Custom Bodywork

The top 10 cosmetic procedures for men--and why one of them may be right for you

These days, you have as many options for upgrading your looks as you have for upgrading your computer. And the number of men availing themselves of a nip here and a tuck there keeps growing: The American Society for Aesthetic Plastic Surgery reports a 47 percent increase in male procedures in 6 years, from 640,000 in 2000 to 940,000 in 2006. Why the jump in plastic surgery for men? Cosmetic surgery has grown into a precise, often pain-free way to slow the visual effects of aging or simply to add the final detailing on a body you've worked hard to build through diet and exercise. Still, there are people who should pass on the surgical solution. With this primer, you'll be able to decide whether a cosmetic fix should be in your future.



Is the surgeon board certified in the procedure you are considering?  Check out the  American Board of Specialties web site to be sure.



You want to change your . . .

Wrinkled Forehead

Cosmetic fix: Botox


A man can feel happy, calm, and rested, but "a wrinkled brow will make him look angry, tense, and tired," says Patricia Wexler, M.D., an associate clinical professor of dermatology at New York's Mount Sinai school of medicine. "Botox produces a more relaxed and likable look."


How it works: The doctor injects diluted botulinum toxin into your wrinkle zone. In about 4 days, the Botox begins to temporarily block nerve transmissions to the muscles that create the wrinkles. As a result, your skin smooths out dramatically. Brief side effects, such as bruising, swelling, or headaches, are possible but uncommon. You'll need new injections every 4 to 6 months to stay smooth. 


Fine points: Avoid the "mask effect" by going to a doctor whose Botox practice includes at least 10 percent to 15 percent men; the doc will be sure to leave some expression lines on your face -- especially the crow's-feet. 


* Price ranges reflect differences in the amount of work performed, your geographical location, and the experience of the doctor.


Number of men who received Botox in 2006: More than 300,000 

Price: $350 to $1,200


Hairy Back/Shoulders/Neck

Cosmetic fix: Laser hair removal


This is the only permanent hasta la vista to hairiness. And while the neck and back are the areas men usually want blasted bare, treatments on the chest and the front of the ears are also popular, says Ramsey Choucair, M.D., a Dallas plastic surgeon.


How it works: This is a simple, safe, and effective procedure. That's because the laser light is fine-tuned to the specific pigment of your follicles, allowing the heat energy to eliminate the hair without burning a hole in your surrounding skin. "It usually takes several treatments to see permanent hair reduction," says Dr. Choucair.


Fine points: You may still have a few stray hairs even after several treatments. And a word of warning to men with blond locks: Laser hair removal doesn't work well on blond (or gray) hair, simply because there isn't enough pigment for the laser light to affect the follicles.


Number of men who had laser hair removal in 2006: more than 170,000

Price: $200 to $600


Balding Head

Cosmetic fix: Hair transplantation


Even though Rogaine and Propecia sometimes slow hair loss or regrow some hair, transplantation is the only way to restore your naked pate completely.


How it works: After injecting a local anesthetic, the surgeon removes a narrow strip of scalp from the strip of permanent hair  around the sides and back of your head. The surgeon divides this donor strip into sections containing one to four hairs, which he then inserts into tiny scalp incisions made at the same angle and direction as the original follicles. These hairs will fall out within the first 3 weeks, but permanently grow back about 3 months later, with the full effect taking about a year.


Fine points: You'll have to avoid strenuous exercise for 7 to 10 days (heat and sweat increase the odds of infection, plus the physical exertion can tug on the donor-area wound and result in a wider scar). You should also resist the temptation to have "megasessions" of 3,000 or more grafts transplanted all at once or too densely. That's because every microincision severs blood vessels and reduces bloodflow to the area. With too many incisions, not enough blood can reach the transplanted hair for the follicles to survive.


Number of men who had hair transplanted in 2006: more than 11,000

Price: $6,000 to $18,000

Love Handles

Cosmetic fix: Liposuction


Fat men need not apply. The best candidates are normal-weight men who can't shed specific fatty deposits. "There are limits to what exercise and diet can do," says Daniel C. Baker, M.D., a professor of plastic surgery at New York University.


How it works: You'll be awake but numb to the sucking, thanks to an anesthetic. The surgeon will insert a metal, strawlike device into the target area and literally vacuum out the fat. And that includes the fat inside a pair of man-boobs--liposuction is an option for about 90 percent of male breast-enlargement cases.


Fine points: Liposuction is safe and effective--in the hands of a qualified surgeon (see "Pick a Top Doctor"). It's also important to remember that while lipo sucks out fat, it can't tighten loose skin, nor is it generally recommended for the face because of the many small nerves and blood vessels in the area.


Number of men who had liposuction in 2006: more than 53,000

Price: $3,000 to $15,000

Tired Eyes

Cosmetic fix: Eyelid surgery


Your eyelids play a subtle yet powerful role in your overall appearance. Specifically, saggy upper eyelids and puffy lower lids send everyone the message that you're overtired, over the hill, or both, says Joel Feldman, M.D., an associate clinical professor of surgery at Harvard medical school.


How it works: The sagging and puffiness is caused by excess fat and skin. To remove the fat, the surgeon will make an incision on the inside edge of the lower lid, both to avoid leaving a visible scar and to reduce the risk of damaging surrounding muscles. Then it's just a matter of scraping out the fat. To remove excess skin, the surgeon makes incisions on the outside of the lid. Most people need to wear dark sunglasses for up to 2 weeks after surgery, although some swelling and discoloration can remain for several months.


Fine points: Eyelid surgery may not completely eliminate those circles under your eyes, and there's a danger that the surgeon will remove too much skin and fat, creating a somewhat feminized appearance.


Number of men who had eyelid surgery in 2006: 28,000

Price: $3,000 to $6,000

Droopy Nose

Cosmetic fix: Rhinoplasty


Like other body parts, the nose droops over time, and the only way to rescue it is with rhinoplasty. "If done properly, people will think a man lost weight or that his hair is different, rather than noticing that it's his nose that's changed," says Alan Matarasso, M.D., a clinical professor of plastic surgery at the Albert Einstein College of Medicine of Yeshiva University.


How it works: In order to reposition your proboscis, the surgeon needs to sculpt the cartilage (the soft part at the bottom of the nose) and bone (at the upper part). This can be accomplished through a small incision either at the bottom of your part or up through the inside of your nostrils, which helps minimize scarring.


Fine points: Not every schnoz can be saved. A surgeon can't change the thickness of the skin on a person's nose -- a problem if you have a bulbous nose and want it trimmed down. Also, find out how he'll handle the tip of your nose. Sometimes the tip might not have enough cartilage to create a strong appearance, in which case a doctor can bolster it by working with a piece of the septum (the cartilage that separates the two cavities) as a graft.


Number of men who had rhinoplasty in 2006: more than 33,000

Price: $5,000 to $10,000

Sagging Face

Cosmetic fix: Facelift


The stereotype of the facelift being only for ungracefully aging women is history. Men are now turning to lifts because they think they look older than they actually are and want to remain competitive in the workplace. Others simply want to look younger.


How it works: Think of making a bed: The more of the sheet and blanket you can pull under the mattress, the tauter the top will be. During a facelift, a surgeon pulls tight and tucks in your skin and the deeper layers responsible for reshaping the face. In order to do this, he makes incisions in front of and behind your ears. (Don't worry; you're under general anesthesia.) Surprisingly, the surgery is not generally painful, because the surgeon is working in layers of the face without many nerve endings. Men usually look good in 2 weeks (1 week sooner than women) because their thicker skin hides the bruising better.


Fine points: Even a facelift isn't forever. "The face sometimes loosens over time," says David Hidalgo, M.D., the former chief of plastic surgery at Memorial Sloan-Kettering Cancer Center. In addition, it's important that the surgeon makes the incisions as inconspicuous as possible, because men can't hide the evidence under makeup and long hair the way women can.


Number of men who had a face-lift or neck lift in 2006: more than 14,000

Price: $10,000 to $20,000


Turkey Neck

Cosmetic fix: Neck lift


If you are or were once overweight, no amount of diet and exercise can take away a turkey neck. Fortunately, a little scalpel sculpting can give you back a chiseled, youthful look.


How it works: A neck lift is similar to a facelift in that a surgeon makes incisions and pulls your skin up to create a tighter appearance. The difference is that excess fat is removed before the tightening. According to Dr. Feldman, it's also important that the surgeon tightens muscle in the neck to prevent sagging. Expect soreness and tightness the first week, and some swelling for a month or two. 


Fine points: Talk to your surgeon about scar placement. Scars behind the ears can be noticeable on men. Also, discuss whether any skin needs to be removed. "You can recontour the fat tissue, and the skin will often adapt to the new contour," says Dr. Feldman.



Price: $7,000 to $10,000

Angry Face

Cosmetic fix: Eyebrow lift


Even eyebrows can use a boost if they're headed south. "Drooping eyebrows cause an aged look. They make the eyes more closed and can even give an angry look to the face," says Sherrell Aston, M.D., a professor of plastic surgery at New York University. "Raising the eyebrows opens up the eyes and face."


How it works: After first making small incisions in the scalp, the surgeon slips tiny, camera-guided instruments under the skin to separate the muscle attachments and reposition the eyebrows. The procedure isn't painful, and you can be back at work in 10 days. For a preview of the result, stand in front of a mirror and use your thumb and index finger to raise the skin on your forehead.


Fine points: Ask about incision placement. If you go in for a lift at, say, age 40, the incision scars may begin to show down the road as your hairline recedes.


Number of men who had their eyebrows raised in 2006: more than 5,000

Price: $4,500 to $10,000

Skin Folds

Cosmetic fix: Tummy tuck


This procedure is for those who've lost a lot of weight and are suffering from a key collateral effect. "Abdominoplasty is usually for men who have a lot of excess skin from weight loss or aging," says Gerald H. Pitman, M.D., a clinical professor of plastic surgery at New York University. 


How it works: This is major surgery. The surgeon will not only open you up to remove excess fat and skin but also tighten the muscles of your abdominal wall. Don't expect to be back at work for 1 to 3 weeks. Also, an abdominoplasty usually requires an incision that leaves a long, hip-to-hip scar, though it can be hidden in a skin crease or covered with a pair of shorts.


Fine points: Liposuction, which will remove fat but not tighten loose skin, may be a better option. Also, keep in mind that abdominoplasty, like liposuction, isn't for men who want to lose weight everywhere; it's for men who are already in good shape but have just one problem area to shape or flatten.


Number of men who had an abdominoplasty in 2006: 8,000

Price: $9,000 to $15,000

Pick a Top Doctor

Find a specialist by asking your regular doctor for a referral -- don't rely on ads or the Internet. Next, make sure the surgeon is board certified in the procedure.  Also, insist on meeting with the doctor first, not  a "consultant" who's really just a sales associate trained to sign you up for procedures. Finally, look for promotional material that touts science over salesmanship ("miraculous results" and "latest technology" are red-flag phrases).




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