LORENZO PESCE / CONTRASTO for TIME SELLING POINT Massimo says his youthful looks help his spa-equipment business

	SPECIAL REPORT

Posted Sunday, March 5, 2006; 12.33GMT
The pair have emerged from consecutive appointments with "the Knife Coach," as she calls herself — Wendy Lewis, a turbo-talking, wisecracking New Yorker. It has been a day of firsts for the ladies, and it's only lunchtime. They have signed up for their first elective surgeries — both will have face-lifts — a decision made easier by their first opportunity, courtesy of Lewis, to examine the results of this operation up close.

Later, in a busy café, Lewis grants me the same privilege, guiding my fingertips to scars under her hairline. Her forehead is preternaturally smooth for someone so expressive, and she has no laughter lines — though she laughs often and heartily. She doesn't look younger than her 46 years but she appears well rested — inexhaustible, in fact. Lewis is a walking advertisement for her self-created profession: she is a consultant on cosmetic surgery, independent from any practitioners, who makes her living by charging clients for advice on how they can improve their appearance and whom they should entrust with the task. She started in the U.S., but has seen clients in Europe since 2000. After this trip to London comes Paris, then Greece this summer. "The growth over here is exponential," she says.

In one important respect, the European market is different from that in the U.S. "Americans are notoriously litigious," says Lewis, "so American doctors practice defensively." Fillers — the injectable substances used to plump out creases and wrinkles — go through the arduous approvals process of the Food and Drug Administration before being licensed for use in the U.S. In Europe, most are classed as "medical devices" so require only a "Conformité Européene" certificate, a cheaper and quicker process. As a result, explains Lewis, "there are more than 70 fillers available in the European Union," but only eight approved for cosmetic use in the U.S. Professional qualifications vary from one European country to the next. "The fact that there are fewer restrictions on European doctors is both good and bad," says Lewis. "It means they can be more creative and try more products, but they also take bigger risks." She warns against cut-price surgery tourism. "A woman came to see me the other day with a brochure for a clinic in the Mediterranean and said didn't it look nice. I told her, 'If you want to go on holiday, go on holiday. What do you know about this clinic? Nothing.'" Quality is everything. "Most clients," says Lewis, "want to look better, not different."

Granted, democracy comes at a price. Alice Kisko, 33, from Aachen, Germany, is still getting used to the breast implants she received earlier this year — and their cost. She and her family went without their usual vacations to help fund the €3,000 operation. Luckily her husband and two children are all enthusiastic about the results. "My 10-year-old daughter was downright excited," says Kisko. "She said my breasts looked 'superwonderful and natural.'" Still, Kisko doesn't plan further cosmetic procedures and wonders about the participants in TV reality shows. "I feel like myself — even though the size of my breasts is still a little unfamiliar — when I look in a mirror. But how can these women do so when they look like entirely different people?" But such disapproval misses the point. If cosmetic surgery has become something that many Europeans — rather than a rich few — now contemplate, it's TV that's responsible.

Makeover!
When Isabelle Dinoire, recipient of the world's first partial face transplant, made her postoperative press debut last month, the scene at the hospital in Amiens, France, echoed the set-piece closing sequences of Extreme Makeover. That TV program uses surgery to transform plain Janes into sultry Suzys. The media applauded Dinoire's entrance and the patient declared, "I now have a face like everyone else. A door to the future is opening."

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