About-Face

Out with the gaunt and tight, in with the plump and juicy. There’s a new face in town—and it’s a baby’s.

A woman I have known for many years did something to her face not all that long ago, and for a few weeks afterward, I was not able to put my finger on it. Did she get her eyes done? Restylane injections? Botox? Then I thought, Oh dear God, she got a face-lift. No one whom I consider a friend and a contemporary had yet gone that far. But there was no denying she had done something major, and frankly I was worried. Had she ruined her pretty face? As the curtain of hair slowly parted a little each week, I could see that her lips were bigger. Nowhere near overcooked-hot-dog-turning-inside-out bigger like Meg Ryan’s, and not even duck-bill bigger like Courteney Cox’s—but big enough to make me feel uncomfortable looking at her mouth when she talked. Don’t look at her lips!

Then one day, about a month later, I ran into her at a party and she looked stunning. The puffiness had settled, the fire under the skin had gone out. Even her lips looked like they belonged on her face. They were shaped just like her old lips, but … juicier. Her whole face looked as if it had been pushed out and plumped up—not unlike a slightly tired but still very stylish down-filled sofa that looks almost new if you keep those cushions fluffed. I cannot say that she looked exactly like her old self—but so close! A fantastic approximation! An uncanny resemblance! She looks like a very impressive artist’s rendering of her.

But there was also a faint likeness to someone else. She looked a little like … Madonna? Strange, I know, since Madonna and my friend have little in common, at least physically. But when I saw the Big Ciccone on the cover of Vanity Fair a couple of months later, I couldn’t help but notice the similarities: the Mount Rushmore cheekbones, the angular jawline, the smoothed forehead, the plumped skin, the heartlike shape of the face. Their faces didn’t seem pulled tight in that typical face-lift way; they seemed pushed out. Looking at Madonna, I kept thinking of the British expression for reconditioning a saddle: having it “restuffed.” Perhaps that’s where she got the idea to have some work done. After the hunt, Madge dismounted her trusty steed and thought, My saddle needs restuffing. And, by George, so does my face!

Women have been availing themselves of new faces since the dawn of plastic surgery, but suddenly it seemed that there was a better new face to be had. There is a New New Face, very different from the old one, and both my friend and Madonna now have it. Once I starting thinking of it in these terms—the face as the new handbag, say—I started seeing New New Faces everywhere: Demi Moore, Michelle Pfeiffer, Liz Hurley, Naomi Campbell, Stephanie Seymour. They all have it! Even the Olsen twins seem to have a starter version of the New New Face, with their big crazy doll eyes and plush lips. Just to be clear, I don’t presume to know exactly what any of these women have done to their faces, if anything at all. It’s possible (though in some cases before-and-after pictures would seem to suggest otherwise) that this face is occurring entirely naturally—after all, these are women who are famous for being beautiful. The point is that there is a noticeable aesthetic shift happening in the face, and that it’s dovetailing with quantum leaps in plastic surgery and dermatology.

Through some unholy marriage of extreme fitness and calorie restriction (and maybe a little lipo), women have figured out how to tame their aging bodies for longer than ever. You see them everywhere in New York City: forty- and fiftysomethings who look better than a 25-year-old in a fitted little dress or a tight pair of jeans. But this level of fitness has created a new problem to which the New New Face is the solution—gauntness. Past a certain age, to paraphrase Catherine Deneuve, it’s either your fanny or your face. In other words, if your body is fierce (from yoga, Pilates, and the treadmill), your face will have no fat on it either and it will be … unfierce. It was only a matter of time before a certain segment of the female population would figure out how to have it both ways, even if it means working out two hours a day and then paying someone to volumize their faces, as they say in the dermatology business. As a friend of mine recently pointed out, there is now a whole new class of women walking around with wiry little bodies and “big ol’ baby faces.” And they look, well, if not exactly young, then attractive in a different way. A yoga body plus the New New Face may not be a fountain of youth, but it’s a fountain of indeterminate age.

Psychologists and anthropologists have long tried to nail down what makes us perceive one face as beautiful and another not. There are theories about the math of it, the “Golden Ratio”—how, if you take careful measurements of the lines and triangles formed by a beautiful face, they will add up to the same proportions first noted by the Greeks to be aesthetically pleasing. More recently, a scientist named Michael Cunningham took it upon himself to study the faces of 50 women, half of whom were finalists in an international beauty pageant. In “Measuring the Physical in Physical Attractiveness” (italics mine), he wrote that the width of an eye, if it is to be part of a beautiful face, should be precisely three-tenths the width of the face, and the chin ought to be just one-fifth the height of the face, while the total area of the nose had better be less than 5 percent of the total area of the face or … you is ugly!

In the end, the science of beauty seems to point to a few general parameters: We tend to like large eyes, high cheekbones, a small nose, a large smile, and a small chin. What the scientific literature doesn’t mention is that we like it all to be as young as possible. This wasn’t always the case. The Gibson Girl ideal of the early twentieth century, writes Daniel Delis Hill in Advertising to the American Woman, had the features of a mature, fully formed woman: “heavy lidded eyes accented with thick lashes; fine, high eyebrows, pronounced cheekbones and firm jawlines.” In the forties and fifties, the most successful models of the day—Dovima, Lisa Fonssagrives, Suzy Parker—were elegant, haughty, aristocratic, especially when photographed by Irving Penn or Richard Avedon. The sixties and seventies brought a sea change that created a younger beauty ideal, but the aesthetic was more casual than adolescent.

But in the last ten years, perhaps with the coming of Britney Spears, the age of the ideal has dropped precipitously. Now both fashion and celebrity magazines are filled with images of teenagers—whether they’re Eastern European models or tanned California reality stars. Their faces are plump and dewy and flushed with youth. As thin as their bodies are, they still haven’t entirely shed the baby fat in their faces. This, it seems, is what women in their forties and fifties are now after: baby fat.

It’s impossible to pinpoint exactly when or how a new aesthetic is born, but it seems clear that once we became obsessed with the baby face of the teenage girl, the world of dermatology came up with more and better ways for us to achieve the plumpness of youth. We’ve moved way beyond simply injecting bovine collagen into our lips. Today there’s a dizzying nanotechnological world of hyaluronic acid and collagen fillers—Zyplast, Cosmoderm, Perlane, Juvéderm, Evolence, Sculptra—each with a different “bead” size targeted to fill every wrinkle on the face (microscopic for the lines around the eyes, heavier gauge for a cheek or nasolabial fold). With these tools, a woman can dramatically alter her face without going anywhere near a surgeon’s office. All that’s required are twice-a-year injection appointments with a cosmetic dermatologist. And then, when a friend comments on her appearance, she’ll respond, without guile, “Plastic surgery? Me? Heavens, no!”

Time is not kind to a face. In Dr. David Rosenberg’s consultation room, a high-tech mini-theater dominated by a big recliner that looks like a seat in first class, we are scrolling through women’s faces on a flat-screen TV. “Here’s another one,” he says, as he manipulates the screen from his laptop. She’s a very attractive woman, 54 years old. “What she’s developing is descent,” he says. “The jowls have made the jawline more square. A little bit of hooding on the upper lids.” Descent. Falling. Your face is falling. The sky might as well be falling. “We all have our pretty days, and some people are more beautiful than others,” says Rosenberg. “But we all age the same way. Our necks get loose, and our eyes get tired.”

Rosenberg is a fit, compact, and stylish 41-year-old with a sweet, almost feminine nature. He has three children with his wife, Jessica Lattman, who is also a plastic surgeon. And hilariously enough, he has a crooked beak—he needs a nose job!

Today alone, starting twelve hours earlier, Rosenberg met with 50 people in this room, showing them pictures of themselves as they are and as they could be. He is the beneficiary of a whisper campaign among a certain New York–Euro society-fashion crowd for his subtle face-lifts and coveted nose jobs. (He did three times as many nose jobs this year than last.) The fashion magazines have been writing about him. In fact, just a few days after I met him, I had dinner with a good friend who is the publisher of one of those magazines. When I told her I was working on a piece about plastic surgery, she leaned in and whispered, “You must talk to David Rosenberg.” Then my friend, who will turn 60 next spring, confessed that she had just plunked down a $4,000 deposit and will be going under Rosenberg’s knife for a face-lift later this year. All told, it will cost her $30,000, including recovery in a fancy hotel and a private nurse attending to her every need.

For many women, the New New Face begins in their thirties and forties with a little Botox here, a little filler there. To extend the handbag metaphor a bit further, it is the dermatological version of the mini-Birkin. A starter bag. But real, serious, grown-up New New Face business cannot—at least at my friend’s age—be achieved with fillers and Botox alone, something she’s been doing for years, with disappointing results. For women in their fifties and sixties, New New Face construction begins far below the surface of the skin.

A cursory history of the face-lift is probably necessary at this point. In about 1905, surgeons figured out that they could make an incision in front of the ear, cut away a bit of skin, and sew it back up to make the face look less old. Then, in the twenties, the “skin flap” was invented, a procedure that involves peeling the skin back like a bedsheet, allowing for much more skin to be cut away for a tighter result. In 1976, a surgeon discovered the SMAS (or superficial musculoaponeurotic system), a cellophane-thin lining just under the skin that is part of the musculature of the face. If you lifted the skin and tightened the SMAS, you got a much bigger correction in the jawline. To this day, the SMAS operation remains the workhorse face-lift. In the mid-eighties, a Swedish doctor began to go under the SMAS, the beginning of a process that led to the deep-plane face-lift of the early nineties.

But even as surgeons worked with deeper layers of the face, the aesthetic was still a superficial tautness. “When I was in early training,” says Rosenberg, “I kept hearing the phrase, ‘This doctor makes the neck really tight.’ And that was a good thing. That was the operative word. Tightest neck out there!” The surgeries were obvious and, in some cases, seen as status symbols. “It’s like wearing a big shiny Rolex,” says Rosenberg. “ ‘I have enough money that Dr. X did it.’ ” But tight is no longer the operative word. “Eighteen-year-olds, they are never tight. What they have is definition.” (Her again: that round-and-soft-and-also-somehow-perfectly-defined teenage girl!)

Past a certain age, to paraphrase Catherine Deneuve, it’s either your fanny or your face—unless you spend two hours a day in the gym and pay someone to “volumize” your face.
What has transpired in the past ten years, says Rosenberg, is “further dissection of the deeper layers” for a face-lift that is almost entirely muscular. Rosenberg and surgeons like him go under the cheek-fat pad and disconnect the platysma, which is a sheet of muscle that supports the lower face, then they resuspend it higher with stitches under the skin. “That’s how you fix the surface—from below,” he says. “I am working on the undersurface, and everything gently comes with it. So there’s a feminine quality, it’s soft and smooth. When it heals, you don’t see tension on the outer surface.”

Rosenberg is also subtly shifting the shape of the New Nose. “Unlike a face-lift, where you are restoring what someone once had, with a nose you are absolutely changing it, making it completely different,” he says. The nose on the New New Face is strong and architectural and straight. Neither flared nor pointed. More Greek than Roman. It’s also the kind of nose job that you’d never notice without before and after pictures (note Angelina Jolie’s very slightly slimmed masterpiece). What it is most certainly not is the cute little ski-jump nose that was ubiquitous in the sixties and seventies—and even popped up again recently on Ashlee Simpson’s face. The “Diamond Nose,” as it was known 30 years ago, was named after a Dr. Howard Diamond of Manhattan, who supposedly did more rhinoplasties than any surgeon before him.

When I tell Rosenberg that a prominent fashion editor told me that people in her crowd are talking about the “Rosenberg Nose,” he is visibly moved. “Awwww. That is crazy.” He looks away for second, apparently misting up. “Nose surgery is so … hard. So technically difficult to master. You have to plan for adjustments with healing. Things settle, it’s almost like making a … a … wine.” He smiles broadly. “This is the first time I’m hearing this. You don’t know how exciting this is.”

Rosenberg didn’t do Angelina’s nose, although he wouldn’t admit it even if he had. Plastic surgeons are very careful not to talk about their famous clientele, because it is the last secret that celebrities try to keep. The stars still require after-hours appointments with an empty waiting room and a special back entrance at Manhattan Eye and Ear, where he does all of his surgery. But it’s difficult to talk about the changing aesthetics of plastic surgery without, well, examples, so reluctantly he agrees to apply his highly trained eye to the faces of Meg Ryan and Demi Moore, Old New Face and New New Face. “Meg may think she looks beautiful,” he says carefully. “But what we are picking up on is a sense that maybe there is an overinflation of the lips, there’s an overabundance of fillers in her face.” He pauses. “What I see with Demi is more of an operation. Let me say it this way: I see preservation of definition, a preservation of facial architecture. Angularity. Very pretty.” He mentions Madonna admiringly as well. “You see the architecture of the jawline, you see the architecture of the cheekbones.”

She didn’t lose her face,” I say.

“She gained it,” says Rosenberg.

The full version of this article, originally published by the New York Times can be found here.