Kay Sherman was not happy with the way she looked. After raising two children, the 50-year-old decided to give herself a gift and underwent plastic surgery.

For decades, cosmetic plastic surgery has been perceived as vain, unnecessary and relegated to celebrities. But local area surgeons say better technology, higher standards of living, and increased media exposure have made plastic surgery a viable option for anyone seeking to improve themselves.

According to the American Academy of Plastic Surgeons, the number of patients from the Midwest and the state of Montana has increased this year by 17 percent. The 2005 report shows that 1.7 million patients from Iowa, Illinois, Indiana, Michigan, Ohio, Wisconsin, Kansas, Minnesota, Nebraska, the Dakotas and Montana went under the knife or chose a minimally invasive procedure, such as Botox.

"People have tried to change their appearance, surgically, since ancient times," said Albert Cram, a plastic surgeon specializing in body contouring at Iowa City Plastic Surgery in Coralville. "The desire to be attractive and feel good is constant."

Cram said he sees about five or six patients a week and about 30 a month. He said breast augmentation, breast reduction, tummy tucks and belt lipectomy procedures make up about 75 percent of his practice.

Sherman, who lost 270 pounds after bariatric surgery, said she chose to have a belt lipectomy in May 2004 and upper body lift in November 2005 as the final step in her body makeover. The surgeries got rid of the excess skin and fat on her stomach and upper arms.

"Surgery used to be thought of as for the very rich movie stars, but the truth is the average person having cosmetic procedures done is middle class," he said.

"Everybody knows that the nice young thing with perky breasts who is a size 10 will probably get the job compared to the size 14 frumpy-looking thing," said Brenneman, 39, who has dropped three pant sizes since her surgery three weeks ago.

Brenneman said after having six children, she wanted to do something for herself. Although she used to oppose plastic surgery, Brenneman said the surgery's impact on her self-esteem has changed her opinion.

John Canady, a plastic surgeon who performs cosmetic and reconstructive surgery at University Hospitals, said the stigma of plastic surgery has decreased significantly during the past 20 years.

"There's a lot of public awareness on it," Canady said, adding that he sees many patients come in who already are well researched about plastic surgery.

"Most people who come in don't want a dramatic Pamela Anderson change. They want something where they look more youthful and relaxed. A lot of times it's a successful surgery if people know a change occurred but don't know exactly what it is," Canady said.

However, the enormous popularity of reality shows such as "Extreme Makeover," "The Swan," and MTV's "I Want a Famous Face," has created unrealistic expectations in some people, local surgeons said.

Cram and Aly said they turn down about 30 percent of their patients because expectations are either unrealistic or indicate emotional instability.

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