Before Christmas, I visited a plastic surgeon for the first time. I had become intrigued by an ad I'd found at the back of New York Magazine. "Don't Leave Your Butt Behind," exhorted the copy on the bright blue background. Next to it was an image of a thin white woman's shapely posterior, with some maroon MacPaint-style lines snaking around her like a crudely drawn thong. "If you always wanted rounder and fuller buttocks," read the ad, "you may be a candidate for the newer technique of Fat Transplantation, as presented by Dr. Lefkovits on NBC-TV."
A couple of phone calls later, I discovered that Fat Transplantation into the buttocks means that a qualified physician Hoovers up some extra flesh from your love handles, thighs, back or belly, and then surgically deposits it into your rear. In short, it's surgery to make your ass fatter.
Yes, fatter. Until a few years ago, having a big rear was a physical fate women were desperate to avoid. I realize that the cultural ideals for female beauty mutate with an alacrity that makes them impossible to chase down. The ideal body image imprinted on my brain during adolescence belonged to the crew of stoned sylphs that called Kate Moss their chief. But that ideal is long past, thanks to Jenny, and her, um, block. These days, babies want back. Even me. After years of wolfing down cheese steaks and quietly internalizing the notion that my ass (along with the rest of me) was considerably fatter than it should be, I've now found the tables turned. The new big-bottomed aesthetic leaves me feeling puny, flat, and after all these years, too skinny! (A moment of silence, please, for how badly society has screwed some of us up.)
It was probably this schizophrenia that led me to the Upper East Side and the mezuzah-affixed door of Dr. George Lefkovits. His ad had been admittedly creepy; I found it unlikely that a medical pioneer would be shilling just beneath an ad for something called "Sensual Aesthetics." But I was professionally curious about this potentially groundbreaking new medical procedure and besides: I wanted an expert's opinion on my ass.
"I am fascinated by the buttocks, period," Lefkovits told me as soon as I sat down in his office. "I find the buttocks, very, very interesting." The 54-year-old doctor, trained at Georgetown and SUNY Downstate, has also worked at Long Island Jewish Medical Center, Lenox Hill Hospital and Manhattan Ear Nose and Throat Hospital. He is a member of the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgeons, and has been board-certified since 1983. He also looks and sounds like Judd Hirsch, if Judd Hirsch were much shorter and quite grave.
"Many, many women are bothered by their buttocks," he went on, noting that depending on how the media and pop cultural wind is blowing, those women might be "bothered" that their buttocks are too big, too small, too low or too high. "There are round buttocks, flat buttocks, high and low buttocks, square buttocks, all imaginable shapes of buttocks," said Lefkovits, the Bubba Gump of Cosmetic Surgeons. "Now, what people want is the fuller, rounder buttocks, because of Jennifer Lopez."
But butts have long been one of plastic surgery's problem areas, and those who have wanted their duffs puffed have been forced to turn to implants. And we need only recall the case of exotic dancer Mary Gale, who successfully sued her plastic surgeon for putting breast implants in her butt, resulting in two breast-shaped buttocks, to realize how bleak those prospects have been.
According to Lefkovits, implants can be inserted above or below the gluteal muscle. It's easier to install the ones that rest above the muscle, but, said Lefkovits, these frequently slip or become hard and very visible. Lefkovits preferred to insert the implants below the gluteal muscle, but explained that that procedure cuts awfully close to the temperamental sciatic nerve, and results in a painful post-operative period. Additionally, because the muscle compresses the implants, results are not eye- or seam-popping.
"So after I've done all that work," he said, "the projection is not enough, plus it's not a real buttock and it doesn't feel good if someone wants to grab you down there."
As I listened to the doctor's menschy voice, I considered my own ass, on which I'd been sitting for almost half an hour. Was my projection enough? Would it feel good if someone wanted to grab me down there? I've known women who have had magnificent, epic asses. Take my friend Ali: a tiny white girl who shows extreme Charlotte tendencies, she carries around a big old round butt that consistently draws compliments and stares. It gives her ballast; it suggests an earthy sensuality in contrast with her prim upper half. It looks good in jeans, and even better in the tailored slacks and tennis skirts she's been known to favor. It kicks my ass, which is just fine, but definitely not Homeric. I don't really know from "projection," but I was guessing that Ali had it in spades.
"Butts are this secretive lust that women want fulfilled," Lefkovits was saying. "People interested in having their buttocks done are actually more embarrassed to talk about it than about their breasts." But, he said, they're getting over it: Lefkovits performed over 50 butt-fat transplants last year, and expects that number to double this year. "More and more women want them done because you know, it doesn't look nice if you have a C cup and then a flat behind." Well thank God I don't have a C cup!
So two years ago, Lefkovits began recycling unwanted fat by converting it into extra junk for the trunk. He harvests the fat -- using specialized instruments that he's still perfecting but which are basically elephantine hypodermic needles -- and carefully gets as much blood out of it as possible, rendering it pure. Lefkovits then squeezes approximately 400 milliliters -- around three-quarters of a pound -- of the schmaltzy goo back into each buttock, "getting the fat into the different tunnels to create a spheric shape." The procedure costs $7,000.
Dr. Lefkovitz provides patients with postoperative panty-girdles and a series of massages over a period of weeks that he said help with contouring and prevent calcification. I wasn't really listening to the massage and girdle part. I was imagining what a truly spheric ass might look like. I snapped back in time to hear him bellow, "When I'm done, when someone grabs you back there, it's pure fat!"
But not for long. The major problem with buttock fat transplantation is that when the fat -- fat which had stubbornly refused to leave its original home despite strenuous exercise and regimented diet -- is plopped unceremoniously into an ass, deprived of its own blood flow, it tends to shrug its shoulders and wander off. More precisely, about 50 percent of transplanted fat gets reabsorbed by the body, taking a patient's perfect sphere of pure fat with it. Lefkovits deals with this teensy setback by telling his patients that should they be unhappy with the results, he will repeat the procedure gratis (except for the operating room charges and anesthesia.) He said he does second operations for about 30 percent of his patients.
In a procedure so riddled with irony, the greatest is this: many of the women who want their hindquarters enlarged do not have enough fat on the rest of their body to do so. "Two days ago, I had to tell a patient that you don't have enough," he said. "It was sad because actually, she was quite flat back there."
Lefkovits said that despite the drawbacks, the demand for the procedure is growing. He attributes it to the "J.Lo effect": Everyone wants a posterior as prodigious as the Bronx-born diva's. It's also a question of ethnicity: black and Latino cultures have their own sets of standards for female beauty, and they have traditionally involved large behinds. Many of Lefkovits' patients are of Latin or African American descent, but he said that he sees an increasing number of white women, and a handful of men too.
In his examination room, he pulled out a photo album full of Polaroids of naked butts. He pointed out a couple of truly terrible cases: a woman whose botched implant job had left her looking like a cartoon character who had swallowed 20 tennis balls. Then there was a butt that had a 3-inch depression smack in its middle, as if the patient had perched on a fence for a decade. But mostly, as Dr. Lefkovits flipped through the images, clucking sadly over the "badly defined creases," "uneven distribution of flesh," "dimpling," "unattractive depressions on the side of the buttock," and "concave lines," I saw a bunch of butts that looked pretty ordinary to me. And the more ordinary these "problem" asses looked, the more extraordinarily flawed I began to realize my own bottom half must be. I began to wonder whether my ego could handle a butt evaluation from Lefkovits.
Fat transplantation is the No. 3 procedure in Lefkovits' office, behind liposuction and breast augmentation. That frequency, he admitted, can mostly be attributed to his claim that he is currently one of the only doctors in New York who will do the operation. "Most plastic surgeons are not attentive to the buttock," he said with a mournful shake of his head. "It's a neglected area."
But I couldn't imagine an outrageously expensive body-tinkering fad from which New York doctors would shy away. They are not exactly puritanical.
Dr. Stephen Colen, an associate professor of plastic surgery at New York University Medical Center and the chief of plastic surgery at Hackensack Hospital in New Jersey, was happy to tell me what he thought of fat transplantation for the buttocks. "This is a fringe type of thing that you're not going to find with [doctors] who are legit," he said, pointing out the problematically high reabsorption rate and impermanence of the operation. When I explained that Lefkovits had come clean with me about the risks of reabsorption, Colen laughed and said, "Yeah, but he's still taking people's money to put fat in their buttocks."
Manhattan-based plastic surgeon Dr. Alan Matarasso agreed with Colen about all of fat transplantation's drawbacks, though he admitted that "this is an area that is of interest to people now." In fact, Matarasso, who is a senior editor at the Aesthetic Surgery Journal, said that the magazine is working on a survey of buttock augmentation procedures that will include fat transplantation.
Dr. Gerald Imber, an attending plastic surgeon at New York Presbyterian Hospital, said, "I know about the procedure, but not in a positive light." He hit on the whole pesky reabsorption issue again before continuing, "I would guess that very few people would take this seriously at this point." He asked whether or not Lefkovits has published on this topic before (he hasn't, but says he plans to) and sniffed, "Most of us publish things first."
I was beginning to think that my butt-fat buddy was a fraud.
But then I heard from Dr. Rod Rohrich (his real name!), the president of the American Society of Plastic Surgeons and the chairman of the plastic surgery department at the University of Texas Southwestern Medical Center in Dallas.
"It's nothing new," Rohrich said with a laugh, after I'd told him about Dr. Lefkovits and about the scoffing I'd heard from other surgeons. "That's just something we call the Jennifer Lopez procedure. It's the fad of, Now we want bigger butts." Rohrich sounded a little weary. "A very good way of doing buttock augmentation is with autologous fat. That's the patient's own fat, and it's good anytime you can use a filler that's the patient's own material." As for the question of reabsorption, Rohrich said, "Well, as long as you're honest and upfront with your patients that they may need to have it done once or twice."
Rohrich has even performed the operation himself, though not often. The problem as he sees it is that the procedure is more popular now because of J.Lo. "It's a fad," he said. "And as with most fads it will dissipate. Most women in America don't want big buttocks. The popularity will dissipate and so will the buttock. In a year or two we'll be seeing the same patients to take the fat out." Rohrich sighed again, as if predicting an end to the Age of Man.
So Lefkovits was redeemed. Sort of. Not that his credentials had mattered all that much to me as I stood in his office a few weeks before, self-consciously trying to work up the nerve to get him to look at my butt. He was smiling at me, twisting in his chair. I asked him whether or not he thought of women he passed on the street as potential patients. Did he size up their flaws? Determine how their aesthetic value could be upped?
"You can't help but notice those things," he said. "Sure, every once in a while I think, that person could be so much more attractive if ..." I asked him if he had ever gone under the knife himself. He nodded, indicating his eyelids. I asked whether his family has had nips and tucks. "My wife and her family think nothing of getting surgery. It's like having a cappuccino for some people."
In the end, I didn't ask him about my own butt. I'd done the mental math and figured out that it surely lacks projection, attractive creasing, shapeliness or whatever. My inner Sybil already knew that I'd be spending the rest of the day -- week, season -- craning and twisting in mirrors, trying to get a good view and compare it to my memories of the "problem butt" snapshots.
I didn't ask the controversial, fringey Lefkovits for my complimentary consultation because I don't need to spend the rest of my life knowing what's wrong with my ass. I'd miss all the fun of obsessing about it myself.