THE American fascination with self-improvement, inside and out, has been documented in many variations. But the ardor for physical and aesthetic enhancement was best captured this year by "Extreme Makeover," an ABC reality program. In it, middleclass Americans - a police officer, a waitress, a local radio D. J. - were transformed by plastic surgery, sometimes several procedures at a time, from plain Janes and Johns into coiffed, glossed movie-star lookalikes.

Along with the approval of BOTOX® for wrinkle reduction in 2002, the popular neurotoxin that has conquered wrinkles, the show drew attention to the increasingly popular notion that plastic surgery is not just for the vain or the wealthy.

If cosmetic plastic surgery is available to the average consumer - thanks in part to lending agencies that specialize in financing cosmetic procedures - and no longer bears the stigma of vanity, the question arises: Are we on our way to becoming a nation of the surgically enhanced? If looking beautiful becomes as easy as buying a car or a dress, will beauty - or an imitation of it - become so commonplace as to be meaningless?

The American Society of Aesthetic Plastic Surgery reports that the overall number of cosmetic procedures has increased 228 percent since 1997. The numbers are likely to rise as the population ages, prices drop, younger patients seek out surgery, technology and genetic engineering generate new techniques, and more doctors from various fields offer cosmetic surgical procedures.

Surgical procedures will inevitably become less expensive, said Dr. Lloyd M. Krieger, a plastic surgeon who also has an M.B.A. from the University of Chicago, in part because procedures that 10 years ago took place in a hospital operating room and required expensive overnight stays now take place in a doctor's office.

And, like any consumer product, as it becomes more popular, the laws of economics dictate that the price will come down. "Usually that does not apply to health care, which is bound up with insurance issues, but in the case of cosmetic surgery, people are using their own money so the typical health-insurance restrictions don't apply," Dr. Krieger said. Consumers approach cosmetic surgery as a retail decision, "as if they were buying a cruise, a vacation, a car."

For a while at least, the distance between those who can afford to maintain a youthful-looking appearance, increasingly a sign of privilege, and the merely plain, the unretouched have-nots, will likely widen.

New technologies will soon be available to draw in well-off patients who might never have thought of cosmetic enhancement. Dr. Steven A. Teitelbaum, a plastic surgeon in Santa Monica, Calif., predicted that the next milestone would be the control of tissue formation, whether to reduce scarring or grow new tissues.

When surgeons can selectively grow tissue in the breast, Dr. Teitelbaum said, patients may face less risk than if they, for example, receive breast implants, which can rupture and cause complications and must also be replaced every few years. "When we can control scarring we can do operations we don't even think of now because of the massive scar formation," he said.

Surely, a backlash against the artificial beauties will erupt. Not a chance, Dr. Teitelbaum said. Surgical work, when well done, is now subtle. "Most people aren't getting those bad face lifts anymore, where the eyes, lips and cheeks are distorted," he said. "If everyone getting plastic surgery looked like that, there would be a backlash."

The aesthetically altered future would surely flummox Darwin. One New York surgeon, Dr. Michelle Copeland, suggested that cosmetically altered couplings could create some surprises. Say a man with a big nose and receding chin has a nose job and a chin implant. With his new profile he manages to marry a beautiful woman, who, by the by, had already had her ears pinned back, her sleepy-looking eyes lifted and her thin lips augmented. Their child might well be a surprise package with the big nose, the Dumbo ears, receding chin, saggy lids and thin lips.

"Well, then the child will simply have to start doing all the things his or her parents did," Dr. Copeland said with a sigh. "I've already seen it happen.”