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The first thing everyone notices is that this is no ordinary doctor's office. As you step inside the glass doors inscribed with the monogram of Dr. Ernest DiGeronimo, one of Dade County's most successful and controversial plastic surgeons, you're greeted by an ornate fantasy of luxury, one that conjures up the grandiose interiors of ancient Rome, or at the very least a bordello patronized by Caesar. Here, past the black marble pedestals topped by golden sculptures of Etruscan peasants and underneath the glittering chandelier, sits the enormous marble-topped reception desk with a gold shield in its center. Patients come to the desk as if they were supplicants at some altar of beauty, then head toward a waiting room appointed with gold-colored French provincial antique chairs and paintings of seminude maidens on the walls. "It shows," the soft-spoken, amiable Ernest DiGeronimo explains, "that I won't settle for anything but the best."
DiGeronimo's patients are equally determined to achieve an ideal of the perfect body and face for themselves, even if it means spending thousands of dollars and enduring the discomforts that follow submitting to a surgeon's knife. DiGeronimo sees as many as 30 patients a day, mostly for consultations and follow-up visits, but he performs about two or three painstaking operations -- including liposuction -- and numerous minor procedures daily; the latter range from facial laser surgery to collagen injections, which place a creamy animal protein underneath wrinkles to smooth them out. Annually, his office grosses in the "millions," he estimates, but he declines to get more specific about his earnings. There are ample reasons why Dr. D. -- as he's known by his staff of nine -- has such a lucrative, busy practice, and they're not simply due to whatever skill and charm and promotional flair he possesses.
Florida, you see, is a gold mine for plastic surgeons. According to the latest figures from the American Society of Plastic and Reconstructive Surgeons (ASPRS), Florida is home to the second-highest number of procedures performed in the nation -- about 40,000 in 1994, by ASPRS board-certified physicians (California is number one) -- and ten percent of the nation's total number of plastic surgeries. Even the type of surgery differs down here: Elsewhere, tumor removal is the most common procedure; in Florida, it's eyelid surgery, followed by liposuction.
The climate is one reason plastic surgeons are so active here, notes Dr. John Cassel, the past president of the Greater Miami chapter of ASPRS. "We're very sun-worship oriented, so there's more body-contouring surgery than you might see up in New England," he adds. And exposure to the sun ages skin faster, leading to a greater demand for face-lifts and chemical "peels," which remove layers of skin cells. However, far more than the sun propels people seeking to transform themselves into the hands of the 47-year-old DiGeronimo. Among other things, South Florida's culture and values and image-making businesses exalt physical beauty above all else. "The influx of models and advertising here gives people a new perception of what's beautiful," DiGeronimo points out. "People see these things and they want them for themselves."
But life in a plastic surgeon's office emphasizes that the desire for an idealized, youthful self has even deeper roots, in the cravings of the heart and mind or perhaps even in our genes. And for some of the patients who come to see DiGeronimo, it is a longing that never may be completely satisfied -- no matter what they want done to themselves.
On a recent afternoon, a thin, attractive woman in her early thirties -- we'll call her Ellen (all patients' names in this story have been changed) -- sits in DiGeronimo's Aventura office asking him for advice about ways to become even thinner. His personal office is jammed with artifacts and decorative touches, some of which are gifts from grateful patients: gold Tiffany timepieces on his desk, purple vases and glass figurines arranged along the oversize picture windows, flowers and greenery practically everywhere. Ellen already has altered her appearance by having permanent makeup tattooed on her lips, eyebrows, and eyes a few months earlier by a DiGeronimo-supervised tattoo specialist named Mirinka (her public name). Now Ellen wants more changes.
"I'm interested in liposuction," she says earnestly.
"In what areas?" DiGeronimo asks. He's dressed in blue surgical scrubs.
"The abdominal area, thighs, and whatever else you want to recommend. I'm into immediate gratification," she laughs.
"How's your weight?"
"My weight's a little high for me, although I was always on the thin side. It's too much work to get it off by exercise," she adds. (She is a little over 5 feet tall, and her 112 pounds is actually well within a normal, healthy range.)
"Even when I was anorexic, about 90 pounds, I had a little bit on the abdomen I couldn't get rid of," she notes casually, pinching her stomach. Neither she nor the doctor seems to view her wish to remove more fat with a suction tube as any kind of continuation of her obsessions over her weight. After all, as DiGeronimo said earlier in the day, "If I can do it and they want it, I'll try to fulfill their desires" -- with a few exceptions. For instance, in another case he rejected an overweight woman's request for liposuction because she was making good progress in losing weight on her own.