No one in New York helps more people seem to be something new than Dr. Patricia Wexler, the dermatologist who has treated Ellen Barkin, Donna Karan, Vera Wang, Barbra Streisand, Sean Combs, and practically every model in New York City. In 1998, when I first met Dr. Pat, her status as a guru was already assured. Barkin told me that she spoke to Dr. Pat at least once a week. Dr. Pat was so thorough, so accomplished, so friendly, so affable, so trustworthy, in fact, that Ellen Barkin, movie star, considered Dr. Pat her primary physician. Even then, Dr. Pat was one of several dermatologists to do procedures such as liposuction and fat injection.

By 2005, Dr. Pat was a bona fide celebrity on her own. In the fall, the designer Carolina Herrera hosted a party for Dr. Pat's new skin-care line. Calvin and Kelly Klein showed up; so did Christie Brinkley. At the end of the party, everyone was clamoring for the goody bag, which included a full set of Dr. Pat's new products. As a famous divorcée of some social status left the party, she delivered a hissing order to an assistant inside the velvet rope: “I need two—can you get me two? I need two—can you get me two?” as if she were asking to buy crack, not begging for an extra goody bag. Dr. Pat believes that New York women in the maintenance game think of dermatology and cosmetic surgery much the way they think about a health regimen. Another dermatologist told me patients become more acquisitive with each new procedure—treating each one like a new bauble. “It's like the new pair of shoes, the new handbag,” one doctor said. “They've got to have it or they'll feel out of the loop. They won't have their Manolos. That's how they treat a lot of these procedures.” What draws many women to the newest and ever more expensive treatments is the same competitive consumerism that drives them to get into hair-grabbing fistfights at the Dolce & Gabbana semi-annual sample sale. Admitting you've had the latest wrinkle filler is no longer a mark of shame; on the contrary, it is a status symbol in the mind of the 21st-century consumer who believes that self-maintenance and an abiding respect for personal aesthetics are deeply moral obligations, to be conducted with militaristic precision: Survey the landscape. Find the enemy. Attack.

In beauty—as in politics or wealth or social ritual—all is relative. I am five feet eleven inches and normally weigh about 148 pounds. In Los Angeles, this means that I am fat, repulsive, and cannot find a pair of blue jeans to fit me in any of the tony boutiques. If I stop in at Fred Segal, the chic celebrity haunt in Beverly Hills, I'm ushered politely away from the Hudson “supermodel” blue jeans toward the sweatpants and dresses made in stretchy fabrics or the shoe department. (No matter how fat you are, shoes usually fit.) The women who shop there have bottoms that are no bigger than mine was in the first grade. In New York City, I'm considered a touch on the pudgy side but acceptable, and my stylish, unusual height makes up for it. In Wisconsin, on the other hand, I see relatives who think I'm not only a touch short but on some kind of sicko starvation diet.

But I'm not a sicko. I'm not obsessed. In my passion for maintenance, for preserving the outer fleshy envelope in its best shape, I'm simply relatively obsessed. There are lots of women with worse problems than mine. (Although this is beginning to sound familiar: as with all addictions, those who are addicted are always looking over their shoulder, pointing out someone else who has a worse habit.)


I hadn't ever given too much attention to my looks before beginning to write articles for The New York Times about Botox and cosmetic surgery. After a while, submerged in the universe of the looksobsessed, I began to wonder how a few small physical adjustments might help. Over the course of the last 10 years, I have developed a habit that some women in less vain parts of the country might find offensive and certainly a serious signal that I am, indeed, obsessed. In other parts of the country, however, some women might look down their noses at me and chortle at how hopelessly frumpy and untended I look. What, no hair extensions? No boob job? No capped teeth? Is she some sort of troglodyte? And although I never believed I was addicted to the singular process offered by practitioners of cosmetic surgery—the skin peels and shots, the expensive creams and procedures, the lipo and the computer-imaging systems that show you the You you ought to be, not the You you currently are—it would take an experience that brought me to the clichéd yet desperate station at which all addicts must arrive to see my obsession clearly: rock bottom. I arrived at this place on a dark January night and saw that my vanity had deprived me of my humanity, that I was, in fact, obsessed beyond the normal boundaries. I was a junkie with a problem.

I was 28 when I met Dr. Michelle Copeland, a plastic surgeon, at a party on Long Island. A lawyer friend introduced us. “She's fantastic,” he said, pulling me aside. “Look at my skin and see how great it is. She's the reason.” I began seeing Copeland every two or three months, not for anything major, just some dermatological treatments. And if someone as serious as this lawyer was doing it—he had argued cases before the Supreme Court of the United States!—I should be, too. This was just a part of physical maintenance, like going to the doctor for a checkup or having your car tuned.

Like other patients, I began to refer to her as Dr. Michelle. My relationship with Dr. Michelle—my reliance on her—very slowly deepened into something that resembled addiction. We had an established routine: Come into the office and put on a little anesthetic cream, a topical lidocaine solution that numbs the skin. Put on a robe and go into room No.1, where Dr. Michelle would go over my face with a microdermabrasion tool, a fine sandblaster that sprays tiny crystals across the face, simultaneously abrading and suctioning off the dead skin cells. The nurse would then slather my face with a black goo, which Dr. Michelle zapped off with a laser. The nurse would clean me up, and the doctor would slather on more goo, this time a clear gel for a light laser treatment to restore collagen to the underlying structures of my face. The doctor would run the probe over my face, each wave of light snapping like an elastic band against my skin. Perusing my face, Dr. Michelle might find a couple of red veins or an area of redness to zap. There might be milia, hard nodules of protein material to be removed. We would think up other things to do. My upper lip might be looking a little thin. So over the years we tried two or three things to plump it up: nothing trashy-looking—subtle, subtle. We tried collagen derived from cadavers. The effect was good, but it disappeared in about two weeks. Ditto with the collagen derived from fetal foreskin cells. I got Botox at least twice a year in the corners of my eyes, where crow's-feet form, in the wrinkles across the top of my forehead, in the wrinkles between my eyebrows.


Dr. Michelle was always cautious and prudent. “Can't we use it here?” I once asked her, pointing to the rings that are a natural part of the skin of the neck. “Don't be crazy, ” Dr. Michelle said.

After the entire process was over, I would pay the bill—often somewhere around $1,800—leave her office, occasionally clutching a blue ice pack to my lip or my forehead, and stagger down Fifth Avenue hoping no one saw me and wondering: Was it wrong to pay my mortgage late so I could get some Botox?

One afternoon I was flipping through magazines at work and read the latest of a hundred articles about liposuction I had seen in Allure and Vogue and Elle, and before I even read it, a little bell went off in my head. It was the same bell that went off when I decided to paraglide off a 10,000-foot mountain in southern Idaho, the same bell that sounded when I decided to get married. It was the pinging, tonic sensation that accompanied the possibility of some mind-opening, life-changing experience, a hopeful voice that gave me encouraging pep talks every once in a while: I can run the New York City Marathon! I can jump off that rock face with nothing but parachute silk and some strings on my back! I can be legally bound to one person for life. I can do it! This time, it said something different, and perhaps less profound: I can get liposuction!

I called Dr. Michelle and scheduled the consultation. I had run the marathon, after all. I had trained for years, eaten right, done 10,000 leg lifts—and I still had those two little annoying jiggling pouches of fat on my thighs, which the beauty industry appropriately yet repugnantly refers to as “saddlebags,” as if the bearer were some sort of pack mule.

In the parlance of addiction, I was moving on to the serious junk. The Botox, the collagen, the facial peels—that was kid's stuff, comparable to smoking cigarettes in the back alley with the bad crowd from school. This was big: Surgery. Anesthesia. I was moving into a shooting gallery downtown, renouncing my parents, and selling my children for crack.

Dr. Michelle operates out of her own offices. She has a full operating theater, staffed with anesthesiologists and nurses. A nurse instructed me to lie facedown on the table, which had been configured to accommodate this position. The anesthesiologist couldn't find a vein and poked several times at my forearm. It made me nervous. Queasy and sweating, I was about to leap up from the table and announce that I was no longer interested when she sank her needle into some deep bloody conduit and it found its place. Count backward from 10, she said.

Ten, nine. I fought the sensation of being pulled into a churning, cold black ocean. I tried to open my mouth to scream, but the mouth—for suddenly, it no longer belonged to me—wouldn't open.

Two hours later, I awoke to a fog. The anesthesia hangover is dense, and I was not prepared for its suffocating incapacitation. When I tried to speak, my mouth produced a wretched slur. My body was reluctant to move and felt foreign, apart from me, the arms and legs meaty, floppy appendages that belonged to another person but had somehow been attached to my own body. The nurses were bundling me into a wheelchair. A wheelchair meant moving, and rolling, and transportation, and I couldn't even speak, so how did they expect me to be mobile? I thought of Jean-Dominique Bauby, the French magazine editor who after a stroke found himself afflicted with the rare condition called locked-in syndrome: his mind was intact, but he had lost virtually all physical control and was able to move only his left eyelid. Unable to write or speak or move, he dictated his memoir, The Diving Bell and the Butterfly, to an assistant who recited a frequency-ordered alphabet until Bauby blinked his eyelid to signal the letter he wanted. I was stupefied. He had had a stroke; I, on the other hand, had willingly turned my brain into some sort of biochemical slurry in the name of beauty—no, not even beauty. In the name of having a smaller ass.


A friend put me in a car on Fifth Avenue and brought me home. As I drifted off to sleep, I talked myself out of panic: My brain will recover. My brain will recover. My brain will recover. And if it wasn't going to, panicking would not help the situation. Breathe in, breathe out. One-nostril breathing. Do not panic. In the morning, my head was clearer but still fogged. It would take about a week to feel fully restored. I got out of bed and gamboled to the mirror: My lower body was swaddled in a black undergarment, something resembling extremely tight nylon bike shorts, but with the strategic areas cut out for the bodily functions. Purple-and-green bruises spread beyond its edges. I looked as if I had been in a terrible car accident.

Apart from the dull pain of the healing process, for which I took the painkillers Percocet and Tylenol No. 3 for three or four days, what was most disturbing was the incarceration imposed by the garment, which I was not to remove for two weeks lest my thighs heal unevenly. The garment was made of itchy, hot material, and its edges dug into my skin, leaving irritated welts. It was my torturer, day and night. It fenced me in, kept my body in check, restricted my movement. At night I had dreams that someone was wrapping cellophane around my head and I was suffocating. During the day I went to work, wearing billowy skirts, sure that everyone was looking at me strangely. Cosmetic-surgery traitor!

I was, for several weeks, overwhelmed by a deep sense of shame. I couldn't believe how much I had willingly hurt myself. I begged my fiancé (now my husband) to reprimand me if I ever thought of doing something so stupid again. It wasn't worth it: the fear of some terrible edema choking off the blood flow to my legs, the painful constriction of the bandage, the lingering fog, the moral shame in knowing that if I had spent eight weeks eating salad greens and running 20 miles a day all of this would have been taken care of by nature, the shame in wasting money that could have been used for something better. I had spent $6,000—about the annual salary of the average Hungarian or Mexican—to correct a minor imperfection of my body, a flaw so trivial that ultimately no one, not even my fiancé, would ever notice a difference. After two weeks, I was allowed to take the garment off. I tossed it in the garbage at Dr. Michelle's office, and she seemed surprised. “What if you want to use it again?” she asked. Again?

Not in a million years.

After a few weeks, the bruising subsided. The swelling was gone. The memory of the self-torture, too, had vanished. My new ass did look better. All of my vows of surgical chastity evaporated as I put on a bikini and walked out to sit next to our swimming pool. The only evidence of the recent month's physical warfare was two freckle-size scars on my outer flanks, the former incisions through which Dr. Michelle had withdrawn the fat. And only a pro would know what those were.

I lay facedown on a lawn chair and breathed in the sweet smells of the day. The sun beamed powerful, healing jets of warmth onto my back. My young stepson-to-be was playing nearby with a friend. I felt a shadow pool on the backs of my legs. “Hi,” a small voice said. I turned around, and it was the friend. A boy of about eight or nine, he was the son of a fashion model. He was kind of a troublemaker, but I liked him.


“Hi,” I replied.

He screwed up his face, trying to blunt a smile. “Did you have fat cut off your butt?” he asked.

Excuse me?

“Did you have fat cut off your butt,” he said, exasperated. “You have the dots, and my mommy has some, and her friends have some, and she told me that when ladies have those dots that means they had fat cut off their butts.”

I was shocked. At the depravity of a society where eight-year-old boys know how to tell who has had liposuction and who has not. At the fact that he felt the freedom to ask. At the fact that he knew (the knowing, wink-wink smile) but was asking just to let me know that he knew.

“No, I did not have fat cut off my butt,” I said as I stood up, making harrumphing noises and gathering my towel around my waist. I marched back to the house, fuming. I had lied. I was mad at an eight-year-old for finding me out. But he had me busted: I was now the proud owner of an ass that didn't rightfully belong to me.

During the years after the liposuction adventure, I visited Dr. Michelle for a number of dermatological treatments: Botox, collagen, the lasers, the goo. She introduced a line of expensive unguents and gels, which I bought. Sometimes, the bill was $1,500. Sometimes, it was $3,300. Money that should have been flowing into my savings account was flowing into my face. And my face looked good. My seriously beautiful cousin who lived in Beverly Hills told me I looked younger than I had when I was 20. As the commercial says: Priceless.

And again I heard the little bell. Why not make another adjustment? It was time to do my eyelids. They were puffy. They looked as if I stayed up late every night drinking red wine.

“You've got a Kathleen Turner thing going,” Dr. Michelle said. “Do what you want, but I personally think you would look better if your eyes opened up a little more.” She took some photographs of my eyes and on her computer used a mouse to open them up. “They will look bigger and bluer,” she said. “You'll see.”

Dr. Michelle showed me pictures of women in their 30s whose eyes she had done. On one screen, their eyes looked like mine, the eyes of someone who had worked hard late at night and partied late at night, who had stayed up studying for exams and stayed up late writing articles on deadline. Their eyes were tense and old-looking, shrouded in delicate folds of hanging skin. On the next screen, their eyes were open, wide, bright, but still retained their original shape. In fact, I was convinced, you could see more of their soul. I thought about it overnight. Unable to quiet the little bell, the next day I signed up for the surgery.

On a Thursday morning, I arrived at Dr. Michelle's office. The surgery and recovery were dramatically smooth this time, from the beginning. I was prepared for the aggressive anesthesiologist from the previous surgery, the one who had poked me until I turned green. But a different anesthesiologist was in residence that day, a relaxed and jovial bearded man, and he joked about how the anesthetic process would make me feel as if I were drinking margaritas.

“Would you like salt or no salt?” he asked. His beard gave him a kind of fuzzy, bearish warmth.

“Rocks, no salt,” I said. This time, going under didn't feel like being submerged beneath ocean waves against my will. I didn't struggle. Smiling, I slid into a warm bath and was out. It would be an ideal way to die, I thought at the time: ignorance is bliss. Dr. Michelle scooped a tiny dropperful of fat out of each of my upper eyelids and sewed them each back up with one long black stitch. The process took less than an hour.


On Monday morning I had the stitches taken out and went to work with makeup on. A week after the surgery, my eyes looked the same, just slightly more open and aware-seeming. The changes were so subtle no one noticed that I had done anything. A couple of people asked me if I had lost weight or if I was wearing colored contact lenses, because my eyes seemed so blue. My sister asked if I had had a nose job. There was no pain in the recovery, unlike in the liposuction experience: there had been none of that gargantuan violence done to the body, just two stitches, one over each eye.

After about a month, I realized what a miracle had taken place. It felt like I had cheated on something but wouldn't ever get in trouble. There would be no more pictures of me in which I looked half asleep. My eyes were bright.

This was going well. I began to think perhaps I should start saving up for something else down the road. I began to look around at my body in a more critical, almost geographical way. What could I do next? What about some more liposuction? What about having a washboard stomach? What about a fantastic nipped-in waist? Why were my upper arms always just a little too fleshy, even when I was at my lowest weight? What about that? Was I getting something resembling a bulb on the tip of my nose?

In January of 2004, I decided to try a new product, Restylane. For several years, surgeons and dermatologists in New York had used it to plump up the skin, even though it had not yet been approved for any human use by the Food and Drug Administration. Doctors simply bucked F.D.A. restrictions and had the drug shipped from suppliers abroad.

Restylane is a commercial name for a synthetic form of hyaluronic acid, a mucus-like substance that occurs naturally in human joints and skin. According to Q-Med, the company that makes Restylane and its counterparts, Perlane and Restylane Fine Lines, patients do not need to be pre-tested for allergic reactions, because the drugs are synthetic, unlike collagen, which is often derived from bovine sources, or other, collagen-like fillers, some of which are derived from human cadavers. Traditional hyaluronic acid is derived from what is called avian sources, the combs of roosters. I wanted to have some of the new, synthetic form injected into my nasolabial folds (laugh lines) and maybe my upper lip. “Nobody will say they are using it, but, believe me, there are lots of little moles bringing it into the country,” Dr. Patricia Wexler told me before it was approved. “You go to your doctor and they will go to the cabinet and unlock it and tell you not to tell anyone. Nobody is going to admit to it.”

As so often in the world of cosmetic enhancement, it was doubtful that any government agency was going to go after doctors using Restylane. Those who had the drug mailed to them from overseas would otherwise have put themselves at risk for malpractice suits, professional rebuke, and, in extreme circumstances, revocation of their medical licenses. But enforcement was extremely unlikely for several reasons. In theory, the New York State Department of Health could have reprimanded a doctor or, at the remote edges of possibility, acted to suspend his or her medical license, according to Kristine Smith, then a department spokeswoman, but in practice the likelihood was remote. “It is not just a matter of someone saying, ‘Hey, I heard this doctor is using a medicine not approved by the F.D.A.,’” Smith explained to me. “Can we prove the doctor was negligent or incompetent? Would other experts in the field consider the care to be substandard?”


Not only was it difficult to prove that a doctor was giving substandard care, there was some foot-dragging on the part of government agencies to heed the complaints of patients who requested illegal beautifying procedures—something like the equivalent of a jury's finding a rapist not guilty because the victim dressed seductively and got drunk. In other words, she asked for it. Doctors were also annoyed at the F.D.A.'s slow approval time. “The F.D.A. in this case is being a bit overcautious—because Restylane has been used in so many countries and so many good places, like Canada,” Dr. Rod J. Rohrich, who at the time was the president of the American Society of Plastic Surgeons, told me. Restylane was not entirely free of complications. Dr. Trevor Born, a plastic surgeon in Toronto, registered some adverse reactions. “There have been reactions, such as patients who develop draining cysts,” he told me. “But in the 3,000 I have treated, I had one patient who had some redness for about three weeks, and that was it.”

In the 2003 press release announcing the F.D.A.'s approval of Restylane, it was described as being for use in the correction of “moderate to severe wrinkles around the nose and mouth.” And that's it. The most commonly reported adverse events were bruising and swelling, which typically occurred at the injection site and were transient and moderate. In countries other than the United States, Restylane was also approved to enhance the appearance and fullness of lips, although the safety of using it for this had not been established in controlled clinical studies submitted to the F.D.A.

According to the corporate literature, “It is produced biotechnologically by natural fermentation in a sterile laboratory environment. This significantly diminishes the risk of transmitting diseases between species or of eliciting allergic reactions in patients who are sensitive to common foods, such as beef, chicken and eggs. [It] has been extensively researched for over a decade and proven to be safe and effective.”

It sounded fantastic. I made an appointment with Dr. Michelle, far in advance. Her schedule was now booked up solid with surgery and skin care, and I had established the habit of calling three weeks ahead to get a time slot. An appointment with her took precedence over all other events.

And then my friend Jerry Nachman died. The first time I saw him, he was reclining on a porch of a friend's house on Shelter Island, New York. He was wearing a bathing suit. He was short and rotund, and his skin was plastered with nicotine patches. In various places, skin tags—excess skin that grows off into rootlike, waving flesh anemones—sprouted from his body. He chewed on a wet cigar. He was almost entirely bald. He had moles on his face and speckling his body. He was a friend of my then boyfriend, and we became close.

He had been the editor of the New York Post when Marla Maples and Donald Trump began their affair. BEST SEX I EVER HAD, said the cover of the Post, and Jerry loved to joke that it was the ultimate libel-proof headline. “He could never sue us,” Jerry would say. “He would have to prove that he wasn't the best sex she had ever had, and what man would do that?”

He wrote for Politically Incorrect and told people that his one distinction there was that not one of his jokes got on the air in two years. Then he became editor in chief of MSNBC and had a nightly talk show. For many years, when I was part of a reporting team that covered the media industry for The New York Times, he was a daily phone call, someone I counted on for perspective, for good judgment, and often for a great opening paragraph. At night, he and I and a group of other regulars would converge at Elaine's to hash out the events of the day. He had been married to a patrician blonde beauty, but they had divorced. He was, by far, one of the most physically unattractive people I have ever known. He was proud of his ugliness, and with good humor, not defensive humor, he made it a badge of honor.


In January of 2003 he announced that he had a malignancy in his gall bladder. A year later, I was at home alone. My husband was away. It was one of those bleak January nights, a cold, dark winter evening when spring and warmth seem painfully, achingly far away. I would do some stretching exercises and watch the evening news. I turned on the television. Jerry was dead.

The funeral was scheduled for two days later. I flipped through my datebook to find out what I would have to cancel to make it. And there it was: my appointment with Dr. Michelle. My heart did a little turn. Then something happened. I decided I could make it. I would just do both.

After the funeral, there would be a gathering at Elaine's, and a few of us were asked to make some remarks. But I could squeeze in a microdermabrasion-and-Restylane session between the two. After all, it would take a couple hundred disorganized, taxicab-hailing mourners at least an hour to leave the congregation on the Upper West Side and make it all the way to Elaine's, on the Upper East Side. And my skin always glowed after a microdermabrasion treatment.

I went to Jerry's funeral. After it ended, I sprang to life and jumped into a car I had hired for the occasion to streamline my plan. Elaine Kaufman, the owner of Elaine's, needed a ride, so I had the driver drop me at Dr. Michelle's and take her to the restaurant. Then he would meet me back at the doctor's office. I would pull off the plan with the efficiency of a military operation. I barreled forward. I did not stop to think through the various potential outcomes. If I had, I might have gone through the checklist of the common symptoms of addiction: Participating in addictive behaviors more often than you intend. Excessive time spent seeking the addictive thing. Giving up other things in life to pursue your addiction. Pursuing and fulfilling the addiction at inappropriate times.

I explained to Dr. Michelle that I was in a hurry and urged her to give me the Restylane. Even though the substance had not been approved for use in the lip area, I asked for injections both into my nasolabial folds and into the lip. She was skeptical and suggested there might be some swelling in the lip area. I pressed her. She put some numbing cream on and injected a small amount into my nasolabial folds. Restylane is a viscous substance, so she would inject it in drops and then massage them through the skin until they coalesced and achieved the correct effect. She asked me if I was ready to do my upper lip.

“We'll just use a little,” she said.

The lip is an extremely sensitive area. I hummed opera, loud, to take my mind off the pain of the injection and the pain of her massaging the gel into place. Jesus, I said, after she was done. That hurt. The nurse gave me ice packs and counseled me to rest with the ice for 20 minutes. Then I would be free to go.

But something was wrong. After 10 minutes, the ice packs, which should have settled down onto my face as any swelling decreased, had actually risen high off my face. I pulled them off and went to the mirror.

I thought at first that I was hallucinating. There was a large mass under my nose. I looked closer, widening my eyes to make sure that what I was seeing was real. It was my lip. It was enormous, a cartoon upper lip bigger than any I had seen, even in the worst plastic-surgery-disaster photographs.


I opened the door to the hallway and made a mewling noise. Because my lips didn't meet, I couldn't make understandable human noises. The nurse rounded the corner. She was new, unseasoned, and her reaction was not helpful.

“Oh my God, oh my God, I've never seen anything like it!” she said with a yelp, tossing her metal tray into the air and scurrying away to get Dr. Michelle.

I lay there for another two hours with ice packs. While my friends were gathered toasting Jerry 20 blocks away, Dr. Michelle was using a small spatula to apply gobs of steroid cream to my upper lip, which had swollen to the size of a large yam. With my lip so grotesquely swollen, I was unable to speak and could only push out semi-recognizable sounds using my upper teeth and lower lip. I was terrified that my lip was damaged forever, horrified that I had insulted Jerry so soundly. I had chosen to keep the idiotic appointment—my upper lip never needed filling anyway!—instead of making sure I would be available to mourn Jerry with all of our friends.

Dr. Michelle called my pharmacy and had them send a prescription for steroids, both cream and pills, to my apartment. The nurse helped me out to the car and driver, who had been waiting for three hours to take me to Elaine's. I couldn't go to Elaine's. I couldn't speak. I looked like a freak.

The driver took me home. I clutched a sweater over my face so the doorman wouldn't see what had happened. I was deeply relieved my husband was traveling: understanding as he can be, this was a visual memory I didn't want imprinted in his brain.

At home, I examined my lip and popped several of the steroid pills (as directed) with a mug of vodka as a chaser (not directed). I wandered around my apartment, sobbing, my lip jutting out. I tried to see the comic side of my misadventure, whirling theatrically around my apartment, pretending I was Goldie Hawn in The First Wives Club. Of course, the author of the book upon which the movie was based, Olivia Goldsmith, had died the week before as she went under anesthesia for elective surgery at Manhattan Eye, Ear and Throat Hospital, so this was perhaps not the best comic choice.

The phone rang all evening long, but I didn't pick it up. I couldn't speak because my lip was so swollen, and I couldn't speak because I was loaded. There was nothing to do but sit on the bathroom floor with my mug full of vodka—I don't know if I chose the one that said HAPPY 29TH BIRTHDAY—AGAIN! on purpose or not—and weep. At 11 o'clock, I staggered to the television set to watch the local news coverage of Jerry's funeral.

It took about five days for my lip to return to normal. I called my editors and said I had to work at home for personal reasons. Two weeks after the Restylane, the skin on my upper lip, which had been stretched to beyond capacity for so long, sheared off in thin papery strips.

Jerry, who was always a straight shooter, would have read me the riot act. He would have called me an asshole. And if Jerry had called me an asshole, that would have meant I had done something terribly wrong.

There was no greater wake-up call. I began to think about tapering off my visits to Dr. Michelle Copeland.

I have now sworn off the big stuff. I have nothing but respect for Dr. Michelle, who counsels restraint and caution. It's been a year since I've had Botox, two years since my last tango with collagen. I gave up on Restylane after that first fling. Barring any need for reconstructive surgery, I will never have implants put inside my body, not cheek or calf or breast. I haven't done a thing to my lips. Curiously, I am not worried about aging, per se. I like aging: I get smarter every year. What I do worry about is getting old, about getting that tired look that marks the faces of people who haven't done what they want to do with their lives, people who shrink from life. Most amazing of all, I noticed the other day that my upper eyelids are getting that puffy, lopsided look again. It was a eureka moment. No matter how much money you spend, or how much plastic surgery you have, or how many dermatologist visits you schedule, inevitably, time's winged chariot will catch up to you and march all over your face.

Excerpted from Beauty Junkies: Inside Our $15 Billion Obsession with Cosmetic Surgery, by Alex Kuczynski, to be published this month by Doubleday; © 2006 by the author.