The day before I sit in on Fisher’s breast surgeries, I observe him do a facelift consultation with a 72-year-old woman named Farzaneh Sperling, who owns a Los Angeles tailor shop and is originally from Iran. She has a frizzy black bob with short bangs, and the day she comes into Fisher’s office, she wears a black minidress covered in gold rivets. “I’m a seamstress. I don’t take your business, but that’s what I do too,” Fisher says jokingly, noting the parallels between tailoring the perfect outfit and the perfect body.

She is seeking to stop the inevitable—getting older. The first thing he tells her is “You’re beautiful, you don’t need anything.”

For the rest of the hour, the two subsequently discuss the things Sperling allegedly doesn’t need. She had, years ago, gotten a brow lift from Fisher, who, with his high caseload, had completely forgotten he’d done that. (“You fix me beautiful,” Sperling says of her previous surgery.) Now she wants a more extreme intervention. A deep plane facelift, which goes from the cheek to the collarbone.

There is also the problem of her eyebrows. “I don’t like your eyebrows, and I think that is so important. I’m a stickler for eyebrows. I would love them to be beautiful. It’s like looking at a picture and there’s no frame,” Fisher says, his voice betraying the faintest hint of a Southern twang. He knows a person who can help with that, he continues.

There is also the problem of her eyes. Her “lid-cheek junction,” he says, could use improvement. Her lid-cheek junction is bulging. But he could go in there surgically and flatten it out, so it would look more like it did when she was young. Her upper eyelid, on the other hand, suffers from a combination of hollowness and extra skin. Carefully, as not to impede her ability to blink, he could remove the aforementioned extra skin.

Fisher, wearing royal blue scrubs with his initials embroidered on them, fishes his phone out of his pocket to show her some before-and-after photos of deep plane facelifts and eye surgeries he has previously done.

Her face suffers from asymmetry, he notes, but there is nothing that could really be done about that. We’re all asymmetrical. “That’s because, usually, when we come out of the birth canal, it’s a very long tube,” Fisher explains. “When you’re born, your head’s not a complete skull. It’s like islands of bone. So it comes through, it’s very molded at that point to come out, and it never snaps back into perfect form. That’s why C-section babies always have more symmetry.”

“Oh, my…” Sperling says.

Also, her lips. Did you know that your lips sag as you get older? A “really good, youthful procedure” that Sperling might want to consider is a lip lift.

Though they don’t discuss prices, Fisher’s representative tells me that the surgeries the doctor discussed with Sperling, which would take about nine hours in total, would cost around $200,000. Pricing depends on the patient’s anatomy, but broadly, a facelift from Fisher and any additional nipping and tucking that goes along with it ranges from $150,000 to $250,000.