In 2006, Americans spent more than $12 billion on cosmetic procedures, proof enough that plastic surgery has become big business. And it's no wonder. Procedures that just a few years ago left a less-than-smooth finish and/or unsightly scars are now more refined, and require far less recovery time. I asked several plastic surgeons to tell me what they considered to be the most important new advances in plastic surgery. Here's what I learned.

Sculpting the Fat

Doctor Craig Vander Kolk, MD, is an experienced plastic surgeon with the Weinberg Center for Women's Health & Medicine at Mercy Medical Center in Baltimore. When I asked him about newest procedures, he told me the future of plastic surgery is in the "tailoring of fat"-not just removing unwanted fat, but contouring the removal areas in an artistic and aesthetic way.

"Liposuction works great," he said, "and we know the risks." And yet there are new techniques and options for liposuction that weren't available even a few years ago.

The basic liposuction procedure is just what it sounds like-a removal of excess fat through a suctioning process. A small incision is made in or near the areas to be suctioned. An appropriately-sized tube, or cannula, is inserted through the incision to loosen excess fat. The fat is then removed using a surgical vacuum.

Dr. Vander Kolk recommends the procedure because it gives the surgeon a great deal of control to sculpt and refine the body, which some of the newer procedures do not. For those looking for an incision-free fat removal, however, there are some alternative technologies in development.

For instance, patients today can melt the fat away with lipo-dissolve, a new technique still waiting for FDA approval. In this procedure, a fat emulsifying chemical is injected into the unwanted fatty tissue. This eliminates the need for an incision and potential scarring.

There are still some concerns that need to be addressed, however. The fat definitely dissolves, but Dr. Vander Kolk cautions that "nobody knows exactly how the body will take care of that quantity of dead cells." There are several known side effects. Many patients have experienced some tissue thickening, swelling, and pain. It's important to know that while this procedure is not designed to produce drastic results, it seems to be effective for removing smaller quantities of fat.

External ultrasonic liposuction is even less invasive, although it faces the same problems. This procedure uses ultrasonic energy to liquefy unwanted fat. "It's for limited areas," Dr. Vander Kolk. "It doesn't go deeply, so it's for people closer to their ideal body weight."

Dr. Paul Wigoda, board certified plastic surgeon in the Miami area, recommends internal ultrasonic liposuction, in which an ultrasonic cannula that "looks like a thin metal wand" is inserted under the skin and liquefies the fat, which is simultaneously suctioned out. Often the surgeon will go back with a regular cannula to make sure he or she has removed all the unwanted cells. Dr. Wigoda says this procedure is much more effective than the external treatments and safer than laser liposuction, which can burn.

By Kathleen Bowers and Allison Pedrazzi