For a while at least, the distance between those who can afford to maintain a youthful-looking appearance, increasingly a sign of privilege, and the merely plain, the unretouched have-nots, will likely widen. New technologies will soon be available to draw in well-off patients who might never have thought of cosmetic enhancement. Dr. Steven A. Teitelbaum, a plastic surgeon in Santa Monica, Calif., predicted that the next milestone would be the control of tissue formation, whether to reduce scarring or grow new tissues. When surgeons can selectively grow tissue in the breast, Dr. Teitelbaum said, patients may face less risk than if they, for example, receive breast implants, which can rupture and cause complications and must also be replaced every few years. ''When we can control scarring we can do operations we don't even think of now because of the massive scar formation,'' he said.
