I think the biggest difference is that Joan wasn't as dumb as a post.

actually, they used the Son'a face-lift machine from star trek insurrection.

I think these people are just cheap as fuck and go with whatever surgeon will slice and dice them on a budget.

Or maybe all the good plastic surgeons are liberal and they can't lose clout with The Cult by going to a liberal surgeon.

They think this looks beautiful. Proof that their wealth has put them totally out of touch with modern society. THESE freaks think they should be making decisions for us, because we are obviously too stupid to do it for ourselves.