In Las Vegas, where women long ago discovered that image often trumps reality, plastic surgeons are reporting a dramatic increase in the number of men getting procedures such as liposuctions, face-lifts and lip augmentations.
The increase eclipses the national trend in plastic surgeries for men, surgeons say, reflecting Las Vegas' obsession for youth and beauty.
The men are getting cosmetic surgery to compete in the workplace, feel better about physical shortcomings and improve their love lives, doctors say. Their desire is fueled and normalized by our celebrity-obsessed culture and TV shows like "Dr. 90210," which features cosmetic surgery.
Although it's becoming more common, men who readjust their bodies are still in the minority and remain very private about it.
"It's kind of weird to hear of a guy going to a plastic surgeon," said a 25-year-old bartender at a Strip nightclub who had liposuction in November and who, like others interviewed for this story, didn't want to be identified by name.
The man said only his mother knows he had about 24 ounces of fat removed from his midsection to trim his waistline and give him "six-pack" abs.
Cosmetic surgery isn't nearly as secretive for women, he said.
"The girls at my work, more than half of them have" breast enhancements, the bartender said. "They'll take their shirts off and show me."
Plastic surgeon George Alexander says in the past five years the number of male patients has grown to about 20 percent of his total practice, compared with 10 percent five years ago.
There are no local plastic surgery statistics, but nationally statistics show a substantial jump in male patients. According to the American Society of Plastic Surgeons, the total percentage of cosmetic procedures performed on men grew by 16 percent between 2000 and 2005. Some procedures have been especially popular:
Reasons for getting enhancements vary. Patients in their 20s who are still in good shape "want a little more of an edge," Alexander said. "I think it gives them more personal confidence."
Many of Alexander's over-40 patients are executives who "want to maintain a natural but youthful appearance" in Las Vegas' image-conscious culture, he said.
One of the older patients, a 57-year-old, is a private business owner whose co-workers and friends said he looked exhausted because of the bags under his eyes. In January he underwent a complete face-lift - brow, above and below the eyes, and neck.
"I wasn't looking to turn the clock back 10 or 20 years or go into a second adolescence," he said. "I just didn't want to look tired."
After the procedure, co-workers who knew about it said he looked a decade younger. Other acquaintances have commented that he looks better, but they don't know why.
Plastic surgeon Robert Troell said men are more image-conscious than ever and now make up 17 percent of his practice.
Relationships are also a big motivator for the patients, Troell said - especially among newly divorced men re-entering the dating scene. Troell advises them that cosmetic surgery will not necessarily improve their relationships.
Procedures performed on men vary according to age, Troell said. Men between 18 and 40 more likely get a nose job, and men over 40 tend more to seek face-lifts and eye surgeries. Liposuction is popular regardless of age, he said.
The male trend toward plastic surgery says a lot about society - including the pressure on men to look celebrity-good, a burden long faced by women, according to Simon Gottschalk, a professor of sociology at UNLV.
It's pathological for an entire population to want to look like stars who are enhanced in magazines and on the screen to appear perfect, Gottschalk said. People are told through advertising and popular culture that appearances help them achieve popularity, success and happiness, Gottschalk said.
"It isn't true, so it's kind of a mirage we're pursuing," he said.
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