What's behind Hollywood's plastic surgery obsession? Radar spoke with industry insiders—from casting directors to A-list doctors—for the truth about the insane pressures, the elaborate subterfuges, and the costs of playing the perfection game

See before-and-after shots of Angelina Jolie and others

FOR MERE MORTALS, the holidays are a chance to congregate with loved ones, rationalize gluttony, and exchange unwanted gifts. For Hollywood celebrities, they're traditionally a time to sneak off to one's surgeon's office for some urgent nips and tucks. With only weeks remaining until awards season—the series of televised events that kicks off with the Golden Globes on January 13—planning is everything. By Thanksgiving, anxious stars are already discreetly arranging to have their palms Botoxed (to avoid sweaty red-carpet handshakes), their laugh lines rendered mirthless with Juvederm injections, and their droopy eyelids carved away. As the ceremonies draw nearer, last-minute earlobe plumpings are not unheard of.
Recently, Rose McGowan lost out on a role in the upcoming film Speed Racer, reportedly because her overstretched eyelids had begun to evoke those of an alien kitten

Each time major celebrities alter their bodies, they're risking millions of dollars in potential earnings and the livelihoods of their entire teams. With the stakes so high, the effects must be subtle. No one wants to be the next Meg Ryan, whose 2001 misadventures in lip enhancement left America's erstwhile sweetheart looking like a duck, a lapse in judgment at which Hollywood still shudders. "She basically installed a vagina on her face," says producer Clifford Streit (American Psycho), adding helpfully, "When your lips get that big, your eyes look too small." More recently, Rose McGowan lost out on a role in the upcoming film Speed Racer, reportedly because her overstretched eyelids had begun to evoke those of an alien kitten.

Even minor procedures are performed in grim secrecy. For A- and B-list stars, admitting to any plastic surgery is only slightly less taboo than admitting to a taste for sodomy. "Everybody lies about it," says actress Julie Bowen (Boston Legal, Ed, Lost). "The men I know are a bit more open, but the girls will lie and lie and lie, even though you're staring right at their scars." Bowen, 37, one of the most defiantly flat-chested successes in the business, has no need to fib: "I haven't had any surgery," she insists, "but I'm totally fascinated with the idea."

She's not the only one. Although much of America has grown blasé about plastic surgery and sees little wrong with a self-esteem-boosting nose job (or three), Hollywood's lies perpetuate our national fixation with its frozen faces. In the tabloid era, editors at InTouch and Star endlessly examine renowned noses for telltale nostril changes, and paparazzi stake out the offices of high-profile doctors like Arnold Klein, a Beverly Hills dermatologist who somehow survived his association with Michael Jackson to become one of Hollywood's elite injectors. Meanwhile, awfulplasticsurgery.com, a website run by a Los Angeles customer service representative, draws more than one million hits a month, exposing the stars' scalpel antics with tantalizing (if sometimes dubious) photo evidence.

Still, thanks to patient confidentiality and stealth tactics, some of the harshest aspects of the industry's bizarrely conflicted relationship with plastic surgery go unreported.

To uncover the real truth about daily life inside this collective neurosis, Radar talked to dozens of entertainment-industry insiders—casting directors, talent managers, actors, and agents—many of whom insisted on anonymity. Several others declined to talk even off-the-record. "You've got to understand the desperation," says Streit. "Hollywood is a sea of desperation surrounding the Beverly Hills Hotel."

This is a town, after all, where stars meet their surgeons for whispered face-lift consultations on the sidelines of their children's soccer games, and use underground parking garages to skulk into opulent "recovery retreats" after surgery. It's a place where Lionel Richie's estranged wife, Diane, anxious to sustain her plastic surgery habit, explicitly demanded $20,000 a year in annual upkeep in her 2004 divorce filing. (Which is arguably a bargain: Some doctors charge that much per day to clear their schedule for a marathon fix-it session, and Demi Moore allegedly dropped some $330,000 for her pre–Charlie's Angels body makeover.) Even high-profile Scientologists, so famously opposed to pharmaceutical self-improvement, have their own plasticizers, such as Edward Terino, M.D., who reportedly performs church-sanctioned "silent" nose jobs in the belief that any music or chitchat in the operating room might subconsciously taint the anesthetized believer.

The fetish for looking generically ageless is by no means confined to on-screen talent. "Actors aren't the only ones to feel the pressure," says Greg H., who spent 23 years in Hollywood as a top casting director, agent, and talent manager before decamping for Seattle. "It's everyone: producers, writers, assistants ... the executives' wives are easily the worst."

"Actually," says producer and manager Douglas Urbanski (The Contender), who's repped stars such as Gary Oldman (his current producing partner) and Isabella Rossellini, "the realtors are probably the most plastic-surgerized people going. L.A. is such a fucked-up place. Where else do you have to look flawlessly sexy to sell a house?" As the Los Angeles Times recently observed, perfection has become the city's requisite standard of grooming: "Walking around with a furrowed forehead ... has become the equivalent of going out with dirty fingernails. It's possible to fix that."

Photos: Kidman, Matthew Salacuse; Ryan, Evan Agostini, Getty Images; Carrot Top, Carlo Allegri, Getty Images; Digital Art: Kidman, Planet Hiltron