Most prospective patients worry about their doctor's diagnosis or his bill; many entering the Beverly Hills office of Dr. Franklin Ashley are troubled by the suspicion that he will consider them vain. To which the plastic surgeon usually replies, "Of course you're vain, but that's all right." Elaborates Ashley, 66: "Our lives should not be run by vanity. Still, it's important that we look as good as we can, as long as there is no danger involved. And if a person's general condition is good, if his heart and lungs are okay, there's no reason why he or she shouldn't have plastic surgery."

If the doctor sounds a wee bit defensive, he has reason. Along with hot tubs, stretch limos and high-priced recreational drugs, one of the indulgences popularly imputed to the well-heeled and would-be Beautiful People is their willing resort to the scalpel. After all, Betty Ford played stitch-and-tell; the late John Wayne had a facelift a few years before he died; Ashley patient Phyllis Diller has been thrice rejuvenated; and even Cher, at 35, has had two postpartum body tightenings, and another for good measure.

In fact, 59 percent of the more than one million plastic surgery procedures performed annually in the U.S. are not whimsical but medically reconstructive—meant to repair birth defects, traumatic damage or the ravages of disease. In addition to thousands of Vietnam veterans who have benefited, burn victim Richard Pryor, Ann-Margret, whose jaw and left cheek were shattered in a 1972 Vegas fall, and Jason Robards Jr. and Mark Hamill, both seriously injured in car crashes, have had their faces and fortunes restored.

"All kinds of knowledge about the reconstruction of bodies was gained during World War II," says Dr. Ashley. "After the war, some doctors drifted into the cosmetic end. Fifteen or 20 years ago, it was still regarded as a 'dirty thing,' but the stigma is dying. We're getting patients younger, but also older, and lots more men besides actors—politicians and businessmen." In 35 years of practice, Ashley has seen the cosmetic field expand to include not only the now routine nose jobs and facelifts, but also the body-contouring operations that have become popular since the mid-'60s. These include breast augmentation via implantation of a sac filled with water or silicone gel (injecting silicone directly into the breast is now illegal), breast reduction and ptosis (lifting saggy breasts), tummy tucks and thigh and buttock reduction.

Of all the procedures he performs, Ashley says, patients probably expect the most from face and breast surgery. "Some people have mild depressions after surgery because they expect to emerge from the cocoon a beautiful butterfly," he says. "We tell them they won't, but they hear only what they want to hear. People expect their bodies to be beautiful without any scar, but there's no way to operate without leaving one. And while we can remove a [preexisting] scar, it will be replaced by another."

As for tummy tucks, says Ashley, they are designed for those in good shape except for "a little pouch on the abdomen that they can't get rid of by exercise." He is leery of grossly overweight people who "expect you to do their work for them," and recommends dieting and exercise prior to surgery so that excess skin can be removed. "Very controversial" is how Ashley describes hip and buttock operations. The problem again is the scar. Explains the doctor: "It's an area where you're bending and stretching all the time."

Born in St. Petersburg, Fla., Ashley graduated from Northwestern University Medical School, served in the Navy in World War II, and logged residencies in New York and Los Angeles before setting up practice in Beverly Hills. He has been affiliated with UCLA for 29 years, including three as its chief of plastic surgery. Ashley lives outside Santa Barbara with his wife, Rosemary, and two children, and is flown twice a week, by private plane, to his offices adjacent to the Beverly Glen Hospital.

As the public acceptance of his specialty is growing, Ashley must on occasion contend with the truly naive. "People bring in pictures showing how they looked when they got married," he notes with exasperation. "They aren't going to look that way no matter what you do. They will look better—more rested, healthier. But if friends come up and say, 'Oh, you had your face lifted,' that means too much has been done." The doctor also debunks the myth, fueled by countless mystery novels and big-screen thrillers, that plastic surgery can change a person beyond recognition. "Of course, if the surgery is improperly done," Ashley adds wryly, "that may happen."

Alterations cost thousands, but Phyllis Diller feels like a million

Comedy doesn't have to be pretty, but even Phyllis Diller blanched when she saw herself on a 1971 episode of the old Sonny and Cher Comedy Hour. "I was playing one of my usual witchy roles," she recalls, "and I threw my head back and there was a growth under my chin. God, it was ugly." The next day Diller, who until then had only joked about facelifts ("Hear about the woman who had so many that she always smiled? A mess at funerals—she looked like the sole heir"), phoned Dr. Franklin Ashley to arrange one for herself. That operation, her first of three, included work above and below the eyes, chin and neck lifts and a nose bob. "It was broken when I was 9 and got longer with time," she recalls. "From one angle I was Irish, from the other Jewish."

Professionally, of course, Diller's electroshock appearance had been her comedy trademark. "My old looks [she's now 63] put me far ahead as a comedienne," she admits. "But that first facelift changed my attitude. I was getting a little sloppy about the way I dressed. I didn't take as much care with my makeup. Men can get old any way they want, but when a woman starts getting puffy or fat, she's an outcast. So it wasn't just a facelift—it was an emotional and psychic lift." To skeptics who believe that only God should make a nose or a chin lift, Diller replies, "Sometimes He goofs. He made the Elephant Man too. And aging is a real thing which nobody enjoys. I'm for doing whatever you can." To assist other people in doing the same, she has written a book, The Joys of Aging—and How to Avoid Them, due from Double-day late this summer.

In her own case, Diller sought out Ashley in 1976 for more work around the eyes and for a breast reduction and lift. She describes her "boob-bob job" as "uncomfortable, but not as painful as some of the things I encountered in breast-feeding." Then last April Phyllis underwent another complete facelift, dermabrasion on her upper lip to smooth the lines around the mouth, and a tummy tuck. "My figure was shot, thanks to gin, mayonnaise, mashed potatoes and gravy—in that order," she explains. "They took out 300 grams [1O½ ounces] of fat and gave me a new navel. Do you have a strong stomach?" Abruptly, Diller peels back the top of her slacks to reveal a 12-inch scar extending horizontally across her lower abdomen at the bikini line. Each of her surgical procedures has been under general anesthesia. "I'm brave, but I can't stand pain," she says. "I was out cold for all of my five children." Only the tummy tuck gave her enough postoperative discomfort for her to take pain pills.

Today Diller, divorced from second husband Ward Donovan since 1975, lives in a 22-room Brentwood mansion with a Lhasa apso, Phearless, a golden retriever, Jemimah, and Pollard, a parrot. She works some 125 club dates and concerts a year and, ironically, now more than ever needs her trademark frizzy fright wig, short skirt and short boots to camouflage her reconstituted appearance. Some of her zingers still concern plastic surgery, but Phyllis has never joked about her own operations: "I don't see anything funny about a tummy tuck." Nor does she know how many lifts she has to look forward to. "You can only pull the skin so far," she says, "especially when it's as thin as mine. When I can't do it anymore, I won't." Besides, Diller cackles, "the only thing left of the original me is my elbows."