Thursday, Oct. 15, 1998 | 9:52 a.m.
The initial discussion might seem like a routine trip to the barber.
Want a couple inches off the top (of your ears)?
How about a simple trim (of your nose)?
Perhaps you'd like to add a little body (to your body).
But for a steadily increasing number of adult men, traditional methods of attending to physical appearance (grooming, physical fitness and wardrobe) are being enhanced by a surgeon's scalpel.
Gentlemen, start your implants.
"The number of males seeking cosmetic surgery is increasing," plastic surgeon Dr. William Canada said during a recent visit to his Las Vegas office. "Like anyone else, men want to look good, they want to have a nice appearance and I'm getting more and more male patients. But they aren't requesting the traditional procedures."
In this case, "traditional" would be considered a face lift, rhinoplasty (nose job) or blepharoplasty (surgery to smooth out wrinkles around the eyes).
But over the past decade, surgeries requested by males have grown to include nearly any flabby, wrinkled or protruding body part.
A quick gander at the plastic surgery cavalcade:
Otoplasty (ear pinback), chin implants, cheek implants, bilateral calf augmentation (or, simply, calf implants), gynecomastia (breast reduction), pectoralis implants (chest implants), liposuction (the surgical removal of fat cells in the neck, hips or abdomen), body sculpting (a form of less-extensive liposuction), abdominoplasty (tummy tuck) and buttocks implants (no explanation needed).
And more choices means more business from males for plastic surgeons.
"In the last 10 years, the medical advances have provided more appealing options to men," said Canada, who has been a practicing plastic surgeon for 28 years, the past 17 in Las Vegas. "I've been getting a wide range of male patients who want to improve their appearance, their quality of life."
Though reliable statistics specific to Las Vegas or Nevada do not exist, the American Society for Aesthetic Plastic Surgery reports that males accounted for nearly 14 percent of the 2.1 million cosmetic procedures conducted in 1997. Nearly 290,000 cosmetic procedures were performed on men in 1997 (the most recent statistics available), more than double the number recorded in 1992.
According to the ASAPS, the number of men opting for liposuction procedures has tripled since 1997 and is one of the most frequently performed plastic surgeries on men. A total of 28,308 American men surgically parted with unsightly fatty masses in 1997, second only to the ever-popular hair transplantation (50,556) and rhinoplasty (44,452).
Clearly, men are gradually embracing the idea that cosmetic surgery can help maintain a more youthful appearance.
"In the past, men have been ... I don't want to say scared, but have had tremendous hesitancy," said Dr. Charles Vinnik, who has been practicing in Las Vegas since 1969, longer than any other plastic surgeon. "There is a greater degree of anxiety for men than women."
It's the nature of the male animal, Vinnik says.
"It's just been more widely accepted through generations for women than men," Vinnik said. "For example, how many men do you know that wear makeup, outside of maybe professional news anchors or actors? I don't know any."
Even mainstream male grooming applications -- such as cologne -- are marketed toward women, Vinnik said.
"They appeal to the female to get to the male," Vinnik said. "Even the (cologne) I wear is because my wife likes it. Men are slow to respond to that sort of thing."
Opting for the knife
What accounts for the rise in male cosmetic surgery?
"It's the same reason you comb your hair and wear nice clothes," Vinnik said. "You want to look good. I've heard from men who work in the casino industry who might get passed over for a job if they look like they're ready to be put out to pasture.
"It's not just for vanity. I hate the word 'vanity,' because it implies that someone is doing this just to chase women. It can change a person's self-image, the way they think about themselves and the way people perceive them."
Vinnik offers up this scenario.
"You have two people up for the same job, maybe a job in a casino, and one might not have the experience but looks really good and vibrant," Vinnik said. "Then you have a person with a great deal of experience who looks like he's been hitting the bottle for 30 years. Who's going to get the job?"
Vinnik's contention is it would be the fresh-faced, Brad Pitt clone over, say, the Jack Klugman lookalike.
"But if you're older, have some job and life experience, and make an effort to look youthful and well-presented, you've got the best of both worlds," Vinnik said. "The workplace, and the world at large, has become more competitive in terms of physical appearance."
Among the elite
Vinnik, whose expertise has been sought by "60 Minutes," Phil Donahue and People magazine, said he feels the percentage of male plastic surgeries in Las Vegas is at least as high as the national statistics, and likely a bit greater.
"It's an appearance-oriented city, a place where appearance really matters," Vinnik said. "If the national numbers are 14 percent (of the total number of surgeries) for men, we might be at 17 or 18 percent."
Canada also said Las Vegas' reputation as another "Silicon Valley" is well-founded.
"There's no question about it, Las Vegas is up there with L.A., Beverly Hills and New York City as the most frequent places it is done," said Canada, who estimates he's performed more than 15,000 operations. "You have people associated with casinos and that's a large number of people. I've had some major personalities, models, bodybuilders, people I can't name, as patients.
"People in general are more receptive to it in Las Vegas than in other places."
Feel like new men
One such person is 39-year-old S.J. Gomez, a native of Bogota, Colombia, whose family moved to San Diego when he was 9 years old. Gomez works as an embalmer ("My customers never complain," he says) and also owns his own landscaping and house-painting business.
Gomez was afflicted with two pronounced facial abnormalities. At age 7, he stumbled and broke his nose and it was never properly reset.
"I always felt that God created the accident and I didn't want to mess with God," Gomez said. "But every day, I'd think about my nose. When I got older, people would think I was a boxer and I'd become more and more sensitive about it."
Also, Gomez's right ear protruded out a couple of inches more than his left, a condition since birth.
"I always would wear my hair long," Gomez said. "That was my remedy. I never wore my hair short. It was not an option because of how my ear looked."
Gomez scoured the Yellow Pages and spoke with "every plastic surgeon in the city" before settling on Canada. He decided to first remedy his ear disfigurement, and Canada stitched back the ear and added a small implant to match it with the left.
Three weeks later, Gomez underwent a rhinoplasty, complete with two small cheek implants. After the swelling subsided, he was ecstatic with the results.
"I expected to have my head wrapped up like a mummy," he said. "But it wasn't like that at all. After I had my ear done, I was at work the next day with just a small piece of tape behind my ear."
Another satisfied patient, 60-year-old retiree Richard Hunter, visited Vinnik seeking to shed one of the demons of male maturity: the spare tire.
"It's nothing to be ashamed of," Vinnik said. "Even with the whole physical fitness craze, people are still asking, "Why can't I get rid of this spare tire?' All mammals tend to gain weight as they get older."
Liposuction, as the term implies, is the extraction of fat cells by using a metal tube inserted under the skin through a small incision, and by repeated motion it breaks up the small fat tissue globules. These are then removed by vacuum suction through the tube.
Sound gross? Not to Hunter.
"I've got the body of an 18-year-old," Hunter, a former contractor, said. "I used to have the little old handles on the side and the paunch in front. I couldn't get rid of them."
Hunter underwent a two-hour surgery to trim the girth and came away 16 pounds lighter. He now stands just under 6-feet-tall, weighing 178 pounds.
"I'm pretty close to an average-sized person," said Hunter, who keeps toned by doing 60 sit-ups and running a mile every day. "I'm completely satisfied."
The game of risk
However, cosmetic surgery is far from risk-free. Complications can include numbness (through nerve damage), ruptured or leaking implants, infection, disfigurement, blood clots, displacement of the prosthesis (when an implant's position shifts unexpectedly), permanent scarring through poor wound healing, as well as the risks inherent in any local or general anesthesia surgery.
"I give my patients a long list of potential complications. I'm not trying to sell a bill of goods here," Vinnik said. "When they really press me, I tell them straight up what the biggest risks are, and that's death, disability or disfigurement. That's true with any surgery, even if you go to the dentist there are risks, no matter how remote."
Vinnik is no proponent of some of the more recent developments in cosmetic surgery. Mention "calf augmentation" or "pectoral implants," and he winces.
"I choose not to do them," he said. "The risk-benefit ratio is not good enough and the complication rate is higher. I strive for bullet-proof surgery, and if I've got the same odds as a craps game, I'm not going to do it."
Dr. William Zamboni, chief of the Medical School's Division of Plastic Surgery at UNLV, said that "calf and pectoralis implants are not considered mainstream plastic surgeries, but in experienced hands they can be safe procedures.
"In general, other than breast implants for women, I generally prefer soft-tissue enhancement rather than adding foreign material, especially in the face," Zamboni said.
Canada, who performed the first calf implant surgery ever in Las Vegas in 1990, says prospective patients should feel at ease with an experienced surgeon.
"The advances we've made have provided patients with more confidence in the safety of cosmetic surgery," Canada said. "I know in my experience that my patients have been very, very pleased."
Canada, author of the book "Beauty Surgery," counts among his satisfied patients a large number of bodybuilders seeking to add tone to their buttocks, chests or calves, as well as men whose legs were atrophied because of polio.
One unique case was an Arizona man whose favorite hobby was quick-draw pistol shooting. He accidentally fired a slug into his leg and suffered nerve damage.
The man's lower leg began to shrink and shrivel, but Canada remedied the problem with a soft-solid silicon implant and, at least cosmetically, the sharp-shooter was as good as new.
"I make people feel better about themselves because they look better," Canada said. "It's a gratifying profession. I still get Christmas cards from patients."
Not many of whom are willing to publicize their surgically enhanced bodies, however.
"It's a very discreet profession," said Vinnik, who performs surgery out of his own Las Vegas office. "Confidentiality is very, very important."
Vinnik, who at 61 has the facial features of a man 20 years younger, is coy when asked if he's ever had his face sculpted.
"It's a question I don't answer," he said with a smile. "I don't want people to speculate on it, just as a matter of practice. I wouldn't tell you if I'd had a hernia or any other medical problem."
No, with cosmetic surgery, it's better to trust your eyes.
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