PUBLISHED: July 18, 2004
By Stephen Bitsoli
Macomb Daily Staff Writer

The number of people opting for cosmetic (or plastic) surgery procedures is on the rise, and not just among women. Sure women account for as much as 86 percent of the 8.8 million cosmetic surgeries in the United States (not including 6.2 million reconstructive surgeries such as tumor removal, scar revision and hand surgery), according to the American Society of Plastic Surgeons' 2004 report National Clearinghouse of Plastic Surgery Statistics. But the number of cosmetic procedures on men also is increasing, up 28 percent to 1.2 million from 2002 to 2003, and for a wide variety of procedures.

Mark Berkowitz, an ophthalmic cosmetic surgeon and cosmetic surgeon at St. Joseph Mercy, has been in the profession for nine years. "There's been an increase (in men seeking cosmetic procedures) for five years. Of the procedures I do, one-third are with men," he said. There are two categories of procedures: surgical, and minimally invasive. In 2003, men underwent 311,926 surgical and 1,234,029 minimally invasive procedures. The most popular male surgical procedure, and by a wide margin, was nose reshaping (129,774), according to the society's statistics. Eyelid surgery (46,308), liposuction (32,092), hair transplantation (27,985) and breast reduction (14,611) rounded out the top five. The numbers are much higher in the category of "minimally invasive procedures," with BOTOX® Cosmetic injections heading the list (333,556), microdermabrasion (241,884), laser hair removal (173,279), chemical peel (103,917), and collagen injection (28,382) leading the list. For both sexes, the most popular minimally invasive procedure is a chemical peel, and the most popular surgical procedure is nose reshaping.

Berkowitz said that while he didn't think nose jobs were that popular, he agreed that eyelid surgery "has always been in the top three for men and women." ophthalmic cosmetic surgery is used around the eyes -- both the eyelids and sometimes the eye brows -- to fix baggy upper and lower eyelids that can increase the appearance of age and reduce vision, making it both an aesthetic and practical operation. Basically, Berkowitz said, these bags are "fat that starts to come forward." Eyelid surgery can be done with a scalpel, but Berkowitz uses a laser because of its many benefits, including that it "stops bleeding at the time" as it cuts, there's less swelling and bruising.

BOTOX® Cosmetic  is derived from botulism bacteria, and is used to remove wrinkles or lines caused by facial movements on the upper third of the face, temporarily freezing the nerves to the face muscles. Berkowitz described microdermabrasion as "somewhere between a chemical peel and a facial," and it can be done in the doctor's office. "It's a self-contained machine that releases crystals," spraying them on the face like a sandblaster, smoothing the skin, then suctioning up the dead layers. "It feels like a cat's tongue," Berkowitz said. A chemical peel itself uses a chemical solution to remove the outer layers of skin, sometimes removing wrinkles, blemishes or even precancerous skin growths. And while men going bald want hair transplanted, hair removal is "popular on the back," and for "shaping on the chest, and unibrows," Berkowitz said.  As for collagen, Berkowitz said, men don't want it for their lips, but as "filler" to remove furrow lines from the brow, or to raise a brow so that the patient doesn't have a permanent "angry" look. Berkowitz now gets the same result with a similar product called Restylane (www.restylaneus a.com). Restylane, Berkowitz said, is a natural product that just became FDA approved in the past six months. Its advantages are that it can last up to three times longer than collagen (nine months instead of three) and won't cause an allergic reaction because it's composed of Non-Animal Stabilized Hyaluronic Acid.

Not in the top five, but increasing in popularity among men, are tummy tucks, which have "increased 143 percent since 2000," and body contouring procedures such as upper-arm lifts and buttocks lifts, which have increased 606 percent and 554 percent, respectively, since 2002, often following gastric bypass or bariatric surgery and a consequent "massive amount of weight loss." The chief difference between the sexes as to the most popular cosmetic surgeries seems to be men are more obsessed with their hair -- keeping or moving it where it's wanted, and removing it where it's not -- while women prefer face lifts. Men don't often get face lifts, Berkowitz said, because "a face lift is usually just the lower face," and that will affect the beard line. Another difference is that women want their breasts increased, men want theirs decreased. Berkowitz also uses photo rejuvenation with Intense Pulsed Light, a light therapy that can remove discolorations. One such pulsed light device is the Quadra Q4 (www.quadraq4.com), which "removes pigmented lesions, vascular lesions and hair." And the Thermage (www.thermage.com) ThermaCool TC System is a means of tightening and contouring skin using radio frequencies to "tighten both skin and underlying tissue, while protecting the skin's outer layer with a cooling cryogen spray" and "generates new collagen growth over time." "It's a noninvasive face lift," Berkowitz said, although it doesn't produce as dramatic or lasting results. So why are men getting more cosmetic surgery? Vanity or practical reasons? "I think it's both," Berkowitz said. Baby boomers, trying to hold on to their jobs as younger people vie for them, want to look younger. Plus, plastic or cosmetic surgery is more socially acceptable. "A few years ago, a man wouldn't (get cosmetic surgery) without talking with his wife," and probably bringing her with him. Now some men are doing it on their own.

Kathie Lorenzo, a psychology professor with Macomb Community College, has been doing research on people who undergo cosmetic surgery. Lorenzo doesn't see cosmetic surgery as a negative, but she is afraid that people are going in without really understanding what they're going to go through, physically or mentally. "When you go to a surgeon, they give you a questionnaire to assess how good a candidate you are for surgery," but she suspects it's often "not a deep psychological interview." Berkowitz agrees that not everyone should go in for cosmetic procedures, and he does put them through a multi-stage screening process. "Before anyone meets with me, they're screened on the phone" by a surgical counselor, then again in the office, where they're asked what they want done and why. Then they fill out a full medical survey, so Berkowitz can check for complicating or contraindicating factors. Then they meet with Berkowitz, detailing what they want done and why. Some reasons are a red flag that indicate the patient shouldn't have the surgery, such as a recent divorce, a death in the family, a diagnosis of depression, use of psychiatric drugs or getting married "next week." Berkowitz said he has heard that last one a lot, and it's not a good idea for practical reasons. "For most procedures," Berkowitz said, "people need a few weeks' time to recover," though it varies from procedure to procedure. Berkowitz is concerned with TV shows such as "The Swan," where people sometimes get radical cosmetic surgery. Though he believes the patients are probably carefully screened (for fear of legal liability if nothing else), he's worried that the viewers will fail to understand or appreciate that the contestants aren't fully healed in a single hour. Lorenzo also thinks people forget there's going to be risk. "It is still surgery, a medical procedure," he said. Olivia Goldsmith, author of "The First Wives' Club," died after undergoing anesthesia for routine cosmetic surgery. There's likely going to be pain. Respondents to Lorenzo's questionnaire post-surgery report that "they were surprised that their face burned, or the top of their head ached." But Lorenzo is not against cosmetic surgery. There are benefits, including that people who have had cosmetic surgery tend to take care of their bodies better. And, to a significant extent, "people feel the way they look."