…she’s had a face lift, nose job, breast implants and liposuction. All on prime-time TV. Welcome to the world of extreme makeover shows – coming soon to a screen near you

Gaby Wood
Sunday July 18, 2004
The Observer

On prime-time TV, Marnie Rygiewicz, a 35-year-old mother of two, faces the camera and tells nearly 10 million viewers what is wrong with her life. Her sons’ father left 10 years ago and she hasn’t had a date since. She’s wiped out from making dinner and going to basketball games and cleaning up. Every morning, when she arrives at the office in Michigan where she works as a medical assistant, people ask if she’s had any sleep. She has lost sight of herself.

The camera pulls back to reveal a panel of experts listening sympathetically to Marnie’s story. The show’s resident therapist mutters something about self-esteem, and the doctors prescribe a solution: a brow lift, a mid-face lift, a nose job, fat removal from under the eyes, a corner lip lift, lip augmentation, a chin lift, breast augmentation, liposuction on the stomach, thighs, calves and ankles, teeth bleaching, a bridge, and veneers. Marnie happily agrees to these procedures, and makes arrangements to leave home for four months. She will spend that time in a hotel in Los Angeles, without ever being allowed to look in a mirror.

Cut to a bandaged figure. Marnie is in pain, and desperate to remove her uncomfortable chin strap. She seems depressed, and after three days without leaving her room she is visited by the show’s ‘life coach’ – a small producer named Nely Galan, who says she is very disappointed in Marnie, who is expected to be in the gym two hours a day, six days a week. The programme makers have given her all this wonderful free surgery, and this is how she behaves?

Months later (or minutes, to a TV audience) Marnie has been perfected. Wearing a fuchsia-pink evening gown, she is ushered into a gothically lit room, where her creators stand in a circle. The surgeons voice their approval. The therapist and dentist applaud. She is shown a mirror for the first time, and, behind her timorously splayed fingers, she begins to weep.

The Swan is one of three major reality-TV shows Americans have witnessed in the past few months in which the patient-protagonists undergo cosmetic surgery in order to improve their lives. All three are due to be shown in Britain. Much like its sister programme, Home Front, ABC’s Extreme Makeover is a kind of interior design programme. Dilapidated women and men are knocked through and rebuilt before receiving finishing touches that depersonalise them and increase their apparent market value. They are then presented to their families, who are delighted with the new product to variously convincing degrees. In MTV’s I Want A Famous Face, people are surgically made over to look like a particular celebrity. There have been dark-haired, acne-scarred twins who want to look like Brad Pitt, a pre-op transsexual who dreams of resembling J-Lo, an Elvis impersonator who feels the competition in Vegas is getting tougher. Only Fox’s The Swan, which is currently in casting calls for a second season, has its patients compete in a final beauty pageant, with swimsuits, lingerie and evening wear, pitting even the ‘new improved’ versions against each other.

The programmes vaunt the idea that they are helping these people find their ‘true selves’, and yet the winner on The Swan is the woman who is thought to have undergone the greatest ‘overall transformation’ – in other words, the one who appears least like her former self. It’s reminiscent of a line in the incisive plastic surgery drama Nip/Tuck: ‘Be yourself. You know you can look better.’ Or perhaps of Lily Tomlin’s old gag: ‘When I was little I wanted to be somebody. Now I wish I’d been more specific.’

These shows have provided some of the most popular and controversial viewing of recent times. Up to 12 million Americans watched them every week; talk-show host Rosie O’Donnell said they had put women back 30 years. One weekly news magazine carried the cover line: ‘Makeover Nation: Why America’s obsession with plastic surgery is going dangerously out of control’, and even People magazine, which has embraced these sewn-up celebrities, asked: ‘Has TV Plastic Surgery Gone Too Far?’ Indeed, few recipes for cultural anxiety could be more inspired than the marriage of two of the most inflammatory contemporary phenomena: cosmetic surgery and reality TV.

Yet these surgical scenarios are truly gripping, both for the reasons their creators hope – the transformations are extreme, the family reunions can be strangely emotional, desperate people seem to become happier before our eyes – and in more nefarious ways: the surgeons are laddish and overly prescriptive, the procedures are risky and irreversible, and there is always the sadistic hope that this week, someone will regret it.

It is 14 years since Naomi Wolf wrote in The Beauty Myth that we were living in ‘the Modern Surgical Age’. What this historical phase was doing to us, she argued, was ‘an overt re-enactment of what 19th-century medicine did to make well women sick and active women passive’. Indeed, cosmetic surgery is the only form of surgery in which the patient is healthy beforehand. Now there are so many layers of simulation involved – televisual surgery as opposed to the real thing, the act of being turned into a copy of someone else – that you might say we have left the Modern Surgical Age and entered the Postmodern one.

‘When I wrote The Beauty Myth,’ Wolf says now, ‘plastic surgery was an extreme choice for the few. Now it has become so normative that people will look odd in the near future if they aren’t surgically altered. The reality shows I feel have a fair dose of sadism involved – really we have reached the point of creating cyborgs.’

Elaine Showalter, author of The Female Malady, among other distinguished feminist tomes, disagrees. ‘It doesn’t seem to me like it’s something sadistic that doctors practise on women,’ she says. ‘I think women are choosing it. And that’s very different. I think that we’re living in an intermediate era, where women are certainly made aware of body image to a degree and with a degree of detail that they never were – it seems to me every year there’s a new part of the body that’s offered up for correction, and you never knew it had standards. But I have the feeling that we’re moving towards a future in which these things will be more routine, and safer, and less expensive. And it will be normalised. Now, for many people this may seem like a horrible world. But I kind of feel that if it were more normalised, it would be just like anything else – that people could do it in moderation… Maybe I’m wrong – maybe it’s just a step into the barbaric, or the downfall of civilisation, but I don’t think so.’

Terry Dubrow, one of the surgeons on The Swan, has asserted: ‘Plastic surgery as entertainment is here to stay.’ But the reality shows have not just made a spectacle out of plastic surgery, they have turned it into something ordinary people feel comfortable having in their living rooms. Unlike many other reality shows here – American Idol, The Bachelor – Extreme Makeover and The Swan are aimed at a slightly older generation, one that has had time to brew some world-weariness and low-grade self-hatred. As a result, TV plastic surgery has become more than entertainment – it has become a kind of blueprint.

Dr Rod Rohrich, president of the American Society of Plastic Surgeons, says: ‘The growth of plastic surgery has been nothing short of phenomenal. With all these reality shows, the interest has sky-rocketed. I think they’ve increased the awareness that plastic surgery isn’t just for the wealthy and for the famous – it can be for everybody, for anybody that wants it if they want to save for it.’

ASPS statistics for 2003 show that its members performed 8.7 million procedures last year, a 33 per cent increase on those performed in 2002, and that nearly eight and half billion dollars were spent. Banks now offer loans for plastic surgery, and credit cards render many procedures affordable (the average cost of a breast augmentation is $3,375. One divorcee I met recently is selling her engagement ring on eBay in order to have a ‘Brazilian butt lift’. And families with annual incomes under $25,000 now account for an astonishing 30 per cent of all cosmetic surgery patients. Only 23 per cent earn more than $50,000 (£27,000).

Since the advent of ‘reality surgery’, Rohrich has seen two things happen: ‘One is that patients now want to have a lot more done – they want this “extreme makeover” – everything done in one sitting, which is not realistic, nor is it safe, in many cases. And it’s also spurred a whole new industry of people who call themselves cosmetic surgeons and aren’t real plastic surgeons, because the interest and growth has been so high. In America, if you have an MD, you can call yourself anything you want. So plastic surgery has become a “buyer-beware” speciality. Not a day goes by where I don’t get a call or an email or see a patient who’s had a problem or has been misguided by a non-plastic surgeon.’

Liposuction, the most popular invasive procedure, is also the most dangerous. Complications include blood clots, organ puncture and infection, all of which can be fatal. The most recent information puts the average death rate for liposuction at 20 in 100,000 (deaths from hernia operations, by comparison, stand at 2 per 100,000). Combining liposuction with a tummy tuck increases the risk 14-fold.

On 14 May, as The Swan was nearing its bikini-clad finale, the prestigious Manhattan Eye, Ear and Throat Hospital was fined $20,000 for ‘egregious violations’ of safety procedures during cosmetic surgery which led to the deaths of two women, including the 54-year-old writer Olivia Goldsmith. The fine is equivalent to about four tummy tucks, or veneers on a mere 10 teeth. In Florida, a ban has been imposed on combined liposuction and tummy tucks after the deaths of eight patients in 18 months. The ban is only three months long. In February, the body of a 35-year-old investment banker was discovered in a suitcase, encased in cement, under the home of an unlicensed cosmetic surgeon. Her body was identified by the serial numbers on her breast implants.

Back at home in Chesterfield, Michigan, Marnie Rygiewicz has started her new life as a stunning blonde. She is selling her house, taking her kids to school again, and looking through the paper to try to pick up a job until something else comes along. She has called a couple of plastic surgeons’ offices looking for work, and she wouldn’t mind doing some modelling – just until she works out what it is she really wants to do.

‘I don’t think the surgery itself really changed me,’ she reflects, two months after The Swan ‘s televised beauty pageant. ‘I just feel like a more confident person. I never really considered myself, like, ugly, but I would look in the mirror and feel like I had wasted so much time, and I wished that I could somehow get some time back.’

As it happens, Marnie only went to the Swan audition in order to accompany her sister, who was trying out. She was chosen, she believes, because she was clearly more of a ‘burn-out mom’, and in the end her sister looked after her two boys for the four months she was away. Now her sister is auditioning for the second season.

‘I want her to go through what I went through,’ says Marnie, who plans to reciprocate the childcare arrangements, ‘I would love for her to have that experience.’

When Marnie speaks about the things she’s looking forward to, I am surprised to find her laying stress on ‘ageing naturally’, since she has been so recently filled with artificial substances. I ask her to list the surgical procedures she has had. There seem to be a crucial few missing. Did she not have a boob job? ‘Oh yes,’ she recalls, ‘I had a breast augmentation. And I had my lips done.’ ‘But,’ she adds, ‘I don’t think I would have needed all that had I not let myself go. It was something that I did to myself.’

Which single surgical procedure does she think made the biggest difference?

‘I would say the one that took the tired bags under my eyes.’

So far, I suggest, none of the symptoms she describes- tiredness, regret, loss of identity – are things for which one might automatically recommend cosmetic surgery.

‘Yeah,’ she agrees, ‘but I did look bad because of the way my life was.’ Has she ever been diagnosed with depression? ‘No.’ So she never thought of taking a drug like Prozac? ‘No,’ Marnie says quietly, ‘I feel a lot better now.’

Marnie has a soft, monotonous, almost somnolent voice. I am reminded of a novel called The Eve of the Future, in which the industrial wizard Thomas Edison designs the perfect woman: her speech is recorded on golden phonographs, and destined only to repeat pre ordained words of love. It’s not that I think Marnie is unreal, it’s just that… well, if you were to invent a sweet, docile, beautiful woman, how far would she be from Marnie Rygiewicz? How did she get to be so perfect?

Dr Randal Digby Haworth, the man who operated on Marnie, speaks to me between mouthfuls from his Beverly Hills office (he is so busy lifting Hollywood lovelies he needs to use these spare moments to catch up on lunch).

‘I always say there are two types of plastic surgeons,’ Haworth explains, ‘doctors who become artists and artists who become doctors, and I am pretty much among the latter.’

Plastic surgery, he says, is ‘a tool. It can be used to customise your appearance in the same way you customise your living environment through interior design, the same way that you customise your car, or your pets, or the way you dress in Prada versus Dolce. In the right practitioner’s hands, plastic surgery is an extension of that – it can allow you to turn your physical fantasies into realities.’

And in terms of his own fantasies, I ask (thinking of the fact that the women on The Swan ended up looking so alike), is there a type of woman he favours?

‘I’m more attracted to brunettes,’ Haworth says, without hesitation.

I actually meant in terms of surgical enhancement…

‘Oh, I see. Good plastic surgery is invisible. It’s bad plastic surgery that gets the attention. I mean, we live in LA, and I’ve oftentimes gone out with girls here on whom I’ve noticed little discreet scars in more intimate moments. I’d say about 80 per cent of people here have had plastic surgery, and yet no one can deny that Los Angeles and Hollywood is the home to some of the most beautiful women in the world.’

But let’s say good plastic surgery as opposed to none at all.

‘OK, well, speaking as a man here, if it’s a girl with a natural “A” versus a beautiful, er, artificial “C”? I’d prefer an artificial “C”. If somebody’s got a nice figure but has love handles here and there? Call me twisted but I’d prefer a good figure versus one that’s less good.’

And has he operated on women he has been in relationships with?

‘Oh, absolutely. I have. It’ s generally repairing stuff that’s not very good – they’ve had plastic surgery before. You know, the breasts don’t fall as well.’

Many Americans would balk at the suggestion that reality cosmetic surgery shows might offer any significant insights into their culture. But the programmes do, I think, illustrate a fundamental American belief: the belief in self-improvement, or self-invention.

The Stepford Wives remake, which is due out in Britain at the end of this month, contains a troublesome new twist: Stepford, the town that turns women into androids, was created by a woman. Perhaps the story, played for laughs this time, is not so farcical after all. Why are women doing this to themselves?

The United States, it might be remembered, is a country founded on the pursuit of happiness, whereas Britain is a country wedded – rhetorically, at least – to its failings. Self-deprecation is our style. As a result, cosmetic surgery can be seen as constructive in America, while meeting with more resistance elsewhere. (It’s striking that liposuction, which was invented by a French surgeon, is more popular in America than anywhere else, and that cellulite, the problem it set out to combat, was a concept unknown to Americans before 1973. Yet these words have been welcomed into a perfectionist’s vocabulary with open arms.)

Happiness is a serious business. Jim Holt, the author of a forthcoming book on the subject, recently wrote an article for the New York Times in which he argued dryly that happiness may be bad for you. A professor at the University of Pennsylvania wrote in to complain that the article was a threat to public health. ‘In countries where happiness is considered to be more important you generally have higher divorce rates, and more suicides,’ Holt explains, ‘because people feel the ideal is that people should be happy almost all the time, and so some radical change is necessary.’

One way of seeing cosmetic surgery is as a new form of equal opportunity. In 1993, two economists found that good looks increased hourly income by five per cent. ‘It’s not just a matter of good-looking people going to work in Hollywood and bad-looking people digging ditches,’ one of them, Daniel Hamermesh, said. ‘Even within any given occupation, good-looking people make more.’

Jim Holt thinks this is unlikely to dim the optimism of a self-improver. ‘The distribution of beauty in America is as imbalanced as the distribution of wealth,’ he says. ‘Americans don’t mind the inequitable distribution of wealth very much because they all feel that it’s possible to become rich here. And there’s something of the same logic that might apply to the way you look.’

Janice Dickinson, self-described ‘world’s first supermodel’ and a judge on another reality-TV show, America’s Next Top Model, believes the addiction to perfection is a disease. She has even given it a name: ‘perfliction’, and diagnosed herself as its inaugural victim. Her symptoms are detailed in a new memoir, Everything About Me is Fake… And I’m Perfect! When I compliment Dickinson on her coinage, she tells me, by way of thanks: ‘”Perfliction” has been trademarked. I’m going to use it for a cream – it comes out in September at Bendels department store.’ It’s not clear how well a cream named after a problem might sell, but there’s no doubting the joie de vivre in Dickinson’s proclamations (‘I’m Dorian Gray!’ she was heard to screech at her book launch, as if Dorian Gray were Cinderella), and who knows – as far as the pursuit of perfection is concerned, she’s an expert.

‘Plastic surgery is an epidemic in the States,’ Dickinson says. ‘But it’s everywhere. They don’t talk about it in England – it’s more hush hush, like everything else is. But it’s always been there. There have been face lifts and botched boob jobs and great boob jobs, starting with… I don’t know – Lady Diana had surgery!’

Did she?

‘Hell, yes – look at her face! I mean, she had a boob job – she wasn’t that well-endowed. I guarantee you that she pumped up the volume.’

What about the pursuit of happiness? Does Dickinson think the women on The Swan and Extreme Makeover will be happier?

‘I don’t know. I’m no one to judge. I can only speak for myself.’

So has cosmetic surgery made her happier?

‘Yes. No. I don’t know.’ She thinks for a while, reminisces about her first boob job, and the trips to Tijuana for illegal wrinkle fillers. ‘I think plastic surgery does not give you fulfilment,’ she concludes, ‘true, godly, Zen contentment.’

A few hours after our last conversation, Marnie Rygiewicz calls back. She leaves a message on my answering machine which seems to hang in the air, filled with its own kind of simple haunting. ‘Hi, Gaby. This is Marnie. I just forgot to mention one thing. I wouldn’t have plastic surgery again. I have had it this time, but I wouldn’t have it again. OK, thanks. Bye.’