By CLOE CABRERA | The Tampa Tribune

Tribune photos by VICTOR JUNCO
Joshua A. Halpern works on a patient.

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Oh, Priscilla.

Pamela.

Courtney.

Cher.

Say it isn't so.

If stars like you - with all your money and connections - can't get injections, implants or a little age-defying surgery without risking disastrous results, what's to become of the rest of us?

Should we put our dreams of surgical lifting and shifting to rest forevermore?

From Botox to boob jobs, cosmetic surgery procedures have increased 59 percent since 2000, according to statistics from the American Society of Plastic Surgeons. Everybody, it seems, wants to buy a little youth or self-esteem. And as the number of people electing to have plastic surgery continues to rise, it appears the number of revision surgeries also is increasing.

Although no agency tracks stats on revision or corrective surgeries performed in the United States, surgeons say they're seeing more patients who want a do-over.

"I'm seeing a growing number of patients come to me to fix work they've had done somewhere else, especially recently," says board-certified Tampa plastic surgeon Joshua A. Halpern. He estimates that at least 12 percent of his practice is revision surgery.

There is money to be made in the beauty business, and demand is high. More and more, facilities are relying on non-surgeons to perform cosmetic procedures, Halpern says. In some cases, physicians who are not trained in that area are allowed to perform procedures that take years of rigorous training to perfect. "It's not just locally, it's a national phenomenon," he says.

When patients go in for a consult, they aren't necessarily being seen by a doctor and many times not by a nurse, he says. "These are hired guns and salespeople who sell the patient on the surgery. Most of them aren't plastic surgeons and they don't have a lot of experience. These types of places are cropping up all over the country."

In March, Nora Massaro, 48, of Temple Terrace, was forced to undergo revision surgery on her breasts when her implants ruptured. Halpern cleaned out the scar tissue and replaced the implants. Massaro says she was surprised to learn the original doctor placed her implants above the muscle, not below, as she was told.

The doctor she chose in Bethesda, Md., offered a great deal: $5,000 to enlarge both breasts. "It was a money issue and it was a very good price," Massaro says. "I was really trying to save money." But the results were poor from the start.

"They were really hard, extremely hard, like concrete," says Massaro, an office coordinator. "And they were very painful. It took six months before I could lift anything without pain. If I hugged someone, they knew I had implants."

After her revision surgery, "it was like night and day," she says. "From the minute I got home, I felt like a million dollars. I didn't even need pain medication. I looked for the surgeon that was the cheapest. Money should never be the issue in choosing a doctor, because you're going to get what you pay for."

Bart Rademaker, owner of Rejuva Medi Spa in Westchase, urges patients to do their homework on the procedure they want and the physician who will perform it.

"Usually, the majority of plastic surgeons are well-trained," says Rademaker, a board-certified plastic surgeon. "But it's always a good idea for the patient to be prepared to ask a lot of questions and discuss their expectations. If a doctor doesn't answer them, you should walk out."

Having said that, he concedes, some patients' expectations can be unattainable.

"You have to do the right thing for the patient," he says. "If it's not appropriate surgery for them or their expectations are too high, I won't do it. We're artists for the face and body. You have to have an innate ability to know the body, what looks good and what doesn't. The patient trusts you to give them the best results possible."

The same applies for minimally invasive procedures, says Susan H. Weinkle, a Bradenton-based dermatologist. Even treatments like Botox, lasers and peels can be dangerous in unqualified hands.

"There are people injecting things and performing procedures which they shouldn't be," Weinkle says. "If someone is offering specials, you need to ask yourself, are they doing a lot of this or are they just trying to generate business? If you're shopping for price, you need to make sure you're also shopping for quality."

Many patients who receive the popular wrinkle fighter Botox, the cosmetic form of botulinum toxin, aren't aware it can cause cold sores to flare up in patients with a history of cold sores. If it's injected improperly, it also can cause skin necrosis, where the cells of the skin begin to die. And injected too superficially, it can cause a tyndell effect, which causes a bluish discoloration of the skin.

"There are so many things that can go wrong if the work isn't performed by someone who is experienced and qualified," Weinkle says. "The success is about 10 percent product and 90 percent technique. Do your homework."

Don J. Perez, owner of Body Science Aging Intervention and Management in Tampa, agrees with that assessment.

"Doctors need to recognize where their expertise lies," Perez says. "You have to stay close to what you can do in your specialty and not go beyond that. I know how far I can take them, and I won't go beyond that scope. In the end, it's really up to you to look out for the patient's health."

Reputable physicians encourage patients who want to become better educated about cosmetic surgery, Perez says. It's perfectly OK to ask a physician how many times he has performed a certain procedure, if he has pictures of previous patients, or if he has performed the procedure on a family member, his staff or himself.

Patricia Ostman, who has undergone a successful tummy tuck, liposuction, facelift and lip enhancement - all as a patient of Halpern - can't stress that enough.

"Cosmetic surgery isn't something to take lightly," says Ostman, 49, of Valrico. "Ask a lot of questions and find a reputable doctor. It's your body and you're the one that has to look in the mirror and live with the results."

Reporter Cloe Cabrera can be reached at (813) 259-7656 or ccabrera@tampatrib.com