Just one look

"You can't bring him a picture and say 'I want Halle Barry's nose,' or 'I want Michelle Pfieffer's lips,' " she says. "He's going to say, 'I'm going to give you Kiné's lips, the best Kiné's lips I can give you.' So as long as we have doctors like [him] then no, we won't all end up looking alike."

If the day did come when everyone looked like a movie star, Gilman says an 18th-century philosopher named M.F.X. Bichat could offer guidance. Hundreds of years ago he pondered what would happen when every women was beautiful according to some social standard.

His answer, Gilman says, is the exact correct one: "We will find ever more subtle ways of defining beauty."

The tiny differences between people will be the new scale of beauty, he says. "Freud called this the 'narcissism of minor differences,' and, taken together with the radical shifting beliefs over time as to what beautiful is, we may desire uniformity, but it will always elude us."

Plastic surgeons throw cold water on the idea that a standard, societal "look" could emerge - even though observers say there is already often a "sameness" to the surgery done by particular doctors. People's genes and bone structure would keep them from really looking the same, argue the professionals.

That's the same argument experts offer for why face transplants - grafting the face of a deceased donor onto a burn victim, for example - will not produce people who look alike. Still called science fiction by some surgeons, such dramatic procedures are now being pursued in some medical circles.

If plastic surgery does become as common as braces, then the concern over its impacts on society could fade, says Blum: "The emphasis will be different. It won't as big a deal. And if it's not a big deal, the sense of its extremity is diminished."

The number of people having plastic surgery is still a small portion of the nation's roughly 300 million people.

Last year, those having procedures fell by 12 percent from the year before, dropping to 6.6 million people from 7.5 million in 2001, according to the American Society of Plastic Surgeons. The ASPS blames the poor economy for the decline.

But the number of procedures performed - ranging from nose reshaping to nonsurgical chemical "peels" - is still dramatically higher than a decade ago, with more men and younger patients involved.

"Extreme Makeover" reflects this demographic shift. Participants offer a range of reasons for their decision: finding better dating and job prospects, having inner youth reflected in their outward appearance, fixing flaws they've had since birth. Most say they just want to look like better versions of themselves.

"You can see some changes in my new look, but they're not to the point where you can't recognize David," says David Patteson, a noncommissioned officer in the Virginia National Guard who lives in Farmville, Va.

Interested in having a look he felt would make it easier for him to get promoted, his changes included a nose job, chin enlargement, and work around his eyes. Rather than worry about what the people in his rural town might think, he explained, "I looked at it and I said, well, what do you want, and what's going to improve yourself and your family's life?"

That attitude may be a natural offshoot of living in a society where self-direction is prized in all areas, and increasingly simple for some to achieve.

Appearance - and by extension, identity - is simply an area in which the potential for control has surged, says Carl Elliott, professor of bioethics and philosophy at the University of Minnesota: "[Identity has] changed from something that's largely given to you, to something that you have the responsibility for creating yourself."

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