Plastic surgery used to be the preserve of the rich and famous. But now more and more people are undergoing surgical procedures from facelifts and breast reductions to liposuction and tummy tucks.

And it is a trend Bruce Lattyak, consultant plastic and reconstructive surgeon, has seen during his career at the Elan Clinic since he set it up eight years ago.

For Dr. Lattyak, whose clinic based at The Mount in Cavendish Road, offers both plastic surgery and medspa treatments, including face, breast, body contouring, hand surgery and skin procedures, has experienced every kind of request from his patients. The business is split 80:20 between medspa and plastic surgery respectively.

Dr. Lattyak, who is Bermudian born-and-bred, originally from Pembroke, but currently lives near Lake Tahoe in California, divides his time between the clinic in Bermuda and a new clinic launched in California, US last summer.

"I do the full spectrum of plastic surgery," he said. "The medspa runs the full-year round and I come down here every three months.

"It has been good being out in California — we are able to bring some of the latest advancements in medspa and laser surgery to Bermuda.

"These include Titan, a non-invasive option to improve skin laxity on all areas of the body, and LimeLight Facial, which uses intense pulse light technology to treat skin redness, tiny red veins on the nose and cheeks, brown spots and skin damage."

Having graduated from the University of California in San Francisco, Dr. Lattyak decided when he was working on ear, nose and throat treatment to move into facial plastic surgery and enrolled in a Fellowship course at the UC Davis in Sacramento in 2000, before returning to the Island in 2001 to start the Elan Clinic.

To begin with, the clinic focused on plastic surgery, but due to a big demand for body plastic surgery, Dr. Lattyak signed up to a two-year course to study for his second residency in General Plastic Surgery at McGill University in Montreal, Canada in 2004.

"Now I do everything from head to toe," he said.

"It has really been a tremendous opportunity to train to do two different residencies.

"I just liked plastic surgery and I felt it was a little less cut-and-dry and much more creative than any other part of medicine that I had encountered.

"I think it suited my personality — it was artistic and scientific at the same time and I felt that was a really good match."

Dr. Lattyak, who is certified by the American Board of Facial Plastic and Reconstructive Surgery, the American Board of Otolaryngology, and the Royal College of Physicians and Surgeons of Canada, has been involved in doing neck lifts, forehead/brow lifts, chin and cheek implants, lip enhancement, broken nose and prominent ear corrections, breast lifts and reductions, and liposuction, as well as skin cancer treatment, removal of skin lesions, Botox, laser hair and vein removal.

But he said the most popular requests are for facelifts, breast lifts and augmentation with silicone and saline implants and tummy tucks.

"It is a little bit of everything — a lot of face and breast surgery and tummy tucks," he said.

"Unfortunately because pregnancy has such major changes on the abdomen and the breast, a lot of women are seeing an increase in issues in those areas."

Dr. Lattyak said the biggest change he has seen during his time in the industry has been the increase in the range and availability of plastic surgery and medspa procedures across the board

"It used to be that if you wanted improvement in construction it was a major surgical procedure or nothing else.

"But today there are many options from minimally invasive procedures to some non-invasive ones.

"Patients have also seen benefits from skin care line prescriptions and laser treatments.

"The surgery is different right down to kinds of facelifts, for example, with more subtle areas of surgery — we are able to offer the full spectrum."

Among the greatest challenges he has faced over his career, has been difficult reconstructive procedures, such as surgery for hand trauma such as fractures, tendon and nerve injuries, and peripheral nerve surgery, like carpal tunnel syndrome and nerve compression, due mainly to the time taken for nerve to reform.

And he reckons in this cutting edge world of surgery and medicine there is not much Bermudians do not know about plastic surgery and similar procedures.

"Bermuda has a very sophisticated patient population," he said. "People here are really very well read in many of the procedures now available.

"It used to be when I started the practice here eight years ago, I would have to explain what Botox was and now I am finding that much less common today.

"But it seems like access to the Internet and the popularity of a number of the most advanced treatments available in Bermuda now means we have a very well informed patient population here, which is very similar to what we see in California — it is really testament to how modern Bermuda is as an island."

The clinic, whose team is headed by Dr. Jane Crerar and includes four registered nurses and two administrative staff, is set to expand its minimally invasive non-surgical procedures, while continuing its medspa treatments like laser hair removal, laser vein treatment, Laser Genesis skin rejuvenation, microdermabrasion, sclerotherapy, Botox, injectable fillers, chemical peels and professional skin care, according to Dr. Lattyak.

He also envisages more patients travelling from Bermuda to take advantage of the treatments on offer in California, although there are number of FDA-approved medspa treatments available on the Island not on the US market, including Restylane Fine Lines, (used to fill moderate wrinkles, lines, folds and scars) and anatomic tear drop-shaped silicone-filled breast implants. Staff will also be moving between the two operations.

"We have really seen tremendous growth in the practice," said Dr. Lattyak.

"We are looking to add new procedures as they become available and we may be expanding the clinic premises if and when the opportunity becomes available.

Dr. Lattyak, who had a wife and two daughters, cites mountain biking, snow boarding, lobster diving and spear fishing among his favourite activities.

For now though he has got more than enough on his plate at work, whether it be carrying out a standard facelift procedure or complex surgery on a nerve injury as he spreads his time and expertise between treating patients in both Bermuda and California.