By: J.P. Faber

For me, living well was not enough. The bags under my eyes had to go. But how they went turned into a tale of tallow, a fat facelift that knocked off years and gave me back my cheeks.

I can’t tell you the exact day I decided I wanted a procedure. Certainly for months I’d been greeting myself in the morning mirror by pushing up the skin on both sides of my face. Then I’d let go, swear quietly, and shake my head. And it looked worse when I smiled, lines carved down the sides of my cheeks like Heath Ledger’s version of The Joker.

Still, it’s not an easy decision to come to. I am a guy, after all, which in most cases means you eschew matters of vanity. Yes, you want to dress well and have a nice car and all that, but that’s not the same thing as making yourself prettier. Brains, money and confidence should be enough for a guy.

At the same time I live in a world where, unless you are hugely powerful, once you look old you get marginalized. Add to that another given—that men (and maybe women, I can’t speak for them) rarely feel their chronological age. That man in the mirror looks strangely like an older version of you, if not an outright impostor.

So I thought that I would get a blepharoplasty—an eye lift—in order to at least erase the bags under my eyes.

Before I could make arrangements for the procedure, however, I ran into Dr. Mark Berman, a cosmetic surgeon from Los Angeles who was then president of the American Academy of Cosmetic Surgery. I told him my plans and he said I had it all wrong. I didn’t need an eye lift, he said, but a facelift using my own fat, augmented by stem cells.

“Your problem is loss of volume,” he said. “You look gaunt.”

Dr. Berman’s take is similar to many cosmetic surgeons who practice what is called ‘autologous’ fat transfers, taking a patient’s fat from an unwanted area and transferring it to an area that has lost fat, or needs to be “volumized.”

The idea of restoring lost tissue is common these days, with popular cosmetic fillers used to plump out wrinkles, or to return volume around the eyes or to the nasolabial folds—the parentheses on either side of your mouth. Fat has a longer history, having been used for some time as an alternative to implants for breast and buttock augmentation.

Now, with the advent of stem cells, the procedure has been amped up several notches. When you enrich the fat with your own stem cells, much more of it survives, and what does survive lasts longer. With stem cells, the fat ‘vascularizes’—meaning it builds its own network of capillaries—resulting in rosier-looking, healthier skin.

It seemed like a great solution to me. Anything involving stem cells—those amazing chameleon-like proto cells that can take on the characteristics of any tissue—struck me as part of medicine’s latest revolution. Nonetheless, it was still a major procedure, one that would involve anesthesia, and hence required justification and resolve.

“I look like one of the Confederate dead at the Battle of Gettysburg,” I said to my wife as I glanced again into an all-too-honest mirror. “I really need to get something done.”

“Whatever you want, honey,” she said. “You know it doesn’t matter to me. I don’t really focus on the details of how you look anymore. You’re more like an aura to me at this point.”

“Dr. Berman says I’ll look 10 years younger,” I said.

“Great, then people can confuse me with your mother,” she said.

I could see that I was on my own with this. Fine. I had looked one too many times at the face of Droopy Dog. It was time to act.

Oct. 5. 2010

I call the office of Dr. Mark Berman to make an appointment for the fat graft into my face. It’s a little scary but it’s time to commit. I’m going to do it. I tell Dr. Berman that I’m ready. We pick a day and he says I’ll be getting a call from his assistant.

Judy, a woman with a mellifluous voice, calls from Dr. Berman’s office to give me instructions and take some information.

“Do you take aspirins?” she asks.

“Yes, the 81 mg a day dose,” I say.

“Well, stop immediately. That acts as a blood thinner and we need your blood to clot. Otherwise the bruising could be very bad. “

“Really?”

“The same goes for fish oil or Vitamin E or any herbal supplements. You have to stop them all. Also I need the contact name and number for the person to call, just in case”

“Just in case?” I say, alarm in my voice.

“Don’t’ worry. It’s just in case. I’ll be there the whole time to hold your hand. You have nothing to worry about.”

Oct. 7 Thursday

Another call from Judy at Dr. Berman’s office. She wants to make sure I don’t take any aspirins, or Vitamin E or supplements. She also emails me a whole sheet on what to do and what to expect from the procedure. The list comes with the title “Space Lift Instructions.” Dr. Berman calls his procedure a space lift. It basically says the following:

1. No aspirin for 4 weeks before surgery

2. No Vitamin E for 2 weeks before surgery

3. No smoking 2 weeks before or after surgery

4. No medication the day of surgery, w/o permission

5. Nothing to eat or drink 6 hours before surgery

6. Shower before hand, but no make-up or lotions

7. Wear comfortable loose fitting clothing, w warm socks

8. Leave all valuables at home

9. Make sure you have a ride home, and someone to take care of you

10. After surgery, stay in bed for 24 hours; sleep on your back, with head propped up by 2-3 pillows

11. Don’t drink alcohol for 5 days

12. Stay away from the sun and from exercise for 2 weeks

13. Don’t move the parts of your face that have been grafted for 2 days

14. Do not diet for a while; the fat needs food

15. Be prepared for bruising

All of this seems quite reasonable. But that was before I had to go through it.

Oct. 13 Wednesday

I have flown into Los Angeles, the city where Dr. Berman practices, and where I will stay with my friends Philip and Kathleen during and after the operation. Judy calls my cell phone to make sure that I’ve got it all down.

“Just make sure to wear some loose fitting pants that you’re not worried about getting stained.”

“Stained?”

“Yes, from saline, or fat, or blood, or a combination of these things.”

“Great. So I should be prepared to say goodbye to whatever I’m wearing, eh?”

“Pretty much. Also, you may want to bring some water or juice, and some soft food. Shakes are good. We just don’t want you to move your face much, or to strain those muscles.”

“Wow.”

“Well, I don’t know how much fat he’s going to put around the jaw, but it’s important not to move much. Also you can expect to get a call from the anesthesiologist. She wants to make sure you have the best experience possible. So just be honest with her. She is good at keeping secrets.”

The best possible experience?

“You may want to take something for the bruising, as well. Some people do.”

As will be confirmed during actual surgery, Judy is one of the sweetest, nicest people I have ever spoken with. He voice is like honey, her attitude sunshine. I want to nominate her for sainthood the next time the Vatican is in session.

Oct. 14. Thursday

I get a call from the anesthesiologist. Her name is Maude Woo, and she has a heavy Chinese accent. “I see you are 56 years young and healthy,” she says. “I always tell my patients how young they are, not how old.” She asks me about any medication I take, and wants to make sure I do not drink any water or eat any food 6 hours prior to the operation. “And you no smokey pot or drinkee with your friends tonight. You be good for me and you have a nice time tomorrow.”

It is now the night before the operation, and I have dinner with my Los Angeles friends, including one who is a nurse. I ask if I can bleed to death from the procedure. I have visions of blood and death and Mickey Rourke-level face distortion. I panic for a few minutes every now and then and think I should cancel the whole thing. She tells me to get a grip.

Oct. 15: The Big Day//Friday

The operation turns out to be completely painless and professional. I never doubted the quality of the doctor or his assistants, including the wonderfully amiable anesthesiologist Maude Woo. She kept cracking little jokes about men being much bigger babies than women.

“You men can’t take any pain, not like women,” she said, laughing. “Maybe it’s because of childbirth. Men could never give birth. Couldn’t take it.”

As for my anxieties about the procedure?

“No problem, I will take care it with something in the IV.”

Just then Judy comes in and says, “Yes, Maude makes a great cocktail.” She comes over and gently strokes my forehead. Just for a moment. But it’s an extraordinary gesture. Did I say saint? Make that angel.

Dr. Berman had given me a terrific explanation of the process earlier, when I first came in.

The process is known as fat grafting, where you take fat from one part of the body and inject it into another part. It’s a procedure that has been practiced for years, with the latest wrinkle being that doctors can now enrich the fat with stem cells that come from the fat itself. Dr. Berman, however, calls the procedure a ‘Space Lift.’

“A couple of years ago someone said that it sounded terrible, using the word fat. So we came up with the term ‘space lift’, and it was a fun way to refer to the filling out of the space,” said Dr. Berman. “Today I more often refer to it as a 3D lift, because we are trying to restore the 3 dimensional characteristics of a youthful face.”

Dr. Berman went on to explain how he was trained in the traditional face lift, which involves “pulling up and back,” based on what he says is a mistaken belief that aging is caused by gravity pulling everything downward over the years.

“As we get older we lose some volume and some elasticity. So, doing some tightening to reduce the envelope has its place,” he said. “But somewhere in the ’90s I woke up and realized that we misdiagnosed aging.” The real reason we look older, he said, was the sagging that resulted from loss of fat. “When I look at someone who is old, I see a person who is fat challenged.”

The only question for me was where I wanted the fat taken from. I chose the abdomen. May as well get a flat stomach out of the procedure, as well.

POST OP

Later that day I emerged from the fog of anesthesia. Maude was there, and Judy brought me the yogurt fruit shake I had brought with me, along with my baggy pants. Dr. Berman wheeled me to the clinic’s backdoor, where my son Nicky had pulled up the car. I was eased into the passenger seat and off we went for a ride across the freeways of Los Angeles.

I was ushered into my friend’s house by Nicky, and there I was propped up in bed. I was ravishingly hungry, but wary about moving my face for any reason. When I looked in the mirror I saw a pretty beat-up looking guy, with eyes squinty and bruises forming nicely under each eye. My friend Kathleen made me some scrambled eggs, which I ate in the kitchen. I wondered aloud whether all this had been worth it, whether the pain was worth the result, whether vanity was shameless. Philip told me to stop talking and made me take one of the pain pills. I went back to bed, put on some music with my headphones, and feel asleep.

I woke up at 8 pm, pretty darn alert. I looked into the mirror and saw a bruised, younger me. A younger version of me who had been mugged. I ate some salmon and chopped up broccoli with lemon, and after that a dessert of flan. My god, it was the best food I’d ever eaten. Then we watched Tvo’d episodes of Mad Men. I took another pain pill and said goodnight.

Oct. 16 Saturday

Last night was almost impossible, in terms of sleep. The problem was partly because I spent so much time sleeping yesterday, and because of simple habit: I always sleep on my stomach. But for the initial recovery I could not put pressure on my face; so I had to sleep on my back, propped up by pillows. But I could not fall asleep in a position that felt so unnatural. Nothing worked, not reading, or listening to music on headphones. I found myself praying for the sweet release of sleep and wondering, which is more important, the sleep or avoiding pressure on the cheek?

I also had to wear a ‘support garment’ for the abdominal liposuction. It wasn’t a girdle, exactly; it was designed more like a bulletproof vest, with a plate in the front and wrap-around straps. Without it my stomach hurt. With it, everything felt nice and tight, all comfortably protected and safely tucked away.

I eventually got up and drove off to have lunch with my friend the nurse. Unfortunately she is also very funny. I found myself clutching my face and begging her not to make jokes. Whenever I did laugh, I had to laugh without moving my face, which made me sound like some sort of a ghoul, like Vincent Price on the Thriller album. For lunch I ate soft stuff, like oysters and cupcakes and coffee (I wanted to stay awake all day so I could finally sleep at night!).

Driving back from lunch Dr. Berman called my cell to make sure I was all right. I said it had gone fine. I wasn’t fully swollen yet, so I didn’t look that bad, and there was very little in the way of discomfort.

I spend the afternoon on pain pills and watching movies. I started with Role Models but it was too funny, so I watched Juno then Hidden Dragon, Crouching Tiger. I was determined to stay awake all day, so I supplemented my coffee with chocolate. I was going to take very seriously the notion of ‘feeding my face’ and not losing any of the fat. I ate Mexican food for dinner (trying to keep it soft!) then stayed up for a while more before finally passed out, strung out across the back of my bed with my arms akimbo, like Jesus crucified on throw pillows.

Oct. 17 Sunday

It is now two days after the operation and time to fly back home. I slept a mere three or four hours but it was lovely, then spent the morning slowly packing—and showering. The shower was incredibly pleasant, finally taking off the truss and washing down the very, very scratchy surface of my stomach, which was nice and flat. I then proceeded to the airport for the long plan ride home, with some snoozing but mostly reading and music – Beatles and the Russian Revolution.

Meanwhile the black and blue marks under my eyes were becoming more pronounced, like purple crescent moons. My stomach was still soar from the lipo, so I keep my belly flap wrapped tightly. I was a little self-conscious about my appearance, but I wore oversized sunglasses, and my midriff protector was hidden, so nobody paid much attention.

Oct. 18 Monday

Since I got in at midnight last night, and since I am still exhausted, I decided to stay home from work. My face is swollen now so that my cheeks are wide and my eyes mere slits. My business partner came by to visit, and told me I looked like William Shatner, but from the Boston Legal period, not Star Trek. I was fat headed, both literally and figuratively. My wife went to the Internet to call up a few images that came to mind thanks to my apple cheeks: Alfred E. Newman (Mad Magazine, thank you!); Howdie Doodie (for all you baby boomer girls and boys); and Chuckie the horror doll.

I might have gotten annoyed at the ribbing, but by now I had entered the post-op period of remorse. I’m not sure if this feeling is universal or not, but it was a potent feeling that I should not have had the procedure, that moment when you blurt out, ‘What Have I Done?’ And then there is the problem of pity. How can you expect sympathy from anyone for cosmetic surgery? I mean, it’s self-induced!

I am still wearing the girdle, or support garment, and it feels good except that my stomach has grown very itchy, like the feeling you get on your arm or leg when it’s in a cast. So I stick my fingers in to scratch. They said I could get rid of the brace after a day or two but it feels good to wear it. It feels like my skin might loosen up and get saggy if I don’t keep it pressed tight. I also weighed myself today, coming in at my lowest ever. So I ‘fed the fat’ as much as possible, eating chocolate and hamburgers, and egg plant and scrambled eggs, and tuna fish and bananas—anything soft and full of calories.

Judy called to make sure I was taking the anti-biotics, and that I wasn’t nauseous. She told me to lay off the fish oils for another week or so, but advised I speak to my doctor about aspirin, which I like to take in low doses everyday for my heart.

Oct. 19 Tuesday

Today was a big day: My first public appearance, returning to work. I felt like a beast. I looked the worst today since the procedure; my eyes were very puffy, making them squinty and narrow. Combined with my newly fat cheeks it made me look quite different.

My staff came into my office and circled round me, just to see the effect. I was a little bit embarrassed, the say the least. It was that odd sensation that I have felt from the beginning, that guilty feeling, mostly about the idea of whether I deserve sympathy for any pain and suffering. Oh, poor fellow, all banged up from what? From trying to make himself look more youthful! Oh, the vanity. Goes against the New England puritanical under-pinning of my upbringing. What I want to tell people is that I got into a horrendous fight. What I want to say is, “You should see the other guy!”

It also made me feel at times strangely alien, like being in somebody else’s body, like I was taking on a new identity. And I could feel the swelling of my cheeks, the bulge that gave me those beady, almost evil-looking eyes. I felt like a monster, like the Minatour, with a boney brow (fat was injected there, too) that smacked of acromegaly, or whatever excess bone growth is called. I felt like a stranger in a strange land, guilty over any suffering, guilt about my vanity.

Oct. 20 Wednesday

This ‘feeding of the fat’ has really gripped by imagination. I feel like I will lose it if I don’t feed it lots of calories. So today I gorged myself on dark chocolate, two full 100g bars (3.5 oz each) of the Ritter dark with hazel nut. I also took another pain pill in the evening after a persistent headache from all the skin and muscle soreness. My doctor did things that I am only now figuring out—the placement of fat at the extremity of my lower jaw, for example, like Sgt. Rock. Just another subtle redistribution of natural volume.

I am also sore around the eyebrows, on the eyelids, and off course on the peaks of the cheeks as well, and I have lumps of fat on either side of my mouth, along the labial folds.

I went to the bank at one point, and had a chat with the teller thanks to looking like a beaten up prizefighter. At first I gave the fight-club line, but then admitted it was a surgical procedure. She was surprisingly sympathetic, and very curious about the details.

My stomach is still sore. The scratching of it feels better than ever, but nothing like that first Sunday when I showered.

Oct. 22 Friday

Today I finally talked to my old friend Johanna about the procedure. I can still hear her yelling to her husband Brian, “He’s taken fat from his ass and put it into his face,” she yelled. “It was from my stomach, okay, not my butt!” I tried to correct her. But it was too late. “Fat from his ass, right into his fact,” she yells again.

“This is a slippery slope you’re on,” she said back into the phone, talking to me again. “Now you’re hooked on it. This is just the beginning. Send us a picture. What do you look like?”

“Peter says I look like William Shatner, but not from Star Trek. From Boston Legal.”

“Oh my God, I can’t believe you’ve done this to yourself. It’s just so freaky. What do you look like? No, I mean, who do you look like?”

“I look like myself, just younger. You have no idea what it’s like once your fat starts to head south. I was looking gaunt.”

“Bullshit, you looked fine. Are you going to look like a freak now?”

And so it went. I finally walked into my favorite café to see if they had some roast pork at the takeout window.

“What happened to you?” asked Josephine the waitress.

“Just a procedure for my eyes. Cosmetica.”

“Ah, I see,” she says, making a ‘well, why not?’ face and putting some nice roast pork into a take out container for me. Must feed the fat.

Saturday Oct. 23

I am rubbing my stomach. My weight has fallen another coupe of pounds. I feel like I must have cancer. I am pulling my shirt up and examining my stomach way too often for my wife’s taste. I feel like I should go ahead and eat big, to see if I can stop the slide.

I end up in a Cuban restaurant called El Exquisito at around 8 pm. There is a one-man band performing tonight, some old guy singing fabulous old Cuban melodies, beating a couple of drums while his computer sound system does the rest. I drink beer, eat buttered toast, eat fried chicken, rice and beans, maduras (sweet bananas) and follow it with a sweet cortatido (coffee with steamed milk & sugar). At home I chase it down with a block of dark chocolate and hazel nuts, a bowl of popcorn, and two slices of buttered rye toast and a glass of milk. My stomach hurts, it aches, it has re-expanded to its former size.

Oct. 24 Sunday

Today I awaken and see that I have gained back a couple of pounds. I do not have cancer. I am, however, a pig.

Oct. 25 Monday

I entered week two of the post-procedure recovery today. My swelling has gone way down, so I no longer look like I have the freakish Jerry Lewis head bloat. My bruising is finally subsiding as well, not as dark as it was, but still nicely defined as two purple scimitars, dabs of camouflage paint on each cheek.

These bloodlines follow where two deep furrows had formerly emanated from my eye’s inside corner—or whatever you call that angular hinge where the eye meets the nose bridge. That droopy dog look is now gone, replaced by fuller cheek sockets and a couple of black eyes. I am now officially part of a new type of human: homoplasticus, aka moldable man, a creature capable of fundamentally altering its physical self.

You may say we have always been able to alter ourselves physically, at least in primitive ways, from stretched Ubangi lips to razor haircuts. But my procedure was not some sort of maiming, nor was it artificial. It was my own fat and fat stem cells re-injected, a true re-molding of the clay from which I am made. It is only another few steps to injecting stem cells into the heart, or liver or pancreas, the beginning of genetic rebuilding.

I should probably wait and see if I look like Mickey Rourke before I say anything more, but it’s really beginning to look good.

Oct. 27 Wednesday

I was morose again this morning about the whole thing, about my face ever loosing its crescent moons of bruise, about the creases in my face simply reappearing, only this time more prominent, about the money spent on vanity, and so forth. I am told it is a normal reaction. Post partum. A female colleague came in and told me a story about the pain and suffering she experienced with breast implants. She said it was a funny story, but it just sounded painful and uncomfortable to me. But it had a happy ending anyway.

Yesterday I talked to a cosmetic surgeon who is a face specialist for men. He understands that facial aging – and its appearance – is all about loosing cheek. The fat heads south. So you need to replace the sunken space. Only he does not do fat transfer. He does injections of fillers, the juvederm and sculptra that not only stuffs the face but stimulates new collegan growth. He says it has no down time, and has the advantage of being temporary – so you can make adjustments every 18 months or so.

I talked to another doctor, however, who is an advocate of stem cell transfers. While he admits that we do not understand how it works, the fact is that it does work. It is history’s first practical, mass application of stem cells for use in tissue reconstruction and replacement. I feel like part of a medical revolution. And I very much like the face that this is all natural, all part of me, no artificial parts.

Oct. 28 Thursday

My stomach still hurts a bit. It still itched a lot just a few days ago, and still does now. It makes me want to scratch, like when I was a kid with poison ivy. And will the soreness ever stop? It makes me wonder if my stomach skin will ever re-attach itself to my muscle wall.

Oct. 31 Sunday

Halloween. Looked at my face tonight and its starting to look normal again. One slash of purple left under my left eye, and my right still swollen. But much, much better.

Still suffering post-partum depression. Friday and Saturday I felt depressed, that I would always look beaten up, and that my deep lines would return anyway, that the whole thing has been a failure. I’m convinced the procedure can only correct the surface damage; it can’t correct the behavior that led to the damage, which will reinstate it if you don’t change.

I lifted weights, lightly, for the first time in three weeks. Tomorrow I will start to run on a regular basis. And eat better. And watch less TV.

Nov. 1 Monday

A fine day in the anti-aging firmament. I commenced with a full array of vitamins and supplements. I feel better already. I know it’s impossible to parse out the variables, but at this point I don’t really care which element of the pack is working. It’s the gang together, all pulling together. I also resumed my Paleolithic diet, with the slight exception of half a slice of cheesecake, which was consumed in honor of a colleague’s birthday.

Nov. 8 Monday

I have begun running again, not worried how the jostling will effect the procedure. I have begun to get compliments, especially from people who have not seen me since mid October. A couple of friends kept going on about how I looked so much better, though they couldn’t put their finger on it. Fantastic.

The biggest thing for me personally is the morning mirror. I no longer have to hold up my cheeks with my fingers. The long, dark curves are gone. The sunken areas are lifted. I actually look pretty darn good. I want to pull a Gene Wilder move from the movie Young Frankenstein, and yell out, “Hey there, handsome! Looking good today!”

Nov. 23

Today my daughter came home for Thanksgiving. She said I looked a bit like St. Nick Dad, with my rosy cheeks. I will get the biggest feedback on Thursday when the family gathers for Thanksgiving.

Nov. 25

Perhaps it is the sign of a good procedure that nobody exclaims that you look astonishingly different. My family at Thanksgiving really didn’t make a fuss. I’d like to think that’s because the procedure looks so natural. It’s like seeing me 8 or 10 years earlier. It’s not like seeing me with a new nose or different colored eyes. It’s just me looking a little better rested, a little more energetic, like they are used to seeing me in years past. Actually, to look older is to look different. To look younger, especially in a truly natural way, is to look the same.

As for me, I feel like a new man. I no longer feel like some kind of creased, aged person who can’t flirt with a decent looking woman—not that this was the purpose of it all. But there is something to the idea that we should all look as good as we feel. As my wife quips when I beam at her, “It’s alarming how charming I feel,” from some old musical. But it’s true. When Christmas comes I’ll be blurting out, “God Bless You, Dr. Berman,” along with “God Bless Us One and All.” And “Thank God for modern medicine.”