by Cap Lesesne
When I’m evaluating actors in my office, I’m hyperaware of lighting. I swing them around into different shadings and intensities of light, turn their head, look at them as light is coming in from oblique angles, from above, from below. For a face-lift, I may decide to leave a little fold or a little more fat than I would take out with a nonactor, knowing that that extra skin may be needed to cover an incision, which could make a difference in a close-up.
A couple of years ago, a stage actress well known for her character roles on Broadway came to see me. She was in her seventies – a young seventy, though – and made sure that I understood that, whatever youth-restoring improvements I made to her face, I was not to overdo it. She wanted still to be considered for the wide range of parts she was frequently offered – late fifties to seventy. In other words, she wanted to look younger but not that much younger. Definitely not “pulled.” While other women her age have told me to make them look as young as possible, for Michelle her driving motivation was to maintain her professional viability. When I did the face-lift, I left a little skin around her jawline, did not pull her neck as tight as I might otherwise have, and did not add quite as much fat to her lips.
I fly to L.A. every two months, for two to three days – a couple days of consults, Botox and injectables, possibly surgery, and a day of seeing friends. I have a relationship with a hotel there and use one of their suites for my meetings. For my patients’ protection, I may register under a pseudonym to fend off gossip-magazine snoops. Sometimes I’ll meet my high-profile consults on Ocean Drive in Santa Monica. I’ll wait by a little park above Pacific Coast Highway, they’ll come walking along, and then we’ll walk side by side – very postwar Berlin. Walking north, they’ll tell me what they want; when we turn around and head south toward the pier, I’ll tell them what I can do. I especially like meeting this way because I get to see them in natural sunlight.
Holly, forty-five, a major actress, was my first appointment on one of my visits.
I rarely watch TV, go to the movies or the theater. So it was not until later that I discovered just how well known and successful Holly was, a rare triple threat: TV, film, and Broadway, big-time projects in all three media. She had several Emmy and Tony nominations to her credit (she won one) and created a defining role in one of America’s most popular film comedies. But I might have guessed she was a star anyway (either that or she would have to be delusional) because when she entered my hotel suite, she had on a blond wig, sunglasses, and a long coat. And in what I would come to see as a stroke of disguise ingenuity, she wore flats. Why was that ingenious? So any nosy people who might spot her would not suspect it was her, because she was short. Holly (I later found out) always wears high heels in public. Always. Wouldn’t be caught dead in flats – precisely to fight off the impression that she’s very short. Meeting me in flats, then, she would appear her natural short short self – ergo, unrecognizable.
Give people credit for thinking these things out.
On our first encounter, I liked her immediately. She was very attractive – great figure, good legs, had worked out her whole life. She had lines on her face but they were not inappropriate. She didn’t have lots of hanging skin and jowl. And she exuded great sex appeal – which, to me, is all about animation and movement. She walked in a way that was alluring, not provocative. When she took a seat, it was in a feminine, stylish way. She was quick to smile. With some of the women I operate on, the older they get, the greater their sex appeal, and it lasts well into their sixties and even beyond. Holly, with a twinkle in her eye, was one of those whose sex appeal would continue for years.
I could see she’d had surgery done on her face. But Holly wanted something done to her eyebrows, and she absolutely did not want her hairline pulled back. I promised her we could accomplish what she wanted by eschewing a whole face-lift and doing a short-scar browlift, which focuses on the eyebrows and wouldn’t cost her a single hair follicle. I would make tiny incisions in the scalp, dissecting and releasing the skin that allows the eyebrows to go up, then elevating that skin and affixing it in a higher position. She nodded. I asked her when she would like the surgery.
She was “between movies,” she said, “so my window of time is now.” She did not say it in a prima donna way. (And given the number of movies she’d made, the phrase between movies seemed a matter-of-fact description, not actorspeak for “it’s doubtful I’ll ever be in another movie.”)
I told her I thought I could get OR time in a couple of days.
Immediately after the surgery, I thought she looked unbelievable. Unfortunately, she didn’t share that opinion. She was anxious about her new look, a typical reaction so soon after the operation. But a short-scar browlift heals relatively quickly, and the bruising is usually limited, along the hairline.
Her husband rushed over to see Holly and called me to say that he was floored, in a good way. Still, Holly was not persuaded.
She invited me to accompany her to dinner three nights later, perhaps to convince herself she looked better (or maybe to taunt me, if she still hated the results). I was planning to still be in L.A. then so I said yes. At the restaurant, we dined with several people, and to them and the many others who stopped by the table, she introduced me (I was impressed to witness) as a plastic surgeon – though not her plastic surgeon.
I was amazed. What had happened to the woman in the film noir disguise?
Then I figured it out. This was a clever woman, a worldly and smart woman. She had convinced the world she was not that short, after all, so she could hide in it by being very short. And now this was another clever move, a test of her own devising.
What she was doing, I surmised, was to see how many of the people who were introduced to me would put two and two together. As an actress, she was good at reading authentic reactions.
After all, what person in show business would actually introduce her plastic surgeon?
No one appeared to take the bait. Then again, several of those I was introduced to were themselves actors, so maybe they were just as good at hiding their reactions.
Holly was happy. Her test was successful. Suddenly, I had done a good job.
It was another example of how you must always accomplish two things: Do make the patient look good; don’t make it obvious why she looks good.
Holly would come to see me two years later for a second operation, arm liposuction, and this time she showed up for the consult undisguised.
The third time I saw her, a year after that, was in Palm Springs. Holly called to ask if I would meet her by the hotel pool. At a conversational volume – no whispering – she told me she wanted a necklift. I nodded that, yes, I thought it might be time.
“Do you want me to show you what I’m thinking?” I asked quietly.
“Yes,” she said.
I stood. “Would you like to go inside, away from so many –”
“No. Here is fine.”
I hesitated for a second. She nodded as if to say, It’s all right.
I nodded back. I held her hair away from her neck, looked at it in front of her ears and behind. I was discreet – that’s the essence of our work, after all – but still: We were by a resort swimming pool, where industry people came and went. It was stunning how much more comfortable Holly had become with the idea of plastic surgery. Indeed, if I wasn’t mistaken, there might even have been a bit of pride-taking in me, in her plastic surgeon, not just any plastic surgeon. She’d come to trust me so much, she seemed to be inviting the exposure.
Perhaps this is what psychoanalysts experience, I thought, when their patients experience “transference.” As for me, while it was a bit of an ego stroke to have this movie star clearly enjoy being around me, I’d just as soon stay behind the scenes.
I try to see as many L.A. patients as I can when I’m there. I always enjoy the chance to meet people on their turf, especially in their home. After my initial meeting with Holly, I was invited to the “bungalow” of a very famous movie actor. I d
rove my rental car along the winding road down into Topanga Canyon. I almost missed the turnoff onto the isolated road where he lived. The house was gated, with two guards outside. When I got inside, though, Billy was standing outside his door to greet me – no butler or maid or entourage. He was down-to-earth and easygoing. He was not considered a dramatic actor but an action-film guy, and he’d enjoyed one of the longer runs in Hollywood. He’d also had too much skin and fat taken out of his lower lids and had small scars visible near his ears.
We sat in his living room facing each other. The dynamic of the virgin encounter between patient and surgeon can be quite amusing – patient scanning doctor’s face and eyes for trustworthiness and a glint of competency; doctor scanning patient’s face and eyes to see what procedures need to be done, and how good the results could be. But it was heightened here, partly because it was in his home, partly because it was man-to-man, partly because he wasn’t a novice. He’d had two procedures done before, he said. This time he knew what he wanted – not to look younger (he was in his early sixties) but to look more natural.
We continued to size each other up. He didn’t waste words. He reminded me of the old movie cowboys who speak not a syllable more than necessary. The actor took out old photos of himself. Even though I had noticed his waxier complexion right away (anyone would have, as I’m sure his moviegoing audience had, too), I was shocked at just how unnatural he seemed now. The browlift he’d had made him look startled, and he’d had surgery to reduce the muscles in his forehead – odd for an actor, I thought, since it compromised his expressiveness. It would have been cruel and pointless to tell him how awful the previous surgeries had been.
“Your job,” he said, his finger pointing at me like a gun. “Make me look natural again.” There was a touch of sadness in his eyes and voice, but it was still well short of desperation.
When I left, I had no idea what he thought of me or what he would decide; maybe that was the actor in him. But I suspected I would not hear back. Straight shooter though he seemed, I felt he’d become fatigued by what plastic surgery had done to him. Enough was enough.
Six months later, he called. “Woulda called sooner,” he said. “Shot a movie.” I was glad to see he was as true as I’d first thought.
“New York, next week,” he said. “Book me. Lots of drugs, Cap.”
Not surprisingly, he showed up at my office alone, just sunglasses and hat as cover. And they might not have been cover: It was a sunny, cool New York day.
Some actors say they don’t want to be noticed, even though they come with an entourage. Or they’ll profess their love of anonymity, then have front-row seats at the theater and make sure to stand and face the audience and pretend they’re looking for someone right before the lights go down, so everyone can get a look.
And some actors really, truly don’t need to be noticed, nor do they have to announce to the world that they don’t need it. Billy was one of those.
Two years later, at the end of a busy day and with the waiting room finally empty, my office manager, Tanya, poked her head in my office.
“There’s a Robert Walker here to see you,” she said. I asked her to show him in.
It was Billy, looking fifteen years younger, accompanied by a younger woman.
“Cap, my friend?” he said. “This is Susan from Chicago. Susan, Cap. She liked the way you made me look. She wants to talk to you about her eyes.”
Sometimes you take risks. Some actresses come with the reputation for being difficult. With Stella, an actress who had costarred on a successful TV crime drama, I knew if I didn’t get it exactly right (by her standards), my name would be smeared across Beverly Hills and Los Angeles.
I did a browlift on her and she was … dissatisfied! How shocking!
“This is not what I had in mind,” she said to me glumly on my cell phone, not two hours after the procedure. “This is … this is … this is gonna be a big problem.”
I pointed out to Stella that it had been all of ninety minutes since the operation was over. I tried to get her to articulate what was upsetting her. She just kept repeating ominously, “This is gonna be a big problem.” When I tried once more to get a specific complaint from her, she said she had another call coming in and cut me off.
Damn, I thought. I should have known better.
Fortunately, this is Hollywood.
The nature of actors is such that the final judgment on certain big career decisions doesn’t always lie with them. Stella’s husband loved the face-lift. More important, Stella’s agent, manager, and publicist all loved it.
Ergo, Stella loved it.
Stella called back a week later to say she was now happy, and when she needed surgery in the future, she’d be calling me.
Which reminds me of a favorite Hollywood story someone told me: Writer gives script to Producer. After the weekend, Writer calls Producer. “Did you read it?”
“Yes,” Producer answers.
“And?”
“I don’t know.”
“What do you mean you don’t know?” asks Writer.
“No one else has read it,” says Producer, “so I don’t know what I think yet.”
Failures
(and What to Ask a Surgeon)
It’s one of the more common questions: Why is there so much awful plastic surgery and injectable work among actresses and actors who can afford anything? Even big stars can have trouble finding the right person. A major, Emmy Award – winning actress went to a reputable Los Angeles surgeon for an upper-eyelid lift, and he was reluctant to do what he thought was best because she was stage-directing his every suggestion. It turned out to be a total failure. He took out all the skin she wanted – and it made the eyelid lag open at night, exposing the cornea.
Why did the problem happen? She had done her homework and had found a competent surgeon – that’s a positive – but there was no rapport between them, and he merely followed her directions rather than taking charge. The same thing happened to me and a Hollywood producer: She came to me and dictated what she wanted done with her face-lift. It was early in my career. She visited me six times before we did the procedure. But I should have said – and do say now, in similar circumstances – No. Hold on. That won’t look good. I wanted to do more than she did; she said, Don’t do this … don’t do that. She dictated to me.
Sure enough, she was unhappy that I didn’t pull her more.
My advice? See a surgeon you trust, spend time with him, and if he has a solution, you should do it his way. And if he doesn’t think a particular procedure is advisable, you probably shouldn’t insist.
Bad work is going to happen, for a variety of reasons. Fortunately, in many cases, things can be done to remedy the problem.
A wealthy, sixty-three-year-old Chicagoan had undergone a face-lift during which two facial nerves were cut, so that she had lost almost half the facial control of her eyelids and smile. Her eyes drooped and she drooled. She disappeared from sight, jetting to Paris (where she had an apartment) so that her closest friends couldn’t see her. When she discussed her plight with an acquaintance, she was referred to me (I had done a face-lift on the Parisian) and paid me a visit. Six procedures later, I had reconstructed her eyelid so that it didn’t droop and her mouth so she wouldn’t drool. A nerve can sometimes be repaired, but at her age I was not confident it would succeed. Instead, I fixed the symptoms by transferring muscle from the scalp, and using sutures to support the drooping muscles. She was better but not perfect. Unfortunately, the facial nerve paralysis is permanent.
There’s a risk in taking on the job of fixing poor results. If you succeed, you get to be the hero. But if you try to correct a disaster and fail (e.g., it’s just so bad to begin with), the distraught patient will often blame you more than the original doctor. You’re the one most immediately associated with the problem, and you may have compounded it. They only remember the last operation.
It’s the alpha and omega of the Hippocratic oath, its golden rule
:
Primum non nocere. First, do no harm.
Laudable and commonsensical. An admonition all doctors should heed. But sometimes results don’t meet expectations – the doctor’s or the patient’s. Sometimes the problem is unavoidable. And sometimes it’s the doctor’s fault. Not long ago, a twenty-year-old woman undergoing a breast augmentation had a respiratory obstruction and went into cardiac arrest. An unlicensed nurse anethetist in the room could not control the airway; the surgeon’s operating room was not certified.
Or this Westchester case, just as disturbing: The patient had apparently not come out of anesthesia for nine hours … at which time the surgeon was finally able to bring himself to tell her family that she’d gone into cardiac arrest, and died, five hours before.
These disasters happen very rarely when a competent, well-trained surgeon is involved.
Although it’s hard to find a positive to terrible stories like this (particularly, of course, for the families of the patients involved), our medical system is set up to make catastrophes less prevalent. Each hospital is required to use a “morbidity/mortality” reporting system, whereby people are motivated to report problems so that our medical institutions can investigate what went wrong and safety is enhanced. Situations like the ones above are, as a matter of routine, brought up by the hospital’s quality assurance program. Such systems are meant to oversee medical disasters and mishaps the way the FAA oversees flight disasters and mishaps.
