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?
She was not quite forty, with striking features and the figure of an even younger woman, and this was her first face lift. Now that the skin had been trimmed around her ears and fastened back in place with rows of nylon sutures and gleaming stainless steel staples, she had started to worry about the mole on her nose. Jim Gilmore, however, didn’t think this was the time to remove it. “Let’s set our priorities,” he suggested gently, “We’ve still got to do your forehead.”
Gilmore parted her hair in a continuous line running from ear to ear right across the top of her head, and then he tied up the strands of long blonde hair into two rows of neat little bundles on either side of the part. He took the scalpel and cut swiftly along the path he had created through her hair, and after a few snips with large surgical scissors the quarter-inch-thick layer of scalp parted to reveal a glistening wedge of the membrane that covers the skull. Blood began oozing from the severed vessels in the scalp, and as Gilmore went across the dome of the head with the electrocautery the veins hissed and sizzled and were sealed off. Then the pace of the operation accelerated suddenly, almost violently.
Moving very quickly, Gilmore stuck first one and then two fingers into the incision and began to pull the scalp away from the forehead, making a sound quite similar to a Velcro fastener being torn apart. Within seconds he had worked his fingers down several inches below the patient’s hairline, and then cut with scissors to a point just above her eyebrows, so that a third of her face just flopped away from the skull like some realistic Halloween mask that could be ripped off, discarded, and replaced. The patient looked up at the ceiling, then down toward the purple canvas espadrilles on her feet. “I don’t know when I’ve been more relaxed,” she said dreamily.
That thin, extremely pliable layer of flesh and gristle that covers our skulls can indeed be as shockingly superficial and impermanent as it appears to be during a so-called forehead lift. But for many of us, like the blonde woman, who was put back together the way she wanted, it is becoming increasingly difficult to separate the well-being of the outer mask from our inner well-being, and that is probably why cosmetic plastic surgery is becoming one of medicine’s major growth industries. And like most medical booms, it echoes rather faithfully the tenor of the times. During the fifties and sixties, for example, we plunged so rapidly into affluence and abundance that we ended up glorifying our heart surgeons and enriching our psychiatrists. During the seventies we kept track of aerobic points, took megavitamins, and self-motivated our way towards physical and mental health, and podiatrists and diet doctors started gaining respectability and making money. With the eighties has come the need for icing on the self-improvement cake, as well as a material edge in a world where competition, both economic and social, has suddenly become much more intense. The eighties are going to be the decade of the nose job and the face lift.
The considerable skills of Jim Gilmore, M.D., board-certified otolaryngologist, fellow of the American College of Surgeons and the American Academy of Facial Plastic and Reconstructive Surgery, and a rising star in the firmament of cosmetic surgery, are generally dedicated to making average-looking people look good, good-looking people look better, and beautiful people look nearly perfect. It is a job that he pursues with the sincere commitment and intelligence of a DNA researcher trying to unlock the secrets of life, even though it is a job that is still largely scorned by much of the rest of the medical community. But at a time when a new face can cost thousands of dollars less than a Japanese subcompact, the rich dowagers and aging screen idols who once endured torment and seclusion in their pursuit of eternal youth have been replaced by hundreds of thousands of ordinary middle-class people for whom new, relatively painless, and rapidly healing procedures have made refurbishing the face a more realistic goal than re-decorating a living room. These are the new believers, the ones who know that good looks can contribute to their good works, and their belief leads them to the operating table like pilgrims to a shrine. Like all pilgrims, each has a tale of his or her journey—tales of love and money, success and failure, life and death. And like all pilgrims, they nurture a hope for renewal at the end of their journey.
“Is it Foolish to Have This Done?”
The lady from Minnesota was spending the summer with her niece in Lewisville, and she had come to see Jim Gilmore in his new offices at Concorde on the Creek in North Dallas. Dr. Gilmore had decided to move from his office in Promenade Center in Richardson, which he shared with several other doctors, for several reasons. For one thing, he had his own ideas about cosmetic surgery, about the aesthetics of the face and what it should look like after surgery, and he didn’t want to be associated with doctors who didn’t share his concerns. For another thing, he wanted a comfortable, living room type of atmosphere instead of the clinical environment he had at the old place. So he hired an agent to find an office that he could rent or an office condominium or perhaps even an entire building that he could buy. He also hired someone to go through his files and make a map that would show where his patients were coming from. As it turned out, about one third were from Highland Park, one third from Richardson, North Dallas, and Plano (the triad of affluent northern suburbs), and one third from out of state. Finally Jim decided on a location right at the LBJ Freeway and Hillcrest Road, where a whole cluster of low, gleaming glass office complexes and concrete-covered parking areas had appeared almost overnight. The building in which he would rent space was one of the least futuristic of the half-dozen in the vicinity, its facade softened by liberal expanses of burnished brick surrounding the black reflective windowpanes.
Gilmore and his four full-time and three part-time staffers made the move to the new office in one weekend and never missed seeing a patient. By the first week in August Jim was on his own, and he had his own new image. He had the latest, highest-quality equipment in his operating room; sumptuous, tastefully upholstered sofas in his reception area and consultation rooms; a new logo for his cards and announcements; and even a little room with a specially designed basin where patients could have the blood and goo washed out of their hair after an operation. The fact that the oriental rug and Ming vase for the reception area had not yet arrived, and neither had the art for the walls, did not seem to bother the lady from Minnesota at all. She very desperately wanted Jim Gilmore to do her face, which put her a step ahead of most patients at this stage.
Ordinarily, when patients come to Gilmore for their first visit, or consultation, they are surgeon-shopping, and since their health or life is not in direct peril—and since they aren’t obligated to pay for the consultation—they can afford to be finicky. Often a patient will mention something he or she didn’t like about a previous doctor, like the woman who became disenchanted with one highly reputable surgeon because he kept glancing at his watch during her visit. A surgeon is undergoing a subtle and often psychologically penetrating sort of trial during this first visit. But at the same time he must consider the patient’s suitability for surgery, because a dissatisfied patient is nothing less than a walking, talking billboard that says Dr. So-and-so doesn’t do good work. And that was what worried Jim about the lady from Minnesota.
She was the first in the day’s round of consultations, so Gilmore, in a brief break following the morning’s surgery, had had a moment to review his game plan. His concept was simple, but the execution would be difficult. He had to get her to talk about her weight. He pulled her chart out of the Plexiglas holder mounted on the wall, entered the second of the two small consultation rooms, and pulled the sliding wood-panel door closed behind him.
The lady from Minnesota and her niece were sitting in armchairs on either side of a small round table covered with a bone-colored linen tablecloth. The niece was middle-aged, trim, and well groomed and wore black trousers and lots of gold and diamonds on her wrists and fingers. Auntie, as she called the aged lady from Minnesota, was also wearing slacks and lots of jewelry, as well as a billowing floral blouse that could not conceal the fact that she was very large indeed. Gilmore, still in his blue surgical scrub suit, came in and sat on the end of the sofa, close enough to reach out and touch the lady from Minnesota. He pulled several black and white photographs from her file, warned her that they were excessively sharp and made her look worse than she really does, and pointed out the great folds of skin that were encircling her eyes. “Let’s decide on our priorities,” said Jim, almost as if he were prompting a child to choose any two candies in the box, but only two. “What do you want?”
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