Confessions of a Park Avenue Plastic Surgeon

by Cap Lesesne

  After landing in Louisville, we loaded into a stretch limo to Churchill Downs. At the racetrack, the chauffeur came around to open the door, and suddenly it was no longer a day at the races but a crush of humanity. Hundreds, even thousands, of people were milling about the entrance we’d pulled up to. Almost all of them were men, boisterous, ready for a good time. Ivana was the first one to step out of the limo. She pulled teasingly at her skirt, crossed her great legs – posing for a moment so they could bask in the sight – said, “Boys, I’m here!” and stepped out of the limo. You couldn’t count the whistles and catcalls. Not to be outdone, Susan Lucci stepped out of the car and exclaimed, as only a seasoned performer could, “Don’t forget about me!” then catwalked down what had turned into a makeshift runway through the crowd. Now, with the fans in a frenzy, Phyllis – Miss America, Kentucky’s former first lady – emerged and blew off the roof.

  I understood what it must have been like for Moses when the Red Sea parted. I was invisible but happy to follow in the wake of these three gorgeous women, who marched up to the VIP lounge, where former Kentucky governor John Brown – Phyllis’s ex-husband – greeted us all with “These are my people! These are my people!” The lounge was filled with celebrities, but the one I enjoyed most was my future mayor, Michael Bloomberg, who surprised and delighted me by revealing a funny side most New Yorkers don’t see, telling several dirty jokes I won’t repeat here.

  Every day should bring new lessons. The lessons might be sublime or trivial, but you should go to bed feeling as if you’ve learned something. For example, one week brought these interesting (to me), sometimes useful, certainly random lessons:

  Lesson: I am discovering the difference between wealthy women who work and wealthy women who don’t. The former tend to follow your instructions; the latter tend not to listen closely. The former realize that swelling during recovery is normal; the latter tend to obsess on trivial details of the recovery. Should a delay or minor problem arise, the former are satisfied by a reasonable explanation; with the latter, no explanation can satisfy.

  Lesson: I figured out one reason why plastic surgeons move so well among the successful and powerful. It’s not just because we provide a skill they cherish. It’s because we’re often just about the only one at these receptions – so overstocked with bankers and lawyers – who is not competing with them for their job or place in the pecking order. What we do is too specialized, too weird.

  Lesson: Women, especially very successful ones, want their plastic surgeon to be empathetic but not a mushball. Come to think of it, that’s what they generally want in a partner, too.

  Lesson: Almost no TV anchor I have ever operated on has ever come in for body work. What you can’t see behind the desk is apparently of little concern to them.

  Lesson: Don’t believe everything you read. It’s coming out now that many women who read a recent story in a women’s magazine – about antiwrinkle injections, so popular in France – are now getting infections. When the story came out, I wondered why the reporter hadn’t dug deeper; I knew one of the physicians mentioned in the story had been experiencing complications back then!

  Lesson: I am learning more in the nerve anatomy course I teach than the students are. We had thirty-two cadavers out today, each for a member of the class, and we dissected out facial nerves. While I was teaching them, I was not only coming up with a new way to dissect nerves faster, but truly appreciating how varied nerves can be – thickness, number of branches, etc. – from person to person. Fascinating.

  It just goes to show: Learning must never stop.

  I didn’t generally witness cosmetic surgery patients engaged in life-and-death struggles.

  Lily was thirty-eight when she came to me to have a childhood scar “revised” – that is, to have its thickness and appearance reduced. It was on her right abdomen, the result of an appendectomy. I cut around the scar, loosening the surrounding skin with a scalpel and scissors, then closed the incision by using different sutures in multiple layers. I then sent the scar to the pathology lab, as I routinely do. (It would come back with a normal reading.)

  When Lily came in to have the sutures removed, she was happy with the result. She pointed out a second abdominal scar she also wanted revised. This one was on the left abdomen, from an operation she’d had as an adult, a year before, to remove adrenal cancer. It’s common particularly for cancer survivors to want scars reduced. The scar reminds them of the cancer, of fear, of mortality.

  During this follow-up visit, Lily spoke to me of unusually intimate things – in this case, childhood operations, an embarrassing scar, cancer. Emotionally, it was as if we’d been through ten or twenty encounters, not two. She opened up. She told me she worked in Manhattan as the office manager of an ad agency. She was single. She looked forward to meeting a guy. She hoped to marry someday. She had a lighthearted, bright way about her, rare in a single New York woman in her late thirties.

  When Lily came back for her second revision, she was not lighthearted. Lately she’d been feeling sharp abdominal pain, and she was scheduled to see her gynecologist about it. Given her history, there was extra reason to worry. I tried to be as calming as I could without saying things that weren’t true.

  While I looked at her in the exam room, she was able to forget some of her anxiety. She complained about the lip of fat creeping over the waist of her jeans.

  “Maybe I’ll get lipo, too, next time,” she said. “What do you think?”

  I said I’d be happy to do it.

  She’d come to my office for a simple procedure, and the motivating factor had been to make her life better, not keep it from getting worse. For a few moments there, it seemed as if I were simply a confidant, not a doctor; she was not worrying over her long-term health. I felt good. I was moved that she could be transported like that.

  When she came back two weeks later for the operation to have the second scar revised, she told me they had discovered a mass in her abdomen. Recurrent adrenal cell carcinoma. We canceled the scar revision.

  “I’m one of your doctors and I will help take care of you,” I told her, seeing the fright in her eyes. “We go on this journey together.”

  I didn’t know how it would go, of course. The course of disease continually surprises. Cells respond to therapy. Cells don’t. I don’t know if it’s accurate even to call Lily a friend. Yet I knew that her next weeks would be very hard, and that I would be getting closer to this woman whose future had just become filled with storm clouds.

  That day, I remember, she wore hip, low-cut jeans, a long Armani blouse, delicate silver-hoop earrings. At one point, she gazed out the window, looking hopeful. She felt less alone, she said. She left the office with a smile.

  “I’ll call after the oncologist’s meeting next week,” she said.

  Six weeks later, Lily was dead.

  I never forget that I’m a physician as well as a plastic surgeon. This thought is nurtured by all the lessons learned from my father, from Dr. Sabiston, from all my mentors. When I first see a patient, I know – and sometimes even say aloud – that we’re about to embark on a journey together. For some, it’s brief; for others, it’s longer. For some, it’s filled with joy; for others, it’s filled with desperation and even tragedy.

  For plastic surgeons who don’t do just cosmetic surgery but reconstructive surgery, too, experiencing situations like Lily’s differentiates us from those who do cosmetic surgery exclusively (dentists, oral surgeons, etc.). I’m not suggesting that the former group should get extra credit: As I said earlier, I believe it’s a myth to think that doing a rhinoplasty or a face-lift, say, is somehow less satisfying and honorable than doing a skin graft. It’s all about making patients happier.

  But I’m also quite sure that having to deal with situations like Lily’s enables us to develop a better rapport with our patients. To be more involved and compassionate, because we, like they, may feel more vulnerable. Plastic surgeons – at least on TV and in the tabloids – don�
�t often get portrayed as having great depths of feeling.

  Thoughts of Lily and others like her remain with me forever.

  No One to Heal

  Tuesday, September 11, 2001, 8:00 A.M., a gorgeous, clear blue New York fall morning, I was in my operating room, doing a face-lift on Dorothy, a native of Odessa, Texas, and a friend of former first lady Barbara Bush. The operation was proceeding routinely until sometime after eight, when Tanya entered with the portable phone. Chyresse, an old friend from Grosse Pointe who worked as a manager for American Airlines, had a question for me while she was in rush-hour traffic on the George Washington Bridge. Lisa, my anesthesiologist, took the portable and held it to my ear.

  I almost never talk on the phone when I’m in the OR, but Chyresse said it was important – a medical emergency concerning one of the flight attendants she supervised. In the middle of her question, she paused and said, “That’s very strange … one of our planes just flew into restricted airspace. I gotta call ops.” And she hung up.

  I thought nothing of it.

  Twenty minutes later, Tanya came in to tell us that there’d been a report that a plane had hit the World Trade Center. Along with most New Yorkers, for the first moments that morning, I assumed the crash was a terrible accident – though, on such a cloudless day, it was hard to believe.

  Maybe ten minutes later Tanya entered the OR again to tell us that a second plane had crashed into the other tower.

  “No way that’s chance,” said Lisa as I continued operating at normal cadence.

  Twenty minutes later, Tanya reentered. “One of the towers collapsed,” she said, shaken.

  For the first time all morning, I paused. I looked at Lisa. Her mouth was hidden behind her surgical mask, but her eyes were wide, animated. I returned to Dorothy’s face – immobile, serene.

  “What about the power supply?” Lisa asked. “Or other attacks?”

  I reassured her that we had backup generators and supplies, and that we were in a safe building.

  Ten minutes later, Tanya entered the OR with an update that the second tower had collapsed.

  “All those people,” said Lisa. “All those people…” She began to cry.

  In my mind I estimated that, if we were very, very lucky, there would be only twenty-five thousand dead. Injured in the tens of thousands.

  And who knew what other terrorist acts still awaited? There would be a great need for help, particularly medical, and I’d had experience working with burn patients during my residency at New York Hospital and Stanford. I told Tanya to cancel our next two surgeries. I finished Dorothy’s face-lift, applied her dressings, and moved her to recovery. For a moment I wondered about her reaction to the news when she awoke.

  Everything’s fine, Dorothy, you were great, face looks fabulous, bruising minimal, twenty thousand dead, the World Trade Center is no more, America is under siege. And remember: ice packs for the first twenty-four hours.

  I wondered just how close she was to the Bushes.

  Tanya and I checked our office supply of flashlights and batteries, and I gave her money to go buy water and food in case they sealed the city and we were all trapped at the office; my staff lived in Staten Island, Queens, and Connecticut. A news report instructed all doctors to report to their affiliated or nearby hospitals. I told everyone to stay in the office.

  Outside it was dreamlike. The feeling was nothing like I imagined it must be downtown, but still it was eerie. No cars moving on Park Avenue, no taxis hurtling to make it through a just-turned red light. For the first time since I’d opened my office on Park and Sixty-fifth a decade ago, I absorbed the significance of the building just two blocks up the wide boulevard from me: the Sixty-seventh Street Armory. The police had sealed off streets. The National Guard was out on Park Avenue, with Ml6s at their hips. I needed to get to St. Vincent’s Hospital, the hospital closest to the crash site. I explained to a policeman that I had to get downtown. He didn’t even ask for ID. He asked permission from his superior officer, who immediately granted it, and we jumped into a cruiser and drove at breakneck speed down the empty avenue. Thousands of people streamed uptown on foot.

  At Thirteenth Street, people were jammed outside St. Vincent’s Hospital, waiting in front of placards that read A+, A–, B, B–, O, donating blood. Everyone was obedient, silent. They must have come from all over the city.

  “Good luck, Doc,” said the policeman as I hopped out. As if by instinct, we both simultaneously saluted each other.

  Given the volume of people milling about, it was disturbingly quiet; inside the Grosse Pointe Central Library on a lazy summer afternoon, with the windows open, might have been louder. Every honking car had gone quiet, every know-it-all New Yorker had become a foot soldier straining to be told where to go to help.

  The silence was broken by two jet fighters coming in low, each with full missile payloads. They were the first wave – Air Guard. Then came the U.S. Air Force, a fuller squadron of fighters in formation, all loaded with live air-to-air missiles.

  It was eleven thirty in the morning.

  Sadly, I stood around for hours with nothing to do, no one to help. As did all the doctors and nurses there. No one was brought into the ER. We all just waited outside for survivors who never came. We knew there had been mass casualties; we didn’t know they had already been vaporized. Or that the number of hurt (or dead) not in the buildings was shockingly low. Now and then, in a scattered funereal march, dazed policemen and firemen would tramp by, covered with soot; every now and then a bystander would run over to them to offer a towel or a handkerchief to wipe them off.

  After standing there for three hours and realizing that no one was coming, I began the walk uptown. People on the street were crying. They crowded into bars, staring at TVs tuned to the news. At the Fifty-ninth Street Bridge there was a mass of humanity, thousands of people crossing over. On Madison and Sixty-fourth, I barely recognized an Andover classmate covered in soot. He was an investment banker who worked at Deutsche Bank downtown and had been a great runner in school. Dazed, he told me he had just stepped out the front door of his office building as the first tower crumbled before his eyes. Then he ran the fastest mile of his life.

  On Fifth Avenue, there were still no cars, and I experienced something for the first time in my almost two decades of living and working in New York City, something I did not even know I was missing all these years.

  I heard birds singing in Central Park.

  Later, after I checked on the office and saw that everyone was okay, and as the clear blue sky turned golden on that ghastly day, and the acrid stench turned north, and the reality of it began to creep in, I headed downtown once more. I got turned away at Canal Street. Construction trucks were lined all the way back up the tip of Manhattan, a fusillade of Good Samaritans: national guardsmen, construction workers, ironworkers.

  Meanwhile, at practically all of the city’s population hubs – the Empire State Building, Penn Station, Port Authority, etc. – one bomb threat after another kept setting off building evacuations. A bomb threat at Grand Central Station was called in. The adjoining buildings, including the Grand Hyatt just above the station, were evacuated. Dorothy, who that beautiful morning so long ago had had her face lifted, who had slept through probably the single most traumatizing, deadly day in the history of America, who was healing with bandages on her face in a hotel suite on the forty-fourth floor, was escorted down the elevator by Giselle, my nighttime nurse assigned to her. In the further surreality in front of the Grand Hyatt, standing there all bandaged up, a young policeman approached Dorothy, probably assuming she’d been injured in the chaos of the day.

  “Ma’am, do you need a doctor?” he asked.

  Dorothy shook her head, wrapped in an Ace-like bandage.

  “What a day,” he said.

  She nodded. “I missed most of it,” she said quietly.

  “Lucky you,” said the cop.

  The Limitations of Plastic Surgery

  The youn
g, beautiful wife of a director of one of L.A.’s most prominent museums came to me, wanting her near-perfect breasts lifted and slightly reduced.

  “Don’t,” I told her. “Leave them. It won’t improve them very much at all. You’ll be left with scars. The improvement is not worth it. Please reconsider.”

  She went to a colleague of mine, who did it.

  A year later, she came back to me. Her breasts were flatter. She had wide scars. Her nipples were numb.

  “Fix them,” she begged, verging on tears.

  I could improve but not eradicate the scars, I told her, and I could partially correct the volume loss of her breasts. I could not restore the sensation to her nipples.

  She was beside herself.

  From the outset, you know some patients will never be happy. Others, you can’t tell. Only afterward do you find out how unrealistic they were about what plastic surgery was going to do for them.

  You didn’t pull me enough. You didn’t take out enough fat.

  One man with a 34 waist came in for lipo. Then he sued me because he felt uncomfortable in size 32 pants, even though I had never promised he would go down a pants size. (The case was thrown out.)

  Sometimes, postoperative denial sets in. Jason’s nose had deviated more than an inch to the left. That’s not a misprint – an inch – having been broken several times from basketball injuries and biking. I corrected it significantly. After the surgery, it deviated to the left four millimeters. It was as aligned and symmetrical as I could get it. Any more wasn’t possible because the scar tissue and the thickness of the cartilage limited what I could do.

  “You can do better,” Jason insisted.

  “Actually, I can’t,” I told him. “It’s the best I can do.”

  Despite the major improvement, Jason was unhappy – angry actually. I showed him his pre-op photos so he could see how far we’d come.