Plastic surgery: tummy-tuck tell-all or top-secret operation?

NEW YORK — Did she or didn't she? We've all engaged in a snark-fest at one time or another, trying to guess if a certain film or television star has had "work" done. And while some — such as Kathy Griffin, Joan Rivers and Patricia Heaton — have been way public about their cosmetic surgeries, the majority opt to keep such procedures secret. After all, our pop-culture celebrities tend to have a vested interest in maintaining certain physical illusions.

But the rich and famous are not the only ones going under the knife. There were 11.6 million cosmetic procedures done in the United States in 2006, according to the American Society for Aesthetic Plastic Surgery, up by 446 percent since 1997, when the ASAPS began compiling statistics. The most popular procedure last year for men and women was Botox injections. Liposuction was the most frequently performed surgery. For women, however, breast augmentation topped the list, followed closely by liposuction.

With so many undergoing elective enhancement these days, should we reveal our choice to friends, neighbors, co-workers, relatives — our children?

Telling friends and relatives about a cosmetic procedure is a highly personal decision, says Dr. Z. Paul Lorenc, a cosmetic surgeon in Manhattan. But that decision is frequently affected by the type of procedure a patient is having.

For instance, highly popular and minimally invasive Botox or Restylane injections are simple and quickly administered procedures that require an office visit and virtually no recuperative downtime. A "lunch-hour makeover" can therefore yield subtle and natural-looking results that other people may not even notice.

"Surgery is a different story," says Dr. Steven Pearlman, who specializes in facial plastic surgery in his Manhattan practice. "That's a major decision that requires undergoing anesthesia. It's exceedingly safer than it was 30 years ago, but surgery requires healing." That means the patient will need physical and emotional support from a spouse, relative or friend during recovery, so telling someone, at least for that very purpose, is recommended by all doctors of cosmetic surgery.

But that's not why Stacy Abrams of Merrick, N.Y., told her friends about the breast augmentation and abdominoplasty (tummy tuck) she underwent last year. "I tell everyone. I'm all for it," says the 40-year-old mom of two who's also had Botox and Radiesse (a dermal filler) treatments for her face. "It's so widely accepted now, you read about it in almost every magazine."

Television makeover shows such as "The Swan," "Extreme Makeover" and "Dr. 90210" have popularized cosmetic surgery to the point where the taboo element has practically vanished, adds Abrams' surgeon, Dr. David Funt.

"For most women, it's not a taboo; they're happy to share it with people," Pearlman says. This is particularly the case when the results are a dramatically enhanced appearance.

"I couldn't stand the way I looked," confesses 59-year-old Connie Alibrandi of East Northport, N.Y. Once she decided to have cosmetic surgery, she thought she'd keep it to herself out of sheer embarrassment. But after her face-lift, she developed a heightened sense of self-confidence.

"It changes your whole personality, your self-esteem," she says happily, and now she readily comes clean to anyone who comments on her younger appearance. What's more, Alibrandi says she hasn't had any negative comments from or felt judged by anyone she's told.

Acceptance by one's peers can be a determining factor when deciding whether to tell or not to tell about plastic surgery. "My friends are in their 30s to 50s and, for my contemporaries, it's normal to talk about it," Abrams says.

Based on the television makeover programs and reality dating shows, hiding voluptuously enhanced breasts is the last thing women who've undergone augmentation surgery desire to do. But that's show business. In Wendy Lewis' real-life experience, she finds her clients who want their breasts done don't want "porn-star boobs." Known as "The Knife Coach," Lewis is a New York-based independent cosmetic-surgery concierge of sorts who counsels patients contemplating plastic surgery. "My clients want what they used to have; soccer moms from Great Neck, for example, who just had a second baby and would like their original fullness and volume back" in their breasts.

That is exactly what Abrams wanted from her augmentation. And although she's been candid about it, "I didn't want it to be obvious," she says.

Sometimes, we think keeping a secret isn't an option. Laura Ellick, a psychologist, says she had no qualms about telling people about her procedure. "I had a deviated septum and lived with it for ages. I never liked my nose, and my breathing problems got bad," the 36-year-old says. Two years ago, she had rhinoplasty surgery.

"Recovery was pretty quick; I stayed out of work for a week," she says. Regarding the results, "I feel much better. I don't have to worry about it anymore. ... It's pretty subtle, and it sort of shows me the flaws we think are wrong with ourselves are magnified dramatically."

Before her surgery, she says, "nobody focused on my nose except me."

And afterward? She says nobody noticed.

Of course, that doesn't mean the people she hasn't directly told about her nose job haven't been playing the speculation game. ...