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game face

Pssst. Come closer. Let me tell you a secret most women of a certain age seldom reveal: I had a face-lift.

While aging gracefully and accepting lines as facial character is a noble goal, is just isn't coming easy to this 50-ish baby boomer. If only my brain would age in sync with my body, perhaps I wouldn't register shock every time I look in the mirror and catch the reflection of a middle-aged stranger. Call me superficial. Call me insecure. Call me honest.

I've been milling over the idea of surgery ever since my rendezvous with the big five-O, but the idea of elective surgery and the associated risks was a scary proposition. I've heard the horror stories about face-lifts gone wrong and seen those plastic surgery patients who ended up looking like totally different people (Ivana Trump, Linda Tripp, Roseanne Barr...) Suppose I start with a facelift and get hooked? Michael Jackson or Jocelyne Wildenstein probably began their insatiable quests with one little nip and tuck. Will I know when to stop?

The thought of looking "done" makes me cringe, too. A friend asked me at a party recently if I could pick out the two women who had face-lifts. Unfortunately, it was easy. Both had that permanent walking-through-a-wind-tunnel look.

Cosmetic surgery is a frequent topic of conversation among my closest friends, who agreed to "talk" for this story only if I promised to change their name, race, the car they drive, the name of their dog or any other remote clue to their identity. I've never understood why so many women who've done "it" maintain a zipped lip. Is it that they can't bear to admit the depth of their vanity or self-centeredness, deep enough to shell out thousands of dollars just to look younger when that kind of cash could house the homeless or feed the hungry? Or is it some crazy one upmanship—that somehow for the grace of God they've escaped gravity's wrath while the rest of the population grows jowls? "We all agreed to grow old gracefully. Then I found out some of my friends were cheating," says the headline in a recent ad touting the benefits of collagen.

"The world isn't a pretty place for older, unattractive people," laments Tammy, a 59-year-old attractive divorcee. "Like it or not, good looks open doors. Being attractive is an additional power, a tool used in both business and social situations. When a woman's looks start to fade, she loses a power she was used to having, along with her self-image."

"Times haven't changed. The double standard is alive and well," says Judy M., once a stunning 62-year-old grandmother who describes herself as the invisible woman. "In my youth I turned few heads. Now if heads turn, it's to look at my Lexus," she laments. You know the drill. Everyone knows at least one paunchy middle-aged guy who's run off with a perky preschooler. Hollywood enforces this ugly reality with every romantic pairing. Richard Gere at 50 was paired with Julie Roberts at 32. Warren Beatty at 61 teamed up with Halle Berry at 30. Ouch. A recent No Nonsense pantyhose commercial features an aging, attractive wife meeting her husband's stunning, much younger assistant. The closing line is, "We know how it is." I bet they sell lots of pantyhose.

Nationwide the business of looking good is booming. The number of cosmetic surgeries tripled from 1992 to 1999, thanks mainly to people like me. "A baby boomer turns 50 in something like every eight seconds," says Dr. Walter L. Erhardt, president of the American Society of Plastic Surgeons. "As a group they're the folks who really got into health and wellness. It's only natural they'd want to continue to look their best." Liposuction is the most common procedure followed by breast augmentation, eyelid surgery, face-lifts, and tummy tucks. The over-65 set is opting for instant remedies in record numbers, too (a 113% increase from 1992 to 1999).

But according to Dr. Erhardt, whose practice is based in Albany, Ga., surgery at an earlier age when the tissues are healthy and the skin still has some elasticity gives you a better, longer-lasting result. "If a woman waits until 65 for her first facial rejuvenation and has a lot of lax skin and loss of tone, laxity could develop and she may need a touch-up after a few months," he warns. "You almost never have to do that on someone in their 40's and 50's."

"Do it," advises Debbie V., a liposucked, face-lifted, Botox-injected, 50-ish friend. "We exercise to stay in shape, use makeup and dye our hair. What's wrong with embracing the latest available medical technology to look less tired and more attractive? These days, plastic surgery is good grooming, it's like brushing your teeth."

Checking Out the Doctors

I make appointments with several plastic surgeons in the Baltimore/Washington area. Some offer free consultations, others charge a fee that is deducted from the surgery. This is no time to skimp. I arm myself with a long list of questions and a big fat notepad. It occurs to me, we ask more probing questions when interviewing a housekeeper who may scrub our floors than a doctor who may cut open our face.

It's buyer beware. Shortly before my appointments I see a scary TV news magazine program about dermatologists, OB/GYN's and even dentists performing cosmetic surgery after attending just a few weekend "how to" seminars. As crazy as this sounds, there are no laws requiring doctors who offer specialty care to meet certain qualifications. All they need is a medical degree to call themselves plastic surgeons and join an increasingly lucrative business. All cosmetic procedures are paid in full, before the doctor picks up a knife. There's no waiting for insurance reimbursements.

The TV show stresses the importance of using a plastic surgeon certified by the American Society of Plastic Surgeons. And it warns about walls of fancy looking certificates from a lot of boards that may hold little meaning.

Medical school and residency history are important to me, too. Accuse me of being a snob, but my face is not about to be pulled off its frame by someone who did his residency in Siberia. I want a background along the lines of Harvard or the Mayo Clinic.

I began each appointment with one question: "If given the chance, what would you do to make me look younger?"

One doctor recommends so many procedures, including an endoscopic brow-lift, Gore Tex insert between my eyebrows, mid face-lift and more, that I feel I've have to change my passport photo. Total projected cost: $19,375.

Another turns out not to be board certified. No way Jose. Yes another has had so much work done on his own face, he looks like he slept in formaldehyde.

Then, there is the Great White Hunter. While a doctor's private time is his business and doesn't determine his surgical skills, this guy's hobby is a total turnoff. His office walls are decorated with mounted dead birds. The feet of some rather large animal server as bookends, and he proudly shows me photos of himself next to a dead elephant he killed on safari. Next, please.

A Washington friend recommends Dr. Albert Fleury Jr. in Chevy Chase. She describes him as a conservative. "You won't look done," she promises. She should know. She looks fabulous.

While not nearly as old as TV's Marcus Welby in his heyday, Dr. Fleury projects the same kind of warmth and compassion. His credentials fit the profile I want: A graduate of the Georgetown University School of Medicine; a clinical assistant professor in plastic surgery at the Georgetown University School of Medicine; past chief of the Division of Plastic Surgery at Sibley Memorial Hospital; a fellow of the American College of Surgeons; board certified by the American Board of Plastic Surgery.

Equally important, I like him. He doesn't oversell. In fact, he undersells. "You don't need a brow procedure. I don't think your brows is particularly low, and you don't have deep forehead wrinkles." Less than 15 percent of Fleury's patients have brow-lifts, a procedure that can frequently result in the startled raccoon look. Since each procedure is sold separately—brow-lift, mid face-lift, eyes—I just saved big bucks.

A mid-face lift is his Rx. "When you get jowls your face looks square. Eliminate the jowls, your face looks oval," he tells me. "When doing a face-lift I have three goals: get the cheeks up, eliminate the jowls, straighten out the jaw." He shows me before and after photos of former patients along with pictures of typical bruising and stitches. The incision looks neat and tidy, not as bad as I'd thought. He advises me to take two to three weeks out of my schedule for the procedure. If there is an important occasion coming up, allow two months for scars and swelling to dissipate.

Assessing the Risks

It is time to talks risks, which according to Fleury, fall into three categories: unexpected bleeding, wound healing problems and nerve injuries. "Around 5 percent of patients who have face-lifts will have some collection of blood after surgery," he explains. "It may give prolonged bruising but no serious problems. A smaller percentage—1 to 2 percent—will have enough bleeding within 24 hours with paint and discomfort to return to the operating room where I can find out what was bleeding; stop it and re-suture. Nerve injuries are rare, less than 1 percent, and almost all return to normal in six to 12 weeks. Healing difficulties occur 10 to 25 times more often with people who smoke.

"With cosmetic surgery of any kind, one in 10 people need a touch-up," he explains. "Something did not meet either your or my expectations and we need to address it. It's impossible to predict which patients are going to have complications."

I like his honesty.

The trend these days is to have cosmetic surgery in a doctor's office. Doctors call them 'surgical suites.' But to me, they are still offices, and the thought of having a three-hour operation in any place operation in any place other place than a hospital makes queasy. Fleury gives me the options of having my surgery at Sibley Memorial Hospital in Washington. For about the same cost as a night at a fancy Ritz-Carlton ($545), I could stay in a great hospital with 24-hour room service and a staff of nurses and doctors nearby, just in case. Plus, I wouldn't have to schlep home and drive back the next morning to have the dressing changed and drainage tubes removed.

I tell Fleury that anesthesia is my No.1 fear. I obsess over the risk of not waking up. I don't want my obit to read, "she died from face-lift complications." How embarrassing. While Fleury uses "twilight" anesthesia, he prefers general and thinks it is more comfortable for the patient. "Ninety percent of my patients go to sleep. Anesthesia in healthy people is very safe when administered by an anesthesiologist," he says. Many doctors use an anesthesiologist service; they never know which anesthesiologist will show up on a given day. Others use nurse anesthetists, not MDs. For me, only a plastic surgeon who uses an anesthesiologist he knows and trusts, in a hospital setting, will do.

We set a date. My "before" pictures are taken. I read the scary form:

"I understand that this operation is not an emergency, nor is it medically necessary to improve or protect my physical health. I have been advised that all surgery involved general risks including but not limited to bleeding, infection, nerve or tissue damage and rarely, cardiac arrest, death, or other serious bodily injury. I acknowledge that no guarantees or assurances have been made as to the results that may be obtained."

Either I have guts or I'm nuts: I sign.

I am given a three page list of vitamins, herbal supplements, over-the-counter and prescribed medications to avoid 10 days prior to surgery. Some of those so-called "harmless" herbal supplements can cause bleeding problems and affect clotting. He recommends taking Arnica Granules, a natural herb available at Fresh Fields, to minimize bruising and swelling. I am given a prescription for an antibiotic to take a few days before surgery to prevent infection.

Under the Knife

I wake up on Monday shaking, and am at Sibley by 5 a.m. The Valium I take an hour before surgery must be a placebo; it doesn't soothe my jitters. My hands tremble as I hoist the tight elastic stockings up my legs, a necessary precaution to prevent blood clots. Even as I climb aboard the operating table I consider chickening out, but my practical side thinks of all the money I will lose. The table is soft and warm. I say something like, "drugs, please," and off to La La Lands I go for 3½ hours. Prior to this procedure the longest I've been under anesthesia is one hour, and it felt like seconds. This time when I wake up in the recovery room, I know I've napped a lot longer.

My eyes are gooey and blurry, full of some ointment to prevent them from drying during surgery. (Eyes open when you're under anesthesia.) The blurriness goes away in a few hours. I don't feel pain, just tightness under my chin along with relief. I survived.

My headdress looks like something straight out of a movie scene. A friend says I look like "The English Patient." Two plastic receptacles, which I call my little Chinese lanterns, are pinned by each ear. They are attached to two drainage tubes inserted into my neck. I ask for a painkiller whenever I feel any discomfort. It takes about an hour for the drug to kick in, and this is no time to be a martyr. I drink ginger ale, bottles of it. I don't want to feel nauseous and my mother used to say ginger is good for settling the stomach. It works, I feel fine.

Day 2, I wake up with a mild sore throat caused by the tube used for anesthesia. I am told it will go away in a day. It does. I feel as if a very tight elastic sling is stretched from under my neck from ear to ear. I can barely open my mouth. Sips of soda or juice are all I can manage. It will be three days before I can brush my teeth.

Fleury arrive at 8 a.m. to replace the big bulky headdress with a smaller version and to remove the drainage tubes. I figure they're just tucked under the skin behind my ear. He starts to take the first one out and keeps pulling and pulling while more tubing unravels out of my head. I think about that old circus gag where dozens of clowns keep coming out of a tiny car and have a little laugh to myself. Surprisingly, this doesn't hurt, it's just a weird sensation.

Time to look in the mirror. My reflection isn't as bad as I expect. While I am swollen, I can already see a dramatic improvement. My turkey neck is gone. At least 5 to 10 years have been snipped off. I am amazed at the lack of pain.

I'm told to keep the elastic stockings on my legs for two more days. (I wear them for three, just to be safe.) Maybe it's the euphoria over having the surgery over with, but I feel great. After a liquid breakfast I dress and wait for Terry, my companion and designated nurse, to pick me up. My girlfriends didn't think a guy would be a good caretaker, but they were wrong. He knows all my favorite ice cream flavors and fetched them at oddball hours. While he never says much, I think the idea of me looking younger as a result of his efforts is good motivation.

Because we live an hour's drive from the doctor and hospital, we stay at the Embassy Suites hotel in Chevy Chase for a few days, just in case. This also means the convenience of room service, plus we can stroll along Wisconsin Avenue without running into neighbors.

On the third day, we take a three-block walk to the doctor's office. All bandages are removed and Fleury cleans around my incision. Even though I saw pictures of what the incision would look like prior to surgery, it's strange to see this extraordinary line of stitches on 'me.' It begins by each temple, travels along the front of and along the cartilage of my ears, continues behind my ears up to the lower scalp. Another incision is under my chin.

The doctor gives me anti-bacterial ointment to apply, and the nurse takes pictures. I get the green light to wash my hair. While I am eager to wash away all this gook around the incision, I'm also afraid. I wait an extra day before standing under the shower.

I graduate to grits for late breakfast, have soup for lunch in a restaurant on Wisconsin Avenue, stroll the Pavilion shopping center and down a frozen yogurt on the third day after surgery! All that anxiety for nothing, I think. My face continues to feel as tight as an elastic band around a watermelon. I am afraid to turn my head, fearful that stitches will snap and my jowls will fall down. "Most patient complain about tightness. That's because of the stitches underneath that are holding things up," says Fleury. He assures me that my stitches will not snap if I move my head.

I rarely take painkillers throughout the day, usually just at night to help me sleep. (It's hard to sleep propped up on a half dozen pillows to reduce swelling.)

Back Home, Day 4

Getting antsy. Impatient. I know, I know, it's only four days after surgery. But since I feel so good, I want the swelling to disappear and the results of my effort to start showing. I still can't open my mouth wide enough to take a bite of a sandwich. Still can't floss my teeth although I do manage to brush. I brave washing my hair. Energy is a little low, so I putter about, reorganizing the closets. Occasionally I get a shooting pain under my chin or on the side of my head caused by the healing of nerve endings.

Fast forward: Two weeks later. I conceal my stitches with makeup and my hair and attend a neighbor's party. No one knows I've had surgery. I am still a little swollen, but not enough for anyone to detect. A miracle, I think.

Two months later. I'm thrilled. For me, the surgery was a cakewalk. I had no bruising. No bleeding. No complications. The skin under my neck and along the sides of my face still feels numbs and firm, about the texture of a doll's skin. I have a significant lump on the back of my head where one of the drainage tubes was inserted and a small lump at each of my temples. I continue to get an occasional shooting pain caused by those nerve endings. I'm told these after effects should be gone in another month.

My doctor says I am at the leading edge of the curve. "Most women have at least some bruising," he says. For me the worst part was the two weeks of jitters prior to surgery when I filled my head with all those 'what ifs' that, thank God, never happened.

Would I recommend it?

Sorry, that's too personal a decision. There are all those nasty risks and considerable expense. My procedure cost $8,600. But the reality is that we are all living longer, and if it's true that baby boomers can expect to reach 125, we'll probably need all sorts of transplants. Someday buying a lifted face may be no different from getting a new knee or a pacemaker. I like to think I'll face those surgeries with my best face forward.

Published in Style magazine, March/April 2001
Written by Mary Ann Treger