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But plastic surgery is also sought by those in pursuit of healing. Often, they are women such as Charlotte, for whom a better body was less an immediate concern than the neck and back pain caused by the one she had. Charlotte didn't necessarily want or need better-looking breasts, just smaller ones. She wanted relief from years of discomfort, and in an affirmation of that modest desire, her insurance company agreed to pick up the tab.
Charlotte's friends told her the surgeon to see was Dr. Gerald W. Johnson. A prominent weaver of aesthetic dreams, Johnson once owned a house with a breast-shaped swimming pool. To ensure the proper lift and form, he staked out the pool's dimensions himself. The result was a shimmering, aqua-blue monument to society's ideal of the perfect breast.
A crude gesture, or so some in his profession judged it. But the custom-made pool was typical of Johnson, who was one of the first, and most tireless, self-promoters in the plastic surgery business. Back then, in the early 1980s, other surgeons were critical of Johnson for chasing patients to undergo surgeries that were largely elective. Nowadays, advertisements touting the regenerative powers of cosmetic surgery are commonplace, and Johnson has been among those reaping the rewards the longest. In circles largely occupied by those with the goods to prove it, it is believed he does the best breast augmentations in Houston. Certainly, few surgeons have done more of them, or profited as much from a woman's desire to gerrymander her figure.
Johnson's best-known achievement is the bosom of the famous-for-being-famous model Anna Nicole Smith, who can thank the surgeon's two operations for a measure of her notoriety. Truth is, though, there's no telling how many of the fabricated female forms out there today can be attributed to Gerald Johnson.
Shortly after opening his practice in the northwest FM 1960 area, he was anointed by a colleague as the man who "made sooper-doopers out of super-droopers," a description Johnson had printed on the back of business cards. Later, he became sort of a Mattress Mac of boob jobs, offering bring-a-friend-and-get-one-free specials. He also began what were called "Grand Teton Days," when he performed as many breast augmentations as he could in one day.
Some who know his work say Johnson, 56, is a daring surgeon, though they are careful not to attach too much praise to that particular quality. Excessive innovation can be troublesome, as Johnson found out in 1991, when the Texas Board of Medical Examiners ruled that the surgeon had committed four counts of "professional failure to practice medicine in an acceptable manner consistent with public health and welfare."
The reprimand grew out of four complaints the board received from patients who had been hospitalized after undergoing liposuction in Johnson's surgery center. The board ruled that Johnson had removed too much fat from each of the women as an ill-advised way to reduce their weight, leading to excessive blood loss and trauma. The surgeon had also kept the women under sedation too long, the board said; one woman was in surgery for eight hours and subsequently developed secondary pneumonia and a stress ulcer. Another woman suffered respiratory distress and had to be admitted to the intensive care unit at Houston Northwest Medical Center.
The restriction placed on Johnson's medical license limited the amount of fat he could liposuction from patients and required him to have transportation to a hospital available before undertaking any surgery. He also was taken to task for an advertisement he ran in the August 17, 1987 edition of the Arkansas Gazette. The ad announced that Johnson was to speak at an upcoming workshop by the American Society of Liposuction Surgery and described him as an "internationally known plastic surgeon and leader in fat transplantation for augmentation of the breasts." That was news to the state board. In a fifth count of their ruling, the examiners said Johnson had claimed "professional superiority or the performance of professional service in a superior manner which was not readily subject to verification."
The restrictions on Johnson's license were lifted in August 1993, seven months after Charlotte first consulted him. During their initial meeting, the surgeon showed her a video of a standard reduction procedure in which fat and tissue are removed through an anchor-shaped incision in the lower half of the breast.
For whatever reason -- time, money, fear -- Charlotte didn't contact Johnson again until June 1994. This time, Johnson offered her the choice of another operation -- a bilateral endoscopic reduction mammoplasty. The procedure called for an incision along the side of the breast, in a fold near the armpit. Because the breast proper wouldn't be touched, there would be far less scarring than the standard procedure Johnson had initially proposed.