Beauty Knows No Pain

Building a Better Body at the 28th Annual Session of the American Society for Aesthetic Plastic Surgery

"Are you here for the convention?"
The inquiring woman behind the registration table at the San Francisco Marriott seems not to notice that the video monitor beside her is oozing gore. On the monitor, an anesthetized patient's face is being sliced open like a mango, exposing a rubbery layer of underlying muscle along the chin line. The camera gamely zooms in for a close-up, and for several moments, the monitor is completely filled by what looks like red throbbing gristle.

"Sir?" the woman asks again. "Are you here for the convention?"
"Uh -- oh, sorry, yeah," I reply. "I was just watching --"
"Here," the woman says. "Have a program."

Thanks. I had the feeling this convention -- the 28th annual meeting of the American Society for Aesthetic Plastic Surgery -- would be the sort of gathering where you wouldn't be able to identify the blood-splattered internal organ without a program.

The Marriott's Golden Gate Ballroom has the expectant buzz of a concert hall just before a big show. Which is only appropriate, since plastic surgeons are in many ways the rock stars of the medical profession. They live the good life, play the lead role in pulsating videos that are often difficult to watch and make their living by deliberately breaking the rules. In the plastic surgeons' case, the rule they regularly break is the central tenet of the Hippocratic Oath: First, do no harm. Cosmetic surgeons make their nut by taking perfectly healthy people, and first, doing them harm. They are men of science (and they usually are men) who have elevated the dissembly and reassembly of human beings into an art form. Their income ranks among the highest of any medical specialist, averaging $180,000 per year net, with the top practitioners often making in excess of $1 million. And like rock stars, plastic surgeons have an increasingly difficult time separating their "art" from commercial pressures. They don't like to think of themselves as being motivated by money, and they will go to great lengths to mask that reality not only from the public, but from themselves. Yet at a convention, surrounded by their own, plastic surgeons begin to let what's left of their hair down. An early sweep of the convention hall reveals a crazy quilt of shop talk.

"You look like you got a tan," says one surgeon.
"Oh yeah," replies his younger colleague. "We were skiing in Jackson Hole for five days."

"Was it cold?"
"No, it was almost too hot ..."
"... You know what I mean -- they have throat cancer and they just have that look," says another doctor, continuing a second conversation.

"... No, no, you separate it entirely from the gland," says a surgeon in a third discussion.

"Entirely?" asks his colleague.
"Completely," the surgeon replies, with a note of finality. "Then you fold the breast over." The surgeon makes a motion with his hands as though he were flipping an omelet.

Dozens of "before" and "after" photos of plastic surgery patients line the walls of the exhibition booths like mug shots at a post office. The surgeons ignore the photographs, probably because they've seen them all before. And after. The droopy, world-weary faces of the "before" shots, taken from unflattering nose-hair angles with the camera flash set to "stun." The finely sculpted, doll-like faces of the "after" photos, the lighting softly caressing the raised cheekbones, the skin lovingly airbrushed to remove whatever blemish the scalpel couldn't excise. For some subjects, this was not their first time under the cosmetic knife. As such, their before shots were actually after shots from previous surgeries, forming a continuous Msbius strip of before and after, after and before.

The American Society for Aesthetic Plastic Surgery (ASAPS) represents about 1,100 plastic surgeons nationwide, and most of them seem to have made it to the Marriott convention. Every year, the group meets at an appropriately serious venue (next year's meeting is already scheduled for Walt Disney World) to view new surgical equipment, attend scientific presentations and, most of all, rub padded wool-blend shoulders with their distinguished colleagues. Many of the older surgeons look like Germany's Chancellor Helmut Kohl -- slightly paunchy in a prosperous Bavarian way, with swept-back silver hair, a ruddy face and an aura of authority that hangs over them like expensive cologne.

The younger surgeons in their late thirties and early forties look tanned and dashing, as though they had recently returned from Club Med vacations on their own private planes. In a way, it's not surprising that certain physical features predominate among plastic surgeons -- the profession is an exclusive members-only gene pool. At this convention, affirmative action is just another Sunday-morning talk show topic. Among nearly 1,000 attendees, I count fewer than a dozen female surgeons and even fewer African Americans. You'd be hard pressed to find this many white males in one room anywhere, unless you dropped in on the U.S. Senate in session.Many of the wives and girlfriends accompanying the conventioneers display the taut, vaguely Cubist features that are the hallmark of repeated plastic surgery. One woman in particular -- a striking blonde in her late twenties -- causes quite a stir. She sports iridescent skin pulled so tightly over her cheekbones it looks like Saran Wrap, and a pair of gravity-defying breasts that jut straight out of her chest, like Amazon breastplates. Picture Total Hair Barbie with implants.

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