head: Plastic Nation
deck: We know that celebs are addicted to plastic surgery, but what about folks
here in Baltimore?
by Jessica Leshnoff
Six months ago, a woman in her late 40’s walked into Dr. Navin Singh’s office
requesting a thigh lift. The plastic surgeon, director of breast reconstruction and
assistant professor of plastic surgery at the Johns Hopkins University School of
Medicine, had already performed a breast augmentation with lift and a tummy
tuck on the patient—and Singh’s partner had performed a facelift, eyelid surgery,
and rhinoplasty on her, as well—but she wanted more.
The procedure would leave a sizable scar, Singh warned her, but she remained
eager to pursue it. The surgeon got the feeling that the woman was “seeking the
thrill” of the procedure, and “just didn’t have a reasonable expectation of what a
thigh lift involved.” She was the classic plastic surgery addict, out for body-
altering surgery for all the wrong reasons, he explains. So he turned her down.
“She became irate,” he recalls. “Typically the answers we provide are, ‘I don’t
think I’m the right surgeon for you.’ It’s the classic ‘It’s not you, it’s me.’”
Another patient, a young man in his late 20’s who was “well into the double
digits” of facial procedures, approached Singh for eyelid surgery. Reconstructive
rhinoplasty earlier in his life was his “gateway” procedure—a hallmark for those
dependent on plastic surgery—to an alarming roster of aesthetic surgeries that,
one by one, wouldn’t signify an issue, but “in aggregate, symbolized to me a
problem,” he says.
“It starts with [the gateway procedure] and creeps onto the rest of their body,”
he says. “They’re insatiable.”
Again, Singh refused to do the surgery.
“I told him honestly that I thought he was starting to look too synthetic and that
I thought he needed to be evaluated by a mental health professional,” he says.
“Oftentimes, a young plastic surgeon will just do it and validate it to themselves
by saying, ‘If I don’t do it, someone else will.’ But you never want to be the last
person to have operated on a person like that.”
But sometimes, “no” just doesn’t cut it, and patients will try to convince a plastic
surgeon to perform the operation anyway—something that confounds Singh.
“Imagine you’ve got a car and the mechanic says, ‘I’m not really the right guy for
this.’ Would you really leave him your car?” he asks. “But yet, when it’s your body
. . . it’s amazing how much they’ll negotiate with you to get you to do something.”
Cosmetic surgeon Hema Sundaram has also seen her share of “over-enhanced”
patients, but the 46-year-old woman who recently walked into her office
definitely took her by surprise.
The woman had already had a laundry list of facial procedures—various
implants, lifts, and fillers—but it was her lips that shocked the doctor.
“They were grossly over-enhanced,” Sundaram recounts. “She came to me
because she wanted more.”
“I just want them totally pumped up,” the woman told her. “As big as they can
Sundaram, who has offices in Rockville and Fairfax, Virginia and is author of the
book Face Value: The Truth About Beauty—and a Guilt-Free Guide to Finding It,
explained to the prospective patient that her look had surpassed natural—and
that she refused to inject her lips with anything else until they went down to a
“To me, the best cosmetic surgery is undetectable, and her lips absolutely
walked in the room before she did,” the surgeon says. “Chances are, she went to
another cosmetic surgeon and got what she wanted.”
The experience of turning someone away who has gone overboard with plastic
and cosmetic surgery is a familiar one to doctors like Singh and Sundaram. With
faster recovery times and a seemingly endless array of procedures to modify just
about any body part that needs “fixing,” plastic surgery is more popular than ever
in America. According to the American Society for Aesthetic Plastic Surgery
(ASAPS), there were nearly 11.5 million surgical and nonsurgical procedures in the
United States in 2006 alone, including 4.1 million injections of Botox—a
neurotoxin used to temporarily smooth facial lines that can even be available at
some certified day spas, or “medi-spas.” All that nipping, tucking, and injecting
equals big business; Americans shelled out nearly $12.2 billion on cosmetic
surgery last year, ASAPS reports. Of course, our celebrity culture is driving this
phenomenon. More and more celebs are being “outed” as plastic surgery
indulgers—and we want to look as great, as young, as nipped and tucked, as they
It’s not only women going under the knife, either. Since 1997, nonsurgical
cosmetic procedures among men have increased a whopping 722 percent, and
men accounted for nearly 1 million cosmetic procedures in 2006 (liposuction was
the most popular procedure for men, followed by rhinoplasty, eyelid surgery,
breast reduction to treat enlarged male breasts, and facelift).
As lips and breasts continue to swell, faces mysteriously tighten, and celebrities
quietly remodel their entire bodies, it doesn’t come as a surprise that people
often go overboard with plastic surgery. When it comes to a plastic surgery
“addiction,” though, one’s friends and neighbors don’t usually come to mind.
Instead, we think of the freakish Michael Jackson, or “Lion Queen” socialite
Jocelyne Wildenstein, or self-proclaimed plastic-surgery expert Cindy Jackson
(commonly known as the “Human Barbie”), not the person standing behind you
at the supermarket.
But everyday people addicted to plastic surgery? The answer is yes, according to
area plastic and cosmetic surgeons.
Although he admits it is truly rare, Dr. Adam Basner—division head of plastic
surgery at Sinai Hospital with a private practice in Lutherville—does turn patients
away who seem like candidates for plastic surgery addiction.
“In a very, very small percentage of patients I’ll say, ‘I don’t think I can help
you,’” he explains of a surgery-seeker who has unrealistic expectations of what
cosmetic procedures can achieve, a warning sign of an addiction to—or at least a
dependence on—plastic surgery. If Basner is unsure about a cosmetic surgery
candidate, he may recommend that a psychologist be involved to determine if the
patient has reasonable expectations.
A person who can’t be convinced that surgery might be futile, or who comes in
requesting to look like someone else, definitely rings a warning bell in the minds
of most plastic surgeons.
“As a plastic surgeon, you have to be able to recognize what can be fixed,” adds
Dr. Michael Cohen of the Towson-based Cosmetic Surgery Center of Maryland. As
for turning away a patient? “It’s a service that you owe to the patient. It doesn’t
do you any good, it doesn’t do the patient any good, and it’s not worth the
This flies in the face of the (perhaps unfounded) reputation some plastic
surgeons have for exploiting insecure people for the money.
“I do believe that most plastic surgeons actually have a great deal of care and
concern for their patients,” Basner says.
Singh agrees, but admits that true “addicts” find ways to manipulate some
surgeons into performing procedures they’re hesitant about. “They will play into
our own narcissism,” by showering them with compliments about their work and
reputation, he says. “Females will also play the ‘damsel in distress,’” role, Singh
continues. “‘I’ve been butchered,’” the women will say. “‘I should have come to
you in the first place.’”
“As men, we’re trained to jump at that,” Singh admits. “Patients themselves can
be very good psychological manipulators.”
For some patients, no amount of surgery will ever satiate their needs. Fifteen
percent of patients seeking plastic surgery have what is called body dismorphic
disorder (BDD), Sundaram says, an obsessive-compulsive disorder that creates a
distorted self image, usually when there’s nothing noticeably wrong to outsiders.
“By and large, [those with BDD] don’t feel better when they get the surgeries . . .
or if they do, they pretty much switch to another part of the body,” explains Dr.
Christopher Welsh, addiction psychiatrist and assistant professor at the University
of Maryland Medical Center. He is careful to distinguish between people with
BDD and those simply obsessed with plastic surgery. “Body dismorphic disorder is
deeper-rooted psychologically. It’s a fixed feeling that something is wrong,”
versus someone who is preoccupied with looking younger, Welsh says. “With
body dismorphic disorder, you act like there’s something wrong with you. . . .
Because your nose is ‘too big,’ it just destroys your life. It’s qualitatively different
than someone who just wants to look younger.”
In the case of BDD, “it’s a need, not a choice,” Sundaram says. Similar to an
alcohol or drug addiction, “your whole life revolves around it,” and those
suffering from BDD may go far into debt to finance their extensive procedures.
BDD aside, the need to look younger—or have bigger breasts, smaller thighs, a
streamlined nose, or more enhanced muscles (for men)—can indeed take over
someone’s life if they have the means for the often costly procedures.
This is not only a danger for adults, but for children, too, says Dr. Shreya Patel
Hessler, a Bel Air psychologist specializing in children, adolescents, and young
women. She is now seeing girls as young as 7 with body image issues, already
mapping out future plastic surgery procedures and counting calories. She sees
teenagers who request cosmetic surgery as graduation gifts. Hessler has also
counseled three young male patients with eating disorders within the past year,
one of whom already wanted pectoral implants to make his chest more defined.
“Without appropriate intervention, [their self-esteem issues] could get worse,”
The psychologist recommends that parents listen closely to what their children
are saying about their appearance, making special note of whom their children
are comparing themselves to, how they respond to compliments on their physical
appearance, and if they make self-deprecating statements.
But parents are often to blame themselves, she states, giving in to their
children’s desires to have plastic surgery because they are so desperate for them
to feel not only good about themselves, but accepted amongst their peers.
Sometimes a procedure such as rhinoplasty can truly boost an adolescent’s self-
esteem, Hessler says, but if your child has a “laundry list” of cosmetic procedures
he or she wants to have done, it’s time to worry.
Even with these concerns, plastic surgery still has its cheerleaders. Christine
Schwab, a California-based fashion reporter and author of The Grown-Up Girl’s
Guide to Style: A Maintenance Bible for Fashion, Beauty and More, isn’t shy about
her love of plastic surgery and cosmetic dermatology. She’s had her share of both
and is quick to admit how easy it is to become addicted to something that, in her
opinion, isn’t all that painful and has such immediate payoff.
“It just turns back the clock so rapidly,” she says. “If you have the money and
looks are important to you, it’s a very good investment. There’s not a lot of pain.
It’s almost like a little vacation. [Often] the results are so good that you get
greedy. I think the problem and the important thing is to have some restraint and
not to get greedy.”
After one successful procedure, “you start noticing other areas of your face and
body that might not match,” she explains. “It’s very easy [to get addicted]. I really
had to put the brakes on myself.”
But even a dyed-in-the-wool cosmetic surgery fan like Schwab knows the
“I always look the best I can without looking foolish, and that’s a very fine line to
cross,” she says. “I don’t want to look like Joan Rivers. She’s lost all the essence of
being Joan Rivers.”
She also notes Melanie Griffith’s “duck lips.” “I’m sure when Melanie Griffith
looks in the mirror, she thinks her lips look like Angelina Jolie’s. But she doesn’t
look like Angelia Jolie. Angelina Jolie’s are natural. Nobody close to a celebrity
tells them the truth. They know they’ll only go to someone else and do it. You
really can’t talk a person out of [plastic surgery]. By the time they get to the
office, they’ve already decided to do it. It’s only a matter of finding the right
person to do it.”
A veteran of the fashion industry, Schwab, who is in her 50’s, is all too familiar
with the pressure to look perfect today’s beauty-obsessed world, and finds
celebrities who deny having had plastic surgery to be woefully irresponsible. She
recalls watching former-supermodel Christy Brinkley on a recent talk show. When
asked how she stays so young looking, she responded with “‘Oh, I drink a lot of
water. I exercise and get enough sleep,’” Schwab recounts. “And I’m thinking,
how dishonest! They’re doing everything that’s available to them. They set the
bar really high for the average person.”
As for people denying that they had cosmetic surgery? Dr. Basner isn’t
surprised. “It’s the one thing nobody talks about,” the surgeon says. “We still
condemn women who have cosmetic surgery. We’re scared of our own mortality.
As a society, we don’t have the social mores that we’re mortal and are going to
Terry Goodwin, for one, isn’t ashamed to talk about the cosmetic surgery she’s
had, but her post-op agony will prevent her from getting any other procedures—
and leaves the 34-year-old wondering how people can get addicted at all. The
Westminster native had a breast augmentation in 1998, going from an A cup to a
C. She’s thrilled with the results—“I never felt proportionate,” she says. “I never
felt I could wear clothes that fit well”—but had to go back under the knife just
days after her surgery because one breast implant was higher than the other.
“It was extremely painful,” Goodwin says of the ordeal. “It wasn’t anything like
[the surgeon] said it was going to be. He said it would feel like I had done 100
pushups. I felt like I’d been beaten. I could not sit up or get out of bed by myself. I
was miserable. It was definitely more uncomfortable than he had prepared me
The worst part? Her implants, like all others, will eventually need to be replaced.
“I dread the fact that at some point in my life, I’ll have to get something done
with them,” she says with a sigh. “I’m absolutely dreading it. I don’t want to ever
go through that again.”
Of course, these are the things that we rarely read about or see on TV.
Plastic surgery-themed television shows, such as Dr. 90210 and Extreme
Makeover, “glorify and glamorize” cosmetic surgery, Dr. Cohen says. “I don’t think
they’re terribly realistic or informative,” he states. “They’re more glitzy and
glamorized. They condense all of the experience [of plastic surgery] into a very
short one-hour segment. People don’t realize it takes a lot of recuperation—ups,
downs, hills, and valleys. The transition isn’t really overnight. It can take quite a
Just ask Terry Goodwin.
“Whenever I see something on TV about how people are addicted to [plastic
surgery], I don’t know how they can be,” Goodwin sighs. “For some reason,it must
be like having a baby because you forget the pain and the misery and you’re
ready for that next round.”