In his 18 years as a plastic surgeon in Beverly Hills, David Alessi, M.D., has gotten a lot of strange requests: the woman who wanted a forehead implant, the one who asked for "ankle lipo" and the patient who requested he break and reshape her jaw for a bigger smile. "Nothing much shocks me anymore," he says. But even he was taken aback by a 25-year-old who recently came in for a consultation. "When I asked what she was here to see me about, she said, 'I want to have my belly button removed.' Completely removed," says Dr. Alessi.
As unusual as that may sound, more and more young women are monkeying around with their body parts. They're shortening their toes, padding their butts with implants and downsizing their labia (yes, labia) to make them more "attractive." These are the new extreme — or, as some docs have dubbed them, "fashion" surgeries. And while they aren't nearly as common as, say, breast implants or nose jobs, they're getting more popular. According to the most recent figures from the American Society of Plastic Surgeons (ASPS), 1,030 "vaginal rejuvenations" were done in 2006 — a 30 percent increase from just the year before. The number of butt implants rose 18 percent in that same time frame.
Surprisingly, many takers are not plastic surgery junkies ("Darling, I've done my boobs and my thighs and now I positively must do something about my labia!"). "Most of the patients requesting extreme procedures are actually first-timers, women who came of age in our makeover culture and simply think everything's possible," says Dr. Alessi, founder of the Alessi Institute for Facial Plastic Surgery and Alessi Skincare in Los Angeles. "Many of my young patients think about getting plastic surgery the way they'd think about getting their hair done."
Some women do have good reason to seek nips and tucks; in certain cases, seriously elongated labia, for example, can make even a brisk walk uncomfortable — let alone sex. And if there's an aesthetic issue that's crushing a woman's confidence, surgery can be a legitimate option. Still, the ubiquity of plastic surgery in general has raised the beauty bar to an impossible standard, says Ann Kearney-Cooke, Ph.D., a Cincinnati-based psychologist and co-author of "Change Your Mind, Change Your Body." "Looking 'normal' is no longer the norm. Now there's pressure to be perfect from head to toe — literally! — and women feel the smallest perceived imperfection needs to be fixed."
So who's doing these procedures? While some unethical doctors want to make a buck off women's distorted body image, plenty of respectable M.D.s are slicing and dicing away. "From a surgical standpoint there's not much difference technically in putting implants in the butt than in the breasts, and liposuction is generally the same whether done on the thighs or shoulders," notes Brian M. Kinney, M.D., a clinical assistant professor of plastic surgery at the University of Southern California in Los Angeles.
"There's a mind-set among doctors," adds Dr. Alessi, "that someone's going to do the surgery, so it might as well be me." Dr. Kinney notes that he's had to fix many botched procedures because a woman went to a less qualified or reputable doctor. "In certain cases," he says, "I'd rather she get it right the first time, whether that means reshaping her nose or labia." There's even an experienced surgeon in L.A. who specializes in "vaginal rejuvenation," a man one colleague jokingly refers to as "the labia king of America."
That said, most doctors do draw the line somewhere. Dr. Alessi, for example, refused to obliterate that 25-year-old's belly button. "I often tell patients, as gently as I can, that they need to see a psychiatrist first, not a surgeon," he says. That's a good thing, since plastic surgery is surgery. "Women don't really consider it to be a serious procedure that leaves scars. But it can cause complications and does require healing time," says Dr. Alessi. Take a look at the extreme surgeries that are gaining popularity among women these days — even though many doctors don't think anyone needs them.
The extreme surgery: butt implants
The dirty details: "It's the whole Brazilian-model look: smaller breasts and curvier behinds," says Dr. Kinney. To do this procedure, a doctor slices the butt cheeks (can we just say: Ow!) and inserts silicone implants. Recovery takes weeks. The other option: a Brazilian Butt Lift. It involves extracting fat from the abs, hips or thighs and transplanting it into the butt. Cost: $6,000 to $13,000 for implants; $7,500 to $15,000 for a lift.
Why you may not want to go there: Shooting pain or numbness (from nerve damage) is not uncommon. Ruptures can occur since people do tend to sit down. And things can get ugly: Lorena, 37, an at-home mom in Florida, had fat injections and a permanent filler put into her rear. "I felt self-conscious about my butt being flat," she says. A year post-op, she developed lumps and open sores that turned into a serious infection. "I had to have a large chunk of my right butt cheek removed," she says. "I would tell any woman considering the procedure: Don't do it! It's not worth the risks."
Better than surgery: Get that butt to the gym. "The surgical results aren't going to be much more dramatic than what you'd achieve through regular exercise," says Dr. Alessi. "Toning moves like squats can go a long way toward reshaping your backside." Looking for more roundness? Frederick's of Hollywood Booty Pads ($36, fredericks.com) slip into your regular skivvies and produce the effect without making you feel like you're sitting on river rocks.
The extreme surgery: labiaplasty
The dirty details: This procedure sculpts and reduces your vaginal lips and yes, it typically involves a scalpel. (Cue millions of women wincing and crossing their legs.) It can be medically necessary in very rare cases, but experts say many women get it so their genitals will look more perfect. After the surgery, you can't have intercourse for about four weeks, and your genitals will be tender and swollen for several months. Cost: $5,000 and up.
Why you may not want to go there: In 2007, The American College of Obstetricians and Gynecologists issued a position statement against cosmetic vaginal procedures due to the possible risks. With surgery in such an incredibly sensitive area, there's a chance you'd permanently lose some feeling or intercourse could become painful.
Better than surgery: Try to get past your self-consciousness. "A lot of shyness and anxiety stems from not being familiar with your body," says Kearney-Cooke. Check yourself out after a shower with a pocket mirror. It may sound like a "Saturday Night Live" skit, but the more you look, she says, "the more comfortable and accepting you become."
The extreme surgery: toe shortening or lengthening
The dirty details: A surgeon trims or shaves bone or, for elongating, drills into the tip and inserts a metal rod. According to the American Orthopedic Foot & Ankle Society, these surgeries should be done only for medical purposes — a painful hammer toe, for example. Yet women are doing it to look better in their strappy shoes. It takes four weeks or so to heal; you must stay off your feet the entire time. Cost: $2,000 to $2,500 per toe.
Why you may not want to go there: "By lengthening or shortening a toe — even a tiny bit — you end up shifting more weight to the other four, which can lead to problems such as bunions, nerve pain and balance issues," says Judith F. Baumhauer, M.D., chief of the division of foot and ankle surgery at the University of Rochester in New York.
Even when the surgery goes well, the healing process can be brutal. Nicole, a 26-year-old salesperson in California, recently had both of her big toes shortened when she went in for medically necessary bunion surgery. "I was out of work for four weeks," she reports. "I had severe pain in the arch of my right foot after the first surgery. And the bones in my left big toe didn't heal properly after the second procedure; four months later I'm still not better." The medical boot she now has to wear isn't exactly the show-them-off, Jimmy Choo moment she'd been looking forward to.
Better than surgery: How about a nice pedicure? Use nudish polish; it downplays a too-long-or-short toe more than bright or dark shades. Then go shopping, says L.A. stylist Christina Ehrlich, who has worked with Jessica Biel and Nicole Richie: "Peep-toes or pumps that reveal toe cleavage are great — you get just a hint of toe."
The extreme surgery: shoulder lipo
The dirty details: A doctor vacuums the fat out of the shoulders to create a more lean, defined look. It can take up to six weeks for the swelling to subside. Cost: $750 and up per shoulder.
Why you may not want to go there: Because unlike thighs and bellies, shoulders never pudge up much in the first place. As Donna Karan, the queen of shoulder-baring dresses once said, "Shoulders are the one place a woman will never get fat — so show 'em!"
Better than surgery: Do a few minutes of triceps dips, shoulder presses and lateral raises several times a week and you'll see more definition in a month (for the how-tos, register for Body By Glamour). "Shoulders respond very quickly to strength training," says Wayne Westcott, Ph.D., fitness research director at the South Shore YMCA in Quincy, Massachusetts.
The extreme surgery: belly button reshaping
The dirty details: With umbilicoplasty, as it's officially called, "women often make their 'outie' into an 'innie.' But some want almost imperceptible changes, like making theirs look less deep or less round and more diamond shaped," says John Grossman, M.D., a plastic surgeon with practices in Beverly Hills and Denver. The surgeon usually cuts an incision around the navel, stuffs some of the skin inside to create the desired look, then sews it back up. Women often get the procedure done in conjunction with a tummy tuck. Cost: $5,000 to $7,500.
Why you may not want to go there: Small as the area is, there's still a risk of infection, prolonged pain and scarring. Plus who knows what you'll end up with? "There's some consensus about what makes for an attractive, well-proportioned face. But we have no definition of an ideal navel," says David Sarwer, Ph.D., of the Center for Human Appearance at University of Pennsylvania Medical Center in Philadelphia. "You might not be totally happy with the way yours looks, but you won't necessarily know how to make it prettier, either. And the doctor doesn't really know any better than you. That's a lot to chance."
Better than surgery: Consider this: "Look, everyone's body is different but fantastic in its own way," says Ehrlich. "Even celebrities have insecurities about their looks, but they're not all getting things fixed! Instead, they work their best features and carry themselves with confidence." A little self-love will feel a lot more satisfying than any plastic surgery, and the only known side effect is happiness. Try it — the surgeon general would most definitely approve.