April 20, 2009 -- Many moms would love to be mistaken for their 20-something daughter's twin. But Janet Cunliffe went as far as Croatia and $14,700 to make sure it happened.
Just four hours of surgery on her eyes and nose, plus a couple of lip injections and a diet, and 50-year-old Janet says she's now regularly mistaken as the sister of her 27-year-old daughter, Jane Cunliffe, according to reporting by the Daily Mail.
"I envied Jane's crinkle-free eyes, full lips and luscious, long blonde hair," Janet told the Mail. "I was desperate to look more like my daughter, but knew no wrinkle creams could ever wind back the clock that far."
From foot binding, to piercings and heels, humans have always gone to great lengths to alter their appearance. But with the relatively low price of modern plastic surgery, people can, and do, go much further today.
One woman's quest for a bigger bosom hit the legal limit; at a gallon of silicone in each breast, any more would have broken Texas state law. Last fall a Korean woman's compulsion for silicone injections led her to try a homemade injection of cooking oil.
Experts say compulsive, severe and risky plastic surgery can belie an underlying psychological problem, but not always.
The following is a list of notable cosmetic procedures compiled by ABCNews.com, as well as reflection by reputable plastic surgeons and doctors on what the medical profession should do about patients seeking extreme plastic surgery.
Mom and Daughter Look Alike, But With Help From Plastic
Cunliffe was not the first woman to ever ask for another person's face. So-called "octomom" Nadya Sulemen reportedly wanted to look like actress Angelina Jolie.
But plastic surgeons say Cunliffe's request to look like a family member is very rare.
"Certainly it's not the usual day in my office," said Dr. Malcolm Roth, director of plastic surgery at Maimonides Medical Center in Brooklyn, N.Y.
"To say, 'you're 50 years old, I'm going to make you 20 years old' -- that's not reasonable," said Roth, who is also the vice president of the American Society of Plastic Surgeons.
However, Roth said in Cunliffe's case, the request to make her look like her daughter might be more reasonable than a request like Sulemen's to look like a total stranger.
"It's her daughter -- they have the same genes, probably a lot of the same facial structure and architecture," he said.
But just because something is possible doesn't mean Roth will always comply with a patient's request.
"Over half of the patients who come into my office for plastic surgery I would not operate on," said Roth, who listed both medical concerns and concern over the idealism of his patients as reasons he'd not operate.
Cunliffe's case might be a drastic request, but Roth said he'd be more wary of her choice to try medical tourism.
"We're seeing, unfortunately, a lot of people who are looking for good deals, going to medical tourism and then they come back with problems that cost them more than they would have paid in the first place," he said.
Breast Implants So Big, They Break the Law
It would be hard to miss Sheyla Hershey if she were walking down the street. She has record-setting breasts after years of plastic surgery.
After over eight surgeries and a gallon of silicone, Hershey's breasts balloon to an astonishing 38KKK, protruding like beach balls from her petite frame. The surgery had to be done in Brazil because of U.S. restrictions on how much silicone can be injected into a person's body.
"I want to look better each day, every day," Hershey told Fox 26 in Houston, Texas. "Everybody's got a dream inside, you know? And it's good when you can make your dream come true."
Hershey, a singer, dancer, actress and model, has consciously undergone multiple procedures on her breasts as well as her nose, lips and buttocks over several years in order to aid her career.
While Hershey's dream might be realized for now, some experts say that the feeling may not last.
"At the moment, the person that says it's enhancing their [career] may believe that," said Dr. Alan Matarasso, a clinical professor of plastic surgery at the Albert Einstein College of Medicine in New York and a spokesperson for the American Society of Plastic Surgeons.
But Matarasso pointed out that overdone breast augmentation could leave a person a breast implant cripple for life, unable to go without implants because the alternative would be stretched out, flat breasts.
"They're not doing themselves any service," Matarassso said. "And most of what we do isn't reversible."
When Plastic Surgery Models the Animal Kingdom
Jocelyn Wildenstein's famous plastic surgery might never be topped. Many women think it's sexy to dress up as cat woman, but this New York socialite decided she literally wanted to be a cat-woman.
When there's a will, and millions of dollars, there's a way. According to The Times of London, Wildenstein spent more than $3 million to transform her face into a feline visage.
Much press coverage mused about her sanity, and there are several documented psychological disturbances that could contribute to such severe plastic surgery.
But Arie Winograd, psychotherapist and director of the Los Angeles Body Dysmorphic Disorder and Body Image clinic, cautions the quick judgment of those who get multiple surgeries.
"There are so many factors -- just because someone gets a lot of surgeries doesn't mean its Body Dysmorphic Disorder (or another disorder)," said Winograd, who defined Body Dysmorphic Disorder (BDD) as a psychological disturbance in which people obsess about a body part or body parts and compulsively act on that obsession in a certain way -- either by checking mirrors constantly, hiding the feature, touching the body part or getting repeated surgeries.
"It's not the vain person or the narcissistic person who likes how they look. BDD is the antithesis," said Winograd. "We are referred a lot of people from all over the place, who we find out later might have other conditions."
Cooking Oil Injections: When Beauty Turns Compulsive
The unfortunate case of Hang Mioku's silicon (and cooking oil injections) last fall showed the world the depths of a cosmetic procedure compulsion.
Mioku's first cosmetic procedure at age 28 seemed normal enough, but after 20 years of surgeries, injections and lifts, the Korean woman had disfigured herself and ran out of doctors who would help her in her quest for silicone injections.
Then, at home in her kitchen, Mioku reached for some cooking oil and a syringe, instead. The public took pity on Mioku and helped pay for surgeons to remove the foreign matter after the local media broadcast images of her swollen face, according to reporting by The Telegraph.
But however much material they reomoved, local doctors said she could never retrieve her original face.
Winograd couldn't comment on Mioku's individual case, but he has seen how a compulsion manifests itself into cosmetic surgeries.
"Cosmetic procedures are a compulsion, but just because someone has BDD doesn't mean they act on the compulsion of surgery versus something else," said Winograd. "But then, there's people who get procedures and keep getting procedures and they're never satisfied because BDD is a psychological problem within and they're trying to fix it by fixing the shell."
Michael Jackson: Multiple Plastic Surgeries
While it's lyrics might attempt to convey a more nuanced message, the title of Michael Jackson's song "Black And White" is a good summary of how many people who get multiple, extreme plastic surgeries see the world.
People with the combination of psychological problems who seek out these surgeries never have a "kind of a good day," said Leslie Seppinni, a psychotherapist in Beverly Hills, Calif.
"It's either, 'I look fabulous today,' or 'I need to put a mask on my face,'" she explained.
Seppinni said the self-hatred that comes on days when some people don't like how they look is part of a drive for flawlessness.
"One thing is that they're looking for absolute perfection, and it's very narcissistic," said Seppinni.
"If they could only fix how they look on the outside ... then life will be so much better for them," she said, and that creates a very all or nothing situation, where they either feel really good about themselves or that they are a complete disaster.
Stemming from a lack of balance in their emotional lives along with poor coping skills, Seppinni said, it often leads some people to imitate a single person who they view as ideal.
"Usually, they have a vision of someone they've conjured up who they believe is perfection. And they sculpt themselves toward that look," she said.
In the case of Octomom Nadya Suleman, that person was actress Angelina Jolie, Seppinni conjectured, noting Suleman's attempts to emulate her.
As for Jackson?
"In his case, for years he said ... Diana Ross was like his ideal vision. He wanted her look," mused Seppinni.
Brigitte Nielsen: Plastic Surgery to Beat Father Time
While some who get multiple plastic surgeries idealize someone else, reality TV star Brigitte Nielsensaid she gets them because she idealizes herself -- or a younger version of herself, anyhow.
"She's trying to get back to a place that she can't get back to," said Seppinni. "There's an emotional immaturity."
People who strive to look like former visions of themselves, or even like someone else, Seppinni explained, often reach a point where they stop maturing emotionally, so, over time, it becomes more and more out of sync with their chronological age.
"Once they start to get help, they have to make up emotionally for the time they [lost] when they weren't maturing emotionally," she said. "Playing catch-up is really painful."
A desire to appear on reality shows, Seppinni said, may also appeal to a frequent-surgery-seeker's narcissism.
But in addition to narcissism, the desire to have multiple plastic surgeries often ties in to borderline personality disorder, where sufferers have difficulty maintaining relationships, and body dysmorphic disorder, where a person becomes obsessed with a minor or imaginary flaw with their body.
"They have a real false sense of what they see in the mirror," said Seppinni.
"Many of them will tell you that when they look in the mirror, they won't look in the mirror unless it's from the neck down," she said, with the person only looking at the part of their body they need to.
"Even though, physically, they've changed [after surgery], they don't see the change, and that's why they continue to move forward with other surgery. They really have a distorted body image."
But the bigger issue, said Seppinni, is how narcissism and an addiction to drama that is common in reality television, affects viewers. It shows, she said, a lack of concern for the message to young women.
"That [a reality TV star] is a person where you have to ask what would you do if your life was productive? What would you replace the drama with?" said Seppinni.
Pamela Noon: Surgery That Never Ends
Pamela Noon looks like a woman 20 years her junior. But it took Noon, who is in her early 60s, over 20 year to complete the transformation -- and she says it's not over.
Noon has had over 26 cosmetic operations on her face and body, as well as over 80 maintenance procedures, such as botox injections. Some of the procedures she has undergone include liposuction, multiple face lifts, brow lifts and rhinoplasty.
"I think [cosmetic surgery] is fairly addictive, because if you do something that turns your life around a little bit, particularly the way you look, you automatically feel better about yourself and are on to yourself every time you see something you should attend to. I'm definitely a work in progress," Noon told the New Zealand Weekend Herald in 2003.
But plastic surgery experts say there could be underlying psychological forces driving people who go to extremes with plastic surgery procedures.
Matarasso pointed out that people who feel they need to constantly perfect themselves physically through surgery could be showing signs of obsessive compulsive disorder, a need for perfection, or an inability to deal with aging.
"No matter what, they're never happy," Matarasso said. "But if [plastic surgery] is minimized to the point of going shopping, they are no longer looking at it as medicine. ... This is real-life surgery with health, welfare and safety complications. You can't take this lightly."