Tuesday, December 18, 2007

Christmas Cleavage

What festive cleavage are you wearing this holiday season? Next to finishing up the gift shopping, I'm sure the first thing on your mind is how to dress up your breasts. At the cocktail party I attended last weekend, I was accused of a Madame X look, a reference to John Singer Sargent's infamous 1884 portrait of the American-born Paris socialite, Judith Gautreau. Her arsenic white décolleté and scandalous slipped shoulder strap drove Sargent (and the painting) out of town.

Think times have changed? Last July, when Hillary Clinton displayed even a very modest amount of chest the blogosphere went wild.

Cleavage is simply the cleft created by the partial exposure of a woman's breasts in a low-cut neckline. Or, if you're a surgeon, it's the intermammary sulcus (fun people, aren't they?). So what gives it the power to shake the world, century after century? Context, context, context. That and men are irrational over it.

Breast cleavage has been a modern, clothed phenomenon; it didn't exist in the Garden of Eden. Any tight, well-structured bodice can lift the breasts upwards and inwards (that was the wonderful in Wonderbra – as opposed to Maidenform lift and separate promise).

Prior to the advent of implants, a large busted woman's breasts merged together under pressure; cleavage became a crevice. Think Bette Midler. A really well engineered bodice can cantilever the breasts in such a way that this is minimized. Think Isaac Mizrahi observations about Scarlett Johansson's Golden Globes dress.

But when it comes to breast implants, the width of the sulcus area (cleavage) is determined by the attachments of the skin to the peri-osteal tissue covering sternum (breast bone) and by the medial attachments of the pectoralis major muscle when implants are in the sub-muscular position.

If those natural attachments are lost a host of uncorrectable deformities distort the cleavage including synmastia, the "uniboob" deformity. This can result from over aggressive dissection towards the midline, particularly in a subglandular (over the muscle) placement. Very large implants, repeated over time can have similar results. Think Pamela Anderson.

Some women have very little fatty tissue overlying the sternum so there's nothing to soften the contour transition from breasts to sternum. This causes the space between the breasts to appear wide. Since the implants must be centered behind the nipples, it's very hard to camouflage, particularly with a subglandular placement. Think Victoria Beckham. (This is something she previously denied until court papers were released in 2005 proving she had undergone augmentation surgery; it's rumored she had revision surgery prior to touring this month. Looks like it to me.)

One woman has written a tome on doing it right. Elisabeth Squires, author of Boobs: A Guide to Your Girls, thinks even older women can attractively show off cleavage, as Helen Mirren (61) does at every awards show. But beware: "If a woman of a certain age squeezes her girls together, she'll get the wrinkled, crepelike look. That's not good." Mirren's plunging bodices carefully avoid that.

Now back to the festive part. Here we have our Christmas party Goofus and Gallant example. For the office holiday party, author Squires's advice is: "[i]f cleavage isn't in your job description, don't put it in." Sorry, Britney. But the adults-only cocktail party? You've got it, Paris. Shake their world: tasteful cleavage and heels are the way to go (but put on the other stocking, puh-leeze).

Be sure and tune in FM107.1 to hear an expanded exploration of celebratory cleavage with Colleen Kruse this Thursday at 10:00am CST, subbing in for Kevyn Burger.

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Thursday, December 6, 2007

Doing Due Diligence (Certification)

ust how does one perform due diligence when selecting a cosmetic surgeon? Being an informed consumer seems more difficult than ever, given the bewildering display of high-profile disasters.

Michael Jackson, at the peak of his earning power and fame, repeatedly received very poor value for his surgical dollar. (And no, boys and girls, that's not a prosthesis; it's surgical tape on the tip of his nose.) If having more than enough money and unlimited access doesn't ensure a good outcome, what does?

The common online sentiment casts the ethical cosmetic surgeon as paternalistic gatekeeper. Most of the public expects these and all physicians to at a minimum abide by primum non nocere (not actually part of the Hippocratic Oath). It's safest to stick with caveat emptor: "let the buyer beware."

The most often hyped consumer advice is to choose a board certified surgeon. This is what Kanye West's dead mother did not do, having apparently evaluated her surgeon's credentials based an Oprah appearance.

For the prospective patient, board certification is the most readily accessible confirmation of a surgeon's training and experience. This is different than state licensure, ie, is the doctor behaving, which is confirmed here.

The vast majority of safe elective cosmetic surgery is performed by board certified plastic surgeons and otolaryngologist–head and neck surgeons. There is plenty of bad territorial ju-ju between the two specialties arising from intense competition for cash. It colors and distorts most of what is published about how-to-pick-a-surgeon. What makes these two kinds of cosmetic surgeons different from one another? There are two divergent training and certification pathways.

Here, along with the alphabet soup, is a set of cliff notes and links so you can be an informed consumer.

All physicians with M.D. after their name complete the basic 8 years post-high school education of undergraduate and medical school.

Cosmetic plastic surgeons go on to an additional 7+ years of training and certification in:
  • General Surgery Residency - 5 years
  • Plastic Surgery Residency - 2 years (some combined programs are 3 years of each)
  • ABPS board written and oral examination in Plastic Surgery
If passed, the surgeon (and about 6,600 others) now has a ABPS-recognized specialty certificate in plastic surgery and joins the member society ASPS.
  • optional Fellowship - 1 year
  • ABPS board subspecialty examination (Plastic Surgery Within the Head and Neck)
This surgeon will continue to identify him/herself as a plastic surgeon or cosmetic plastic surgeon. More societies will be joined: ASAPS. These specialty societies are the sources of the yearly continuing education of the surgeon.

Cosmetic otolaryngologist–head and neck surgeons go this direction for 5+ years:
  • General Surgery residency - 1 year
  • Otolaryngology - Head & Neck residency - 4 years
  • ABOto board written and oral examination in Otolaryngology - Head & Neck Surgery
If passed, the surgeon (and about 12,000 others) now has a ABOto-recognized specialty certificate in Otolaryngology and joins the member society AAO-HNS for continuing education in the field.
  • optional Fellowship - 1 year
  • ABOto board subspecialty examination (Plastic Surgery Within the Head and Neck) or the ABFPRS subspecialty exam
This fellowship-trained surgeon will now refer to him/herself as a facial plastic surgeon. More societies will be joined: AAFPRS. More continuing education.

The American Board of Medical Specialties (ABMS) is the major examining organization whose Member Boards (of which the ABPS and ABOto are two) certify physicians in more than 130 specialties and subspecialties. For a chart listing the current certificates offered by ABMS Member Boards, go here. (There are other, overlapping certification organizations as well.)

These board certification exams are probably the most difficult, stressful part of the not-so-young physicians training experience. The written boards are all-day specialty-specific computer-based examinations (completing the more general knowledge exams taken at the end of the first residency year). If passed, an excruciating oral examination takes place where senior physician examiners interrogate the candidate and pass judgment on the ethical and technical aspects of his/her practice.

Subspecialty certification is not required in order to practice cosmetic surgery. It's important to physicians preparing to practice because it is a recognition of exceptional expertise and experience specifically in that field.

What's important for the consumer is that board certification under the ABMS umbrella brings with it an requirement for continuing education and re-testing every 10 years. That makes these surgeons a safer bet for you and me.

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Jackson 5 - Gold - Doctor My Eyes

Thursday, November 15, 2007

Fatal Attraction (Death)

When and why does cosmetic surgery prove fatal? Rapper Kanye West's mother arrived in the emergency room DOA Saturday night, subsequent to undergoing an outpatient abdominoplasty (tummy tuck) and breast reduction on Friday. Of course the American Society of Plastic Surgeons (ASPS) has immediately issued press releases to say how rare this is– they don't actually keep statistics on all who die during or as a result of undergoing elective aesthetic surgery– but who wants to die?

Is it always the doctor's fault? Yes and no. Many variables are outside the control of the surgeon– from anesthesia to the vagaries of healing to patient non-compliance. In general, though, there is one personal variable that has tripped up the established, credentialed plastic surgeon more than any other. That liability is his own ego. Operating on a patient who shouldn't be operated on, deluding oneself about one's surgical omnipotence, can lead to disaster. Sometimes this is compounded by poor judgment and/or skill set.

That may indeed be the case with this death.

The surgeon, Dr. Jan Adams (53), has two previous malpractice suits under his surgical scrubs and three more in gestation (one of which also involves a co-morbidity: diabetes). Shown here in his booking photo, his most recent convictions for DUI in March and April of 2006 led the California Medical Board to consider suspending his license (it's pending with the State). Of the 60 ASPS board certified plastic surgeons listing Beverly Hills as their venue, Adams isn't one of them. When it comes to checking out a physician, Google is your friend.

Dr. Jan Adams considers himself a top plastic surgeon in Beverly Hills, despite his lack of board credentials. He authored Everything Women of Color Should Know About Cosmetic Surgery. He hosted Discovery Health's Plastic Surgery: Before and After show and has been featured pretty much everywhere on the talk circuit. Check out the OprahAftertheShow chat. He's a showman. Is he the most articulate spokesman for plastic surgery? Nope. Was his handiwork on display lovely? Nope. But he is a rare commodity: a black surgeon marketing to women of color.

Donda West (58) also consulted with another Beverly Hills surgeon, Dr. Andre Aboolian. This board certified plastic surgeon insisted on a preoperative clearance from an internist because of an underlying condition. "I always insist on a medical clearance for women over 40, and in this instance, it was particularly important because of a condition she had I felt could have led to a heart attack."

The operating surgeon's response? Adams claims that he did nothing wrong and shared his opinion of his colleague Dr. Aboolian: “[h]e is sleazy and manipulating the truth to elevate his own importance.” That's not generally anything a reputable plastic surgeon would publicly say.

Using a board-certified surgeon at an accredited facility and operating on a healthy person with medical clearance is the prudent route. It isn't possible eliminate all risks in elective aesthetic surgery, but it can really reduce them by not doing too many procedures at one time and by screening for medical conditions beforehand.

Dr. Aboolian didn't specify the underlying morbidity due to patient confidentiality, but the autopsy results will be out in 6-8 weeks. It could very well be that Donda West had an abnormal heartbeat. Arrhythmias (irregular heart rhythms) can result from coronary artery disease, but also occur in normal, healthy hearts particularly as we age. Many don't require any treatment at all, but do pose an additional risk when having surgery. Electrolyte imbalances in the blood (such as low sodium or potassium) brought on by excessive postoperative vomiting can precipitate a heart attack.

Is it safe? The real question to ask is how to make it safer, relative to the risks of any surgery. Once you, the prospective patient, have done your due diligence and selected a physician, here is what you can and should do to protect yourself:

• Don't lie to your surgeon. Devulge everything, everything, truthfully: the smoking, the drugs, the OTC, the supplements, that "baby heart attack" you had 10 years ago....it really does make a difference.

• Involve the primary care physician who knows you top to bottom by getting him/her to medically clear you for surgery. Elective aesthetic surgery should carry the same standard of clinical medicine as any other surgery: it's not fluffy spa medicine.

• Stick with 6 hours or less of anesthesia; you can always come back for more.

• And last, but not least, know how to reach your surgeon that first night. You want– and s/he will give you– all the secret numbers, so you can phone about anything untoward. Before you crash, call your surgeon. Really. Wake them up! Your surgeon wants you to live.

Thursday, November 8, 2007

Toss Those Tweezers! (Eyebrows)

h, the eyebrow. The window frame to the soul. They get plucked, penciled, and pierced; tinted, trimmed, and threaded; shaved, stenciled, and waxed. They must be important!

In fact, the eyebrow is the spokesperson for the face - particularly in women. Much of the time we have little control over the tiny muscles governing their spontaneous expression: arching in surprise, knitting together in concern, up and down in anger, irony, and joy. It's a large part of what makes the face, in both men and women, interesting.

From skinny to bushy, the brows tell of culture, fashion, and politics.

Robyn Cosio, author of The Eyebrow, argues that the story of the eyebrow's progress through the 20th century parallels the story of women's independence. The flapper era desexualized the newly liberated woman by taking away her hips, breasts, and eyebrows - penciling them back on thin and clueless through the 30s. Was the heavier, natural brow of the 40s and 50s a redefinition of femininity after the social upheaval of sex roles during the war years? The unkempt, even unruly, eyebrows of the 70s an encapsulation of the women's movement?

The eyebrow of the new millennium is large again. Ladies, toss those tweezers! A whole bevy of Eastern European fashion models— Daris, Natalia, Vlada, Eugenia, Sasha and Snejana are inspiring a return to the bold brow. Last Fall, the NYTimes profiled stylists who declared “[o]n both coasts, everybody wants a thicker brow that reminds you of Elizabeth Taylor and Ava Gardner.” Styles may cycle in and out of favor, but many stars have made their mark with a face anchored by a prominent brow and, often, little else. It's a big statement. Strong eyebrows make one look intelligent and empowered.

Nefertiti was a make-up queen when it came to her brows. She shaved them off and painted on those dramatic, elegant brows. Try to picture Audrey Hepburn without her brows, or Sophia Loren.

Bette Davis wouldn't have made it past her screen test if the cinematographer Karl Freund hadn't convinced the director that she had "lovely eyes" and would be suitable for The Bad Sister (1931).

Stars have completely changed their looks over the years by changing their eyebrows. Joan Crawford's incredibly thin blond brows of the 1920s evolved into her signature thick black brows of the 1950s. Look at how Madonna handles her eyebrows each time she reinvents her look.

Getting the right brow isn't easy. There's actually a catelogue of celebrity browshapes to help you analyze what features appeal to you. Round brow? Julia Roberts. Arched? Think Keira Knightley. Softly angled? Nicole Kidman. Curvy? Kirstie Alley. Flat brows? Brooke Shields.

Too much brow? A unibrow or monobrow, medically known as a synophrys, is fairly common in some ethnic groups. It's a sign of feminine beauty in Caucasus and Iran, where connected eyebrows are a sign of virginity and being unmarried. Salma Hayek has been quoted as saying she misses the days when she had one eyebrow because it would have come in handy for her role as Frida Kahlo, the legendary Mexican artist.

Less painful than tweezing or waxing, threading is a very trendy (and ancient) way of shaping the brow. Threading is widely used in India, the Middle East, China and Turkey on both men and women. (It is a Persian tradition to use threading to remove all of a bride's body hair before her wedding night in Iran.) Brad Pitt have been quoted in praise of eyebrow threading!

Doing without eyebrows is quite altering. In Thomas Hardy's Tess of the d-Urbervilles, the beautiful heroine cuts off her eyebrows to protect herself from the lust of men. It is an effective subterfuge. Charlize Theron bravely shaved her eyebrows to better portray the title role in Monster (2003).

Last month, da Vinci's iconic Mona Lisa was scanned using a high-definition camera. A 240-million pixel image using 13 light spectrums, including ultra-violet and infrared, reveals she probably once had eyelashes and eyebrows.

Putting them back on is possible. Permanent makeup will last a number of years, but eventually the tattooing fades, a bit like disappearing ink. It's said that in the 1700s, English women wore falsies made out of tiny pieces of mouse fur. Today salons specializing in brows enhance very sparse ones by gluing a tiny fiber onto each existing hair, a form of eyebrow extensions. There are also brow prosthetics — little toupees for the hair-impaired — in a multitude of shapes and shades. Surgeons offer hair transplant techniques involving tiny hair grafts.

Gravity & aging cause the forehead tissue to sag downward, dropping the eyebrows from their youthful position to a lower position above the eye. It's generally perceived as an aged appearance– or tired, sad, or mad.

Time for a lift! If Botox chemical fix doesn't do it anymore, then it's time for surgery. In a direct browlift the incision is immediately above the brow in a forehead crease– this raises each brow but not the entire forehead (Sylvester Stallone). A temporal lift places a wedge excision in the hair for a lateral pull. A coronal lift puts the incision behind the hairline, excising a wedge of scalp and hoisting up the entire forehead including the eyebrows (Elizabeth Taylor). The least invasive, most natural look involves an endoscopic lift of the brow by re-suspension of the forehead muscles under the brows.

Interested in this look? Eyebrow extensions can cost between $75 to $250 and takes 45 minutes to two hours for an effect that lasts two weeks. Brow reconstruction with hair transplants by a physician involves 150 to 200 grafts for a complete male eyebrow or 100 to 150 grafts for a complete female eyebrow at $4-10/graft. A facial plastic surgeon might charge $3,900 to $5,900 for an endoscopic browlift.

Like the music we played on air?

Brad Roberts - Crash Test Dude: Brad Roberts Live - Singing Your Favorite Hits - Bette Davis Eyes

Lauryn Hill - The Miseducation of Lauryn Hill - Can't Take My Eyes Off of You

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Thursday, October 25, 2007

Squeek! Squawk! er...

Laryngitis strikes a blow for world silence. That's right, Anne has no voice and won't be heard from this week. Sigh.

Thursday, October 11, 2007

The Mom Job (Postpartum)

ell, if the NYTimes is asking the question then we should try to answer it: Is the 'Mom Job' Really Necessary?

Apparently, many say "Yes."

The surgery trifecta of tummy tuck/lipo/breast lift with implants is the new post-partum must-have. Forget about designer diaper bags. This surgery is touted as a husband's way of saying "thank you for a job well done," a quick way to lose the excess 30 lbs. and go back to what you were before. Sort of.

The 'Mommy Makeover' is at core a marketing strategy: package together multiple surgeries so that the consumer buys more, not less. It's the same bundling tactic used to up-sell everything from makeup to cars.

Plastic surgeons report these surgeries rose 11% for women ages 20-29 from 2005-2006. There was all sorts of speculation that Britney Spears had a tummy tuck (abdominoplasty) after giving birth to her second child, Jayden James. In fact, she had a cesarean-section (....no, Virginia, surgeons don't perform both at the same time and, no, her recent VMA appearance doesn't show operable post-pregnancy changes).

The concept of a 'Mom Job' is that post-pregnancy changes are deforming and undesirable. For a particularly sickening, slick example see this industry advertisement. Much closer to the truth, according to one of the advocate surgeons featured in the NYTimes, it's really about "feeling self-conscious or resentful about their appearance."

Of course, pregnancy affects every woman differently, with age, genetics, and self-control playing a role in how the body appears afterwards. But most of the involuntary changes are restricted viewing only: just when would one's stretch marks be on display? Are naked breasts and belly a part of a woman's public or private persona?

Perhaps most revealing is a quote from one of the 'mommy' patients: “I don’t think it was an issue for my mother; your husband loved you no matter what.” Is plastic surgery the answer for women who feel less competitive on the sexual marketplace? With marriages recycling every 15 years perhaps marketing to the marital insecurity of child-bearing women is bound to be profitable.

The vulnerability of today's child-bearing generation of women and popularization of body plastic surgery is not a coincidence. Take Heidi Montag, featured on US Magazine's cover last week: Revenge Plastic Surgery. Her impetus to undergo plastic surgery at 21 is characterized as arising from "painful body-­image problems." And just who is she revenging herself on? Mean boys? Lauren Conrad? Isn't this what our parents used to call "a stage" and one which would "build character?"

Her boyfriend/manager is "so proud of her" and she professed afterwards: "Right before I went in I was like, 'What if I don't wake up? Oh, this is scary.' Then I thought, 'I don't care.' If I don't wake up, it's worth it. I just wanted it so badly."

Does this sound like a teenager or a mature adult?

So what is the secret to post-partum perkiness? Stretch marks may be faded with laser treatments, but nothing makes them go away short of an abdominoplasty. The separation for the outer-most abdominal muscle (diastasis recti)– formerly your six-pack– can also be surgically stitched together during an abdominoplasty. Barring bad habits, it will heal on its own in about four weeks after a vaginal delivery. The rest is just your mother's advice: don't gain more than 30 lbs. while pregnant, nurse afterwards to slim down, grab sleep when you can, and be good to yourself.

That's the secret.

Want this look? Expect to spend upwards of $12,000 to $15,000 minimum for a plastic surgeon's fees on breast lift/augmentation, abdominoplasty, and liposuction.

Like the music we played on-air? Here

Thursday, September 27, 2007

Piercing Images

t used to be a big deal for a 16-year-old girl to get her parents' permission to pierce her earlobes (one each please). But ever since Janet Jackson's little "wardrobe malfunction" during the Superbowl half-time show, even the elderly Norwegian bachelors in North Dakota know ear piercing is old school. Nipplegate may have been a publicity stunt to pump up Janet's exposure just before the release of her new album– but what it really exposed was how mainstream body piercing has become.

American researcher Anne Velliquette, PhD observed, "[t]oday's social climate welcomes body art to an extent that no other period in modern history can rival." Her thought is that it provides meaning to persons bewildered by the fragmentation and chaos of postmodern society: your body is the one thing you have ultimate control over.

What Janet Jackson was exercising control over with was a nipple shield, a decorative piece of jewelry held in place by a 'normal' piercing rod or barbell placed through the areola. Her 1997 album Velvet Rope featured close-ups of her nipple piercing as part of the album artwork. She no longer wears jewelry in either her septum or tongue piercings, but her ears, navel, and genitalia are still adorned. (It is thought to be a clitoral piercing.)

She has competition from Christina Aguilera. Aguilera has five piercings in her ears and one piercing each in her nose, her lower lip, and right nipple, plus 3 more. She has said these are in a place known only to her doctor and her boyfriends: it's diamond-studded, "really beautiful and expensive" and "in a place that most people wouldn't have the guts to do it."

Like the nipple placement, genital piercings reportedly enhance sexual sensitivity. Piercing sites in men include the penile glans and urethra, foreskin, and scrotum; sites in women include the clitoral prepuce or body, labia minora, labia majora, and perineum.

Britney Spears gained some media attention as she organized a "nipple piercing party" for her staff on Valentine's Day 2004 (her own left nipple is pierced). Singer Pink (Alecia Moore) recently got all dressed up and had her nipple pierced in front of her mom– on videotape. Don't we all? The boys go in for it too, particularly the musicians: Tommy Lee, Axl Rose, Lars Ulrich, and scads of others.

As a matter of fact, the really flamboyant multiple piercings seem to be the domain of male celebrities, but only amongst those that don't make their money on the silver screen: Dennis Rodman, Benji Madden, Dave Draiman are standouts.

Christy Turlington is said to have started the female naval ring fad when she strutted her belly jewel on the modeling runway. After multiple ear piercings, navel rings are by far the most common choice amongst female celebrities and the American women who imitate them. Alyssa Milano, Beyonce, Britney Spears, Gwen Stefani, Jessica Alba, Lindsay Lohan, Madonna, Keira Knightley, Naomi Campbell, Nicole Richie, Paris Hilton, Teri Hatcher all chose this placement.

When Scarlett Johansson gifted herself a bull-style nose ring in 2005, though, you could hear the howls reverberate in cyberspace. On occasion she pops it in when strolling about and it's rediscovered anew by legions of disapproving fans. The actress is currently the face of L'Oreal, and adamant that the nose ring is attractive: "[i]t's all about my creative side and I personally look lovely. So what exactly is the problem with it?" Less controversial was her piercing of the nasal alar rim (the fleshy curve of the nostril). That placement evokes images of dark, exotic Eastern women, while the other conjures up a large, wet nose attached to 500kg of un-neutered beef.

Nose piercings were first recorded about 4000 years ago in the Middle East. Even Genesis 24:22 mentions it: when Abraham requested a wife for his son, Isaac, one of the gifts presented to Rebekah was a golden nose ring. The practice of nose piercing moved on to India during the 16th & 17th centuries with the type of jewel indicating social status. Indian women traditionally pierce the left nostril, thought to be connected with the female reproductive organs, to make childbirth easier and lessen menstrual pain. Nostril piercing came to the West in the late 1960s along spiritual enlightenment from India. Punk rockers and their followers adopted the practice in the 1970s, and it was revived again in the 1990s. Now the likes of Lisa Bonet sport them.

Is there a downside to this? Well, Nicole Richie did set off an alarm at the Reno Airport as she passed through a metal detector with her nipple piercing in situ.

In general, the medical specialty societies frown on it. The American Medical Association (AMA) goes as far as considering some forms of body piercing to be illegal surgery. The major things to keep in mind before you pierce your tongue, eyebrow, belly button, lip, nipple, genitals or navel are long healing, infection, dental damage, and scarring.

Nose piercings like Johansson's are usually are performed in the inferior fleshy part of the septum and not through cartilaginous tissue. Noses, like many cartilage piercings, can be notoriously long in healing because that type of tissue is not well vascularized. The wound heals from the surface, growing a tunnel of new skin inside the hole to form a permanent piercing.

The infection rate for tongue piercings is relatively low, but the tongue & lip studs and rings can lead to chipped and cracked teeth. And then there's the excessive drooling and speech impediment problem, but that's minor.

Even good old-fashioned ear piercing isn't exempt: up to a third of persons with pierced ears had one or more complications (e.g., minor infection, allergic reaction). The most disturbing are keloid formation (exuberant scar formation in dark skinned individuals) and traumatic tearing (bifurcated earlobes aren't stylish). 'High' piercing through the cartilage of the pinna (like Fergie's) is particularly associated with poor healing and more serious infection because of the avascular nature of auricular cartilage.

And then there's the 'stretching' or 'gauging' craze. It's the deliberate expansion of a healed fistula (hole in the skin) for the purpose of wearing big jewelry. It's been around for a while: even Otzi the 5000 year old Iceman mummy found in the Valentina Trujillon glacier had an oversize ear piercing. In Ireland gold artifacts from Bronze Age were identified as ear spools and boxes needing perforations 7+cm diameter.

Most piercings can be stretched far beyond their initial size. 'Blowouts' from over-stretching, especially ones caused by 'dead stretching,' can create scar tissue, which can lead to keloiding or hypertrophic scarring. And stretching too quickly can lead to a buildup of unsightly scar tissue, often described as the 'cat-butt' effect.

Now there's a lovely thought.

Want this look?
Part of the popularity of body piercing is the entry level pricing: it's cheap. Most piercings start at under $100, even the really interesting ones. Make sure you inquire about sterile technique and be prepared to involve your physician is goes wrong.