Can you read between the lines? (Photo by LawrenceChua)

Think you’ve seen a stiff poker face? Think again! We're proud (and puzzled) to announce the arrival of "Pokertox," a special kind of Botox aimed at helping gamblers retain that elusive expression of, well, no expression at all.

Poker faces have long been a trademark of the game’s highest rollers, proclaimed creator Jack Berdy, a doctor of aesthetic medicine. The new technique, he said, means that all players can have a much-sought-after frozen forehead.

“I came up with the idea for Pokertox in the last week or so,” Dr. Berdy told The Observer over the phone earlier. “It was just a natural match for the business I’m in and an application that hasn’t been done before.”

A former player himself, the doc said that he “certainly” would have dabbled with the saline stuff if he were still properly involved with the game.

Skeptics have been quick to brand the process as gimmicky, but Dr. Berdy remains confident that “most of my doctor peers will think it’s a wonderful idea.”

Tells such as a furrowed brow or curled lips can now be magicked away with just the prick of a needle, thanks to Dr. Berdy’s innovative new use for the juice. From bagel heads to frotox, there is certainly no shortage of wacky trends where facial paralysis is concerned, although this one could perhaps be more lucrative than its forehead forebears.

The hope that “the serious players will try Pokertox and then talk about it with others” is integral to its success. But given that Dr. Berdy hasn’t yet had any guinea pigs in the Pokertox chair, it remains to be seen whether or not his idea will transform players into the high-rolling tricksters he envisions.

His elation at this new idea may have blinded him to the perils of Pokertox, though, as the prospect of application abusers hadn’t yet struck. The Observer suggested to Dr. Berdy that his innovation may entice criminals into the chair for some guilty-face-eradication (hey, it could happen), but the doctor laughed off our sincere concerns for the judicial integrity of America, saying: “That thought hadn’t even crossed my mind!”

With the process needing touching up every three to four months, Pokertox could be a big winner for both players and practitioners alike. Dr. Berdy may be enthusiastic about his new Botox baby, but only time will tell if his brainwave makes the desired splash in the U.S. poker scene. Or, you know, the witness stand.

Cosmetic procedures, the organization reported, dropped 9 percent in 2008 to 1.7 million. Breast augmentation fell 12 percent, liposuction fell 19 percent and tummy tucks 18 percent. Meanwhile, Botox injections grew 8 percent, to 5 million. The Wall Street Journal also reported a story about how injectibles seemed to be immune from the recession.

But then The New York Times reported just the opposite: Sales of Botox fell about 3 percent to about $329 million in the fourth quarter of 2008, compared with the fourth quarter in 2007, said Allergan, the substance's manufactuer. And so the spas and medical professionals that administer these treatments seem to be finally slashing prices.

According to an email the Daily Transom received from Tribeca MedSpa, "the current economic climate has caused beauty buffs to question their investment in aesthetic services and products."

And so the spa has decided to do something different for its stiff-faced customers. For the month of September, Botox is going for $16 per unit (normally $24). The fine print on the spa's website indicates that a minimum purchase of "50 units" is necessary to enjoy the discount. We're not sure how much wrinkle removal that is, but it sounds like a lot!

Jennifer was untroubled by the barnyard origins of Evolence, which arrived on the market in September 2008 but has yet to become a buzzword on the society circuit. “I heard in the media that it was derived from the pig and it sounded rather gross to me, but then they elaborated that we have similar tissue,” she said breezily.

And so on Monday, March 2, Jennifer arrived at the Park Avenue office of Darrick Antell, a plastic surgeon. Dr. Antell’s nurse wiped the makeup from the patient’s cheeks and applied a topical anesthetic; the doctor himself then injected a single syringe of whitish substance into her cheeks via a tiny 30-gauge needle. The entire procedure took 15 minutes and cost $700. Jennifer rode the subway immediately back to work afterward.

“I love it!” she enthused, calling from her office several days later. “I’m getting looks. ‘Oh, your skin looks great.’ I think it’s because the cheekbones are a little more defined. It’s kind of subtle.” There has been no bruising and no swelling—common, if typically short-lived, side effects of hyaluronic acid injections—just a minor, lingering pain to the touch. She even went back for another syringe the next day. “I just thought it looked so pretty,” she said.

‘A HUGE BREAKTHROUGH’

In the 1980s, we got ourselves shot full of bovine collagen (which required an allergy test several weeks beforehand, never desirable when one is seeking an instant pick-me-up). In the ’90s, we began freezing our faces with a derivative of the botulism toxin. In 2003 came Restylane, a breakthrough hyaluronic acid (or H.A., as it’s known in the trade) derived from bacteria. Nowadays many New York doctors also offer Radiesse, a filler made of synthetic liquid bone, and Sculptra, which was invented to treat the hollow cheeks of H.I.V. patients. 

But … pig fat? Oy vay!

“It’s a huge breakthrough,” argued Dr. David Goldberg, a dermatology professor at Mt. Sinai School of Medicine, who will soon publish a study on the use of Evolence in the eyelids; he estimates he’s used it on 200 or so patients already. “There’s nothing wrong with the H.A.’s, but the negatives of H.A.’s historically have been that there can be a fair amount of swelling, which you don’t get from any collagen, including Evolence.”

“It’s easier in some cases to hide from the husband,” allowed Dr. Howard Sobel, a Park Avenue cosmetic dermatologist, in an email.

Carol R., 52, an Upper East Sider who has previously been injected with Restylane, Radiesse, Juvederm and longer-lasting silicon, tried Evolence from Dr. Sobel’s needle for the first time two months ago. “I usually bruise down on my chin no matter what they inject,” she said. “It gets blue, and then it gets purple. It’s not very attractive. You look like either you got punched in the face or you did something. Every woman knows you did something.”

But with Evolence, Carol exulted, “I didn’t swell at all!” She went out to dinner with two other couples the night of her injection. And it didn’t trouble her in the slightest that what was in her face might also have been offered on the menu. “I had [bovine] collagen for years,” she said. “I guess if you could eat bacon, you can put it in your face! And I like bacon!”

Doctors similarly scoff at the notion that New York women might be wary of using pig fat to achieve a baby face. “Oh, come on, when it comes to beauty?” said Dr. Francesca Fusco, a much-loved dermatologist who shares offices with Dr. Patricia Wexler. “In all the years I’ve practiced, nobody’s ever said, ‘I’m a vegetarian, so I don’t want the bovine-based collagen.’” Indeed, perhaps our fetishization of the greenmarket has made us more inclined to pork up, facially speaking. “It’s like we have farm-fresh faces!” Dr. Fusco giggled.

“A lot of people would rather have a natural substance derived from a pig than a substance made in some laboratory,” Dr. Goldberg said (H.A.s are cross-linked by chemicals; the creation of Evolence entails a patented technology involving sugar, sort of like a closely guarded barbecue-rub recipe).

Perhaps Evolence’s most surprising characteristic, however, is that it is made in … Israel, by a company called ColBar Life Sciences, which was purchased by Johnson & Johnson, the squeaky-clean American company widely associated with plump baby faces, in 2006.

“We think we have a game-changer on our hands,” declared Monica Neufang, a Johnson & Johnson spokeswoman for  Evolence, just after returning from the annual meeting of the American Academy of Dermatology in San Francisco, which she called the new brand’s “coming out.” (They had wooed dermatologists with live demonstrations and dinners).

Ms. Neufang said that the product had been approved by at least one rabbinical council but that religious patients should consult their rabbis for guidance “We do not have rabbis on staff,” she said. But: “By the time you purify the product, the collagen that results is virtually identical to human collagen.”

She admitted that her company has thus far been rolling out its find rather stealthily. “Our product injects very differently than H.A.’s, and since that is the lion’s share of the market, we wanted to make sure we have a robust training program in place for physicians, so we’ve really been focusing on that for the first six months,” she said. But in the next month or so, get ready to see Evolence everywhere, as the brand targets consumers more directly.

‘RED AND BUMPY’

But even in an era when dissecting the work done on celebrity faces is all but public sport, and everyone from George Clooney to Debbie Harry admits cosmetic “enhancement”—brawny tennis player Lindsay Davenport is even the spokesperson for Juvederm!—might Evolence’s feed-lot beginnings invite increased scrutiny of our beauty addiction?

Julie, a 36-year-old doctor (though not a dermatologist) in Manhattan who had a Restalyne injection several years earlier, tried Evolence three months ago. “It still looks good!” she said the other day, calling from her office. “I didn’t have really bad lines to begin with, but it smoothed them out, gave it more of a fresh look.” She equated it to “a polish, like the top coat on your nail polish.”

A reporter wondered what she thought of the product’s porcine origins.

“I didn’t know that,” Julie said. “But thanks a lot!”

She is Jewish, she added, albeit nonreligious. “I don’t really eat pig, so the fact that it’s in my face isn’t thrilling,” she said. “But I guess if you’re doing something like this, you’re probably not too concerned about those kinds of things anyway.”

Karen, 58, of the Upper East Side, was more concerned about the adverse reaction she experienced after her first Evolence injection last month, which kept her close to home for about a week. “I’ve had a lot of fillers,” she said. “If you get a bruise, that’s one thing, but I was very red and bumpy.”

Her concerns were echoed by several New York doctors who are not yet sold on the swinish collagen du jour. “There have been reports in the Canadian literature, one study where they had 20 patients who were injected with Evolence in the lips and they developed nodules that had to be surgically removed,” said Dr. Lisa Zdinak, who has a practice on East 74th Street. “So I took that off my palette. I used it in the nasolabial folds, but when I read that I couldn’t use it in the lips, I thought, ‘Why am I even bothering with this?’ I have H.A.’s!” (Evolence enthusiasts counter that Evolence Breeze, a thinner form of the filler currently being used in Europe for lip-plumping, will likely be F.D.A.-approved in the near future). 

“It’s late on the scene, to be honest with you,” said Ariel Ostad, a dermatologist on Lexington Avenue. “Everybody’s already so comfortable with hyaluronic acid. And then the fact that it’s pig.”

But the substance’s defenders grunt at such criticism. “It’s been used for several years in Europe and Israel; they’ve shown that there’s little correlation between sensitivity to collagen and sensitivity to Evolence,” said Dr. Mauro Romita, a Fifth Avenue plastic surgeon who added that the product is currently his number one choice for the nasolabial region.

Dr. Paul Lorenc, a Park Avenue plastic surgeon who led  Evolence’s F.D.A. approval study, touted the fact that 76.5 percent of pork-injecting patients in his study were still showing notable improvement after one year, as opposed to our cow-plumped sisters of yesteryear, whose volume shrank in just three months. Moreover, Dr. Lorenc said, Evolence flows more easily through the syringe than do H.A.’s, resulting in less of a chance of “over-correction,” as he called it.

As expendable income seems to be drying up in inverse proportion to patients’ ravenous appetite for filler, Evolence’s long-term prospects are anyone’s guess. “I think it will come down to pricing and marketing,” said Dr. Sobel. “In my opinion, a lot of the injectibles are similar.”

Tell that to Laura, 49, a limousine company sales rep, bartender and enthusiastic recent Evolence convert who works in Long Island City. “It’s outrageous,” Laura said. “It’s not, like, drastic, but people will just say, ‘You’re looking good these days!’”

But does it ever give her pause that she has our porcine friends to thank for this? “If you just say the word, ‘I have pigs in my cheeks …’” she said. “But no one knows. It is what it is. I don’t really care.”

mbryan@observer.com

But let’s not waste time talking about old Ted. There are so many other crackpots to opine about this week, I’m afraid I’m going to have to jump around wildly, a bit like Ted Haggard after a batch of nasty crystal.

Speaking of nastiness: People continue to recoil from the odiousness of the characters in Notes on a Scandal, my favorite movie in decades. A Hollywood-insider friend told me that Dame Judi herself was quite reluctant to take on the role and that the general consensus is that if she doesn’t win the Oscar, it will be because her character, Barbara Covett, is simply too vile. Am shocked by the low nasty-threshold of all concerned. Having grown up in the U.K., I can tell you that there is nothing excessive about this depiction. The female British schoolteachers of my youth were irate, nihilistic, fag-snorting closeted lesbians, almost to a man. If an ordinary pink-cheeked lass were to have shown up at my school looking for employment, the headmistress would have said, “Go away, and come back when you have become an irate, nihilistic, fag-snorting closeted lesbian—then we can talk.” Trust me, this movie is little more than a documentary.

The same lily-livered prissiness is being directed at American Idol. The judges continue to be criticized for their blunt mockery of the contestants. As a loyal viewer and person with functioning eyes and ears, I can honestly say that the contestants are not at risk, my new favorite phrase. Far from it: They are all suffering from extremely high self-esteem and will definitely survive the verbal lashings that they occasion upon themselves. Besides, aren’t there enough pleasant smarmy people on the telly? We could use more abusive, foul-mouthed and unremittingly surly people, non?

Which brings us to Anna Nicole Smith: As you are no doubt aware, I am frequently to be heard inveighing against porno-chic and slutty dressing in general. That ubiquitous 80’s Playboy Bunny look—fake boobs, fake hair, fake lips—is the opposite of the glamorous eccentricity which I feel is the primary component of good style. My main issues with the new bleach ’n’ Botox whore-look are (a) it makes everyone look the same and (b) it is confusing. Dressing like a sex worker while working for Avis or selling real estate is silly and misleading. You may as well dress like Simone de Beauvoir or Carrot Top.

And so to Anna Nicole: As I write these words, I feel the grief groupies gathering with their armfuls of teddy bears and cellophane-wrapped flowers. The late Vicki Lynn Hogan is about to have a Princess Diana moment. And why not? Give that broad a good send-off. We loved her for her unpretentious honesty: Unlike all the fake hoochies referred to above, Anna Nicole’s bodacious porno-chic was not disingenuous—far from it. She dressed like a former stripper because she was a former stripper. A big blonde busty bad-girl, she was—and is—the People’s Pole Dancer. May she rest in peace.

Anna Nicole Smith’s career choices may have been a bit dodgy, but at least she wasn’t an astronaut. What an unacceptably goofy profession, especially for a woman. And yet the whole world has gone into shock because Lisa Marie Nowak—the homicidal member of the NASA love triangle—turned out to be a nutcase. The whole concept of space travel is so insane—oooh! Let’s all leave suburban New Jersey and go live on Mars!—that it would only appeal to straight men in Dockers with God complexes and women with mental-health problems.

Here’s another one from my everyone-is-surprised-except-me file: “Why would a rich Hollywood society gal like Kim Kardashian feel the need to make a porno tape with her one-time boyfriend, rapper Kay-J?” asked a bewildered populace last week. To which I answer, “Why not?” She’s merely doing a Nancy Cunard. Nancy was the shipping heiress and Negrophiliac—this is not my word: The 1920’s craze for all things African was dubbed Negrophilia—who scandalized crusty London society in the 20’s with her black lover and her armfuls of ivory bracelets. If you grew up rich in boring 80’s-90’s Brentwood, wouldn’t you want to Nancy it up a bit?

Now a random fashion gripe: As a midget, I am utterly furious that the trend for bizarrely high shoes—Louboutin, Marc Jacobs, Balenciaga, etc., etc.—hasn’t impacted the men’s footwear industry at all! Not a platform! Nor a wedge! Zippo! In fact, men’s shoes are getting flatter and wispier! While my female colleagues at Barneys staggered through Fashion Week on these monstrous constructions, I was doomed to lurk at the level of their kneecaps in my Prada Beatle boots with a half-inch heel. Grrr!

Another general annoyance: If one more person grabs me by the grosgrain-trimmed lapel of my madly au courant velvet Thom Browne jacket and says, “Oh, you should have a blog!”, I will start snorting crystal. My standard answer has always been, “I don’t need a blog—I already have a column.” But now that Cathy Horyn (NYT) and Teri Agins (WSJ) both have blogs and columns, this no longer gets me off the hook. Given that Cathy and Terri’s newspaper scribblings are also available on-line—as are mine—one is tempted to ask, “Just how many delivery systems does a gal need for her rants and observations?”

Finally, to affairs of the heart. I normally try to avoid getting in the middle of celebrity break-ups, but I am dumbfounded as to why Olivier Martinez would leave Kylie Minogue (non-stop Aussie good times) for Penélope Cruz (gorgeous, but, like many actresses, takes herself a bit too seriously.) Any insights would be gratefully received.

PS: Regarding Anna Nicole—if Nicole Kidman doesn’t snatch up the rights to play the busty bad girl in the biopic, she is making a big mistake. She could pack on the pounds. This could be her Raging Bull.

But oh, how quaint it all seems now.

On Dec. 13, in an Upper East Side apartment building miles from Wall Street, a clutch of doctors and lady patients gathered in the office of Dr. Neil Sadick for an event that would have made their 80’s forbears quiver with awe: a celebration of the merger of doctors’ practices. Dr. Sadick, a dermatologist renowned for his expertise in hair restoration and lasers, was absorbing the practices of plastic surgeon Theodore Diktaban and cosmetic dermatologist Cheryl Karcher.

As befits any party that was announced with a press release, this one featured waiters in discrete black-and-white mufti, a ready supply of flutes of champagne, and a constant stream of bite-sized hors d’oeuvres—including one that looked remarkably like a mole atop a potato chip. There were photographers from Patrick McMullan, and guests, like Miss Teen U.S.A., who were happy to be photographed. There was a general plastic surgeon, a facial plastic surgeon, a vein specialist, and there were women—lots of women—whose frozen foreheads and fiercely plucked brows testified to their familiarity with such services.

“It’s a good sign that everybody here looks like they don’t need to be here,” said a guest of indeterminate age, race and even accent, whose lips had been pumped so full of something that they looked as if they might float, Hindenburg-style, from her face at any moment. “Their skin looks great.”

The December merger soirée was the latest in a string of rollouts and announcements for Sadick Dermatology. Just six months earlier, Dr. Sadick had hosted a party to celebrate his move into his new Park Avenue office.

In this new space, Dr. Sadick had effectively face-lifted his practice from the standard fabric-draped doctor’s lair to a 4,000-square-foot Jetsons set of an office with four exam rooms, a photography suite, an operating room, a research area and more than $2 million worth of laser equipment. But the move, like the merger, was also more than aesthetic: It was an attempt to torque his practice up a notch by transforming it to a center for “whole-body rejuvenation.”

“It’s been an idea of mine for the last five or six years to aggregate the best of various sub-specialties that are involved with whole-body rejuvenation,” said Dr. Sadick, a wrinkle-free 55-year-old with bright white teeth. “This facility represents the first facility where one is able to have whole-body rejuvenation in a single clinical setting.”

Dr. Sadick’s anti-blemish mega-center most likely does represent some firsts: the first time a doctor celebrated both an office opening and a merger with a press release and party; the first time, perhaps, that a wrinkle warrior attempted to incorporate a teaching institute into his office (research and “patient and physician education” will apparently be a big part of the center’s work).

More likely, the doctor’s sleek rejuvenation emporium is merely a variation on the growing theme of dermatological empire-building.

Cosmetic dermatology has become big business in New York. While skin doctors used to occupy a relatively low rung on the medical ladder, these days it’s all too common to find them enjoying life in sprawling, art-strewn dermo-lofts, a press flack at the ready. They have product lines (considered a must for those who want to be taken seriously in the business), and they have spa facilities. They have “research” labs, cosmetic-company consulting deals and branding strategies. They have all the components of multi-pronged mini-corporations—right down to the chief operating officer with the business plan.

“I am literally running three companies on a day-to-day basis,” said Adam Dinkes, the 33-year-old C.O.O. in charge of Sadick Dermatology’s research group, clinical practice and skin-care line.

“And this is just the beginning of what I’m going to be able to do with this,” he said. “This is a real opportunity for me to literally create the future of an entire industry.”

(So much for the old wife/office manager combo.)

Doctors and dermatology-watchers trace this trend to a small ganglion of recent influences—from aging baby boomers’ quest for eternal youth to the competition induced by some dermatologists’ decision to forgo insurance.

But most significant of all, perhaps, has been the Botox revolution, the explosion of age-defying injectables that have flowed into dermatology like pure Persian Gulf crude.

Or so one doctor explained it.

“You know how oil money just sort of changes a country? Well, all this oil money came into our profession,” said David Colbert, a Flatiron-area dermatologist. “It’s like plastic surgeons and dermatologists hit black gold, because suddenly they had Restylane coming up out of the ground, and Botox. So suddenly it’s like being in the Middle East, like in Dubai, where there’s all this oil money.”

Or, at the very least, it’s like being in the Amazon, Miami or wherever, depending on the doctor’s branding strategy.

Down at Dr. Laurie Polis’ Soho Skin and Laser Dermatology, for instance, the brand is all Zen, eco-beauty, with bamboo trimming and a slate waterfall to help get patients in the mood before they head for Botox, chin implants, or some time on the couch (yes, the center provides psychological services). For Dr. Frederic Brandt, the plump-lipped “dermatologist to the stars” (and author of his own beauty primer, Age-less), the brand might be summed up as simply fabulous.

As for Dr. Sadick, his brand smacks you right in the maxilla as soon as you walk through the glass-and-iron door, up the epoxy resin steps and into a space that is operating-room bright and eye-scorchingly white. (“It’s white on white on white,” Mr. Dinkes explained.) An illuminated alcove featuring Sadick skin-care products glows parallel to the entrance, and beyond that, the waiting room, spirited straight from Brazil, with its white retro couches, Saarinen coffee table and wrap-around wall mural. The mural, which is a blowup of a collage by the artist Pnina Gagnon, is a palimpsest of hair follicles, sweat glands and broken bits of text that “speaks to everything that we do here,” Mr. Dinkes said.

“You know, it really was trying to … look into the future and say, ‘What does the best doctor’s office of the future look like?’” said Mr. Dinkes. “And I would argue that at this point we’ve certainly achieved our goal.”

Mr. Dinkes was sitting in Sadick Dermatology’s square, white (yes, white) conference room, outlining the philosophy behind the new mega-center. Slim and trendy, with a 5 o’clock shadow that wrapped all the way around his head, he looked like a younger, handsomer Stanley Tucci. He had brown eyes, an efficient stare and a penchant for delivering statements like “Our motto is: ‘The beauty of science and the science of beauty.’”

Mr. Dinkes joined the Sadick operation three years ago with the mission of applying his business-school skills to “building the next generation of the business.” Dr. Sadick’s companies were booming at the time, Mr. Dinkes said, but, while the doctor had “an understanding” of where the industry was going and “where he needed to position himself,” he needed someone to help him get there.

“The goal,” said Mr. Dinkes, “was to move the company into this new direction to realize the vision of the future of dermatology.”

And what does the “vision of the future of dermatology” look like? To begin, it doesn’t have wall plaques, because Mr. Dinkes found the constant straightening they required irksome. So he replaced them with digitally scanned versions that now run across a flat panel in Dr. Sadick’s personal office.

The future also relies a lot on instant-messaging, “so we can communicate without actually talking, which keeps the noise level down,” Mr. Dinkes said. It features iPod stations in skin-care rooms so patients can “customize” their experience, as well as a tea bar with glassware—not Styrofoam!—because this is a Park Avenue establishment, after all. And because Sadick Dermatology is also an academic institution, the whole shebang can be transformed into a teaching facility for weekend workshops for doctors or Dior. (Dr. Sadick is Christian Dior’s global medical advisor.)

“Everything is to another level,” said Mr. Dinkes.

But beyond the surface changes, Mr. Dinkes’ greatest achievement was, perhaps, changing the “way of thinking” that prevailed among some staffers from the old operation. That way of thinking was, quite simply, “small business.”

“Everything from the phone system, the people at the front desk, the medical staff … everything needed to be re-evaluated to determine whether the way things were done would fit into the new picture,” he said. “And in many cases, unfortunately, the staff had to be changed.”

Now, many staffers and a new office later, Mr. Dinkes is confident that Sadick Dermatology is “on the right path.” So is his boss, who took a brief break from his work to glow about the new digs, “making patients happy,” and his current research into such far-out procedures as “non-invasive fat removal.”

“We also plan on opening other centers using this as a model,” he said, grinning.

Meanwhile, outside, roughly 1.5 million uninsured New Yorkers prayed the sudden winter weather wouldn’t make them sick.

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).

Alex Kuczynski had a book party on Thursday. Her book is about plastic surgery.

The Transom thought it would be funny to go up to random blondes and say, “Alex, it’s a pleasure to meet you, loved the book.” (Get it? Like she was unrecognizable from the knife?) But the first two both said, “What? I didn’t write the book.” Har har. Anyway, Ms. Kuczynski’s hair is now her “natural” brown.

And then there she was: Ms. Kuczynski’s cosmetic surgeon, Dr. Michelle Copeland.

“She did my eyes, my posterior and my Botox,” brayed Ms. Kuczynski, directing an affectionate almond-shaped gaze downward onto the diminutive doctor. The leggy author wore a red and black dress, black tights and heels that put her in line for tallest-person-in-the-room status.

“Everybody should have such a wonderful subject,” said Ms. Copeland. “Alex is a delight. It’s easy to make her look good.”

“You’re so cute,” responded her 38-year-old subject, her upper lip remaining remarkably stiff. Ms. Kuczynski, who writes the “Critical Shopper” column for The Times and is somehow the First Daughter of Peru, then turned a critical eye on The Transom.

“Have you had any work done?” she asked.

She suggested Preparation H for the eyes. “That’s what models use.”

On that note, Ms. Copeland, what was more challenging—fixing Ms. Kuczynski’s eyes, or her ass?

“Eyes are more difficult,” said the doctor, “because first of all there’s one on each side, so you have to make them symmetrical. And they’re so visible—they’re right there, up front and center, so you wanna make it look natural.”

Ms. Kuczynski later explained that while her eye issue made her look like the “cartoon character Bill the Cat”—one was prone to sagging half-shut—the issue with her posterior was less severe. Thbbbt!

“There were two teeny-tiny teaspoon-size wiggling portions in what, in the industry, is called the saddle-bag region,” she said. Despite a year of training for the New York Marathon, the “junk in the trunk” persisted. So she had Ms. Copeland liposuction it out. That was five years ago, and “the wiggly portion is generally still gone.”

Indeed, Ms. Kuczynski said, the twin themes of her book Beauty Junkies are: “It’s O.K. to be you, and watch out who does your ass.” And that “people really need to understand who is an actual plastic surgeon, and who is a dermatologist who just took a weekend seminar.”

“A few years ago,” she said, “I was on the brink of just doing every new thing, and I’m really glad I pulled back.”

She said that Senator Hillary Clinton’s Republican challenger, John Spencer, is an “intolerant asshole” for his recent charges that Mrs. Clinton was “ugly” before having “million of dollars” of plastic surgery.

Most of female guests at the party at the “21” Club were on board with her “scalpel in moderation” thesis.

“It’s not the Holy Grail. It’s more like fur—it should be done sparingly,” said Candace Bushnell.

“If I had the balls to get it done, I would—but I’m terrified of needles,” said Daily News editrix Orla Healy. “But Candace is so sweet. She’s given me the names of some good Botox people.”

P.R. princess Peggy Siegal had just arrived from the New York Antiques Show. “There’s nothing worse than bad plastic surgery, and there’s nothing better than great plastic surgery,” she offered.

Speaking from experience?

“I’ve never had any bad plastic surgery, so you can fill in the cracks or the lines or whatever,” she said, adding that the “work” around the room looked pretty good. Particularly compared to that at the Antiques Show.

“People who are confident tend to do better and have better luck than people who don’t feel good about themselves,” said Ms. Kuczynski’s mega-investor husband, Charles Stevenson. “So I think cosmetic surgery has a positive contribution to make.”

Does he ever worry about his wife’s willingness to go under the knife?

“There is a risk in every surgery,” he said. “But I try to be supportive, as every husband should.”

And what of the men in the room? Mr. Stevenson said he thought not.

Producer Brian Grazer was also against it. “I think it’s desexualizing for a man,” he said. Shortly thereafter, he asked The Transom where it had purchased its shoes.

“I thought about having my chin done,” said 60 Minutes anchor Steve Croft. “The only time I could do it would be during my summer vacation, so …. But there are probably some men on the show who have had work done.” He declined to name names.

Recently unemployed Daily News gossip columnist Lloyd Grove is willing to try new things. “I was hoping to run into some plastic surgeons here tonight,” he said. “At this stage, I know could use some tightening around the jowls, and I’d like to get my breasts done.”

Ms. Kuczynski said she wishes Mr. Grove would give some serious consideration to at least one slice. “He’s a very handsome man, but Lloyd does have a mole on his cheek that I’ve been asking him to have removed for several years.”

Mr. Grazer’s wife, the novelist and screenplay writer Gigi Levangie Grazer, is over the whole scene. “My forte is writing about people on the West Coast who’ve had everything done and have little knots of skin in the back of their heads because of all the face-lifts.”

“I’ve had Botox, but not for a while,” she said, using a finger to indicate a few wrinkles in her T-zone. “And I’ve been very stressed out raising two boys. I think enough with the Botox, people should start doing antidepressants again. People should go back to downers.”

Ms. Kuczynski was actually surprised by how few face-lifts she’d seen that night. By around 9, as the party was starting to thin out, she was having trouble spotting anyone who’d even had a “touch-up.”

“Nope, nope, nope, nope, not her,” she said, scanning the room. “At this point in the party, anybody who had had plastic surgery has left. I think that probably is reflective of the fact that an older crowd might come earlier. Generally, older people have had some work done.”

—Spencer Morgan

Our Girls Are Growing Up

“I think the 20’s are for learning and figuring things out, and the 30’s are for applying what you’ve learned, no?” said Zani Gugelmann, the breathtaking socialite. She has a cleft chin that even Viggo Mortensen would envy.

So Ms. Gugelmann is 29, but already thinking like a 30-year-old. She was among several hostesses of an Avenue magazine party last week in honor of the 80th anniversary of Coco Chanel’s iconic “Little Black Dress.”

This is how she lives like an adult: “I always get up at 8:30,” said the willowy brunette. She toils as a jewelry designer. “I eat some breakfast and call a couple people who I know will put a smile on my face. Then I get started with the day, returning e-mails and going to appointments.”

Does that leave time for boys?

“I was engaged when I was 23,” said Ms. Gugelmann. She was in a black Chanel slip dress. “I was too young. And so, after that didn’t work out, from like 23 to 26, I put my little blinders up and said, ‘I am not going to let myself fall for anyone.’ Because I just wanted to enjoy myself.” But hold the phone! Now she’s nearing the big 3-0, and the blinders are off. “In the last four years, I’ve been able to take a step back and figure out what I want. It’s all about character and integrity. Even just little things, like how you treat a cab driver. The little things are a huge reflection of one’s character.”

Fabiola Beracasa, another gal-about on hand at Chanel’s 57th Street store, is off the market. “Yes, I’m taken,” she said. Ms. Beracasa had opted for one of her mom’s couture blouses and paired it with black leggings. “Nothing’s a done deal until you sign the marriage certificate, but it’s pretty serious.”

—S.M.

58th Street Re-Gayed

“If you live on the East Side, you don’t have to go to Chelsea anymore,” said Tom Shanahan, surveying his recently renovated Upper East Side gay bar. It is called O.W., and this was at the grand reopening party Friday. “We’re going to have all the activities they have here!”

“You know ‘Catch a Rising Star’? We’re going to have ‘Catch a Rising Queer’!” said the 35-year-old gay civil-rights attorney. Earlier this summer, Mr. Shanahan and several investors bought the bar on East 58th Street. He said the club would also offer gallery shows in the lounge area, a lecture series, a “go-go boy” night and the occasional private nudist party.

“We put in a new stage up front with theatrical lighting,” said Gordon Ahlstrom, one of Mr. Shanahan’s partners. He will run the day-to-day mechanics of the bar. “So I can do performance pieces, I can do poets, I can do comics, I can do fashion designers. It’s limitless!”

The renovation of O.W., which stands for “Oscar Wilde,” is the first step in Mr. Shanahan and Mr. Ahlstrom’s plan to return East 58th Street to its gay heyday.

“There used to be four gay bars on this street, so it was sort of like—you know Chinatown? Well, this was like the gay street on the Upper East Side. So we’re trying to bring that back,” said Mr. Shanahan. They are also looking to buy one of the restaurants on the block. At present, there is one other gay establishment on the block, the Townhouse Bar. That bar, historically, caters to the trade, if you will.

“Chelsea has its own scene going on, and it’s a very unique scene and there’s nothing wrong with it,” Mr. Shanahan said. He wore a mocha-colored leather jacket and jeans. “But that’s just not my world. Here, it’s mostly professionals.”

Aside from being active in gay land—Amanda Lepore is one of his clients—Mr. Shanahan has also been “a capo” in the McManus Midtown Democratic Association for over a decade. He provides free legal advice at the political club every Thursday night.

“What I want to do is tie in the political stuff and the advocacy stuff to this club,” he said. They’ve already held several fund-raisers. “And you know, Jim McManus is like my godfather, so I guess I’m following in some big shoes,” he said. Mr. McManus is the head of the political association, which has been running politics in Hell’s Kitchen for more than a century.

Mr. Shanahan admits he’s taking a slightly more “progressive” route than his mentor, but says Mr. McManus has been involved in backing a number of businesses, including the original Siberia bar—which, while it didn’t have official nudist parties, was known to get pretty wild.

By no small coincidence, Siberia bar owner Tracy Westmoreland is a friend and client of Mr. Shanahan and stopped by to raise a glass. He was impressed with the new digs. “This place used to be a shithole,” he said.

“The décor’s beautiful,” said Mr. Shanahan’s boyfriend, Jude Scott. “It’s an actual lounge now. It’s got like striped upholstery and stuff, and the artwork is very busy and abstract. And all the upholstery design is very geometric in shape.”

—S.M.

The Transom Also Hears ….

Our resident canary on the barstool at the Los Angeles hotspot Hyde reports that the nightclub’s celebrity patrons weren’t keeping up their end of the fabulous bargain last Tuesday night. First it was Scrubs star Zach Braff sitting at the bar, drooling all over a waitress.

“He was wasted and it wasn’t even midnight,” said the witness. “He kept asking the waitress what time she was getting off work. And the waitress was trying to get him to calm down and to drink water.”

Then around 1:30 a.m., Nicky Hilton—fresh off her breakup with Entourage star Kevin Connolly—arrived at the Sunset Boulevard club with a support group consisting of her sister Paris and Kim Kardashian. “They were trying to cheer her up and have fun, you know, like a girls’ night out. But Nicky looked like she was forcing it,” said the source, who is friendly with Ms. Hilton.

“You can tell she’s still really down about Kevin. You know, she thought she was going to marry him! They were looking at rings and everything. And then he goes and cheats on her like that. I heard that she’s been crying, like, a lot. You have to feel for her.”

—S.M.

It was the eve of the publication of her new book, The Female Thing: Dirt, Sex, Envy, Vulnerability, and Ms. Kipnis, who said she’s in her “late 40’s,” seemed a tiny bit nervous about how graciously she, and it, would be received. Ms. Kipnis called the book, which critiques women’s conflicted obsessions with cleanliness, romantic love, orgasms and rape, an “update on the topography of the female psyche.” She described the tone of some early reviews with that dreaded word: “mocking.”

“I’m curious to know if that will persist, and if writing about femininity actually will end up being my intellectual downfall and I’ll never be taken seriously again,” she said, looking austere at the Noho Star cafe for breakfast on Sept. 29. She was dressed for urban combat—or perhaps for battles of a cerebral nature—in a black sweater and pants, her white, almost translucent skin and angular features brought out by pink lipstick and smoky eyeliner. On her feet were tweed wedges with maribou poufs on the toes.

“You know, I think it’s not an unaggressive book, actually,” she continued in her elongated Midwestern drawl, an anxious furrow appearing between her eyes. “And I think any amount of aggression you put out in the world comes back to you.” Although that’s obviously something she seeks out: “I’m maybe playing a bit of a provocateur role,” she said. She took a bite of toast.

Ms. Kipnis, who teaches film production at Northwestern University, is not incorrect in thinking that the media needs more sharp, intelligent female writing. Instead, the proliferation of self-indulgent essays—retro first-person tales of dating, wedding-planning and baby-making—seem to do more for the author than the reader. Both the television and print worlds are crowded with self-important boys fighting amongst themselves, but there’s no Simone, Susan Sontag or even a kooky new Camille Paglia on the horizon. The literary landscape is as uninspiring as a girl’s credit-card balance after a Jimmy Choo sample sale—as Ms. Kipnis herself might write in her self-consciously irreverent voice.

“I did think what was missing was an element of honesty,” said Ms. Kipnis, who criticizes the work of Maureen Dowd, Caitlin Flanagan and Eve Ensler, not to mention most feminist academics and theorists (she does admire Barbara Ehrenreich). She refers to much of what goes on as “you go, girl” culture: “It’s a whole men-are-dogs, men-are-untrustworthy kind of advice literature which acts as if men are de facto emotional incompetents, and women are the ones with the soul and the depth and the emotional awareness,” she said, adding that women need to look inward to find the source of many of their problems. “It does seem so smug.”

Ms. Kipnis, however, doesn’t regard this as an irreconcilable problem; having made her name writing “academically” about subjects such as Hustler magazine and porn (a sure way to ensure that one’s college courses are always full), she seems intent on catapulting beyond the walls of academia and filling the void herself.

LAURA KIPNIS GREW UP IN, and now lives in, Chicago, but she’s openly ambitious about her desire to settle permanently in New York (“It’s fucking freezing there,” she said, among other things, about the Windy City).

She attended art school in San Francisco, became known as a video artist and then went on to publish articles in academic journals, which led to university teaching gigs in Madison and Michigan, as well as at New York University in 2002 and 2003. (Ms. Kipnis holds the title of professor at Northwestern without the coveted credential of a Ph.D.)

After publishing books in the academic world—Bound and Gagged: Pornography and the Politics of Fantasy in America and Ecstasy Unlimited: On Sex, Capital, Gender & Aesthetics—she made her mainstream debut with Against Love: A Polemic, a sassy book-length essay arguing that marriage and monogamy are suffocating and unnatural (“domestic gulags,” in her parlance), which was published in 2003. People—men in particular—seemed intrigued by a single-woman author who made a passionate case for adultery (although she said that she was once in a stable 12-year relationship and isn’t anti-marriage). The book was widely, and for the most part enthusiastically, reviewed.

“I was kind of amazed with that book,” Ms. Kipnis said, marveling at how “intellectually seriously” it was treated. “I thought that it would be polarizing, and I thought there would be some real bashing, but as far as I know, the reviews were just entirely … kinda celebratory and positive to an extent that just ... surprised me.”

Slate’s culture editor, Meghan O’Rourke, reviewed the book and later asked Ms. Kipnis to write for the online magazine. The collaboration led to pieces about Playboy, Deep Throat, Americans’ expanding waistlines and politics. Ms. O’Rourke described Ms. Kipnis as their “maverick voice on feminism.”

Most of Ms. Kipnis’ newest book was written in New York, in an apartment she owns in Chelsea, while she was on a two-year leave from Northwestern. When she’s in town, she hangs out with, among others, Ms. O’Rourke, as well as the New Yorker writer Rebecca Mead and her husband. (Ms. Mead reviewed Against Love for The New Yorker and the two struck up a friendship.) In fact, Ms. Mead’s home was the setting of at least one of the dinner parties mentioned in the book, in which Ms. Kipnis described an “attractive successful single professional female in her mid- to late thirties” who was ranting at the table about what wimps most men are. Ms. Mead said that Ms. Kipnis is “excellent” to have at a dinner party.

“She can always defend herself and argue with people who aren’t necessarily used to being taken on,” Ms. Mead said. “And she’s always game. So I don’t think she’s ever declined an invitation.”

The dinner-party anecdote was meant to illustrate what seems to be Ms. Kipnis’ central point: that women have mixed feelings about their own emancipation. “[B]eing female at this point in history is an especially conflicted enterprise,” she writes sagely in the “Envy” section, “like Birkenstocks with Chanel, or trying to frown after a Botox injection.”

The 160-page riff that ensues is decidedly less focused than Against Love. Ms. Kipnis divides the female psyche into four quadrants (the “dirt,” “sex,” “envy” and “vulnerability” of the title), and within them covers sexual satisfaction (“orgasms have become an index of female progress”), housework (“it’s unclear whether the real domestic problem between the sexes is that men won’t clean or that women will”), rape (“It may come as a surprise to hear that as many men as women are probably raped [in prison] every year in the United States, and possibly more”) and women’s general love-hate attitude towards men. Freud makes an appearance on page 11, Naomi Wolf on page 145, with Nietzsche somewhere in between.

She pointedly avoids giving any sort of advice, which many women have probably come to expect from their fellow women. When asked what she hoped to accomplish with The Female Thing over breakfast, Ms. Kipnis paused.

“I think my ambition is to—I don’t know how this is gonna sound—but for the world to be a bit more interesting than it is,” Ms. Kipnis said. “So I’m … trying to contribute to making these conversations feel a little more interesting. And also, on a personal level, just kinda have fun.”

A COUPLE OF WEEKS LATER, Ms. Kipnis was party to a conversation with a very different tenor. She was the guest of honor at a seminar held at Columbia University to discuss the “Dirt” chapter of The Female Thing. A group of students, many likely from women’s studies (several bandanas and unshaved armpits were in attendance), and a handful of professors gathered around a conference table in a fluorescent-lit basement room. The whole exercise served as a potent reminder of both the perils and the luxuries of academic life.

One of those present, an older woman with short hair and spectacles, was squirming in her seat.

“I still don’t know what this book is about,” she harrumphed, furiously chewing her gum.

Ms. Kipnis swept in and took her place at the end of the table. After a heady introduction by one of the grad students, she explained that “femininity and feminism are in incessant conflict” with one another. She read several passages from the book’s preface aloud (“when it comes to the female situation, contradictions speckle the landscape, like ingrown hairs after a bad bikini wax,” etc.). While she spoke, her lips pursed into a perfect “O” shape that jutted out in front of her face.

“I loved reading this—it was so much fun, I felt like I was cheating,” gushed one young woman when Ms. Kipnis finished reading.

The conversation hopscotched around the table, covering questions of who Ms. Kipnis was hoping to reach with her book (“both academics and readers of Time magazine,” she said); the link between housework and pornography; the question of whether there is a “female propensity to masochism”; and the inevitable theme of ladies’ anatomy: “I kept coming back to the vagina,” Ms. Kipnis declared at one point, by way of explaining why women behave the way they do. “No matter how you get into the theory, it does come back to the fact that you have a vagina. It sounds stupid to say it …. ”

There was heated talk of “cross-cultural claims” and “transformational possibilities,” “social constructionism” and “materiality.” One of the three men in the room piped in that he had had “some impatience with the straight constructionist line” in the excerpt.

Ms. Kipnis seemed to be rather enjoying the friendly banter, until someone put forth a question that demonstrated that even an edgy, feminist contrarian has her limits. A man with a shaggy white mustache gathered the sheaf of papers spread out on the table in front of him with the efficiency of a government bureaucrat.

“I found it interesting that there was no reference at all to oral sex,” the man began. “Feel-ah-shee-o or coo-ne-linguis raises all sorts of issues that you might have discussed—heh, heh! My sense is that feel-ah-shee-o occurs more and is expected more than coo-ne-linguis.”

Ms. Kipnis was staring at him, and somewhere somebody let out a giggle.

“Do you think that oral sex has any role in this discussion?” the man said.

It was a fair point, but Ms. Kipnis was having none of it.

“Uh … no, I didn’t take that up,” Ms. Kipnis said.

It was the eve of the publication of her new book, The Female Thing: Dirt, Sex, Envy, Vulnerability, and Ms. Kipnis, who said she’s in her “late 40’s,” seemed a tiny bit nervous about how graciously she, and it, would be received. Ms. Kipnis called the book, which critiques women’s conflicted obsessions with cleanliness, romantic love, orgasms and rape, an “update on the topography of the female psyche.” She described the tone of some early reviews with that dreaded word: “mocking.”

“I’m curious to know if that will persist, and if writing about femininity actually will end up being my intellectual downfall and I’ll never be taken seriously again,” she said, looking austere at the Noho Star cafe for breakfast on Sept. 29. She was dressed for urban combat—or perhaps for battles of a cerebral nature—in a black sweater and pants, her white, almost translucent skin and angular features brought out by pink lipstick and smoky eyeliner. On her feet were tweed wedges with maribou poufs on the toes.

“You know, I think it’s not an unaggressive book, actually,” she continued in her elongated Midwestern drawl, an anxious furrow appearing between her eyes. “And I think any amount of aggression you put out in the world comes back to you.” Although that’s obviously something she seeks out: “I’m maybe playing a bit of a provocateur role,” she said. She took a bite of toast.

Ms. Kipnis, who teaches film production at Northwestern University, is not incorrect in thinking that the media needs more sharp, intelligent female writing. Instead, the proliferation of self-indulgent essays—retro first-person tales of dating, wedding-planning and baby-making—seem to do more for the author than the reader. Both the television and print worlds are crowded with self-important boys fighting amongst themselves, but there’s no Simone, Susan Sontag or even a kooky new Camille Paglia on the horizon. The literary landscape is as uninspiring as a girl’s credit-card balance after a Jimmy Choo sample sale—as Ms. Kipnis herself might write in her self-consciously irreverent voice.

“I did think what was missing was an element of honesty,” said Ms. Kipnis, who criticizes the work of Maureen Dowd, Caitlin Flanagan and Eve Ensler, not to mention most feminist academics and theorists (she does admire Barbara Ehrenreich). She refers to much of what goes on as “you go, girl” culture: “It’s a whole men-are-dogs, men-are-untrustworthy kind of advice literature which acts as if men are de facto emotional incompetents, and women are the ones with the soul and the depth and the emotional awareness,” she said, adding that women need to look inward to find the source of many of their problems. “It does seem so smug.”

Ms. Kipnis, however, doesn’t regard this as an irreconcilable problem; having made her name writing “academically” about subjects such as Hustler magazine and porn (a sure way to ensure that one’s college courses are always full), she seems intent on catapulting beyond the walls of academia and filling the void herself.

LAURA KIPNIS GREW UP IN, and now lives in, Chicago, but she’s openly ambitious about her desire to settle permanently in New York (“It’s fucking freezing there,” she said, among other things, about the Windy City).

She attended art school in San Francisco, became known as a video artist and then went on to publish articles in academic journals, which led to university teaching gigs in Madison and Michigan, as well as at New York University in 2002 and 2003. (Ms. Kipnis holds the title of professor at Northwestern without the coveted credential of a Ph.D.)

After publishing books in the academic world— Bound and Gagged: Pornography and the Politics of Fantasy in America and Ecstasy Unlimited: On Sex, Capital, Gender & Aesthetics—she made her mainstream debut with Against Love: A Polemic, a sassy book-length essay arguing that marriage and monogamy are suffocating and unnatural (“domestic gulags,” in her parlance), which was published in 2003. People—men in particular—seemed intrigued by a single-woman author who made a passionate case for adultery (although she said that she was once in a stable 12-year relationship and isn’t anti-marriage). The book was widely, and for the most part enthusiastically, reviewed.

“I was kind of amazed with that book,” Ms. Kipnis said, marveling at how “intellectually seriously” it was treated. “I thought that it would be polarizing, and I thought there would be some real bashing, but as far as I know, the reviews were just entirely … kinda celebratory and positive to an extent that just ... surprised me.”

Slate’s culture editor, Meghan O’Rourke, reviewed the book and later asked Ms. Kipnis to write for the online magazine. The collaboration led to pieces about Playboy, Deep Throat, Americans’ expanding waistlines and politics. Ms. O’Rourke described Ms. Kipnis as their “maverick voice on feminism.”

Most of Ms. Kipnis’ newest book was written in New York, in an apartment she owns in Chelsea, while she was on a two-year leave from Northwestern. When she’s in town, she hangs out with, among others, Ms. O’Rourke, as well as the New Yorker writer Rebecca Mead and her husband. (Ms. Mead reviewed Against Love for The New Yorker and the two struck up a friendship.) In fact, Ms. Mead’s home was the setting of at least one of the dinner parties mentioned in the book, in which Ms. Kipnis described an “attractive successful single professional female in her mid- to late thirties” who was ranting at the table about what wimps most men are. Ms. Mead said that Ms. Kipnis is “excellent” to have at a dinner party.

“She can always defend herself and argue with people who aren’t necessarily used to being taken on,” Ms. Mead said. “And she’s always game. So I don’t think she’s ever declined an invitation.”

The dinner-party anecdote was meant to illustrate what seems to be Ms. Kipnis’ central point: that women have mixed feelings about their own emancipation. “[B]eing female at this point in history is an especially conflicted enterprise,” she writes sagely in the “Envy” section, “like Birkenstocks with Chanel, or trying to frown after a Botox injection.”

The 160-page riff that ensues is decidedly less focused than Against Love. Ms. Kipnis divides the female psyche into four quadrants (the “dirt,” “sex,” “envy” and “vulnerability” of the title), and within them covers sexual satisfaction (“orgasms have become an index of female progress”), housework (“it’s unclear whether the real domestic problem between the sexes is that men won’t clean or that women will”), rape (“It may come as a surprise to hear that as many men as women are probably raped [in prison] every year in the United States, and possibly more”) and women’s general love-hate attitude towards men. Freud makes an appearance on page 11, Naomi Wolf on page 145, with Nietzsche somewhere in between.

She pointedly avoids giving any sort of advice, which many women have probably come to expect from their fellow women. When asked what she hoped to accomplish with The Female Thing over breakfast, Ms. Kipnis paused.

“I think my ambition is to—I don’t know how this is gonna sound—but for the world to be a bit more interesting than it is,” Ms. Kipnis said. “So I’m … trying to contribute to making these conversations feel a little more interesting. And also, on a personal level, just kinda have fun.”

A COUPLE OF WEEKS LATER, Ms. Kipnis was party to a conversation with a very different tenor. She was the guest of honor at a seminar held at Columbia University to discuss the “Dirt” chapter of The Female Thing. A group of students, many likely from women’s studies (several bandanas and unshaved armpits were in attendance), and a handful of professors gathered around a conference table in a fluorescent-lit basement room. The whole exercise served as a potent reminder of both the perils and the luxuries of academic life.

One of those present, an older woman with short hair and spectacles, was squirming in her seat.

“I still don’t know what this book is about,” she harrumphed, furiously chewing her gum.

Ms. Kipnis swept in and took her place at the end of the table. After a heady introduction by one of the grad students, she explained that “femininity and feminism are in incessant conflict” with one another. She read several passages from the book’s preface aloud (“when it comes to the female situation, contradictions speckle the landscape, like ingrown hairs after a bad bikini wax,” etc.). While she spoke, her lips pursed into a perfect “O” shape that jutted out in front of her face.

“I loved reading this—it was so much fun, I felt like I was cheating,” gushed one young woman when Ms. Kipnis finished reading.

The conversation hopscotched around the table, covering questions of who Ms. Kipnis was hoping to reach with her book (“both academics and readers of Time magazine,” she said); the link between housework and pornography; the question of whether there is a “female propensity to masochism”; and the inevitable theme of ladies’ anatomy: “I kept coming back to the vagina,” Ms. Kipnis declared at one point, by way of explaining why women behave the way they do. “No matter how you get into the theory, it does come back to the fact that you have a vagina. It sounds stupid to say it …. ”

There was heated talk of “cross-cultural claims” and “transformational possibilities,” “social constructionism” and “materiality.” One of the three men in the room piped in that he had had “some impatience with the straight constructionist line” in the excerpt.

Ms. Kipnis seemed to be rather enjoying the friendly banter, until someone put forth a question that demonstrated that even an edgy, feminist contrarian has her limits. A man with a shaggy white mustache gathered the sheaf of papers spread out on the table in front of him with the efficiency of a government bureaucrat.

“I found it interesting that there was no reference at all to oral sex,” the man began. “ Feel-ah-shee-o or coo-ne-linguis raises all sorts of issues that you might have discussed—heh, heh! My sense is that feel-ah-shee-o occurs more and is expected more than coo-ne-linguis.”

Ms. Kipnis was staring at him, and somewhere somebody let out a giggle.

“Do you think that oral sex has any role in this discussion?” the man said.

It was a fair point, but Ms. Kipnis was having none of it.

“Uh … no, I didn’t take that up,” Ms. Kipnis said.

But sometimes the merry-go-round of culture swoops back around, depositing the old controversies right back in front of you like a stomping, pouty kid. Time slips back, and despite all other indications of social or at least temporal progress, the disgraced, buried past returns. Like Dick Cheney. Or creationism. Or, yes, silicone-boob jobs.

Throughout the last few months, rumors have been whipping through the breast-augmentation world that the Food and Drug Administration is on the verge of returning silicone implants to the open market after a 14-year partial ban on the gel-filled bosom enhancers. The ban, which came down in 1992, had never fully eradicated silicone—women who had endured mastectomies or had a breast “deformity” or agreed to participate in a study could still opt for the gel—but the average Pamela Anderson groupie, the cosmetic breast enhancer, was out of luck. She had to make do with saline.

But last summer, the F.D.A. sent word to two competing implant manufacturers, Inamed and the Mentor Corporation, that their applications to sell a new generation of silicone-filled sacs were “approvable with conditions.” And since then, whispers of an imminent F.D.A. decision date—the most recent centered on July 4—have regularly sifted through the country’s plastic-surgery capitals, from the C-cup-loving streets of New York to the D-cup-worshipping beaches of California and Texas. (Implant size is, apparently, the one area where New Yorkers are more conservative than Texans.)

In a sign of just how confident the manufacturers are in the F.D.A.’s intentions, both Inamed and Mentor have included revenue from silicone implants in their 2006 earnings projections, CNNMoney.com reported.

“We believe that silicone will be approved,” said Dr. Mark Jewell, an Oregon-based plastic surgeon and president of the American Society for Aesthetic Plastic Surgery. “I can’t tell you when, but I think it will be soon.”

A spokesperson for the F.D.A. declined to comment on the rumors, saying only that the applications “are still being reviewed.”

Like the return of all thorny cultural controversies, the news of a potential silicone resurgence has resurrected not just the specter of the gooey sacs, but the old debate around them. And it is as toxic as ever. (And we should emphasize: This is a debate about cosmetic enhancement, not reconstructive surgery.)

In one corner—the corner of the nip-tuckers and implant-makers—the return of silicone has been hailed as everything from the triumph of science over “emotion” to, paradoxically, a victory for women. Cloaking themselves in the velvet mantle of women’s defenders, they have touted silicone not only as safe, but, frequently, as a better product for women than saline: better-looking, better-feeling, the difference between “a zip-lock bag of Jell-o versus a zip-lock bag of water,” said Dr. Jewell.

“I think that we’re the advocates of women who want this operation,” he continued. “These devices should be … available for patients as choice. This is choice.”

That this language skates suspiciously close to the rhetoric of the pro-choice movement makes the whole thing all the more surreal.

And enraging to women’s-rights advocates.

The news of a potential silicone comeback has not gone over well among its historic opponents in the women’s movement. Sounding the old battle hymns feminist, they have grabbed their signs and science Ph.D.’s and argued that, surgeons’ and silicone-makers’ claims to the contrary, silicone has not been proved safe. It wasn’t safe years ago, it isn’t now, and the F.D.A. should not overturn its ban, they say. (Some have also accused the pro-implant warriors of spreading rumors that approval is imminent to create a climate where approval is a done deal.)

“We feel like there are enough warning signs and unanswered questions that women deserve better,” said National Women’s Heath Network director Cynthia Pearson. “This is a disputed product and a disputed body of [scientific] information.”

It is also a deeply symbolic product, one that hovers not just at the intersection of health and sexuality—always a pungent brew—but of women’s health and women’s sexuality.

In today’s America, free-to-be-you-and-me has long since given way to lipo, face-lifts and an ever-wider array of injectables: Botox for the brows, Gore-Tex for the lips, and restylane for those pesky wrinkles around the nose and mouth. In 2005, the American Society of Plastic Surgeons reported nine million cosmetic-surgery procedures on women, up 38 percent from 2000. And while most people acknowledge that you can shave, wax, laser or strut about in pasties and still be a feminist, it’s also no wonder that women’s groups are freaked. Silicone is the stalwart flag of last retreat.

THE HISTORY OF THE BOOB JOB IS LONG and puckered, a Wild West–style tale of experimentation, complications and little regulation. The story begins with a Viennese doctor (of course) who tried injecting paraffin into women’s breasts in the 1890’s, and it continues with tales seedy and strange of doctors experimenting with everything from synthetic sponges to glass balls to industrial-grade silicone (think transformer fluid) injected directly into Vegas showgirls’ breasts, according to Elizabeth Haiken’s Venus Envy. That many of these experiments ended in less than happy results—cysts, gangrene, a few deaths—didn’t stop doctors from experimenting anyway.

The silicone-filled breast implant arrived on the bust-enhancing scene in 1962, to excitement from doctors and enthusiasm from the press. With its handy little protective pouch, this device was to be the solution to all those hapless decades of trial and error, to say nothing of the cruel disease of bustlessness. Once again, however, the big promises went largely unquestioned and unregulated.

But in the late 1980’s, the decades of scientific complacency gave way to scandal. After several critical magazine articles and an F.D.A. study linking silicone gel to cancer in rats, women began coming forward with tales of woe: ruptured implants, free-sloshing silicone (silicone in their breast cavities, their bloodstream, their lymph nodes), and symptoms that ranged from generalized aches, pains and exhaustion to arthritis and lupus.

“[I] was at a rally in Washington, D.C., where women from all over the country came together … and literally every woman had the same story,” recalled Carol Ciancutti-Leyva, whose mother believes that she became ill from ruptured implants, and who is now making a documentary about the subject. “Every woman had the same symptoms.”

Within short order, lawsuits were filed, the media pounced and a debate erupted. Surgeons called the allegations “junk science”—and launched a $2 million counter-campaign—but in 1992, after hemming, hawing and holding three days of hearings, the F.D.A. declared that manufacturers hadn’t done their safety homework and removed the implants from the general-use market. When Dow Corning, the country’s major silicone-implant maker, went bankrupt in 1995, the disgraced polymer seemed officially banished from the cosmetic-implant market.

In fact, it was only in temporary exile.

On Dec. 31, 2002, Inamed filed an application with the F.D.A. to begin marketing a new generation of silicone implants to mammary-challenged Americans—a move that was followed several months later by Mentor. The companies had been emboldened by a series of studies that found no clear link between silicone and serious autoimmune disease, but their move still sparked controversy—nearly three years of it, in fact, including several heated F.D.A. hearings, two rounds of applications (the F.D.A. turned down Inamed’s first attempt) and some serious lobbying (Mentor spent $850,000 on lobbying in 2005 alone).

Such back-and-forth has done little to clarify the burning question of implant safety in the public’s mind.

To listen to its boosters, silicone gel is a decidedly harmless, inert substance, the wonder material behind countless medical innovations, from testicular implants to neurosurgical shunts. “Silicone is everywhere,” said Dr. Helen Colen, a Park Avenue plastic surgeon who supports the return of silicone, though she generally prefers saline. “Your IV lines are silicone, your syringes are silicone. Everything is silicone. And yet only the breast got the raw deal?”

Beyond ubiquity, surgeons and supporters point to a pool of studies, including the much-touted 1999 Institute of Medicine Study, which did not find “statistically significant” links between silicone implants and systemic autoimmune diseases. That some of these studies also warned about an increased incidence of painful or disfiguring local complications—like infection, rupture and a nasty-sounding condition called “capsular contracture”—tends to get less airtime.

“Certainly, there are some local problems. Silicone gel implants got ruptured, and silicone got in the tissues, and that could produce lumps and bumps,” said Dr. Sherrell Aston, the celebrated celebrity plastic surgeon. (Many plastic surgeons dismiss rupture as a minor concern, saying it generally does not lead to serious silicone leakage these days because of sturdier implant shells and gooier silicone gels.) “But the real question is whether they produce any systemic disease, and there’s no evidence in the literature to support that.”

Silicone opponents beg to differ. Not only do they warn that rupture remains a potential problem in today’s new implants—one that can lead to additional surgeries and complications—but, they say, the literature offers a number of noteworthy examples of downright unhealthy silicone side effects, some of the scariest of which are presented in an ongoing National Cancer Institute study. Among its findings: Women with implants were two to three times as likely to die from brain cancer and respiratory cancers, and four times as likely to commit suicide, compared to other plastic-surgery patients.

As for those nasty connective-tissue ailments and autoimmune disorders about which so many women complained, implant opponents aren’t convinced that silicone is innocent there, either. While a number of studies found no observable tie to these diseases, implant critics say the studies are not entirely conclusive or trustworthy. In many cases, the sample size was too small; in other cases, the studies were too short; and frequently they were funded by the implant industry—charges that the groups have also lobbed against Inamed’s and Mentor’s trials of their cohesive-gel implants.

“A lot of this is a data-quality issue,” said Susan Wood, former director of the F.D.A.’s Office of Women’s Health, who resigned last year after the agency refused to approve Plan B despite evidence showing that it was safe. (The agency finally approved it last month.) “I think there needs to be a stand for high-quality data from the companies that has enough people over a long enough period of time …. Because, from what I know of what’s been presented, the studies don’t demonstrate that these products are safe enough for approval.”

THE F.D.A. HAS REMAINED STUBBORNLY MUM on its plans to approve, or not approve, silicone-gel implants, and the reality is that it could as easily give (or deny) its blessing tomorrow as it could over Thanksgiving, after the confirmation of the new F.D.A. commissioner, or during the next eclipse. But one thing is certain: If and when silicone plops back onto the cosmetic-implant market, it will find a ready home in American bosoms.

Between 1992 and 2005, the number of women getting breast augmentation for breast augmentation’s sake bounced an eye-popping 756 percent, from less than 33,000 to more than 279,000, according to the American Society of Plastic Surgeons. If this trend continues, the number of lady augmentees should climb a hefty heap higher next year. And should silicone get the government go-ahead, a good chunk of these women can be expected to choose the gel-filled sacs over saline—in spite of the higher cost, in spite of the hullabaloo. Already, some women have opted to hold off on their Betty Boop dreams until silicone returns, several doctors said.

“I’m trying to find on the Internet what the newest rules on silicone are, and if/when they will be laxer,” one woman wrote on the popular implant message board, BreastImplants411. “I’m looking into a ba”—shorthand for breast augmentation, not Bachelor of Arts—“and only want silicone …. ”

The impulse that drives some women to plump their breasts with silicone or saline—and again, we’re not talking about women who’ve had mastectomies—has long been a source of inter-lady conflict. During the years of hearings, anti-implant crusaders frequently rubbed up against enhancement buffs who accused them of condescension and, yes, suppressing their right to choice—consumer choice, that is.

“I don’t understand the hatred for these products,” said Arlene Nicole Cummings, an implant veteran who runs a Web site, Implantinfo.com, that she said gets more than one million hits a day. “It’s almost like some women feel like you betrayed them, like you have … given in to what society thinks women should look like.”

Ms. Cummings denied that such pesky impulses had anything to do with her desire to boost her bust. “It was not that way at all,” she insisted, pointing instead to an operation she had when younger to remove a breast tumor that left one breast small and underdeveloped, as well as to the vagaries of breast-feeding. “They just felt empty and saggy,” she recalled of her post-baby breasts. Her husband didn’t mind, but she “hated” them.

“For me, it was so much deeper—I just did not feel complete,” she said. “So when I filled them out, I was like, ‘This is great ….’ I could buy clothes; I fit into everything. It just completed me.”

But to one mother, acting student and saline-implant owner, that need for completeness is just the problem. On a recent Thursday, this woman, who gave her name as Foxy, sat perched on a vinyl barstool at Ten’s World-Class Cabaret, where she works evenings to pay her tuition, talking about the decision she now regrets.

“The big deal is men … because you want to be acceptable,” she said of the decision she made six years earlier, when she was just 23. “Unfortunately, in North America, big boobs seem to be a huge factor in our makeup of society these days—to get through doors, or get things open, or get paid, really.

“It’s an American thing,” she concluded with a quick, wry smile. “It’s the American dream—or at least it gets you one.”