Plastic Surgery Confidential

Cosmetic surgery is now so popular that even young, healthy, attractive women are choosing to be “enhanced.” In a quest for insight into this $13 billion industry, the author—a five-foot-nine, 120-pound 27-year-old—went undercover, asking three plastic surgeons what they’d do to her nose, her breasts, and her, uh, “banana rolls.” The answers were as different as the doctors themselves.

With a swoop of his well-manicured fingers, Dr. David P. Rapaport lifts the lining of my black Calvin Klein underwear—and gives me a wedgie worthy of a grade-school bully. With nothing left to shield my naked flesh from his discerning eyes, I stand in the unforgiving light wondering what the hell I was thinking when I decided to come here.

My mission within this sterile examination room is simple enough: to catch an up-close-and-personal glimpse of a multi-billion-dollar industry. This is my first stop in a series of three consultations with plastic surgeons at various price points. I plan to give each one free rein over my face and body, to discover how far each will go in urging me to alter my objectively healthy, 27-year-old, five-foot-nine-inch, 120-pound figure. Alongside me is a Vanity Fair staffer appointed to pose as my boyfriend while secretly recording the sessions.

Dr. Rapaport, who charges $200 for a consultation, received his M.D. from Tel Aviv University in 1985, trained at the N.Y.U. Institute of Reconstructive Plastic Surgery, and made New York magazine’s 2003 list of the city’s best cosmetic surgeons. His Fifth Avenue offices are lavish, with pristine walls and plush carpeting. My companions in the luxe waiting room include a stunning, Prada-clad Asian woman and multiple photo albums showcasing before and after shots for various nips and tucks.

Now the doctor and I stand in front of the floor-length mirror while he deconstructs the “before” me. “As a Caucasian woman, you probably—if you were doing lipo—would want this brought down,” he says, pointing to my “banana rolls”—his clever name for the part of my rear end that peeks from beneath my underwear lining. “And again, you know, in jeans, to most people … on white women, you guys like to get this down. And we like to see it down.” I gulp, realizing that I’ll never be able to eat my favorite fruit again without thinking of my own ass.

I’ve always thought of plastic surgery as a wealthy, distant relative—one I don’t want to know now, but on whom I might have to rely someday. To avoid dooming myself to a choice between hypocrisy and wrinkled skin, therefore, I’ve refrained from condemning it altogether. Still, it’s hard not to disapprove of what its rise has wrought: the expressionless faces, the cartoonish body parts, the celebrities who look like they’re wearing masks of their former selves.

The roots of plastic surgery are certainly honorable enough. The term derives from the ancient-Greek word plastikos, meaning “to mold.” The earliest recorded examples date back to 600 B.C., when the Hindu surgeon Sushruta developed techniques for repairing mutilated faces. It was not until the mid-19th century that the aspirations of plastic surgeons swayed markedly toward superficial ends, when anesthesia became more widely available. New techniques were developed in the mid-20th century, in response to the needs of wounded veterans from World Wars I and II, but even then the emphasis remained on healing, not on enhancing.

Fast-forward to the present. In 2007 alone, Americans spent $13 billion on 11.7 million cosmetic procedures (both surgical and nonsurgical). An ongoing controversy over what qualifies as “cosmetic” makes it difficult to determine the number of treatments that were purely restorative, necessitated by third-degree burns, mastectomies, and other medical issues. But what’s clear is that the overall number of men and women undergoing cosmetic procedures in the U.S. has increased by 457 percent since 1997, when relevant statistical data was first collected. As many as one in 20 people today reportedly suffer from Body Dysmorphic Disorder (B.D.D.), a sort of “imagined ugly” syndrome. While difficult to diagnose, plastic-surgery addiction is often linked to B.D.D. Dr. Barry Eppley, who writes a blog titled “Explore Plastic Surgery,” estimates that one-third of plastic-surgery patients will eventually return to have additional work done.

As elective plastic surgery becomes more prevalent, it’s becoming acceptable at younger and younger ages—or so it seems. The data suggests that the percentage of patients aged 19–34 has hovered close to 20 percent over the past few years, and that the proportion under age 18 has remained near 2 percent. But there’s no escaping the example of young celebrities such as Britney Spears, Lindsay Lohan, and Blake Lively—all rumored to have gone under the knife before their 21st birthdays. Is cosmetic surgery becoming a shortcut to self-esteem for people who are too young to know better?

When I began this project, I was relatively certain that I didn’t need plastic surgery. I also suspected that plastic surgeons might tell me otherwise. To test my hypothesis, I went undercover. In the process, I hoped to learn something about what happens inside examination rooms across New York City and, by extension, the United States. Are teenybopper idols and those who emulate them freely choosing plastic surgery? Or is plastic surgery choosing them?

Back in the Upper East Side exam room, Dr. Rapaport pinches me from shoulders to knees before concluding: “You look absolutely nice, but, even if I were a blind guy and put my hands here”—he seizes my sides—“there are little lumps. This could be brought down just to give you a little bit better of a curve.” These lumps, I learn, are my “waist wads.” To his credit, Dr. Rapaport does note that my “waist wads” are “borderline.” But, he says, “I’ve done supermodels with much less than this. To them it was important. To each his own.”

Having reviewed my figure to his satisfaction, Dr. Rapaport recommends liposuction on my outer thighs, love handles, and banana rolls, which will set me back about $8,000. He also raises the possibility of sucking the fat from my inner knees but does say after more pinching that they’re actually “quite empty.”

The good news is that the lipo can be done at the same time as my breast augmentation. The doctor boasts that he is one of few in possession of an Axis Three visualization system, a state-of-the-art digital-imaging program that can display the 3-D outcome of my boob job in the next room—but only after he finishes with me here.[source]

“You’re a 34B, and you want to be aaaaa … ”