The plastic surgery business is booming in Bermuda. Could it be that local residents are following the lead of the various reality TV shows depicting individuals who are physically transformed and emerge ecstatic from the process?

Perhaps makeover mania has reached our shores as the Island's only full-service plastic surgery practice, the Elan Clinic, which was established just over a year ago by facial plastic surgery specialist Dr. Bruce Lattyak, is experiencing increased demand for its services, both in terms of the number of patients coming through the door and the number of procedures conducted by the medical team at the facility.

And according to Dr. Christopher Johnson who is based at the clinic and is currently the Island's only full-time plastic surgeon, the fact that patients no longer have to go overseas for a wide range of procedures seems to be driving the increase in business.

"Patients in Bermuda were travelling abroad and they now really appreciate having the ability to have their needs met here," he says.

And of course there has never been a full-time plastic surgeon based here on the Island before."

Those patient needs cover a wide spectrum, from the botox treatments, facelifts and liposuction typically associated with cosmetic procedures to complicated reconstructive surgery for accident victims, most commonly serious facial injuries from moped crashes, as well as burns and injuries from violence in the community.

"Not everything we do is about making people look 'beautiful'," says Dr. Johnson. "There's a lot we do here that's about making people whole again."

And while people may tend to think of the Elan Clinic largely in terms of plastic surgery services, the surgical dentistry and cosmetic dentistry components of the practice are also doing very brisk business.

Dr. Laidlaw Fraser-Smith, a partner in the clinic and well-known as the leading dental surgeon in Bermuda, says that the overlap between both sides of the practice comes into play for both cosmetic and, perhaps even more importantly, reconstructive procedures. "This is true when we treat injuries to the face, basically for the reconstruction of broken faces," he says. "We have all the skills needed to do that in one facility, and we can treat the whole community."

Dr. Laidlaw Smith accepts referrals from all the dentists on the Island and treats patients for all types of major dental problems that require surgery from impacted wisdom teeth, to dental implants to repairing injuries from a broken jaw.

The practice has also recently introduced one-hour dental whitening treatments which, in perhaps a sign of prevailing fashion trends, is in great demand. "The treatment lasts for anything from six months to two years depending on your maintenance habits and things like consumption of tea or red wine," says Dr. Fraser-Smith.

The idea for the clinic became a reality when Dr. Lattyak decided to build on his former facial plastic surgery practice, which he started in 2003. In the Elan Clinic he brought together services that provide patients with on-site out patient plastic surgery procedures and surgical dentistry at the Woodlands Road, Hamilton practice together with conducting operations at the King Edward VII Memorial hospital. Dr. Johnson, a Harvard Medical School graduate and accomplished general plastic surgeon, joined the clinic four months ago from the US, where he still maintains his own plastic surgery practice in Manhattan. He will be part of the team at the facility while Dr. Lattyak completes qualifications and training in general plastic surgery overseas.

Growth industry

"From what I have already seen plastic surgery is a growth industry in Bermuda," he says. "This practice has had an excellent response and the patients here are as sophisticated as they are in the States. They ask the right questions and for the most part come to us well-informed about plastic surgery. They're very good at following up (after their procedures) and they have much better family support than in the States."

Patients come from all walks of life according to Dr. Johnson, from policemen to accountants to housewives to politicians, although predominantly professionals tend to use the clinic's services. Like any other commercial operation they track where their business is coming from and find that word-of-mouth as well as newspaper advertising are the main ways in which they get new clients.

One of the most important aspects of their work is confidentiality. Patients undergoing on-site out patient procedures are able to slip in and out of the building via a discreet entrance in the building. Pricing for their services vary widely depending on the procedure required. For example, surgical cosmetic procedures can range in price anywhere from $2000 - $10,0000, with laser surfacing skin treatments being at the low end of the scale to face lifts being the most expensive. However, prices are only confirmed at the time of consultation as diagnoses vary from patient to patient.

It is a busy practice and Dr. Johnson has had an action-packed four months. He says that on balance he sees about the same numbers of patients for both cosmetic and reconstructive plastic surgery. And the most common procedures?

"I would say that I do two to three tummy tucks and the same number of breast reductions every week, in addition to other out patient procedures and operations at the hospital practice," he says. "Liposuction and breast enhancement would be the next most popular."

He adds, however, that some of these procedures can be classified as reconstructive, even if the medical need is not obvious as it would be in the case of breast cancer survivors for example. By way of example he says some breast reduction patients prior to surgery suffer inordinately from physical ailments directly related to the area he works to correct.

It is in cases like these that problems can arise either with some doctors not seeing the need for a referral for plastic surgery or with getting insurance coverage for the procedures.

"Women here were being denied surgery because previous doctors did not refer them since they related their condition solely to obesity," he says.

"But some (women) develop physical conditions due to their size, such as back problems and neck issues, that made it difficult to exercise.

"And some of the insurance companies here have a hard time understanding that there is at times a medical need for such a procedure."

He says that this is a major difference between practising in Bermuda as compared to the US: "We definitely find that there are more issues here with the insurance companies than I have had in the US. And there is no independent avenue of appeal here for when a claim is denied, which is another issue."

He adds, however, that one major benefit of working being in a practice like the Elan Clinic is the variety of work he conducts on a weekly basis. "There is typically no overlap between cosmetic and reconstructive plastic surgery in the States in any one practice," he says.

All indications are that based on the demand for the services from the market in its first year of business the Elan Clinic looks set to see continued growth. Dr. Johnson says that while this augers well for the business, he feels that the team on the plastic surgery side of the practice in particular must always use every opportunity to educate the community about the reality of their work, and its results.

"The 'reality' shows about plastic surgery on TV are not realistic and its our job to ensure people understand that plastic surgery will not solve all of a person's personal problems," he says.

"The worst thing would be for people to see it in those terms.

"There's pain involved, sometimes a very long healing process and even some depression after surgery. We ensure that we inform our patients as fully as possible about everything involved as part of the care we provide here."