Plastic made PERFECT.

Tummy tuck or breast reduction--more gay men and lesbians are turning to the knife

Although ancient Greek culture idealized beauty, homely Socrates was considered quite a catch because of his intellectual gifts. Contemporary American culture also esteems beauty--check out any Calvin Klein billboard or GQ ad--but Socrates would have a hard time getting a second look today.

While gay men and lesbians often have different ideas about physical beauty, they are far from immune to the pressure to conform to cultural ideals of beauty. Stereotypically, this pressure might drive some gay men to the gym and encourage some lesbians to shun lipstick. But increasingly it's sending members of both groups to the plastic surgeon.

Tummy tucks, liposuction, pec implants, face-lifts, chin alterations, nose jobs, eye lifts, ear pins, hair weaves, electrolysis, penis enlargement, breast enlargement or reduction, skin peels--today, virtually every body part can be made bigger, smaller wider thinner or in any other way "better." Beauty may be in the eye of the beholder, but more than ever that eye belongs to the same body it is beholding.

"Chris," a 40-years-old gay man who asked that his real name not be used, had a chin implant at 21. Fourteen years later it was redone with a more modern technique. He also underwent stomach liposuction.

"I'm an artist and sculptor," he says. "I didn't like the aesthetics of my chin. I thought it should be more prominent." His stomach was a different story: "I always wanted look like a go-go boy!"

In 1998 more than 1 million cosmetic procedures were performed on people like Chris. While straight women make up about 75% of patient, the number of lesbian and male--gay and straight--patients growing experts say.

"All men want the same things--noses, liposculpture of the chin and abdomen, laser [body] hair reduction--but the difference is that straight men won't do it as readily," says Richard Escajeda, a San Diego plastic surgeon who works with a growing number of gay male clients.

When lesbians go under the knife, which doctors say happens less often than with gay men,it's most frequently for breast reconstruction. But unlike straight women, who often have their breasts enlarged (in some cases to please men who value that physical attribute), lesbians usually opt for breast reduction. Many women, regardless of sexual orientation, experience physical and emotional discomfort due to breasts they consider too large. The fact that many lesbians have their breasts reduced could be a reflection of their being less influenced by male standards of female beauty, says Richard Marfuggi, a New York plastic surgeon who wrote Plastic Surgery: What You Need to Know--Be-fore, During, and After.

Lesbians do have plastic surgery on body parts other than their breasts, but they seem less likely than gay men to talk about it. "It took me a while to admit to my lesbian friends that I'd had some plastic surgery done to my eyes and neck," says a prominent 60-year-old lesbian architect from Santa Monica Calif., who asked to remain anonymous.

"I was happy to have the work done and more than pleased with how I look now," she says. "However, on another level I felt ashamed. Lesbians aren't supposed to value anything--especially around appearance--that isn't authentic. There's not a lot of support for it in our community. It's the `sensible shoe' culture. If you have plastic surgery, you're not being honest about your age. Your exterior is pretending to be younger. You're not being your authentic self."

This difference between gay men and lesbians may have cultural roots, says Los Angles-based psychotherapist Betty Berzon, who seldom hears about plastic surgery from her lesbian patients but discusses it often with gay men. "Gay male culture focuses a great deal on physical appearance," she says, "whereas I don't think there is an ideal image' of what a lesbian should look like. There is much less pressure to live up to a certain standard of appearance." She notes, however, that this is changing: "Young lesbians are more focused on physical appearance than older ones."

Experts debate whether the increasingly important role played by physical appearance and plastic surgery is a good thing though. "You can't separate it from the body-trans-forming aspects of gay culture," says Michael Shernoff, a Manhattan psychotherapist who has spent 25 years working with gay men. "Contemporary urban gay male life emphasizes the buffed body with big, hard pecs, which is physically unattainable for most people."

Unattainable even for most models, it seems. "Calvin Klein models not only spend five hours a day in the gym, but their images are digitally altered, with all the flaws edited out," says Susan Bordo, a University of Kentucky humanities professor and author of The Male Body: A New Look at Men in Public and Private.

Plastic surgery also takes a toll in time, money, aggravation, and pain. "People who do this must view their body as causing enough distress to create discomfort," Shernoff says. "Plastic surgery can be healthy or so narcissistic as to become unhealthy. I ask patients who think about it, `What are your goals? What do you hope will be different?' With someone who has already achieved intimacy or is in a relationship, maybe they admit it's silly and vain, just a serf-indulgence. Some people know a nose job won't get them a [partner], but they will be happier when they look in the mirror. Other people think it will provide a magic answer or cure a problem. It's my job as a therapist to help them explore their perspective."

Psychological suffering can be real or imagined. For some, plastic surgery becomes a treadmill. More than 20% of plastic surgery patients are repeat customers. "An individual who is miserable in this culture may certainly feel happier in the short run," Bordo says. "But you can get addicted: You get rid of one flaw, but then you see another. You become enslaved to an ideal you can never fully attain."

Marfuggi puts it succinctly: "If you think you can't get a date because of a hump on your nose and then you think you can't get one because you've got bags under your eyes and then because of your spare tire, maybe surgery isn't the answer. Maybe you're just a rotten person."

On the other hand, cosmetic surgery may lead to success even without more dates. "I've seen men have great insights without getting the outcome they dreamed of," Shernoff says. "They say, `I've been looking for answers externally; now I realize I have to look inside myself.' That's pretty perceptive."

As a Broadway actor, 25-year-old "Cal" knows how important appearances can be. But he insists the only person who can make a decision regarding plastic surgery is the individual himself. "The extreme is the Chelsea boys who spend their lives lifting and tucking, like it's a sport," he says. "That's not for me, but it's their choice, and it's not for me to judge."

Before his liposuction, he says, "everyone tried to talk me out of it. I heard all kinds of horror stories. As it turned out, having my wisdom teeth out was much worse. And afterward everyone said how good I looked and wanted my surgeon's number."

Shortly after surgery Cal went to Banana Republic, tried on smaller pants, and "bawled from happiness." Today, months later, he still feels joyful and philosophical.

"It would be nice to think everyone accepts himself and everyone else, however they look," Cal says. "But get real. The world isn't like that."

A NIP HERE, A TUCK THERE

Advances in medical science have led to an array of methods to slim down some body parts, build up others, and keep still others looking perpetually young. While some surgical procedures require weeks of recovery time, other treatments can be scheduled easily during one's lunch hour. Some of the most popular procedures being performed today on gay men and lesbians include:

1. Eye lift

Erases the sagging skin and weakened muscles that create droopy upper eyelids and lower lid bagging. Cost: $1,700-3,000, depending on whether both the upper and lower lids are done

2. Botox injections

Erases forehead and frown lines through the injection of small amounts of the botulism toxin to weaken muscles. Treatments last about four to six months. Cost: $30 per treatment

3. Collagen injections

Reduces or erases wrinkles around the mouth and cheeks via the injection of bovine collagen into these areas, Cost: $400

4. Laser skin resurfacing 

Uses a wand of controlled light to remove outer layers of the skin, tighten loose skin, and erase wrinkles, skin folds, and brown spots, Cost: $1,300-$2,800

5. Breast reduction

Most common among lesbians but also performed on men. Some insurance companies cover the cost of the procedure for women because large breasts can cause chronic back, neck, shoulder, and breast pain. Cost: $5,500 for women, $2,800 for men

6. Pectoral & calf implants

Creates a musclelike appearance through the implanting of soft solid silicone. Cost: $6,000

7. Liposuction

The removal of unwanted fat. The most common target areas are the abdomen and flanks, but the procedure is also performed on hips, buttocks, thighs, knees, upper arms, chin, cheeks, and neck. Cost: $1,900 per site

8. Liposculpture

Often used to carve grooves into the abdominal muscles to make the fat on top of them have a rippled "six-pack" look. Cost: $3,000

9. Tummy tuck

Flattens the abdomen by lifting the loose abdominal skin, tightening the muscles, and removing excess skin and fat. As part of the procedure, a new navel is created to replace the original, which is removed during the surgery. Cost: $4,000

--Sue Rochman

Woog's latest book is Friends & Family: True Stories of Gay America's Straight Allies.

For more information on plastic surgery and the procedures people are having done, go to www.advocate.com