Sandra Lena Silverman knows a thing or two about cosmetic surgery.
The Miami-based 54-year-old has splashed out $300,000 on more than 25 procedures (she’s lost count of the exact number) over nearly three decades.
But while Ms Silverman is now regularly complimented for her age-defying looks, it was a long process of trial and error to get the look she wanted.
After doing some minor tweaks in her 20s and 30s – including facials, peels, lasers, Botox, filler, breast augmentation, rhinoplasty and a vaginal reconstruction – she thought she had been through it all.
But then she started feeling especially bad about her appearance in her 40s, and when she looked in the mirror, she said it was like ‘staring at an old crone, a total Disney witch’.
Ms Silverman is now sharing her insights with Daily Mail readers in the hope that she can prevent people from making the same mistakes.
One in four Americans will undergo some kind of cosmetic work in their lifetime, but some surveys suggest up to six in 10 regret it.
Sandra Lena Silverman, who is based in Miami, told DailyMail.com that it was a process of trial and error to look the way she does now at the age of 54
The surgery she was most pleased with was her mini facelift, which was done at the same time as a forehead lift, at the age of 47. Above left, before the procedure and right, afterwards
Vaginal reconstruction left me incontinent
PRICE: Up to $20,000
Of all of the cosmetic procedures she has tried, Ms Silverman says the vaginal reconstruction she had in her early 40s was the most painful.
Explaining why she opted for the procedure, she says: ‘I would argue that my full vaginal reconstruction wasn’t cosmetic because my uterus was falling low after the birth of my son, so I actually needed it, but it was the most painful thing I’ve ever gone through.
‘The major issues I faced were incontinence and the fact that I was so loose down there that I couldn’t feel anything during sex. It was bad. And not great for my marriage.’
During the procedure she also had labiaplasty to reduce the size of her labia minora – the skin folds surrounding the urethra and vagina. The entire operation took around six hours.
Although the surgery went well and the results were ‘spectacular’, Ms Silverman reveals that the recovery was very tough.
She says: ‘I had a catheter for two weeks after the surgery and was prescribed Percocet with Tylenol for the pain, which had the side effect of making me terribly constipated.
‘Words cannot fully describe the pain. Since I had a catheter, I couldn’t go to the bathroom, so I had to take [the laxative] MiraLAX. Then I would have explosions.
‘I ended up needing to wear a freakin’ diaper! Not to mention during that two week period, I had to go to the emergency room three times.
Touching on her own experience with breast implants, Ms Silverman says: ‘For my first breast augmentation on my late 20s, the profile was too high and the medium was too large, so I actually ended up looking top-heavy. I eventually got saline implants replaced with silicone and did a breast lift and went smaller and lower’
‘My husband was in Las Vegas for much of this, so I was handling it all solo for the most part. Eventually, the doctor changed my pain medication, and that helped a lot.
‘Once the catheter was out, I was on the mend, but everything down there hurt for a good month.’
While things are ‘still looking and feeling great down there’ 15 years on, Ms Silverman says for others contemplating the surgery ‘if you don’t need it, don’t do it’.
Don’t get filler in your 20s and 30s
PRICE: From $500 to $1,500 per syringe
Fillers – gel-like substances injected beneath the skin to restore lost volume, smooth lines and enhance facial contours – have become big business because the results are instant with little-to-no down time.
The number of women using fillers has increased close to threefold in the US over the past decade.
In 2010, 1.8 million filler procedures were performed, increasing to 5.3 million in 2023.
The most popular dermal filler brands are Juvederm, Restylane and Sculptra.
This is because they are made using hyaluronic acid, which is a natural component of the skin, and experts say these brands offer a more natural look.
The most popular areas for dermal fillers include the lips, cheeks, and under-eye areas, and volumes range from 0.25ml for a ‘bee sting’ look in the lips to up to 3ml per cheek for chiseled cheekbones.
Despite their popularity, Ms Silverman warns against getting fillers too early, as she believes they can age the skin prematurely.
This is because they can stretch the top layer of skin and users will need to keep replacing this lost volume with yet more filler, leading to a ‘puffy’ or ‘hamster cheek’ look.
She explains: ‘Anything that removes fat or stretches out skin is not good for when you age.
‘Try to stay away from filler in your face when you’re in your 20s and 30s.’
She also had one horror story with filler in her lips, where the injector made her look ‘like a duck,’ so she flags the importance of finding a reputable clinic.
Once damage is done, she says it can take a long time and lots of money to reverse the effects of filler.
Looking back, Ms Silverman says she would have avoided getting filler so early as this led to her needing a facelift.
Now she is older, she is a big fan of the injectables and she has ‘gotten them almost everywhere at this point’ including in the lips, smile lines, chin, jaw, temples, nose, cheeks, knees, vagina, butt, hands, earlobes, and corners of the mouth.
Never do buccal fat removal
PRICE: Anywhere from $5,000 to $20,000
Chrissy Teigen (pictured in May, 2021 on the right) admitted to receiving buccal fat removal in September 2021. Teigen’s (pictured in late 2021 on the right) face has a more angular appearance after receiving the procedure
Buccal fat removal has become a hot procedure over recent years to achieve a more chiseled look.
The procedure involves removing fat pads from inside the cheeks, giving them a more angular face as a result.
Among the most notable A-listers who have had or are rumored to have had their buccal fat pads removed is model Chrissy Teigen, who kickstarted a major trend among celebrities and non-celebrities.
She admitted that she had had her buccal fat removed and also talked about her eyebrow hair transplant.
But other well-known stars including Lea Michele, Bella Hadid, and Anya Taylor-Joy are also believed to have had the procedure.
Explaining why she advises against the fashionable tweakment, Ms Silverman says: ‘You actually need your buccal fat because as you age, you lose volume in your face.’
With no padding in the cheeks, the beauty expert says people can look too sucked in and gaunt as they get older.
She warns that then filler is then needed to add volume, and this can change the shape of your face further.
‘So make sure that’s what you’re willing to do,’ she concludes.
Don’t do the ‘Y’ Lift
PRICE: Between $2,000 and $7,000
The Y Lift, better known as a ‘liquid facelift’, is a ‘facial contouring’ technique that uses strategically placed fillers to rejuvenate the face.
It aim is to restore a youthful ‘Y’ shape from the cheekbones to the chin, and improve the appearance of wrinkles and sagging skin.
It can be completed in as little as 30 minutes and the results are immediate, whereas facelifts can take a few weeks to see any results.
But Ms Silverman says getting a Y Lift is something she will ‘always regret’.
She reveals: ‘The first time I did it was great – I got filler in the perimeter of my jowls, which was lifting and made me look more sculpted.
‘But the second time I did it, I got pie-faced, and by that I mean there was so much filler in my cheeks that I looked completely round, like a pie.
‘It caused my skin to stretch and then sag, and it took about two years to fully fix it because the filler goes deep inside the muscle.
‘By the time I got my facelift two years later, I still had filler in there.’
Ms Silverman said her face looked too rounded after too much filler and she warns it can change the shape of your face for the worse
Do LOTS of research before rhinoplasty and breast augmentation
Price for rhinoplasty and breast augmentation: Each treatment from $5,000 to $10,000
Ms Silverman says that she wishes she had done more research before getting her first nose job but it was before the age of the internet and it was more difficult to find feedback on practitioners.
Because of this, she ended up with a mediocre doctor who took out too much cartilage.
She recalls: ‘I got my first rhinoplasty in my twenties and it was honestly underwhelming. I went to a doctor in Baltimore and received his signature style: these itty-bitty noses.
‘During our consultation, I described what I wanted, that is a normal size nose, not a teeny tiny one. I trusted he would listen and not take his typical approach with me. I was wrong – UGH! I left his office with a nose that was just… too small.
‘I didn’t like it. While it was better than what I had started out with, it wasn’t what I wanted, and I kicked myself for not going to someone else. The shape of my nose bothered me for years.’
Since her first nose job, Ms Silverman has had two more and she is finally happy with the way it looks, describing it as ‘fine’.
The beauty expert says the same amount of research needs to be done ahead of getting breast implants.
To help pick a doctor, she recommends looking at as many before/after photos as possible to get an idea of the results they can offer.
Touching on her own experience with breast implants she adds: ‘For my first breast augmentation on my late 20s, the profile was too high and the medium was too large, so I actually ended up looking top-heavy.
‘I eventually got saline implants replaced with silicone and did a breast lift and went smaller and lower. Be cautious about going too big or too high.’
With both nose jobs and breast augmentation procedures, Ms Silverman says it is a ‘must’ to choose a board-certified plastic surgeon who specializes in that specific procedure.
She adds: ‘DO NOT TAKE ANY SHORTCUTS TO SAVE MONEY! Do your research, as always, and be sure to tell your surgeon exactly what you’re looking for during your consultation.’
Watch out for facial peels
PRICE: Anywhere from $125 to $2,500
When it comes to facial peels, Ms Silverman says she has ‘tried them all’.
These treatments are designed to exfoliate the skin and promote new cell growth to improve skin texture and address various skin issues such as acne and pigmentation.
Ms Silverman’s favorites are the retinol and chemical peels that her facialist Mindy Kim offers at her office in the Miami area.
While she now has her favorites, she says she has ‘been down some major rabbit holes with specialists who looked good on the surface but would do things to my face and body that made me look worse, just so I’d come back and spend more with them’.
Again, she says the most important thing is to do thorough research and to pay attention to online reviews.
She also warns that some of the harsher peels require anesthesia and can be ‘pretty strong so you look like a burn victim afterward’.
For the more intense peels, she warns that recovery can take at least a week so you will need to plan accordingly and ‘you can’t get too many of them because your skin can get very, very thin’.
Don’t get liposuction… on the knees
PRICE: From $3,000 to $6,000
LEFT: The bad lipo Ms Silverman did in her knees with sagging afterwards RIGHT: After she had a threading treatment to rectify the issue. The specialized, dissolvable threads work by lifting and tightening the skin
The first time Ms Silverman tried liposuction on her body was in her 30s, right after she had her son, and she said the experience was ‘great’.
But when she went for her second round of lipo in her 40s it proved to be a disaster.
While getting her stomach done, the doctor said she could get her knees sculpted and Ms Silverman agreed.
But she said it was a decision she went on to regret.
She explains: ‘The lipo doctor also told me that she could liposuction my knees. In the moment, it seemed like a good idea (this was before I’d realized the terrible results on my stomach).
‘Oh, if only I could go back in time! She ended up taking out too much fat from my knees, which made them very uneven.
‘Now, with so much fat gone, the skin on my knees started to sag majorly; I had to get threads (specialized, dissolvable threads to lift and tighten the skin) in them. This is when I also started to get filler in my knees too.
‘I had to go back for tweaks about every five months. All in all, my liposuction experience was terrible.’
Because of her traumatic lipo experience, Ms Silverman says she would never recommend the treatment on the knees because the fat there is necessary.
She concludes: ‘I actually caused more damage by removing the fat when I could have just eaten more protein and done more lunges at the gym. Don’t touch your knees.’
And… the surgery she was most pleased with?
Ms Silverman says of all the procedures she’s had, she was most pleased with her mini facelift, which was done at the same time as a forehead lift, at the age of 47.
She got the facelift to help lift sagging skin, something she had unsuccessfully tried to do with fillers in the past.
‘The facelift that I’d had done turned out to be great as all the inflammation in my cheeks and under my eyes started to go away
‘The facelift that I’d had done turned out to be great as all the inflammation in my cheeks and under my eyes started to go away,’ shes
‘The facelift that I’d had done turned out to be great as all the inflammation in my cheeks and under my eyes started to go away,’ she
‘I was starting to look sculpted, and even more lifted than I’d been in my thirties.’
Going forward, Ms Silverman says she plans to maintain herself through ‘diet, nutrition, working out, and small treatments’.
Ms Silverman’s book, From Bullshit to Botox: A Rebel’s Guide To Self Love And Eternal Youth, is out now
