Pamela Johnston of East Hanover understands the pressure to be thin because she has lived it. The 25-year-old recovering anorexic and bulimic recalls binge eating at age 9 and consuming low fat, low-calorie and diet foods on a regular basis.

"Women think they need to look like this, yet the women that look like that don't even look like that," Johnston said of the airbrushed models splashed across magazines covers.

She's not alone in her quest for physical perfection, and she recognizes society's long-standing obsession with youth and beauty. Whether through diet, exercise or plastic surgery, many people feel it's necessary to strive for an ideal appearance.

"People now realize, which is an absolutely fascinating concept, you can make yourself beautiful," said Jonathan Reader, a professor of sociology at Drew University in Madison.

Johnston loved food but faced negative consequences for her delight. "As a result, I would try to do what I could to keep my weight as low as possible while still figuring out some way to continue to eat emotionally," she said.

A fast metabolism prevented Johnston from gaining weight until her middle teens. At 5 feet 6 inches and a high of 185 pounds, working out incessantly and binging and purging up to six times a day eventually caused her weight to plummet to 110 pounds.

"It really was very telling about what we value in America," she said. "All the money that's going into the diet industry, the cosmetics industry -- can you imagine if we put that to global aid, the differences that would happen in the world."

Stories about dieting and recipes abound in newsstand publications. The average American woman wears a size 12 or 14, but many strive to be smaller.

"There's so much focus on size; it seems like it's so impossible to create any kind of lasting change in terms of the messages that are sent," Johnston said. "It's two-sided, because the media wouldn't say it if people don't want to read it."

"I've got to be the best at my diet, but I've also got to cook these gourmet meals. It's so contradictory," said Dr. Lona Whitmarsh, an assistant professor of psychology at Fairleigh Dickinson University in Florham Park.

"There wouldn't be this constant flow of drugs in the United States if there weren't people with disposable income looking for something missing in their life," Reader said. "To me it begins way back with Hollywood, but more immediately after World War II."

"Marilyn Monroe started as a pinup and then was in the movies, but then the movies are on television," Reader said. "She's very interesting, because there are so many Marilyn clones, right down to the present."

Whether it's Paris Hilton or Britney Spears, celebrities are represented as the ideal. "They have high recognition. Hollywood makes narcissism a whole worthy goal," he said.

"You can date it with the birth control pill," Reader said. "People are willing to put more of their body on display in public. If you do so many exercises and that doesn't work, you supplement whatever diet you're on, you go to a tanning salon, you get blond streaks."

Some parents are rewarding their daughters with breast augmentation as a graduation present, and Reader said that what you don't get on the track you could get at the pharmacy or in the plastic surgeon's office.

"There's no question that there's an interest in plastic surgery that is unprecedented," said Dr. Farhad Rafizadeh, chairman of plastic surgery at Morristown Memorial Hospital. "Probably part of the interest is due to the fact that we are able to do a lot more today than we were able to do before."

Not only are surgical procedures less invasive and highly effective, Rafizadeh said, but the results are more predictable because of refinement techniques, and plastic surgery is widely available and affordable.

Non-surgical procedures such as Botox, Restylane and fillers are quick, can be done in the office and "make a big difference in people's appearances," Rafizadeh said.

There will always be belief in the powerful myth "that looks is a shortcut to filling in the gaps in their self-confidence and their esteem," he said.

The desire for a quick fix is common, and though some have practical value, others are claiming more than they can deliver. "Plus we do know that what happens on the outside has nothing to do with character or confidence," Reader said.

Newly transformed participants on the reality TV show "The Swan" compete against each other in a beauty pageant. Whitmarsh is troubled that a show of this genre gets ratings.

According to the American Society of Plastic Surgeons, the top five cosmetic procedures of 2004 were liposuction, nose reshaping, breast augmentation, eyelid surgery and facelift.

There's an element of commercialism among television networks in promoting plastic surgery, Rafizadeh said, "from the media more so than the people themselves."

"Neither us nor society is ever in favor of shows like 'Nip/Tuck' or these shows that sort of make fun and trivialize everything. It's entertaining, there's no question about it, but it's not really reality," he said.

Patients who like the outcome of surgery often decide to have additional procedures, motivated by looking and feeling better. Satisfaction can cross the line into obsession when a patient who has had nearly everything augmented asks, "What else can I do to look better?"

"It behooves the medical professional to watch for that, and you and the patient both aren't greedy; you're not going beyond what's beneficial to something that is questionable," Rafizadeh said.

Men are realizing, as women have, that there are things they can do to improve their appearance. Competition in the workforce may play a role, but Rafizadeh said he hasn't seen a tremendous upswing in the number of men seeking plastic surgery.

"It's like anything else in life," Rafizadeh said. "If you do something, you have a good result, you had a good experience, you want to go back to it."

Wendy Klug, 54, of Summit knows exactly how that feels. She turned to Dr. Farrokh Shafaie, an attending physician in plastic and reconstructive surgery at Overlook Hospital in Summit, for liposuction on her hips in 2001.

"I felt that I was jowly and my eyes were a little bit droopy. I wanted to have some kind of edge because the type of job I was looking for I had no background in. After, I didn't look angry anymore and I definitely didn't look tired."

"They assume you can do more, they assume you're more fit," Klug said. "We do judge --it's not fair, it's wrong, it's superficial, but we do it. It's hard to say which came first, lack of self confidence about ourselves or whether it's just bombarding of media."

"There are many reasons why jogging in the '70s became a craze," Reader said. "Research showed that if you exercised it was good for you, it made differences in all sorts of ways and that gave everybody an attainable goal."

Some feel the need to preserve youth and beauty because they compare themselves with others who have maintained their looks well into later years.

"The pressure is on a lot more because it's quality of life; there are many more people who really, without the help of anything, are in pretty good shape and are attractive," Reader said.

"The notion that outward manifestation of inward deterioration goes with that, and we're only beginning," Reader said. "Because of all the complexities with our health care and pensions, ageism and suits based on ageism are going to come into play." At some point, he said, negative comments based on age will be condemned just as sexist comments are today.

While graying men are considered dignified, society deems graying women old. In this male-dominated culture, Reader said, as long as the man is not under indictment, has a good job and a few social skills, it doesn't matter what he looks like.

When it comes to appearance-based discrimination, Reader said, "If you are significantly overweight in the workplace, that would count against you because there's less job security than ever."

In certain professions --banking, insurance, real estate -- the bar goes up and looks are important. "Looks can keep you on a job if you're incompetent longer than someone who's not so attractive and more competent," Reader said.

Paula Joy, 45, who works for Montville Township, had struggled with her weight for years and tried everything to lose the extra pounds, from diet pills to liquid diets to diet doctors to Weight Watchers to over-the-counter remedies.

Even actively playing on a women's softball team and a women's volleyball team and leading a coed volleyball program, Joy was at her wit's end about what to do next.

She had gastric bypass surgery in September 2004 with Dr. Muhammad S. Feteiha, bariatric surgeon at the Overlook Hospital Bariatric Surgery Center. She has since dropped 97 of her 237 pounds.

Joy also finds that it's socially acceptable for someone to say, "You look great, you lost weight. But they don't say, You look like crap, you gained weight.'"

It's a cultural gender message that males are frequently defined by their activities and accomplishments while females are identified by their appearance. This poses a challenge for those with body dysmorphic disorder (BDD) who agonize about their physical image.

"The psychologist really attempts to help you work with an internal acceptance of self, but now, when we have this society that allows you to work on the outside, it doesn't take away that displeasure, so nothing is perfect enough," Whitmarsh said.

"We are losing a huge human resource potential by not allowing our girls to feel like there are lots of choices and lots of possibilities for them."

Female athletes who become involved in their sport and feel confident about their athletic performance have an emotional buffer from other societal pressures.

"It's very frightening, our wanting quick results rather than worrying about the long-term effect," Whitmarsh said. She said procedures don't always go as planned. Your original appearance might not have been perfection, but you could be risking worse: disfigurement.

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