The Bare Method: Inside our Plastic Surgery Cover Story

A Q&A with Los Angeles magazine deputy editor Nancy Miller about our October feature on the billion-dollar industry

Photographs by Jeff Lipskey

Plastic surgery seems to be a topic everyone has an opinion on. But “The New Face and Body of Plastic Surgery” doesn’t champion or denigrate the industry’s trends. Was this topic harder than most to approach with an open mind?
Yes, particularly because I came in with my own judgment on the topic—superficial, grotesque—and had to shake that off to approach this in a fresh way. I realized plastic surgery is treated in media usually in one of three ways: endorsement, circus act, or horror story. I didn’t want this to be an endorsement of plastic surgery because a list of “Best Plastic Surgeons” is not at all the editorial mission of an L.A. mag story.  I didn’t want the circus act of “twins getting face-lifts!” because that’s stuntwork, not journalism. I didn’t want to do horror stories of surgery gone wrong, because that’s just a cheap way to exploit a reader’s emotions and it’s an insult to their intelligence.  

So as I was researching and coming up with ideas, I realized there were new things to say, an opportunity to cover not only the procedural elements of cosmetic surgery, but also to take a cultural and sociological look at it—at how these procedures have become cheaper, easier, and more democratized, and, with that, the kind of woman (and in a few cases men) who are getting it aren’t the Beverly Hills matron or the blond bimbo we’ve endured as a stereotype of our city for three decades. There’s a whole spectrum of procedures that reflect a new aesthetic—and in turn, that reflects a demographic shift in L.A. Or, to put it more simply: Butts are the new boobs.                              

Because of what we see on TV (hello, Real Housewives!), we think of plastic surgery as something rich, mostly white women do to look younger, thinner, and to have bigger boobs. But that’s not the full picture, is it?
Not at all. I will say reality TV has had a bizarre and surprising influence on “normalizing” plastic surgery (which we’re defining as any artificial manipulation to the face and body, including less invasive procedures such as Botox), where the people on these programs are casual and cavalier—they make it all look fun, with Botox parties and breast implants as gifts. We have a good time with that in a piece called “Seven Unreal Things We Learned From The Real Housewives“—it’s a caricature exported as “reality.” 

Use of Botox has spiked 621 percent in the last decade. Whoa. Why do you think that is?
The last five years, it was the economy. The surgeons I interviewed all said that the financial collapse led to a drop in face-lifts and other expensive procedures, and women instead were opting for “surgery lite”—Botox, fillers, and other injectables known as MIPs—minimally invasive procedures. It’s the difference between a few hundred bucks a pop and several thousand. Another reason for the spike in injectables is that FDA approval happened over a decade ago, but women were afraid of  “poison” in their face. Over the years Botox has become more common, and women feel more confident that it’s safe. I should also mention that the marketing of these products, from television ads to brochures wallpapering your dermatologist’s office, have had a huge impact on pushing these products. What women need to know, though, is that injectables are largely unregulated in terms of who can have them and where they can be done. It’s a Wild West of people claiming to be experts, but it’s important that women and men who want to get an injectable do so through a board-certified physician.   

Your research uncovered facts like the highest price for an all-in-one makeover ($100,000) and the percentage of all procedures done in the U.S. happen in our Pacific/Western region (31 percent). What one stat surprised you the most? 
I think the stat that shocked me was that 70 percent of cosmetic procedures are undergone by women who earn less than $50,000 a year. That’s not in the story, because that’s not a figure I reported—it’s one mentioned in Lauren Greenfield’s documentary Beauty CULTure, which came out this year. It struck me that a fair number of multiple procedure patients are working-class single mothers who are going back into the dating and/or professional world and see plastic surgery as an opportunity to make their lives better. For many of them, it might be; I don’t know. 

In an essay she contributed to the package, Greenfield says “everything is something to be changed.” Is the growth of the plastic surgery industry indicative of larger changes in our culture?
Yes, that the new virtue is not in good deeds but in perfect features. Greenfield observes this, and I agree. We look at our body parts as projects in constant need of improvement. And that’s something people might not realize. It became clear to me in my research that one procedure, like Botox, leads to another, like an eyelift, which leads to a face-lift…basically as soon as you fix one thing, you notice something else, and it never ends. 

We reported how difficult it was for the magazine to find the right cover model for the issue. What look were you going for, and why?
This was so telling—and depressing. We wanted a model who was healthy-looking. A natural beauty with curves that reflected a “new ideal”—that is, a rounder figure, natural breasts, hips ,and backside. We asked for a size 6-8, and we couldn’t find a single model—not ONE—who was that size. There is no plus-size market in L.A. Our photo editor, Amy Feitelberg, called every agency in the city. Finally we managed to get a model who was a size 4 and looked fleshy enough. Other than that, it was all size 0s. I guess I was a little clueless about that.  

$10.4 billion was spent on cosmetic procedures in the U.S. last year alone. Where does the industry go from here?
I kept asking doctors for their predictions on next trends and oddly, they didn’t have a grand vision of what will happen next in terms of innovation. It strikes me that they’re making enough money so they’re not entirely concerned about improving their process, other than making their process go faster (like our 60-minute face-lift) so they can get more patients and make more money. But I did observe that the market for injectables and other minimally invasive procedures is so booming, that’s where the money is—the subtler tweaks and natural-looking results without going under the knife. We have a list of those items in a sidebar called “10 Things to Stick into Your Face Besides Botox.” I should note that plastic surgery is a global fascination, so there are things going on in Asia, particularly South Korea, that might make their way here, but with our FDA approval process, it won’t be for several more years, I imagine.