Above a fitness centre in West Hollywood, there is a billboard that depicts spaceships hovering in the sky, accompanied by the words: "When they come, they'll eat the fat ones first." The sign drew angry protests from the few overweight inhabitants of this most aspirational part of LA, but most passers-by just glanced up, smiled, and hurried on with their lives.
Life in LA, particularly in West Hollywood and its even more expensively dressed neighbour Beverly Hills, does not involve accepting bodily imperfection. This is a city of com- petition, aspiration and dreams, where failure is never mentioned by name, even if it can sometimes be heard howling like a distant wolf from beyond the Hollywood Hills.
And it is also a town of quick solutions – not to achieving The Dream itself, but to the perceived barriers that could hinder your pursuit of it. Enter the aesthetic plastic surgeons, the cosmetic dermatologists and the anti-ageing doctors – the skilled cutters, tighteners and medicine men who promise beauty, eternal youth and a fast-track to success.
The epicentre of this pursuit is Sunset Boulevard which conveniently straddles Beverly Hills and West Hollywood. It's here that the Sunset Medical Tower glints in the Californian sun, attracting both the desperate wannabes of Hollywood and the moneyed elite of Beverly Hills. A steady flow of patients, many wrapped in bandages and wearing dark sunglasses, navigate the stone steps to the entrance before being whisked to the marble-clad waiting rooms of their respective specialists.
On the fourth floor, a discreet plaque on a large door reads "Laser Vaginal Rejuvenation Institute of Los Angeles". The door opens to a warren of operating rooms and examination suites, where Hollywood's current high priest of body improvement, Dr David Matlock, sits leafing through a copy of Playboy magazine, occasionally pausing to tear a page out.
This is LA where any and every "ailment", including age, is tackled with ferocious commitment. But when Matlock's patients say, "Doctor, please make me feel 16 again," they have something rather unconventional in mind. Matlock's speciality is the new trend for tightening and "tidying" the vagina through surgery. *
Flipping open a book of explicit "before and after" photographs of his work, Matlock smiles proudly. "This is the fastest-growing area of plastic surgery in the US. I'm doing five procedures a day and I have a five-month waiting list." Matlock's clients are diverse, from actresses to post-childbearing housewives. "There is no 'type' that comes here: doctors, lawyers, models, executives... we get them all," he says.
The close-up photographs may look more like something from Readers' Wives than the glossy, soft-focus world of Playboy, but, according to Matlock, it is the Playboy "look" that his clients want. "People bring in pornographic pictures and say to me, 'Doctor, pin these up in the operating room, this is what I want to look like.'" Recently he had to cancel an advert in a local paper after being inundated with calls.
A gynaecologist for 21 years, Matlock says his secret is to listen to women and then tailor his work to his clients' needs. In his brochure he promises to "completely re-sculpt and rejuvenate the vagina in a one-hour laser procedure".
Outside, as dusk falls, hundreds of other types of cosmetic surgery procedures are being performed in clinics across the city. Many operations are now considered so routine that they are performed in doctors' offices and on-site "operating rooms" rather than in hospitals. There are numerous tales of malpractice and operations gone awry.
In Beverly Hills, it seems, you get what you pay for and, at the upper end of the market, plastic surgery patients still drowsy with medication and connected to intravenous drips are ushered out of discreet back exits into waiting limousines with blacked-out windows. They are then whisked off to luxurious recovery centres with hospital facilities, specially designed for post-operative cosmetic-surgery patients.
One of Dr Matlock's clients, a Los Angeles hairstylist, Joany Macias, 33, had laser vaginal rejuvenation six months ago. "To be honest, I never thought that I needed it," she says. "I did it out of curiosity because I was worried I was missing out on something." Macias says her * boyfriend at the time didn't encourage her but, afterwards, liked it. "As soon as I had it done I felt the difference. My friends all want the operation now, too."
Macias had breast augmentation at the same time, the last of her group of 10 friends to have this operation. "Everyone wants to look good now; if it's not perfect, fix it!" she says, reeling off a list of the cosmetic improvements they have all undergone, including Botox, liposuction and, for three of her friends so far, G-spot amplification (collagen is injected into the G-spot area to increase sexual pleasure for the woman).
This last procedure would seem to contradict the widely-held view that women are undergoing surgery only in order to please men. "Women want to look good and have the best sexual experience possible," agrees Matlock. "After this, sex is better for them, because they have complete control. Some women say, 'Make it like I never had children, like I'm 16 again.' That's a big line. One client said, 'I want to be 14 again.' I said, 'you naughty girl!'"
Matlock shrugs off criticism that his clients are trying to conform to an unrealistic ideal, one shaped, according to Betty Dodson, a New York sexologist and author of Sex For One: The Joy of Self Loving, "by a small group of male publishers, photographers and pornographers".
"The porn industry has influenced this 100 per cent," Matlock agrees. "People see porn films and think, 'I don't look like that.'"
Matlock's art comes at a price, and his menu card and price list offer many options: laser vaginal rejuvenation (LVR) promises "enhanced sexual gratification" and "correction of stress urinary incontinence" (common in women who have given birth). Designer laser vaginoplasty (DLV) is more about appearance, involving "aesthetic reconstruction of the vulvar structures damaged by childbirth or ageing", or simply giving "that Playboy look".
Prices range from $4,000 (£2,200) for a DLV, to $8,000 (£4,400) for an LVR. A combo DLV/LVR deal costs from $9,000 to $17,000 (£5,000 to £9,400). One famous film-business client paid $38,000 (£21,000), but insisted on celebrity treatment and having the whole clinic to herself. Perhaps she missed a trick: when * the porn star Houston, best known for her record-breaking group-sex sessions, had a genital nip and tuck, she auctioned her pruned private parts on for $4,500 (£2,500).
Not all clients are so extreme. Mayela Thomas, a 50-year-old mother of three and a patient of Dr Matlock's, describes herself as a holistic practitioner, specialising in herbs, meditation and massage. "I had LVR six weeks ago, but I did it for me," she says. "You want to feel young forever, no matter what." It helped her self-esteem and made her more confident, she says, adding, "After my boyfriend looked at it he said, 'I can't believe it, you look so different.'"
The market for genital surgery isn't restricted to women. Dr Gary Alter, a Beverly Hills cosmetic surgeon, specialises in genital surgery for both sexes. Like Dr Matlock, he offers specialised vaginal surgery, but also offers penis lengthening. "There's an increasing culture of people out there who are very obsessed with and vocal about their bodies," he says.
The general acceptance of cosmetic surgery as a cultural norm is backed up by the clients of the Gavert Atelier Hair Salon in Beverly Hills. Twenty-two-year-old Gretchen Schlosser, who is having a manicure, has so far resisted any temptation to have surgery, but says her 19-year-old friend checked in for a breast enlargement and the surgeon talked her into having liposuction at the same time. "She was tiny... really thin already!" Schlosser says.
The salon's co-owner, Stuart Gavert, smiles. "Do people here feel insecure about their looks? Yes, thank God, it's how I've made my living for the past 30 years!" In the next chair sits 12-year-old Danna McDonald, who is having her hair straightened for $600 (£329). "It makes my face look thinner," she says checking herself in the mirror. "I've got too much baby fat."
As cultural standards change, so too does the benchmark with which we judge ourselves against others. "A 60-year-old woman in Beverly Hills is going to look like a 40-year-old woman in Kansas," Gavert says. "Women come into my salon depressed, poking at their hair, suggesting that they need a new hairstyle. Sometimes I have to tell them it's a face-lift they need," he says, "but I know how to say it nicely."
Gavert has also succumbed to the pressure himself, with Botox injections and regular visits to his "youth doctor" who prescribes him human growth hormone (HGH). "It increases your sex drive and gives you better skin and muscles," he says. "But I don't take it all the time, it's $2,100 [£1,200] for seven shots!"
Dr Uzzi Reiss, whose business card describes him as a specialist in anti-ageing medicine sits behind a large desk in his Beverly Hills practice, while his wife coordinates clients in the busy waiting-room. Reiss's speciality is administering "bio-identical" hormones to his demanding clients, the most controversial of which is human growth hormone.
Reiss, like many doctors in LA, uses products that are not approved by the US Food and Drug Administration, believing that his own preparations offer solutions the off-the-shelf drugs cannot match. "The medical profession hates the term 'anti-ageing', they hate us tampering with hormones. But other symptoms of age – bad hearts, rheumatism – are all treated with modern medicine!"
Reiss is 61 years old, and says he takes human growth hormone, claiming that it decreases the rate that the ageing body declines by decreasing fat and building muscle. "I'm not the tiger I was when I met my wife 35 years ago," he says, "but this helps." Reiss resists the notion of miracle cures, and stresses that he simply replaces and balances hormones that his clients have naturally lost with age. "The best anti-ageing treatment is to be born right. If your parents lived to be a hundred, then you're on the right horse!"
Susan Whyberd, a 57-year-old client of Dr Reiss's, lives in the Hollywood Hills. "He's a magician!" she says, "I feel terrific, like I'm 25." Whyberd has had her eye bags surgically removed as well as a chin-definition operation. "I looked in the mirror and started getting depressed. When you start looking less like you have for the past 50 years, it is depressing."
Whyberd's treatment is a cocktail of hormones, including HGH, which she says has made her feel and look better. Sipping drinks by the pool at the Mosaic Hotel in Beverly Hills, Whyberd and her friend Wendy Randall compare notes on their respective surgeons, dermatologists and their anti-ageing doctors. Randall has had liposuction, eye-bag removal and a "mini" face-lift and is being prescribed hormones by Dr Reiss. "My friend in New York says, 'You're outta your mind.' Her doctor tells her we're all mad out here. But when she visits she says, 'What did you do? I gotta have some of that!'"
In Beverly Hills' Rodeo Drive, a silver sculpture of a woman's torso stands like a totem above the lines of expensive Mercedes and image- conscious shoppers below. Among them walks Jocelyn Wildenstein, a 60-year-old socialite known for her extraordinary face that is the product of multiple cosmetic surgery operations. Wildenstein's doctors have delivered her a face devoid of wrinkles, with full lips and high cheekbones, but she has achieved these goals at a price. Her faces bears little resemblance to the one she grew up with and even in Beverly Hills Wildenstein draws odd glances from passersby.
Later that evening, at the exclusive Beverly Hills Four Seasons Hotel, Wildenstein talks about her appearance. "If you feel good with your imperfections, with your ageing, then you should do nothing," she muses, adding, "otherwise, it's all about choosing the right doctor." *Reuse content