Many dystopian tales involve commonplace plastic surgery, and one teen lit series -- Uglies -- even makes it the central plot device. I will never read any of those books, but the reviews note that the price that young people pay when they get crowned with artificial good looks in adolescence is that they also get lobotomized -- how subtle.
In real life, there would already be a heavy price to pay -- namely, all that money! Dystopians rarely have good foresight or imagination; typically they're just railing against whatever policies their enemies favor, not honestly predicting the outcomes of such policies. Plastic surgery is never going to be cheap, not anytime soon, because the supply of people who can do it is tiny. Even if there were no barriers to entry, such as the AMA keeping the number of doctors low in order to boost their salaries, there would still be few plastic surgeons, and they would only have so many hours in a day to practice.
For one thing, you have to be pretty smart, have a decent sense of aesthetics, have good fine motor coordination, and be up for grueling and stressful work, having someone's life in your hands. Most smart people are going to do other things than medicine -- law, banking (maybe not so much anymore, but we'll see), business, academia, etc. -- and even most doctors aren't going to want to be plastic surgeons because they'd get a bigger kick out of some other field.
So the number of hours that all plastic surgeons will devote to making people look better will stay small for a very long time -- it's just not something you can automate and have a machine do. Each patient is unique, you need to adjust your plan as the process is unfolding rather than go through a fixed set of instructions, and most importantly you need to have a human being's sense of what looks good. Thus, if plastic surgery becomes commonplace, the vastly larger demand will swamp the supply, and the price of it will shoot through the roof. It would be like the price of housing if people flooded into a tiny area like San Francisco, or the price of higher ed if a ton more people want to get into college than there are available spots.
I think that outrageous price would wake most people up, and plastic surgery would plummet as people decided to spend their money on better things. Still, let's grant the dystopians the premise that in the future plastic surgery is incredibly common because people really are that desperate to look good and will shell out big bucks, possibly at the expense of other things we consider sacred like housing and education. Even then, is there no other way that people could free themselves of the plastic surgery burden?
Yes -- through evolution by natural selection. Think about it: in a world where plastic surgery is common, and therefore where the price of it is crippling, people who are good-looking because of their genes rather than the doctor's hands will be more sought after as mates. Such a person could say, "Look, you're so anxious about how good your kids will look that you're going to break the bank to make them that way -- why not just have kids by me and save yourself the money?" That would be even more persuasive because a plastic surgeon only has so much control over the human form, unlike the genes that build you up to begin with. For example, you can't radically change the shape of your skull through surgery, although what your kids' skulls looked like could be strongly altered if you chose a different father or mother.
In a world where everyone pays an arm and a leg to ensure that the next generation looks good, a genetically good-looking person would be like someone who could almost costlessly conjure up unsettled land in San Francisco or a new prestigious university. They could give you what you want for hardly anything, although admittedly you would have to suffer the costs of sleeping with a stunner.
Gradually as people began flocking to the good-looking people rather than the plastic surgeons in order to prettify the next generation, much of the demand for plastic surgery would die out because people would look better from birth. The society would still be as obsessed with outward appearance as it was during the heyday of plastic surgery, only now parents would be meeting their goal not through man's attempt to rationally plan nature's development, but through the good old fashioned way of just letting nature take its course.
This overestimation of the strength of technological change compared to the strength of evolution runs through most dystopian stories. It betrays the level of hubris that such writers have: they may express dread about how powerful man's control over nature is, but they don't deny that man is capable of besting nature in all sorts of ways. But evolution by natural selection would win -- it is so much smarter than any group of human beings. The only way that we could continue to be held captive by some technological change is if the technology could also evolve on its own, in which case we'd find ourselves caught in an evolutionary arms race.
The handful of great dystopian stories have this feature, for it's really the only plausible way for technological doom to fall upon us. We either fumbled our way into creating evolvable machines, or deliberately decided to play god this way, and we set off an arms race against the machines that threatens to wipe us out. The first Terminator movie is probably the best known example of a good dystopian story. Unfortunately most others just assume that mankind will be preyed upon by society or culture forever, with no evolutionary way around it. The message is then to vote for the author's party so that this bleak future never arrives.
Most people recognize the author's petty attempt to grab power that underlies the average dystopian story, so that these don't get very much attention. The small number that the genre appeals to are rabid, partisan evangelists who want to keep the wrong party from planning things. They're like the loser guy whose laboring rants try to persuade his cute friend not to date that cocky, exciting, handsome devil -- "I mean, just think about all the" bla bla bla. Dude, we know whose interests you're really trying to serve. Now stop whining and get a life.