The Wall Street Journal

Gym, Check. Diet, Check. Face, Lift

Younger Men Seek Cosmetic Surgery as Stigma Fades, Recovery Gets Easier; Goodbye, 'Turkey Neck'

For David Culpepper, the deciding factor was his fiancée, playfully telling the 59-year-old executive she didn't want wedding pictures "with that big old saggy chin." On Dec. 31, the Virginia businessman got rid of it, undergoing a face-lift and chin implant in the office of New York plastic surgeon David Hidalgo.

Women account for the majority of cosmetic procedures, but more men are opting for plastic surgery and other enhancements to lift droopy necks, excise excess body fat, and pin back protruding ears.

Younger men are increasingly viewing cosmetic procedures—generally not covered by insurance—as an acceptable way to make themselves more attractive, or correct embarrassing or unmanly features.


David Culpepper before his Dec. 31, 2010, surgery.

Thanks to advancements in techniques, surgeries that once required a hospital stay are now done on an outpatient basis, with less time needed for recovery. Surgeons say this appeals to men who don't like the idea of taking lots of time off for an elective procedure.

Newer, minimally invasive, temporary treatments such as Botox injections and dermatological fillers are intended to create subtle changes such as erasing a few wrinkles. They can be done during a quick office visit.

"Men are figuring out what women have long known—that appearance really does matter," says David Sarwer, an associate professor at the University of Pennsylvania who conducts research on the psychological aspects of cosmetic and reconstructive surgery for its Center for Human Appearance, an academic center bringing together plastic surgeons, dermatologists and psychologists.

Men are motivated by competitive issues such as maintaining an edge in a youth-dominated work environment, Dr. Sarwer says, and may seek procedures after a divorce, when they are entering the dating scene again. Baby Boomers make up a significant proportion of cosmetic surgery clients.


A photograph marked up by plastic surgeon David Hidalgo in New York. Dr. Hidalgo tightened the neck and inserted a chin implant. Cheek tissue was elevated to better reveal the jaw line. A one-inch incision was made under and just behind the chin to tighten the muscle in the neck and put in the chin implant. Incisions were also made around the ear to tighten the skin. Dr. Hidalgo also cut inside the lower eyelid to remove some fat.

The number of men who had cosmetic procedures rose 2% to more than 1.1 million last year, says the American Society of Plastic Surgeons, whose members practice both cosmetic and reconstructive surgery. This lags the 5% increase among women, but growth in several particular procedures was markedly greater among men: Face-lifts increased 14%, the number of men who opted to trim away excess fat with liposuction rose 7%, while the number of eyelid surgeries increased 15%. By contrast, only 9% more women had face-lifts in 2010 and the number of women undergoing liposuction rose 2%. Eyelid surgeries for women increased 3%.

Younger men and teens often opt for surgery that will give them a more masculine appearance. For example, nearly 75% of the 18,000 men who underwent a procedure known as gynecomastia—male breast reduction—were between the ages of 13 and 19.

Physicians are all too happy to take on male patients. With a tough economy, plastic-surgery procedures overall remain 18% below 2000 levels. Although minimally invasive skin treatments and fillers are up 110% since a decade ago thanks to a flood of new products, last year those treatments rose just 5%.

Some studies indicate men are less satisfied than women after cosmetic surgery, and doctors say it's important to manage their expectations. "Men are sometimes not as tolerant of pain and discomfort, and sometimes don't articulate what they want as well as women," says Jeffrey Kenkel, a Dallas plastic surgeon and president of the American Society for Aesthetic Plastic Surgery, which represents cosmetic plastic surgeons.

David Frederick, who has conducted research on body image at the University of California, Los Angeles, says that in the 1940s and '50s, the ideal man portrayed in movies and other media was far less toned and muscular, "but men today who grew up playing with action figures, looking at men's magazines and seeing widespread mass use of gyms and weight training feel under much more pressure to have a masculine face and body."

Other research shows men are driven more by their own notions of what they should look like. A study co-authored by University of South Florida researcher J. Kevin Thompson for the journal Sex Roles found that in men, personal dissatisfaction with the body, or parts of the body, may drive favorable attitudes towards cosmetic surgery, rather than the desire to achieve a societal ideal of attractiveness.

Jim Wehrheim, a 61-year old financial executive, says that although he works out regularly, has a healthy diet, and was generally satisfied with his appearance, he was bothered by "crow's feet and a double chin." His wife of two years, who is 19 years younger, was supportive of a surgical solution, he says. Pittsburgh plastic surgeon Leo McCafferty performed a face-lift in January. "Women have breast implants and face-lifts and Botox, so why shouldn't it be OK for men?" says Mr. Wehrheim.

Howard Sobel, a Manhattan dermatologist, says about 20% of his liposuction patients are male, compared to 5% a decade ago—when men who came into his office for a cosmetic procedure would ask to come in the back door or ask to be seated where no one could see them. They have become less shy—and willing to sit in the waiting room. And the healing process is less visible for the increasing number of men using Botox and other fillers: "The worst thing they might get is a little bruise and they are out of the office in 15 minutes and right to dinner," Dr. Sobel says.

Dr. Hidalgo, who operated on Mr. Culpepper, says men "aren't raised with the notion that one devotes regular time to beauty care," and can be more comfortable with the one-time fix that more extensive plastic surgery offers, rather than the recurring visits required for Botox and injectable fillers.

And only surgery fixes the areas that men complain most about: heavy hooding over the upper eyelids, lower eyelid bags, and a flabby neck that hangs over a shirt collar.

Men's faces can pose more challenges than women's. Their heads are bigger, and blood tends to ooze from broken capillaries in bearded skin more easily than from women's skin, so surgery may take up to three hours compared with two hours for women. Most men are presentable two weeks after surgery, Dr. Hidalgo says.

Mr. Culpepper, who owns a company that repairs industrial cooling and heating systems in Virginia Beach, Va. and races sports cars as a hobby, says the first 24 hours after surgery were "pretty weird," but he was back to work in two weeks. He married Cindy Galardi a few weeks after the surgery. And aside from some remarks by friends and associates that he looked good after he was back at work, no one took any notice of the surgery. He says he couldn't be happier with the outcome: "Sometimes I look in the mirror, and think, damn, that is good—I can see the difference."

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