Diary of an Eye Job
Thursday, October 24
With her dark hair, wide mouth, and strikingly sexy, big brown eyes, thirty-year-old Dana Oster, an anesthesiologist at New York Hospital-Cornell Medical Center, seems an unlikely candidate for an eye job. But seated in the Fifth Avenue office of plastic surgeon John E. Sherman, MD, Dana and her husband, Jonathan, are firming up the last details for her laser transconjunctival blepharoplasty - the permanent removal of fat from under the eyelids - scheduled for the next day. Since she arguably does not require any alteration, Dr. Sherman makes his case vigorously to me. "You can see the pockets she has," he says, gesturing to moderate puffiness beneath Dana's eyes, which makes her look, if anything, a little underslept. "That varies depending on how much fluid she has - whether she's premenstrual or she's eaten Chinese the night before."
Dr. Sherman lists the advantages of the operation for Dana: Since the laser - rapidly replacing the scalpel as the instrument of choice in plastic surgery - will incise the conjunctive, the pink membrane on the inside of the eyelids, there will be no visible scarring; since the laser's heat cauterizes blood vessels as it cuts, there will be minimal bruising; and, because of Dana's age and the relative elasticiy of her skin, she will not require laser resurfacing on the outside of her lids, as some patients do, to make her skin retract after the fat is taken out. Ectropion - a turning out of the skin of the lower lids that can be caused by the removal of too much skin - is a serious potential complication of the operation, Dr. Sherman explains, but he says he's never heard of it happening to a young patient with this method. "Of all the operations we do," Dr. Sherman says, "this is the most predictable. In sports terms, it's a slam dunk. You don't see patients like her. She's got great eyes. She looks great before the operation, but she'll look even better after."
Later the Same Day
The Osters and I walk from Dr. Sherman's office to a nearby coffee bar, where Dana talks animatedly about her decision to have the operation. Since she sees critical surgery patients as well as cosmetic ones in her own work, she's aware of the risks involved in any kind of operation, and describes herself as "conservative as far as elective procedures go." She has mixed feelings about plastic surgery: "I might look at someone and be, like, My God. Her fifth boob operation?" she says. "But if they derive something from it and it helps them internally, you really can't judge. I try not to, anyway."
Dana says she's been aware of the bags under her eyes since she was a child but has never been acutely annoyed by them or felt they were a tragic physical flaw.
It's the kind of thing where I would say to John now and then, 'Look at these bags under my eyes,' she explains, shrugging. Still, when Dr. Sherman, who occasionally works with Dana at Cornell, noticed her eyes were puffy above her surgical mask and approached her one day about having the operation (and offered his services gratis), she began to consider it seriously - and put her fears and biases about cosmetic surgery in perspective. "I thought about the whole need-versus-want thing. I mean, I don't really need this," she says. "But I weighed the risks and benefits, and there aren't a lot of risks: It's not an invasive procedure. I'm young, I'm healthy. There's minimal bruising - I won't have to miss work." She pauses. "It's kind of like having a mole on your face. It's not a big deal, but if it bugs you and it's a minor thing to take it off - why not?"
When I ask her if she's anxious about the surgery, she shakes her head firmly and says, "I'm calm and excited to see the results. That's all."
"I just hope I don't lose you," John sniffs theatrically. Dana laughs and rolls her eyes. "Shut up."
Friday, October 25
Dana, wearing a pink surgical gown, is lying on the able when I enter the operating room in Dr. Sherman's office; though she's smiling, her former calm has dissolved. "I'm so nervous!" she cries. As the anesthesiologist inserts an IV into the back of her hand, Dana, who has only had anesthesia once before, confesses that, for her, the experience of being sedated is a funny mix of busman's holiday and science experiment. "All day long I give people these medicines and I wonder, What the hell do they feel?" she says. The anesthesiologist pumps the first part of a mix of drugs - analgesics and anxiolytic-into the IV, and Dana tries to gauge her reactions clinically: "I feel it: It's a calming effect. Thoughts are separating." She is quiet for a moment, then says, slowly, "Wow. Wild. Unbelievable." When Dr. Sherman, dressed for surgery in green scrubs, green rubber clogs, and a red calico beanie, sees that Dana is sedated (he calls it "the margarita effect"), he and a scrub nurse place corneal shields - metal disks like oversize contact lenses - on her eyes to protect them. Dr. Sherman injects local anesthetic into Dana's lower lids and turns on the Three Tenors.
Using a smooth metal hook, the nurse lifts Dana's right lower lid away from her face to expose the conjunctiva. Dr. Sherman takes up his laser - a pen-like tool connected by a long, flexible metal arm to a large generator - and begins making cuts in the tissue. (As promised, the laser's incisions are eerily bloodless.) Using tweezers, Dr. Sherman begins pulling out pieces of lumpy, pale-yellow fat that look - there is no nicer way to put it - like chicken scraps; he then runs the laser's beam back and forth over the fat until it detaches, sealing the blood vessels at the same time. (This part of the procedure causes a small amount of smoking and sparking and since the smoke - essentially vaporized tissue - could conduct viruses, another nurse holds the hose of a smoke retractor near Dana's eyes.) Dr. Sherman removes nine corn-kernel-sized balls of fat from under the right eye, and then he repeats the procedure on the left, taking out roughly the same amount. Just as I'm beginning to be able to uncurl my toes, Dr. Sherman removes the corneal shields, pushes back his stool, and declares, "We're done." (Since the conjunctive heals quickly, Dana does not require stitches; the entire procedure has taken about twenty-five minutes.) Dr. Sherman points to the areas under Dana's eyes, which are notably flatter, and, beaming, says, "Look at the difference in the contour. See where it goes down now? You can see the outline of her muscle. You couldn't see that before. Great, huh? We always end in time for this" - he raises his hands to indicate the Three Tenors' rousing finale and shakes his head, as though genuinely baffled by his luck. "We have fun here. I can't believe I get paid to do this."
Friday, November 1
One week after the operation, I visit Dana at Cornell, where she's taking a break between surgeries. Her hair is tucked under a mesh net, and, even so, she looks beautiful. There is a faint yellowish bruising on the skin below her eyes, and while her lower lids are still swollen enough to cover the bottoms of her irises, she looks exactly like herself - only maybe a bit more alert and well-rested than she did before. She says she still feels mild tightness and tenderness around her eyes and that her vision is slightly blurry. (Dr. Sherman has reassured her this will disappear as soon as her eye muscles fully recuperate.) In general, though, Dana is pleased with the results - overwhelmingly so. "The swelling went down a day later; I was back at work on Monday. I started exercising again four days after the operation." A few people at work noticed the bruising, she says, but, generally - and happily - the results are apparent only to her. "I don't see the bags anymore, which is just kind of cool," she says, smiling. "It's something that I know is different. And I'm glad it's nothing more dramatic than that."