the writing and photography of Neil Kramer

Plastic Surgery

Sophia and I teach each us other new things. It is one reason for the longevity of our bumpy marriage. I taught Sophia about the appeal of “The Brady Bunch.” Sophia taught me to spot someone with plastic surgery.

Celebrity Plastic Surgery Watch is one of our favorite games at home.

“You see the way her boobs stay up like that, against gravity — fake breasts.”

All My Children, our daily soap, is a cornucopia of plastic surgery (and anorexia). Recently, one of the new characters dropped her dress in front of the hunky lead, and Sophia and I had to look away from the protruding bones in her back. This is sexy?

After countless years of playing Celebrity Plastic Surgery Watch, we have come to a conclusion. Too much surgery can produce a weird result — a woman starts looking like a man, and vice versa. Why is that? Perhaps it is nature’s way of saying that the youthful tautness of the skin looks unnatural after, say 35.

Recently, Jerry Seinfeld’s wife (too lazy to look up her name — hey, I’m a blogger, not a journalist) was on Oprah hawking some cookbook of recipes for junk food for children made with sweetened pureed vegetables. Her idea is to fool her kids into eating their broccoli. Oprah was oohing and aahing over this concept, as if this was the most brilliant idea since Existentialism. Of course it appealed to Oprah, being a brat herself. Just think how f**ked up Seinfeld’s kids are going to be because their mother went out of the way to make them cake created from broccoli. I don’t want to sound like an old fart, but whatever happened to the mother telling her child to “eat your goddamn peas and carrots or no Nintendo for a week, you nitpicking slug?!” In a Jewish household, guilt always worked. I ate my vegetables because children were starving elsewhere.

Anyway, I’ll leave my tirade against Jerry Seinfeld’s wife for another post. Let me stick to the topic at hand.

“She had surgery” said Sophia.

“No, she didn’t.” I answered. “She’s so young. She’s like 28.”

Sophia laughed at my naivete. Why did she laugh so hard? Was it because I thought she was 28 or because I thought that 28 is too young to have plastic surgery?

Later in the program, Oprah’s new Dr. Phil — her new medical boy-toy — Dr. Mehmet Oz, came on to help promote Jerry Seinfeld’s wife’s evil book. Having plugged Crazy Aunt Purl’s book last week, I understand how friends want to help promote each other, but at least Laurie’s book is good, and she doesn’t go around constantly reminding you that she is Jerry Seinfeld’s wife.

The minute Sophia and I saw Dr. Oz, we knew something was different with him. We’ve seen him on Oprah before. His hair looked fuller and neatly coiffed. He was sitting straighter, as if a professional “communicator” gave him lessons on showing authority on TV. The capper was that he looked at little more… feminine. Sophia and I didn’t even have to say anything. We just nodded. He had “work.”

Let me make a disclaimer here. I hope you don’t think that this is going to turn into a mocking piece about the vanity of plastic surgery. Far from it. Maybe it would have been four years ago, even three years ago. But age is creeping in. And I’m sure there are several of you that have had some work done. There is no denying that there is a lot of pressure on everyone to look young and “fresh,” especially for women. It’s difficult to go a day without hearing someone talk about Botox or tummy tucks, even from young women.

Do these procedures really make you feel more self-confident?

I think men are luckier than women in the way they define themselves. While our looks are important, we don’t usually let it be the barometer of who we. One of the things I like about the blogging world is that we don’t base our relationships on looks. A woman who writes sexy IS sexier than the supermodel. Of course, there is always Flickr, where it is the best-looking people who feel most confident taking photos of themselves 365 days a year.

Yesterday, in my “anniversary post,” I included some photos of Sophia and me at Laguna Beach. We had taken several photos together, and choosing which one to post took three times longer than writing the post. It is funny how publishing a photo of yourself can seem more scary than writing personal things online. Sophia didn’t like one of the photos, because the angle made her look tired. In another photo, I hated the way my hair looked. As we critiqued ourselves, we talked about the possibility of plastic surgery someday. After all the times we made fun of it, would we actually do it ourselves? Sophia said she might do something for her laugh lines. I didn’t even know this bothered her. Until she pointed it out, I didn’t even notice it.

I can be vain sometimes, but I don’t fret over my appearance too much. Who has the time? Lately, I feel the urge to improve my appearance. Is it the effects of therapy, or just reading too many of your self-obsessed blogs? I should stop getting my haircuts at Supercuts. Is it time for me to get new glasses? Didn’t one of you recently say that they are too big for my face? Do those whitening stripes really make your teeth whiter — so I can finally stop Photoshopping my teeth?

I feel OK enough with my body, even though there is no logical reason to feel proud of it other than it is mine. I don’t usually walk around shirtless, showing off my clean-shaven chest, like everyone on All My Children, or like every other guy carrying a surfboard on Redondo Beach.  I probably should go to the gym and exercise a lot more. I’ve always had a fantasy of Sophia grabbing my arms and saying, “Ooh, such muscles!,” something she has never said… ONCE. It would sort of be cool to have women checking out my abs and muscular chest, or to overhear two women giggling and saying “Neilochka has such a great ass!” It gets tiring always having to be witty to get a woman’s attention.  I’d like to have her fantasizing about sex with me without any effort on my part, other than taking off my shirt.  Well, I guess the going to the gym 6 days a week would require some effort…

For someone who loves his Penis, I have never understood men’s overwhelming obsession with that area. It’s probably the one part of the anatomy that there is NOTHING you can do to change what you have, despite the spam in your inbox. Sure, we all imagine ourselves walking around the living room with hard-ons the size of the Eiffel Tower, but honestly, what do you need it for? Are you in her home to have sex or to be her cat’s scratching pole? At least with your abs, there are exercises you can do to make them stronger.  You can lift 200 pounds with your penis forever, and it’s not going to get any bigger.

I have a pointy nose, like my father did, but I like it. I really like noses, especially the ones that women are sometimes self-conscious about. Am I the only one who finds bigger noses on women sexy? I like Barbra Streisand’s nose. I like the noses of Jewish, Italian, Greek, and black women. My least favorite nose is the one after mediocre plastic surgery that looks like the nose of a pig.

If I ever get plastic surgery it would be for my chin. I have a weak jaw that has given me a double chin. I didn’t think about my chin much until I started putting photos on my blog and noticed it (thanks a lot! I blame you bloggers). While I can whiten my teeth with Photoshop, I’m not that skilled to get rid of a double chin. Sure, I can trick you by standing in front of my home while Sophia shoots the photo from the roof, pointing down so you don’t see the chin, but I know in my heart that the double chin is still there.

Will I ever really get surgery? Probably not. It’s just not ME. But I’m more understanding of why people do have plastic surgery… and I wouldn’t be surprised if I changed my mind in a year or two, depending on whether or not I am still with Sophia. Being single can make you do a lot of wacky things. I just hope society doesn’t get to the point where it seems ODD to look untouched.  It seems to be getting to the point where it is more acceptable to have that scary, taut Joan Rivers face than to look like a real middle-aged woman.

A Year Ago on Citizen of the Month: I Still Remember the Wedding Dance


  1. You can call me, 'Sir'

    My hair sent me a card a few months ago:

    Dear Dude
    Your Hair

    I’m 34. Thirty-friekin’-four. Still, it’s not the traumatic event I thought it might be. Time marches on, a season for everything, blah blah blah. I can’t ever see submitting myself to plastic surgery for anything, though. There needs to be a better reason than vanity to allow a stranger to cut me.

  2. Dave

    When I was a young, stupid, insecure boy, I got a hair transplant that some evil bastard who called himself a doctor did to me. I asked for it, so I can’t blame him. But, he actually told a 16 year old balding boy that he wasn’t sure how far my hair would proceed falling out. Sometimes I think docs are partially to blame.

    I looked like I had a false hairline of pubes. I finally got them removed. How’s that for a circuitous way to go bald? I feel so much better not trying to hide and wear my resulting scars as a reminder to not be insensitive to others who look different.

    Great post.

  3. helen

    Honestly, we should be thankful for what we have. You still have your hair. 😛

    My father lost 90% of his and still spend a fortune on hair

    In the end, it just boils down to whatever rocks your boat. It takes courage to undergo plastic surgery…. and just as much not to.

  4. tiff

    Starting at about 40 I noticed “things” happening that were the direct and cruel result of aging.

    The chins! The boobs! The bags! Oh my!

    I’m stuck as to which one to “fix” first. I’d taken to saying that I was going to get me some plastic surgery for my 45th birthday, but it’s come and gone and I still don’t know what to do first, or, mosre tellingly, which fix would be cheapest.

    I’m with you on the noses thing. I think the girl in your illustration looked way batter in her “before” picture.

  5. tiff

    way BETTER, that is.

  6. Caron

    I used to be really cynical about plastic surgery and the people who had it done to themselves. Now, I am a little more thankful for the skills the doctors gained working on them.

    I had breast reduction surgery a few years back to alleviate constant back and shoulder pain. As much as you love them Neil, they can be a literal pain in the neck. Now, I can stand up straight pain free, and, I’m in my 40s with relatively perky breasts! (Although, my god, gravity is amazing!)

  7. Guilty Secret

    I love the anonymity of the blogosphere. I wish there were a magic way I could see my readers’ mental images of me. I could ask them to describe it, but that wouldn’t really work.

    I agree, it will be horrible if plastic surgery (hey? When did they get away with changing that name?) becomes so commonplace you look weirder without it than with it.

  8. sizzle

    i’ve thought about plastic surgery but i am too chicken to have surgery on purpose.

    you’ve just reminded me how much i loathe oprah. thanks!

  9. Kelliqua

    I love how the taut faces and cheekbones are perched on wrinkly, chicken-skinned necks. It seems that not much can done about that dangling skin, yet.

    I know that I’ll never get plastic surgery, I just want to grow old naturally and gracefully and I’d rather spend the money on a great vacation.

    Mrs. Seinfeld’s book also caused the same reaction in me. Even if you are sneaking in ingredients what the hell is that teaching kids? “Oh honey, you don’t want broccoli? Let mommy make you a cake, instead.” Yeah, that’ll teach healthy eating habits.

  10. Bre

    Sometimes it’s not just about society and the pressure that they put on you. I’ve had plastic surgery and while there was surely an impact from “society” on my decision, the decision was about me. It was about my health, my wellness, my comfort, and my body – not about achieving a body that fit into someone else’s idea of “perfect”

  11. plain jane

    Not to make you feel bad…but my honey went for his flu shot a couple of days after his 60th birthday and the nurse actually said, “wow, what muscles.”

    No plastic surgery for me, just my charming personality and a good underwire bra.

    P.S. Crazy Aunt Purl does go on and on about how she is Al Gore’s girlfriend. Tee hee.

  12. Not Fainthearted

    I used to think I’d never do any of it. Not even whiten my teeth! Then I realized my grandmother, mother and sister all had to have their upper eyelids done because they were interfering with peripheral vision, and so it’s likely I will too. and hey! that’s plastic surgery…and then I began thinking….what else could they do “while they’re in the neighborhood…”

  13. brettdl

    I have no interest in changing my body, but I’m fascinated by those who do. My wife came home with an enormously thick magazine that was all about changing your body.

    In two-thirds of the before and after pictures, I think the person looked better in the before. (These were all photos of healthy women.)

    But the magazine tells me just how BIG a business body changing has become. What people won’t do for (imaginary?) perfection, even if it’s fleeting!

    That said, I totally understand when there are medical reasons. A common problem in my family are heavy eyelids, which need fixing to see. (I haven’t had that problem so far.)

    And we’ve had several friends who’ve had radical mastectomies. No arguments there.

    Even if I wanted to change myself, past experience says I shouldn’t:

    I once had to use my wife’s teeth whitener because my toothpaste ran out: My teeth started to hurt like hell and my dentist had to prescribe something to make the pain go away.

    Put something on my skin, and I’m just as likely to get a rash. So there you go.

    BTW, I have a huge nose and yet I married a beautiful woman who likes it.

  14. Dave G

    “Oprah was oohing and aahing over this concept, as if this was the most brilliant idea since Existentialism.”

    I haven’t read the complete article but this line made me laugh out loud 🙂

  15. Neil

    Just to make my own ideas clearer to myself, I probably shouldn’t have used the words “plastic surgery.” I am thinking more of the cosmetic type rather than fixing drooping eyelids or reducing breast size for health or comfort reasons. No one thinks about those things as “cosmetic” anymore, or has any “moral” opinion on it. It is shameful that some women have to fight to get covered for reconstruction after breast cancer surgery. Instead, I’m talking more about the natural effects of aging — the lines, wrinkles, sags, etc. that we have become afraid of. Frankly, I don’t even have much of a stance against that either. If it makes you happy – why not. We have an anti-aging society. I just think sometimes, the result looks worse than it did before. Is Joan Rivers really fooling us into thinking she is still 30?

    So, you don’t have to be afraid to admit some work to me. Remember, I live in Los Angeles. People throw parties for their new boobs.

  16. GraceD

    Plastic surgery, vanity, penis size, yes, all fascinating topics.

    But a broccoli cake? I’m still reeling over that. And suffering simultaneous GI distress and a sugar rush at the mere suggestion.

    By the way, the real problem with the young lady pictured above? The intense 80s make-up. Truly bad cosmetics.

    Thank you for this post. And know that I find your muscular blogging very attractive, indeed.

  17. Neil

    And Tiff — I definitely would do the first girl. Her nose makes her look elegant and mysterious, and wild in bed.

    The second girl looks like the typical check-out girl at a Redondo Beach Ralph’s Supermarket.

  18. Finn

    I long ago eschewed the idea of having my Florentine nose de-bumped. I’ve come to appreciate it for what it is.

    I have, however, had a bit of fat sucked out of my abdomen because it annoyed me that not matter how much I worked out, it wouldn’t leave. I’m more comfortable in my skin now.

    The key is not to overdo and to get good work done. Shop around for a top surgeon!

  19. Neil

    Finn — I knew you would be the honest one. Now that is very hot! I know that “the sucking” is a popular procedure. Is it painful? Does it stay off? Do women usually do it after having a child? Can I do it instead of every exercising again?

  20. churlita

    I know I’ve said this before, but I like the things about people that make them look more interesting. I’m 42 and I don’t want to go out with a guy who looks 22. If I did, I’d just date a 22 year old. I live in a college town, I’d have more luck with that age anyway.

    I think aging on the outside is like aging on the inside. Some people get better with age, and some people get crankier and more unhappy and it shows.

    Luckily, I live in Iowa where almost nobody gets plastic surgery, because no one really cares.

  21. di

    Well you could grow some sexy stubble. My man does, it disguises his little chimpmunk cheeks when they get a little chipmunky.

    You know, he doesn’t like me calling them that but they’re awfully cute. Anyway, try stubble but clearly Neil, you’ve already got what it takes to have a bevy of woman flocking around you … didn’t you notice?

    I hate going to the dentist’s,can’t imagine surgery for anything that wasn’t life or death …

  22. communicatrix

    Oh, lordy…where to start?

    Your looks? The ridiculous/dangerous futility of 99% of plastic surgery? Scary body image messages young girls are bombarded with every day? The ludicrosity (yes!! I say so!) of Jerry Seinfeld’s wife’s book’s premise?


    So many soapboxes, so little time. I’ll leave you with this, because I love you, dear:

    Go ahead and spruce yourself up. We gals do it all the time with new clothes, hairdos, accessories, etc. If you don’t let it get out of control (and I don’t see that happening) it’s fun, it shakes things up, it’s good for personal growth.

    Stop short of elective surgery. As the child of a man who *had* to have it (bad intestines run in the fambly), you never, ever want to subject yourself to anesthesia unless the alternative is worse.

    I leave it to the individual to decide “worse.” Darwinism in action, baby.

  23. communicatrix

    Oh, yeah–one more thing:

    big noses are waaaaaaaaaay sexy.

    That is all.

  24. Ellen Bloom

    I grew up in Beverly Hills in the 60’s. It was always fun trying to figure out after Christmas or Easter break who had rhinoplasty over vacation. Mine was done over Easter vacation when I was 16. A rite of passage!
    I used to be so good at spotting nose jobs, that I could even tell you which BH doctor did the deed from the style of the nose!!!
    I moved on since then.

  25. Danny

    Before you abandon your tirade about Jerry Seinfeld’s wife, can I join it? I saw a few minutes of that show last week when Oprah was going apeshit over Jessica Seinfeld’s new book which she screamed over and over again was LIFE-CHANGING, instantly turning it into a runaway bestseller. Um, excuse me, but did Jessica Seinfeld invent the household appliance knows as…the blender? I’ve never seen any dumb book so bizarrely hyped. I’m fine with throwing a little hidden vegetable purees in other foods but there is nothing new about that either, and I agree that kids should also be encouraged to eat real, whole, fresh vegetables. Oprah was off her rocker in that episode. I like her but her crazy enthusiasm for that book smelled like an “I can make your sales skyrocket” favor for a friend. Yuck.

    As for plastic surgery, the horror stories are legion in this town but in the end it comes down to GOOD plastic surgery versus BAD. No one argues the fact that Michael Jackson and lots of other people look like android freaks but we know, for example, one movie star in her late 70s who’s had several very successful procedures (i.e., you can’t tell she had them except for the fact that she looks about 50 and is absoultely gorgeous) and it has frankly done wonders for her career. So I would never begrudge anyone who wants to go under the knife, I’d just encourage them to find the best freaking doctor money can buy. But don’t get me wrong, I’m not advocating plastic surgery, I LOVE wrinkles, and wrote a whole blog post about how refreshing it was to see Liv Ullmann’s naturally aging face.

    As for me, I will never get anything done but I can’t say I don’t every gaze at my newfound turkey neck and wish it could be restored to its former tautness. And I hate being bald but I hate the so-called “solutions” for it even more. It would be nice to live in a world where we all accept ourselves as we are.

  26. V-Grrrl

    Two of my sisters had nose jobs done by the same surgeon at the same time. They were in their early 20s and paid for the surgery themselves out of their secretary salaries.

    I have an Italian nose and I like it. I have a really small chest but would never consider implants. The boobs are naturally perky, a plus at this late stage in my life. I have a poochy stomach but would never consider liposuction. I joke that it’s my love bumper.

    I have lines on my face, and I’m OK with those too.

    What do I HATE?

    The blue spider veins on my legs. Those make me feel older than anything else going on with my body. I’d love to have them zapped, though I probably never will.

  27. Neil

    Danny — It is an interesting to realize how much harder we are on ourselves than others. To me, you look great and would say you shouldn’t even give a thought to your hair (or lack of). But if this was my HAIR — I would be like you and obsessing. Why do we tend to treat ourselves so poorly?

  28. Neil

    V-Grrrl — So, why wouldn’t you do it then? Just to be devil’s advocate — it might give you a thrill to get rid of them. I’m pretty sure you can afford it. Do you not do it because you think it is being too vain, or are you just afraid of doing it?

  29. sassy

    What a great post !

    I’m 31, which seems from this end, and as a woman, the ‘beginning of the end’. I know, it’s young, and I’m being overly dramatic, but coming to terms with losing youth is so stinking hard !

    If I was rich and wasn’t so afraid of pain I think I’d do it too, why not? A little lipo, botox and springy boobies can’t hurt a gril. Thugh I think it definitly is scarier than aging when you see someone who goes to extremes.

  30. OMSH

    I’m fully grey – okay, mostly grey at 35. I colored it until 29 and gave up. I mean, at 18 it was kinda strange to have that skunk stripe, but now that I’m at least 1/2way to 40 no one cares…much.

    I don’t anymore.

    I’m also overweight. By society’s standards I’m dreadfully ugly, but my husband still thinks I’m a beautiful woman and he’s who I’m here to please.

    I think I’d never truly consider any kind of surgery unless a feature of mine became too much for my husband to look at. And watching him age and being more and more attracted to him as he does just makes me realize that most likely our attraction is more of an all over joy than a physical thing.

    I doubt I’ll have need for it and I’ve got a lot of laugh lines.

  31. Suzel

    I taught my husband how to spot a really bad toupee. I’m very proud of myself 🙂

  32. Lefty

    Neil, never fear. You have a GREAT ass.

  33. Neil

    Lefty — Are you telling me the truth? You don’t think it’s too fat, do you?

  34. 180/360

    I am fascinated by the plastic surgery shows- probably because I know I could never do it myself. But after watching countless episodes and hearing the same thing about “how it is going to boost these people’s self-confidence”- it just worries me how as a society we’re getting further and further from reality.

    I think birth noses were designed for the faces they are on. I think aged skin shows progression of life. I think small boobs are so much sexier than completely fake ones. I think imperfection is beautiful in its own right. It is what makes us all unique and I can only imagine how scary Hollywood is going to look in the years to come.

  35. Jennifer

    Honey, I can barely be bothered to put makeup on. The day I start saving my pennies so some rich bastard can carve pieces of me away like so much orange rind? Well, it’ll never happen.

    Thing is, do these people think they look GOOD? They’re usually just this side of scary. If they’re lucky. What happened to a person’s face having real,honest-to-goodness character, for better or for worse?

  36. adena


    I HATE my nose!

    I’m glad some people here (including you) like the big noses, but I’ve always hated mine.

    I’m pure Gaelic in ancestry, yet I’ve managed to wind up w/ either an Italian or Jewish nose…I’m not sure what happened there.

    I’ve always been really self-conscious about it, actually.

    Don’t know as I’d stoop to surgery, tho’.

  37. Jenny from Chicago

    Ummm…I tagged you for a five things meme. If you don’t do it I will probably have some really bad plastic surgery. So, do it.

  38. gorillabuns

    i have a thing for guys with big interesting noses.

    just like i like a guy with big rough-looking hands.

    and no, this has nothing to do with the size of a guy’s unit.

  39. Fitèna

    I watched a french show or dangers of PS where there was this lady who thought her breats where too much. Its a real problem for her and it almost cripples her. Cries all the time is what she does. Her husband and she decided she was going to have a reduction. She had her reduction and came to the show. Not because she was from the pannel who thought PS was great, no. She came to cry about the surgeon having reduced too much and how now she has a 14 years old breasts. Her husband and she decided she was going to have implants.
    I think it was supposed to be sad but man on man did I laugh! She’s going to pay her breasts back is what I kept thinking!
    Do you trust people who keep telling you they like you the way you are?


    PS: Dear Neil, please have Sophia DHL me her red white dotted hat below! Amen

  40. better safe than sorry

    i’m turning 50 in a few months and i’m ok with it, i’ve accepted how i’m aging. for years i thought that when i turned 50 i would get a breast reduction, i’ve got a bit of a back issue with straps that dig into the shoulders…but now that i’m so close, i’m actually afraid to get the procedure done, but wish i had the courage to do it.
    and my kids all eat their veggies, its part of a proper nutrition regime in our home.

  41. Paul

    I am lucky and a lot of people still mistake me for 25, despite being 36. I just pat their guide dogs nicely on the head and thank them.
    You and Sophia look great as you are … dont change!

  42. Miguelina

    I’m also afraid that normal looking people will be the freaks and the generic cosmetically enhanced look will be the norm. I still can’t get over the fact that 18 year old girls get boob jobs.

  43. mrsatroxi

    I have a large nose. I dislike my profile. But I don’t think about it much unless I see a photo of myself side-to. Surgery? No. I hate doctors, I hate hospitals. I’m only doing that when I have to. For somebody else, if it helps them feel comfortable in their skin? Go ahead, I say. I sorta think a person should try some therapy before going under the knife, though. But, again, I hate doctors! 🙂

    “Sophia said she might do something for her laugh lines. I didn’t even know this bothered her. Until she pointed it out, I didn’t even notice it.”
    This part of your post reminded me of a short story by Pearl S. Buck. I can’t remember the title! When I get home, I’ll look for it. Anyway, it’s my favorite description of the “blindness” of love, how different and important looks can be for us women, compared to menfolks. It’s good. A little dated, but the emotion is there…

    Thanks again for your kind comments.

  44. kerrianne

    “Cornucopia of plastic surgery” is my new favorite phrase. Classic.

  45. savia

    The jaw surgery I’m on a waiting list for isn’t for aesthetic reasons, but it will have an aesthetic result – moving my lower jaw forward is going to give me a chin. A chin!! (As you can see, I know how you feel.)

    Anyway, whenever I get in for surgery, I will be sure to blog all about it, and you can get an idea of what it’s like. You know, just in case you decide to take the plunge.

  46. New Diva on the Blog

    I would like to think that I will grow old gracefully and accept it, but having just passed the annual celebration of my 29th birthday (no I am not going to tell you how many annual 29th birthdays I have had) I am beginning to wonder. I do spend a good deal of my time sweating my a@# off at the gym to try and fight aging. At least I hope I am sweating my a@# off, otherwise what is the point?

  47. John Tubbs

    As you can see, it becomes popular for celebrities to have a plastic operation. Obviously, the appearance is signifficantly improved after plastic surgery. Celebrities are always in the public eye, so it is important to look perfectly all the time.

  48. About Cosmetic Surgery

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