Last fall, for the first time in his life, Nicolas Ridout, 58, removed his shirt in front of strangers and went for a swim. This was not the first time a t-shirt had marked a personal milestone. Thirty years ago as a camp director, he wore another shirt with the words “Large and in Charge” printed on the front, and for that he earned the nickname Big Dog. The title endured for decades because Big Dog was larger than life: a 380-pound theatrical Santa Claus, beloved by the kids, parents and counselors of Sugarloaf Fine Arts Camp.

But when the two-week camp ended each year, Big Dog had to go back to being Nicolas Ridout, an aging ambulance coordinator who habitually avoided mirrors, didn’t date and wanted to end his life.

“That Big Dog persona, that thing I had at camp, was not enough. It carried me, it did. I woke up every day looking forward to those two weeks,” he says. “In life outside of camp, being fat is a bitch. People don’t like fat people. Fat people don’t like fat people. And socially speaking and business-wise, it was a bitch.”

“I finally awoke to the situation that either I’m going to end this, or were going to do this get busy living.”

Following years of failed dieting, Ridout underwent a gastric bypass. Afterward, with his stomach condensed to the size of a thumb, he lost 120 pounds in 9 months, and then another 65 pounds over the succeeding five years. As fat melted away, the residual skin hung six inches below his belt line. His chest gradually stopped looking like that of a man.

A mutual acquaintance introduced Ridout to a Sacramento-based plastic surgeon, and the doctor moved forward with three different operations to remove the excess skin on Ridouts arms, abdomen, chest, face and neck, and also to contour his back. Following the first procedure, the eyelid lift, an infection arose from the stitches and caused raw flesh to protrude across both Ridouts eye sockets, covering his corneas and leaving him unable to close his eyes.

Once healed, Ridout presumed his suffering was over, but an infection from the second surgery swelled his abdomen. A brown-tinted fluid built up inside Ridout and began to leak out of his belly button. The pressure at which the pus flowed out of him was astounding, says Ridout, who describes it like pressing on a gas can.

The liquid also trickled below his waist, bruising his thighs and ballooning his scrotum to double its size. But those complications were trifles compared to the discharge from his naval pipeline.

“Three times a day, at least, I would lean over the sink and massage and let this fluid come out of my belly button,” he says.
“The smell, God. I was in the ambulance business. I moved patients. I cleaned up gurneys. I’ve dealt with vomit; I’ve dealt with shit. This was unbelievable. It was sick.”

“I’m leaning over, my head is against the mirror, and Im thinking, what is going on here. What am I doing?”

Ridout now weighs 195 pounds, and on a cool day in mid-January he wears a matching turquoise tie and vest, a pressed suit and shiny shoes. He has a ring in his ear and two on his fingers. Newly freed from his cocoon of fat and saggy skin, Ridout says he’s comfortable in his body for the first time in his life and ready to find a soul mate.

His story, as painful to recount as it may be, is worth more than shock value. Although a total body metamorphosis is uncommon, thousands of men in the Capital Region use medical technology each year to fix bodily defects. And following varying amounts of pain and occasional infection, they generally walk away pleased. The degree of complication experienced by Ridout occurs in fewer than 1 percent of patients, says the surgeon who operated on him, but to a lesser extent, some form of adverse reaction occurs in about one in 10 patients. As a general rule, the bigger the surgery, the higher the likelihood of negative side effects. But once the healing process is over, men typically say they are happy with the results.

Larry Tosta, 63, underwent an eyelid surgery last summer following years of fretting about a puffy appearance caused by allergies. For about a week after the surgery, Tosta says he looked like he had gone 12 rounds with Mike Tyson. “But afterward, I felt like I looked better,” he says. “That’s a good feeling, to be honest.”

In clinical terms, the difference between plastic surgery and cosmetic surgery is that plastic refers to reconstructive procedures following a trauma, like a car accident or breast cancer. Cosmetic surgery aims to enhance more natural defects like obesity or wrinkles. But operators argue the lines are blurred.

“As plastic surgeons, we think of all the surgeries we do as fixing something,” says Dr. Charles Perry, who performed Ridouts three procedures. “Whether it is a defect covered by an insurance company or a defect or condition that causes the patient to feel less than whole, we strive to help.”

Common procedures for younger men include rhinoplasty for a deformed nose, otoplasty, which pins back protruding ears, and gynecomastia to slim down an overgrown pectoral region, colloquially called man boobs. Male patients over 35 typically choose hair transplants, liposuction and blepharoplasty, which smoothes out their eyelids.

But that’s not to say men don’t also use cosmetic surgery to reverse the normal effects of aging or obtain an idealized physique. The American Society of Plastic Surgeons reports that approximately 13,000 men received hair transplants in 2010, though that number was a 67 percent drop from 2000. Also that year, approximately 2,000 men underwent malar augmentations for cheek implants, and 200 men had pectoral implants.

“In treating older men, surgeons try to enhance deteriorating features in order to magnify the vitality still felt within,” Dr. Perry says.

(Men) look in the mirror and they don’t recognize the person that they are seeing, he says. “They are seeing changes they are not comfortable with, as far as aging goes. Losing a lot of weight or being in the sun, they feel like they are looking older than their peers, and perhaps thats not helping them advance their careers or social life.”

People dont like fat people. Fat people dont like fat people. And socially speaking and businesswise, it was a bitch.

Nicolas Ridout, ambulance coordinator and cosmetic surgery patient

Seeking an edge in the corporate world is an oft-heard motivator when a patient first walks into the doctors office. Surgeons say they often hear stories from men who are entering the job market or seeking a higher-paid position.

“If you look tired or you look old, then people may not give you as much credibility,” says Dr. Debra Johnson, a surgeon with Sacramento-based Plastic Surgery Center. “They may think you look over the hill, or you’re not interested, or you don’t have as much on your game as somebody else.”

Surgeons caution, however, that a tummy tuck or a forehead lift is not going to lead to a new job or promotion. While that sounds obvious, many prospective patients ask their doctors about secondary gains that are outside a surgeons control.

“We try to release self-confidence,” Dr. Perry says. “I cant make you succeed in business.”

From an executive perspective, a dedication to appearance can speak to a man’s organizational qualities and material achievements as well as his vanity. In the book “Beauty Junkies,” author Alex Kuczynski argues that American consumerism has turned the formerly taboo into the same mark of prestige associated with designer clothing and other professional accessories.

Kuczynski writes: “Admitting you’ve had the latest wrinkle filler is no longer a mark of shame; on the contrary, it is a status symbol in the mind of the 21st-century consumer who believes that self-maintenance and an abiding respect for personal aesthetics are deeply moral obligations, to be conducted with militaristic precision: survey the landscape. Find the enemy. Attack.”

Despite the passages masculine imagery, the cultural attitude that plastic surgery is a feminine activity will likely endure until women no longer dominate the waiting rooms of doctors offices. Those lobbies are often adorned with wallpaper and hidden speakers playing light rock, a setting that amplifies the fact that there is simply nothing rugged about using medical instruments to achieve beauty. Given the social baggage, its easy to understand why many men feel ashamed about going in for a treatment.

“(Men) want no one to know,” says Dr. Johnson. “If a woman has plastic surgery, everyone is like, oh, you didnt need it, or oh, you lucky bum. But for men, I think they feel other men will think they are vain or unmanly.”

Another distinction between the sexes is in how they select a procedure, says Dr. David Kaufman of Kaufman and Clark Plastic Surgery. “When a man comes in, he has decided what he wants and usually gets it. Women come in and are usually interested in a broad range of what we offer. We need to work with women to develop a plan to effectively and efficiently satisfy all their wants,” he says.

In 2010, men made up about 13 percent of total cosmetic surgeries and 8 percent of noninvasive procedures such as laser hair removal. Local surgeons interviewed for this article said men make up between 5 percent and 10 percent of their total clientele.

Last year, the American Society of Plastic Surgeons published a press release titled Men Fuel Rebound in Cosmetic Surgery that claimed cosmetic procedures on men had jumped 2 percent in 2010 to more than 1.1 million. The statistics were picked up by The Wall Street Journal in an article suggesting a new trend. But as noted by a blogger for the Orange County Register, the news release and media reports failed to note that the survey had a 3.8 percent margin of error, and 2009 was an unusually low year for male cosmetic surgery.

In fact, while facelifts and a few of the outlier procedures like buttock lifts and lip augmentation are on the rise, the most popular surgeries for men those that reshape the nose or remove and tighten skin around the eyes, chest and belly have either decreased in the past several years or have not increased enough for statistical significance. In total, male cosmetic surgeries in 2010 were down 48 percent from 2000.

Increasing, however, are the numbers of men going in for minimally invasive dermatological procedures such as Botox, which has spiked by 258 percent nationally since 2000. Skin treatments can be completed in a short office visit and allow the patient to return to work afterward.

Botox, the commercial name of neurotoxin botulinum toxin A, is a poison that in large doses can cause botulism, leading to respiratory failure and death. An article by the American Medical Association claims that botulinum toxin is the most poisonous substance known and cites instances of its use as a terrorist bioweapon. But in a Botox treatment, the drug is diluted and used to temporarily paralyze facial muscles that cause wrinkling. Botox can also iron out existing wrinkles. With proper application, there is no significant risk of botulism, though some patients have complained the treatment led to general aches and pains.

The ASPS does not keep data on the percentage of surgeries that result in complication, but operators say that about one in 10 surgeries they do is to repair another doctors work. The cosmetic market is largely unregulated, and practitioners stress that consumers need to research the credentials of anyone providing a treatment (see sidebar, page 59).

The Capital Region is not a plastic surgery destination. A recent poll showed Sacramentans were the least likely population out of 20 major U.S. cities to know someone who had undergone cosmetic surgery. The poll, conducted in November by online coupon giant Living Social, asked 4,000 urban residents 200 in the Capital Region questions pertaining to vanity and treatments. Out of the 20 cities, local respondents were least likely to characterize Sacramento men as handsome and also least likely to refer to them as metrosexual. Moreover, the capital also had the most residents agree to the following statement: “People in my city have bad personal hygiene.”

To top it off, 23 percent of local residents said they intended to spend less money on personal appearance in 2012 than they did last year that was the largest fraction of any urban population willing to make that statement.

In defense of our regional culture, online authors for the Lonely Planet travel guide write, Sacramento’s better half is the city of regular people who enjoy a good time without the burden of putting on cosmopolitan airs. But while it may be true that one of the capitals finest social assets is a lack of narcissism, it doesn’t get around the fact that a sample population reports the men here are ugly and more likely to do nothing about it.

Those that do take the step for surgical enhancement often come back with stories that give plastic surgeons pride in their work. A few months after his final surgery, Nicolas Ridout set out on a cruise by himself to the West Indies. One day while touring a waterfall, Ridout removed his t-shirt and went swimming with other vacationers. When he crawled out of the water and wrapped in a towel, reality set in and he started laughing.

Retelling the tale, Ridout again begins to laugh, and his laughter grows to a guffaw that brings tears to his eyes. “This is the way its supposed to be, isn’t it?” He says. “You want to go swimming, so you take your shirt off. Christ Almighty, it works!”