Emily Reed was 24, a model and actress from Idaho who had recently moved to New York when her taxi turned in front of an oncoming car on Central Park West and she smashed into the Plexiglas divider. She had multiple operations to restore her appearance and preserve her breathing, but the results only made matters worse. One plastic surgeon sewed her lips together asymmetrically; another’s overly rigorous excision of cartilage left her with a “saddle nose”—a dreaded rhinoplasty complication marked by a broad bridge and a scooping central indentation. “I don’t know if you could even call what I had a nose,” says Reed. Finally, she sought out the services of Jon Turk, one of the country’s leading revision rhinoplasty surgeons. In a nearly five-hour operation, the New York–based Turk used bone from Reed’s skull and cartilage from the back of her ear to rebuild her nose. He created a new bridge with Gore-Tex, and remade her surgically contorted upper lip with Alloderm, a cadaver-derived skin matrix.
“There’s very little margin for error with a nose because you’re dealing with form and function,” says Turk, who describes himself as “the guy who does the noses that have been operated on four times already.” He routinely encounters “shrink-wrapping,” in which nasal skin, thinned out in an effort to give more definition at the tip, ends up contracting and revealing underlying cartilage. Turk also restores his share of “Polly beaks,” a deformity that results when a surgeon mishandles the nasal septum, leaving the patient with the jutting profile of a parrot.
Yet for every patient who has been the victim of a sloppy surgeon, there’s another who is the victim of her own gnarled self-image. The offices of revisionist surgeons overflow with those who fail to find satisfaction in the cantaloupe breasts and surprised-looking eyes that were precisely what they had commissioned.
David Sarwer, an associate professor of psychology at the University of Pennsylvania’s Center for Human Appearance, investigates the prevalence of Body Dysmorphic Disorder among cosmetic surgery patients. He also consults with revisionist surgeons when they fear that an additional procedure, however good the outcome, may fan rather than quell the flames. “The surgeon may not realize that a patient’s distress far outweighs whatever gains can be made through surgery,” says Sarwer. “And that’s when surgery can be a mistake. A good revisionist recognizes when it’s time to call in the services of a different kind of doctor.”
But for patients whose reasonable expectations aren’t met, corrective surgery can be therapy enough. Maxwell, the breast surgeon, has operated on women who have had up to 12 breast augmentations before coming to him, “especially in the beach communities,” he says, “where you end up with that overfilled Baywatch breast.” Before treating Day, he employed a sophisticated computer with 4-D imaging capability to show her a near-perfect simulation of her future contours. The technology is particularly helpful when patients come in with misguided hopes about cup size. “I always say that you don’t buy a size-16 shoe when you have a size-8 foot,” says Maxwell. “You have to find the implant that fits the patient.”