Rejuvenate On Your Own Terms

Walk into any ‘ole spa—even in the biggest cities—and chances are you’ll be presented with a menu of options, including multiple types of facials, peels, laser treatments and things called skin resurfacing and microdermabrasion. All the descriptions may confuse you more, so you start asking questions of the people behind the counter. Unfortunately, they seem to know less than you.

Not so at the Classique Medical Spa, in Northborough, Massachusetts, which is owned by Dr. Cynthia Poulos, a board-certified plastic surgeon with decades of experience. Dr. Poulos opened her spa in 2000 to offer non-invasive treatments because she wanted to help patients keep their skin beautiful over time, instead of simply operating and sending them on their merry ways.

Since then, more and more of these treatments have been introduced and are being offered by board certified plastic surgeons across the country. Performing them in a soothing and beautiful spa environment adds to their appeal and popularity.

“I love to operate,” Dr. Poulos says, “but I like to explore alternate ways to deal with issues.” The doctor meets with each patient to discuss his/her skin care goals and what are the expectations from each treatment option, or group of treatment options. “We’ll decide the best course depending on whether someone wants to correct, rejuvenate or enhance their appearance,” Dr. Poulos explains. “My medical background gives me the ability to thoroughly evaluate the safety and effectiveness of available treatments. I will only offer them in the spa when I am convinced they have value.”

The doctor’s spa staff includes licensed aestheticians and nurses. Located less than an hour’s drive from Boston, Classique Medical Spa is a great stop for a rejuvenating treatment in the area. Dr.Poulos’ practice and spa are located at 17 South Street in Northborough.

A Beautiful Chicago Evening

Put one plastic surgeon, one fashion designer, two hair gurus and an elegant-FOF-who-knows-how-to-entertain together in one room and what do you get? Answer: A party worth attending. Which is just what more than 40 women did recently, at the magnificent Chicago Gold Coast home of Gerri Shute.

Dr. Gus Galante, ASPS board certified plastic surgeon, discussed why someone considers plastic surgery and who is a good candidate, then gave a live Botox demonstration and chose the lucky raffle winners for a box of Latisse and a $50 gift certificate to Ralph Lauren Restaurant. Fashion designer Maria Pinto unveiled her spectacular new M2057 collection. And beauty gurus, Elline Surianello and Nic Andrews, shared some of their valuable hair secrets with the rapt guests.

In true Gerri Shute style, the buffet, drinks and service were delicious and impeccable. Thank you, Fab Friend Gerri, for everything you did, and Dr. Galante, for sponsoring the wonderful evening.


Against Plastic Surgery? Read This Now!

Dr. Malcolm Roth is Chief of Plastic Surgery at the Albany Medical Center in Albany, New York, and former president of the American Society of Plastic Surgeons. A practicing board certified plastic surgeon for 25 years he is passionate about his profession and one of it’s most articulate spokesmen.

FOF talked to Dr. Roth about changing consumer attitudes towards plastic surgery and about changes in the field itself.

What is most rewarding about being a plastic surgeon?

We restore and enhance lives. We perform procedures in the reconstructive area that make people function better. A woman who has had a mastectomy, for example, can go to the beach looking as she did before. We work on children born with deformities and on cardiac patients who have infected wounds after heart surgery. We make people happier about their appearance and more confident about themselves.


{Life Changing Plastic Surgery Story} “I Used To Have Buddha Hips…”

Liposuction procedure performed by Dr. Wallace.

“I always swore I’d never get plastic surgery,” says 53-year-old Beth*, from Dallas, TX. “But somewhere around the age of 50 I woke up and changed my mind.”

A jewelry designer and mother of two, Beth never wanted to look “overly done,” a look she sometimes sees in Dallas, she explains. But after having two kids and emergency surgery for an ectopic pregnancy, she was “left with a not very pretty scar” on her abdomen and some other body issues that had been bothering her. “I’m your basic pear shape,” Beth says, “with smallish, B-cup breasts and what I call my Buddha hips.” Over time, she felt her shape was growing increasingly unbalanced. “Between the scar tissue and my widening hips, it was difficult to find ready-to-wear clothes that fit.”

So Beth decided it was time for “a little mommy makeover” and went for a consultation with Dr. Charles Wallace, a Dallas board-certified plastic surgeon. Here, she ta exactly how she got the “natural look” she was looking for.

*Name changed to protect privacy.


A “Cool” New Fat-Busting Treatment Using H2O

Charlotte, North Carolina — FOF recently caught up with Dr. Jeffrey Ditesheim about a “cool” new, minimally invasive lipo-technology, called AquaShape, that uses the pulsating action of sprayed water to remove fat and sculpt the body. Dr. Ditesheim is the first first board certified plastic surgeon in North Carolina to offer this procedure to his patients.

“AquaShape is a gentle way to eliminate fat and shape your body permanently,” the doctor told us. “It’s strong enough to remove fat, but gentle enough to minimize downtime.”

Liposuction is the most popular plastic surgery, according to the American Society of Plastic Surgeons, with more than 205,000 procedures performed in 2011.Although lipo has evolved dramatically over the years, Dr. Ditesheim reports that some surgeons continue to use outdated techniques because they’re faster.

“The goal shouldn’t be to do something because it’s faster or more agressive,” he says. “I don’t look at liposuction as a way to destroy or remove fat; it’s about shaping the body to create a more beautiful or more proportional shape.”


Game-Changing Advancements

Texas—FOF recently chatted with Dr. Charles Wallace, board-certified plastic surgeon in Dallas, Texas, about the latest—and greatest—innovations in the field. “We’re really excited about a couple things that I believe are game-changing advancements,” the doctor believes.

The new implant in town!

“Sientra has introduced FDA-approved, shaped breast implants that come in a broad selection of sizes, profiles, projections, and surfaces, giving women more options for breast augmentation and reconstruction than ever before,” Dr. Wallace reported.

“The new Sientra implant is simply the best we’ve ever seen. In my opinion, it’s the first truly meaningful change in breast implants for decades,” Dr. Wallace explained. These high-strength, cohesive gel implants are made from a more viscous gel than other FDA-approved, silicone gel-filled implants, he said. “They feel natural, yet retain their shape very well and are less likely to rupture and leak. If they’re cut in half, for example, they remain form-stable. The silicone gel inside the shell does not ooze or migrate out of the casing.”

The Sientra implants also minimize the potential for ripples and wrinkles, so the results are more predictable, with fewer potential problems and less likelihood for revision surgery, the doctor added.

Sientra Implant Shape Retention Demonstration. Left: Cut implant with visible gel stability. Center: Pressure induced gel displacement. Right: Gel retraction demonstration shape retention.


{Life-Changing Plastic Surgery Stories} “I Felt Like My Lower Face Was Sinking Into My Chest.”

Written by Ramona Duoba

Deciding to have a surgical procedure often comes after a defining moment. You glance at your passport photo and can’t believe what’s happened to your looks during the last decade. You won’t go near the pool without meticulously wrapping a sarong over your swimsuit. You secretly pull back the skin on your face to see what you’d look like, minus the lines around your mouth, eyes or on your forehead. Penelope L.’s defining moment was a bit more dramatic. “When I did cardio exercise I had a sensation that lasted about a minute and then stopped suddenly. It wasn’t an ache or pain. It was something that was just different. It’s kind of hard to explain. The sensation was on my left side and probably had more to do with my breathing, but my breathing never stopped. The doctor recommended I have an EKG. On April 29, 2011, the same day as the Royal wedding, I checked in for an outpatient procedure. The last thing I remembered hearing was, ‘We’re taking you to the O.R.’ Fifty-year-old Penelope had three major heart blockages. “I was a walking time bomb,” she said.

How was a triple by-pass your defining moment?
Once I recovered I told myself I wasn’t putting off what I wanted to do. My jowls had to go. Sagging jowls run in my family. My mom is beautiful, but she has them.

When did you have the surgery and are you happy with the results?
I had a lower face-lift and neck lift surgery on December 14, 2012. I’m very, very happy with the results. I no longer walk around with my lower face sinking into my chest. Now I look more the age that I am and I really like that.

You are a practice administrator for a plastic surgeon, so you see patients and their results daily. What was the procedure like for you?
The lower face and neck lift were a breeze. I had I-V sedation, also known as a twilight. I just felt like I was having a really good sleep. Dr. Magassy pulled the neck back behind my ears and the lower face up in front of my ears. I came home with a wrap that looked like a helmet. The reason for this is to keep everything in place for the first 48-hours of healing. If you can imagine the wrap underneath your chin, pulling up, it helps with the contour. The wrap was the part that bugged me the most, but then again it was only 48-hours.

Did the procedure require liposuction?
Dr. Magassy always does a little lipo with this procedure. It’s called sub mental liposuction and it eliminates any fat that might be lying there.

Were you swollen?
Yes, but I didn’t bruise because I pre-medicated with Arnica Montana, a supplement to prevent bruising and swelling. The noticeable swelling lasted about two weeks.

How long was the recovery?
I had the surgery on a Friday and was back at work the following Tuesday. Since I work in a plastic surgeon’s office it wasn’t uncomfortable to be there with a swollen face. There was a little redness from the stitches, which lasted about three weeks. The area from the sutures is slightly raised so I use a silicone in a tube for scar management.

How did your friends and family react?
I went to have my nails done a couple of weeks after my surgery and the manicurist asked if I changed my hair color. When I told her I had a lower facelift she said, ‘You don’t look like you had surgery at all, you look well, like you had a vacation.’ No one asks if I had work done. Everyone thinks I look ‘well rested.’ I had the surgery just this past December and the friends I saw after Christmas just told me that I looked really good.

You’ve worked for Dr. Magassy for seven years. What do you like about him? Why did you choose him?
I’ve seen the results of many patients over the years and I liked them, so Dr. Magassy was an easy choice. He has the experience and I knew there would be a balance of the results I wanted and what he felt I needed. The results are subtle and natural. What you want may not be what you need.

How has this surgery changed your life?
It has enhanced how I feel about myself, the image I put forth in my job. I love telling people what I do for a living and what I’ve done to my face. I’m not hush-hush about it. I talk candidly about it. Getting natural results is the product of skilled hands. Don’t wait until it’s too late because once your skin becomes even more lax, you’re likely to look more pulled back after surgery. It’s harder to achieve a subtle result.

Are you considering other procedures?
Not now. Maybe I’ll have my eyes done, but I’ll let Mother Nature decide. When it’s time, I won’t think twice.

A note from Dr. Magassy:
Penelope was an excellent candidate for the lower face lift and neck lift surgery. Besides being motivated to do this surgery, she has nice bone structure. The surgery took about 2 1/2 to 3 hours under a local anesthesia. An incision is made in the hair line and the skin is raised. Penelope had sagging skin and it was very elastic, so her results are great. I see her every day and her attitude is terrific. I have seen this type of surgery make a big difference in a person’s life. They feel better about themselves. Much more confident. They feel as good as they look and vice-versa.

{Life-Changing Plastic Surgery Stories} “I Looked Like A Melting Snowman!”

Karen B., 62, vividly remembers report card day in sixth grade. “In those days, your grades were listed with your height and weight,” Karen explains, and the teacher would read them out loud as he handed the report to you. “I remember jumping out of my seat and running to his desk in tears, begging him not to read mine.” Karen was 12 years old and 126 pounds. “I was the biggest girl in the class. Always,” she says.

Smart and ambitious, Karen excelled in school, eventually earning a B.S. in chemistry and becoming a nurse. She married a Marine in her early 20s and they had two children while he built a successful business. Through it all, Karen felt powerless over her weight, which fluctuated between 220 and 280. “I would diet, work out and then gain it back,” she says. Finally, in 1989, she had gastric bypass—then a new procedure—and lost 120 pounds. “But the brain is funny thing,” she relates now, “and you can find ways to circumvent the surgery and eat what you want.” Over the next two decades, the weight crept back. “When I retired three years ago, I was hanging out at about 215.”

Then, during a routine physical, Karen was diagnosed with diabetes. Shocked and upset, she spent the next year researching on the internet.  “I found a good diet and a trainer at LA Fitness. I also started taking Byetta, a diabetes medication.” Over the year, the weight came off steadily. “I hated working out. Hated it,” Karen laughs. But ultimately, her weight got down “to the low 140s” and stayed there for two years.

Now at her “perfect weight,” Karen was thrilled, but when she looked in the mirror, she saw “all these sags. I looked like a melting snowman.  My 10-year-old granddaughter would say, ‘I love your arms, Grandma!’ and would swing the skin back and forth!

“I didn’t want to grow up to be a saggy, saggy old lady,” Karen says. So she asked a friend who was in a gastric bypass support group if anyone had come to talk to them about plastic surgery. “She gave me Dr. Boynton’s name and said he seemed wonderful. So I called his office.”

Ten months and two surgeries later, and the results speak for themselves. “I want to run through the mall naked!” Karen laughs. “I have not stopped smiling.” Here, she explains the details of what Dr. Boynton did to give her “a body I never in my wildest dreams thought I would have.”

Tell me about your first meeting with Dr. Boynton.

First of all, the thought of showing someone an old body with all this saggy droopy skin on it made me want to die of embarrassment! I’ve spent my whole life trying to tuck it in and not show it. But you walk in his office, and everyone is so nice. He meets with you while you’re dressed, so you can get to know him. He tells you about his philosophy and his training, and you can just feel that he has a good spirit. I thought, ‘I can handle this!’

What surgeries did you have?

Dr. Boynton likes to do things in stages. He’s very careful, which I like. The first surgery was a tummy tuck and some liposuction on my flanks and lower back. He told me he likes to start with the tummy—the core. After having two babies my muscles were spread apart, so the muscle repair was a big deal. He did a breast lift in round two, as well as a breast augmentation and my upper arms.

How was the recovery?

Surprisingly easy. Dr. Boynton had explained that he was using Experil, a new drug that keeps you comfortable for 72 to 96 hours after the surgery. He injects the drug along the muscles and the incisions during surgery so when you wake up you really feel great. I’m a geek, so when he told me about it I went on YouTube and watched procedures being done. I was very impressed. After the first recovery, I asked him if he could use Experil again when he did my breast augmentation and he actually researched it and learned the technique for breasts at my request. I couldn’t believe he did that.

When were you able to get up and leave the house?

One and a half weeks after the second surgery I went to the mall, still with my compression garment on, because I wanted the woman at Victoria’s Secret to measure me. I wanted to see what size I was. She couldn’t believe I was out. She said, ‘no one is up like this two weeks later!’

So what is your new size?

Well, I went to Black House White Market the other day and I bought a new pair of pants, because literally everything is falling off of me. And they were a size four.  A four! I’m someone who used to be over the moon about a size 10. I showed my husband and he was like, ‘did you ever in your wildest dreams think you’d be a size 4?’

What’s your husband’s reaction to all of this?

My husband is the most wonderful person. He has told me my whole life, ‘I love you no matter what you weigh.’ And he has loved me unconditionally no matter what. What makes him happy now is seeing how happy I am. That’s the kind of guy of guy he is. I said ‘honey, you have your trophy wife and you didn’t even have to get divorced and lose half your money to get it.’

What about friends? What do they say?

People who haven’t seen me for a while have said, ‘Oh my god, what have you done?’ And I just say, ‘I lost some weight and I kept it off and I had a little something something done.’ And then I hand them Dr. Boynton’s card. I  went back to see my co-workers after my tummy tuck and they could not believe it. Three of them asked for his card.

Do you plan to have any more surgeries, or are you done?

In the fall we’re going to do legs and butt—get the sags off and finally finish it. We’re not quite there, yet, but as long as Spanks exist I can fake it til I make it!

What’s your overall impression of Dr. Boynton?

I have worked with hundreds of doctors over my 32 years as a nurse and assisted on many surgeries, and I can tell you he is number one in every respect. I feel like I am in such competent hands. But more than that, he’s very real and down to earth. You can talk to him. One day I came into his office with my 10-year-old granddaughter. She has a lot of physical disabilities, and the first thing he said when he saw her was, ‘You have pink river shoes on!’ And that just melted my heart, because most doctors—especially surgeons—won’t do that. They are too rushed and harried and they have no bedside manner. His heart is right there.

And trust me, you never want to go to a doctor that a nurse wouldn’t go to!

What would you tell an FOF who was considering surgery?

It’s never too late. I’m an evangelical Christian, and I remember going to a big camp meeting in 1981 with a popular evangelist minister. He had everyone close their eyes and think about  the desire of their hearts. Mine had always been to be a normal size. He said, ‘I will pray for everyone here, and if you hang onto that, it will happen.’

Well, it took 32 years—diabetes, exercise, bypass surgery. It wasn’t overnight, but all this time has made me appreciate it that much more. I mean, unless you’ve lived in double your body, I don’t know if you can really appreciate size-four pants. This is the first time ever in my life that I actually feel desirable and alive and sexy. Before, that wasn’t even in my realm of awareness.

Dr. Rosenblatt Holds An After-Hours Get Together

“He’s a God to me!” gushed Rodi, one of Dr. William Rosenblatt’s FOF patients, at a get-together at his New York office this week. Looking fantastic at 57, Rodi told the gathering of 15 women (and one man) that Dr. R performed a breast reduction on her and removed “three or four chins.” Delighted that she “hasn’t had to wear a bra in two years,” Rodi also is thrilled that her back “no longer hurts” from the heaviness of her breasts. As for some of the fat that Dr. R eliminated from her chin, he injected into her cheeks to give her face more fullness.

Billed as An Evening of Beauty on the email invitation from Dr. Rosenblatt’s office, the program featured a discussion of new plastic surgery trends, including an introduction to Xeomen, which the doctor calls a “new Botulism toxin.” Manufactured by Merz, the same company that brings us the filler, Radiesse, Xeomen, is “15 to 20 percent less expensive than Allergan’s Botox, but has  the same  effect, lasts the same amount of time, and is injected the same way,” Dr. R explained.

Although Xeomen has been around for a while, he told us, it couldn’t be introduced in the United States until some legal issues were resolved. Now Merz is charging doctors less so it can take market share from Allergan, a common tactic among drug companies.

Xeomen is used to paralyze muscles and get rid of the deep lines in the glabella region, the area on the forehead between our eyebrows, where lines develop from frowning repeatedly over the years. It’s often used also to eliminate crow’s feet around our eyes and “bunny lines,” which develop when we wrinkle our noses, Dr. R said. “I sometimes inject it to elevate the eyebrows slightly, but I don’t like to fully paralyze a forehead. It looks terrible when you can’t raise your eyebrows.”

While we sipped wine and enjoyed sushi and raw veggies with hummus, Dr, Rosenblatt covered other techniques and trends.

On Breast Implants

“Silicone breast implants, even on the rare occasions that they might break, don’t explode. They run trucks over these and they do fine, from what I understand. The silicone won’t pour out, even if the implant were to be cut. It would act more like silly putty and blub up.”

“Round silicone gels are the most popular in this country for elective cosmetic breast augmentations. Newer implants on the market, commonly known as ‘Gummy Bear’ implants, are hard, not soft like silicone. They work pretty well for breast reconstruction after mastectomy, but I don’t find that they work well for

routine cosmetic breast augmentations.”

On Breast Lifts

“A breast isn’t lifted only by an implant. To determine the sagginess of your breasts: Put a pencil or finger under the breast. If the nipple is below the line created by the pencil or finger, you need a surgical lift.”

“Just putting a really, really big implant into a sagging breast will create what’s called the ‘Snoopy deformity’: The breast is here and the implant is here,” said Dr. R, pointing to two different spots on his chest. “If you have very large breasts that sag, we do a small reduction and then lift them up. The bigger the breasts are, the more they’re going to sag. If you have smaller breasts, you can lift the skin and put in an implant at the same time.”

“Breasts are held up by just skin. They don’t have ligaments or muscles. They have nothing.”

“Different styles of implants are popular in different parts of the country: Slightly smaller implants in the Northeast. In the Southeast and California, they start where we leave off.”

On Liposuction

“Liposuction is designed for skinny people, in order to remove some lumps and bumps and a little excess fat. It’s not designed for overweight people. Diet is what works with them. The biggest liposuction we do is 12 pounds, which is a drop in the bucket for really heavy people.”

Following a brief Q&A period filled with laughs (another of the doctor’s patients, who had breast augmentation last year, said ‘they’re mine and they’re magnificent,’ recalling the famous line on Seinfeld,) Dr. Rosenblatt did live Botox and Radiesse demos.

{Life Changing Plastic Surgery Stories} The Eyes Have It

“When I was young, I remember walking through the cosmetics section of a department store, where there were so many mirrors, and thinking ‘Jeez, I look pretty good,’” says Kathy H., an FOF from Indiana. “As I got older, and the bags under my eyes started getting worse, I didn’t want to go near those same mirrors.”

Now 65, Kathy decided to finally do something about her bothersome bags 10 years ago. Impressed after her initial consult with Dr. Gus Galante, she booked her procedure on the spot. A month later, he performed his magic.

So pleased with the results, Kathy returned to Dr. Galante three years later for a lower facelift. Today, she sees him for Botox injections.

“It changed my life,” says Kathy, who once thought only “movie stars and important people” got plastic surgery. “I’m happy to look in the mirror again.” Here, she chats with FOF:

Eye surgery performed by Dr. Galante.

What bothered you about your eyes?

I had bags and my upper lids were droopy. I had no crease. It always bothered me but got worse as I got older. I tried everything on the market–nothing would take them away.

How important are your looks to you?

Very–I used to be in real estate and worked with the public. Now, I work at the local humane society but still want to look good, for myself.

How did you find Dr. Galante?

A couple of people I knew had been to him. I live in Indiana, near Chicago, and there are a lot of surgeons in the city. Turns out Dr Galante was in my own backyard (Schererville, Indiana). I called and spoke to his receptionist, Marcie. When I told her what I wanted done, she made it sound so simple and told me she had it done herself. So, I went for a complimentary consultation.

Were you nervous?

Yes. I grew up in a blue collar town. I thought of plastic surgery as something only wealthy people do. Not anymore. When I went to Dr. Galante’s office, I expected to see all these beautiful, 30-year-old women. But, there were normal people like myself. And, after I spoke with Dr. Galante, my apprehensions completely went away. I knew it was going to work out well. I ended up booking a treatment for the following month.

What did you like about Dr. Galante?

He is very trustworthy and would never talk you into doing something you don’t need.

Tell us about the eye bag removal procedure.

I went in at 6:30 in the morning on a Friday and was out by noon. I had twilight anesthesia so I wasn’t completely out. My stitches were removed on Monday. I iced my eyes the way I was told.  They were very swollen. Marcie told me this was normal and, in fact, I looked better than most people. Within a week, I was back at work with just slight bruising near my cheekbone. I could see the full effect after about a month, and was very happy.

What did your friends and family think?

They all loved it and thought I looked younger. I didn’t necessarily do it to look younger, I just didn’t want to look tired anymore.

Are you married? Was your husband supportive?

My husband died three years ago, but he was supportive at the time.

Do you date?

I’m dating someone now. He’s older than I am. We met in high school and his wife died a couple years before my husband died.

Do you want to get married again?

No. I like being independent.

Why did you decide to have a lower facelift, three years later?

My jowls started bothering me. I put my makeup on in front of a magnifying mirror and I thought, ‘This has got to go!’

Describe the treatment.

I went into surgery about 6:30 a.m and was home at about 2 p.m. I was out completely, under general anesthesia. I had to return the following day to have a drain removed. Healing is slower than for the eye surgery.  It took about five to six months before I could see the full results.

What did you and your friends and family think?

They thought it wasn’t as noticeable as my eyes, but that it looked great. It was certainly noticeable to me.

Did you have anything else done since the lower facelift?

I go to Dr. Galante for Botox about two to three times a year.

You are pretty open about your procedures. Did you ever think about hiding the fact that you had plastic surgery?

No. It’s just the personality I have. There’s no reason to hide it.

How do you think it has changed your life?

It’s the best thing I’ve done for myself and I wish I had done it earlier. Women over 50 have done things for others all their lives. Now, they should do something for themselves. If you don’t feel good about yourself, you can’t feel good about anything or for anyone.

A note from Dr. Galante:

I think Kathy’s statement about wanting to look less tired, not necessarily younger, represents the typical expectation of the patient who seeks facial rejuvenation. Her “after” photos demonstrate just that…a clean, refreshed look. Kathy initially presented with concerns about baggy upper eyelids and puffy lower lids. The upper lid problem is excessive skin which can mask the lid and sometimes even block the peripheral field of vision. My treatment for this was the removal of the skin and a slim strip of muscle to better define the crease. The lower lid problem is the bulging outward of fat which normally sits in the eye socket to cushion the globe.  I made a small incision just under the lashes to gain access to the protruding fat, and then removed it. A small amount of skin was also taken to keep the area smooth.

Kathy went on to have a facelift and most recently a few Botox injections to keep her appearance fresh. Again, the end result in these patients is to look better, not necessarily look younger. Looking good makes one feel good, and feeling good after fifty should be an attainable goal for anyone who wishes for it. The recipe to this feeling includes a healthy diet, exercise, engaging social relationships, optimizing emotional, intellectual, and spiritual well-being, using the most favorable cosmetic, hair, and clothing styles, and a plastic surgery procedure, if desired.