In 2014, The Hollywood Reporter dispatched me to investigate the tragedy of a plastic surgery patient who’d fallen to her death from a Beverly Hills medical plaza soon after a facelift. She’d been in the care of a respected doctor with a client list known to include Demi Moore and Meg Ryan. The coroner concluded this had been an accident, linked to a post-operative clinical psychosis, and her family explained that the neurobehavioral disturbance meant the woman “we knew and loved for her calm, positive disposition never regained consciousness.”
By that point I’d already spent years covering the glossy underbelly of Los Angeles. Yet this story burrowed into me and remained there. Not in its specifics but in its thematics. There was something deeply compelling about the situation’s darkness and absurdism — she landed steps from Lisa Vanderpump’s restaurant Villa Blanca — amid the manifest yearning. A novel crystallized.
More than a decade later, I’m publishing In Pursuit of Beauty (Blackstone) on July 1. As my colleague Seija Rankin put it last week in her roundup of new summer fiction, the novel “follows a Beverly Hills plastic surgeon whose unconventional methods land her in jail, and the potentially unwitting journalist who agrees to ghostwrite her story from the other side of her prison cell.”
Courtesy of Blackstone Publishing
In Pursuit of Beauty couldn’t help but be influenced by my day job as a journalist at THR, whether in my complicated encounters with mercurial, larger-than-life subjects not unlike my doctor protagonist (Heidi Fleiss, Angelyne) or else through other socio-anthropological reporting ventures. Case in point: I owe thanks for a riff about Beverly Hills’ Persian Palaces to the real estate agents from Bravo’s Shahs of Sunset, who once shared with me their deep and personal expertise about the singular émigré architectural style during a ride-along through Trousdale Estates. Perhaps the toughest part of finally finishing the book was continuing to come across material — during, for example, a summer 2024 expedition into L.A.’s dental veneer culture — that could no longer be transmuted into fiction.
In this excerpt from In Pursuit of Beauty, Dr. Roya Delshad tells of the turning point in her fledgling Beverly Hills plastic surgery practice, when she became a figure the media would label the Robin Hood of Roxbury Drive.
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My practice never lost money. It just didn’t make much, barely anything in fact, and I hustled a lot with a tiny team. Our all-female office consisted of someone at the front desk who handled the appointments, a medical assistant who helped me with patients, and a billing specialist who filed claims.
I was initially able to fill my calendar because I accepted insurance at disadvantageous rates, at the bottom of the Beverly Hills market. One could argue my acquiescence, due to a lack of clout, set the bottom of the local market. These were prices that more established doctors, those whose practices were teeming with the preferred sort of patients (which is to say, cash paying), would flatly turn down.
My chief gambit in establishing my practice in this ultracompetitive realm was a willingness to work on the weekends, at least for the first couple of years. I didn’t perform procedures then; the surgicenter I used was closed. But my office was open on Saturdays and Sundays. We took Tuesdays off instead.
On the weekends, it was just a physician’s assistant, a front desk girl, and me. My regular staff was with me on Saturdays. On Sundays I relied on a rotating array of part-timers from other practices to fill in. While I didn’t love working six days a week I figured it wouldn’t be forever. I had perspective. It wasn’t as exhausting as medical school and residency, with those crazy around-the-clock hours. Not by a long shot. I could tough it out.
The unrivaled weekend appointment availabilities, along with my, shall we say, flexibility with insurers, had the effect of producing a patient population notable for its diversity. By this I mean I saw far more middle-class and even working-class individuals (I really should just say “women,” since my clients were more than 95 percent female) than my colleagues in Beverly Hills. I lured this demographic in preponderance, turning myself into a shameless bargain-basement option that nevertheless still featured comforting prestige plumage. I was a Loehmann’s of the scalpel, simply because I was available to see them, in practical terms. Their insurance plans would allow the visits, and Saturday or Sunday appointments meant they wouldn’t have to request time off and be subject to the mercy of their superiors, from the sorts of jobs — often compensated hourly instead of salaried—that didn’t offer any inclusive annual paid time off. These folks came from long distances, as far as Simi Valley to the north, the Inland Empire to the east, and Orange County to the south, which meant that a visit to my office was at least a half-day commuting commitment.
Perhaps not every young plastic surgeon seeks to super-subspecialize, but everyone I knew did, and I was not immune. There was money to be made by becoming the go-to of a particular problem and recognition to be received from colleagues for being its agreed-upon authority.
I homed in on areolas and nipples as my areas of expertise. There were reasons for this. I liked how these were by their nature more intimate procedures, the work seen by far fewer people (mothers, sisters, close friends; mostly, of course, sexual partners). And while the importance of the visual outcome is obvious — achieving undetectable incisions via adept suturing — the aptitude of the practitioner’s craft determines the effect the patient didn’t think enough about in advance: loss, or not, of feeling. Sensation, a keen alertness to its fragility and its complexity, is of crucial importance. It adds another dimension to what’s at play in the operating room. Outside of vaginoplasty, there’s no procedure where cognizance of touch response is as integral to surgical success.
I’ve got plenty of regrets. Never having the chance to truly master this space is one of them. I know it may sound odd, but it was shaping up to be my forte. In my own shop, as I strived to get it going, I didn’t have the luxury to focus on just one thing. I played all the hits: tummy tucks, breast lifts, butt implants, nose jobs. (Septorhinoplasty, covered by insurers who were skeptical about claims of deviated septums, was by far my most common procedure and biggest moneymaker, carrying my practice.) I also offered comprehensive “mommy makeover” packages that were great deals — for the patients, if not for my bottom line.
Still, the benefit of the way my practice was set up was that I found myself, for a plastic surgeon based in Beverly Hills, working on a wide ethnic array of body types. The nipple and areola work would, indeed, cycle through with all the rest. Those procedures are quick and simple, so I got to do a lot of them. And when it comes to procedures, there’s an arc connecting experience and excellence.
The two most common surgeries in this genre are areolar reductions and inverted nipple corrections. Rarely do women want larger areolas — it’s always “I hate these pepperonis.” Sometimes it’s about making one areola or nipple look like the other, reconfiguring the shape via skin excision. Although if the conclusion is reached that one needs work, typically the patient’s attitude becomes, Why not optimize the other while we’re at it, and make them both perfect, given all the trouble? (I can’t fault that attitude.)
Inverted nipples are common and can be agonizing, especially when they further invert upon contraction. Those afflicted are enormously self-conscious. Then there’s the reverse extreme: nipple reduction — long, protruding, often sagging nipples that are the consequence of breastfeeding. They can be painful if they’re not flattened.
The ladies in the office (we called each other “lady”; it just became a thing) once gave me a cake from one of those erotic custom dessert shops kept busy by bachelorette parties. It featured a nicely shaped pair of breasts and two long lit candles jutting from their centers. “Happy Birthday, Dairy Queen!” the cursive icing read. I felt the love.
They were all funny and fun like that. We were funny and fun together, and I miss them. Among my anxieties about opening my own business was being a boss: the hiring and firing and managing, with all the attendant interpersonal hard-assedness it entails. I’d never done it before. I’d forever been the student, the junior, the protégé. Maybe I just lucked out, but the ladies I ended up with all had their shit together while, as a bonus, being a reliable joy.
Then again, I did take the advice of a mentor who had his own Beverly Hills practice: assess prospective staff at the interview stage on vibe. He explained that to him a résumé, while an indication of base qualification, was nonetheless a “mere hypothesis” that could only ever be borne out once on the job. What mattered was in-person rapport. “You need to ask yourself,” he told me, “‘Do I want to subject myself to this individual in the break room, at the holiday party?’ ‘Do I want to subject other staffers to this individual?’ It’s quality of life. Atmospherics correlate to morale.”
Sonya, my front desk henchwoman, took no prisoners in ensuring that patients were kept in line, and by this, I mean not flaking on appointments. Her bubbly personality and Valley girl upspeak combated excuses both legitimate and not with lethal cheer. During confirmation calls, she would remind them of our steep penalty fees for cancellations within twenty-four hours or showing up more than ten minutes late. Her entire immediate Filipino family — mother, father, three elder sisters, and one elder brother — were home health aides. The baby girl had gone rogue after at first doing the same.
“I need more action,” she told me when we met, about wanting to work in an office. Sonya was twenty-three years old. I would later learn that when (not if) she got married, it would most definitely be in a Monique Lhuillier gown — Lhuillier being Filipina — and that “gorg” Vanessa Hudgens was her idol, for representing her community in such a shining light, even if she’s “only half, from her mama.” Sonya bore a faint resemblance to Hudgens. I told her this once, offhand, and she levitated near the ceiling. So I kept on doing it at intervals.
Where Sonya was a classic extrovert, happiest when gabbing, feeding on energy, my medical assistant, Narine, effervesced on a much quieter and more intimate register. (I’ll note here that I’ve changed all the names of my employees and patients in this chapter for their privacy.) She had a shy graciousness to her, a way of speaking that made you lean in. This was her first gig out of school. Her job was to be my right hand, and she participated in all my examinations. Narine’s soft presence affected the delicate alchemy in the room as secrets were shared, dreams and fears aired. Vulnerable patients felt a kindred spirit.
I got a kick out of the daily interplay between the demonstrative Sonya and the more subdued Narine, who grew up in Glendale and whose rather gloomy conception of her Armenian ethnicity appeared to be defined by her passionate advocacy for genocide recognition — she volunteered for an organization seeking to raise its awareness in the U.S. — and interest in the life and ideas of the pathologist and physician-assisted euthanasia activist Jack Kevorkian. Sonya was a huge fan of the Kardashian women. They reminded her, in the best possible ways, of her female-dominated family, in their loudness and vulgarity and ecstatic intergenerational bonding over glamour and sheer, clear, bickering love for each other. She presumed that Narine, a fellow Armenian, would be another disciple.
Yet Narine, a lovely, petite toothpick with a Wednesday Addams thing going on in her posture and pale-dermis-to-dark-hair contrast, saw the curvaceous Kardashians as a burden, despite acknowledging they’d used their platform for good in spotlighting the genocide. She wasn’t a hater, per se, but she wasn’t enamored either, and she didn’t like to see her “people” reduced to some “clucking swirl of extensions” in pop culture.
The big lecture I received from my mom — a career administrative manager — before I opened the practice was on “cultivating a positive office culture.” She deservedly felt she was an expert on this. Her main insight, beyond banalities involving setting boundaries and remaining attentive to the texture and nuance of morale, was “to be proactive without creating expectations.” This meant bringing in a masseuse or a mani/pedicurist or Sugarfish for sushi or Sprinkles for cupcakes, but always unannounced and never on the regular.
When I think about those times at the practice, that sweet spot after I worked through the initial anxious hustle of getting it all running and before everything imploded, I return to the end of many days, after the last patient had been sent away, when we were each handling our respective paperwork. It was a narrow stretch, maybe fifteen minutes before Sonya had to catch her bus home. She had this radio by her desk, always tuned low to the Top 40 on KIIS. One day early on we were debating the Taylor Swift and Katy Perry songs that were most likely to age into eternal radio classics, the new oldies. “From KIIS to KOST,” I said, referencing the local adult contemporary programming option. She looked lost. I turned the dial to KOST and cranked the volume. At that very moment, Seal was crooning “Kiss from a Rose.” I intoned, “This is where you can find your favorite pop when it’s no longer popular.”
Her response: “I thought that was YouTube.”
In my office, the close of countless afternoons turned into goofy if heartfelt ad hoc KOST sing-alongs, part ironic girlie hormone indulgence (“Time After Time,” “The Sweetest Taboo”), part sober karaoke (“Don’t Know Much,” “Africa”). My staff knew their Whitney and Stevie and Madonna. It was glorious, genuine cheese like the Peter Cetera and Squeeze hits that were the acquired tastes. Yet once the ladies opened themselves to adult contemporary, which is to say recent cultural history, they were all in.
I swear this was not forced frivolity. After the first few times, I wasn’t the only one turning on and turning up KOST. It became a shared habit. Now if this all reads like a cliché teen sleepover of adult women backdating themselves several decades — or a movie montage of that sleepover — I wouldn’t argue. We also discussed myriad boy problems in depth and at length, along with the latest twists on The Bachelor, The Bachelorette, and Bachelor in Paradise. Narine would pantomime Vanessa Carlton’s piano playing in the video for “A Thousand Miles.” Sonya would mimic the emphatic hand-and-arm gesturing of Boyz II Men performing “I’ll Make Love to You.” They would join me in a full-throated rendition, once they familiarized themselves with the lyrics, of Wilson Phillips’s “Hold On.”
So yeah, we were cutesy-annoying — hardcore. The sporadically game, often reluctant fourth-wheel participant in all of this was Jenny, my billing specialist. She was good for the Aaron Neville half of a “Don’t Know Much” duet. Jenny arrived at my practice direct from Seattle, where she’d earlier done the same work for, in succession, a gastroenterologist, neurologist, and urologist. Originally from a small town a couple of hours east of that city, she’d chosen to move after breaking up with her University of Washington sweetheart and making the quarter-life crisis decision to move to LA to pursue her songwriting dream. “It was one of those now-or-never things,” she’d told me a few months into our time together.
Unlike the three of us, she wasn’t pursuing a career in health care. I almost passed on hiring her for this reason, except her references had such effusive words of praise about her work ethic and her meticulousness. And unlike the three of us, she wasn’t a local. A lifetime of having to endure assorted flavors of dumb commentary about LA from nonresidents — which reached its ill-informed, condescending apex during my sojourn along the East Coast — has predisposed me, unfairly or not, against transplants.
To her credit, Jenny was very good in, and very serious about, her self-styled “day job.” She was a true professional. Still, I was forever on guard around her, antennae attuned to interpret perceived disdain, whether from the subtle reproach inherent in the severity of her high-cut blunt bangs or the austerity of her dark attire or the mystery of her alien-crop-circle-ish abstract arm tattoo. “Sorry,” she once said, batting away an inquiry into the inking, “it’s a private thing.”
So I was a little extra pierced when Jenny, our very own resident musician, boasting next-level taste (or so I gathered from errant spying on her desktop computer’s open Spotify account), would decide to viciously warble a drenched-in-sarcasm “Kiss Me” — after all, I remain a dyed-in-the-wool She’s All That fan. By the same measure, I’d be relieved on days when sincerity, that better angel of our nature, won out and she’d lean into an emphatic “You’re Still the One” or, for that matter, a tender “You Were Meant for Me.”
Jenny, through no fault of her own, brought out my insecurities. She was one of those smart, well-meaning women of a certain progressive-minded bent who’d built and sought to inhabit a complete moral landscape of authenticity — and, it was presumed, justice — through correct political, social, and aesthetic choices. Some were overt, others less so. The consensus edicts were clear when it came to cultural consumption. Among others: Wear minimal or, better yet, no makeup; embrace challenging art and entertainment, ideally created by diverse voices; eat organic and sustainable; shop local; support small businesses; seek out the homemade and the handcrafted wherever possible.
Her lifestyle amounted to a rebuke of my own laziness. I recycled and was prone to pangs of half-Jewish guilt. That was about it. Perhaps this was Jenny’s point: Be the change you wish to see in the world, la-di-da. But I registered it all as an irritating affront.
So, because I’m a bad person, I have to admit enjoying how oblivious the other ladies were, time and again, to Jenny’s with-it white-girl values. Exhibit A: that Jenny’s decision to live at the less-gentrified southern edge of hipster Echo Park was met by a baffled and bemused Sonya with, “Why would you choose to live in super-dangerous Filipinotown when you could afford to live in a perfectly nice part of the Valley?” Exhibit B: that Jenny’s elated discovery of delicious local Armenian chicken chain Zankou — prompting rare outright effusion: “I can’t stop thinking about that garlic sauce!” — was punctured in the most wah-wah of terms by Narine with, “My family hasn’t gone there 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 to blame. Mom and Dad never bought it.”
Depending on how you look at it, I was either blessed or cursed to have Jenny’s point of view, her progressivism (millennial socialist, forged by student loan debt and the Great Recession), at my disposal for what came next. I couldn’t have gotten myself into the same trouble I did if things hadn’t been what they were. Now, I’m not trying to spread blame, far from it. I take full responsibility; it’s all on me. I’m merely providing context for my actions, in the interest of clarity.
There was one more way Jenny was unlike the three of us. It was plain when she first began working at the office that she thought my patients were somehow fundamentally suspect for undergoing plastic surgery. We never discussed it. She never said anything. I just knew.
But by that same measure, it was plain that within months, even weeks, her outlook had changed. Jenny saw and overheard the results. And by “results” I don’t only mean physical. I’m talking psychological: the tears of happiness, the smiles. Again, we never discussed it. She never said anything. I just knew. She became a believer.
Another believer, a longtime member of the converted, set my downfall in motion. She didn’t realize, probably still doesn’t realize, that her act of good faith had such ramifications. To repeat, this isn’t about blame. It’s context.
Irena was a Beverly Hills mother in her late forties with three children. She was a Russian immigrant, a stunning trophy wife unmarred by age, married to an American businessman: the full cliché. She’d started visiting another Golden Triangle plastic surgeon when she was still single two decades earlier and invested in the works. Over the years her husband had financed tune-ups, including mommy makeovers. How she paid for the early procedures was vague. She’d said, in passing, she’d been a model. I suspected, based on experience and intuition, she’d been an escort, meeting her Mr. Right in a Pretty Woman–esque scenario. At the most respectable, it was a millionaire-matchmaker situation.
Irena brought in her early-twenties Mexican housekeeper, Gabriela, for a consultation. Gifted procedures weren’t out of the ordinary among relatives. Occasionally financing even occurred among friends. However, this was the first I’d experienced stemming from an ongoing business relationship. The ethics made me queasy. Yet I was set at ease by the palpable benevolence involved. (Of course, let’s be real about the bounds of the bigheartedness: It’s not like she and her husband sprang for Gabriela to see her own surgeon; this discount doctor would do.)
Gabriela was a strong candidate for chin and jaw augmentations to correct a substantially recessive profile. “I had the same thing but in reverse; mine was overly jutting,” Irena said, her Russian accent reduced to a trace by time, her thumb and forefinger charting her own features while holding her housekeeper’s hand in sisterhood. The combined procedure involved a chin implant as well as a titanium plate for the repositioned jawline.
I was struck by the tender rapport between the housewife and the housekeeper. Gabriela’s English was basic and Irena’s Spanish was nonexistent. However, their affinity was visible in the shorthand of gesture and giggle that’d been established, I imagined, over years insulated in Irena’s home.
There was something bittersweet about their dynamic. I was happy these Russian and Mexican immigrants born a generation apart had established a friendship across class and race divides. I was also saddened their bond was, to my mind, doomed by their original sin: transgressing their vast employer-employee duality. Then again, who was I to stand in judgment of people seeking mutual solace from the isolation of adulthood, however hopeless and money poisoned? Wasn’t I doing the same thing by socializing with my staff — presuming to be on their level?
When later I had Gabriela away from Irena, I asked her if she really wanted this. She was, in my professional estimation, an otherwise cute girl with one unfortunate malposition. Gabriela said, in Spanish, “Want this? I’ve dreamed of this my whole life! I just didn’t know it was a possibility.” Waterworks commenced. Narine had a box of tissues at the ready, a soothing hand massaging her back. It wasn’t yet noon. We were already on the third patient cry of that day.
The surgery was a success. On the day of the procedures, I met Gabriela’s kind and tentative mother, who accompanied her to the surgicenter along with Irena. The recessive chin and jawline must have been paternal traits.
Irena granted her several weeks off to recover. Gabriela’s new facial profile was in ideal balance. She was thrilled with the outcome. “It’s better than I could have hoped,” she told me, wiping away tears at a checkup several months later, once the swelling had almost completely subsided, “even when I allowed myself to believe in the pictures you printed out for me.” She was speaking of the side-by-side image renderings I’d presented to her on my desktop computer at our initial meeting.
All was well — another triumph. Then, five months after the surgery, Gabriela was back in my office, this time with her identical twin sister, Alejandra. You can guess where this is going.
My heart sank: a definite fuckup on the most elementary patient history leading to what would’ve been a foreseen turn of events. I later learned, in a fit of after-action recrimination, we’d marked that she had two sisters and both were older. Due to a language impasse or unrelated breakdown or gross negligence, we hadn’t bored down to the nuance that one of them was a mere three minutes older.
If I’d been aware, I would’ve warned Gabriela. She was cleaving from the story she’d shared with her twin, one of communal pain. Alejandra, who worked as a stock girl in one of the wholesale shops in downtown L.A.’s Flower Market, would now bear it alone. Maybe Gabriela would’ve gone through with the operation anyway, taking advantage of the opportunity her benefactor had offered her and her alone — despite what would’ve been my pointed caution. Who knows? It was a fable worthy of Aesop.
No matter. Here the twins were, seated across from me, by my hand no longer identical. They didn’t need to tell me of the new emotional distance between them, but they did. They didn’t need to tell me of the new raw tension between them, but they did. They didn’t need to tell me of the guilt and jealousy and betrayal, but they did. Narine, as always, had the tissue box at the ready. They made use of it.
Here were the facts. Alejandra, like Gabriela, had a green card, and insurance under Medi-Cal. Like Gabriela, she was a strong candidate for chin and jaw augmentations. The orthognathic element (jaw work) could be covered by her plan, since I would be citing medical necessity on account of TMJ, headache, dry mouth, and lip incompetence—several of these issues she did have. The challenge would be arguing that the genioplasty procedure (for the chin) was anything but cosmetic.
“I just want to look like my sister,” Alejandra told me, in Spanish, tears streaming. She and Gabriela didn’t need me to condescend to them by expressing the truth: that I truly, deeply, crushingly understood this exact impulse. So I didn’t. Instead sentiment overwhelmed me and I told them — this is where it all went wrong, the point of no return — “We’ll find a way to make it work.”
Alejandra’s surgery, too, was a success. She somehow was able to take the necessary time off from work to recover and still hold on to her job. And I ended up coding her genioplasty as medically necessary due to the worsening aftereffect of an inconsequential accident she’d experienced years earlier when tripping on a buckled segment of sidewalk on the way to her bus stop after work.
This worsening was a lie, the first of many, but not the biggest whopper, not by a long shot. At least in this case there was an underlying truth. The sidewalk spill itself wasn’t total fiction.
I felt a pinprick of sin for conjuring the bogus aftereffect: the specific fact itself (having to do with an airway defect), the ease with which I’d done it. How much worse did I feel than I did when alleging a disputable headache or case of dry mouth? Not much. By comparison, the pleasure I found myself taking in doing what, all things considered, was a minuscule bad thing in service of doing what, all things considered, was a sizable good thing? It was immense.
Excerpted from In Pursuit of Beauty (Blackstone Publishing). Copyright 2025 by Gary Baum.
