But here’s what’s really interesting, and kind of disturbing. While the number of cosmetic procedures has skyrocketed, the number of people undergoing them has risen at a slower rate. In other words, a significant number of cosmetic procedures in America are being done on the same people.

  These aren’t the painfully addicted people, who turn to surgery the way some people succumb to eating disorders. There are people, sometimes called “scalpel slaves,” who get dozens of cosmetic surgeries, constantly thinking the next one will fix some gnawing problem in their lives. If the doctors don’t turn them away, they can end up looking rather bizarre, even grotesque. (Michael Jackson, anyone?)

  But short of truly ill “scalpel slaves,” there is a growing group of regular, healthy Americans who try a modest cosmetic enhancement or two, and decide they are so fabulous that they just have to have a couple more.

  In 2005, over half of facial surgeons’ patients got more than one procedure—up from just 28 percent in 2001.

  True, some of that dramatic growth reflects greater use of the interventions that call for ongoing treatment, like Botox and chemical peels. But that’s just people getting facial work. If the rate were even half as high for people getting any cosmetic procedures or, say, over three years instead of one, you’d still have well over 2 million people in America who’ve gone for repeat elective cosmetic work on their bodies.

  Some in the industry certainly want it that way. While the American Society for Dermatologic Surgery warns against doing multiple procedures at once, plenty of Web sites, where the average American is more likely to turn, hawk the idea. They claim that since overall recovery time is shorter, the interruption to your life is smaller, the cost is lower, and there is no additional risk to being under anesthesia for longer—then why not get your breasts enlarged while you’re getting them lifted, or get your face lifted while you’re getting your tummy tucked? Two-fers are a good deal, it seems, no matter the industry.

  Source: American Academy of Facial Plastic and Reconstructive Surgery, 2006

  And pop culture seals the deal. On ABC’s 2002 show Extreme Makeover, ordinary Americans can fulfill “lifelong dreams and fairy-tale fantasies,” as teams of plastic surgeons, dentists, dermatologists, Lasik surgeons, and “master body sculptors” come into their lives to fix everything that Nature didn’t.

  The explosion of plastic surgery in America reflects a virtually out-of-control obsession with youth. Even as America ages, and the boomers at 60+ are the most populous generation, they still want to look and feel like 30-somethings. And our culture says Go For It. As we have seen elsewhere in this book, Americans are living in an era of militant self-determination. People are readier and abler than ever to date whomever they want, vote however they feel, breed whenever they want, and worship however they like, without regard to either the biological or cultural limitations that constrained their parents and grandparents. Who cares what I used to look like? Who cares what 50-year-olds “naturally” look like? I will take control of the information, resources, and experts available to me, and I will remake myself as I desire.

  There will be consequences. New York Times columnist Maureen Dowd has mused, “What happens genetically when a man who has his nose done, chin augmented, and ears pinned back is attracted to a woman who’s had her eyes done and her lips plumped up and her face lifted? And they have a baby and look at each other and moan, ‘My God, where did this ugly baby come from?’” Plastic surgery for babies, of course.

  And there’s a Catch-22 in Hollywood. No one can get the big roles today without a perfectly smooth face, so everyone runs off to get Botox. But with cosmetically engineered faces, no one can really act with any lifelike facial emotion. Are middle-aged film characters done? From now on, every character in a blockbuster film is under 25? Even if they’re played by a 40-year-old?

  And what about the medical profession generally? At the moment, plastic surgery is a relatively small specialty among board-certified physicians. But increasingly, doctors trained in OB/GYN, general medicine, and even ER work are realizing that the Medical Beauty Business—what with its few emergencies, zero night calls, independence from insurance companies, same-day payments, and low malpractice costs—is a very sweet place to be. At least, for them. Unfortunately, there is already a serious doctor shortage on the horizon, given the expected medical needs of the aging boomers. If more and more doctors are drawn to servicing the healthy rather than healing the sick, that situation is only going to get worse.

  Nonetheless, expect a boom in “Aesthetic Medicine,” and a bit of a turf war among doctors as to who gets to practice it. (Can gynecologists really do facial peels?) Look also for lawsuits by patients who bought new eyebrows from doctors who, it turns out, were actually trained only in internal medicine.

  People may not live forever. But for many, the appearance of living forever is enough, and they are willing to undergo surgery after surgery to make it real. While for most people, the goal is to avoid doctors, Surgery Lovers feel just the opposite—they crave the latest and greatest procedure to give them a boost of youth. Perhaps this trend will yield a generation of narcissists. Or it may spawn a generation with the self-confidence to overcome the luck of the draw when it comes to looks.

  THE INTERNATIONAL PICTURE

  Americans seem to be more alone than not, globally speaking, as they rush to plastic surgeons for a tummy tuck or a nose job. According to a survey conducted by ACNielsen in November 2006, 80 percent of people across forty-one countries said that plastic surgery is “not an option.” Asia frowns on the practice even more, registering a disapproval rating of 86 percent.

  That said, however, there are people throughout the world who would like to be waiting with the Americans in the plastic surgeon’s outer office.

  Significant populations in Russia (48 percent), Greece (37 percent), the Baltic republics (35 percent), Ireland (31 percent), and Turkey (29 percent) said that they would “consider cosmetic surgery when I’m older.” The Czechs, the Dutch, the Norwegians, and the Hungarians were wildly against it.

  While most of the top ten surgery-considering nations were European, Korea did buck the Asian trend by expressing interest at a rate of 28 percent. While many Asians disapprove of plastic surgery (94 percent in Hong Kong, 92 percent in Indonesia), Korea has 1,200 plastic surgeons, the highest per capita in the world. (To put this in perspective, California has only around 900.)

  As in the U.S., surgery-loving men are on the rise. Wealthy Iranian men are flocking to get nose jobs, Kurdish men are secretly seeking out age-concealing treatments and hair transplants, and Korean men flock for procedures of all types.

  One survey of South Korean men between the ages of 25 and 37 showed that 86 percent believe that if they have a good appearance and fit body, they will be more competitive in the workplace. An estimated 56 percent were dissatisfied with their body.

  The other global piece of the Surgery Surge is that more and more people are hopping in planes and engaging in “plastic surgery tourism”—in order to get the best price for their procedures. Favorite destinations include Venezuela, Brazil, the Dominican Republic, Colombia, Ecuador, Mexico, Thailand, and South Africa.

  Powerful Petites

  There is no shortage of accounts—including in this book—about how America is getting bigger. Men are nearly three inches taller, on average, than we were a century ago. Both men and women are twenty-five pounds heavier, on average, than we were forty years ago. Like Peter Gabriel in his hit song “Big Time,” our cars, our houses, our eyes, our mouths, are getting big big big big big. So much larger than life.

  But while much of America is supersizing, there is a substantial group of little women who insist that size doesn’t matter. Or rather, it does matter (if it’s theirs)—and they don’t intend for their small physical stature to give them short shrift.

  They are America’s Powerful Petites.

  They came to America’s attention in May 2006, when the New York Times reported that three of the country’s most influential department stores—Neiman Marcus, Saks Fifth Avenue, and Bloomingdale’s—had drastically shrunk or eliminated their petite departments.

  A hue and cry arose, from five feet off the ground. From Houston to Orlando to Philadelphia to Fresno, the Petite Flap was reported on, opined about, and fretted over. By the end of June, Saks had changed its mind, and some of the clothing designers, who had shut down their petite lines in response to the department stores’ decisions, reopened.

  Little Women are apparently Big Business.

  In retrospect, it seems that the department stores had made a reasonable judgment. Whereas petite sales were a growing industry overall—up 11 percent to $10 billion in 2005, with stores like The Gap and Ann Taylor expanding their lines—petites had fallen off as a percentage of department store sales. The retailers wanted to make room for bags and shoes and jeans, which were selling better.

  But the Little Ladies of America would have none of it.

  It turns out that most of the really vocal protesters were elite shoppers (this was Saks and Neiman Marcus, after all) and they were decades-long customers, meaning they were older. Indeed, some of the news stories speculated that one of the reasons the stores had tried to do away with their petite departments was that they were trying to lose their association with older, drabber, and pushier ladies—precisely the ones who came out swinging.

  But peeved matrons aside, the Great Petite Flap of 2006 tells us something about short women in America.

  Because even as the American frame grows longer, there have never been as many petite women in America as there are today.

  In the garment industry, “Petite” means clothing for women 5'4'' and under. Along with “Juniors” (teens), “Misses” (women starting at 5'5''), and “Plus-Sizes” (sizes 14–28), “Petite” completes the universe of women’s clothing. In addition to shorter hemlines, petite clothing generally also means narrower shoulders, higher armholes, smaller buttons, and shorter waist-to-hip lines. If you’re 5'1'' and try to wear Misses clothes, you will find yourself not only tripping on pant legs and pushing up sleeves, but also contending with droopy inseams and NFL-like shoulder pads. It’s embarrassing.

  So why the rise, so to speak, in Petite Ladies?

  Part of it is that today’s women are living longer. An American girl born in 1900 could expect to live to 43; an American girl born in 2000 can expect to live to 80. As the population ages, more of America’s women have the genes of an earlier era, when people topped out a little shorter. They’ve boosted the petite count.

  Second, all that aging means a fair amount of shrinking. Beginning at age 50, the discs that cushion our spinal column start compressing, and we lose height. By age 80, we lose an average of one and a half inches. Not to mention the shrinking that comes from osteoporosis and compression fractures, changes in posture, flattening of the arches, and increased curvature of the hips and knees—all common to aging. A few of those symptoms in combination could knock a lifetime Misses shopper smack back to Petites.

  But most importantly, the predominant immigrant populations in America are shorter, on average, than the native-born. The Dutch, considered the tallest people on earth, topped out in terms of immigration to America back in the 1880s. Sweden peaked around then, too, and Norway in 1900. For the last half-century, the overwhelming majority of America’s immigrants have been Latino and Asian, who skew a good two to three inches shorter than the average American woman. While they haven’t been numerous enough to bring down America’s average height, they do—at more than 1 million per year—push up the petite count.

  You would think that the growing petites would have clothing manufacturers scurrying to outfit them. But for the most part, clothes-makers are chasing the obesity trend, trying to keep up with America’s Full-Figured Gals and Big and Tall Men. Lane Bryant opened seventy-five new outlet stores in July of 2006 alone. Who’s dressing the tiny ladies?

  Here’s the other important implication of being undersized and under-the-radar. The Powerful Petites have brought to light the remarkable truth that apparel-makers don’t actually know how big any of us are. The standard sizes that America’s clothing manufacturers use—like the 6-8-10-12 system that most women assume was established in a forgotten time—was actually created in the 1950s, fairly haphazardly, and for a far smaller, more homogeneous population than America has now.

  Not until 2004 did the Department of Commerce join with merchandisers to remeasure America—subjecting 10,000 underwear-clad volunteers to a white-light closet that produced hundreds of accurate body measurements in under a minute. But so far, they’ve publicized almost nothing, and experts say they’re unlikely to revolutionize everyday America’s clothing anytime soon.

  What the researchers did reveal is that whereas the typical American female shape used to be an hourglass, now it is a pear. Hips are now officially wider than shoulders. We are tall, short, and everything in between—just like Sesame Street always said. But as a result, there is a seriously under-tapped market out there.

  While runway designs may never accommodate anyone but the gauntly statuesque, the rest of us may have learned something from the Powerful Petites. It may be time for us all to storm down New York’s Seventh Avenue, with our hips bulging and shoulder seams pinching. Half of American women say current styles don’t flatter them, and when they do find clothing they like, they can’t find their size. Whether people are shrimpishly short or terrifically tall, they’d all like some clothes that fit, please. And whichever clothes-makers come around to accommodating that are sure to have a serious advantage.

  PART XII

  Technology

  Social Geeks

  The Geek in America is as entrenched a personality as the Jock, the Cheerleader, the Punk, and the Rebel.

  But a funny thing happened on the way to the Star Trek convention. Technology crossed over from being a thing for introverts to being a thing for extroverts. While the cliché still hangs on that devotees of technology—people who use it constantly, know its lingo, and race to buy the latest gadgets—are social “losers,” the truth is that the most enthusiastic users of technology in America are also the most social people in America.

  Geeks as we knew them have all but disappeared, possibly even becoming anti-tech—seeking solace in being cut off and disconnected. Once upon a time, working with technology provided an outlet for brilliant but anti-social people who found comfort in machines that responded to them in ways people did not. Now, technology plays the opposite role. And with new music players like Microsoft’s Zune now connected to everyone else’s, even the solitary act of listening to your own music in headphones is about to become part of a social community. The social uses of technology, with its new emphasis on “connection,” have far outstripped the antisocial, individualistic purposes technology used to serve.

  The implications for technology marketing are staggering. Whereas tech companies used to target their products to pasty, lonely guys, now they sell having a great PC or cell phone as cool—as much fun and as social as buying a great car. Being tech-savvy was once socially disdained. Now it is at the center of organizing friends, parties, and the social life of the family.

  Here’s the proof. In a recent poll, we overlaid some Myers-Briggs personality test questions with questions about people’s habits, attitudes, and preferences regarding personal computers, cell phones, handheld devices like BlackBerrys, and portable music players. If the old Geek cliché were right, the most devoted techies would be the most introverted, antisocial personalities, right?

  In fact, the opposite is true. Although the U.S. adult population as a whole is about 49 percent “extraverted” (defined by Myers-Briggs as folks who draw their energy from the world and people around them), nearly 60 percent of the most enthusiastic tech users are extraverted. These are the people who read about advances in consumer electronics and digital devices; are described by friends as into the latest technology and knowledgeable about computer software; and who look forward to new versions of operating systems. But these are also the people who are the most busy juggling family, work, and school, and who are living the most active and engaged lifestyles. They go to movies, exercise and play outdoor sports, and listen to recently downloaded music from iTunes far more than those at the other end of the spectrum who were very reluctant to use technology. By more than 2 to 1, the techies opted for “nightlife/hitting the town” as a form of entertainment more so than the “reluctants.”

  It’s the reluctant users—the ones who buy and use technology only when they have to—who turn out to be the introverts, by the significant margin of 57 to 43 percent. These people are not only less interested in technology, they are also less interested in sports, news, magazines, and fashion, and they tend to be more conservative and cautious all around. The people who shy away from social life now also shy away from computers—associated as they are with extroversion, ironically enough.

  Source: PSB, 2005

  In fact, the Geek cliché is completely turned on its head when people are asked about their social habits. Fifty-three percent of the “super-engaged” and “enthused” technology-users consider themselves to be socially savvy, compared to only 39 percent of reluctant technology-users. Fifty-eight percent of enthused technology users say they can “talk easily to almost anyone for as long as they have to,” compared to only 40 percent of the reluctant tech people.