What Happens Between Before and After A rarely seen side of plastic surgery.

ve been interested in the way women’s outside relates to their inside,” says the photographer Lauren Greenfield. To that end, Greenfield has spent time over the past 20 years documenting plastic-surgery patients in operating rooms and recovery centers. Her work shows the very literal insides — the blood and tissue — exposed in cosmetic surgery, where the skin is peeled away from the muscle, where tubes drain fluid from beltlike incisions below the waist, where faces are scarlet, swollen, crusted, oozing. “The first time I felt a little sick was when I put down the camera and was watching a face-lift,” she says. “The face is so important and symbolic. It was hard to see it pulled off.”

The photographs are among those collected in Greenfield’s new book, Generation Wealth (an exhibition of the same name is on view now in L.A., and will open at New York’s International Center of Photography on September 22). They capture a side of plastic surgery that’s remained mostly unseen and little discussed, even as plastic surgery, in general, has become much less private. The medical reality they depict is a graphic reminder of what patients are willing to endure in pursuit of a magical transformation. Of course, “if you saw brain surgery or abdomen surgery, you wouldn’t like it,” says Dr. Robert Kotler, who specializes in facial cosmetic surgery in Beverly Hills. But “it’s healthier for patients not to be surprised.”

The leap from wrinkles to general anesthesia can seem unfathomable to anyone who hasn’t made it. Yet more and more do. Figures from the American Society for Aesthetic Plastic Surgery show the number of procedures climbing across the board since the late ’90s. Nonsurgical interventions (like Botox, lasers, and fillers), meanwhile, have become routine. But rather than replacing face-lifts — which remain “the gold standard” — they serve to “complement, enhance, temporize,” explains Dr. Alan Matarasso, a plastic surgeon in New York. “The general thinking is that these patients have bought into the process,” says Dr. Steven Teitelbaum, a Santa Monica plastic surgeon, “and that they will progress to surgery when their desires surpass the capabilities of these modalities.”

It’s tempting to dismiss such choices as extreme, but Greenfield regards her subjects with sympathy. “It’s sad because you see the necessity, an almost desperate necessity, to hold on to the things that give women value,” she says. “I think these choices are rational given the values of the culture.” And Greenfield herself got a glimpse of their experience while visiting a dermatologist for a non-cosmetic issue: He quickly offered her Botox.

“I didn’t even know I had wrinkles,” she says. “Right there, he created a problem that didn’t exist. It’s like realizing you’re naked in the Garden of Eden.”

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