MIAMI - (KRT) - Manny Meland's father had a double chin, and he lived with the way gravity and time had transformed his once-taut neck into a loose pocket of skin and fat.

It was different for the younger Meland, now 65. Post retirement, he dropped 25 pounds with five-mile walks along Miami's South Beach and realized diet and exercise would never get rid of the extra skin under his neck.

Last May, Meland went under the knife.

''The older you get, the more attention you should pay to the way you look,'' said Meland, who has thinning hair and an easy smile. ``When my darling wife comes home, I always want to look my best.''

He's part of a small, but growing, minority in cosmetic surgery - men.

Last year, 807,692 men underwent surgical and non-surgical cosmetic procedures, nearly a 200 percent increase from 1997, according to the American Society for Aesthetic Plastic Surgery. (Their overall share has hovered around 12 percent as the cosmetic surgery market has exploded.)

Meland's newly tightened neck, and willingness to talk about it, sit at a convergence of trends: a society that encourages men to worry about appearance; cosmetic surgery as the pop culture quick fix; and new technology that makes surgery safer, with less downtime.

But, some doctors worry about a too-casual attitude toward surgery. And increased demand has driven controversial male procedures, like solid silicone implants.

''It almost became like getting your teeth cleaned. I've had to keep myself in check,'' said Dan, who came from Tampa, Fla., to Miami to get implants, first in his chest and then, an impulse buy, in his butt. ``It was easy. I wrote a check and went to sleep and woke up and two weeks later I looked great. It could get very easy to get hooked into that.''

Men come to Dr. John Cassel for surgery on sagging upper and lower eyelids, and go home the same day. Cassel, a cosmetic and reconstructive plastic surgeon in Miami, sees young men with enlarged, feminine breasts, called gynecomastia, and men with ''love handles'' looking for liposuction.

Dr. Deirdre Marshall operates on boys with protruding ears, men who arrive at the office bundled in jackets to hide their breasts, men in their 40s or 50s asking the plastic surgeon for liposuction or eyelid surgery before a 20-year class reunion.

For some, it's a final step after returning to the gym. For others, it's changing a feature that's always bothered them, a post-divorce boost, or a way to ''keep ahead of the young guys'' at work, Cassel said.

On the operating table, there are more distinct differences - male face-lifts can't ignore the beard, and aim for a more rugged, rather than completely unlined, result. Some doctors say men have more realistic expectations than women, others say they're worse with pain, or less likely to return for follow-up appointments.

Dr. Lance Raiffe, a cosmetic and reconstructive plastic surgeon in private practice in Miami Beach, estimates that between 10 percent and 15 percent of his patients are male. The ''neck-lift'' he performed on Meland is a particularly popular procedure for men with drooping skin that gets in the way when they button their shirts. In Raiffe's practice, this surgery runs from $3,500 up.

In Meland's neck-lift, Raiffe cut an oval from just under the chin to the Adam's apple. It's a delicate 1 1/2-hour operation - separating the skin from underlying tissue, tightening the neck muscle, suctioning and trimming excess fat.

Two weeks later, Meland said, he was back to normal.

''People said, `Oh man, you look so good,''' said Meland, who decided not to tell anyone why. ``I just basked in it.''

All that remains of the zig-zag stitches along Meland's neck is a small scar, only visible when he wrinkles his chin. He rather likes it, joking that it makes him look like the chin-clefted actor Kirk Douglas.

Men are still more hesitant than women to discuss their surgeries, but say the stigma is decreasing.

''I'm not a crusader, but I'm telling guys, do it,'' Meland said. ``You'll feel better.''

Quite a change from the 1950s and '60s, when Baltimore's Johns Hopkins Hospital screened every cosmetic patient with psychological tests, wrote historian Lynne Luciano in her 2001 book, "Looking Good: Male Body Image in Modern America" (Hill and Wang, $25). The 20 men who wanted surgery between 1957 and 1959 were all diagnosed as ''seriously disturbed,'' Luciano wrote.

Now, three-quarters of the patients seeking solid silicone implants at Dr. J. Howell Tiller's South Beach offices are male. He used to operate mostly on gay men, he said, but these days, there's no one type of man who chooses to spend around $8,000 for implants.

''They are young, old, gay, straight, married, or single,'' said Tiller, who calls his $14,000 bicep/tricep/chest implant combination the ``Dr. Tiller six-pack.''

Most plastic surgeons say they don't do implants - there's little data on how long they hold up - and they argue that men can get the same results in the gym, without the risks of infection, fluid accumulation and shifting implants. But Tiller, who said infection has forced him to remove only four or five implants in 12 years, isn't swayed: ``It ain't natural to spend three hours in the gym each day and take steroids either.''

Cut to an operating room at Baptist Hospital in Kendall, Fla.

Plastic surgeon Michael Kelly is masked and gowned, his male patient sedated. Two ''before'' photos tacked to the wall show a neck that droops from chin down to Adam's apple.

Kelly opens the man's neck with a cut below his chin, the blade's path traced out beforehand in blue marker. He is aided by a small light as he suctions and cuts out the fat and stitches together the pink platysma muscle.

The next cuts run up from the earlobe to the top of the ear, then down again along the man's hairline. He separates skin from muscle and burns tiny blood vessels until he has a clean cavity from ear to chin.

At this moment, mid-surgery, you can see the subtle, incipient change as the once-drooping neck defies age to approach the coveted right angle.

To Kelly and his patient - who would awaken later that day to go home with face wrapped in gauze - this was a successful surgery.

''He's doing great, he's perfect,'' said Kelly, who expects the surgery to last at least seven to 10 years.

To the historian of male cosmetics, it's another example of how we're choosing to confront mortality in the operating room.

''Is the entire country ultimately going to have to face the anguish of growing older, which every year seems to be invested with less dignity?'' Luciano asked. ``I guess so.''

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© 2003, The Miami Herald.

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