Dermatologists making deeper cuts into domain of cosmetic surgery.(Knight Ridder Newspapers)

MIAMI BEACH _ The sucking sound fills the room, a menacing hiss. The patient, supine on an operating table, eyes the doctor calmly as she prepares to mine the fat from his belly, swollen now with four liters of anesthetic, lined with black felt pen like a topographic map.

"It's an elegant procedure. Like playing the violin," says Dr. Helena Igra, a dermatologist and cosmetic surgeon based in Miami Beach.

Igra fiddles with the source of the hiss, a cannula, which resembles a knitting needle with holes, and pushes it through an incision in the patient's stomach, quickly weaving back and forth. The skin tents. There's a gurgle, then a swish. Fat appears in the cannula's tube, looking exactly, as Igra notes, "like chicken fat in a blender," and steadily makes its way to an attached, sealed jar.

The patient may feel "like a water balloon" now, but in three hours, two fewer liters of fat will occupy his body, and he'll be able to hop off the table, saunter out of her office and head straight home.

Like increasing numbers of people nationwide _ some 814,000 last year, up 20 percent from the year before _ this man, a 54-year-old engineer from Miami who wished to remain anonymous, has chosen a dermatologist over a plastic surgeon to do away with stubborn pockets of fat. He wanted a quick fix for his blossoming belly and love handles, what Igra describes as "genetic, diet-resistant, exercise-resistant fat."

According to noted cosmetic surgeons, the surge in demand for their services has sparked an anxious outcry from plastic surgeons, who usually perform heavy-duty surgeries like face-lifts, or facial reconstruction.

"There's enough to go around," said Igra. "Unfortunately, the plastic surgeons feel threatened by us."