This is what people see when they look at Lucie Lukesova: A classic Eastern European beauty, ample and soft, with flawless skin, naturally rosy cheeks and sparkling blue eyes.
This is what Lukesova sees when she looks at herself: Fat chin. Big belly. Padded hips.
So a few weeks ago, she had liposuction. She describes it as one of the happiest days of her life. The 3 1/2-hour surgery corrected what she perceived as flaws. Whether it corrected her self-image remains to be seen.
Lukesova is 19.
Teenagers and young women are going under the knife in record numbers, and they're not just getting nose jobs anymore. Last year, cosmetic surgeons performed some 25,000 elective procedures on teens, according to national figures from the American Society of Plastic and Reconstructive Surgeons--a nearly 100 percent increase over 1992. They put breast implants in nearly 2,000 girls. They sucked the fat out of 1,645.
In the Washington area, home to nearly 100 plastic surgeons, a mini tummy tuck and a new chest are just the thing to wear down the graduation aisle under the cap and gown, at least in a certain set. For some cosseted children of perfection-seeking boomers, a Cross pen doesn't pass muster anymore.
Roger Friedman, the head of plastic surgery at Suburban Hospital in Bethesda, did a breast augmentation on an 18-year-old last month.
"She was 5-foot-9 and 125 pounds, and she had breasts like a man," he says. "She was graduating and wanted this done in time for the next step."
And he had done her mother's implants, 10 years ago.
At Suburban Hospital, which has a hefty 46 plastic surgeons on staff, a 19-year-old gets a breast reduction and throws in some abdominal liposuction for good measure; a 14-year-old gets a chin implant; a dozen twentysomethings opt for bigger breasts, all in a week.
In Gaithersburg, Gregory Dick sees about four teenagers each month on the prowl for liposuction or breast augmentation; that's a fourfold increase over eight years ago. He sends nearly half of those away.
"The trouble with adolescent surgery is it's a tricky business," Dick says. "Many times the teenager doesn't know what he or she wants and is responding to peer or media pressure." Several surgeons said they are reluctant to make permanent alterations during the transitional teenage years. "Teenagers' images change as fast as their body," says Mark Mausner, a Chevy Chase surgeon who does about 400 procedures a year. "One day, the dress looks terrific, and the next day, it isn't fitting right."
One 22-year-old Columbia woman says she has been yearning for liposuction for some years. "I have always had a weight problem," she says. Always means ever since she was 13 or 14. "Even when I had lost some weight, there was this one stubborn area where it wouldn't go away," on her stomach and hips, she says. A recent college graduate waiting to hear about her medical school applications, she took $5,000 of her savings and just spent it on a mini tummy tuck and liposuction.
That was her graduation gift to herself.
She is five feet tall and weighs about 125 pounds.
Now why wouldn't the nation's capital be a hotbed of plastic, elastic surgical activity? It is a center of image-making. And its affluent, educated, savvy adolescents are keenly aware that their driven, ambitious parents are prodding, shaping, bobbing and tweezing the visuals on themselves.
"In New York, you go to a cocktail party and they'll tell you where they had surgery. In L.A., you go to a party and they'll show you where they had surgery," says Mausner. "In Washington, nobody talks, but everybody has surgery."
Add to that all of the following: an obsessive quest for perfection; a fusillade of slender but busty advertising images; a parade of celebrities with cosmetic enhancements in full jiggle, including the 17-year-old pop sensation Britney Spears, now appearing on MTV with her new, improved breasts; cheaper, safer procedures marketed aggressively.
And, in a weird and paradoxical way, feminism itself shares the blame: If a girl can be anything she wants to be--a Citadel rat, a Web millionaire, a professional basketball player--then why can't she carve out a different body for herself?
Body Addition and Subtraction
At Six Flags America in Largo, a trio of 13-year-olds, taut and already tan in their bathing suits, wait in line for pizza and discuss what offending body lump they will remove first, when they get their liposuction. "I'm fine with my nose. I wouldn't pay the money for the nose. I'm going first for this," says one girl, and she reaches up and grabs the skin where her shoulder meets her back. There is no fat there.
The Big Adult Voice has been sounding the alarm for some years over girls and their poor body image, but eating disorders and depression continue to rise. The increase in elective aesthetic surgery among the young is but the latest manifestation, an extreme and quick fix helped along by a booming economy and overindulgent parents.
Dismay over body image starts for girls even before puberty. Some 40 percent of 9-year-old girls told researchers they feared getting fat; 81 percent of 10-year-olds said the same thing. "All the self-consciousness with body image has filtered down to the very young. I hear a greater preoccupation every year, and most of it is focused on weight," says Rita Freedman, a New York psychologist and author. Young girls and older teens are "convinced that unless they approximate whatever image is touted in the media, they will have no chance of being socially successful."
And the prized female form in fashion ads remains rail-thin, without womanly hips and rump. In the rest of the popular culture, it's skinny while nearly toppling from big breasts. "You are a victim of this crazy ideal body image that is impossible to achieve unless you create it yourself," says L. Kris Gowen, a psychologist and former researcher at the Stanford University Center on Adolescence. "And it's fake. Hey, breasts are fat. To have very large breasts and a skinny body is really counter to the norm." It's the big and glossy norm in the magazine plastic surgery ads, however.
"I don't know anybody who is satisfied with the body," says Lukesova. "I want to add a piece here, cut a piece there."
"I find it very hard to find a woman who is happy with her breasts. They are too big, too small, too saggy," says Susan Otero, a reconstructive breast surgeon at Washington Hospital Center. "Everybody has something about them."
The earlier onset of this dissatisfaction, researchers suggest, is because our culture is drenched in visuals.
"We are in a period in time when the myth-making has increased tremendously because of the amount of imagery in our lives," says Freedman, "computers, videos." Children are photographed ceaselessly, almost from the moment of conception. First come the ultrasounds, then the preschool graduations, followed by those pesky professional photographers lurking around the Little League games. At the same time, the marketing to kids is ever more specific. "There is such a commercialization of their bodies--what they should eat, what they should buy, what they should wear," says Freedman. "There is a lot of money to be made by persuading 15-year-olds that their lip color should be blue instead of red."
Sex fogs up this picture most of all.
Teenagers and even young women are not old enough to make permanent decisions about changing their bodies through liposuction or breast surgery, the psychologists argue, because their sexual identity is still in flux. The surgeons say they tend to agree, but some among them are wielding the scalpels and pushing up the statistics.
"The breast carries tremendous psychological overlays," says Mausner, whose clients are "everyone, from secretaries to maids to the people you see on television." Sexy is healthy, but "what is considered looking healthy? Being tan and having big breasts. It's ridiculous." Teenagers and women in their early twenties, he says, rarely understand their developing sexuality.
Otero notices that, as a female surgeon who does mostly reconstructive work after mastectomies, "my views of women's breasts are very much different." She's learned with experience that her own aesthetic sense of "what looks natural and pretty" doesn't jibe with her clients who often want the "Playboy breast, with the nipples looking up into the air." She smiles a little, then allows: "It's hard to be a feminist and do breast surgery."
Despite physicians' reluctance to put breast implants in teenagers, the American Society for Aesthetic Plastic Surgery has guidelines on teen surgery that are timidly encouraging. "When one breast significantly differs from the other in terms of either size or shape, surgery can help girls as young as 16," one of the guidelines suggests. And breast reductions are widely accepted as appropriate for girls of 16--and even covered by insurance--even though many times the surgeon must remove and reset the nipples, damaging nerve endings and milk ducts in the process.
The woman from Columbia has a newly minted degree in psychology--and a pre-liposuction 27-inch waist. She comes from a deeply religious culture that disapproves of too much attention paid to personal appearance. In her studies, she has been thoroughly exposed to the academic research on body-image sickness in girls and young women. So how does she reconcile what she knows to what she feels?
"See, that is the funny thing. I kind of agree with all that," she says, slowly, "but then I succumb to it myself."
The parents are often the worst. Dick calls it the "JonBenet Ramsey Syndrome." Overintense, wanting their children to be perfect, baby boomers who refuse to age without a fight, they drag their sons and daughters into the doctor's office and make demands. They wave the checks. Their children sit slumped in the chair, not speaking. Every surgeon has these horror stories.
Gregory Dick: "A mother brought in the daughter because the breasts are deformed, one was one size, and one the other. The daughter didn't seem to mind so much. I said, 'Any pressure from boyfriends?' The parent scoffed. 'What boy would be interested in a girl with breasts like that?' I almost fell out of my chair."
Steven Hopping: "I had a mother; she lost weight and had liposuction, and she had a short, heavy daughter, 15. She had a bad complexion. She was under psychiatric care. The mother pleaded with me and my staff, and reluctantly, I did the lipo. And now, a year later, her weight is up. She's not any happier. That was a mistake I made. You would love to help these people and be the one to save them. I'm a surgeon; I love quick changes myself. But I didn't solve any problems. I just moved it around."
Mark Mausner: "The woman who didn't have perfect breasts as a child wants her daughter to do it. You always have to be aware of the family dynamic and listen carefully to who is talking. Half of the job is psychiatry."
Even mothers who would never dream of sanctioning plastic surgery for their daughters unconsciously hand down a legacy of obsession.
Rita Freedman is treating a 16-year-old girl who has a weight problem. "Her mother is weight-obsessed, and she had lipo. The girl looks at a mother who is much thinner than she used to be, and who is much thinner than herself, and she feels judged. The mother is trying to relax and remove herself from how she feels about her heavy daughter. It's all very difficult."
$1,666 Per Inch
"I did this for myself," insists the 22-year-old after her tummy tuck and liposuction. Her parents, who are from the Philippines, never knew until afterward. "I don't think they really understand why I did it." Plastic surgery is generally accepted now, she says, but she's still a little embarrassed, and doesn't want her name used.
"I know that spending this money on your looks is supposed to be wasteful, but I had saved it up and I didn't really miss it," she says. When the swelling goes down, she says, her surgeon told her the 27-inch waist will be 24 inches. That's the goal: Only $1,666 per inch.
For Lucie Lukesova, having liposuction was "a dream come true."
"I love my body," she says, "but it's a pressure from the friends and acquaintances. They say, 'You should lose some weight.' " She said she has tried, "but I don't have the willpower. I can keep it for two weeks, and then it's bye-bye."
She saved some money from her job taking care of her toddler niece, and then she met up with Hopping, a surgeon at Columbia Hospital for Women who is somewhat of a trendsetter in these procedures. He offered to waive his fee if he could use her to demonstrate new liposuction techniques in front of other doctors.
"All the big body is gone," she says excitedly, the week after her procedure. "I'm still swollen, but it looks much smaller." She is thrilled with the way her neck looks, where Hopping removed her flab. Nothing hurts very much. She is doing her normal duties.
Before her fat cells were sucked away, she carefully ticked off her faults in an interview. "I think you are lovely," said the reporter. Lukesova smiled a little, lowered her big, blue eyes and murmured "thank you," but she shook her head. And now?
"I am very happy," she says.
"Now, I am looking in the mirror all the time."
CAPTION: Surgeon Alberto DiGiuseppe marks under Lucie Lukesova's chin in preparation for liposuction. "I don't know anybody who is satisfied with the body," she says.
CAPTION: Surgeon Alberto DiGiuseppe, center, works on Lucie Lukesova's chin while Michael Olding focuses on her stomach.