LOS ANGELES
PITY poor Ashley Tisdale. Riding high from her success as the scheming Sharpay in “High School Musical 2,” she seems to have come down with a minor case of Jennifer Grey syndrome.
After having surgery to fix what she said was a deviated septum on Nov. 30, she emerged two weeks later with what looked to many casual observers like a brand-new nose. Celebrity magazines and blogs piled on, questioning her for tinkering with the trait that many people say made her special.
Five-year-old fans said they no longer recognize her. She looks “plain,” “average,” even “Stepford,” according to some of the online comments.
“Any character her face once had is GONE!” says one of hundreds of opinions that poured into perezhilton.com after the first post-surgery pictures of the 22-year-old actress surfaced. “Bye Sharpay. Hello bland!”
As a celebrity, Ms. Tisdale might have expected scrutiny. (At least she still looks like herself, unlike Ms. Grey, the “Dirty Dancing” star whose rhinoplasty altered her face so much that her acting jobs dried up.) But anticipating and dealing with negative reaction to changed looks is not just for the boldface set.
Plastic surgery has become mainstream almost 11 million procedures were performed in the United States in 2006, up 7 percent from the previous year. The vast majority were performed on women, with breast augmentation and nose reshaping leading in popularity.
Doctors say that anxiety about the response is common among patients and that they can expect comments that are not of the you-look-fabulous variety.
“As patients become more open about it, they should expect more open feedback, good or bad,” said Dr. Richard A. D’Amico, the president of the American Society of Plastic Surgeons, who practices in New York and Englewood, N.J. “There’s no question it adds some stress to the decision-making process.”
Plastic surgeons say rhinoplasty has the most potential to jolt the patient’s friends and loved ones. But any type of facial surgery can spark strong reactions, including silence, stares, gossip and confrontational remarks.
Sometimes people react as if mourning a loss.
“A couple of people said: ‘Where’s Pat? You don’t look like yourself,’” said Pat Casanova, 57, an asset manager in Los Angeles who had a face-lift two years ago. “They were just a little bit in shock.”
Lois W. Stern interviewed more than 100 women for “Sex, Lies and Cosmetic Surgery: Things You’ll Never Learn From Your Plastic Surgeon” (Infinity Publishing, 2006). She said the women gave various reasons for less than ecstatic responses to their surgeries: some said that looking better and feeling more confident unhinged boyfriends and husbands; a few had relatives who disapproved of the cost; and some said that friends became jealous and competitive.
Ms. Stern, who herself has had a face-lift, found that men became more attentive and complimentary while women’s reactions ranged from thrilled to hostile. Her once chatty hairdresser clammed up when she noticed the surgical scars on her scalp.
“I could feel something in the air, there was a different tone and I left her because of that,” said Ms. Stern, who lives on Long Island. “With some people, their value system says it’s a frivolous thing.”
Not all criticism is subtle, especially from those who believe surgery has robbed someone of an endearing feature or rendered him or her almost unrecognizable. Dr. R. Merrel Olesen, the founder of La Jolla Cosmetic Surgery Center in La Jolla, Calif., recalled a case of buyer’s remorse in which a woman wanted her prominent nose back, after being shunned at a reunion for erasing a feature shared by many relatives. “The family almost made her suicidal,” he said.
Image BEFORE AND AFTER The actress Ashley Tisdale, as she appeared in 2005, left, and earlier this month. Recent surgery on her nose has upset some of her fans.Credit...Left, Frederick M. Brown/Getty Images; right, Peter Kramer/Associated PressOften, the harshest disapproval comes from children.
“My son was really sad,” said Jane Glenn Haas, the founder of WomanSage, a group for middle-aged women, and a columnist for The Orange County Register.
Ms. Haas said an inheritance from an uncle nine years ago allowed her to get rid of what she called her “walrus” look a double chin and bags under her eyes. She went ahead with the surgery, though dreading the reaction.
“I thought people would make fun of me because I’m not a glamorous type of person,” she said. “I felt a need to justify it. I told everybody I used money that I had inherited.”
The face-lift was overwhelmingly embraced by everyone in her circle, she said, except her 31-year-old son. He told her she looked “like an Orange County woman,” which she said meant a woman with so much money she could buy herself a new face.
“I thought he was kind of kidding at first,” she said. “I felt very badly because I realized that there’s a ‘mother look.’ I didn’t look like that anymore.”
Ms. Haas told her son to get over it. “I was very pleased with the way I looked,” she said.
Dr. D’Amico said that what best equips patients to deal with the emotional consequences of cosmetic surgery is wanting to do it for themselves. If the motivation is something like needing to be liked by others or trying to fix something else that is wrong in their lives, “you refer them to a counselor,” he said.
Some patients, of course, hear nothing but compliments. Linda Rios, 50, a stay-at-home mother in San Diego who had a face-lift in July, said that if anyone made catty remarks, she is unaware of it.
“Everybody I’ve talked to is in awe,” she said. “Several of my friends have asked for my doctor’s card.”
And many patients say that after a while, the surgery is all but forgotten. Still, enough of a stigma lingers to make some people deny, fib or at least not advertise the reason they look different.
Sandra Miller, of Los Angeles, a 38-year-old writer, had surgery at 18 that included fixing a deviated septum and straightening the tip of her nose. Last year she again had a little work done on her nose.
She told no one about the first surgery and only a few close friends about the second one.
“You’re kind of embarrassed to say that there’s a problem with the way you look,” she said. “I wanted to look better but didn’t want people to know why.”
In Hollywood, where looks make or break careers, it is almost unheard of for an A-list star to own up to artificial enhancements. Ms. Tisdale told fans on her Web site that her nose surgery was for “health” reasons. But plastic surgeons say that fixing a deviated septum does not result in a changed nose.
Dr. Brent Moelleken, whose sees his share of celebrities at his practice in Beverly Hills, Calif., says some patients come at odd hours, wear disguises to throw off paparazzi, or pace their surgeries over several years “so you can’t put your finger on what’s happened to that person.”
Although he suggests that patients get a new hairstyle or admit to at least getting the eyes done as a way to explain away a new look, Dr. Moelleken said the best course is to come clean.
“The people who are the most open about their plastic surgery have the most positive experience,” he said. “If you’re open about it, you’re unembarrassable.”
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