Does This Woman Need A Facelift?

“Do your nasolabial folds bother you?”

“My what?”

Renee Bennett O'Sullivan, a Wellesley cosmetic surgeon with a predilection for medical jargon, traced the lines traveling from the base of my nose to the outer corners of my mouth.

“What about your fat cheeks?” she added matter-of-factly.

That I understood. But, frankly, I had never looked in the mirror and despaired over fat cheeks or nasolabial folds. I was here to explore surgical options for my sagging chin and the cellulite in my thighs. O'Sullivan wasn't the only doctor whose opinion I was soliciting; over three days, I had appointments with five cosmetic surgeons—three males and two females. What I came away with was a set of five unique opinions; to act on any of them would range in cost from $2,900 to $14,150.

Let the buyer beware of seeking aesthetic perfection. I know that drooping jowls and cottage-cheesy thighs are small physical complaints. I also know that at 40, I may seem like a premature candidate for plastic surgery; however, I fit into the pattern of a rapidly increasing number of women who wish to stave off the ravages of time before it has produced much serious damage. But I was here on assignment from Boston Magazine to find out what Boston's professionals would have to say, and what alternatives they could offer against the inevitable march of gravity.

Cosmetic enhancement is not just for pop stars and actresses anymore, nor are facelifts solely for wealthy women of a certain age. Plastic surgery's biggest demographic group is adults under 50. The numbers are growing: The American Society for Aesthetic Plastic Surgery (ASAPS) reports that nearly 2.8 million cosmetic procedures were performed in the United States in 1998. Men, who reportedly constitute nearly one-third of all patients, are one of the fastest-growing segments, forking out the dough for liposuction, eyelid surgery, facelifts, penile enhancements, pec and buttock implants, and other procedures. The American Society of Plastic Surgeons (ASPS) reports that the number of teens 18 years old and younger having liposuction or breast augmentations has more than doubled since 1992. Each year roughly 15,000 teens have surgical procedures performed (2 percent of the total), including nose and ear jobs. The American Board of Plastic Surgeons has no minimum-age requirements. Teen girls can't order cocktails, but they can order big breasts.

If they can afford them. The vast majority of cosmetic procedures are not covered by insurance, and the cost, usually upward of $3,000, is often shouldered these days by people with little disposable income. According to polls, two-thirds of patients have family incomes of under $50,000 a year, and most meet their surgical payments through credit cards, installment plans, and hard-earned cash delivered up-front.

Helen Bransford, author of Welcome to Your Facelift (Doubleday, 1997) and wife of Bright Lights, Big City author Jay McInerney, took the plunge at 47, getting lipo under the chin, a forehead peel, an upper-eyelid tuck, dermabrasion (removing fine wrinkles through an abrasion tool), and a standard facelift, all at once. The chronicle of her surgery began with what she describes as a “trigger event.” Her husband came home one night after interviewing Julia Roberts and raved about the actress' beauteous attributes. Helen was understandably jealous, but Jay reassured her he had told Julia all about her, leaving out only the pesky detail of her age (Helen is seven years older than Jay). This sent her running pell-mell to plastic surgeons across the nation for advice, ultimately having her operation done near her home in New York City.

The Best Plastic Surgeons in Metro Boston
Elof Eriksson Brigham and Women's Hospital Division of Plastic Surgery 75 Francis St. Boston, MA 02115 617-732-5093 Joel J. Feldman Doctors Office Building 300 Mount Auburn St. Suite 304 Cambridge, MA 02238 617-661-5998
Robert M. Goldwyn 1101 Beacon St. Brookline, MA 02146 James W. May Jr. Massachusetts General Hospital Wang Ambulatory Care Center, Room 453 15 Parkman Street Boston, MA 02114 617-726-8220
John B. Mulliken Children's Hospital Division of Plastic Surgery 300 Longwood Avenue Boston, MA 02115 617-355-7686 Julian J. Pribaz Brigham and Women's Hospital Department of Plastic Surgery 75 Francis Street Boston, MA 02115 617-732-6390
Sumner A. Slavin 1101 Beacon Street Brookline, MA 02146 617-277-7010 Joseph E. Upton III 830 Boylston Street Suite 212 Chestnut Hill, MA 02167 617-738-6760 Michael J. Yaremchuk Massachusetts General Hospital Wang Ambulatory Care Center Room 453 15 Parkman Street Boston, MA 02114 617-726-5280

New England, according to the ASPS, ranks eighth out of nine regions for the number of plastic-surgery procedures performed each year, beating out only the West North Central region comprised of Iowa, Kansas, Minnesota, Missouri, Nebraska, and the Dakotas. Boston, of course, offers excellent medical services, doctor and hospital care, and for me, an out-of-towner, the advantage that I know only one person in the city, a good friend who can keep a secret. If I were to have any kind of cosmetic surgery, with the attendant bruising and swelling, I'd want an anonymous place to lie low after such an appearance-altering procedure. An acquaintance once had the misfortune of running into me soon after she'd had an eyelift. Though she was wearing sunglasses, I detected that the outer edges of her eyes were bruised. I blurted, “What happened to you?” There was an awkward silence and then she deadpanned, “My husband beat me.” She laughed, and I, completely naïve, was clueless as to how to react. Later, I talked to a mutual friend who convinced me it was plastic surgery that had caused the bruising, and not a violent husband. I'd rather not risk any such encounters with people like myself.

Nor would I want my husband to see me right away. He seems happy with my looks as they are, and is not in favor of my having work done. Yet it is the very fact of my recent marriage that would make it financially possible for me to indulge in cosmetic surgery. The American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) did a survey of “trigger events,” with simple aging cited as the top reason Americans (34 percent) consider facial plastic surgery. Self-esteem accounts for 20 percent, other people's comments 15 percent, and “celebrity inspiration” just one percent. Other reasons can include getting a divorce or wanting to advance in a competitive job market.

Here's how I proceeded: I found the plastic surgeons I visited through the Internet, all of them board-certified. According to the AAFPRS, only 6 percent of Americans currently use the Internet as a first resource, with the majority (50 percent) turning to their primary-care physician for referrals. Consulting friends who have had plastic surgery accounts for 23 percent, and another 10 percent check with a plastic-surgery organization.

My Boston friend accompanied me into an examining room for each appointment. Consultation fees varied from $75 to $125, and visits spanned 30 minutes to two hours. I began each meeting exactly the same way, explaining that my chin was starting to sag, and my outer thighs had cellulite. Then I shut up and let each doctor go at me. I kept waiting for someone to suggest I get Pamela Anderson Lee-size breast implants, but that never happened.

Cher's not the only one who might have benefited from consulting more than one doctor. In her book, Helen Bransford lists “doctors' votes for famously bad lifts”: Helen Gurley Brown, Glenn Close, Glen Campbell, Carol Burnett, Michael Jackson, Strom Thurmond, Joe Pesci, Roy Scheider, Janet Leigh, and Burt Reynolds. Surely they could have afforded the best. Bransford includes another tantalizing list of “naturally aging beauties or brilliant cosmetic work?”: Sophia Loren, Elizabeth Hurley, Candice Bergen, Heather Locklear, Raquel Welch, Phylicia Rashad, Jacqueline Bisset, Meg Ryan, and Goldie Hawn.

Should I decide to act on any of the doctor's following recommendations, I would much prefer to be in the latter “has she or hasn't she?” category. Who wouldn't?

Richard Bartlett

My first appointment was with Richard Bartlett, whose Web page listed every kind of plastic-surgical procedure imaginable—from burn reconstruction to tummy tucks. That day he was working out of Children's Hospital, and when I walked past a waiting room full of toddlers and concerned-looking parents, I felt as frivolous as a dog dressed in a mink coat.

Bartlett is an instructor in plastic surgery at Harvard Medical School, and has a squeaky-clean, well-tended appearance. He was dressed professorially, in a tweed sports jacket and solid red tie, and he treated me with Marcus Welby-like gravity. He gently pressed his fingers under my chin. “There is some laxity,” he ventured, and then began to offer his opinion.

Bartlett ruled out chin liposuction, saying that since he didn't feel much fat the results would be minor. Instead he recommended a “small” facelift. He had me hold a mirror in front of my face while he demonstrated the effect of tightening my jaw line. He said that since I wore my hair up, he could cut along the hairline to minimize the visibility of scars, which would be red at first

but fade after six months. Gaining or losing 10 pounds wouldn't be a problem, but packing on an extra 30 might be. He said he would expect the facelift to last 10 years. Because it would take longer to come out of a general anesthesia, Bartlett advised IV sedation and local anesthesia for the procedure, which he said allows patients to talk through the surgery yet, in most cases, have amnesia about it afterward. He also recommended spending a night in the hospital to be properly monitored (he would perform the surgery at Brigham and Women's Hospital, not Children's). The risks, which he freely offered without my asking, involve infection, hematoma (bleeding under the skin), and nerve damage. “That's never happened to one of my patients,” he said, knocking on wood.

Next he had me don a gown so he could examine my thighs. When he complimented me on the good shape of my legs, I preened and made a mental note that he looked remarkably like Bill Pullman. My workouts had paid off, he said, but nothing could be done that would effectively rid my thighs of their wavy texture. Oh, well.

Bartlett was patient and methodical, and not pushy in the least. He seemed to assume that I would be seeing other doctors before I made a decision. What echoed in my mind later, however, was his recommendation of IV sedation over being out cold. I remembered a story I'd heard about a woman who was under IV sedation during her plastic surgery, and opened her eyes. She saw her facial skin and part of her hairline resting on her chest and promptly threw up. And she didn't have amnesia about it afterward.

Consultation fee: $97; Recommendation: small facelift under IV sedation, no liposuction. Breakdown: $4,500 surgeon's fee, $575 anesthesia fee, $1,408 hospital fee, $1,073 overnight stay. Cost: $7,556.

William P. Adams
The Adams Center, on Newbury Street across from Chanel, evoked more of a Beverly Hills-style experience than Children's Hospital. The pastel waiting room was plushly furnished and fragrant with potpourri. Reading material included W, Seventeen, and this magazine, and on the walls were landscapes interspersed with framed honors and degrees bestowed on William P. Adams (Dartmouth, Harvard, American Board of Plastic Surgery).

Adams, in practice for 20 years, was dressed in a fine wool suit and had the air of an ex-football pro. His office windows overlooked the Public Garden, and his elegantly curved wooden desk held high-tech paraphernalia: a laptop, a palm pilot, a cell phone, a digital camera. After some brief small talk, he got down to business and examined my jaw-line area. “What you're talking about is a facelift,” he stated.

And he didn't use the word “small.” A vision of Cher danced through my head. To illustrate my alleged need for a facelift, Adams described how the skull shrinks with age, but the “envelope” of facial skin doesn't contract along with it. In my facelift, Adams would use general anesthesia, and he outlined the same concomitant risks that Bartlett had, adding one more: death.

That jarring word put this form of elective surgery in a slightly different perspective. Even though infection and nerve damage are rare—and death (from a reaction to the anesthesia) even rarer—they are possibilities one must consider anytime invasive surgery is performed. A facelift is not just a harmless little nip-and-tuck.

Helen Bransford describes it this way: “A facelift is real surgery. It is nothing remotely like a lunchtime fix . . . The skin is opened and excess fat is delicately removed from the face, jawline, and neck. The hated, drain-clogging substance is chicken-fat yellow (unless you're a beta carotene freak, in which case it's golden orange). Beneath the skin, the muscles and connective tissue are tightened up so the skin can be redraped over cleaner, smoother contours, minus the old lumps and sags.” After the incisions are hemmed up, the bruising and swelling often last a couple of weeks. The scars, though concealed behind the ears, behind the hairline, and under the chin, never completely go away. Adams told me the advantage of my having a facelift done young is “subtlety”—as opposed to a dramatic difference that everyone would notice.

Adams also thought liposuction would improve the contours of my thighs. He warned me not to expect to go down a size in pants, and that the cellulite texture would remain. He could do both the facelift and the liposuction at the same time, followed by a night in the hospital. Within a year, if I had any problems with uneven results of either procedure, he would fix the problem free of charge or for a much-reduced fee.

Since Adams seemed so high-tech, I wondered if he could do imaging, to show me how I could expect to look after the surgery. He demurred, saying that he does imaging for nose jobs, but for facelifts it works better to pull the patient's skin tight and have her look in a mirror. He volunteered to show us his photo album of work, and the before-and-after difference in several of them was significant. He was especially proud of having stretched and redraped a woman whose neck wrinkles formerly made her look “like a Chinese dog.” My friend and I were duly impressed; Adams became relaxed, casual, almost avuncular, chatting pleasantly and asking where we were going to dinner as if he were interested in tagging along.

Consultation fee: $100 (payable toward cost of surgery) Recommendations: Full facelift (under general anesthesia), liposuction on my thighs Breakdown: $9,500 surgeon's fee, $1,718 hospital fee, $100 overnight stay Cost: $11,318.

Peggy Howrigan
'You are way too young for a facelift,” Peggy Howrigan immediately declared after examining me. I wanted to kiss her. Howrigan works in a typically suburban medical center in Wellesley, her small waiting room holding the best magazine selection of all: Allure, House & Garden, Architectural Digest, Conde Nast Traveler, and Seventeen, which was starting to seem de rigueur (that rising teen element, perhaps?). Soothing classical music played. I wished we could have spent more time reading, but Howrigan was right on schedule. Her spotless office afforded sun-splashed views of the town and river. An Oriental carpet and family photos warmed the room, but there were no personal revelations or small talk. Our consultation was strictly business.

A bit of liposuction could alleviate the laxness in my chin, she said. But she emphasized that because of the position of my voice box, the change would be “modest.” With polite, Hillary Clinton-ish professionalism, she demonstrated how she would make three small incisions behind both ears and under my chin, and then suck out the fat with a thin catheter. The surgery would last about 90 minutes, and she would stitch together the edges of two muscles inside my skin, creating a “sling” to hold up my new taut chin. An IV sedation and local anesthetic were all that would be required, and I would be awake but “in California land,” implying a dreamy, drifting state. Risks might include bleeding and possible scarring, rippling, or unevenness of the skin, all of which were unlikely. After a rest in the recovery room, I could go home.

Howrigan said she would strive for a smooth, even contour. To keep everything in place, I would have to wear a head strap for a week, then at night for at least another week. The bruising on my chin area would travel down my neck, so wearing a turtleneck would be in order. There would be some mild pain and discomfort for a week, and I should not expect to see full results for eight weeks after surgery. If my jaw-line was not completely even after the swelling went down, touch-ups would be at no extra charge.

After observing my dimpled thighs, Howrigan said that there was nothing she could do to fix cellulite. “Unfortunately, it's a problem we don't have a solution for yet,” she said sympathetically.

Consultation fee: $75 Recommendations: liposuction under my chin (under IV sedation), no lipo on my thighs Breakdown: $2,100 surgeon's fee, $375 operating room fee, $425 anesthesia fee Cost: $2,900.

Renee Bennett O'Sullivan
I thought we'd made a mistake and entered a vet's office when we reached a rambling white house in Wellesley, a portion of which is the headquarters for Renee Bennett O'Sullivan. English setters were roaming through the halls and I had to step over a sleeping pooch to reach the waiting area. The receptionist led me to a closet-like room to fill out a questionnaire, where I could also admire O'Sullivan's many framed degrees and honors, including a Who's Who of American Women plaque. It was so claustrophobic, and the questionnaire so lengthy, that I moved into the more spacious waiting room to fill it out. In addition to the usual history of diseases, hospitalizations, allergies, etc., I was asked to reveal whether my sex life was satisfactory, which states I had lived in, all my previous jobs, any psychiatric problems, what I did to relax-everything but my sign and the names of childhood pets.

The doctor kept me waiting for an hour, giving me plenty of time to observe a surprising amount of clutter: thrift-shop artifacts, an ancient TV, shelves bulging with messy files, and stacks of magazines badly in need of recycling (old Reader's Digests, outdated Seventeens). Her inner sanctum was no less disordered, the desk piled high with what appeared to include papers, folders, maps, bracelets, travel memorabilia, and paperweights. Under her doctor's coat she wore a bulky, lint-and-pet-hair-speckled sweater. During our two-hour consultation, dogs frequently nosed in, and my friend's pants got globs of drool when she petted them. O'Sullivan shares her practice with her daughter, Kimberley Lloyd O'Sullivan, and said that together they have six dogs.

I got an idea that she was close to 70 when she asked me if I knew what day it was. “Pearl Harbor,” I said, getting the answer right. She lamented that no one remembers it anymore, not like when she was younger. The December 7th date took on a new significance for me as I felt myself coming under attack.

Dr. Renee (as the staff called her) pulled at my face as if she were stretching pizza dough, and recommended a facelift. Though the light was dim in her office, she pointed out nasolabial folds and fat cheeks—even though she said she doesn't do liposuction on the face because of scarring. She also repeated everything into a hand-held tape recorder. I began to feel as if I were in a Woody Allen movie: “New paragraph. Patient's skin has sun damage but she says she hasn't gotten a suntan in years. Patient says she had minor problems with acne as a teenager. Semicolon. Her acne may have destroyed the elasticity of her skin.” Then came forth a stream of medical terminology that was as incomprehensible to me as anything on ER.

Perceiving my rising sense of bafflement, Dr. Renee pulled out a plastic diagram of human skin and fat cells that looked straight out of a high school human physiology class. She proceeded to deliver a lecture on the epidermis and subcutaneous layers of skin. She said that liposuction under my chin could “tide me over” for a while, but the benefit of having a facelift at a young age was the better “contractibility” of the skin. Then she told a story about an old woman having lipo on her stomach whose skin wouldn't contract, and two old men she'd seen with “turkey waddles” in their neck area who were wrong in wanting lipo instead of facelifts-that old contractibility problem again. That somehow led to a story about a little boy with a fat “pooch” under his chin, who no longer got teased in the schoolyard after she performed lipo on him. Next came an account of her operating on transsexuals and moving fat from one part of the body to another. I asked if we could please get back to the subject at hand: me.

Dr. Renee led me upstairs into a small examining room that had cobwebs, visible dust, and water stains running down the walls. Instead of having me change into a gown to look at my thighs, she asked me to drop my pants. Not only did Dr. Renee think she could make a dramatic difference in my outer thighs with lipo, she informed me that my inner thighs touched each other and my kneecaps were fatty. “I'm just pointing it out so you can think about it,” she said.

The small exam room had better light and she stared closely at my face. I thought I detected zeal in her eyes when she told me I looked old for my age. Shaken, I descended back to her office for her final analysis of my condition. She said she could do lipo on my legs in two areas at a time, which would take about four hours, including prep time. She remarked that my legs were slim but she could still effect a “major” change. A facelift would also produce significant improvement.

Before we left, the receptionist worked out a price list, noting that Dr. Renee would charge $950 an hour for my surgery. She said she hoped to see me again soon, and that a 70-year-old woman had just been by, one of Dr. Renee's former patients, and she looked no more than 55. I held my tongue. As I passed by the waiting room, stepping over another dog, I saw an adolescent girl filling out the questionnaire.

Consultation fee: $125 Recommendations: facelift (borderline case), liposuction on thighs (to be performed together, under general anesthesia) Breakdown: $6,500 doctor's fee, $3,500 facial work, $2,225 hospital charges, $350 for an overnight stay, $1,575 for thigh liposuction ($1,950 for thighs and knees) Cost: $14,150.

Julian Pribaz
Compared with my visit to Dr. Renee, my appointment with Julian Pribaz at Brigham and Women's Hospital was like a cocktail party. He had a charming Aussie accent, and a groovy, humorous personality. My friend came with me into the examining room and took a seat. Then a female assistant stepped in to observe. Then a male intern knocked on the door and asked if he could watch. I okayed his presence too, though the room was getting crowded. I was adamant, however, that I would not display my butt to so many people. When another female assistant knocked on the door, Pribaz finally poked his head out of the room and shouted, “You cannot keep doing this!”

Composing himself, Pribaz quickly judged that my skin was in good shape and I did not need a facelift. If I so desired, he could get rid of some excess fat under my chin with lipo, but it wouldn't make much of a difference. It was time for him to ponder my thighs. He courteously asked the crowd to step out. “Ah, jodhpurs,” he observed when I turned my back to give him a look.

He said lipo on my outer thighs could smooth out my silhouette and a little fat removed from my buttocks would contour that area further. I would have a local anesthetic and spend one night in the hospital. He was clear, concise, and finished in under 30 minutes. His assistant, Kelly, the one who'd been yelled at, came in, red-faced, to discuss prices. She was refreshingly honest and friendly and said, “You will not be hearing from me again after this meeting. Cosmetic surgery is up to you. If a woman is having a mastectomy, I'll call to remind her to make an appointment, but I won't do that with you. We have anorexic girls coming in here who weigh 80 pounds and want liposuction. There's no fat to take and so the doctor won't do it. Or in some cases, we have 18-year-old college girls coming in with their first credit card, wanting breast implants to make their boyfriend happy. The doctor tells them to go away and think about it first, and hopes that maybe they'll find another boyfriend who will love them the way they are.”

Consultation fee: $88 Recommendations: liposuction of the thigh and buttocks area (local anesthetic) Breakdown: $2,360 surgeon's fee, $625 anesthesia fee, $1,580 hospital fee, $1,200 for one night stay in a semi-private room Cost: $5,765.

My visit to Boston plastic surgeons was an eye-opening lesson in the ambiguity of physical perfection, and what can and cannot be realistically accomplished through surgery. The various suggestions left me bewildered and some of them downright frightened me. I did not come away with a clear idea or consensus. For me, the prospect of spending thousands of dollars for a questionable outcome would—more than any drooping chin—make it hard to look in the mirror.