PROVINCETOWN — Cape Cod and, for that matter, New England are perhaps not the first places one thinks of when one hears the words “plastic surgery.” We value our old salts. And to some observers, at least, Puritanism still looms large here.
“In the Northeast,” said Dr. Russ Babbitt, a plastic surgeon in Fall River, “we are definitely still experiencing the ripple effects of the fact that we were founded by the people who left England in the 1600s because it was way too racy.”
In her 2018 book about plastic surgery, Perfect Me, the philosopher Heather Widdows argues that the plastic surgery industry has escalated the expectation that people — women, in particular — look perfect. Plastic surgery has caused our idea of what is normal looking “to become narrower and harder to attain,” she writes.
Because of Botox, Widdows writes, wrinkles and jowls have begun disappearing in some circles. Shaving and waxing — not plastic surgery, but still beautifying practices — have, she points out, made hairless adult bodies, for women but also increasingly for men, the default.
Widdows argues, in other words, that plastic surgery and other beauty technologies don’t just respond to our thinking, but actually shape it.
But not here, right? This is New England. Massachusetts. And the Outer Cape — a land of natural beauty.
Think again. Dr. Scott Allegretti, whose practice is called Provincetown Dental Arts, specializes in cosmetic dentistry practices. There is demand for cosmetic work, Allegretti said, “wherever you have people looking in a mirror.”
In fact, you can get plastic surgery right here in Provincetown.
The possibilities are not loudly announced. But if you haven’t been looking your best lately, and your network is tuned in, you could find yourself sitting in a chair in the living room of Dr. Rick Silverman’s Provincetown beach house, giving your consent as Silverman tweaks first this and then that.
In his living room, Silverman regularly wields syringes full of Botox, a neurotoxic protein produced by a bacterium. It paralyzes and shrinks facial muscles. He also uses hyaluronic acid fillers to resculpt cheeks, jawlines, noses, or even all three, should the need arise.
On a normal summer weekend, Silverman said, he sees as many as seven patients in Provincetown, in 30-minute appointments. He charges anywhere from $700 to $1,000 for these living room services.
Silverman’s official practice is based in Newton, where he specializes in treating gynecomastia, the medical term for “man boobs.” (Silverman does not treat gynecomastia in Provincetown because it requires an operating room.)
The demand for cosmetic surgery has increased across the country during this time of isolation. According to the American Society of Plastic Surgeons, 64 percent of plastic surgeons have seen an increase in consultations. Dr. Marc Fater at Cape Cod Plastic Surgery in Hyannis and Babbitt both reported that their practices are up 20 percent compared to 2019.
Silverman, for his part, has not noted an increase in business but, with the availability of telemedicine consultations, said he has been able to speak with patients across the country and globe. Some patients plan to fly down to him from Canada once the border reopens.
Speculation as to why plastic surgery has increased during the pandemic includes the practical idea that the pandemic, with its lockdowns and face masks, is the perfect time to inconspicuously heal from certain procedures. There is also the hypothesis that, unable to go on elaborate vacations or reserve tables at fancy restaurants, people with disposable income are spending it in new ways. Maybe there is a “Zoom boom.”
But it’s possible the uptick is just the natural progression of attitudes as acceptance of cosmetic procedures grows. Even into New England. That’s what Babbitt thinks. “I get busier every year,” he said.
Silverman said his work is not all about vanity. He treats HIV-associated facial lipoatrophy, the significant loss of fat from one’s face that is a complication of HIV and a side effect of many HIV medications. Silverman uses fillers to help these patients look more like their earlier selves.
Silverman has also treated drag queens in Provincetown who ask him to use fillers to feminize their faces, giving them the appearance of higher, fuller cheekbones, bigger lips, and a more heart-shaped jawline.
Allegretti, who also provides Botox and fillers, said that, although he is a dentist, he sees these practices as part and parcel of his work. “I call it a smile beautification program,” Allegretti said. A smile “is not just the teeth — it’s the whole face.”
“Looking good makes you feel good,” Allegretti added. He believes that, in turn, “increases your self-confidence and drive to succeed and interact with people. You feel like you can take on the world.”
Silverman recalled a 13-year-old patient from his gynecomastia practice who was “enthusiastic, vibrant, fun” until asked to take his shirt off for the consultation. His mother and grandmother were in the room and he was embarrassed to be shirtless, even in front of them.
Gynecomastia is typically not covered by insurance because it is not considered a reconstructive procedure. But Silverman believes it should be. “You have kids with gynecomastia who are being made fun of,” he said. “We don’t think it’s a tragedy, but it is.” When the 13-year-old came back to Silverman’s office post-operation, “he ripped his shirt off and had a big smile on his face.”
“Looking good and feeling good are very intertwined,” Babbitt said.
What’s important, these doctors say, is practicing “conservatism.” Usually, that’s easy in this corner of New England because patients here tend to want subtle changes.
Dr. Fater said his goal is for friends and family of his patients to be unable to pinpoint why that person looks different. When his patient walks into a party, he said, someone might ask, “Are you wearing your hair differently or did you lose weight?”
To succeed, but subtly, Babbitt said, “the key is avoid treating SIMONs.” The letters stand for Single Immature Male Overly-expectant Narcissist. Those seeking perfection, are, at least on this coast, it seems, advised to grow up first.