Brush With Perfection

Without the fat lip and the funeral, who knows how this story would have turned out? The fat lip belonged to New York Times writer Alex Kuczynski. The funeral was for her close friend Jerry Nachman, a journalist who died of cancer in 2003. As she grieved, Kuczynski faced a dilemma: the service was the same day as her regular skin-rejuvenating session with her plastic surgeon. Appointments were hard to get and she didn't dare skip one. So she decided to squeeze in a little microdermabrasion between the funeral and a tribute afterward at a Manhattan restaurant.

What happened next was not pretty. After the funeral, Kuczynski sped across town to her doctor, who blasted her skin with crystals that swept away dead cells. Then she asked for a quick injection of Restylane, a mucouslike substance that she hoped would plump up her upper lip. The needle had barely been withdrawn when Kuczynski felt a strange mass on her face. Her lip was so grotesquely swollen (eventually reaching the size of a yam) that she missed the tribute and barely left home for the next five days.

That was when Kuczynski--celebrated in Manhattan media circles for her stylish good looks--says she hit rock bottom. It signaled the end of what she describes as her addiction to cosmetic procedures--a long, strange trip that began when she was in her late 20s and included frequent Botox injections and two bouts of liposuction to remove fat from her hips and her eyelids. It is also a pivotal moment in her compelling new book, "Beauty Junkies: Inside Our $15 Billion Obsession With Cosmetic Sur-gery" (Doubleday). Like so many other women (and a growing number of men), Kuczynski, 38, says she was vulnerable to the quest for physical perfection because of the premium American culture places on youthful beauty--even in areas where appearance shouldn't matter at all. "Study after study shows that people who are attractive are treated more leniently by juries," she says in an interview. "They get higher ratings as college professors. That's just a fact of life."

Kuczynski traces the history of cosmetic surgery from World War I, when pioneering doctors miraculously reconstructed soldiers' mutilated faces, to a recent Hollywood party, where she observed a telling mini-drama involving a group of nearly identical women standing off to one side. Thanks to obvious surgical intervention, Kuczynski says, "They all had the same nose, the same lips, the same cheekbones and the same hair color, and they were all wearing the same sort of warm beige tones that women start wearing in L.A. in their late 30s because you can't wear black. It makes you look old." Kuczynski watched with amusement as a studio executive sidled up to one of the women, touched her elbow, and said, "Time to go, honey." When she turned to look at him, they both saw his error. He apologized, Kuczynski says, "and moved three women down" to his real wife.

In her book, Kuczynski blames Hollywood for creating a standard of beauty that doesn't exist in nature--basically pert, symmetrical features atop a skinny body with large breasts (also called "tits on sticks"). In this unreal world, no one ever gets old or gray. "We're striving for a notion of celebrity perfection," she says. "The platforms upon which we are delivered celebrity images have multiplied. You have a picture of Angelina Jolie that comes to you on your cell phone, on your wireless PDA, on TV, in tabloids, on your computer." The ubiquity of those images makes perfection seem attainable, even normal.

Changes in the health-care system have also fueled the obsession, Kuczynski says. Frustrated with insurance bureaucracies, many doctors are lured by the prospect of an all-cash business; cosmetic surgery fits the bill. Because it's elective and not medically required, it's generally not covered by insurance. Doctors deal directly with patients. The problem, Kuczynski says, is that "anybody who has a medical degree can hang out a shingle that says they are a cosmetic surgeon." Plastic surgery is recognized by the American Board of Medical Specialties; cosmetic surgery can have a more ambiguous definition. In some states, Kuczynski says, ear, nose and throat doctors or dentists calling themselves cosmetic surgeons can do procedures like face-lifts. That may be risky for uninformed patients.

State health boards monitor doctors, but, Kuczynski says, they're often overworked and understaffed. "The last thing a state health board is going to do is go after an un-qualified 'plastic surgeon' who's really a gastroenterologist doing liposuction that he learned one weekend at the Hilton," she says. One state official she interviewed described botched procedures as "victimless crimes." In his view, she says, "these patients were so vain that they asked for this procedure. It's kind of their fault." Kuczynski ad-vises potential patients to check credentials.

The ultimate solution, of course, would be to accept minor imperfections and the changes that come with aging. That's where Kuczynski is headed--she hopes. "As part of writing this book, I got so sick of beauty that I let everything go," she says. "I stopped doing Pilates. I kind of stopped doing the diet. I stopped coloring my hair ... And I've stopped the dermatological procedures except I do go and get micro-dermabrasion because it's 10 min-utes and it's about the same cost as a facial, and I hate facials because they take an hour and a half." As she approaches 40, Kuczynski says, she's trying hard "to be comfortable with who I am as an aging person." Bring on the wrinkles.