Back when it wasn’t cool to trust anyone over 30, Pete Townshend hoped he’d die before he got old. But on television these days, it seems that people would rather die than look old.

I’m talking, in part, about those creepy reality programs that romanticize plastic surgery – ABC’s “Extreme Makeover,” Fox’s “The Swan,” MTV’s “I Want a Famous Face” – that are the blood-and-guts extension of scalpelless transformation shows such as Bravo’s “Queer Eye for the Straight Guy.”

But I come not to decry cosmetic surgery, but to celebrate it. Or, at least, to celebrate Miami plastic surgeons played by Dylan Walsh and Julian McMahon on “Nip/Tuck,” the FX drama that, with “The Sopranos,” “Curb Your Enthusiasm” and “The Shield” on hiatus, is the most deliciously twisted show on television.”

“Nip/Tuck,” now in its second season, is purely fictional, but it’s just as gross as any of the reality shows, if not more so. The show, which premieres at 10 p.m. Tuesdays and airs throughout the week, shows all of the disgusting, real-looking details of surgical procedures, from full-blown face-lifts to the removal of contraband from the beach-ball-sized breasts of South American women used as drug mules.

A “Sopranos” comparison is apt, not because “Nip/Tuck” is as richly rewarding as the HBO mob drama, but because the FX show manages a similar trick. Like a good gangster movie (or a gangsta rap album), “The Sopranos” critiques the culture of violence while showing how attractive it can be.

“Nip/Tuck’s” overriding theme is that society is obsessed with appearances and the preservation of youth at all costs. That’s a truism across the pop cultural landscape, from the once-again virile dudes dancing to “We Are the Champions” in Viagra commercials, to the insidious effect MTV has had on the music industry, where what you look like is at least as important as what you sound like. Britney Spears and Avril Lavigne better watch their backs, because there’s always somebody younger coming to take their places. Look out for that JoJo girl and her “Get Out (Leave)” song: She’s only 13!

We look aghast and laugh at Michael Jackson as he lives out his Peter Pan fantasy on his Neverland Ranch, even as we try to recapture our youth by going back to the music that once rocked our world. Meanwhile, Joan Rivers continues to transform herself into something unrecognizable before our eyes.

The “Nip/Tuck” trick is that it points out the folly of our ways while functioning as a wickedly entertaining prime-time soap opera, with more bare-bottomed, hard-bodied nudity than any show that’s ever been on regular cable.

McMahon plays a morally challenged satyr (devilishly named Christian) who gets more booty than Wilt Chamberlain. He’s already broken his nose during one bout of sexual acrobatics this season and been brought down to size by his inability to satisfy a genitally mutilated Somalian woman, played by Aisha Tyler.

One over-the-top plotline involves a hit-and-run car accident involving Walsh’s character’s son Matt, played by John Hensley, who, in what might be a brilliant plastic surgery sight gag, looks disturbingly like Michael Jackson. And in another, when a couple decide to shoot themselves rather than face the depressing prospect of growing old together, the wife winds up hideously disfigured and tells her doctor it took “almost dying to realize that aging isn’t a curse, it’s a privilege.”

“Nip/Tuck” is a cutting satire that wields a message, often with a heavy-handed chisel. In this season’s premiere, Christian presents his partner a syringe of Botox for his 40th birthday present, and Vanessa Redgrave, playing the mother of her real-life daughter Joely Richardson, is a still-shapely 67-year-old author who wants a face-lift because “age is what mutilates” and she needs a sexier book-jacket photo.

Every episode begins with the doctors asking a patient: “Tell us what you don’t like about yourself.” The not-so-subtle idea is that beneath our desire for washboard abs, wrinkle-free foreheads, and life without love handles, there’s a deep current of self-loathing that we think we can do away with if we just swallow a pill, go on a makeover show, or meet the right plastic surgeon. What makes “Nip/Tuck” so much fun is that it indulges those fantasies, and then shows us their dark side.

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