Doctors say they are aware of the problem and are taking steps to address it, which is in itself significant. Overindulgence in aesthetic treatments has been a problem since plastic surgery was invented some 200 years ago (initially to treat war wounds, by the way not droopy jowls), but the effort to sensitize plastic surgeons on the topic has only begun in earnest in the past 10 years. The ASAPS, says Nahai, now regularly invites psychiatrists to speak at its seminars. One thing doctors are taught to look out for is body dysmorphic disorder (BDD), a psychiatric condition affecting a small percentage of overenthusiastic antiaging patients. BDD sufferers are chronically unhappy with one or more perceived physical flaws and often continue to be unsatisfied despite repeated surgeries. The Los Angeles Body Dysmorphic Disorder Clinic (you knew there had to be one) estimates that 1 to 2 percent of the population has BDD, though of course not every sufferer undergoes plastic surgery. "If someone in their mid- to late 20s or early 30s has already had six or seven cosmetic operations, that's a red flag," says Nahai. Doctors say they try to determine a patient's motivation for seeking surgery or enhancement, and screen particularly for recent upheavals like divorce, which may indicate a patient is seeking treatment to handle a problem larger than crow's feet. Such patients are often referred delicately to a psychiatrist. "BDD is not treated with surgery; it's treated with psychotherapy and antidepressants," says Sander Gilman, Ph.D., director of Emory University's program in psychoanalysis.
Unfortunately, there is huge profit to be made in antiaging today, and since even pediatricians and OB/GYNs clamor to oversee medi-spas, patients with BDD can almost always find someone willing to grant them their wishes.
But BDD being rare, the frozen expressions and voluminous lips crowding the Chateau Marmont owe mostly to a more pedestrian impulse. You start and based on a confluence of factors, emotional and environmental you just can't stop. Doctors say people with addictive personalities are more prone to overuse, but that it can happen to any of us provided we're rich enough. (Botox, at an average of $417 a pop, and laser resurfacing, which can run upwards of $2,000, are fevers many of us can't afford to catch.) The very fact that many of today's cosmetic treatments are repetitive may make them more addictive.