Hair, Give Me a Head of Hair

Oh, let us count the 50 ways to lose your hair. There's androgenetic alopecia (pattern baldness), traction alopecia (evil minded hairdressers), telogen effluvium (physiological trauma like meds, chemo, stress, illness), and alopecia areata (an autoimmune disease) just to name the top ones.

Male and female pattern baldness is based on genetic background (thanks, Mom and Dad) and refers to progressive loss in predictable stages over predictable areas of the scalp. For men it can start in late puberty and peaks about age 40; for women the onset is at menopause. It accounts for about 95% of all pattern hair loss in both men and women. Mid-frontal hair loss increases with longevity; by age 80 over half of all women and 73% of men are affected. If you are wondering about the other stats, the average head of hair contains 100,000 hair follicles, while each follicle can sprout about 20 individual hairs. A healthy head of hair might lose 100 strands a day. Length comes 1.25cm a month.

There's a reason we associate bald-headed men with sexiness. In the primate world frontal balding conveys male status and maturity. A powerful sex hormone (DHT, the metabolite of testosterone) triggers the hair loss through folicular miniaturization and it takes a certain amount of confidence and bravado to just shave off what's left. Think Samuel Jackson, Patrick Stewart, Telly Savalas, Sean Connery, Steve McQueen, Yul Brynner, Vin Diesel, Ben Kingsley, Bruce Willis, Andre Agassi. Not a wimp among them.

Some clinical treatments for male pattern baldness exist, primarily finasteride (Rx Propecia) and topically applied monoxidil (OTC Rogaine). It works for most, but only if taken daily for eternity. The balding Olympic skeleton slider Zach Lund dropped his drawers and tested positive for fenasteride, netting a yearlong suspension and missing the 2006 games in Turin, Italy. In 2004 it had been added to the list of banned drugs in international sports because in tests it masks detection of cheater-drugs like the steroid nandrolone.

Hair replacement systems are widespread. Of course, there's always the wig, though we dignify it for men with a more elegant word: toupee (from the French toupet meaning hair tuft). These small wigs or hair pieces have been used since ancient times. The earliest known one was found in a tomb in Egypt circa 3200 BC. Julius Caesar wore one. True to form, only dead Hollywood men admit to wearing them: Frank Sinatra, Humphrey Bogart, George Burns, Bing Crosby, Bobby Darin, Fred MacMurray, Jimmy Stewart, John Wayne.

"I'm amazed by how often people ask me whether or not I wear a hairpiece, a wig, or a rug, as it is affectionately known."

And there are newer alternatives. Lord Xenu can't grow hair on his head, but a hairweave can approximate it for John Travolta. In 'netting' a thin, breathable net (similar to illusion tulle) is interwoven with the existing hair and supplemented with extensions. Even without the extreme closeup, his graying sideburns give it away. Other technologies include bonding, tracking, fusion, clip ons. Let's just say HairClub for Men has come a long way in the last 30 years.

Any number of female stars have experimented with these alternative methods for adding fullness and length to existing hair. Here's a whole webpage devoted to Paris Hilton's fake hair escapades! Sometimes, the look is less than successful, as displayed here on Britney Spear's head.

The permanent solutions involve cosmetic transplant of hair from one part of the scalp to another (here's a good journal article). The most up-to-date involves a surgical office procedure that harvest hair from the back or sides where it is thick and transplanting it in the thinning front regions. Using a local anesthetic, mini grafts of just a few or single follicles are used in place of the 'doll plug' punch grafts of yore. Four or more sessions, three months apart are usually required. Rob Schneider exhibited classic male pattern baldness pre-2005: hair receding from the lateral sides of his forehead and a thinning patch on the vertex (top). He's had some really nice hair transplant work. Less skillful is the work Ben Affleck has had done.

The unintended loss of one's locks is generally more disturbing for women than men. Sudden diffuse hair loss, telogen effluvium, is caused by an interruption in the normal hair growth cycle. A greater than normal number of hair folicles enter the rest stage (telogen) at all once, instead of in sequence. It takes another 3 months for the affected folicles to move into the growth state (anagen). It's at this point that the new hairs force out the old hairs and profuse shedding occurs. It has a myriad of traumatic causes: chemotherapy, childbirth, puberty, major surgery, chronic illness, severe emotional or physical stress. Usually the mechanism is a temporary disruption of hormonal balance.

Taking away a woman's hair can be a form of punishment. In ancient Greece it signified an enslaved woman. In France during WWII it marked collaboration with the Nazis. Even today it's used in US prisons. Then there are the women who chose to go bald. Sigourney Weaver may have been first with Alien 3. Demi Moore took it all off for G. I. Jane as did Natalie Portman for V for Vendetta. While praised for her unique voice and original songs, Sinead O'Connor is also noted for her expression of anger. When Britney Spears shaved her head, it triggered institutionalization in a treatment center.

Most Americans see a healthy bald woman and assume she’s a lesbian, radical feminist, political extremist or understudy for an alien role ala Star Trek. The sight of a woman’s bare scalp still makes society’s hair stand on end.

Beauty and sexuality remain tied to a woman’s hair. Natalie Portman said post V haircut: "It was kind of wonderful to throw vanity away for a bit."


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Hear Anne live on the Kevyn Burger show 10:00 to 11:00am Thursdays featuring Knifestyles of the Rich & Famous.

Bride of Botox

Botox has overtaken Hollywood in a big way. The shine reflecting off those smooth, wrinkle-free foreheads is blinding. We need a new term for these shadowless faces. Suggestions anyone?

Approved for cosmetic use by the FDA in 2002, Botox (Botulinum Toxin Type A) has numerous established therapeutic applications. It is a neurotoxin protein produced by a bactierium, one of the most poisonous naturally occuring substances in the world. It acts by blocking neuromuscular transmission, the body's signal for movement. Used in minute doses, it treats conditions caused by muscle spasms, from blepharospasms and dystonias to hyperhidrosis. (That's tics, spazzes, and flop sweat for the lay person.)

It also happens to work quite well on those wrinkles that come with facial muscle movement. In fact, physicians refer to them specifically as "lines of expression," which is also the secret to verifying it's Hollywood use: can the actor in question emote using a full range of natural facial expressions?

Who admits to it? Teri Hatcher confession is perhaps the most common: "In the past I've had Botox and collagen." The picture at right gives the lie to that. It's the same claim made by the author of Beauty Junkies: Inside Our $15 Billion Obsession with Cosmetic Surgery. Alex Kuczynski (39) says botox was her "gateway drug" before she swore off everything. One look at her television promotion for the book tells you she isn't clean just yet.

But a few are open fans. Vanessa Williams (43) endorses it: "I think it's fine...It's a reality that so many people are incorporating into their lives...bring it on!" Virginia Madsen (45) is actually the spokesperson for Allergan, manufacturer of Botox and Juvederm. There's probably not a virgin face in Hollywood over the age of 12 right now. Even the youngest of actors is indulging in 'preventative injecting.' Early intervention immobilizes the movement that causes eventual wrinkling.

Botox is the gold standard for treating crow's feet, brow furrow, and forehead lines. It works by partially paralyzing the muscles creating those wrinkles. Done well, it provides a 'chemical browlift' and rejuvenates the upper third of the face. But a heavy-hand with the needle yields an immobile forehead like Nicole Kidman (40), Marcia Cross (45)...Nicollette Sheridan (43) won't comment. All exhibit shiny foreheads so frozen, it's almost frostbite.

What are the giveaways? Sometimes a still picture is more than enough. A grinning 40-year-old Caucasian woman has wrinkles. Inept technique can yield 'Spock' eyebrows, arched too far laterally or sprung apart medially. In motion, the face no longer emotes within anthropological norms because the eyes and brows don't move. Women in particular express a great deal with the upper third of their face (ask any man). Bad Botox really flattens an actress's range of emotion.

This mixed message has implications elsewhere, as well. Outside of Hollywood, Katie Couric fell victim to incautious use of Botox. John Kerry's presidential bid was almost derailed by a venture into Botox (or the appearance of it). Too much Botox garbles the visual cues for the observer, the face doesn't 'read.' When that happens, the viewer is liable to think all sorts of things.

What's exciting are the new, emerging uses of Botox for pain disorders in dentistry like TMJ (temporal mandibular joint disorder), bruxism, and temporal masseteric fasciitis pain syndrome. How you might ask? Botox works on smooth muscle fibers and, as it turns out, some pain fiber nerve termini– a source of many pain syndromes. Blocking the nerve transmission in pain fibers yields relief for all sorts of neuralgias such as migraines. Major medical research centers are actively exploring new treatment avenues using Botox for many intractable medical problems involving hyperfunctioning of muscle fibers. Emerging uses at Mayo Clinic (search on the word 'botox') include treatment of BPH (benign prostate hypertrophy) and irritable bladder syndrome. There really is a lot to be said for Botox, but don't expect to hear it out of the mouths of Hollywood stars.

Jane Fonda (69) famously blurted out: "No, I have not had Botox. I will see a woman in Hollywood walking towards me and I'll think that I know her but I don't know who she is. It's terrifying. Everyone looks the same....What I like about England is that people look like they're supposed to look."

Now Jane Fonda has had plenty of work done, but she still looks natural and age-appropriate. In moderation, Botox can look natural. Her objection has legitimacy, however. Many of these younger women who seek to emulate a creaseless existence have ended up erasing their individuality, who they are. In some cases they take it to an extreme and change species (think Joan Rivers).

As Cate Blanchett (37) shouted "...just live your life, death is not going to be any easier just because your face can't move!"



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Hear Anne live on the Kevyn Burger show 10:00 to 11:00am Thursdays featuring Knifestyles of the Rich & Famous.

Women & Tatts

It all comes down to Cher. Back in 1972 when she was 27 years old and newly separated from Sonny, she got her first tattoo:

"I thought it would be something different, a statement of freedom. Good girls didn't have tattoos then, no one was doing it...It was really the first step of an experiment to state making decisions on my own....I had made so few real decisions that I was bound to be bad at it. I was right."

Now all the A-list (and A-wannabe) celebrities are inking their bodies. The tattoo has become a female fashion accessory, rather than the rite of passage. It's no longer taboo, but still a little risque– different but accepted. It's almost difficult to name an actress who hasn't got a tatt. Everybody's doing it, from girl-next-door Jennifer Aniston to Bay-babe Pamela Anderson.

The subject matter of body art has undergone a revolution of sorts. The old stereotype of sailors and marines – and who doesn't know an aging WWII veteran with a blurry rendering on his bicep – are of a generation who never dreamed of finding their own name tattooed across the flesh of their stateside sweetheart. Today that's all changed. Women are elbowing out young men to get in the door of the tattoo parlor. In a recent survey, 22% of the UMass undergraduate women sports a tatt, twice the rate of the male students.

While "Mom" and the names of sexual partners still rank high in frequency and gang symbols are widespread amongst the prison-bound populace, the upsurge is in young women. Estimates are as high as 36% of all American women ages 21-32 now sport a tattoo. They seem to be indulging in tattooing as more of a journal of sorts. And the celebrity women are no exception. According to Angelina Jolie:

"Usually all my tattoos came at good times. A tattoo is something permanent when you've made a self-discovery, or something you've come to a conclusion about."

Okay, not counting the blue-tongued dragon she got when she was drunk and dropped trou in Australia a few years back (now covered by the black cross/dagger handle). Perhaps the most prominently tattooed actress today, Jolie has 13 tatts at last count and several older ones that were converted or removed. She has stated she’s just a “punk kid with tattoos” at heart, but dressed and strutting the red carpet, she is radiating more of a regal tribal look these days.

Some stars go so far as wearing it, literally, on their wrist. Not satisfied with a cement star in the sidewalk, Eva Longoria and Ashlee Simpson both sport small black outlined stars on their left wrists. Victoria Beckham has five stars on her lower back. Perhaps it’s part of the Michelin rating system?

And then there are those who want to commemorate their childhood. Nicole Richie sports a pair of ballerina slippers, as if her father’s composing Ballerina Girl for her wasn’t enough. But the little pair of angel wings on her back? You decide. Christina Ricci decided on having Aslan, the lion god of Narnia tattooed onto her left scapula to symbolize her emancipation from a hellish childhood – and seven more to go with it.

And then there are those fans that just go in for having the star himself as the tattoo: elaborate celebrity images are getting more and more popular. Reminds one a bit of those edible photographic sheet cakes.

This young female demographic is characterized by a certain exuberance of spirit that settles down as it approaches strapless wedding gowns and steady jobs. And tattoo removal. In the good old days, you died with your tattoos. Or you traded them in for horrific scars. Before the advent of lasers, a variety of treatments were tried: dermabrasion or skin sanding, X-ray treatments, chemical peel, liquid nitrogen, dry ice or CO2 'snow,' flesh-colored over-tattooing. The most common method? Surgical excision and skin grafting of the hole left behind. It wasn’t pretty.

The advent of medical laser technology has changed all that. Tattoos are created by placing drops of ink under the skin via a needle (hopefully). A Q-switched Nd: YAG laser is the one most often used to remove tattoos and other pigmented or discolored skin. The high-intensity light beam penetrates the dermis and is absorbed by the ink, vaporizing the pigment colors. It feels like rubber bands snapping against the skin. Hard. Over and over. The lymphatic system (the body’s natural filtering system) clears the dissolved particles of ink pigment. A tattoo that cost a few hundred dollars could require several thousand dollars and many laser sessions to remove.

Bright green, yellow and red inks are most difficult to remove. A new tattoo technology is available starting this fall called Freedom-2, a type of ink encapsulated in beads and designed to break up after one treatment with a special laser. It will be interesting to see if this 'removable' tattoo changes what and how often people adorn their bodies with images.

Tattoo removal clinic chains are making their mark or erasing it, so to speak: Dr. Tattoff, Tat2BeGone and Tattoo MD sprung into being on the West coast. Many states don't regulate tattooists or tattoo parlors, but do regulate medical lasers. These tattoo removal clinic chains are most often staffed by nurses. In other locales laser removal is supervised by physicians: plastic surgeons, dermatologists, or practically any physician with a laser payment to make.

Angelina Jolie has spent time in the doctor's procedure room: ex-husband Billy Bob's moniker has been lasered and the real estate tattooed over with the longitude and latitude of each of her four children. And Cher? At 61, she now thinks tattoos are "just plain stupid" and is in the process of getting them all removed.

In the final analysis, young women getting tattooed may be all about empowerment.

And power is really sexy.

What do you think? Click on the envelope icon and send us your thoughts.


(Okay, this last tattoo is made up.)


Want This Look? A professional tattoo can be had for under $100, and one that costs a few hundred dollars could require several thousand dollars and many laser sessions to remove. Dr. Tattoff charges $39 per square inch of tattoo for each treatment. Full removal takes an average of eight treatments, spaced at least a month apart, using different Q-switched lasers for different-colored inks.

Too Rich, Too Thin

Women think about their weight the way many men think about sex: all the time. So when is thin, TOO thin?

Just these last few weeks too thin has been selling Hollywood gossip rags. In Touch magazine apparently photoshopped out Angelina Jolie's (32) protruding arm veins for its May cover. The normal body fat that gives a smooth contour to the flesh is missing. Her emaciated arms reflect a significant weight drop while grieving her mother's death this past January. And Keira Knightley (22) is in and out of the tabloids. She has long denied eating-disorder rumors and in January of last year she sued a British tabloid for implying she lied about not having anorexia after losing weight during the grueling Pirates shoot. She probably is telling the truth. Neither woman appears to have a pathological relationship to food.

Last February former supermodel Tyra Banks was on the cover of People after having made a huge internet splash in an unflattering bathing suit. The very same month she was featured inside Vanity Fair channeling Audrey Hepburn. At 5’10” and 161 lbs. Banks's BMI is 23.1 and well within the range of normal health. It should surprise no one that the same woman can look fat in a paparazzi shot and stunning in a photo shoot. We all can.

Body Mass Index (BMI) is sophisticated way to calibrate height & weight (BMI=kg/m2) and do away with the "big boned" excuses. Here are the standards used in medicine:

Less than 18.5 = underweight
18.5-24.9 = normal
25-29.9 = overweight
30-39.9 = obese
40 or more = morbidly obese

We are a fat country and getting fatter. Approximately 33% of adult Americans are obese and an additional 32% are overweight. Yet we also have an peculiar national body dysmorphia, where female celebrities are ruthlessly pilloried for appearing at a normal weight. So from where does this national body distortion arise?

One finger points to the fashion industry. Unlike cigarettes and liquor, American is not protecting it's young from the influence of underweight image marketing. For example, Tyra Banks (33) began modeling on the catwalk at age 18 with a BMI of 16.2; by age 20 as she finished puberty she was curvy enough that her agency pressured her to lose 10 lbs. Instead, she switched to underwear/swim suit modeling in 1995. By 1997 she was the first black woman to be featured on a Sports Illustrated cover, then going on to Victoria’s Secret stardom – all with a BMI 18.8! That's just within the range of normal.

Drugs, diet pills, fasting, laxatives are rife in the image industry – very, very few of these women are that underweight by nature. After a spate of anorexic models died or fell ill last year, Madrid Fashion Week city council organizers enacted ground-breaking legislation: mannequins with a BMI of less than 18 (5'9" 123 lbs.) would be banned from the catwalk. About a third of the models who appeared the previous year won't qualify under the new guidelines, top models such as Brazil's Fabiana, Spain's Esther Canadas, Britain's Kate Moss and Estonian Carmen Kass. But Madrid is alone in treating this as a public health issue. The really big fashion venues – Milan, Paris, New York, London – aren't buying in.

"We worked hard to restrict advertising for alcohol and tobacco because of the potential dangers to our young people, and fashion is now the only major industry without health guidelines." –Lynn Grefe, CEO, National Eating Disorders Association

One study found 47% of school girls 5th-12th grade want to lose weight because of magazine pictures – pictures which are photoshopped out of reality (there are whole websites devoted to exposing this.) The print and film media are actively engaged in a manipulation of public perception. The female image school girls buy into is a simulacrum, an unsatisfactory imitation of, a substitute for real womanhood."Even I don't look like Cindy Crawford when I wake up in the morning," admits the famous supermodel.

How serious is it? It’s a mental illness that progressively damages the body, fatal to 15-20% of sufferers. It precipitates more deaths among females aged 15 to 24 than all other causes combined. (It caused Terri Shiavo's heart failure and brain death.) And eating disorders have doubled since 1960s. An estimated 10 million girls and women, as well as 1 million males suffer from anorexia nervosa (starves, obsessive, body dysmorphia, compulsive exercise) or bulimia nervosa (normal weight, binge/purging cycles). There is some evidence of altered brain chemistry that makes it hard to stop. For more information check ANRED.

Of course there are some famous dead Hollywood anorexics, like Karen Carpenter (32) and Margaux Hemingway (41), along with the aforementioned Audrey Hepburn (61). Several stars lived through it and talked afterwards: actress Jane Fonda (69) suffered from bulimia from age 13 to 37.

The current crop of Hollywood sufferers includes many. Nicole Richie (25) repeated bouts of fainting underscore her eating disorder/drug problem. In November, Richie told Us Weekly: "I'm not in rehab, and I don't have an eating disorder. I'm getting the help I need and taking care of my health." Denial ain't just a river in Egypt. Mary-Kate Olsen (21), Kate Bosworth (24), Victoria Beckham (33) all share the disease.

There are a few stars in Hollywood speaking out against the pervasive thin image. Cameron Diaz (34) has said:

“We get ideals from images that we see and there certainly should be more responsibility put on those people who are putting those images out into the world. Let’s be a little bit more responsible to what’s realistic.”

Kate Winslet (31), nicknamed 'Blubber' in school, has unapologetically appeared nude in six films. She describes the trend as "unbelievably disturbing." After being Photoshopped into an approximation of supermodel perfection for the cover of a GQ magazine Winslet veraciously complained: “the retouching is excessive. I do not look like that and more importantly I don’t desire to look like that.” Listen to what the GQ editor said in response and take it to heart – and tell your children:

"These days you only get two kinds of pictures of celebrities - paparazzi pictures or pictures like these which have been highly styled, buffed, trimmed and altered to make the subject look as good as is humanly possible. We do that for everyone, whether they are a size six or a size 12. It hasn't a lot to do with body size. Practically every photo you see in a magazine will have been digitally altered in this way."

Want this look? It can't be had surgically, but recovery in a facility can be expensive and ongoing.

Body Lift

Jennifer Hudson (26) gained weight to play her breakout role in Dreamgirls. Hollywood had to find an unknown to play the heavy, young singer biographically based on Florence Ballard of the Supremes.

"I had to maintain my weight to keep up, because we had a lot of dancing and performing to do and [my character's] not supposed to be a little girl....so you're all just going to have to get used to my jelly," she laughs, "Hey, somebody has to represent the big girls. Why not me?."

Just who are the "big girls" out there? In America, over half of all adults are overweight. Sixty-four percent to be exact. And in the last 20 years it's tripled amongst the 6-19 year-old group, rising to 16% of the population. It's not getting better, it's getting worse in the US.

So it makes sense that bariatric surgery is the new big thing. It's use is restricted to those with a BMI of 35+ or about 100 lbs. overweight. Over 177,000 surgeries were performed in 2006 (6 years ago it was 37,700). The average cost is $30,000 but insurance coverage is available for BMI of 40 or greater (the definition of morbid obesity). Even Medicare pays. Calculate your own Body Mass Index here.

There are two main procedures: gastric bypass and gastric banding. Gastric bypass surgery, involves fashioning a egg-size pouch (90% reduction) out of the top of the stomach and reconnecting it to half of the small intestine. Two feet of intestine go in the bucket. It’s permanent. Patients experience nutritional deficiencies or malabsorption of micro nutrients. Calcium supplements and Vitamin B12 injections are routinely required following gastric bypass. Gastric dumping syndrome also can occur.

Gastric banding is an adjustable restriction using an inflatable band to temporarily create a small pouch at the top of the stomach. Different from the traditional malabsorptive weight loss surgery, eg, Roux-en-Y gastric bypass surgery (RNY), Biliopancreatic Diversion (BPD) and Duodenal Switch (DS), banding does not cut or remove any part of the digestive system.

The tiny capacity it leaves takes away the choice about eating. You vomit. Another lovely way to phrase it is PB’ing (Productive Burping): regurgitation of non-acidic swallowed food from the upper pouch.

Who’s had it done? Singers Carnie Wilson & Ann Wilson, Star Jones (on Larry King Live 150lbs), American Idol’s Randy Jackson, Al Roker (NBC weatherman), Sharon Osbourne, Anne Rice, Roseanne Barr, (on Rosanne’s advice Etta James went to the doctor in a wheelchair & lost 200 lbs.). Nicole Richie HASN’T nor has Kirstie Alley.

It is not without serious risk: a 50% complication rate and bowel obstruction are two biggies.

After weight loss the hardest part of the adjustment may be emotional.

"I really still think of myself as a very big woman," she said. "My mind hasn't had the opportunity to catch up with the progress my body has made in a short amount of time." Debra Voight, opera singer (44)

There is another major adjustment, as well. One looks like a human sharpei. It's like having a size 26 skin hanging on a size 8 body.

Choosing the type of body sculpture is a balance of compromises, the scar for the excision vs. the benefit of the lift. The body is three dimensional. Body lift surgery addresses the loose drooping tissues circumferentially. It usually involves several stages: lower body lift, breast lift, arm lift, upper body lift. The lower body lift extends the tummy tuck incision completely around the lower torso, allowing re-suspension of the lateral and anterior thighs along with the traditional tummy tuck improvements. A medial thigh lift is also possible. An upper body procedure removes loose skin from the arms (bracioplasty), breasts (mastopexy) and upper torso. Patients wear a support or compression garment for two to six weeks.

Such surgery can run from $20,000 to $50,000 for an entire body and it usually leaves long, visible scars on the arms, chest, stomach and legs.

As to just who in Hollywood has had these post-bariatric surgeries? Star Jones has had public complications during one of her staged procedures. Rumor of Britney Spears staging a "come-back" via a body lift is just that: a rumor and a ridiculous one at that.


Hear Anne live on the Kevyn Burger show NEW TIME: 10:00 to 11:00am every Thursday featuring Knifestyles of the Rich & Famous.

Cigs & Sun

Who said glamor is dead? Catherine Zeta-Jones (37) "out on the terrace, half-nude, very pregnant, and sucking down a cigarette" may typify a defiant backlash in Hollywood. Today we look at the effects smoking on the skin of the rich and famous.

Cigarettes, in combination with sunbathing, is what will build the character actresses of tomorrow– or at least ones who look the part:

"I really like smoking..." Salma Hayek (40)

"I only wanted to quit if it was easy." Courtney Cox (42)

"I smoke. I smoke Camel Lights. I'm not going to stop." Gwyneth Paltrow (34)

"There is a tremendous satisfaction in the spit, and I can do it and not mess up my lipstick." Ashley Judd (38)

"Britney Spears showed off the enormous rock given to her by new fiancé Kevin Federline on the balco

ny of her swish Los Angeles apartment - and then proceeded to empty an ashtray full of butts on to the street below." June 28, 2004, The Mirror (UK)

So who else smokes off-screen? Lindsay Lohan (20), Kirsten Dunst (24), Charlize Theron (31), Drew Barrymore (32), Cameron Diaz (34), Uma Thurman (37), Naomi Watts (38), Jennifer Aniston (38), Nicole Kidman (39), Elizabeth Shue (43) just to name a few. All of these younger actresses are known for their looks and have built a career on them. So what exactly does smoking do?

Free radicals form when the body is exposed to tobacco smoke; these highly unstable and powerful molecules cause disease and damage cell DNA. The cells of your body start behaving erratically, producing a range of responses that make your skin age faster. The immune system is impaired by smoking, as well. (Ask any plastic surgeon, they won't operate on a patient who's actively smoking pre- and post-surgery, movie star or not.)

"Smoker's face" is actually part of the medical lexicon. Lighting up affects your visage on multiple levels:

• restricted blood flow through the capillaries (tiny veins near the skins surface) preventing oxygen and nutrients getting to the skin;
• increased production of an enzyme which breaks down the supply of collagen vital to skin elasticity, accelerating age-related decline;
• reduces the body's store of vitamin A which provides protection from damage;
• inhibits absorption of vitamin C, a vital antioxidant for skin protection;
• continual puckering from drawing on a cigarette and squinting in reaction to the smoke create deep, premature wrinkles around the eyes and mouth.

But the really big film news is the come-back of Mr. Butts. New research shows more cigarettes, cigars and pipes are being smoked in films now than at any point over the past 50 years. An analysis of 150 films produced between 1950 and 2002 has found there are now about 11 depictions of smoking in every hour of the typical film. In the same time period, the percentage of smoking Americans dropped by nearly 45% to just 22% of the population; Hollywood depictions have doubled in the last 10 years.

Of course, there have long been iconic images associated with screen smoking. Audrey Hepburn ignored her mother's beauty tip to: "keep to six cigarettes a day only."At her worst times she chain smoked two to three packs a day. She also suffered from asthma and died of colon cancer at only 63, frail and old for her years. Not exactly what we want to imagine for the sublime Holly Golightly.

It's no secret that cigarettes are the preferred diet aid of the very thin. Kate Moss (33) is regularly photographed with her cigarette, a lighter and a mobile phone as her fashion accessories. And what do they have to look forward to? Here's Melanie Griffith (49) who smokes like a chimney: a poster child for the effects of cigs & sun– and at the outer limits of what plastic surgery can do for her. Take a good look. That's your skin on drugs (nicotine).

Lest you think the media influence is completely to blame for a new generation of smokers, there is one more influential factor: parents. Here's Melanie helping out her daughter, Dakota. Susan Sarandon (60) was quoted as saying "Kirsten Dunst asked me the other day how my skin looks so good. I said: 'Well, first off, don't smoke.' " Do you think Dunst will take her advice?


Hear Anne live on the Kevyn Burger show 11:00 to noon every Thursday featuring Knifestyles of the Rich & Famous.

Which Breasts Are Best?

Let's go back to the question of breasts today– and get over it! This month's Jane magazine polled 600 adult women about their breasts: 74% of those surveyed said they were dissatisfied with the shape and size of their own breasts. Let's get this fixed.



























No, Jessica Simpson is not the real thing nor should any woman compare herself to silicone-enhanced breasts. It's like comparing apples and oranges. They're not the same fruit. But just to convince you, let's walk through how the all-seeing eye-of-Anne knows when those ta-tas are altered.

What gives away breast implants? Capsules, growth spurts, ripples, tunnel cleavage, adhesions, rimming, hardness, distortion, disproportion, immobility, scars, supernatural suspension. Shall we illustrate this?

Here's a candid picture of the original equipment from early in her career. Jessica Simpson's breast appear to be a small C-cup, her father's groping comments aside. She's 18 or so in this picture, about the time when breast growth is complete (pregnancy-related changes excluded). In the last eight years, however, Jessica Simpson has had some unusual growth spurts...and even more unusual circumscribed 'weight loss'...all in her breasts. They've been in, they've been out, they've been in again. Currently they appear to be out. Cue the music— "Thanks for the Many Mammaries." Does any of it make her look more or less beautiful? You decide.

In 1992 the FDA effectively took silicone breast implants off the cosmetic market and only recently re-approved them for elective augmentation surgery. Last November the FDA lifted its 14 year near-ban on silicone gel implants. None of this slowed down the current wild popularity of bigger bazooms through plastic surgery.

The viscosity of the filling material is what distinguishes the feel of the augmented breast, since all implants use silicone outer shells. Saline implants are round and filled with simple salt water. Most of what you see on inflated chests is in fact saline-filled and a poor substitute for real mammary tissue. These surgically implanted sacs can feel akin to a waterbed—especially during physical activity. Silicone implants, by contrast, are filled with a synthetic gel, a consistency not unlike a weak squeeze ball. Silicone gel also comes in a variety of shapes and conforms more closely with the natural tear-drop shape of real breasts. Saline implants have a round, balloon-ish quality and are much easier to spot with a quick glance.

A lot of women opt for subglandular placement (under the mammary tissue, over the pectoral muscle). The advantages? It can postpone a breast lift (mastopexy), by adding volume to counter mild sag (ptosis), but this is temporary. Keep in mind that the only thing supporting the implant is the elastic integrity of the skin and breast tissue.

Paula Abdul shows the perils of too much, too late. A subglandular placement requires less recovery time with less post-op discomfort, since the muscles are left intact. Actresses and strippers also prefer it for the enhanced projection. Conversely, a very large implant placed sub-muscular (without tissue expansion which is what post-mastectomy patients undergo) is agony. But it looks more natural.

Other disadvantages to a subglandular placement? Ripples and adhesions. As the implant drops, or settles into place, the surface of the shell can pull on the scar capsule, which in turn pulls on the skin. This produces traction rippling ala Beyonce.

A lot of surgeons operate through incisions you might not guess. The trendiest is transumbilical (TUBA), an approach through a naval incision. Transaxillary (armpit incision) is also popular. An incision hidden in the inframmamary fold (crease under the breast) or peri-areolar are the most common and can give truth to the lie. It also often impairs nipple sensation. Poor Tara Reid.

Placement of the breast implant over the pectoral muscle (subglandular) is very obvious in thin women with little natural breast tissue. The highly technical description is generally "bolt-on breasts." In Hollywood you really can be too rich and too thin. Just Victoria Beckham.

The most common cause of an unnatural appearance? Capsular contracture occurs when the scar tissue that naturally forms around the implant tightens and squeezes the implant into a hard, unnatural appearance. The previous older generation of silicone breast implants were particularly prone to this. No surgeon can completely control for the vagaries of healing and this has caused many stars, from Demi Moore to Courtney Love, to undergo multiple breast operations.

And most tellingly, when you squeeze on a breast– say with a tight bodice– the outline of any subglandular implant becomes more obvious, particularly in thinner, Hollywood-type women. The demarcation of the upper rim of the implant is a dead giveaway. It doesn't happen in nature.

Real, voluminous breasts look like Scarlett Johansson's "girls" in a fitted gown: pillowy with no tunnels in sight.


Hear Anne live on the Kevyn Burger show Thursdays featuring Knifestyles of the Rich & Famous.