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msnbc.com contributor
updated 7/10/2008 8:26:55 AM ET 2008-07-10T12:26:55

When Krystal Schwegel got a nose job last November, she kept her surgery on the down low. “I only told about three people,” says the 25-year-old publicist from Burnsville, Minn. “I did it during winter when people kind of hibernate and I didn’t go out or do anything with my friends for a month or two. Only the people immediately around me knew.”

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But when David Quinta got surgery on his schnozz in January, he chose a different route — YouTube. The 21-year-old posted a series of videos about his plastic surgery and recovery process, which altogether have garnered more than 35,000 views.

“I just thought it would be fun to post a video about it,” says the full-time psychology major from Fair Lawn, N.J. “I know some people might say, ‘Oh, it’s fake, you’re being plastic’ or whatever, but I decided to bring it out into the open. I’m not shy about it.”

These two twentysomethings — one firmly ensconced in the cosmetic closet, the other out and proud — are fairly representative of our society’s complex and conflicted feelings over the “work” we do. While many celebrities, CEOs and private citizens like Schwegel are careful to keep their nips and tucks under wraps, others proudly wear their surgical tape on their sleeves — “coming out” at post-surgery soirees, broadcasting breast enhancements on reality TV, popping by the Botox booth with their BFFs while shopping at the mall. 

Having work done has become so accepted, so seemingly commonplace, it’s spawned both a children’s book, "My Beautiful Mommy," which explains plastic surgery to the Play-Doh set, and a new line of celebratory greetings cards aptly titled Lift Me Up (the breast enhancement card offers a hearty “Congratulations on the twins!”).  

“The stigma is definitely disappearing,” says Camie Dunbar, the 40-year-old Ft. Worth, Texas-based founder of Lift Me Up. “People just talk about plastic surgery more now. My friends are saying, ‘I just had my boobs done, do you want to see?’  They’re so open about it. The topic is just out there.”

Plastic surgery is so out there that Americans underwent nearly 12 million cosmetic procedures — and spent more than $13 billion on them — in 2007, according to the American Society for Aesthetic Plastic Surgery. A survey released by the group earlier this year found that 56 percent of women and 57 percent of men give cosmetic surgery a big thumb’s up.

What’s more, the same survey found that 78 percent of women and 79 percent of men “would not be embarrassed” if others knew they had cosmetic surgery.

But for the rest, stealth is still key.

Copping to clumsiness not vanity
“We have a lot of patients who tell their friends they’ve had dental work to explain why their face is swollen after a procedure,” says Lorraine Russo, executive director of Dr. Z. Paul Lorenc’s aesthetic plastic surgery practice on Park Avenue in New York. “One soccer mom who had a tummy tuck but still had to car pool said she’d developed a back problem from working out to explain why she couldn’t stand straight.”

Image: Quinta
When David Quinta underwent a nose job (before at left; after seen right) earlier this year, the 21-year-old chronicled the streamlining of his schnozz on YouTube.
Russo says she routinely helps patients come up with “little white lies” to explain away post-operative bruises and nicks: brow-lift incisions are blamed on an accidental collision with a kitchen cabinet, post-rhinoplasty black eyes attributed to an unfortunate incident involving an open door.

“We had one person even use the excuse that they had some skin cancer removed after they had a [brow lift],” she says.

But feigned clumsiness, well-crafted whoppers and camouflage cosmetics aren’t just reserved for business colleagues and casual acquaintances, says Dr. Ranella J. Hirsch, a cosmetic dermatologist in Cambridge, Mass., and president of the American Society of Cosmetic Dermatology and Aesthetic Surgery.

“I’ve got cases where I treat both husband and wife and neither one of them knows,” says Hirsch. “I’ve got five couples like that right now. I also treat lots of sisters, lots of friends — and nobody knows.”

To help maintain the subterfuge, Hirsch offers her patients a “bag of tricks,” including tips on how to avoid post-operative bruising (eat pineapple, avoid aspirin or anything that causes the blood to thin). Like Russo, she also helps patients devise cover stories: a trip to the dentist if they’ve had dermal fillers around the mouth, a “procedure at the eye doctor” to explain an eye lift.

Although noninvasive procedures, such as Botox or laser peels, are much easier to mask, some people even try to keep major surgeries a secret. Nose jobs are inevitably attributed to that age-old excuse: the deviated septum. Sudden breast syndrome is squelched under bulky sweaters. Privacy-focused patients even sign up for “surgical safaris” where they can rest and recuperate in exotic locales such as Jamaica, Costa Rica, Thailand and South Africa — nipped and tucked away from friends, neighbors and all those nosy questions. Slideshow: How celebrities are aging

Why lie?
But with cosmetic procedures more popular than ever, why all the need for deception?

Some people are simply more private than others; they were raised to keep their business — and their breast enhancements — all to themselves, says Dr. Hema Sundaram, a Washington, D.C., dermatologist and author of “Face Value: The Truth About Beauty — and a Guilt-Free Guide to Finding It.”

“On the West Coast, people are a lot more open about having procedures done and that may be cultural,” she says. “On the East Coast, we’re more Puritan, more traditional. There’s a WASP-y type of life philosophy. You don’t let anything hang out — not your emotions, not your ‘work.’”

Power and status can also come into play, says Russo, who’s spent nearly 20 years offering support and advice to her husband’s Park Avenue patients.

“The people who really hide it the most are the very high society people, the celebrities, the CEOS who’ve been on the cover of Time and Newsweek. They’re doing it to stay in their place of business and to stay powerful. They’ll say they just have good genes even when they’ve had surgery. They’ll take it to their grave.”

Age can also be a factor when it comes to owning up to cosmetic work. People under the age of 25 have been hearing about plastic surgery for years (either from family members, Facebook or shows like “Dr. 90210”) which probably explains why the latest ASAPS study showed men and women ages 18-24 to have the highest approval rating for procedures. Millennials have also grown accustomed to chronicling their private life in a public forum. As a result, younger patients are more comfortable with both the idea of having work done and slapping the results out there for all to see.

“Letting it all hang out, on YouTube or elsewhere, after having ‘work’ done is now another way to achieve your five minutes of fame,” says Sundaram. “However, this trend is still offset to some extent by societal stigma.”

And that’s where things get complicated.

Staying true, but looking good
“There’s more pressure to look good and there’s also more pressure to stay true to yourself,” says Krystal Schwegel, who chose not to go public with her nose job at the time but says she doesn’t mind talking about it now. “There are definitely mixed messages out there, which is why I kept [my surgery] on the down low.”

Some of those messages have to do with assumptions about a person’s self-esteem, says Liz Rankin, a 27-year-old Seattle teacher who plans to keep her forthcoming hair transplants hush-hush (she says she’s willing to talk with msnbc.com because she wants to shed light on the condition — which looks to be alopecia — and let other women know there are new options available).

“I think a lot of people assume if you have work done that you don’t have any self-esteem, that you hate yourself,” she says. “And I don’t agree with that.”

Of course, if you get surgery on the sly, it had better be darn good surgery. Otherwise, you might end up being ridiculed by friends and family the same way starlets and celebrities are pilloried in supermarket tabloids and sites like Awfulplasticsurgery.com (Who wants to be known as the girl with “Cyclops breasts” or “slug lips”?).

Which brings in another aspect to the fear, shame and guilt society brings to the surgical table: the bigger the procedure, the harsher the judgment.

“It’s very complex,” says Sundaram. “We make moral judgments about people if we consider them vain. And if you’re willing to have a drastic invasive procedure, how vain must you be?”

The stigma of being labeled superficial is so powerful, in fact, even those who are up front about their work can question their decision.

“I’m totally comfortable with sharing the information that I’ve had a tummy tuck,” says Stephanie Abdullah, a 38-year-old entertainment PR specialist from Hollywood, Calif. “I'm happy about it and I’m not in no closet. But I just mentioned it to a guy I’ve been seeing and he looked really stunned. Now I’m wondering, did my telling him make him feel any differently about me? Am I now a fake? A phony?”

Lying is getting easier
Recent trends in cosmetic work may be putting a lot of these issues to bed. Plastic surgeries that used to require weeks or months of recuperation are being replaced by less invasive procedures that carry less downtime — and, apparently, less social stigma.

“Many of my patients are more comfortable talking about the minimally invasive stuff than they are talking about the cold hard surgery,” says Sundaram. “By and large, if they’re having ‘little’ procedures done — Restylane and Perlane and Botox — there’s more openness.”

Ironically, this openness may be something of a moot point.  Not because we’re finally at peace with our eternal quest for youth and beauty, but because aesthetic plastic surgeons and dermatologists are now better able to give us that stealth we so desperately seek.

“These days, it’s all about smaller changes, subtle changes,” says Dr. Hirsch. “You don’t have to make up a story if you go to a really good cosmetic dermatologist. I’m Spanx, I’m why the dress fits well. I’m the best vacation you never took.”

Diane Mapes is a Seattle freelance writer and author of "How to Date in a Post-Dating World."

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