Beauty Knows No Pain

As the silicone breast controversy demonstrates, the growing popularity of plastic surgery hasn't necessarily made it safer. A medical newsletter available at the convention tells of overzealous facial liposuctions that have resulted in a jut-jawed condition known as "the Dick Tracy effect." Another saga in the newsletter describes an improperly liposuctioned woman "who said that she could reach down to her mid-thigh, grab a handful of skin and pull it up to her groin ... these people simply plop like an old pair of golfer's pants." Plastic surgery's acceptance has been fueled more by social dynamics than scientific advances.

Perhaps as a peace offering, the McGhan booth distributes the best freebie of the convention -- a canary-yellow tote bag emblazoned with the company name. By convention's end, practically every surgeon is carrying a McGhan tote, a weird sight for a group of professionals who earn in the six figures. But as KQED discovered decades ago, few people can resist the lure of a free tote bag.

Media images of beauty have been an indispensable catalyst in the plastic surgery explosion. In Hollywood, plastic surgery is considered to be a rudimentary precondition of employment, like taking the gum out of your mouth before a job interview. Meanwhile, television mindlessly supports cosmetic surgery as a transformative experience. Before and after shots are a regular staple of afternoon talk shows, and only occasionally are risks explored or even mentioned. Celebrity books regularly exalt the regenerative powers of plastic surgery. Dolly Parton's recent autobiography even thanks her many plastic surgeons by name and supplies an 800 number for plastic surgery referral. Barbara Walters' TV specials serve as soft-sell infomercials for plastic surgery, with the tastefully nipped-and-tucked interviewer regularly sitting down to chat with surgically altered stars. Many women's magazines are shameless boosters of cosmetic surgery, with breathless accounts of new "breakthrough" procedures surrounded by -- surprise! -- advertisements for plastic surgeons. Even Cosmopolitan, which occasionally reports on the risks of plastic surgery, features a cover model every month whose Himalayan cleavage sends a very different message.

The American media images of beauty are so Western that some ethnic clients have turned to the knife in a sad attempt to assimilate. There are eye operations for Asians that make the eyes look rounder and procedures for Latinos and African Americans to narrow their noses, making them appear more Caucasian. The illogical extreme of this surgical ethnic cleansing is represented by Michael Jackson, who has managed to obliterate his race and now appears to be working on becoming a different species.

The surgically enhanced body is such a common media presence that it's become the standard for comparison. It's little wonder why so many people are dissatisfied with their God-given bodies when Science promises to do God one better.

Back at the Marriott, the convention is in full swing. Scientific lectures and papers are being presented in the Buena Vista Ballroom, raising topics ranging from "Facelifts -- Are We Going in the Right Direction?" and "Aesthetic Lip Augmentation -- An Art Form in Progress" to "Blepharoplasty Update -- The Good, the Bad and the Ugly." One scientific presentation, "Surgical Management of the Cocaine Nose," presents what must be a dream assignment for a plastic surgeon -- a patient wealthy enough to blow a hole in his septum through repeated cocaine use and still have enough money left over to afford plastic surgery. The Partnership for a Drug Free America should dump that advertisement of the fried egg sizzling in the pan and instead show a cocaine-ravaged nose being peeled open with surgical retractors. This is your nose during rhinoplasty -- any questions?

In the exhibition hall, much of the talk centers around what the medical profession euphemistically terms "building the practice" -- what most people on the other end of the stethoscope would call "drumming up new business." With elective surgery, there's a fine line between serving a need and creating needs, a line many plastic surgeons have long since crossed.

"The plastic surgery pie is being sliced in so many more pieces," one surgeon complains to his colleague during a coffee break, using an appropriately invasive metaphor. "There are so many other doctors getting into it that it's gotten much harder to build a practice."

He's right: Any licensed physician can legally call himself a cosmetic plastic surgeon and needn't have ever performed -- or even watched -- a single cosmetic operation before picking up a scalpel. Attempts to restrict entry into the field have been rebuffed by the medical lobby, so today eye surgeons do brow lifts. Ear, nose and throat surgeons perform facelifts and rhinoplasties. Dermatologists perform derm-abrasions.

Turf wars have erupted between the rival camps. Plastic surgeons who have been "board certified" by the American Board of Plastic Surgery (ABPS) usually insist that they are the most qualified to perform cosmetic surgery. To be certified by the ABPS, doctors must have completed three years of surgical training, two to three years residency in plastic surgery, at least two years of plastic surgery practice, and a written and oral examination in the field.

"I think board certification is extremely important," says Dr. Brunno Ristow, an ABPS-certified San Francisco plastic surgeon, who says his patients range from socialites to "a woman who sells hot dogs at Candlestick." "Board certification shows that a surgeon is proficient in several areas. But simply being board certified doesn't mean you're brilliant. And not being board certified doesn't mean you're a crook."