Change Your Looks, Change Your Life: Quick Fixes and Cosmetic Surgery Solutions for Looking Younger, Feeling Healthier, and Living Better

INTRODUCTION

The Time for Change Is Now

WHAT IF?

We’re a culture that imagines and embraces possibility. What if we could actually change? What if we could genuinely improve ourselves? What if we could look better than we ever have—or ever thought we could—and still remain true to ourselves? What if? is the idea behind this book.

Helping people imagine how their looks—and, by extension, their lives—can improve is the most challenging and rewarding part of my daily work. In my twenty years practicing as a plastic surgeon, I’ve met hundreds of women and men who come to my office wanting to change something: the violinist, spirited and vivacious as a forty-five-year-old, whose skin betrays her sixty-five years; the fifty-year-old computer executive with bags under his eyes who fears losing a deserved promotion to a younger co-worker; the thirty-seven-year-old single mom who repeatedly breaks off promising relationships because she’s scared to get naked with a new partner. The effect their appearance has on their self-confidence is more than skin-deep; it has enormous impact on their emotional health, the quality of their lives, and their future outlook.

TODAY’S REVOLUTION IN COSMETIC SURGERY

I have been privileged to witness the self-image of so many patients undergo extraordinary and dramatic changes, even after minor work. And I’ve come to see how cosmetic surgery can be a powerful, and empowering, tool; its reach extends beyond flattening a stomach or removing a deep-creased scowl or smoothing pitted skin. It can help to restore energy and optimism, to give that literal lift needed to make more far-reaching physical and, ultimately, psychological improvements.

Back in the early 1970s, when I was one of the few women in my class at Harvard Medical School (and the first to graduate with a dual degree in dentistry and plastic surgery), the discipline of plastic surgery was in its infancy. It had only recently shifted from its long-standing focus on reconstructive surgery (fixing cleft palates and badly broken noses, for instance) to cosmetic (or aesthetic) surgery, the practice of doing for people what nature didn’t or couldn’t. We who specialized in cosmetic surgery performed massive, Hollywood-style face-lifts and experimented with such new body-sculpting procedures as liposuction; the results, while encouraging, were less than stellar. As technology improved, we were able to make even more dramatic changes on patients who needed or wanted them.

Today, we have entered a kind of Golden Age of plastic and cosmetic surgery: In just the last half-decade, medical advances have greatly reduced the invasiveness, risk, pain, and recovery time of most procedures, radically transforming what the profession can do. No longer must every fix and its aftermath be anxiety-ridden, painful, or time-consuming. New techniques like these have contributed to advances in the field:

Twilight sleep puts patients in a deeply relaxed state without the debilitating grogginess of general anesthesia. Patients walk out of my office on their own just a couple of hours after a procedure.

Endoscopic surgery, which uses a long, thin tube attached to a video camera, allows me to perform such procedures as a forehead lift with only three tiny incisions behind the hairline, rather than the old ear-to-ear headband incision that leaves a nasty scar. Recovery time? Three days, versus three weeks.

Liposuction, first introduced in the 1980s, has improved to the point where we can now remove large amounts of fat from all over the body, all at once, without causing the blood loss and massive bruising and swelling that used to be routine. And large-scale surgical procedures such as tummy tucks, neck lifts, and arm lifts are now often eschewed in favor of lipo, which in many cases tightens and flattens skin just as effectively with virtually no scarring.

Small-incision surgery means shorter, better-placed, and quicker-to-heal scars for almost all procedures. A face-lift used to require a long, winding incision from the temple area, under the ear, and into the hairline. Now I usually opt to do a mini-lift, requiring a much shorter, and less visible, incision. Another example: Breast reductions used to incur a three-part scar, with the longest section in the breast crease. Today, I resort to this traditional method only when breasts are far too big to support one of the smaller-scar alternatives: an incision around the nipple, or one around the nipple and down to the breast crease. Not only do smaller incisions minimize scarring, but with a quicker recovery they are good news for those who must return to normal life as quickly as possible after surgery.

Many new techniques achieve superb results without surgery. For example, I may opt to forgo a face-lift and instead perform a series of minor procedures without putting someone under the knife. Collagen or fat injections in the face strategically plump it up; while microdermabrasion, a painless process in which a steady stream of fine crystals is sprayed at the skin, dramatically buffs and tightens the skin’s surface, especially in combination with light lasers, which stimulate new collagen growth.

In short, what were once major surgeries are now outpatient procedures that can be done in my office, during lunchtime.

THE ART OF SCIENCE: A WOMAN’S TOUCH

Scientific progress is only part of what defines my job. Over the years—and very much with the help of my patients—I’ve come to see that plastic surgery is an art. If I’m a scientist first, then I must be an artist second. And I learned this because I listen: My patients share their wishes and concerns; along with my fellow surgeons, I use the increasingly adaptive technology at my fingertips to express what is unique and beautiful about each person, and I attempt to do this creatively and sensitively.

Let me repeat something I just said: I express what is unique and beautiful about each person. That is it, in a nutshell. In recent years, surgeons have become more educated in the subtleties of beauty—real-life, individual beauty, not the cookie-cutter perfection we associate with the oft-lifted, tucked, and bobbed. And we’ve grown much better at sculpting human beings.

Why? Frankly, I think it’s because of the rising number of women plastic surgeons in the field.

That sounds sexist, I know. But I can testify to how things used to be, and they weren’t pretty. I had a hard time becoming a plastic surgeon. In the 1970s, when it came to giving women an equal chance, even Harvard was less than enlightened. On the first day of anatomy class, the professor projected on the screen a slide of a Rubenesque naked woman. Pretty much everyone but me (one of only a couple of women in the class) hooted at her voluptuous curves. Today, those former medical students are out in the world, shaping noses, recontouring thighs, enlarging or reducing breasts—in short, helping to define beauty. And many of those male surgeons tend to style their idea of the perfect woman—like so many Pygmalions. The problem with that? The ideal that guides men is often a far cry from female standards of beauty.

It’s cliché to say that women are more empathetic and better listeners than men, but I find that female surgeons naturally take a more collaborative approach with their patients, rather than offering fatherly wisdom or intimations of male flattery. As a woman, for instance, I never create the breasts I want to see on a patient; I create the breasts she wants to see. Or scars: For a woman, a scar is ugly—a blemish that invites curiosity, rather than a badge of honor, as many men see it. So I always explore with a patient ways of minimizing (or altogether avoiding) scarring, a concern that I believe many of my male colleagues have overlooked for far too long.

Fortunately, many male doctors have now got it. Increasingly more attentive and responsive, they’re better able to listen to and work with a patient as a partner. In turn, patients are more likely to go into a first consultation with a prospective surgeon feeling empowered, and can expect customized procedures that take into account cultural, ethnic, and personal preferences.

To be a good plastic surgeon, then, it is not enough to possess know-how, manual dexterity, and framed diplomas that trumpet our qualifications. We must also be imaginative, resourceful, and respectful. To do my job well, I must make sure that the women and men who leave my office not only look better but feel better. And while not all doctors practice this way, I’ll show in the following chapters how to hold your doctor to the same high standards.

All patients must have the courage to ask, What if? That way, they can embrace all the wonderful possibilities that plastic surgery offers.

COSMETIC WELLNESS: WHY LOOKING GOOD IS GOOD FOR YOU

Before I address the questions my patients invariably ask when considering surgery and the specifics of the surgery itself, please consider one more thing: Cosmetic surgery not only can help fix something that has long bothered you, but it can be the catalyst for all kinds of other improvements. Sure, your face and/or body will improve, but more to the point, your life will improve.

Countless times I’ve seen how cosmetic surgery patients, after their procedures, change their approach to physical well-being, and this sets off a positive domino effect that improves their mind-set, too. When a patient sees a difference to her jawline or waistline, she becomes more motivated to take care of herself. Again and again I see patients embrace, post-surgery, a skin-care regimen or workout program with new enthusiasm and dedication because the results they’ve sought for so long are finally visible, with more results within reasonable reach. Indeed, a physical improvement often jump-starts an entirely new approach to living.

After surgery, patients are likely to create a different look for themselves—new wardrobe, hairstyle, makeup—which, in turn, emboldens them to take important life steps such as switching careers, or beginning a new relationship, or simply feeling confident about how they look when they walk into a room. I call this happy phenomenon cosmetic wellness.

I’ll tell you something else, which will probably surprise you: Cosmetic intervention itself can be physically healthy. That’s right! For instance, topical treatments like microdermabrasion and laser resurfacing stimulate the skin’s own cells to regenerate, tightening and invigorating skin to do what nature can no longer get it to do on its own. And liposuction has been shown to make patients not just thinner but actually healthier: A study presented at a recent conference of the American Society for Plastic Surgeons showed that women who’d undergone large-volume liposuction lowered their blood pressure and insulin level (a risk factor for diabetes). And anyone with double-D-sized breasts who has had them reduced enjoys immense relief once her back and shoulders are not being damaged by constant tugging on her frame.

Getting my patients to subscribe to cosmetic wellness is, in the end, why I do what I do. But their commitment to looking and feeling better transcends the mere physical; the more profound improvement is almost invariably psychological. How we feel about ourselves has as much impact on our overall well-being as does eating right, exercising regularly, and lowering the toxic stress levels of our jobs, relationships, and bad habits. Even nutrition gurus and health-club freaks admit that no amount of healthy behavior makes up for poor attitude and low self-esteem.

Best of all, cosmetic wellness—a holistic approach to physical and emotional health—is in your power. In fact, I’d argue (and most mental health professionals will agree) that it’s your critical personal responsibility to take a farther-reaching approach to your well-being. Because when you feel good about yourself—when you’re performing at your peak, and feeling fully optimized—then you’re a better partner, lover, parent, professional, and friend.

This is why I believe plastic surgery and other cosmetic interventions are as critical a part of being healthy as are working out regularly, eating a low-fat balanced diet, taking vitamins, meditating, and getting enough sleep. Following these steps will help you to be the best you can be—top to bottom, inside and out, in every way.

That’s what this book is about. Now let’s talk about you.

PART ONE

Take Control of Your Looks

1

Getting to Yes:

Making the Decision

Now that you have a sense of what cosmetic surgery can offer, let’s explore why you picked up this book.

Take a long, honest look in the mirror. You can do it for real (turn on that harsh overhead light and peel off some clothing), but my bet is you’ve done it often enough to know what it is about your body or face that you’d like to change.

What is it, for you? Maybe you’ve caught sight of that wattle that blurs your chin line (or, worse, that hangs over your crisp white collar) too many times. Maybe it’s the crow’s-feet that grab makeup and make a spray of fright lines at the corners of your eyes. Maybe it’s your nose or earlobes, both of which sag as we age. Maybe it’s your Hi Janes (the fleshy underside of the arm that continues to wiggle after you’ve stopped waving hello to your friend Jane); do they make you avoid wearing your favorite sleeveless blouse or halter top? Maybe it’s your breasts—how far down has gravity pulled them? Maybe it’s your stomach—are you willing to expose your midriff? (Perhaps you’re currently carrying too much weight, once carried too much weight and your skin just hasn’t got the message yet, or were never able to pull things up and together after your last pregnancy.) Maybe it’s your hips: Is there no A-line skirt out there that can hide hips that bear witness to every Krispy Kreme you’ve wolfed down? Maybe it’s those pesky spider veins, crisscrossing the backs of your legs like road maps of the East Coast. I could go on and on.

Perhaps you recognized yourself in one of these complaints, or more than one. If misery loves company, then at least you’ll be happy to know that virtually everyone sees a problem or three when looking in the mirror.

That’s the bad news. But we’re positive thinkers here, and we’re going to leave harsh reality behind. Instead, let’s conjure that wonderful phrase again: What if?

CHANGE IS WITHIN YOUR POWER

What if you could wave a wand and change just one part of your body—what would it be? (Forget whether it’s practical, reasonable, or defensible, or whether anyone—including your own judgmental self—would approve.) Now ask yourself something else: How many times in the last week have you thought about your nose, or crow’s-feet, or wattle, or saddlebags? How many times in the last day? How many times have you thought about that flaw in the last five years?

Now ask yourself how your life might have been different, in big ways or small, in the last five years if you hadn’t been self-conscious about this part of yourself. How might your attitude about yourself have been different? How might this have had a ripple effect on the rest of your life?

The way we see ourselves and believe we’re perceived by others is tied up with the way we look. Call it shallow, label it politically incorrect, swear that real beauty is on the inside…but, like it or not, looks matter. Beauty has always been a powerful stimulus and motivator: Throughout history, across all cultures, people have loaded themselves down with uncomfortable jewelry, submitted to body piercing and tattooing, worn outrageous wigs, and squeezed themselves into constricting corsets, clothes, and shoes, all in slavish pursuit of their culture’s ideal of beauty. Today, in every area of our lives—at work, while socializing, in the public eye—attractive people consistently get more attention than their acne-scarred, overweight, receding-chinned counterparts. What’s worse, our culture is obsessed with celebrity, and the mass media multiply and magnify examples of human perfection every day. In such an environment, how tough is it to just be yourself and like it? (In a recent People magazine poll, an anemic 10 percent of women said they were satisfied with their bodies.) Add to all this an aging population with expectations (realistic or not) of prolonged youth. It’s a marvel that everyone but two or three well-adjusted supermodels isn’t wracked by feelings of inadequacy and low self-esteem.

The pressure is often felt most intensely in the workplace. Studies show that traditionally good-looking people are perceived as smarter and friendlier than others; they make more money, and are five times more likely to be hired. But this isn’t a recent phenomenon: Even the ancient Greek philosopher Aristotle once said that Beauty is better than all letters of recommendation. With the continuing influx of women and corporate downsizing making work environments more competitive than ever, there’s increased pressure to look polished—and youthful. One of my patients, a thirty-eight-year-old publishing executive on whom I performed a neck and forehead lift, describes the pressure this way:

In my profession I constantly interact with people, and I believe maintaining my looks gives me an edge. I’m not talking about being movie-star beautiful—who can be?—but I feel that appearing well put together, energetic, and youthful earns people’s respect and attention, and ultimately gives me greater credibility. I am convinced looks make you money, so I think of surgery as an investment. Plastic surgery isn’t just about beauty. It’s about power.

Plastic surgery isn’t just about beauty. It’s about power. By allowing you to make subtle but important changes to your looks when and how you want, cosmetic surgery is a valuable, low-risk investment in your future health, happiness, and well-being.

ONE WOMAN GETS TO YES

Take Martha, for example. When the elegant sixty-three-year-old volunteer worker came in for an appointment, she told me she’d grown tired of striding confidently into a room, only to catch a glimpse of her reflection in a nearby mirror and feel that confidence disappear. I just don’t feel as tired and as old as I think I look, she said, despairingly.

I saw what Martha meant. While her voice projected energy and sharpness, she looked weary and her face was drawn. Yet she was reluctant to sign on for a cosmetic procedure, mostly for philosophical reasons. She felt that getting a face-lift was self-indulgent and a betrayal of her feminist beliefs. Her therapist, in fact, had counseled her not to seek a surgical remedy, urging her instead to deal with who she was and to accept her limitations. Martha was too embarrassed even to discuss the issue with her grown children for fear that they would judge her harshly.

I pointed out to her that getting a face-lift, far from being a cop-out or an act of denial, can in fact be an effective, life-affirming way to embrace who you genuinely are. Although Martha’s face did not reflect how she felt about herself, her negative feelings about how aging had diminished her spirit were absolutely valid. Should she have simply discounted her unhappiness? Of course not—and I think even her therapist would agree with that.

When Martha showed up two weeks later for a second consultation, she told me she’d come to see that wanting to look more attractive and vibrant was a worthy and respectable goal. I’m confident in who I am, and my decision can’t compromise that, she said. She had told her children about her plans, and was surprised at how supportive they were. Even I was astonished when she made the appointment for her surgery and asked for the works: forehead, eyes, neck, cheeks, lips! I won’t say that Martha was anxiety-free: As the pre-surgery anesthesia was administered, she whispered to me, I’m a liberal person by nature, but please be conservative! Still, her feelings afterward spoke volumes: Martha was thrilled with the results, and she’s confident she made the right move by taking control of her looks. And, happily, she’s stopped avoiding mirrors.

THE LIGHT-BULB MOMENT

Like most of my patients, Martha didn’t just one day decide to have cosmetic surgery, and I’m betting you didn’t wake up this morning and, out of the blue, pick up this book. Probably for months, even years, a niggling voice in your head has been adding up all those flaws you just took stock of in the mirror. Are those wrinkles?!…Since when have I had a double chin?…My butt is so big, I’d rather die than wear a bathing suit…. I wish my breasts weren’t so droopy.

After months or weeks or years of lowered self-esteem and mulling over the possibility of plastic surgery, something—an overheard comment, a death in the family, a milestone birthday, a divorce—will propel a person into my office demanding a change. A light goes on. It was definitely a midlife crisis, says Toni, a fifty-one-year-old schoolteacher of her decision to have a face-lift, but I’d already gotten my sports car in my thirties! Here are just a few examples of such courageous decisions:

Light-Bulb Moment #1: The Photo Album

For Leslie, a fifty-nine-year-old attorney, her daughter’s wedding was the impetus to have cosmetic surgery:

"My first daughter was married five years earlier. When I saw the photos, I was appalled. There I was over and over again: at the church, in the receiving line, and I looked tired and, well, old. I had always heard of people getting plastic surgery, but I thought it was something only movie stars did. Then a couple of years ago I went to a professional function where I talked with a woman I vaguely knew who was very open about telling me that she had just had some work done on her chin. For the first time, I thought, ‘Gee, even people with average looks who aren’t happy with their appearance can do something about it.’

"My younger daughter was planning a wedding that fall. Around Memorial Day I resolved to take care of the wrinkles on my face and neck before I was again forced to pose for all those family portraits. After looking together at the computer images of my face, the doctor and I decided we would do a rhinoplasty, eyelid lift, mini-forehead lift, and mini-face-lift. Although the recovery was somewhat difficult, by the fall I was feeling wonderful and looking great. I was more confident, and just plain happy to look so much younger.

"I could even tell that strangers reacted differently to me. You read articles about older women being invisible in our society. Maybe it was the way I carried myself—who knows? Whatever it was, I