With his own reality TV show, cosmetic surgeon Dr Robert Rey is fast becoming more famous than his clients. But is everything fantastic in his plastic world? Sanjiv Bhattacharya finds out...

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Is he here yet?" An anxious TV producer checks the foyer of stage 26 at Hollywood's Paramount Studios. She works for The Insider, a top-rating tabloid gossip show, where the presenters, crew and production team are all waiting to shoot a segment about Hillary Clinton - specifically, the rumour that she has had a nose job. The trouble is, the guest expert, cosmetic surgeon Dr Robert Rey, hasn't arrived. He is over an hour late.

The producer checks her watch for the 100th time and starts to pace. Then, suddenly, the doors swing open and in bursts a man wearing a sharp grey suit, orange shirt and manic grin. "Hey, pretty girl!" he exclaims.

Instantly, the room is filled with the smell of his cologne and the sound of his endless, exuberant chatter. "How did you get so sexy?" he asks the receptionist, and promptly starts punching and kicking the air like a boy who's just discovered Bruce Lee. One kick narrowly misses the receptionist's face, making her jump back. The doctor laughs. "Ha ha ha! All my suits are made so I can kick!"

Dr Rey is without question the most prominent cosmetic surgeon in Beverly Hills, if not the world. He's not only a surgeon to the stars but a celebrity in his own right, thanks to his show, Dr. 90210, which launched in 2004 and quickly became the highest rating program on the E! television network, inspiring a rash of reality cosmetic surgery shows, like Extreme Makeover and The Swan.

But Dr. 90210 is less about surgery than about Rey himself and his frenetic lifestyle. By day, we see him perform boob jobs for a cavalcade of strippers, porn stars and insecure college girls. And by night, he's doing martial arts, while his wife, Hayley, the mother of his two children, waits in vain for him at their palatial home in the hills. Hayley doesn't approve of his martial arts, which he frequently jokes is something he does "to get away from the wife". In one series, Rey goes for his tae kwon do black belt, while Hayley progressively develops an eating disorder, her weight dropping to just 40 kilograms. Rey tries to make it up to her in his own eccentric way: when Hayley later leaves for a trip to Canada, he reorganises her wardrobe, arranging her clothes according to season and colour.

When I decide to shadow him for 24 hours, I expect an outsized personality - just not quite this big. Only a few hours in his company is exhausting - he has the energy of a precocious child on a sugar fix. Yet he's 46 years old, a remarkably well preserved 46 at that - Rey has a six-pack and not a line on his face. "I'm pretty ripped for my age," he boasts. "You probably want to know what I eat, right?" OK, then. "Right, every morning I have 10 eggwhites and then a bowl of raw oatmeal with bananas and wild honey. Then I eat, like, seven or eight small meals all day long. Lots of protein, like chicken, turkey and fish. About 20 yoghurts. And half a bottle of ketchup." Half a bottle?
"Sure! For the lycopene. It's important for men - to prevent prostate cancer." With that, he jumps into his black Porsche and tears off to his surgery, just around the corner from Rodeo Drive. He works in an elite building crammed full of top surgeons and dermatologists. But of all the surgeons in the building, Rey is the most famous. It's no accident, as he's a tireless self-publicist. In his waiting room, every inch of wall space is plastered with press clippings, whether in English, Portuguese (from his native Brazil) or Spanish (he's a star throughout Latin America).

As usual, Rey has a busy day ahead - four breast augmentations (by far his most popular procedure) - and he's already hours late. So, wasting no time, he ushers us into the surgery to meet his first - Melissa, a slender 24-year-old dance instructor. "Hey there, pretty girl!" exclaims Rey, sweeping back the curtain. Melissa is sitting, topless, with her boyfriend. "See how my girls are so pretty? In a country that is 60 per cent overweight, all my girls look like this - how is that possible?"

It's possible because Dr Rey hand-picks all of his patients. Melissa is one of 18 girls he's chosen for this week. "We refuse 90 per cent of the cases that come to us," he explains. "I gotta weed out the psychos!"

Grounds for refusal range from the common (emotional instability or unreasonable expectations) to the odd: "I look at the writing on the forms," he adds. "Do the y's come up or not? If not, she's insecure. Basically, I'm a psychiatrist with a knife."
Melissa seems sane enough - she wants a D-cup to fill out her leotard a little more and "feel more womanly". But right now, she's clearly nervous. She sits in silence as Rey draws thick black lines around her breasts and down to her navel, rattling through his pre-op preamble. "OK, I cannot make you perfect, only God himself can make you perfect," he states, looking up to the ceiling for a second. "Seriously, out of 11,000 breasts, I think I've seen five perfect breasts in my life. I think Madonna is one. And Princess Diana."

He reminds Melissa not to move her arms after the operation, to take her tablets, go for a walk every four hours and stick to a high-protein diet - "Only eat it if it walks, crawls, flies or swims" - and then he's done.

It's showtime.
Melissa is led to the trolley and the anaesthetics begin to drip in. As she goes under, Rey starts doing his martial arts again. "This is a stressful job. Any minute, this girl can die. Do you know how I maintain my composure under this avalanche of stress?" He throws a few slow punches and raises his hands in prayer. "That's how. Martial arts keeps me calm in a chaotic world."
It's an extraordinary operation. He makes a small cut near the bellybutton, then plunges a variety of metal rods under the skin up to the base of the breast, where he wrenches and pulls to clear a passage for the implant. At times, the procedure looks rough and brutal - Melissa's body is twisted this way and that - but there's hardly any blood.

Equally extraordinary is the way that Dr Rey happily chats away throughout the operation. At one point, he explains how breast augmentation works along the same principles as tae kwon do. "It's all yin and yang," he claims. "Sometimes I have to be rough, sometimes I am gentle." And he talks about God. A devout Mormon, Rey says a quick prayer with his team before every operation. He even listens to scriptures in his Porsche on the way to work. "It gets me in the right frame of mind," he explains, ramming a metal rod underneath Melissa's skin. "God created the human body, so it makes sense to listen to God before working on it, right? And this is a religion to me. It angers me when people refer to medicine as a business. Yes, I get paid, because I have to feed my family - but I'm the only guy that doesn't treat it as a business and I'm one of the most successful doctors in the world."

It's a surprising perspective as he appears to operate like the consummate businessman. It was Rey who pitched the show Dr. 90210 to the TV networks, not vice versa. He has a series of DVDs out, called Rey's Anatomy, and he recently earned $315,000 [$AUD380,000] for appearing in a commercial for a major burger chain. Promoting junk food is hardly the Lord's work, let alone a doctor's, but Rey shrugs it off - "That was God's blessing: that money will put my children through college."
Rey seldom turns down an interview. "That's not to generate business, that's because I want to go to [US] Congress. The more publicity I get, the more chance I have to help my Latino brothers and sisters. I want to be the first Latino governor of California!"

Should he succeed, Rey's story would be a fairytale for the ages. He started life in the slums of Sao Paulo, Brazil, living in poverty because his father was "a total asshole, a womaniser and a drunk", who never brought any money home from work.
Then, Mormon missionaries came by and persuaded his father to let them take his children to the US for a better life. And so, in 1974, Rey and his siblings - one brother and two sisters - arrived in the American state of Utah, where they lived with Mormon families (his mother later followed, working as a cleaner to help Rey fund his university degree).

Rey describes the path to cosmetic surgery as a long, gruelling road, constantly struggling with poverty along the way. Still, he ended up at Harvard - the numberplate on his Porsche reads "Harvard alumni" - and now he's a multimillionaire. "I'm the most successful loser you're ever going to meet," he claims. "God gave me no talent - all I have is steady hands. People learn twice as fast as me - it took me 10 years to get my black belt; most people get it in five. But I have fire in my belly. The fire that comes from humiliation. I used to walk past rich houses in Saoo Paulo and I knew somewhere inside there must be happiness."

He yanks the instruments out from under Melissa's skin and starts sewing her up. It's over. And he's off to eat a can of tuna - drowned in ketchup.

That night, Rey works until 8pm and squeezes in some martial arts before he gets home. He takes five different martial arts classes a week, so he's seldom home for dinner with his kids, Sydney, five, and Robbie, two. And come Saturday morning, he's up at 7am again for more martial arts. Afterwards, he's all pumped up.

But as we drive to his mansion in the hills, Rey's mood visibly drops. His house is huge - 836 square metres over four storeys - but it feels cold and empty. There's precious little furniture and nothing on the walls, except a few paintings and a photo of a Mormon temple. The only room that feels inhabited is the children's playroom, where Sydney is fighting with Robbie over the toys. It doesn't help when Rey sits down to try to play with them. Their shrieking echoes through the house. Hayley, his wife - super-skinny, blonde, big boobs (thanks to her husband) - tries, in vain, to restore order.

"This house is too big for us," declares Rey, showing me around. "You know I've only stepped on my fourth floor twice? I made the poor person's mistake: I bought the big house, the German cars, everything. I don't know why - maybe I've got an inferiority complex."

It's as though a cloud of regret has come over him since being with his family. The excitable boyish enthusiasm has given way to a more pensive, rueful side. He describes his kids as "neglected - they don't even know me" and talks about getting "an A for my career and a C minus for being a father".

"My mortgage is $27,000 [$AUD33,000] a month," he reveals earnestly. "Think about that. I have dreams at night of a big monster chasing me. That's why I work so hard. The wind blows hardest when you're at the top of the mountain. Everyone wants to knock you off. I even got death threats - I'm serious. When I did breast augmentation for a rapper's wife, I got a letter from some crazy guy saying he was going to throw acid in my face and burn my office down. That's why I've got security cameras all over this place."

He points them out - and then it's time for us to leave. They're taking the children to a birthday party - a Beverly Hills society event hosted by the daughter of the president of US TV network CBS. Heidi Klum's and Larry King's children will be there, among others.

As we wrap up the interview, Rey seems pained to show me that despite his showy wealth and naked ambition, he's still a good guy. "Look around in Beverly Hills, see if you can find anyone smiling," he urges. "These people aren't happy. I'm more unhappy today than ever, even when I lived in the ghettos in Brazil. One day, I promise you, I'm going to go back to Brazil and run a charitable mission."

Then, just as we say goodbye, he turns and breaks into a winning smile: "Just one last thing - can you mention my DVD?"