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Aesthetic surgery for men increasing in popularity
Health Watch
By DANIEL S. JORGENSON, M.D.
Special to The Journal

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Traditionally most people have considered aesthetic surgery as something only women pursue. Now, however, there is an increasing desire for aesthetic surgery among men who want to remain competitive in the work force.

This is particularly true in an economy where widespread downsizing is forcing men in middle and upper management positions to go back out into the job market. As middle-age men compete with younger men for new jobs and promotions, more men in their fifties and sixties are seeking the edge that aesthetic surgery can provide. This is true in many different fields, including the armed forces where both appearance in uniform and performance are carefully considered in all promotional decisions.

Among the most common aesthetic surgery procedures that men request are liposuction and abdominoplasty. As men age, localized areas of fat often collect around their abdomens and around the breasts; this can occur even when men are at their proper weight. Ultrasonic liposuction -- a technique that uses high-frequency sound waves to break up fat without injuring surrounding vessels, nerves and skin -- effectively removes fat from the abdomen, flanks (often called "love handles") and breast area. If the patient's skin tone is adequate, the skin will tighten up on its own following liposuction. Sometimes, the surgeon will need to remove sagging abdominal skin by pulling the extra skin down and resecting (cutting and removing) it. This leaves a scar low on the abdomen that is hidden beneath underwear. Extra skin in the breast area is removed if necessary, with incisions hidden around the nipples with the added benefit of raising the nipples to more normal position.

Abdominoplasty in men is a somewhat more limited procedure than in women, who require more extensive surgery to address the stretching of the abdomen that occurs during pregnancy. In cases where there is a significant area of skin to be resected, the belly button will be reattached in the appropriate area of the abdomen. During abdominoplasty, the surgeon may also tighten the external abdominal muscles (rectus muscles), pulling them in toward the center to create a more defined waistline. In addition, men sometimes carry their fat intra-abdominally, as compared to women whose fat is just beneath the skin. This means that in assessing a man for abdominoplasty, it is important to determine just where the extra layer of fat is located.

Patients undergoing aesthetic abdominal surgery typically go home the same day surgery is performed. Advances in pain management allow patients to return home with a catheter inside the abdominal closure that continues to infuse anesthetic. This markedly decreases post-operative discomfort.

In addition to looking better in their clothes with the help of abdominoplasty, more men are also seeking facial rejuvenation with face-lifts, eyelid surgery and brow-lifts. As we age, the skin on our faces tends to droop. The eyelids drop down and this can create a rather stern look that isn't friendly and can be a detriment for those who deal extensively with the public at work.

Receding hairlines in men present their own challenges; however, an endoscopic approach to brow-lifts, combined with a new system for soft tissue fixation that distributes the weight of the brow-lift across the forehead, creates a "power lift" through five tiny incisions. The small fixation device dissolves as the patient heals, while holding the brow tissue in place. The result is a more long-lasting effect with little evidence of surgery once healing is completed.

Brow-lifts are often done in conjunction with eyelid surgery, resulting in a rested, youthful, friendly appearance. Some men also benefit from a small chin implant/chin-lift or even a face-lift to recreate a stronger chin line.

Dr. Jorgenson is board certified in plastic and reconstructive surgery. A former chief of plastic surgery at Walter Reed Medical Center, he is now on the medical staff of Cayuga Medical Center and in practice locally at Plastic Surgical Associates of Ithaca. Health Watch appears on alternating Thursdays in The Journal.

http://www.theithacajournal.com/news/stories/20040129/localnews/310700.html