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Saving Face: My Plastic Surgery at Age 13

I was diagnosed with Moebius Syndrome. Its most noticeable symptom? I cannot smile. At the age of 13, my mother took me to see a plastic surgeon.
Photos courtesy of the author

According to a November 6, 2013 New York Times article, so many women in Valencia, Venezuela were having plastic surgery that mannequin factory owner Eliezer Alvarez refigured his stock mannequin to have "a bulging bosom and cantilevered buttocks, a wasp waist and long legs, a fiber glass fantasy." Plastic surgery surged in popularity amongst Venezuelan women in the 1970s and 1980s, when the nation's already popular beauty queens were thrice crowned Miss Universe. Venezuelan beauty pageant entrepreneur Osmel Sousa—known as "The Czar of Beauty"—recommended the first Miss Universe get a nose job. "I say that inner beauty doesn't exist," Sousa said. "That's something that unpretty women invented to justify themselves."


On a rainy day 20 years ago in my native country, England, at age 13, I had plastic surgery—and so, paradoxically, began a persuasion I was ugly; that I did not look the way a woman should. Sometimes, I still feel persuaded of this, and hide behind my hair or a book. Reading was the first place I felt beautiful. Instead of mirrors, I held books; words, up in front of my face, reading myself into safe, distant oblivion.

But first, here it is: my face. Eyes whose lids do not fully close. Broad nose. Lips permanently open; asymmetrical, motionless even when I speak. Crooked, crowded teeth. Skin uneven in places from teenage acne. And high, sculpted cheekbones. In the context of my face, my cheekbones are perfect. They catch light, symmetrical, curving smoothly. They tell lies. I hate them, and love them. They were supposed to make me look more normal.

I was born with a rare condition of facial paralysis called Moebius Syndrome, the most remarkable symptom is that I cannot smile. This element of my condition shocks people the most: "Oh my God, you can't smile? Really?" It is not so much the not-smiling that horrifies people as what the smile itself represents. Women must smile. A woman is supposed to smile, because then she is pretty, and pretty wins. With smiling come advantages. The smile that placates or seduces, fools adversaries; buys time.


In many ways, I had a normal childhood. There were gifts and adventure, weekly Sunday lunches at Granny and Grandpa's house, family walks, arguments and camping trips. I also had so many pets, I dreamed of becoming a veterinarian. More than that, as a child I felt normal. I didn't even fully realize I could not smile until age seven, when a primary school girlfriend asked me some pointed questions about my face. Before this, my sensation, inside, of joy, of smiling, was so pronounced I was absolutely convinced everyone could see the smile I pictured on my own face. If I changed the position of my feet, if I wore a different dress, if I swallowed a certain way, thought a happier thought—then people would be able to see my smile.


I wanted to be seen. But the girl I imagined people seeing inhabited a body that was not mine. A rift grew between the feminine perfection I desired for myself and the damaged body I lived inside. In an early morning fantasy, I stepped onto a conveyor belt that transported me through a Fix Everything machine. In a matter of minutes, the machine bathed me, clothed me in the finest garments, and gave me a normal, animate face. It was a pleasant fantasy. Often I returned to it with embellishments—a tiara, silk shoes, curling auburn hair instead of brown hair that hung straight. Still, I was fairly innocent of the role beauty would play in my future. I was primarily concerned with whichever book I happened to be reading, or the well-being of my pet rat.

A woman is supposed to smile, because then she is pretty, and pretty wins.

Outside a Manchester city theater, in orange street lamp glow, I met a homeless man who kept a white rat in his poncho pocket, and, for months after, pestered my mother to get me one. That Christmas, I found Ratty—a white rat with pink eyes and chocolate nose—in a birdcage behind our tinsel-laden pine tree, his long tail protruding from a newspaper nest. I was ten. I fell in love. Ratty roamed free in my bedroom and came when I called his name. Rats were underdogs, and some survivalist in me adored ignoring their diminished status. Ratty traveled everywhere with me, riding in my sweatshirt sleeve, his tail hanging down below my wrist like an ugly ribbon.


Two years later, Ratty died and, as another magical Christmas approached, my mother took me to see a plastic surgeon.

Read More: I Feel Bad About My Nose

There is no cure, per se, for Moebius Syndrome. The bilateral facial paralysis caused by damage to the sixth and seventh cranial nerves is permanent. You are born with strange stillness. When you become aware of the difference this stillness marks your face with, you enter a dream from which you never wake—a child's surreal uncertainty, a parent's practical nightmare.

The National Health Service (NHS) surgeon my mother and I met wanted to transplant muscle from my inner thighs into my face, giving me a slight, crude smile, and leaving obvious scars across my face's center. Even at a naïve 12 going on 13, I was dubious, as was my mother. This surgeon saw my face, but not me—the tom boy who could not stop reading. For him, my body was a faulty face only, his knife the simple solution. Blood, the footnote no one had to read.

Soon after, my mother and I went to a private plastic surgeon for a second opinion. This surgeon told us that what the NHS surgeon had proposed was inexcusable butchery. Furthermore, he recommended a cosmetic alternative that would leave me without any visible scars. Rather than attempting to surgically impose a smile onto my face, he would imitate the pads of muscle my cheekbones lacked by inserting "malor" implants through incisions carefully hidden inside my mouth, where my upper gums met my cheeks' insides. Strangely, he did not show me the implants themselves, only a catalogue photograph of what looked to me like large, white wax kidneys.


"You are petite," the surgeon said, "So I would use our smallest available implants."

My parents scheduled the surgery for six weeks before the date we would emigrate from England to America, leaving gritty Manchester's urban hub for mountainous, pine sap-scented upstate New York. While no one said so out loud, I gathered that my face was on the list of things to take care of before my family and I left England. It probably stemmed, too, from my age—a gangly, shy 13-year-old. Wouldn't my career into womanhood be easier if my face was fixed?

I wanted to be seen. But the girl I imagined people seeing inhabited a body that was not mine.

I remember, long before plastic surgery entered my parents' and my conversations, staring into my own eyes in the mirror, leaning in so close I could see tiny individual color pixels—green, gold, russet, blue, black. In my memory, these reflected little girl eyes are huge, perhaps because they were still learning to see. Back then, how I was perceived concerned me very little. I was looking out, innocently hungry for the world, where, I thought, books came to life. Looking into my eyes in the mirror now, I still see colors, pupils, irises, whites, but also, the face surrounding the parts of me that see. The mask of its history does show, even in my eyes.

I could tell you about the day of my malor implants surgery, the private hospital and gentile surgeon and nurses spotless in white. I could tell you the details of what happened stuck with me longer than normal time. I could tell you it hurt, then did not, then again did. I could tell you I was ready. I could speak of resilience, strength, self-improvement. I could reduce it all to a whisper. But the fundamental truth is I was a little girl who made a big mistake without realizing it was mine to make.


At the same time, my innate aesthete appreciates these plastic cheekbones. They do look good. Sometimes ethereal, and always deceptively natural. What haunts me, though, is the sensation of foreign objects lodged permanently in my face. As a first experience of physical intrusion, they were inimitable. Someone else got into my body before I did. I trusted the soft-spoken man who implanted my cheeks. Because he praised my long hair and fair skin; appealing to my vanity, I trusted him. Of course, at the time, not yet being a woman, or even, really, an adolescent, my notion of plastic surgery was very, very fairy tale. Like in the Fix Everything machine of my childhood fantasies, there was no pain, no worry, no consequence besides waking up looking better.

Lying in bed back home four days after the surgery, I stared up at the blank wall's smooth pallor, my head flashing hot with pain. My mother sat beside me on the bed's edge, and said soothing things. The pain killer I'd just swallowed would soon take effect, this was temporary suffering, she was really sorry it hurt. But her uncertainty was as palpable as the stabbing, burning sensations in my face.


In my memory, those first few weeks of recovery are intertwined with preparations to leave England, my family's days spent emptying the house and packing offered welcome distraction from the new face I would reluctantly get to know. I helped my mother fold clothes into boxes, deciding what to keep, what to give away. I took breaks in the back garden's hammock, placing an ice pack across the top half of my face, listening to birdsong and passing trucks.


After the flight to America, I was shell-shocked as a refugee. I spoke as little as possible and sought solitude at every turn. Through adolescence, I cloaked myself in a kind of emotional paralysis, the barrier of my enhanced but ever-paralyzed face seeming to take over the person I let the world see. In other words, I didn't ever let people inside. I couldn't. If I let anyone inside, I wouldn't have anywhere left to hide.

Looking back on the bed ridden post-op girl turning to her mother for an elusive comfort, I recognize a landmark. That is, without saying as much, my mother let me know how becoming a woman would hurt, how little she could do to stop it from hurting. These are the transactions women survive by. Their tenderness after violence. Their understanding of touch.

Toward high school's end, I worried about having my senior portrait taken. It filled me with terror. Local photography studios mailed me sample portraits—girls my age with blonde highlights, smiling around white teeth, clutching teddy bears or red roses, perched on platforms draped in neutral fabric, and backdrops carefully texturized grey, cracked by light. You can bring props important in your life, the studio's brochure read, Let your senior portrait express the real you! I hid the brochures from my parents, determined not to appear in the yearbook's pages. Who was the "real me"? Did such a person even exist?


What haunts me, though, is the sensation of foreign objects lodged permanently in my face.

The ugliness I felt would take years to pick apart. Not all of it related to my face, but most of it orbited around the tyranny of image. Being seen, or not seen, became my obsession. I buried all the emotions connected to this dichotomy of visibility and invisibility. The feelings built up in sedimentary strata, year after year, until my cool façade just had to break. Such a breakage is never tidy, but it lets toxins out, and light in. Greek drama aimed for catharsis—purgation, cleansing, of the emotions. Medea avenges her husband's infidelity by murdering their children; Oedipus, after marrying his mother, dashes out his own eyes. Watching, the audience remembers vengeful moments, identifies with the lamenting blind man, perhaps thinking, we are together in this.

My stage was a mirror. I'm still talking to it, still acting out old stories.

A couple years ago, I walked into a department store hoping to buy a pair of shorts. Pale, fluorescent light rivaled the sunny afternoon outside. There weren't many shoppers, so my meandering through a space empty except for displays of t-shirts and dresses and stretch jeans took on the laconic buzz of a dream. Rounding a corner, I found myself facing a gaggle of stark naked mannequins, their white plastic breasts and buttocks pert as any Barbie doll. They had neither heads nor feet, and their nudity, amongst such abundant stacks and racks of colorful new clothing, struck me as ironic. These were bodies divorced from identity. Their marred perfection set a ghostly tone. Tearing my eyes away, I found a pair of red cotton shorts, paid, and stumbled out onto the street.

When I was 16, I dressed with great care. My nine year old sister and I shared a bedroom, so she sometimes watched me dress from her bed across the room. It was summer. I hated high school, and was happy to be on vacation, swimming and hiking with my tight-knit family, carefree. Today, I had selected a short denim skirt and pale yellow camisole top embroidered with white flowers, its shoulder straps, too, stitched in white. Underneath, hoping to be sassy, I wore a black bra. There was only one narrow mirror in our bedroom, hung at eye level, and I was studying the top half of my body's reflection when my sister leaned forward on her elbows. She caught my eye, her expression thoughtful, characteristically sweet.

"You look great," she said, "From the neck down."

The blithe comment hit me with stun gun force. But I plucked at my camisole, and said only, "Oh."

In a flash, the headless, naked mannequins on their low platform reminded me of this exchange. During the 15 intervening years, I had long forgiven my sister's comment as a child's misstep, spoken before she knew any better. I had attended undergraduate college, moved to New York City, had a nervous breakdown, moved back home, gotten a therapist and a job and a cat. Yet, there I was again, 16, beheaded by a casual remark, or 18, wondering if classmates reading the yearbook would question the blank square across from my name, or thirteen, dizzy, going under.

I headed up Broadway, breathless, one hand clutching my navy blue shopping bag's thin, arcing straps, the other hand involuntarily reaching for my throat.