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Different Sizes for Different Regions
By JAMES GORMAN

Published: April 27, 2004

ANCOUVER, British Columbia — Although it may seem that the standard of beauty promoted by cosmetic surgery is uniform, surgeons say that there are regional and national variations and that the ideals have changed over time.

Neither noses nor breasts, the bread and butter of cosmetic surgery, are what they used to be. At the annual meeting of the American Society for Aesthetic Plastic Surgery here last week, the president of the society, Dr. Robert W. Bernard, said in an interview that when he started out "the look among youngsters was a little, tiny turned-up nose." Now he said, it is more natural.

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Dr. Adrien E. Aiache, of Beverly Hills, Calif., who has done a lot of work with calf and buttocks, or gluteal, implants, said that because of a different standard of beauty, gluteal implants were far more popular in Brazil and that breast augmentations were less popular.

One of the most common procedures in cosmetic surgery is breast augmentation. But, Dr. Bernard said, there are clear regional variations. "In the Sun Belt area," he said, "larger means larger than it does in the Northeast."

He said that in a conservative area like Westchester County, where he practices, when women have breast augmentations they want subtle changes. "If they're an A, they want to be a B," he said. "They don't want to be a D. There is a constant refrain: `Don't make me too big, don't make me too big.' Literally, as they're being wheeled in to the operating room, they'll say that to the nurses.

"And yet, when I talk to some of my friends from other parts of the country, they laugh at me when I tell them the size implant that I use. It's nothing."

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