Our Quest To Be Perfect

Most cosmetic procedures are performed safely and patients are satisfied. Still, many specialists are troubled by those who come in seeking help after botched jobs. There are no national statistics, but Dr. Gerald Pitman of New York, considered one of the top liposuctionists in the country, estimates that the revision rate for all cosmetic surgery could be as high as one in 10. Landa Pappas, a 51-year-old DJ in Boston, had her "lopsided lips" augmented with an implant five years ago. But the Gore-Tex fibers used to build them up began poking out like bedsprings from an old mattress. The surgeon who performed the procedure tried twice to fix her lips, but after repeated infections, Pappas turned to Dr. Michael Kaminer of Beth Israel Hospital in Boston for a $2,500 redo. "It's kind of a barbaric procedure," says Kaminer, who had to spear Pappas's lips from end to end and dig through scar tissue to implant a new device. "The patient has to really trust she'll look better when it's all over."

Many of the newest techniques are also controversial. A few doctors offer penile augmentation, removing fat from the thighs or buttocks and grafting it onto the penis. Critics call the surgery unsafe and unethical since it can result in permanent dysfunction. For many other patients, live-fat-cell injections are a welcome alternative to Gore-Tex or to collagen, which can cause allergic reactions. But frozen cells like DiPirro's are much more fragile. Many doctors say they're probably dead by the time they're injected and are ineffective because they simply dissolve into the patient's body.

Laser resurfacing, which is edging out chemical peels and dermabrasion, works by vaporizing the skin. It can cause oozing and crusting, and lingering redness can last months. Some doctors say there's still not enough evidence that the $2,000 procedure does that much to help long-term. Botox, the wrinkle remover, is approved by the Food and Drug Administration only for rare eye muscle disorders. Doctors are allowed to use the drug "off-label," but slip-ups could cause temporary paralysis in eyelids. Only a few physicians offer pec implants because of problems with infection and slippage.

Liposuction, the most popular procedure for both men and women, can be especially risky in the wrong hands. In traditional liposuction, patients have been known to lose too much fluid during the suctioning process, sending them into shock. In the newer "tumescent" method, doctors inject a medicated solution into the fatty tissue to reduce bleeding, but in rare cases, it can cause fluid buildup in the lungs and fatal blood clots. A recent study in New York cited these problems in the deaths of five patients from 1993 to 1998.