Back a long time ago, in the olden days of the last century, we all knew how to respond to a set of enormous fake breasts. We stared. We muttered, “Oh my Lordy.” It was new then, and comical in a grotesque, medically questionable kind of way. Pamela Anderson was nothing if not an absurdity, a fifteen-year-old boy’s dream girl blown up to comic-book proportions. Dolly Parton, at least, had the sense to make fun of her extreme, and extremely lucrative, implanted bosom. “I was the first woman to burn my bra,” she once said, in her girly southern lilt. “It took the fire department four days to put it out.”

Now, things are much different. You can’t go anywhere without encountering boobs that’ve been inflated, a face that’s been peeled, or a butt on the back end of a tuck. In 2004, according to the American Society for Aesthetic Plastic Surgery, nearly twelve million men and women succumbed to various elective “procedures.” Almost a half million had liposuction. More than 300,000 had their breasts enlarged. Hundreds of thousands more had their eyelids chopped and their noses sculpted. People now walk around with Pete Postlethwaite-sized cheek implants, snipped ears, hair plugs, fraudulent six packs, and lips that look to be melting. It appears that we’ve overcome the aversion to purchasing what nature didn’t, or would never in a million years, provide.

The question arises, then, as we teeter on the brink of total plastic surgery acceptance: How should the casual observer respond to these sudden changes in the people we know and sometimes love? Because even though Americans are going under the knife in record numbers, we innocent bystanders still seem required to pretend as though nothing’s happened. (It’s no coincidence that teenage girls often ask for breast implants before heading to college, where a new crowd will be none the wiser.) We’re supposed to keep our wrinkly, thin-lipped yaps shut when a once-craggy face suddenly appears taut as the blanket on an army cot, when B cups miraculously turn into double Ds, springing forth from a cocktail dress like beach balls bobbing in a swimming pool.

There are bodily changes we’re meant to acknowledge, even admire. Like tattoos and purple hairdye jobs. But then, an alteration as dramatic as a new nose is supposed to pass without comment. Perhaps it’s part of our growing collective belief in fantasy, the fuzzing line between truth and fiction, our willingness to be complicit in enormous lies. Spider-Man really can leap from building to building, Saddam Hussein had weapons of mass destruction, and this is definitely my original butt.

Conventional wisdom dictates that we wait for those who’ve had plastic surgery to mention it first, to indicate whether the enhancement is intended to be noticed. But that seems ridiculously tactful, not unlike the way you’d treat someone with cancer or a mental illness. It certainly would be a relief if the conversational climate were more open, more breezy. Then a person could come right out and ask whether there are crunching noises during rhinoplasty. We could ask if, as plastic surgeons like to suggest, a man with calf implants truly feels like a butterfly released from a cocoon. How refreshing it would be to stop merely observing the sped-up, tilt-a-whirl evolution of the race, and say, “You know, the cleft in your new chin looks like a tiny butt.”—Jennifer Vogel