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BEFORE

NOV. 20, 2009

AFTER

JAN. 10, 2010

WHAT SHE HAD DONE:

1: MINI BROW LIFT

2: BOTOX IN FOREHEAD AND FROWN AREA

3: NOSE JOB REVISION

4: FAT INJECTIONS IN CHEEKS, NASOLABIAL FOLDS AND LIPS

5: CHIN REDUCTION

6: NECK LIPOSUCTION

7: EARS PINNED BACK

8: BREAST AUGMENTATION REVISION

9: LIPOSUCTION ON WAIST, HIPS AND INNER AND OUTER THIGHS

10: BUTTOCK AUGMENTATION

At 17, Heidi Montag left her home in Crested Butte, Colo.-and got a fast education in Hollywood beauty when she arrived in L.A. "Everyone had the biggest boobs!" she says. "I was flat and insecure." Her insecurity only deepened after she landed a role on MTV's The Hills. In 2007 she had a nose job and a breast augmentation. But it wasn't enough. "For the past three years I've thought about what to have done," she says. "I am absolutely beyond obsessed." And so on Nov. 20, with her husband, Spencer Pratt, 26, by her side, Montag, 23, turned up at the Beverly Hills office of her plastic surgeon Dr. Frank Ryan, where she spent 10 hours under the knife. Now, seven weeks after recovering in secrecy (she didn't even tell her family what she had done), she shares every detail of her physical and emotional journey-and tells why she plans to have more surgery in the future.

Let's start with the obvious: Most people would think you already looked pretty good. Why make all these changes to your face and body?

I would say the biggest reason is to feel better, to feel perfect. I was made fun of when I was younger, and so I had insecurities, especially after I moved to L.A. People said I had a "Jay Leno chin"; they'd circle it on blogs and say nasty things. It bothered me. And when I watched myself on The Hills, my ears would be sticking out like Dumbo! I just wanted to feel more confident and look in the mirror and be like, "Whoa! That's me!" I was an ugly duckling before.

How did you find a doctor?

Dr. Ryan is the same doctor who did my nose job and breast augmentation in 2007, so I knew I'd be in good hands. In the three years since he last operated on me, we've had at least 20 meetings so we could look at photos of me and of what I want to look like. I brought in a lot of photos-like Angelina Jolie, she has those really high eyebrows and I love them. He's been studying what to do, going over every single detail again and again. I trust him!

Did you really need 10 different procedures?

Think about the industry I'm trying to go into. My ultimate dream is to be a pop star. I'm competing against the Britney Spearses of the world-and when she was in her prime, it was her sex appeal that sold. Obviously, looks matter; it's a superficial industry.

Why not at least spread the surgeries out, so you could make more gradual changes?

That's kind of my personality: Everything at once. And I really just wanted to go under anesthesia once, instead of going under again and again. It felt safer for me. Plus I have a tight schedule: My album just came out, I'm launching a line of hair products, I'm about to start filming for The Hills. I didn't have any more time.

Are you still swollen?

Yes, and my face especially still feels a little frail. I know everything is going to turn out perfectly when all the swelling goes down.

How much did the surgeries cost?

It was beyond expensive [national averages according to the American Society of Plastic Surgeons indicate Montag's procedures would have cost upwards of $30,000], but well worth it. I'd been saving for two years after my first surgery. I knew it would be an investment for my career.

There will be some fans who think Spencer suggested you do all this. Any truth to that?

He was very resistant about the whole surgery. For the past few years he's been like, "No, Heidi-you are so beautiful. This is out of control." But I'm my own person, and I knew in my heart what I wanted. It's my body at the end of the day.

Are you happy with your body now?

I love my body! I still feel a little fragile, but I've never felt more beautiful and sexier. I didn't know I could have this much confidence.

How do you feel about your breasts?

I'm already planning my next surgery-I'm determined to get bigger ones! I know it sounds crazy [she is now a DDD], but I just love boobs. They make me feel more womanly. Dr. Ryan is very safety-conscious, and this was the most he could put in this time. But I can't wait to do it again. When I posed for Playboy [in Sept. 2009], I didn't fill out one of the bras and they had to Photoshop my boobs bigger, and it was so disheartening. I almost cried. I want to pose for them again but this time have it be sexier. Although I still don't think I'd be nude.

Does it worry you that people will fixate on your breasts?

I hope so. They better! That's kind of the point. Sex appeal is really important and it's not saying that you're only sexy if you have big boobs. That's not true at all, and honestly the way I got Spencer, I had no surgery. It was my inner beauty that he loved.

Other than still wanting larger breasts, are you happy you went through all this?

It was so worth it! I see an upgraded version of me. It's a new face and it's a new energy. It's a new person, and I feel like almost all of the things I didn't want to be and who I turned into kind of got chiseled away. So I'm very excited for the world to see the new me, and a real me.

Who is the real you?

I honestly was never the prettiest girl. I was more like the frumpy sidekick to Lauren [Conrad, her costar on The Hills]. Everyone on that show was rich, and if you look at my wardrobe that first season, I was wearing Lauren's leftovers! So now that I feel like a sexy, confident woman, that to me is a Cinderella story.

Your faith is very important to you. Did you struggle at all with changing what God gave you?

I prayed about it for a long time and said, "God, if it's wrong, then I won't do it." But I never got that feeling. My body is just a shell; God doesn't care. It's what's inside that God cares about.

Okay, so take us to Nov. 20, waking up after your surgeries. What were you feeling?

I saw stars. Everything was spinning. I knew kind of what happened, but nothing was solid. The pain was everywhere-my head felt like it had a jackhammer on it. I couldn't talk because of my jaw and chin. When I saw Spencer, I started crying hard, and I was like, "I feel like I wanna die right now. I'm in so much pain. I don't know what to do."

Beyond the extreme pain, were there any other frightening moments?

I was in so much pain, I asked for more Demerol. And that drastically slowed my breathing. They had to rush an oxygen mask over my face; another five minutes, who knows? It was that scary-I almost felt like I was gone.

How long did you stay in the hospital?

After surgery they took me in an ambulance to Serenity After Care, a recovery center in Santa Monica. I was there for five days, and then I got to go home. The first day being back was really hard. I asked Spencer to cover all the mirrors in the house because I didn't want to fixate on what I looked like then. And I felt bad that he had to even look at me. I looked like I had been hit by a bus. I was a purple, swollen mush-I didn't look human! It was so scary. I could hardly move. Couldn't even walk. And my back was black and blue and purple. It was more traumatizing just seeing it than even feeling it really. When I had a nurse come over so I could bathe, the first time the water touched me, I freaked out. I just felt so fragile.

Did the recovery process test your relationship?

Asking my husband to take down my pants so that I can go to the bathroom? That's not something I ever wanted to have to do. I mean, you want your husband to look at you and feel sexy, not have him waiting on you hand and foot, feeling like you don't want him to look at you. But it took our marriage to another level.

How has your family been dealing with your decision?

I actually didn't tell them that I was doing this. The first time I had plastic surgery, I told everyone I was getting it, and nothing but negative and unnecessary things were said. Most of the people around me were unsupportive. But I'm a married woman, and at this time in my life I can make my own decisions. So I told my family I've been sick, which is true. They just don't know it's from plastic surgery.

Are you worried about the public's reaction to your makeover?

People can say whatever they want, but I'm the one living in my skin. I'm the one in this cutthroat industry. Every starlet is getting surgery every other day to keep their looks up. They just don't talk about it. I wanted to be honest. For me, this was a personal choice.

Do you finally feel beautiful?

Yes, I think I look way better and I'm way happier. Before, I wouldn't even want to smile in photos since it would elongate my chin. My eyebrow lift just took my face to another level, made it a little bit more European-exotic. And for the first time, I have sexy ears! I can wear updos, instead of hiding them behind my hair.

Does that mean, aside from your breasts, you're finished with plastic surgery?

I'm just starting. As you get older, there are so many different treatments-all the big celebrities get their spider veins removed. Let's just say there's a lot of maintenance. Nobody ages perfectly, so I plan to keep using surgery to make me as perfect as I can be. Because, for me, the surgery is always so rewarding.

FOR MORE OF HEIDI'S PLASTIC SURGERY JOURNEY, VISIT PEOPLE.COM/HEIDIVIDEO