As an undercover police detective, Joe, 36, was used to becoming other people. His life depended on looking the part convincingly. But when he looked at himself in the mirror, he didn’t always like what he saw. A regular at the gym five days a week, Joe was by no means overweight. But despite his workouts, he still wasn’t well defined. At the gym, he was afraid to take off his shirt, favoring loose sweats instead. A little bit “chunky” is how a fellow workout buddy described him. He just felt fat.

“I worked out hard, but no matter what I did I couldn’t get rid of the love handles,” he says. Joe adds that he had simply reached a fitness plateau. Regardless of what he did or how his workout changed, it didn’t seem to help. But he refused to give up. Instead, he did what women across America have been doing for years: Undeterred by images like that of the 400- pound man on the evening news or the hypervain college student made famous on MTV for his desperate (obsessive) desire for calf implants, Joe decided to turn to a plastic surgeon for a bit of medical intervention. His procedure of choice? Liposuction for those pesky love handles, plus a tummy tuck to reduce the excess skin puddling around his midsection. Together, the two procedures are known as a torsoplasty, and they’ve become an increasingly popular procedure among men looking for a way to sculpt away their flab.

Joe isn’t alone. Cosmetic surgery among males has surged steadily over the last six years, increasing by 8%, according to the American Society of Plastic Surgeons. Last year, men received a record 1.1 million cosmetic procedures, ranging from relatively benign Botox injections to all forms of liposuction (which, not surprisingly, remains overall one of the most popular procedures for men). That makes male cosmetic surgery a major portion of a $12.2 billion-dollar-a-year industry.

“Surgery goes hand in hand with the rising trend of improving health and fitness. People are taking better care of themselves and want to look as good as they feel,” says Richard A. D’Amico, M.D., president-elect of the American Society of Plastic Surgeons. “The old myth about plastic surgery was that it was a lazy-person’s substitute for diet and exercise. Nothing could be further from the truth. The best use of plastic surgery is for it to be part of a healthy lifestyle that is lifelong.”

Although men are still a minority, at about 10% of cosmetic surgery patients, the days when a little nip and tuck was confined to Hollywood or others in the public eye are long gone. Increasingly, plastic surgeons are seeing relatively young, fit, everyday men—guys just like Joe—flood their reception rooms. And for men in their 20s and 30s, body contouring of all forms has never been more sought after.

Take Dan, a 31-year-old banker from Denver. He decided to turn to surgery after a two-year battle with a problem he realized he would never be able to fix: man boobs (excess breast tissue, a condition doctors call gynecomastia). In the end, Dan weighed his options and decided to fork over nearly $7,000 for male-breast-reduction surgery. For him, the decision made sense. No matter how hard he worked or how perfect he made his diet, experts told him surgery was the only way he’d ever end up with a flat chest. For Dan and the thousands of guys out there just like him, doctors say the problem with their bodies isn’t always the result of poor lifestyle or bad diet (although both obviously contribute to breast growth and obesity). Rather, the issue may simply be heredity.

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Breasts are made of breast tissue and adipose tissue (fat), and all guys have it; some men just grow too much of it during puberty. For many it goes away, and for others it’s barely noticeable. But for some, it’s a problem that only gets worse, especially as they get older and build fat and muscle mass. The phenomenon is far more common than you’d think. No wonder, then, that enough men seek treatment every year that breast-reduction surgery is the fifth-most popular surgical procedure in the books. (Nose jobs, surprisingly, are the No. 1 surgical procedure among men, followed by eyelid surgery, liposuction, hair transplants, then breast reduction.)

And as fate would have it, working out just won’t make the problem go away. In fact, gynecomastia may be even more common in men who lift weights regularly, as in Dan’s case. Some specialists believe that may be the result of certain over-the-counter supplements. Anything that changes hormonal levels in the body, they say, be it a pill, powder, liquid, or food, may send the body into a tailspin. Mess with those hormones and your body is only too happy to go back to puberty mode, causing all sorts of potential disasters, including the growth of your own personal D-cup rack. Dan believes that’s just what happened to him.

When he was in his 20s, he worked out heavily. He built a gym in his basement and lifted weights at least five times a week, all the while taking as many supplements as he could get his hands on. At the height of his fitness, about five years ago, he would boast to friends about being “190 pounds and solid muscle.” Then, two years ago, he started feeling a hard lump on each side of his chest. Although his chest didn’t look any less buff, especially in a T-shirt, it began to hurt when he lifted. Hoping to solve the problem, he had a physical and ended up with the diagnosis of gynecomastia. He wasn’t thrilled with the possibility of an expensive surgery, so despite the pain, he tried to endure—until a shoulder injury sidelined him from working out. That’s when his breasts really started to grow. “I’d worked so hard to look amazing and all of a sudden my body just melted,” he says.

Although he knew he was gaining weight, Dan didn’t realize just how bad things had gotten until he saw a videotape of himself. Unintentionally, to compensate for his developing breasts, he had begun to slouch forward—it was his subconscious way of keeping people from seeing his extended chest. “I looked terrible,” he admits. That’s when he decided to book his initial appointment for surgery. “I was always the guy at the beach with my T-shirt off. I didn’t recognize myself all hunched over,” he says. Two weeks later, still bandaged and a bit swollen, Dan says his only regret is that he didn’t find a plastic surgeon sooner. “This problem destroyed me for two years.”

Whether you’re overweight like Joe or just unhappy with your body shape like Dan, coming to terms with the body you’ve been given can be a lifelong struggle. And it never gets easier. That’s because the number of fat cells we each have is pretty much set by the time we reach puberty. When we gain or lose weight, we’re not changing the number of fat cells in our bodies, we’re simply expanding or contracting what’s already there. And the distribution of those cells, and how much they can contract, is completely beyond our control. It all comes down to genetics. Which means you can be incredibly fit everywhere else but may never shed those love handles if it’s in your genes to have them, doctors say. The one bright spot? Compared with women, men are actually more ideal candidates for liposuction and contouring surgeries. Experts say male fat tends to be more localized and less stretched by things such as pregnancy, soif you do choose to go the surgical route, at least you can expect good results.

So it works. But should you jump on the table and go under the knife to fix those flabby trouble spots? The jury on that one’s still out. Those who’ve done it typically argue that the surgery has changed their life and helped them deal with even bigger issues they may have been facing. “You can’t underestimate the power of male vanity,” says George Lefkovits, M.D., who lectures about such issues at plastic surgery conferences and whose Manhattan-based practice has a client base that is almost half men. “It is not true to think that guys are not vain—men are very vain!”

Still, it’s important to keep your expectations realistic. “We are talking about real surgery that comes with real wounds and real healing time,” cautions David Watts, M.D., the New Jersey–based surgeon behind Joe’s transformation. “You need to remember the outcome that your friend got is not necessarily the outcome you will get. People think plastic surgeons have a magic wand like Harry Potter. Yes, plastic surgery can get you to the five-yard line. But to win the game, you still have to punch the ball into the end zone yourself. And that takes diet and exercise.”

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