Sultan of Skin

Flesh insight from an esteemed St. Louis plastic surgeon

"I stopped for a minute and thought, 'You know, there's no way I can argue with what he said.' So we made an exception in his case."

The work led Young to patent a penile implant. He and a fellow surgeon grafted a part of the urethra into an arm-skin flap — effectively growing a penis from an arm. It was the first device allowing men to stand while urinating and have an erection. Its nickname? "El Guapo."

Young, whose favorite actress is Lady Chablis, the transvestite in Midnight in the Garden of Good and Evil, quit doing the costly sex-change surgeries in the 1990s. But every so often he's reminded of his work. While waiting in line last year at a Chinese buffet in Belleville, he felt a tap on the shoulder. He turned around, only to find one of his old transsexual patients about to sit down to dinner — with his wife and children.

Liposuction is  the most popular cosmetic surgery nationwide.
Jennifer Silverberg
Liposuction is the most popular cosmetic surgery nationwide.
Master skin sculptors: C.B. Boswell, Leroy Young, Rob Centeno.
Jennifer Silverberg
Master skin sculptors: C.B. Boswell, Leroy Young, Rob Centeno.

Some of the first Americans to experiment with cosmetic surgery were syphilis sufferers with depressed noses, according to Venus Envy: A History of Cosmetic Surgery by Elizabeth Haiken. It was the late nineteenth century, and the handful of doctors willing to treat these patients tried everything, from bone grafts to injections of paraffin mixed with Vaseline, white-oak bark or goose grease.

Beginning in the twentieth century, demand for facial surgeries rippled through a cross-section of society, including actresses, socialites — even outlaws on the lam. In 1924 the New York Daily Mirror awarded "the homeliest girl in New York" a surgical makeover. Seven years later a doctor reportedly performed the first public facelift in a New York City ballroom before hundreds of spectators.

For most of the twentieth century, though, the medical profession dismissed cosmetic surgery as a morally repugnant, risk-laden back-room venture — or, as Haiken writes, "the province of charlatans and quacks."

Only in the past decade has the specialty acquired true mainstream acceptance. According to the American Society for Aesthetic Plastic Surgery, doctors have more than quadrupled their aesthetic procedures since 1997. Last year alone, more than 8 million Americans opted for minimally invasive treatments, such as Botox, and more than 2 million people chose cosmetic surgeries — with liposuction being by far the most popular.

The latter statistic doesn't include penis-widening, scrotal lifts or hymenoplasties (the tightening of a woman's hymen, colloquially known as "revirginizing") — even though patients across the nation are beginning to request these operations.

Vanity, plain and simple, is the number-one motivator.

"Thirty years ago my colleagues in the mental-health profession believed anyone who changed their appearance was dealing with pretty significant psychological problems," observes David Sarwer, a psychologist who presides over the Center for Human Appearance at the University of Pennsylvania.

"More recent research suggests there are very few differences today between those who seek cosmetic surgery and those who don't," Sarwer continues. "Having surgery is not about repairing long-standing conflicts with parents or curing a failing romantic relationship."

Says Guy Stofman, chief of plastic surgery at Mercy Hospital of Pittsburgh: "People want it, they can afford it, and they do it. It's no different than buying a luxury car."

Plastic surgeons are often referred to as "psycho-surgeons," since they must interview patients carefully to weed out the "wackadoos," as Leroy Young calls them.

"Right after my residency ended, I'm seeing patients one day and in comes this guy who says he got sent by the CIA," Young recounts. "He tells me he has to go on a little covert mission, and they want him to get a facelift." Young made a call to the agency at the man's insistence, only to learn he was well known to the CIA "as a total nut."

Some patients appear perfectly normal initially, Young adds, only to pull out a magnifying glass to prove even their slightest defects.

"I saw a 37-year-old woman recently who's already had upper and lower brow lifts, five rhinoplasties [nose jobs], eight or nine breast jobs; and four or five rounds of liposuction," notes Young's partner, C.B. Boswell. Most recently, the woman wanted a facelift.

"So I looked at her, and I said, 'Um, what bothers you, exactly?' She said: 'My jowls are loose.' But you look at her, and she's perfect. This lady has no anatomical thing I could correct."

The male equivalent is known in the profession as a "SIMON" — a single, immature, male, over-expectant narcissist. "People who meet those criteria aren't going to be happy with anything," says Boswell. "You probably don't take them on."

As Young sums up: "Frankenstein's rule: The person that makes the monster keeps the monster."

Doctors are still unsure as to what causes silicone-gel implants to fail, but sometimes they do. Early one morning last month, Young is removing a ruptured device from a svelte 63-year-old. Clear goo oozes through his knobby fingers as he arcs his right arm dramatically above the breast.

"Remember Ghostbusters!" he yells. "Slimer!"

Young proceeds to tell the staff the woman had the implants for 28 years but is suing the manufacturer, Dow-Corning. "Tasted the nectar and didn't like it," cracks Rob Centeno.

"You know that song, 'The good things in life are free, but what I need is money,'" replies Young, as he begins burning a white ring of brittle calcium inside the woman's breast.

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