Sultan of Skin

Flesh insight from an esteemed St. Louis plastic surgeon

Centeno is among a handful of doctors nationwide mastering gluteal aesthetics. Two years ago, he recruited subjects through local gyms and bikini contests, and studied almost 200 photos from celebrity and X-rated Web sites, trying to formulate the proportions of a perfect posterior.

"It's gotten gradually larger through the years," he says. "Think of Twiggy in the '70s, Kate Moss in the '80s — then Claudia Schiffer in the '90s." And today? "Definitely Britney Spears — before she got pregnant."

Centeno traveled to Mexico City to watch surgeons there perform gluteal augmentations. He then practiced on cadavers locally to put his own newfangled set of complex ratios into practice. He uses solid silicone implants or fatty tissue from the patient's own body to plump up the rear end.

Liposuction is  the most popular cosmetic surgery nationwide.
Jennifer Silverberg
Liposuction is the most popular cosmetic surgery nationwide.
Master skin sculptors: C.B. Boswell, Leroy Young, Rob Centeno.
Jennifer Silverberg
Master skin sculptors: C.B. Boswell, Leroy Young, Rob Centeno.

More than 2,300 Americans had gluteal augmentations last year, according to the American Society for Aesthetic Plastic Surgery. In St. Louis, says Centeno, it's not unusual to greet patients bringing in magazine photos of Jennifer Lopez or Beyoncé and asking, "Can I have this ass?"

What got Centeno interested in gluteal aesthetics was operating on the morbidly obese. "People lose all this weight, but they end up with no butt," he explains. "Well, we decided we could recycle tissue from other areas of their body to restore the volume."

Massive-weight-loss patients typically have nutrient deficiencies and other health problems that make them riskier candidates for cosmetic surgery. Still, they are the fastest-growing patient population in the field, thanks to the surge in gastric-bypass operations during the past five years.

"Many of us think there won't be enough plastic surgeons to serve all these patients ten years from now," says Young. "It took the whole specialty completely by surprise."

After shedding hundreds of pounds, massive-weight-loss patients typically end up saddled with extra skin that refuses to contract. "We had one patient who liked to ride a motorcycle, but her arm skin would flap in the wind," says Young. "I had one who was a cook, and when she'd go to the grill her arm skin would graze it and get burned," adds Centeno.

"I thought I looked like a melted candle, or a mudslide," says Amy French, a 35-year-old from St. Peters who lost 159 pounds after a gastric bypass. "If you took a golf ball and put it in a tube sock, that's what my breasts looked like."

The hallway outside the plastic surgery unit at Barnes-Jewish West County Hospital reeks of meat singeing on a griddle when massive-weight-loss patients recline on an OR table. Almost all of them require liposuction, but first the doctors have to spend hours burning through the extra skin and tissue to extract the fat.

"We get lost in here," says Centeno.

"Yeah, it's weird," Boswell adds. "Their muscles end where yours and mine do. There's almost always a really small person inside the large one."

The biggest trouble spot is the pannus, a flap of extra skin resembling an apron that hangs down from the stomach and lower back — sometimes as far as the knees.

"It'll hang so low they can't perform hygiene," says Young. "They get yeast infections. They can't wipe their bottom. One woman told us the only way she and her husband could have intercourse was when one of the neighbors came over and held the pannus up!"

Adds Boswell: "Sometimes we'll be operating and find bits of toilet paper under there."

Young and his partners have removed more than 70 pounds of extra stomach and back skin in a single body-lift surgery — far too much for the little gray Sunbeam kitchen scales in the ORs at Barnes West. But the nurses cut the flesh into pieces the size of salmon steaks and weigh them so the doctors can give final tallies to the paying customers.

Thirty-nine-year-old Cathy Haug of Bridgeton lost 200 pounds after a gastric bypass. Young gave her a body lift and gluteal augmentation in December. "I got out of bed and thought I was going to die," she says. "My body was traumatized."

Haug had to sleep in a recliner and couldn't stand straight for two weeks. Drains protruding from her torso exuded fluid "like murky water" well into January. The following month she had to pad her underwear with cloth diapers because her wounds separated and started leaking black goo.

Haug nonetheless drops her pants to show her taut tummy and scars to a new acquaintance in a parking lot. "I want Dr. Young to do my arms next," she says. "I can't wait."

Three years ago Leroy and Jill Young left Clayton for a rustic three-acre spread in Wildwood. Their Dobermans have the run of the place, with their doggie portraits occupying the living room.

Young keeps in his second-story office a black marble statue of Nefertiti, queen of Egypt — "one of the definitions of classic beauty," he says. Two shelves above lies an old SS Nazi helmet that the doctor bought over the Internet. "I've always been fascinated by the SS," he explains. "They were very good at what they did — so well-trained — even though they were evil."

The home's crowning jewel is the land surrounding it. "It was a compromise," he says. "I wanted a lot more. I wanted a lake or a pond." It's no Kentucky farm, but there's ample room for Young to grow his leeks, onions, lettuce and raspberries.

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