Aesth Plast Surg DOI 10.1007/s00266-014-0440-1
ORIGINAL ARTICLE
NON-SURGICAL AESTHETIC
A Social Evaluation of Perception on Body Contouring Surgery by Turkish Male Aesthetic Surgery Patients Bora Ozel • Billur Sezgin • Kirdar Guney Osman Latifoglu • Cemallettin Celebi
•
Received: 8 August 2014 / Accepted: 2 December 2014 Ó Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery 2014
Abstract Although aesthetic procedures are known to have a higher impact on women, men are becoming more inclined toward such procedures since the last decade. To determine the reason behind the increase in demand for male aesthetic procedures and to learn about the expectations and inquietude related to body contouring surgery, a prospective questionnaire study was conducted on 200 Turkish males from January 1, 2011–May 31, 2012. Demographic information, previous aesthetic procedures and thoughts on body contouring procedures with given reasons were questioned. The results of the study showed that 53 % of all participants considered undergoing body contouring surgery with the given reason that they believed
This study was presented at the 17th World Congress of the International Confederation for Plastic, Reconstructive and Aesthetic Surgery IPRAS meeting, held in Santiago, Chile, 24 February–1 March 2013. B. Ozel (&) Department of Plastic Reconstructive and Aesthetic Surgery, Gulhane Military Medical Academy, Selimiye Tibbiye Street, 34668 Istanbul, Turkey e-mail: [email protected] B. Sezgin Department of Plastic Reconstructive and Aesthetic Surgery, Erzurum Regional Training and Research Hospital, Erzurum, Turkey K. Guney Department of Plastic Reconstructive and Aesthetic Surgery, Konya Regional Training and Research Hospital, Hacısaban Mah. 42090, 06500 Konya, Turkey O. Latifoglu C. Celebi Department of Plastic Reconstructive and Aesthetic Surgery, Gazi University Faculty of Medicine, 14th Floor, Besevler, 06500 Ankara, Turkey
their current body structure required it. For those who did not consider contouring operations, 92.5 % said they felt that they did not need such a procedure. The results of the statistical analysis showed that BMI was a significant factor in the decision making process for wanting to undergo body contouring procedures. The results of the study showed that mens’ consideration for aesthetic operations depends mainly on necessity and that the most considered region was the abdominal zone in regard to contouring. We can conclude that men are becoming more interested in body contouring operations and therefore different surgical procedures should be refined and re-defined according to the expectations of this new patient group. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Keywords evaluation
Body contouring Men Turkish Social
Introduction Although aesthetic procedures are known to have a higher impact on women, men are becoming more inclined toward such procedures over the last decade. According to the 2013 American Society for Aesthetic Plastic Surgery (ASAPS) data of cosmetic surgery gender distribution in the United States, male patients accounted for 9.4 % of all cosmetic procedures [1]. The most popular surgical procedures for men are listed as liposuction, blepharoplasty, rhinoplasty, male breast reduction for the treatment of gynecomastia and otoplasty, respectively. This evolution has resulted in an
123
Aesth Plast Surg
increase in the number of cosmetic procedures for men by 273 % since 1997 [1]. Twenty-seven percent of all the patients presenting to our clinic seeking to undergo cosmetic operations are male. The pattern of increased interest seems to be parallel with the general trend as male patients constituted 20 % of all cosmetic procedures in our clinic 4 years ago, and 12 % 10 years ago. This inclination toward plastic surgery also seems to have affected the general outlook on body contouring surgery, as gynecomastia surgery has increased from 15,968 procedures in 2000 to 22,939 in 2013 (up by 13 %) [1]. A total of 363,912 liposuction cases were recorded in 2013 which demonstrates a 106 % increase since 1997 [1]. As a result of health-related government policies and campaigns for weight loss, another newly generated group of patients seeking improvement in their body shape has emerged in the last decade. Patients seeking body contouring surgery after massive weight loss constitute a rapidly growing patient population in the plastic surgery practice as body contouring surgery can dramatically improve the shape and proportion of the body, enhance appearance, and boost self-confidence [2]. Many studies have been reported on the perception of post-bariatric patients regarding body contouring surgeries [3–6]. In this study, we intended to evaluate the perception regarding body contouring of Turkish males inquiring about cosmetic surgery. Likewise, with the increase in interest for men’s aesthetic procedures, we aimed to seek the motives behind the increase in demand for male body contouring procedures in the Turkish male population. To the best of our knowledge, this is the first study that addresses the perception of body contouring in a non-post bariatric healthy male population.
Materials and Methods A prospective questionnaire study was conducted to determine the main motives for undergoing body contouring surgery and to establish a relationship between age, body mass index (BMI; kg/m2), and different characteristics of male patients intending to undergo such surgical procedures. Male patients who presented to the plastic surgery outpatient clinic for various inquiries between January 2011 and May 2012 were asked to fill out a questionnaire inquiring about demographic information, previous aesthetic procedures, and general thoughts on body contouring. These patients were randomly selected from male patients who had presented to the clinic for follow-ups regarding different surgical procedures such as rhinoplasty, otoplasty, scar revisions, and from those who had presented with various inquiries. None of the patients had previously undergone body contouring procedures.
123
Questionnaire Questions: 1. 2. 3. 4. 5. 6. 7.
Age. Weight and height. Level of education. Preferred methods of body contouring. Degree of knowledge regarding body contouring surgery. Desire for body contouring surgery. Preferred areas for undergoing body contouring surgery.
Statistical Analysis Statistical evaluation was carried out using SPSS for Windows v.15.0. Mean values and standard deviations of all data were calculated. All results are expressed as mean ± standard deviation. The Chi-Square test and the One-way Chi-Square test were used to analyze differences in parameters. Statistical significance was defined as a p value less than 0.05.
Results A preliminary evaluation of male patients undergoing body contouring surgery was done to determine the general ratios of male patients undergoing body contouring surgery in our clinic. The evaluation demonstrated an increase in demand for body contouring surgery regarding both male and female patients yet the increase in male patients was more dramatic. In 2005, men who had surgery for body contouring comprised 6.4 % of this patient group, whereas in 2013, the percentage of men having undergone body contouring was 32.9 % (Fig. 1). The increase in the male to female ratio for body contouring throughout three different time periods within the last decade was statistically significant (p \ 0.05). male to female ratio of performed body contouring operations 100 80 74
60
67.1
93.6
%
female
40
male 20 26
0
32.9
6.4
2005
2010
2013
year
Fig. 1 The change in the ratio of male to female body contouring operations at our clinic throughout the last decade
Aesth Plast Surg
A total of 200 male participants completed the questionnaire. The average age of the participants was 39 years (18–63 years). Fifty-five percent of the respondents stated that they had information regarding body contouring surgery. The sources of information were stated as internet (43 %), word of mouth communication (32 %), and television and printed media (15 %). When asked about their general thoughts regarding body contouring surgery, 53 % replied that they would consider undergoing body contouring procedures. Of those considering undergoing body contouring, 44.3 % stated that they believed their current body structure required it. The other given reasons were to enhance their appearance (30.6 %) and to have a specific disliked body part (25.1 %). For those who did not consider contouring operations, 92.5 % stated that their physical status did not require such a procedure. The other reasons for turning down body contouring surgery were socio-economic reasons (5.4 %) and religious beliefs (2.1 %). The results of the statistical analysis showed that age and the level of education were not significant factors for considering undergoing body contouring surgery (p [ 0.05). The mean BMI of the participants was 31.2 kg/m2. Participants were categorized into two groups according to body mass index to determine the effect of weight on the perception for body contouring. On the basis of BMI, subjects were classified as normal weight and overweight into Group 1 (BMI less than 30 kg/m2), and Group 2 (BMI equal to or over 30 kg/m2), respectively. Forty-six percent of participants were categorized into Group 1, with an average BMI of 26 kg/m2 whereas 54 % of participants were categorized into Group 2 with an average BMI of 35 kg/m2. The results of the analysis showed that Group 2 considered undergoing body contouring surgery at a significantly higher percentage than Group 1 (Fig. 2) (p \ 0.05). Data regarding the preferred method for body contouring were evaluated. Increasing the level of physical activity was recorded as the first alternative (with 52 %), whereas a
smaller percentage of participants (12 %) answered that they would rather undergo contouring operations initially. Other mentioned methods were structural body building and dieting (Fig. 3). The difference between groups for body contouring method preferences was also statistically significant (p \ 0.05) as participants of Group 1 preferred to undergo body contouring procedures more than Group 2, whereas there was no significant difference regarding the two groups for the other methods of body re-shaping (p [ 0.05). Participants who claimed they wished to undergo body contouring surgery were further asked which operation they would want to undergo primarily. Forty-one percent replied ‘‘abdominoplasty’’, which was followed by liposuction at 28 % and gynecomastia operations at 22 % (Fig. 4). Statistical analysis showed that there was no significant difference between the two groups regarding the types of surgery they wished to undergo (p [ 0.05).
Discussion During the last 20 years, aesthetic surgery has been under the influence of social changes that may shed light on the reasons behind the increase in demand for male body contouring procedures. First of all, there has been a considerable change in men’s fashion trends as men are wearing more slim-fitting clothes in comparison to the last decade. This trend has brought on an increase in discomfort of disliked body parts; such that gynecomastia patients may feel embarrassed when they wear a T-shirt. Weight loss programs and health-related government policies have also led to an increase in bariatric surgery patients worldwide as well as in Turkey. This has paved the path for the increase in post-bariatric operations which are directly affiliated to body contouring procedures.
Preferred methods of body contouring 60
Percentage of participants considering body contouring surgery
50
100
40
80 60
%
45.6
48.1
34.3 62
% 30
Average Group 1
No
40 20
52
65.7
Yes
20
22.8 16
38
10
17.5
20
Group 2 17.5
14.1
16.6 12
0
6.5
Group 1
Group 2
0 Physical activity
Dieting
Body building
Surgery
Methods
Fig. 2 Percentage of participants in Groups 1 and 2 who would consider undergoing plastic surgery for body contouring
Fig. 3 Preferred primary method for body contouring
123
Aesth Plast Surg Preferred type of surgery 50
40
41 41.3 40.7
30
30.5 28
%
Average 25
20
25
Group 1
22 19.4
Group 2
10 9
8.6
9.2
0 Abdominoplasty
Liposuction
Gynecomastia
Other
Surgical procedures
Fig. 4 Type of body contouring surgery considered by participants
According to the results of this study, body mass index was determined as an independent predictor for considering body contouring operations. Giordano et al. reported a significant association between the amount of weight loss and BMI with the desire for body contouring in post-bariatric patients [3]. As expected, this was in correlation with our study in that participants with a BMI over 30 kg/m2 were determined to be more enthusiastic to undergo body contouring procedures than participants with a BMI less than 30 kg/m2. Kitzinger et al. studied patient expectations of body contouring surgery after massive weight loss in 252 patients. The most important expectation of body contouring surgery was improved physical appearance [4]. Our results differed from the results of Kitzinger’s study in that our study demonstrated that men considered undergoing aesthetic operations mainly depending on necessity rather than just an improvement of their physical appearance, which was recorded as the second reason for wanting these procedures. The main difference between the two studies is that Kitzinger’s study focused on post-bariatric patients, whereas none of the participants of our study had undergone bariatric surgery. This is why only a small group of participants resorted to surgery as the first alternative, even if their BMI was over 30 kg/m2. The study showed that the abdominal zone was the most considered body part regarding body contouring as males could be seeking to have a slimmer waistline. This observation confirms the results presented in several studies, which focused on post-bariatric surgery patients [4–6]. Even so, the most common surgical operation for males at our clinic is gynecomastia surgery. Patients who had undergone gynecomastia surgery were not included in this study which could explain the reason why gynecomastia ranked in at third place for the preferred surgical procedure within the questionairre. We believe that the discrepancy between the desired body contouring operations and the actual performed procedures is caused by a difference in thresholds for different surgical interventions. Patients that are operated for
123
gynecomastia have a lower threshold for deciding to undergo surgery in comparison to other body contouring surgeries. This may result from the fact that gynecomastia operations are considered to be easier than other body contouring operations. The fact that the surgery has become so widespread also plays a role in the patient’s decision-making process to undergo a certain type of surgery. According to the 2013 ASAPS statistics gynecomastia surgery statistics have increased by 13 % since 2000 [1]. Although following a well-balanced diet and exercising consistently to maintain or attain a fit and healthy body are important factors, heredity, weight gain or loss and aging can result in a change in body proportions. As supported by the data of this study, even though many male patients would rather change their diet and exercise regime to regain their body structure, body contouring surgery can help many people reshape body features that can not be improved by physical activity or body building. Males have started to be more inclined toward undergoing such procedures when lifestyle changes do not necessarily provide the structural changes that they desire. Therefore, body contouring surgeries will be catering to the male population more and more throughout the future. Body contouring, which encompasses a range of surgical procedures on different areas of the body, is one of the most rapidly growing fields of plastic surgery [7, 8]. When we look at the data, the number of aesthetic operations has trippled within a time period of 10 years at our department. Body contouring operations have increased correspondingly. Areas treated by body contouring surgery include the neck, upper arms, female and male breast, abdomen, flanks, back, hips, buttocks, thighs, knees, and ankles. The female population has always been the dominant group for body contouring surgery as different surgical techniques have emerged consistently to obtain more desirable results for the female form. As male patients are becoming a more predominant group for body contouring surgeries, different techniques and approaches must be defined to obtain results that are more suitable for the male form as well. We believe that different surgical procedures will be refined and re-defined in the future according to the expectations of this new patient group. This study examined the perspective of Turkish men on body contouring. The study was limited to patients already acquainted with plastic surgery. This can be considered a limitation in which the study results cannot be generalized to the general male population yet we believe that this study group was a better pilot group to determine the motives for wanting to undergo body contouring surgery as they would be more willing to discuss the topic. We believed that the answers of this patient group would be able to shed light on what males consider to be the most important factors when deciding to undergo body contouring procedures. Future research can be conducted to
Aesth Plast Surg
examine the differences in expectations regarding female and male body contouring procedures in order to define the main aims of each type of surgery in regard to different genders. The thresholds for deciding to undergo different body contouring operations and the basis of how these thresholds are formed can also be a topic worth examining. Conflict of interest The authors declare that they have no conflicts of interest.
References 1. American Society for Aesthetic Plastic Surgery (2014) Cosmetic surgery national databank. Statistics 2013. Aesthetic Surg J 34:1S–22S 2. Song AY, Rubin JP, Thomas V et al (2006) Body image and quality of life in post massive weight loss body contouring patients. Soc Behav 14:1626–1636
3. Giordano S, Victorzon M, Stormi T, Suominen E (2014) Desire for body contouring surgery after bariatric surgery: do body mass index and weight loss matter? Aesthet Surg J 34:96–105 4. Iglesias M, Ortega-Rojo A, Garcia-Alvarez MN et al (2012) Demographic factors, outcomes, and complications in abdominal contouring surgery after massive weight loss in a developing country. Ann Plast Surg 69:54–58 5. Kitzinger HB, Abayev S, Pittermann A et al (2012) After massive weight loss: patients’ expectations of body contouring surgery. Obes Surg 22:544–548 6. Al-Hadithy N, Mennie J, Magos T, Stewart K (2013) Desire for post bariatric body contouring in South East Scotland. J Plast Reconstr Aesthet Surg 66:87–94 7. Aldaqal SM, Samargandi OA, El-Deek BS et al (2012) Prevalence and desire for body contouring surgery in postbariatric patients in saudi arabia. N Am J Med Sci 4:94–98 8. Klassen AF, Cano SJ, Scott A et al (2012) Satisfaction and qualityof-life issues in body contouring surgery patients: a qualitative study. Obes Surg 22:1527–1534
123
ORIGINAL ARTICLE
NON-SURGICAL AESTHETIC
A Social Evaluation of Perception on Body Contouring Surgery by Turkish Male Aesthetic Surgery Patients Bora Ozel • Billur Sezgin • Kirdar Guney Osman Latifoglu • Cemallettin Celebi
•
Received: 8 August 2014 / Accepted: 2 December 2014 Ó Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery 2014
Abstract Although aesthetic procedures are known to have a higher impact on women, men are becoming more inclined toward such procedures since the last decade. To determine the reason behind the increase in demand for male aesthetic procedures and to learn about the expectations and inquietude related to body contouring surgery, a prospective questionnaire study was conducted on 200 Turkish males from January 1, 2011–May 31, 2012. Demographic information, previous aesthetic procedures and thoughts on body contouring procedures with given reasons were questioned. The results of the study showed that 53 % of all participants considered undergoing body contouring surgery with the given reason that they believed
This study was presented at the 17th World Congress of the International Confederation for Plastic, Reconstructive and Aesthetic Surgery IPRAS meeting, held in Santiago, Chile, 24 February–1 March 2013. B. Ozel (&) Department of Plastic Reconstructive and Aesthetic Surgery, Gulhane Military Medical Academy, Selimiye Tibbiye Street, 34668 Istanbul, Turkey e-mail: [email protected] B. Sezgin Department of Plastic Reconstructive and Aesthetic Surgery, Erzurum Regional Training and Research Hospital, Erzurum, Turkey K. Guney Department of Plastic Reconstructive and Aesthetic Surgery, Konya Regional Training and Research Hospital, Hacısaban Mah. 42090, 06500 Konya, Turkey O. Latifoglu C. Celebi Department of Plastic Reconstructive and Aesthetic Surgery, Gazi University Faculty of Medicine, 14th Floor, Besevler, 06500 Ankara, Turkey
their current body structure required it. For those who did not consider contouring operations, 92.5 % said they felt that they did not need such a procedure. The results of the statistical analysis showed that BMI was a significant factor in the decision making process for wanting to undergo body contouring procedures. The results of the study showed that mens’ consideration for aesthetic operations depends mainly on necessity and that the most considered region was the abdominal zone in regard to contouring. We can conclude that men are becoming more interested in body contouring operations and therefore different surgical procedures should be refined and re-defined according to the expectations of this new patient group. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Keywords evaluation
Body contouring Men Turkish Social
Introduction Although aesthetic procedures are known to have a higher impact on women, men are becoming more inclined toward such procedures over the last decade. According to the 2013 American Society for Aesthetic Plastic Surgery (ASAPS) data of cosmetic surgery gender distribution in the United States, male patients accounted for 9.4 % of all cosmetic procedures [1]. The most popular surgical procedures for men are listed as liposuction, blepharoplasty, rhinoplasty, male breast reduction for the treatment of gynecomastia and otoplasty, respectively. This evolution has resulted in an
123
Aesth Plast Surg
increase in the number of cosmetic procedures for men by 273 % since 1997 [1]. Twenty-seven percent of all the patients presenting to our clinic seeking to undergo cosmetic operations are male. The pattern of increased interest seems to be parallel with the general trend as male patients constituted 20 % of all cosmetic procedures in our clinic 4 years ago, and 12 % 10 years ago. This inclination toward plastic surgery also seems to have affected the general outlook on body contouring surgery, as gynecomastia surgery has increased from 15,968 procedures in 2000 to 22,939 in 2013 (up by 13 %) [1]. A total of 363,912 liposuction cases were recorded in 2013 which demonstrates a 106 % increase since 1997 [1]. As a result of health-related government policies and campaigns for weight loss, another newly generated group of patients seeking improvement in their body shape has emerged in the last decade. Patients seeking body contouring surgery after massive weight loss constitute a rapidly growing patient population in the plastic surgery practice as body contouring surgery can dramatically improve the shape and proportion of the body, enhance appearance, and boost self-confidence [2]. Many studies have been reported on the perception of post-bariatric patients regarding body contouring surgeries [3–6]. In this study, we intended to evaluate the perception regarding body contouring of Turkish males inquiring about cosmetic surgery. Likewise, with the increase in interest for men’s aesthetic procedures, we aimed to seek the motives behind the increase in demand for male body contouring procedures in the Turkish male population. To the best of our knowledge, this is the first study that addresses the perception of body contouring in a non-post bariatric healthy male population.
Materials and Methods A prospective questionnaire study was conducted to determine the main motives for undergoing body contouring surgery and to establish a relationship between age, body mass index (BMI; kg/m2), and different characteristics of male patients intending to undergo such surgical procedures. Male patients who presented to the plastic surgery outpatient clinic for various inquiries between January 2011 and May 2012 were asked to fill out a questionnaire inquiring about demographic information, previous aesthetic procedures, and general thoughts on body contouring. These patients were randomly selected from male patients who had presented to the clinic for follow-ups regarding different surgical procedures such as rhinoplasty, otoplasty, scar revisions, and from those who had presented with various inquiries. None of the patients had previously undergone body contouring procedures.
123
Questionnaire Questions: 1. 2. 3. 4. 5. 6. 7.
Age. Weight and height. Level of education. Preferred methods of body contouring. Degree of knowledge regarding body contouring surgery. Desire for body contouring surgery. Preferred areas for undergoing body contouring surgery.
Statistical Analysis Statistical evaluation was carried out using SPSS for Windows v.15.0. Mean values and standard deviations of all data were calculated. All results are expressed as mean ± standard deviation. The Chi-Square test and the One-way Chi-Square test were used to analyze differences in parameters. Statistical significance was defined as a p value less than 0.05.
Results A preliminary evaluation of male patients undergoing body contouring surgery was done to determine the general ratios of male patients undergoing body contouring surgery in our clinic. The evaluation demonstrated an increase in demand for body contouring surgery regarding both male and female patients yet the increase in male patients was more dramatic. In 2005, men who had surgery for body contouring comprised 6.4 % of this patient group, whereas in 2013, the percentage of men having undergone body contouring was 32.9 % (Fig. 1). The increase in the male to female ratio for body contouring throughout three different time periods within the last decade was statistically significant (p \ 0.05). male to female ratio of performed body contouring operations 100 80 74
60
67.1
93.6
%
female
40
male 20 26
0
32.9
6.4
2005
2010
2013
year
Fig. 1 The change in the ratio of male to female body contouring operations at our clinic throughout the last decade
Aesth Plast Surg
A total of 200 male participants completed the questionnaire. The average age of the participants was 39 years (18–63 years). Fifty-five percent of the respondents stated that they had information regarding body contouring surgery. The sources of information were stated as internet (43 %), word of mouth communication (32 %), and television and printed media (15 %). When asked about their general thoughts regarding body contouring surgery, 53 % replied that they would consider undergoing body contouring procedures. Of those considering undergoing body contouring, 44.3 % stated that they believed their current body structure required it. The other given reasons were to enhance their appearance (30.6 %) and to have a specific disliked body part (25.1 %). For those who did not consider contouring operations, 92.5 % stated that their physical status did not require such a procedure. The other reasons for turning down body contouring surgery were socio-economic reasons (5.4 %) and religious beliefs (2.1 %). The results of the statistical analysis showed that age and the level of education were not significant factors for considering undergoing body contouring surgery (p [ 0.05). The mean BMI of the participants was 31.2 kg/m2. Participants were categorized into two groups according to body mass index to determine the effect of weight on the perception for body contouring. On the basis of BMI, subjects were classified as normal weight and overweight into Group 1 (BMI less than 30 kg/m2), and Group 2 (BMI equal to or over 30 kg/m2), respectively. Forty-six percent of participants were categorized into Group 1, with an average BMI of 26 kg/m2 whereas 54 % of participants were categorized into Group 2 with an average BMI of 35 kg/m2. The results of the analysis showed that Group 2 considered undergoing body contouring surgery at a significantly higher percentage than Group 1 (Fig. 2) (p \ 0.05). Data regarding the preferred method for body contouring were evaluated. Increasing the level of physical activity was recorded as the first alternative (with 52 %), whereas a
smaller percentage of participants (12 %) answered that they would rather undergo contouring operations initially. Other mentioned methods were structural body building and dieting (Fig. 3). The difference between groups for body contouring method preferences was also statistically significant (p \ 0.05) as participants of Group 1 preferred to undergo body contouring procedures more than Group 2, whereas there was no significant difference regarding the two groups for the other methods of body re-shaping (p [ 0.05). Participants who claimed they wished to undergo body contouring surgery were further asked which operation they would want to undergo primarily. Forty-one percent replied ‘‘abdominoplasty’’, which was followed by liposuction at 28 % and gynecomastia operations at 22 % (Fig. 4). Statistical analysis showed that there was no significant difference between the two groups regarding the types of surgery they wished to undergo (p [ 0.05).
Discussion During the last 20 years, aesthetic surgery has been under the influence of social changes that may shed light on the reasons behind the increase in demand for male body contouring procedures. First of all, there has been a considerable change in men’s fashion trends as men are wearing more slim-fitting clothes in comparison to the last decade. This trend has brought on an increase in discomfort of disliked body parts; such that gynecomastia patients may feel embarrassed when they wear a T-shirt. Weight loss programs and health-related government policies have also led to an increase in bariatric surgery patients worldwide as well as in Turkey. This has paved the path for the increase in post-bariatric operations which are directly affiliated to body contouring procedures.
Preferred methods of body contouring 60
Percentage of participants considering body contouring surgery
50
100
40
80 60
%
45.6
48.1
34.3 62
% 30
Average Group 1
No
40 20
52
65.7
Yes
20
22.8 16
38
10
17.5
20
Group 2 17.5
14.1
16.6 12
0
6.5
Group 1
Group 2
0 Physical activity
Dieting
Body building
Surgery
Methods
Fig. 2 Percentage of participants in Groups 1 and 2 who would consider undergoing plastic surgery for body contouring
Fig. 3 Preferred primary method for body contouring
123
Aesth Plast Surg Preferred type of surgery 50
40
41 41.3 40.7
30
30.5 28
%
Average 25
20
25
Group 1
22 19.4
Group 2
10 9
8.6
9.2
0 Abdominoplasty
Liposuction
Gynecomastia
Other
Surgical procedures
Fig. 4 Type of body contouring surgery considered by participants
According to the results of this study, body mass index was determined as an independent predictor for considering body contouring operations. Giordano et al. reported a significant association between the amount of weight loss and BMI with the desire for body contouring in post-bariatric patients [3]. As expected, this was in correlation with our study in that participants with a BMI over 30 kg/m2 were determined to be more enthusiastic to undergo body contouring procedures than participants with a BMI less than 30 kg/m2. Kitzinger et al. studied patient expectations of body contouring surgery after massive weight loss in 252 patients. The most important expectation of body contouring surgery was improved physical appearance [4]. Our results differed from the results of Kitzinger’s study in that our study demonstrated that men considered undergoing aesthetic operations mainly depending on necessity rather than just an improvement of their physical appearance, which was recorded as the second reason for wanting these procedures. The main difference between the two studies is that Kitzinger’s study focused on post-bariatric patients, whereas none of the participants of our study had undergone bariatric surgery. This is why only a small group of participants resorted to surgery as the first alternative, even if their BMI was over 30 kg/m2. The study showed that the abdominal zone was the most considered body part regarding body contouring as males could be seeking to have a slimmer waistline. This observation confirms the results presented in several studies, which focused on post-bariatric surgery patients [4–6]. Even so, the most common surgical operation for males at our clinic is gynecomastia surgery. Patients who had undergone gynecomastia surgery were not included in this study which could explain the reason why gynecomastia ranked in at third place for the preferred surgical procedure within the questionairre. We believe that the discrepancy between the desired body contouring operations and the actual performed procedures is caused by a difference in thresholds for different surgical interventions. Patients that are operated for
123
gynecomastia have a lower threshold for deciding to undergo surgery in comparison to other body contouring surgeries. This may result from the fact that gynecomastia operations are considered to be easier than other body contouring operations. The fact that the surgery has become so widespread also plays a role in the patient’s decision-making process to undergo a certain type of surgery. According to the 2013 ASAPS statistics gynecomastia surgery statistics have increased by 13 % since 2000 [1]. Although following a well-balanced diet and exercising consistently to maintain or attain a fit and healthy body are important factors, heredity, weight gain or loss and aging can result in a change in body proportions. As supported by the data of this study, even though many male patients would rather change their diet and exercise regime to regain their body structure, body contouring surgery can help many people reshape body features that can not be improved by physical activity or body building. Males have started to be more inclined toward undergoing such procedures when lifestyle changes do not necessarily provide the structural changes that they desire. Therefore, body contouring surgeries will be catering to the male population more and more throughout the future. Body contouring, which encompasses a range of surgical procedures on different areas of the body, is one of the most rapidly growing fields of plastic surgery [7, 8]. When we look at the data, the number of aesthetic operations has trippled within a time period of 10 years at our department. Body contouring operations have increased correspondingly. Areas treated by body contouring surgery include the neck, upper arms, female and male breast, abdomen, flanks, back, hips, buttocks, thighs, knees, and ankles. The female population has always been the dominant group for body contouring surgery as different surgical techniques have emerged consistently to obtain more desirable results for the female form. As male patients are becoming a more predominant group for body contouring surgeries, different techniques and approaches must be defined to obtain results that are more suitable for the male form as well. We believe that different surgical procedures will be refined and re-defined in the future according to the expectations of this new patient group. This study examined the perspective of Turkish men on body contouring. The study was limited to patients already acquainted with plastic surgery. This can be considered a limitation in which the study results cannot be generalized to the general male population yet we believe that this study group was a better pilot group to determine the motives for wanting to undergo body contouring surgery as they would be more willing to discuss the topic. We believed that the answers of this patient group would be able to shed light on what males consider to be the most important factors when deciding to undergo body contouring procedures. Future research can be conducted to
Aesth Plast Surg
examine the differences in expectations regarding female and male body contouring procedures in order to define the main aims of each type of surgery in regard to different genders. The thresholds for deciding to undergo different body contouring operations and the basis of how these thresholds are formed can also be a topic worth examining. Conflict of interest The authors declare that they have no conflicts of interest.
References 1. American Society for Aesthetic Plastic Surgery (2014) Cosmetic surgery national databank. Statistics 2013. Aesthetic Surg J 34:1S–22S 2. Song AY, Rubin JP, Thomas V et al (2006) Body image and quality of life in post massive weight loss body contouring patients. Soc Behav 14:1626–1636
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