An article in The New York Times

The deep horizontal lines across his forehead and the yawning crevices between his brows bothered Michael Ross. In younger days, he said, he had baked too often in the sun, using a double record album covered in aluminum foil as a reflector.
”I take care of my body,” said Mr. Ross, now 42 and a middle school teacher. ”In a tank top and shorts, I look younger than the average 40-year-old. I was concerned that, from the neck up, I didn’t.”
That is why Mr. Ross, who lives in Briarcliff Manor, N.Y., was on the examining table one recent afternoon in the Great Neck office of Dr. Lyle S. Leipziger, chief of plastic surgery at North Shore University Hospital-Long Island Jewish Medical Center. He was there for a procedure that has rejuvenated many a female face of his acquaintance: a Botox tuneup.
”Smile for me, nice and big,” Dr. Leipziger instructed, and the wrinkles needing reduction stood out. The doctor stuck a slim needle into the crow’s feet around Mr. Ross’s eyes and injected them with botulinum toxin (Botox).
On an island where women already jam plastic surgeons’ offices, Dr. Leipziger and others have also been seeing a rise in the number of men who want to look fresher or who think that success in the workplace demands a more youthful appearance.
”Men now look in the mirror just as much as women,” Dr. Leipziger said. ”The desire to look good transcends the sexes.”
More men seem to be adding a stop at the plastic surgeon’s office to maintenance regimes that go far beyond a daily shave. Affluent suburban men are pampering themselves at day spas and salons with facials, manicures and pedicures, following trails well worn by women.
Though his thrice-yearly Botox treatments are still not a topic he’s very likely to bring up on the golf course, Mr. Ross says male friends frequently comment on how relaxed his face looks, even if they can’t quite figure out why.

Men still account for only about one-eighth of the 10 million cosmetic surgery procedures performed nationwide in 2005, according to the American Society of Plastic Surgeons, but their share has risen by 44 percent in the last five years.
”Men have become much more comfortable seeking plastic surgery,” Dr. Leipziger said.
More than 313,000 Botox injections, the most popular minimally invasive procedure, were given to men last year. Ranking next in popularity were laser hair removal, microdermabrasion and Restylane injections to plump sagging facial folds.
Because men’s muscles tend to be thicker than women’s, Dr. Leipziger said, more Botox is needed to achieve the same result. He told Mr. Ross that it would be two weeks before full results were visible.

Men are choosing more-permanent procedures as well. The most popular last year, according to the American Society for Aesthetic Plastic Surgery, were liposuction, nose reshaping (or rhinoplasty), blepharoplasty to remove bags and tighten the eyelids, breast reduction and face-lifts.
Dr. Michael Setzen, chief of rhinology at North Shore University Hospital in Manhasset, said that he had seen a 25 percent jump in men wanting nose jobs. Typically, he said, they come to his Manhasset office complaining of nasal congestion or sinusitis and then slip in remarks about disliking the bumps on their noses. He uses computer images to show what surgery could do for them.
”Men are very concerned how they will look afterward,” Dr. Setzen said. ”They don’t want to look feminine, they want to look very much like they do look, but they want the bump corrected.” Women, on the other hand, usually want a clear change, and may come in asking for a Nicole Kidman nose, he said.
Chin augmentations are also popular with men. ”Men are interested in a strong chin — that is a male dominant feature,” Dr. Setzen said.
South of the face, male patients often want help ridding themselves of persistent love handles or may be embarrassed by enlarged breasts, a condition known as gynecomastia.
Last month, Philip Shenassa, 46, a businessman from Kings Point, underwent breast reduction surgery.
”It bothered me for a long time,” Mr. Shenassa said. ”I was sensitive and constantly aware of it.”
He said that the surgery to firm up his chest, done by Dr. Leipziger, had made his looks much more professional.
”If you can improve your appearance and your self-confidence, what is wrong with it?” Mr. Shenassa said. ”If you know what you want from life, you should go for it and do it.”
Dr. Leipziger, who at 46 has naturally boyish good looks, said he hadn’t had any cosmetic surgery himself.
”But if I needed it, I would,” he added.
This News is Brought to you Courtesy of Dr. Mark Bishara and The Paragon Plastic Surgery & Med Spa in Mansfield and Southlake, TX


In consultations, women ask dozens of questions about the safety, durability and longevity of saline and silicone gel implants – the two types that are approved for sale by the U.S. Food and Drug Administration. Here’s a sampling:
Is it normal to have different-sized breasts?
Breasts are sisters, not twins. There’s no such thing as perfectly identical breasts. Most women have breasts that are slightly different sizes. In consultations, when women look at dozens of before-and-after photos, they are surprised and relieved to see that they are not the only ones with different-sized breasts.
The asymmetry can be addressed during surgery, by enlarging breasts with implants of different sizes, augmenting the smaller breast or reducing the larger breast. While surgery cannot transform those sisters into twins, it can make them look like sisters from the same family.
Will I be able to breastfeed if I get implants?
In most cases, breast augmentation surgery does not interfere with breastfeeding, because milk ducts are generally not disturbed during the procedure. When implants are placed through an incision made around the areola, milk ducts are sometimes disrupted, which may affect breastfeeding. However, not all women are naturally able to breastfeed, whether or not they have cosmetic breast surgery.
Do implants get in the way of reading a mammogram?
They can. That’s why technicians routinely ask women if they have breast implants. If so, they will gently displace (push up) the implants and take extra views of each breast. Because of the number of women who have had breast augmentation, radiologists are likely to have experience evaluating breasts with implants.
Can you make me a full C cup?
Women commonly think that being in proportion means wearing a C cup bra. Because there is no standard bra cup-sizing system, and because breast implants are measured in cubic centimeters not cup size, it’s better to refer to proportional as a “C look.” To achieve that, a 5-foot-tall woman with a small frame might end up wearing a B cup bra and a 5’ 8” woman might wear a D.
How soon can I get back to work and to working out?
The former depends on what your job entails. Generally, women who work in an office setting can go back to work on the fifth day after surgery. Those whose jobs entail lifting, pushing or pulling normally return to work at the end of the second week.
Three weeks after surgery is a milestone: That’s when women can run, ride a stationary bike and do lower-body weight training.  It’s also when policewomen or soldiers can put their bulletproof vest back. Women are usually comfortable doing arm exercises (upper-body weights) starting about six weeks after surgery.
Do breast implants have to be replaced every 10 years?
Breast implants don’t have an expiration date. They can handle hundreds of pounds of pressure, which is why a mammogram – which can apply up to 50 pounds – doesn’t harm them.
Through the years, manufacturers have increased the strength of the implant shell. On average, less than 3 percent of implants rupture or deflate.
Will my breast implants melt in a sauna?
Both silicone gel and saline implants have an outer silicone shell, which can melt at temperatures greater than 392 degrees Fahrenheit. A conventional sauna is typically between 150 and 190 degrees. If you were in an environment where your implants would melt, you’d melt too.
Women come in for a consultation to get their questions answered and to make an informed choice. While breast augmentation is not right for everyone, for those who choose it, it can make a life-altering difference.

This information is brought to you courtesy of Dr. Mark Bishara and The Paragon Plastic Surgery & Med Spa in Mansfield and Southlake, TX

Body contouring is a general term that refers to any surgical procedure that alters the shape of different areas of the body. Body contouring after massive weight loss refers to a series of procedures that eliminate and/or reduce excess skin and fat that remains after previously obese individuals have lost a significant amount of weight, in a variety of places including the torso, upper arms, chest, and thighs.
Obesity is in epidemic proportions in the US and many parts of the world. It is defined as a condition where a person’s body mass index (BMI) is 30 or greater. BMI is calculated by dividing the patient’s weight in kilograms by their height in meters, squared. Normal weight individuals have a BMI that ranges from 18 to 25. Overweight people have a BMI from 26 to 30, with 30 and above people considered obese. Once the BMI reaches 35 and above, patients are considered morbidly obese. From a BMI of 30 and above a person’s life span is shortened. In addition, obesity negatively affects the economic health of a society as well as other aspects of adult and child health, often for life. Childhood obesity is on the rise in Europe as well.

The Facts About Body-Contouring Surgery

When you lose 100 pounds or more, what happens to the extra skin? For many, the answer lies in body-contouring surgery.

Body Contouring: Is It For You? continued…

Short of surgery, there is really nothing that can help. Exercise won’t tighten it, and skin creams and lotions won’t do a thing to help.

7 Things to Do Before Having Surgery

If you are considering body-contouring surgery, here’s what you should do before surgery:

  1. Stabilize your weight — at your goal — for at least three months, and be sure to correct all nutritional deficiencies (which are common after weight loss surgery).
  2. Establish a reliable support network of family and friends to help you during recovery.
  3. Make sure you can get enough time off from work to recover. It will take 4-6 weeks depending on the procedure.
  4. Understand that everything is a trade-off between removing skin, getting a contour, and having a scar. Scars are permanent. They do get lighter, but don’t disappear over time.
  5. Prioritize your body according to the area that bothers you the most, and concentrate your surgery there first. You may find you don’t need additional procedures.
  6. Prior to surgery, stop smoking (to reduce complications) and increase your protein intake to 50 to 70 grams per day to speed healing.
  7. Choose a surgeon who is board-certified in plastic and reconstructive surgery — not just a board-certified doctor.

At the office of Dr. Mark Bishara and The Paragon Plastic Surgery & Med Spa our treatment plan is specifically designed for patients who have recently undergone bariatric surgery and are left with loose, sagging skin as a result of the extreme weight loss. Cosmetic surgery after massive weight loss includes procedures such as facelift and neck lift, breast lift, abdominoplasty, arm lift, thigh lift, body lift, and abdominal hernia repair.  Please contact our office to ask more about body contouring procedures at (817) 473-2120 or visit our website at

Your Choices of Breast Enhancement
Breast surgery has been around for more than a century. Each year an increasing number of women opt for cosmetic breast surgery, mainly augmentation (to enlarger size) surgery.

If you have thought long and hard about breast augmentation and have decided you want it, then you will next need to decide on what form of augmentation. Here there are two particularly popular forms of implants which are explained below:
Implants (Silicone or Saline)
Implants are perhaps the more common form of breast enhancement. These involve implanting a foreign object into the breasts as ‘fillers’ to pad these out. These implants can be placed wither directly below the skin, or can be ‘submuscular’ (which is recommended for those who already have larger breasts) and this will make some difference to the appearance. At the same time there are different types of implants that can be used, though most often silicone implants are used. While saline implants (bags filled with a mixture of salt and water) can also be effective and have their own advantages, these are more prone to aesthetic problems which can include rippling and other problems.

History of cosmetic breast surgery
Breast augmentation surgery involves placing of a silicone gel-filled implant in the intrices of breasts with the aim to enhance size.
Implants made of different materials have been tried in the past; use of silicone implants began in 1962. The commonest kind of breast implants used today are saline and silicone implants.
• Saline implants – as the name suggests, these are filled with sterile salt water which is either pre-filled or can be filled in at the time of the procedure. Saline implants requires a smaller incision (as compared to silicone implants) – this is usually taken under the crease of the breast or the armpit and thus is very hard to detect.
• Silicone gel-filled implants – are made of a silicone gel and come only in pre-filled variety. Although, these require a much larger incisions, they are much safer than the saline ones – chances of an infection greatly decrease with silicone based implants.
This information is brought to you courtesy of Dr. Mark Bishara and The Paragon Plastic Surgery & Med Spa


Although men do not face the same hormonal changes with aging that women do, the male biological clock still ticks, and over time changes in a man’s appearance can lead to a negative self-image, which can take a toll on mental and physical health. Today, men are turning to cosmetic surgery in an effort to help break the cycle of interaction between appearance and negative self-image. Because of this emerging trend, more male patients will be asking their trusted primary care providers for advice in navigating the potentially treacherous world of cosmetic surgery.
Whether in the public eye or leading a more private life, many men put forth energy, effort, and income to maintain a healthy, youthful appearance. Increasing access to more affordable, innovative, and less invasive forms of cosmetic surgery has resulted in more men turning to cosmetic procedures in an effort to look and feel younger. In fact, the American Society of Plastic Surgeons 2010 Report of Plastic Surgery Statistics indicates that of the 12.6 million plastic surgery procedures conducted annually, over 1.1 million were performed on men — a dramatic increase from the 225,009 procedures performed on men in 2000. Demonstrating their cost-effectiveness in these challenging economic times, minimally invasive procedures, such as botulinum toxin injections (Botox) and fillers, were up more than 9% from the prior year in 2010-2011. The more costly operative procedures that men undergo in large numbers include robotic hair transplants, nose reshaping (rhinoplasty), liposuction, cosmetic eyelid surgery (blepharoplasty), and facelifts, as well as surgery to correct male breast enlargement (mastopexy).
The ideal cosmetic plan maintains a life-stage balance of facial and body appearance that allows one to look their best throughout adult life. At earlier stages in life, avoiding excessive sun exposure, toxins from smoking, and recreational drug use will help to stall the progression of environmentally related aging changes. Later, avoiding significant weight fluctuation minimizes the development of loose or flabby skin. Body issues unrelated to such lifestyle factors as diet and exercise are best addressed once bone and soft tissues have reached maturity. For some, a time may come when surgery is considered for body issues unrelated to lifestyle, and plastic surgery may be the best option to help maintain a healthy self-image.
When selecting a plastic surgeon, patients should be sure to consider expertise and board certification. It is important to do the research and be patient with the selection process, because it can take some time. Patients should consider the procedure carefully and discuss with the surgeon whether a procedure is the right step to help meet their goals; this is an important part of the process because cosmetic surgery is not the answer for everyone. Patients should consult with their physician so that they can ask the correct questions in order to move forward appropriately.
A plastic surgeon will help identify patients whose body image goals and objectives may not be met with an operation alone. Postponing surgery with referral to a nutritionist, exercise trainer, or internist may be the appropriate outcome of the initial consultation. For surgery that is entirely elective, all patients should be close to their ideal health before having an operative procedure. If lifestyle choices and habits are not addressed preoperatively, the results of most cosmetic surgeries will be transient and therefore ultimately not worthwhile.
The following is a guide to help men look and feel their best throughout the lifespan.

Men in Their 30s

A man’s circulating testosterone level begins to decrease after age 30 years, with loss of lean muscle mass averaging 1% a year. Because of this, the most important thing a man can do to keep himself looking youthful is to continue building and maintaining his muscle mass. A regular program of cardiovascular fitness paired with weight training is essential to mitigate the natural aging process of decreased muscle mass. Proper hydration and attention to rest and diet are reflected in a healthier, more youthful appearance.
At this stage, age-maintenance procedures that are less invasive and are cost-effective can deliver results that look far more natural than other, more radical surgical choices. Skin care, sun avoidance, and proper use of sunblock are also crucial at this and every life stage.

Men in Their 40s

The use of botulinum toxin injection (Botox) and fillers has become much more common among men in their 40s and 50s, who are beginning to deal with the loss of facial skin elasticity. Because a man’s face has a more robust blood supply than a woman’s face, surgeons performing any personal enhancement treatments on the face must consider such factors as the depth of skin peeling, energy levels for light base treatments, and frequency of past use of topical medications.
The most common aesthetic procedure for men in this age group involves rejuvenation around the eyes. Blepharoplasty (eyelid surgery), when done well, can help revitalize a man’s face in a discreet manner, without announcing to the world that a cosmetic procedure was performed.

Men in Their 50s and Beyond

Men in this age group will typically experience increasing skin accumulation along the jawline and the neck; this is often referred to as “jowls.” Traditional approaches for face and neck lifts do not work particularly well on men because the scars cannot be hidden under the hairline, as with women. To avoid the problems caused by hairline alteration, an alternative operation to a traditional face and neck lift is performed: Using a geometric incision pattern to remove the excess neck skin hides the scar in the area between the bottom of the chin and the Adam’s apple. The presence of hair follicles in the beard also helps camouflage the scar.

Regardless of age, encourage your patients to take a planned, realistic, and conservative approach to achieving their ideal body image. Less favorable cosmetic surgery outcomes among men, such as those seen in Bruce Jenner, Mickey Rourke, and Burt Reynolds, can and should be avoided with the guidance and support of surgeons who demonstrate a clear understanding of what cosmetic surgery options are available, along with knowledge of overarching health concerns.
At the office of Dr. Mark Bishara and The Paragon Plastic Surgery & Med Spa, we provide a wide range of cosmetic procedures to help patients look and feel their best. These procedures are designed to improve the appearance of the face and body through minimally invasive techniques that provide highly effective results. Many of these procedures can be combined in order to achieve your desired appearance.  Please call our office to find out more about us at (817) 473-2120 or visit our website at