Put on your best face?
I was watching a late-night talk show recently and the featured guest was Gwen Stefani. I was never a big fan of her music–even though she’s very talented, no doubt– except for a cover she did of a Christmas favorite, Oi to the World by The Vandals. It‘s right up there with Joey Ramone’s Merry Christmas, I don’t want to fight tonight.
I didn’t recognize her. At all. Her face was so cellophane-y, her eyes narrowed to a severe squinty Japanese parody, her hair wicked, wicked blonde and ironed board straight, her lips like Cupid’s balloons. I couldn’t believe it. She used to have such a pixie-punk appeal, an almost whimsical snarl, and the charming chirp of an underfed weasel. WTF?
So, I did some research into plastic surgery and here’s some of my takeaways: it dates back to the Egyptians in 1550 BC, but was almost always war-injury reconstruction and not purely cosmetic, all the way up and through WW II. And for a long time after. In fact the Botox boom only started in the past twenty years or so.
A quick digression: when I lived in Africa botulism was a real and feared disease, and we boiled everything, while the Egyptians were bathing in and drinking Nile water like, well, water. As recently as 1999 and 2019 outbreaks of botulism in Alexandria where I lived killed over a hundred people. When I was first told people were injecting it into their faces, voluntarily, I thought it was a joke.
Let's start with rhinosplasty (nose job) since it’s the most common. The aesthetic nasal segments are: the dorsal (bridge), sidewalls, tip, alar-nostril sill (nostril), the soft-triangle (interior nostril), and the columella (nostril bridge). The three main procedures are: lateral osteotomy (narrowing), medial osteotomy (bridge reduction), and supratip break sculpting to create the cute and coveted “button nose.”
Moving down to the filtrum and the lips. Upper tooth show on repose usually means a short filtrum. A Botox “lip flip” causes the muscles to relax and means less exposure. That’s true for lower lip show too. Unfortunately, your kissers can become asymmetrical, misshapen and cartoon balloons, so be careful.
If you look at a human skull, the face is mostly cavities, not bone, and sphincter muscles cover those holes and provide protection. Again, insert another "ass" joke here. I won't.
The “Ponytail” is a sub-cutaneous facelift (surskin only) using a minimally invasive endocropic procedure to tighten the face and minimize the incisions in front of the ear, the anterior temporal points, because of the potential of hairline shock loss–hair falls out due to surgery. It’s safe from a motor nerve perspective since it’s only performed on the gliding plane (top three skin layers of the face). But less invasive = less effective and less lasting.
The five layers of the SCALP are: skin, subcutaneous, and aponeurotic–which are collectively known as SMAS (superficial musculo-aponeurotic system), then the loose areolar tissues, and finally the periosteum, filled with nerves and veins and all sorts of complicated anatomical stuff that we won't go into here.
The technical name is a rhytidectomy, which literally means “getting rid of wrinkles,” so a facelift is really a misnomer–it only repositions tissues with the result that the skin is smoothed out. It doesn't lift anything, except maybe your spirits. Or your wallet out of your purse or pocket.
For a deep-plain facelift, the surgeon starts with a lateral incision around the ear, and often a submental incision along the crease under the chin, to better fix neck-skin laxity, adiposity, and the platysmal bands that’ve formed due to the midline dehiscence of the muscles. "Turkey neck" is a witty descriptive that describes the condition. While he’s there, the surgeon can also increase, decrease, or smooth out the gonial angle of the mandible (jawline), typically between 100–130 degrees, for a more chiselled look.
But first he releases the four main ligaments: zygomatic, mandibular, masseteric, and cervical retaining. This will relax the platisma and SMAS and allow him to smooth the face into place and remove the excess skin. He can then suture things up nicely, with no tension. The incision is well-hidden in the hairline, with minimal shock loss, and a bevelled-incision.
The deep-plane facelift also affects the nasal labial folds, those nose to mouth flaps that always remind me of Burt Lahr’s jowly and high-hairlined, come to think of it, Cowardly Lion.
There are other a la carte menu items to choose from: an upper blepharoplasty (eyelid lift) increases upper tarsal show (of the superior tarsal muscle known as Muller’s muscle), while canthoplasty reshapes the corners of the eye–also known as “almond eye” or “cat’s eye” surgery. This procedure raises the lateral canthus (outer corner) since it tends to sag as we age, to make it higher than the medial canthus (inner corner) so tears can flow. And they might.
Crow's feet can be eliminated with a little finesse of the scalpel a this point. The surgeon can also sculpt the glabella, the space between the eyebrows, as well as tighten the lateral frontalis, the muscles on either side of the forehead, to raise the eyebrows, which for almost all of us have gradually sagged due to brow ptosis. He might also reduce upper eyelid dermatochalasis which is the excess skin and fat of the upper eyelid that usually accompanies eyelid ptosis. This makes the eyes seem rounder and bigger.
Asian blepharoplasty or double-fold surgery does something similar, making Asian eyes more Caucasian by introducing folds into the obicularis oculi since they don’t have these features.
There are tons of other procedures, big and small, demanding constant upkeep and expensive maintenance, with the same bottom line, the illusory goal of all women it seems: to look like a twenty-six year old white hooker. But trust me on this – I've known many, and they absolutely should not be anyone's paradigm of anything, ethics especially.
I'm being facetious, of course, but there are many other pervasive body modification procedures that are also just as invasive if not as immediately obvious since they are, well, since you can't see them written all over someone's face. I'm talking about botox, boob jobs, and hair implants to name a few. And steroids and tattoos and piercings. Teeth capping. Laser hair removal. I could go on, but where does the healthy pursuit of perfection end and body dysmorphia begin?
I understand the human desire to be the best version of ourselves, and that sexual attractiveness is biological mate-selection down to the very marrow of our bones. There’s no getting around that. Anatomy is destiny, as Freud said, even though I don't mean it in the same way he did.
Not to end on an easy, glib note, but seriously, in today's topsy-turvy times a friendly smile from a young woman, unadorned with anything other than her own innocent naturalness, has to be one of the most beautiful things in the world.
Engraving is from De Curtorum Chirurgia per Institionem, "On the Surgery of Mutilation by Grafting," by Gaspare Tagliacozzi, 1597.