He could have chosen the Cadillac Escalade SUV, the ride he favours whenever he’s transporting Finn, his perfect Rhodesian Ridgeback show dog. But today, for the drive from his One Balmoral penthouse condo to the York­ville clinic in which he works, Trevor Born picked the Porsche. It’s a car as sleek and black as the fine suits he wears to meet with clients. And because appearances matter to Trevor Born more than most—even, it might be said, more than to most plastic surgeons—the look holds even in surgery. Neither the anaesthetist from Toronto East General Hospital nor any of the nurses can remember ever seeing another surgeon wearing black scrubs. Born says he does it for his patients. Traditional blue or green make them nervous, apparently; fashion black helps them relax.

This morning the patient is a 55-year-old Yorkville woman, lying unconscious and chemically paralyzed in the clinic’s state-of-the-art, terrazzo-and-marble-floored operating room overlooking Ramsden Park. Mona, as we will know her, has been thinking about this moment for more than 10 years. A woman with an expressive, joyful face, she has watched the de­teri­oration of her features, the multiplying lines, the hollows, the encroaching haggardness of old age, with not so much dismay as an increasing determination not to let it go unchecked. Every day the face she presented to the world seemed a less accurate representation of the vibrant woman she was. When she decided she could take it no longer, she asked a friend of hers, an international movie star as it happens, for advice. Of all the cosmetic surgeons out there, she asked, who were people talking about? Who should she go to? The actress came back with the answer: Dr. Trevor Born.

He has posted two pictures, images that Mona considers cruel, on a large wooden easel near the operating table. Like a kind of anti-art, they show her face in its stark reality, from the side and front, every inch marked with the ink lines and arrows and circles Born has penned onto her skin to guide him in the artistry to come. What authors do with words or painters with colour, he says, “I do with needles and knives.”

Now, because the lines on Mona’s face have faded since the pictures were snapped, he takes the time to re-ink them as she sleeps. “The key to all of this,” he says, “is pre-op, and following your plan.”

“Follow your plan” could be Trevor Born’s motto. “Of all my friends,” says a man who has known Born for 30 years, “he’s the one living his dream life. He’s living the life he described to us.” It’s a life that includes safaris in Botswana, spas in India and Christmas in Aspen, heli-skiing and windsurfing and a great head of hair. It includes a New York wife even more famous and photographed than he is, and an international clientele important enough to become as mythic and unknowable as the Sasquatch. It’s a life lived with the belief that in this city, there is no one better at what he does than him.

“I’ve hit the jackpot,” he admits. And why? Because he’s the man who knows what aging uptown women want—the ability to, as Cher sings it, turn back time—and gives it to them without anyone being the wiser.

Plastic surgery has been around since before the age of Christ. In ancient India, adulterous wives had their noses lopped off, and so a technique was developed to build new noses from flaps of skin cut from the cheek or forehead. Through the First and Second World Wars, plastic surgery developed as a means to return disfigured men to a semblance of normalcy. But from the early days of the 20th century, there has been another side to the science, fed by women willing to pay surgeons to cut into their flesh in the hope that flesh could be made more beautiful. Western society became habituated to movie star beauty just as women were striving to fix a place for themselves in the modern economy. So women had unwanted moles and hair burned off by X-rays, their faces injected with carcinogenic mixtures of paraffin and goose grease or Vaseline. Doctors performed nose jobs and face remodellings onstage, for fainting audiences, like vaudeville routines. Many patients must have deemed the risks necessary. As early as 1927, Hazel Rawson Cades, the beauty editor of Woman’s Home Companion, wrote, “Being good looking is no longer optional.... There is no place in the world for women who are not.”

Today cosmetic procedures like Botox injections feel as common­place as teeth whitening. In the U.S., more than 11 million cosmetic procedures (with surgery accounting for nearly 2 million of those) were performed in 2006, an increase of 446 per cent since 1997. In Ontario, spending on cosmetic surgery hit an estimated $210 million in 2003 alone. How many of these procedures are performed by qualified surgeons is anyone’s guess. Within Toronto, there are 51 doctors who belong to the Canadian Society of Plastic Surgeons. (Besides Born, the most prominent names, catering to a similarly high-end clientele, include Sandy Pritchard, Tom Bell and Lloyd Carlsen.) Though British Columbia and Alberta have strict regulations governing the training required to do plastic surgery, lax rules in Ontario have allowed family doctors and even spa aestheticians to claim expertise and perform cosmetic pro­cedures on the side. It was only in the wake of real estate agent Krista Stryland’s death following a liposuction surgery that Ontario’s College of Physicians and Surgeons decided to toughen its standards, announcing this past November a plan to regulate who will be able to call him- or herself a “surgeon,” and what training will be required.

To protect themselves, wealthy patients form networks of whispered referrals, like secret orders, around the most trustworthy doctors. In each group of friends, one surgeon will become the go‑to saviour. And go they do, because the wish to ward off the stigma of age is a powerful, undeniable force.