Just one look

Plastic surgery is common enough in American culture that people don't think twice when they see it on The Learning Channel or in the pages of Oprah's magazine.

But "Extreme Makeover," a reality series launched recently by ABC, may be adding some edge to the question of where society is headed with all the nipping and tucking.

The fact that the prime-time show has drawn about 12 million viewers per episode - and that participants say their experience is an "education process" for those considering procedures - focuses the concerns: What would it be like if everyone had cosmetic surgery? Would we all start looking alike?

Changing your features is not as controversial as, say, being cloned (unless, perhaps, you're Michael Jackson). And some people, including a few on "Extreme Makeover," do it to fix serious problems.

But as cosmetic surgery becomes more mainstream, unique noses and untucked tummies might be increasingly hard to come by, much the way braces have made crooked teeth largely a thing of the past.

"By the year 2020, no one will ask you whether you've had aesthetic surgery, they will ask you why you didn't have aesthetic

surgery," predicts Sander Gilman, a University of Chicago professor who has studied the history of plastic surgery.

Today, he says, it's acceptable to live in a world where you can change your looks but choose not to. But in 20 years or so, he says, "in certain societies - Brazil, Argentina, more and more the UK, South Korea, Japan - the [question will be], 'Why didn't you take advantage? Why are you walking around bald?' " he says.

Reversing society's fascination with quick fixes could be difficult. Cultural observers say that surgery, now viewed as a viable option, is always in the back of people's minds, even if they never act on it. And it's not just self-assessment - more people now look at one another with what Virginia Blum calls "the surgical gaze."

In her forthcoming book, "Flesh Wounds: The Culture of Cosmetic Surgery," the University of Kentucky professor suggests that America's potent celebrity and consumer cultures are driving people to want to alter their bodies as quickly as fashions change. "Beauty is now as disposable and short-lived as our electronic gadgetry," she writes, "more impermanent than even the flesh it graces...."

In the few years since Professor Gilman wrote his 1999 book, "Making the Body Beautiful," for example, women in Brazil have gone from wanting to reduce their breasts in order to look less primitive, to wanting to enlarge them to conform to what's perceived as the Western norm.

"That's something that's just unbelievable to me, because it happened so quickly," he says.

Settling on one standard of beauty may be one of the biggest hurdles to having a society of Barbies and Kens - who or what would be the model? Blum argues it's a moving target, where people are constantly trying to look "better," but what defines better-looking is always changing.

And, of course, until the aging process is reversed or teens start wearing tents, there will likely always be some pressure to look younger or have a tank-top body.

For one "Extreme Makeover" participant, the key to keeping people from all looking alike lies in the responsible behavior of plastic surgeons. Kiné Corder, a Chicago barber who had corrective work done on her lips, says doctors, like the one on the show, are the gatekeepers, making sure changes are simply an extension of a person's natural 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."