Dr. Michael Salzhauer said so many moms brought kids to their appointments that he was motivated to stock up on lollipops in his Bal Harbour, Florida office. In My Beautiful Mommy, he explains mommy's recuperation, changing look and desire for plastic surgery.

"Many parents don't explain to their kids what's going on," said the father of four, with his fifth child on the way. "Children are very perceptive. You can't hide a major surgery from them. When mom goes down for two weeks after a tummy tuck it affects them."

Illustrations show a crook-nosed mom with loose tummy skin under her half shirt picking up her young daughter early from school one day and taking her to a strapping and handsome "Dr. Michael." Mom explains she is going to have operations on her nose and tummy and may have to take it easy for a week or so. The girl asks if the operations will hurt, and mom replies, "Maybe a little," warning she will look different after the bandages come off. The girl asks: "Why are you going to look different?" Mom responds: "Not just different, my dear — prettier!"

Many women are aware that implants can break down over time, requiring replacement just like car tires. Both saline implants, made out of a saltwater solution, and silicone implants, made out of gelatinous silicone, can form minute tears in their rubbery shells, causing ruptures. In the case of such defects that require product replacement, both manufacturers, Allergan Inc. and the Mentor Corporation, offer guarantees. Mentor has a 10-year guarantee to replace implants and defray some surgical fees; Allergan's warranty includes lifetime implant replacement and up to $1,200 for fees for the first 10 years.

Dr. Mark L. Jewell, a plastic surgeon in Eugene, Ore., who is a past president of the American Society for Aesthetic Plastic Surgery, said he warns his patients that breast augmentation surgery automatically guarantees a second operation at some future date. He added that many patients in clinical studies had elected to have follow-up operations to change implant type, size or position.

"Women are used to having their hair or nails done on a regular basis to maintain their appearance," said Dr. Jewell, who has conducted clinical trials for both implant manufacturers and is a consultant for Allergan, the manufacturer behind the ads running in Elle. "Ultimately, breast implants may also be a matter of maintenance."

But a rupture is only one of the local complications that may engender additional surgery. Like cocoons that grow around larvae, scar tissue can form around implants; and sometimes that scar capsule hardens and squeezes the implant, causing pain and deforming breasts. And saline implants can cause visible, tactile rippling beneath the skin.

Fig. had operated 15 offices in seven states that promoted a series of injections, at a cost of about $2,000 per body part, to reduce fat deposits on areas like the thighs and abdomen. The procedure, commonly referred to as lipodissolve, involves injections of drug compounds that have not been approved for cosmetic medical use by the Food and Drug Administration.

Since Fig., originally named Advanced LipoDissolve Center, opened its first office in 2005, its clinics performed more than 100,000 antifat treatments across the nation, the company said in an interview in September. In the last three years, 145 clients of Fig. have filed complaints to the Better Business Bureau of Greater St. Louis citing lack of results and adverse reactions, including pain and swelling. In the past week, 150 more consumers complained, said Christopher Thetford, a trade practice consultant at the Better Business Bureau. Mr. Thetford said his group hoped to help customers, who had to pay for the antifat shots up front, obtain refunds.

According to its Web site, Fig. will contact clients who had not completed their antifat sessions about continued treatment or refund claims. Attempts to contact the company met with a recorded message at its headquarters saying that Fig. was consulting with counsel and was likely to file for bankruptcy.

For the past few years, Dr. Howard Sobel, director of the Skin and Spa Dermatologic Cosmetic Surgery Center on 960 Park Avenue, has been quietly plumping up women's ears with injectable serums such as Restylane and Radiesse—the same ones he uses to rejuvenate their faces. "As people get older, the ear loses volume and shows wrinkle lines," said Dr. Sobel. "It's part of the aging process."

Dr. Sobel noted that if a woman is using fillers in her face to clean up things like naso-labial folds and forehead lines, making her face appear more youthful, then aging ears may stand out even more. Put another way, you want the handles to complement the vase—kind of like making sure your accessories match your outfit.

Though in this case, of course, accessories are precisely the problem. "One patient only wore big, heavy earrings, and part of the reason was that she was trying to cover her stretched-out ears!" Dr. Sobel said. "She didn't realize that the big earrings were only making the earlobe stretch more. When the hole gets too big it starts to pull the ear down. So we repaired the pierced hole in her ear and injected it, which added volume back, and it looked like her old ear." This is a common procedure, he added.

Dr. David A. Stoker, a plastic surgeon in Marina Del Rey, Calif., has a surgical cure for the ravages of motherhood. He, like many plastic surgeons nationwide, calls it a "mommy makeover." Aimed at mothers, it usually involves a trifecta: a breast lift with or without breast implants, a tummy tuck and some liposuction. The procedures are intended to hoist slackened skin as well as reduce stretch marks and pregnancy fat.

"The severe physical trauma of pregnancy, childbirth and breast-feeding can have profound negative effects that cause women to lose their hourglass figures," he said. His practice, Marina Plastic Surgery Associates, maintains a Web site, amommymakeover.com, which describes the surgeries required to overhaul a postpregnancy body. "Twenty years ago, a woman did not think she could do something about it and she covered up with discreet clothing," Dr. Stoker said. "But now women don't have to go on feeling self-conscious or resentful about their appearance."

In 1970, Our Bodies, Ourselves, the seminal guide to women's health, described the cosmetic changes that can happen during and after pregnancy simply as phenomena. But now narrowing beauty norms are recasting the transformations of motherhood as stigma. These unforgiving standards are the offspring of pop culture and technology, a union that treats biological changes as if they were as optional as hair color. Gossip magazines excoriate celebrity moms who don't immediately lose their "baby weight." Even Cookie, a luxury parenting magazine, recently ran an article that described postpregnancy breasts as "the ultimate indignity" and promoted implant surgery; a photo of droopy water-filled balloons accompanied the article.

Many women struggle with the impact of aging and pregnancy on their bodies. But the marketing of the "mommy makeover" seeks to pathologize the postpartum body, characterizing pregnancy and childbirth as maladies with disfiguring aftereffects that can be repaired with the help of scalpels and cannulae. "The message is that, after having children, women's bodies change for the worse," said Diana Zuckerman, the president of the National Research Center for Women and Families, a nonprofit group in Washington. If marketing could turn the postpregnancy body "into a socially unacceptable thing, think of how big your audience would be and how many surgeries you could sell them," she said.

The augmentation operation only takes between 30 and 40 minutes, so women undergoing it need only low levels of anaesthetic drugs, and is carried out using an extremely precise cutting device which reduces bleeding. John Tebbetts, a Texan plastic surgeon who is due to describe the operation at the annual meeting of the British Association of Aesthetic Plastic Surgeons says women should no longer assume they need a period of convalescence after having their breasts enlarged.

"After the surgery we tell the women to go home, have a little nap then get up after two hours, wash their hair which helps them stretch their muscles, then go out to dinner. "Between 80 and 85 per cent of our patients go out on the evening of their surgery." He added: "Women have got to get out of the mindset that they are going to be ill after this operation."

Women who undergo the new procedure, which is being marketed as the "out to dinner" breast augmentation, are promised no visible bruising or need for special bras. They are allowed to drive on the day of surgery and resume normal activities the following day.

"It's been a challenging few years, being the age I am. Almost to the point where I felt like, well, they don't know what to do with me. I am not 20. Not 30," she revealed to Red magazine. "There aren't that many good roles for women over 40. A lot of them don't have much substance, other than being someone's mother or wife."

Demi's frustration with Hollywood's attitudes toward "women of a certain age" was evident throughout her interview with the publication. "If we are told we are not valuable once we hit 30, it is a problem," she said. "We all have more to give ... We can't just wait for something to happen. We have to say, 'I'm mad as hell and I'm not going to take it any more.'"

After a string of flops in the 1990s, she took a career break, during which time she met her current husband, 29-year-old Ashton Kutcher. Miss Moore then returned to the screen in 2003's Charlie's Angels: Full Throttle, emerging from the sea in a skimpy bikini which showed off the results of a cosmetic surgery spending spree. As well as breast implants, collagen injections and liposuction on her hips, thighs and stomach, she had a £5,000 procedure to lift the sagging skin on her knees. She also employed an army of advisers - including a nutritionist, personal trainer, yoga teacher and kick-boxing coach.

Nearly 11 million cosmetic plastic surgery operations were performed in the United States in 2006, up by 7 percent from 2005, the group said. It also said more than 5.2 million reconstructive plastic surgery procedures were performed last year, mostly removal of tumors.

The most popular cosmetic choice was breast augmentation, with 329,000 reported in 2006. This is the first time "breast jobs" have passed nose reshaping surgery, performed on 307,000 people in 2006.

The group reported an 8 percent rise in minimally invasive cosmetic procedures such as injections to fill out wrinkles, with more than 9 million such operations. Botox treatments were by far the most common, with more than 4 million treatments in 2006.

Because the implants made of silicone gel are softer than the saline implants currently available, plastic surgeons said they would quickly become preferred among the more than 300,000 women in this country who have breast implants each year. Critics of the decision lambasted it and said that longstanding safety concerns had not been resolved. But supporters of the implants, including leading surgeons, applauded it.

"For us, it's a triumph of science," said Dr. Richard A. D'Amico of Engelwood, N.J., president-elect of the American Society of Plastic Surgeons. "We’ve always felt that the science would bear out the use of the implants." Dr. Daniel G. Schultz, director of the F.D.A.'s Center for Devices and Radiological Health, said that the agency's review, based on company-sponsored studies as well as long-term use of the implants abroad, had determined that their sale is in the best interest of women.

But Dr. Schultz warned that no device is foolproof and that there was a possibility that women would have to have the implants replaced at some point, sometimes because they rupture. Studies have found that the majority of women with silicone implants would have a rupture at some point. According to the federal agency, one study found that 69 percent of women had a rupture. "Women should know that breast implants are not lifetime devices," he said in a telephone briefing for reporters last night. "Women having these procedures done need to be prepared for the fact that there is a likelihood they will require additional surgery," he said. He also recommended regular M.R.I.'s to monitor the devices for "silent rupture," which can occur without a woman’s knowledge. He said the first M.R.I. should be performed when the implants are 3 years old. Because many of the procedures are cosmetic, it was not clear whether those M.R.I.'s would be covered by insurance.

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Defending the decision to lift the ban, Dr. Schultz said, "we have been looking at this data continuously for the last 10 years. We have been watching as data had been collected, we have been watching as data has accumulated. We believe that from a scientific standpoint, the decision that we'e making tonight is, in fact, in the best interest of American women."

But he said the agency would require the companies to conduct post-approval studies involving a total of 80,000 women to continue monitoring the safety of the implants. He said that information would be collected about rates of rupture, cancer and autoimmune diseases and effects of the implants on reproduction. That would enable the agency to evaluate concerns about the implants in a large number of women.

Using procedures pioneered by the hair loss industry for balding men, surgeons are using "plug and sew" techniques to give women long, sweeping lashes once achieved only by glued on extensions and thick lashings of mascara. And just like human hair -- for that is the origin -- these lashes just keep on growing.

"Longer, thicker lashes are an ubiquitous sign of beauty. Eyelash transplantation does for the eyes what breast augmentation does for the figure," said Dr Alan Bauman, a leading proponent of eyelash transplants. "This is a brand new procedure for the general public (and) it is going to explode," Bauman told Reuters during what was billed as the world's first live eyelash surgery workshop for about 40 surgeons from around the world.

Under the procedure, a small incision is made at the back of the scalp to remove 30 or 40 hair follicles which are carefully sewn one by one onto the patient's eyelids. Only light sedation and local anesthetics are used and the cost is around $3,000 an eye. The technique was first confined to patients who had suffered burns or congenital malformations of the eye. But word spread and about 80 percent are now done for cosmetic reasons.

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The surgery is not for everyone. The transplanted eyelashes grow just like head hair and need to be trimmed regularly and sometimes curled. Very curly head hair makes for eyelashes with too much kink.

Few Americans had heard of a beauty treatment called Thermage until Oprah Winfrey began championing it on her talk show. Billed as a procedure to tighten skin, Thermage uses a radio-wave emitting machine to heat and expand collagen beneath the skin's surface. In episodes with names like "How to Stop the Clock on Aging," "Look Younger! Live Longer!" and "Look 10 Years Younger in 10 Days," Ms. Winfrey introduced Thermage as one of the "latest cutting-edge treatments" and as a "lunchtime face-lift" that requires no recovery time.

When Thermage was first showcased on "The Oprah Winfrey Show" in 2003, "the show drove so much interest that our sales reps were selling machines over the phone," said Stephen J. Fanning, president and chief executive of Thermage Inc., which sells machines to doctors for about $30,000. And every time "Oprah" reruns one of its Thermage episodes, most recently last summer, traffic on the Thermage Web site (thermage.com) spikes to 30,000 hits for the day, Mr. Fanning said. Ten to 14 percent of the people who visit the site after seeing an "Oprah" episode end up visiting a doctor's office to have a facial procedure, at an average cost of $3,500, he added.

Ms. Winfrey's ability to create best-selling books with an endorsement on Oprah's Book Club is well known. Much less recognized is her Midas touch in the beauty industry. With an average of about nine million viewers daily, the "Oprah" show drives enormous traffic to cosmetics counters, spas and doctors' offices when she endorses a product or a treatment, according to beauty industry executives. "Getting on Oprah is like winning the lottery," said Marianne Diorio, senior vice president of global communications for Estée Lauder. "Because her audience really trusts her, if Oprah or her producers sincerely fall in love with some product or person, the results can be spectacular," Ms. Diorio said.

The skin-care brand Philosophy was sold only in a handful of stores when Ms. Winfrey included its Hope in a Jar moisturizer in a 1996 episode. "She took this obscure little company and gave us national name recognition," said Cristina Carlino, founder of Philosophy. The brand now sells in Nordstrom, Macy's and Sephora stores and on QVC. Last December, when Philosophy Amazing Grace Shower Gel appeared on "Oprah," the product's monthly sales increased to 18,000 bottles from 3,000 the previous December, said Ms. Carlino, who calls her manufacturing plant "the house that Oprah built."

• Make sure that your physician is board certified by The American Board of Plastic Surgery. Many physicians practicing as plastic surgeons advertise that they are board certified, but they don't mention what their certification is in a different medical specialty, such as ear, nose and throat, oral surgery, etc.
• Get references from friends or acquaintances whom have had a similar procedure done by that plastic surgeon.
• The plastic surgeon should also be comfortable showing before and after photographs of his/her patients, as well as having former patients discuss their procedures with you. The surgeon should also be comfortable discussing how many of these procedures they have performed. Be very realistic about the procedure and results.
• The surgeon should have hospital privileges to do that procedure. Any surgeon can perform any surgery in his/her own facility. Only appropriately qualified surgeons can do the same procedure in a hospital or ambulatory surgery center. Make sure the surgical facility is appropriately accredited.
• Some health issues also need to be considered. Smoking is one of the two most detrimental external influences you can have on your aging process, skin, and the results of your surgery. You should completely quit at least two weeks before the surgery to allow your body and lungs to clear some of the damaging chemicals such as carbon monoxide. The other detrimental influence is excessive sun exposure.
• For the best results, you should be in reasonable shape regarding your weight and exercise regime. Your blood pressure and any diabetic risk factors should also be under control.
• The surgeon should also give literature about the procedure, as well as discuss possible risks and potential complications. No procedure is without risk and this should be clearly communicated in the consultation and preoperative discussions.
• The surgeon should be very realistic about the recovery process rather than give a best-case scenario. Too often a patient is told that the recovery will be short and easy when there may be bruising, swelling, and additional time needed.