After The Makeover

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NOW: Stacey Hoffman, 32, strikes a pose in front of a Lincoln, Neb., barn. Her surgery included a nose job, brow lift and chin implant. She also lost 55 lbs.20 lbs. since her show aired

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Karen Richardson has stuck with her new look and changed her eating and shopping habits accordingly. Karen, 44, an emergency-room nurse from Wilson, Ark., who hated her nose and always dreamed of going without glasses, corrected both problems, made some other fixes and arrived back at work newly cheerful and gregarious. Young patients who used to shy away from her because she looked permanently grouchy, she says, suddenly sought her company.

Such a happy post-op adjustment isn't guaranteed, though, which is one of the reasons that Dr. Stephen Schendel, professor of plastic and reconstructive surgery at Stanford University, has mixed feelings about television's real-life, high-concept Cinderella stories. "It shows people what's possible," he says, "but on the other hand it leads to false expectations." Schendel feels the program glosses over "the difficulties of the postoperative period." The doctor also finds it worrisome that the show's producers offer no formal counseling to the participants. "Who's following up?" he asks. "And if they do have concerns, whom do they go see?" According to producer Marla Brodsky, the show will put participants in touch with a doctor or therapist, but only if asked. "If you need us, by all means come to us," she says. "But will we send doctors out to you and have them call you every week? No, because there's no need."

Another problem with the program is that it may be manufacturing a new form of dissatisfaction among people — particularly those without the money for a full face-and-body overhaul. In the growing list of American wants that, once identified, turn into needs, the desire for a radically new appearance just as the old one is showing signs of wear could be a source of unfathomable resentment. Already, specialized clinics devoted to remodeling the rich in the manner shown on Extreme Makeover are springing up. One of these, the Advanced Aesthetics Institute, based in West Palm Beach, Fla., intends to open branches soon in Dallas, Miami and Beverly Hills, Calif. Given that list of ritzy addresses, it's not unreasonable to imagine that one's ZIP code may someday determine one's appearance.

Stacey Hoffman felt the sting of others' resentment when she went back to work at her Nebraska nursing home. "People just made it miserable for me," she complains. She refuses to let it bring her down, though. Her dream these days is to land a sales position with Planet Thong, a suggestively named lingerie start-up that sounds just perfect for the new Stacey.

What happened to the old one? Maybe it's lying on the operating-room floor.

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