Only chemical face peel can remove the vertical wrinkles of the lip.

What's your fantasy? A face free of wrinkles, a symmetrical nose, ears that lie flat against your head, a pronounced chin? If you're a woman, do you desire breasts as voluminous as Anita Ekberg in her prime? If a male with your hair dropping as falling leaves from an autumnal tree, would you welcome a pate like Samson's before he trusted Delilah ? Plastic surgery may be the partial answer to some of these longings. Not only has the surgery become simplified, painless, and medically safe, but psychological attitudes have now changed so that cosmetic surgery is no longer the privilege of a pampered matron who can afford to fly to a Swiss clinic. A highly competitive society that does not prize the venerable, plus the exaltation of youth, often impels people in the work a day world to maintain their appearance via surgery.

The cinema has done a great deal to mythicize plastic surgery as a means of changing not merely physical features but the total persona. Who has not heard of Gary Cooper submitting to facial surgery while in the throes of cancer in order to complete his last film, or of Phyllis Diller's transformation from an ugly, aged duck into an acceptably aging goose? In Ash Wednesday, audiences thrilled to the sight of the actual cutting of flesh in the total rejuvenation of Elizabeth Taylor, who ostensibly had almost every part of her body worked on simultaneously.

My favorite bit of cinematic nonsense involving plastic surgery can be found in the old Bogart film Dark Passage (1947) where Bogie takes a bum rap, resorts to a sleazy operator called “Doc" who works on Bogie in a barber's chair. A week later, when the beauteous Lauren Bacall removes the bandages, the man becomes none other than the Humphrey Bogart whom we know and love but unrecognizable as a criminal.

Cosmetic surgery does not belong to the realm of personality renovation. You neither have to resort to some “Doc” to bootleg your face for a couple of hundred bucks, nor do you have to be rich to afford it. It's a case of priorities. You may obtain cosmetic surgery for the price of a two week vacation in New York and mere are now 21 plastic surgeons in San Diego county who have been certified by the American Society of Plastic and Reconstructive Surgeons as specialists in this area.

Which is not to say that the presence of eminently qualified specialists removes special hopes and anxieties. In a large waiting room where I interviewed, a middle aged man, obviously agitated, spoke compulsively to anyone who would listen:

“It's not a lift, really, just that my face has this crease, and when I shave it bothers me, and I have to look right for my job. In my line of work I have to look right. I'm not vain, but after all, it’s been bothering me and bothering me, and I didn't want my real doctor to know so I saw this name in the Yellow Pages and here I am...”

“You’re a brunette,” sniffs the lady whose dewlaps quiver,“and I heard that natural redheads come out the best, then blondes, then brunettes. The coarse dark skinned people, they’d better save their money. I'm told.”

“Is it true?” offers another with a large mole on her nose, that you have to have a psychiatrist certify that you’re o.k., stable, I mean? Suppose you’re a man and you get to look 25 years younger but in other parts you’re still the same, I mean wouldn't that make you feel awful?” Her voice dips with fear. “If you have to be checked out by a shrink, I’m not going through with it.”

None of the above anxieties need concern anyone who has a realistic approach to cosmetic surgery, which intends to ameliorate, improve, correct, or remodel. Generally speaking, a face lift may allow you to look three years younger or no years younger, but it makes you appear as handsome as you can for that age. Also, some candidates are automatically ruled out if their expectations appear absurd when chatting with the doctor, if they have poor general health, or, in relationship with their face, they are obese and have thick oily skin or unusually short necks. Some senior citizens: over 70, have had successful plastic surgery if they are in good health.

Suppose you want a nose job (rhinoplasty) a face lift, enlarging or reducing the size of the breasts (mammaplasty) or even the removal of a tattoo, how do you find a good doctor? According to my informant, himself a Board certified physician, the best way is to ask someone who has had plastic surgery performed with satisfaction. 90% of this doctor’s patients have been referred to him by other patients, and 10% arrive by way of other physicians. These statistics reverse the ratio of other specialties where 90% of the patients are doctor’s referrals.

A Board certified doctor has had four years of training as a general surgeon, plus two as a plastic surgeon, plus having had to pass special examinations. A decade ago, a plastic surgeon had to have practiced two years and presented 10 representative cases before qualifying for Board exams, but this process has now been simplified.

In San Diego, to obtain a qualified plastic surgeon, you may consult your family doctor or internist; call the local County Medical Society; inquire at a teaching hospital (University Hospital), or write the American Society of Plastic Surgeons, 29 East Madison, Chicago IL. Ethical plastic surgeons are not permitted to advertise, so be wary of those who do.

If you've read your San Diego Union or Pennysaver with care, you may have wondered about a certain Margie who assures you that you may obtain a “bargain” face lift. I did call her and she offered to take me to a Tijuana clinic where I could obtain a job at one third the American cost. Recently. I tried to find this doctor listed in the Tijuana phone book, but no such luck. Yet without a doubt there are people who are chauffeured over the border for work that may be obtained here at fairly comparable prices. She quoted $1200 as against $1400 in San Diego and the drama of being spirited across the border did smack of a 1940’s film.

However, the major change in cosmetic surgery is that it is no longer hospital oriented. In San Diego, many Board certified surgeons have banded together to perform cosmetic surgery in their offices, under hospital conditions. These clinics eliminate high hospital costs. The process allows the patient to return home the same day. The office I visited and whose facilities I inspected performs 30-36 surgeries a week, with three doctors operating, though not necessarily simultaneously. With the exception of breast reduction (reduction mammaplasty) which requires general anesthesia and a hospital stay of 2-4 days, common types of cosmetic surgery are done under local anesthetic (a valium drip) and in the office.

The other major change relates to gender. Many men resort to cosmetic surgery for baggy eyelids (blepharoplasty), face lifts, chemical face peel, dermabrasion, even stomach flattening (abdominal lipectomy). Vanity does not impel men as much as simple economics. It is no secret that unemployed men over 50, as well as middle aged men with jobs, frequently have to mask natural aging. Senator Proxmire, with his hair transplant, face lift etc. may obtain the publicity, but plastic surgeons can testify to legions of men who resort to their skills.

A few words about the face lift. The term face lift has been used by the public to mean general reconstruction, but to the surgeon it addresses itself to loose skin or wrinkling of the skin on the cheeks and under the neck. Deep wrinkles around the mouth and eyes are not affected by a lift, which literally lifts the skin from the face, snips off the excess and secures it into the scalp and around the ear. Usually, baggy eye pouches are also removed (uppers and lowers), though each of these may be elected as separate surgeries. A person may have the flab of a “turkey neck" and wattled cheeks corrected by the lift, as well as the pouches under the eyes.

However, only chemical face peel, which peels off layers of aging skin, can remove the vertical wrinkles of the lip. Dermabrasion or sanding of the skin improves surface irregularities. Recently, when Peggy Lee appeared as a guest on the Johnny Carson show, her face seemed as smooth and as free of imperfections as a woman 25 years her junior. One can only conjecture how this was achieved.

One of the most popular surgeries for women at present is the breast implant. For years, while the controversy over silicone injections raged, plastic surgeons tried to find a safe and relatively inexpensive form of breast augmentation. Liquid silicone has been deemed unsafe in California — it destroys and damages tissues and may result in the loss of the breast itself. The new implants come in all sizes and shapes and are placed behind and not into the breasts. Allegedly, the implant of a soft, pliable material placed behind the breast merely lifts up and out what nature presented in the first place. The breast augmentation theoretically does not impair breast feeding, examination for possible tumors etc.

The office I visited does 25 to 30 breast implants a month, with July and March the biggest months (spring and summer vacations). The surgery takes one and a half hours, and except for restrictions on tennis, golf, swimming, or bowling for five weeks, the woman can resume her normal life within 24 hours.

For those who wonder about the fees: they vary. Doctors will take into consideration the reasons for the surgery, and the patient's financial condition. Example: a starving actress who needs cosmetic surgery may be in a better situation for reduced fee than a wealthy executive. The scale below, based on San Diego, is therefore approximate, give or take a hundred or so either up or down.

Bear in mind that cosmetic surgery remains only one of several types performed by the plastic surgeon. Congenital anomalies (children born- without ears, noses etc.), cleft lips and palates, surgery of the hand, trauma surgery (reconstruction following an auto or motorcycle accident), correction for burns, and for head or neck cancer, are also a large part of the plastic surgeon's duties.

The Crippled Children Society has funds allocated for any who cannot afford expensive surgery. Medicare will cover the cost of most of the above, and Mercy Hospital has a low fee or no fee clinic attached to its regular surgery clinic. Therefore, no one from a deprived economic class has to suffer for want of excellent plastic surgery care in San Diego. The very doctor I interviewed, who has a posh private practice, does all other forms of reconstructive surgery at Mercy Hospital for no fee or very low fees. Even in cosmetic surgery, you can, as they say in New York, “boggin" (bargain). No teen ager need suffer psychological pangs because of a distorted nose of Dumbo-like ears or a skin pocked and scarred as Vesuvius.

Lest this article sound as optimistic as those appearing in “ladies" magazines, remember that no doctor I spoke to would admit to gross failures or to vastly disappointed patients. Some must exist, but as I emerged from interviewing into the fastidious San Diego sky. I remembered Rock Hudson in the movie Seconds and I thought .... Myths live and only mirrors lie.