Does This Make Me Look Operated?

What do Sharon Osbourne (56), Vanessa Williams (45), Jennie Garth (36), Daisy Fuentes (42), Brooke Shields (43), Simon Crowell (49), David Hasselhof (56), Linda Evangelista (43), Janice Dickinson (53), Lisa Rinna (45), Lori Loughlin (44), and Courtney Cox (44) all have in common?

Fewer wrinkles!

It's not a coincidence that there has been a slew of Botox "confessions" from Hollywood celebrities in the last few months. It coincides with Allergan's (the manufacturer of Botox® Cosmetic aka Botulinum Toxin Type A) marketing push launched in 2007 and formatted as a hybrid public service/infomercial/giveaway featuring well-known personalities.
Olympians Mark Spitz (58) and Nadia Comaneci (47) both gave lecture tours on “Your Personal Best” this fall. Virginia Madsen (44) hawked Botox with her mother in "Freedom of Expression."

By her own admission, Madsen got the job by a slip of the tongue in an interview shortly after the surprise success of her Oscar-nominated film role in Sideways (2004).

But it is really just stating the obvious: Aging Hollywood faces have help from knives and needles.

Short of the kind of admissions currently being featured in magazines, how do you know who's telling the whole truth?

It's all in the ears.

Rhytidectomies do the heavy lifting and offer the most clues. In a traditional facelift, an incision is made in front of the ear extending up into the hairline and down around the bottom of the ear and then up behind it, usually ending in the hairline. (For an excellent pictorial tutorial of the actual surgery, go here.)

Shall we play I Spy? I spy with my little eye....operated auricles.

A pixied earlobe is the distorted result when the reattached lobule is pulled down and forward onto the cheek. A fine example is Micky Rourke's (56) left ear; both are shown. A competent facial plastic surgeon will preserve the shape of the lobe you with which you were born. Otherwise, a big earring is the answer.

Poor scar placement and poor incision planning can be covered up with hairstyling– less so if you are David Gest (55). Over time, John Cleese's (69) aging facelift has relaxed into something appearing fairly natural, but his misplaced post-auricular scar in probably still very visible. (Check out the big kiss scene in Fierce Creatures, 1997).

The pre- and post-auricular skin of the ear is specialized: it is thin and nonhair-bearing. In some (especially men) the facial skin does not match identically with the ear skin. Removing this patch of pliable, hairless skin can have unnatural results....like shaving your ear.

Perhaps more subtle is temporal hair loss or the sacrifice of the tuft of hair at the upper junction of the ear and face. As with Sophia Loren's (74) right ear, it can give a man or woman the appearance of wearing a wig.

The incision can go behind the tragus, that little cartilaginous bump in front of the ear hole, or in front of it. Female stars like Joan Rivers (75) usually opted for behind, in order to camouflage the scar. Poorly handled, the natural definition/indentation in that area is lost, blunting of the facial-ear junction.

Sometimes the tragus itself is distorted and pulled forward by the tension of the lift and/or the thickness of the redraped skin (this settles out over time as it has for Madonna, 50).

And whose operated ears do I Spy here?




After a traditional facelift, some of these stars may appear wonderful in photos, but as soon as they try to move their faces they look a bit Frankenface. The old-school operated look is something smooth and taut, but not young. The new look is all about volume, not subtraction. Volume is the very essence of facial youth and next-generation surgery is all about adding it.



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I Spy answers:

Frightful Facelifts

And now as promised, an early Halloween special! Let's start with the frankly frightful – results that make children cry and dogs bark.

Jocelyn Wildenstein (62) is pretty scary with shocking surgically-enhanced features (reportedly inspired by a love of exotic wild cats). The ex-wife of a billionaire art dealer, she has undergone about seven surgical sessions including not only a facelift, but drastic eye reconstruction surgery and custom SUV-sized implants to her lips, cheeks, chin, and brow as well. Here she is in her latest incarnation.

Who else might we see trick-or-treating?

You can count on Joan Rivers (75) to show up. Her face has been around the block several times. Her last facelift is perhaps the most deforming; check out her Loose Women appearance on YouTube. The cheek and lip implants have left her face stiff and her speech a bit slurred.

She's got company. Several aging stars have opted for the Madame puppet look: too tight, too thin, all cheeks and chin.

Dolly Parton (62) sleeps in her makeup when staying metropolitan high-rise hotels – just in case of emergency evacuation. Her wig is at the ready on the lamp shade.

Faye Dunaway (67), once among the most beautiful in Hollywood, also has an affinity with Madame after a recent touch-up to her cheeks.

There are those celebrity women whose decorative efforts merely accentuate the horrific. Jackie Stallone (71) needn't say "boo!" Her makeup does it for her.

Thinking about a Halloween video? Forget Nightmare on Elm Street. Rent The Boynton Beach Club and be ready to swear off geriatric sex after viewing Loretta Swit (70) and Dyan Cannon (71) animate their masks.

But women don't have the worst of it. Off-camera, tell-tale facelift results can't be camouflaged as readily with hair and makeup if you're a guy.

But men – they're just so uninhibited!

Pre-auricular incisions like Michael Douglas's (63) are placed in front of the tragus to avoid repositioning beard inside and behind the ears.

It's very tricky to preserve the characteristically male pre-auricular bare skin and sideburn; obliterate both and you get David Gest's (55) look. He's shaving right into his ears! His tragus is pulled foward by placing the incision behind it and the scar resurfaces in what's left of his sideburn.

But my favorite male mask belongs to Burt Reynolds (72). Even his toupee can't hide his pixied earlobes and the pulled, unnatural vectors.

Another popular male choice is to dress up as an alien. How else do you explain Mickey Rourke's (56) chosen look? Or his fellow extraterrestrial, Scott Thompson (43), aka Carrot Top?

The Brits love Tarts and Vicars fancy dress parties and changing sex is a popular theme on this side of the pond as well! I think we'll be sticking with just the costume part of it for our own Halloween this year....




New Feature FM107.1 on Demand - audio archive
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Did you miss hearing Anne flesh it all out with Kevyn Burger on-air? Use this link to find the FM107.1 audio archive of Knifestyles broadcasts by date (second hour). Step one: select the date shown on the blog posting; step two: click on Kevyn Burger; step three: click on second hour. Enjoy!

Regrettable Rhinoplasties

Does seem as if young Hollywood starlets all share a common gene pool? The ubiquity of the narrow bridge, defined tip, straight dorsum– something distinctly American and that you won't find on screen in foreign films– isn't due to the great melting pot, it's the surgeon's knife.

Like diamonds, rhinoplasties are forever. Once you've purchased it, you'll be wearing it for the rest of your life.

The nose doesn't grow back or stretch with time. The very best of the rhinoplastic surgeons (and there are fewer of them than you think) can improve on a bad result, but revision surgery will never restore your original nose to your face.

As they say in the business: "you want to hit a home run the first time you're up to bat."

So what makes for a poor result?

First, an anatomical primer. Surgeons identify the supporting structure under the nasal skin by its anatomical parts:

From the apex or nasal tip, the columella projects inferoposteriorly toward the center of the superior lip, adjacent on either side to the nares. Encompassing the border of the nares are the alae of the nose superiorly and laterally, and the floor of the nose inferiorly. At the posterior aspect of the base of the nose is the piriform aperture, bordered superiorly and laterally by the frontal processes of the maxilla and the nasal bones. The inferior portion of the cartilaginous nose, otherwise considered the base of the nose, includes the lobule, which consists of the lower lateral cartilages, the tip, the alae, and the columella. In the midline, the posterior aspect of the medial crura of the lower lateral cartilages articulates with the caudal membranous septum. Anteriorly, the medial crura are enclosed within the columella. The lateral crura of the lower lateral cartilages project superiorly to overlap the inferior aspect of the upper lateral cartilages in the midline. Laterally, these crura loosely attach to the piriform aperture....

And now to illustrate. Double-click on any of these images to get a close-up. Take a good look.

The nose falls apart over time, ie, the underlying architecture of the nose is so compromised that the look (and function) can't be maintained. Repeated surgeries become necessary. Michael Jackson (50) is the poster child for what is termed a 'crucified nose.'

Alternately, the surgical result may stay put but it's a look that doesn't appear in nature ala LaToya Jackson (51). Closely related to this phenonmenon is the 'operated look,' a nose that is plausible but clearly the result of surgery, distracting even to the untrained eye. Calista Flockhart (43) has just such a rhinoplasty. Her skin is thin and her resected greater alar cartilage on one side almost pokes through the tip, like a knuckle.

Scarring and overly aggressive resection of the cartilage causes a 'pinched tip' (thinning of lateral cura) and/or 'notched nostrils' (lateral crus). That girl, Marlo Thomas (70) has both.


Her first cosmetic surgery was way back in 1965. Joan Rivers (73) was actually much prettier than she ever thought she was and her initial surgeries made her only slightly less so. But her nose has been, for some time now, the classic example of too much, too often. The net result is a 'putty nose,' one which looks as if it was fashioned out of silly putty and stuck on her face.

Now you see it, now you don't. Onlay grafts to build up the dorsum are always tricky. Alloplastic grafts (eg, silicone, gortex) tend to become infected and extrude; allografts (eg, cadaver donor tissue) reabsorb over time. Only autogenous ones (eg, the patient's own septal/ear cartilage, rib, iliac bone) tend to last. Just ask Lil' Kimberly Jones (33).

Polly want a cracker? No. The pollybeak deformity is a disproportionate fullness in the supratip which evolves postsurgically. It can be cartilagenous or soft tissue in nature and is often the result of a misjudgment on the surgeon's part. Furthermost left is a 1983 preoperative photo of Meg Ryan (46); the next two date from '01 and '08.

Excessive 'columella show' can cause the operated nose to have the appearance of a long, drooping tip. And seeing inside someone's nostril can provide fodder for embarrassing rumors about what's up inside there. Here are three postoperative views of Paris Hilton (27).

Correction of the twisted nose poses one of the greatest challenges in septorhinoplasty. "My face is full of imperfections and it is what it is." Easy to say when you're Dr. McDreamy and have landed gigs as the face of both Versace and Avon campaigns this year. Patrick Dempsey's (41) rhinoplasty took place sometime around 1991-1994. Symmetry is defined by an imaginary line drawn equidistance between the medial canthus (inner corners of the eye) through the middle space of the two front teeth/cupid's bow.

Perhaps the most incongruous mistake is when a perfectly natural-looking result simply doesn't suit the wearer. Jennifer Grey's (48) new nose so disoriented her fans that her career faltered. Twenty years postoperatively, it still hasn't recovered.

To hear more, tune in to hear Anne discuss it all with Kevyn Burger on FM107.1 at 10am Thursday.