Confessions of a Park Avenue Plastic Surgeon

by Cap Lesesne

  My parents were thrilled to have me back: I’d been gone, basically, for seventeen years, since I was fourteen. And I didn’t have to look hard to find my medical digs: I would share my father’s office on Mack Avenue, in Grosse Pointe. Within ten days, I was booked up, largely because my father’s name carried such respect in town. I had invaded the turf of the handful of plastic surgeons in the area, and they were not happy about the development. But that was too bad: Wherever you practice, it’s going to be competitive – maybe even more so with elective surgery, where people can take their time choosing whom they want. I would be grabbing lots of my new patients from the upper middle class and working class of Detroit. It would be a broad-based practice. Getting hospital privileges wouldn’t be a problem. And it didn’t hurt that my educational background was first-rate. (I may not have been a natural self-promoter but I knew enough that Duke Medical School, Stanford surgical residency, and Cornell and New York Hospital plastic surgery residency were big pluses.)

  This was going to work, I thought.

  Even better, a woman that all of us boys had noticed as teens (she was twenty when I’d left for Andover) was still in Grosse Pointe, and just as attractive as ever. Chris had been an all-state swimmer all those years ago, and she was still athletic – five feet ten, swimmer’s build, a blue-eyed brunette.

  We met at a country club party, and suddenly she noticed me; I was no longer a fourteen-year-old Poindexter to her twenty-year-old vision of loveliness. Older and wiser and more confident now – and reasonably within age range, thirty-two to her thirty-eight – I asked her out to dinner, and she agreed. Later, we went sailing and biking together. She worked for the local newspaper, the publishing side. For two months during that summer, while I was finding the rhythm of being a plastic surgeon on my own, Chris and I enjoyed a lovely romance. In a way, it was like Summer of ’42, only better. I was not the teenage boy who gets one night with Jennifer O’Neill; I was the teenage boy a decade and a half later who gets Jennifer O’Neill to take him seriously.

  I was doing surgery, which I loved. I was learning how to run a business, which I needed. And I was enjoying my evenings with a swell, pretty girl.

  Maybe perfection was attainable.

  It lasted for only a moment.

  Returning to Michigan was a failure. Within weeks of being back, I realized that Thomas Wolfe was right: You can’t go home again. I loved being close to my parents, but I’d been gone too long. I had changed. I’d seen the world. Instead of being comfortable at home, I was nervous. Every day there, I missed being in the thick of New York activity.

  Even Chris would not be enough to keep me in Grosse Pointe. I had put in too many years of medical training, and I knew I had to give everything to that, wherever it needed to take me, before I could concern myself with other parts of my life.

  Chris understood. We promised to stay in touch, no strings attached.

  At the end of August, two months into my Michigan practice, I left my dad’s office on Mack Avenue. The other plastic surgeons in the area, I’d like to think, were glad to see me go. Years later, one of them came up to me at a party. “I’d have paid your ticket,” he said. I flew back East. I was going to try it there if it killed me.

  Back in New York, I was driven. I was not going to fail. I still had to rent office space; I was as broke as I’d been at the beginning of the summer. I didn’t hear from Chris for months and assumed she’d moved on; I admit I didn’t take time to call her either. I figured we would see each other the next time I was home.

  I continued to cover work in the ERs, looking for referrals. I rented office space in Westchester County, too, north of the city, and became affiliated with the hospital nearby, so that I could expand my base; it was dumb to rely for my livelihood exclusively on Manhattanites, millionaires or otherwise. There was no time to go home for Christmas. I called Chris.

  Her line had been disconnected.

  I continued to drive forward. Almost all my work was reconstructive, typical for a plastic surgeon starting out. Occasionally I removed small skin cancers.

  Finally, I got my first-ever cosmetic surgery patient of my own.

  Clara Lee, a meek lady in her midfifties, came to my office. She said that I had done some reconstructive work on a friend of her daughter’s and did I do face-lifts?

  Yes, I told her eagerly.

  When it was time to pay me, she took out a brown paper bag and removed a fat bunch of $20 bills and gave me the proper amount.

  Two years later, two FBI agents showed up at my office, a man and a woman. They asked me questions about a Clara Lee – did I know her?

  “Yes,” I said.

  “What do you know?” the male agent asked while the female agent snooped around the room.

  “I did a procedure on her,” I said.

  “A face-lift?” he asked.

  “Yes.”

  “Do you have any before and after photos of her?”

  “Actually, I don’t. She didn’t want me to take any pictures of her afterward.”

  The male agent nodded. The female agent was now studying my diplomas hanging on the wall.

  “Why all these questions?” I wanted to know.

  “Clara Lee was a branch manager of Hongkong and Shanghai Bank who embezzled two million dollars and then fled to South America. We’ve been trying to track down leads of her whereabouts.”

  I nodded, stunned, and the agents soon left.

  Maybe one minute later, there was a knock on the door and the female agent entered. She closed the door behind her. She was maybe thirty-five.

  “Do you do breast implants?” she whispered.

  Things slowly but steadily began to pick up. I did an arm liposuction for an outgoing forty-six-year-old woman who was happy enough to come back for liposuctions of her saddlebags (outer legs) and abdomen. She told me she loved going out to bars and she loved men, but she felt uncomfortable sleeping with them because of her stomach. Months later, she returned and pointed to her thighs and stomach. “Can you believe how lean I am?” She told me her sex life had improved. “Men look at me differently.”

  I did a face-lift on a patient without using sedation, a pretty rare occurrence. (I used only local.) But he wanted it that way: He was an actor in Alcoholics Anonymous, and he felt that being sedated was breaking his vow. It was strange having him look up at me while I was doing surgery, and far stranger still for me to be conversing with the patient during the operation.

  The OR was my (and any surgeon’s) favorite place in the world. It’s where I was in total control. As someone at Stanford had said, a surgeon’s first love is the OR, his second is his patients, his third is sex.

  Consumed by work, when I looked up, it was springtime in New York, the trees blooming. I was finally getting more referrals. It was no longer so far-fetched to think I might truly realize my dream of being a surgeon. I was thirty-three.

  I finally had a chance to call a friend from home. I asked if he knew where Chris had moved to.

  “Moved?” he asked. “She died.”

  Two months after I had left Grosse Pointe, the friend told me, Chris was diagnosed with pancreatic cancer. Three weeks later, she passed away.

  Model Behavior

  Thanks to more patients and to high school and college friends working and living in New York, I started to meet more people in the city. I had to temper this diversion, though, because a surgeon can have only so active a nightlife, especially a young surgeon consumed with succeeding, and who thought about plastic surgery every waking moment. And New York nightlife, of course, happens late at night, every night. I couldn’t stay out late the night before surgery, couldn’t drink much, certainly couldn’t smoke or do drugs (no deprivation there, since I’ve never been tempted; why do something that makes you lose control?). On weekends, though, I made an effort to get out. To me, nothing was more exhilarating than sitting around a table and talking with new friends at some downtown spot. These fun, smart, ambitious pe
ople were frequently available to do things like that because we were young, unattached, broke, and, well, young. (Some virtues, I know only too well as a plastic surgeon, are attributable simply to the glory of youth – from skin elasticity to the capacity to recover from little sleep.) We were all trying to figure out what would happen to us. Were we among those fortunate ones who would make it in New York? Or would we, at some point down the road, find ourselves tucking our tail between our legs and admitting that we didn’t have what it took? I was the straight arrow in a very hip gang that included Nicole Miller (future clothes designer), Patrick McMullen (fashion photographer), Pam Taylor (future marketing maven for the Absolut vodka campaign), and others. Pam said that if she failed, she would go to Europe and be a ski bum. Nicole said she’d go to Tahiti and sell T-shirts. I confessed that I didn’t know what I’d do; I’d already tried going home and it hadn’t worked. Back then, if you wanted to have a private practice specializing in cosmetic surgery, you pretty much had to be in New York or Los Angeles. I couldn’t just go anywhere and set up a practice. If New York beat me up, then I’d probably return to the Bay Area, or maybe try LA. Certainly people prized surgically enhanced faces and bodies there.

  At parties, whenever Nicole or Pam would introduce me to their friends as “Cap, a plastic surgeon,” there would inevitably be a pause or a smile or a laugh or a disbelieving look. It was likely I was the only plastic surgeon at the party. Invariably, a model or young actress, hearing what I did, would sidle up to me and find a way to steal an on-the-spot consult.

  “Which are better?” she would quiz me, glassy-eyed, as she pressed her breasts against me. “Silicone or saline?”

  I wanted and needed to immerse myself in New York culture, for the camaraderie. But I was a nerd and – thanks to my medical training – a disciplined one. I remember going to a downtown club to see a performance by a young singer named Madonna … and having to leave after three songs; I had a browlift scheduled for seven thirty in the morning. There were downtown loft parties with musicians and models and actors, and I would enjoy them – chatting, meeting people – while always surveying the scene as if from above. For me – for most doctors but especially surgeons – a party was a different experience from what it was for lawyers or investment bankers. I stood on the sidelines and watched the counterculture fly by. Still, I enjoyed the parties and nightlife, probably because they represented such a contrast to my day job. Absolute order by day, total recklessness by night – even if my idea of “total recklessness” was, by New York standards, fairly tame.

  One Friday night Nicole and I went to The Rave on the Upper West Side. Great music, a lively scene. Coming from work, I stood there in my overly conservative Midwestern suit and a loosened tie, the music pounding, and at one point found myself flanked by two men – one heavily pierced and tattooed, the other in leather. Alcohol was flowing, of course, and patrons were making numerous trips to the bathroom that had nothing to do with relieving themselves. The fashion was outrageous. I remember thinking that, although I’d always tended to see the similarities in people rather than the differences, I was fairly sure there was little overlap between me and the men on either side of me.

  A moment later, a group of men in drag walked by … and one of them did a double take. I was clearly the reason for his hesitation.

  It was one of my patients.

  He lived on the straitlaced Upper East Side. He was an investment banker. As straight an arrow as you could find. Two months before, I’d done a nosejob on him.

  Had I not seen his eyes, I wouldn’t have recognized him. From the way he and his friends were decked out – in heavy makeup, mascara, and tight blouses – he couldn’t have expected to be identified. He realized I’d recognized him: His frightened look still burns in my brain. Fortunately for him, I was trained to keep secrets.

  I nodded, ever so slightly, hoping to assure him that he needn’t worry, at least not about this. His secret was safe.

  He returned a tiny, sheepish smile.

  My more active social life began to yield some professional benefits. I met a booker at one of the top modeling agencies who referred some of her models to me. At first it was hard for me to believe how many models, including the top ones, underwent surgery. For the most part they wanted liposuction of the hips and the outer thighs, and occasionally breast implants. I would do biopsies of moles and lipomas, too. Back then, liposuction was the most common procedure I did on models; today, it’s still lipo, but cheek implants, lip augmentation, and rhinoplasties are common, too. Also, virtually all models have some injections, either Botox or Restylane. And while I did breast augmentations then, it was not yet de rigueur, whereas today, the model who hasn’t had breast implants is a trailblazer.

  Not all models are technically beautiful. Isabella Rossellini, for one, is not a classic beauty, but she photographs well. Most well-known models sport some asymmetry – for instance, Lauren Hutton and that famous gap in her front teeth. (I also thought about Cindy Crawford’s mole, and how much I wanted to remove it; I knew it had helped to make her career, but I just didn’t get its appeal.) Gisele Bundchen may come closest to technical perfection, but even she has a heaviness in her upper lids.

  I did a breast augmentation and multiple small lipos on one struggling model; three weeks later, her booker called to say she’d had her best go-see ever.

  Two well-known print models came in, each to have a small bump on her nose removed. After the surgery, their business opportunities expanded; they could now do runway modeling, too.

  One particularly homely twenty-year-old came to me for a rhinoplasty, neck lipo, and breast implants, to jump-start a modeling career.

  The models were friendly and smarter than you’d think. I thought about asking a couple of them out, but, as a professional, I couldn’t do it. It would never work out. My lifestyle and theirs – our hours and our obligations – were incompatible.

  One Friday morning I got my biggest model-related job yet – even if the procedure was tiny.

  “Francesco Scavullo on the line,” said my office manager.

  The world-renowned photographer, who had made his name with his signature cover shots for Cosmopolitan, was shooting a Danish model for a Victoria’s Secret print campaign. She was wearing a string bikini, Francesco was telling me over the phone, and he was bothered by a little smidge of hip fat pinching over the string. Of course I understood what he was saying: Plastic surgeons, fashion photographers, and models see flaws that are imperceptible to others.

  Scavullo needed to finish the shoot in three days. He and Anna came to my office that afternoon. Right away I could see it would be a relatively easy hip lipo – but what about the bruising?

  “I’ve got to have it done,” said Anna. “I need this job. How often do you get to work with Scavullo?”

  “Yes, honey,” said Scavullo. “You need to have this done.”

  I couldn’t help but be amused. Any guy who saw Anna in this bikini would probably drool; any woman would covet that body, pinch of fat or not. But that’s the way it goes. Anna was a victim of the perfectionism of Scavullo, and of the readers of the magazines who saw the ad.

  I did the procedure the next morning, a Saturday. We put iced towels on her until Sunday evening, and Scavullo shot on Monday, using concealer to cover what was left of the bruise.

  After that, Anna’s booking agent, knowing I could help get her clients out of trouble quickly, sent more models my way and even put the word out among former clients, too, that I did professional work.

  Working with these new patients, I got to understand, in particular, the poignant predicament of the ex-model. Diane, a well-known former Sports Illustrated swimsuit model who had, at thirty-eight, technically finished her modeling career (though she had business ventures on the side), came in to see about a breastlift. She was tall, brunette, and still magnificent, but she’d had a child and she told me she thought her breasts sagged. She was used to their being up and youthful.
She was not going to tolerate any aging.

  She took off her shirt and bra.

  When we measure a breast for “ptosis” (sag), we measure the distance from the sternal notch – the middle of the chest, between the collarbones – to the nipple. (Of course, much of this can be done simply by looking.) A distance of nineteen to twenty-one centimeters (71/2″ to 81/4″) is considered normal. Anything greater than that is drooping.

  Diane had beautifully proportioned breasts. I measured her at twenty-two centimeters – barely sagging.

  “It would be easy to do a lift,” I said, “and I could even do short-scar surgery. But there would still be a scar on otherwise beautiful breasts that really aren’t sagging.”

  That was not the answer Diane was looking for. “But you would do it,” she said.

  “I can’t see putting a scar on you for such a trivial improvement,” I said.

  Instead of being happy that she was not a victim of ptosis like other thirty-eight-year-old mothers with relatively sizable breasts, she was disappointed. I would not operate.

  She came back a year later, and I measured her again. She had dropped a quarter of a centimer, if that.

  She returned a year later. Again, the sag had hardly changed.

  It was as if Diane wanted her breasts to sag more. She was in an unfamiliar and uncomfortable place: As an ex-model, she was still gorgeous but she was no longer perfect. And while being ever-so-slightly imperfect would have been more than acceptable to the vast majority of civilian women (or men) out there, Diane seemed to prefer adding scars to her body rather than to accept that time had, if gently, visited her, just as it does everyone else.

  Did she go elsewhere to get a breastlift? I don’t know.

  It used to be that models, both print and runway, were naturally beautiful, with great bone structure and unaltered body shapes. Starting in the 1980s, this gradually became the exception rather than the norm. The explosion of office-based surgeries, better monitors, and better drugs led to improved cosmetic surgery results. In essence, advances in technology drove aesthetics – and the trend continues today: With injectables, it’s now routine for teenagers and women in their early twenties (not to mention older women) to come in for bigger lips, which can be had in ten minutes.