Two Beverly Hills plastic surgeons showed me the promise of a perfect face. So why am I keeping this shabby old one?

Published November 29, 2005 12:41PM (EST)

I am not a handsome man. All that means is that my face has never been my fortune. Luckily for me, it hasn't been my punch line, either. I have some pretty eyes and, like everyone, I have my moments. I may even be thought attractive by those who love me, but that is emphatically not the same as the irrefutable mathematics of plane and placement that make for true beauty.

As a teenager reading "Death in Venice," I understood the world to be divided between the Aschenbachs and the Tadzios. There are those who gaze, and those who are gazed upon. I am not talking about the natural inequity of attention that the old bestow upon the young -- we are all hardwired to respond to babies, for example, but it would take the rare and deeply odd child to singsong to a grown-up, "Who's got a cute receding hairline? Oh yes it is." I am talking about within one's own cohort: some are destined to promenade the Lido in Venice, blooming like flowers under the heat of appreciative stares, while the rest of us are born to watch, sweating through our grimy collars and eating our musty strawberries while the plague rolls in.

Inveterate Aschenbach that I have always been, we are at peace, my face and I, although it can be a tenuous cease-fire. A certain degree of dissatisfaction with my features is part of my cultural birthright. In my largely Jewish high school scores of girls got new noses for their birthdays, replacing their fantastic Litvak schnozes with "the Mindy," as Paul Rudnick has dubbed that shiny-skinned, characterless lump. Despite the prevalence and remarkable timing of these operations, coinciding as they so often did with upcoming Sweet Sixteens, they were always framed as life-or-death necessities -- emergency procedures to repair lethally deviated septa and restore imperiled breathing. Even then, we knew enough to lie. Elective cosmetic surgery was the province of the irretrievably shallow. It was also a largely female pursuit. For most boys, failing the unlikely scenario wherein you infiltrated the mob, turned state's evidence, and got a new set of features thanks to the good doctors at the witness protection program, your face was an irreducible fact.

Still, without benefit of a mirror I can easily reel off all of the things I might change, given the opportunity. Starting at the top, they include a permanent red spot on the left side of my forehead; a brow pleated by worry: a furrow between my eyebrows so deep that at times it could be a coin slot; purple hollows underneath my eyes that I've had since infancy, and, also since childhood, lines like surveyors marks on my cheeks -- placeholders for the inevitable eye bags I will have; a nose more fleshy and wide than prototypically Semitic, graced with a bouquet of tiny gin blossoms resulting from years of using neither sunscreen nor moisturizer; a set of those Fred Flintstone nasal creases down to the corners of my mouth; a permanent acne scar on my right cheek; a plank-like expanse of filtrum between the bottom of my nose and the top of my too-thin upper lip; and, in profile, a double chin.

None of which is really a problem in New York City. Being a little goofy looking suits the supposed literary life-of-the-mind I lead here. (What a paper-thin lie. There are days when I'd throw out every book I own for the chance to be beautiful just once. Reading is hard, to paraphrase that discontinued Barbie.) Seriously contemplating the erasure or repair of any of these is inconceivable within the city limits. It's too small a town. There is a place, though, where the sunny notion of physical perfection and its achievement by any means necessary is carried unashamedly on the smoggy, orange-scented air: swimming pools, movie stars. Cue the banjo music.

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I make consultations with two Beverly Hills surgeons. I want them to tell me what they might do, as though I had limitless inclination and resources, with no input from me. The reason for my silence is that I'd like outside confirmation of those things that are true flaws and those that are dysmorphic delusions on my part. There is also the vain hope that it is all dysmorphic delusion. That if I fail to bring it to their attention, somehow it will turn out that I've had the nose of a Greek statue all along. Primarily, though, I am hoping to catch them out in a moment of unchecked avarice; instead of proposing the unnecessary pinning back of my ears, I imagine them letting slip with their true purpose, as in, "I recommend the Italian ceramic backsplashes in my country house kitchen." Or "You'd look much better if my toxic punishing bitch of an ex-wife didn't insist on sending our eight-year-old daughter, Caitlin, to riding lessons in Malibu for $300 an hour."

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Garth Fisher's practice is decorated with a grandeur disproportionate to the space, like a studio apartment tricked out with pieces from the set of "Intolerance." The waiting area has overstuffed sofas, a small flat-screen TV in the corner, tasseled wall sconces, and a domed oculus in the low ceiling, painted with clouds. Fisher's office is full of bulky antique furniture in dark wood with turned legs, armoires, walnut bookcases. Behind his desk are many photographs of his wife, Brooke Burke, a model and television personality. Were I differently placed on the Kinsey scale, I might even pronounce her "hot," dropping my voice an octave and adding an extra syllable to the word. She is a near-perfect beauty.

Fisher himself is also nice-looking, a handsome man in his early forties. Blue-eyed and chestnut-haired, he has a bit of the early-seventies Aqua Velva hunk about him. I ask him, looking directly at the enviable cleft in his chin, if he's had any work done himself. Very little. A tiny bit of botox between his brows and some veneers on his teeth. He also had his nose done, to correct some football injuries. To my dismay, he is similarly conservative in his approach to others. Of the eight potential patients he saw that day, he refused to take on seven of them. Some were not candidates while others had unreasonable expectations about what plastic surgery can realistically do, even now.

"This is the Dark Ages. This is like 1904," he says. Future generations will be amazed by the inevitable advances, he predicts. For now he is more than willing to allow other doctors to use their patient populations as the guinea pigs for new and experimental treatments. He has not done a penile augmentation, for example ("scary business"), neither does he offer those silicone pectoral or calf implants.

"I want a simple life. All I've got to do is do a good job and tell the truth."

The only reason he agrees to give me unsolicited advice is that he knows I am a writer (indeed, the only way I could get an appointment with two top Beverly Hills plastic surgeons is that they know I am a writer). He remains notably uncomfortable with the charade. "If someone comes in here like this," he pulls his ears out from his head like Dumbo, "and all they want fixed is the mole on their chin, then that's all I'm going to mention." Assured of my thick skin, he eventually allows as how he might "clean some things up" that steal focus from my eyes.

We go into an examining room where he keeps his computer simulator. The process begins with taking two photographs -- the "befores." I look the way I always do, but it's embarrassing to see myself up on the monitor with another person sitting there. My profile looks careworn, simultaneously bald and hairy. My eyes are sunk into craters of liver-colored flesh, and my ear is a greasy nautilus, as if I'd just come from listening to a deep-fat fryer.

Fisher demonstrates his morphing tool by drawing a circle around my chin with the mouse. Pulling the cursor, he extends my jaw out like a croissant. It is a fabulous toy. I want to wrest the mouse from his control and really go to town, giving myself fleshy horns, pointy corkscrew ears. If he would only let me, I would pull out the flanges of my nostrils until they looked like the wings of Eero Saarinen's TWA terminal at JFK. "But your chin is perfect," he says, snapping it and me back to reality. "Three millimeters behind your bottom lip." Instead, he points out how the end of my nose droops down to the floor, while the arch of my nostrils is very high. (I write "too high" in my notebook before realizing that these are my words, not his.) He raises the tip, lowers my nostrils, and then straightens out the slope of the nose itself. It is subtle and aquiline. He then smoothes out the area under my eyes. In real life this would involve the removal of some fat and tightening up the skin. Finally, he points to the small vertical indentation between my brows, just like the one he had before botox. He recommends a small amount of the neurotoxin, just enough to smooth it out without robbing me of my capacity to emote. Of all the features that render me less than perfect, I've actually always sort of been attached to those that lend me an air of gravitas, covering up my shortcomings of character and intellect. I ask if it's all right to leave it as is. "Well," he shrugs, "it's okay if you're playing a lawyer or a judge." Instead, I get him to give me a slight Mick Jagger moue. "I don't like those lips, but I'll let you have them." He plumps up my mouth.

The photographs are printed out, the two images side by side against a dark background with no discernible seam between them. I am a set of twins. My original self seems a melancholic killjoy. His reengineered brother, on the other hand, looks clean and a little haughty. And how about that marvelous new nose! Pointy, sharp, a weapon. Despite that old stereotype about Jewish intellectual superiority, I think I appear cleverer as well ("perspicacious," as my ethnically cleansed self might say). Fisher's instinct about my new mouth was also right on the money. It gives me the beginnings of a snarl, like I've wedged a handful of Tic Tacs in front of my upper teeth.

But even my misbegotten new upper lip cannot dampen my spirits. I step out into the beautiful California dusk to catch a cab with a spring in my step. I'm feeling handsome, as though Fisher's changes were already manifest on my face and not just in the envelope of photographs I clutch. Reality soon sets in. The sidewalk of Santa Monica Boulevard simply ends without warning and I have to dart, terrified, across four lanes of traffic. I cannot find a taxi on the deserted leafy streets of Beverly Hills, and I have to walk all the way back to my hotel. "Good evening," the beautiful young doorman says to me when I arrive, an hour and a half later. He smiles in my direction, but his eyes are looking just above my left ear.

Studying the photographs the next morning, I am already experiencing some misgivings. It is not the regret of "What have I done?" that dogs me so much as a feeling that I want more. I briefly curse Garth Fisher's innate professionalism and hope that Richard Ellenbogen, my next surgeon, will not hang back and keep me from achieving my true physical glory.

If his office is any indication, I'm in luck. Where Fisher's was the McMansion version of the baths at Pompeii, Richard Ellenbogen's Sunset Boulevard practice (hard by the Hamburger Hamlet where Dean Martin ate every day) defies easy aesthetic description. It is an astonishment of styles and motifs. The reception desk is framed by two arching female figureheads as might be found on the prow of a Spanish galleon. The walls of the waiting room are peach plaster set with Tudor timbers. There is an ornamental brick fireplace in the corner, sofas in floral chintz, and everywhere, absolutely everywhere --on the mantel, along the plate rail (hung with swags of floral chintz bunting) -- are ormolu clocks, Bakelite and old wooden radios, commemorative plates, lamps and small sculptures of those young, barely pubescent deco-era girls, the kind who festoon old movie-palace plaster and frequently hold aloft globe lights. All of it in under 150 square feet.

There is a benevolence to this crowded exuberance; one's own physical flaws shrink to nothing in the midst of such riotous excess. The staff is friendly and funny. "Here to get your breasts done?" cracks one woman when she sees me. Another confides, "Sometimes he," meaning Ellenbogen, "will just say to a patient, 'You don't need this. Buy a new dress and save your money.' We love our patients."

Ellenbogen is known for fat grafting and facial reshaping. Instead of pulling and tightening a face, he replaces the fat in the areas that used to be fuller, before aging and gravity did their work. For a patient in their mid-fifties, for example, he will analyze a photograph of them at half that age and isolate the facial regions in need of filling. The patients I look at in his albums do seem juicy, for lack of a better word, although the result looks not so much younger as vegetal. They look like Arcimboldo paintings, those Renaissance portraits constructed entirely out of fruit. To give them their due, they don't look like drum-tight gorgons, either. In folder after folder, I do not come across even one of those monstrous surgerized analogues of Joan Rivers. Where are those faces, I wonder aloud to Ellenbogen?

"We call that the New York look," he says. Apparently, there is less need for that kind of wholesale renovation in Los Angeles, where Hollywood hopefuls have been a self-selecting group for almost a century. "People are prettier here. It's now the children and grandchildren of Sandra Dee. In New York, you've still got all those great Jewish immigrant faces." Ellenbogen is allowed to say this, possessed of one as he is himself. (He's had some botox, his neck done, and lipo on his love handles, although he still supports a somewhat cantilevered belly as befits a man of sixty.)

He doesn't do computer imaging. "It's hokey. It's used by people who aren't artists. It's not a true representation of what a surgeon can actually do. It's like a real estate agent saying, 'This would be such an incredible view if you just planted some trees here and put in a garden...' " Instead, he takes two Polaroids and, using a small brush, mixes together unbleached titanium and burnt umber and paints the changes on one of them. Like Fisher, even with carte blanche, Ellenbogen only envisions minor treatments. Again with the straightening of the nose and raising the tip (one hour), he would also build out my chin a little bit, using a narrow curving strip of milky white silicone -- like something from the toe of a high-end running shoe -- fed down through the mouth behind the lower lip (ten minutes), and a final procedure (fifteen minutes) in which he would inject fat into my extremely deep nasojugal folds, those tear troughs under my eyes. (Garth Fisher is not a fan of re-grafting. "You'd love your doctor for six months," and no longer, he implies.) Total cost, around $12,000.

There is nothing so intimately known as our own face. Even the most deprived existence provides opportunities to gaze into a reflective surface now and then -- puddles of standing water, soup spoons, the sides of toasters. We know what pleases us, and also have a fairly good sense of what we would change if we could. Sometimes, though, we just get it plain wrong. Ellenbogen shows me a photo of a young man in his twenties; a pale, strawberry blond with the kind of meek profile that gets shoved into lockers. "This kid came in and wanted me to fix his nose. 'It's too big!' he said. I told him, 'It's not your nose. I'll prove it to you. I'll build out your chin. If you don't like it, I'll take it out and do your nose for free.' " Ellenbogen was right. The merest moving forward of the jaw has made the nose recede. The change is remarkable.

The fellow may have been focusing on the wrong feature, but at least he wanted something. There is a reason that both Fisher and Ellenbogen were so reluctant to suggest procedures to me. An unspecified and overarching desire for change speaks to a dissatisfaction probably better served by a psychiatrist. One surgeon I spoke to will not treat people in their first year of widowhood for just that reason. To briefly rant about "The Swan," the television show that takes depressed female contestants -- all of whom seem to need little more than to change out of their sweat suits and get some therapy -- and makes them all over to look like the same trannie hooker: what makes "The Swan" truly vile is that for the months that these women are being carved up like so much processed poultry, all of the mirrors in their lives are covered over. Such willing abrogation of any say or agency in how they will be transformed by definition means that in the real world, they would not be candidates for surgery. It is the very sleaziest of all the plastic-surgery makeover shows -- quite a distinction, that; like being voted the Osbourne child with the fewest interests.

Garth Fisher, in what might be considered an unconscious act of penance for contributing to the culture in which something like "The Swan" can exist (he is the in-house surgeon for the comparatively classier "Extreme Makeover"), has created a five-hour DVD series called "The Naked Truth About Plastic Surgery." Each hour-long disk is devoted to a different procedure and region of the body -- breast augmentation, brow lifts, etc.

In spirit, "The Naked Truth" is more educational tool than sales pitch. It is refreshingly up front about the complications that can arise, like bad scarring, hematoma, numbness, pigment irregularities, infection, skin loss, even embolism and death. In the liposuction section, there is a shot of Fisher in the operating room. The backs of the patient's legs are shiny brown from the pre-surgical iodine wash, and crisscrossed with felt-tip marker. Fisher is sawing away under the shuddering skin with the cannula, a tool resembling a sharp, narrow pennywhistle attached to a hose. There is a savagery to his movements, the way one might angrily go back and forth over a particularly tenacious piece of lint with a vacuum cleaner. He looks up at the camera, his arm going the whole time. Although wearing a mask, his eyes crinkle in an unmistakable "Well, hello there!" smile.

There are shots of clear plastic containers of extracted fat -- frothy, orange-yellow foam floating atop a layer of dark blood -- and pictures of postoperative faces looking like Marlon Brando after he's been worked over in "On the Waterfront." Such footage might have once had a deterrent effect but is now familiar to any toddler who has ever been parked in front of The Learning Channel. That these images have to be followed up by the cautionary tone of a narrator who says, "just because something can be done does not mean it should be done" and "if you can reach your goal without surgery, then you are better off," speaks to how far down the rabbit hole we've tumbled. It's as if the whole country regularly watched newsreel footage of buses full of children going off of cliffs and was still blithely picking up the phone to make bookings with Greyhound.

I might be more apt to drink the Kool-Aid if I was more impressed by the results. The before and after photos of liposuction, for example, do show a reduction in volume. But if I were to endure the risks of general anesthetic, the pain, the constriction garment that must be worn like a sausage casing for weeks after the surgery, and the months-long wait for final results, I wouldn't just want a flatter stomach with no trace of love handles. I would insist upon the tortoiseshell reticulation of a six-pack, that abdominal Holy Grail. That's hard to achieve with liposuction. There is a procedure that replicates the look, called "etching," where the coveted tic-tac-toe pattern is suctioned out of the adipose tissue, giving the appearance of musculature with no muscles present; morphology absent of structure, like the false bones in McDonald's creepy McRib sandwich. Garth Fisher doesn't recommend or offer it. Gain weight, he points out, and the artificially differentiated lobes of your fat expand and rise from your stomach like a pan of buttermilk biscuits.

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In the end, it is neither thrift nor fear of the knife that deters me. Far more than the physical transformation, it would be the very decision to go ahead with it that would render me unrecognizable to myself.

I once bleached my hair almost to platinum for a part in a short film. It lent me a certain Teutonic unapproachability, which I liked. But as it grew out, it faded to an acid, Marshmallow Peep yellow and my head started to look like a drugstore Easter-promotion window. Dark roots and straw-dry hair look fine on a college kid experimenting with peroxide, but I looked like a man of a certain age with a bad dye job clutching at his fleeting youth with bloody fingernails. I could see pity in the faces of strangers who passed me on the street. Mutton dressed as lamb, they were thinking. To all the world, I was the guy who broadcasts that heartbreaking and ambivalent directive: "Look at me, but for the reasons you used to!"

It must be murder to be an aging beauty, a former Tadzio, to see your future as an ignored spectator rushing up to meet you like the hard pavement. What a small sip of gall to be able to time with each passing year the ever-shorter interval in which someone's eyes focus upon you. And then shift away.

From: "Don't Get Too Comfortable" by David Rakoff. Copyright )2005 by David Rakoff. Posted by arrangement with Doubleday, a division of Random House, Inc..

By David Rakoff

David Rakoff's forthcoming book is "Half Empty." He lives in New York.

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