Ever since 1890, when the use of anesthetics and antiseptics made it unlikely for people to die getting a nose job, cosmetic plastic surgery has been part of the global culture. By the 1920s, plastic surgery grew ever more common, and became associated with vanity. New techniques developed during World War II helped further increase demand for -- and types of -- the elective surgeries.
The era of minimally-invasive techniques has marked a new generation of plastic surgery options, with 14.6 million cosmetic procedures performed in the United States in 2012, up 5 percent since 2011. Here are the current most popular cosmetic surgeries, according to the American Society of Plastic Surgeons.
Initially, cosmetic plastic surgery was not seen as a vanity procedure, said Emory University professor Sander Gilman, author of Making the Body Beautiful: A Cultural History of Aesthetic Surgery.
"Jews in Germany had their noses reduced so they could get jobs," Gilman said. As such, it was equally common for men and women to undergo plastic surgery.
"By the end of the 19th century there's a common understanding in the West that you can transform yourself, you can move classes -- and you can get a new nose," Gilman said.
Ear pinbacks were also popular at the time, to correct "prominent ears."
By the 1920s, the world of cosmetic surgery had shifted. By then, the first textbook about facial cosmetic surgery was in circulation, called "The Correction of Featural Imperfections" by Charles Miller. Women sought face lifts for reasons associated with vanity, not employment.
"It becomes something we associate with the upper middle class," Gilman said.
Everything from ivory to rubber has been used to augment breasts since the beginning of the 20th century. Nothing worked well (one of the first experimental substances, paraffin, had particularly bad results, with breasts that grew hard and lumpy and high rates of infection) until the Dow Corning Corporation developed the first silicone breast implants in 1961. Even though breast augmentation dropped 7 percent from 2011, it's still the No. 1. plastic surgery in the U.S., with 286,000 procedures in the U.S. in 2012. (It's followed by nose reshaping, eyelid surgery, liposuction, and facelifts.)
"People who have had significant weight loss are coming to grips with dealing with [their bodies]," said surgeon David Reath, a member of the American Society of Plastic Surgeons. "Whether they've lost weight through weight reduction surgery or diet and exercise, if they were overweight for a long period, the
skin hangs around, and it’s very demoralizing. They're looking for a solution."
One solution appears to be a procedure called an upper arm lift, which involves either liposuction or brachioplasty, a surgery that removes loose skin is removed from the back of the arms.
Plus, "anytime we start talking about arms the image of the buff First Lady comes into mind," Reath said.
"This is up in every age group of men," Reath said. "I think it's because there’s a growing awareness that there is a solution to something that's extra troubling to men of all ages. It can have a tremendous psychological effect on young men going through puberty."
In fact, the number of men having cosmetic procedures in general has increased so dramatically that Gilman thinks it will once again even out to match the rate of women who undergo plastic surgery.
New minimally invasive and cheaper procedures such as Botox and other injectable fillers took off when the economy took a downturn, Reath said.
"You could take less time off from work [to recover]; year after year it has continued to grow," he said.
In fact, the popularity of such procedures is growing so fast that Gilman believes there will come a point in the next 10 years or so where people will wonder why you didn't have a cosmetic procedure if you have sagging skin under your jaw or lines around your eyes.
"It's becoming the standard," he said.
Ryan Shay was at the peak of fitness when he lined up at the start of the New York City Marathon in November 2007 with the hopes of qualifying for his first Olympic team. Less than six miles later, the 28 year old collapsed. Soon after, he was pronounced dead.
When Shay's autopsy revealed scarring in the healthy, young runner's heart, scientists finally woke up to the possibility that exercise might not be the panacea for health that it has long been touted to be, said Peter McCullough, a cardiologist at Baylor University Medical Center in Dallas.
Since then, a growing, still controversial body of research has begun to show that all the exercise in the world won't protect your heart if you don't also eat well and for some people, take drugs to overcome cardiovascular risk factors. Exercising too much may even raise the risk of developing clogged arteries.
The message is not that exercise is pointless, experts caution. Instead, it's that you can't eat with abandon just because you're fit and slim. It may also be unwise to exercise with abandon, no matter what you eat.
"There was this false belief that you could just eat junk food and be more liberal with your diet and then exercise and it would somehow prevent artery blockages to the heart," McCullough said. "Lo and behold, exercise doesn’t prevent these blockages from occurring. And some analyses show extreme endurance exercise may actually somewhat promote heart blockages."
"People say, 'I run, so I can eat whatever I want,'" he added. "That's not true. That needs to go away."
It's well established that moderate exercise has major benefits for heart health. When couch potatoes start moving, even by just walking three times a week, studies show that cardiovascular deaths drop by up to 25 percent and lifespans lengthen. Regular exercisers live an average of seven years longer than sedentary people.
Exercise strengthens the heart, making it a more powerful pump and helping it become more efficient at turning oxygen into fuel. That kind of fitness boosts the chances of surviving heart attacks, illnesses and even car accidents.
But working out does nothing to prevent the artery-clogging effects of eating a diet high in saturated fat, new studies suggest. That contradicts a long-held belief that athletics worked like a drug to protect the heart against atherosclerosis -- a build-up of plaque inside the arteries that can constrict blood flow and lead to heart attacks and strokes.
Over-exercising may even increase the risk of developing atherosclerosis. In a study just published in The Journal of the Missouri State Medical Association, McCullough and colleagues used advanced CT imaging technology to compare the hearts of 23 sedentary men with 50 male marathoners who had completed a minimum of 25 races. Imaging revealed a greater volume of plaques in the distance runners.
The results fall in line with other studies showing that moderate running is good but excessive running may be bad. One long-term study of 54,000 Americans, published last year, found the lowest rates of death among people who ran 5 to 20 miles a week. People who ran more than 25 to 30 weekly miles, on the other hand, lived no longer than people who were inactive.
It's not yet clear why ultra-athletes might be at greater risk for artery blockages, but one theory is that the extra twisting and pumping motions induced by repetitive exertion might put too much wear and tear on the arteries, leading to a type of scarring called fibrosis.
It's also possible that over-exercised hearts suffer from chronic stress and the need to constantly repair damage induced by excessive free-radical production.
About half a million people finished marathons in the United States last year and someone dies in virtually every major long-distance race, McCullough said. The new findings are a wake-up call for people who think they're doing their bodies a favor by pushing themselves to their limits.
"I was personally a big-time marathoner. I ran a marathon in every state in the U.S.," McCullough said. "I retired based on our research findings. I said, 'This is not doing me any good and could be doing me harm.'"
For people who maintain a more moderate level of exercise up to two or three hours a week, it's also important to remember that exercise is not the only factor that influences heart health, said Norman Lepor, a cardiologist at the Cedars-Sinai Heart Institute and the University of California, Los Angeles' David Geffen School of Medicine.
Smoking, eating a diet high in salt and trans fats, and having a genetic predisposition to heart disease are just as important.
"Focusing on athletics only affects what's really a modest part of the equation for the development of cardiovascular disease," Lepor said. "Someone can be in shape and still at risk of having a heart attack."
"I don't want in any shape or form to slam exercise," Lepor said. But, he added, "it can really be too much of a good thing for some people."
Emotions ran high at the American Heart Association meeting last year when researchers held a seminar to discuss the new findings, McCullough said. Many doctors feared that the public would get the wrong message about exercise, which remains essential for combatting rising rates of obesity and related health problems.