Over the past decade and a half, Dr. William Wei-Lin Shaw has performed some of the most miraculous operations imaginable. He has sculpted new body parts--feet and hands and mouths--from ones grotesquely malformed at birth. He has reformed faces--jaws and noses and chins--eaten away by cancer. He has reconstructed appendages--legs and scalps and genitals--severed by machines or crushed in automobile accidents.
During the past 15 years Shaw also has done tummy tucks and face lifts and nose jobs. He has made small breasts large and beefy thighs slim. He has pinned protruding ears and lifted sagging buttocks. Eyelids, cheeks, necks, ankles--virtually every part of the anatomy that is subject to the toss of genetic dice or the ravages of time is a candidate for his expertise.
Shaw is a plastic surgeon.
Like many in his speciality, the 48-year-old chief of plastic and reconstructive surgery at UCLA has undertaken a variety of surgical cases, some of which are considered beyond hope, others that are debatably outside the bounds of necessity.
Plastic surgery is a field of medicine that has grown phenomenally over the past two decades. In the past 10 years, the number of procedures has doubled. Last year alone, there were at least 2 million plastic surgery operations in the United States. This year about one in 100 Americans will undergo plastic surgery, although estimates vary since plastic surgeons are not required to report the number or kind of procedures they do.
Thus far, most operations, more than 60%, have been classified as "reconstructive"--that is, they involve functional rehabilitation of parts of the body maimed by accident, disease or birth defect. Because they are considered medically necessary, reconstructive plastic surgeries are covered in large part by health insurance.
The rest (and by far the fastest-growing area of plastic surgery) are operations that are considered "cosmetic"--that is, purely aesthetic procedures designed to perfect the look of the body. Although prices range from a few hundred dollars for nonsurgical treatments, such as collagen injections to smooth wrinkles, to more than $10,000 for face lifts and hair transplants, patients must pay most, if not all, costs themselves.
Cosmetic surgery is no longer the prerogative of actresses or aging dowagers. Today's typical patient is, according to the California Society of Plastic Surgeons, a product of "Mainstream U.S.A."
A recent survey by the Chicago-based American Society of Plastic and Reconstructive Surgery found that fewer than one quarter of all cosmetic surgery patients had household incomes of more than $50,000 a year. About a third were in the $25,000 to $50,000 bracket, and another third had household incomes of $25,000 or less. (Nearly 10% did not state their income.)
"Even in Los Angeles, the entertainment capital of the world, a patient for cosmetic surgery is as likely to be a schoolteacher as she is to be a starlet," says Dr. Henry J. Kawamoto, president of the California Society of Plastic Surgeons.
And the she may be also a he . Although men represented about 5% of plastic surgery patients in the early 1980s, they now make up 20% to 25% of such patients, according to a number of estimates.
The popularity of cosmetic surgery is said to be a by-product of two sociological phenomena: divorce and dieting. While dieting can result in sagging skin, divorce demands that people, sometimes late in life, start looking and feeling their best. And what better way to build confidence than with a new head of hair or a new set of breasts?
Women, especially feminists, it would seem, might have compunctions about subjecting themselves to the pain and risk of plastic surgery for purely cosmetic reasons. Not so, insisted Ms. Magazine. Women may have burned their bras in the 1960s, but in the 1980s they have come to prefer bigger bras to no bras. Cher, who may have has succumbed to the surgeon's knife as often as any modern entertainer, is, according to Ms. editors, an exemplary 1980s feminist. She has used cosmetic surgery as a way to "reinvent herself." Plastic surgery is for "real women" who "dare to take control of their lives," the editors said in the magazine.
Not everybody is so enamored of plastic surgery.
"It (getting plastic surgery) has to do with a feeling of entitlement--with believing you are entitled to have a perfect body," explains one Los Angeles psychiatrist, many of whose patients have considered cosmetic surgery. "As far as I'm concerned I am entitled to a perfect body only after I have a perfect personality. As soon as I'm always nice, always patient, always insightful, then maybe it's time to start thinking about letting someone work on my behind and belly with a knife."
Like many plastic surgeons who are highly trained and whose skills are much in demand, UCLA's Shaw has little time for jokes or philosophy.