Stars and the Scalpel

Fashion Wire Daily NY December 26, 2001 - Can we talk? Joan Rivers, the self-proclaimed arbiter of Hollywood style, talks as much about her own plastic surgeries as she does about other stars' fashion gaffes. But while famous folks like Rivers, Phyllis Diller, Michael Jackson and Jocelyn Wildenstein (aka The Bride of Wildenstein) can pass off their multiple body modifications as aesthetic adventurousness or a plain old sight gag, there's a fine line between people who get numerous nips and tucks, and those on a compulsive quest for perfection.

Two-thirds of cosmetic surgery patients are repeaters, according to a survey conducted by the American Society of Plastic Surgeons in 2000. For some, especially those in the entertainment business, it's merely a fact of life. And even for the average American, the stigma attached to a little beauty maintenance work now and then has all but fallen away.

But as plastic surgery gets closer to the norm, the standards for what is extreme have been redefined. "Jocelyn Wildenstein's surgeon is a friend of mine," says John Grossman, MD, a plastic surgeon in Denver and Beverly Hills who counts Dolly Parton and Cher among his clients (Cher is said to have had a breast enlargement, a nose job, a tummy tuck, a butt lift, a face lift, cheek implants and liposuction). "If you look at [Wildenstein] or Michael Jackson, who is so incredibly grotesque, you can't help but wonder what plastic surgeon would keep operating on them. But under both circumstances, as you develop a relationship with a patient, you can convince yourself that it's not up to you to be the arbiter of what's attractive. This woman thinks being a cat woman is attractive. She seems to be saying it's fine. Michael Jackson knows he's very artistic and aesthetically attuned to what he wants himself to look like."

But many plastic surgeons feel an intense obligation to keep those desires in check, even for their famous clients. "I have one patient who is a model in New York City," says Brian Maloney, MD, a plastic surgeon in Atlanta. "I suggested that she get help because she had a bigger problem than wanting me to make her lips fuller. Here was someone who is fixated on the appearance of her lips but the rest of her was emaciated. At my suggestion, she enrolled in an eating disorder program."

Multiple liposuctions, breast-reduction surgeries, chemical peels and collagen implants are all signs of an unhealthy pursuit of perfection, says Robert Butterworth, PhD, a psychologist in Los Angeles who admits to having his chin done. "Originally people got plastic surgery to look younger and more rested," he says. "What's happened lately is that people are looking at plastic surgery as a way to change not only how they look but their personality. They're saying, 'I want to look like her or him.' That's where it's different. It's not just to enhance what you've got."

To get a sense of a person's psychological preparedness, plastic surgeons largely rely on their own experience and that of their staff as to how the patient behaves when they come in for an appointment. "There are certain characteristics among people who aren't good candidates for plastic surgery," adds Dr. Grossman. "If they're overly demanding or overly picky, I might not take them on as a patient. It's not tough to turn them away because you recognize that these people can ultimately be a threat to your practice."

Plastic surgeons also consider it a red flag if you come in with a picture of the celeb you want most to resemble, says Stephen J. Ronan, MD, a plastic surgeon in the San Francisco Bay Area. "Most times it's okay if she says, 'I want those breasts' or 'I want my lips to be full like hers.' It's when she says, 'I want to look like this person,' and she is 50 pounds heavier than the actress or has a completely different facial structure that I wonder if she thinks she's going to be a supermodel once she has lipo. I try to never operate on that kind of patient."

Most plastic surgeons welcome patients to come in and talk about their expectations before a surgery date is ever scheduled. And you usually don't have to pay for such a consultation. "Half of what I do is psychiatry," says Maloney. "I really want to understand where she's coming from. Is she trying to save her marriage or job? Or is this just a solid person who feels 25 on the inside but 45 on the outside."

But there are people for whom no number of operations solves the problem they perceive about themselves. "The problem is in their head and not their anatomy," says Grossman. "There is no level of perfection that will satisfy them. The request for multiple operations on the same area or other is a symptom of something far deeper."

In the end, every plastic surgeon should probably have a psychologist on their payroll, says Butterworth. "Plastic surgery junkies need to think about why they keep wanting more work done. Obviously it's much easier to change your outlook on life than it is to change your external look," he points out. "And if you have surgery thinking you'll resemble a celebrity and don't end up looking like Britney Spears or Tom Cruise, you're in for a big disappointment." But take heart: It's more likely than not that the stars you're aiming for have gone under the knife themselves-even Britney.

Dr. Ronan is Board Certified by the American Board of Plastic Surgery. His specialty is aesthetic or cosmetic surgery. If you would like to discuss this or any other aesthetic procedure in detail, please call (925) 736-5757 or email us for a complimentary consultation.