From PEOPLE Magazine Click to enlarge
Patricia Heaton took her red carpet walk at the Emmy Awards on Sept. 19 seriously. After all, the 46-year-old star of Everybody Loves Raymond and mother of four had put a lot of effort into looking radiant. And so she did, in a dress by Elie Saab, jewelry by Tony Duquette—and a tight tummy by the plastic surgeon also responsible for her nicely lifted breasts, all of which she'll cheerfully discuss if you ask. Accepting a compliment about her appearance, she smiled slyly. "There's a reverse thing that happens when you move [to L.A.]," she said. "You get younger-looking as you get older. It's odd."

Call it odd. Or a dream come true. Or go with the term such A-list actresses as Sarah Jessica Parker, Julianne Moore and Jamie Lee Curtis use: "an epidemic." A troubling one that many believe is sweeping the industry. From press interviews to red carpets to the lunch line for craft services, actresses are talking about plastic surgery with a passion usually reserved for discussions of tax cuts or, you know, what to wear to the Oscars. "It's out of control," says Shannen Doherty, 33, star of FOX's North Shore. "Why get lipo when you can work out or eat better?" For Kirstie Alley, 53, who plans to take on the phenomenon in her new Showtime series Fat Actress, "it's sick. We should start concentrating on our lives, [not] our noses and breasts." Kate Winslet, 29, told Harper's Bazaar she will "never" have surgery or Botox, because "I want to be able to really show the expressions on my face." And at 58, Diane Keaton, whose brief nude scene in last year's Something's Gotta Give provoked audience cheers and gasps, declares herself against plastic surgery as a matter of "integrity. I want to express my age and be authentic. Why do so many people follow somebody else's idea of what is attractive?"

But don't get Keaton wrong. When it comes to having a little work done herself someday, she makes no promises. As she says, "We'll see how it goes."

Which leads to another expression favored by today's A-list actresses. In the words of Hilary Swank, 30, "Never say never." The entire nation is enthralled by cosmetic surgery—according to the American Society for Aesthetic Plastic Surgery, 8.3 million Americans had procedures in 2003, up 20 percent from the previous year and nearly 300 percent from six years earlier. Hollywood's leading ladies, even those in their 20s, are nipping, tucking and injecting more than ever before, even if they do arrive at the doors of swank doctors from Manhattan to Miami Beach to Beverly Hills dragging their Manolo heels. "I can't think of a baby boomer I've seen recently who hasn't said to me, 'I never was planning to have a face-lift, but...,'" says Manhattan plastic surgeon Dr. David Hidalgo, who notes his clients also include twentysomething celebs. "Young people may have a disdain for plastic surgery," he says, "but nobody wants to lose anything."

They stand to lose one thing, though: their convictions. For actresses in their 20s, taking a stand against plastic surgery is relatively easy. But as age begins to take a toll, many hear—and heed—the call of the knife. At the office of cosmetic dermatologist Dr. Anna Guanche, just outside L.A., where there is a two-to three-month wait for a patient wanting Botox or laser resurfacing (as with all doctors, V.I.P.s get in faster), "there is a mad rush that begins at about age 40 to look 10 years younger. For actresses, their looks are their jobs," Dr. Guanche explains. "People come in saying they're losing auditions. It's not an issue of vanity. It's a necessity." And as celebrity makeup artist Ashunta Sheriff, whose clients include Alicia Keys, Usher and P. Diddy, notes, even for young stars, "this is the kind of industry that you're expected to be perfect."

And why not, if the means are available? At 23, Nicole Richie, costar of The Simple Life, sees "at least" Botox in her future. "It's all the rage," she says of plastic surgery. "To me it isn't all that different from getting fake tans or teeth-whitening. Why grow old gracefully when you have the technology to prevent it?" Jennifer Aniston, 35, is of a like mind. "Hey, I don't say no to anything. Anything that makes you feel better, go for it," she says. Her former Friends costar Courteney Cox Arquette agrees. "I don't think anything's wrong with plastic surgery," Cox told In Style, though she added, "I don't understand when people change drastically."

Indeed, for surgeons who cater to today's stars, the most frequent request--and the greatest challenge--is not to make a dramatic change (think Joan Rivers), but to safeguard an asset. "They want to preserve a face or a body familiar to millions of people," says L.A. plastic surgeon Dr. Stanley Frileck, "not alter it." That's why, in a nondescript building in Beverly Hills tucked between the Peninsula Hotel and Barneys, Dr. Brent Moelleken does "such tiny procedures that no one knows the face is changing," he says. An eyelid-lift here. A slight nose reshaping there. Even small-incision face-lifts done to look undone. "In the '70s and '80s God forbid we left one wrinkle behind," says Dr. Moelleken, who has a four-month waiting list. "That was an unreal look. Now it's all about looking natural." Across the country Dr. Hidalgo notes the same trend. "It's the physical version of airbrushing," he says. "It's plastic surgery lite."

Of course, there can be too much of even a lite thing. The ease of modern surgery--minimal scarring and recovery time--can be very appealing. Even addictive. The result, says makeup guru Bobbi Brown: "People start looking weird." Even some who embrace plastic surgery are afraid it's gone too far. Drew Barrymore, 29, had a breast-reduction operation in the '90s but notes, "I just know it's a slippery slope, and everybody's starting to look a little waxy lately. I'm going to do everything I can not to go down that road."

Pop star Gwen Stefani wants to avoid it too. At 35, the married singer is looking forward to motherhood. "I'm hoping my children will save me from my vanity," she says. If it doesn't, plastic surgery is an option—but not, she adds, a real solution: "It sucks to have to grow older. We all have to accept it."

Karen S. Schneider. Carrie Bell, Margi Blash, Alexis Ciu.Todd Gold, Maureen Harrington, Julie Jordan, Kimberly Lansing, Marisa Laudadio, Kwala Mandel, Dana Meltzer and Vicki Sheff-Cahan in Los Angeles, KC Baker and Liza Hamm in New York City and Meredith Nadler in London

  • Contributors:
  • Carrie Bell,
  • Margi Blash,
  • Alexis Ciu,
  • Todd Gold,
  • Maureen Harrington,
  • Julie Jordan,
  • Kimberly Lansing,
  • Marisa Laudadio,
  • Kwala Mandel,
  • Dana Meltzer,
  • Vicki Sheff-Cahan,
  • KC Baker,
  • Liza Hamm,
  • Meredith Nadler.