article courtesy John E. Sherman, M.D., F.A.C.S.



From tummy tucks to thigh-lifts, plastic surgery is rarely about looking better naked. Jennifer Scruby on what women will sacrifice to look good in clothes.

Whenever forty-four-year-old San Francisco socialite Catherine Howard* lolls poolside at the posh Burlingame Country Club, she bares a teenager's flat stomach, a tungsten-firm bottom, and toned, ripple less thighs. The only thing to hide in this show of perfection is the series of tiny liposuction scars tucked beneath the elastic of her Hermes bikini. "I couldn't care less about the scars," says Howard. "You could probably see them when I'm naked, but I have a husband, and they don't bother him either." For more and more women, swapping permanent scars for a better shape is an even trade-off... "patients are more interested in looking better in clothes than looking better naked...Ninety percent of your life, you'll be dressed. Are you going to worry about scars when you look wonderful?"

The soreness and the scars didn't bother me," agrees New York artist/writer Lisa Wolf, who recently underwent liposuction on her thighs and stomach - dropping three inches and gaining a few pointillist-style scars and a half-moon-shaped seam on her bikini line in the process. "I was very aware of where the scars were going to be, and I wanted to make sure they'd be as little as possible," she says. "But no matter how hard 1 worked out or dieted, I'd always had a little extra fat on my lower abdomen, on the sides of my thighs, and above my knees. After the surgery, I just kept looking in the mirror and saying, ?Wow-it's gone.? The stitches seemed pretty irrelevant."

The Trade-Offs

In plastic-surgery circles, the biggest trade-offs, scarwise, and tummy tucks, breast reductions, and breast lifts and thigh lifts. LA-based publicist Cornelia Drew* swore off ever having cosmetic surgery after tending a newly breast-lifted friend for a week. "I saw her chest right after it was done, and it was terrifying," she says. "My ultimate goal would be to look good naked, and if you have scars, what's the point? It seems like false advertising - you lure someone to that point and then it's a hatchet job. Who wants to look like a patchwork quilt?"

Of course, for the millions of women snapping up cosmetics and wriggling into Wonderbras, false advertising via surgery is a moot point. If they can venture out in liquid Gucci cutout dresses, so what if there are a few artfully concealed flaws in the canvas? "I have tummy-tuck patients in their early twenties who've had twins...If there's a scar, they don't mind - from a C-section or an appendectomy you may have a scar. That's acceptable, but having a poochy tummy is not exactly wonderful." Steven Teitelbaum, MD, a Santa Monica plastic surgeon with a cadre of celebrity patients, reports that more than a few of his subjects are willing to make a Faustian pact flat-out: "They say, ?I just want to be able to wear a bathing suit again - I don't care what the scar looks like,?" he says.

The Toughest Cut

"The rule of plastic surgery is that when patients come in, they're trading one deformity for another," says John Sherman, MD, assistant clinical professor of cosmetic surgery at New York Hospital-Cornell Medical College. "The ultimate is a breast reduction - for that goal they're sacrificing an unblemished breast." Fresh from auditioning for Rent, New York singer/dancer Lisa Woodward, twenty-two, dismisses the stitch marks she got while downsizing from a 34DDD as a small sacrifice. "It's not like I'm going to be posing in Playboy," she points out "I was more interested in getting rid of back pain and looking better in my clothes. Especially for the business I'm in, huge breasts labeled me. That's what people noticed first: blond hair, blue eyes, and boobs." Beth Toland,* a twenty-five-year-old Hollywood executive and former model who went from a 36DD to a C-cup, also bears the traces of her anchor-shaped incisions without regret. "The scars are something that you and someone you love might know about," she says. "But giant boobs were something that everyone could see."

How Much is Too Much?

Since the newest plastic surgery breakthroughs are designed to make scars imperceptible - hiding them in navels for abdominal liposuction or under armpits for breast implants, for example - another growing camp is willing to assume a few discreet scars to look better bare-skinned. Before she had breast implants, points out a former Miss Colorado, "I was already wearing two to three bra pads to fill things out so I looked fine in my clothes." Of course, in the process of exchanging one imperfection for another, things can go haywire. Zachary E. Gerut, MD, assistant clinical professor of plastic surgery at Albert Einstein Medical Center in New York, cites liposuction, which is one of the most commonly performed operations in cosmetic surgery and has the highest rate of patient dissatisfaction. "I see a number of patients who should never have had liposuction, because their skin was already too loose, and afterward it hangs down like on a basset hound," says Dr. Gerut. "They look fine in clothing, but they look grotesque without it. I just saw a thirty three year old woman whose body looks like it's sixty-something."

On humans, a sharpei-style birthday suit is something only a loved one might accept. And, ironically, say doctors, it's often a supportive lover who gives a plastic surgery prospect the courage to stake her hide in the first place. "People who are in very stable relationships, marital or not, are more willing to accept a serious scar to look wonderful in clothes than are people whose concern will be, ?How do I tell my first-time lover how I got this crazy thing??" observes Dr. Gerut. Clearly, the biggest danger of a plastic surgery body scar is a potential loss of face. "I would not want people to look at my thighs and see a scar and go, ?Oh, she had liposuction,? " says Howard. "I don't want anyone to know I'm that vain. But I've been married fifteen years - it's amazing what he doesn't notice anymore."