The Magazine

Implant or Animal?

From nose jobs to liposuction, perfection awaits.

Apr 23, 2007, Vol. 12, No. 30 • By RACHEL DICARLO
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Beauty Junkies

Inside Our $15 Billion Obsession with Cosmetic Surgery

by Alex Kuczynski

Doubleday, 290 pp., $24.95

In the decade since she turned 28, Alex Kuczynski has had an eyelift, Botox, collagen treatments, liposuction on her thighs, and a disastrous Restylane injection that inflated her upper lip to the size of a large yam. After the lip-swelling experience, Kuczynski, a reporter for the New York Times, abandoned cosmetic surgery for good and wrote Beauty Junkies, a droll examination of the modern obsession with cosmetic surgery, its cultural implications, and the horrifying surgical procedures and upkeep some endure in the quest for perfection.

There's the Upper East Side podiatrist, known as New York's "foot face-lift" doctor, who shortens her clients' toes so their feet fit into ultra-skinny Jimmy Choo heels, and injects collagen into their soles so their feet can withstand the brutal pounding of high heels on cement. The podiatrist explains her practice to Kuczynski: "We live in a 15-second culture. That's how long it takes for a man to look at you and decide if he will be in love with you. That's it. And if you're wearing stiletto sandals and your feet look like hell, he's not even going to give you the time of day."

One of Kuczynski's creepiest subjects is Mrs. X in Los Angeles, the wife of an entertainment mogul, whose upkeep "encompasses all her interests: It is her profession, her hobby, passion, and primary relationship." She is a member of the Restylane frequent-user awards program, has her porcelain veneers changed yearly, slathers her skin daily with cow-brain extract, and finds something to be nipped, tucked, or remolded once a year. Among her friends she's considered the norm. She won't give up her age to Kuczynski, but on a good day she might pass for 30--although she has a 33-year-old child from her first marriage.

Some have died on the operating table, including, in a fatal twist of New York irony, novelist Olivia Goldsmith. Goldsmith's book The First Wives Club (later made into a movie) exalts a trio of middle-aged women who, Ivana Trump-style, don't get mad but get everything, and derides as vapid and shallow the younger women for whom their husbands leave them. In real life, Goldsmith entered the prestigious Manhattan Eye, Ear, and Throat Hospital for a chin tuck and went into cardiac arrest after receiving the anesthetic. She died instantly.

Then there's the nonsurgical Botox, a purified crystalline form of poison found in spoiled sausage which, when injected into the face, eliminates lines by paralyzing the surrounding muscles. Botox became something of a household word in 2004 when John Kerry was rumored to have used the stuff to smooth out his furrowed brow. Since then, sales have risen $200 million a year. Since 1997, they've increased by 2,446 percent. American women used to host Tupperware parties for their friends or have the Mary Kay lady come by to show them how to put on their makeup in five minutes or less. Now they have "pumping parties" at which a doctor arrives with a bag full of needles and Botox to inject the host and her friends while they sip vodka and gin tonics or some other calorie-free cocktail.

A whole new lexicon has emerged to describe the world of the improvement-obsessed. There's the "carb face," for those faces that show evidence of ingesting bread and sweets; "trout pout," for overfilled lips; and "Kabuki mask," for an over-Botoxed face incapable of showing expression.

Cosmetic surgery is no longer the exclusive privilege and distraction of the wealthy or famous. Radio shock jocks promote contests in which young, female listeners write raunchy letters describing why they deserve breast augmentation. College girls save their money for cheap liposuction. There are cyber-begging websites like myfreeimplants.com on which women pose topless in hopes that a benefactor will donate a large sum to their cause. The public adores TV makeover shows and dramas about plastic surgery such as The Swan, Extreme Makeover, and Nip/Tuck.

Here are some facts presented by Kuczynski: In 2004, 290,343 Americans had excess fat trimmed from their eyelids--up from 229,092 two years before that. (Evidence that women now reject old glamour in the form of the droopy "bedroom eyes" look Marlene Dietrich and Tallulah Bankhead helped bring into vogue.) Liposuction is Americans' favorite procedure. In 2004, 478,251 Americans had fat vacuumed from their bodies--up 111 percent from 1997. Tummy tucks are up 144 percent.

What precipitated this mass consumption? Part of the explanation is supply and demand. The prices of many surgical procedures have plummeted. Ten years ago you would have been hard-pressed to find a doctor to perform liposuction for less than $7,000. Now, a woman can track one down to do the job for $700. Reluctant to deal with stingy insurers, more and more specialists have made cosmetic procedures the centerpiece of their business. What dermatologist wouldn't eschew haggling with insurance companies over payment for treating plantar warts and acne in favor of an all-cash Botox and liposuction business? A $500 vial of Botox, which takes 15 minutes to inject, brings in more than $3,000 in revenue while delicately removing a freckle might only generate $12 from the insurance company. Similarly, why would a dentist want to make a living treating gingivitis and canker sores if he can bring in $30,000 cash capping one woman's teeth?

Cosmetic surgery has become so lucrative that everyone wants in. In California last year a group of oral surgeons and dentists, though they hold dental degrees and not MDs, successfully lobbied the legislature for licenses to perform facelifts, nose jobs, breast implants, and liposuction. (Governor Schwarzenegger, a sometime consumer of cosmetic enhancements, vetoed the bill.)

Then there are the Baby Boomers who, having reached middle age, are more transfixed with the idea of staying young than any preceding generation. They formed their identities alongside the watershed events of their youth, and many see preserving a youthful appearance as a way of preserving their identity. They also know that one of the factors in professional success is a thin, attractive, youthful appearance. Study after study shows that pulchritude counts in professions it shouldn't: Good-looking teachers, stockbrokers, artists, engineers, and mechanics earn more in their lifetimes than their homely counterparts.

The other half of the equation is pornography. The mainstreaming of pornographic images in everyday life has changed the way women, especially young women, see themselves. Male aesthetic preferences are based, to some degree, on pornography or images derived from pornography, such as lingerie catalogues, comic books, and video games. How else to explain MTV's Real Life: Plastic Surgery, where "girls want to look like Pamela Anderson, not Kate Moss?" If men universally rejected fake body parts, women wouldn't want them.

Then again, as Kuczynski suggests, maybe cosmetic surgery is the new feminism. Being perfectly sculpted and styled from head to toe is just one more way of having it all. Successful women in, say, New York, where every sidewalk is a runway, might feel compelled to meet both male and female standards of achievement: power in the workplace, in addition to being thin, smooth-skinned, and perfectly coiffed and made up. Now more women than ever can strive to earn like Heidi Miller (CEO of treasury and securities services at JP Morgan Chase) and look like Heidi Klum. Whether such a combination spells happiness is another matter.

Rachel DiCarlo is managing editor at the Hudson Institute.