Harvey Austin
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Ch. 1
Ch. 2
Ch. 3
Ch. 7

The Uplifted Face
by Harvey W. Austin, MD

CHAPTER 7spacer gif[chapter_7.pdf]l

The Reactions of Intimates

spacer gifNo one has cosmetic surgery in a vacuum. It occurs, rather, in community. Your community may be small, as a couple or a family. More often, cosmetic surgery is an event that your circle of friends and relatives become aware of — either before or after. Most patients discover, sometimes to their chagrin, that people know.

spacer gifMany of my patients hope they can keep their surgery secret. No one wants to be judged — and found lacking. But secrecy doesn't work well. Insisting on secrecy is a waste of energy and may mean that more important things get dropped out. Like having an appropriate support person close at hand in the days immediately after surgery. Or moping inside the house so no one will see you when it would be better to get out of the house and take a walk or be with friends. Friends are a resource, unavailable to the secretive.

spacer gifOne fifty-year old woman let it be known that she was going to visit relatives for a month in Florida. Instead, she had a face lift and her eyes done. She came home under cover of darkness to hibernate for that month. Her plan backfired. She lived in an open suburban neighborhood on a winding street with houses lawn-to-lawn. Early one morning, about a week post-op, she scuttled out to the mailbox. She was spotted by a neighbor. Shortly after she "returned from Florida" looking oh-so-refreshed, her neighbor invited her to tea. During the visit, the neighbor sadly informed my patient that her husband had been playing around while she had been gone. "The whole neighborhood knows it," she confided. "And I saw her with my own eyes, too. One morning this bimbo had the gall to sneak out to get his mail for him!"

spacer gifI worry if a patient seems overly secretive. It can point to a lack of trust, not only of others, but often of herself. While I can understand a healthy reluctance to "tell the whole world," I don't want secretiveness to detract from the result. And it can.

spacer gifThere are a whole group of people who have an interest in your decision to have cosmetic surgery and how it turns out. Spouses, parents, children, and friends.

spacer gifSpouses

spacer gifMy practice is 90% women . About half are married. Many of the others, whether single, divorced or widowed, also have a "significant other" in their lives. There are three basic responses from their husbands or lovers when women confide their interest in cosmetic surgery.

spacer gifThe Great Response

spacer gifThe first (and best) response sounds something like this: "I love you the way you are. But if this is important to you, then I support your decision."

spacer gifAha, a healthy male. Pray for one of these. Here's a man who knows the difference between you and him. He is interested, loving, caring. And is not likely to be a real pain in the ass if some small thing goes wrong post-op. He will be supportive. He will listen.

spacer gifMany times, this husband — or lover (I'll use the term, husband for convenience) will accompany her to the initial consultation, or, if not, to the pre-operative visit. He wants to meet the surgeon and feel comfortable with the whole set-up. He stands up and shakes my hand when I come in. He sits quietly, letting her speak for herself without interruption. From time to time he nods in agreement to something she says. I can sense him smiling. He is on her side, I think to myself. Good! Just to check it out, I usually ask him how he feels about her having cosmetic surgery. Again, he affirms his love for her decision. He often asks a couple of questions letting us both know he is on the team. Good questions. Sometimes, if I sense she might be a little too nervous to hear some of what I am saying, I might turn to him and ask him to remember some of the things we speak of, so he can remind her if she should forget "I'm so relieved you brought him into it, "one said by way of thanks. "I already knew he was in my corner, but it was still nice to hear him say so to someone else. To another man."

spacer gifThe Devastating Response

spacer gifWomen have sometimes told me the response they most dread is their husband's disapproval. That can be tough to deal with, to be sure, but there's one even worse. Fortunately, it is also rare. How would you feel if, when, after careful consideration, you told your husband you were thinking about having a face lift. And what if he said, "Well, thank God. It's about time! You've been looking lousy for years."

spacer gifMany women show up for consultations not having told their husbands. Some feel, I suspect, that it truly is none of their husband's business and have no interest in defending their actions and decisions to him. "It's my face and my life. I will do with it as I choose," one explained. Of course she's right, and she got no argument from me, but sometimes there's an edge in her voice which has me wonder about the quality of their relationship.

spacer gifMany women like to gather information, check out their own feelings, get their ducks in a row before discussing cosmetic surgery with their husbands. "Otherwise", they tell me, "He'll start asking all kinds of questions I won't know the answers to, and if I'm not certain myself yet, I'll start feeling overwhelmed and just give up on the whole thing." I understand this. Though I am a personal advocate of the "half-baked idea," most men are not. Men want fully-formed ideas presented in a logical and complete manner. They say they want to hear "the facts" and are impatient with process. Well, facts are fine in detective work or in the engineering realm, but facts alone are simply not enough in the realm of well-being, self-esteem and cosmetic surgery.

spacer gifSometimes it is better not to involve husbands in the initial consultation. Some should be brought in at a later stage. But it's always a good idea to bring a friend. What you forget she will remember. And she can be a big help in "sorting out" your thinking about what procedures to have — if any.

spacer gifThe Dreaded Response

spacer gifHow about the husband who says, "Cosmetic surgery? Don't be ridiculous! Why would you want something like that? You look just fine to me!

spacer gifSuch remarks stir up mixed emotions. On the one hand, to the women it's flattering. They are surprised to hear that their husbands have any opinion at all about their appearance. They had begun to wonder if their husbands even looked at them any more. On the other hand, many feel hurt and embarrassed. When they tell me of such a response, I am embarrassed for them. There's so much ownership implied in that remark. As though the only reason a woman would want cosmetic surgery is for her husband. I can sense subjugation and disempowerment behind that telling comment. I can also feel the pain of a woman admitting to another person, particularly a man, that her husband feels he owns her. She's almost in tears. As I.

spacer gifI want her to stand up for herself and go right home and tell him, "What's wrong with you? What has my looking fine to you got to do with anything? I wasn't put here on this planet simply to look fine to you!"

spacer gifYes, I want her to take him on, to confront his subjugation. Let him know that she is a fully-functioning, legitimate, fully-licensed human being in her own right and who does he think he is to assume that her appearance is dependent on his approval? Never mind his basic lousy attitude, or the fact that he thinks that he is in charge of the money because he makes more than she does, even if he doesn't. Hell, at this moment, I'm ready to take him on, put out his lights. The son of a bitch!

spacer gifAs I write this, I am furious and practically in tears. I am in touch with what I do for a living and what I have done all my life and what my life is about. I can see that my overly strong point of view about women regaining their own power is my issue. It is about wanting my mother to have her life back. And it is about my guilt for the role I played. It is about her no longer putting up with my father's abuse — and even my own abuse when I was in my teens. Hell, I probably began saying nasty things to her even before I was a teen. For I was indeed my father's son.

spacer gifShe was a quiet woman, my mother, a gentle woman. A woman, who at age 26, left her six sisters and her mother's household to get away from an alcoholic and abusive father. I doubt she knew she was marrying into a different kind of abuse. To my father and later, to us kids, she was a door mat. She catered to my father and felt his words lash her and never did anything to fight back. "Mom, stand up for yourself," my sister and I would urge in whispers when the verbal abuse was at its worst. "You don't have to take that from him." Yet I am my father's son, and on some level I sided with my father. I believed him when he told her she was stupid. She must have believed him, too. She said stupid things, it seemed.

spacer gifOne time, she looked at a car and wondered out loud if it was a Ford or a Buick. It must be a Buick she concluded. It was a Ford. And then, I realized, it was always a Ford! She guessed wrong one hundred percent of the time. I never noticed it before. Do you know what it takes to guess wrong every single time? It takes a very sharp mind to make everything that comes out of your mouth sound totally wrong. Up until then I could never figure out how such a stupid woman could wind up with my very sharp-minded father. Nor could I ever figure out why she always won at the Grange Whist. Whist is tough. I am a pretty sharp guy, but I am a lousy whist player. I can never remember what cards have been played. Of course my father wasn't there for those contests. He didn't care about whist. Not too surprising, I guess. Why would he want to be around anything my mother did well? It might violate his precious ideas of his supremacy.

spacer gifI guess it's pretty clear that I don't like disapproving husbands, particularly myself when I do it.

spacer gifO.K. A little more rationally now. So… on the other hand… have a certain compassion for husbands. I know that they're deeply frightened.

spacer gifAnd that their disapproval is a way to mask their fear.

spacer gifLet's first look at what disapproval represents, particularly in a close relationship. Disapproval is a manipulative device. It is designed to manipulate another's actions. So is approval. In fact, I do not need your approval for any action in my life because it is my life, not yours. You, likewise, do not need my approval to take an action in your life, because it is your life, not mine. I was not put on earth to approve or disapprove of you. Nor the reverse. While approval is one of the classic ways of shaping children, I am not commenting on its dubious value for that purpose here. I feel that manipulating via an approval/disapproval mechanism is not appropriate for the relationship between adults

spacer gifYet, husbands and wives sometimes act as if they have the God-given right to approve or disapprove of the each other's actions. This thinking is rampant in our culture.

spacer gifIf I sense I have permission, I often tell women this about their husbands. "There's something you may not know about men," I begin, "because virtually all men enter into a great conspiracy so you will never find out. It is this: Men are terrified."

spacer gifOf what, the woman asks, puzzled. "Everything," I reply. "Simply everything. What do you think that all our macho is designed for? To hide the terror. Why else?"

spacer gifI usually wait a few seconds for that to sink in before continuing. "So here is what the bottom line is — for all men I know. Of course your husband could be the only exception" I smile. "Their secret internal conversation would sound like this if you put it on loudspeaker, 'If my woman gets any better, why would she stay with a creep like me?'"

spacer gifSometimes the woman gives me a dubious look. I shrug. "Check it out, then. But don't ask him — he will feel threatened and deny it. Just listen to him and watch his body language when you broach any subject that resonates of self-improvement."

spacer gifBut there's an even deeper reason for men's defensive reactions, and on occasion, women's too. It is imbedded deeply into our very language and our marriage vows — so deeply that it unspoken and extraordinarily powerful.

spacer gifTo illustrate, suppose I asked you to bring me some water. Most likely you would hand me a clean glass almost full of cool water. The same request to "bring me some water" could have been fulfilled by your bringing me a bucket of dirty water and dumping it on my head. Technically fulfilled. But not really, because the request, "bring me some water" carries some cultural information with it. It carries the implied information of "glass" "clean" "cool" and "handed." Unspoken, implied and all the more powerful for being invisible.

spacer gifIn that same vein, the marriage vows have spoken words — "love, honor… in sickness, etc." The ceremony also contains certain unspoken but powerful vows which, if kept, tend to promote harmony. These same implied vows, when broken, will not only enrage the partner but do so in a way that neither partner is likely to know why all the anger.

spacer gifIt would seem that there is an unspoken powerful vow operating in a marriage: I promise I won't change. At least, not any faster than you. This is not a real problem for most marriages, because in most marriages both the partners are committed to things staying the same. To most of us humans, change is threatening (especially when we don't initiate it and sometimes even when we do). So in most marriages there is a pull to non-change which keeps things the same. And bland. There's nothing wrong with this. It's just the way it is for most of us.

spacer gifBut people who are actively considering cosmetic surgery are not "most of us." Cosmetic surgery takes a certain commitment to change, courage and creativity. These are not common commodities. And often they are present in one, but not in both partners. So what's a poor husband to do when his wife is considering a major change and he's still the same old, same old? Change himself? Not likely. The best he can do is cross his fingers, put a smile on his face, step out of her way and hope to hell she's not going to leave him. But he can't usually say that. He's just too frightened.

spacer gifAnd this is the good picture of the frightened husband. Many men are not up to this "best" version. They respond — well, actually they don't respond. They react. A response is a considered phenomenon. A reaction is more of a knee-jerk. Automatic. These husbands react in the gut-level primordial way of any animal threatened with the loss of something necessary. They behave the same way they did at the age of four when another kid grabbed their truck — and haven't a clue they are doing it. Their reaction might show up as:

  • Withdrawing, sulking — the silent treatment. Denying there's anything wrong. It then becomes your job to find out why he's upset.
  • Disparagement of your wish to change, which may come out as, "What's the matter with you? You having hot flashes or something?" Or, sarcastically, "I thought you had your mid-life crisis last year."
  • Invoking the deity, as in "for God's sakes why would you want to do something like that?" or "Why would you want to do something like that?. It's unnatural. God made you the way you are. Cosmetic surgery goes against God."
  • Verbal attacks. "It's who you are inside that counts, not what's on the outside. That's just the superficial stuff. Too bad you think so little of yourself that you think you need to change."

spacer gifThey are unable to tell you their hidden truth, which is, "I'm terrified that if you change you might leave me. I'll do everything I can to prevent that. Including putting you down." This truth is unspoken, but dominating, lurking beneath the bravado.

spacer gifIf you can hold his terror with compassion and have the space for him to tell the truth (and if in fact you are not planning to leave him) — then his telling you the truth can open up some enormous space in your relationship.

spacer gifOn the other hand, if you are indeed getting your ducks in a row for a grand exit, I don't have any more to say about him. You're gone and he's dog meat.

spacer gifBut if you're staying, give the guy a break and have more compassion for him than he has had for you. One of you has to be big about it. And you're elected. You're the one who's planning to change how you look, the one intending to break the unspoken vow.

spacer gifYou might begin by telling him that you know that change is fearful business. Perhaps such an acknowledgment will open up a stuck area of communication for the two of you and lead to a discussion about powerful background vows. Such conversations are uncommon in most marriages. But just because something is seldom mentioned does not mean it does not exist. Bringing such topics to light may enrich you both. It's a little known fact, but husbands can change too.

spacer gifOver Time

spacer gifAs the weeks pass after surgery, as your face "settles in" — as the odd feelings and the sense of looking a little "off" disappear — you will begin to focus less on how you look. Make-up will go on easier, you will spend less attention on your hair, less attention on "that last damn spot" that seems slowest to heal. And you will simply be yourself. Your new face becomes your new reality — as if it had always been that way.

spacer gifYou will even forget what you looked like before — until you run across your pre-op photos. Suddenly, you will have the two "you's" side by side. It can feel very strange, because standing simultaneously in two realities is disorienting. You will have the memory that you did indeed once look like that "before" person, feel like that person. But you are likely also to be in disbelief. One woman told one of our nurses, "My instant reaction to those before-photos was that they were pictures of my mother I had never seen before. But then I knew they were me but I was confused when they could have been taken. O.K., I told myself, they are the pictures I had taken in Dr. Austin's office. But my next response was anger because I knew I never looked like that. Finally it sunk in. They really were me and I did look like that. I felt embarrassed. I ran to the mirror to be sure I didn't still look that way. I didn't, thank Heaven!"

spacer gifYou may discover two things. First, you may find you have a younger, prettier outlook on life. Not just a shift in your look, abut a shift in outlook. And a better attitude toward yourself.

spacer gifThe second is that your husband has also changed. He might be acting younger, a little more frisky perhaps. Less crusty. And just generally nicer. How odd, you think. Why on earth would that happen? After all, you had surgery, not him. But as one man explained, "It's like you switched my wife for someone just like her, only better." He continued, "I notice I'm proud of her. Not that she looked bad before, but now she looks really great and it somehow reflects on me. I feel better about myself that my wife looks so good. Is that so odd?"

spacer gifNot at all, I told him. I suspect that this results from one of the basic laws of life: We become what we put ourselves around. So your husband abruptly finds himself around a younger, prettier, more alive-looking and alive-acting woman. So he, unconsciously becomes that way, too. A nice side-benefit to cosmetic surgery — you get to be more like you… and he also gets better. Not so bad.

spacer gifThe husband of one of my patients whom I shall call "Jackie," wrote to me trying to get a grip on how his relationship with his wife had changed after her cosmetic surgery.

spacer gifIn the weeks since Jackie's surgery I'd been dimly aware that there was something new about her. The other night at the dinner table I decided to tell her straight. "Jackie," I said, "Do you realize you haven't said anything sarcastic or gotten your feeling hurt by anything I've said in weeks? It's been wonderful being with you."

spacer gif"Thank you," she said. "How could I be hurt when you look at me that way? How could I be sarcastic?"

spacer gif"What way?" I asked. I turned and looked at myself in the mirror. The face I saw was smiling and soft. "Like this?"

spacer gif"Yes, exactly. You have been looking at me that way all week."

spacer gifI realized then that I now relate to her as though she totally approves of me. Perhaps because she looks like she approves. I was there when she asked you to help her look as youthful and as attractive as she could be. She felt her sagging face, down-turned mouth and hollow eyes made her look haggard, and perhaps they did, but to me she looked disapproving. And I guess I took it personally.

spacer gifNow she looks vibrant and alive. Her mouth is inviting and kindly and her eyes are wide open and sparkling. I love looking at her. I am fascinated by her face. Here is this new gorgeous face and I love it! Her voice rings softer on my ears. She smiles at the things I say, rather than frowning, as she had in the past.

spacer gifTo me, she is a different woman. Sure, my mind tells me this is the same old Jackie, but my experience is different. This is a new Jackie. I can't really explain it, but being around her makes me feel new too.

spacer gifParents Hardly Notice

spacer gifParents hardly notice. "Oh, Hi, Honey, how are you?" Mom answers, taking your packages, oblivious to your new nose.

spacer gifRuth had been dreading telling her mother about her face lift and kept it secret for months. She didn't want her mother to be disappointed in her yet again. She had more fear about visiting her mother than she did about having surgery. Before the visit she braced herself for her mother's disapproval. She thought she was prepared. But she was completely unprepared for the reaction she actually got. Nothing. "Nice to see you, dear," her mother said. "How's Herbert?"

spacer gif"It was so odd," Ruth told me. "I mean , I really do look ten years younger. It's obvious in my pictures and in the mirror. But my mother never noticed. Can you believe that? I don't think that woman has really looked at me since I was twelve." She kept shaking her head in disbelief — and in disappointment.

spacer gifWe hear such stories so often that we've concluded Ruth must be right. Mothers do not see you the way you are. They keep looking at the picture of you they carry in their head. Some daughters are relieved when their mothers don't notice. "I finally got away with something," Betty reported proudly. "I was such a goody-two-shoes most of my life that it felt good to leave my folks out of it."

spacer gifBut Ruth was unprepared for the hurt she felt about her mother's non-response. Later on, she told me, "I was upset at first, but now I'm glad she didn't notice. I realize I had projected a lot of attributes onto my mother that weren't hers at all. They were mine. I had gotten her and me mixed up. It's much clearer now. I came across the term 'differentiation' the other day. It seems to describe what's happened to me out of this. I feel more whole and not so much Ruth/Mom any more."

spacer gifDads are a different story. I don't hear much about them from our patients. I gather that women see fathers as showing up as one of three basic types: the adoring kind who gives a lot of positive strokes; the controlling kind who has strong opinions on every aspect of his daughter's appearance — her hairstyle, her weight, her clothes — and the silent kind, who seem not to notice how his daughter looks, not commenting unless prodded. One said of her father, a silent type, "I knew he loved me, bus after I hit puberty, he'd never really look at me," one explained. "It hurt my feelings something awful. I felt rejected. Then, around the time I got married, he warmed up again. He could tell me I looked nice without getting all embarrassed. Which is what he said the first time he saw me after I had my eyelids done. I asked him why and if he noticed anything different. 'New hairstyle?,' he said, clearly guessing. And then, get this: 'You look more like your mother every day.'"

spacer gif"I could have punched him, but I could see he meant it as a compliment. And he didn't mean my mother as she looks now, pushing 80. But some younger version he carries in his mind."

spacer gif"Back in junior high I realized I had to learn to live without his approval of my appearance, so after a while his unawareness didn't really bother me. I even found it funny that he didn't really see me. He sees me the way I looked when I was in the Girl Scouts. I'm not sure I really see him either. I remember telling my college friends that he was really handsome, with dark hair. When I went home for the weekend I saw that his hair was thinning and mostly gray."

spacer gifOther women have told me their fathers don't want to know they've had cosmetic surgery. They may think of such information as too feminine, "… as if I were talking about a change in my eyeliner or my bra size," one explained. Or, as another put it, "My dad would rather think of my improved appearance as a sign that my life is going well. That I'm happy. So he doesn't have to worry about me." A third said, "When I tried to tell my father I had recently had some work done. He cut me off, saying 'Well you look just fine to me." I felt caught in a weird time warp — he acted as if I was asking his permission — beforehand."

spacer gifFathers of single daughters are more likely to comment on their grown child's cosmetic surgery. According to one patient's theory, this is more so if the daughter is divorced rather than never having married. Her thinking is that a divorced woman who has cosmetic surgery seems to signal that she is opening herself to the possibility of another relationship with a man. This brings out the protectiveness in fathers. One father seemed overly worried how his 40 year old daughter was healing "I'm sure he didn't realize it, but he treated me like damaged goods," she said. "His comments on my face got all mixed up with things that were never said as I went through the divorce. I finally realized I just had to stay away for a while until I made peace with my new face. Funny thing was, when I finally visited again, looking wonderful, he was clearly in my corner. It was as if he'd never been anxious."

spacer gifChildren Get Upset

spacer gifOften a woman chooses her daughter as her support person. The mother-daughter team usually works out quite well, but there are two dynamics that can raise real conflicts. The first can occur when the daughter is so tightly bonded that, during the post-operative period when the patient loses perspective, the daughter might also lose her perspective.

spacer gifI recall Joan, 58, who, in spite of our saying otherwise, still hoped — nay, expected — to have every single wrinkle of her heavily wrinkled face disappear. She was upset when there were still some present. She was certain I had done a poor job and was angry about it. Harriet, Joan's daughter and support person, was angry too. Even though Harriet and I had agreed, privately, that Joan was stuck in unrealistic expectations, when in the exam room with her mother, Harriet invariably got sucked into Joan's anger and upset and found herself matching it. Harriet even spoke in the exam room as though she herself was the patient rather than her mother. She continued to drive Joan to biweekly follow-up visits long after Joan could have driven herself. Over the year-long follow-up, they continued to operate at this symbiotic level.

spacer gifThe second dynamic is more common. In short, when parents have cosmetic surgery, their kids go nuts. By this I mean is that the children, regardless of age, often find themselves upset when they look at their mother's swollen and bruised face. More upset than if it was a friend. Their upset seems to be about more than the swelling and bruising, for the upset often continues for weeks or months after the bruising eases. On questioning, mostly we hear some variation of "She just doesn't look my mother anymore." Exactly. There's something lost — the familiar look of mother. And the child takes it very personally.

spacer gifThe key word is "… my …" The upset is not about the mother and how she is healing, or even whether the surgery has improved her appearance. It is personal and about the child. It is as though mother has broken a promise and the child resents it. Just as the unspoken wedding vows seems to be "I promise not to change," so, too, grown children sometimes relate to their parents as though the parents had made a similar but slightly different promise — that they will never abandon them. That they will always be there for them, be predictable, and never change. Long after we have become parents ourselves, many of us do not really realize that our parents have lives, loves and desires of their own, apart from us.

spacer gifA personal example. When I was 45 my father came to visit my wife and me. Pop and Mom had been separated for thirty years, non-divorced only because of her Catholicism. Pop had brought with him his current girl friend, an attractive woman blonde woman a little younger than I. I was a little shocked at this but covered it up by laughingly referring to her, for some reason I no longer remember, as the "upstairs maid." She and my father slept in the guest room in the basement.

spacer gifThe next morning as I was walking up the sunlit stairs from the basement, she leaving their bedroom, joined me and we walked up the stairs together silently, side by side. She leaned toward me slightly. I remember her blonde face turning and her smiling lips seeming to move very slowly as she enunciated each word distinctly, burning these words into my memory. "Your — father — is — quite — a — man."

spacer gifI was stunned. I looked at her, opened my mouth to speak, nothing came out. The world had stopped. I had one of those profound moments of realization that… until that very moment… I believed my father had no other role in life than to be my father.

spacer gifSo, when we come across an adult child who seems upset, angry, or distant as a response to a parent's surgery, we speak with them gently about the special upset that children have when their parents change. We let them know that it seems to be universal and not just confined to them. We suggest that they go off quietly and close a door and get in touch with their inner child who is horrified by what is happening and terrified that mother has left — and cry their anguish.

spacer gifThe irony here is that the mother imbedded in the child's memory is long gone by the time the child becomes an adult. I noted earlier that some parents don't seem to notice their children's cosmetic surgery. In fairness I have to add that some children don't notice their parents' surgery either. Just as they don't really notice their aging. (Like the patient I mentioned earlier who "knew" her father had thick, black hair.) Sometimes, a child, returning home after a long absence, and forgetting that time has also passed for their parents, are shocked that their parents now look like their grandparents

spacer gifThe knowledge that a parent has cosmetic surgery may disturb an adult because it suggests (or worse, documents) a life outside their parental role. And no matter how old or young the parent is, the very act of having cosmetic surgery carries a sexual message. An act that makes children uncomfortable.

spacer gifOf course having cosmetic surgery doesn't mean that a person is preparing to go on the prowl. But the very fact of improving one's appearance through medically unnecessary surgery suggests a certain vitality, an attitude toward life that is, in itself sexy, whether the person chooses to act on it or not.

spacer gifFriends — Who They Are, and Who They're Not

spacer gifFriendships have not been easy for me. I find them both easy and hard to write about. Easy because I have thought a lot about them, feeling envious and on the outside. And difficult at the same time because I'm still not sure I know much. My guidelines when young were few. To me, a person whom I considered a friend one day might beat me up the next. I trusted no one and had almost no friends. And I never knew why.

spacer gifWhen I was grown, my first father-in-law told me that a man is lucky as he goes through life if he has even one very close friend. So, from time to time over the years, I considered myself fortunate that I finally had a close friend. Of these six or so individuals, only one remains close to this day. He has been my best friend for years. Perhaps he and I have stayed close because I finally understood the basic rule of friendship. I didn't understand this rule for the others and so maybe that's we are no longer close. While this rule may be obvious to you, it was not to me. But it operated as a basic rule of life, regardless of how blind I was to it.

spacer gifFriendships disappear. It's like the rule, things fall. Thud. That's why we have tables and shelves. To keep things from falling. Because things fall. Sure, the table prevents things from falling but tables and shelves do not violate the rule. They both obey the rule and their very existence points to the rule.

spacer gifWell, friendships disappear. Same way. When nothing is put in to block the disappearance — friendships disappear. Unless there are metaphorical tables and shelves to keep that from happening, friendships simply fall away. But for a long time, I didn't know that. I thought that once a close friend, always a close friend and I didn't need to do anything to have that continue. So I seldom called and many times didn't return calls or even send Christmas cards. And I thought that that those actions would not have any consequences. Very foolish. Not only did I do nothing to put a table in, I kept moving the table out of the way. No wonder I had no friends. I was a bad friend. Actually, because I contributed nothing, I wasn't a friend at all. I was all take and no give.

spacer gifSo now it looks to me that friendships disappear from inattention and neglect. But there seems to be another reason also, and this is if the balance of the friendship is thrown out of whack. The friend changes. Actually, of course, each of us is always changing. But we change in different degrees and at different rates. Too much change and the friendship cools and may eventually disappear Take the extreme case where your close day-to-day-on-the-phone-confiding-friend marries a man you don't like and who doesn't like you — then moves 3000 miles away. The friendship is likely to fade or disappear, unless the two of you find a way to preserve and reconnect with what brought you together in the first place.

spacer gifAlmost every woman I've mentioned this example to has had an experience like it. And sometimes the friendship goes away forever. As one woman explained, "I guess I decided she wasn't really the person I thought I knew after all. I simply could not include this jerk she married in the picture. For a few years I waited to see if she'd come to her senses. But no, she adored him. I thought she had changed but apparently that aspect of her was there all along. So maybe I changed. I saw what I had not seen before — or at least got to the point where I could no longer ignore it."

spacer gifOther women tell me they have preserved friendships in instances where they didn't like their friend's husband by finding ways to have "just us girls" weekends, during which, by mutual agreement, mention of either of our husbands was off limits.

spacer gifI bring up change and friendship as preparation for what your friends might say or do after you have cosmetic surgery. Most of my patients report that their friends are really supportive. But not always. Sometimes friends are really bad after cosmetic surgery.

spacer gifMostly, I think, it depends how aware each of you is about what your friendship is about or what it takes to maintain it. Sometimes those whom we call good friends are not; we are wishful thinking. She might be dancing to quite a different drummer. She might even be a jealous enemy posing as a friend for her own reasons.

spacer gifBut let's about friends who really are friends. As a man, women's friendships are a mystery to me and I am envious. It seems to be so easy for one woman to call another, whereas when men call each other, it is a project. There has to be a reason. If a man calls another, it raises the question of the purpose of the call. And we have to get to the purpose quickly so we don't waste his time.

spacer gifI am envious how, walking into a room, I sometimes find women being easy with each other, maybe touching or whispering and giggling. I want to join them and be a part of it. But when I walk over, it stops. They look at me with a question. I have no answer. Once or twice, I tried saying I just wanted to be there with them. They assured me that was O.K. — but the dynamic had shifted, replaced by the strange awkwardness of my presence.

spacer gifI know it has something to do with the masculine tendency to "solve the problem and get on with it" when the "problem" doesn't ask to be solved. But it's more than that. There's a different energetic. And I can't just drum that one up. At least not this time around. Maybe next incarnation.

spacer gifBut among women, just as among men, there are background, unspoken agreements. One is the same as for spouses — I promise I will not change, at least not any faster than you. There's an evenness in the relationship that needs to be maintained. One woman spoke of it as a "gentle tit for tat." Another said that friendships rely on a "kind of balance." It is possible that you, by having cosmetic surgery, have unwittingly broken some background promises. Perhaps these:

  • You promised not to change. Then you did. If only by upsetting the previous balance.
  • You promised to give your friend a certain amount of attention. Then you got caught up in the healing and, for a while, didn't have much attention to give. (If your friend has not had cosmetic surgery, she may find this especially difficult to understand during the weeks when you look fine on the outside but are still in what we call the weird stage inside.)
  • You promised you wouldn't look any better than she does. Now you do.
  • You promised you would never show her up by doing something that she was scared to do. Then you did.
  • You promised you wouldn't do anything that would have their husband look at you "that way." Then you did. And she saw him look.
  • You promised to check with her first about something as important as this. And you didn't.

spacer gifSuch unspoken promises are part of the fabric of your friendship whether or not you are conscious of them. By having cosmetic surgery, you have done something that threatens the balance of the relationship. So there are likely to be consequences.

spacer gifOn one hand, she might handle her hurt by being really straight and confronting you directly. Hope for this. It's clean. It hurts but it can also open the door to a frank discussion of feelings on both sides. Your friend's candor can provide an opportunity to make the friendship more solid than ever. As long as it does not happen so soon after surgery that you're unable to muster an honest reply,

spacer gifMore likely, though, your friend's anger and resentment may show up less directly. From her unconscious bag of tricks may come a device that attempts to restore the equilibrium. Unconscious and automatic. If you are aware, you will notice. You have seen them before. She has used them on others in the past — and probably on you. Or you — and she — might be blind to them. So you will be blindsided.

spacer gifThese "adjustment strategies" may be as subtle as a raised eyebrow, a faintly disdainful tone, a hesitation of touch, a subtle holding back of approval. You know the stuff. You may even have done such things yourself. Especially when you've been hurt. They may show up as apparent sympathizing with you when you are upset about some swollen or bruised area, but with your "third ear" you hear a smug "I told you so" quality to her words. Another way is "damnation by faint praise." As in, "Oh, no … really … you look nice… and your nose is really much better." (You didn't have your nose done. You had a face lift.)

spacer gifOr the consequences may be as blatant as "forgetting" to visit you like she promised.

spacer gifSuch reactions can seem especially hostile or acute if you are the first one in your crowd to have cosmetic surgery. "Not only did I have surgery, but my friends sliced me up too." Painful.

spacer gifAnother of my patients says a friend's reaction to cosmetic surgery is likely to depend on whether she expected to have been told beforehand. And it's the way she feels, rather than you. "As girls," my patient says, "we tell each other everything. Or at least we operate on the expectation that we tell each other everything. No secrets. From each other that is. But we don't share everything with every friend.

spacer gif"There may be some you feel free to discuss appearances with and others you don't. I know one woman who cooled toward someone she had previously considered a friend because that friend told her she ought to get Collagen for her forehead wrinkles. I think maybe there was something fault-finding about the way she said it"

spacer gifEach of you have to address the question of whether to tell a friend that you are considering cosmetic surgery, have already decided to have it, or are recovering from it. And each friend is different. If a friends thinks you and she are particularly close, and if you've had recent conversations where you could have mentioned that you were thinking about surgery, she's likely to feel foolish if she finds out some other way. It has nothing to do with whether or not she likes your results or would like to have some work done herself. It's the sense of deceit that stings. She feels wronged.

spacer gifIf you upset a friend by not confiding in her, and she lets you know that, consider it an opportunity.

spacer gifI would suggest that you not retort in kind. Consider just staying vulnerable and letting her know how awful you felt about yourself when you looked in the mirror ahead of time, perhaps telling her how frightened you were by the prospect of having the surgery. Speak about the emotions you had when the bandages were removed. Tell her what it's been like to go through the swelling and the bruising and the weird feelings as you heal. Be very vulnerable. And let her know you love her. That you need her friendship just as much as you did before.

spacer gifIf you're willing (and able) to be vulnerable, you'll know what to say. Try to, in the face of your obligatory self-concern during the post-op period, stand in her shoes. (Of course you shouldn't have to. She really ought to understand without your saying so. But she probably won't. So it's probably going to have to be your job. After all… it really was little old you who broke one of the unspoken promises.)

spacer gifLook at the relationship and at yourself. Were you honorable or cowardly? Did you hold back for fear of her disapproval? To protect her from your greater affluence? Did you fail to tell her as a pay-back for something in the past?

spacer gifAgain, I'm not suggesting you're under any obligation to tell anyone.

spacer gifAnother consolation.. You are on your way to becoming a different person than you were before. After surgery your physicalness has shifted, your experience has shifted and your outlook has shifted. Your entire personal process through life has changed direction. You have, as a close friend put it "… not just moved from one side of the train to the other like most people do. You have gotten out in front of the train and laid new track. So your train is going in the direction you want it to go." You will, from this new vantage point, re-evaluate everything in your life, including who your friends will be.

spacer gifYou won't even need to work at this re-evaluation. It will occur on its own.

spacer gifNow let's look at the issues of friendship and disclosure from another perspective. How can you be a good friend to someone who has cosmetic surgery, even if she didn't tell you ahead of time?

spacer gifThere is your reaction — and there is your response. Reaction is automatic. Response is considered. Patients sometimes cry in my office because they have had too much to contend with after surgery. Not only their own reactions but the reactions of their spouses, their kids, and their friends. Their own reactions are tough enough to handle. No matter what we tell them, we can't really prepare them for how they're going to look in the days immediately after surgery. They may have a hard time with the bruising and swelling, the rawness of any resurfaced area, the hard-to-the-touchness of it. It doesn't look right to them. It doesn't feel right.

spacer gifWhen your face doesn't look right, or when your face doesn't feel right — you're NOT right. And all the reasoning in the world can't keep the terror at bay. Your own emotions may blindside you with their power. So, quite simply, your friend is nuts with emotion, terror and imagining. She is wrapped very tight trying to hold it all together. And she may feel compelled to stare in the mirror, sometimes for hours, as if she could watch herself heal. Your sweet friend is a bit insane.

spacer gifThe stage is set. And then you come along. She might look just fine to you. But perhaps not. It depends on how recent the surgery was, what she had done, the particular way she is healing, and how much experience you've had with the healing cycle. It will affect what you see.

spacer gifHere's a worst-case scenario. Let's suppose you see her early -- say at five days or maybe even at ten days or two weeks after surgery. She is still swollen and bruised, and she looks a little weird. You are stunned. Omigod, you think. I thought she had cosmetic surgery to look and feel better. She looks awful and feels worse. What do I say? What can I say?

spacer gifYou are at a fork in the road. Will you ask, "What will be helpful?" Or will you scream and carry on, pull your hair and tell her how terrible she looks and how could she have been so stupid in the first place — thus acting out that which she is trying to avoid? And worsening the situation.

spacer gifWill you go with that reaction? (You might be more likely to do so if you feel hurt that she didn't tell you ahead of time she was going to have the surgery, you feel she should have, and you haven't examined that hurt. Spite is powerful.)

spacer gifWill you react, or will you call forth an appropriate response? Will you be like the kindly teacher seeing one of her children with the scraped knee? Will you be like the good surgeon who, upon first gazing at the torn-up patient in the emergency room, takes a deep breath, lets a cloak of calm settle about her, and walks in quietly, her manner reassuring all — nurses and patient alike?

spacer gifEach of us can access this cloak of calm. This calm in the face of the storm, which says, "Aha. A response is called for here, not my emotional reaction. My friend must be in great distress. Of course. And I will be with her in her distress, for I know who she is and that she can handle this. And I know that this swelling and this bruising and this fear will pass. And I will be with her as she goes through its passing. This is about her, not about me. I will have my own emotional reaction — later, elsewhere — and I will need someone to comfort me, too. But not now. Right now compassion and understanding and kindness is called for. And I am capable of providing it. And I shall."

spacer gifBlessed be you for such a reaction. Each of us is capable of it, this selfless putting aside of our right to our reaction and standing inside an other-centered response. From time to time this is called for in life — from us for another. From another for us. And, as adult human beings, we can choose to respond this way. It is a choice and we are each capable of making it.

spacer gifHere is an opportunity to step into a larger set of shoes. Here is the place, the fork, where Shakespeare asked, To be or not to be? This is exactly what he meant. Here, like many other places in life, there is the opportunity to take an existential stand for who we are.

spacer gifThis is also an opportunity to examine yourself. Look at your reactions to her. Then use these check out your own feelings and attitudes toward yourself, toward aging, toward your body, toward change and courage, and finally, toward cosmetic surgery.

spacer gifAll these things will pass. Cosmetic surgery does really make you look better. Redness fades, swelling disappears, bruising disappears. It takes a while. Fortunately, afterwards you look better. Then, much later, you feel better too. As a quick guideline, you look OK to others in about three weeks. But you don't feel OK for three months. That's most people. Not everyone. It varies a whole lot and it's still normal.

spacer gifAnd the hurt feelings and fear and lack of compassion — the whole mishmash — also will disappear. Your self-esteem will rise and carry the day. The process works. Just like the roller coaster car running up and down those awful nauseating tracks, it will eventually come around and slow down and the ride will be over. So too cosmetic surgery. And you will have joined the ranks of the courageous and powerful. And look great, too.

Harvey W. Austin, MD
Box 1470
Berlin MD 21811

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