The Hard Body Sell

The cosmetic surgery industry has long preyed on women's body-image insecurities. Now it's targeting the other 49 percent.

In a Web site photograph for the Beverly Hills, California, Barron Centers Body Recontouring and Male Enhancement Clinic, a smooth-skinned, muscular man embraces a lovely woman reclining in the grass. The site is advertising liposuction and penile enlargement surgery. "The positive results are the same for virtually every person: greater self-esteem, a new level of self-confidence, the ability to feel your best," promises the copy. "This improved self-image is evident not only in your sexual life, but in most other arenas." Below that, a large banner announces: "New Lower Fees."

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Talk about a hard sell.

Welcome to the macho world of cosmetic surgery. Once the hush-hush domain of aging society women, the fast-growing market for cosmetic procedures increasingly includes male baby boomers. Over the past five years, the number of men having liposuction has tripled, according to the American Society of Plastic and Reconstructive Surgeons, and the number having face-lifts has doubled. In 1997, men spent almost $130 million on liposuction, face-lifts, nose reshaping, and eyelid surgery, up from $88 million in 1992. (Women, by comparison, spent $882 million in '97, up from $479 million in '92.)

"It's definitely a growing trend," says San Francisco-based plastic surgeon Corey Maas. "After all these years of guys walking around with big beer-bellies and wrinkly faces while women are looking better and better, finally, men are catching on."

Men are responding to a consumer culture that is less and less forgiving toward those who are not young, trim, and attractive. Bombarded with advertising images of perfect men, they're having manicures, dyeing their hair, concealing blemishes, and getting facials. Cosmetic companies have concocted macho-sounding campaigns for their men's product lines, and sales of men's grooming supplies are increasing 11 percent per year, totaling more than $3 billion in 1996.

Cosmetic surgery, with ads promising quick and easy high-tech results, is being marketed to men the way sports cars and stereo equipment are sold -- as accessories to make them more attractive, powerful, and masculine. "It's extremely important for the working man to appear energetic and youthful," says a Web site ad for the Palm Beach Plastic Surgery Center. "You may feel young and ready to go, but your sagging lids, loose neck, or thinning hair may portray a less vibrant impression than you would like." As one male University of California at Berkeley professor who had facial plastic surgery puts it, "If it's available, and it makes me look better, and I have the money, why not? It's not any stupider than going out and buying a Jaguar."

Also, women are no longer settling for chubby, balding executives. They don't have to. "It used to be that men responded to physical beauty and women responded to power and status," says David Sarwer, a psychologist at the University of Pennsylvania's Center for Human Appearance. "Now women have their own power and status, and they're looking for more attractive men.

"Increasingly, men are coming in for antiaging treatments," continues Sarwer. "The baby boomers, who have been the generation on the forefront of so many social changes, are now marching to the cosmetic surgeon's office."

In some ways, this new trend among men finally validates what women have always known: Looking good is hard work. But it's also ironic. Feminists who had hoped that gaining equality in the workplace would mean they could stop worrying so much about appearance are finding that men are worrying more about their own -- and presumably haven't learned any lessons from women's body-image issues. Of the millions of people diagnosed with eating disorders such as anorexia nervosa or bulimia each year, almost 10 percent are men, and silicone calf and pectoral implants -- to beef up the less-than-muscular leg or chest -- are also gaining popularity among men. Cosmetic surgeons are quick to point out that they don't use gel, so the leakage problems women have had with breast implants do not occur.

Still, men are far from being as anxious or depressed as women about their looks. "There's definitely more emphasis on men's looks, bodies, and weight than in any time in the past, but I don't think men will ever feel the intense pressure to be trim and attractive that women face every day," says Debbie Then, a California-based social psychologist who studies appearance. But with cosmetic surgery ads that emphasize self-esteem, it can't be long before men start taking their physical imperfections to heart.

Indeed, men are growing more insecure. A 1997 nationwide Psychology Today survey showed men's escalating dissatisfaction with their abdomens (63 percent), weight (52 percent), muscle tone (45 percent), overall appearance (43 percent), and chest (38 percent). In each area, respondents' dissatisfaction had risen at least 10 percentage points from survey results in 1986.

Psychologists also have identified in men a disorder known as body dysmorphia, which involves extreme, exaggerated dissatisfaction with body parts and appearance -- for men that most often means body build, hair loss, and genital size. Men with the disorder will resort to extensive stints at the gym (five to six hours a day), steroids, or implants.

Whether or not the problem is between men's ears, cosmetic surgeons are doing their best to help men improve what's on top of their heads -- and between their legs. In 1996, men spent about $12 million on penile enlargements. Privately, many plastic surgeons say the results are rarely impressive -- and often dangerous. Dr. Martin Resnick, chair of the Department of Urology at Case Western Reserve University and secretary of the American Urological Association, says that "penile enlargement has not been shown to give patients the degree of enlargement they desire. And in some cases, the procedure has led to infection and deformity."

In 1996, the Medical Board of California (MBC) suspended the license of a cosmetic surgeon who had advertised that patients could gain an average of 2 inches in length and an increase in girth of up to 50 percent through penile procedures; of the more than 4,500 enlargements he performed -- as many as 10 a day -- more than 100 patients complained of excruciating pain.

A more common procedure men seek, however, is liposuction for love handles. While liposuction is promoted as safe, a recent study by doctors in California showed that one in 5,000 patients dies as a result of the procedure, usually after removing large volumes of fat. Robert del Junco, a head and neck surgeon who leads the MBC's commission to investigate cosmetic surgery, says poorly trained doctors -- in an effort to make more money in the managed care environment -- do the procedures after only a weekend seminar's worth of training. "There are a lot of marketing schemes out there that work whether or not a doctor is qualified," says del Junco.

But despite the risks, it's likely that more men will undergo cosmetic surgery, especially as the technology shortens recovery times and the procedures become less intrusive. Men are seeking lunchtime fixes: a collagen injection to smooth out wrinkles, a dermabrasion to reduce blemishes.

The effort to look young and attractive is going beyond gender, as our culture becomes more androgynous and appearance becomes paramount. Obsession with appearance is likely to become less a matter of gender than of class; people will spend whatever they can afford to save their looks.

Inevitably, more men will develop the kinds of body and appearance neuroses that many women have suffered for years: eating disorders, body dysmorphia, and general self-loathing for not measuring up to an impossible ideal. It may disappoint women, who have counted on men to be less obsessive about facial flaws and extra pounds -- real or imagined. But we'll be sympathetic. We know how it feels.

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