Once reserved for the rich and famous, cosmetic surgery has become increasingly common among mainstream Americans, and more widely accepted, too. A nationwide survey of 1,000 adults, conducted last year by the American Society for Aesthetic Plastic Surgery (ASAPS), showed that 54 percent of respondents approved of cosmetic surgery and 24 percent (30 percent of women and 18 percent of men) said they would consider it for themselves. And about three-quarters of men and women said if they had cosmetic surgery, they wouldn’t be embarrassed if others knew.

Times have certainly changed from the days when cosmetic surgery was a dark secret. Some patients today are even flaunting their new looks, particularly in cosmetic surgery hot spots like Los Angeles, New York, Miami and Dallas. Botox parties have become common and some patients like Andis have had post-operative coming-out parties where they strut their stuff for friends and family.
“Cosmetic surgery is not something that’s in the closet anymore,” says Dr. Robert Bernard, a plastic surgeon in White Plains, N.Y., and president of ASAPS.

Andis’ surgeon, Dr. Julio F. Gallo, agrees. “It’s less of a taboo subject now,” he says.

In fact, Gallo, a partner at the Simons Center for Nasal and Facial Plastic Surgery in North Miami Beach, says he doesn’t need to advertise. He keeps busy with patients who are referred from other satisfied customers who’ve spread the word.

Hanging on to youth
Doctors say media coverage of plastic surgery and television shows like “Extreme Makeover” and “Nip/Tuck” have gone a long way toward bringing surgical enhancement out of secrecy.

Another driving force is the desire by baby boomers to hang on to youth, in any way possible, says Dr. Rod Rohrich, chairman of plastic surgery at the University of Texas Southwestern Medical Center at Dallas and president of the American Society of Plastic Surgeons.

“We don’t want to grow old gracefully,” he says. “We want to manage how we age.”

Exercising and eating right are a big part of that. But increasingly, so are nips and tucks. Cosmetic procedures -- both surgical and nonsurgical (like Botox injections) -- have more than doubled over the last five years. About 6.9 million cosmetic procedures were performed in 2002, the latest year for which statistics are available. That’s a 228 percent increase since 1997, according to ASAPS.
 Numbers dipped from 2001 to 2002: cosmetic surgical procedures increased just 1 percent while nonsurgical approaches dropped 23 percent. Bernard points to the economic uncertainties of the time as a likely explanation. But both he and Rohrich expect demand for procedures to climb in the future, particularly for nonsurgical procedures like Botox and facial fillers, treatments that quickly erase the signs of aging in people as young as their early 30s and can be performed during a lunch hour.

Indeed, people who are starting to show their age are the most common clients. In 2002, people between 35 and 50 underwent the most cosmetic procedures of any age group, 44 percent of the total.

Unlike in the past, where women often waited until their 60s or 70s to get a face lift, today’s cosmetic surgery patients are coming in much younger, often in their mid-40s or so, for their first surgical procedures, says Bernard.

And those procedures are usually less invasive, he says. So rather than a full facelift at 65, a woman may have a cheek lift or neck lift at 45, and then other “maintenance” procedures a decade or so later.

“There’s been a steady march toward less invasive procedures,” Bernard says, a trend he believes leads to better, more natural results and often faster healing times.

“You don’t change dramatically from one day to another,” says Gallo.

Men opting for procedures, too

While women still have the most procedures -– nearly 6.1 million in 2002 -– men also are getting work done, often to gain an edge in business. More than 800,000 men had procedures in 2002, such as liposuction, nose reshaping, eyelid surgery and Botox injections.
Overall, the most common surgical procedures nationwide in 2002 were liposuction, followed by breast augmentation, eyelid surgery, nose reshaping and breast reduction. Among nonsurgical procedures, Botox injections top the list, followed by microdermabrasion, collagen injections, laser hair removal and chemical peels.

And a range of people now opt for such procedures. During one week in early January, for instance, Bernard says he performed a face lift on a former Miss America, a neck lift on a man who worked as a carpenter, a neck lift and eyelid surgery on a housewife, and eyelid surgery on a school teacher.

“I really think that says it all,” Bernard says. “It’s no longer just for movie stars. It’s no longer just for the extremely wealthy.”
Not without risk

The procedures are not without risk, though, as the death last month of Olivia Goldsmith, 54, author of “The First Wives Club,” illustrates. She suffered a heart attack while under anesthesia to remove loose skin from under her chin.
While deaths from cosmetic surgery are uncommon, more likely risks can include infection, bleeding, scarring, difficult recoveries and not getting the desired results.

Patients who take their cue from television shows may need to temper their expectations, says Bernard. Patients on “Extreme Makeover,” for example, may get well over $100,000 spent on them, he estimates, including their multiple surgeries, cosmetic dentistry and the services of makeup artists, personal trainers and fashion gurus. “It raises an expectation to the patient who comes in to an unrealistic level,” he says.

As for Andis, she’s happy with her results. “Everybody thinks that with plastic surgery you look stretched out,” she says. “I just looked refreshed.”

And she feels better on the inside, too. “I have a lot more confidence,” she says. “I feel I look much better and that comes out in my personality because I’m happier.