Breast Implants and Botox?

Poison or Beauty? Is Inamed Aesthetics (IMDC: NASDAQ) poised for a happy ending with the FDA? Health concerns over silicone implants crushed Dow Corning with $3 billion in claims in 1992, but has Inamed Aesthetics proven to the FDA that silicone implants are safe enough to approve for marketing to the general population?

By Natalie Pace, iSophia CEO

s baby boomers battle aging, and the FDA in on track for fast approval of silicone breast implants and wrinkle fillers (collagen competitors), should you embrace Inamed, Allergan, Medicis, Mentor or LifeCell, or just learn to cherish the tried and true stocks that you already own?

Inamed's stock popped 23% after the FDA advisory panel recommended approval of its silicone breast implants on October 15, 2003, but the 9-6 vote for approval isn't the FDA sure shot that panel recommendations normally precede.

Saline implant breast augmentations have ballooned over the last decade, since the banning of silicone implants for most women in 1992, but the more natural feeling silicone breast implant is making a strong comeback this month, after the FDA panel's nod and the subsequent expected FDA approval of Inamed's pre-market application. So why isn't it a FDA slam-dunk this time around?

94% of 5,000 women randomly surveyed said they would recommend the breast augmentation procedure to others (The American Society for Aesthetic Plastic Surgery). Susan Scherr, spokesperson for the National Coalition for Cancer Survivorship and twelve other organizations, including the National Alliance Breast Cancer organizations and the Y-Me National Breast Cancer Organization, supports silicone breast implants as an option for reconstructive surgery. Over the last ten years, breast augmentation surgeries have soared by 600%, from 32,000 in 1992 to 225,000 in 2002 (The American Society for Aesthetic Plastic Surgery). 80% of the 225,000 women getting breast implants each year are paying their own bill and electing the surgery as a life-improvement strategy, not because of breast cancer or other reconstructive need (National Institute of Health). Arlene Nicole Cummings, the founder of ImplantInfo.com, notes that her online readers are mostly married women with children, who just "want to get back what we lost after pregnancy and nursing," and should have the same options for implants that women with cancer doÑsilicone or saline.

Clearly, there are a lot of women who want the option of the more natural feeling silicone breast implants, over the heavier, saline water balloons. Shouldn't women simply have the right to choose?

Should the medical community protect women from their own vanity? Does the research indicate any relationship at all between silicone implants and disease or death?
Not many chairmen of FDA panels go on record to call the opinion of their peers "misguided" and to "implore" the FDA not to approve a pre-market application (PMA), as Dr. Thomas Whalen did in a letter to the Food and Drug Administration Commissioner, Mark McClellan, and to five members of Congress, namely Senators Jon Corzine, Edward Kennedy and Frank Lautenberg, and Representatives Roy Blunt and James Greenwood. Dr. Whalen, the chairman of the FDA's advisory panel and the director of the Robert Wood Johnson University Medical Group, wrote, "It serves the reputation of the FDA in general, and the standing of the panel process in particular, exceedingly poorly to have had all of the plastic surgeons vote the [Inamed] PMA as approvable on such a close vote." What are Dr. Whalen's concerns? Long-term safety "was clearly not demonstrated and to approve this device poses threats to women that are clearly unknown." One established danger, in Dr. Whalen's opinion, was the obscuration of normal breast tissue to the mammographic detection of breast cancer. Other areas of concern were silicone leakage, re-operation rates, local complications and that the Institute of Medicine's report was based upon "low quality data." Dr. Whalen asked the FDA to demand a more rigorous, controlled study that demonstrated that silicone implants, "despite their established breakage and leakage rates, are safe in the long term."

Can you feel the collective gasp of horror from all the recent buyers of Inamed stock, who gambled on sales exploding with the spark of FDA approval?

Are implants safe or not? What does the research reflect?
Each side points to select indications of the National Institute of Health research as support of their divergent positions. While researchers conclude that there is no link to breast cancer or connective tissue disorders and implants (so far), studies show increases in brain cancer, lung cancer and suicide with women who elected to have silicone breast implants. The question is whether or not these occurrences are attributable to lifestyle choices (electing implants), or simply due to factors common to women who choose implants (such as smoking or a higher propensity for suicide in the first place). Dr. Thomas Joiner, a Bright-Bruton profession of psychology at Florida State University, testified before the FDA panel that the women who elect augmentation are already in higher risk groups for suicide than the general population. In fact, according to the "conservative" calculations of Dr. Joiner, women who get implants (mainly affluent white women) are statistically four times more likely to commit suicide than the actual suicide rate that occurs.

Does the National Institute of Health have an opinion on whether or not silicone implants should be approved at this time?
As expected, the NIH does not have a position on whether or not Inamed's application should or should not be approved. Dr. Louise Brinton, the author of the National Institute of Health's report, entitled, "Breast Implants: Status of Research at the NIH," did clarify the agency's position regarding the research, however, in a telephone conversation on November 13, 2003. With regard to the correlations between brain cancer, lung cancer and suicide, Dr. Brinton said, "Results were based on small numbers. Biologic reason was not readily forthcoming. Our conclusion was that further studies should be done to determine whether these excesses were real." In the report itself, Dr. Brinton specifically recommends that "excess risks of suicide and cancers of the lung and brain appear to warrant further scrutiny." Further findings from the report are provided below.

NIH studies, which examined data on over 13,500 women who had silicone breast implants for cosmetic reasons in both breasts prior to 1989, indicate the following:

1. Implants are not related to breast cancer risk
2. Increased risks of suicide, brain cancer and lung cancer are inconclusive, but warrant further scrutiny
3. It is difficult to draw conclusions between connective tissue disorders and breast implants. "A large meta-analysisÉconcluded that there was not sufficient evidence to support any relationships with these disorders."
4. Implant patients in study groups experience lower rates for nearly every cancer and for total mortality when compared to the general population (outside of suicide, brain cancer and lung cancer). The cause attributable to this phenomenon is that people who undergo elective surgery tend to be healthier than their peers.

Inamed touts the first, third and fourth indications, while Diane Zuckerman, the president of the National Center for Policy Research for Women and Families, focuses on the correlations between silicone breast implants and brain cancer, lung cancer and suicide. It is also argued that disease and immune disorders take longer to manifest than the two and three year result periods that Inamed submitted with its application. At the panel discussions themselves, many disabled women complained of silicon leaking into their lymph nodes, lungs and other organs, and directly blamed the implants for bringing on such debilitating diseases as lupus, brain disorders, rheumatoid arthritis, multiple sclerosis, fibromyalgia and more. Some had leakage for years that went undiagnosed because their breasts "looked" fine, even when surgery revealed that the implant was half empty or more. Certainly in some of the testimonies, there was a clear genetic predisposition for cancer and/or immune diseases. Some of the women testifying were breast cancer survivors with one or more sisters suffering from cancer, lupus, MS or another disease. The testimonies of women who had their leaky implants removed, and immediately found their chest pain had vanished and, within two years had full recovery of their immune systems, were particularly compelling, and appeared to argue that, perhaps, silicone was a factor in the symptoms.

Even though the percentage of women who are so displeased with their implants is much smaller than the number who would recommend augmentation to their friends, under 6% according to The American Society for Aesthetic Plastic Surgery, with the potential side effects so horrific, will approval of Inamed's PMA application to market silicone breast implants to the general population turn out to be a blessing or a curse?

Flashback to 1992: The fall of Dow Corning.
There were three major implant makers eleven years ago, when headlines exploded with stories that silicone breast implants had decomposed to blackened rot, were leaking silicone into organs and lymph nodes and were the root of undesirable diseases and immune disorders. After the 1992 allegations that silicone implants were responsible for serious health-related problems, including compromised immune systems, Dow Corning was forced into bankruptcy, to settle over $3 billion in claims. The FDA banned silicone implants in all surgeries except for women who had a mastectomy or other health related concern, or for women who were trying to fix problems that resulted from saline implants. (For a firsthand account of multiple surgeries that resulted in silicone implants, see the iSophia report entitled, "From Pancakes to Hooters: Three Women Discuss How Science Endowed Where Nature Failed, and whether or not they'd do it again.")

Both Inamed and Mentor are well-established in the safer saline implant market, as well as diversified into other aesthetic products, however, it should be noted that consumers went after Dow Corning eleven years ago with a vengeance akin to that directed today at the tobacco industry. (Philip Morris is still surviving, and rallying recently, under its new publicly traded name, Altria.)

The controversy did little to kill the aesthetic appeal of enhanced breastsÉ
From Baywatch to Britney, breast implants have captivated worldwide audiences over the last eleven years, and women, seeking to stave off the harsh hand of gravity and childbearing, or simply to catch the eye of their favorite guy, have sashayed into the offices of cosmetic surgeons, eager to undergo the knife. With an aging population, an economy on the mend (easier to pay for the perks when the mortgage is covered!) and a pipeline of aesthetic drugs on the fast track for FDA approval, the number of women getting breast implants is expected to continue to grow significantly.

Inamed has a clear lead (possibly up to a year) over Mentor Corporation, if they receive FDA approval for their silicone implants, but are implants, given their very volatile and controversial history, a very stock safe bet? Certainly investors should at least be aware of the wraith of Dow Corning. Medical liabilities can be a very costly thing, even in companies that have diversified into other portions of the aesthetic markets, like both Mentor and Inamed.

Betting on Beauty Stocks: Breast Implants or Botox?
For the momentum investor, who is astute with entrance and exit strategies, trading in before FDA approval and cashing out before any potential scandal can be very profitable. (Of course the trick is accurately reading the signs of those events, without illegal inside information!)

Botox maker, Allergan (AGN: NYSE), hasn't exactly paralyzed the aesthetic biotechnology world, posting a mere wrinkle of an up-tick, +15%, since FDA (PMA) approval of Botox on April 15, 2003. Sales this quarter (3Q 2003) are up almost one hundred million over last year, however, to $443.3 million, from $350.6 million, largely on strong sales of Botox. So, why aren't investors eager to buy in? Perhaps they understand that Botox is a toxin, related to botulism, with many potential undesirable side effects. The good thing about botulism is that it paralyzes muscle, and paralyzed muscles can't wrinkle. The bad thing about the botulinum toxin A (Botox) is that it can cause headaches, infections, flu symptoms, droopy eyes and nausea. With the new craze of Botox parties, and the mix of alcohol and non-Board certified physicians giving the injections, the likelihood of problems increases as well.

Are there safer, attractive bets in this booming world of beauty enhancements?
Medicis Pharmaceuticals Corporation (MRX: NYSE) is the company that holds the US and Canadian rights to market, distribute and commercialize the dermal filler product lines for Restalyne. Restalyne is a collagen competitor that has been in use in Europe since 1996, with the added benefit that Restalyne is a non-animal acid that doesn't require patient sensitivity testing prior to administration. (Collagen, being derived from cows, requires sensitivity testing prior to administration.) The FDA's General and Plastic Surgery Devices Advisory Panel is reviewing the Pre-Market Approval (PMA) application for Medicis' Restylane on Friday, November 21, 2003. Inamed has its own dermal filler that is scheduled for review on the same dayÑHylaform. Medicis has already put a sales and marketing strategy in play, increasing first quarter selling, general and administrative expenses by 38% to $30 million, in anticipation of positive results.

Another potential biotechnology stock popper in the aesthetic arena is LifeCell (LIFC: NASDAQ), a company that makes various surgical and reconstructive products, including AlloDerm, Cymetra (a version of Alloderm) and distributes cryo-preserved allograft skin. Third quarter financial results posted product revenues up 16% from last year, to $10.1 million. Net income grew 47%, to $506,000. Revenue growth was driven by a 38% increase in demand for AlloDerm. Pacific Growth rates LifeCell an "overweight," citing the company's pipeline of new products. LifeCell is on track to have a new human tissue based bone-grafting product available for market by the end of 2003, with the powerhouse Stryker Corporation signed up to market it.

Sales for Botox, implants, dermal fillers, obesity intervention and other beauty enhancing products are ROBUST to say the least, and as American women age, the trend is likely to explode. At the same time, it is unlikely that the road will be a smooth ride to paradise. As we've seen in the past, beauty turns to scorn very quickly in the wake of disease, disability and/or death. Applying sound entry and exit strategies to potentially volatile stocks like those mentioned in this article can be VITAL to your fiscal health! Click here to review the BEAUTY report card for yourself!

The Corporate Whisperer: She helps corporations find their heart and individuals find inner peace.

Marilyn Tam, former President of Reebok's Apparel and Retail Products Group, former and Executive Director of the Us Foundation, Photo Credit: Clint Weisman

Marilyn Tam, a former, serial executive in the sporting apparel industry, talks candidly in an exclusive interview with iSophia about everything from child labor and sweat shops to the four key principles that are responsible for her achieving such a high-level of personal and moral success.

Interview by iSophia CEO, Natalie Pace.

arilyn Tam is the former President of Reebok's Apparel and Retail Products Group, the founder and Executive Director of the Us Foundation (www.usfoundation.org) and a respected corporate consultant who helps companies to achieve their bottom line goals in a socially responsible way. Wonder what she thinks about Sean Combs and the alleged sweatshops in the Honduras? Wonder how anyone in the clothing business can claim to have principles and INNER PEACE?

iSophia note: This interview was conducted a few weeks before Sean Combs was put into the hot seat by the National Labor Committee, an organization that is promoting better conditions for foreign laborers. The Southeast Textiles Factory (SETISA) is located in the San Miguel Free Trade Zone. According to the National Labor Committee, work requirements include weeks up to 69.5 hours without overtime, wages as low as $0.75/hr, excessive production goals, mandatory pregnancy tests, no healthcare (a violation of Honduran law), limited bathroom breaks, no conversation permitted, repetitive stress injuries, and drinking water contaminated with fecal matter. Workers are paid just fifteen cents for every $40 shirt they sew for Sean Combs (formerly Puff Daddy), and complaints are met by intimidation and firing.

In defense of his labor practices, Mr. Combs asserted that there was a monitoring system in place, and the Honduran officials have reported no exploitation, according to Reuters. It should be noted that the employees at the Southeast Textiles (Setisa) earn almost double (65 to 98 cents/hr.) the hourly rate of minimum wage ($.55 cents/hr.)   (the Washington Post, 10.29.03, Michelle Garcia and Michael Powell). Further, while watchdog organizations are actively trying to improve the lives and working conditions of low-paid, foreign workers, fortunately, at least, this most recent clothing line scandal does not involve child labor, as was the case just a few years ago.

According to Caroline Lewis, an International Labor Organization spokesperson, "Since 1995, when the ILO/IPEC project was launched in Bangladesh, the number of textile factories employing children was reduced from nearly 45% to 2.5% of the total. The actual number of children employed has been reduced from nearly 10,000 in 1995 to around 1500 [currently]." Admittedly, to ensure that children are not used clandestinely, monitoring of the factories is ongoing, and factory owners are threatened with the loss of contracts, if they are discovered to be in breach of the International Labor Organization agreements. The good news is, however, that our shoes and clothes are no longer made by ten year-olds, and there have been successes in sending those former child laborers on to school. (For more information on how Levi Strauss and Reebok eliminated child labor in the sporting goods industry, click here.)

For more information on how you can help make the labor situation a little better abroad, click on the link listed below:
http://www.nlcnet.org

N. PaceÑ Before we delve into the secrets of your success (and how we can copy you!), I want to ask some hard facts about the apparel industry's labor practices. Sean Combs is taking heat for, allegedly, having sweatshops and there is still a web-site called BOYCOTT Nike, even though both of these companies purport fair labor practices, swear they don't use child labor and have monitoring systems in place. Which companies are still using child labor and/or sweatshops in foreign countries to manufacture their goods?

Marilyn-- We have to understand that we are not another country's culture. You can't go to Zimbabwe, and say, "They're not making eight dollars an hour." Does anybody make eight dollars an hour there? What is the living wage for that country? Does everybody in the factory make above living wage? How many breaks do they get a day? Do they have adequate ventilation, bathroom and lighting--basic things that people don't think about very much. These are the critical things to ask in the business. We, at Reebok, brought things up to that standard before we went in. The factory owners were not excited about investing in all these things. In time, however, they found that it was better for them. Quality went up. Mistakes and rejects went down. Efficiency went up. The situation was a win/win.

N. PaceÑSo Reebok and Levi Strauss have these labor standards, but are there companies that aren't as conscientious about their policies and foreign labor?

MarilynÑYes! But there is another side to it. We have consumers in the US who say they don't want to buy anything that's not made by people who are not well fed and well-dressed, but then again they only want to pay $10 for the item. Are you buying the $3 t-shirts? 3- for $10 t-shirts make things go back the other way. The manufacturer can only sell you what you want to buy. If you're demanding the lowest price, chances are you're not living up to the standards you say you believe in.

N. PaceÑThe cheapo American consumer is a silent partner in unfair labor practices? Interesting point, however, both Nike and Sean Combs' clothing lines are pretty expensive. It doesn't seem like the practice of buying more expensive clothing is all that effective in improving foreign labor circumstances.

Marilyn--Home Depot doesn't sell endangered wood anymore because consumers made a statement. You can do the same thing in any industry if you let the manufacturer know that you're not going to accept products made out of the standards you don't want. The power is with the people. If you don't buy it, they can't sell it anywhere. Consumers always think they're just the victims, but we're the people in control.

N. PaceÑBottom line: you're an insider, which companies go in and hire without the reform?

Marilyn--I can't say without auditing them, but there are a lot of socially conscious funds, like the Green Money Fund. They have a socially responsible division. They can give you an update. Vote with your dollars. Think all the time that you are investing, whether it's by buying a product over another or by investing in a stock! There's no difference between the two. Whether it's our time, energy, focus or money, it's investing. As soon as women realize that, investing money is no different than all the things they're juggling all the time.

iSophia note: There are links to a number of socially conscious organizations at the bottom of this interview. Becoming socially aware is now only a click away!! And you can't say we didn't TRY to get the names of the corporate creeps out of Marilyn Tam.

N. PaceÑAll right, let's turn from the world stage and focus on improving the personal landscape. You've got a book, How to use What You've Got to Get What you Want, that aims to teach people a most elusive idealÑinner peace. How can something that escapes so many of us be as simple as the title makes it seem?

Marilyn--Most people think that what they want is outside of them. I taught a course training for Fortune 500 employees who are identified as technically brilliant--upper management people. The first thing I said was, "Let's list our assetsÑnetworking, education, training, personal connections, and other things like that." There were three big sheets on the wall. After a certain period of time, I looked at my sheets of paper. I only had writing on one sheet. All that was listed were personal assetsÑmotivation, optimism, bright, driven. Nothing about their PhDs, relationships or networking. I told them, "Do you realize what you just did? You've just said that what you really need, you already have!" In this world, you're told that you've got to do this to get that. Now that you know you already have what you need, you can do what you need to achieve your goals. If youÔre motivated to save lives, you can get a degree in medicine. That is just another step in the process. First the driving force is required; then you can achieve things.

N. PaceÑStatistically, there is strong correlation between nepotism and achievement. Rich Girls have a show on MTV. Rupert Murdoch's companies are headed up by his sons. How can the average person achieve against those odds?

Marilyn--What people say is that you have to look a certain way, dress or drive or live in a particular area. All that is untrue. I'm a perfect example. I'm a woman. An immigrant. Physically, I'm not very tall. I'm a minority. And, when I started, I was way younger than everybody else. I have an accent. I didn't have an Ivy school education. No connections. I didn't have all of those things that people usually say if you want to be a big success you have to have. My achievement came from inside. Know that whatever you wish, you can achieve because you already have what you need inside to get it. Saying that, there are tools that you'll need to get there. If you have the drive, you can get on the moon.

N. PaceÑTrying to figure out what we really want has kept a lot of us on the psychiatrist's couch for decadesÉ

Marilyn-- When you do what calls to you, you have inner peace. In the end that is what everybody wants. Not the title, the spouse, the home, the recognition. It's really the inner peace. I read this interview with John D. Rockefeller. People asked him, "Mr. Rockefeller, you're so wealthy! How do you know when you have enough money?" He said, "I just need a little bit more." He doesn't have that inner peace. He's sucked into that achievement complex, thinking more is more. Happiness is an inside job. It's true.

N. PaceÑAre there any shortcuts to inner peace and figuring out what you really want? Most of us are too busy working four hundred hours a day!

Marilyn--So many people in our culture are so mesmerized by the onslaught of information that we get, that we don't stay still enough to listen to our own voice. We're so used to having something or somebody tell us something all the time. How often do people go quiet? The first thing to do about figuring out your purpose is to be quiet and listen to yourself. It could truly be just being quiet, or going for a walk in nature. Others use a journal. Others meditate or listen to music. Just be in that space of question or wonderÑ"I wonder what it is that I really want?" Between your birth date and your death date, there's this line, the dash. What do you want that to represent? That's your mission. Once you find your mission, that is your point north of your personal compass. Whatever you do may change. You may have six careers and 515 jobs, but it doesn't matter. If you're always serving your mission in life, you'll always be comfortable and happy.

If you feel like your job is not fulfilling you, then maybe you have another mission. Maybe you want to sing. How can you make that happen? Instead of saying, "I'll never by on Broadway," you can fulfill your mission by singing in a church group. It doesn't have to be in the same way that others fulfill them. Ask yourself, "What serves me? What makes me happy? What do I want people to say about me when I'm dead?" That's very different than being told you're not living up to the Joneses. Leave an impact on the world, whether by raising a child or raising a garden. Some way you're going to leave an impact.

N. PaceÑHow do you begin making sure that your job serves your mission? Do we have to quit our jobs, give up all the conveniences we love and ladle soup in Africa?

Marilyn-- My friend decided that he wanted to be remembered as a good friend and as a good father, not just by giving money away." He shifted some of his balance to dealing with people on a different level. It wasn't a radical shift from businessman to shaving his head and going to India, but it made him so much happier. It wasn't 100% change, just a 20% shift. That's the key. Most people don't know their mission because they've bought into the American dream. If you're a girl you're supposed to do this. If you're a boy, that.

N. PaceÑThat's all changed now, hasn't it? We've got almost equal gender representation in medical, law and MBA schools now.

Marilyn--Many years ago, I volunteered for a nonprofit, "An Income of Our Own," to teach 5^th and 6^th grade girls how to be financially independent. One of the first questions we asked was, "How many of you believe you'll marry a rich boy when you grown up?" Over 35% raised their hands. "How many of you know a rich boy now?" A much smaller groupÑmaybe 5%--then raised their hands. They still believe in the Cinderella story. They don't know their mission. They think life is going to be good for them because this knight in a white uniform is going to save them. Hello, we don't even ride horses anymore! Stop all these voices, and find out what really makes you happy. Don't be afraid to hear what it says.

N. PaceÑLet's talk about the tools. You outline four key principles to success. "Tell the truth. Make partners. Make big mistakes. Die by Your own Sword." Let's start with the first principle. Why is telling the truth so important to "getting what you want."

Marilyn: Lies are dangerous. We have seen so many cases in corporate life, of how not telling the truth has brought companies down. Enron. WorldCom. When you tell a lie, it's hard to remember. Telling the truth is not only simpler and easier, it can actually lead to a more positive outcome. When I interviewed at Nike, I told the truth about what was wrong with their merchandise, even though I knew that meant that I might not get a job, and I really wanted to work there! I told Phil Knight that the company would not do well if they hired me to open a store with merchandise that wasn't up to the image of the company. Fortunately, the CEO [Mr. Knight] was big enough to realize that I was saying something that was good for him. "Maybe I should fix the merchandise first!" he thought. That's how I became the VP of apparel for Nike, and ended up creating a new trend for the company. Of course, their stores are legendary now. That came from fixing the ground problem first. If we hadn't done that, the company would have been miserable from opening the stores.

N. PaceÑOur readers are so accustomed to the high quality of Nike apparel. Can you give them an example of what kind of problems there were with the clothing line, before you became vice president?

MarilynÑNike had grown so fast in the 80's, and the bulk of the income at that time was coming from footwear. They capitalized on the demand by buying apparel from the ready-made market. The tops and bottoms didn't always match. The quality was inconsistent. The socks didn't fit. If you bought a Nike shirt, the next time it might be a different size. The shrinkage factors were inconsistent. It was important that the apparel was fixed before the stores were opened. The interview did end rather quickly after I told Phil Knight that. I came back to California thinking that I blew my chances. It made a big differenceÑto tell the truth. Instead of going in there and losing with the stuff they had, we had a chance to create something great. It took a leap of faith from me. I had to tell the truth and know that the consequences might not be what I wanted to hear. Ultimately, it turned out to be good for everybody concerned.

N. PaceÑThe little white lie must have been so tempting. "Oh! What fine apparel you have, Mr. Knight!" Thinking flattery would gain the job.

Marilyn-- I would have been out of a job within a year and a half, or however long it would have taken to open a store and watch it collapse. It was doomed to failure. You have to have integrity in what you do.

N. PaceÑAll right, on to principle #2. Make partners. Do you mean make the right partners? Do you help people distinguish between business ventures that will hurt them and those that should help?

Marilyn--You just assume that people want partners. Some people say, "Why do we need partners? They will hurt you. You can't trust them." If your dream is so small that you can do it by yourself, you're not dreaming very big.

N. PaceÑHow do you find the right partners, the ones who will not hurt you and can be trusted?

Marilyn--You really have to find somebody who is philosophically aligned. You don't want people who are LIKE you, but who are philosophically aligned. You may not agree on everything, but if your higher goal and missions are similar, you have a higher place to start from. Some people would say, "Make money at all means." For me, if someone doesn't have integrity, no matter how much they can do for you in the short term, sooner or later something may happen and you'll be out in the lurch. The key is to make sure that your integrity and mission are aligned in the same way.

For instance: Your market is women. If somebody else says I want to have a magazine, but my mission is to reach as many people as possible, they might want to add a porn factor. You can see how that would radically be different from your vision. They might suggest advertising in areas you don't believe in, like tobacco. Your partner is going to be someone you're going to live with and trust on a bigger level than even your relationship! You spend more time at work than at home! That is key. Make sure you're philosophically aligned, and the mission is coherent.

N. Pace: How can your third principle, making big mistakes, be a part of any viable plan? That seems counterproductive to success!

MarilynÑOftentimes when I tell my teams this principle they don't think I mean it. They're really skeptical about why it is a good thing to make big mistakes. What I mean by that principle is: Take risk, but don't take risk randomly. Take risk and stretch in ways that will help you and the company grow. If you stay put, you stagnate and the company will collapse. If you think you're going to make a big mistake, you'll plan, organize, strategize and make contingency plans. The chances, with those things, are of great success, much more than if you were careless and made small mistakes. Be mindful and strategize and take those steps that will catapult your company to the next level. It's a matter of knowing that change is inevitable. How do you stay ahead of the curve? By planning and strategizing. If you fail after all that, you learn from that. You have your contingency plan in place!

N. PaceÑIs "Die by your own sword" another way of saying "Do whatever it takes?"

Marilyn--Actually, it means stand by your own principles. We have so many people, media, telling you what to do, how to do things, what to think. So many companies in the world are trying to listen to the latest trend, poll and opinion that the company is jerked around without grounding. In the Dot.Com days, companies didn't have any idea what they were making. They just pitched things. They said, "Ok I can make that." Then they went back to the office and tried to get the engineers to make it. They had 60,000 people working like dogs, but they didn't have focus. They were trying to sell what somebody else wanted to buy, but if you don't have a clue what is meaningful for you or your company, you're going to lose. Who's your customer and what products are you trying to sell? These businesses weren't done because people had a desire and a mission to serve. It was just a desire to make lots of money. The whole dot.com, B2C then became B2B, they were just morphing, trying to stay ahead of the curve, without focus or vision. That doesn't work. When you say, "These are people I want to serve," you're much more likely to succeed. You must get up in the morning, and be happy with what you're doing. Then you're focused and creating the right support team. If you make a mistake, it's going to be a big mistake. Even if it doesn't work, you're going to feel comfortable about yourself.

N. PaceÑLet's talk about one of your most notable achievements--Weebok. This was such a great idea! Weeboks came out in the early 1990s when I had my son, and I remember thinking that the person who launched toddler sneakers was a genius! (Wow! And here I am talking to her!)

Marilyn--The idea came from Nancy, a woman who worked for me. She had her 1^st child in her mid-30s. She went home and realized that there was nothing for her child. There were things for people who shopped at mass merchant stores and frilly designer clothing, but nothing practical, durable and attractive that was not overpriced for everyday wear. She came back with a proposition, asking me how we could make it happen. She knew there were other families out there that were looking for what she wanted.

We were in the perfect position to do it. Reebok was known for performance and quality, and as a "cool" company. I looked at her and told myself the truth. She was a woman with an all-financial background. She had no merchandising experience. She wasn't a designer. She wasn't a salesperson. We needed a lot of other things to make this happen. I said, "I like the idea, but we'll need a lot of support." Also, we had a short time frame. As soon as we started researching the market, we found that Guess? and the Gap were doing it also. If we were going to come out strong and be a contender, we'd have to do it right the 1^st time. We couldn't just invest large amount of dollars to create a new division of the company. How could we do this quickly with a minimal amount of money? We had to make partners within the company. Apparel and footwear came in to lend experience. Production and factories agreed to give us small production runs. We needed to get advertising to work with us, including outside advertising companies, so that they knew they were supporting us on a common vision. We talked to the community. What's comfortable? What are the price points? We went to the retail stores. What would you buy? What kind of packing do you want? We used all of the principles that I already had as my personal philosophy. We wanted the one chance we had to be the best possible one. It was fun, exciting and scary. We were rolling the dice pretty big.

N. PaceÑAnd the reward? It was a huge success, as we all know, but what were the numbers?

Marilyn--Within three years, we were at $60 million sales. It was a great story of how when you live by the four principles, it actually comes true.

N. PaceÑDo you own stock in any apparel companies?

MarilynÑI own both Reebok and Nike. Nike--I heard an analyst say two weeks ago that they put it at $68. They're at $62 now. Reebok is in the 30s now. They have a good recommendation now. They have come up very nicely in the last year. They've maintained and grown. It used to be said that those stocks are not as liable to be hit by recession because they are items that people need. I'm not sure about that. You don't have to buy the $80 sneakers. You may need sneakers, but you might go to Costco and buy something for $20. This last recession seemed to have borne out that these companies are relatively recession proof, however. They were less hurt in the downturn. I think the challenge for apparel and sportswear companies more is whether they are well run.

N. PaceÑYou mention good management. I think most investors are always looking for ways to evaluate management effectively. How do you recommend that people get to know who's minding the store?

Marilyn--You can see what they stand for in actions. You may not know the CEO, but you can look at what they do in the community, and in the mission statements. There is a lot to be said about long term. Unless you're a day trader, you need to look at things that you'll be comfortable with--that you would use yourself and be proud of. Then you say, "Ok, let's see the financials". The first filter is, "Are you comfortable with this product?" If you have something that you don't feel good about, you're not comfortable buying from that store. When you're not comfortable, you're not in a place where you feel that you invested the money wisely. I wouldn't invest in a tobacco company, even if it were a great tobacco company. You have to be socially and fiscally responsible.

N. PaceÑBack to the same theme, that one person can make a difference, by living by his or her personal mission in life.

MarilynÑYes, I love this one story that my friend, Robert Muller, told me. He heard it over 20 years ago. Since he first heard the starfish story, it has driven his life.

"One day this man finished with work. He'd had a horrendous day. His mind was bursting with information. "I'm just going to drive my family crazy if I go home right now," he thought. He went for a walk on the beach. But he was still embroiled in the day's problems. He really wasn't on the beach, just walking mechanically, while all this stuff swirled in his head. He looked up, and there was this woman walking toward him. She was picking something up every few steps and throwing it into the ocean.

Finally, when they run across each other, the man asked her what she was doing. She bent over and picked up a starfish and threw it into the ocean. "I'm saving the starfish," she said. Suddenly he realized that the beach was littered with starfish. The storm the night before had brought them into shore. Hundreds of thousands of starfish were littered everywhere. The man said," You're not making any difference! There are still thousands and thousands left stranded!" The woman picked up another, threw it into the ocean and said, "I'm making a difference to that one."

That story inspired Robert to walk a mile and clean that mile of beach in front of his hotel room everywhere he went. That was his way to make a difference, as a reminder that you can do what you can as an individual. Almost three and a half years ago, in Italy at the Conference for the League of Nations States, Dr. Muller was asked, "You're a big, powerful guy, what can you tell our readers? They're just little people, who can't make such a difference." Robert told the story about the starfish. That following weekend, 200 beaches in Italy got cleaned by people who were inspired, when they found out that Robert had cleaned the beach before he gave his talk at the League of Nations States. That inspired nations around the Mediterranean to form Clean Up the Mediterranean Sea Project, which every summer cleans up the Mediterranean. Now there is a Clean Beaches campaign, which is a permanent project in Italy. As an individual, your little act of goodness may be rippling throughout the world. There is a story about the butterfly that flaps her wings and causes a hurricane in the other part of the world. You never know! That's a good way to think about life. Peace reverberates out.

N. Pace--Any last comments?

Marilyn--Believe in yourself. For women especially, know that you've got what it takes to get what you want. Believe in yourself.

iSophia Members are invited to ASK MARILYN YOUR QUESTIONS about HOW TO GET WHAT YOU WANT IN OUR CHAT ROOM ON WEDNESDAY MORNING, 11.19.2003, from 8:45 - 9:15 a.m. PST. To order Marilyn Tam's book, How to Use What You've Got to Get What You Want, at the lowest possible price, click here!

http://www.overstock.com/cgi-bin/d2.cgi?PAGE=PROFRAME&PROD_ID=473989

If you're interested in finding out more information on How to Use What You've Got to Get What You Want or how to book Marilyn Tam for a speaking engagement, go to: HowToUseWhatYouveGot.com.

Additional resources on socially responsible investing and/or spending:
The National Labor Committee:

http://www.nlcnet.org/
http://www.freethechildren.com/youthinaction/child_labour.htm
http://www.ilo.org (International Labour Organization)
http://www.greenmoneyjournal.com/

Full disclosure: Natalie Pace does not own positions or stock in any of the companies mentioned in this article.

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Breast Implants: More than Just Barbie Obsession.

Steven S. Carp, MD, FACS Carp Cosmetic Surgery Center, Inc.

A Women's Choice. by Steven S Carp, MD, Carp Cosmetic Surgery Center, Inc. Canton, OH. info@carpcosmetic.com. 1-877-518-7620.

Nearly everyday I am asked why a woman would want to have breast implants. "Aren't they dangerous?" "Why would someone do that to themselves?" The answer is very clear when you talk with women who have had their lives so deeply affected by breast cancer. Or women who do not have to decide which bra to wear, but rather why wear a bra at all with a Ôboys' figure. The image for both is the same. I do not feel complete as a woman. The bond between external appearance and femininity is strong. And certainly breasts are an integral feature.

n 1963, the first silicone gel filled breast implant was introduced, followed by saline filled implants in 1965. Over the next 25-30 years, various modifications were made and the statistics show that women are generally very happy with the results. Over 12 years ago, breast implants, especially silicone filled, became the focus of concern with reports of women claiming to have significant health problems related to their breast implants. In 1992, a ban was issued by the US Food and Drug Administration (FDA) on the use of silicone filled implants for cosmetic breast augmentation. It is important to note that women desiring breast reconstruction, for example after mastectomy for breast cancer, could still receive silicone gel implants. Admittedly, the manufacturers did not have complete data to address some of these health concerns. Saline implants remained available for general used in augmentation and reconstruction during this time.

In 1999 the National Academy of Science's Institute of Medicine released a detailed study following their review of all the available studies on breast implants and concluded that there was no solid scientific evidence of a link between breast implants and any disease. The FDA officially approved saline filled breast implants in 2000.

On October 15, 2003 the FDA advisory panel recommended the approval of silicone filled gel implants for general use in both reconstruction and cosmetic augmentation. The FDA reviewed new data on silicone gel filled implants derived from ongoing clinical studies submitted by the implant manufacturer, Inamed Aesthetics. Again, according to Inamed's conclusions, there was been no solid evidence associating breast implants with any disease. Silicone gel is a potentially a popular implant because it produces a natural feeling breast, especially in women with minimal breast tissue. The panel did recommend that patients have extended follow-up, ensure complete patient informed consent and physician continuing education. The FDA will next consider the panel's recommendation .

iSophia note: There were many witnesses at the FDA advisory board's panel hearing who reported severe health concerns that they believe were directly related to silicone leakage from their implants. The health problems included lupus, multiple sclerosis, and much more. Please see the article above, entitled, "Breast Implants and Botox?" for a more detailed report on the controversy around the safety of silicone breast implants.

The American Society for Aesthetic Plastic Surgery, (consisting of only Plastic Surgeons certified by the American Board of Plastic Surgery), and the Aesthetic Surgery Education and Research Foundation, surveyed more than 5,000 women anonymously regarding breast augmentation patient satisfaction. Here are some of the findings:

• 89% of women surveyed said that breast augmentation met their goals
• 94% would recommend the procedure to others
• Only 17% reported skipping recommended follow up examinations
• Only 13% reported having second operations, of these 92% chose implant replacement, not permanent removal. 35% chose larger implants, and 27% wanted to improve shape or position
• More than 90% remembered being told about specific risks associated with breast augmentation surgery

As a Plastic Surgeon in private practice I routinely perform breast augmentation surgery. My experience certainly has been consistent with this survey. I spend a great deal of time counseling patients about the benefits, options, and especially the risks of breast augmentation. It is surgery; it does entail risk. However, when a woman is able to understand the risks, she can make an informed decision about what is best for her. I occasionally see a patient in my office for consultation after she has had surgery elsewhere. One of the common themes is either not haven been given all the information prior to surgery or that she did not understand or recall something being discussed.

Women should be certain that they have been given detailed information and that it is understood. If not, ask or go somewhere else. It is easy in the excitement of the moment to forget to ask the right questions or even to listen to all the information. Because of this, I give patients a personalized book of over 20 pages of specific information relative to breast surgery, including important do's and don'ts that must be adhered to pre and post operative. This will help to insure you will have a wonderful experience.

Breast augmentation and reconstruction are not for everyone. But, for a woman with reasonable expectations, and a clear understanding of the risks, who is under the care of an experienced board certified Plastic Surgery, it can positively change you for your life. It is a Women's Decision.

Beauty and the Botox Party: When Cosmetic Surgery becomes Addiction.

Dr. Mary Powers, a board certified plastic surgeon, talks candidly about obsessions, reality and just how much it would cost to look like Demi Moore! Dr. Mary Powers. 310.586.9775. 1301 20^th Street, Santa Monica, CA 90404.

ll right, we all want to look like Demi Moore. We wouldn't kick the 25-year-old lover out of bed. We all want our ex-husbands to gush over us and shower us with child support in the millions (creative assumption here about the size of Bruce Willis' check, not known fact). And then we wake up, wonder how popcorn managed to go directly from the stomach wall to the top of our thighs, watch a snoring husband pound at the snooze button on a screaming alarm for the tenth time, and then stumble into the shower, where we pinch our breasts into temporary perkiness. Face it: cosmetic surgery is something that crosses a lot of minds when we walk past a mirror, whether you're nineteen or ninety. So, do you wonder when you should really consider cosmetic surgery? (For facelifts, it's earlier than you think.) Wonder how much it costs and should you start saving now? Afraid that you'll end up looking like Michael Jackson? Dr. Mary Powers, has seen it all during her years of practice, and she shares her wisdom and experience freely in the interview below.

iSophiaÑOur readers should know that you're somewhat of a star in the medical world.

M. Powers--I did a television pilot called Real Radical. I don't like that whole business of having a microphone attached, recording everything you say. You don't feel there's that true one-to-one contact. You don't feel like you have that connection. About the only thing reality television can do for you is make you look foolish.

iSophiaÑExtreme Makeover makes cosmetic surgery look like a fairy tale, like a dream come true. Is there one thing, one piece of reality that you would give viewers?

M. Powers--This isn't a joke. It's not like saying, "I'm going to try those pants or shoes on and if I don't like them, I'll return them." There are life-threatening issues that can occur. Especially the older the patient gets.

iSophia--Really? I never considered that a facelift could be life threatening!

M. PowersÑOnce you're over 50, you need to make sure you're in good health. Women are at risk of cardiovascular disease. Heart attacks are the number one killer of women. You need to make sure you're improving your life, not adding to the problems.

iSophiaÑHere on the West Coast, we see 30 year-olds with Botox and fattened-up lips. Some of these women look like Donald Duck. Who should seriously consider plastic surgery?

M. Powers-- Someone who feels that they've done everything else, and now the only thing that can be done is surgery. Take jowling of the face. There's no treatment except accepting it or a facelift. Fat deposits. Women who've had kids. They work out and lose weight, but the fat remains on the hips, thighs and tummy. Sometimes it just doesn't disappear. That's what it's for. Once you have kids, the breasts go south. There's nothing that will lift them up again. Obesity is a major health problem. People who lose the weight, then have to get rid of the loose skin.

ISophia--Do you get rid of loose skin from the entire body?

M. Powers--It starts from head to toe. Face to neck lift, to arms trimmed up, brachioplasty. Their tummy needs work, that apron of skin that can hang over their genitalia. That part is covered by insurance. It is a health issue. If there is a fold of skin hanging over your private area, you can get infections. There is a total body lift. They hoist the outer and inner thigh skin. That's pretty drastic, but it's the only thing that gets that loose skin up again. The bottom line is: don't get that heavy. Unfortunately, a lot of Americans are overweight.

ISophia--Who would you counsel not to consider plastic surgery?

M. Powers--Someone who has mental instability. There are people who don't see themselves in a realistic way. What they want is not a realistic thing. I remember seeing a young male, 15 years ago. He wanted to look like Michael Jackson. There was a woman, 5'2" middle-aged and overweight. She brought in a picture of Brooke Shields. One of these things where it's clear that there's not going to be a fit. That's not a surgical issue. That's a psychological issue. As a doctor, you have to say, "Is this a realistic goal?" Some people become cosmetic surgery addicts. Then of course, there's the Michael Jackson example that's always brought up. When to say, "Stop!" Now that I have bigger breasts, I want skinnier thighs. When you start pushing the envelope. Having things that aren't realistic done.

ISophia--Isn't a good amount of being sexy just healthy eating and exercise?

M. Powers--You can't control genetics. Sometimes people truly do have physical characteristics that they've lived with all their lives that aren't desirable. Large nose. Extremely large or small breasts or hips. It's not just healthy eating and/or life style. For some things, there are only surgical remedies.

ISophiaÑWhat are the risks?

M. PowersÑInfection, bleeding, scarring, and asymmetry. Exact risks are specific to the area. Long-term risks are low. That's the reason why plastic surgeons go through so much training. When I see the patient, I evaluate her. Not everybody is in perfect health when they come through the door. Are her heart, lungs and everything else in order, so that she can stand the stress of the 6-hour face life. You need to be a healthy candidate, and then the surgery is relatively low risk. The whole bottom line is to improve the person's life. To get that bump removed. Not to saddle them with some problem of any kind.

ISophiaÑBotox has become all the rage. Breast implants have increased 600%, from 32,000 in 1992 to 225,000 in 2002. You can get cadaver flesh sewn into your lips. Do any of these trends concern you?

M. Powers--Botox parties. Bringing in this party atmosphere of drinking wine and eating and signing illegal consent forms. It's just silly. It doesn't make sense at all. People think it has a certain amount of glamour. To me, it's totally nonsensical. The Association of Plastic Surgeons condemns Botox parties. Anyone who is doing that is not a board-certified. Anybody can purchase Botox, and say, "I do Botox and collagen." This isn't buying a tube of lipstick. This is injecting material into your body. It should be done by people who are trained--dermatologists and plastic surgeons, but any physician can do it--family practice, gynecologist. You just have to be an M.D. That's why we, as a society of Plastic Surgeons, always stress board certification and board eligibility, to be sure the surgeon has the background, training and proper education, and that they've met those requirement. If someone says they're board certified, they should have expertise and knowledge to handle complications, as well as doing the procedure. You want to look good, but you want to do it safely.

ISophiaÑIt's freaky to me. I'd be hyper-concerned about knowing where the needles had been, and a million other details.

M. Powers--What if it wasn't sterile and you develop a facial infection? It wouldn't be humanity, if everything were 100% perfect.

ISophiaÑDo you administer Botox?

M. Powers--Sure. All kinds of injectibles. We have Botox and collagen. Collagen used to be from bovine or porcine (pig or cow). Now they have a human-derived collagen. Cosmoderm. That seems to be more gentle and causes less swelling. There's also Cymetra--micronized cadaver dermas. That is used to fill up lines and lips. People felt that would be somewhat permanent. Its cousin is Alloderm. Cadaver rolled into sheets for face plumpers. That's usually in conjunction with something else. Unless you're young, collagen alone won't do the trick. When you're over 40, we have loose, excess skin in places, like the neck, eyes and breasts. Time and gravity takes its toll, especially after childbirth.

iSophia note: Alloderm and Cymetra are made by Lifecell, a NASDAQ company that is publicly traded under the symbol: LIFC. Botox is made by Allergan, AGN: NYSE.

ISophia--Is a facelift good for life?

M. Powers--Any procedure you do, you don't stop Mother Nature, time or gravity. You just turn the clock back. If you paint your car and leave it out in the sun, you'll loose all that benefit. A lot of times, things like liposuction, breast reduction, tummy tuck, it's a launching pad for the patient to get back on track for herself. Those are the people who look the best. They don't look like they were ever 70-90 pounds overweight.

ISophiaÑSo, if I brought in a picture of Demi Moore and said, "Please make me look like that. I want a 25-year-old lover!" How much would it cost?

M. Powers--Remember the bottom line is that the reason stars are popular is that they sell an image. That image is based upon physical features. If you're a man, you can get by being a rugged individual. A woman actor needs to have that appeal. In our society, the appeal is still young or young looking. I don't know how much surgery Demi Moore has had, but she wouldn't look as good as she does if she didn't put a lot of hard work into it. Surgery can't do everything for you. You need to do yoga, running or exercise. People think they'll go from flabby and 50 pounds overweight to looking like Demi Moore. (iSophia note: Dr. Powers is not talking about us here!! We hope.) They're totally wrong. The best results are to get the head start with the surgery, and then continue with the diet and exercise. You also have to have the right frame of mind. You need to balance work and play. You need time for yourself. That's a major issue for most women. They don't allow themselves the time to work on their bodies and their own mental health. That's the challenge for everybody--male and female. To balance work, play, taking care of themselves and their family.

ISophia--Is there a viable alternative to breast implants? What about that surgery that is being performed on mastectomy patients, with living tissue?

M. Powers--Yeah. That's breast reconstruction. I do both cosmetic breasts and breast reconstruction. That is when a woman has lost her breast tissue due to cancer. You're willing to take potion of your body to create another part of your body. That involves expense, scarring and recovery time. With cosmetic surgery, you're taking something normal and trying to improve it to a better appearance.

ISophiaÑSo implants are the best option for the woman who wants to do something about her breasts heading south.

M. Powers--If you want your breasts lifted without implants, you just tighten up the skin. For a woman with D cup, if she wants a perky B-C cup, she can have those, but you're not going to have a perky D. If you have excess skin, it can be lifted. The overall size or volume is the criteria that you examine.

ISophiaÑHow safe are implants?

M. Powers--I'm using saline and gel. The gels are in the market for women who have implants already and want to replace themÑwhen there is a need for reconstruction or in the case of chest wall deformity. The major issue is that if the shell breaks, the gel leaks out. It causes silicone granuloma. In order to remove it you have to remove chest muscle. These women who have leaky breast implants, sometimes they wait seven years and then they have major problems. Cohesive gel implants have been used in Europe for seven years. They give a very natural shape. Ideally, these can be the first and last set a woman has. As long as she's happy with the shape and feel of them, she doesn't have the pressure to remove. It will be available to the general population in 1-2 years. Otherwise you have to go to Europe, if you want to get them, after this study closes in January.

ISophiaÑSo, the appeal of gel over saline is the feel.

M. Powers-- One feels like real breast tissue, and one fills like a water balloon. The other issue is that the saline implants have rippling. Sometimes you can see that rippling on the side. Some women are happy with them. If it does rupture, it's just saline or salty water. That's why the gel implant is appealing. They get the squishiness of gel without the spillage.

ISophiaÑWhat's the price of a pair of implants?

M. Powers-- For me, breast augmentations cost in the range of five to six thousand. The overall range can be from $2995-$8000. It's basically whatever the doctor can demand. A face-lift averages $6,000-$8,000. Someone in demand might want to charge $20,000. Do some shopping. Find out what kind of fees are involved. Compare it to someone else. You do get what you pay for.

ISophiaÑWhat's the ballpark price on Botox?

M. Powers-- If you're paying $99, chances are that it won't last. It might last 2-4 weeks, and then it is gone. We dilute it in such a way that the person will get 2-4 months of muscle paralysis. Some of this is the story of life: you get what you pay for.

ISophia--At what age should a woman consider work on her face?

M. Powers--That's an individual issue. A woman should consider a facelift when she starts to see sagging of the face and tissue where the jaw line is not as smooth or tight as high school or prom pictures. There really isn't anything except a facelift that will smooth and tighten. Laser treatments can help out. Good skin care. Those are all things to stall the inevitable. Some women are okay with a little turkey skin on their neck. You go from an oval face to a square face. Soft tissues drop. The skin falls and you end up with a square face because you've got the jowls. It's better to do things a little on the early side than the late side. It's much better to do things to maintain, instead of dramatic makeovers. As a saggy 60, you won't get as good of a result as if you do something in your late 40s/early 50s..

ISophiaÑIs there any way to prolong the inevitable?

M. Power--Everyone can use skin care, especially in Southern California, with the sun exposure. Blotchy lines and wrinkles. The rest is how aggressive you want to be in terms of facial rejuvenation. It also depends on where they are in their life. There are some patients who go through traumatic divorces, where their husband dumps them for a younger woman. One patient was married for 20 years, but felt like she left herself go. The woman had a neck lift, implants and weight loss. She looks great. We turned lemons into lemonade.

ISophiaÑOkay, okay. We're still refusing to watch Extreme Makeover, but I see your point. Some people, err, perhaps even us, might benefit from cosmetic surgery, provided it's approached with a good grasp on reality. SoÉ Can you make me look like Demi Moore for under $15,000?

From Pancakes to Hooters: Three Women Discuss How Science Endowed Where Nature Failed, and whether or not they'd do it again.

iSophia features "Word on the Street" to help individual investors inform their stock buy/sell decisions .

f you are considering breast augmentation, or if you're considering investing in a publicly traded implant manufacturer before the FDA ruling comes down, then you might want to understand the real world experiences of women who have elected breast augmentation surgery. Consumers drive profits and earnings, and disgruntled patients can bring down companies, as evidenced in Dow Corning's bankruptcy in 1992, under the crushing weight of $3 billion in claims against their breast implants!! If you can predict what consumers can't get enough of or what patients are going to battle until the death, you're on the road to predicting tomorrow's HOT or SHORT STOCK! In the short run, at least, stocks are a popularity poll.

Why do 13% of women who get breast augmentations need second operations, and is there generally any malpractice involved in the decision to do it again? (At 13%, that is a statistically important ratio!) What circumstances make a woman undergo the knife twice? What does it mean to improve shape or position? Implants have become more popular than ever now, but there are mixed opinions on whether or not the silicone implants are SAFER than ever. So what's the consensus of the women who are getting the implants these days?

The three women listed below are a small, random, sampling, however, they seem to bear out the numbers researched by the American Society for Aesthetic Plastic Surgery, that 94%of the women who had their breasts surgically enhanced are pleased enough with the results to recommend the procedure to others. One of the one women featured had not just a second, but also a third surgery to get it right. Wonder if she sued for malpractice? Read on for their candid and intimate stories of how science has changed their lives, and whether or not, their fantasies of a better body did indeed come true. Discover the pros and cons, the pains and numbness, the stares and style from three women who are living with the joys and consequences of their beauty enhancement.

1^st Portrait of Beauty:
Suzanne is a middle-aged musician who lives in upstate New York with her dogs and cat. She inherited and manages her family's estate. Suzanne got her silicone implants twenty years ago, in the early 1980s. She's never had another surgery.

Why did she do it?

I was 22 or 23 at the time I got my implants. I had waited for my breasts to develop since I was twelve, and they never did. I figured that at 22, if they hadn't by then, they weren't going to. It was a desire to have the experience of a womanly body, a full body. It was also reaction, albeit not a very educated or conscious reaction. There was so much information on image and about beauty and worth and what makes a woman's worth and how all that gets so convoluted and twisted around. It's a false image. But I had the desire to have that image and to use that in a personal way.

How does it feel, 20 years later?

Twenty years later, I don't even think about it. [My implants] are not separate from me. It's part of my body, part of who I am. It doesn't feel awkward or odd. It never really has. Okay, I had to go into a surgeon to have my breasts developed and there they are. There's not really a sense or feeling of separation. It feels very much like my arms, my legs or my butt. That's what it has always been. If I were presented with the same decision now, I don't know if I'd have any great charge on it either way. I have no idea what I would feel like at this point in my life with a different body, and, after twenty years, I don't feel gravity. Not really, maybe a tiny little bit.

Have there been any medical complications or symptoms?

The only complication that I had was when I had my first mammogram. The idiot didn't know what he was doing. He sandwiched my breast so hard. Two weeks later, I noticed tingling in my arm and side. My left breast began to harden. There was an encapsulation. I never had it fixed. It never seemed to be that much of a problem. It was just a little harder than the other side. Then I had a chiropractic adjustment one day. I think it tore some of the scar tissue loose. From then on, it was much looser, so I never really had to go back in and have it properly dealt with.

Silicone or saline?

In terms of silicone or saline, I would go saline now because of the potential health issues. We don't know enough about silicone. I haven't had any health issues that I think are directly related. I have had some immune disorders. Frankly, I believe that they were stress related. When the stress eased, the immune disorders also shifted. I did have some cysts in my left side. I don't know if the reason was because of the implants. I have a sense that it is, but it's not conclusive.

Advice for women considering implants

The only advice that I would give a woman who is considering breast implants is: don't do it for anyone else but yourself. Question why you are doing it. It's major surgery. It has a major psychological impact. I think psychologically, the same issues are going to come into your life. You can pick your breasts to fix on, or another body part. For me, I probably would have gotten less attention from guys, especially when I lived in LA.

It's like that classic cartoon of a woman meeting a guy and his eyes go straight to her chest. Maybe I would still meet this guy. Maybe his eyes would have gone to my eyes first. Not that I've stayed with very many people whose eyes went first to my chest.

2nd Portrait of Beauty:
Dannie Sue: Middle-Aged professional woman, living in a rural town near where she grew up. Danni got her implants a year and a half ago, at age 46, after wanting them for two decades!

Why did you do it?

I was always self-conscious about the size that I had. Getting implants was something that I always wanted to do. My husband made a gift of the money to do it. I'm very happy and satisfied.

How much did you spend and was price a consideration?

I spent $4,000. I called several other doctors. Some were actually less expensive, but I just felt confident and felt good about the doctor whom I chose. The four or five hundred dollars I would have saved didn't matter. Once I went to the doctor for a consultation, I was sold on having her do the surgery. She made me feel very confident and trusting in her. I liked the idea that she was female. I was also in a consultation with a male doctor, and I felt comfortable with him, too.

Complications, Symptoms and/or Pain?

I had my surgery in June of 2002. I feel great now. I'm comfortable. I'm happier. I feel much better about my body. I'm pleased with the results.

The first day after my surgery and the next day were really tough. You can't move your arms without pain. I'm sensitive to pain medications. I was a drowsy idiot. You need to have someone with you after you go home. You need to have someone caring for you a little bit. Obviously not being able to move your arms is a pretty big deal.

I did have some pain when my nerves were coming back. The pain lasted for a couple of days, and then it was completely gone. I haven't had any problems whatsoever since.

Any loss of sensation?

In terms of personal pleasure, they warned me before the surgery that sometimes the nipple sensation is lost. I told them that it was important to me, but not essential. In my case, I still have it, so I was very fortunate.

Would you recommend breast augmentation to other women?

My 19-year-old daughter, Linda, had it done just a few months. I thought she was way too young. I said, "Linda, it's the most painful thing you'll go through, outside of having a baby!" Linda got encapsulation in one of her breasts. They had to go back in and redo it. She's doing real well now.

My other daughter, Cassie, has been blessed with nice ones. Linda or I, either one, would have been happy to have what Cassie has got. Cassie's not big, but she's just got enough. Cassie isn't happy with her body, but she doesn't want to have surgery. I was like a pancake. Probably like a 34, barely A. Now I'm a 36C. Linda is a 36C. Before she was a 34A. Cassie is a 34B.

What's the best part of having implants?

It's so much fun to go shopping for bras. Before it was a search to find the most natural looking padding. Now I get to go find the skimpiest bra that has no padding. It's a thrill. There is one little part I can press, where I can tell it's an implant. Other than that, I don't think there's anything that makes it look unnatural. I think they would feel exactly like a real breast.

Before I got the implants, there were times when I felt extremely sexy. My biggest thing was that I never could find a swimsuit that I could wear that fit without completely emphasizing my lack of breasts. I could never wear something sexy and strapless. Other than that, most of the time, I felt quite sexy, except at evening gown time, when you really want to have a cleavage.

Does it feel strange when you're exercising?

The only thing strange about exercising is that the first time I tried to do pushups, it felt like they were going to come flipping right out of there. To be honest, I haven't done pushups since then.

3rd Portrait of Beauty:
Julianne, age 26, got her first implants seven years ago, at age 19Ñbehind her parent's back. She's since had two additional surgeries to get it right. Wonder if she'd do it all over again?

I decided to get implants because you can go to the gym and sculpt your body only a certain way. A man can get a bigger chest by lifting weights. A woman wants to make her body look a certain way, she can't necessarily do that by going to the gym and eating right. A breast augmentation is permanent. You don't have to have padded bras. Another reason for breast implants is that I've seen my friends, and as they've gotten older, their breasts sag. I thought it was horrible. By having the implants, they're perkier. More intact. It keeps them shaped the way I like them. It's a younger, youthful look that is permanent.

Why did it take three surgeries to get it right?

I had my first surgery at age 19--big mistake. I did it behind my parent's back. I didn't have anyone to talk to about it. I didn't have enough advisement. I didn't understand the importance of finding the right doctor, and I was very concerned about the price.

Because it was a hidden secret, I was on my own. Originally, I had an appointment with a doctor, a guy famous for doing the implants of a major television star. He was very reputable. A week before my surgery, he had a really bad knee injury. I was in a panic. I had to take time off from work, and I'd already planned the surgery. So, within one week, I scrambled to find a new doctor. I thought it was my only opportunity. How can I take off work again! At the time, I didn't realize. It's your body. It's something permanent. Do it right the first time!

So, here I was debating between a couple of different doctors. One was charging $5,000, another $7,000. Now at 26, I have ended up spending $14,000 to fix mistakes that two different doctors madeÑthe really bad jobs that they did. I ended up paying a shit load more money because I was trying to find somebody who would do it cheaper. I thought all doctors did the same job. Absolutely not true.

Why was your surgery a "hidden secret"?

I know that my parents are completely against plastic surgery. They wouldn't have been a help, even if they'd been in on the secret. I was trying to keep it from some of my friends. My very best friends knew, but they were young. They didn't know anything. I was the only one of my friends getting it done. Back then, it was less popular, in 1996, just a few years after the scandals.

How can two different doctors get it wrong? Was there malpractice involved?

The first time, there was a problem with communication.. The implants were very separated. The doctor didn't do anything WRONG. It wasn't malpractice, but I didn't like the way they looked. I felt that it was pointless that I got them. They didn't have a natural look. So, then I thought, why don't I go to a Beverly Hills doctor? Big, big mistake. The problem was communication. I wanted them to fall together more and be a little bit bigger. The Beverly Hills doctor took me way bigger and blew me up to 680 ccs. The average woman gets about 350 to 400 cc's, somewhere in that range. I looked ridiculous. Guys would make comments and think I was a porn star. It was kind o