Joan Rivers knows her face has launched a thousand quips. A cartoon in the New York Post depicts Rivers preparing for the 2005 Academy Awards by having her face yanked into a ponytail. The website awfulplasticsurgery.com calls Rivers "the third scariest looking celebrity after Jocelyn Wildenstein and Bruce Jenner." The Los Angeles Times has smirked at the "blinding bronze tautness" of Rivers's cheekbones. And Robin Williams got a lot of laughs while presenting this year's Oscar for Best Animated Film, saying: "Animation characters are becoming ever more expressive and alive. Unlike Joan Rivers."

Is Rivers upset? "Oh, please," as the 72-year-old entertainer would say.

To be the butt of a joke in front of 80 million viewers is "wonderful, wonderful," says Rivers, turning the other cheek implant. "They cannot parody you unless they know you, and when they know you, it means you're part of the culture, and when you're part of the culture, it means you're successful. Oh, no, I'm thrilled, thrilled. It's hilarious. I have now become the poster girl for plastic surgery."

Rivers has also been called manic, foulmouthed, and spiteful for her red-carpet inquisitions, but at home, she is the gracious Mrs. Rosenberg, sitting on her favorite maroon velvet tuffet in the library of her Manhattan triplex, offering tea and pound cake. Her butler slips in and sets down an iced decaf next to her tape recorder. It is there, she says, apologetically, because she has been misquoted in the past. Blame an interviewer who once asked Rivers how many procedures she has had. "As a joke, I said 138, and he took it down verbatim," she recalls. That number—or one close to it—keeps popping up in stories about her. "One hundred and thirty-eight," she repeats incredulously, gesturing with the wings of her chiffon poncho, purchased as part of a set on QVC for $89.39. "How stupid! What? Are you crazy? I don't have the time to go in and do it constantly."

Her lack of time is all too clear. Her handlers have shoehorned this interview between her TV Guide Channel duties, club dates in New York City and Scotland, and a trip to England for Prince Charles and Camilla's wedding. Ringing phones are being answered somewhere by assistants. A household staff member dresses one of Rivers's dogs for a chilly walk. Rivers is getting her hair fluffed by hairstylist Kiki Ko ("When I want to look like a New York woman, it's Kenneth. When I go to California doing the Golden Globes, and I want those bitches to see she ain't dead, Kiki will take what is fashion and do it appropriately for me"). Later, Rivers will meet with some writers about her Broadway-bound autobiographical show. And finally, when most New Yorkers are getting ready for bed, a car and driver will bring Rivers and entourage to the QVC studios outside of Philadelphia to hawk her Results beauty products during the midnight-to-1 A.M. slot. (Rivers's costume jewelry, perfume, and makeup have grossed more than $600 million so far.)

Clearly, being camera-and scrutiny-ready is crucial to Rivers's multiple enterprises. She may not have had 138 cosmetic procedures, but she has obviously had her share, and her transformation over the past four decades, from a "homely" Joan Molinsky (her words) to an Eva Gabor facsimile, couldn't have happened with hair and makeup alone. Rivers admits to having two full face-lifts and a lot of "minor" procedures or "tune-ups," as she calls them, mostly performed by Santa Monica plastic surgeon Steven Hoefflin and New York City dermatologist Patricia Wexler, both of whom have been given unprecedented permission by their famous patient to talk about her treatments in detail.

People may be curious as to why she has had so much cosmetic surgery, but Joan Rivers can't comprehend why more of them haven't. Even though she makes fun of herself in her act—"my grandson calls me Nana New-Face"—according to Rivers, cosmetic surgery is not an option; "it's an obligation." All that counts in life is beauty, she tells her audiences; "No man will ever put his hand up your dress looking for a library card." She reiterates this more seriously offstage. "One: When you look better, you are totally treated differently. Two: People want to be around attractive people; I don't care what you say. And three: Most important, it's about feeling good about yourself. That's what plastic surgery is all about."

Rivers isn't as superficial as she sounds. A Phi Beta Kappa key holder from Barnard College, she studied anthropology with Margaret Mead. But she still can't get over some of her aging classmates at her fiftieth reunion last year. "I thought, What happened to all of you? Beautification doesn't have to involve big procedures. It's about fine-tuning. You fine-tune your car; you repaint your apartment; when the rug gets shabby, you replace it"

Like the rebels from her comic generation—Lenny Bruce, Woody Allen, Mike Nichols and Elaine May—Rivers plunders her neuroses for material, particularly her obsession with looks. Rivers was a fat, awkward child and a dateless teenager. (Once, while playing spin the bottle, one boy stared at her before getting his kiss and said, "Let's forget this.") In 1986, she admitted in Playboy that "not one man has ever told me I'm beautiful—in my entire life," not even her husband. Her rage against aging—which she calls "a weapon of mass destruction"—became part of her shtick after she turned 50, replacing routines about childbirth and her gynecologist. "Everything I talk about onstage I really mean on a certain level," she says. "I really do tell those women, 'You want to look better.' I really do say, 'Try to marry for money.' I really do say how horrible it is getting old. It's funny, but it's true."

Steven Hoefflin, who has been performing surgery on Rivers's face for 22 years, says, "Joan is a true rebel of aging. For her, plastic surgery is a fashion declaration. She is one of those women who would not walk down the street in wrinkled clothes—or a wrinkled neck."

Except for self-deprecating diva Phyllis Diller, no other public figure has been as open about her surgical enhancements as Rivers, ridiculing herself before others ridicule her. "All comedy goes back to, 'I'll do the joke before you so you can't hurt me.' That's still my cover," she once said. She has mentioned some of her procedures in her autobiographies and a self-help book, even dedicating her book on creative aging, Don't Count the Candles (HarperCollins), "to all those innovative plastic surgeons of tomorrow—Hurry!!!" And last year she played herself on TV's plastic-surgery drama Nip/Tuck, confessing, "I've been tucked more times than a bedsheet in the Holiday Inn." (Rivers is scheduled to do another cameo on the show next season.)

Rivers says she lost her surgical virginity in 1965 at age 32, when she was a struggling comic playing dingy clubs, writing for Candid Camera, and trying unsuccessfully to get on The Tonight Show with Johnny Carson. That year, she had an eye-lift to remove the legacy from her parents—"a bag under each eye, a nicely matched set," she writes in Don't Count the Candles. It was also the same year she married Edgar Rosenberg, a German-born, British-bred TV producer.

It was her humor, not her face, that accounted for Rivers's breakthrough performance on The Tonight Show in 1965, when Carson predicted she was going to be a star. And she became one, doing continuous club dates interspersed with more TV appearances and more success as a writer (she even combined comedy and plastic surgery in her screenplay for the 1973 TV movie The Girl Most Likely To..., the Story of an unpopular girl who gets a new face after an auto accident, then murders her enemies).

In 1977, while editing Rabbit Test, a film she had written and directed, she figured she'd get her whole face done "and nobody will see me while I'm editing the film." The more popular Rivers became and the more she was photographed, the more she saw her imperfections. Her hairstylist urged her to ditch her plain black dress and add a little glamour to her act. She responded with sequins and surgery.

Rivers had her nose thinned in 1983, the year she was named permanent guest host on The Tonight Show and also released her hugely successful comedy album What Becomes a Semi-Legend Most? Among the credits in the album's liner notes is "Joan Rivers's plastic surgery by Frank Kamer"—a well-known Beverly Hills ear, nose, and throat surgeon. In a People magazine cover story that April, Rivers admitted, "I got my nose done because I had a deviated septum, We thinned it down a little." Her developing friendship with Hoefflin led her to switch doctors, and Hoefflin started his work on Rivers by thinning her nose even more and giving her check implants. Even her hysterectomy in 1986 became an unlikely opportunity to make herself more presentable, "Someone has to sew you up," she writes in Don't Count the Candles. "Make them give you a tummy tuck at the same time... That's what I did."

In 1986, she had a chemical peel on her face and the skin under her eyes tightened in preparation for her own late-night talk show on Fox, to be produced by her husband. The surgery was a success, but the show was a disaster before it even started. Carson never spoke to Rivers again after he learned she would be competing with him. Then, six months after its debut, Fox canceled the show because of poor ratings. Rosenberg became deeply depressed, blaming himself for the failure. Rivers pleaded with him, unsuccessfully, to get psychological help and threatened to move out of their Los Angeles home until he started therapy.

Depressed herself, and with time on her hands, Rivers scheduled some liposuction. Rosenberg, on a business trip, called a few days before her surgery, threatening to kill himself. "Of course I did not take him seriously," Rivers wrote in her 1991 book, Still Talking, "I remember making a flip joke: 'Don't do it till Friday, because Thursday I'm going under anesthesia.' He laughed." On August 13, 1987, Rivers was waiting to be picked up from the hospital after her surgery, when her daughter Melissa arrived, out of breath, saying, "Daddy is dead." Edgar Rosenberg had killed himself in a Philadelphia hotel room with a combination of sleeping pills and alcohol. Now, when asked if she's had liposuction, Rivers says only, "Liposuction didn't work for me."

After a lot of guilt and therapy over Rosenberg's suicide, and a rift and reconciliation with Melissa, Rivers needed to work, and she needed to look her best to get a better job than her gig as the center square on Hollywood Squares, So, in December 1988, Hoefflin performed a full face-lift (including another lower eye-lift—not a superficial lift to tighten skin, but a deeper one to reposition sagging muscle and tissue). Afraid she might die during the procedure and leave her daughter an orphan, Rivers arranged for a cardiologist to stand by.

Hoefflin's new face-lift boosted Rivers's self-confidence. In photos, and onscreen, she looked softer. Over the next two years, she received good reviews for her role in a Broadway play and hosted a syndicated daytime talk show, as well as a gossip show on USA Network. Now all she wanted were lesser procedures: in 1990, another chemical face peel and surgery to get rid of loose skin under her neck; in 1992, another neck tightening; in 1993, another chemical face peel; in 1994, a brow-lift after the airing of her TV movie Tears and Laughter: The Joan and Melissa Rivers Story (in which mother and daughter played themselves).

Rivers seemed to be aging in reverse. She started yet another new career, hosting Fashion Police with Melissa for E!, in which she critiqued moviestar style at awards shows, ambushing celebrities with biting humor. The show's ratings were almost as high as the awards programs themselves, with viewers tuning in to see how Rivers might insult a celebrity's style to his face—or behind her back. Her fashion slams did have an effect—for instance, after she belittled the engagement ring Kevin Costner gave his fiancee, the actor traded it in for something larger. Plus, she has said, "If you're making $20 million a picture, do you care if I think your hem is up or down? And if you do, you had better get to the analyst fast."

As Rivers scrutinized others, she continued to alter her own looks with dermabrasion, fat injections, and another neck-lift. "She likes to think of this as maintenance," Hoefflin says, "and Joan is a high-maintenance woman." Dermatologist Patricia Wexler is also part of the maintenance plan, injecting Rivers with Botox and collagen every four months since the late 1990's. ("Botox is nothing," Rivers says. "They'll be doing it in malls pretty soon.") Wexler says that, unlike other celebrities, Rivers doesn't ask for special treatment—no house calls or after-hours appointments. "She doesn't come through the back door," says the dermatologist. "She is always on time. She makes jokes and says hello to everyone in the waiting room." Wexler usually injects collagen around Rivers's jawline, nasal-labial folds (smile lines), and the corners of her mouth, and shoots some Botox into her forehead, around her eyes, and along the Jaw. "That keeps it tight and neat. Joan loves to be neat."

Rivers has worked both Wexler and Hoefflin into her material, one way or another. "Pat Wexler—isn't she great?" Rivers says in her act. "At her fiftieth birthday party, all these celebrities walked in, saying, 'I don't use Pat Wexler.' Then Pat asked everyone to help blow out the candles on her cake, and"—Rivers mimics a woman with inflated lips trying to purse and blow and who can't do it—" Pfff, pfff pfff, pfff" She frequently promotes Hoefflin during her TV appearances on Larry King Live and QVC, calling herself Hoefflin's "work in progress." Hoefflin is also Michael Jackson's former nose surgeon, an association he plays down. ("The last nose I did [for Jackson]," he says, "was between Thriller and Bad.") But Rivers has remained true to him. Hoefflin was a major investor in her original jewelry company, and she has contributed one-liners to his yet-to-be-published book about plastic surgery. Rivers occasionally sends him tapes of her public appearances for his evaluation. "I can say, 'Steve, watch me on the Academy Awards. Do you think I need anything?' He'll call and say, 'You look perfectly fine. Relax.' Or 'I don't like the way your neck looks.' How great is that?!

Some of those conversations led to Rivers's 2000 canthopexy (a procedure that lifts the outer corners of the eyes) and to more surgery around Thanksgiving 2004, when Hoefflin lifted the corners of Rivers's mouth and injected fat in her face. While some say Rivers looks fresh, others believe she looks frozen, including New York City plastic surgeon Z. Paul Lorenc, author of A Little Work: Behind the Doors of a Park Avenue Plastic Surgeon (St. Martin's Press), who writes that many patients mention Rivers as an example of someone who is "pulled too far." Wexler disagrees. "Glamour is her business. No one would appreciate seeing her looking old. If you compare her appearances on Ed Sullivan to today, she's much prettier now. She's going in the right direction."

Hoefflin isn't immune to criticism about his handiwork. "Everyone knows she had surgery, so naturally there will be comments," he says. "I get 90 percent complimentary remarks and 10 percent uncomplimentary ones." But Rivers has her own standards, Hoefflin says, "and Joan has the result she wants."

The woman who is on the record saying, "A bad face-lift is better than none at all," draws the line at lip enhancement. "The lip that looks like it will explode is scary," she says. But if Rivers had to pick between being overdone and not done enough? "No question," she says. "Overdone! Fashion experts are always advising, 'Take one piece of jewelry off before you go out of the house.' I say, 'Put another piece on. Life is fun—let's put on costumes.'"

Let the critics carp. She only wishes she'd never admitted her true age: "I've watched actresses older than me become younger than me." Rivers says that she's happy when she looks in the mirror, "and as long as we have a society that has mirrors everywhere, I will be saving my pennies." For her, the alternative is too depressing. "I was trekking in Nepal several years ago," she recalls. "I saw this wrinkled old woman, and I said [to the guide], 'Ask her how old she is.' The woman replied, '47.'" Nana New-Face pauses, and with an expression of mock horror, roars, "That would have been me without Steve Hoefflin!" Rivers's assistant appears in the doorway, pointing to her watch. Time's up.

Portraits of a Lady

Joan Rivers has altered her face more often than most women change hairstyles.

1950-The aspiring actress as a college freshman. Some people believe that Rivers shortened her original nose, but she denies it.

1965-Rivers gets rid of her parents' legacy—"a bag under each eye." After a four-day courtship, she weds Edgar Rosenberg.

1978-While editing Rabbit Test the year before, Rivers has a facelift, and realizes the doctor has forgotten to operate on her eyes.

1985-Rivers had her nose thinned two years earlier. "If the nose looks better shorter on camera, shorten it."

1988-In December, Rivers gets a face-lift from Steven Hoefflin that repositions her cheeks, neck, and eyes.

1990-Rivers wins an Emmy Award for The Joan Rivers Show, launches her jewelry line on QVC, and gets a face peel and neck-lift.

1992-Hoefflin refreshes Rivers's previous face-lift and tightens the skin around her neck and chin again.

1995-After having another chemical peel and a brow-lift during the previous two years, Rivers poses for a Got Milk? ad.

1999-Over the course of four years, Rivers has dermabrasion, fat injections, a mini neck tuck, collagen, and Botox.

2001-After a canthopexy [which tilts up the corners of the eyes] and a laser peel in 2000, Rivers has another neck-lift.

2002-Rivers wears a big collar probably as neck camouflage. "She is very particular about her neck," Hoefflin says.

2003-Rivers updates her look with fat injections, dermabrasion, Botox, a neck touch-up, and a new, blonder hairstyle.