Sheri Nichols Bucy is far from vain but has always been conscious of her appearance. She’s been in the public eye for her entire career, first as a singer, dancer and actress in Detroit, then in Los Angeles and now Nashville, where she is co-owner of NashTrash Tours.

Sheri and her real sister, Brenda, perform as the Jugg Sisters, an uproarious and often-profane comedy duo who guide people around Nashville on a Pepto Bismol-pink bus with a BYOB policy and a no-holds-barred philosophy.

It’s a great third act for Bucy, who conceived of the tour after becoming disillusioned by the focus on age and looks in Los Angeles.

“I was in my thirties and reading for grandmother roles – I’m not kidding,” Bucy recalls of her Los Angeles days.

“I was heartbroken. After my last grandmother read I told my agent, “What the f---! I’m out of here.”

The business has been wildly successful for 18 years. And over that time it’s doubtful that anyone noticed the “family jowls” beginning to appear around Bucy’s neck.

But she did, and that was enough.

“My grandmother could hide small children underneath her jowls,” she says with her trademark humor.

Sheri Nichols Bucy, co-owner of NashTrash Tours, decided the family tradition of dangling jowls was an inheritance she didn’t want. So she, like so many others in Middle Tennessee, elected for surgery.

-- Michelle Morrow | The Ledger

“I saw it in my aunts and my mother, and they did nothing about it. When I was 40, I could see it coming and I always, in the back of my mind, said, ‘When the time comes, I’m going to do something about it.’”

So a month ago, at age 59, Bucy treated herself to a neck lift, becoming one of the millions of people – mostly women but a growing number of men – who have a surgical or non-surgical cosmetic procedure done every year.

“I don’t mind a few wrinkles. I’m owning it,” Bucy says. “But this s--- I did not want to own.”

As cosmetic surgery becomes more accessible and the culture becomes more open, the era of secrecy and even shame around “having work done” has passed. And there’s a general feeling that life is too short to put up with something that can easily be changed.

“When I’m 65 or 70 and things start to go south, I won’t give a s--- anymore,” Bucy adds.

“But these years when I still have so much energy and I want to get out and do stuff and be a part of the community … I’m in theater and I’m an actress. I’ve got to be thinking about this package all the time.”

Don Griffin, M.D., discusses self-image with patient Dara Carson. Griffin is a board-certified plastic surgeon and the owner of Nashville Cosmetic Surgery in Belle Meade.

-- Leigh Melton Singleton | The Ledger

Cosmetic surgeons now offer a large and ever-growing menu of tools to improve one’s appearance, thanks to the advent of technologies such as lasers and minimally invasive techniques for body shaping that range from burning to freezing of fat.

It’s a growing field, too, with “med spa” franchises moving into the state, as well as physicians from other specialties lured to cosmetic surgery by consumers’ growing demand.

Bucy chose Ronald Gilmer, M.D., to do her neck lift – liposuction and incisions behind the ears to pull up and tuck the remaining skin – based on friends’ recommendations and his high qualifications.

Gilmer is a board-certified plastic surgeon with an established practice and has been doing liposuction in Middle Tennessee for more than 30 years.

Another factor was the price.

Gilmer cost half as much as some other quotes that required an overnight hospital stay. Gilmer operates in his office, which is one of only 14 office-based surgical suites in Tennessee that are certified for performing the highest level of surgeries.

An increasing menu of procedures

Cosmetic surgeons are seeing strong business, buoyed by Tennessee’s growing population, rebounding economy and advances in medical devices, technologies and treatments that can often produce results approaching surgery while minimizing discomfort and downtime.

Nationwide, the top cosmetic surgery procedures are liposuction, breast augmentation, eyelid surgery, tummy tucks and nose surgery, with 1.1 million procedures for those five alone in 2014, according to the American Society for Aesthetic Plastic Surgery.

But that’s dwarfed by the number of non-surgical cosmetic procedures now performed. There were 3.6 million Botox injections alone in 2014, followed by collagen filler injections, hair removal, chemical peels and microdermabrasion.

A total of 15.6 million cosmetic procedures, including both minimally-invasive and surgical, were performed in the United States in 2014, an increase of 3 percent since 2013.

Such procedures are now on the menu at most traditional cosmetic surgery practices, along with traditional surgery and body shaping techniques such as CoolSculpting, a non-surgical alternative to liposuction that freezes fat for eventual removal by the body.

Lasers are widely used in physician offices and medical spas for everything from hair removal and skin resurfacing to eye lifts.

“Nowadays we have so many great minimally invasive technologies that rarely do I find the need to do surgery on someone,” says Steven Bengelsdorf, M.D., owner of Franklin Skin & Laser.

“Liposuction is the gold standard when it comes to fat removal, but we have devices so good that they are almost achieving liposuction results.”

Most surgeons are now offering both to accommodate patients, says Joe DeLozier, M.D., a longtime board-certified plastic surgeon.

DeLozier

“People want a lot of value for their dollar so it’s not uncommon for someone to come in and say, ‘I want to CoolSculpt my body,’ but then when they see the cost of that versus being put to sleep for an hour and having liposuction, oftentimes it’s more advantageous to do something surgical, depending on the number of areas.

“It’s nice to offer both.”

DeLozier, who has practiced in Nashville since 1991, does plenty of breast augmentations and liposuction, but is prized by clients for his technique with facelifts.

“It’s not exactly the trend, but among the age group I’ve grown up with – the 50 to 70 range – and because I’ve been around a long time, at this point they’re looking for facial rejuvenation,” he adds. “That’s my reputation.”

Body lifts on the rise

People of all ages are getting procedures done on the theory that it’s never too late – or too early – to change something you don’t like.

Fashion-driven trends like “Brazilian butt lifts” may come and go, but procedures like fat removal and breast implants remain perennially popular.

Over the past decade, practices have also seen more patients needing surgical removal of skin and body reshaping following massive weight loss.

The rise in such procedures correlates with an increase in people undergoing bariatric or weight-loss surgery, according to the American Society of Plastic Surgeons, which represents 7,000 board-certified plastic surgeons.

In 2013, 179,000 Americans – nearly 500 a day – underwent weight loss surgery, according to the American Society of Metabolic and Bariatric Surgery. The following year, nearly 45,000 patients who experienced massive weight loss underwent plastic surgery to reshape their bodies.

When people lose considerable weight, they’re often left with excessive amounts of sagging skin, particularly in the thighs, under the arms, around the abdomen and in the breasts.

“I’ve seen a lot of people who have lost 100 or 150 pounds or 200 pounds,” says Don Griffin, M.D., a board-certified plastic surgeon and owner of Nashville Cosmetic Surgery in Belle Meade.

“You can exercise fat away, but you can’t exercise loose skin away. Some of them are size 4 on the inside, but they are still wearing the loose baggy outfits because they have to hide all the loose skin. They lose the weight and they feel better about themselves, but their self-esteem is still in the gutter.”

Jay Lucas, M.D., a plastic surgeon and owner of The Lucas Center Plastic Surgery in Knoxville, says bariatric surgery started to generate a wave of body reshaping clients about 10 years ago.

Those clients typically need several stages of surgeries, including a circumferential body lift that reshapes the gluteal, flank, lateral thigh and pubis areas, a breast lift or augmentation and arms and lateral chest contouring, and a medial thigh lift.

“Those are big operations; they’re all outpatient and people do well,” he explains.

Non-invasive options abound

After losing 140 pounds without surgery, Dara Carson sought out a non-invasive way to reduce her chin and neck area.

Carson

She began Kybella treatments in September with Griffin. Kybella is a relatively new injectable treatment that is FDA-approved specifically for burning subcutaneous fat in the neck area.

“After a massive weight loss journey, I had to accept that some parts of my body will never be addressed with exercise. Your neck is one of them,” Carson points out.

The procedure involves multiple injections in the treatment area with a tiny needle. Some patients need up to six sessions to achieve their goals; Carson says she could see a marked improvement in her jawline after one.

“I’m prepared that I may still have to have a surgical neck lift,” she explains. “But I wanted to look at non-invasive procedures first.”

Before meeting Griffin, Carson, 40, says she never thought she would set foot in a cosmetic surgery office.

“I had all these judgments. I thought it was a very shallow, vanity-based thing,” Carson adds.

“Dr. Griffin has challenged and changed my view of what cosmetic surgery is. His view of beauty is diverse. He doesn’t have a Barbie doll aesthetic. His goal is to make you feel better, not just look better.”

Most established cosmetic surgeons in Tennessee, especially the ones with repeat customers over the years, say their work brings personal satisfaction beyond the monetary rewards of a thriving practice. They’re privy to their clients’ most personal fears and insecurities, and often serve as psychologists as well as surgeons.

“I really love working with the people who walk in and they have no self-esteem; they’re beaten down because every message in society is ‘pretty, pretty, pretty,’” Griffin says.

“You have all these swimsuit magazines, and a young girl comes in with no breasts or breasts that are sagging. Intellectually, they know that they shouldn’t let it affect them that much, but it does, and you can do something for them.

“You can help that woman who puts her nightgown on, turns the lights off, slips under the covers and then takes her nightgown off to be intimate with her husband. He’s seen her through all these babies, but she still won’t let him see her naked.

“And it’s the same with the weight loss patients. Now they can wear regular clothes and their self esteem goes from the doormat to out the roof.

“Everybody’s story is a little bit different, but it’s just so much fun to watch patients transform. The older you get the more it’s about life, and not just what you do for your job.”

Bengelsdorf echoes the theme.

“It’s not about vanity,” he says.

“It’s not just some rich person with disposable income trying to look better than they already do. I have these divorced moms who are trying to get back into the dating scene, and they really appreciate what I can do for them with Botox.

“Another very common story is, ‘I’m trying to get back into the job market and everyone around me is so young. I feel like I really need to look younger in order to compete effectively.’

“The stuff I do, people just light up. There are a lot of really grateful patients. It’s very, very rewarding.”

Feeling better goes a long way

Bucy is still recovering from her surgical neck lift about a month after the procedure.

It will take up to six months for the stiffness to completely go away, but her pronounced new chin already looks natural – aside from the stitches hidden by a turtleneck.

Asked for a “before” photo that shows her former neckline, Bucy has a hard time finding one.

“I hadn’t even taken photos of myself in two or three years,” she admits. “It affected my self-esteem big time. All my friends go, ‘Oh, Sheri, I never noticed it.’ And you know what? They’re lying.”

After finally locating a photo, the difference is obvious: she looks both younger and thinner than before the surgery – even though she weighs about the same.

“I’ve been thinking about it for almost 20 years, and I’m so glad I got it done. I don’t have any regrets whatsoever,” Bucy says of the procedure.

“I highly recommend it. It makes you feel better about yourself, and that goes a long way, doesn’t it?”