Shortcut to a Perfect Body?

Cosmetic surgery still has its risks, reports Allison Schecter.
Alison Schecter has written for New Woman, Elle, and Parenting.

That giant sucking sound you hear is 109,000 Americans a year having fat vacuumed from their bodies. Liposuction is now the No. 1 cosmetic surgery procedure in America in part because of a rise in interest from men. In 15 years the proportion of men among Dr. Richard W. Fleming's patients at the Beverly Hills Institute of Aesthetic and Reconstructive Surgery has gone from 10 percent to 40 percent, for example. And in January, male patients started outnumbering women in the practice.

There are no statistics on the sexual orientation of plastic surgery patients, but doctors say a majority of male patients are gay men after a gym physique. Ben, a 29-year-old law student in New York, is fairly typical: Despite regular workouts and a prohibition on fatty foods, he's tormented by his waistline and considering liposuction. "What fun is 'clothing optional' if your love handles aren't?" he asks.

The trick is balancing the fun of a nicer physical appearance and the side effects connected with the most popular procedures among gay men: liposuction, pectoral and calf implants, and laser hair removal. Now that these are performed quickly and with no overnight hospital stay, it's tempting to forget that cosmetic surgery is surgery, with its risks - and its expense. Liposuction, for example, starts at about $2,000.

Then, of course, there is the matter of whether this particular form of body obsession is a little extreme in the first place. "Fitness isn't just about bodies; it's a state of mind," says David Camacho, a trainer at New York's David Barton Gym. "Some people would rather buy a chest than deal with reality."

As simple as liposuction is, the procedure is invasive. The surgery, which can take anywhere from 45 minutes to several hours, involves inserting a small hollow tube called a cannula into an incision through which unwanted fat deposits are suctioned out. Dr. John E. Sherman, an assistant clinical professor of surgery at The New York Hospital -Cornell Medical Center who also has his own practice, supplements traditional liposuction with a newly approved technique called ultrasonic assisted liposuction, or UAL, in which ultrasonic vibrations break down fat cells - much like the probing motion of the cannula itself - before they are vacuumed out.

There is always a risk of infection with liposuction, though such cases are extremely rare. More commonly, patients experience bruising and swelling or a loosening or bumpiness of the skin. Sometimes these go away and sometimes they don't. A girdle-like compression garment that is generally worn for up to two weeks can help minimize side effects; during that period, doctors recommend no exercise or sexual activity.

Liposuction is also used in treating gynecomastia, or male breast enlargement. Candidates for this procedure generally have genetically determined fat deposits in the breast area or are on high doses of anabolic steroids or certain ulcer medications. (Sometimes the condition can be caused - yes, it's true - by smoking a lot of marijuana.) Liposuction for gynecomastia is one of very few cosmetic procedures that may be covered by health insurance.

Definitely not covered are the instant "muscles" constructed with custom-made silicone implants. The favorite sites for these are the pectoral area and the notoriously hard-to-develop calves - especially on the West Coast, where bodybuilders get calf implants to even out their top-heavy physiques and movie actors resort to temporary pecs for shirtless roles. Even among plastic surgeons, the procedure is controversial. The results can look unnatural, and the implants often shift, cause infection, or harden the tissue around the implant.

Maybe your pectoral muscles are fine, but obscured by an overabundance of chest hair. Plastic surgeons and dermatologists are now treating hirsutism with experimental lasers that over a less painful alternative to waxing or electrolysis. Sessions cost up to $500 each for time-consuming, larger areas of the body such as the back and chest. Because the treatment is so new, nobody really knows if the hair will grow back And there's a risk of lightening or darkening of the skin, scarring, or blistering from the heat generated by the laser's flash.

The entire range of below-the-neck cosmetic procedures is expected to become safer as techniques and equipment become more refined. But for now, doctors advise even liposuction candidates to review their non-surgical options carefully. That may mean logging extra miles on the StairMaster - like Ben the lawyer, for example, who is putting off his decision and praying that hip-huggers go out of style again soon.

CHOOSING A SURGEON

The American Society of Plastic and Reconstructive Surgeons and the Plastic Surgery Educational Foundation have an information service (800-635-0635, http://www.plasticsurgery.org) that will give callers the names of five local plastic surgeons certified by the American Board of Plastic Surgery (ABPS}. Call each surgeon's office and ask the fol-lowing questions:

• Has the surgeon completed an accredited residency program in plastic surgery?
• Does the doctor have privileges at an accredited hospital-in case of complications?
• Does the surgeon have recent experience with the procedure you're considering?