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In one important respect, the European market is different from that in the U.S. "Americans are notoriously litigious," says Lewis, "so American doctors practice defensively." Fillers — the injectable substances used to plump out creases and wrinkles — go through the arduous approvals process of the Food and Drug Administration before being licensed for use in the U.S. In Europe, most are classed as "medical devices" so require only a "Conformité Européene" certificate, a cheaper and quicker process. As a result, explains Lewis, "there are more than 70 fillers available in the European Union," but only eight approved for cosmetic use in the U.S. Professional qualifications vary from one European country to the next. "The fact that there are fewer restrictions on European doctors is both good and bad," says Lewis. "It means they can be more creative and try more products, but they also take bigger risks." She warns against cut-price surgery tourism. "A woman came to see me the other day with a brochure for a clinic in the Mediterranean and said didn't it look nice. I told her, 'If you want to go on holiday, go on holiday. What do you know about this clinic? Nothing.'" Quality is everything. "Most clients," says Lewis, "want to look better, not different."
Jacqueline Dusseaux, 43, a realtor from Montargis, 100 km south of Paris, could relate. She had a face-lift at the end of January. "The wrinkles were starting to become a real problem around my chin and eyes, to the point that when I put on eye-shadow, it would disappear in the creases," she recounts — while admitting that she had to adjust to her "new face." "Just the other day I went to get medicine. Everyone was staring at me," says Dusseaux. "Then the pharmacist came over and said, 'My God, with the other customers it is hard to tell that they have had something done, but on you it really shows.'" And she hasn't told her parents. "In France there is still a taboo," says Dusseaux. "People have certain perceptions of you once they know you have had work. It is perceived as a frivolous thing that rich people do. I don't understand it. Anyone can have plastic surgery now. It has been democratized."
Granted, democracy comes at a price. Alice Kisko, 33, from Aachen, Germany, is still getting used to the breast implants she received earlier this year — and their cost. She and her family went without their usual vacations to help fund the j3,000 operation. Luckily her husband and two children are all enthusiastic about the results. "My 10-year-old daughter was downright excited," says Kisko. "She said my breasts looked 'superwonderful and natural.'" Still, Kisko doesn't plan further cosmetic procedures and wonders about the participants in TV reality shows. "I feel like myself — even though the size of my breasts is still a little unfamiliar — when I look in a mirror. But how can these women do so when they look like entirely different people?" But such disapproval misses the point. If cosmetic surgery has become something that many Europeans — rather than a rich few — now contemplate, it's TV that's responsible.
Makeover!
When Isabelle Dinoire, recipient of the world's first partial face transplant, made her postoperative press debut last month, the scene at the hospital in Amiens, France, echoed the set-piece closing sequences of Extreme Makeover. That TV program uses surgery to transform plain Janes into sultry Suzys. The media applauded Dinoire's entrance and the patient declared, "I now have a face like everyone else. A door to the future is opening."
That's precisely the subtext of many makeover programs broadcast on European TV channels. The absence of beauty, they suggest, precludes a normal existence. In the past, cosmetic surgeons had to rely upon before-and-after shots of clients: you've seen the dowdy mugshot followed by the coiffed glamour-puss look. The genius of the reality television shows was to develop this emotive narrative into multipart series. Their names resonate with promise: The Swan, 10 Years Younger, Make Me Perfect. Poland's first-ever locally produced surgery show, Make Me Beautiful, attracted 100,000 applicants in its first season.
One of the most successful examples of the transformation genre, Extreme Makeover, devised in the U.S., has been sold to broadcasters in 30 European territories; the format has also been licensed to homegrown versions in six European countries. Each episode introduces participants at their lowest ebb, discusses their "defects" and emphasizes their unhappiness in voiceover. Then comes the transformation scene: a surgical makeover, usually involving multiple procedures, new teeth and wardrobe, and industrial quantities of makeup. Finally we arrive at the "reveal," the climax when the transfigured patient is unveiled, à la Dinoire, to the applause of friends and family.
It's a great moment. But Wendy Lewis worries the TV shows have raised unrealistic expectations. "We've created a culture of people who can't afford surgery or aren't stable enough for it. We've made it seem a little too accessible. Having your boobs done won't mean you meet the man of your dreams." Moreover, she challenges the idea that surgery is an option for everyone. "This is a luxury and an elective item. If you can't afford the fee, if you start going into financing, then there's so much riding on the outcome of that surgery that it puts too much pressure on you."
Besides, sometimes surgery doesn't do the trick. Gérard Le Gouès, a Paris-based psychoanalyst and author of a book about cosmetic surgery, Un Désir dans la Peau (A Desire in the Skin), believes that many successful surgical operations are "failures, psychologically speaking — I would estimate about 35-40%. Surgeons aren't psychological specialists."
And sometimes it's more than the psyche that's damaged. In France, Muriel Bessis, 62, has undergone five breast operations, six facial procedures and 11 years of tribulation to achieve her current look. And she says frankly, "I do not recognize myself." In 1985, Bessis, a Parisian speech therapist then in her early 40s, decided her breasts would benefit from a little work. The operation was not a success. She eventually consulted a second surgeon who offered to fix her breasts and to give her an eye-lift. "After the surgery I was unable to close my eyes for almost a year. I looked inhuman. My husband had to put drops in my eyes constantly and I had to sleep with my eyes open. The stitches were put in in such a way that I also lost all my hair." Bessis founded a support group for fellow sufferers and discovered she was far from alone in her experience. But "women were not speaking out because they felt guilty. Why did they feel guilty? Because they had willingly been operated on when there is nothing technically wrong with their bodies."
Bessis does not oppose cosmetic surgery; she just wants the discipline to be as well-regulated as other branches of medicine. Le Gouès, the psychoanalyst, stresses that cosmetic surgery can bring about substantial benefits. "Take, for example, a young woman whose breasts are too large. She can't do sports; she has trouble knowing how to dress well; she has trouble with boys. In other words, it's a sort of handicap for her." A breast reduction, he suggests, will not only solve the practical problems. "There's something more; suddenly her chest is something she's pleased with, that she finds beautiful." Hold that nice thought and add one twist to it. In Europe today, increasingly, that "she" opting for breast reduction is a "he."
The Deadly Male
"We've had a very good january — a phenomenally good January — so I thought, 'I'm going to treat myself,'" says Mark Jennings, who works in the London M&A division of one of Europe's leading banks. A trip to Verbier? A new Porsche? Nah. Jennings, 41, invested part of his bonus in stomach liposuction at London's Harley Medical Group. "I work very long hours — it comes with the territory — but I've been fit all my life so it shocked me when I started to get a midlife belly," he explains. Gym visits did little to beat the small bulge. "So I looked into cosmetic surgery."