The Perfectionist

In the Upper East Side office of plastic surgeon Dr. Lara Devgan, M.D., there’s a framed Andy Warhol “Souper Dress” on one wall and a Supreme-branded footstool sitting beneath the desk — both trappings befitting a star of our current Instagram-driven facial-customization “moment.” More surprising is the collection of hand-drawn sketches neatly lined up across the top of a white cabinet.

Some depict women’s faces, others their nude torsos. Drawn on thin sheets of white artist’s vellum, they have an earnest, Old World appeal, like the loose studies a painter might make before putting brush to canvas. Except that on each page, there is a series of sharp, emphatic pencil lines radiating out from the subject’s nose, eyelids, chin, nipples, identifying room for improvement: mild asymmetry here, “periorbital hollowing” there. The delicate pooch of “submental fullness” beneath a jawline. The ominous “midface descent” of a cheek.

For Devgan, who is trained in painting, sculpture, and photography, “putting it on paper” is part of her process. It’s her homework, a pre-surgical anatomical meditation that helps her map out the exact surgical maneuvers ahead. For a long time she kept these studies to herself, but eventually she realized patients like to see them. Maybe when entrusting your one-and-only face to a surgeon, it’s comforting to know that the one you’ve chosen has the taste and sensitivity of an artist. Maybe there’s also something satisfyingly brutal, even cleansing, about having the cold, hard truth — every little detail you’ve picked apart in front of your own mirror, plus many you might never have noticed — confirmed by someone who has the ability to make it all better.

We meet on a Tuesday, one of Devgan’s three weekly days for performing surgery. Devgan declines to state either her height or her exact age, saying only that she’s in her mid-40s. By my estimate, she’s about 5-foot-2, delicately built, with the lush eyelashes and flowing dark hair of a Disney heroine. Her affect is gentle, yet her attention is diamond-sharp. She appears to really study my face as we talk, presumably an occupational hazard. I find my mind doing double duty, wondering if she’s doing double duty: mentally tallying the many things she could fix about me. I resist the urge to ask what they are. “Midface descent” is a thing you can’t unknow.

“To spend time in Devgan’s office is to accept that, beautywise, the rich and famous are playing with an entirely different deck of cards than the rest of us — and that it is spectacularly unlikely that the people we ogle are not availing themselves of the full realm of surgical possibilities.”

By 11 a.m., Devgan has already performed one patient’s eyelid surgery and another’s lower face and neck lift, both in the private, fully accredited surgical suite on the basement level of her office. The HQ where we sit is itself a flex, lavishly spread over five stories in the back of a doorman building on Park Avenue, with a double-height, art-lined waiting room — imagine the lobby of the now-defunct women-only club The Wing, viewed in gray scale — and Chanel foundation in the bathroom to mask any postprocedure irritation.

Devgan reels off today’s remaining to-do list. She’s about to go mark up her next surgical patient, whom she expects to operate on for three to four hours. Then she’ll pivot to several hours of nonsurgical consultations, administering shots of Botox and fillers and recommending laser skin treatments. This is rare for a sought-after surgeon: Such enhancements are typically administered by a dermatologist. Devgan believes she’s the only American Society of Plastic Surgeons-accredited surgeon with this kind of “vertically integrated” practice. To get the best results, she says, she needs all of the tools. “You can’t build a building with only bricks, right?” she says. “You need bricks, mortar, plaster, paint.”

Between Instagram and TikTok, Devgan has just shy of a million followers. Yet online fans only see a tiny fraction of what actually happens here. In an era of increasingly obvious and cheerfully publicized facial overhauls, Devgan estimates that less than 2% of her patients are willing to let her post their photos. For everyone else, the work she does is strictly top secret.

She’s aware that we all want to know who, specifically, this “everybody else” includes. But she will only say, “I take care of a number of the super-viral transformations that have become popular in the media.” Suffice to say, if you have recently found yourself squinting obsessively at a photo of an A-list actor, model, Silicon Valley power player, or even a member of a presidential administration and noticed that things look subtly different in a way that could be just good makeup or a more flattering ponytail — except that no ponytail has ever made anyone look that much better — and debated “Did she? Didn’t she?” there’s a good chance that she did and that Devgan was the one holding the scalpel.

Like anyone working in her ZIP code, Devgan does service women of a certain age who aren’t trying to fool anybody when they debut a brand-new face (perhaps because they couldn’t even if they tried). But her calling card is the stealthy, almost undetectable upgrade — a knack for taking faces that are already enviably beautiful just a few degrees closer to… perfect. That skill has brought a significant chunk of young-ish Hollywood to her door.

Celebrity hairstylist and friend-to-the-beautiful Harry Josh (who tends to women like Priyanka Chopra and Rose Byrne) has been known to whisper Devgan’s name to his clientele. “She’s costly,” he tells them. “But you will never ever look overdone. You’re paying for a sense of security to remain natural but fresher.”

Maximum subtlety is anything but a minimalist endeavor.

If, this past summer, a certain billionaire’s wedding seemed to offer final confirmation that the “natural” look had gone the way of the buffalo, raising questions about our collective sense of what a human face is “supposed” to look like — are we losing our sense of what looks believable? Does believable even matter any more? — Devgan has perfected a newfangled approach to a rather old-fashioned idea: good taste.

She calls it “global facial micro-optimization”: tweaking “little, uncanny, beautiful details” all over the face and neck in a way that adds up to an overall difference without anything really changing. This doesn’t mean fewer procedures — often, quite the opposite. A less media-workshopped name for it might be “more is less.”

“Plastic surgery is the ultimate Goldilocks problem — you don’t ever want too much, and you don’t want too little,” she says. In other fields, “you want to get 100% on your test, or you want, you know, 0% of garbage left on the street. You’re trying to maximize by achieving the most or the least possible.” In her world, “the most beautiful outcomes are in the gray area.”

The goal of completely ironing out a patient’s flaws is what got us to this overdone moment in the first place, she argues. The trick is to “tolerate minor imperfections,” while also making “tiny, millimeter-level changes all over the features of the face.” Often this means tweaking things that the online plastic surgery peanut gallery wouldn’t even know to consider.

For instance, the way light reflects off the face, “the highlights and low lights and definition and jaw line.” The “canthal tilt” of the eyes, i.e., whether their outer corners slope up or down (something I had never heard of but most of TikTok lost its mind over as the one true indicator of beauty in 2023). The “lip show,” or how much of the reddish inner vermillion peeks out when a patient smiles. Whether the eyes appear large enough — yes, this, too, can be altered. “We’re trying to get all these tiny things, and none of them are at an extreme,” she says. “It’s all a balance of the seesaw."

To spend time in Devgan’s office is to accept, beyond a shadow of a doubt, what we already know: that, beautywise, the rich and famous are playing with an entirely different deck of cards than the rest of us — and that if it is possible to change all of this without anyone ever suspecting, it is spectacularly unlikely that the people we ogle are not availing themselves of the full realm of surgical possibilities.

According to the American Society of Plastic Surgeons, the male to female ratio of plastic surgeons in this country is approximately 5:1.

Also, that they’re doing a lot. In terms of the sheer number of procedures undergone, maximum subtlety is anything but a minimalist endeavor. In the rhinoplasty of yore, surgeons performed one procedure to deliver a smaller, more delicate nose. Today, Devgan might also “create a little more architecture” with the cheekbone and jawline. The idea is that far too much blame has been placed on the imposing nose, when the other features surrounding it — like that micrognathic (i.e., weak) chin — are also not pulling their weight.

“It’s the way you might use 10 or 15 products to get a no-makeup makeup look,” Devgan says. Instead of just wiping away a defining feature — to flog the most overused tragic-plastic-surgery example: instead of pulling a Jennifer Grey — she’s balancing all the features to “help someone feel almost a little more like themselves.”

As Josh alluded to, balancing out one’s entire face is not an inexpensive endeavor. Devgan charges $150,000 to $300,000 for surgical “global facial micro optimization.” She says she gets her best results through a combination of surgical and nonsurgical procedures, which in some cases involve tweaks that must be constantly maintained, such as nonsurgical rhinoplasty — in which a nose can be refined using injectables, at a cost of $2,500 every six to 12 months. Rhinoplasty surgery would certainly be more “durable,” as Devgan puts it, and would eventually be more cost-effective, too. But for the “aesthetic perfectionist,” she says, the nonsurgical approach requires minimal downtime and delivers “an extremely specific and precise result.”

I have to hustle to keep up as Devgan heads to the consult room, where her next patient is waiting to be marked up before her surgery. Or should I say surgeries. She’s scheduled for five. Despite what I have learned about the more and the less of Devgan’s approach, the sight of this woman is astonishing. Even makeup-free and dressed in the universally unflattering garb of surgical gown, no-slip socks, and disposable blue paper cap, the patient (let’s call her Janine) is enviably lovely. In her late 40s, she has the kind of delicate, finely shaped features that suggest “ex model,” Titian-red hair, and smooth, porcelain skin daubed in freckles. It seems unimaginable that this woman is a candidate for any facial surgery, let alone five of them. And yet.

“I’ve been thinking of having this done for years,” she says, “especially this.” She pokes at a hint of unevenness beneath her jawline.

The doctor begins to sketch angles and lines all over Janine’s face using a blue surgical marking pen, stepping back occasionally like an artist considering her canvas — this time not on her sketch pad, but in three dimensions. Janine, who is wrapped in a faux-fur throw to ward off the office’s air-conditioned chill, fills the silence with nervous chatter. How many incisions will there be? Is Devgan sure the brow lift won’t make her look surprised? Devgan appears to skirt the question of how many incisions, saying instead that they will be nearly undetectable — mostly hidden inside her hairline, except for one continuous cut that will swoop from inside the ear to all the way behind it. She also doesn’t say that this cut is an essential part of loosening Janine’s entire middle face region from its moorings, but presumably Janine has already made her peace with that.

“You can’t build a building with only bricks, right? You need bricks, mortar, plaster, paint.”

Devgan pauses to study her subject’s eyes, then steps closer to mark the sliver of eyelid — slightly different on each side — that she will soon slice away. As for the brows: “It’s surgery in millimeters, not centimeters. Everything we do is going to be a very tiny, discreet move,” she says.

When she’s satisfied, Devgan offers a final recap. “So, we’re going to slightly lift and reposition the lateral eyebrow. Reduce hooding of the upper lid. Lift the malar eminence of the midface, so you have less of this heavy feeling. Improve the lower face, so that we get more of a restored heart shape.” Given all this, it is difficult to imagine which, if any, of Janine’s “slight imperfections” she will actually be tolerating. From the sound of things, today’s approach is full monty.

Finally, Devgan, too, pokes at the (to my eye) unfairly maligned undercarriage of Janine’s jaw, promising, “then we’ll clean up all the stuff going on under here."

“I want mine to look like yours,” Janine jokes to the doctor.

“Coming right up,” Devgan says.

Back in her office for a few minutes before surgery, Devgan takes a sip of Diet Dr Pepper and confesses, almost a little guiltily, that her own jawline — yes, it’s snatched — is the work of Mother Nature. She has not had plastic surgery. She’s had injections of deoxycholic acid, commonly known by its brand name Kybella, to reduce fat under her chin. She does her own injectables, including neuromodulator (Botox) and “judicious fillers.” She gets micro-needling facials in which her own platelet-rich plasma (PRP) is cocktailed with other skin-smoothing and plumping ingredients, and shallowly injected back into her face. And twice a year, she has skin resurfacing with an erbium laser — also popular with her clientele. By the standards of the Upper East Side, this regimen is distinctly low maintenance. For now. “You never know,” she says.

Behind her desk sits a photo of Devgan and her husband, a tall, blond Belgian American energy entrepreneur, on a beach with their children — all six of them — fanned out beside them, everyone in matching wetsuits. They have four sons and two daughters, all between the ages of 7 and 13, plus three Siamese cats: Agra, Flufferton, and Minerva.

According to the American Society of Plastic Surgeons, the male to female ratio of plastic surgeons in this country is approximately 5:1. The male to female ratio of superstar, A-list surgeons with five-story Park Avenue offices is presumably even wider. The male to female ratio of plastic surgeons with all that and six young children? Incalculable.

“The most beautiful outcomes are in the gray area.”

In her ascent to the top of this ego-driven, male-dominated profession, Devgan — the daughter of two doctors — has used what could have been impediments (her petite stature, her large family, her femininity) to her advantage. Becoming a mother, she says, deepened both her empathy and her caretaking impulse. Her “micro” aesthetic comes naturally to a lover of tiny objects, who, as a kid, used to take apart watches for fun. She even believes having smaller hands allows her to handle tissue more delicately than a man, working with smaller incisions, creating subtler work that leaves less noticeable scars.

Historically, standard surgical tools are sized for a 70-kilogram, 6-foot man. For someone Devgan’s size, using them is “almost like being left-handed and using right-handed scissors,” she says. In 2024, after years of paying top dollar for custom-sized surgical implements, she decided to make tools of her own, which she now also sells to other plastic surgeons. She thinks her more delicate millimeter-level calipers and curved dissection scissors improve results. “They physically allow a greater degree of refinement,” she says. “Almost like a mechanical pencil allows a greater degree of sharpness than a Sharpie.”

Downstairs, in her surgical suite, Devgan suits up in protective gear and joins her team: an anesthesiologist, a nurse, a scrub tech, and a medical assistant. The operating table is set to Devgan’s height — no stepstools in this OR. Janine lies silent, already unconscious and intubated, her pretty face crisscrossed with the lines from Devgan’s pen and tinted yellow by an antibacterial coat of Betadyne. Beneath the sound of her heart monitor comes the strains of Taylor Swift’s “Getaway Car,” but no one is singing along.

Devgan, now already injecting Janine’s face with anesthetic, is serious and focused. She plans to work from the top down: first the brows, then the eyes, then the midface, then the neck. With a scalpel, she carves a small, almost bloodless hole in Janine’s hairline, pausing to cauterize the incision to minimize bleeding. Gently, she tugs the tissue and fascia above Janine’s right eyebrow in a barely perceptible northeasterly direction — like what you might do standing in front of the mirror, just to see — then secures it in place with sutures that look like common dental floss. Other things to come in this operating room will be far more graphic. But the opening foray is no fuss, no muss: One side of Janine’s brow lift is done. In the space of seven minutes, her face is permanently changed.

After months of chatter about plastic surgery, endless social media conjecture over the before and after photos of people we’ll never meet, and a steady stream of articles (including this one) documenting what seems to be a new era of shamelessness about the pursuit of beauty — the vulnerability of Janine’s unconscious form, and the seriousness and solemnity with which she is being ministered to, feels like a necessary reset. Elective or not, “necessary” or not, this is what plastic surgery is: a real operation, with real stakes. And for patients like Janine, a true exercise of something greater than vanity — trust.