Hardly a month passes that cosmetic surgeons don’t have a new tool with the potential to make us look better, and many options are nonsurgical: lasers, Botox, fillers.

But sometimes the change a patient wants still requires surgery.

The American Society of Plastic Surgeons says the top five cosmetic surgeries in America in 2007 were breast implants (347,524), liposuction (301,882), nose reshaping (284,960), eyelid surgery (240,660), and tummy tucks (148,410).

According to the ASPS, people in this area have more facelifts than Southerners or Midwesterners but fewer than those who live on the West Coast. Apparently, New Englanders don’t like their noses, because they get far more of them fixed than anybody else. Washingtonians get fewer nose jobs than those living in other areas of the country.

A New Look in Surgery

In the early 1970s, young women getting a new nose often emerged with identical, smallish, slightly turned‑up noses regardless of what the rest of the face looked like.

Today, patients and doctors are more inclined to improve a nose or any other feature in the context of the patient’s looks.

“We’re all coming to understand that ‘ideal’ doesn’t work on every face,” says James Bruno, a plastic surgeon in Chevy Chase. “Patients want to alter a feature they don’t like but still look like themselves afterward.”

Suzanne Kim Doud Galli, a facial plastic surgeon who practices in Reston and the District, agrees that a softer, more natural look is the trend.

“Practically every facelift patient comes in saying, ‘Don’t make me look like Joan what’s-her-name,’ ” she says. “The overlifted look is out.”

In 2007, Americans spent $12.4 billion on 12 million cosmetic procedures, an increase of 7 percent over the previous year. A lust for Botox, fillers, lasers, and the like accounted for most of the increase; the number of operations held steady among women and went up slightly among men.

Will our zeal for looking good continue now that the economy has weakened? Local plastic surgeons have noted a slowdown in big-ticket surgeries, but many say people are still coming in for noninvasive solutions. While some patients might delay having lipo or an eyelid lift, says Doud Galli, “it’s likely that others will say, ‘Since I can’t invest in the stock market, I’ll invest in me.’ We want the boost of looking good when times are tough.”

“I had my boobs done last year, and what a confidence booster,” volunteered a 27-year-old accountant sitting next to me on Amtrak recently. Would she have spent her money the same way this year? “You bet!” she said. “I only wish I’d done it sooner.”

What Men Want

Of the 12 million procedures in 2007, a million were on men, a 17-percent increase over the year before.

Men are discovering Botox: Getting it draws them into doctors’ offices more than any other procedure. After that, men go for lasers, especially treatments that remove unwanted hair from the back and chest. They’re also getting more fillers and more microdermabrasion, which takes off the top skin layer typically by spraying on and then sucking up tiny crystals.

In the past ten years, the number of surgeries on men has grown 3 percent. Nonsurgical procedures have jumped 886 percent.

“I do a lot of Botox and Juvéderm on men these days,” says Talal Munasifi, an Arlington plastic surgeon. He’s also seeing males who want their faces and jowls tightened with a laser treatment. “Women have always been able to get a facelift, but a lot of men don’t have any wrinkles in front of their ears where you can hide a facelift scar,” as many women do, he says. Munasifi says that lasers can do about a third of what a facelift can to improve appearance, with little or no downtime. He says men who have heard that lasers can repair old acne scars also are making appointments.

Men are leery of having work that will show, says C. Coleman Brown, a Chevy Chase plastic surgeon. When it comes to surgery, men get liposuction, eyelid surgery, rhinoplasty, male breast reduction (gynecomastia), and hair transplants, in that order, says the American Society for Aesthetic Plastic Surgery. “Men who come in for lipo tend to be very fit,” says David Kung, a Chevy Chase plastic surgeon. “They want to touch up an area they can’t seem to contour with exercise and diet.”

A significant number of men have a genetic predisposition for a pouchy neck, even in their twenties and thirties. The sag can vanish after a little lipo if the skin is still elastic. “It’s the kind of thing a man can do and nobody will know he had something done,” Brown says. “They’ll just think he looks good.”