First published in August 1997.
I should have been flattered.
The editor decided I looked like someone who didn’t need plastic surgery, although I had been wondering if I needed it. That meant I was well suited to find out what cosmetic surgeons are selling these days. We would let them tell us what I needed.
At 37, I thought I was a long way from the surgeon’s knife. And yet… when I look in the mirror and smile, I notice wrinkles around my eyes and creases stretching from my nose and around the corners of my mouth. I figured that, if anything, the talks with cosmetic surgeons would give me the information I’d need when things started to sag and droop in, say, five or ten years.
So I visited five plastic surgeons, gave them all the same complaints about wrinkles, and waited to see what they’d suggest.
I secretly hoped these professionals would say: You’re crazy. You don’t need a thing.
But four out of five doctors told me I wasn’t crazy. It turns out that what I thought was a mild case of crow’s-feet and some common creases around my mouth were the least of my worries.
One thing I learned from the experience: If you’re not sure you want or need plastic surgery, don’t ask surgeons to help you decide. After all, it is the rare individual in the service business who suggests you don’t need the service you’ve come to discuss. They could only assume from my visit that I was ready to be lifted and tucked.
By the time this was over I realized, too, that it isn’t only the knives of plastic surgeons that cut deep.
Stop One: Taking It on the Chin
The consultant who did my “pre-interview” at the Austin-Weston plastic surgery clinic in McLean had two black eyes, staples in her head, and a huge bandage wrapped around her midsection to help a recent liposuction heal. And these were not her first surgeries.
It made me feel horrified by the idea of plastic surgery, but I decided to go through with my appointment with Dr. Harvey Austin. This is a man who had overhauled a woman he thought looked good enough to marry, so I was sure he was going to suggest big things for me. After the well-chiseled surgeon stared intently into my wrinkles for a few minutes, he showed me that when I’m not smiling, I don’t have any real wrinkles. He declared me ineligible for a facelift. It was far too soon for me to have the fat sucked out of my eyelids or my forehead pulled back over my scalp.
His eyes, however, seemed stuck on my chin. My thin chin.
He moved his fingers along what he suggested was a large indentation between my cheeks and my chin. Aside from an old auto-crash scar, I never think of my chin as an area in need of help.
Waving his arms like a conductor, Austin began a passionate speech about my face creating my “life’s options,” as if to suggest cosmetic surgery might boost my career. He went on. “You’re pretty… like the girl next door,” he said. But thanks to science and silicone, a row of implants could give me “fullness” along the bottom of my face. It would cost $2,500, with another $1,000 for “scar revision” on my existing scar.
I told Austin that implants gave me the creeps. I related a story of a lunch I had with a natural-looking Reagan administration official in the early ’80s. After a few glasses of wine, she allowed that she had had a nose job, cheek implants, surgery to turn the corners of her lips up, and a chin implant. She grabbed my hand and put it on her chin. “See!” she said proudly as my fingers moved back and forth over what felt like a peppermint patty swimming under her skin.
Austin opened the door and shouted, “Cathy!” In came a pleasant-looking woman who had been behind the front desk. He motioned for me to feel her chin, and, indeed, the peppermint patty seemed well anchored to her chin bone. When he showed me Cathy’s “before” picture, it was clear she had barely had a chin prior to surgery. Was I in that bad shape?
Still, I was happy Austin didn’t think I needed a facelift or eye tuck. Then came the crowning blow to my ego. He said my big problem down the road was going to be eyes that are too far receded into my head. It would cause dark shadows and general signs of premature aging.
The parking lot was full at Austin’s office. I sat in my car staring in the rear-view mirror at my chin and dark circles.
Round Two: What Pigment Problem?
After the animated Harvey Austin, the soothing, schoolteacher-like Dr. Stephen Kay was a relief. It was also reassuring to meet with a doctor and staff who looked close to like what God intended. I thought, this is not a man given to frivolous face rearranging.
From his Wisconsin Avenue office near Mazza Gallerie, Kay patiently explained the relationship between the face’s skin and muscle and how as people age their muscles are less able to hold the skin taut.
He looked at me closely and declared that with me it wasn’t a matter of muscle: “The skin is the problem.” Then Kay calmly laid out my options. “You don’t want to change your expression,” he said. But I might want to get laser surgery around my eyes and have some of my fat–taken from an area where there was excess–injected into the folds on my face. I winced.
The laser surgery would be quick and relatively painless, he said, although the area around my eyes would be red for at least a week. I wouldn’t be able to wear makeup for those first seven days. After that, the area around my eyes would be pink for several weeks or months, but not so pink that makeup wouldn’t cover it.
I found myself thinking this wasn’t so bad–at least no head staples. After what I’d been hearing, surgery now seemed inevitable. Maybe lasers would, as Kay suggested, keep me ahead of my aging for several years.
Whether I had surgery or not, Kay suggested other stopgap measures. He asked what types of creams I’ve been using on my face. I told him, until lately, Estee Lauder’s Fruition. He waved his arm toward Saks Fifth Avenue across the street, looked like he had tasted something bitter, and said, “those are cosmetics.” My recent switch to MD Formulations on the advice of an esthetician seemed only slightly less distasteful. He recommended I try the prescription wrinkle cream Renova and gave me several samples.
Newly worried about my dark, sunken eyes after my visit with Dr. Austin, I asked Dr. Kay about the problem. He handed me some skin-bleaching cream. Later, at the front desk, when I went to pay the $50 consultation fee, Kay’s assistant asked me for my insurance card. I told her the visit was not covered because I was discussing elective cosmetic surgery. “But you have hyperpigmentation!” she exclaimed.
Kay’s quote for laser surgery and fat injections: $1,350. Fat injections alone would be $325. I told Kay I had a lot of expenses associated with a new house and might have to wait on surgery. He tried to comfort me: “It’s not devastatingly urgent,” he said.
Next Stop: What’s the Rush?
Dr. James French is one of the most talked-about surgeons in youngish female circles. He’s handsome, in a natural sort of way, and married–to a brain surgeon. He has a Southern sincerity that has won many a female patient over. “He’s going to tell you to get lost,” a friend and former French patient assured me.
Hardly. Though I wore more makeup than I had for my other visits, I couldn’t fool French. Following my lead to the wrinkles under my eyes and nose-to-mouth (nasolabial) creases, he slowly laid out my options–all of which involved surgery. He did say at the outset, “You don’t need a facelift.”
He suggested either laser surgery around my eyes or blepharoplasty, the technical term for an eyelift. He urged that the latter would be better, even though it would involve slicing into my lower eyelids and would cause bruising for several weeks. He thought that was better than putting up with the reddened skin that a laser would leave around my eyes for several months.
He gave me two options for my other facial folds: Injecting the creases with my own fat or fat from a cadaver. That would cost $1,250 for one session. I later learned that injected fat wears down; more visits would likely be required.
Those who work in offices where black eyes are a common sight seem unfazed by the idea of going to work looking like you’ve been beaten up. After you work for Dr. French a year, sources say, the doctor waives his fees for plastic surgery–you only pay for the operating room and the anesthesia. Similar arrangements are typical in the business, so bruises seem to be an occupational hazard.
French nearly had me convinced that I needed surgery–and that some selective slicing around my eye now could eliminate the need for more surgery for years. He said it is becoming quite common for women in their thirties to have cosmetic surgery.
I met with French in his Fairfax office–he also has offices in Annandale and Chevy Chase–and I did find him charming. After the consultation, he ushered me into the business office for my price quotes–$3,260 for blepharoplasty or $2,460 for laser eye surgery and fat injections.
French wanted to make an appointment for my surgery. He was the only doctor I talked to who assumed I’d be ready to make a decision that quickly. I declined.
Finally: Just Say No
Then I talked to Dr. Mary McGrath.
McGrath works out of governmentlike quarters in a George Washington University Hospital building. She doesn’t have any well-put-together assistants. And she’s not much of a saleswoman: She has never had plastic surgery herself and appears in no rush to urge anyone else to take the plunge.
She seemed surprised to see me. I liked her immediately.
About the only thing that caught her eye were some “expression lines” between my eyebrows that showed up when I frowned. Her solution? Try to stop frowning.
Unwittingly, she proceeded to refute what other doctors had told me. She looked closely at my face and tried to grab as much skin as she could on my cheeks. “There’s not enough skin to get,” she declared. Any kind of eye or cheek surgery, she said, was out of the question.
If she were to perform any surgery, “in three years, you’d be back where you were,” said McGrath. I didn’t have much to fix, she said, and I would continue to age.
“So where do we go when you’re in limbo?” McGrath asked. She gave me the name of a dermatologist with whom I could discuss creams or chemical peels. But she said even that was unnecessary.
Surgery for a 37-year-old? “Maybe if you had lost 100 pounds,” she said. She called promotions about the miracles of laser and other surgeries for patients without sagging skin a “lot of hype.”
The Last Word: Sticking My Neck Out
Walking into Dr. Talal Munasifi’s Arlington office is like entering a decorator’s show house. Grecian urns and statues adorn a purple and bronze-toned lobby. Munasifi says he spent months combing antique stores and designer outlets for the perfect leather chairs, modern tables, and other pieces. And he’s more than willing to take the time to talk about creating the perfect face.
As his eyes and hands moved from my eyes to my cheeks to my chin, Munasifi grabbed a fold of skin from my neck. “Does this bother you?” he asked. Not until now, I said.
He gave me my options. Instead of cutting into my lower eyelids along the lash line, he could go inside the lids and remove the “fat pads.” Then he would use a laser to “resurface” the eye area to help smooth out fine lines. Total cost: $3,550.
He didn’t want to do anything to fix my nasolabial folds. After all, he said I’d “be back in two years” to have something done about the chicken neck I never knew I had.
Though he suggested surgery, Munasifi’s was a soft sell. I could easily make do with some vitamin-C cream, he said. He even tried to be complimentary.
“You know,” Munasifi said as I was preparing to leave, “you’ve aged very well—you don’t look older than 37.”
