2014 saw me assigned by The Hollywood Reporter to delve into a tragic incident involving a patient who plummeted from a Beverly Hills medical complex following a facelift procedure. The doctor in question was well-regarded, with celebrities like Demi Moore and Meg Ryan on his client list. The coroner determined that the death was an accident, related to a post-surgery clinical psychosis, and her family explained that the neurobehavioral issues meant the woman, who was known for her tranquil, optimistic demeanor, never recovered consciousness.
For quite some time, I had immersed myself in exploring the sleek underside of Los Angeles. However, this particular tale dug into me and stayed put. It wasn’t the details that resonated with me, but the themes. There was an undeniable allure in the darkness and absurdity of the situation, even as it unfolded just outside Lisa Vanderpump’s restaurant Villa Blanca – a stark contrast to the palpable longing. And so, a book took shape.
Approximately thirteen years on, I’ll be releasing “In Pursuit of Beauty” (Blackstone) on July 1st. As my coworker Seija Rankin expressed last week in her roundup of new summer reads, this novel chronicles the story of a Beverly Hills plastic surgeon who uses unconventional methods, leading to her incarceration. The narrative also follows an unaware journalist who agrees to pen her account from within the confines of her prison cell.
The writing process for In Pursuit of Beauty was inevitably shaped by my dual role as a journalist at THR, with experiences drawn from interactions with intriguing, larger-than-life characters such as Heidi Fleiss and Angelyne, similar to my fictional doctor. Additionally, I gained insights for socio-anthropological reporting, like understanding the unique Persian Palace architectural style in Beverly Hills, thanks to Bravo’s Shahs of Sunset real estate agents, who generously shared their knowledge during a tour through Trousdale Estates. However, the most challenging aspect was encountering fresh material, such as exploring L.A.’s dental veneer culture in summer 2024, that could no longer be transformed into fiction as I completed the book.
In the passage from the book “In Pursuit of Beauty“, Dr. Roya Delshad recounts a pivotal moment in her budding Beverly Hills cosmetic surgery practice, when she earned the nickname “the Robin Hood of Roxbury Drive” by the media.
***
In simpler terms, my business didn’t bring in significant profits, but it also never faced financial losses. I worked tirelessly with a small team to keep things running smoothly. Our office was run entirely by women, with one person managing appointments at the front desk, another assisting me with patients, and a third handling billing and insurance claims.
At first, I managed to schedule appointments by agreeing to insurance rates that were less favorable, occupying the lower end of the Beverly Hills market. It could be said that my agreement, perhaps due to a lack of influence or reputation, effectively established the low prices in the local market. These rates were ones that more seasoned doctors, who typically handled high-paying patients without insurance, would outright reject.
To set myself apart in this highly competitive field during the initial stages, I chose to work on weekends – Saturdays and Sundays specifically, while our office had a break on Tuesdays. Although I didn’t perform procedures during that time, the surgical center was closed. However, my office remained open on weekends, providing an opportunity for clients to visit at their convenience.
On the weekends, it was just me, a PA, and the receptionist holding down the fort while my full team took their day off. Saturdays were a solo mission, but Sundays were covered by temporary help from other clinics. Six days a week wasn’t ideal, but I knew it wouldn’t last forever. Compared to medical school and residency, this was a breeze – no more sleepless nights or back-to-back shifts. I could handle it.
My unique weekend availability, combined with my adaptability in dealing with insurance providers, attracted a diverse group of patients – more often than not women – who were middle-class or working-class. While I could have simply said ‘women’, most of my clients fell into this category, making up over 95% of my practice. I deliberately catered to this demographic, positioning myself as an affordable yet prestigious option. In essence, I was the discount department store for surgery, offering quality at a lower price. This was due to my availability, which made visits feasible without needing time off or worrying about approval from their employers. These individuals typically held jobs that didn’t offer much paid vacation time, and coming to see me often meant a significant commute, with some traveling from as far as Simi Valley in the north, the Inland Empire in the east, and Orange County in the south – meaning a visit to my office was at least half a day’s journey.
It’s possible that not every young plastic surgeon aspires to further specialize extensively, but the ones I encountered all did, including myself. There was an opportunity for financial gain by becoming an expert in a specific issue and respect from peers for being recognized as the leading authority on it.
I focused primarily on breast surgeries, particularly areolas and nipples, due to several factors. Firstly, these procedures have a more personal nature, involving fewer viewers – typically family members, close friends, or intimate partners. Secondly, the visual outcome is undeniably important, requiring skillful suturing for inconspicuous incisions. However, an often underestimated aspect is the preservation of sensation, a delicate yet significant part of the surgery. Understanding and respecting this sensitivity is crucial, as it adds a unique layer to the surgical process. In terms of procedures outside of vaginoplasty, none place as much emphasis on tactile response as breast surgeries do in ensuring surgical success.
Among my many regrets is the missed opportunity to fully master a specific field, particularly in the realm of space exploration. Although it might seem unusual, this was an area where I felt I could excel. However, running my own business didn’t afford me the luxury to specialize in one area alone. Instead, I had to cater to various needs and requests.
In my shop, I provided a wide range of services, from tummy tucks to breast lifts, butt implants, and nose jobs (which included septorhinoplasty – a procedure often covered by insurers due to skepticism regarding deviated septums, making it my most frequent operation and the primary source of income). I also offered comprehensive “mommy makeover” packages that were beneficial for patients but less so for my financial situation.
In my practice based in Beverly Hills, as a plastic surgeon, I had the advantage of working on a diverse range of body types from various ethnic backgrounds. The nipple and areola adjustments were recurring tasks that came with the package. These procedures are straightforward and easy to perform, allowing me to do numerous ones. It’s clear that there’s a correlation between experience and mastery in surgical procedures.
In this field of surgery, the most frequently performed procedures are areolar reductions and corrections for inverted nipples. Women rarely express a desire for larger areolas; instead, they often complain about their size being too big, like “I hate these pepperonis.” Sometimes the issue is symmetry, ensuring both areolas and nipples match, which may involve removing skin to reshape them. If it’s determined that one needs adjustment, patients often ask to improve the other as well, aiming for perfection since they’re already undergoing surgery. (I can’t disagree with their desire for improvement.)
Many people have inverted nipples which can become uncomfortable or even painful during contraction. This self-consciousness is common among those affected. On the other hand, some individuals experience a different issue: overly extended nipples, often due to breastfeeding. These nipples may sag and cause discomfort if not flattened. Both conditions can lead to self-consciousness.
One day at the office, a group of women who often referred to each other as “ladies” surprised me with a cake from a bakery popular among bachelorette parties. The cake was decorated with an intricate design of two sculpted breasts and two tall candles poking out from their centers. A message in cursive icing read, “Happy Birthday, Dairy Queen!”. I appreciated the affection behind the unique gift.
They always made me laugh and brought enjoyment, just like that. We found each other amusing and entertaining, and I truly miss them. One of my worries about starting my own venture was becoming a boss: the recruitment, dismissals, and leadership, along with the challenging interpersonal toughness it demands. I had no experience in this area. I’ve always been a learner, a beginner, or a protege. It seems like I got lucky, but the women I eventually hired were organized and dependable while also bringing constant happiness.
Similarly, my mentor with a thriving Beverly Hills practice advised me to gauge potential hires based on chemistry during the interview process. He considered resumes as a foundation for qualifications but viewed them as “preliminary assumptions” that could only be validated on the job. For him, it was all about building personal connections. He emphasized the importance of considering, “Would I feel comfortable having this person in the break room or at the office holiday party?” and “Would I be putting my colleagues through a challenging work environment with this individual?” He highlighted that creating a positive work atmosphere contributes to staff morale.
Sonya, my trusty assistant at the front desk, showed no mercy in maintaining order with our appointment schedule, making sure patients didn’t miss their appointments. With her lively demeanor and distinctive Valley girl tone, she was adept at countering excuses, both valid and not, with an infectious enthusiasm that bordered on relentless. During confirmation calls, she would warn them about our hefty penalties for cancellations within 24 hours or arriving more than ten minutes late. Interestingly, her entire immediate Filipino family – parents, three older sisters, one older brother, and even the baby girl who had initially followed suit – were all home health aides. However, the youngest member of the family has chosen a different path after initially doing the same work.
When I saw her,” I recalled, “Sonya expressed her desire for more involvement in an office setting. At twenty-three years old, I discovered later that when Sonya eventually gets married, she’d probably wear a Monique Lhuillier dress, as Lhuillier is Filipina. Additionally, Vanessa Hudgens, who represents her community so brightly, even though she’s ‘only half,’ from her mother’s side, is someone Sonya deeply admires. Interestingly, Sonya shares some similarities with Hudgens.” I occasionally pointed out this resemblance to her, and it seemed to make her quite elated, as she would almost float off the ground in response.
In contrast to Sonya, who thrived on extroverted interactions, Narine, one of my assistants (whose name has been altered for privacy), was more subdued and reserved in her demeanor. She had a gentle, graceful manner that drew people closer. Being fresh out of school, this was her first job. Her role was to support me extensively, including during all my examinations. Narine’s quiet presence seemed to alter the subtle dynamics in the room, particularly when sensitive topics were discussed or emotional burdens were unveiled. Patients who were apprehensive found a sense of kinship with her.
I found the daily dynamic between Sonya and Narine intriguing. Sonya, raised in Glendale, was outgoing and flamboyant, while Narine was more reserved. Narine seemed to view her Armenian heritage as somewhat somber, a perspective shaped by her activism for genocide recognition and her fascination with Jack Kevorkian, a notable figure in the cause of physician-assisted euthanasia. Interestingly, Sonya admired the Kardashian women, finding them reminiscent of her boisterous, colorful family, characterized by their loudness, bluntness, and emotional bonding across generations, centered around glamour and their passionate, bickering love for each other. Sonya assumed that Narine, being another Armenian, would share her admiration.
Narine, who resembled a delicate toothpick with a hint of Wednesday Addams’ elegance in her stance and contrast between her pale skin and dark hair, found the curvaceous Kardashians to be a challenge, even though she recognized their efforts in highlighting genocide through their platform. She wasn’t necessarily critical of them, but she didn’t admire them either, and it displeased her to see members of her community portrayed as a “clucking whirl of extensions” in popular culture.
The advice my administrative manager mom gave me before starting my practice was all about fostering a positive work environment. Given her years of experience, I couldn’t help but feel that she was an authority on this subject. One key point she emphasized, going beyond the usual tips about setting boundaries and monitoring morale, was the importance of being proactive without creating unrealistic expectations. In other words, surprise your team occasionally with treats like a masseuse, manicurist, or sushi delivery from Sugarfish or cupcakes from Sprinkles, but never make it a regular occurrence.
During those moments at the practice, after we’d navigated the initial bustle of getting everything organized and before things started to fall apart, I often recall those quiet periods towards the end of each day. It was around the time when our last patient had left, and we were all attending to our individual paperwork – perhaps a fleeting fifteen minutes before Sonya needed to catch her bus home. She always had a radio by her desk, playing Top 40 from KIIS at a low volume. One day, while discussing which Taylor Swift or Katy Perry songs might become timeless classics on the radio for years to come, I jokingly said, “From KIIS to KOST,” hinting at the local adult contemporary station. Sonya seemed confused, so I switched the station to KOST and turned up the volume. At that moment, Seal’s “Kiss from a Rose” was playing, and I quipped, “This is where you can find your favorite pop songs when they’re no longer trendy.
Her response: “I thought that was YouTube.”
After work in my office, many afternoons would often turn into spontaneous, sometimes silly but heartfelt KOST sing-alongs. These sessions ranged from the more ironic or girly hormone-indulging tunes like “Time After Time” and “The Sweetest Taboo,” to the more serious karaoke choices such as “Don’t Know Much” and “Africa.” My team was well-versed in Whitney, Stevie, and Madonna. It felt glorious, almost cheesy in a good way, with songs like those from Peter Cetera and Squeeze becoming an acquired taste. However, once the women opened up to adult contemporary music, which is essentially recent cultural history, they were all on board.
It wasn’t just casual fun; we genuinely enjoyed listening to KOST together. Over time, it became a regular thing among us. If you think this sounds like a typical slumber party of grown women reminiscing about their youth – or a scene from a movie set in one – I wouldn’t disagree. We also delved deeply into various relationship issues and the latest developments on The Bachelor, The Bachelorette, and Bachelor in Paradise. Narine would act out Vanessa Carlton’s piano playing in the “A Thousand Miles” music video. Sonya would imitate Boyz II Men’s hand and arm movements during “I’ll Make Love to You.” Together, we learned the lyrics and sang loudly the hit song “Hold On” by Wilson Phillips.
To put it simply, we were quite intense and annoying at times. Jenny, my assistant in billing matters, was somewhat detached from the whole scene, often finding herself as the fourth wheel. She had a soft, melodious voice, reminiscent of Aaron Neville in a duet. Prior to joining my practice, she had worked for various medical professionals in Seattle – a gastroenterologist, neurologist, and urologist, in that order. Originally hailing from a small town east of Seattle, Jenny moved there following her break-up with her boyfriend from the University of Washington. She decided to relocate to LA during a quarter-life crisis, chasing her dream of becoming a songwriter. As she explained a few months into our working together, it was one of those moments when she felt she had to act quickly or miss the opportunity entirely.
She, unlike us three, doesn’t work in healthcare and initially I considered not hiring her due to that. However, her references spoke highly of her dedication and attention to detail, which caught my interest. Additionally, she isn’t from around here. My experiences with outsiders making misinformed comments about LA has led me to generally dislike transplants, even though it might be unjustified.
It should be noted that Jenny was exceptionally proficient and dedicated to her personal profession, which she referred to as her “day job.” She truly embodied professionalism. However, I found myself constantly vigilant around her, always sensing potential disapproval, whether it was hidden in the strictness of her sharply cut bangs or the somberness of her dark clothing, or the enigma surrounding her abstract arm tattoo that resembled crop circles from another world. Once, she apologetically brushed off a question about the tattoo, saying, “I’m sorry, but it’s something personal.
I felt a bit taken aback whenever Jenny, our in-house musician with a keen musical palate (apparently from my occasional sneak peeks at her open Spotify account), would sing a mocking version of “Kiss Me”. Given that I’m an ardent fan of the movie She’s All That, it didn’t sit well with me. On the contrary, I was relieved on days when she chose to sing earnestly, like when she belted out “You’re Still the One” or a heartfelt “You Were Meant for Me”.
In this version, I tried to use simpler language and make the text more straightforward while maintaining the original meaning.
Jenny, unintentionally, stirred up my feelings of insecurity. She was one of those intelligent, well-intentioned women with a progressive mindset who seemed to construct and live within an entire moral framework that valued authenticity – and, it appeared, justice. This framework was defined by specific choices regarding politics, society, and aesthetics. Some of these guidelines were obvious, while others were more subtle. The general expectations for cultural consumption were well-established. For instance, favor minimal or even no makeup; appreciate complex art and entertainment, preferably created by a diverse range of creators; choose organic and sustainable food; shop at local businesses; advocate for small enterprises; look for homemade and handcrafted items whenever possible.
Her way of living served as a stark contrast to my idle habits, making me feel a twinge of partly Jewish remorse over my own inactivity. In essence, she seemed to be saying: Emulate the changes you aspire for in life, isn’t that just delightful? However, I perceived it more as an annoying provocation.
As a gamer, I can’t help but admit that I find it amusing how clueless some of the other girls are, time and again, about Jenny’s urban vibe. For instance, when Jenny decided to reside at the less-gentrified southern edge of hipster Echo Park, Sonya responded with a puzzled look and asked, “Why would you choose to live in potentially dangerous Filipinotown when you could afford a nicer part of the Valley?” Another example is when Jenny got excited about the local Armenian chicken chain Zankou, exclaiming, “I can’t stop thinking about that garlic sauce!”, which was met by Narine with a shrug and a comment about a tragic event in the restaurant’s past: “My family hasn’t been to Zankou since I was a kid, when the owner killed his mother and sister and then himself. My parents’ friends knew the guy. To this day they insist his advanced brain cancer was somehow responsible. My parents never bought it.
From a different perspective, I found myself in an unusual position – either fortunate or unfortunate – to adopt Jenny’s progressive viewpoint, shaped by student loan debt and the Great Recession. This unique perspective played a significant role in what followed, as I wouldn’t have landed in the predicament I did without these circumstances. However, I want to make it clear that I’m not shifting blame; I own up to my actions fully. I’m simply offering this background information to help you understand my choices better and promote transparency.
Apart from our shared traits, there was an additional difference between Jenny and us. It quickly became apparent when she started working at the office that she harbored a skepticism towards my patients who opted for plastic surgery, viewing them as somehow questionable. However, this topic never came up in conversation. She never expressed her feelings explicitly; instead, I sensed it intuitively.
In the same vein, it was clear that within a matter of weeks or months, her perspective had shifted dramatically. I witnessed and eavesdropped on the evidence, and by “evidence” I’m referring to more than just physical changes. I’m talking about emotional transformations: the tears of joy, the beaming smiles. Interestingly, we never talked about it. She didn’t express her feelings explicitly. However, I intuited that she had been converted. She had embraced the belief.
A loyal follower, who had been with the group for a long time, unwittingly triggered my downfall. She may not have even realized at the time, and still might not, that her well-intentioned action would lead to such consequences. To clarify, this isn’t about assigning blame; it’s about understanding the circumstances surrounding the event.
Irena, a woman in her late forties from Beverly Hills and a mother of three, was a Russian immigrant. She was often referred to as a beautiful trophy wife, with no signs of aging, married to an American businessman, fitting the stereotype perfectly. Before her marriage, she had frequented a well-known plastic surgeon in the Golden Triangle for several years and invested heavily in cosmetic procedures. Over time, her husband funded various touch-ups, including mommy makeovers. The details of how she paid for those early treatments were not clear. She once mentioned casually that she had been a model. My suspicions, based on observations and intuition, suggested that she might have worked as an escort, meeting her future husband in a scenario reminiscent of the film “Pretty Woman.” At best, it could be described as a wealthy matchmaker arrangement.
In her twenties, Irena hired a Mexican maid named Gabriela for a consultation. It wasn’t uncommon among her family circle that special treatments were exchanged. Sometimes, financial assistance was even offered among friends. However, this was the first time such an arrangement had arisen from a professional business relationship, and it gave me pause due to the ethical implications. Yet, I found comfort in the evident kindness behind it. (To clarify, let’s not get carried away with their generosity; they weren’t paying for Gabriela to have her own surgeon – a discount doctor would suffice.)
As someone who also struggled with an overly prominent jaw, I could deeply relate to Gabriela’s situation. Her profile was recessive, while mine was jutting out significantly. Time had softened Irena’s Russian accent to a whisper, and as we held hands, her housekeeper and I, she traced the lines of her own features, symbolizing our shared understanding. Her transformation involved a chin implant, along with a titanium plate to reposition her jawline effectively.
The connection between the housewife and the housekeeper deeply touched me. Although Gabriela’s English skills were limited and Irena didn’t speak Spanish at all, they clearly shared a strong bond. This bond was evident through their quick, unspoken gestures and frequent laughter, which I assumed had developed over many years spent together in Irena’s home.
There was a mix of joy and sadness in their relationship. It was heartening to see these two individuals, one Russian and the other Mexican, born in different generations, form a friendship that crossed class and racial barriers. However, I couldn’t help but feel a sense of foreboding as their bond seemed destined to be undone by the original transgression – their role as employer and employee. Yet, who am I to pass judgment on people finding comfort in each other amidst the isolation of maturity, no matter how bleak or money-influenced that connection might be? After all, wasn’t I also engaging with my subordinates, pretending we were equals?
Their friendship was both uplifting and worrying. It was great to see a Russian and Mexican, born in different eras, become friends despite class and racial differences. But it seemed their relationship might be doomed because they were employer and employee. Still, who am I to judge people looking for companionship in adulthood, even if it’s complicated by money? Isn’t that what I’m doing when I hang out with my team, acting like we’re equals?
After I had separated Gabriela from Irena, I inquired about her true feelings. In my expert opinion, she was generally an attractive girl with a single unfortunate flaw. Gabriela responded, in Spanish, “Do I want this? I’ve yearned for this all my life! I just didn’t realize it could be a reality.” Tears began to flow. Narine had tissues on hand, gently rubbing her back to comfort her. It wasn’t even noon yet. We had already consoled the third emotional patient of the day.
The operation went smoothly. On the day of the procedure, I encountered Gabriela’s gentle and apprehensive mother, who escorted her to the surgery center together with Irena. It seems those recessed features in the chin and jaw might be inherited traits from the father.
Irena gave her a few weeks of leave for recuperation. Gabriela’s new facial structure looked harmoniously balanced. She was overjoyed with the results. “It’s better than I ever dared to imagine,” she said to me, dabbing away tears during a follow-up visit several months later when the swelling had almost entirely gone down, “even when I let myself believe in the before-and-after images you showed me.” She was referring to the side-by-side photos I’d displayed on my computer screen during our first meeting.
Everything was going smoothly – another success. However, five months following the surgery, Gabriela returned to my office, this occasion being unique as she arrived accompanied by her identical twin sister, Alejandra. Needless to say, a familiar situation unfolded.
My spirits plummeted: an avoidable mistake in the most basic patient’s medical history led to predictable consequences. Later, in a wave of self-criticism after the event, I discovered that we had recorded she had two sisters and both were older. Due to a misunderstanding or unrelated issue or severe oversight, we didn’t delve deeper into the detail that one sister was merely three minutes older.
If I had known, I would have alerted Gabriela. The secret she confided in her twin sister was one of mutual suffering. Now, Alejandra – who worked as an assistant in one of the wholesale stores in Los Angeles’ Flower Market – carries that burden alone. Perhaps Gabriela would still have gone ahead with the operation, seizing the chance provided by her benefactor and no one else – despite my presumed warnings. After all, it’s a tale reminiscent of Aesop’s fables.
Regardless, there they were, my twin companions, no longer mirror images before me. Their silence didn’t conceal the emotional chasm that had grown between them; instead, it echoed loudly. Similarly, their silence didn’t veil the newfound tension, but it palpably filled the air. They didn’t hide their feelings of guilt, jealousy, and betrayal; instead, they openly displayed them. As usual, Narine kept a tissue box close by, which they utilized without hesitation.
In this scenario, both Alejandra and Gabriela shared similar circumstances: they possessed green cards, were enrolled in Medi-Cal insurance, and presented themselves as strong candidates for chin and jaw enhancements due to orthognathic issues. The medical necessity for the jaw work could be supported by her insurance plan since there were concerns related to TMJ, headaches, dry mouth, and lip incompetence, which Alejandra indeed experienced. However, justifying the genioplasty (chin procedure) as anything beyond cosmetic would prove challenging due to its inherent aesthetic nature.
Alejandra confided in me that she yearns to resemble her sister, while tears flowed freely. She and Gabriela didn’t require my patronizing words to acknowledge their feelings; I knew they were grappling with the same desire. But rather than expressing this truth, I was overwhelmed by emotion and simply said, “We’ll figure out a solution.” This was the turning point, the moment from which there was no return.
Alejandra’s surgery also turned out well. Somehow, she managed to take the required time away from work for recovery without losing her job. In the end, I classified her genioplasty as medically essential due to the worsening effects of a minor accident she had years ago, caused by tripping on a raised part of the sidewalk near her bus stop after work.
This situation wasn’t entirely true, but it contained some element of reality. To put it another way, while the details might have been distorted or exaggerated, there was a kernel of truth at its core. Specifically, the fall on the sidewalk didn’t happen solely in imagination.
As a fan, I couldn’t help but feel a tiny twinge of guilt for fabricating a seemingly minor detail, an airway defect. But compared to the discomfort I felt when I falsely claimed a debatable headache or dry mouth, it barely registered. The joy I experienced from performing what, in hindsight, was a relatively insignificant wrong deed, in order to accomplish what, overall, was a considerable good deed? It was immense.
Excerpted from In Pursuit of Beauty (Blackstone Publishing). Copyright 2025 by Gary Baum.
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2025-06-17 00:26