“Tell me what you don’t like about yourself.” So begins a consultation between Miami plastic surgeon Sean McNamara (Dylan Walsh) and his potential client, a scary-looking Colombian named Silvio (Robert Lasardo). The conversation turns tetchy as the good doctor, who likes to think of himself as helping people feel better about themselves — preferably wealthy people — can’t make out the Spanish Silvio speaks with his brother Alejandro (Raymond Cruz). Sean summons his partner, Christian Troy (Julian McMahon), who, as it happens, does speak Spanish.

At this instant, Christian also happens to be performing a butt implant surgery. The moment allows FX’s new original series, nip/tuck, to demonstrate why it’s already generated controversy, even before its premiere 22 July. Sean offers to take over the procedure, just as Christian is sticking his hand inside a bloody, sliced-open rear-end cheek and sloshing it around; Sean notes that he’s put in the implant backwards, prompting Christian’s predictable joke, “You’ve saved my ass again.”

Ewww. This combination of crude humor and gross-out imagery is designed to scandalize. And indeed, the earnest but mostly clueless Sean and the salacious pretty boy Christian are two sides of a coin, self-involved, avaricious men who see women as objects and property, yadda yadda. This much is revealed in a too-clever pair of cross-cut scenes: as Sean has mechanical sex with his wife Julia (Joely Richardson), Christian is having sex with Kimberly (Kelly Carlson), his beautiful one-night pickup (when he offers to buy her an appetizer, she smirks, “I don’t eat, I’m a model”).

Shot from above, the first bedroom scene shows Julia’s boredom (she literally yawns as Sean endeavors to “finish”), while the camera in Christian’s scene shoots the lovely girl on her hands and knees, from below. Christian is on her doggystyle, as the camera shows her pleasurably impassioned face and his wildly whooping one. Needless to say, Sean and Julia don’t achieve quite this same level of bliss.

But these parallel trajectories — hinging on the men’s egotism and ignorance — are nip/tuck‘s only focus. Former journalist and creator/writer for the late, great WB series Popular, series creator Ryan Murphy has said that he wants the series to address the U.S. cultural obsession with plastic surgery (male as well as female, though the latter is more prevalent), particularly within upscale populations: indeed, according to the American Society of Plastic Surgeons (ASPS), almost 6.6 million Americans had cosmetic plastic surgery in 2002. Ryan’s interest lies in what he considers the fundamental deception of elective plastic surgery, that changing one’s appearance will improve self-image and even one’s “life.” “This is a show,” he tells AP, “where the bandages come off and everything’s worse than before” (17 July 2003).

To this moralizing end, the first episode takes aim at specific targets, for which the Miami setting is especially helpful. Here, race, nation, and class differences are entangled in pernicious ways. For one thing, plastic surgery performed by a couple of good-looking white men implies a kind of ethical onus. The premiere illustrates this by having Sean consult with a woman whose son has been badly burned and needs more skin grafts (after several already), which she can’t afford. Sean says they can’t take the case, because they don’t have time; she articulates the appropriate accusation: “Shame on you,” she begins, asserting that, if she were a wealthy size 4 looking for breast implants or lipo, he’d have plenty of time for her. Sean looks vaguely vexed. Hmm. Maybe he is a moneygrubber.

Sean is likewise the vehicle for the show’s critique of self-involved whiteness and Americanness. Not only does he not speak Spanish and complain when he hears it spoken by everyone else in his kitchen: Julia, his daughter Annie (Kelsey Lynn Batelaan), son Matt (John Hensley), and maid Rosa (at which point he is reminded that in South Florida, “English is the foreign language”). His efforts to learn Spanish on tape are partly ridiculous and partly ingratiating.

Christian, by contrast, offers no overt signs of scruples. He asserts openly that they’re in a “vanity business,” not only because of their clients, but also because of their own interests. Still, the premiere offers up a flash of motivation for his bad behavior (hint: his father was mean). That this is revealed during a scene when he’s flashbacking in an elevator, accompanied by the Clipse on the soundtrack, underlines the film’s interest in seeming current, but doesn’t explain much.

The premiere has Christian looking especially greedy and insensitive, making a move on Julia and blithely abusing just about anyone who steps in his path. Apparently, he regularly picks up women (as he does Kimberly), sleeps with them, and convinces them they need expensive surgery (“Am I really this ugly?” wails former Homecoming Queen Kimberly, after he marks her up with lipstick and makes her face the resulting grotesque in a mirror, as if the mirror offers any kind of truth). And then, he regularly dumps them, leaving the girls in tears and, in Kimberly’s case, in bruised, pussy, swollen misery. The scene is upsetting enough so that — prodded by their nurse Liz (Roma Maffia) — even the willfully ignorant Sean notices Christian’s lousy business practices.

The partners’ conflict is hurried along when Sean’s conscience is oddly bothered when he finally ascertains that Silvio, the Colombian who has offered up $300,000 — in an alligator briefcase, no less — to pay for his facial reconstruction, might be a less than upright businessman; the episode also complicates your own assumptions concerning Silvio’s particular, and very visible, iniquity. He has lots of things not to like about himself — as does most every character in this first premiere — but he doesn’t see it that way.

Christian knows what you know (he sees that same briefcase full of bucks) and Sean is plainly self-deluding and singularly unimaginative. Yet, one more ugly secret emerges (he is, as one character puts it, a “boogie man”), one that adds considerably to this unsurprising stereotype of the Latino drug dealer. If tv viewers were unhappy with the images in Kingpin, this episode is emphatically worse on nearly every count. Even an arguably “right” decision, leading to the end pf Silvio’s brutality, leads to horrific results that are, not incidentally, possible only in a plastic surgeon’s operating room (lots more ewww.)

In fact, it is this wholly and repeatedly exploited possibility that has led to public protests against the series, from an offended group, namely, plastic surgeons. The ASPS has stated that it “has serious concerns about the show’s inappropriate representation of the practice of medicine and specialty of plastic surgery.” Accusing the show of not being “realistic,” the group defends its own practices and ideals.

This process — offend and respond — repeats what is fast becoming standard practice in engendering interest in a new tv series (or movie, or book, or whatever). While premium cable tv has been strategizing such excitement for years (most famously and most successfully with The Sopranos), basic cable has only recently discovered the formula. FX’s own The Shield garnered early attention for its violence, corrupt cops, and bad language, all to the beat of social “realism,” choreographed with a very active handheld camera. Indeed, the series’ acute political insights are less often noted than its startling plot events (and, of course, Michael Chiklis’ awards, though the whole cast is worthy, perhaps especially CCH Pounder).

nip/tuck is a slicker enterprise, fittingly, given that its subject matter is about glossy façades and strivings for superficial “perfection.” And while it sensationalizes the costs of these appearances, and eases mainstream acceptance by demonizing those characters you’d expect to be demonized (vain women; unethical doctors; brutal Colombians) and offering little in the way of respite. (Liz the nurse does appear to have a sense of proportion, but then again, she seems to have worked for these guys for some time.)

Just how down and dirty Christian and Sean will get, as they conjure a new and exponentially more warped relationship at the end of episode one, is a question, not especially interesting. But the series’ investment in “realism” is not up for debate. Plastic surgeons are not focus; they’re merely symptomatic. nip/tuck means to shake up and shock, to indict a cultural obsession with the most egregious and spurious sorts of “perfection.” That it makes these points with imagery that is hyperbolically nasty is yucky, but not necessarily deep.