California is in many ways its own country. It is an economic engine that matches or exceeds many European countries. The movie industry was born in California and remains there, providing a unique twist to the cultural fabric of the state. The dot com explosion was also born there, and now has risen from the ashes so that the state probably hosts most of the current crop of venture-driven Internet and tech startups.

For better or worse, Californians care a lot more about appearance than those of us who aren't boutique oriented and never will be. If you're a Californian, you are more likely than most in the country to exercise regularly, dress for the occasion and follow fashion trends. Increasingly, Californians also take advantage of physical enhancements provided by plastic surgery.

The state's actors and actresses were early adopters of plastic surgery procedures that provided a younger looking face. Botox has been a technological improvement in facial treatment, but many long established plastic surgery procedures remain a common practice in both Southern California and many of Northern California's communities.

A tummy tuck has become a quick way to slim down, as has liposuction. Indeed, many of the technological advancements for liposuction were introduced in California hospitals and clinics. It is also fair to say that Californians brought breast augmentation into the plastic surgery mainstream.

Plastic surgeons in California also seem to have established a practice of frank discussion with potential patients about long term effects of their work. Breast augmentation, breast lifts and liposuction make changes that may need further attention over time.

Candor about cosmetic surgery is commonplace in California, at least partially because the plastic surgeons practicing in the state are dealing with rapidly growing interest from the state's women about procedures that are no longer beyond their reach. California is full of fine medical schools that have produced an abundance of board certified plastic surgeons. For those reasons, California residents can find a plastic surgeon they are comfortable with at a manageable cost.