Plastic surgery has a new face, and it's more Joe the Plumber than Joan Rivers.

Last year saw nationwide increases in face-lifts (14 percent), liposuction (7 percent) and even breast reductions (6 percent) among men, according to the American Society of Plastic Surgeons. Men got 13 percent of the nation's cosmetic surgeries in 2010, compared with 8 percent in 2008.

And it isn't just the rich and famous fueling the upsurge. As procedures have become more affordable -- a big boon because insurance plans don't typically cover nipping and tucking -- more "regular guys" and "man's men" are getting cosmetic work done for professional and personal reasons.

Plymouth-based Dr. George Landis has seen middle-class patients tapping into funds that otherwise would go for more leisurely pursuits.

"It's got to come from discretionary money," Landis said. "Instead of it going for a new boat or a trip to Mexico, that year it goes to the surgery."

Dr. Ralph Bashioum of Wayzata has noticed a similar pecking order: "You might see a man get a liposuction this year in advance of a beach vacation next year."

The contributing factors are old (vanity dates at least to Narcissus) and new (Botox is largely a 21st-century phenomenon). And, of course, the economy is a consideration.

"With the recession, men need to be more competitive to get a job," said Dr. Joseph Gryskiewicz, president of the Minnesota Society of Plastic Surgeons.

It's also "a little more socially acceptable" to have such work done, Landis said.

That's especially true among the so-called "me generation," said Dr. Ron Shapiro, who specializes in hair transplants. "[Plastic surgery] used to have a connotation," he said. "It has become more accepted, especially with boomers wanting to look younger."

But men loathe talking about it publicly. Requests from their doctors' offices for interviews got positive responses -- as long as the patients could remain anonymous.

"Men are more private about this than women," Bashioum said. "It might be like this kind of surgery was for women 20 years ago."

But they're still showing up at plastic surgeons' offices for eyelid lifts, cheek implants and earlobe reductions.

Many of the increasingly popular procedures are nonsurgical. Some men still get face-lifts, but "there has been a real sea change as to how we view facial aging," Landis said. "It used to be pulling the face tight. Now it's more restoring soft-tissue volume."

Last year men got 9 percent more Botox injections -- some of them from dentists expanding their repertoires -- and 10 percent more "filler" treatments (which fill up holes to restore fullness to the face) than in 2009.

And then there are the nonfacial procedures, which often are follow-up operations.

"With the obesity epidemic and weight-loss procedures," Gryskiewicz said, "the fellows losing 100 pounds end up with these saggy boobs."

Whether someone gets a gastric bypass or loses weight "the old-fashioned way, diet and exercise, you still leave a lot behind in the breast area," Landis said. "Larry the Cable Guy says his weight loss goal was a B cup."

Bill Ward • 612-673-7643