Adventures in the skin trade Surrendering to the soap of Nip/Tuck BY JOYCE MILLMAN

It was inevitable, in the age of reality TV, that plastic surgery would become a spectator sport. It has all the fairy-tale elements of transformation so popular in the genre. It’s also gross enough, and some of the patients’ stories are pathetic enough, to attract aficionados of the mean-spirited train-wreck school of reality programming. In the latter category, there has never been a show as reprehensible as Fox’s reality series The Swan, in which women with self-perceived physical "flaws" threw themselves on the mercy of plastic surgeons and begged to have their lives fixed. Then the women competed in a "pageant" to crown the ultimate loser, er, winner of the series, the woman who had undergone the most dramatic transformation.

The Swan (which is returning for a second season in October) was an unparalleled television display of female self-loathing, but it’s just one among many plastic-surgery reality shows. There’s also ABC’s "heartwarming" Extreme Makeover, where people with obvious body-image issues (some with outright deformities) get new faces and bodies and then everyone cries and praises the Lord. The newest of the plastic-surgery reality shows, E!’s Dr. 90210, about a real-life buffed and photogenic Beverly Hills plastic surgeon, is billed as "the real Nip/Tuck," in reference to the buzz-heavy FX drama series about fictional plastic surgeons. But let me just say this: I have seen Nip/Tuck, and Dr. 90210, you are no Nip/Tuck.

A handful of episodes into its second season, Nip/Tuck (Tuesdays at 10 p.m.) is an engaging, addictive soap for people who usually sneer at soaps. (Like me.) There is a liberating drama-queeniness to Nip/Tuck; it’s shamelessly stuffed with orgies, infidelities, paternity mix-ups, horny teens, buggering priests, coke-sniffing porn starlets, car wrecks, suicide, breasts, breast implants, breast implants filled with liquid heroin that have to be removed from drug mules, sexaholics, custody battles and, perhaps most tragic of all, the murder by toilet of Frisky the gerbil. This is the kind of show where a victim of female genital mutilation undergoes a clitoral reconstruction (confident of their abilities, one doctor tells the other, "If we build it, she will come") and then asks to be taken on a post-op test drive.

But Nip/Tuck is much better and more genuinely affecting than all of this might sound. Created by Ryan Murphy, who was responsible for Popular, a pitch-black high-school satire that the WB didn’t know what to do with, Nip/Tuck is put together with wit, style and unexpected flashes of wisdom and heart between the acrobatic sex (hey, can they do this stuff on basic cable?) and glossy, grisly operating-room scenes. Nip/Tuck is about the connection between self-image and self, about vanity and honesty, about the gap between what we think we are and what we want to be.

The tag line, used by Miami plastic surgeons Sean McNamara (Dylan Walsh) and Christian Troy (Julian McMahon) to greet new patients, is, "Tell me what you don’t like about yourself." But Nip/Tuck isn’t really about the patients. The patients are just a device to get Sean and Christian to confront what they don’t like about themselves, and it’s never just skin deep. Friends since college, now in partnership together and skittishly turning 40, the doctors are pretty on the outside but a mess within. If you’ve never watched the show, you’re strongly advised to get hold of the 13-episode first-season DVD (available from Warner Home Video), because there’s too much back story to encapsulate in a "previously on Nip/Tuck" blurb. And once you start watching, you’re going to get sucked in anyway, so you might as well surrender now to the pleasures of well-acted, juicy storytelling. Here’s a rundown of the main characters.

Dr. Sean McNamara is a workaholic straight-arrow who is losing his wife, Julia (Joely Richardson), to inertia. This season, he developed a psychosomatic tremor in his hand and had a brush with death, all of which prompted him to face mortality by eating potentially toxic blowfish and swimming with sharks. Square-jawed Walsh plays the gifted but fallible Sean with endearing earnestness and, when he’s trying to be an alpha male, comically shaky bravado. Judgmental and a bit of a prude, Sean takes the bored Julia for granted; their up-and-down marriage is realistically harrowing. Starved for a connection he no longer feels with his wife, he had an affair last season with a breast-cancer patient who had no hope of recovery; eventually, he helped her commit suicide. He confessed the affair to Julia but said he did it only because he knew she was having an affair with her personal trainer. She wasn’t.

Dr. Christian Troy. Don’t you love that ridiculous studly name? Jacqueline Susann couldn’t have done better. Christian is in love with Julia, whom he has known since college and whom he slept with once when she was dating Sean. He loves Sean, Julia, and their two children as the family he never had, but he’s not above manipulating them to get closer to Julia. Christian is an insanely attractive blend of sensitive metrosexual, old-school womanizer, and little boy lost. He’s not too manly to overcome his fear of emotional intimacy and form a nurturing bond with his-out-of-wedlock infant son, Wilber. Or to weep when he confronts his memories of being sexually abused as a child by his foster father. But former daytime soap hunk McMahon is manly enough to carry off his character’s debauchery with melting charm. When Sean asks him during a double surgery on twin sisters whether he ever "did twins before," Christian deliberately misunderstands him, adopts a perfect Sean Connery accent and replies, "Mother and daughter onesh, but never twinsh." Did I mention that Wilber was born after a one-night stand with an angry sexaholic and isn’t even his biological son — a fact that became obvious in the delivery room when the baby arrived and he was black?

Julia McNamara. Cranky stay-at-home mom Julia is seething with resentment at Sean, whom she put through medical school. Her own dream of becoming a pediatrician was derailed when she unintentionally became pregnant and she and Sean got married. Now she’s trying to be her own person, which includes throwing Sean out (twice), taking him back (twice), and carrying a torch for Christian. She recently had a secret DNA test run on the paternity of their — hers and Sean’s — teenage son and then felt compelled to share the result with the boy’s real father. Can you guess who that might be? As Julia, Joely Richardson is a revelation who lives up to the family name. Like her mom, Vanessa Redgrave (who occasionally guests on the show as Julia’s bitchy mother), she can be fearlessly unlovable; like her sister, Natasha Richardson, she can be achingly vulnerable. And Richardson’s lived-in beauty — the off-kilter nose, the laugh lines around sky blue eyes — suggests that Julia is the one character on the show who’s being honest with herself.

Matt McNamara (John Hensley), the McNamaras’ 17-year-old son, is a lying sleazeball who looks uncannily like post-surgical, post-bleaching Michael Jackson, though no one ever mentions this distracting point. Last season, Matt asked his father for a circumcision because he was being called "anteater" in the locker room, but when Sean refused, Matt tried to do it himself with a pair of cuticle scissors. Ouch! Once the snippage healed (Sean had to repair the damage, of course, removing the foreskin properly), Matt wasted no time getting into bed in a three-way with two hot cheerleaders. ("Uncle" Christian was very proud of him.) Matt also almost killed an unpopular female classmate while driving his friend’s car after they did bong hits under the bleachers at school; he has never admitted his involvement, letting his hapless friend take the fall. Still, being a sensitive young man, Matt did prevail upon his dad to rebuild the victim’s face free of charge.

There are also some splashy characters lolling around the periphery. Gina Russo (Jessalyn Gilsig), Christian’s one-night stand from hell and the mother of "his" son, has had some spectacularly fishwifely moments. The doctors’ rival plastic surgeon, Merrill Bobolit (Joey Slotnick), or as Christian calls him, "Boobalot," is a smarmy delight as a schlub in paradise. Famke Janssen is currently doing a shameless soap-bad-girl stint as Ava Moore, a predatory "life coach" whom Sean hires to help Julia find herself but who ends up finding Matt instead. The only disappointment in the cast is Roma Maffia’s anæsthesiologist, Dr. Liz Cruz, whose character hasn’t been given much to do except spout the clumsily written feminist angle on society’s unrealistic notions of female beauty. In case you haven’t figured it out from the name, Liz is a les. It’s too bad the writers haven’t put as much personality into the character as the sly Maffia puts into her performance.

But Nip/Tuck always circles back to the four irresistibly watchable protagonists. They’re self-centered, greedy, immature, needy, self-righteous, vain, and, sometimes, touchingly brave, compassionate, and generous. They are decidedly not plastic. Beneath its soapy exterior, Nip/Tuck is a richly imagined tale of how difficult it is for us to be as flawless of heart and deed as we can be made of body.