She had to have three plastic surgeries______she had a beautiful face.
B) by the time
Before she had (i.e., could have) a beautiful face, she had to have three surgeries.
by the time ...
You need to finish your homework by the time I get home. <up until the time I get home>
She had to have three plastic surgeries up until the time she had a beautiful face.
She had to have three plastic surgeries by the time she was 20. Otherwise, her insurance company wouldn't pay the bills.