Plastic surgery can improve your looks ? but Bermudian surgeon Dr. Bruce Lattyak may turn you away unless you have a clear idea what you don?t like about yourself.

Dr. Lattyak opened the Elan Clinic in 2001 to service the local community in both cosmetic and reconstructive head, neck and facial surgery. But he said numerous requests from both doctors and directly from his patients, led him back to school to train in general plastic surgery.

He did a three-year programme at Canada?s McGill University in general plastic surgery and as a result can now perform a variety of much requested cosmetic procedures including breast augmentation, breast lift, liposuction and tummy tucks. He can also conduct reconstructive work for those who may have suffered an accident.

?A common misconception is that plastic surgery means only cosmetic surgery,? he said. Reconstructive surgery can often physically benefit the patient. In rheumatoid arthritis where joints become inflamed, surgery can improve function or prevent further loss of function. It is particularly important in hand injuries, amputations, crush injuries, burns, nerve problems and arthritis.

While the majority of surgeries he does are cosmetic, Dr. Lattyak is not quick to cut. ?Most of the work we do is conservative,? he said. ? We use tried and true methods and only the latest techniques that have been tested.? He said local patients do not tend to want drastic dramatic changes. And he tries to achieve as natural an appearance as possible.

?By and large they want results that fit their bodies,? he said.

Contour threads ? a new technique to help lift sagging faces ? does not leave as marked a difference as a face lift but Dr. Lattyak said many patients opt for it.

?Many people look for things that have less down time and are more subtle in results,? he said. The contour threads procedure requires only a local anaesthetic. Patients can be in and out in much the same time as a visit to the dentist. And they will not be unrecognisable or look completely different when it is finished.

?We try to customise treatments for each individual patient. It is most important that they have a realistic expectation of the results,? he said.

In fact Dr. Lattyak turns away about 20 percent of the people who come to him for surgery. He said his aim is to have a happy patient at the end of the procedure. ?Our happiest patients are the ones who come with a particular issue that they can identify. It is something they have thought about for a long time and really want to change.

?It may not bother anyone else but they would like it changed.?

He said he turns away patients who have unrealistic expectations on what the surgery will do for them. ?Cosmetic surgery cannot change a person?s life, provide them a new job, or boyfriend, wife or husband. It helps with self esteem but is not a panacea for what is not working in someone?s life,? he said.

A patient who thinks a tummy tuck will reunite her with her estranged husband and get her a fabulous job is the sort of person Dr. Lattyak does not operate on. He said it is important for the patient to understand the risks and options available to them and in cases where a patient?s needs are different from the surgeon?s surgery should not be carried out.

?There needs to be a comfort level between the patient and the surgeon,? he said.

It is also important that the patient identify the specific problem they have with their body. ?I?ve had patients come in and say ?Here?s my body what do I need to change??,? he said. ?It is not for me to determine. The reasons people want cosmetic surgery may be very subjective. Someone may feel very self conscious about a part of their body that looks just fine to everyone else.? In some cases plastic surgery needs to be ruled out because of a preexisting condition or illness the patient has.

The most common cosmetic procedure Dr. Lattyak performs is blepharoplasty ? eyelid surgery. The surgery can be done under local sedation at the Elan Clinic?s surgical unit. It normally takes between one and two hours and leaves patients looking younger and brighter. Ear lobe tears are easily corrected in an in-house operation, which takes about 15 minutes. Next to eyelid surgery this is the most requested procedure followed in popularity by tummy tucks and liposuction. All the surgeries can be done at the Elan Clinic?s Bermuda Ambulatory Surgery or at The King Edward VII Memorial Hospital. Most cosmetic surgery is not covered by medical insurance.