America, the beautified
Not so long ago, it would have been difficult to imagine Naomi Wolf ever contemplating plastic surgery. Her 1991 bestseller, “The Beauty Myth,” argued that women, no longer restricted by traditional roles of homemaker and wife, were constrained by another kind of social control, equally as stifling: the struggle to fulfill Madison Avenue’s definition of beauty.
“I’m 41 now, but when I was 26 cosmetic surgery was a fringe activity,” Wolf says today. “Now it’s so normal, if I choose to age without it, I’m going to be the only old hag in America.”
The quest for physical perfection has become a national pastime. We’re not talking the occasional nose job or breast augmentation, liposuction or lunch-hour Botox. Patients are getting younger, they’re getting multiple procedures, dentists are lobbying to be licensed to perform rhinoplasty as well as root canals, and when we’re not getting made over we’re watching makeovers on TV. No longer a science fiction fantasy, the possibility of becoming someone else is now a reality. The secret is not, as the late cosmetics titan Estee Lauder famously said, “hope in a jar,” it is wish fulfillment under the knife or needle.
Never have more people been moving toward a universal standard of beauty. It brings to mind the classic “Twilight Zone” episode “Eye of the Beholder,” in which a woman born with the handicap of ugliness undergoes corrective surgery. As the gauze is removed from her face, the doctor despairs, “Nothing. No change.” In the twist ending, it’s revealed that the patient is a beautiful blond, while her doctors and everyone else in this alternate universe are pig-like. With a remake of “The Stepford Wives” in theaters, it appears we’re revisiting the age of conformity. Does what’s on the inside really matter anymore, or have we become a makeover nation?
Richard Rakowski is betting on the latter. He founded the Advanced Aesthetics Institute, where pedicures, tummy tucks, blond highlights and Botox injections can be coordinated under one roof by what he calls a “dream team of self-esteem.” The first facility opened in November in West Palm Beach, and two others in Florida soon followed. In December the company caught the attention of L Capital, a private equity firm sponsored by the luxury goods conglomerate Moet Hennessy Louis Vuitton, which invested $20 million in the venture (a 40% stake). In May, Rakowski acquired the Georgette Klinger salons in Beverly Hills, Costa Mesa and seven other cities, which will be the vehicles for the further expansion of his concept later this year. He has plans for a network of 44 of the one-stop shops across the U.S. and abroad.
Rakowski believes he is at the forefront of an era he calls “post-Hollywood,” a time when lighting technicians and makeup artists no longer have a monopoly on the tools of image, and youth and perfection are attainable by more than the celebrated few. Today, he suggests, anyone can be one of the beautiful people.
The one-stop beauty shop
“We knew it couldn’t be pink, Italian or floral,” Rakowski says, “so, since our idea is to bring the architects of beauty together and to use a blueprint for beauty, we made it blue.”
The AAI flagship in West Palm Beach is in fact a shade of robin’s egg blue one might sooner expect of a Las Vegas wedding chapel. Far from the tony shops on Worth Avenue, it shares an airport-adjacent neighborhood with a baked goods outlet and a ragtop car museum. Outside, there’s a canopy, so freshly coiffed hair won’t be mussed if clients retrieving their cars from valets find the Florida humidity has turned to drops. Inside, visitors are greeted by an “aesthetics concierge” standing at a lectern like a restaurant’s maitre d’. On the walls are artsy black-and-white photographs of nature paired with corresponding images of the human physique -- a craggy tree trunk and limbs with a pair of hands and feet, for example. There are also quotes about beauty by Shelley and Dryden, and by Rakowski: “If beauty is only skin deep, then why are our hearts so moved by it?”
Dressed in a light-blue camp shirt, dark pants and Gucci-like loafers, his curly salt ‘n’ pepper hair combed into a neat helmet, Rakowski isn’t just the CEO of AAI, he’s also a client. On a tour of the facility, he ticks off the cosmetic procedures he’s undergone, at times employing home-improvement metaphors. He’s had Botox and Restylane, and he’s had his teeth bleached to a tint of white so bright that they beam from his tanned face. But it was his eye lift surgery two years ago that inspired the AAI concept. “I turned 50, looked in the mirror and said, ‘Oh my God, I’ve become my father.’ I felt like I was out of sync with my own body.” The next day he made an appointment for a blepharoplasty, and although the results were fine, the experience -- poor customer service and communication with his doctors -- left him thinking he could do better.
After $6 million of research over 18 months, Rakowski says, he found that “women are not satisfied anymore with the over-the-top, marketing-based promises being made by anti-aging creams. They are looking for real results. What changed everything was Botox, because it promised to reduce wrinkles and wrinkles went away.”
A fan of the show “Trading Spaces,” Rakowski also found himself fascinated by “the dynamic of someone coming into my space, taking over and telling me all the things I need so I can have a better environment.” Long before “Extreme Makeover,” he says, he predicted that the body would be the next focus of self-improvement mania.
With his partners at the Greenwich, Conn., investment banking firm Kidd & Company, Rakowski has spent the last 26 years developing businesses that integrate growing but fragmented markets. They tackled sunglasses with Sunglass Hut, telecommunications hardware with Chatham Technologies Inc. and healthcare with American Healthways. Beauty is a notion Rakowski finds inexact. To revolutionize the personal care industry, he believes, the focus must be shifted to objective aesthetics.
“A big component of someone’s appearance is their skin. In the past, people would say, ‘You’re glowing.’ But the skin glows for a specific reason, because of pore size, distribution and hydration. It’s all measurable. The same thing goes for facial symmetry, the lips, eyes and nose.”
Through his research, Rakowski says, he determined that there were no industry standards by which to measure the results of a cosmetic procedure except for “before” and “after” pictures, two of which, incidentally, are displayed in the lobby of AAI. So the company has embraced an array of high-tech diagnostic tools such as the Marquardt Facial Analysis Mask, the Visia six-part complexion analysis, daVinci Smile Art and Canfield UV Analysis -- to assess facial symmetry, skin quality and elasticity, sun damage and hair condition.
The AAI concept isn’t that different from the medi-spas that are already thriving in many big cities, offering Botox and Restylane injections alongside facials and eyebrow waxing. Except AAI can perform extreme makeovers -- giving clients new faces and bodies, hairstyles, makeup, even wardrobes if need be -- and has done them for free as a marketing tool.
But Rakowski insists that rather than bringing the extreme makeover to the masses, his vision is to make aesthetic procedures comfortable and convenient. “People told us they wanted a place that was a combination of Johns Hopkins, the Ritz-Carlton and a Swiss clinic,” he says.
Although surgeries are done at local surgery centers, a doctor provides consultations on site. The aesthetics concierge, who typically has some medical training but is not a doctor, coordinates the beauty team, from colorist to surgeon, and all aspects of the makeover process. For example, the concierge is available to go to the client’s home the night before to rearrange household items so they are easier to reach after post-operative bruising. Nonsurgical procedures such as Botox injections begin with a massage, and are performed in spa-like treatment rooms with heated, padded beds and soothing music.
Now a practicing Buddhist who believes that “everyone should be on a level playing field,” Rakowski describes engineering his own makeover, one worthy of prime time TV. The son of Holocaust survivors, he grew up in Brooklyn, a self-described “fat Jewish kid” named Rezy. “I had a black woman’s name, so I had the whole issue of my parents’ background and my name. I felt like the boy named Sue in the Johnny Cash song,” he says.
Starting his freshman year at Hunter College in the Bronx (now Herbert H. Lehman College), he was a poor student who was labeled “not very bright,” he recalls. But that was about to change. After piling up 38 parking tickets on campus, he argued in court that he had a right to know what he was charged with, and that if the tickets were legible he would plead guilty. Every ticket was thrown out. He went on to argue in court on behalf of his fellow students, and their illegible tickets were thrown out too. The case made him a campus hero. He met a woman he ended up dating all summer, lost 70 pounds, changed his name to Richard, and when he returned as a sophomore, nobody recognized him.
“That is when my life started,” he says.
Risk factors
In the age of reality shows such as “The Swan” and “I Want a Famous Face,” an age of surgery as entertainment, the term “makeover” has become a lightning rod in aesthetic medicine circles. Surgeons don’t want to give the impression that they are selling life-changing treatments; they don’t want to give the impression that they are selling anything at all. But the line between medicine and commerce has become increasingly blurred. Surgeons advertise on TV and in newspapers, some citing their makeover show credits. Some have enlisted public relations firms to help land media coverage or, ideally, a guest spot on ABC’s “Extreme Makeover,” the one surgery show most doctors support.
AAI has done three extreme makeovers, one of which was profiled on ABC’s “Primetime” before an episode of “Extreme Makeover.” But Rakowski says again and again that he is not in the extreme makeover business, and that most clients want only one or two treatments at a time. “That is a form of entertainment. There are very few people -- there are some, but very few -- who are saying, ‘I want you to make me over.’ ... In real life, a person decides the cabinets in their kitchen look tired and old and they resurface them. They need some new hardware, but they don’t have the money, so they wait six months and buy a new sink. Then they notice the old granite countertop. That’s the way people work in life. Someone gets hair extensions and all of a sudden everyone says she looks much younger. So she does a little Botox and buys some new makeup. Then they might realize their eyebrows are crooked.”
But cosmetic surgery isn’t exactly like a trip to Home Depot. Critics contend that AAI is really about the cross sell. Booked for a massage or a pedicure, clients might find that their curiosity leads them to the medical wing, where computer imaging tests analyzing facial symmetry are offered for free. During initial treatment consultations, which are also free, the concierge might use a flip chart of photos to assess common complaints (saggy eye lids, jowls, etc.). Could AAI be introducing clients to a Pandora’s box of physical faults they never knew they had?
To Linda Wells, editor in chief of Allure, the idea of making plastic surgery too friendly is frightening. “Can you imagine handing out one of those flip charts of neuroses in New York or Beverly Hills? Women would check off each and every thing,” she says. “Even if you take away the moral issue, surgery should be approached in a careful and cautious way, and maybe a clinical way. Maybe you need a doctor’s office with steel and bright lights.”
Naomi Wolf agrees. “I’m not going to say ‘The Swan’ is an evil patriarchal oppressor, but the forces I wrote about are still strong, especially the economic ones.” She recently participated in a study conducted by the Dove beauty product company that yielded some contradictory results: 90% of women consider their looks “average” or “above,” but less than 50% are “very happy” with their faces. “You have two extremes, the cosmetic extreme who are getting more technical and cut-it-all-to-pieces, and the group of women who are saying, ‘I’m going to get off the treadmill and out of the rat race,’ ” Wolf says. “But capitalism is still working the way it was.... Cosmetic surgery is a growing market, and women are being under-advised about the risk.”
Even Dr. Peter Fodor, who is on AAI’s medical board and has been approached to run a future Beverly Hills outpost, has reservations. “The concept has a lot of appeal, but the line must be drawn in the sand. If you were not aware of something that can be done, we are there to let you know it’s feasible. But I don’t use computer imaging because I don’t want it to be an incentive,” he says. “The last thing I want to be involved in is a hard sell.”
AAI’s credentialing process for doctors is extensive. Besides assembling a medical board (which includes Dr. William Dorfman, a cosmetic dentist seen regularly on “Extreme Makeover”) the company entered a consultative agreement to have its practices reviewed by Johns Hopkins Medicine.
“We felt that the ideas AAI put forward is the way the field will go,” says Craig A. Vander Kolk, professor of plastic surgery at Johns Hopkins and co-director of the Johns Hopkins Cosmetic Center. “We evaluate that the environment is safe and meets standards we have in our own cosmetic center. We review brochures, in terms of the claims they make about what works and doesn’t work. And we are working with AAI to help them come up with the best protocols and the best treatments.”
He adds, “We are strict on the commercial aspects. We have guidelines about what hair salon people can and can’t say. They are not allowed to say ‘Maybe you should have your eyebrows lifted’ or ‘Maybe you should have a little Botox.’ ”
Dr. Toby Mayer of the Beverly Hills Institute of Aesthetic and Reconstructive Surgery, who has appeared on “Extreme Makeover,” isn’t entirely convinced. “As in other areas of medicine, you can walk in the door, but where’s the constraint of the plastic surgeon earning a fee being a consultant for the patients and saying, ‘You don’t really need this’? “ he asks. “With mass marketing, that goes down the tubes.”
“The model is not without precedent, but the scale is -- this is a chain,” says Deborah A. Sullivan, an associate professor of sociology at Arizona State University and author of “Cosmetic Surgery: The Cutting Edge of Commercial Medicine in America.” “They are capitalizing on ‘Extreme Makeover’ and ‘The Swan,’ going from the extreme to the mainstream.” Surgery, Sullivan adds, is rarely a one-time thing. “This is a way of building loyalty to a place. But that’s done on the one-on-one level in doctors’ offices as well.”
The concept of a one-stop shop that uses diagnostic tests brings up a debate within the aesthetic medicine community about whether the discipline is an art, a science or a little of both.
“I find beauty in embellishment and mathematic variation,” says Dr. Laurence Rifkin, a cosmetic dentist in Beverly Hills who is also a trained artist and sculptor, and who will appear on an upcoming episode of “Extreme Makeover.” “Formulas are a starting point but not an end point. Every face has its unique quality, and it’s not always perfect -- like Cindy Crawford’s mole. When I design teeth for a smile, I evaluate the balance between the teeth, gums, nose and skin. The composition is equal to any sculpture or painting.”
Many patients seek out surgeons based on their specialty. Someone might be attracted to a doctor with a reputation for doing “good noses,” not because he’s a graduate of Duke University medical school.
“It’s McDonald’s come to plastic surgery,” Mayer says of AAI. “You can standardize a Big Mac, but you can’t standardize cosmetic surgery.”
The poster girl
According to Rakowski’s research, consumers often consult their hairstylists for beauty advice. So AAI’s strategy has been to take over and redesign existing salons with built-in customer bases. Kara Geib had been getting her hair done at Cosmo & Co. in West Palm Beach for five years before it became the AAI flagship and her hairstylist, Antonio, told her about the new services AAI had to offer.
A whip-thin blond with an ample chest, Geib, 32, strolls nonchalantly past her own “before” and “after” pictures in the AAI lobby and is greeted by Rakowski, who acts like a proud father. A librarian from Ft. Lauderdale, Geib had long been unhappy with her dark brown, curly hair, the bump in her nose and her small breasts. So, after consulting a concierge, she decided on Japanese hair straightening, blond highlights, a chin implant, nose job and breast enhancement -- all services AAI provided for free in exchange for her fulfilling the role of “research project,” as she is referred to on the company website.
“I’m a different person. I’m ready for anything. I can be myself without reservation,” Geib says of her transformation. She’s even lost a slight stutter she had since childhood. “We have to face reality. We live in a world where a book is judged by its cover, and image does matter,” she says.
Geib is turning heads in bars for the first time in her life, she’s more assertive at work, and she even had the confidence to overcome her fear of public speaking recently and address a group of 150 fellow library professionals. “I’m a big cheerleader, and I do give credit to AAI where credit is due. But there are times now when I just smile and thank people for their nice compliments and take them as my own.” Without pressure from AAI, Geib says she is more than willing to be a poster girl, speaking to the media on the company’s behalf. She signed a contract allowing AAI to use her photograph, but she receives no monetary compensation. However, her hair and makeup services are free for the year following the makeover, which itself would have cost $20,000 if she’d had to pay for it.
Yet even Geib, who had a storybook wedding when the bandages were barely off her face and talks of her makeover in life-changing terms, can see the implications. “I know people who have called for consultations,” she says, “who want ‘the librarian look.’ ”
Booth Moore can be contacted at booth.moore@latimes.com.
