Our Quest To Be Perfect

Women aren't the only ones worried about the future. Last year more than 99,000 men signed up for liposuction, eyelid surgery and face-lifts (among other procedures), compared with fewer than 55,000 in 1992, the first year the ASPRS began keeping national statistics. "Nine years ago I'd see fewer than five [men] in a year," says Dr. Cristina Keusch, a plastic surgeon in Boca Raton, Fla. "Now I see five in a month." Some want to stay competitive with twentysomethings at work; others are divorces beginning to date again. Or, like many women patients, they're motivated by simple vanity. Kevin Callahan, a 31-year-old creative director in Florida, makes no excuses for the silicone rubber implants inserted under his pectoral muscles. "I wanted the biggest pecs I could get without looking like a steroid monkey," he says. "I wanted to look buff." Lean and muscular, Callahan plays tennis and works out at the gym twice a week. But he's still not satisfied with his body. His next surgery: buttocks implants. "I've done all the squats and lunges I can do, but it's just not in the genes," he says. "So I'm going to let the doctor do some sculpting for me."

The most controversial category of new patients is teens. Last year, 1,645 patients 18 and younger had liposuction, and 1,840 had their breasts enlarged--twice as many as in 1992. In California, which leads the nation in "augs," as they're known in the business, the procedure has an air of being "pretty common" to girls like Amber Reeves, soon to be a junior at Huntington Beach High School. "A lot of seniors at my school get breast augmentation as a graduation present," she says. "I know at least four girls who had it done last year." Last month, at just 16, she joined the crowd, boosting herself from a B cup to a C "basically to even everything out," she says. "I realized my hips weren't going to get any smaller, no matter how much I dieted." Her goal is to be "thin but healthy in a toned sort of way. Kind of like Madonna."

Such material-girl aspirations have ignited a debate among surgeons. Some say they won't do breast enlargements on anyone under 18. "It seems to me that someone we don't consider old enough to order a drink shouldn't be considering plastic surgery," says Imber. The ASPRS, which represents the country's 5,000 board-certified plastic surgeons, has no official position. It's "a judgment call that should be made between the surgeon, the family and the patient," says the group's president, Dr. Paul Schnur. Some believe teen surgery can be appropriate under the right circumstances--if a girl is physically developed and mature enough to understand the risks. "The key here is not chronological age," says Dr. Fritz Barton, president of the American Society for Aesthetic Plastic Surgery, "but the age of development."

As the client pool expands, so does the number of providers--but they come with vastly different credentials. The gold standard in plastic surgery is certification by the American Board of Plastic Surgery, which requires a minimum three years of training in general surgery and two in plastic surgery. But many of the estimated 50,000 other doctors practicing in the field learned their skills in short courses or apprenticeships. "Anyone with an M.D. can call themselves a plastic surgeon," says Dr. David Ross, an ASPRS member since the 1970s. "That is why we have catastrophic liposuctions--this is not a business people can jump into with a weekend course." Dermatologists like Chicago's Dr. Gary Barsky charge that such an attitude is elitist. "It's a turf war," Barsky says. "It seems they don't want anyone else doing this, no matter how good." For doctors in his specialty, he says, procedures like laser resurfacing and liposuction are a "natural evolution."