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"I'm not obese, but I don't want to diet that much," said Dockry, a healthy, athletic owner of his own hair-care distribution company in Carlsbad. "I'll go to the gym, but I don't want to spend all that time on the bike or whatever. It's not that much fun."
Once reserved for Hollywood stars or wealthy socialites, plastic surgery has become a quick-and-easy (but not so cheap) procedure for middle-income managers and even military officers who must impress for success.
The rapid growth of plastic surgery - and the number of doctors performing it - has also raised concerns about the regulation of the industry.
Men now account for 14 percent of the 2.1 million cosmetic procedures performed last year in the United States, according to industry figures. In the past five years, male liposuctions tripled, while the number of face lifts performed on men has doubled.
These trends are reflected in the youth-seeking culture of Southern California - where the San Diego yellow pages now lists 101 entries under "Plastic and Reconstructive Surgery" - but plastic surgery for men is now becoming more common across the country.
"So many men give the same story," said William Mullis, a Charlotte, N.C., plastic surgeon for 22 years. "They'll go into see someone for a morning meeting and they'll have this tired, hung-over look even after eight hours of sleep."
Paul Loewenstein, a Milwaukee plastic surgeon, has seen his male clientele double to about 10 percent of his practice in the past three years. "They want to be more competitive with the younger males in the job market," he said.
Dieting and exercise are easier said than done. And men in jobs that require public contact believe they won't make the sale unless they look fitter and younger than the other guy. Even though the average American male accumulates fat throughout his life, the image of a baggy, saggy Willy Loman character from "Death of a Salesman" doesn't cut it anymore in some professions.
Some say this obsession with appearance - and the willingness to spend thousands of dollars to transform it - mirrors our culture's impatience and its reluctance to get older.
"Baby boomers don't want to age gracefully, they want to have it their way," said Ralph Holmes, chairman of the department of plastic and reconstructive surgery at UCSD's school of Medicine. "Your and my grandmother thought they would get older. There's no way around it."
The statistics point out that it's mostly middle- and upper-income white males who are getting plastic surgery. For men, the most common procedures are hair transplants ($3,000), nose jobs ($3,300) and liposuction ($2,600 per site). These costs can double and triple, depending on how much work is done.
Plastic surgery is expensive, and it isn't risk free.
An estimated 60 to 100 patients die each year as the result of liposuction out of an estimated 110,000 procedures annually in the United States, according to estimates by a panel of the Medical Board of California. That represents and unacceptable risk, said Robert del Junco, and Orange County plastic surgeon who is leading the medical board panel that is looking at some possible professional reforms.
Unlike other medical specialties, doctors can perform plastic surgery without a three-year stint of hospital training known as a residency. Doctors practicing in other fields, such as ophthalmologists; ear, nose and throat physicians; or urologists, for example, can legally perform plastic surgery after completing weekend courses. "We have this trend in medicine where anybody and anyone can be a plastic surgeon," said del Junco, who did his training in a hospital setting.
Physicians certified by the American Board of Plastic Surgery have completed hospital-based residencies. But many doctors belong to boards or societies unrecognized by the American Board of Medical Specialties, such as the American Board of Esthetic Surgery and the American Liposuction Society. Such groups can set any standards they want, and most lack the resources to police their members.
The growth of plastic surgery, for men and women, and the glut of doctors have fueled some of these problems.
Dermatologists are doing facelifts, ophthalmologists are doing eyelifts and cosmetic tattoos, gynecologists are doing liposuction.
Some doctors perform these procedures without the backup of a hospital emergency room. Del Junco said it is important for patients to ask their doctor what they have in place in case something goes wrong during or after an operation, such as resuscitation equipment, heart monitors and a post-operative recovery area staffed by a trained nurse or doctor.
Minor procedures such as collagen injection that don't involve anesthesia or the removal of large amounts of body fluids can be done without a full operating room.
Patients should also make sure their plastic surgeon has a medical license and medical malpractice insurance, is certified by the American Board of Plastic Surgery and that the surgery center is accredited and affiliated with a hospital.
Inside a well-lit operating room in the medical building near Scripps Hospital, Merrel Olesen prepares for a routine liposuction. His patient, 36-year-old Mark Harke, is knocked out cold on a table, his breathing controlled by a machine and an anesthesiologist.
Harke's bare torso is shaved and tinted ochre-yellow with antiseptic solution. He's trussed up like a big ham ready for the oven. With a few strokes of a magic marker, Olesen has outlined sections of his patient's chest, stomach and waist from which he plans to remove fat.
After injections of saline and epinephrine, a drug to constrict blood vessels and reduce blood flow, Harke's skin takes on a reddish mottled hue. A technician massages Harke's body with slime-covered pads of an ultrasound device that helps break up the fatty tissue underneath the skin.
Olesen then cuts two small incisions on each side of the torso. Into one hole, the doctor inserts a 14 1/2 inch needle attached to a plastic plunger. Olesen works the needle back and forth between the muscle and skin layers, dislodging fat that has taken years to accumulate, then siphoning off the mixture of yellowish liquid fat and blood into a plastic bottle.
"That's 45 cc's," he calls out to the operating room nurse. She make sure an even amount of liquid is taken from each side so Harke will come out with a smooth contour to his new, leaner body.
Olesen inserts the needle into the small hole and works it through the fatty areas, careful not to puncture the overlying skin with the tip of the syringe.
"It's hard work, like going to the gym," he says.
In 20 minutes, Olesen has finished the chest and moves down to the stomach. "The main thing is to get the contour smooth," Olesen says. Harke "has smooth skin and should have smooth skin when we're finished."
Once the fat cells are removed, they won't come back. But if the patient puts on weight in the future, it will accumulate in other parts of the body. He may have a slim waist, for example, and flabby thighs.
Several plastic surgeons interviewed said that once the cells are taken away, patients seem to keep the fat off.
Eighty minutes after he began poking the metal syringe into Harke's body, Olesen finishes after removing about two quarts of the fat-blood fluid.
Harke is slowly brought back to consciousness and goes home with a friend. A day later, he cooks Thanksgiving dinner.
"I regretted (cooking) the next day," Harke said a week after his operation. "All my muscles hurt, I ached everywhere and slept all day."
Six weeks later, Harke relaxes in the back yard of his Encinitas home. He breaks out in a big smile when asked if he's pleased with the results.
"I'd definitely do it again," he said. "All my friends are amazed."
Article printed in the San Diego Union, February 1999.
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