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A Certain Aesthetic

A Certain Aesthetic

Dr. Carolyn Chang’s office was a San Francisco sanctuary, a place of beauty and calm tucked away in the tony neighborhood of Pacific Heights. The lighting was soft and buttery. The white leather furniture was sleek and understated, the walls adorned with contemporary art. Glass and brushed steel coffee tables displayed Harper’s Bazaar and W Magazine. Dr. Chang was, after all, one of the leading plastic surgeons in the United States. She had lifted the faces of many of Hollywood’s famous and fabulous. I was here for an audition, to see if my goals were a fit for Dr. Chang’s signature, natural aesthetic. 

Dr. Chang’s patient coordinator, Niloo, called my name in a hushed whisper, “Nancy Deyo?”

“Here!” I said, a bit too loudly. The honed and hopeful looked up over their fashion magazines. 

“Dr. Chang will see you now.”

Niloo guided me through a hallway filled with framed magazine articles. 

Carolyn Chang—tall, svelte, silhouetted by the backlit sun—posed in the doorway. “Hell-ooo, I’m Carolyn Chang,” she said, her voice low and luxurious.

She had the long black hair and taut skin of a 30-year-old, dressed in Chanel Couture fresh off of the Paris runways. Louboutin heels completed the image. I later learned from Nurse Jerri that in Dr. Chang’s fifteen-plus years of medical practice she had never worn the same outfit twice.

“I had an accident climbing Mount Kilimanjaro sixteen years ago,” I began as we settled into leather sling back chairs, reciting the speech I had practiced earlier. “I was bedridden for a decade, unable to recover, and became addicted to opioids in an effort to manage my pain.”

Dr. Chang nodded as I told her my story, focusing her surgeon’s eye on my face. “Stress and pain can accelerate the effects of aging, especially in extended trauma situations.” 

She reached a manicured hand toward me. 

“May I?”

I nodded my consent and she began gently touching my face, neck and eyelids.


My mother was classically beautiful. Throughout her life, she cultivated an elegant, minimalist aesthetic. Everything was smooth, white and unblemished, from her face to her furniture. I tried to keep that part of our shared DNA in check, but it got the better of me late in my 50s. When my teeth yellowed, I opted for veneers to enhance my appearance. Just like my mother would have done, I chose the whitest tooth color available. Two years later, I was consumed with the need to “freshen up” my face. 

Fixated on the crow’s feet around my eyes, the crosshatch pattern circling my lips, and the flesh hanging loosely between my chin and neck, I was adamant that cosmetic surgery would reverse the effects of aging that had followed my accident on Mount Kilimanjaro. 

My North Star was a photo of my 35-year-old self in Sydney, Australia, sitting at an outdoor bar on the harbor, the famous opera house behind me. My husband Chris’s camera zoomed in on my face, soft and sun kissed, smooth and rounded. My lips were full. My eyes looked directly into the camera, happy and hopeful. I had felt in that moment a zest for life, the years stretching luxuriously before me, and I wanted that look again. I wanted that feeling again. 

Dr. Chang came highly recommended by one of Chris’s work colleagues. “You will look like you, only younger,” she promised. I bequeathed my Sydney photo to Dr. Chang, who vowed to base her work on it. I went under the knife one month later.


Discreet was an understatement. I woke up after surgery in a private room in a private wing of San Francisco’s California Pacific Medical Center, complete with a private nurse, who never left my side. My face and head were wrapped in mummy-like gauze, with slits for my eyes, nose and mouth, and tiny tubes draining liquid from my surgically altered face. I was Ralph Fiennes in The English Patient, minus the burns. 

My private nurse explained that Chris was not permitted to see me until I was discharged the next morning. It was common for patients to overreact to any concern reflected in a loved one’s eyes. True to form, Chris had on his poker face as he arrived with my baseball cap, sunglasses and hooded jacket in hand. I was given my discharge papers, one prescription for Tylenol with Codeine, another for Valium, and instructions not to look in the mirror for five days. I was directed to take the drugs like clockwork, which I did. 

I spent the first three days in bed, at Dr. Chang’s orders, lying on my back with frozen peas held to my face and eyelids. Along with repeated doses of Tylenol with Codeine, freezing my face took the edge off of the throbbing, while the Valium numbed the panic. The skin around my neck was so tight I could barely swallow. I would have welcomed the distraction of television, but my eyes were too swollen to stay open. Instead, I relied on Chris’s music playlists. Music and medication had seen me through the worst of the aftermath of my Mount Kilimanjaro accident, though they now evoked unexpected memories of addiction and despair, which complicated the regret I was already beginning to feel.


Thwack. The sound of my cheek and browbone smashing against the hard, oak floor of our kitchen brought me back to consciousness. 

“What was that?” Chris called out from his office in the next room.

“I’m OK,” I said quickly, not sure if I believed it. “I stood up too fast and got dizzy.”

In fact, I was lying face down on the floor, bleeding from the impact. My face was already swelling on the right-hand side and it hurt like hell.

Had the expanded drug cocktail finally caught up with me? I knew the damage was bad. Self-medicating was in order, I concluded, so I increased both the dosage and frequency of the Tylenol with Codeine. Twenty-four hours later, I was nearly out of my pain medication. I needed a refill. I reached for my cell, but it was Saturday, and Dr. Chang’s hours did not include weekends.

Monday morning could not come soon enough, and when it finally did, I sprang into action. I needed more medication, and I also knew that I needed help titrating off of it. I burst into Dr. Chang’s office without an appointment and babbled to Niloo, and the sea of patients in the waiting room, that I had fallen on my face and needed a refill of pain meds. 

The women’s faces, turned toward me in unison, were caricatures in that moment: smooth plastic skin, plumped-up lips that stretched ear to ear, pencil thin necks, eyes large and unblinking. Did I look like them already? Would I? They were The Stepford Wives from a dystopian future. 

Was I now one of them? 

Niloo quickly and gently escorted me to the inner office. After a quick consultation with Nurse Jerri, I raced to the nearby Walgreens.


In a matter of weeks, the pain subsided. The bruises healed. The stitches were removed.

Dr. Chang was so thrilled by her result that I became her newest “star” on Instagram. My before and after photos were prominently posted to her feed, the crow’s feet gone, the crosshatch lines no longer circling my lips, the chin sculpted yet soft. Her followers’ response was immediate and enthusiastic, as was mine. I was ready for relaunch.


The San Francisco Tenderloin was bustling the day of my first public outing. Feeling fabulous – smooth, tight and fresh-faced – I sashayed into a local diner to meet my friend Julie. After a quick bear hug, we sat down for an overdue catchup.

Julie gave me a long, confused stare, and said, “You look different.”

“I got my hair cut,” I offered.

“No, that’s not it. You look different.”

At the recommendation of Dr. Chang, I had gotten my hair cut and colored just before surgery. She told her clients to do a makeover of their choosing to reduce the probability of awkward moments, like the one I was now having with Julie.

“It must be the highlights in my hair,” I said.

“I just don’t remember you looking like this,” she insisted.

I did look different. My face was leaner and more angular. My lips were stretched thinly toward my ears. My smile, once one of my better features, spread too widely across my face. Granted, I did not resemble Joan Rivers or Meg Ryan, women who have traveled the slippery slope of surgery, each nip and tuck a futile attempt to hang onto their youth, taking them further from the faces they once knew. Was I still Nancy? The changes were neither “minimalist” nor “natural.”

My friends had once called me a “triple threat” – looks, smarts, personality. I had used all three to navigate professional and personal worlds, but the fantasy of a post-Kilimanjaro comeback based largely on beauty was deeply flawed. I had “freshened” my face, but it had done little to instantly rejuvenate my life. Where was that joy and exuberance, that sense of purpose? I titrated off the Codeine and Valium, which was hard, though not nearly the struggle I had undergone after the accident. Again, I was in post-surgical purgatory, seeking a new beginning, and somewhat bewildered at my prospects for returning to a “normal” life, one with direction, community, and physical and mental health I could depend on.


It has been four years since I went under the knife. My face, long since healed, is now tired, lined and loose – and not the way I had imagined it would look as the years passed. What I would have looked like at 62, had I not chosen the surgical route, is unknowable. But I do know that this face is no longer mine. It is a new face, curated to be fresher, a better version of the one I was born with, a new baseline from which time and gravity continue their forward march. In this way, I think, the surgery was a success—I do look different—but not the success I had imagined. 

Friends my age know that external beauty fades. Many welcome the lines and sags along with the lived experience that created them. I embrace this notion intellectually, though I suspect my insecurities will always favor maintaining my looks as long as I am able. This insight brings me shame in a society I have often criticized for its fixation on youth and beauty. I feel that shame when I see teenage girls with eating disorders who want to look like the latest anorexic Instagram influencer. I feel that shame when I meet women who hate themselves for not being young enough or beautiful enough, who aspire to the aesthetic of their husband’s favorite Sports Illustrated swimsuit model.

I have no regrets about enhancing my teeth.

I do, however, regret having cosmetic surgery. Not even the best surgeon can make a 62-year-old look 35 again. This single act is perhaps the biggest difference in how my mother and I fanned the flames of our respective vanities. My mother struggled all of her life to hang onto her beauty, using dieting, teeth whitening, skin cremes and facials to slow the march of time, and when that no longer worked, she surrounded herself with beautiful things. I took the opposite approach. In trying to restart my life after a decade of suffering, I chose plastic surgery to reverse my own decline. If we both used the tools available to us when we needed them, my mother sculpted the world around her when her own looks receded, while I altered my appearance but kept my surroundings the same.

It never occurred to me that I might emerge from surgery with a different face, or that I would not be able to resurrect the feeling of joy, that sense of hope. Perhaps this face is my burden to carry, then, a constant reminder of the risks I undertook and the decisions I cannot undo. My face is the first thing I see each day when I look in the mirror. I am not that exuberant 35-year-old in the photo, but rather a humbled 62-year-old: my aesthetically altered self. In the end, I think my mother chose the better approach. She embraced the beauty around her and accepted that her own carefully cultivated aesthetic had its natural limits. Cosmetic surgery, veiled in necessity but fueled by vanity, is a fool’s errand. Gravity and time always win.

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