Snip, Suction, Stretch and Truss

By Martha Smilgis

A nip here, a tuck there, and the face you have at 40 is no longer the face you deserve but the face you can afford. In the past five years, thanks to new surgical wizardry, media hype and the laws of gravity exerting their inevitable effect on baby boomers, cosmetic surgery has soared in popularity. Last year some half a million Americans were snipped, suctioned, stretched and trussed, compared with 300,000 in 1981. Once the province of aging screen stars and wealthy matrons, cosmetic surgery now attracts middle-class office workers, many in their 30s and 40s, and many of them men. Los Angeles Plastic Surgeon Richard Grossman describes the phenomenon as "another transition" for the restless Me generation: "They protested against the wars, and now they're protesting against the mirrors."

More often than not, today's face-lift clients are fitness buffs who view a little surgical correction as the finishing touch to their efforts at the health club. "These people are in great shape and aware of their diet, yet their faces look older because of sun exposure," observes Dr. Stephen Kurtin, a New York City dermatologist. Michael, 46, a lean Manhattan executive typifies the trend. Over the past six months he has undergone a grand-slam rehab: eye lift, face-lift and collagen shots to plump out his facial wrinkles. "I had a body by Michelangelo and face by Goya," he says. "No matter how much exercise I did, the face didn't respond."

According to the American Society of Plastic and Reconstructive Surgeons, the number of men seeking cosmetic correction has increased 35% in the past two years. They often cite professional image and job marketability as the reasons for smoothing creases or trimming jowls. Explains Dr. Melvyn Dinner, director of the Center for Plastic Surgery in Cleveland: "The 40-year-old who has lost his job is competing with a young hotshot. It's the competitive demand to look youthful."

Improving one's looks surgically has never been easier. A number of quick procedures can be done on an outpatient basis and require a short recovery period. Tops on the list, for women, is suction lipectomy, an operation developed in France and introduced in the U.S. in 1982. Also called liposuction, it entails the insertion under the skin of a hollow, blunt-ended tube that is attached to a high-powered suction machine that vacuums out the fat. The procedure can take 30 minutes to three hours, depending on how many problem areas are worked on. Removal of saddlebag thighs runs about $2,000; love handles, $1,500; saggy jowls, $1,300; and baggy knees, $1,200. Observes Dr. Jack D. Norman, a Miami plastic surgeon: "Twenty years ago, it was the nose job. In the 1970s, it was silicone implants. Now the rage is lipectomy."

An even newer trick, called lipofilling, makes use of the fat removed by liposuction to build up other areas, such as filling out cheeks on the face or redefining a jawline. The inspiration for the idea came from patients, says Beverly Hills Plastic Surgeon Ian Brown. "They kept coming in and moaning, 'Why can't you just take some from here and put it in there?' " he recalls. "Now we are doing just that." Steven Soll, 38, a Los Angeles financial planner, is looking forward to having fat suctioned from under his double chin and reinserted to strengthen his jawline. "I could go out and spend $20,000 on a car to make myself feel better," he explains, "or I could spend $3,000 to change something that has always bothered me." An older, simpler method to smooth the skin involves the injection of protein collagen into scars and wrinkles. This procedure usually requires several treatments plus an annual booster. Cost: $750 to $1,000.

Such readily available quick fixes for cosmetic problems have fostered a remarkably casual attitude toward plastic surgery. "I see it as a little investment in health, like owning an electric toothbrush," says Joyce Nesbit, 32, a Los Angeles psychologist who has enthusiastically undergone several procedures. But cosmetic repair has greater risks than a day at Elizabeth Arden. Collagen shots are painful; they can cause twelve to 18 hours of swelling and sometimes provoke allergic reactions. After liposuction, bruises and discomfort can last for weeks. Moreover, there are risks with any operation. Last March, Patsy Howell, 39, a Texas mother of two, died of a severe infection three days after undergoing lipectomy. At least two other deaths from infections have been reported.

The best protection against disaster is choosing the right doctor. Despite an abundance of qualified plastic surgeons, the $250 million-a-year industry has attracted numerous charlatans and quacks working in "chop shops." Doctors advise prospective patients to seek board-certified surgeons who have admitting privileges at reputable hospitals. Says Dr. Carl Korn, assistant professor of dermatology at the University of Southern California: "Choosing a surgeon is tricky, tricky, tricky. Walk into the office and look around at the others there who have had work done, and then only go in yourself if you like what you see."

Doctors debate whether or not public enthusiasm has gone too far. At Johns Hopkins, Dr. John Hoopes turned away a 23-year-old woman "who felt she would feel better if she had an eye lift." Hoopes estimates that he and his colleagues reject about 25% of those seeking cosmetic surgery, often because they are too young. But New York Plastic Surgeon Gerald Imber encourages preventive surgery for clients in their 30s and 40s: "The results are better when the raw materials are fresher." Indeed, so many eager candidates are intent on preserving their youthful looks that crow's-feet and turkey gullets may soon become endangered species.

With reporting by Jennifer Hull/New York and Nancy Seufert/Los Angeles