Fatal Attraction (Death)

When and why does cosmetic surgery prove fatal? Rapper Kanye West's mother arrived in the emergency room DOA Saturday night, subsequent to undergoing an outpatient abdominoplasty (tummy tuck) and breast reduction on Friday. Of course the American Society of Plastic Surgeons (ASPS) has immediately issued press releases to say how rare this is– they don't actually keep statistics on all who die during or as a result of undergoing elective aesthetic surgery– but who wants to die?

Is it always the doctor's fault? Yes and no. Many variables are outside the control of the surgeon– from anesthesia to the vagaries of healing to patient non-compliance. In general, though, there is one personal variable that has tripped up the established, credentialed plastic surgeon more than any other. That liability is his own ego. Operating on a patient who shouldn't be operated on, deluding oneself about one's surgical omnipotence, can lead to disaster. Sometimes this is compounded by poor judgment and/or skill set.

That may indeed be the case with this death.

The surgeon, Dr. Jan Adams (53), has two previous malpractice suits under his surgical scrubs and three more in gestation (one of which also involves a co-morbidity: diabetes). Shown here in his booking photo, his most recent convictions for DUI in March and April of 2006 led the California Medical Board to consider suspending his license (it's pending with the State). Of the 60 ASPS board certified plastic surgeons listing Beverly Hills as their venue, Adams isn't one of them. When it comes to checking out a physician, Google is your friend.

Dr. Jan Adams considers himself a top plastic surgeon in Beverly Hills, despite his lack of board credentials. He authored Everything Women of Color Should Know About Cosmetic Surgery. He hosted Discovery Health's Plastic Surgery: Before and After show and has been featured pretty much everywhere on the talk circuit. Check out the OprahAftertheShow chat. He's a showman. Is he the most articulate spokesman for plastic surgery? Nope. Was his handiwork on display lovely? Nope. But he is a rare commodity: a black surgeon marketing to women of color.

Donda West (58) also consulted with another Beverly Hills surgeon, Dr. Andre Aboolian. This board certified plastic surgeon insisted on a preoperative clearance from an internist because of an underlying condition. "I always insist on a medical clearance for women over 40, and in this instance, it was particularly important because of a condition she had I felt could have led to a heart attack."

The operating surgeon's response? Adams claims that he did nothing wrong and shared his opinion of his colleague Dr. Aboolian: “[h]e is sleazy and manipulating the truth to elevate his own importance.” That's not generally anything a reputable plastic surgeon would publicly say.

Using a board-certified surgeon at an accredited facility and operating on a healthy person with medical clearance is the prudent route. It isn't possible eliminate all risks in elective aesthetic surgery, but it can really reduce them by not doing too many procedures at one time and by screening for medical conditions beforehand.

Dr. Aboolian didn't specify the underlying morbidity due to patient confidentiality, but the autopsy results will be out in 6-8 weeks. It could very well be that Donda West had an abnormal heartbeat. Arrhythmias (irregular heart rhythms) can result from coronary artery disease, but also occur in normal, healthy hearts particularly as we age. Many don't require any treatment at all, but do pose an additional risk when having surgery. Electrolyte imbalances in the blood (such as low sodium or potassium) brought on by excessive postoperative vomiting can precipitate a heart attack.

Is it safe? The real question to ask is how to make it safer, relative to the risks of any surgery. Once you, the prospective patient, have done your due diligence and selected a physician, here is what you can and should do to protect yourself:

• Don't lie to your surgeon. Devulge everything, everything, truthfully: the smoking, the drugs, the OTC, the supplements, that "baby heart attack" you had 10 years ago....it really does make a difference.

• Involve the primary care physician who knows you top to bottom by getting him/her to medically clear you for surgery. Elective aesthetic surgery should carry the same standard of clinical medicine as any other surgery: it's not fluffy spa medicine.

• Stick with 6 hours or less of anesthesia; you can always come back for more.

• And last, but not least, know how to reach your surgeon that first night. You want– and s/he will give you– all the secret numbers, so you can phone about anything untoward. Before you crash, call your surgeon. Really. Wake them up! Your surgeon wants you to live.

Toss Those Tweezers! (Eyebrows)

Ah, the eyebrow. The window frame to the soul. They get plucked, penciled, and pierced; tinted, trimmed, and threaded; shaved, stenciled, and waxed. They must be important!

In fact, the eyebrow is the spokesperson for the face - particularly in women. Much of the time we have little control over the tiny muscles governing their spontaneous expression: arching in surprise, knitting together in concern, up and down in anger, irony, and joy. It's a large part of what makes the face, in both men and women, interesting.

From skinny to bushy, the brows tell of culture, fashion, and politics.

Robyn Cosio, author of The Eyebrow, argues that the story of the eyebrow's progress through the 20th century parallels the story of women's independence. The flapper era desexualized the newly liberated woman by taking away her hips, breasts, and eyebrows - penciling them back on thin and clueless through the 30s. Was the heavier, natural brow of the 40s and 50s a redefinition of femininity after the social upheaval of sex roles during the war years? The unkempt, even unruly, eyebrows of the 70s an encapsulation of the women's movement?

The eyebrow of the new millennium is large again. Ladies, toss those tweezers! A whole bevy of Eastern European fashion models— Daris, Natalia, Vlada, Eugenia, Sasha and Snejana are inspiring a return to the bold brow. Last Fall, the NYTimes profiled stylists who declared “[o]n both coasts, everybody wants a thicker brow that reminds you of Elizabeth Taylor and Ava Gardner.” Styles may cycle in and out of favor, but many stars have made their mark with a face anchored by a prominent brow and, often, little else. It's a big statement. Strong eyebrows make one look intelligent and empowered.

Nefertiti was a make-up queen when it came to her brows. She shaved them off and painted on those dramatic, elegant brows. Try to picture Audrey Hepburn without her brows, or Sophia Loren.

Bette Davis wouldn't have made it past her screen test if the cinematographer Karl Freund hadn't convinced the director that she had "lovely eyes" and would be suitable for The Bad Sister (1931).

Stars have completely changed their looks over the years by changing their eyebrows. Joan Crawford's incredibly thin blond brows of the 1920s evolved into her signature thick black brows of the 1950s. Look at how Madonna handles her eyebrows each time she reinvents her look.

Getting the right brow isn't easy. There's actually a catelogue of celebrity browshapes to help you analyze what features appeal to you. Round brow? Julia Roberts. Arched? Think Keira Knightley. Softly angled? Nicole Kidman. Curvy? Kirstie Alley. Flat brows? Brooke Shields.

Too much brow? A unibrow or monobrow, medically known as a synophrys, is fairly common in some ethnic groups. It's a sign of feminine beauty in Caucasus and Iran, where connected eyebrows are a sign of virginity and being unmarried. Salma Hayek has been quoted as saying she misses the days when she had one eyebrow because it would have come in handy for her role as Frida Kahlo, the legendary Mexican artist.

Less painful than tweezing or waxing, threading is a very trendy (and ancient) way of shaping the brow. Threading is widely used in India, the Middle East, China and Turkey on both men and women. (It is a Persian tradition to use threading to remove all of a bride's body hair before her wedding night in Iran.) Brad Pitt have been quoted in praise of eyebrow threading!

Doing without eyebrows is quite altering. In Thomas Hardy's Tess of the d-Urbervilles, the beautiful heroine cuts off her eyebrows to protect herself from the lust of men. It is an effective subterfuge. Charlize Theron bravely shaved her eyebrows to better portray the title role in Monster (2003).

Last month, da Vinci's iconic Mona Lisa was scanned using a high-definition camera. A 240-million pixel image using 13 light spectrums, including ultra-violet and infrared, reveals she probably once had eyelashes and eyebrows.

Putting them back on is possible. Permanent makeup will last a number of years, but eventually the tattooing fades, a bit like disappearing ink. It's said that in the 1700s, English women wore falsies made out of tiny pieces of mouse fur. Today salons specializing in brows enhance very sparse ones by gluing a tiny fiber onto each existing hair, a form of eyebrow extensions. There are also brow prosthetics — little toupees for the hair-impaired — in a multitude of shapes and shades. Surgeons offer hair transplant techniques involving tiny hair grafts.

Gravity & aging cause the forehead tissue to sag downward, dropping the eyebrows from their youthful position to a lower position above the eye. It's generally perceived as an aged appearance– or tired, sad, or mad.

Time for a lift! If Botox chemical fix doesn't do it anymore, then it's time for surgery. In a direct browlift the incision is immediately above the brow in a forehead crease– this raises each brow but not the entire forehead (Sylvester Stallone). A temporal lift places a wedge excision in the hair for a lateral pull. A coronal lift puts the incision behind the hairline, excising a wedge of scalp and hoisting up the entire forehead including the eyebrows (Elizabeth Taylor). The least invasive, most natural look involves an endoscopic lift of the brow by re-suspension of the forehead muscles under the brows.


Interested in this look? Eyebrow extensions can cost between $75 to $250 and takes 45 minutes to two hours for an effect that lasts two weeks. Brow reconstruction with hair transplants by a physician involves 150 to 200 grafts for a complete male eyebrow or 100 to 150 grafts for a complete female eyebrow at $4-10/graft. A facial plastic surgeon might charge $3,900 to $5,900 for an endoscopic browlift.


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