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Then came the new millennium, says Thompson, a time when hit TV shows like Will and Grace and Queer Eye For The Straight Guy threw that culture change into overdrive. 

“It’s only been relatively recently – and the whole ‘metrosexual’ phenomenon has helped this – that most men would even want to admit that they’ve ever thought about what they look like,” Thompson says. “It was considered unmanly. It was considered sissy.… That’s really changed considerably. Now we’ve even got some men’s makeup and special men’s scents beyond simply aftershave lotion.… Just the fact that we now have men’s magazines that aren’t simply about nude women speaks to what I’m talking about.”

So where are men now, in an age where getting an extreme makeover isn’t simply an elective surgery option but the basis for a hit television show?

Says Thompson: “For a guy to have a lot of work done is not considered nearly as outrageous as [it] would have been just a generation ago. There are perfectly macho guys today who wouldn’t think twice about getting work done.”

Speaking of Extreme Makeover, which in 2007 ended a five-year run in prime time on ABC, the show comes up frequently in conversations with surgeons, academics and patients as a key influencer in changing the way men and women view cosmetic procedures.

Dr. Jon Perlman, a Beverly Hills plastic surgeon who was one of the surgical stars of the show’s “Extreme Team,” performed more than 40 surgeries in his years associated with the program. He says he continues to see the show’s influence at his private practice.

“It’s been in virtually everybody’s living room,” Perlman says. “I rarely see a patient who hasn’t seen that television show and found that it’s had some impact on them. It may not be the only reason that got them to come in and have plastic surgery, but it made them feel far more comfortable about the concept, realizing that it’s for ordinary people.”

Provided these ordinary people have several grand in disposable income to spend on bettering their appearance. Each February, the ASAPS lists average prices for a wide variety of procedures, from the most popular among men – liposuction, eyelid surgery and nose jobs – to the more esoteric, like the “buttocks lift” undergone by 31 men nationwide in 2007 or the 277 “upper arm lift” procedures performed on men last year.

The conclusion? Looking better can leave your bank account looking considerably lighter.

The national average cost for eyelid surgery is $2,840, the ASAPS reports. The average facelift cost runs about $6,800, while the average cost for a nose job is more than $4,300. On the non-surgical side, costs range from an average of $380 for a Botox treatment to an average cost of more than $2,400 for a laser skin resurfacing treatment.

Though the American economic downturn and the plummeting real estate market have some in the industry concerned, costs like the above haven’t hurt business at the Scottsdale offices of Dr. James Nachbar. With more than 20 years as a surgeon – the past seven years specializing solely in cosmetic procedures – Nachbar says he’s seeing more men than ever come through his doors for touch-ups, and they seem to be getting younger and younger.

“For eyelid surgery, oftentimes they’re in their thirties,” Nachbar says. “Maybe they have a little extra bag of fat that gives them a baggy appearance in their lower eyelid.… The otoplasties (cosmetic ear surgery) and rhinoplasties (nose jobs) are often procedures we even see in teenagers. Otoplasties can be as young as 8 years old. But now in their 20s and 30s, I think it’s not uncommon for guys to have [these procedures].”

Does this mean more men have become more vain over the years, that societal pressures have started to do a number on men’s self-image the same way these pressures have long been blamed for making women unreasonably critical of their own appearance? Nachbar doesn’t think so. To him, what he does for his patients has less to do with vanity than it does with improving their quality of life.

“The things we treat are things that are very emotionally important and very deeply important to [our patients],” he says. “It makes a big difference to have these things done. That’s the perspective that I see – I see the patients being very grateful for what we do for them. I don’t think they feel that it’s frivolous at all.”

Nachbar, like all the surgeons who commented for this story, spoke of the difference between “real life” cosmetic procedures and what happens in the Hollywood world of on-screen self-improvement. The difference is not necessarily in the outcome but in the approach. TV docs and private practice doctors basically go about things 180 degrees differently, Nachbar says.

“Like everything else, the real world is much more boring than they make it out to be in Hollywood,” he explains. “When they do the TV shows… they do everything possible to get a response out of people because that’s what they’re selling. That really is entertainment. In reality, we do the opposite. We try to make sure patients know everything ahead of time, exactly what to expect, so that there are no surprises.… That way, hopefully we avoid the emotional ups and downs.”

Even after all that cautioning, Nachbar says, some patients still respond to their new looks with their heart more than with their mind. He likens it to a far less frequent, gentler form of post-partum depression.

“The surgery is very emotional, especially for people who have big things that really bother them a lot,” he says. “When you improve that for them, it’s a very emotional sort of thing for a lot of people.… I think sometimes the healing process takes a little bit longer than they were thinking. After a month or so, sometimes there’s things that are still sore. Maybe they were hoping they would be better by now. I think that that sometimes plays into it.”