Our Quest To Be Perfect

Ten years ago, when she was only 25, Holly Lagalante shelled out $2,500 for an eyelid lift. The tab nearly maxed out her credit card, but the results--more bright-eyed, less droopy--left her absolutely giddy. Two years later, Lagalante, a petite blonde from suburban Chicago, was back for liposuction on her thighs ("I'd love to have Heather Locklear's body," she says). Then varicose-vein removal. And, later, a forehead peel. Last year she had $7,000 left to pay off when she lost her $9-an-hour job managing a health-food store, moved in with her mother and filed for bankruptcy. Still, she claims she's happier and more self-confident since her body overhaul and has no regrets. She now has a new job as a salesclerk at a local mall and says that when she finishes paying off her debt she'd like to reward herself--with a forehead lift or maybe liposuction to fix her saggy knees. "It's been tough on me financially, but it's worth every penny," she says. "It's life-changing."

Not so long ago aspiring starlets and women "of a certain age" were pretty much the only patients who went under the knife--and they did so in secret. But now the image-conscious of all ages--and genders--quest for perfection. "The person we see today," says Dr. John Tebbetts, a plastic surgeon in Dallas, "is your sister, your next-door neighbor, the lady in the grocery store." Teen girls beg their parents for liposuction and breast augmentation, prompting a heated debate over how early is too early to perform elective surgery. Twenty- and thirtysomethings go in for cosmetic "maintenance": a chemical peel here, a little microsuction (liposuction for the face) there. Record numbers of baby boomers get their fat sucked out and "rejuvenate" their cheeks and eyelids. Any stigma has melted away as quickly as fat cells during liposuction. Dr. Stephen Perkins of Indianapolis says his patients used to flee when they saw him at parties for fear they'd be found out. Now, he says, "they come up grabbing their friends" to introduce potential new customers.

This boom is fueled in part by doctors frustrated with managed care and dwindling reimbursements in the last few years. Insurers won't cover procedures that are purely esthetic, so patients must pay the full cost (which can easily run upwards of $3,000) for what one doctor calls "happy surgery'' out of pocket. To draw in business, physicians are advertising like mad in newspapers, magazines and even on TV. But as more jump in, there's concern about safety and oversight. Board-certified plastic surgeons spend years in specialized training, but anybody with a medical degree can perform cosmetic procedures. Just last week, as 500 plastic surgeons debuted a nationwide television and radio campaign promoting breast augmentation, Florida's state medical board--a national leader in regulating office surgery--debated tough new rules.

Advanced techniques, promising less-invasive procedures and swifter recoveries (the famed "weekend face-lift") make surgery seem less scary to first-timers. High-beam computer-controlled lasers blast away fine lines and wrinkles. Endoscopes, pencil-like tubes with cameras on the end, allow doctors to make small incisions rather than drastic cuts. While the number of reconstructive surgeries (fixing burns or lacerations, for example) have stayed fairly stable this decade, cosmetic enhancements have steadily gone up. The bottom line, according to a new report by the American Society of Plastic and Reconstructive Surgeons (ASPRS): a 153 percent increase in the number of cosmetic procedures performed by plastic surgeons since 1992, to more than 1 million last year. And that number is considered highly conservative, since it excludes work done by noncertified specialists, such as dermatologists, dentists--even gynecologists.

Many of these patients struggle to cover the cost. Two thirds report family incomes under $50,000 a year. "They pay you by credit card or check and you have no idea whether it will take them one month or 10 years to pay it off," says Dr. Albert Dabbah, a Florida plastic surgeon. "If they want it badly enough, they'll treat it like any other commodity." Some are choosing lifts and tucks over vacations and even down payments on first homes. Not to worry if you have no such savings. Loan companies now offer monthly payment plans for body work.