Skin Deep

Don't like your face? Your breasts? Your tummy? Get yourself new ones. Plastic surgeon Ernest DiGeronimo makes the kindest cuts.

The pair enters a nearby dressing room, and Ellen briefly hikes up her skirt and blouse to show DiGeronimo the body parts that so disturb her. She points to her thighs and then she grabs her abdomen. He tells her, "You see when you pinch the fat that some of it is thinner and some of it is fatter; liposuction will reduce those areas. But we have to leave some fat there."

"Why?" she asks.
He laughs but doesn't offer any lectures about the necessity for a minimum amount of body fat for, say, survival or menstruation. Instead he reassures her that it's needed for proportion's sake. "And if you do lose some weight, you'll look even better," he tells the woman who considers herself a recovering anorexic.

"I used to be perfect without this," she grouses, touching her stomach.
When they return to DiGeronimo's office, she presses him about a more extreme operation, a "tummy tuck," but he tells her, "You'll do fine with liposuction." He then bluntly describes the harsh realities of the procedure: "What it takes are some puncture sites, small little incisions that I insert a little tube in, in an area that doesn't show too much. The operation itself takes under two hours, and you'll have some puncture sites after the operation that are black and blue for a month or even two."

Despite his description of the procedure, she's eager to go ahead. But because she's still doctor-shopping, she doesn't commit to a specific date during this visit. Ultimately she selects a Broward physician, Dr. Melvin Propis, because, as she later explains, DiGeronimo "was kind of limited in what he wanted to do." Propis, she adds, has agreed to do liposuction, a breast lift, and a chin implant. Ellen observes, "Whether it's necessary or not isn't the point. I want the optimal look."

It is somehow fitting that in Miami, a place where people often come to start their lives over, they also choose to stake out new ground in yet another frontier: their own bodies. Body parts, like so much else here, are considered malleable and transitory. In DiGeronimo's office, he and his staff encourage the view that the body can be easily altered (although they also disclose the pain and risks that may be involved in surgery, such as infections and cardiac arrest). The idea of the changeable self is most effectively promoted in a little room in which DiGeronimo shows patients computerized images of themselves.

For Alice, the before-and-after photos are just part of her efforts to determine if the doctor can make the precise improvements she wants. At first glance, when she's talking to the doctor in his office, it's hard to see what -- if anything -- about herself she wants to change. Dressed in a trim business outfit, she's a strikingly pretty woman. But something troubles her. "I want a small nose," she says, running her finger over a modest bump on her nose. "It's really the bone in here that bothers me."

"That can be filed down," DiGeronimo tells her.
"I was also thinking of a chin implant," she adds, believing it would help make her nose look even smaller. "You're not really a candidate for that," he says after a moment's deliberation. Then, with an almost jaunty air, he adds, "Let's go down to have a computer profile. Just tell me how much you want to take off."

They pass through a door -- ringed by a horseshoe-shape display of gold-colored metal leaves and a Roman numeral -- and enter a room with a camera, TV monitor, and photo printer. He has her pose for a side shot of her face, freezes it on the right side of the screen, then sits down with a white electronic sketch pad and begins moving around what looks like an oversize pencil. "Let's work on your nose," he says. On the left side of the screen, a little pointer starts moving back and forth, erasing the bump. "We want to smooth off the bone by filing it down," he remarks, almost as if it could be done that simply in the operating room.

"It still looks big," she complains.
"You want me to make it shorter?" he asks, as the nose changes shape again.
"I'd like it to go up a little on the end," she adds.

With that, DiGeronimo also takes a front photo of her, and, at her request, makes her nose look thinner. She goes over to a machine, presses a button, and watches as Polaroids of her old and new selves emerge. She studies the pictures carefully. "I think it looks a lot better," she concludes.

Ultimately the doctor will make clear to her -- as he does with all his patients -- that he can achieve only a close approximation of the look in the photos. But for now, he lets the pictures subtly sell her on his services: The new, improved Alice seems to be within her reach at the press of a button.

Alice is no stranger to cosmetic surgery. Now 30 years old, she had her breasts "augmented" nine years ago, and has been hungering to have a nose job for about four years. She isn't fazed by the higher-than-average costs cited by DiGeronimo's office -- $4475, including follow-up supplies and drugs -- or the views of her boyfriend, friends, and family. "People around me think I'm crazy to have it done," she notes. But now she has the Polaroids that show her how she can be remade, spurring her toward the operating room and the promise of a renovated self. "It's a vain thing," Alice admits. "It's all about appearances."

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