There's much less of Darlene Jenkins these days, and she feels much better about it.
A tummy tuck two years ago removed almost 20 pounds of skin around her abdomen. An arm lift last July took away nearly 2 inches of drooping skin under her upper limbs.
"I feel confident in who I am -- and I feel healthier," said Jenkins, who took the dramatic steps after losing 175 pounds from gastric bypass surgery four years ago.
"The skin is so stretched out after such dramatic weight loss that the elasticity is gone, and no amount of being in the gym could get it back -- because I was in the gym," the 43-year-old Elkhart resident added. "I'm more secure in myself. I (don't have) to hide like I did when I was large."
Jenkins is among a growing number of Americans who are having plastic surgery or cosmetic procedures to correct or restore physical appearance. In the United States, the number of surgical and nonsurgical cosmetic cases rose by 44 percent last year to 11.9 million.
Plastic surgeries such as liposuction, breast augmentation and facelift grew by 17 percent.
"Society is certainly entranced with the idea of holding on to a youthful look as long as possible," said Dr. Ronald Downs, a plastic surgeon in the Elkhart County area since 1992. "Many people say they feel better when they look better."
For years, plastic surgeries and cosmetic procedures were most popular on the nation's two coasts. Cosmetic changes have spread to the Midwest over the last seven years or so, according to Downs, founder of The Center PC -- a comprehensive plastic surgery practice at RiverPointe Surgery Center adjacent to Elkhart General Hospital.
Makeover shows on television have influenced all of America. Viewers can see physical transformations right before their eyes.
"Now it's so much more popular to talk about it," said Dr. Alissa Shulman, a plastic surgeon with the Plastic Surgery Center PC at Memorial Hospital of South Bend and a consultant at The Retreat Women's Health Center in Goshen.
"Before, nobody wanted to know anyone had anything done," Shulman added. "Now it's like a badge of honor to have things done."
Plastic surgery comes in two major forms:
* Reconstructive surgery -- performed on abnormal structures of the body, which may be caused by congenital defects, developmental problems, trauma, infection, tumors or disease.
* Cosmetic surgery -- performed on normal structures of the body to improve a patient's appearance and self-confidence.
Discussion of expectations is essential to the planning process. Plastic surgeons sometimes have multiple consultations with patients. Physical and psychological issues are addressed.
"It's important to make a well-educated decision about the procedure," Downs said. "The right reason is to feel good about yourself. The wrong reason is to please others.
"If you want breast augmentation for your boyfriend, that's not the right reason," Downs continued. "Self-image is the key."
Plastic surgeons can only improve physical attributes, appearance or features. They can't create new ones.
"We can't change who they are as a person," Downs said. "It's not a personality change, although many times a patient comes to feel better about who they are -- and it comes out through their personality."
Plastic surgery isn't appropriate for everybody. Downs estimates that he rejects more than 5 percent of his requests. Shulman says she may turn away up to 20 percent, especially individuals with health risks.
"Not everybody needs to look like a Barbie doll," Shulman said. "I tell patients you're probably going to have the same shape afterwards -- just less of it.
"I can't change Mother Nature," she continued. "I can alter it a little bit. I can soften things. I can smooth things out. But you're still going to be you."
Downs uses computer imaging for procedures like liposuction, breast augmentation and rhinoplasty (nose jobs).
"It helps the patient better understand the expectations and the concept," Downs said. "We use the computer to show adjustments and possibilities.
"It doesn't give the patient an image of what they're going to look like," Downs added. "With breast augmentation, nobody wants to look like Dolly Parton, and 50 percent want to look like Pamela Anderson."
For the rest, Downs sits down with patients to determine size and fullness through 3D, computer imaging.
Shulman, who has been practicing professionally for five years, stopped using computer imaging.
"I try to keep things fairly vague," she said. "We're going to make your breasts larger. We're going to make your hips smaller.
"There's a lot I can do on the computer that doesn't bode out in real life," Shulman continued. "Your face doesn't peel like that. Your skin doesn't heal like that. I don't want to give a patient an image in their head, because then they can't get rid of that image."
It's a myth that plastic surgeons don't leave scars.
"You can't cut the skin and not leave a scar," Shulman said. "The best we can do is hide them in lines or crevices."
Patients can get a background check through the plastic surgeon's "book" -- a collection of before and after photographs of previous patients and procedures.
"First, it gives patients an idea of what the procedure looks like and where the scars are," Downs explained. "Second, it gives them an idea on how that doctor has done some of those procedures in the past."
Most surgeries are outpatient procedures, but recovery periods vary.
A tummy tuck usually requires a couple weeks off work, with no exercise for five or six weeks. More complicated surgeries, like breast reconstruction, may require two or three days in the hospital and five or six weeks away from a job.
Complications include bleeding, infection and delays in wound healing.
"Serious complications are very rare, although they do occur," Downs said. "They're usually not life-threatening."
The cost of procedures is expensive, and most insurance plans don't cover cosmetic procedures, unless something like drooping eyelids are impacting eye sight.
Insurance usually only pays for a tummy tuck, if it was covered as bariatic surgery.
Contact Rick Meyer at rmeyer@etruth.com.