Mastering the Art of Fixing Your Face

For most of my life, the idea of plastic surgery has seemed a bizarre, almost perverse extravagance, the province of the idle rich and appearance-obsessed celebrities. 

But as I've entered my late thirties, and the lines around my eyes have grown a little deeper, my sense of distancing judgment has somewhat subsided. 

Not that I ever plan on having a procedure done myself, but at least I'm starting to empathize with why someone might consider it in the first place. Getting old is a hell of a scam.

I'm certainly not alone. Between 1997 and 2012, the number of cosmetic procedures performed on men rose by 106%, according to the American Society of Aesthetic Plastic Surgery. In the five years leading up to 2014, procedures for men rose 43%. 

Last year alone, there were 68,106 aesthetic breast reduction surgeries in the United States, with men accounting for 40% of them, a record high.

GETTING OLD IS A HELL OF A SCAM

That's in part because we live in an culture that has thrown the expectations for beauty that have long been placed upon women onto men as well, which is a…victory? Not really sure about that. But it's also because science and technology has made many procures much more affordable, and less of a time investment due to speedier recovery periods.

I talked to Stafford R. Broumand, M.D., one of the surgeons at 740 Park Plastic Surgery in New York City, and the former president of the American Society of Plastic Surgeons, about the changing face of plastic surgery, what types of things men are getting done now, and what the future hold for the changing field.

ESQ: Is the term "plastic surgery" still accurate or is it outdated?

Dr. Broumand: The "plastic" in plastic surgery comes from plastikos, a Greek derivative of "malleable." Skin is malleable; hence the name. But cosmetic surgery, aesthetic surgery, plastic and reconstructive surgery: they're all basically the same thing.

Do you see mostly female patients or a good amount of males?

It's a mix. And I guess we're talking now because it's becoming more prevalent in men of all ages. Some are young men who have a small amount of breast tissue for whom it's a self-confidence issue. They might have other areas of fat even though they work out in the gym five times a week. Or they're in business and don't want to look so stern and mean-looking, so they have Botox or fillers to soften some folds on their face, or liposuction on their neck to make them look thinner and more angular. And as they're getting older they might have extra eyelid skin.

What are the most common procedures men are getting now?

Eyelid surgery—blepharoplasty—to get rid of the extra upper eyelid skin, or getting rid of the bags under the eyes, known as lower-eyelid blepharoplasty. The latter is extremely common.

Is it an intense procedure?

It's not. It's a surgical procedure done in the office, and then you go home. You take three or four days off, you might be bruised when you get back to work. But it's not painful.

The next thing is neck liposuction, which involves reshaping or sculpting the neck to get rid of the extra fat. We can do that under local anesthesia. You come in the office and we're chatting with you the whole time.

The non-surgical treatments include Botox, which is becoming much more prevalent among men, to soften the wrinkles of the forehead, or to eliminate crow's feet around the lateral eyes. Or they get fillers if they have deep folds. There's a crease from the nose where the cheek and the lip join that you can have filled. We also have non-surgical skin-tightening, which is called Ultherapy. It's an ultrasound treatment that is done with a little sedation that can be done on the forehead, cheek, or neck region.

What is actually going on there, science-wise?

You put an applicator or transducer on the skin, and a computer generates an ultrasound pulse that's diffuse at the skin surface but gets focused underneath, which transmits to that lower portion of the skin and causes it to tighten.

What are some of the other newer things, or looking forward, what are some things that are being devised now that we may be seeing down the line?

We're trying to expand the ultrasound skin tightening into the chest and legs. Other technologies are fat freezing and cool sculpting, and there's also now laser fat reduction. You apply an applicator to the skin, and the energy gets transmitted through the skin surface and is concentrated in the fat area, and it dissolves or burns the fat.

You're freezing the fat?

Either you freeze it or burn it. With a cold applicator, it ends up looking like a stick of butter that's frozen and that has to be massaged out. When it's frozen, 20% of it dies over several weeks and your body absorbs it. Or you could have the laser treatment where the surface of the skin is chilled, but the deeper tissues heat up to a certain level that helps dissolve the fat.

How do you make sure this stuff is safe?

These are all FDA-approved procedures, and certain offices such as ours test them out. We enroll patients in studies and gather data, which is then presented to the FDA for approval.

Where do you see things being five, ten years from now? How far can this field go?

There will be more technologies such as directional skin-tightening, where they put these fine needles in the skin, and take out little cores just like you see in aerated grass, and your skin grows back tighter.

Is cosmetic surgery relatively safe?

My advice is that you go to a person who's board certified and qualified, someone who performs these procedures on a regular basis. And when something doesn't work, they know what to do. We know how to handle adverse reactions to all of the procedures we do. We're not going to be surprised and say "we don't know what to do now."

Is such surgery still largely for wealthy people?

No—there's a range of things you can have done. For dissolving fat, for example, we also have an injectable called Kybella.

Is that one of the more affordable options?

Yeah, you can dissolve the neck fat for $1,500. The Brazilian butt lift is also becoming more and more requested, and that has a range too, depending on where you go and how much you have done. That's largely for women. For men, getting to have neck liposuction under local is cheaper than having it under general anesthesia. It doesn't break the bank.

Do you ever see people who don't need the procedure they think they do? Everyone is insecure, and sometimes we look at our bodies differently than they actually are.

It happens all the time. We do not do a procedure without having a consultation—we have to evaluate our patients before we do or even suggest anything. We get a better sense of where they're at psychologically, socially, and physically. Every day we tell people, that a procedure is not for them, that there are alternatives: weight loss, exercise, understanding their perceptions might not be the reality. People see things in print and say they want to look like this person or that person, and the reality is that those people are airbrushed, and they may have had procedures done that make them look abnormal. So we've got to point that out.

Luke O'Neil

esquire