by Cap Lesesne
Today, 15 percent of my patients are men. The most popular procedure I do on them is a necklift. Mid-face-lifts represent a considerably smaller part of my surgeries. Lots of men want rhinoplasties and eye lifts. Liposuction for hips and stomach are also popular. I’ve never done a male tummy tuck.
Lots of surgeons don’t like doing face-lifts on men. Male skin is less pliable. Men have a greater concentration of blood vessels in the face than women do, making us more prone to bruising. Postoperatively, I advise men to wrap their faces a little tighter than I advise for women, and men need to be more disciplined about applying ice for the first forty-eight hours. Our hair follicles go deeper, all the way into the subcutaneous level of fat, and our hair distribution must be considered: Most men don’t have hair in front of or right behind their ears. When doing a full face-lift (as opposed to a browlift) on a man, particularly a balding or bald man, I make my incisions inside the ear or right behind it. I might also leave some extra skin to cover an incision, or, where possible, shorten the scar. With a woman, I can go for a smoother face and neck, because scars are easier to hide.
Men decide faster than women what they want. Of course there are variations within each sex. But when Typical Guy comes into the office, he knows exactly what he wants.
Can you do it? he asks. What are the risks? How much does it cost?
I tell him the good and the bad. He makes up his mind right there in the office.
When can you do it? he asks.
I tell him. He leaves.
In the days before the operation, he rarely calls. He almost never complains. Afterward, when it’s done, it’s done.
Women second-guess themselves much more, both in the consultation and in the days before surgery. “Should I make it a 34C?” says a woman who seemed sure she wanted a 36B. Or: “Should I do my nose, too?” Almost no woman makes up her mind yes or no while sitting in the consultation, unless I’m the third or fourth surgeon she’s visited and she’s decided to go with me.
Women also want to tell a story. “There’s this role I want to play,” began one actress, and described the character, the character’s backstory, the play, her favorite role in high school, and her sister’s recent conversion to born-again Christianity before getting to what it was about her face and body that she’d come about. (Ten minutes later, she got to the punch line: “Can you reduce this scar?”) Other women will talk about a skirt or blouse that they love but have stopped wearing because of this or that flaw. They’ll provide lots of personal history. I listen.
George notwithstanding, men almost never talk about their life.
Some of my most fulfilling moments occur when husbands call to thank me. It’s usually about a month after the procedure. The men are pleased with their wife’s new appearance.
But not all.
In this case, the husband was calling to complain.
“Thanks a lot, Doctor,” he said edgily. “You broke up my marriage.”
“Excuse me?” I said.
He told me that a month before, I had done breast augmentation on his wife – a gift from him to her. One day months earlier, he had commented on the smallish size of her chest, and she had not let him forget it.
After the surgery, her attitude about everything in the marriage changed. Instead of her appreciating his gift, he said, she appreciated nothing about him. And said so.
She left him.
“It’s your fault,” he told me on the phone.
That’s the exception, though. Mostly, men will express gratitude to me for anything from a revised scar to a small lipo to an eyelid lift on their partner. The men tell me that their wife is happier and more confident, and the husbands are reaping the benefits of the improved state of mind.
Husbands rarely accompany their spouse to plastic surgery. So when they do, it’s a nice change. One morning, a handsome couple in their forties came in. She wanted a face-lift. I looked at her, examined her under various lights, told her I would need to see photographs of her when she was younger, then described to her in detail what was involved.
The whole time, her husband sat there, not saying a word, sizing me up.
That afternoon, my office manager, Tanya, told me that the husband was on the phone and wanted to know if he could come in the following day.
Fine, I told Tanya.
The next day, he was back in my office – only this time accompanying his Dutch girlfriend, who wanted a breastlift.
After the consult, the man took me aside and said he knew he didn’t have to tell me (or my staff) to schedule the surgeries on different days.
Gay men, on the whole, want the same procedures as straight men except for two differences: They sometimes ask for lipo when they don’t really need it, and they’re more likely to come in for multiple procedures. They want eye lifts, nosejobs, and liposuction, usually for the stomach. My gay clientele is particularly high-profile and accomplished, made up of movie directors, artists, actors, advertising men, and doctors.
If there’s one patient demographic – a rather narrowly defined one – that I can now say is almost guaranteed to be unhappy with their operation, it’s narcissistic gay men who come in for nasal surgery. They’re unhappy with themselves beforehand; they invariably express deep unhappiness with the procedure afterward.
On the other hand, it’s hard to find a patient easier to satisfy than Richard, a top advertising executive who, upon being introduced to me at a cocktail party, listed, at full volume, all the procedures he could use.
“God, I really need to have my eyes done!” he said. “And lipo my hips, please! And maybe a little neck work? Could we do that?”
Anyone speaking so boldly about cosmetic surgery, I thought, was probably not completely serious about it, so I didn’t expect to see Richard again. But three months later he showed up at my office and confirmed that he wanted all the procedures he’d rattled off.
I described the details of each procedure, then told him the effect would be subtle and that no one would notice.
“No one will notice?” he said. “I don’t care if they know! I want them to know!”
When it comes to sensitive subjects, a woman will often demur. A man who speaks openly about sensitive things will usually do so in a different tone.
Once, while on a trip to Florida to meet with consults, I took an afternoon to visit an Andover buddy, Kent Vogel, who’d become a fighter pilot and had invited me to Tyndall Air Force Base in the panhandle to watch jet-fighter training. He said the pilots would love it.
“They’ll laugh their ass off at a plastic surgeon,” said Kent.
I understood what he meant – not that what I did was “sissy” stuff, but that, in some ways, it represented the very opposite of the realm he maneuvered in.
I got security clearance (I found out later that they’d scouted me all the way back to my prep-school days) and was introduced to the colonel, a Vietnam vet in charge of the fighter squadron. He briefly introduced me to the fliers – “The Makos,” they called themselves, based out of Homestead, Florida. They’d all been flying since they were maybe sixteen, and they looked like clichés of American fighter pilots. In all my days as a plastic surgeon and circulating among beautiful people, I’ve never seen a better-looking, sharper bunch of young men.
It happened to be Aerial Dogfight Day, with the exercises designed to prepare the pilots for dogfights. They also constantly entertained the possibility of an enemy jet emerging from Cuban airspace. Before the pilots went up, I watched and listened as they went through their checklists: one for avionics, one for hydraulics, one for power systems, one for armaments. What they did and what I did wasn’t so opposite, after all; their preflight preparation reminded me a great deal of what I did preoperatively.
Then the guys went up.
The colonel let me watch the exercises with him from the control room. Looking at the incredibly high-tech instruments all around me, I could see everything going on with each of the jets involved in th
e exercises – their location, their airspeed, the angle of their bank. I was amazed by the sophistication of the technology. This is what I loved so much about science: Every instrument was an improvement on an instrument that had come before and would help lead to better instruments tomorrow. It was true for plastic surgery and true for fighter jet technology.
On a big screen, I could see the jets – each represented by a knot of constantly changing numbers – maneuvering around each other, and I tried to follow the flight path of my friend Kent, who was up there in the thick of the dogfight. Everything going on in the cockpits was broadcast over the loudspeaker, and the rush of it and the language were exactly as one might imagine.
“He’s on my tail!” bellowed one of the pilots over the loudspeaker. “He’s on my tail!”
The numbers representing the lagging jet swooped in just as the lead jumble of numbers twisted away in a nifty maneuver. They were beautiful machines up there, screaming across the sky.
“He’s on your tail, Vogel! Look out!”
The colonel looked at me. “Your friend just got flamed.”
Afterward, in the pilots’ room, Kent and other members of the squadron sat around talking about what they could have done better. The colonel entered and rubbed his hands together.
“Okay, gentlemen,” he barked, “the real reason Dr. Vogel brought in Dr. Lesesne here is because … you’re all ugly!” The colonel went down the line, pilot by pilot, pointing out the allegedly hideous defects of each man’s face – this one’s nose, that one’s hairline, this guy’s teeth. The comments were pointed, and somewhat truthful, but generally hilarious, since each guy looked like a young Harrison Ford or at least a cousin of Tom Cruise’s.
It was a thrilling day; such a contrast to the tone of my work. It was especially illuminating, even amusing, in reminding me of the vast differences in style and psychology between men and women. Here were two professions, both highly technical, both highly confidential. Here, guys could be heard yelling over loud-speakers; guys were getting “flamed” in front of their colleagues; guys were openly mocking each other’s looks (and guys far less good-looking than these men will do the same, I’ve noticed).
Would any woman ever do that to her girlfriend? In front of other women? Might she enjoy being shot down in front of them, or shooting her friends down? And having it broadcast?
Are you nuts?
I’m Ready for My Close-up Now
It’s not just that Hollywood embraces cosmetic surgery like no other place on earth – that it’s more ubiquitous, more celebrated, more procedures per patient, and it’s initiated at a younger age. What’s more noteworthy, I think, is that the on-screen talent aren’t the only ones who’ve had plastic surgery. All the entertainment-industry players have had it, too, if they want to be players – directors, writers, and particularly agents and studio executives. An executive at a major movie studio periodically calls to get my opinion on what work I might advise for an actor they’re considering to star in a big-budget picture. I’ll recommend a procedure or two (or none at all), knowing, as I do now, that the real reason he’s calling is to see when I’ll be out there again, to work on him and his executive-level buddies.
Corporate Hollywood wants the same procedures as the stars – nose, eyes, lipo, breast implants, cheek implants, and a much higher percentage of injectables than the general population. It makes sense. Their task is to drive film approval, and most of their product is youth-driven films. Many of them feel as if they can’t compete professionally in a town based largely on looks if they don’t themselves look good.
Yet despite the celebration of plastic surgery in the Hollywood culture, there’s still a desire to keep one’s surgery secret, on one hand, while on the other, to expose who’s had what.
I’d been invited to an awards banquet. I was keeping a doctor’s low profile (not hard to do given the star power in the theater) when a director, whom I know socially, sat beside me and gestured at one of America’s most popular leading men across the room.
“I would cast him if he weren’t such a lush and didn’t look like he’d been partying all night long,” he said. “Can you make him look less dissipated?”
“Sure,” I said.
“How would you do it?”
“The first thing is to make sure he’s stopped drinking. Then I’d take the bags out from below his eyes and remove some skin from the upper lids. He could use some neck work, not too much, and liposuction for that belly.”
The director – who, while prominent, didn’t come close to the clout of the star – seemed to think he might be able to convince the star to come see me.
It didn’t happen so fast.
Months later, I noticed heavy retouching of photographs of the star in ads for his new movie. Weeks after that, Tanya said, “There’s a call for you from Los Angeles.”
It was the star.
He asked if I did Botox. I said yes. But it became apparent to me, from his questions, that he was starting down the road of cosmetic fixes much more major than Botox.
Despite the comment of a woman friend, one of Hollywood’s top agents, that “all actresses have work done if they’re going to stay in the business; this growing-old-gracefully business is nonsense,” it obviously applies to certain types of talent and not others. Pamela Anderson along with many B-list actresses would have different careers had they not had breast augmentation (often more than once). For many of them the decision to have such surgery is extremely justified. For some less ostentatious actresses, plastic surgery can prolong careers or keep the range of their offered parts from narrowing.
Then again, to be believable, a face that has signs of aging should not be totally smooth. If you obliterate all crow’s-feet or the nasolabial folds from an aging face, a mask will result, diminishing the ability to express oneself facially. If Meryl Streep or someone of her ilk had such a procedure, it would probably hurt her credibility and thus her career. Actors need to be especially wary of using Botox or fillers to smooth their skin because it results in a flat, affectless face. (I worked on one actress who wanted me to give her Botox “so I look sad,” she said. She came back a year later, on the eve of taking another role, asking for Botox in another part of her face “so I look happy.”) An actor should improve the contour of the face as it ages and make the pigmentation more homogeneous, and not worry so much about skin texture.
Actors have the right to be pickier than anyone else about plastic surgery. For them, a bad face-lift isn’t just demoralizing. It loses them movie roles. It costs them their livelihood. True, fashion models also live off their looks – more singularly than actors, in fact – but models (except for Lauren Hutton and a few others) are invariably long out of the game by forty-two, the age when most people, gorgeous or not, start “needing” work (give or take a few years, depending on genes, sun damage, and cigarette/alcohol/drug consumption).
I take precautions with actors. When I ask for photos, I tell them I don’t want head shots, which are almost always retouched. Scheduling is crucial with actors, given long film shoots and particularly the seasonality of TV work. For the biggest stars (and extremely secretive lesser ones), I give them my cell number, something that most high-profile patients prefer (and which all politicians insist on). Leading up to the surgery, the actor or actress often wants to speak only with me, or she might even use a friend as her front person.
When an actor shows up for the surgery, only my anesthesiologist and I know who it is. They’ll typically come to the office for a face-lift early Saturday or Sunday morning, usually wearing sunglasses. (This is at my Park Avenue office. While I do initial consults and injectables in L.A., I do most of my Hollywood-related surgery in New York.) Depending on where I perform the operation, afterward the star is driven in a hired car to a “safe hotel” in Santa Monica or Manhattan (a discreet, high-end hotel that has a separate wing). A private-duty nurse will stay with the star for a night. A number of California-based actors actua
lly prefer to have surgery in New York because they believe the medical institutions are, on the whole, better. (I agree: There are more major teaching hospitals in New York, the plastic surgery departments are older, and there’s a greater concentration of expertise.)
I find that most major actresses are not the egomaniacs they’re often made out to be and can be quite delightful. Because of their livelihood, the first, last, and only determining standard is results. There are excellent plastic surgeons all over Los Angeles and Beverly Hills, and some movie stars have had masterful face-lifts and eye jobs where they’re able to keep the same expression year after year. This is especially important when they’re making sequels. Sylvester Stallone may have had too much work. Who knows? What would he have looked like had he had nothing done? The plastic surgery ethos on the West Coast tends to favor shinier, more “obvious” results. Some actors prefer that. Most don’t. The popular magazines and tabloids that speculate on stars’ possible plastic surgery procedures ignore the pressure on actors to look young for their careers. So while one can criticize an obvious result, people fail to take into account that most actors must do something to stop time, if they want to remain employed.
When I operate on actors, I consider thoroughly that their look will be influenced very much by all kinds of light falling on them. While filming Around the World in 80 Days, Shirley MacLaine, then twenty-two, said she learned the most about acting from Marlene Dietrich, age fifty-four, because Dietrich knew how to act “in light” – that is, how to get the cameraman to give her favorable light. (Who can forget Gloria Swanson, as the faded movie star Norma Desmond in Sunset Boulevard, delivering her famous line – “All right, Mr. DeMille, I’m ready for my close-up” – as she approaches the camera with her head tilted ever so slightly to one side, her good one?) When I was an on-air health consultant for NBC News, the one piece of advice I remember was Make friends with the cameraman to get good lighting. American history might be very different if Richard Nixon had learned that simple lesson.