Miracle Makeovers: Nip-and-Tuck Unpacked

112006 article book schiff Miracle Makeovers:  Nip and Tuck UnpackedA few years ago, I spent an afternoon on the Upper East Side with a keen-eyed Frenchman during his maiden trip to New York. There were marvels aplenty, but at the end of the day he had developed a single fixation: What was up with the old people? They looked taut and shiny and strange. In Paris, old people looked old. At the time of his visit, Paul-Armand was 8.

It seems he has company. As Alex Kuczynski tells it in Beauty Junkies, she’d barely installed herself poolside, in a bikini and under a blazing sun, when a shadow fell over her legs. “Did you have fat cut off your butt?” demanded the small child at her elbow. Testily, he explained: “You have the dots, and my mommy has some, and her friends have some, and she told me that when ladies have those dots that means they had fat cut off their butts.” With an emphatic “no,” Ms. Kuczynski put him in his place and stalked off, a towel around her waist. She was indignant. She was also lying.

Her loss is our gain. If you’re going muckraking, you want someone who has tasted the goods. Ms. Kuczynski’s portrait of the exploding cosmetic-surgery business—and of our corresponding addiction—is leavened by her own adventures in the skin trade. She took her first dip in the rivers of Botox at 28 and opted for liposuction and to have fat removed from her eyelids by her mid-30’s. “I was a junkie,” she confesses, and as a reader I wouldn’t want it any other way. Would you believe Eric Schlosser or Morgan Spurlock if they were vegetarians? For that matter, would you trust a short, squat brunette with this job?

It’s not only because she had 16 ounces suctioned off her bottom (at a cost of $6,000) that you want to read Ms. Kuczynski, a former New York Observer reporter who now writes for The Times. Not many people can begin a sentence with Serbian terrorists and end it with Pamela Anderson. Doubtless Borat can, but he wouldn’t be explaining plastic surgery’s origins in World War I. “Enhancement technologies” actually took off when mortars and grenades—rather than time—ravaged our faces. Ms. Kuczynski offers a little tour of reconstructive miracles, from 16th-century noses that could be sneezed right off your face to Fanny Brice, who—as Dorothy Parker had it—“cut off her nose to spite her race.” We get the first, almost inadvertent breast enhancement and the botched face of the beautiful Vanderbilt heiress. Who but Ms. Kuczynski would have noticed that Hemingway proleptically described what we recognize today as a bad face-lift? He was talking about war veterans, whom he granted more respect than my little friend Paul-Armand did their tight-faced heirs.

Where once a cosmetic surgeon compared her 1960’s practice to an abortion clinic, her field today is the toast of the town—and a $15 billion industry. Dentists have lobbied for the right to perform face-lifts and breast implants; the American Society for Plastic and Reconstructive Surgery classifies small breasts as a deformity. (Dress sizes have ballooned accordingly. And while we’re less preposterous on this coast than on the other, women everywhere seem to prefer cartoonish missiles to what Ms. Kuczynski wistfully terms “the Diane Keaton of breast implants.”)

Ms. Kuczynski turns out to have been a latecomer to the party; she talks to 23-year-olds who are getting Botox, and reports that breasts are the new high-school graduation present. In part we are beholden to “age management,” in part we are correcting God’s mistakes. On both counts, we have crossed a critical Rubicon. Ms. Kuczynski compares post-surgery notes with her housekeeper, who has had a successful eye-lift. Elitism has sailed out the window; you no longer have to be genetically lucky, just surgically inclined. You also have to wonder how much Ms. Kuczynski is paying the cleaning lady.

How exactly have inner virtues lost out to surgical virtuosity? Ms. Kuczynski rounds up the usual suspects: Lara Croft, the simplistic male mind, Sports Illustrated, online porn. She also collars psychiatry (the inferiority complex is cosmetic surgery’s best friend) and the insurance companies, which have not only made the practice of medicine financially unattractive but which now market cosmetic surgeries to boost the bottom line. Managed care has chased packs of doctors into cosmetic surgery, and the result is physicians who specialize in marketing rather than medicine.

The makeover of the Hippocratic oath is unsightly, but so are a lot of other things. This is a book that will give you ideas, all of them expensive. You’d have to move to California to develop a taste for “tits on sticks” (if you’re a woman, I mean), but here at home there’s plenty to do. Where have I been that I’d never heard of permanent lipstick? There are things in these pages I thought you wore on the ski lift but that you evidently inject into your face. After Beauty Junkies, you’ll never eat lunch in this town the same way again. You’re going to catch yourself doing what I did yesterday: thinking everyone back into his or her real face. And then some. If Ms. Kuczynski’s statistics are correct, then someone in that room had indulged in an eyebrow-hair transplant, toe liposuction or a scrotum reduction—or was, by the time coffee was served, considering labiaplasty. My guess is that no one had opted for the bootleg Botox, but then again, there were two last-minute cancellations.

Ms. Kuczynski points up the hazards of the enterprise—on a day when she should have been at a friend’s memorial service, she was hideous and housebound, the victim of a Restylane injection gone awry—but her warnings will only whet your appetite. Who wouldn’t love to be carded at 36? As fantasies go, it’s up there with going back to high school knowing what you know now. Hers is arguably the best advertisement for the industry since A Chorus Line and “Dance: Ten; Looks: Three” first directed us to Park and 73rd.

Beauty Junkies supplies guidelines and hotlines, addresses and prices. The advice comes with a classic Kuczynski twist: “Distrust doctors who use the same procedure over and over again and produce patients who all look the same; distrust doctors who are too tan, or who have bad hair implants, or who look as if they were Michael Jackson’s twin brother.” Those kind of salted peanuts abound on every page. There should be a cocktail named for this woman.

Ms. Kuczynski glides past a good deal as well, though I realize that’s part of the exercise: You’re not in the market for profundity if you’re so much as reading this review. All the same, some questions lie messy and untweaked on the page. Once there was a dividing line between those who bought into this business and those who argued before the Supreme Court (or wrote for The Times). What happened? Briefly, Ms. Kuczynski pauses at a fascinating intersection: “Looks are the new feminism,” she declares. If a woman is powerful, she has to be beautiful too, she notes, without wondering if that serves to enhance or excuse the effect.

She touches lightly on the arms race (“If she gets to play Gidget forever, why shouldn’t I?”) but generally doesn’t get too caught up with issues of masochism, control or identity, or with our yawning, aching hunger. In the last pages she thrashes about, attempting to sum things up without seeming either too flip or too profound, tucking a miscarriage and King Lear in somewhere on her way to a unified theory of our collective addiction: We actually believe what we see in the mirror. Well, maybe, but isn’t eternal adolescence a kind of pathology? Aging may feel like one, but it isn’t, strictly speaking, an ailment. Whence the collective rush to vote our pasts off the island? Is the reality on our TV’s any different from the fiction in our mirrors or in our memoirs?

Let me be clear about this: You’ll want what she’s having. And if you’re going to go there, you’ll want Alex Kuczynski as your Virgil. For that matter, if you’re going anywhere, you probably do. I would trust her with anything—except a dot-connecting 8-year-old.

Stacy Schiff’s most recent book is A Great Improvisation: Franklin, France, and the Birth of America (Owl).