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San Diego has the second highest concentration of plastic surgeons in the United States, trailing only San Francisco. This I learned from Dr. David Wolf, who heard it at last year's national meeting of the American Society of Plastic and Reconstructive Surgeons. Even if that ranking isn't precise, a look in the phone book confirms that this is a plastic surgical mecca. Full and half-page ads shout of ear reshapings, tummy tucks, skin rejuvenation, eyelid surgery, nose jobs, and more. Complimentary Initial Consultations are the norm and there's Financing Available! In the Pacific Bell Yellow Pages, I counted 126 local physicians offering at least some of the tricks of this trade.

The competition was already building when Wolf opened his practice here in 1981. He was drawn to La Jolla, ""easily the most dense place in San Diego as far as the number of plastic surgeons,"" because ""I like challenges,"" he told me. ""Being sort of arrogant, I figured I was the best. I felt I might as well go where people said, 'Oh, you'll never make it.' ""

Nowadays Wolf is busier than he'd like to be. The day of our interview he was running about 50 minutes behind schedule. A young, delicate-looking blonde sat in the waiting room, having just filled out a patient questionnaire that rested on the sill of the receptionist's window. It revealed that she was considering a nose job. Among her previous plastic surgeries, I noted, were a breast augmentation, liposuction, and dermabrasion.

Some plastic surgeons' offices rank among the fanciest quarters in medicine: marbled or plushed or chromed or otherwise decorated with an intensity that launches them into another orbit - one inhabited (one would imagine) by rich, tasteful patrons, rather than sick people. Other plastic surgeons' offices are more restrained, and Wolf's, located in one of the big medical buildings next to Scripps Hospital, is one of the latter. A nubby, neutral fabric lines the walls and the floors are parquet, but this is a typical doctor's office, upscale but unremarkable.

When Wolf finally burst into the waiting room, he apologized for the delay, then plopped down on the sofa. He's 47, lean and athletic and alert. He wore no white coat, just a buttoned-down shirt, silk tie, and pants under which could be seen a pair of highly polished black cowboy boots. ""One of my patients recently saw the boots, and he asked me, 'Are those just for show, or can you ride?' I said, 'Look, I'm from Texas. I better be able to ride!' ""

His Texas accent is still unmistakable. "There were no doctors in my family. We weren't friends with any physicians. Yet I always knew I was going to be a doctor. From really young. It never changed."" He says as soon as he entered Tulane University's medical school, "It was apparent there was a group of medical students who were very interventionist-prone. Who were more aggressive. They liked to be in charge. They liked to be in surgery. And I was one of them." The memory comes to him that on the first day of school, ""They showed us this really gross movie. The name of it was Radical Hemimaxillectomy with a Nucleation — which is basically taking off half a face. I still am not quite sure why they showed us it. But about half the class got sick and left. And the other half became surgeons!""

Wolf says for him the choice of plastic surgery was also very easy. "It seemed the most complete of all the specialties. In general surgery, all the stomach surgery was being reduced because of Tagamet and other medications that were coming out." Chronic, intractable ulcers that previously had to be excised were becoming a thing of the past. And a lot of [the general surgeons'] vascular surgery was being taken over by vascular surgeons. It was a decreasing specialty as far as I could see.

"Cardiac surgery was not that interesting because they basically did one operation the majority of the time. Neurosurgery was sort of depressing because they worked on kids. I don't mind working on kids. I just don't want to work on kids who are dying. I like kids too much."

"Urology was sort of boring. You know, looking up the bladder wasn't all that interesting. Ob-gyn was boring. So, of all the fields, plastic surgery was sort of neat because it could do it all. People think of just cosmetic surgery. But plastic surgery surgeons are trained in microvascular surgery. We're trained in hand surgery. We're trained in head and neck surgery -- for cancer of the head and neck. We're trained in major soft tissue injuries, in burns, in cleft lip and palate work. Cosmetic is one of just eight or nine fields we're trained in."

Before Wolf received all this specialized training, he spent three years in the Navy in San Diego (from 1972 to 1975). Then he returned to New Orleans and studied general surgery, a standard preliminary step for aspiring plastic surgeons. After five years of this, he went on to three years of plastic surgery training in San Francisco, then moved to La Jolla. Despite his initial cockiness, starting a practice in the cosmetically crammed area ""tuned out to be a tough nut to crack. It took me a while to get busy,"" he says.

Wolf says he built his business by assisting other plastic surgeons and covering for them when they went on vacation, as well as serving as a backup doctor for emergency rooms all over the county, "riding the circuit, we call it," he said, smiling. he says he didn't do any advertising until after he was established. "I was a bachelor and there was a magazine I'd never even heard of, called San Diego Woman, that had me as bachelor of the month. I was sort of tickled by it all. I got so many letters, I was amazed! I got hundreds! And I figured, 'You know, somebody must read that.' I've put a couple of very low-key advertisements in there."

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