This story originally aired on June 24, 2005.
Before plastic surgery turned into TV entertainment, before cosmetic procedures grossed $12 billion a year and before the notion of slicing into perfectly functioning body parts became routine, Cindy Jackson, way back in the 1980s, blazed the trail.
"I was the first extreme makeover," she said from her home in London.
"My entire face: my forehead, nose, eyes, cheeks, chin, lips. The surface of my skin has been completely redone. My neck has been lifted and I've had liposuction from my waist to my knees," she said.
Life as Aging Midwestern Woman Was 'Hell'
From the time "20/20" first met Jackson, more than a decade ago, she's helped to clarify why reshaping one's body doesn't necessarily reflect a colossal ego.
But does she consider herself vain?
"No. I'm not vain. People who look in the mirror and think they look pretty good are vain. I look in the mirror and I always see room for a little improvement."
She says nips and tucks and peels and slices are the only way to get ahead in a society that respects — and rewards — beauty.
"What I've been through was painful, yes. It was hell," she told "20/20" in 1995. "But it wasn't as painful as living my life as a plain, ordinary, aging Midwestern woman."
Jackson's quest to achieve a new life through a new look began with the same glamorous icon that millions of little girls have idolized: Barbie.
"I looked at this doll and her glamorous life and her glamorous clothes and I wanted to live that life," she said. And indeed, with her curvy figure, sculpted face and long blond hair, Jackson could pass for Barbie — or her mom — anywhere.
But other women, like Eve Ensler, who helped liberate women in the bedroom with her smash hit "The Vagina Monologues," thinks Barbie is a bad image. "From the time you're little, you are inundated into believing that there's a right way and a good way of looking," said Ensler. "And it's usually what you're not, you know."
Ensler continued. "A lot of our energy is spent, frankly, mutilating ourselves, and I think it's a heartbreaking campaign, and I think we should abandon it."
Why? What's wrong with trying to look good?
"I think there's a difference between being healthy and caring about how you look and obsessing about fixing something that in my mind isn't even broken," she said.
Time was, obsessing over one's appearance horrified society and angered its gods. In Greek mythology, Narcissus died after he fell in love with his own reflection. For most of Western history, vanity was a sin, condemned by the church and vilified as a false god. The first common plastic surgeries mended noses that had collapsed during the syphilis epidemic of the 16th century. But back then, if you did it, you hid it.
Today, Americans not only celebrate their surgeries, they announce them, publicly. It's all part of a trend that's been chronicled on "20/20." Soap opera star Linda Dano admitted, "I'm not embarrassed by it. I'm having a face-lift. It's not a big thing."
I've watched women having their eyebrows or blush or lipstick permanently tattooed on. I winced at the idea of women having their toes broken, just so they could fit into their Manolo Blahniks.
Men Join Women in Quest for Physical 'Perfection'
And it's not just women. Jackson's surgery became her career — books, a consulting business and a Web site, which is where a young man named Tim found her.
As he leafed through a batch of magazines, Tim picked out Tom Cruise's eyes, Brad Pitt's nose, Johnny Depp's cheeks, Jude Law's teeth and Russell Crowe's chin — all of which have now surgically replaced his natural features. And Jackson not only helped Tim carve a new face, she gave him a new name. Barbie's pal is now Miles Kendall. That's Ken Doll, get it?
"I was a hermit before. I was an unsociable person," Kendall, or rather Tim, told us. "I hated my life. Instead of buying a BMW, I bought a new face!"
But the price of perfection is measured by more than dollars. You can be hurt, or maimed, or at the very least, disappointed. And it's very rare, but you could die. And what about the psychic damage from all that pressure to be perfect?
"We're telling our daughters that they will never be good enough, they'll never be pretty enough," Ensler said, "and I can't think of a more damaging or just desecrating message to be sending to anyone. I always say the most revolutionary thing you can do in this century is to love your body and get on with it. I think there's something beautiful about aging. If it didn't lead to death, it would be perfect."
But it's precisely that imperfection that has sent Jackson and her followers to their surgeons. When asked about her future, Jackson said with confidence, "I look younger now than I did 20 years ago and I also look younger than I did eight or nine years ago. So I don't plan to grow old."
A neat trick if you can pull it off. And judging by the numbers who are trying, maybe the only sin today is getting it done badly — or not at all.