updated 7/14/2004 9:46:54 AM ET 2004-07-14T13:46:54

Guest: David Sarwer, Joan Kron, Elaine Young, Neikie Reno, Janice Dickinson, Peggy Northrop, Robert Kotler

ANNOUNCER:  DEBORAH NORVILLE TONIGHT.

DEBORAH NORVILLE, HOST:  Cosmetic craze.  Is our national obsession with looking young spinning out of control?

(BEGIN VIDEO CLIP)

UNIDENTIFIED FEMALE:  I‘m ready.

(END VIDEO CLIP)

NORVILLE:  With more and more Americans demanding a nip here and a tuck there, plastic surgeons really have their work cut out for them.  They‘re even operating on prime-time television.

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE:  Suction.

UNIDENTIFIED MALE:  This butt‘s for you.

UNIDENTIFIED MALE:  The major thing we‘re going to do here is to straighten his septum.

(END VIDEO CLIP)

NORVILLE:  And it‘s no longer just for the rich and famous.

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE:  I don‘t think Baby Boomers want to age gracefully.

(END VIDEO CLIP)

NORVILLE:  But buyer beware: There can be an ugly side to trying to look too beautiful.

(BEGIN VIDEO CLIP)

UNIDENTIFIED FEMALE:  I just completely looked disfigured.  It was devastating, really.

(END VIDEO CLIP)

NORVILLE:  And aging Baby Boomers aren‘t the only ones jumping on the makeover bandwagon.

(BEGIN VIDEO CLIP)

UNIDENTIFIED FEMALE:  It was something I want to do for myself.

(END VIDEO CLIP)

NORVILLE:  The patients are getting younger, and makeovers are getting more extreme.

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE:  ... with a nose job, chin lift, scar removal...

(END VIDEO CLIP)

NORVILLE:  So what‘s behind this ever growing quest for perfection?  Can Americans find happiness under the knife?  And is the celebrity culture to blame?  Tonight, the American obsession with perfect profiles, perfect proportions, perfect people.

(BEGIN VIDEO CLIP)

UNIDENTIFIED FEMALE:  I look beautiful!

(END VIDEO CLIP)

ANNOUNCER:  From studio 3K in Rockefeller Center, Deborah Norville.

NORVILLE:  And good evening, everybody.  Botox, breast implants, facelifts, liposuction—Americans spent more than $8 billion on cosmetic procedures last year.  Tonight we‘ll explore the national obsession with plastic surgery.

Up first, I‘m joined by Joan Kron.  She writes about plastic surgery for “Allure” magazine.  She has had a facelift and a nose job, and she wrote a book about her experiences entitled “Lift: Wanting, Fearing and Having a Facelift.”

Also joining us tonight is Dr. David Sarwer.  He‘s an associate professor of psychology at the Center for Human Appearance at the University of Pennsylvania School of Medicine.  He specializes in the psychological aspects of cosmetic and reconstructive surgery.

Thank you both for being with us.  Doctor Sarwer, I want to start with you first.  When did the notion of caring intently about what‘s on the outside go from being vain to being perfectly acceptable?

DAVID SARWER, ASSOC. PROFESSOR OF PSYCHOLOGY:  I think, in some ways, it‘s probably changed in the last several decades.  To a certain extent, my colleagues in mental health years ago probably saw the interest in cosmetic surgery as being a function of narcissism run amok.  And I think in the last several decades, we‘ve really learned that, whether we like to admit it or not, our appearance does matter.  During that same time, there‘s evidence to suggest that we‘ve become increasingly unhappy with the way that we look, that more than half of American women, slightly less than half of American men, are unhappy with their appearance.  And some of that is probably motivating our desire to change ourselves through cosmetic procedures.

NORVILLE:  And yet there‘s an extraordinary number of people who have resorted to cosmetic procedures.  I want to throw up a graphic, and just take a look at how many people are doing this.  In the last year, 8.7 million cosmetic surgeries were done, 87 percent of them with women, 13 percent of them with men.

Joan Kron, this has been your beat for a number of years, but the numbers of surgeries have grown exponentially in just the last couple of years.

JOAN KRON, COLUMNIST, “ALLURE” MAGAZINE:  Yes, they have.  They‘ve gone up by huge percentages.

NORVILLE:  Why?

KRON:  Because the more publicity that is given to it, the more people want it.  When they see what‘s available, when they read a story about something that‘s available that they didn‘t know was available, they want it, like a box of corn flakes, too.

NORVILLE:  And how much of the trend is driven by the fact that these days, you can have things done to your face that don‘t necessarily involve a scalpel?

KRON:  Well, people more and more don‘t want a scalpel, and they want things—they want everything that‘s easy, fast, painless.  Those are the things they like.  That‘s the holy grail.  It‘s not always possible, but more and more things are available that can make them look slightly better, or maybe a little even more than slightly better, but they‘re not going to last.  They‘re temporary, but they‘re fixes, and they‘re happy with that.

NORVILLE:  And are they, indeed, happy with this, Dr. Sarwer?  When you look at the post-operative, post-procedure surveys, generally speaking, are most people glad they did whatever they did to themselves?

SARWER:  Studies suggest that the majority of patients are very satisfied with their post-operative result, in the terms of the way their appearance looks.  There also are a growing number of studies that now suggest that as far out as two years after surgery, patients show improvements in things like body image, quality of life and a decrease in depressive symptoms.  So it really does seem like there are some psychological benefits to these procedures.  Whether or not they endure over the long term, however, is a question that‘s yet to be answered.

NORVILLE:  Well, I have to ask you, is that the placebo effect, or is that a real change in these people‘s live?  Am I better because I think I‘m better, or is it really different?

SARWER:  Not so much—I‘m not so sure if it‘s a placebo effect as much as it also might just be a function of in the first year or two after surgery, you‘re probably more likely to get those positive comments from friends and colleagues about, You look great, you look well-rested.  And that very well may be what‘s motivating and changing some of these changes we see long term.  As I said, it would be interesting to see in some of the longer-term studies if patients report these same improvements five, seven, ten years after surgery.

NORVILLE:  Joan, you started reporting on this more than 10 years ago.

KRON:  Right.

NORVILLE:  How have you seen the attitudes change since way back when, and today, when something like 80 percent of women say they wouldn‘t be embarrassed if people knew they‘d had work done?

KRON:  Well, I did a story in “Allure” about the fact that people were coming out more, that they were talking about it more.  And the people who keep it a secret tend to be the movie stars because natural beauty trumps artificial beauty in the hierarchy of beauty, and they do not want to admit they‘ve had anything.  And so people in public life don‘t like to admit it -- very few people.  And I said in my book the only people who admit it are comedians and—the Joan Rivers effect, you know?  Other people, normal people are...

NORVILLE:  Are less reticent to talk about it?

KRON:  Yes.

NORVILLE:  I wonder how much television has been an impact in this, too.  I mean, if there‘s a trend, TV‘s always looking for a way to make money on it.  I want to take a look at a TV show that‘s just gone into the second season last week.  It‘s called “Nip and Tuck,” and here‘s an episode from that show, which has been airing on cable.

(BEGIN VIDEO CLIP - “NIP/TUCK”)

UNIDENTIFIED MALE:  We‘re plastic surgeons, Sean, the literal faces of this business.  Looking our age is as bad as a stained carpet in the waiting room.  Have you ever seen a fat personal trainer?

UNIDENTIFIED MALE:  But we don‘t look our age, Christian.  With advances in nutrition and exercise, 40 is the new 30.

UNIDENTIFIED MALE:  You sell youth for a living.

(END VIDEO CLIP)

NORVILLE:  So 40 is the new 30, 50 is the new 70.  David, whatever happened to the days when your face could look what your age was?

SARWER:  Yes, I‘m not sure if we ever really had those days, Deborah, to be very honest with you.  I think that, throughout time, we‘ve always looked for ways to improve our appearance.  And I think, in some respects, what‘s really happened here is the technology has simply caught up with the interest and the demand.  I think, in terms of shows like “Nip/Tuck” and some of the other more reality-based shows, however, it‘s unclear how much of this is really going to have an effect on the increasing numbers of cosmetic surgery patients.  Probably a few years away for telling for sure.  It‘s really hard to say right now, is this just simply a guilty pleasure, where people watch these shows and enjoy what they‘re seeing, or is it really shaping our attitudes and ultimately who decides to go forward for surgery?

NORVILLE:  What do you think, Joan?  I mean, it‘s kind of like driving down the freeway and there‘s a car crash on the other side of the highway.  You don‘t necessarily have to stop and watch, but when you‘re flipping channels and one of these shows comes on, you kind of have to.

KRON:  Well, I think people look at it because they—they object to it.  They believe that vanity is a bad thing, and they want to feel superior.  But they secretly desire it, and so there‘s this ambivalence.  There‘s a constant ambivalence on this subject.

Now, I was at a dinner party recently, where a husband sitting next to me said, I think it‘s terrible.  I think that it‘s a fraud.  I think that anybody who has a facelift is a fraud.  And after dinner, I met his wife, who was sitting at another table, and she asked me for a recommendation for a doctor.

NORVILLE:  Oh, my goodness!

KRON:  So—you see?  So within the same family, people can have different attitudes, or they—the husband doesn‘t even know that the wife is desiring it.

NORVILLE:  And the attitudes change because I know you went into this reporting about this subject, and you ended up at the end of a report many years ago going, Wait a minute.  Sign me up.  What changed your mind?

KRON:  Right.  I didn‘t know—I didn‘t realize I wanted it.  And as I was talking to four doctors and doing interviews and taking notes and running home and writing down everything they said, I realized, You know what?  I could benefit from this, and I would like this.  And my husband said, What are you doing?  And I said, I‘m going to have it.  He said, You‘re on your own.

NORVILLE:  And are you pleased with the results?

KRON:  I am pleased with the results, yes.

NORVILLE:  Doctor Sarwer said that studies show that many people, at least in the initial few years after a procedure, feel that their lives are more enhanced.  They have a better sense of self-image.

KRON:  You have a better life.  But what‘s wrong with what we‘re seeing on TV these days is that we see it happening just like this, very fast.  We don‘t see the—we see just two seconds of pain, and then suddenly the big reveal.  We don‘t see the long time it takes for the swelling to go down, to get used to your new face, and this is what is making unrealistic expectations.  And then people two weeks later say, I can‘t go out to dinner.  Maybe I had a bad job.

NORVILLE:  The unreality part of reality television.

KRON:  Right.

SARWER:  Deborah...

NORVILLE:  David, I‘m going to have to let that be the last word, but I thank you very much.  Joan Kron, David Sarwer, thank you both.

We‘ll be back in just a moment.

ANNOUNCER:  Coming up: extreme makeovers.  What would possess anyone to go under the knife 15 times?  This woman‘s done just that.  The story behind her $80,000 quest for perfection when DEBORAH NORVILLE TONIGHT returns.

(COMMERCIAL BREAK)

NORVILLE:  Welcome back.  We‘re talking this hour about America‘s obsession with cosmetic surgery.  Now we‘re going to meet two women who have both been under the knife plenty of times, each for very different reasons.  Elaine Young has had 45 plastic surgeries in the last 25 years, almost all of them after her cheekbone silicone implants shifted.  It created craters and bumps in her face.  Neikie Reno always wanted to be a model, but she didn‘t like the way she looked, so in her late 20s, she decided it was time to change things.  Eighty thousand dollars and 15 operations later, after fixing her face, her breasts, her cheeks and her teeth, she now says she feels complete.

And ladies, we thank you both for being with us.  Elaine, first I want to start with you.  Your odyssey began back in the 1970s, when you had this silicone injected in your cheeks.  I want to put up a picture of you back then and ask—tell me, if you could, please, what it was you didn‘t like about your appearance back in the mid-‘70s.

ELAINE YOUNG, HAD 45 COSMETIC SURGERIES:  Probably from my childhood insecurity, nothing more.  I had cheekbones.  I had just gotten a divorce, and I think that I thought that would be the answer to being happy and finding another husband, another boyfriend.  And so I had silicone injections, which moved all over my face.  My face was completely swollen.  And I went on a terror (ph) for 20 years of surgeries.  But I must admit, in between, I did have plastic surgery done to try to make my appearance better.

NORVILLE:  When did you realize that the silicone was not working, that this was causing a problem for your face?  Was it right off the bat, or was it after a period of time?

YOUNG:  It was one year after, it start the moving, and I didn‘t understand it.  It was in ‘79.  They knew nothing about silicone.  Today I can tell you I believe in plastic surgery, but silicone belongs not in bodies but in cars.

NORVILLE:  What questions should you have asked?  Do you look back and think, Gosh, I was too trusting, Gosh, I was too naive, Gosh, I was too insecure?  What woulda-coulda-shouldas have you asked yourself?

YOUNG:  I was too insecure.  I think that is the main thing.  And I thought my doctor was an excellent doctor.  He owned his own hospital.  You can‘t go by the money.  You can‘t go by where they are.  You‘ve got to check out a doctor, see who they‘ve done and see what their track record is.  And that‘s what I didn‘t do.

NORVILLE:  And what have you had to endure since then, Ms. Young, to try to get rid of the silicone and give yourself an appearance that you can be proud of?

YOUNG:  Well, I found a doctor.  As I—you said, 45 surgeries later, I feel that I‘m starting to look better.  I‘ve been a nightmare for all these years.  I‘ve had faith I would be all right.  By the way, I feel very lucky.  I had gangrene in my face, but I‘ve talked to women who call me from all over the world who have died from silicone.  It‘s gone into their bloodstream and into their brain.  It does not belong in your body.

NORVILLE:  We‘re going to come back to you in just a moment.  Now I want to turn to Neikie.  Neikie, you—before we talk about everything that you‘ve done, I want to put up a picture of you from before you started the plastic surgery odyssey.  And as we look at you, tell me what it was that you didn‘t like about your appearance, when we see this cute, athletic girl, who‘s obviously got a great figure.  What don‘t you like about that picture?

NEIKIE RENO, HAD 15 COSMETIC SURGERIES:  For me, it was more my nose than anything.  Being a child—we all know that children aren‘t always nice to one another, and I got teased a lot about my nose.  So I knew—I mean, I focused on that, and I knew that that was what I wanted to do to change something.

NORVILLE:  And the first thing you did then was have your nose worked on?

RENO:  No.  Actually, I didn‘t.  When I went in to the doctor and I talked to him about my nose, I also talked to him about my breasts, and...

NORVILLE:  Now, this is you before your surgery, before your nose was changed.

RENO:  Yes.  No.

NORVILLE:  Is this after?

RENO:  This is after.  This is right after I had...

NORVILLE:  The procedure done?

RENO:  Uh-huh.

NORVILLE:  And let‘s put up kind of the menu, if we could, of what you did.  I mean, it‘s an amazing list of everything that you‘ve had done to your body.  You‘ve had your breasts worked on four times to the tune of $26,000.

RENO:  Right.

NORVILLE:  Your eyes were $5,000, eyebrows $1,500, scar between your eyes, $500.  Your nose was $5,000, cheek implants $5,000, your lips done twice for $9,000.  Buckle fat in your cheeks, whatever that is, $1,500.  Liposuction for $3,500, and $26,000 for veneers for your teeth.  Your body cost $83,000.  Where do you get that kind of money?  That‘s incredible!

RENO:  Well, it is difficult when you are talking numbers that are as large as that.  For me, what I did was—I was very driven.  It was something that I wanted to do, so I got a loan.  I put some on credit cards, and then I got some help along the way.

NORVILLE:  So you‘ve been paying off all of these surgeries as time goes by?

RENO:  Yes.

NORVILLE:  Is it worth it?  How do you feel about yourself now?

RENO:  I feel really good about myself.  I‘m very glad that I did it. 

If I had to do it all over again, I‘d do it again.  But I had a good cosmetic surgeon, and the procedures that I‘ve chosen I think were procedures that were good for me.  And—yes, I‘d do it.  It‘s worth it.

NORVILLE:  Ms. Young, when you hear Neikie‘s story and you see the result that she‘s had from her procedures, what goes through your mind?

YOUNG:  I think she looks great.  And I totally believe that we‘re all obsessed with plastic surgery.  I think people won‘t admit it, but they are because everybody‘s doing it.  It‘s, like, the in thing to do to look as good as you can.

NORVILLE:  And do your friends come up to you, Neikie, and ask you for recommendations, ask you what it feels like?  What‘s the most common question you get?

RENO:  That is a really common question is, Who is your cosmetic surgeon?  Just because, you know, when you do look at me, I don‘t think that you can look and tell that I‘ve had so many procedures done.  She‘s good.  She‘s a great cosmetic surgeon.  And so that‘s a really common question.  And then the other question is, is, Did it hurt?

NORVILLE:  It had to hurt like the devil.

RENO:  Some of it did, yes.

NORVILLE:  It hurt a lot?

RENO:  Right.

NORVILLE:  Because as our guests just a moment ago said, one of the things that all of these TV shows minimize is the amount of pain.  Ms.  Young, tell me a little bit about the pain that you‘ve had to endure in all of these corrective procedures that you‘ve gone through.

YOUNG:  Well, I managed to find a way to just get through it.  The pain didn‘t bother me.  I would go out with bandages.  I would show homes.  I just had to do what I had to do.  And in between, I could help a lot of people.  I would get calls in regard to plastic surgery, and I basically would say, I believe in it, but don‘t do silicone, and if you want to look better and have your nose done or liposuction, do it, anything to feel better because the world is so competitive, especially in Beverly Hills, California.

NORVILLE:  And are you pleased, Ms. Young, with your appearance today, after all of these surgeries?

YOUNG:  Well, it‘s, like, the best I could do.  I mean, I‘m grateful that I even have a face left.  I‘ve had it removed 40 times, this eye alone.  And my face is paralyzed here from all the anesthetics and the grapefruit-sized silicone removed from here.  All the nerves were removed from my face, as well.  So I‘m pretty grateful.  I‘m pretty happy.

NORVILLE:  Yours is a cautionary tale.  Neikie, yours a tale that worked out much better.  But what advice would you give anyone who‘s watching this program thinking, Oh, I don‘t know.  Maybe I want to look into it.

RENO:  I think that the advice that anyone should take would be to find a good cosmetic surgeon, do the research, you know, find out if they‘ve had—if they‘ve done procedures that are not, you know, good procedures and the outcome is not very good because...

NORVILLE:  Find out what problems they‘ve had...

RENO:  Correct.

NORVILLE:  ... not just the success stories that they‘ve got.

RENO:  Correct.  And if a doctor doesn‘t tell you that he will let you talk to patients that he‘s worked on, then that doctor is someone that you really should not consider going to.

NORVILLE:  All right.  Neikie Reno, Elaine Young, thank you very much. 

We appreciate you both for being with us.

YOUNG:  Thank you very much.

RENO:  Thank you.

NORVILLE:  Good luck to you both.

When we come back, we‘re going to talk some more about the risks of cosmetic surgery.  Is it possible that the quest for beauty can be fatal?  That‘s ahead.

(COMMERCIAL BREAK)

(NEWS BREAK)

NORVILLE:  Back now with more on America‘s obsession with self-improvement.  Remember Goldie Hawn‘s collagen-laden lips in the movie “First Wives Club”?

(BEGIN VIDEO CLIP - “THE FIRST WIVES CLUB”)

GOLDIE HAWN, ACTRESS:  Do it, Morris.  Do it to me now.  I need it. 

You‘re the only one who does it the way I like it.  You‘re the king.

ROB REINER, ACTOR:  Please.  If I give you any more collagen, your lips are going to look like they got stuck in a pool drain.

(END VIDEO CLIP)

NORVILLE:  Olivia Goldsmith, the author of the novel “First Wives Club,” which inspired that movie, died after she went into cardiac arrest under anesthesia during a chin tuck procedure last January.  But the American Society of Plastic Surgeons says Olivia Goldsmith‘s death represents an extremely rare risk.  Their study found only one death from cosmetic surgery in over 51,000 cases.  So just how serious are the risks for either a bad result or perhaps even death?  And how do you go about picking the right cosmetic surgeon?

Joining me now is Dr. Robert Kotler.  He‘s a plastic surgeon on the faculty at UCLA Medical School and the author of “Secrets of a Beverly Hills Cosmetic Surgeon.”

Doctor Kotler, thanks for being with us.  I want to put up a picture, if we can, of some of the procedures that are most popular right now.  Over two million botox, 900,000 laser hair removal, 850,000 microdermabrasion, and then over 300,000 liposuction, and close to that in terms of breast augmentation.

Those last two are surgeries.  They involve anesthesia.  We know that was a problem with Ms. Goldsmith‘s death.  How risky are these surgical procedures?

DR. ROBERT KOTLER, PLASTIC SURGEON:  Well, Deborah, in cosmetic surgery, the risk is not in the cutting and the sewing, it is in the anesthetic.  And unfortunately, that‘s what happened to Olivia.  There were problems with the anesthetic which shouldn‘t have occurred.

NORVILLE:  And how can a person who has decided, through all the research, that he or she wants to go through one of these procedures, they find a great doctor—how can they make sure that the anesthetic part of the equation is to their satisfaction and they don‘t run the risk of this going on?

KOTLER:  Well, you‘re right, that‘s the question, because there‘s that component, and also the facility, the location.  But the anesthetic, I believe, should be given by a physician anesthesiologist.  Unfortunately—not a nurse anesthetist.

NORVILLE:  Which was the case in Goldsmith‘s case.

KOTLER:  Yes.  The state of New York was critical of the hospital because the nurse anesthetist was apparently unsupervised, as they described it.  So I believe—and frankly, for myself and my family—I want a doctor anesthesiologist.

NORVILLE:  And when you‘re decided the doctor who‘s going to do the procedure, in many states, almost anybody can do a cosmetic procedure.  In California, oral surgeons are able to do cosmetic facial work under California law.  Explain to us how that‘s possible.

KOTLER:  Well, that‘s a product of a recent law that went through the legislature.  Unfortunately, I think there was some confusion in Sacramento. 

You know, frankly, the training that dentists have is not the same as physicians.  But, typically, the most important thing is to have a physician as your cosmetic surgeon who is board certified in one of the four specialties.  That‘s eye surgery, plastic surgery, head and neck surgery, or dermatology. 

And then you have to look at how specialized is that practice.  And I like to see the doctor who‘s had additional training, who‘s trained longer and stronger, meaning the doctor took a fellowship, which is the finishing school, the further, beyond the residency training in cosmetic surgery exclusively.  And I also like to look for specialists who are very focused, who don‘t do more than five or six cosmetic procedures and they do nothing but cosmetic surgery, no reconstructive surgery.

NORVILLE:  In other words, if you want to have your nose done, don‘t go to the guy whose specialty is breast enhancement? 

KOTLER:  That is absolutely correct. 

NORVILLE:  And how do you make sure that the result that that doctor has had has consistently been one that his patients are happy with, because I‘m not aware of anywhere you can go and look up doctor X, Y, Z and find out where their track record is.  It‘s very hard for a consumer to get dispassionate information about physicians out there. 

KOTLER:  You‘re right, Deborah.  There‘s no central registry.  But there are several clues that you can get at the consultation.

One is, you need to see the doctor‘s work in a before-and-after album, and not two or three cases, but 20 or 30.  Secondly, you should be able to speak with patients that have had the same procedure.  Cosmetic surgery practices have enough patients among which are some who would be comfortable discussing their experience.  That‘s very important.

NORVILLE:  And what about having the procedure done in the doctor‘s office?  One of reasons I‘m told for the explosion in cosmetic work these days is, you don‘t have to go to a hospital anymore.  Many procedures are done in doctor‘s offices, in off-campus facilities.  How do you make sure that that place is a safe place to have a procedure done? 

KOTLER:  That‘s a great question, because, you‘re right.  The hospital is not the preferred location for many reasons, including the lack of privacy and cost. 

A licensed, accredited, fully kind of endorsed, if you will, outpatient surgery center or a physician‘s office is an appropriate place.  But I will tell you also that a doctor anesthesiologist will not work in a facility that isn‘t up to snuff.  The facility has to meet certain standards and the same standards, incidentally, that a hospital has to meet, in terms of life support systems, emergency treatment. 

NORVILLE:  And, finally, I want to roll some footage from the ABC show

·         or I think it was the Fox show called “The Swan,” where the reveal happens and the young lady sees herself for the first time.  Let‘s take a look at that tape. 

(BEGIN VIDEO CLIP, “THE SWAN”)

UNIDENTIFIED FEMALE:  I look beautiful.  It‘s not like one of those fake mirrors that make you look skinnier or prettier.  I cannot believe this is me. 

UNIDENTIFIED FEMALE:  You better believe it, Kelly, because it is. 

UNIDENTIFIED FEMALE:  It is me. 

UNIDENTIFIED FEMALE:  Yes, it is.  And you look amazing. 

UNIDENTIFIED FEMALE:  Thank you. 

UNIDENTIFIED FEMALE:  How do you feel? 

UNIDENTIFIED FEMALE:  I feel beautiful. 

(END VIDEO CLIP)

NORVILLE:  And when you see this doctor on television, is the media doing a disservice to people who might be considering this?  That‘s a real fairy tale example we just saw.  The typical patient does not look at themselves for two months.  They look at themselves.  They‘re black-eyed.  They‘re bruised.  They look pretty frightening. 

KOTLER:  Right. 

Well, it‘s entertainment.  That program is not a documentary.  And that‘s the difference.  And you‘re right.  There is a whole process that the patient goes through.

But I want to tell you that if the prospective patient has that opportunity to speak with one or two or even three patients that have been through the process, I think they‘ll have a clear understanding.  There will be no surprises.  And, incidentally, there was a comment made earlier about pain.  Today, doctors, physicians, when it be surgeons or anesthesiologists, certainly have the means to alleviate pain.  We have got a zillion great pain medications.  I don‘t think any patient should ever suffer.

NORVILLE:  But should a doctor continually do procedures on the same person?  We‘ve all seen plenty of examples.  There are lots of celebrities out there we could name that have gone back to the trough more than once.  At some point, shouldn‘t the doctor say, no, madam, no, sir, you‘ve had enough? 

KOTLER:  You said it, because each successive procedure becomes riskier.  And that risk-reward ratio becomes unfavorable.  You have to know when to quit, common sense. 

NORVILLE:  All right, Dr. Robert Kotler, thank you for being with us.

KOTLER:  My pleasure, Deborah.

ANNOUNCER:  Next, she wrote the book on what it takes to stay on top of the modeling game.  Janice Dickinson should know.  She‘s been at it for 30 years, with a little help from her plastic surgeon.  Confessions of a supermodel—when DEBORAH NORVILLE TONIGHT returns. 

(COMMERCIAL BREAK)

NORVILLE:  A supermodel tells the world, everything about her is fake.  Now she tells me why she went under the knife and maybe why you shouldn‘t - - next.

(COMMERCIAL BREAK)

NORVILLE:  Think what you want about cosmetic surgery.  For some people, it is a way of life and often it‘s a career move in today‘s youth-obsessed culture.  Who feels more important to stay young and beautiful than all those folks who make a living in front of the camera, movie actors and fashion models?

Janice Dickinson has been dubbed the first supermodel.  She has appeared on countless magazine covers, and she has been modeling for 30 years.  Recently, you‘ve seen her as the co-host of the television show “America‘s Next Top Model.”  And she makes no secret about the fact that she‘s had a little work done. 

Joining me now is supermodel Janice Dickinson.  She‘s the author of “Everything About Me Is Fake and I‘m Perfect,” a new book in which she candidly reveals her own lifelong struggle to achieve perfection. 

I love the title because there‘s a great sense of humor and a great sort of frankness about it.  What‘s the message you want to send to people out there? 

JANICE DICKINSON, AUTHOR, “EVERYTHING ABOUT ME IS FAKE AND I‘M

PERFECT”:  Thank you for that. 

I wrote—I came up with this title doing a talk show circuit on book one, “No Lifeguard On Duty.”  And I noticed several young women sitting in the studio audience of “The Ricki Lake Show” clinging to Victoria‘s Secret catalogues.  And I looked down and I asked why that particular catalogue.  And the response was from these young women ages 13 to 17, because we want breast augmentation, breast implants.

And that‘s when I went, whoa, wait a minute.  My hair, fake color, my teeth, porcelain veneers, my nails, artificial.  I‘ve had breast augmentation, but I waited until after I lactated and had a child first.  “Everything About Me Is Fake and I‘m Perfect” evoked a response out of these young women.  And my message was, hold it.  Don‘t alter your bodies at age 17.  Wait until at least you‘ve had children. 

NORVILLE:  But do you think people are getting that message, because they‘re altering their bodies at 17 and younger and they‘re altering their bodies constantly throughout their lifespan.  It‘s as though people are unable to be happy with who they are the way they are. 

DICKINSON:  I believe you‘re absolutely right.  Just speaking from personal experience, I waited. 

I have had a career of being a model, coined the term supermodel, and having to appear beautiful for magazines over—spanning the last decade of 30 years.  You do the math.  I‘m no spring chicken.  And I noticed that the girls today are invoking Lindsay Lohan‘s image of—she went out and bought herself a pair of boobies.  Britney Spears wearing low-cut, plunging neck lines, humping stripper poles, this is not a good message for our youth today.  I have a 10-year-old daughter.

(CROSSTALK)

NORVILLE:  Look, we don‘t know that Lindsay Lohan has gone out—and she contends that her bosom just—she‘s a growing girl and her body is developing. 

But what I‘m curious about is, you are a beautiful woman.  You were, as you said, one of the first supermodels.  And yet, in your book, you talk very candidly about the number of plastic surgery procedures that you‘ve gone through over the years.  Most recently, you‘ve had a number last spring. 

Can you just give us kind of the lowdown of what you‘ve actually done? 

DICKINSON:  Now you‘re starting to sound like Dr. Phil.

But—I‘m sorry.  I started with my feet.  It was—for any of those women out there who suffer from bad feet, I started with my feet, to alter my feet because of a bunion, a bunionectomy I had.  Then, after I had my child, Nathan, 17 years ago, I noticed that my breasts weren‘t what they used to be, so I pumped up the volume in that department. 

And then when I noticed how easy it was to settle in.  And my jowl started drooping and my eyes started drooping after thousands of hours of grimacing over the years, I decided to pull in the trim and have a little surgical procedures last March by Dr. Frank Ryan in Beverly Hills.  And he did minimal work on my eyes and minimal work on my face. 

And I think after 50 years walking the planet, I deserved—it was like going in for a root canal.  But mind you, my message is wait until halfway mark of at least my life before going out and attempting any surgical process. 

The premise of “Everything About Me Is Fake and I‘m Perfect” is, I don‘t look like this when I sat before you today, Deb.  I had an hour and a half of hair, an hour and a half of makeup.  There‘s lighting in here, more lights underneath me to light Yankee Stadium.  And in “Vogue,” “Bazaar,” “Cosmo,” after voto—voto—photodigital and everything they do with the cameras, Photoshop, supermodels don‘t look like that when they walk in the front door. 

Cindy Crawford has a team of experts for the next 20 years making her look like Cindy Crawford before she steps into a photo shoot. 

NORVILLE:  What about the fear?  There is risk.  These are surgical procedures.  And it seems like in the last year there was this repetitive drumbeat of terrible headlines where women had gone in for—quote—

“routine cosmetic surgery” and they didn‘t come out, oftentimes because of an adverse reaction to anesthesia. 

Too many people I think look at this as analogous to going and getting a pedicure and a manicure at the corner shop, when it‘s a far more serious procedure. 

DICKINSON:  Obviously, these women didn‘t research their surgeons or they didn‘t take the time to speak to the surgeons about perhaps heart problems. 

I‘m not a doctor, so I don‘t want to come off sounding like a horse‘s ass, but I did a lot of research before I found out Dr. Frank Ryan‘s work, and it speaks for itself.  He‘s the Bentley of surgeons.  I‘m high-strung. 

(CROSSTALK)

NORVILLE:  Let me ask you about your profession.  You‘re a beautiful woman.  You continue to work in front of the camera.  How many other beautiful women who work in front of the camera have had a little tweaking done? 

DICKINSON:  All A-list actresses.  I can‘t mention names.  It‘s a litigious society.  But I happen to know personally the hundreds of supermodels that don‘t exist—hundreds of models that exist today.

The procedures, for example, Artecoll, Restylane, collagen, Botox, these are wrinkle fillers.  There‘s more botulism in my face than in several small countries in micro—Asia. 

NORVILLE:  Do you ever worry that it might turn on you, if you‘ve had so much of this stuff done, that, at some point, they may discover, oh, my gosh, we never knew this was the side-effect?  Do you ever worry about the long-term implications?

DICKINSON:  Hell, yes.  But, yes, I do worry, but, in the meantime, worrying is not going to put money in the bank for my children‘s college education. 

So it‘s—I‘m a single mom and you‘ve got to do what you got to do.  For me, as a woman behind the camera, I‘m on “America‘s Next Top Model” and I am judging young girls.  And one of the first things I say is, I like the way your big nose looks.  We can work with that.  You can change trend by the way your larger nose looks.  I‘m not about whacking off noses or adding to or taking away from breasts or waistlines, unless a person really decides that they really truly can‘t live without it. 

NORVILLE:  Maybe people do it to great effect.  And you‘ve given us a little insight on just how all the tricks of the trade come together. 

Janice Dickinson, thank you so much for being with us.  We look forward to seeing you again.

DICKINSON:  Thank you so much.  God bless.

NORVILLE:  And coming up next, if you‘re not convinced that a nip and a tuck is for you, well, you‘re not alone.  My next guest says she has got plenty of good reasons to say no to the knife. 

(COMMERCIAL BREAK)

NORVILLE:  Cosmetic surgery is not for everyone.  For some, aging is a natural process and they think what happens to our faces and our bodies over time should not be altered. 

Joining me now is Peggy Northrop.  She‘s the editor in chief of “More” magazine, which caters to women over 40.  Peggy believes that aging women don‘t need cosmetic surgery to be beautiful. 

And it‘s nice to have you here.

PEGGY NORTHROP, EDITOR IN CHIEF, “MORE”:  Thank you. 

NORVILLE:  What ever happened to that old yarn about growing old gracefully? 

NORTHROP:  I actually think there is an equally important and sort of unrecognized trend, that there are a lot of women who feel that they don‘t need plastic surgery.  They want to look like themselves. 

Now, of course, they‘re coloring their hair and they want to be fit and they want to feel healthy and they want to exercise.  But we are certainly seeing that among our readers.  You give them a choice between, you know, travel or a romantic getaway and plastic surgery and they opt for travel every single time. 

NORVILLE:  Is it because there‘s a sense of adventure in older women today?  Or they‘re afraid of pain?

NORTHROP:  I think there‘s a sense of adventure.  No—well, certainly, I would be afraid of the pain myself, but I do think there‘s a sense of adventure and a sense of confidence that women feel when they hit their 40s. 

We just surveyed 3,000 of our readers.  And that will appear in a future issue.  But we asked them, how do you feel about your looks now?  How did you feel—do you feel better or worse than you did five years ago?  And what I found so striking was that, when women hit 40, they actually feel better about their looks. 

Most of our readers, the vast majority, say that they‘re very pleased

by what they see in the mirror. 

NORVILLE:  And is that because they feel good about their lives in general?  It‘s not just what they see in the mirror, but when they look at the total picture of their lives, their families, their relationships, they‘re more or less comfortable? 

NORTHROP:  I think that‘s what it is.  I think that, when you hit your ‘40s, you stop worrying so much about what other people think of you.  I think that‘s the great benefit of age and that sense of confidence that you can reinvent your life, you can do the things you want to do and you have more time for yourself. 

NORVILLE:  I want to look at another survey that was done by the American Society of Aesthetic Plastic Surgery.

And they also surveyed people.  And they found, when they asked if you would consider cosmetic surgery, 34 percent of women said they would; 14 percent of men said they would, which is a strikingly low number when you look at how many articles in the magazines and television programs are now dealing with this subject.  Do you think that is an accurate reflection? 

NORTHROP:  When we ask our readers about what they would consider, I‘m very struck by the fact that they will consider things, but they‘re not doing those things. 

NORVILLE:  So how many in your survey would consider surgery? 

NORTHROP:  In our survey, there are about 15 percent of people who would consider it.  And that goes up with age. 

Certainly, they‘re interested in the things that are a little bit less invasive.  They‘re not going for face-lifts.  If it‘s Botox—about 8 percent of our readers overall say they have done that. 

But, again, it goes up with age.  But it‘s not a very big number.  They like to know that they have the options.  But, for our readers, it‘s much more about taking care of yourself in the here and now and using OTC products.  There are lot of products that are out there now that people feel good about.

NORVILLE:  But, having said that, your magazine, like every other magazine that caters to women out there, is going to do articles about plastic surgery.  People are interested in this subject.  They‘re incredibly curious about it. 

NORTHROP:  They are very curious.

But I do think it‘s like—it‘s the kind of thing that we like to keep in our back pocket.  While I‘m not interested in doing it, I never would say absolutely, never, I would do nothing. 

NORVILLE:  And the other thing that‘s interesting, the same survey from the American Society of Aesthetic Plastic Surgery also queried, and 80 percent of women and 74 percent of men said, if I had had something done, I wouldn‘t be embarrassed for my friends to know.  So the stigma of cosmetic work seems to definitely have fallen by the wayside.

NORTHROP:  I think that‘s true. 

NORVILLE:  And what does that say about us as a society?

NORTHROP:  I think that perhaps people are worried about how it is going to affect their careers.  Certainly, those of us who are in the public eye, we look around and think, who with gray hair is getting the jobs?

So I think there‘s some of that.  In terms of the stigma that‘s going away, I think people just feel like it‘s part of the armamentarium.  It‘s like vitamins.  I don‘t think that that‘s their experience.  I think that‘s an opinion.  And I think that‘s where we really have to draw the distinction. 

NORVILLE:  But you would say it is a fact of society today, the better you look, the younger you appear, particularly if chronologically you are up in years, the more likely you are to get the guy, to get the job, to be seated at the better table in the restaurant? 

NORTHROP:  Well, I‘m not sure that that‘s true.  I think that there is an opinion, again, but I don‘t think that that‘s what our readers‘ experience is. 

They have a sense of self-confidence.  They feel confident about their looks.  They feel like the whole package of their lives is working for them and they really, really good about that. 

NORVILLE:  Do you see that as the next trend, people saying, I am nonsurgery, here me roar? 

NORTHROP:  I hope so.  I hope it gets as much coverage as the surgery trend has gotten. 

NORVILLE:  All right, Peggy Northrop from “More” magazine, thanks so much for being here. 

NORTHROP:  Thank you. 

NORVILLE:  And we look forward to seeing more about your survey in future issues.

NORTHROP:  Thank you. 

NORVILLE:  When we come back—if you want to learn more, by the way, before we go to the break, about cosmetic surgery‘s good and bad, just log on to our Web page.  It‘s NORVILLE.MSNBC.com.  We‘ve got several links there to some interactive before-and-after surgery pictures.  You might find them interesting.

We‘ll be back.

(COMMERCIAL BREAK)

NORVILLE:  Send in your ideas and comments to us at NORVILLE@MSNBC.com.         

That‘s our program for tonight.  Thanks for watching. 

Coming up tomorrow, the attack, the press, the spin, the pressure.  The candidates have to handle it, but what about their kids?  Jenna and Barbara Bush are now officially members of the Bush 2004 campaign team.  Chelsea Clinton spent eight long years from tween to teen under the microscope.  How do presidential children cope with the attention, the pressure, the Secret Service going on along on your dates? 

Tomorrow night, some famous sons and daughters with tales from the presidential campaign trail and from the White House.  And they offer their tips for the next White House generation—that and more when you join us tomorrow night.

Coming up next, “SCARBOROUGH COUNTRY” and why the president isn‘t addressing the NAACP convention.  “SCARBOROUGH COUNTRY” is next. 

We‘ll see you tomorrow. 

END   

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