Photo: Amy Winehouse and her new breast implants last month. (Getty Images photo)

UNLUCKY LADY

As if she didn’t have enough troubles already, singer Amy Winehouse has been hospitalized for treatment of leakage in her breasts, her father says.

The Grammy award-winning singer recently got breast implants and reportedly was considering having more plastic surgery to improve her figure.

Mitch Winehouse told London’s The Sun,”It wasn’t because she had a cold. She’s fine, she just had a little (Mitch points to his chest) leaky something or other.”

Plastic surgeon Dr. John Di Saia of San Clemente and Huntington Beach was skeptical about reports that the implants themselves were leaking.

“It is unlikely that an implant would be leaking this early but anything is possible. Hopefully she just had a minor wound problem,” he wrote in his Truth in Cosmetic Surgery blog.

Winehouse, who has struggled with substance abuse, spent several days in the hospital for what was originally reported as a drug reaction related to cold remedies.

People magazine said, “She had taken some over-the-counter cures for a cold, and they reacted with other medication in her system.”

People also quoted Mitch Winehouse as pleased with his daughter’s plastic surgery, saying that her newly enlarged bust was “great.”

An unnamed source close to Amy Winehouse said the plastic surgery helped her feel “really good about herself … She’s been saying how she wants to get back in the gym.”

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OC AND VALLEY HO

This week’s episode of “Real Housewives of Orange County” didn’t follow up on the plastic-surgery plans of Lynne Curtin and her daughter, who visited Dr. Milind Ambe last week.

I wouldn’t mention it here except that TV enthusiast Michael Hewitt, The Watcher, wrote a hilarious account of this week’s show titled “‘Real Housewives’ Watchalong: Dull on the rocks.”

Among the least of his jibes was his account of the introduction of the surgically enhanced new Housewife, Alexis Bellino (pictured):

Alexis and Jim have been married four years and have three children: a 3-year-old son and 20-month-old twin girls. “We both wanted to have a very structured family life where God was first, our marriage was second and our children were third,” Alexis says.

That’s craziness! Where does plastic surgery rank? And booze? If those aren’t higher than the kids, you have no business being on this show, lady.

More typical is The Watcher’s description of the introductory sequence of Thursday’s show:

The episode opens in the familiar Orange County community of Scottsdale, Ariz. We watch an SUV pull into the – get this – Hotel Valley Ho, a place the producers could not possibly have picked accidentally.

Gretchen and Slade emerge from the car, Slade now sporting the subtitle “Gretchen’s boyfriend,” and check into the Valley Ho. I may never tire of typing “Valley Ho.”

If you need a laugh, CLICK HERE to check out his watchalong review.

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Photo: Bo Derek a year ago, shortly before her 52nd birthday. (Getty Images photo)

‘I’M ONE OF THEM’

Actress Bo Derek, 53, says she’s sometimes scared of how age is affecting her face, but she resists the temptations of plastic surgery, Botox and injectable fillers.

“When you look at women who have had plastic surgery, they have lost something — usually an expression, something unique to their faces,” she told London’s Mail Online.

“They start to look the same. I’ve always admired the women who didn’t do it, so I have to keep reminding myself that I’m one of them and not the other.”

She doesn’t discuss the experience of looking in the mirror. She says photos are what sometimes upset her.

“When I look at some photographs of myself, I think, ‘Oh, I look all right,’ ” she said. “But, in others, I scare myself; I wish I had my old skin.”

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SHARED BIRTHDAY

A prominent abstainer from cosmetic medicine and a prominent user of  lip-plumping injections share a birthday today.

Actress Jodie Foster, 47, (pictured) says bluntly, “It’s not my thing.” She’d rather hear people say she has a bad nose than say she had a bad nose job, she says.

“I’d rather have a comment about who I am than about something that identifies me as being ashamed of who I am,” Foster said.

Actress Meg Ryan, 48, (see slide show above) doesn’t say a lot about plastic surgery, but she has often been criticized for having excessive injections of filler to plump up her lips.

Dermatologist Dr. David Sire of Fullerton, for example, says he sees signs of filler around her mouth and in her lips. She is much fuller there, he says.

The cosmetic work is overdone, he says. “One of the keys of cosmetic enhancement is to leave the person looking natural. The goal is to look relaxed or refreshed, not changed,” Sire says.

Related links:

• A fresh new face for Madonna
• Injecting youth into Madonna, Sharon and Meg

Slide shows:

• Celebrity birthdays: Who’s another year older Nov. 19?
• Madonna from 1990 to now
• Top celebrity slide shows of all time
• Emmy awards game — Spot the Botox
• Secret nose jobs abound in Hollywood
• Then and now — Lindsay Lohan looks old at 23
• 10 years of perky Kelly Ripa
• Celebrity nose jobs: Some botched, some beautiful
• Stars’ botched plastic surgeries
• Victoria Beckham breast test

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Photos: The first and second pairs of photos at right and below are actual “before” photos and digitally manipulated “after” photos from iSurgeon. The similar pair of photos at the bottom of this file are from BodyPlastika. (Photos courtesy of Dr. Michael Salzhauer and Think Basis Inc.)

ALTERED REALITY

Plastic surgery on the iPhone? It’s not a silly as it sounds, but does it wreak havoc with people’s minds?

Cosmetic procedures aren’t actually performed on the phone, of course. Instead, the hoped-for outcome of plastic surgery can be depicted there in pictures that potential patients can modify and discuss with their doctor.

That’s how the iPhone programs are supposed to be used. But several local cosmetic doctors worry that any such image manipulation can give patients unrealistic expectations.

Issues confronting users of iPhone apps include:

• Are the apps basically marketing tools?
• Can a bulging belly be turned into a slim one, as two iPhone apps suggest?
• Are disclaimers needed?

Three iPhone apps were the topic of this week’s online “In Your Face CHAT”:

The Shafer Plastic Surgery App, developed by plastic surgeon Dr. David Shafer of New York. This program provides answers to questions about plastic surgery. It’s is free for a “Lite” version that answers as many as 1,000 generic questions. The price is $2.99 for a version that allows users to ask specific questions. Shafer responds daily by email, he says.

On the iPhone App Store, the free version averages a two-star rating (out of a total of five stars) from a total of 52 users. The upgraded version gets a three-star rating from five users. “Thousands and thousands” have been downloaded, Shafer says.

iSurgeon, developed by plastic surgeon Dr. Michael Salzhauer of Florida. It allows users to take photos from the iPhone and change them to see what plastic surgery possibly could accomplish. It also includes a game mode. Salzhauer is the author of last year’s book “My Beautiful Mommy,” aimed at helping children understand why a mother undergoes plastic surgery.

His app “is currently in review at the Apple Store, and by some mysterious formula, they will determine the release date. Based on past application approval times, it should be any day now,” Salzhauer said during the chat. The price will be 99 cents for a “Lite” version that stamps a virtual watermark on patients’ photos, or $1.99 for a version with no watermark.

BodyPlastika, developed by Think Basis Inc. of Toronto and Seattle. Like iSurgeon, the program allows users to modify photos so they can be presented to a plastic surgeon or emailed to friends as a joke.

“The goal is to allow people the opportunity to state their desire and then allow the surgeon the opportunity to speak to them about what is realistic and what is not,” Nick Dumitru, the company’s president and founder, told chat visitors. “It’s a way for surgeons and patients to better engage in the conversation to come to a mutually acceptable goal.”

BodyPlastika costs $3.99 from the iPhone apps store. It has a rating of 2.5 stars out of 5 stars, with only eight raters. About 100 apps have been sold so far, Dumitru said.

Shafer was absent during the chat because he had an unanticipated operation during the scheduled time. He later submitted comments about some of the issues discussed in the chat.

“With a low number of raters, the ratings are not statistically significant,” Shafer said of App Store ratings. “Also, if you erase an app off of your iPhone, you are asked if you would like to rate it. Therefore, the ratings are skewed towards those people who did not like the app and erase it off of their phone. For those who are using the apps, they have not been prompted to rate the app since they have not erased it.”

These issues were discussed in the chat:

UNREALISTIC EXPECTATIONS

Plastic surgeon Dr. John Di Saia of San Clemente and Huntington Beach told me before the chat: “Although I am comfortable with computing, I have never felt comfortable with showing patients [manipulated images]. I felt they would set people up for disappointment.”

App developers disagreed.

“Personally, I couldn’t imagine practicing without imaging software,” Salzhauer said. “They are incredibly useful. In fact we use very similar digital imaging in the office all the time as a way of communicating to patients about their goals with surgery.”

Shafer added, “Simulated images are great for giving the patient an idea of how they may look after surgery. I have to caution patients that what is achievable in a computer rendering is not representative of what can actually be produced in the operating room,” Shafer said.

Dumitru said, “Any tool a patient can use to communicate with the doctor is useful. Of course there will be a lot of passing it around to the friends as well beforehand. It’s all part of a person’s decision-making process. Whether they choose to use it for fun or a medical discussion is up to them.”

DISCLAIMER NEEDED?

Since iSurgeon and BodyPlastika can create unrealistic photos, I asked whether either app has built-in disclaimers. Neither one does.

The question originated with a comment from plastic surgeon Dr. Val Lambros of Newport Beach: “Some plastic surgeons use imaging like this. I don’t. I think it is kind of gimmicky and the doctors’ insurance companies require that docs who use this software to have patients sign a release saying that the results shown on screen are not the results that will be seen in life. It is much easier to manipulate electrons than it is to move skin and bones and healing.”

Shafer, whose app has no such photos, stated, “There should be a disclaimer that the ‘afters’ produced on the app are for entertainment purposes only and do not substitute the qualified opinion of a plastic surgeon.”

In his face-to-face consultations, Salzhauer said, “I always say, explicitly and in writing that the images are NOT a guarantee.”

“Dr. Guyuron in Ohio (one of my plastic surgery heroes) actually prints the words “NOT A GUARANTEE” right on the photo.

Dumitru said, “Colin, you do make a great point. We’ll be adding a disclaimer to the Web site later today to cover that point. I hadn’t thought that people would take the software so literally.”

TURNING A BULGING BELLY INTO A SLIM ONE

Dr. Christopher Zachary, chairman of the UCI Department of Dermatology, objected to a pair of iSurgeon photos (at top of this post) showing a dramatic reduction in a man’s protruding belly.

Lambros joked that he wishes that change were possible. “I would kind of like the belly shot myself,” he said before the chat.

“This is unobtainable,” Zachary said in advance comments. “Much of this abdominal girth in this image is probably [fat deep in the abdomen]. I would say that it would be impossible to deliver on this pre vs. post image.”

Shafer and Dumitru agreed.

“These are not realistic results that could be achieved through surgery,” Shafer said.

Salzhauer defended the photos, which came from him: “Regarding the intra-abdominal fat… It’s true, with liposuction you can’t get that degree of improvement, but you can get closer to the results you showed with a tummy-tuck. That allows one to tighten abdominal muscles and the like.”

Dumitru said the similar photos on his Web site (at right) “are designed to show what the app can do and not so much what can be achieved with surgery.”

MARKETING TOOL?

“Are patients more likely to go to a plastic surgeon if they have fiddled with their photo and created an image that they’d prefer?” I asked.

Salzhauer replied, “Yes. Most people — once they see what they could look like — they will be excited and motivated about doing something about it.”

Di Saia commented in advance, “These programs set up sales. They tend to improve revenue probably due to the ‘wow factor.’ ”

Because of the apps’ value as a marketing tool, Salzhauer said he should contact the American Society of Plastic Surgeons to see if it would support the two products.

For more discussion of these issues, see a gently edited transcript of the online “In Your Face CHAT.”

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This so-called “Bo-tax” proposal is a scaled-back version of a 10 percent tax on cosmetic treatments that the U.S. Senate Finance Committee reportedly considered during the summer,  then apparently dropped.

The tax would help pay for the overall health-care reform. An estimated $5 billion that the tax would raise “was needed to make the numbers work” in the health-care bill, according to an unnamed Democratic Senate aide cited on the Politico Web site.

Reid said that the bill would cost $848 billion over 10 years, but it would reduce projected budget deficits by $130 billion during that period because new taxes, fees, and a slowdown in the growth of Medicare would more than offset the costs.

The proposed tax would cover all “cosmetic surgery and medical procedures” that are performed by a licensed medical professional, excluding reconstructive surgery.  The bill defines cosmetic procedures as ones that are “not necessary to ameliorate a deformity arising from, or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or disfiguring disease.”

Many cosmetic doctors oppose the tax, which make their services more expensive.

In the summer, area doctors’ arguments against the proposal included:

• The tax would burden women disproportionately. Malcolm Roth, vice president of the American Society of Plastic Surgeons, said the tax would discriminate against women, since they account for 86 percent of cosmetic patients.
• Separating purely cosmetic treatments from reconstructive procedures would be difficult and would penalize people seeking to correct deformities.
• The tax would stigmatize cosmetic plastic surgery and send the message, “It is bad, like cigarettes or alcohol and therefore worthy of scorn and punitive taxation.”

Plastic surgeon Dr. Donald Altman of Irvine commented, “There is a notion that cosmetic surgery is a frivolous gesture for individuals who haven’t anything better to do.

“Cosmetic surgery patients are hard-working individuals who suffer all of the ups and downs and health problems that face the rest of us – such as heart disease, cancer, depression, hypertension, and so forth. …

“[Should these patients] pay a premium during a cycle in their lives when they want to do something good for themselves?”

The tax plan is on Page 2,045 of the Senate’s 2,074-page bill. The text of the tax proposal is printed below.

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This is the wording of the tax proposal:

SEC. 9017. EXCISE TAX ON ELECTIVE COSMETIC MEDICAL PROCEDURES.

(a) IN GENERAL.-Subtitle D of the Internal Revenue Code of 1986, as amended by this Act, is amended by adding at the end the following new chapter:

”CHAPTER 49-ELECTIVE COSMETIC MEDICAL PROCEDURES ”Sec. 5000B. Imposition of tax on elective cosmetic medical procedures.

”SEC. 5000B. IMPOSITION OF TAX ON ELECTIVE COSMETIC MEDICAL PROCEDURES.

”(a) IN GENERAL.-There is hereby imposed on any cosmetic surgery and medical procedure a tax equal to 5 percent of the amount paid for such procedure (determined without regard to this section), whether paid by insurance or otherwise.

”(b) COSMETIC SURGERY AND MEDICAL PROCEDURE.-For purposes of this section, the term ‘cosmetic surgery and medical procedure’ means any cosmetic surgery (as defined in section 213(d)(9)(B)) or other similar procedure which-

”(1) is performed by a licensed medical professional, and

”(2) is not necessary to ameliorate a deformity arising from, or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or disfiguring disease.

”(c) PAYMENT OF TAX.-

”(1) IN GENERAL.-The tax imposed by this section shall be paid by the individual on whom the procedure is performed.

”(2) COLLECTION.-Every person receiving a payment for procedures on which a tax is imposed under subsection (a) shall collect the amount of the

tax from the individual on whom the procedure is performed and remit such tax quarterly to the Secretary at such time and in such manner as provided

by the Secretary.

”(3) SECONDARY LIABILITY.-Where any tax imposed by subsection (a) is not paid at the time payments for cosmetic surgery and medical procedures are made, then to the extent that such tax is not collected, such tax shall be paid by the person who performs the procedure.”.

(b) CLERICAL AMENDMENT.-The table of chapters for subtitle D of the Internal Revenue Code of 1986, as amended by this Act, is amended by inserting after the item relating to chapter 48 the following new item:

”CHAPTER 49-ELECTIVE COSMETIC MEDICAL PROCEDURES”.

(c) EFFECTIVE DATE.-The amendments made by this section shall apply to procedures performed on or after January 1, 2010.

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The event is scheduled for noon to 1 p.m. Pacific time. CLICK HERE to drop in on the chat during those hours or to arrange for a reminder ahead of time.

Dr. David Shafer of New York will discuss the Shafer Plastic Surgery App, “the world’s first plastic surgery iPhone Application,” which provides answers to users’ questions about plastic surgery.

Dr. Michael Salzhauer of Florida will discuss his iSurgeon app, which allows users to upload photos, then change them to see what plastic surgery can accomplish. It also includes a game mode. Salzhauer is the surgeon who wrote the book “My Beautiful Mommy” to help children understand why their mother undergoes  plastic surgery.

I’ll ask the two doctors my own questions, but will also pose readers’ questions about plastic surgery in general or about the two iPhone apps in particular. Advance questions from readers will be accepted by email, Twitter and Facebook through mid-morning:

• Email cstewart@ocregister.com with “CHAT question” in the subject line; or
• Send a Twitter message referencing @InYourFace.
• Become a fan of the “In Your Face” page on Facebook and post a question on the Wall there.

Or simply join us online and ask your questions live, starting at noon Pacific time.

Because each “In Your Face CHAT” will be on the Internet, visitors can participate from anywhere - at 3 p.m. Eastern time or 8 p.m. London time, for example.

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Schedule of past and future “In Your Face CHATs”

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Photos: Above, country singer and actress Reba McEntire, who reportedly has had a facelift. Below, the expanded bust of actress Nicole Kidman has aroused suspicions that she has gotten breast implants. (Getty Images photos)

DOLLY PARTON IS JUST FOR STARTERS

Many country musicians are fond of plastic surgery, and the crowd at last week’s Country Music Association awards in Nashville was no exception.

Dolly Parton, the queen of country plastic, showed up early to celebrate the release of her “Live From London” DVD on Monday, Nov. 9.

On Wednesday, Nov. 11, participants and onlookers for awards ceremony included the following celebrities whose reliance on cosmetic medicine quickly became a topic of discussion:

• Actress Nicole Kidman (pictured at right), the wife of country singer Keith Urban. Pictures of her low-cut gown stirred up the blogosphere, with plastic surgeon Dr. Tony Youn concluding that she had gotten breast implants. But she told Ladies Home Journal that her breasts grew when she was pregnant last year, and have stayed large since then.
• Singers Naomi and Wynonna Judd. “It is rumored that both women have been under the knife for facelifts, browlifts, and eyelid lifts. In addition … they both seem to have had Botox and fillers added to their lips,” plastic surgeon Dr. Jennifer Walden told MakeMeHeal.com.
• Singer Kellie Pickler, who got her breast implants about two years ago. They were a sensation at last year’s Country Music Awards show. This blog’s slide show “Kellie Pickler breast implants in spotlight” remains the most popular one in the “In Your Face” archive.

See the new slide show “Plastic surgery, Nashville style” for a full report on those stars and also on:

• Barbara Mandrell
• Carrie Underwood
• Faith Hill
• Reba McEntire (pictured above)
• Martina McBride
• LeAnn Rimes
• Patricia Heaton
• Lee Ann Womack
• Taylor Swift

Not all of those celebrities have been plastic surgery patients.

The most prominent among the abstainers is Swift, 19, who was named Entertainer of the Year. She won that an award without help from cosmetic medicine.

Related posts:

• Plastic surgery enthusiasts at country music awards (April 2009)
• Kellie Pickler breast implants in spotlight
• Kenny Rogers regrets plastic surgery but is hopeful

‘KELLIE PICKLER BREAST IMPLANTS’ slide show

• MTV AND PLASTIC SURVEY — It plays a starring role at MTV awards show
• MILEY CYRUS — Age 16 going on 20
• KELLIE AND NICOLE — Pickler’s breasts, Kidman’s Botox

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The bleach explains the change in Sosa’s skin, which has occurred from May (the left-hand photo) to this month (the photo on the right).  It doesn’t explain why he would want to bleach his skin.

Sure, he wants to moisturize it, but plenty of moisturizers don’t change the skin’s color. Sosa’s choice of a bleaching agent might suggest that he has bought into the attitude that lighter skin is more attractive.

It’s an attitude that is pervasive in many cultures, and not just ones that are predominantly white. Among of natives of many Caribbean islands, lighter skin is often preferred.

In the Dictionary of Caribbean English Usage, for example, the definition for “light-skinned” is illustrated by this quote: “In Toronto, he would have called her ‘mixed,’ but at home, here, she would be regarded as one of the sought-after light-skinned women.” And this one: “In such a milieu, the light-skin guy … was an Adonis.”

A headline on  “The Root,” a Web site that presents “a variety of black perspectives,”  states that “Sammy Sosa’s new vampire complexion is a jarring reminder that, from the Dominican Republic to Dakar to New Delhi, white is still right, yellow is still mellow and if you’re black, get back.”  That article by Shiwani Srivastava adds:

To be fair, it’s certainly not just Sammy Sosa, the Dominican Republic and India. It’s Japan, Malaysia, Cuba, Iran, Britain, Singapore, Mexico, Sri Lanka … the list goes on and on. The skin lightening cream industry is a $432 million a year industry in India, $7 billion a year industry in China—and it’s growing globally.

A similar attitude is present in the United States.

In a blog elsewhere on “The Root,” writer Jada F. Smith states:

Black entertainment has made little progress in the last century when it comes to colorism. Both dark- and light-skinned blacks continue to be cast in roles that perpetuate stereotypes within our own community. Light-skinned people are good; dark-skinned people are bad. Light-skinned people live comfortably; dark-skinned people live in the projects.

Don’t believe that colorism is still seeping into our psyches? Read Monique Fields’ piece about her 4-year-old daughter who told her, “Brown people drive old cars.”

Smith sees the same attitudes cropping up in the highly praised film “Precious” and elsewhere in popular culture, where blacks sometimes discriminate against people whose skin is darker than a “brown paper bag”:

Call it overanalyzing, but is it a coincidence that Precious’ dark-skinned mother is physically and verbally abusive, her dark-skinned father is a drug addict who rapes her, and the main character herself is a dark-skinned 16-year-old mother of two? Meanwhile, the teacher, social worker and nurse who uplift and bring positivity into her life are all light-skinned. …

Pretty much every other Tyler Perry film has a dark-skinned male aggressor and light-skinned male savior (Shemar Moore vs. Steve Harris in “Diary of a Mad Black Woman” and Blair Underwood vs. Boris Kodjoe in “Madea’s Family Reunion.”)

When a character gets replaced on a sitcom, their complexion usually gets lighter (from Janet Hubert-Whitten to Daphne Maxwell-Reid on “The Fresh Prince of Bel-Air” and Jazz Raycole to Jennifer Freeman on “My Wife and Kids.”)

And the biggest black entertainers right now could probably all pass a brown paper bag test (Beyoncé, Rihanna, Halle Berry, Mariah Carey, Tyra Banks, Alicia Keys).

Plastic surgeon and blogger Dr. John Di Saia of San Clemente and Huntington Beach thinks Sosa has gone too far. “He is likely using hydroquinone with a good sun screen. Dramatic results (maybe too dramatic). … I would have liked it maybe half as light, but he didn’t ask me,” Di Saia wrote on his blog.

In an interview, Sosa told NPR that he might help the the product’s manufacturer with marketing. That would be a change from the typical pattern of denial that Srivastava cites:

The thing is, despite the popularity of skin lightening creams, no one wants to admit that they use them. …

Now it turns out [Sosa] may want to endorse the cream as a spokesman. Oh, Sammy. If he does, he’ll join the ranks of Bollywood superstar Shah Rukh Khan (think South Asian Tom Cruise, minus the Scientology), who came under fire for his advertisements endorsing a new skin lightening cream for men in India.

This would be yet another blow in the long line of attempts to spread the word that some people happen to like dark brown skin, thank you very much, from the Black Is Beautiful movement in the U.S. in the ‘60s and ‘70s to the recent Dark Is Beautiful campaign in India.

But Srivastava thinks Sosa’s acknowledgement of what he’s doing could be a positive step.

It might “start an important dialogue about what hydroquinone actually does to your skin, about treating skin conditions that really do affect people of color and about the difficulty of finding makeup as a brown woman—even today,”  Srivastava writes. “Maybe we’ll start talking honestly about our deeply rooted preferences and prejudices that make skin lightening a multi-billion-dollar industry worldwide.”

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