resolves itself or is corrected by your doctor fairly easily. Once the swelling is completely gone in a few months, you might notice that one arm is slightly bigger than the other.
Asymmetry does happen in surgery, as in nature. If anyone notices the difference, just tell them you punch harder with the bigger arm.
The major drawback is if you have the full brachioplasty, there will be scars running the length of your upper arm.
Reasons to be cheerful? Brachioplasty is considered a low-risk surgery. If you have local anesthesia, it’s unlikely anything will go wrong. Plus, you’ll get the arms of your dreams.
You won’t be afraid to hug a child, for fear of crushing her.
You can hail a taxi and not slap the guy standing next to you with your flab.
You can put on a tank top when it’s hot, just like everyone else.
You can wear clothes that fit your arms and your torso.
Most important, you won’t be self-conscious anymore. You can swing your arms freely as you walk, fling them around your beloved’s shoulders, arrange them akimbo on your hips, and know that, in any position or posture, your arms look good.
You can be miserable your whole life and do nothing. Or, you can do something, be miserable for a week, and then be happy for the rest of your life. Hardly seems a choice. All this freedom can be yours for only $5,000. A bargain, in my book.
In an hourglass figure, you don’t want all the sand to be on the bottom. Women with thunder thighs are self-conscious about rolling down the street with them. Often, the large-legged have normal-sized or petite waists and they have to buy pants that are tight in the thighs and gigantic around the middle. It’s as if they were made of halves of two different women. In photos from the waist up, they appear model-thin, or totally average-sized. But when the camera pulls back and reveals their lower half, the photographer has to attach the wide-angle lens.
A bottom half that’s out of proportion to the top couldn’t be more frustrating. The thigh anxiety goes way beyond having to sneak mismatched bikini tops and bottoms past the checkout girl at Bloomingdale’s. You’re self-conscious and fraught with fear about what heavy thighs look like, and what they might do. Every step you take, every chair you break, every orgasm you fake, you’ll be cursing them.
Men might say they like meat on a woman’s bones, but they don’t mean the meat of an entire brontosaurus.
The only real way to reduce upper leg volume is with thighplasty, or thigh lift, which nine thousand women got in 2007.
The thigh lift is the surgical equivalent of pulling down a fat pant leg and pulling up a skinny one. It’s a bit more complicated, as I’ll get to in a moment. The first step on the path to slenderizing your thighs is unconsciousness. Unlike an arm lift, the thighplasty calls for cutting in a sensitive area—the groin—and I personally would not want to be awake for that. Some doctors offer local anesthesia and sedation. If you’re strong-willed, take it. If you’re at all wigged-out by the idea of cutting near your privates, go for general anesthesia, even though, as always, if you go under, there’s a minuscule chance you won’t wake up.
Once you’re numb/sedated or asleep, the doctor will clean the area and make his incision. If the problem is inner-thigh jiggle, you’ll need a standard or medial lift, which helps tighten the inside, front, and back of the thigh. The cut is along the bikini-line crease, starting in the front and moving all the way back to the butt. Sometimes, another incision is made, creating a V-shaped wedge of skin, which will also be removed along the inside of the thigh, groin to above the knee, so the skin envelope, when it’s sewn back together, will be nice and tight (but not so tight you can’t walk, run, sit, do a split, hang from a chandelier during sex, etc.).
If your complaint is saddlebags along the outer thigh, the incision will run from the bikini crease upward, across the hip at the lower panty line, and extend down to the butt crease. It’s a long cut. The promise is that the scar will be hidden by underwear and bathing suits. The scar is yours to keep, but it’ll fade. As with the arm lift, and the tummy tuck, for that matter, you have to decide which you hate more: the body part or the scars.
Thighplasty is often combined with liposuction of the area. Depending on your doctor’s style, he’ll do that before or after the incisions are made. Next, he’ll pull the skin back in place, excise or remove the excess, and stitch you back together. If you had the wedge cut, you’ll have a new vertical seam along the inside of your thigh from knee to crotch, as well as the curved scar along the bikini crease. You’ll probably also have a drainage tube to siphon off excess fluid. That will come out in a few days. Also, you’ll be cleaned, bandaged, and fit into a compression garment to stem swelling. Next, the surgeon will start all over again, on the other leg. The operation(s) will take two to four hours.
Drawbacks? Starting with the worst, if you had general anesthesia, there’s the tiny risk of death on the table. Highly unlikely. Extremely remote. But, as always, I’d be remiss not to mention it at all.
Next, you’ve got the four constant risks of any surgery: swelling, bruising, bleeding, pain. All of these are temporary, preventable with medication, or easily fixable by your doctor.
The other routine risk with surgery is infection. I call special attention to infection with an inner thigh or medial lift because the incision is dangerously close to where you pee and poop. You have to be extremely careful not to let any urine or feces get near the wound as it heals. But even the most anally retentive can’t stop every single microscopic contamination. You will need to buy a large bottle of antibiotic soap and wash in the shower after every trip to the toilet.
Some doctors close this wound with Dermabond, a medical Krazy Glue, to seal the area to better prevent infection. California surgeon Dr. Lisa Cassileth told me her infection rate went from 70 percent down to five percent by covering the incision with Dermabond. It’ll peel off on its own after a few weeks, around the time the wound is healed.
You can’t have sex until the three-week mark.*
Asymmetry is also a worry. But if both your legs are smaller, does it really matter if one is slightly smaller than the other? If the difference is freakish, complain to your surgeon and get a follow-up lipo to even them out. Also, you might have numb spots from nerve damage, which will most likely wear off in a few months.
The benefits? No more skirt-style bathing suit bottoms or sarongs across your hips at the beach.
You can wear jeans. Not fat-girl jeans, either. Skinny jeans!
Also, you can’t exert yourself for two months. Slack off and enjoy it. All the time you’d spend at the gym to get rid of those thighs? You can spend it now doing whatever unhealthy activity you choose (except smoking, which interferes with healing).
And when you do go back to the gym, and your thighs are half as big as they were, won’t you shock and amaze everyone there! You will have to wait six weeks for the wounds to heal, but it’ll be worth the wait and the $4,000 to $7,500 you’ll pay for the thighplasty
Do your legs look like a road map of Russia? Lots of swollen, snaking red and blue varicose and spider veins? Why you have them, not even the smartest doctor can say. Blame your parents, of course. You blame them for everything else, and visible veins are genetically inherited.
Also, you might have a job that has you standing a lot.
Or sitting a lot.
Maybe you exercise too much.
Or too little.
The only thing we know for sure: the valves in your leg veins are not doing their job right, and, as a result, blood gets re-routed into venous dead ends that twist, turn, bulge under the skin, or turn into branched reservoirs that look vaguely like webs. “Web veins” sound slightly more appealing than “spider veins.” Doesn’t matter. You could call them Gisele Bündchen, and they’d still be ugly. Besides making you look ancient, varicose and spider veins can swell, ache, bleed, and cause ulcers on your legs.
Here are three options to get rid of the squiggles, in descending order of magnitude:
This procedure is for large, close-to-the-surface saphenous veins. It’s the most drastic option and the most painful. The operation, which you can have under general anesthesia if you prefer, is considered minor. The doctor makes an incision or cut at the top of the vein in the groin area. It’s tied, or ligated, to stop blood flow. Then a second cut is made at the bottom of the vein by the ankle. A thin wire is threaded from the ankle incision up the vein to the groin. And then the wire is pulled out, bringing the vein and all its branches along with it.
The one mitigating factor about removing the saphenous vein? It’s what cardiac surgeons use for heart-bypass operations. If you have your leg vein stripped, you’d better take care of your heart!
The soft-core version of vein stripping is called ambulatory phlebectomy, a similar process that surgically removes smaller varicose veins, one at a time. With this, you need only local anesthesia.
A friend of mine had her veins stripped a few years ago. At the time, she was thirty-eight, thin and gorgeous, but was absolutely obsessed with her wormy-looking legs. She said the procedure itself didn’t hurt (she was knocked out), but for days afterward, she had throbbing pain in both legs and hated the compression garments she had to wear for two weeks. A good patient, she followed doctor’s orders about taking ten short walks a day, and keeping her legs elevated otherwise, and ended up thrilled with the results: her legs are smooth and pink, and look like they belong on her young body, and not on her eighty-year-old grandmother’s.
The procedure takes one to four hours, depending on how bad your veins are. It’ll cost between $1,000 and $3,000 per leg. There’s always the risk that more varicose veins will develop. In up to 90 percent of cases, your legs will stay vein-free forever.
This is a very popular (384,000 had it in 2007) no-knives treatment for small varicose veins. The doctor fills a syringe with a mixture of a painkiller and a sclerosing agent (either a saline or an alcohol-based solution) and then injects it directly into the varicose vein. The sclerosing agent irritates the walls of the veins, causing them to collapse. Collapsed veins mean no blood can get into them, rendering them invisible on the surface of your skin.
Eventually, the out-of-commission vein is absorbed by the body. You might have some redness on your leg afterwards or bruising. You’ll also have to wear compression garments and take short walks many times a day. No downtime here, you can resume lunching and shopping immediately.
The length of the procedure is one to two hours and costs between $150 and $500 per leg, per treatment. The risks are few: discoloration around the injection sites, which might take a few months to fade, a possible and rare blood clot might form where the vein used to be, the possibility of an allergic reaction, some swelling, bruising, and minimal, manageable pain.
In an odd complication, you can’t take birth-control pills for six weeks before and six weeks after sclerotherapy, due to the risk of hemorrhaging. It’d be horrible to have sclerotherapy to remove veins, go off the pill, get knocked up by mistake/accident, and then get a huge new crop of varicose veins during pregnancy, that need to be treated with sclerotherapy, so you go off the pill …and so on.
Before you know it, you’ll have more kids than veins.
This is for spider veins, the web-like matrix of red veins that are under the surface of the legs. To start a treatment, the doctor will apply a clear, cool lubricant to your legs to protect the surface skin from the laser. Then he’ll zap you in the spider veins with a hand-held device.
The laser feels a bit like a snap on your flesh, but it doesn’t hurt enough to get sedation or even topical numbing. The laser penetrates the skin layers and is absorbed by the vein’s red pigments. The hemoglobin can’t take the laser heat and coagulates. The vein can’t take the clotting pressure, so it collapses.
Again, eventually, your body will absorb the spent veins.
The whole procedure takes less than an hour. You can return to your life, already in progress, as soon as you leave the doctor’s office. You might be a little red, but not so you or anyone else would care.
The one catch about laser treatments: you can’t get results after just one session. You’ll need to go back every six weeks for four or five sessions. But at the end of the six-month course of treatment and the $2,000 or so you’ll spend, the spider veins will be eighty percent gone. And good riddance.
Have you seen Madonna’s hands lately? She’s got the face of a thirty-year-old, the body of a twenty-year-old, and the hands of an eighty-year-old crone. Hands are an easy giveaway of a woman’s age.* Fortunately, there’re a lot of procedures to make them look as young as the rest of you.
The reason hands are so hard-hit by aging is exposure. Many women are very good about putting sunscreen on their faces every day, but how many of us remember to put it on the back of our hands? The sun saps collagen and elastin, making skin lax, and causes pigmentation problems, aka dark spots. Plunging our hands into hot water to wash dishes sucks the moisture out of our skin, which speeds collagen and elastic erosion. What’s more, as we age, we lose fat on the hands, making all the bones and veins more obvious.
So what to do? First matter of business: re-plump the hands to hide the bones and veins. You can refill bony areas with a fat transfer, taking adipose tissue from where you don’t need it (hips, belly, butt) and injecting purified cells under the skin of your hands. The fat cells that create new blood-supply connections—about half—will take up permanent residence in your hands. The rest will be absorbed by your body, which is why doctors tend to overfill.
The alternative to a fat transfer is refilling bony hands with a hyaluronic filler like Restylane, Juvéderm Ultra, or Perlane. The process is simple. You’ll get injections under the skin at the doctor’s office, and the effects will last up to eight months, depending on which filler your doctor recommends. In terms of cost efficiency, a fat transfer is more expensive, but it’s a one-time fee. Fillers are less pricey, but you’ll have to get injections repeatedly to maintain the results.
Once your hands are plumped up, you can firm up the skin via laser resurfacing. A fractionated laser resurfacing involves the surgeon zapping your skin with the hand-held laser wand. The heat from the laser penetrates deep into the dermal layer of skin, stimulating new growth of firming collagen and elastin. The results will become evident in a month and increasingly so over the next six months.
Finally, for the complete hand rejuvenation, you’ll have to remove the age spots. A pigmented laser can take care of those. The doctor will zap them with the laser several times, and the spot will peel away.
A full hand job—including fat transfer or filler, resurfacing, and spot removal—costs between $5,000 and $8,000.
Although feet do get bonier with age, the change isn’t obvious, thanks to the fact that we wear shoes all day long, hello!
However, standing and walking for decades worsens bunions. Bunion removal surgery is extremely complicated. In fact, there are a hundred different ways to do it, depending on the individual case. That said, all of the procedures involve bone, ligament, and tendon removal. Full recovery takes at least eight weeks and up to six months. Immediately after surgery, you have to stay off the foot for a couple of weeks. The pins and stitches will come out within a month. You’ll have to wear a walking cast or special shoes for two months and resume normal activities at that time.
Bunion surgery costs anywhere from $3,000 to $10,000, but it will be, at least partially, covered by medical insurance.
Be very careful about this one. According to studies, up to 33 percent of people who had bunion surgery weren’t happy with the result. Most doctors warn against any elective foot surgery.
Unless the bunions are so painful that every step hurts, don’t do it.
God forbid something goes wrong, and you can’t walk again. Or you lose a digit. A friend of a friend went in to have her bunion removed, and, during the recovery period, her big toe got gangrene and half of it had to be cut off.
She’ll never wear flip-flops again.
Some women voluntarily had their toes lopped off. I remember reading in Alex Kuczynski’s book Beauty Junkies about a woman who had her toes shortened to fit into Jimmy Choo shoes. Okay, that’s insane!
She’ll never play “This Little Piggy Went to Market” again. But at least she gets 10 percent off on a pedicure.