Just in case reading Alex Kuczynski's "Beauty Junkies: Inside Our $15 Billion Obsession With Cosmetic Surgery" wasn't enough to convince me that the plastic surgery craze has saturated society, my mother called me a few days after I started the book to cheerily announce she had made an appointment to get veneers put on her teeth.
My mom, a wiccan who wears clogs and writes poetry in her spare time, is not exactly the Joan Rivers type. But 50-something years of hating her teeth has driven her to the ranks of Faye Dunaway, Ben Affleck, Tama Janowitz and countless others whose smiles are veneer-perfect. She's still a far cry from Michael Jackson or Jocelyn Wildenstein, the New York socialite who had plastic surgery to make her face appear more feline, but that's exactly Kuczynski's point; growing numbers of Americans are opting for a cosmetic fix. As she notes, in 2004, almost 12 million surgical and nonsurgical beauty procedures were performed in the United States. That's up 44 percent from the previous year and includes 166,187 nose jobs, 290,343 eyelifts, 478,251 liposuctions and 334,052 breast augmentations -- a surgery that has become so commonplace it may have contributed to an increase in the average bra size from 34B to 36C over the past 15 years. And then there's Botox, injections of botulinum toxin A that can paralyze muscles in the face and erase wrinkles -- which are up 2,446 percent since 1997.
Lest we get bogged down by the numbers and worry she's penned some kind of alarmist polemic, Kuczynski blithely assures us she's not out to shame us for our obsession with beauty. She notes that it was helpful for her, when attending plastic surgery conferences as part of her research for the book, to offer up her own work -- then the doctors and pharmaceutical reps "don't think you are a confrontational reporter hoping to root out the evils of vanity. By telling them you've tried Botox or lipo, you are saying that you're one of them. You understand. You've been converted."
Kuczynski, the author of the New York Times' "Critical Shopper" column, confesses to a Botox habit that started at age 28 in this part memoir, part exposé, which has been both anticipated and mocked (often in the same breath) for what seems like an eternity at the New York Post and Gawker. She's also had liposuction on her outer thighs, collagen in her lips and an eyelift. Now in her late 30s, she looks well preserved, and has the serene author photo (looking very pretty, I might add -- hair liberally and expensively highlighted, creamy skin, wry smile and not a wrinkle in sight) on the back cover to prove it.
"Beauty Junkies" is most gripping as a history of plastic surgery -- from the Koomas of circa 600 B.C., an ancient Indian caste of potters given the task of fashioning new noses for women who had had theirs cut off as punishment for adultery, to the surgeons who used plaster of Paris moulages to help reconstruct faces disfigured from air combat and grenade wounds during World War I. She gives us a laundry list of today's zeitgeist-worthy procedures, like buttock implants (if you want the posterior of Jennifer Lopez), bellybutton enhancement (if the shape of your navel is the bane of your existence), and nipple enlargement (if your areola simply must match a new set of breasts). As a reporter covering the trend beat, she's received solicitations for an array of procedures including snap-on temporary teeth, a "Russian thread lift" (in which barbed threads are pushed beneath the skin and anchored to the skull as an alternative to a face-lift), fat-dissolving herbal tonics, and a particularly painful-sounding operation that cuts open toes and removes the bones to better fit pointy heels. The Times doesn't allow her to accept services from news sources, but that's fine: Of the 600 or so offers of free treatments, she says, she would have considered becoming a patient of only maybe five of the doctors. She's skeptical of physicians eager to have a signature cosmetic procedure or who need to hire public relations gurus to lure clients and can't just rely upon word of mouth -- and urges us, potential patients all, to adopt her standards as well.
She breaks down the new economy of cosmetic surgery, where Botox is the most profitable treatment for doctors, who can squeeze $3,000 worth of injections out of a $488 vial and, as an added bonus, don't have to fuss with health insurance. These procedures were once the domain of the rich, but have increasingly become de rigueur across economic levels; credit cards, high-interest plastic surgery loans and even "cyberbegging" Web sites like myfreeimplants.com, where women seeking money for their boob jobs can post images and pleas to would-be male benefactors (Kuczynski tries it and makes $96 in three weeks), all facilitate expensive surgeries for the cash-poor. She pauses in her own cautionary tale of getting an allergic reaction to Restylane, an alternative to collagen made of hyaluronic acid, to marvel at how her housekeeper, a Guatemalan grandmother, manages to save up for an eyelift, and ultimately seems relieved to find this common ground between the two of them.
Cosmetic surgery has a culture of its own now, where Ashlee Simpson's nose job graces the cover of tabloids like Star, a magazine that also runs a regular feature called "Knifestyles of the Rich and Famous." TV shows like "Nip/Tuck," "Dr. 90210," "Extreme Makeover," "A Plastic Surgery Story" and "I Want a Famous Face" and magazines with titles like Skin Deep, New Beauty and Elevate are all entirely devoted to cosmetic surgery. There's slang like "trout pout" (for fishlike, overly plumped-up lips) and "kabuki mask" (a face so expressionless as to resemble a lacquered mask) that one can use while checking out Web sites like awfulplasticsurgery.com, which allow us to speculate on whether Avril Lavigne really did get a nose job or if Lindsay Lohan's breasts are fake. Kuczynski delights in naming names, calling out Sarah Jessica Parker, Nicole Kidman and Marcia Cross (whose face she uncharitably compares to the embalmed Lenin's) as Botox users.
We can always blame the baby boomers, who began to turn 60 this year, for the proliferation. Or Generation X, which has moved so far beyond the idea of what connotes adulthood -- marriage, children, jobs you hate -- that they've created a culture of being forever youngish. We can tell ourselves that the ubiquity of cosmetic surgery has lessened, and in some circles completely removed, the stigma of getting work done, or that we simply live in an image-based culture. But blaming our culture instead of delving deep into the self-hatred behind the quest for surgical beautification is an easy out. A knife-assisted makeover has become an increasingly common aspiration for teenagers and matrons alike, but shouldn't we be worrying why we're so looks-obsessed to begin with?
In her profiles of "regular" people, Kuzcynski appears to again blame the culture for creating a population who "view aging as a medical ailment that ought to be treated," and conveys their various plights with the utmost sympathy: For instance, there's a 19-year-old who's getting prophylactic shots of Botox and two women from California who go to South Africa every year for surgery safaris (their fourth trip, however, is just for vacation). There's Hollywood housewife "Mrs. X," who has made maintenance a full-time job -- including but in no way limited to injections of Gore-Tex (no longer reserved just for winter parkas), Botox, collagen, Restylane and Artecoll; liposuction; tummy tuck; brow lift; two variations on a face-lift -- who had her breasts done three times (implants in, implants out, larger implants in), and who recently partook in vaginal cosmetic surgery. Men aren't neglected here: There's the lawyer whose goal is to live without such indignities as wrinkles or sweat and who gets Botox every two months and has to lie to and rotate doctors in order to get it so frequently. More creative still is the former Navy SEAL who gets a faux bullet wound to avoid shame in the locker room.
However stoic Kuczynski remains in the face of faked wounds and labia-plasties, in the chapter devoted to weight loss surgeries, she lets loose her inner Mean Girl. Looking at photos of formerly obese people whose 280-pound weight loss after gastric bypass has resulted in drapes of stretched skin covering the body, she says she would have rather remained obese or die than look like a human character from a horror movie. When confronted in the flesh with a lawyer who had excess skin removed after losing weight, she's nonplussed: "To be honest and brutal and bitchy, she doesn't look that great."
Of her own experience, she's almost evangelical when talking about the restorative effects of a well-executed eyelift. She speaks of her own inner torment, torn between wanting to challenge a doctor who's trying to find a mathematical ideal to quantify a beautiful face and wanting to have her own face scanned in a computer to see what she should get fixed. She even tells her mom to get a nose job. She's quick to call her decade as a beauty junkie "foolish and vain" -- because no one serious relies upon their looks, right? -- and writes herself off as "weak, and easily susceptible to the pressures of a morally debatable, deeply intoxicating subculture."
She resents the pressure to conform to a beauty ideal, but at the same time she "won't be accepted by a culture that embraces beauty until I look like someone who belongs inside it. And I can't subvert what I can't get access to." She pays lip service to subverting the ever-escalating standard of beauty, but she doesn't address why so many women (and some men) are trying so very hard to fix themselves in the first place. "Beauty Junkies" does little to incite or inspire change, stating that it is ultimately "our choice that damns us or elevates us" in the end.
Kuczynski goes as far as to call the ultimately self-serving act of cosmetic surgery a political statement. "Looks are the new feminism" is a point she's so fond of she makes it twice over the course of the book. "Where once demanding equal rights and pay was a way for us to ask for an equal share of the power, the new way we show we have power is to be styled -- from top to bottom, from shoe sole to eye tuck -- to prove hat we have our act together. This is how we demonstrate to the world we have it all, both the yin and the yang, the masculine and the feminine."
But she also wants us to know she's opting out. On a recent appearance on the "Today" show, Kuczynski reported that not only has she been Botox-free for a year and collagen-free for two, but she is wearing no nail polish and has stopped dyeing her hair. She claimed to feel prettier than ever, but it's too bad that her brow, presumably slow to recover from a decade of Botox-induced paralysis, still didn't move when she spoke.