So You Don’t Like The Way You Look?
Well, would you change your face if all it took was the price of a good stereo, a few days’ living in bandages, and some tiny scars even if your closest friends wouldn’t notice—that is, if that was all it took?
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An hour and a half into the operation, Muriel’s fact lift began. Again Gilmore went around her ears, cheeks, and neck with the syringe full of Xylocaine. With the scalpel he cut swiftly around the entire ear and along two horizontal lines: one extending forward from the top of the ear to just under the sideburn and the other from the middle of the back of the ear into the hairline. He pulled at the edges of the flap that he had just created with several picklike skin hooks similar to the ones he had used on the eyelids—the tiny blood vessels in the skin can be crushed if the surgeon touches them with his fingers, resulting in skin loss—and then he began to cut the skin and a thin layer of subcutaneous tissue away from the face with the large scissors. When the skin had been separated from most of the cheek and part of the neck, Betty and Jim pulled it up so that he could peer into the red cavern between the skin and face. The skin, laced with tiny red blood vessels, glowed yellow from the light behind it.
Gilmore took the scissors again and dissected a second, several-millimeters-thick layer of the facial or platismal muscle, known to surgeons as the SMAS (for subcutaneous musculoaponeurotic system). This would be the basis for the bilevel face lift. After separating the layer of SMAS all the way down into the neck, Gilmore pulled it up to a point just below the earlobe and tacked it into place with several permanent nylon sutures. The excess SMAS, a triangular flap about an inch on each side, was trimmed off and thrown into a big plastic trash can. When the skin flap was subsequently laid back in place, it concealed about a third of the ear. Gilmore cauterized some blood vessels, packed gauze between the skin flap and the facial muscle, and went over to the other side of the head and did the same thing all over again.
Now it was closing time. First, Gilmore removed the packing and began carefully cauterizing any oozing blood vessels, until the SMAS was dry and covered with tiny black dots. He injected the SMAS with Marcaine, a long-lasting anesthetic, in order to reduce postoperative pain. Then he pulled the skin back over the ear, cut about a one-inch-long slit for the earlobe, and began tailoring the skin. Working in much the same fashion as he had with the eyelids, Gilmore made cuts perpendicular to the main line of the incision, tacked up the flaps, trimmed them, and then sutured everything back together. Even with Gilmore’s nimble, quick hands, it was an excruciatingly tedious process of gradual adjustment, with lots of big one-inch flaps of Muriel, followed by smaller slivers, making their way to the trash can. It began behind the ear, where most of the tension is put and where staples can be used to close parts of the incision, and ended along the crazy contours at the front edge of the ear, which were sewn with the finest needle and thread. And it had to be done again on the other side of the face.
When it was finished, Muriel’s face had been transformed. Her eyes had started to swell and turn purplish, but her face had not yet begun to react to the trauma it had just endured. This was a temporary lull, however, the eye of a physiological hurricane, and three hours after he began the surgery, Gilmore began to swathe Muriel’s face in cotton packing bound with cotton bandages—he insists on doing this part of the procedure himself and considers it an art that can contribute greatly to the patient’s comfort and recovery after surgery—until she looked like a Siberian peasant woman preparing for a winter outing.
Muriel began to emerge from her Sumblimaze twilight world. “How does the mouth look, Jim?” she asked, concerned about the extent to which the face lift would eliminate the lines around her mouth.
“It looks real good,” replied Gilmore. “How are you doing?”
“Super.”
“I Love the Compliments”
Jim Gilmore performs more than four hundred operations a year. At an average surgeon’s fee of about $1800 each, his gross income approaches $1 million a year, which is about as much money as one person can make by working every day with his own two hands. Jim, however, maintains that the money is unimportant; if he didn’t love his work it would never be worth it. “I could make just as much money in real estate,” he says with implacable self-confidence, “and with a lot less stress.” Like many doctors, he is incorporated, and the sum of his overhead and the salaries he pays his assistants is enormous. Unlike many doctors, he pays himself a relatively modest salary, lives in a less than opulent section of North Dallas with his wife, Gay—an ex nurse—and his three children, and drives an older Datsun 28OZ, which is hardly a status car for a successful doctor. His life is totally controlled by his work. He never stays out late or drinks the night before surgery; he runs four to six miles most mornings because he feels that it builds him up to a mental and physical peak before surgery, abstains from coffee or soft drinks on the mornings when he is operating, and will even see patients and remove stitches on Saturdays and Sundays. His daily routine is an unrelenting cycle of psychological sparring, critical surgical and aesthetic judgments, and sheer manual drudgery. He pushes himself through it like an athlete trying to break a world’s record every day of the year. “My life is goal directed,” he says. “I can’t afford slumps. I can’t afford to be mediocre even once.”
Not everyone approves of Dr. Gilmore’s goals, including many other doctors and nurses. Gilmore is aware that many physicians think that cosmetic surgery is a retreat from the classic standards of medicine, and because nurses at many hospitals resent cosmetic surgery patients so much, he makes it a point to perform all of his in-hospital surgery at a small hospital in Richardson, where the chief of surgery is a plastic surgeon and the climate is generally more receptive. But he also feels that his critical colleagues are shortsighted. He thinks that doctors need to turn more toward preventive medicine rather than just concerning themselves with diseases. He thinks that it is necessary to treat the whole person, and in that context cosmetic surgery is the finishing touch. He cannot say, however, that there was ever a moment when he made a conscious philosophical decision to begin focusing on cosmetic surgery. It was really a sort of aesthetic seduction, something growing out of a lifelong but generally subordinated interest in painting and sculpture. “Had I had the opportunity,” he says, “I might have become an artist.”
Aside from surgery and art, Jim’s intellectual passions run to ecology and humanitarian causes. “I see myself,” he says, “as a very small part of a much greater whole.” He belongs to the Sierra Club and Midway Hills Christian Church, which is active in a number of liberal social issues, and he donates medical services from time to time to church-supported causes. But most of Gilmore’s fellow parishioners are unaware of the nature of his practice, and he does wonder how many of them would admire the use to which he has put his skills. On a day-to-day basis, however, such questions don’t disturb him. “When I’m at work,” he says, “there’s so much positive feeling around me that I never think about things like that.”
Muriel Hughes attributed her extraordinarily rapid recovery to several factors, giving approximately equal credit to the surgeon’s skill, her own active lifestyle and good eating habits, and the fact that once she finally decided to go through with it, she became completely confident that everything would turn out well. Whatever the reasons, Muriel was doing business on the phone the day after her operation. On the third day the heavy bandaging and some of the stitches were removed, and while Muriel’s face was somewhat swollen and her eyes slightly purple, it was obvious that she was coming back very fast. That Saturday—the fourth day after surgery—she put on some dark glasses and went out to show a building to a client. On Sunday more stitches were removed, and on Monday she put on makeup and went back to work. By the end of the week all of her stitches were out, the women at the beauty shop were agog at the almost total absence of bruising and swelling, and an executive with an elevator company was already giving her the heavy rush. “I love the compliments,” said Muriel. “I just feel a new burst of energy.” And she couldn’t say enough about Jim Gilmore. “I guess,” she mused, “that I just got in with the best in the business.”
Two weeks after her surgery Muriel came in for the first collagen injections in her upper lip. By then her “result” was dramatic. She was still Muriel, her face still had character and some of the wrinkles and none of the stretched, taut look of a face lift, but she looked measurably better, more vital, more beautiful. Her face really was a kind of masterpiece, and Muriel was thrilled with it. She had some of the predictable feeling of tightness, but there was no evidence of the once feared nerve damage, and her incisions were already virtually unnoticeable lines of pale pink.
Three weeks after her face lift Muriel Hughes had Jim Gilmore do her nose. She was worried that at her age the broken bones would ache from time to time, but other than that she was strictly upbeat about the whole thing. “I hear,” she said as confidently as a track handicapper betting on a race he knows is fixed, “that noses are what he does best.”
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