Dr. Ellenbogen's Plastic Surgery Blog

Kim Kardashian Plastic Surgery Rumors: Did She Get A Nose Job?

Thu, 07/31/2014

Kim Kardashian’s nose seems to be shrinking with each passing day. The “Kim Kardashian: Hollywood” app mogul, whose new endeavor is expected to make her millions, has a face that has changed a lot over the years, especially recently.

Kim Kardashian Face Before


Kim Kardashia After


Rumors circulated after Kardashian married Kanye West in May that she had had a “pre-wedding nose job.” Gossip Cop said a Kardashian circle source denied the rumor, but would the Kardashians really admit to plastic surgery? Probably not; and a plastic surgeon told Radar Online it was possible she has had more done to her face than the admitted Botox.

“Kim has transformed over the past eight years,” Dr. Anthony Youn told the news site. “I suspect that she may have had a rhinoplasty (nose job), as her nose looks thinner, shorter, and more refined now than it did in 2006. Her lips appear to be plumped with injectable filler such as Juvederm.”

It was rumored that West forbade his missus plastic surgery since his mother Donda died on the operating table while receiving cosmetic enhancements. But Youn believes Kardashian has resorted to whatever it takes to appear fresh and young.

“Her skin is flawless and looks better now than it did eight years ago! I suspect that she’s had multiple skin tightening treatments, like chemical peels and laser treatments. She may also be benefiting from filler injections in her cheeks, such as with the new Voluma,” he said.

Kardashian famously posted a picture of herself with blood on her face after she got a $1,500 “vampire facial” to help her look forever youthful. In essence, blood from her arm was extracted, the plasma was separated and then pumped into her face with Restylane or Juvederm. “Overall, she looks like she’s aging in reverse,” Youn added.

Aging in reverse is probably exactly what Kardashian wants people to think, but nature doesn’t work that way. Radar Online posted five pictures taken of her face side by side to see the drastic change in her face: one in 2006, another in 2008, 2012 and finally 2014. Click here to see the pictures, courtesy of Radar Online.

In a Star magazine article cited by Gossip Cop, Kardashian is said to have undergone her nose metamorphosis to mirror Charlize Theron. “She’s obsessed with Charlize Theron’s perfectly snubbed nose and wanted a similar profile,” a source reportedly told Star. “A family source claims that Kim had a top secret 4 a.m. nose job a few weeks before her nuptials,” the magazine added.

Korean Reality Show Aims to Undo Excessive Plastic Surgery

Thu, 07/31/2014

SEOUL, South Korea — The citizens of this hyper-competitive East Asian nation are the most cosmetically enhanced people in the world, going under the knife more per capita than Americans, Italians, Greeks and Brazilians.

Here in Apgujeong, a beauty belt in the glamorous Gangnam district, an untold number of South Koreans and medical tourists flock each year to hundreds of plastic surgery clinics. By California standards, packages of multiple procedures fetch bargain prices.

It is here that both male and female patients seek out an East Asian ideal of beauty: a softer, slimmer jaw, an eye lift, and a raised nose bridge — often on the assumption that better looks will land them better-paying jobs and loving spouses.

But what happens when a few insecure souls take their drive to an extreme, contorting and spoiling their youthful, angelic faces with a dozen operations?

One reality show is pushing back, calling for a more reasonable standard. “Back to My Face,” as the program is called (the show uses an English name, not a Korean one) gives addicts an opportunity to, ironically, go under the knife one last time to restore their natural beauty.

Each episode features four or five young women who’ve undergone 10 or more operations, along with a surgery-loving man who appears in the May debut. Contestants gather in a communal house and then mingle in the streets of Seoul, guided by the South Korean comedian Park Myeong-su and treated to a cameo by one naturally beautiful actress.

"Please just stop. You're beautiful, and you shouldn't get any more surgery"

A series of games, activities and intensively blunt discussions force participants to reflect on their choices and to muse on what it means to be beautiful. Will people accept me for who I am? Why am I trying to be somebody else? And worst of all, do I unknowingly look like everybody else, with the same oval eyes and pointed nose?

In one exercise, the contestants pull aside the pedestrians of Seoul, exhibiting “before and after” photos of themselves and asking what other surgeries they need. Cheeks? Eyelids? Nose? Jaw?

The response was friendlier than the reality show participants, timid and self-doubting, expected.

"Please just stop. You're beautiful, and you shouldn't get any more surgery," said one onlooker.

Image: Plastic surgeon Park Yong-joon treats a patient at the Wonjin cosmetic surgery in the Gangnam area of Seoul© LEE JAE WON / REUTERS / REUTERS

South Koreans are the most cosmetically enhanced people in the world, going under the knife more per capita than Americans, Italians, Greeks and Brazilians.

Other times, the conversations get intimate, with participants coming to the understanding that they’re under a “grass is greener” spell. “I’ve realized that the plastic surgery girls are too similar looking,” lamented one contestant, reflecting on her cookie-cutter face. “Now I think I was also good enough in the old days, too,” before her plastic transformation.

Each contestant later concludes with a declaration: either they’ll revert back to their old facial structure, proclaiming “back.” Or they’ll proclaim the word “stop,” staying with their post-surgery face.

The activities and discussions are intended to encourage patients to conquer their insecurities, said a spokesman. That’s the opposite of another popular reality show that follows around Korean women seeking more Gangnam-style plastic surgery.

Seoul's Gangnam District is the wealthiest neighborhood in South Korea, known as its "Beverly Hills" because of the concentration of wealth. An untold number of South Koreans and medical tourists flock to its Apgujeong section each year to visit one of the hundreds of plastic surgery clinics.

In chic urban Seoul, intensively competitive residents can succumb to an extreme take on “keeping up with the Joneses.” Some are insecure not just about their looks but try to live up to impossible standards on the whole. Ivy League degrees, elite corporate jobs, height, and a symmetrical whitish face are considered the zenith of human achievement.

South Korea is home to one of Asia’s biggest beauty scenes, partially the result of the intense pressure to succeed. Male makeup is a booming market, with many department stores selling the image of the smooth, milky complexions of K-Pop stars.

A few crazed addicts have already indulged too far in their love of cosmetic enhancements, inflicting grotesque and irreversible damage to their bodies. In one famous episode, a South Korean woman injected cooking oil into her face, bloating it. Months of futile surgeries could not repair her disfigurement.

From Kim’s Butt to Angelina’s Lips: The Plastic Surgery Procedures Women Want

Thu, 07/31/2014


According to data from a popular online cosmetic surgery community

Kim Kardashian Butt

Angelina Jollie Lips

Remember the woman who spent $30,000 to look like Kim Kardashian? Well, she’s certainly not the only person who has spent serious time and money t0 look like a celebrity — and Kim in particular. In fact, for women seeking cosmetic surgery, Kim’s butt is the most requested celebrity feature, according to data fromRealSelf.com, an online community where users come together to discuss plastic surgery procedures.

To determine which celebrity features are most popular, RealSelf scanned all its content pages to see which names users are mentioning the most when inquiring about procedures. So in other words, this data is more anecdotal than scientific, says Alicia Nakamoto, vice president of community at RealSelf.

To get a derrière like Kim’s, most women opt for the the Brazilian Butt Lift, which is a procedure that takes fat from one part of the body (like the abdomen, thighs or arms) and transfers it to the buttocks. The average cost is $6,725.

After Kim, here are the other most popular celebrity mentions of 2014, along with the corresponding body part or procedure:

  • Beyoncé – butt
  • Madonna – face and hands (anti-aging)
  • Angelina Jolie – cheeks, lips
  • Rihanna – skin lightening
  • Jennifer Lawrence – nose
  • Jennifer Lopez – butt
  • Kate Middleton – nose, smile
  • Julia Roberts – lips, smile

Every once in a while, a key moment in pop culture will cause a spike in celebrity requests. When Maleficent hit theaters, for example, more women began inquiring about Angelina Jolie’s cheekbones. When Snooki was popular (remember those days?) and got some work done to her teeth, people began asking about getting theirs as white as hers. And when Krista from The Bachelorette underwent a post-natal “mommy makover,” a surge of women began expressing interest in the procedure as well.

But for the most part, the majority of people discussing plastic surgery on RealSelf don’t reference specific famous people at all.

“Ninety-nine percent of the people do not want to look like a celebrity,” Nakamoto says. “They just want to fix something very personal and go on with their lives feeling more confident with themselves.”

Nicole Kidman’s Old Breast Implants Getting New Attention

Wed, 07/02/2014

It’s been about four years or so since Makemeheal.com first speculated that actress Nicole Kidman had received breast implants. Which means that for something like five years Nicole has managed to keep her plastic surgery secret. Yet all of a sudden others have caught on to Nicole’s full chest and her old breast augmentation is once again news.

Makemeheal.com has some thoughts on why Nicole’s breast implants is suddenly getting attention:

1)   previously her frozen face and consequential Botox denial were stealing all the attention so no one bothered to look below her neck

2)   Nicole is finally comfortable showing off her cleavage in low necklines and may have been covering up in the past so that people wouldn’t notice her sudden blossoming

Whatever the case may be, The National Enquirer has interviewed expert plastic surgeons who agree that Nicole has definitely had a small breast augmentation at some point.

Nicole Kidman

“It appears she has had a pretty impressive breast augmentation,” Plastic surgery guru, Dr. Anthony Youn, who has not treated Kidman said. “I suspect that she’s gone from a big a or small B to a full C (cup size)” he elaborated.

He goes on to say that the augmentation was a job well done.

“Overall I think it looks good, although maybe a touch overdone,” he said. “It’s also possible she still has some swelling.”

Dr. Fred Pescatore, author of The Hamptons Diet, who also hasn’t treated Kidman, believes she’s had some serious breast augmentation. “She hasn’t aged that much or gotten heavy so I feel they look like nice small implants,” he opined.

Given that folks are just now taken notice, yet another possibility is that, as Dr. Youn says, Nicole has had her smaller implants replaced with a larger size recently, so they really are still swollen.

Back in 2010, Dr. Youn blogged about Nicole’s bigger chest, saying:

On his blog, plastic surgeon Dr. Anthony Youn says, “These photos from NYDailyNews.com reveal what appears to be new breast implants. It would be very unusual for a woman as thin as she is to have breasts as full and round as those are. I haven’t seen her with obvious implants before, so she may be recently postop.”

Dr. Youn then explains why Nicole’s breasts appear so round and high, ” It can be quite difficult, even with today’s silicone gel implants, to create a really natural look in someone who has so little body fat, especially after she’s had children and the breast tissue has thinned. Now, a plastic surgeon can make matters worse (less natural-looking) by placing an implant that is overly round or doesn’t fit the person’s dimensions. Excess scar tissue (capsular contracture) can make the breasts look rounder and less natural, too.”

“Nicole has denied having plastic surgery in the past. I wonder if her denials will continue?”

It took years of public speculation and finger pointing for Nicole to finally admit that she uses Botox. However, despite evidence that Nicole got the injections on a regular basis, she only admitted to trying the dermal injectable.

Jennifer Aniston’s Beauty Secret May be Radiesse

Wed, 07/02/2014

Jennifer Aniston is no fan of Botox. But it seems that she may have a soft spot for plastic surgery after, despite her reputation for being a natural beauty and aging as naturally as possible. An older report from Ok! magazine says that while Jen may not find Botox to be a wonder treatment, she does like Radiesse, a filler fix for wrinkles.

In an interview with People magazine, Jennifer was asked whether she would prefer Botox or wrinkles, to which she responded, “Wrinkles.” Her response was taken to be a dig at the newly engaged Courteney Cox, Jen’s former Friends costar and real life bestie. While Jen reportedly stays hydrated with water and moisturizer, Courteney is beginning to resemble a plastic doll due to her Botox overuse.

Jennifer Aniston

Still, water and skincare products probably aren’t the only things that Jen does to stay young. Although she probably hasn’t done anything surgical, such as a facelift or eyelift, she has said that after trying Botox she didn’t like the results, as they were too harsh.

“I didn’t like the hard aftereffects,” Jen admitted after trying the treatment once.

“Aging naturally is beautiful,” says Jen.

Still, while Jen may not like the effects of Botox it seems that it hasn’t stopped her from trying other dermal injectables, such as Radiesse.

A source close to Jen tells OK!, “She’s had Radiesse.”

Apparently Jen uses Radiesse in select areas where her lines are the most prominent, in order to have the most natural possible results, include the lines around her mouth.

“She has it done long the marionette lines [the vertical lines that extend from the bottom of the nose to the chin],” says the source. “It is also injected ever so slightly into her lips to give fullness – but not a fake bee-stung look. It is done strategically to look natural and subtle and lasts up to eight months or so.”

Given that Jennifer has a reputation for aging naturally and using natural products, Radiesse likely appeals to the actress because in addition to filling in the areas where natural collagen has slagged off due to age, Radiesse actually promotes the production of natural collagen, reportedly as much as 20%, even after just one use.

In addition to Radiesse, Jen probably is being fairly truthful about the rest of her skincare regimen. She is said to drink as many as 12 glasses of water a day and given that she is frequently photographed with a water bottle in hand, it seems likely.

And in her role as a spokesperson for Aveeno products, Jen told E! News, “I always like to read labels so I know what’s going into our food and what’s going into our bodies. I thought it was really fun to see what’s going into our skin.”

She also emphasizes exercise as an important part of feeling good, in addition to looking great.

“It’s not about bikini season,” she told People magazine about her fitness routine. “It’s about being healthy. Of course we want to have toned skin and legs and muscles and all that, but it’s really just about feeling great.”

The painful quest for the perfect nose

Sat, 06/28/2014


Researchers claim to have found that the 'perfect nose' points upwards, just as the UK's nose job season gets into full swing. Radhika Sanghani reports

Nicole Kidman may have a 'perfect nose' as hers points upwards slightly
According to researchers women like Nicole Kidman may have a 'perfect nose' as hers naturally points upwards Photo: GETTY IMAGES

As teenagers, my girlfriends and I were all very conscious of our noses. We all cared about the way we looked and we wanted to be beautiful. We defined beauty from the way our favourite actresses, singers and models looked. It didn’t take long for us to realise that having a straight, small, slightly upturned nose was integral to being beautiful.

If you didn’t have that perfect nose, you had two choices: either accept your large, non-perfect nose and pray that the Roman look comes back into fashion ASAP, or get plastic surgery.

I opted for the first choice but many of my girl friends had nose jobs, or rhinoplasty, as it’s medically known. They all reached a point where the way their noses looked was making them so miserable that their parents eventually agreed to help them out. For some, it wasn’t a financial strain, but for others, it meant a few years of the family saving up for the procedure, which can cost between £3,000 - £7,135depending on the surgeon.

As someone who used to feel self-conscious about her nose - and grew up surrounded by girls who hated their noses so much that they went under the knife - I know how serious an issue this can be. It’s why I was really disturbed by a study that claimed to finally have the answer to what makes a perfect nose: a 106 degree angle between the nose and a woman’s face.

The study, which showed 106 people photographs of young, white women with varying nose angles, found that 106 degrees was considered to be the most feminine and “aesthetic” for a nose. Dr Omar Ahmed, of New York University, the lead author of the study, sounds thrilled to have found out what we constitute as beauty.

Too much pressure

I’m less thrilled. Young women and girls already face so many body image pressures on how they ‘should’ look, and this just doesn’t help. It turns women’s bodies into separate parts, and automatically makes every woman who doesn’t have a 106 degree angle nose – let alone one that faces downwards, dear god – feel as though her nose is very un-perfect.

Rebecca Adlington has said she's been bullied about her nose

The study promotes a dangerous mindset which ignores the fact that beauty is not just about angles – it’s about a person’s smile, laugh, personality and everything else. Ultimately, this study just turns the nose into another unattainable body part for young women, along with the 'thigh gap', flat stomachs and perky breasts.

But it’s especially worrying considering that we know young women are so bothered by their noses that they’re increasingly having rhinoplasty to help with their confidence levels.

Official statistics show that last year 3,841 women had rhinoplasty which was a 19 per cent rise from the year before. They don’t show an age breakdown, but Charles East, a consultant surgeon in facial plastic surgery and a member of the British Association of Aesthetic Plastic Surgeons, tells me he sees about 20 teenage girls a week wanting nose jobs.

More teens than ever

Scarlett Johansson's nose looks like it has a 106 degree angle

“It’s the most common operation among teenagers and it’s increasing,” he says. “There’s that age group where their parents have the means to pay for it before they go to college, or start a new job. At this time of year the office is full of parents saying, she’s finished her A-levels now so we want to get this done.”

His clients are either young girls who have support from their parents, acknowledging their daughter’s misery and just want her to be happy, or older women who have waited to establish themselves financially before changing the noses they’ve hated for a long time. The general trend for all women now is to have a subtle refinement, such as getting rid of the bump and refining the tip, to look “nice and natural”.

He tells me there are even racial preferences – which is something that Dr Ahmed’s study ignores by only focusing on Caucasian women – for noses. Chinese people typically want a "nasal bridge built" while "the white Anglo Saxons don’t like the bump and want a more feminine profile".

"People with a more Mediterranean look with a broad nose want a smaller nose with a more refined tip," Mr East explains.

With young girls who come to him, he tells me they don’t like their faces when they look in the mirror and many hate having their photo taken. I remember this from my school days, where we larger-nosed girls had an automatic fear of side-profile photos.

Selfie panics

Miley Cyrus taking a selfie

We’d spend hours de-tagging them from Facebook, which fits in with a recent study from the American Academy of Facial Plastic and Reconstructive Surgerywhich found one in three facial plastic surgeons saw an increase last year in patients who were more self aware about their looks because of selfies and social media.

When you’re photographing your face on a daily basis, you do start to notice that your Instagrammed selfie doesn’t look like Cara Delevingne’s because your nose is twice the size, and for a lot of girls that does create serious anxiety. We’ve moved away from a world where women are only shown beauty standards in magazines and movies – in this digital age you can see unattainable, photoshopped women everywhere you look.

It means that young women are facing more pressures than ever before. When you add 'scientific studies' claiming that there is such a thing as a ‘perfect nose’ to those pressures, it’s seriously disconcerting. Most teenagers trust science, and if they see a study showing that 106 degrees is the must-have for a nose, those with lower self-esteem may start to want surgery.

There’s obviously nothing wrong with people having nose jobs if that’s really what they want, but if they’re being pressured into having them, then that is a problem. Young women don’t need to be told they should look a certain way – especially one that ignores every race other than Caucasians – because for most of us, that’s impossible. This new photo project proves just how different perceptions of beauty around the world really are.

Instead, we all need to be reminded that it doesn’t really matter what angle your nose is from your face, so long as it does its job and lets you breathe. And that, above all, 'perfect' is a fiction constructed by savvy plastic surgeons on the hunt for work.


Scarlett Johansson, Kate Middleton, Kate Beckinsale, Jessica Biel have the ideal nose

Fri, 06/27/2014

New findings published in the JAMA Facial Plastic Surgery journal concluded that the ideal nose for a white female features a slight tilt upwards. Specifically, 'a rotation of 106 degrees (columellar facial angle) was found to be the most aesthetic' -- while a nose that tilted slightly downwards of 90 degrees was found to make the face appear 'droopy.'

According to the The Telegraph, '[Scientists] used digital portraits of young white women aged 18 to 25 years, which were ranked online by almost 4,000 men and women drawn from the same age group. They were asked to compare photos of women with noses 96, 101, 106, 111 and 116 degrees to their face.'

Plastic surgeons claim that four well-known female celebrities fit the bill, according to The Daily Mail:

Scarlett Johansson:

Scarlett Johansson

Scarlett Johansson during 'The Black Dahlia' Los Angeles Premiere - Arrivals at Academy of Motion Picture Arts and Sciences in Beverly Hills, California, United States. (Photo by Jon Kopaloff/FilmMagic)

Kate Beckinsale:


Actress Kate Beckinsale arrives at the 2013 Vanity Fair Oscars Viewing and After Party on Sunday, Feb. 24 2013 at the Sunset Plaza Hotel in West Hollywood, Calif. (Photo by Jordan Strauss/Invision/AP)

Jessica Biel:

BEVERLY HILLS, CA - NOVEMBER 20: Actress Jessica Biel arrives at the Premiere Of Fox Searchlight Pictures' 'Hitchcock' at AMPAS Samuel Goldwyn Theater on November 20, 2012 in Beverly Hills, California. (Photo by Frazer Harrison/Getty Images)

The Duchess of Cambridge:

The Duke And Duchess Of Cambridge During A Visit To A Inner City Arts Youth Project, In Los Angeles, Usa. (Photo by POOL - Julian Parker/UK Press via Getty Images)

Kate Middleton's perfectly angled nose is also reportedly the most requested with plastic surgeons. An article published on The Huffington Post in January of 2013 alleges that 'Britain's biggest cosmetic surgery provider Transform reported ... that Catherine's nose was the most-requested celebrity facial feature in 2012.'

Published within the findings, the study's first author Dr Omar Ahmed of New York University said: 'Throughout history artists and scholars have been engrossed in the pursuit of capturing what constitutes beauty. ... To our knowledge this is the first population-based study to attempt to simultaneously determine the ideal NTP -- nasal tip projection -- and rotation.'

Selfie surgery: The face of plastic surgery is changing, skewing younger

Thu, 05/01/2014

INDIANAPOLIS – When we talk plastic surgery, our minds can often wander to perceptions of middle-aged women looking to become young again, but hold on. There’s a younger crowd hitting the operating room. It’s a growing trend of “selfie surgery.”

It’s the photographic phenomenon that’s now a part of our daily lives. So much so, the world selfie showed up in the dictionary last year.

The cellular self-portrait doesn’t discriminate. From girl to guy, chances are you’ve snapped one to show off your goods on social media.

These pictures pop up everywhere, all the time, piercing us in ways you might find shocking.

“I think that some people are surprised by the fact that younger people are undergoing cosmetic surgery than we’ve seen in the past,” said Dr. Scott Shadfar, a facial plastic surgeon with Meridian Plastic Surgeons in Indianapolis.

Call it the selfie effect. Plastic surgeons are.

“I’ve seen this certainly in the last two or three years be more prominent. People just more and more are referring to, well, I saw myself in this picture,” said Dr. Stephen Perkins, a facial plastic surgeon with Meridian Plastic Surgeons in Indianapolis.

An annual poll of facial plastic surgeons revealed a new trend. The “selfie” is sliding people under the knife, especially those under thirty. The photos arm them with awareness of cosmetic oddities they’d like to change.

“People are sharing their images more, and they want to look as good as they can when they’re sharing those images,” he said.

Rachel Bradney is 19 years old, from Carmel, and now goes to college in Florida.

“I love the outcome. I love my new nose,” she said.

When she was 18, she got a new nose, a feature she admits she never liked through her teenage years.

“It was just really big. Honestly, it was just really big and didn’t have a lot of shape to it, and so I kind of had it smaller and added a little bit of shape to it,” said Bradney.

Pictures show the change, and though the teen said for her it wasn’t all about the “selfie,” she admits other photos online posed pressure.

“I don’t feel like it’s possible for that not to have an affect,” said Bradney.

Dr. Stephen Perkins said a nose job and work around the eyes are two increasingly common procedures. Perkins contends patients don’t make decisions based solely on photos, but the pictures play to their lingering desires.

“Is it just a whim motivation which you’d maybe associate with a glance at a selfie, or is it an I’ve always wanted it done, but now I’m seeing it in a different light? Or an I’m getting a little older, and it seems to be more prominent to me,” said Perkins.

Tightening up those features doesn’t come cheap. A nose job costs between $5,000 and $10,000 not counting anesthesiology fees. Surgeons said psychologists refer some patients, and intense consults are an integral part of the process.

And as for any dangers or the perception of unnecessary surgery, Dr. Scott Shadfar said the knife doesn’t cut unchecked.

“I think that we have to, as physicians, have some discretion as to what patients qualify for these types of procedures. And that’s a discussion you have with the patient when they come in, and we counsel them appropriately,” he said.

There are even apps out there that can slim down your photos. We found one called SkinneePix that trims from five to fifteen pounds off your pictures.

But all this personal self-promotion doesn’t sit well with clinical psychologist Dr. Shelvy Haywood Keglar.

“I think it kind of gets to another level of vanity in our society,” said Keglar.

Keglar said the lack of image acceptance these days leads us down a dangerous road.

It used to be Hollywood celebrities with photos everywhere, searching for that perfect face. Now, with the selfie, Keglar said we’ve all become famous in our own worlds, and the added attention has an effect.

“The constant looking at yourself or sending it to someone reinforces that’s not the way I want it to be. I need to change my nose. I need to change my lips. I need to change something,” he said.

Keglar said people have two basic needs, feeling loved and important. Selfies and photos in general satisfy our insecurities, until we see something we don’t like.

“I think that’s why it’s such a big thing with folks today. It helps promote that need and fulfill that need,” he said.

So maybe there’s more to a selfie and all those Facebook photos than just the harmless point and click. They are power-packed pictures, changing the way we look at ourselves and altering who may be sitting in the surgeon’s chair in the years to come.

“This will definitely shape the future in terms of the youthful population that we will be seeing seeking treatment for cosmetic surgery,” said Dr. Scott Shadfar.

National stats from a facial plastic surgeons group show 14 is the earliest age someone can undergo a rhinoplasty, also known as a nose job.

Some nose jobs are considered cosmetic, while others may be covered by insurance if there’s a medical need.

Despite the pros and cons, psychologists said parents should have a talk with their kids about the online photo phenomenon and its effect on body image.

Read more: http://fox59.com/2014/04/30/selfie-surgery-the-face-of-plastic-surgery-is-changing-skewing-younger/#ixzz30UhjwLHO

Read more at http://fox59.com/2014/04/30/selfie-surgery-the-face-of-plastic-surgery-is-changing-skewing-younger/#uivIBMLP58zMZrWK.99

Zafirlukast (Accolate): A New Treatment for Capsular Contracture

Tue, 04/29/2014

From Aesthetic Surgery Journal, the Official Publication of the American Society for Aesthetic Plastic Surgery

by S. Larry Schlesinger, MD; Richard Ellenbogen, MD; Michael N. Desvigne, MD; Steven Svehlak, MD; and Robert Heck, MD

Background: Capsular contracture after breast augmentation or reconstructive breast surgery is a difficult problem. Previous studies have suggested that alteration of the inflammatory response could have a role in reducing the incidence of capsular contracture. Objective: We report a series of patients with Baker class III or IV capsular contracture who underwent treatment with zafirlukast. rlukast.

Methods: Patients received a regimen of zafirlukast 20 mg by mouth 2 times daily for 3 months.

Results: In many cases, dramatic softening of the breast capsule was evident after 1 to 3 months of treatment.

Conclusions: Zafirlukast appears to effectively soften early capsular contracture and may prevent the formation of capsular contracture in those patients at risk. (Aesthetic Surg J 2002;22:329-336.) Implantation of a silicone elastomer outer shell filled with either saline solution or silicone gel is an accepted, safe, and effective method of augmenting or reconstructing the breast mound. A difficult problem often encountered after implant placement is that of capsular contracture.

Capsular contracture has been defined as a thickened periprosthetic scar engulfing the implant that results in a hard, distorted, often painful, breast.’ It is not a complication but an exaggeration of a normal physiological response after breast augmentation. The “normal” physiological response that occurs after implant placement is an inflammatory foreign body reaction that results in a collagen capsule surrounding the implant.2 The factor or factors determining the severity of this response are not completely understood. Many local factors have been believed to produce an increased inflammatory response, such as hematoma, infection, trauma, and silicone implant leakage. To date, we have not always found a specific cause in each case of capsular contracture encountered. However, most investigators agree that the degree of contracture is associated with an acceleration or prolongation of the inflammatory process. Examination of histologic specimens elicits the myofibroblast as a culprit. In particular, it appears that the phases of fibroblast proliferation and collagen deposition are exaggerated in cases of capsular contracture, as shown by the increased capsular collagen content found in patients who underwent capsulectomy for severe (Baker class III or IV) contracture.

The incidence of capsular contracture reported has been quite variable (2% to 30%). The use of textured implants placed submuscularly has lessened the incidence.3,4 Additionally, several studies in recent years have suggested methods to help decrease the risk of capsular contracture.5-8 These discussions, although helpful, still leave the question of what causes capsular contracture unanswered. Ersek2 attempted to alter the physiological response in patients with evidence of capsular contracture by treating these individuals with localized steroid irrigation. He reported a remarkable improvement in 165 patients over 6 months with continued improvement up to 18 months. This study demonstrated that the degree of contracture could be reduced by altering the body’s immunologic response. In another study, Miller et a19 used an animal model of 90 Sprague-Dawley rats to show that an alteration in the immunologic response resulted in a change in the capsule thickness, cellular component, and collagen organization of the periprosthetic capsule. The problem with such treatment is that the risks of steroid use are not insignificant. Most surgeons avoid the use of steroids (either systemic, intraluminal, or pocket irrigation) because of the potential long-term complications. However, the theoretical gain from immunomodulation has merit, particularly if immunomodulation can target the key inflammatory reaction responsible for producing an exaggerated fibrotic response.

The Development of Zafirlukast

In 1979, the term “leukotrienes” was given to a family of lipid mediators that were derived from their cell source (leukocytes). Specifically, identification of “the slow-reacting substance of anaphylaxis” led to identification of several additional inflammatory mediators.1° Arachidonic acid, a constituent of cell membranes, is released by phospholipase A2 in response to a number of biologic signals. Once released, arachidonic acid can follow at least 2 metabolic pathways. One of these is the 5-lipoxygenase pathway, which gives rise to the cysteinyl leukotrienes (LTC4, LTD4, and LTE4). These potent mediators have been shown to cause an eosinophyllic influx. After identification of these inflammatory mediators, efforts were made to develop a structurally similar analog that could modulate and perhaps halt the inflammatory process.11

In November 1996 the Food and Drug Administration approved the use of zafirlukast (Accolate; AstraZeneca Pharmaceuticals, Wilmington, DE), a leukotriene receptor antagonist (LTRA), for the treatment of asthma. This class of drugs has the unique ability to prevent asthma symptoms rather than treating an attack once it occurs. In vitro studies have demonstrated that zafirlukast inhibits the eosinophilic influx and contractile activity of smooth muscle in all 3 leukotrienes (LTC4, LTD4 and LTE4) in both humans and laboratory animals. Additionally, studies have shown that in sheep, zafirlukast also suppresses the eosinophilic response, resulting in a decrease in bronchial “hyperresponsiveness.” From November 1996 through 1998, zafirlukast tablets were prescribed more than 4 million times. Zafirlukast 20 mg administered by mouth 2 times daily is indicated for the preventative and long-term treatment of asthma in adults and children 12 years of age or older. Generally, it is well tolerated, although reported side effects may include headache (12.9%) and nausea (3.1%).12-14

A Link to Capsular Contracture

A series of accidents contributed to the discovery of zafirlukast’s effects on capsular contracture. In 1996 a local pharmacist, who was of Spanish descent, mentioned to the senior author (S.L.S.) that since he started his asthma medication, he noted a significant improvement in his previously pigmented scars. He said the medicine was a new type of antiinflammatory agent, zafirlukast. The senior author began using zafirlukast to help minimize hyperpigmentation seen after laser resurfacing in Asian and darker-skinned patients. Then in 1998, he saw a patient in whom a capsular contracture (Baker III) developed after an elective breast augmentation was performed 2 months earlier. She explained that she did not want to go through any additional surgery. She had already been taking vitamin E and performing breast massage daily. It was at that moment that he considered zafirlukast, thinking that perhaps by working on the early inflammatory process, zafirlukast might affect the later stages that lead to capsular contracture. After 1 month of therapy, the breasts softened. After 3 months, the patient returned to Baker class I. The senior author continued to selectively prescribe zafirlukast to those patients in whom capsular contracture developed and who did not desire surgery.

Another author (R.E.) first heard of the effectiveness of zafirlukast for treating capsular contracture from the senior author. Before he could begin using it in his own practice, he found confirmation of its effectiveness from a patient who was scheduled to undergo an open capsulectomy for a Baker class IV unilateral capsular contracture.

This patient had already undergone surgery for severe capsular contracture that then recurred within 60 days. When she presented for surgery, the surgeon was unable to determine which side required the procedure. The patient then informed him that in the interim since her last visit, the breast capsule had softened significantly after her primary care physician had initiated treatment with zafirlukast, 20 mg by mouth, for her asthma.

The authors report a series of cases in which zafirlukast was given for capsular contracture after breast augmentation or reconstruction. In these cases, the medication was prescribed only after capsular contracture was noted and documented by a physician. In many cases, after a therapeutic trial of zafirlukast 20 mg by mouth, twice daily for 3 months, the patients and surgeon appreciated a dramatic improvement of the contracture, defined by the softening and improved appearance of the breast. In some cases, patients who otherwise would have undergone surgical intervention were treated successfully with zafirlukast.

Case Studies

Patient 1

A 33-year-old white woman with bilateral hypomastia presented for augmentation mammaplasty. The patient was a nonsmoker without significant medical history and with no previous breast surgery. The examination showed small breasts bilaterally with no ptosis. Before surgery, the patient received the antibiotic cefazolin 2 g.

The patient underwent bilateral transaxillary endoscopic subpectoral augmentation with Mentor Contour profile saline solution—filled, smooth 450-cc implants (Mentor Corp., Santa Barbara, CA) (right, 490 cc; left, 480 cc). JP 7-mm drains (Allegiance Healthcare Corp., McGaw Park, IL) were inserted.

As part of her postoperative care, the patient received cephalexin 500 mg by mouth, 4 times daily for 7 days, and an Ace wrap band. The drains were removed on postoperative day (POD) 3, and the sutures were removed on POD 5. The patient also received vitamin E and breast massage.

The breasts remained soft until 4 years and 2 months later, when Baker class III capsular contracture developed in the left breast. The right breast remained soft (Baker class I). The patient was placed on zafirlukast 20 mg by mouth 2 times daily. One month after initiation of treatment, the left breast was softer . Three months after treatment began, the left breast was Baker class I, and remained so at 4 months after initiation of treatment.

Patient 2

The patient was a 19-year-old white woman with bilateral hypomastia and no history of previous breast surgery. She smoked 1 pack of cigarettes per day. The examination showed small breasts bilaterally without ptosis. Before surgery the patient received the antibiotic cefazolin 2 g.

The patient underwent bilateral transaxillary endoscopic subpectoral breast augmentation with Mentor Contour Profile saline solution—filled 350-cc implants (right, 380 cc; left, 380 cc). JP 7-mm drains were inserted.

As part of her postoperative care, the patient was treated with an Ace wrap band. The drains were removed on POD 3, and the sutures were removed on POD 5. The patient also received vitamin E and breast massage.

Two weeks after operation, bilateral Baker class III capsular contractures developed. The patient was given zafirlukast (Accolate) 20 mg by mouth 2 times daily, for 3 months. Two months after initiation of treatment, both breasts were significantly softer (Baker class II). After 3 months of treatment, both breasts were Baker class I, and she was taken off medication. At the patient’s most recent follow-up examination, S months after she was taken off medication, both breasts remained Baker class I.

Patient 3

The patient was a 42-year-old white woman with bilateral hypomastia and mild breast ptosis. She had a history of eczema but was otherwise healthy. The patient was a nonsmoker with no history of previous surgery to the breasts. The examination showed bilateral hypoplastic breasts with grade II ptosis. Before surgery, the patient received cefazolin 2 g.

The patient underwent Benelli mastopexy with subpectoral augmentation with Mentor smooth round 200-cc implants (right, 200 cc; left, 210 cc). JP 7-mm drains were inserted. Suction-assisted lipoplasty of the hips, abdomen, back, and axilla was also performed.

After operation the patient was treated with cephalexin as in case 1 and a Warner bra (Warner’s, New York, NY). Drains were removed on POD 3, and the sutures were removed on POD 6. PDS deep sutures (Ethicon, Inc., Somerville, NJ) required removal because of “spitting.”

Three months after operation, redness developed at the left nipple that was believed to be a “reaction to a suture.” At S months after operation, a lump developed on the right breast that required surgical excision. The lump was identified as an inclusion cyst. The patient was placed on cephalexin therapy. Five days later, she noted increasing firmness of both breasts. Two weeks later, after a local infection developed at the right nipple, she was taken off cephalexin and placed on wide-spectrum antibiotics. One month later (7 months after operation) all incisions were healed, but severe capsular contracture (Baker class IV) was evident in both breasts that required surgical intervention. Before the second procedure the patient was given cephazolin 2 g.

The second procedure was an open capsulotomy and implant exchange with PIP High Profile 230-cc implants (PIP America, Santa Barbara, CA). JP drains were placed.

After operation, once again the patient was treated with cephalexin and a Warner bra. The drains were removed on POD 3, and the sutures were removed on POD 6. The patient also received vitamin E and breast massage.

Twenty days after operation, the patient noted increasing firmness of both breasts. The patient continued breast massage and vitamin E therapy. At 4 months after operation, severe capsular contracture of the left breast developed (Baker class IV). The right breast remained soft (Baker class I). The patient was placed on zafirlukast, 20 mg by mouth 2 times daily. One month after initiation of treatment, the left breast was much improved (Baker class I).

Patient 4

A 39-year-old Hawaiian woman was diagnosed with infiltrating ductal carcinoma in the left breast in June 2000. She underwent a modified radical mastectomy with immediate reconstruction with placement of a tissue expander. Pathologic study revealed 1 of 12 nodes positive for tumor, stage III disease. After operation, the patient received chemotherapy (doxorubicin, cyclophos-phamide, paclitaxel) and was also placed on a study protocol for trastuzumab. In February 2001, she underwent exchange of the tissue expander for a McGhan textured saline-filled implant placed submuscularly. Six weeks after implant placement, the patient received local radiation therapy to the left breast (5000 rads total).

Immediately after radiation therapy, she noted redness and blistering of the skin surrounding the left breast. Three weeks after therapy, the patient noted hardening of the left breast mound. This quickly progressed to a Baker class IV capsular contracture at 5 weeks after radiation therapy. The patient was treated initially with breast massage and vitamin E therapy without relief. She was referred by her surgical oncologist and reconstructive surgeon for possible treatment options.

On initial examination, the patient had a Baker class IV capsular contracture of the left breast. She was placed immediately on zafirlukast, 20 mg administered by mouth 2 times daily. Two weeks after the initiation of treatment, both the patient and the physician noted dramatic softening of the breast implant. After 1 month on zafirlukast the pain and distortion had resolved, and the implant was “soft,” approaching a Baker class I. In addition, the patient appreciated a significant improvement in the mastectomy scar, which she described as extremely hard and firm before initiation of zafirlukast therapy.

Patient 5

A 54-year-old Japanese-American woman underwent augmentation mammoplasty in 1986 in which 250-cc silicone implants were placed on each side above the muscle. After operation the patient had no complications. The breasts remained soft for 5 years.

In 1991 the patient noted increasing firmness in both breasts. She received no treatment at that time. Seventeen years after surgery, she presented for possible surgical intervention. On examination, she was noted to have Baker class IV capsular contractures bilaterally. She was placed on zafirlukast 20 mg administered by mouth 2 times daily. Three weeks later, the patient noted some improvement of the softness of both breasts. At 3 months after therapy was initiated, she had improved from Baker class IV to a class III in the right breast and class II on the left.


Capsular contracture is a common problem after placement of breast implants for augmentation or reconstruction. The precise mechanism by which the body produces this response to the implants is unknown. What we do know is that an inflammatory response occurs that results in periprosthetic fibrosis. The severity of this response appears to determine whether a patient will exhibit distortion or a painful periprosthetic scar.

Once capsular contracture develops, the current recommendations for treatment are breast massage, oral vitamin E therapy, and, lastly, surgical intervention.ls However, most surgeons agree that the best treatment for capsular contracture is prevention. It is difficult to predict which patients may have severe contracture. Certainly, a patient with development of a postoperative infection or hematoma would be at risk. Additionally, one might also consider those patients with a history of hypertrophic scarring to be at risk for significant contracture after breast augmentation. This “high-risk” group of women may benefit from prophylactic intervention that would decrease the inflammatory response.

Early intervention and prophylactic intervention appear to be the best means of decreasing the incidence of significant capsular contracture. Historically, surgeons have avoided the use of steroids in the treatment or prevention of capsular contracture because of the inherent risks. However, a more targeted approach that focuses on limiting the inflammatory response may prove more efficacious and safe. LTRAs have proven to be safe and efficacious for the treatment of asthma. Their antiinflammatory characteristics target early cellular-mediated proliferation without producing a generalized immunosuppression.

Possible Mechanisms of Action

The role of the macrophage and the mast cell may be particularly important in the physiological mechanisms by which LTRAs inhibit capsular contracture. Myofibroblasts having the properties of both fibroblasts and smooth muscle cells have been suggested as the cause of excess collagen production and extracellular matrix deposition.16-21 In addition, in 1981 Baker et a122 specifically credited the myofibroblast as the probable cause of capsular contracture. They postulated that drugs that inhibit myofibroblast smooth muscle activity would be beneficial in preventing capsular contracture.

If indeed the myofibroblast is responsible for the exaggerated collagen deposition and the resultant smooth muscle activity postulated in capsular contracture, perhaps immunomodulation at the cellular level can reduce capsular contracture. These mechanisms include inhibition of the macrophage and mast cell response. First by reducing the cellular response of SRS-A (substance of anaphylaxis) (Figure 1, A), the “histamine-like” response generated by eosinophills, mast cells, neutrophils, and lymphocytes will be inhibited. Second, by preventing monocyte activation, cytokine and growth factor release, and the production of superoxide radicals, the inflammatory cascade will be reduced significantly (Figure 1, B).10’23’24

A report by Niessen, et al 18 suggests that the macrophage is a pivotal intermediary between the inflammatory phase and scar formation. The macrophage release of fibroblast activating cytokines, transforming growth factor—(3, platelet-derived growth factor, and interleukins is important in collagen production, organization, and extracellular matrix degradation. Niessen et a118 suggest that all of the cellular and immunologic processes, not just fibroblast activity alone, are important in the formation of excessive scar tissue. The relationship between mast cells and scars is also suggested, as mast cells are found among dermal collagen bundles and are found in higher numbers in hypertrophic versus “normal” scars.23 The mast cell response is characterized by histamine-like activity, which is capable of stimulating collagen formation and is notably increased in keloid tissue. The result is an increase in the collagen matrix found in scar tissue. This response is directly inhibited by LTRAs and would appear to reduce the rate of capsular contracture.

The important role of the macrophage and mast cell in wound healing is generally accepted. However, although their role in the formation of capsular contracture is suggested, it is not completely understood. We believe that both myofibroblast smooth muscle contractility and prolonged collagen deposition may be involved in the development of capsular contracture. If so, reducing the activity of the macrophage and mast cell may prove to be useful. Use of LTRAs to diminish the early inflammatory process led by the macrophage and mast cell may indeed impede further cellular mechanisms, such as myofibroblast activity, fibroblast proliferation, and collagen deposition as depicted in Figure 2. The precise mechanism by which zafirlukast reduces or prevents capsular contracture is not completely clear and deserves further investigation.

Zafirlukast Versus Montelukast

One author (R.E.) discovered that montelukast (Singulair; Merck & Co, West Point, PA), a pharmacologic agent similar to zafirlukast but requiring only a single dose at bedtime, also reduced the incidence of capsular contracture. Its effectiveness came to light after a patient with capsular contracture saw her breast capsule decrease from Baker class III to Baker class I during the 6-week period after she began taking montelukast to treat her chronic rhinitis. The physician began using montelukast both prophylactically and to treat newly established contractures. Although it did not completely eliminate production of a firm capsule, the incidence of contracture fell significantly, and those that did form were easily reduced through early recognition and treatment with closed compression. Moreover, women with Baker. class IV contractures who received montelukast noted subjective improvement with decreased pain and increased upper arm mobility.

The authors compared results after treatment with zafirlukast and montelukast and found that although the mechanisms of action and immediate results attained with both agents were similar, slightly better response rates were obtained in patients treated with zafirlukast. The likely explanation for this difference is that zafirlukast blocked all 3 of the leukotriene receptors whereas montelukast blocked only 1.


Capsular contracture after breast augmentation is not an uncommon problem. The best treatment is prevention. Although we do not completely understand the cause of capsular contracture after breast augmentation or reconstruction, an exaggerated inflammatory response does occur. The role of specific cells such as the macrophage or mast cell is not completely defined but suggested. Alteration of the immunologic response of the macrophages and mast cell with LTRAs may alter the inflammatory cascade just enough to prevent the severe fibrotic reaction that occurs with capsular contracture.

We have noted a statistically significant decrease of the capsular contracture rate from 4% down to 1 % after the introduction of zafirlukast to our practice. The senior author has been treating capsular contracture with zafirlukast for approximately 3 years. We have found that it is very effective in the treatment of capsular contracture detected early (less than 6 months after onset) and as prophylactic treatment in patients considered at high risk. “High risk” is defined as those patients with a history of previous capsular contracture, periprosthetic infection, or hematoma or patients with a propensity to form hypertrophic scar. Additionally, to our surprise, zafirlukast has been used successfully to treat established capsular contracture, including contracture after radiation therapy. In our practice, the need for surgical intervention to treat significant capsular contracture (Baker class III or IV) has been significantly reduced since zafirlukast was prescribed. The experience of other authors (R.E., S.S.) is anecdotal but also indicates that zafirlukast dramatically reduced the incidence of capsular contracture after breast augmentation and is effective in softening established capsules, particularly those identified and treated within 6 months. Our experience thus far has shown zafirlukast to be effective after the patient has been taken off therapy, although the length of time it remains effective is uncertain.

For those patients with longstanding (1 year or more) severe capsular contracture (Baker class III or IV), surgery remains the treatment of choice. However, in patients with longstanding contracture who are not surgical candidates or do not desire surgical intervention, zafirlukast has been effective in reducing pain and distortion of the breast capsule.

The precise mechanism by which the LRTAs decrease or prevent capsular contracture warrants further investigation. In addition, longer follow-up results are needed to determine the long-term effect of capsular contracture prevention and treatment. The indications and use of zafirlukast for capsular contracture will be better defined as we learn more. However, we suggest that there is a role for immunomodulation by the LTRAs in the prevention and early treatment of capsular contracture. Specifically, we view zafirlukast as a potential contender as we continue the “fight” against capsular contracture after breast augmentation or reconstruction.

Reality TV producer Triana Lavey was a big fan of taking selfies, and would use photoshop apps like Perfect365 to make herself look flawless.

Sat, 04/26/2014

Reality TV producer Triana Lavey was a big fan of taking selfies, and would use photoshop apps like Perfect365 to make herself look flawless.

“Your social media presence is just as important as your real life presence,” she toldABC News.posted on April 26, 2014 at 4:31pm EDT

BuzzFeed Staff

Reality TV producer Triana Lavey was a big fan of taking selfies, and would use photoshop apps like Perfect365 to make herself look flawless.

Reality TV producer Triana Lavey was a big fan of taking selfies, and would use photoshop apps like Perfect365 to make herself look flawless.

But Lavey constantly felt self-conscious about how she looked in pictures, and decided to take the next step in her search for the perfect selfie: Plastic surgery.

But Lavey constantly felt self-conscious about how she looked in pictures, and decided to take the next step in her search for the perfect selfie: Plastic surgery.

“Your social media presence is just as important as your real life presence,” she toldABC News.

While looking at her face in photos or while Skyping, Lavey would often find herself staring at what she felt were imperfect features, like her chin or nose.

While looking at her face in photos or while Skyping, Lavey would often find herself staring at what she felt were imperfect features, like her chin or nose.

“It’s kind of the first thing I look for in a photo, which is, how does my chin look? Which is really weird,” said the senior talent manager for the uFluencer Group, a Los Angeles-based public relations firm that specializes in managing rising social media stars.

The semi-finalist on Last Comic Standing visited Beverly Hills surgeon Dr. Richard Ellenbogen to talk about a chin implant, but he recommended she also get additional procedures, like fat grafting and a nose job.

The semi-finalist on Last Comic Standing visited Beverly Hills surgeon Dr. Richard Ellenbogen to talk about a chin implant, but he recommended she also get additional procedures, like fat grafting and a nose job.

The surgery would be worth around $15,000, but Lavey got a discount for being a family friend of the doctor.

“To me, plastic surgery should be a last-ditch effort,” she said. “After you have worked out, after you’ve good discipline in your diet and exercise then you go to surgery.”

“To me, plastic surgery should be a last-ditch effort,” she said. “After you have worked out, after you've good discipline in your diet and exercise then you go to surgery.”

Although she had the surgery two years ago, Lavey told ABC News that she has since had corrective surgery on her nose, more fat-grafting, and Botox.

Although she had the surgery two years ago, Lavey told ABC News that she has since had corrective surgery on her nose, more fat-grafting, and Botox.

“I look like myself, but Photoshopped,” she said, adding that she considers Botox a necessity.

“It’s kind of like in my bills like rent, food, gasoline, medical insurance…[then] Botox.”

And she finally got to put up what she called the “quintessential profile shot.”

And she finally got to put up what she called the 'quintessential profile shot.'

“I never would have put that on,” she said, “because my little chin would’ve been looking like a little turtle.”

The now-38-year-old said the surgery wasn’t just an ego boost, but a way to enhance promoting herself on social media.

The now-38-year-old said the surgery wasn't just an ego boost, but a way to enhance promoting herself on social media.

“Today this business is moving at the speed of the Internet,” she said. “Your selfie is your head shot so you can reinvent yourself every day with your iPhone. It’s a legitimate form of promoting yourself.”

She added, “Not everyone is born beautiful, and if you can get a little help from an app or a nip-tuck then more power to you.”

Do you think she looks more selfie-ready?

Do you think she looks more selfie-ready?



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