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July 2, 2015

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J. Patrick Coolican:

Learning to be more understanding toward people getting cut, pricked and needled for beauty


Leila Navidi

Patty, who did not want her last name used, is a volunteer patient for a live demonstration of dermal filler use by Dr. Phil Werchler of Spokane, Wash. during the American Academy of Cosmetic Surgery Annual Scientific Meeting at Caesars Palace on Thursday, January 17, 2013.

J. Patrick Coolican

J. Patrick Coolican

American Academy of Cosmetic Surgery

Patty, who did not want her last name used, is a volunteer patient for a live demonstration of dermal filler and neurotoxin use during the American Academy of Cosmetic Surgery Annual Scientific Meeting at Caesars Palace on Thursday, January 17, 2013. Launch slideshow »

On my way to the cosmetic surgery convention, I walk through the smoky, low-ceilinged, bad-for-your-skin, older section of Caesars Palace. Then I pass some renovations and new construction that aims to keep the aging brand vibrant and then the giant statue of Caesar, who is perfect and ageless and long dead.

Finally, as I near the American Academy of Cosmetic Surgery’s annual scientific meeting, I am greeted with a standing cardboard advertisement that depicts an attractive woman, mature, wearing a beautiful, white silk dress gathered above her knees as she leaps into the air. “Why TriPollar is my treatment of choice for cellulite.”

“Turn Back Time,” the ad commands.

It would be easy, far too easy, to go all high dudgeon on this convention, to be the preening moralist who decries an industry that preys on vanity while real medical needs go unmet.

“Don’t underestimate the effects these visible signs have on patients,” says Dr. Suzan Obagi, the president of the Cosmetic Surgery Foundation and a professor at the University of Pittsburgh Medical Center.

“It is remarkable to make these patients feel better about themselves,” she says, noting survivors of accidents, diseases and dog bites. But there’s the rest of us, too, watching hopelessly while gravity and chromosomal reality cruelly decide our aesthetic fate.

So let’s go with an open mind and try to see the world through the eyes of the patients, who suffer the arrows of age and imperfection, and the doctors who treat them.

Americans spent nearly $10 billion on cosmetic procedures in 2011, about 60 percent of that in surgeries, according to a different trade group, the American Society for Aesthetic Plastic Surgery. According to market research company IBISWorld, we spent $21.4 billion on dermatology and cosmetic procedures.

Women had 92 percent, or 8.4 million, of all cosmetic procedures, surgical and nonsurgical. Breast augmentation was the most common surgery.

The first day’s breast seminar is almost entirely men, on the stage and in the crowd. Phrases such as “ inframammary fold position,” “mastopexy” and the ever-frightening “capsular contracture” — a complication when the immune system reacts to the foreign material of the implant — are bandied about.

A Seattle-area surgeon who has the kind of jaunty humor you’d expect from a man who gets paid significant sums to do breast augmentation is teaching “Choosing the Right Implant.”

Both saline and silicone have their own advantages, but “in Seattle,” he says, “silicone is king.”

But if you screw up and select the wrong size or type of implant, you could wind up with “rock in a sock.”

He compares the work to a high-end shoe store, where of course they’re going to pick the right fit for you.

Breasts are just one part of cosmetic surgery. The conference offers seminars on liposuction, genital procedures for both men and women, hair restoration, face lifts, tighteners and fillers.

Like all scientific conferences, the language is technical and jargony: A seminar promises “Chin Augmentation with Laser Liposculpture Improves Cervicomandibular Definition.”

But on the exhibit floor, products are pitched more simply, such as the “Vampire Face Lift.” The company uses a centrifuge to spin out red blood cells from the patient’s drawn blood, leaving behind what’s known as “platelet-rich plasma,” which promises healing powers that are yet to be proven.

Then a pen-like instrument with rotating needles pricks at your face, causing “micro-injuries.” Finally, the plasma is applied, filling the wounds and -- theoretically anyway — restoring the face to some of ts original beauty.

The Vampire Facial costs $500 to $800 per treatment, with one to three treatments recommended, though the change is supposed to be more permanent than the paralyzing toxins such as Botox already in wide use.

Kim Kardashian received the Vampire in Miami recently. The tabloids told me that.

I meet a salesman for Restoration Robotics, which has a robot that does “follicular unit extraction,” meaning it pulls out the hair in the place where you have it and puts it in the place where you need it. The “harvesting” takes about three hours.

In a ballroom, doctors are working on real demonstration patients, who lie motionless while the dermatologists and surgeons repeatedly insert needles into their faces.

“See that deep line like someone took a hatchet to her?” one asks.

They are applying “toxins” that straighten lines by way of paralysis. Odd that they haven’t come up with some euphemism like calling a Ferris wheel an “observation wheel” — even though the products have been deemed safe, the cosmetic medicine folks still just call them toxins.

Working around the lips, a doctor warns, “I find out if they play a wind instrument or sing because obviously they won’t be able to do that” due to the lips’ decreased flexibility.

Then they inject “fillers” because faces, especially among people with leaner builds, start to hollow out. Most notably, under the eyes, in what’s called the “teardrop trough.”

Backstage, Obagi notes that whatever we learned in school about judging people on the inside, it’s a fantasy, and of course she’s right.

“Consciously or not, you’re going to judge me, and I’m going to judge you by the way we look,” she says. That is why she’s happy to use her gifts to make people happier by helping them, as she says, “age better.”

Some of her patients are middle-aged and older women in the job market, already facing the glass ceiling, who say they need the competitive edge of cosmetic procedures. Who are we to judge them?

Obagi posits that people who frequently contract the muscles in their glabella region, the little space between the eyebrows and at the base of the forehead — we are the world’s scowlers — are treated differently.

“When you soften that, it changes not just how you feel, but how people treat you,” she says.

She says when the scowlers are treated with a toxin to the glabella, their rates of depression decline. No one is sure why, but it might be because the world interacts with them differently, less harshly. Sort of like if you just practice smiling a lot, you’ll wind up happier.

I ask her to diagnose me. What are my imperfections, and how can I fix them? She says I’m losing fat in my teardrop trough, so I need a filler. Also, I’m developing permanent lines — “worry lines” — on my forehead, which could be fixed with a toxin.

That I have these lines is not surprising. They probably come from my fixation on death, decay and loss.

I again think of the standup cardboard advertisement and its catch line: “Turn back time.” Ultimately, sure, this convention is about slowing or reversing aging and looking as good as you can even though it’s all sagging and drooping and hollowing.

But it’s also about who we were and what we might have been but will never be. We long for the past, to correct the regrets and relive the joys, and this is as close as we’ll get.

Not a week ago I was reading David Foster Wallace’s “The Pale King,” and the narrator describes what he calls “the same basic fear that you and I have and that everybody has except nobody ever talks about it ... that time is always passing and that every day we’ve lost one more day that will never come back, and our childhoods are over and our adolescence and the vigor of youth and soon our adulthood, that everything we see around us all the time is decaying and passing, it’s all passing away, and so are we ...”

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  1. "It is remarkable to make these patients feel better about themselves," she says . . . . ."Consciously or not, you're going to judge me, and I'm going to judge you by the way we look," she says."

    Coolican -- "she" keeps the fashion industry and parasites like these in business. I think it's a severe character flaw to live by other's opinions, especially those unspoken. For some of us accepting the tyranny of the herd is unacceptable.

    " little does the common herd know of the nature of right and truth." - Socrates in Plato's "Euthyphro" (399 B.C.E.?)

  2. JPC: Did you include "hair restoration" in your calcs on men's expenditures for cosmetic procedures? I'm always amazed at what they will go thru trying to have 20-something hair. They'll keep the paunch and butt but will spare no expense for hair.

  3. Thanks to the alert readers who pointed out, some friendly, some of course insulting, "dudgeon." One said I should blame auto-correct in the publishing software. Let's go with that.

  4. Leaving external beauty as a mating attraction element, there is a social context that serves to benefit some people in achieving goals and wealth, for both men and women. I also leave out those who have severe defects or injuries that necessitate cosmetic correction.

    The more money and power one has, the more expectations of the importance of external appearance, especially if it is linked to a more youthful appearance.

    Let's not forget how much products and advertising does to make people feel they are at a disadvantage, or they are less and need to buy and do more to be happy. This represents a huge financial consideration of business.

    Those who achieve greater financial wealth have the money to gain and keep the image they believe they need or want.

    That is just the way it is in society now, right or wrong.

    Does that mean that people who cannot throw money at plastic surgeon's are losers? NO!!! Perhaps they are even bigger winners going beyond the facade.

    Accepting reality, and working within it, offers the opportunity to find some deeper values in life such as building character, focus on developing their own sense of self worth, growing in moral values that help cement relationships with others, and learning to see people for who they are rather than how the look.

    When people can see the heart and soul of others, they are wealthy and others are beautiful.

    No matter what appearances are, or how little or how much money people have, all are capable of contributing to needs of others in one way or another. The heartfelt helping of others is one thing that serves to bring out beauty and it attracts others to see the character of a person, rather than the outer facade. External appearance resides in the shadows with the sincere expression of love given to others.

    The Opinions forum is a unique example. There is no view of physical appearance. The words written expose the character and values of people. How do we see the writers? Are there more layers to peel away beyond the surface? Will changing the facade help, or distract? Depends on many things.

    Can cosmetic surgery be an illusion? Can it sometimes ruin the unique external beauty of a person? In my opinion, yes. An example for me is Barbra Streisand and Cher. I really liked their natural appearances. They stood out in their own beauty, and not they are more like the crowd. What a pity!

  5. Enjoyed the article, Mr. Coolican.

    But I seem to have a different take than a lot of other people do regarding this issue.

    To take a chance and reveal a little about me....

    In 2007, I was diagnosed with a life threatening cancer. Squamos carcinoma. Deep within my nasal area.

    The doctor informed me that I would either have to lose my nose.

    Or lose my life.

    I calmly informed the doctor that I guess I'm not going to be nosy anymore.

    To make a long story short, after surgery, and subsequent chemotherapy, coupled with radiation therapy, I am happy to say that I have now enjoyed over five years of extra life.

    Certified to be cancer free.

    I don't place emphasis on cosmetic surgery. Because I am disfigured, I have placed an emphasis

    I'm still alive.

    I may not be much to look at with my bandages that I have to continually wear.

    But I'm alive.

    Life is precious.

    Believe me.

    To back up my story, the LV Sun had asked me in the past if they could do a story on me. Because I have a nasty habit of commenting to articles on the LV Sun website.

    I declined.

    Because a percusor to the story was to have a picture taken of me.

    I guess what I'm trying to say is...

    Don't matter what you look like....

    ....just enjoy life.

    Not trying to be dramatic, but take it from me.

    I am indeed enjoying every second of life. It is precious.

    What you look like is of no consequence. It's your inner self.

    And life.

    I'll say it again. Believe me. Life is precious. I'm living proof.