Matthieu Roy’s friends used to call him a frog — and not only because he was a transplanted Quebecker living in Toronto. His calves were “like toothpicks really, like frog legs,” so scrawny that he shied away from wearing shorts, going to the beach and playing water sports.

After years of trying to bulk up at the gym proved fruitless, Mr. Roy forked over $8,000 to a plastic surgeon to insert silicone implants into his calves.

“I just feel a lot better about myself. It’s like when you get an amazing new haircut or you decide to dye your hair a different colour or you buy a shirt that you really like,” the 25-year-old marketing student said in an interview.

“It really helped me to get a lot more self-esteem about myself. You know it’s been a year, I got a new girlfriend and I just have the feeling that it’s all because of this, and it sounds a bit silly but that’s really the way I feel.”

Mr. Roy, who was 24 when he had the surgery, is one of an increasing number of young men who are shelling out thousands of dollars to perfect their bodies through a host of surgeries, from rhinoplasty to refine noses to liposuction to erase love handles and create chiselled abdominal muscles, also known as six-packs.

“Men are becoming subject to the same forces women have always been subject to,” said Stephen Mulholland, a Toronto plastic surgeon whose male clientele has mushroomed in the past decade. “The previous generation of young men did not do this.”

While there are no comprehensive Canadian statistics on cosmetic surgery, those in the field say they are seeing more and more men, including those who are in their 20s and even teens.

In the United States, the number of cosmetic procedures performed on men has more than tripled since 1997. Males got 10 per cent of all enhancements last year, according to the American Society for Aesthetic Plastic Surgery.

Men’s interest in cosmetic surgery is in line with an overall explosion of nipping and tucking. In 2004, the society said the number of surgical procedures in the U.S. jumped 17 per cent over 2003 levels. When considered along with non-surgical treatments, such as laser hair removal and Botox injections to smooth our wrinkles, the figure soared 44 per cent.

As plastic surgery becomes more common, the stigma of going under the knife is slipping, in part because of a host of celebrities — including Joan Rivers, Cher, Pamela Anderson and Patricia Heaton of Everybody Loves Raymond — who have openly discussed their revisions.

Even ordinary Joes are being featured on prime-time reality shows such as The Swan and Extreme Makeover. The latter has chronicled the surgical transformations of several men, including a law-enforcement officer, an aspiring artist and a man who had been wrongfully convicted and sentenced to death.

Indeed, the male body is being “disrobed in many ways,” said Michael Atkinson, a sociology professor at Hamilton’s McMaster University who is halfway through a three-year study into Canadian men’s uses of cosmetic surgery.

Though the stereotype of yesteryear may have been beer bellies, hairy backs and general inattention to style, men now live in a culture intensely focused on all things aesthetic, from a toned physique to health and fitness to quick fixes. Many young women readily proclaim their affinity for sculpted abs, and encourage their boyfriends and husbands to be surgically enhanced.

Young men, especially those who live in cities, are acutely sensitive to body issues in a way previous generations never were, Prof. Atkinson said.

“All these things sort of crystallize and sort of put some pressure on young men to do this and to think about this.”

“These guys are saying, ‘Yeah, everybody is talking about this. Everybody is sort of reinforcing this as the norm. I want to look like a masculine body. I want to look like a healthy body. I want to look like an attractive body. I want to look like I care and have a sense of morality and ethics about my body.’ “

Prof. Atkinson, who said some men have a striking lack of knowledge about risks and side effects, said so-called minor treatments appear to be “pathways” into more serious surgical procedures.

“This is what we have to be aware of right now, as we start seeing this mushrooming of the younger populations into this and kids who are 15 and 16 now speaking about wanting plastic surgery.”

He told the story of one man who underwent five procedures in just three years. The man, who was in his early 30s, started out with a nose job, then got his eyelids lifted. His face looked so good, Prof. Atkinson said, that he got a hair transplant, then liposuction and finally laser eye surgery.

“He sort of progressively rebuilt himself in three years. He’s starting to represent this ‘I- want-to-do-this-and-I-want-to-do-this-now,’ Extreme Makeover mentality. [They think] ‘I’d like to do this as quickly as possible because I want to look good today, not tomorrow.’ “

The surgical procedures most popular among men in Canada, according to plastic surgeons, are liposuction, nose jobs and eyelid lifts. While in high demand in places like California, calf, buttock and pectoral implants for men are rare in Canada, though “slowly rising” in popularity, said Marc DuPéré, the doctor who operated on Mr. Roy’s calves.

Also common, but rarely discussed, is male breast-reduction surgery to correct a condition that is often the result of hormonal imbalance or weight gain.

Ryan Tucker, a 21-year-old Toronto waiter, had such an operation, which can cost about $8,000, last year after years of embarrassment and teasing. The results have made a big difference; he now wears thin T-shirts in the summer instead of heavy clothing.

“I definitely feel a lot better about my body. It’s given me a little more confidence in terms of being able to stick my chest out and walk around,” he said.

“It’s all about the confidence factor.”

As a kid, Scott O’Leary was called Dumbo because his ears stuck out. In January, the 20-year-old construction worker from Alliston, Ont., southwest of Barrie, had them pinned back. The $3,000 operation “makes me look a little bit better and I feel a little bit better.

“I think plastic surgery is perfectly fine, to be honest with you,” he said. “Because, what the hell — why look good when you can look great?”

http://www.theglobeandmail.com/servlet/ArticleNews/TPStory/LAC/20050328/SURGERY23/TPHealth/

Originally posted at http://www.plasticsurgery.org

For Immediate Release: July 16, 2008

ARLINGTON HEIGHTS, Ill. –A study examining plastic surgery procedures performed in accredited outpatient facilities found that office-based surgery is as safe as surgery performed in hospitals. The study published in July’s Plastic and Reconstructive Surgery® (PRS), the official medical journal of the American Society of Plastic Surgeons (ASPS), reviewed more than 1.1 million procedures and found the mortality rate to be significantly less than one percent or 0.002 percent.

“The study shows that plastic surgery in accredited facilities is safe and deaths are rare,” said ASPS Member Surgeon Geoffrey Keyes, MD, study co-author. “However, people should consider plastic surgery with the same seriousness as medically necessary surgery. Most importantly, patients should have their procedure performed by an ASPS Member Surgeon in an accredited facility.”

The study reviewed data collected from January 2001 through June 2006 by The American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), which mandates biannual reporting of all complications and fatalities. The data was obtained from facilities accredited by the AAAASF, which requires that surgeons be board-certified and have credentials at a hospital to perform any procedure being contemplated at an office-based facility. The ASPS requires all of its Member Surgeons to operate only in accredited or licensed facilities.

The study found deaths occurring at office-based surgery facilities are rare. More than 1.1 million operative procedures in AAAASF-accredited office-based outpatient surgery centers were studied from 2001-2006. Deaths were infrequent, occurring 2.02 in 100,000 procedures or 0.002 percent, which is comparable to the overall risk of such procedures performed in hospital surgery facilities. The vast majority of deaths were due to pulmonary embolism (a blood clot that travels to the lungs, blocking major blood vessels). Pulmonary embolism is an uncommon cause of death associated with any type of surgery whether elective or medically necessary.

These new findings contribute to a growing safety record for office-based surgery procedures. A 2004 PRS journal study examined 400,000 operative procedures in AAAASF-accredited office-based outpatient surgery centers from 2001-2002 and found that death occurred in 1 in 59,000 procedures or 0.0017 percent.

“While all surgery carries risks, the bottom line is that this study illustrates patients can and should feel safe when they go to an ASPS Member Surgeon who performs their procedures in an accredited facility,” said ASPS President Richard D’Amico, MD. “Amazingly, only 14 states mandate accreditation of facilities, so it’s up to the patient to be knowledgeable. A patient’s safety and life is everything.”

Nearly 11.8 million cosmetic surgery procedures were performed in 2007, up 59 percent since 2000, according to ASPS statistics. Fifty-nine percent of cosmetic surgery procedures were performed in an office-based facility, 21 percent in a free-standing ambulatory surgical facility, and 20 percent in a hospital.

By Jane Weaver
Health editor
MSNBC
updated 1:08 p.m. MT, Thurs., March. 4, 2004

Kirk Thompson, 41, had lost 400 pounds in the two years since his gastric bypass, or “stomach stapling,” operation at Ohio State University Medical Center in October 2001. Down from a peak weight of 745 pounds, the West Virginia native was closer to a normal weight than he had been in decades. After years of suffering congestive heart failure and rarely leaving his home except to go to the hospital, Thompson’s health was improving.

But while he’d lost a huge amount of weight, when he looked in the mirror he saw the same obese man he’d been since high school. He was still carrying 100 pounds of extra skin, including layers of flesh around his abdomen that hung down nearly to his knees.

“It was hard to walk,” says Thompson, who works with a weight-loss support site called ObesityHelp.com. “It made me so off-balance that I was almost stumbling.”

So Thompson went back to Ohio State to have the skin around his abdomen and upper legs tightened.

About 25 pounds of loose skin were removed by a tummy tuck and lower body reshaping, an operation that is becoming one of the fastest growing areas of plastic surgery in the United States.

“It feels great and really strange,” says Thompson, who lost 12 inches around his waist from the plastic surgery. “It made my whole life different.”

Driven by the American obesity epidemic and by the high-profile success stories of celebrities such as NBC’s Al Roker and the novelist Anne Rice, the number of weight-loss, or bariatric, procedures is expected to top 144,000 this year, according to the American Society for Bariatric Surgeries. But the road to weight loss doesn’t always end there. Many of those patients will seek a plastic surgeon to help their formerly obese bodies look more normal.

Statistics from the American Society of Plastic Surgeons show that 52,049 people had some kind of body contouring following massive weight loss in 2003, the first year the association has tracked that specific category. Plastic surgeons say it’s clear there has been a significant increase in demand for these procedures.

“People are now a lot more aware that skin surgery may be part of their gastric bypass operations,” says Dr. Robin Blackstone, a surgeon and director of the Scottsdale Bariatric Center in Arizona.

Five years ago Dr. Albert Cram, chief of plastic surgery at the University of Iowa, used to perform one tummy tuck or body lift a month on patients who had lost massive amounts of weight. Now his department averages one or two a week.

“It’s growing significantly,” he says.

People who have lost more than 100 pounds may find that weight-related illnesses like diabetes or hypertension go away, but they still don’t look thin. The skin becomes like an elastic band that has been stretched too far. No matter how much exercise, or what kind of exercise, they do, the skin doesn’t go back to its normal size.

“Expanded skin doesn’t have the same capabilities as before weight gain; it’s damaged skin with stretch marks,” says Dr. Jeffrey Kenkel, vice chairman of plastic surgery at the University of Texas Southwestern Medical Center in Dallas. “From the head down to the ankles, there’s a lot of overhanging skin.”

Not just about vanity

For some weight-loss surgery patients, a body lift isn’t about vanity or for simply cosmetic purposes. Hanging folds of flesh around the abdomen can cause rashes, chronic infections, hygiene problems and difficulties with exercising. These people may have conquered the health problems like diabetes that accompany excessive weight, but their clothes still don’t fit properly.

“The profound effect is on body image,” says Dr. J. Peter Rubin, director of the Life After Weight Loss Program at the University of Pittsburgh Medical Center, a center which specializes in body contouring and counseling. “The plastic surgery after weight loss can have just as powerful an effect on someone as the gastric bypass.”

Not every person who has a weight-loss operation will see the need for additional surgery to counteract skin laxity. Age and genetics play a part, with older patients and those whose weight tops 400 pounds being the most likely candidates, plastic surgeons say.

The most common procedure is the tummy tuck, or the abdominoplasty, an operation designed to remove the “apron” of skin hanging from the stomach. Some people have skin removed from their sides and back, and their buttocks reshaped.

Other weight-loss patients may need a lower body lift, which includes lifting the skin up from the knees almost like pulling up a pair of pants, says Dr. Deborah White, a plastic surgeon in Scottsdale, Ariz. Some may need tightening and lifting in their upper arms, the chest or breasts.

“A person’s arms may not go into the sleeves of their clothes because there’s too much extra skin,” says White.

Most of the skin-lifting procedures are scheduled about a year to 18 months after a patient’s gastric bypass so that the majority of the weight has already been lost.

“The key issue is that a patient’s weight is stable and is as close to the ideal body weight as possible,” says Rubin.

Recovery includes several days of hospitalization. After six weeks, the patient can return to work and can usually begin exercising after eight weeks, says Rubin. Scars can take a year to heal.

But recovery may not be the most difficult part of body contouring. Getting coverage from an insurance company may be. As the number of people getting gastric bypass has surged, commercial insurers are becoming more resistant to covering the $30,000 procedure, citing safety issues. They’re also more likely to deny payment for any operation not considered medically necessary.

On average the cost of an abdominal tuck is between $6,000 and $10,000, depending on the area of the country. For a lower body lift with a thigh reshaping, the price can reach $10,000 to $20,000. A complete body contouring, including face lift, can top $30,000, according to estimates.

Most doctors spread the procedures, which can take five to 10 hours in surgery, over several months.

‘Big operation’

While skin surgery doesn’t carry the same risks as gastric bypass — which has a nationwide mortality rate of 1 in 200, according to doctors — there can be complications. The patient is placed under general anesthesia, which can be risky for someone who may have weight-related heart problems.

There’s a danger of post-surgical blood clots. Long incisions can be slow to heal, fluid can collect between the muscle walls and the skin and severe scabbing can slow recovery.

“It is a big operation and recovery is extensive,” says Cram. “If we tighten as much as we can, the patient can have problems bending forward and can feel constrained for awhile.”

While any plastic surgeon can perform body contouring, Kenkel urges patients to find an accredited overnight facility and seek a doctor who has experience with other weight-loss patients.

“It does require a magnitude of care,” says Kenkel. “Other techniques don’t fit these patients because they’ve lost such volume in their tissue that needs to be replaced.”

Thompson is going back for more skin tightening in April, when doctors are expecting to remove another 35 pounds of skin from his chest and sides. His legs, arms and back will be reworked in another series of surgeries.

He acknowledges that the surgeries are difficult but he isn’t worried.

“The answer at the end is, it’s worth the pain,” he says. “I was so large I couldn’t go out. Now I fit in and I’m almost totally normal.”

http://www.msnbc.msn.com/id/3972656/

Originally posted at http://www.plasticsurgery.org

For Immediate Release: October 08, 2008

CHICAGO - Breast augmentation, lift, combination lift/augmentation and reduction achieve high satisfaction rates; enhance self-esteem and quality of life; and 99 percent of women would have their surgery again, according to a first-of-its-kind study to be presented at the American Society of Plastic Surgeons (ASPS) Plastic Surgery 2008 conference, Oct. 31 - Nov. 5, in Chicago. The study found breast lift and lift/augmentation to have a high level of patient satisfaction that rivals breast augmentation and reduction.

“Many studies have shown breast augmentation and reduction are highly gratifying procedures for women, but until now we’ve had limited information on patient satisfaction for breast lift or combination lift/ augmentation. This data fills in the gap,” said Eric Swanson, MD, ASPS Member Surgeon and study author. “When the vertical technique is used in the augmentation/lift procedure, patient satisfaction is high.”

In this prospective study, 325 patients were interviewed about their breast procedures over a five year period, with a response rate of 81 percent. Almost all patients, 99 percent, would have their procedure again and 91 percent of patients reported improved self-esteem. Overall, patient satisfaction was 96 percent. The average result rating was 9.2 out of 10. According to Dr. Swanson, the high patient satisfaction rates for breast lifts and reductions in the study applied only to the vertical technique, which was used on all patients.

The study also evaluated preferred breast shape, discomfort level, and recovery. Most women preferred a convex breast shape, i.e., fuller contour at the top of the breast.

“Naturally, breasts are fuller towards the bottom, but our study found patients want more fullness on top, which is hardly surprising in view of the purpose of bras,” said Dr. Swanson.

Patients reported using prescription analgesics an average of 5.4 days, resumed driving in 5.8 days, returned to work in 7.5 days, and felt “back to normal” in 27.8 days. Pain rating was moderate overall, 5.4 out of 10, higher for breast augmentation (5.9) and lower for breast reduction (3.3).

Nearly 348,000 women had breast augmentations in 2007, making it the number one cosmetic plastic surgery procedure performed last year, according to ASPS statistics. In addition, more than 106,000 women had breast reductions and 104,000 women had breast lifts last year.

By E.J. Mundell
MSNBC contributor
Updated: 3:18 p.m. ET Feb. 18, 2004

She was browsing through the racks at a local mall several weeks ago when a young man who looked to be in his 20s approached her. “I just wanted to tell you, you look beautiful,” he said.

While a comment like that might lift the spirits of many women, for Lynne, a 44-year-old from St. Louis who asked that her last name not be used, it was proof-positive she’d made the right decision in joining the growing number of American women seeking out gluteal, or buttock, implants.

“I think it makes a bigger difference in a woman’s figure than a breast implant,” she says.

While statistics on the number of gluteal-implant surgeries are only beginning to be collected, officials at the American Society of Plastic Surgeons say 614 of the procedures were performed in the United States in 2002, although the actual number could now be much higher. Doctors are reporting a rising demand for the surgery.

Lynne’s surgeon, Dr. Robert F. Centeno, who has a private practice in St. Louis, credits much of the surge in the procedure’s popularity on the famous fanny of one celebrity in particular -– Jennifer Lopez. “As many people that you might have that criticize her buttocks as being too big, she has impacted on what is perceived to be an attractive buttock,” he says.

The influence of other “bootylicious” pop stars like Beyonce Knowles as well as fashion trends also are transforming the bottom into a top priority for those considering plastic surgery, Centeno says.

“If you have low-rise pants and you don’t have a butt,” he says, “it doesn’t look very good.”

What’s ideal?

The exact dimensions of the “ideal” backside are still being debated, but Lynne knew she wasn’t quite hankering for something J-Lovely.

“I think she has some curves and there’s some shape there that looks good,” she says. “I just think there’s a little too much of it.” She opted instead for a smaller, but still pert and well-rounded, derriere.

Meanwhile, Centeno and his partner, Dr. V. Leroy Young, have been hard at work investigating the precise geometry of the perfect bottom. To this end, they plan a study where a group of objective observers rate the aesthetics of 500 adult heinies.

They’ve already come up with some preliminary conclusions. For women, “maximum projection” -– the point at which the buns stick out farthest from the body –- should be about level with the pubic mound, according to Young. For men, maximum projection would be a bit higher, closer to the navel.

Furthermore, Young says, “the gluteal crease, where your buttocks join your thighs, should not go past two-thirds of the way across the thigh.” Finally, every perfect backside should have that pert “dimple” at the top, where the upper curve of the buns meet at the base of the spine.

Better-booty business booming

Whatever the ideal turns out to be, U.S. demand for more fabulous fannies is currently outstripping supply.

While the trend started on the two coasts, plastic surgeons in nearly every state are now being inundated with requests from patients, according to Young, who is also director of the Emerging Trends Task Force at the ASPS.

“It’s become much more mainstream,” he says.

However, Young estimates that across the country, there are probably only about a hundred surgeons trained to perform gluteal implants. He and Centeno have already passed on their expertise to others. But, says Young, “there’s hardly a week that goes by that someone doesn’t call us and say, ‘Can we come watch you do this?’”

About 90 percent of the people shelling out an average of $6,000 to $10,000 for gluteal implants are women, although surgeons are beginning to see more male patients.

And Beverly Hills plastic surgeon Dr. Adrien Aiache says celebrities are wasting no time in getting their buns in line for implants, either.

“More ‘beautiful people’ are doing it than anyone else,” he says. “If you have a pretty girl who’s been pretty all her life and all of a sudden she’s seeing the big 4-0 coming on, she gets scared and she wants everything to look better. And that’s what we’re seeing a lot of now. They don’t want to lose what they have.”

Complications can occur

Surgeons agree that attempts to maximize one’s gluteus do not come without risk. Studies examining the rate of complications for the procedure are at an early stage, but Centeno estimates that around 10 percent of patients can develop serious, long-term problems.

During the most common type of gluteal implant, the patient is put under general anesthetic while surgeons place anatomically designed, solid silicone implants within the gluteus maximus. Ideally, the hollow into which the implant is positioned should create a snug fit, but in some cases implant rotation can occur, creating what surgeons call the “double-bubble” effect.

Other potential problems include infection of the implant site, capsular contracture (the formation of a hard fibrous shell around the implant) and the ability of the patient to feel the implant over the long-term. In one study, about 6 percent of patients receiving the most common type of gluteal-implant procedure experienced one of these complications.

Post-op, patients are asked to refrain from sitting for about seven to 10 days because pressure can re-open the surgical incision, hidden in the cleft of the buttocks.

Still, compared to the breast augmentation she underwent a few years ago, Lynne described her buttock-implant procedure as “a piece of cake.” Aside from having to lie down for the week after surgery, she says she felt little discomfort and ended up taking none of the painkillers Centeno handed out.

And the lift she received from buttock augmentation was psychological as well as physical. After a lifetime of having a “flat butt,” Lynne says, the full impact of her transformation really hit home when she attended an office party at her husband’s firm. At 44, she was one of the oldest women in a room populated with twentysomethings. Back home after the party, her husband mentioned that “every guy in the room” had something flattering to say about her appearance, including, “Your wife is hot!”

Nevertheless, Lynne says she underwent the surgery for herself, not others. “I did not have expectations that someone was going to love me more or that my life would change,” she says.

She also plays down the impact of pop stars like Lopez and Knowles on her decision to have surgery. Instead, it was the realization that she could actually do something about a drooping, middle-aged posterior that moved her to action.

“Women have been unhappy with their backsides for years,” she says. Now, “they’re realizing that there’s something you can do about it.”

http://www.msnbc.msn.com/id/3972633/