Imagine this: You are a person of a certain age who is bothered by the sagging skin on your neck.

On Instagram, an image of the newly rejuvenated Kris Jenner jumps out at you.

For as long as she and the Kardashians have been famous, their faces have made an argument against the idea that God created us as we should be.

But now, Ms. Jenner looks dewier than her daughters. Even if you lament the family’s effects on American culture, it is hard not to admire the surgical handiwork of Steven M. Levine, a famed Park Avenue doctor who Ms. Jenner readily names as the one responsible for her face-lift.

Unfortunately, you cannot get a consult. An automated voice message at Dr. Levine’s office states that he is accepting new patients only via referral.

You might, at this point, head to Reddit and look through scores of reviews for other plastic surgeons whose patients walk away pleased with what they regard to be a similar result.

Or you might schedule an appointment with Melinda Farina, a 44-year-old former dental assistant who over the last decade has become one of the most significant players on the plastic surgery scene.

Unlike Dr. Levine, Ms. Farina does not perform face-lifts, tummy tucks or nose jobs.

Instead, she is a consultant who calls herself the Beauty Broker and charges around $750 for an hourlong consultation, after which she connects clients to the surgeons she thinks best fit their aesthetic and can work within their budgets. (She also has a team of eight consultants who work for her; their fees start at $350 per consult.) From there, she may handle myriad tasks associated with surgery — among them translating medical jargon, soothing frayed nerves and handling aftercare.

A decade ago, prime players within the beauty industry were busy selling the idea that the best way to reverse the aging process was not with invasive surgeries but with a variety of injections and laser treatments.

Recently, the pendulum has swung back.

Part of this, doctors say, is because of GLP-1 drugs such as Ozempic and Wegovy, which can lead to sagging skin after weight loss that cannot be easily addressed without surgery. But it is also because of the proliferation of face-lifts, nose jobs and eyelid surgeries featured on Instagram and TikTok.

With more awareness and information comes more choice and more uncertainty.

Enter: Ms. Farina.

She has benefited from the secrecy and shame that was once associated with plastic surgery, marketing herself as a person capable of helping clients find the best physicians.

She has appeared on her client Gwyneth Paltrow’s podcast, talking about her increasing antipathy toward fillers. She has spoken before scores of surgeons at some of the plastic surgery industry’s biggest conferences. And she is doing everything she can to ensure that even as high-profile people begin to speak more openly about the work they’ve had done, her middle-person services remain in demand.

Ms. Farina has also made waves by arriving at the party with her own set of knives.

She has gotten into legal spats with beauty influencers. She has publicly accused two of the industry’s best-known doctors of botching procedures. (One of them sued her. The case was settled out of court.)

“We sign NDAs with all our celebs — and discretion and privacy is the most important thing all the time,” Ms. Farina said on a recent afternoon, sitting at a banquette at the Surrey Hotel on the Upper East Side of Manhattan.

She was clad in a white Balmain skirt with black horses, a rose gold Rolex President dangling from her wrist as she picked at an artichoke salad.

At her side, a gold Prada scrunchie was attached to the gold strap of her black Hermès Kelly bag.

Ms. Farina likes to say that her approach is less rather than more.

“I’m a shoemaker with no shoes,” is how she tried to make the point that she is not overly reconstructed, before allowing that she has had certain things done: a nose job at 19, a fat transfer to volumize her breasts at 36, a breast reduction at 41. Fillers and lip injections (“biggest regret,” she said) at some point as well. She did also have shoes; they were four-inch Jimmy Choos.

Earlier that day, Ms. Farina had accompanied a client (“they’re not patients; I don’t have a medical degree,” she said) to a surgery.

The client was from Dubai. Ms. Farina said the client was in New York for a face-lift and hair transplant. “You gotta get them in, get them out, get them back to Dubai and make sure everything goes well and that there’s no issues at all,” she said. “So we have a whole post-op team taking care of her. She’s a pretty prominent figure.”

Of course, Ms. Farina could not say who she was.

From the Ferry to Park Avenue

“I come from a blue-collar family, not the 1 percent, and that’s at the heart of who I am,” said Ms. Farina, who grew up on Staten Island.

Her mother ran a wellness center at a hospital; her father worked in construction.

She said that after high school, she went to the University of Medicine and Dentistry of New Jersey but transferred after less than two years to New York University, though she did not graduate. She began working at the Upper East Side cosmetic dentistry practice of Dr. Larry Rosenthal, with the idea being that she would become a dental technician.

As is the case for many people with well-tended personal brands, the details of her origin story aren’t always consistent. She’s in the business of self-improvement, and in telling her own story, there is a certain amount of retroactive reinvention. Her knowledge of her subject is encyclopedic; her awareness of how easy it is to check facts, occasionally less so.

On her website, Ms. Farina says that she “brings a robust educational background from N.Y.U. and Columbia University” to her work in “the medical and dental aesthetics fields.” New York University’s College of Dentistry said it had no record of her having studied there. Columbia University would not comment on whether she had taken courses there, citing privacy concerns. (Ms. Farina said she wasn’t surprised that N.Y.U. couldn’t find a record: “I was there for two or three months.”)

As she tells it, while working for Dr. Rosenthal she realized that if she was going to be in the business of optimizing people’s looks, she need not confine herself to their mouths.

Encouraged in part by Dr. Rosenthal, she began to think about becoming a consultant. “He said, ‘I’ll introduce you to people,” she recalled.

The consultancy she formed eventually became Beauty Brokers Incorporated. She charged clients for her services and also received payment from physicians to be in her referral network in the early days.

One of the first people she began referring patients to was Dr. Jonathan Sherwyn, an Upper East Side surgeon. She sent him patients seeking breast augmentations and began working out of his office. (He also performed both her breast procedures.)

Another was Dr. Sam Rizk, who works on Park Avenue and gave Ms. Farina a nose job when she was 19.

In Dr. Rizk’s waiting room on a coffee table is a binder of testimonials from happy patients. Buried inside is a note from Ms. Farina typed up shortly after she went into consulting.

“It has been 2 years since you re-contoured my nose and the compliments continue to pour in!” she wrote to “Sam,” ending the note by saying: “I knew from the second I met you … that you were ‘the one’ ha ha. None of the others could compare!”

Sitting inside his office recently, eating a danish, shortly after completing a deep-plane face-lift, Dr. Rizk explained her success by saying: “She knows her stuff better than some doctors do. And she has balls of steel.”

The Skeptics, Haters and Fans

“When you’re working with surgeons on the Upper East Side and dealing with this type of clientele, it rubs off on you,” said Ms. Farina, who now lives in Weehawken, N.J., in a $2.5 million house that she rents, along with her golden retriever, Eddie Vedder.

She said that the rarefied world she moves in for work has had some impact on other areas of her life. “Everyone would say, ‘She’s high maintenance,’” she said. “And the men felt like they could not afford dating me.”

She does now have a boyfriend, who works in software development. She regularly posts photos of him on Instagram, but declined to name him.

Life is busy, controversy follows, she acknowledges.

“There are skeptics, there are haters, there are people who believe I do not belong, and there are surgeons who think what I’m doing is absolutely necessary,” Ms. Farina said.

Dr. Elizabeth Chance, a leading surgeon in Charlottesville, Va., credits Ms. Farina with enveloping her patients in a “blanket of love” and “culling her network” when surgeons fall short.

Dr. Theda Kontis of Baltimore, the president of the American Board of Facial Plastic and Reconstructive Surgery, calls Ms. Farina a person who takes advantage of legal “loopholes” in a barely regulated industry, while preying upon the insecurities of potential patients.

“She creates the illusion that the doctors don’t really know what you need,” Dr. Kontis said in an interview.

Ms. Farina attributes this “mishmash of feedback” to the fact that the business is still a “old boys’ club” within which she occupies a complicated niche as a person who drums up business for the doctors but, ultimately, answers to those who seek out their services and don’t always walk away happy.

Ms. Farina is known for going into the operating room and watching surgeries — a practice that is not illegal but is certainly unconventional — and for telling doctors when she thinks their fees are too high. That doesn’t always go over well with the big egos of her industry.

“If you ask a prominent plastic surgeon to name the best three in the country, most would be hard-pressed to name the other two,” said Dr. Steven Teitelbaum, a Los Angeles plastic surgeon, to whom Ms. Farina refers many complicated “revisions” — adjustments that enhance or correct past surgical work — but few new patients. “She told me, ‘You’re too expensive,’” he said.

Ms. Farina is not shy about publicly criticizing people in the field. And she has also been sued by prominent physicians.

In 2013, Dr. Raffi Hovsepian, a Beverly Hills plastic surgeon claimed in a lawsuit that in 2012, he paid Ms. Farina $10,200 to join her referral network.

Dr. Hovsepian said that in exchange, Ms. Farina was supposed to refer him a minimum of three patients over a year.

The referrals, he said in his complaint, never came to him.

As Ms. Farina presents it, that was not the arrangement.

She says she usually recommends three or four doctors to each client, who then picks the one she or he likes best. “It’s not my fault if you can’t close the deal,” she said.

The suit never made it to court, and Ms. Farina still sends patients his way. “He’s a good surgeon,” she said, showing off a cache of emails from her office to his over the past few years. “Maybe not the nicest person. But I love his work.” (“I’m not interested in being part of your article,” said Dr. Hovsepian, when reached for comment.)

In 2019, Ms. Farina was sued by Dr. Simon Ourian, a Los Angeles cosmetic dermatologist to Lady Gaga and several Kardashians.

It happened after she called him a “fraud hack” on Instagram.

Dr. Ourian, who had his license revoked in 2009 by the Medical Board of California but was ultimately placed on probation until 2013, never worked directly with Ms. Farina.

He claimed in his lawsuit that she was “steering clients/patients to aesthetic and cosmetic professionals who pay ‘membership fees’” to her firm, while “disparaging other doctors.”

Ultimately, Ms. Farina settled out of court.

In an interview, Dr. Ourian said he could not discuss Ms. Farina because of a nondisparagement agreement.

Then he called her a “good friend and a bad enemy.”

“I agree,” she said.

The Magic Potion

Last year, Demi Moore starred in “The Substance,” a sci-fi horror movie about a woman who takes a potion to restore her youth. While she was racing down red carpets on her way to a Golden Globe win and an Oscar nomination, conversation swirled over who — if anyone — was responsible for her enviable real-life face.

On Instagram, a Texas beauty influencer named Dana Omari claimed without evidence that Ms. Moore had received a face-lift courtesy of Dr. Levine, Ms. Jenner’s surgeon.

Soon after, the Beauty Broker — who said she “can neither confirm nor deny” that Ms. Moore is a client — pounced. She posted about the scourge of sensationalist plastic surgery claims online and cited Ms. Omari’s post as a prime example.

Ms. Omari replied by telling her Instagram following of 250,000 that Ms. Farina was nothing more than a “dental hygienist who gets paid on both ends to book patients with plastic surgeons she says are in her ‘little black book.’ And allegedly she gets kickbacks.” (“I said allegedly,” Ms. Omari reiterated in an interview.)

So Ms. Farina sued Ms. Omari for defamation.

In response, lawyers for Ms. Omari produced a 2019 email apparently sent by Ms. Farina to doctors within her network proposing a compensation system of sorts for referrals:

“Going forward, our clients (the patients) will pay us directly 10 percent of the overall surgical fee. All we ask is that our surgeons grant our clients a 10 percent discount as a courtesy.”

Ms. Farina said that she sent that email to four people “testing the waters for a new business model” but that it never came to fruition. She also said that it has been several years since she received any payment from doctors.

Also introduced into evidence by Ms. Omari’s lawyer were photographs of numerous Christmas gifts that Ms. Farina had posted on Instagram from various doctors.

One example: “So pretty! Thank You So Much Dr. L,” she captioned a story that contained a photograph of a black quilted Dior handbag that generally retails for north of $3,000.

The suit is ongoing.

Dr. Scott Hollenbeck, the president of the American Society of Plastic Surgeons, who does not know Ms. Farina, said that he didn’t have much issue with a consultant providing what amounts to marketing services for doctors.

“Merely recommending a doctor doesn’t feel quite as wrong as saying ‘You should get a lower blepharoplasty.’”

But as it happens, that was exactly what Ms. Farina was recommending on a recent Wednesday afternoon.

She was sitting in front of her laptop, talking over Zoom to Nancy, a 44-year-old small business owner from St. Paul.

Nancy agreed to let a reporter watch her consultation with Ms. Farina on the condition that her last name not be used.

Nancy had sharp, angular features and a sample-size waist. She looked a lot like Bethenny Frankel. She was upset about a hollowing out that she believed was taking place below her eyes. “You don’t need a face-lift, so that’s the good news,” Ms. Farina said.

“I’m not ready for that,” Nancy replied, nodding.

“No, you look great. But I do notice there’s some hollowing going on,” Ms. Farina said.

Gesturing at Nancy, she focused on the “area beneath her eyes. “That needs to be re-draped and repositioned,” she said. Then she got technical: “So we do what’s called a transconjunctival blepharoplasty, which is a procedure where they go under the lid and they make a little incision and lift that fat pad up and reposition it.”

Within minutes, Ms. Farina had a list of plastic surgeons, and was dispensing information about their prices, though she noted her ability to negotiate lower ones.

Of course, as much of this information becomes available on the internet, some of Ms. Farina’s detractors argue that the same platform that has enabled her rise may ultimately be her undoing. But so far, she sees little evidence for this being true.

“Kris Jenner is not even my client,” she said later. “And when she came out about her face-lift, my inbox blew up. We got over 700 inquiries that day.”

Kitty Bennett contributed research.