Lift: Wanting, Fearing, and Having a Face-Lift by Joan Kron

From the Publisher

An award-winning journalist recounts her own dramatic decision to have cosmetic surgery—and helps readers considering a face-lift make their decision wisely and safely.

The most respected journalist in the field of cosmetic surgery today, Joan Kron leads readers through the face-lift process—from initial deliberation to finished result. Lift addresses the issues of identity, vanity, and economics, answers questions about how to choose a doctor and where to have the procedure done, and reveals the latest information about new techniques. Drawing on dozens of real cases, interviews with doctors and nurses, historical data, and her many years of frontline reporting, Kron delivers the whole story behind facial reconstructive surgery—not just what's in the news or the gossip columns. Arming readers with the right information, questions, and approaches, Lift is an invaluable resource for anyone contemplating changing their life by changing their appearance.

"Witty, informative, smartly written and unflinching in its details." — The New York Times

A portion of the author's royalties is being donated to the National Foundation for Facial Reconstruction to subsidize psychological counseling for individuals with facial conditions.

Joan Kron is an award-winning journalist who has covered plastic surgery for Allure for the past seven years. She has been a staff reporter for the New York Times, New York magazine, and the Wall Street Journal. Her previous books include Home-Psych and High-Tech. She lives in New York City and East Hampton, New York.

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HOW I GOT THIS FACE

"There are only two subjects worth talking about-menopause and face-lifts."

— A WASHINGTON NETWORK NEWSWOMAN, QUOTED BY GAIL SHEEHY,

IN THE SILENT PASSAGE: MENOPAUSE

I am older than Gloria Steinem and younger than Helen Gurley Brown. Until recently, when cameras became my enemy, I was certain I would never do it — have a face-lift, that is. In the 1960s, when I was in my thirties and married to a general surgeon, I went to a lecture on cosmetic surgery. "How horrible! I'll never have that," I exclaimed to the woman next to me, as graphic slides of a face-lift procedure flashed on the screen, taking me under the patient's lifted cheek flap and showing me all the tissue from her ear to her chin.

    If those slides weren't a deterrent, my lumpy appendectomy scar was. "You can never have a face-lift," my mother warned. "You're like me, you're a keloid healer." She was operating under the common misconception that thick abdominal scars are keloids (they're not — keloids are cauliflowerlike tissue growths that spread beyond the bounds of the incision) and that a thick hypertrophic scar in one place on the body is predictive of how one will heal elsewhere on the body (wrong again — the face heals differently).

    Like many women, I defused my feelings about aging by alternately joking about plastic surgery and condemning it. Deep down, though, everything about this rite of passage fascinated me — surgeon-shamans, secret-society membership, the scarification ceremony, cult of bravery, period of social withdrawal, and dramatic reentry with a younger visage.

    Fast-forward to 1991. I am a journalist covering the psychology of appearance for Allure but I am still surprisingly clueless on the reality of lifts. I don't know the difference between a skin lift and a muscle lift, a phenol peel and a TCA peel. I can't tick oft the names of the top plastic surgeons. All I know is that while I'm getting older-looking, many of my contemporaries are getting better-looking.

    I finally had a reason to learn the ropes while on assignment in L.A., working on a piece about beauty rituals in the capital of self-invention. I scoped out the A-list of local surgeons and also discovered a uniquely Hollywood institution — the plastic surgery recovery house. On a tour of one of these pretty-in-pink establishments, I got my first look at women recuperating from face-lifts. Seeing one after another of these bruised, swollen-faced, tranquilized women was a sobering experience, especially when, in the middle of the house tour, a Beverly Hills Fire Department Emergency Unit arrived — siren wailing — in response to a 911 call about a postoperative patient who was hemorrhaging. I turned to the photographer working with me, rolled my eyes, and vowed, "Not me, ever."

    So how was it that twenty-eight months later, I am in New York's premier plastic surgery facility — Manhattan Eye, Ear & Throat Hospital — as the bruised, swollen, tranquilized one in the helmet dressing, oozing bloody fluid through drains attached behind my ears. I have just undergone a two-and-a-quarter-hour face-lift (face, neck, eyes, and lip peel, to be precise) and my nonmedical second husband, a retired advertising executive, is standing at the foot of my bed, shaking his head and muttering helpfully, "You couldn't pay me to have this done."

    When I assure him I'm feeling no pain and that considering the anticipated result, it's the most worthwhile discomfort I've ever endured, he thinks I'm delirious.

    Within two weeks, his disbelief has turned to amazement. The swelling has subsided. I have graduated from Tylenol-and-codeine to plain Tylenol. The change in my appearance is remarkable. I am still myself, but a ten-years-younger-looking version of myself — the me I had lost. The result, I feel, is worth the temporary aches and annoyances — and, yes, even the money.

    How do I explain this about-face?

    Like many journalists, I have often used writing to work through my own personal issues. In fact, it was the death of my sixteen-year-old daughter in 1968 that propelled me into a writing career at the age of forty. I rescued myself from disabling sorrow by writing about grief therapy, and covering, for more than a decade, the emerging death and dying movement. When I divorced (as, I learned covering the field, many parents do after the loss of a child) and remarried, I had an identity crisis over what surname to use (second husband's name, first husband's name, maiden name?) and resolved it by writing about the legality of a married woman using a name other than her husband's. (I ended up keeping my first husband's name. I felt I owned it after using it for twenty years.)

    And now I was ready to deal with another kind of loss: aging. It was through journalism that I started down the road to my first face-lift. Allure's editor, Linda Wells, expressed interest in having a first-person article on shopping for a face-lift. I volunteered, maintaining I was uniquely qualified. After all, I reasoned, I was one of the few writers in the room old enough to need one — not that I would ever want one.

    The story required scheduling consultations with four leading plastic surgeons and pretending to want a face-lift. Undergoing one was not part of the assignment. The magazine would pay for the office visits, but not for surgery (and, of course, accepting any, gratis, in return for publicity was strictly forbidden).

    Pretending turned out to be not that hard. I kept saying "it's just research," but with each visit, I became more open to the whole idea. I took to studying my face in the mirror and in old photos. Discussions with friends and acquaintances led to surprising confessions of trips to California for secret eye-jobs and face-lifts done literally under my nose. I was dumbfounded. If, as the handwringers say, a face-lift makes a person look like a test pilot in a wind tunnel, how come my friends had surgery without my realizing it? Obviously plastic surgery could be more subtle than I realized.

    Sometime between the first phone call and the last office visit, I had crossed the line from stealth journalist to consumer. Impulsively I signed up for a $15,000 face- and eye-lift and lip peel — which is how I ended up in early 1992 in a bed in Manhattan Eye, Ear & Throat Hospital.

    The magazine assignment that landed me in this hospital bed, "Shopping for a New Face," turned out to be more than a memoir of choosing a surgeon. It was also the story of my conversion. Afraid of jinxing myself, I had asked the magazine not to publish the article until after the surgery was successfully behind me. My literary agent, now deceased, advised me to have the lift and write about it if I wanted to, but not to use my own name. So, the piece ran a few months later under the byline "Anonymous."

    To my surprise, the article struck a collective nerve. Letters and calls showed that, although I was older than the magazine's typical reader, the conflicting emotions I had experienced (grief for my lost youth, humiliation at the thought of possibly dying for vanity, sticker shock, confusion about the array of options, and my reluctance to grow old gracefully) were strikingly universal. Call it "growing old disgracefully," but many people wanted to follow suit.

    I'd given a lot of thought to choosing a doctor but little to the after-math, specifically post-surgery protocol. It's customary after a face-lift, when people remark on your refreshed look, to credit your hairdresser or lie and deny — deceits that make me uncomfortable. Impulsively (again), I began telling the truth. If someone asked me why I looked younger, better, different, whatever, I usually said, matter-of-factly, "I had a face-lift." However, when a relative of my husband's ex-wife remarked bitchily, "I don't remember you being this pretty," I just smiled.

    In return for my honesty, I was rewarded with an outpouring of confidences from women, and men, who were considering cosmetic changes and needed a sounding board. No matter how much you want it, the prospect of a face-lift evokes fear, shame, and embarrassment. Such superficiality calls into question your values about money, risk-taking, self-indulgence, and that most dreaded attribute — vanity. Perhaps the hardest thing about a cosmetic surgery purchase is admitting that you find something about yourself unacceptable, that you don't measure up, and worse, that you care. How uncool!

    We want to believe it's what's inside that counts. But we know — from a lifetime of flattery, slights, deferential gestures, averted eyes, and other signs of approval and disapproval — that appearances count, too. We all have a back story. As a child, I was repeatedly told I looked like my father, not like my mother, who was often compared to the glamorous Sylvia Sidney. That hurt, but I got over it. Being talented was a compensation. I was never offered the ingenue role in the school play — and a good thing, because I suffered from terrible stage fright. I preferred to design the costumes. In college, studying theatrical design, I switched from Carnegie Mellon to the Yale Drama School because, at the time, Yale did not require designers to be in plays.

    More recently, a friend told me that women like me (presumably, average women) cannot possibly understand how hard it is for women like her — very beautiful women — to lose their looks as they age. Gee, thanks. I have always had a sweet face. A little makeup, attitude, and a good haircut does wonders. I was much more concerned about my battle with weight than I was with my face. I never felt disadvantaged above the neck until I began to look in the mirror and see my grandmother.

    I had hoped that a face-lift would make me recognizable to myself again and lift my spirits. And it did. It also gave me something I hadn't bargained for — a new career — or, more precisely, a new niche in my old career.

    "Shopping for a New Face" launched me on the cosmetic surgery beat. I have traveled to Brazil to study the plastic-surgery star system; to Seattle to do a psychological autopsy on a dissatisfied patient who murdered her plastic surgeon and killed herself; to Hollywood to count the nose jobs of cosmetic surgery's most visible consumer, Michael Jackson; to Paris to visit the anatomy lab where important face-lift research was carried out in the 1970s; to Bologna to see where nose reconstruction surgery was perfected in the sixteenth century; and to a medical meeting in Orlando for the unveiling of the inconclusive first-year results of "the Twins Study": a shoot-out by four famous surgeons (sponsored by the University of California) to see which of four face-lift techniques yields the best results. Perhaps the most significant thing I've learned from all this is how far we will go in discomfort, expense, and risk for appearance. And how much justifying we do. Most people, I've found, believe their own face-work is absolutely necessary — and everyone else's isn't.

    If you eventually have any, I warn you, once you've lost your innocence and had your first procedure — and it turns out well — you will very likely want more. Collagen and Botox injections often become a dress rehearsal for a face-lift. And one face-lift can occasionally lead to another, as I was to discover.

    Nearly five years after my first lift, a recurring sinus condition required an operation. As long as I was having general anesthesia, I reasoned, why not have a few aesthetic adjustments on areas (brow and nose) I didn't deal with before. On the following pages, I'll be referring to my two trips to the "face factory" as my first lift and my second lift.

When I tell people I'm writing a book about the face-lift, they invariably ask me two questions. And as much as anything, this book is intended to answer them.

    The first question: Are you "for" it or "against" it? Most people expect me to denounce it.

    I stand, once again, somewhere between Gloria Steinem and Helen Gurley Brown, this time ideologically. (Steinem had an eye-lift, not to look younger, she has said, but in order to wear sleep-in contact lenses.) But she isn't opposed to cosmetic surgery for others if it is "life-enhancing." Brown, meanwhile, favors it wholeheartedly. (She has admitted having had a nose job when she was forty, a face-lift, and, more recently, an eye-lift and a mini face-lift.)

    Obviously, I'm not against cosmetic surgery. What I am against is deciding to undergo it impulsively and signing up without being fully informed, or cutting corners on the doctor, the anesthesia, and the aftercare.

    The second question, surprisingly: How old is the face-lift technique? There's a presumption that the operation is of recent origin, maybe thirty or forty years old, as if no one ever cared about their appearance or valued their youthful face before the self-involved "Me generation." Most people are surprised to learn that the first rhytidectomy, as it is called in medical parlance, was first attempted, timidly, in Germany almost a century ago, in 1901. But human beings have had relationships with their images ever since prehistoric people saw their reflections in bits of polished metal. Upper eye-lifts for, presumably, vision problems were performed in Imperial Rome in the first century and 1,000 years ago in the Arab world; and treatments to erase wrinkles and tighten sagging skin may date back at least 5,000 years and have been a constant since then, as has the debate about the virtue of beauty — having it, losing it, trying to get it back.

    A recipe, written in hieroglyphs, for a rejuvenating acid face peel was found in the Edwin Smith Surgical Papyrus, circa 3000 B.C., the oldest existing surgical text. But, before you jump to conclusions about the timelessness of female vanity, I should point out that the complicated instructions for preparing the paste and applying it are described under the headline: "For Transforming an Old Man into a Youth."

    It's ironic. Here we are on the cusp of the twenty-first century. We have surgical remedies for the stigmata of aging that the Egyptians would have given all the gold in Tut's tomb for, and that Queen Elizabeth I, who, in her old age, outlawed looking glasses in her household, would have given the crown jewels for. Yet, we worry about the correctness of using the resources at out command. Having a face-lift isn't natural, critics carp.

    But as Times health columnist Jane Brody pointed out recently in a column about another body practice that's considered "unnatural" — hormone replacement therapy: "A woman's current life expectancy, on average, of seventy-seven years is not natural either. Nature programmed us to live up to the age of menopause — long enough to bear children and raise them." What to do with out bodies and ourselves in these bonus years is the new dilemma.

    In this book, I have tried to share some of what I have learned about the face-lift from history, from countless scientific presentations, and from talking to hundreds of individuals about their misgivings — and outcomes — and from my own surgeries. The most important lesson I can share may be that no two people have the same experience.

    One woman is so ecstatic about her face work, she says, "I don't look at it as an expensive purchase. I consider it a new lease on life." At the other extreme is a self-described plastic surgery "victim," who went public on Sally Jesse Raphael's talk show. The disfigured patient is one of a small, but growing, number who fall into the hands of untrained and unethical practitioners. The woman's visage is every face-lift patient's worst nightmare. She has been advised she'll need six operations to correct her masklike appearance and over-operated-upon eyes.

    But even when the quality of surgery is top-level, one patient can breeze through the recovery and her best friend can be miserable for weeks. Much like the experience of childbirth, there is no one standard kind of convalescence. The person who finds her first face-lift a breeze may find her second one a pain — and vice versa. The choice of doctor, your medical history, your attitude, your support system — all contribute to the outcome.

    A face-lift is not for everyone. This book won't tell you whether or not you should have a lift, what doctor to go to, how much your surgery will cost, or what vitamins and herbal remedies to take beforehand. I'm always suspicious of writers who prescribe precise formulas. Each doctor has a preferred pre- and post-op regimen and there is no consensus except that aspirin before surgery causes bleeding and the so-called benefit of taking trendy Arnica is controversial. And, most of all, I can't promise a perfect outcome.

    But, I hope, the book will help you clarify your attitude about the aging face and navigate between the mystery, the hype, and the old wives' tales surrounding restorative procedures. Friends can be a great support; however, as one surgeon warned, from his own experience, face-lift "patients receive notoriously inaccurate information from other patients who have undergone the procedure." Although several experts have reviewed the text for technical accuracy, this book isn't the last word on the subject. But I hope you'll find it to be a knowledgeable companion whether you're a serious candidate or just window-shopping.