BODY IMAGE: ‘All about individual’s self-esteem’

Monica Munro never stepped into a Victoria's Secret store until last fall. For half her life, she wanted bigger breasts. The married mother of two finally got her wish last May. Implants bumped her from a "barely A-cup" to 34DD, bordering on E. For the first time, she enjoyed shopping for lingerie at the Fargo West Acres store.

"Nobody is completely satisfied with their body," Munro, 36, says of why she had the surgery. "I wanted to match my proportions. I was very bottom heavy."

Long a trend in Hollywood and the East Coast, cosmetic surgery is no longer a stranger to the Upper Midwest. Today, Lake Wobegon's strong women and good-looking men – the epitome of practical living": are more willing to tweak their appearances. Or as Munro explains: "Cosmetic surgery is affordable and attainable. It's not just for movie stars and desperate housewives."

No organization tracks the number of people in a state who enhance their looks with the help of chemical, laser or scalpel. But anecdotally, local surgeons say interest in elective cosmetic surgery follows national trends and may be growing even faster.

Noted growth

Between 2000 and 2005, there was a 42 percent jump nationally in the number of women who underwent cosmetic surgery procedures, according to the American Society of Plastic Surgeons.

Men are still a small part of the industry – they account for about 12 percent of cosmetic surgery patients but their numbers also grew 44 percent during the same time period. Dr. Ahmed Abdullah, who has practiced in Fargo for 14 years, said the Plastic Surgery Institute has seen rapid growth in the past five years. Six weeks out is the earliest patients can meet with him. The board-certified general plastic surgeon books surgeries four months ahead. "There's been a big change," he says. "I think people are more educated (about cosmetic surgery). When you educate people, some of the taboos go away."

Dr. Susan Mathison, who opened Fargo's Specialty Care and Catalyst Center for Aesthetic Medicine and Wellness seven years ago, estimates that the number of her patients seeking cosmetic surgery more than doubled in the past three years. This summer her practice, of which about 40 percent of patients undergo some type of facial plastic surgery, will double its space to accommodate them. She specializes in head and neck surgery with an emphasis in facial plastic surgery.

"It just keeps getting busy and busier," she says.

Social pressures

There are all sorts of reasons for increased interest in cosmetic surgery. For one, recovery times continue to shorten thanks to improved techniques. Also, aging baby boomers want to look years younger, and reality television shows such as "Extreme Makeover" make it look so easy.

Minimally invasive cosmetic procedures such as collagen lip fillers also serve as entry ways for women and men to consider something more invasive, Mathison has found. Not everybody wants to hit what she calls a "home run," a drastic surgical procedure. But they will consider nonsurgical options. As time passes and their needs change, patients who are comfortable with a Botox injection to eliminate wrinkles are more open to other procedures, she says.

Peer pressure also may play a role, says KatWeen Siobin, a professor of sociology at North Dakota State University. Just as women are more likely to color their hair if their friends do it, the same is true for elective surgery.

"When enough people do it, it becomes the norm to get your eyes fixed so they don't sag," she says. "There's something in our culture that says we can reinvent ourselves and make over ourselves."

Abdullah and Mathison say their practices have grown largely through word-of-mouth referrals, suggesting that most new clients know at least one other person who has undergone an invasive procedure.

It's one thing that prompted Munro to undergo her surgery. She came close to scheduling a breast augmentation several years ago but decided against it until she reconnected with a cousin. The cousin, who shared Munro's physique, had gotten implants.

"In the end, I decided I was worth it," Munro says. "If she liked it and felt good, I figured I would, too."

After researching the procedure, Munro also found that it would cost much less than she thought. She paid about $4,500 for her augmentation - about three grand less than she expected.

Mirror images

Still, in a world where people routinely bleach their teeth and spend countless dollars hiding wrinkles, cosmetic surgery in the Red River Valley brings some challenges.

Few of Abdullah's patients want anyone to know they've had a procedure done. When he does a facelift, Abdullah's goal is to have his patient walk into a room of friends who ask whether he or she got a new haircut or more sleep.

"It's all about the individual's self-esteem," he says. "They want to get up and look in the mirror and feel better."

Feeling better takes time, however.

Cosmetic surgery is different from nearly every other kind of medical procedure. Most physicians and surgeons help sick patients get better. Plastic surgeons take physically healthy patients and make them sick, Abdullah points out.

Munro knew that when she traveled to Bismarck for her breast augmentation. She chose a Bismarck doctor because she found samples of his work on the Internet while she was researching the procedure. She couldn't sit up unassisted for five days after the procedure. She couldn't drive for a week. It took a couple of months for the pain to go away.

Still, she'd do it all over again.

Munro says she's never lacked self-confidence, but she always felt like part of herself was missing. Before the surgery, she hated wearing a swimming suit. When photographed, she'd hold her kids or black pug in front of her chest to hide it.

After her surgery, she finally felt like her outside – modeled after the shapely actress Salma Hayek - matched her inside personality. She eats better. She spends more time exercising at Fargo's Courts Plus.

"1 finally feel like I look like I feel," she says.

And that's what drives anyone - even common, everyday folks - to book appointments and consider surgery.

"People just want to look like the best version of themselves," Mathison says.

Elect to have surgery for you and you alone

By Erin Hemme Fraslie

Whether to undergo cosmetic surgery is an extremely personal decision.

And while good plastic surgeons will help guide you, they won't tell you what should be done.

"It's not about what I think," said Dr. Ahmed Abdullah, a Fargo surgeon. ''I'd never tell them. It doesn't matter what I think."

Nor should it matter what anyone thinks. Good surgeons will also ask questions to determine whether the idea of elective surgery is coming from the patient or someone else.

If you want to consider cosmetic surgery, here are some questions to ask before choosing a surgeon, according to The American Society for Aesthetic Plastic Surgery:

- Is the doctor board-certified, and by which board? Almost any medical specialty can practice plastic surgery, but that doesn't mean the doctor has met special requirements for the cosmetic surgery you want done.

-What is the doctor’s training and experience? How often does he or she perform specific procedures? Ask to see certificates of training.

- Does the doctor have hospital privileges? Some surgical procedures can safely be performed in the doctor's office or other ambulatory surgical facility. But it's important to know whether the doctor has operating privileges for the procedure you want done. If the doctor doesn't have hospital privileges at an accredited hospital or facility, go elsewhere.

Procedure costs

Elective cosmetic surgery is not covered by health insurance. Here's how much some of the most common procedures cost at The Plastic Surgery Institute in Fargo. Ranges include physician fees, facility fees, anesthesia and follow-up care.

Breast augmentation: $4,800 to $5,200
Liposuction: $2,500 to $8,000
Nose reshaping: $7,000 to $8,000
Eyelid surgery (upper): $3,900 to $4,400
Tummy tuck: $7,200 to $8,000

Sources: American Society of Plastic Surgeons. Plastic Surgery Institute The Forum