Cap Lesesne - Confessions of a Park Avenue Plastic Surgeon

“I don’t care if I die,” she says. “I waited my whole life to look good. I’m not going one more day looking the way I do.”

Her eyes are piercing; there are no remnants of the effects of anesthesia. “Just do a good job,” she coaches me.

Despite her aberrant readings, I accede to Lee’s wish and complete the face-lift. This time, her signs remain stable. After I finish and suture her, we call for an ambulance to transfer her to the hospital, to make sure she’s monitored.

The moment the EMS technicians place Lee on a stretcher – the face-lift dressing cradling her head – her eyes roll back and she turns blue.

Oh, God, I think. She’s gonna go.

She is having a heart attack.

Fortunately, Lee responded to another drug-reversing agent. She came to; she did not code. That night, in a crowded emergency room, with an IV in her arm, she asked me, “Did you do a good job?” It’s a question she would ask me every day for the week it took her to recover in the hospital’s cardiac care unit.

I nodded.

“Then I’m happy,” she said. “And if I’m not happy, nothing else matters.”

We plastic surgeons are perhaps second only to psychiatrists when it comes to being privy to patients’ intimate secrets. As a doctor, though, I’m committed to strict confidentiality. Divulging anything is not just unethical, it’s illegal: I could lose my license. Indeed, a proper plastic surgeon doesn’t even acknowledge his patients when he sees them at events, unless they’ve been explicitly open about their operation. At a Los Angeles charity function crammed with A-list actors and industry players, several patients of mine roamed the mansion’s grounds while I strolled with one of the town’s most powerful female executives.

“You’re lethal to walk around this party with,” she said, taking me by the arm. “I’d love you to comment on who here has done what.”

“I can’t do that,” I said.

She looked at me sternly, as if that might do the trick.

“I can’t,” I said.

Now she practically batted her eyelashes.

“I can’t,” I said. *

So why would a doctor like me write an exposé about what goes on behind the scenes in my profession?

The last decade, especially the last three to five years, has witnessed a revolution in my profession and its public perception. There’s less stigma now to having cosmetic surgery. There are more public expressions of pride by patients. Once upon a time, the only celebrities who confessed to going under the knife were Joan Rivers and Phyllis Diller. It’s long been rumored in our circles that the legendary L.A.-based plastic surgeon Dr. Frank Ashley did face-lifts on John Wayne and Gary Cooper (among other Hollywood legends). There was Ann-Margret’s obvious facial reconstructive work following her terrible fall in 1972, while rehearsing for a show in Las Vegas. Aside from that, though, there was mostly silence about who’d had work done – and the silence wasn’t only from famous folks whose appearance was critical to their livelihood, but the not so famous, too. The high schooler who returned in the fall for her senior year with a suddenly smaller, usually upturned, nose – likely an idealized Caucasian variation modeled on Grace Kelly or Barbie – did not necessarily explain, much less advertise, how the change had come about.

Today, much has changed. Far more people talk openly about the procedures they’ve had (though many still won’t, and some, like Sharon Stone, who sued a plastic surgeon for implying that she might have had work, shudder at the very suggestion). My patients rarely feel the need to disappear for weeks, so they can return to their hometown looking refreshed. In 2004, according to the American Society of Plastic Surgeons, 9.2 million cosmetic surgery procedures were performed in the US, a 24 percent jump from the year 2000. During the same period, the British Association of Aesthetic Plastic Surgeons (whose figures only cover their own members and not nationwide figures), over 16,000 procedures were carried out, an 18 percent jump since 2000. 22,000 were carried out the following year, marking a 37 percent jump between 2004 and 2005. Comparing 2005 to just one year before, almost all major cosmetic surgeries in the UK increased markedly: breast augmentation was up 51 per cent; surgery on the eyelids, 50 percent; face/neck lifts, 42 percent; rhinoplasties, 35 percent; brow lifts, 35 percent; otoplasty (for the ears), 28 percent; liposuction (major), 25 percent; abdominoplasty, 24 percent; liposuction (minor), 10 percent; and breast reductions, 9 percent. And because of recent technical and medical developments, which have led to the popularity of nonsurgical, outpatient procedures such as “injectibles” (unfortunately not recorded in the UK, but in the US in 2003, such minimally invasive procedures jumped 43 percent over the previous year, a clear indication of UK trends), the decreased cost of beautifying and enlivening one’s looks, particularly in the face, is increasingly attracting the non-wealthy. Those who might once have chosen a forehead lift (average US fee, $2,800; average UK fee, £3,000) are opting instead to get a Botox injection ($375 every five months in the US; £350 in the UK). *

Yet despite the more accepting attitude toward cosmetic surgery, and despite the booming business my profession is enjoying, the surgeon – the good one, anyway – remains behind the scenes. For most patients, the goal is subtlety, and the doctor who delivers subtle results is greatly appreciated – discreetly.

To repeat, then: Why would a doctor like me write an exposé?

Because of my experience as a plastic surgeon and my particular skill – to reposition the skin and tissue of the face, to sculpt fat, to reverse the residuals of pregnancy, and to undo some of the other changes wrought by time – I have come to see, hear, and understand an extraordinary amount about the range of our dreams and disappointments, our motivations and fears. Two decades of solo plastic surgical practice have exposed me to the yearnings of the human heart. While I’m a technician who transforms his patients physically, I also bear witness to their psychological transformation, which frequently starts before the bruising has resolved. For instance, a woman having breast augmentation often sees such a radical upswing in confidence and body image, she makes another dramatic change: new boyfriend, new job. Why? Often, her man becomes more interested in her – way more. Indeed, a husband may become so infatuated with his wife’s new breasts that she may perceive his lust as weakness. She may lose respect for him. I can’t count how many times I’ve seen it happen.

On the other hand, couples that come in together for cosmetic surgery – a small but not insignificant part of my practice – almost always display some of the healthiest relationships and long-term intimacy I’ve ever encountered.

Like it or not, I’m exposed to my patients’ lives before, during, and after surgery. You know many of them from magazine covers, movies, and TV. Some of them walk the fashion runway. Some run for office. Some are royalty. Some are rock stars. Some are socialites. Some are international tycoons. You’ve seen their boldfaced names, or those of their spouses, in the gossip columns and the business pages. My practice is located in the epicenter of the plastic surgery world – an eight-block stretch along Park Avenue between Sixty-fourth and Seventy-second streets where the major players have discreet offices that cater to (among others) the wealthy, the famous, and the beautiful.

And the often unhappy.

I am not a psychiatrist, nor do I have Oprah’s gift for empathy. I am not overly warm and fuzzy – an occupational necessity rather than a character flaw. But I have sat and listened and tried my best not to judge as prospective patients have come into my office and shared with me their aspirations, the physical attributes that haunt them, and other insecurities. They tell me their stories, proving that even the most successful, attractive, and seemingly aloof people suffer many of the problems that haunt all of us, regardless of status. We all share the identical fears about appearance, age, and time. We worry that our looks or aging will lose us love, security, desire, or sexual attractiveness. He can’t get the movie role he wants. She can’t get a date. He’s been working out for six months and still has an abdominal roll. She comes to me after a divorce or on the eve of menopause. He comes to me not long before he’s up for a promotion, or right after he doesn’t get it. She’s about to cheat on her husband, though he doesn’t know it; in fact, she doesn’t yet know it. (What else am I to make of a comely young woman, half-French, half-English, who repeatedly complains to me about her investment banker husband, and who describes her intensive spinning class and free-weights regimen – her first serious exercise since giving birth five years before – and yet insists that the face and breast surgery she desires are “only for herself”?) *