Today, much has changed. Far more people talk openly about the procedures they’ve had (though many still won’t, and some, like Sharon Stone, who sued a plastic surgeon for implying that she might have had work, shudder at the very suggestion). My patients rarely feel the need to disappear for weeks, so they can return to their hometown looking refreshed. In 2004, according to the American Society of Plastic Surgeons, 9.2 million cosmetic surgery procedures were performed in the US, a 24 percent jump from the year 2000. During the same period, the British Association of Aesthetic Plastic Surgeons (whose figures only cover their own members and not nationwide figures), over 16,000 procedures were carried out, an 18 percent jump since 2000. 22,000 were carried out the following year, marking a 37 percent jump between 2004 and 2005. Comparing 2005 to just one year before, almost all major cosmetic surgeries in the UK increased markedly: breast augmentation was up 51 per cent; surgery on the eyelids, 50 percent; face/neck lifts, 42 percent; rhinoplasties, 35 percent; brow lifts, 35 percent; otoplasty (for the ears), 28 percent; liposuction (major), 25 percent; abdominoplasty, 24 percent; liposuction (minor), 10 percent; and breast reductions, 9 percent. And because of recent technical and medical developments, which have led to the popularity of nonsurgical, outpatient procedures such as “injectibles” (unfortunately not recorded in the UK, but in the US in 2003, such minimally invasive procedures jumped 43 percent over the previous year, a clear indication of UK trends), the decreased cost of beautifying and enlivening one’s looks, particularly in the face, is increasingly attracting the non-wealthy. Those who might once have chosen a forehead lift (average US fee, $2,800; average UK fee, £3,000) are opting instead to get a Botox injection ($375 every five months in the US; £350 in the UK).*
Yet despite the more accepting attitude toward cosmetic surgery, and despite the booming business my profession is enjoying, the surgeon – the good one, anyway – remains behind the scenes. For most patients, the goal is subtlety, and the doctor who delivers subtle results is greatly appreciated – discreetly.
To repeat, then: Why would a doctor like me write an exposé?
Because of my experience as a plastic surgeon and my particular skill – to reposition the skin and tissue of the face, to sculpt fat, to reverse the residuals of pregnancy, and to undo some of the other changes wrought by time – I have come to see, hear, and understand an extraordinary amount about the range of our dreams and disappointments, our motivations and fears. Two decades of solo plastic surgical practice have exposed me to the yearnings of the human heart. While I’m a technician who transforms his patients physically, I also bear witness to their psychological transformation, which frequently starts before the bruising has resolved. For instance, a woman having breast augmentation often sees such a radical upswing in confidence and body image, she makes another dramatic change: new boyfriend, new job. Why? Often, her man becomes more interested in her – way more. Indeed, a husband may become so infatuated with his wife’s new breasts that she may perceive his lust as weakness. She may lose respect for him. I can’t count how many times I’ve seen it happen.
On the other hand, couples that come in together for cosmetic surgery – a small but not insignificant part of my practice – almost always display some of the healthiest relationships and long-term intimacy I’ve ever encountered.
Like it or not, I’m exposed to my patients’ lives before, during, and after surgery. You know many of them from magazine covers, movies, and TV. Some of them walk the fashion runway. Some run for office. Some are royalty. Some are rock stars. Some are socialites. Some are international tycoons. You’ve seen their boldfaced names, or those of their spouses, in the gossip columns and the business pages. My practice is located in the epicenter of the plastic surgery world – an eight-block stretch along Park Avenue between Sixty-fourth and Seventy-second streets where the major players have discreet offices that cater to (among others) the wealthy, the famous, and the beautiful.
And the often unhappy.
I am not a psychiatrist, nor do I have Oprah’s gift for empathy. I am not overly warm and fuzzy – an occupational necessity rather than a character flaw. But I have sat and listened and tried my best not to judge as prospective patients have come into my office and shared with me their aspirations, the physical attributes that haunt them, and other insecurities. They tell me their stories, proving that even the most successful, attractive, and seemingly aloof people suffer many of the problems that haunt all of us, regardless of status. We all share the identical fears about appearance, age, and time. We worry that our looks or aging will lose us love, security, desire, or sexual attractiveness. He can’t get the movie role he wants. She can’t get a date. He’s been working out for six months and still has an abdominal roll. She comes to me after a divorce or on the eve of menopause. He comes to me not long before he’s up for a promotion, or right after he doesn’t get it. She’s about to cheat on her husband, though he doesn’t know it; in fact, she doesn’t yet know it. (What else am I to make of a comely young woman, half-French, half-English, who repeatedly complains to me about her investment banker husband, and who describes her intensive spinning class and free-weights regimen – her first serious exercise since giving birth five years before – and yet insists that the face and breast surgery she desires are “only for herself”?)*
Many of my patients are between forty and sixty, with the rest divided evenly between those older and younger. Women are particularly vulnerable during these decades. Their childbearing years are nearly over. Their kids are getting older. Their parents may be dying. They’ve become the elders, the generation in charge. Patients sit in my consult room and tell me things not even their husbands or girlfriends or best friends know. Essentially, they want me to restore a lost youth, back to when they were nineteen, or twenty-six, or thirty-five, or forty-seven. Their determination to rediscover happiness and self-assurance supersedes all else. “If I don’t look good after this face-lift,” said Lee, the seventy-year-old who shrugged off the heart attack she’d had immediately following her operation, “then nothing matters.”
I maintain a familiarity with my patients for brief periods or for much longer. Frequently, I get to know them well – maybe too well. I become friendly with many, travel with them, attend their weddings and even those of their children. Sometimes I’m invited to their post-divorce parties. It’s no wonder such a bond should form between patient and doctor. In doing something so intense and personal, and which can palpably improve lives, I can’t help but achieve a closeness unusual for doctor and patient. For my patients’ part, they can’t help but reveal themselves candidly to me. Part of this intimacy stems from the fundamental difference between elective and nonelective surgery. By the time prospective patients have chosen to appear in my office, they’ve thought deeply about personal and often painful subjects – their self-perception, how others regard them, and their goals.
During our introductory consultation, the patient and I will share pleasantries, then she’ll switch gears. For example, Renee, forty-two, suddenly tells me, “I’m meeting my old high school boyfriend next week, and I don’t look as good as I want to. Can you do a liposuction of my abdomen and legs and fat grafts for my lips in time?” (I can.) Or Frank, a New York TV anchorman, orders me to make him look younger by removing the fat