Joseph Eviatar invites me to look at my face, which is currently filling up a large flat screen monitor at Omni Aesthetic MD in Manhattan's Flatiron District. Somewhat reluctantly, I comply.
Eviatar, looking much fresher than his 50-odd years, is breaking down the main elements of classical handsomeness and unwittingly breaking my heart in the process. He defines a handsome, masculine look as a horizontal (not curved) brow, angular (not rounded) cheekbones, a strong, defined jawline, and a jutting chin.
At several points during our consultation I squint my eyes and scour the monitor for signs of any of the elements of handsomeness bulleted by Eviatar. I conclude that he has his work cut out for him but he seems unconcerned. In fact, he's quite confident that immediately after 45-minute appointment with him next week I'll look significantly more chiseled and masculine. He says that four or five days after that, "well-rested," "balanced," and "more symmetrical" can be added to the growing list of positive adjectives with which my face can be described. He even asks me if I'd like an instant nose job that would change the shape of my schnozz from Roman to Greek by getting rid of the hump at its bridge. Of course I fucking do.
How is he going to manage all this? Via the cunning off-label use of dermal fillers and neurotoxins. Allow me to unpack the pertinent elements of that last sentence.
Off-label means an application of a medicine that differs from the use or uses it was approved for by the Food and Drug Administration (FDA). While that doesn't mean that off-label use is improper or illegitimate, it does mean that this use can't be advertised and is only employed after a discussion with a patient about his or her specific needs.
"Dermal fillers are commonly used off-label in different anatomical areas of the face, neck and body but patients should understand the risks associated with these," says Anthony Rossi, dermatologist at Memorial Sloan Kettering Cancer Center and assistant professor of dermatology at Weill Cornell Medical College. "It is important to understand that different fillers are more appropriate for different areas and it is not just the product but the expertise of the physician that is paramount."
With regards to dermal fillers, there are two dozen that are FDA approved though what they're currently approved for is limited to the correction of folds and wrinkles, lip augmentation, as well as adding volume to areas where facial fat has been lost due to the aging process or effects of antiviral medication in HIV patients.
The treatment plan that Eviatar discusses with me involves both approved use—like adding age-related lost volume to my cheeks—as well as off-label applications like adding volume to my chin, jaw and the bridge of my nose, thereby changing their shape.
"Think of them as facial implants," Eviatar says. "They just happen to be in liquid form. They're called dermal fillers and that's what they are approved for but with you I'm going to be using them subdermally."
The fillers Eviatar will be using on my face are made from hyaluronic acid, a synthesized version of a carbohydrate the body naturally produces and calcium hydroxyapatite, a heavier type of filler, that naturally found in human bone.
"Which product we use is determined by where we use and what we want it to do," Eviatar explains. "In some areas like around the eyes, we want it to spread whereas on the bridge of the nose, we need it to hold together create structure."
Neurotoxins (Botox, Dysport etc) have all kinds of FDA-approved medical applications—they work by temporarily paralyzing the muscles that crease our faces when we contract them by doing things like laughing, frowning, being surprised—basically showing a range of human emotions. Eviatar will be using neurotoxins for other things that are not approved by the FDA such as reduce my forehead muscles' ability to put a curve in my brow and my chin muscles' wont to pull the corners of my mouth downwards. That second application, Eviatar says, will give me a "friendlier' appearance when my face is relaxed.
Yes, apparently the good doctor is MacGyvering a medical solution for my resting bitch face.
Before our thorough consultation concludes, Eviatar tells me what to expect during and after my session. He'll be using a topical numbing cream on my face to reduce discomfort from the injections and the session itself will take around half an hour. I'll see results of the filler immediately though Dysport will take several days to take effect. The three fillers made from hyaluronic acid (Juvederm Voluma, Juvederm Ultra and Restylane Defyne,) will last up to 18 months though their effects can even be neutralized with a soluble enzyme "antidote" called hyaluronidase if I don't like the look. Eviatar assures me that while the effects will be not be so pronounced that anyone I know would think I looked "done."
"They may remark that you're looking good," he explains. "But my job is to accentuate your best features, minimize what you don't like, and have you looking and feeling like your best self—not anyone else."
Of course, I don't want to look "done." But looking done is certainly not the worst case scenario should things not go quite to plan.
"You are injecting a substance into the skin—hyaluronic acid or longer lasting fillers such as calcium hydroxylapetite or poly-l-lactic acid, fat, or even newer more permanent fillers," Rossi tells me. "And with any injection there is a risk of infection, bruising, swelling, and nodule, or granuloma, formation." He then mentions a couple of other little things I should hope to avoid like, oh I don't know, necrosis of the skin, and inadvertent arterial injection which can cause blindness and stroke.
For a moment I ruminated on the inherent irony of losing one's sight in the quest to become better looking. It seemed like encapsulation of everything wrong with our rotten society; a Grimm's fairy tale meets Keeping Up With The Kardashians. I was deterred enough to ask Rossi tell me the odds of a catastrophic failure while secretly reserving the right to ignore them should I feel like it.
"Dermal fillers are relatively safe however these adverse events can occur," he says. "While there is not an exact percentage of complications occurring from dermal filler, in a recent paper there have been at least 98 cases of blindness or vision changes that have occurred with fillers."
Rossi then mentioned his own study (manuscript pending publication) which examines cases of complications from cosmetic procedures. He concluded— quelle surprise!—that patients that saw non-physician practitioners had more complications than those seeing physicians.
The next time I lay my eyes on Eviatar—who is a physician, I checked—seven days of actually knowing what is wrong with my stupid face have elapsed and I have anesthetic cream slathered all over it. He reiterates the treatment plan and I put my name to a form handed to me on a tablet. Presumably it said something about me not having a legal leg to stand on should this thing do horribly wrong. Sign and recline.
Eviatar begins injecting me along the length of my brow with Dysport—a neurotoxin similar to Botox. He tells me that he's injecting a tiny amount intended to both level off my brow and make me look a little more awake. I can feel every insertion of the needle but, speaking in my capacity a wuss, it's really no big deal. He then shoots a little more along my hairline, then moves on to chemically chillax the muscle that's giving me a sad look when I'm not actively smiling, which luckily isn't that often. Lastly, the Dysport gets shot into my masseter muscle which, Eviatar tells me, will both contribute to a more defined jaw line and help me with my bruxism—teeth grinding or jaw clenching when I'm asleep.
The first filler that goes into my face is Juvederm Voluma. Placed along my zygomatic arch and cheeks, it's intended to give a more angled triangular look to my cheekbones and my face in general. The discomfort is slightly more pronounced. Perhaps because filler is thicker than neurotoxin solution and requires a large gauge needle or maybe because the filler is injected deeper or maybe the initial surge of adrenaline is suddenly wearing off.
"Not only is the filler here going to give you that chiseled look," Eviatar says. "The extra volume is going to soften the nasolabial fold, which is the line that goes between the corners of your mouth and the sides of your nose. You could fill these lines in with filler but I think that we'll get a much better result from pulling out the cheek a little and softening that line out."
Within a few short minutes, more fillers are being squirted along my jaw line and into my chin. It hurts just a little more than the cheeks did but it's all very manageable. Radiesse is the thickest filler being used on my face and as such, the needle needs to be the heaviest gauge.
The final part of my treatment is the re-sculpting out of my nose.
"Like a lot of people, you have a hump at the bridge of your nose," Eviatar reminds me. "With filler we can resculpt this area to give you more of what's often called a Greek nose which is straight from the forehead to the tip."
The shots to the bridge were the most painful yet but the several shots that went into the tip of my nose and the columella—the "little column" on the underside of the nose, between the nostrils—was positively eye-watering and there were a fair few of them.
When I turned to face the mirror, I was immediately struck by how my jaw line appeared more squared off, my nose straighter, my cheeks more voluminous and angled. What's more, I noticed that the extra volume in my chin had accentuated my heretofore barely perceptible chin cleft which I was very excited about. Before I left, Eviatar reminded me to refrain from wearing glasses that would pinch the bridge of my newly sculpted nose for a few days.
The effect of the fillers seemed more pronounced immediately after my session and, by the time the muscle relaxing effect of the Dysport kicked in, the introduced material seemed to have settled into my face and mellowed a little. The only bruising I had was on the bridge of my nose and it was easily concealed with a schmear of tinted SPF.
I hadn't told many of my friends that I'd be spending an hour getting my face revised and, as predicted, no one could pinpoint what was different about me. I did, however get a couple of unsolicited comments about my general handsomeness, which I wasn't mad at in the slightest.
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