Breast implants, hair replacement surgery or a face-lift performed by the Nordstroem Hospital in Helsinki are among the newest offerings in the carrier’s Finnair Plus loyalty service, according to the program's Web site. "Finnair contacted the hospital," Mikko Tuomainen, the airline's director of loyalty programs, said in a telephone interview. "The idea was to incorporate partners and services from all walks of life."

About 1.3 million flyers are enrolled in Finnair's loyalty program, Tuomainen said. Earning the 3.18 million points for breast augmentation surgery requires 120 round-trip, business-class flights between Helsinki and New York, according to a points table on Finnair's Web site. Miles earned with the airline are valid for five years.

Finnair, which added the cosmetic surgery service about a month ago, is in talks with medical practices to offer other health care services, Tuomainen said. Points can also be combined with cash and used for services ranging from restaurants and clubs to car rentals and hotels. Frequent flyers use three-fourths of all points for flights, Tuomainen said.

The second time I had plastic surgery I got it done for free. People was covering it and I met a team of doctors that had a publicist who kept adding procedures. The guy who did my LASIK surgery wanted to do a "tune-up" and now I've had five surgeries on my eye. I have partial blindness in one of my eyes, actually. It was very much like Nip/Tuck where they'd be like, "Tell me what you don't like about yourself," and then they'd draw all over you with markers to highlight your "problem" areas. One of the doctors was like, "We can do a little teeny lipo on your upper arms." I said, "Are you sure?" He said yes, so I went along with it.

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Paparazzi get photos of celebrities doing pretty much everything, but they never seem to get pictures of stars after surgery. Why is that?

Oh, there's a whole system you need to know about. First of all, the plastic surgeons in Beverly Hills all have secret celebrity doors. After the surgery, you leave the plastic surgeon's office covered in a sheet that's not unlike a burqa. Your assistant takes you to an upscale hotel where you hide in a dark room of shame until you're better. There are bandaged rich ladies walking around the hallways of the Four Seasons and the Peninsula in Beverly Hills right now. It's not unlike being a war criminal or a terrorist.

In the study, which will be published this week in the Proceedings of the National Academy of Sciences, the researchers describe how Stanford plastic surgeon Dr. Michael Longaker's liposuction patients donated one to three liters of their fat, which he called "liquid gold" [San Jose Mercury News]. The researchers separated out the globular fat and prepared the fat tissue cells for reprogramming–a process that took only two days, instead of the three to four weeks required for skin cells. The reprogramming procedure was also faster, taking only two weeks. Finally, it was 20 times more efficient than the skin cell conversion.

In a similar study, published in the Journal of Cell Science, researchers found that reprogramming melanocytes, the pigment-producing skin cells that give rise to moles, was also faster and more efficient than reprogramming regular skin cells. While much more work needs to be done to prove that both kinds of altered cells are safe, the researchers say that making stem cells out of waste products could be a boon for medical research. Says Longaker: "There's a lot of fat in America, unfortunately, and it's a renewable source of cells" [Nature News].

No wonder that earlier last month, news of a surgical "cure" that touts a high success rate ricocheted worldwide. The double-blind study, published in the journal Plastic and Reconstructive Surgery, found that more than 80 percent of patients who underwent surgery in one of three "trigger sites" significantly reduced their number of headaches compared with more than 55 percent of the group who had sham surgery. More than half of the patients with the real surgery reported a "complete elimination" of headaches compared with about 4 percent of the placebo group.

Forehead lifts are cosmetic procedures that plastic surgeons typically perform to smooth furrowed brows. But a decade ago, after some of his patients reported that their migraines improved post-operation, Dr. Bahman Guyuron, a plastic surgeon and the lead author of the study, began to search for a surgical solution that could address migraine trigger points -- which he defines as where the headache begins and settles -- in the forehead, temples and the back of the head.

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The theory behind the surgery is that because some migraines are caused when sensitive nerve branches are squeezed and irritated by muscles, deactivating those muscles could bring prolonged relief. In the off-label use of Botox for migraines, those same muscles -- when paralyzed with Botox injections -- have eased headaches in some patients for roughly three months. Forehead lifts, Dr. Guyuron reasoned, might result in a longer-lasting, perhaps permanent, alleviation of pain. Only study participants who responded positively to Botox were offered the surgery.

The Senate Finance Committee has discussed imposing a 10 percent excise tax on cosmetic surgery deemed unnecessary for medical purposes. The idea was broached in a meeting with OMB Director Orszag in mid-July, after which Senate Finance Chairman Max Baucus told reporters he had heard some "interesting," "creative," and "kind of fun" ideas.

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Malcolm Roth, vice president for health policy and advocacy at the American Society of Plastic Surgeons, said the New Jersey tax has only brought in about 25 percent of anticipated revenue since it was enacted in 2004 and imposes "another bureaucratic layer," including questions of how to determine what procedures are eligible. Roth said lawmakers at the federal level could expect the same administrative headaches and lack of anticipated revenues if they went down the New Jersey route.

The itemized deduction, for example, has been the subject of litigation in federal tax court. In a 2001 case, a nurse was awarded the deduction for surgery to remove an overhanging skin mass after the IRS initially denied her claim. The court agreed that the mass, which formed after the woman lost 100 pounds, was prone to infection and interfering with her hospital work.

Roth, a plastic surgeon at Maimonides Medical Center in Brooklyn, N.Y., said it "would be a discriminatory tax against women," noting that 86 percent of patients are female and 91 percent are of working age between 19 and 64. He also disputed the notion it would be a "tax on the wealthy," noting most patients earn less than $100,000 a year. "People put money aside for years, sometimes weekly under-the-mattress deductions" to get the surgery they want, he said.

Cellulite is a telltale sign that life is a crapshoot. Most women get cellulite after puberty. But men usually don't, not even if they've got the girth to qualify for "The Biggest Loser." That's because the connective tissue bands under men's skin are crisscrossed like a net, keeping their fat more evenly restrained. By contrast, women's tissue bands are organized in vertical columns, so fat may bulge irregularly.

"At a normal weight your fat cells fall nicely into valleys of connective tissue," said Dr. Michael D. Jensen, a clinical professor of medicine at the Mayo Clinic, who has studied fat for 25 years. "When you get too many fat cells or too big of fat cells now they push up on the roof." Or, your skin. What's more, women don't have as thick a roof as men, all the better to show dimples. And thanks to estrogen, women have more fatty reserves.

It doesn't stop there. As we age, the connective tissue strands between our skin and muscle, which used to stretch to accommodate weight fluctuations, become inflexible. "Some of the bands tighten down and you get pockmarks with bulges next to them," said Dr. Brian M. Kinney, an assistant professor of plastic surgery at the Keck School of Medicine at University of Southern California. Voila, cottage cheese.

Nor do all women start with the same give in their connective tissue. One explanation for a slender woman with cellulite is thin skin and unusually tight connective tissue. By contrast, the neighbor we love to hate can gain 15 pounds but is blessed with stretchable bands that accommodate a fat uptick. No orange-peel bottom for her. Grrr.

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An anti-cellulite cream can offer a "temporary benefit simply because of swelling, but you have to keep using it," said Dr. Michael F. McGuire, a clinical associate professor at the David Geffen School of Medicine at the University of California, Los Angeles. (Most creams mildly irritate skin, causing a little swelling which camouflages dimpling for a bit.) That reapplication is a "benefit" for the makers of creams, he added, especially given that "realistically there is no cure for cellulite."

According to recent medical journals, physicians have used it to treat chewing problems, swallowing problems, pelvic muscle spasms, drooling, hair loss, anal fissures and pain from missing limbs.

"We see it as a molecule that keeps on giving. As we understand it more, it gives us new ideas of how to use it," says Dr. Mitchell F. Brin, a neurologist who is the chief scientific officer for Botox at Allergan, the drug’s maker. No other therapeutic agent "has so many demonstrated uses," he says.

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"It's trial and error with a nerve poison," says Dr. Sidney M. Wolfe, the director of the health research group at Public Citizen, a consumer advocacy group. Last year, the group petitioned the Food and Drug Administration to require a warning label for injectable toxins.

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The F.D.A. has approved Botox to treat four problems: eye muscle disorders, neck muscle disorders, excessive sweating -- and that deadly age giveaway, eyebrow furrows. But Allergan, a $14.5 billion specialty pharmaceutical company, owns or has applied for patents on more than 90 uses for the drug. Dr. Brin of Allergan says Botox has a long safety track record — backed by 30 years of favorable research, studies on 11,000 people worldwide and 17 million treatments in the United States since 1994.

Manhattan plastic surgeon Stephen Greenberg saw an opportunity in this growing trend and recently began promoting a "Job Fighter Package" for men and women. "We've probably done no less than 50 to 60 tune-ups since launching the package about five months ago," Greenberg said, noting that not all the "tuneups" have involved surgeries, but also less costly and invasive procedures like cosmetic injectables.

"Men and women in their 40s and 50s are competing with peers 10 to 15 years younger and employers naturally tend to go to a person who looks fresher and younger, despite who is better qualified," Greenberg said, adding that a lot of his patients view the surgery as an investment and are financing it with loans. Plastic surgery loans can involve financing charges of 12 to 19 percent, according to industry experts.

In addition to the perceived competitive advantage from a face lift, some surgeons believe the recession is starting to cause more and more patients to get "work done" for an emotional lift in these dark times. "I think when people are down about the economy, they want to do things to make them feel better," Greenberg said. New York City plastic surgeon Steven Pearlman agreed. "People are fed up and are starting to figure that it's time to live a little. Cosmetic surgery is about investing in yourself. It makes you look good and feel better about yourself, a dozen times a day when you look in the mirror," he said.

"I think I look pretty good for 43. But I don't look the way I did when I was 23," says Crawford. "So if Star magazine or whatever wants to print a picture of me on the beach from the back, at the worst possible angle, and say that I have cellulite, I'm like, Guess what? I do, and I never said I didn't.

A total of $10.3 billion was spent last year on cosmetic procedures, a category that excludes reconstructive surgeries. That's a 9 percent drop from 2007. Cosmetic surgeries fell 9 percent to 1.7 million compared with 2007, according to the Arlington Heights, Ill.-based society. Of that total, breast augmentation dropped 12 percent to 307,000 procedures, and liposuction fell 19 percent.

Tummy tucks tumbled 18 percent to 122,000. But society President Dr. John Canady said in a statement business will recover with the economy and as the children of baby boomers start to consider surgery. He said repeat patients and those who put off more extensive surgery likely bolstered the number of lower-impact, minimally invasive procedures. They grew 5 percent to 10.4 million. Botox injections grew 8 percent to 5 million, while laser hair removal fell 2 percent.