THE American fascination with self-improvement, inside and out, has been documented in many variations. But the ardor for physical and aesthetic enhancement was best captured this year by ''Extreme Makeover,'' an ABC reality program. In it, middle-class Americans -- a police officer, a waitress, a local radio D.J. -- were transformed by plastic surgery, sometimes several procedures at a time, from plain Janes and Johns into coiffed, glossed movie-star lookalikes. Along with the approval of Botox for wrinkle reduction in 2002, the popular neurotoxin that has conquered wrinkles, the show drew attention to the increasingly popular notion that plastic surgery is not just for the vain or the wealthy. If cosmetic plastic surgery is available to the average consumer -- thanks in part to lending agencies that specialize in financing cosmetic procedures -- and no longer bears the stigma of vanity, the question arises: Are we on our way to becoming a nation of the surgically enhanced? If looking beautiful becomes as easy as buying a car or a dress, will beauty -- or an imitation of it -- become so commonplace as to be meaningless?
