in the Name of Beauty

When he escaped Communist-controlled Poland as a boy, Z. Paul Lorenc never imagined he'd end up in one of the wealthiest corners of the United States, paid to slice into human bodies in the name of beauty.
During 17 years as a plastic surgeon on Manhattan's Upper East Side, Lorenc has operated on famous actors like Katharine Hepburn (after skin cancer), high-powered CEOs and members of what Lorenc calls the Park Avenue Posse—the ultra-rich clientele living near his offices.
His book, A Little Work: Behind the Doors of a Park Avenue Plastic Surgeon, written with Trish Hall, lays bare the weaknesses of his patients, of surgeons and of a society increasingly obsessed with physical perfection.
You say patients often lie. What do they lie about?
Their medical history. People often hide that they smoke, which affects your face. Others lie about medications they are taking, which can be very serious.
One male patient was taking steriods but wouldn't tell me. He wanted a face-lift and nothing would stop him. I've never seen a patient's face bleed so much in my life.
I try to convey to the patient that I'm on his side. I'm the one that's going to be taking his face apart and putting it back together. We have to have totally open communication.

Some people will even tell me that they haven't had plastic surgery before, when it's obvious they have.
Do you have a sixth sense for liars?
Sometimes. Usually, I see the face-lift scar. In that situation, I find a reason not to operate.
Do you say, "I know you've had surgery"?
Occasionally I will, but I don't like to be confrontational.
How are male patients different?
Men opt for different types of surgery. Rhinoplasty [nose job] and liposuction are most common.
Men, I think, find it more difficult to follow postoperative instructions. Many are business owners or in finance. They're in control all the time. They're the masters of the universe.
I once did the face of a man who owns a huge company, very well known. I went into his room two hours after the surgery to make sure he was OK. He should have been resting, but he was screaming into the phone at someone in his office, still running the company. The nurse didn't know what to do. His wife was crying. I had to disconnect the phone in the middle of his conversation.
Can a person really be addicted to plastic surgery?
Absolutely. The job of the plastic surgeon is to put on the brakes.
But evidently many surgeons don't.
Many of these people have body dysmorphic disorder. They're obsessed. I'll never forget one young man who came to me for a scar on his face. He insisted that he had this awful acne scar. I looked through my [magnifying glass] but found nothing there. He was totally focused on it.
The worst thing for me to do would be to operate. Because afterward he would have had a real scar.
Do you think plastic surgery is distorting what is considered attractive? For example, that women should have big, round breasts?
I'm totally against cookie-cutter procedures. But much of this is media-driven. These shows on TV have done a disservice to what I do for a living. For instance, the show on MTV I Want a Famous Face, where someone tries to look like Britney Spears—that's insane.
Your big love outside of work is art. It's not tough to see the connection between that interest and your job.
I work with the ultimate medium, if you think about it. People always ask, "What's your favorite procedure?" My favorite is a rhinoplasty because it's truly artistic.