Skin Deep

preventive medicine against aging. Younger skin is more elastic, the effects last longer, and the recovery period is shorter.”

“But couldn’t that encourage obsession?” Steve asked.

“Yes, which is why I make a psychological profile of patients before I operate. One woman who came in was only twenty-seven yet had sixteen surgical procedures. She was a slave to the scalpel, and had spent a fortune.”

“What did you do for her?”

“Sent her home. She needed a psychiatrist, not a surgeon.”

“I imagine all the makeover shows haven’t helped,” Steve said.

“No, especially with women wanting to have Nicole Kidman’s nose or Angelina Jolie’s lips. We also turned away a woman who was obsessed with wanting to look like Jessica Simpson. She had had several reconstructive procedures and was still not happy. She couldn’t pass a mirror without being sick at how she didn’t resemble the singer.”

“That sounds pathological.”

“Yes, technically a form of body dysmorphic disorder. So, when people come in with photos of the features they want, I tell them that they may be disappointed because we cannot guarantee the exact likeness. And unless they accept that, I won’t operate.”

“Is it mostly women?”

“We get an occasional male.” He tapped a few keys. And on the screen appeared a man with a slick black pompadour and a hurt truculent expression. “Rodney is an Elvis impersonator.”

There was a resemblance but mostly in the hair, eyes, and huge white sequined collar.

“That’s before.” Monks tapped a few more keys and the screen split with a shot of Elvis Presley on the right and Rodney on the left. It was nearly impossible to tell the difference. “Of course, he had to have had some basics to work with—forehead structure, cheekbone width, length of jaw. It’s much harder to take down bone than build up, which can be done with fat injections and implants. That’s what we did here.”

“Amazing,” Dana said, staring at the screen. “And you probably added another twenty years onto his professional life.”

Monks moved his mouse and clicked a few keys. “Particularly challenging was this fellow.” On the screen was the image of a rather ordinary-looking man with a short wide nose, long narrow face, and thin lips. Then Monks clicked the mouse and the next slide was a glamour shot of a beautiful woman with golden hair, large open and heavily made-up eyes, high cheekbones, and full red lips.

“My goodness.”

“What’s interesting is that he didn’t want to look like any particular woman, he just wanted to look feminine, which meant some alteration of his facial structure in addition to his eyes, lips, and nose.” Monks clicked the mouse, and more shots of the man followed in a cocktail dress with short blond hair, in kabuki whiteface and kimono, in leather bondage attire and shiny black hair, and in a huge blond fright wig and lavish makeup.

“A drag queen,” Steve said.

“Yes, and an internationally famous one who does performance theater with a traveling dance and theater company. The challenge was to create female features out of his.”

“Looks like you succeeded,” Steve said, “but it sounds confusing.”

“Well, these men aren’t attempting to pass as women except as a hobby or professional art form—as opposed to some private sexual identity thing or gender dysmorphia.”

“Back to Dana,” Steve said. “Where would the procedures be done?”

“Right here. We have our own operating room down the hall and OR staff, including an anesthesiologist and nurses, which, by the way, makes procedures a lot cheaper than at a hospital.”

“Since you raised the ugly stuff,” said Steve, “what about cost?”

Monks smiled. “We do have a financial assistant, but since you asked, for upper lids our standard fee is four thousand.”

“What about a nose job?”

“Seventy-five hundred.”

So much for that, Dana thought. “What about removing crow’s-feet?”

“Any that remain would be a matter of collagen treatments, which is three hundred dollars per procedure.”

“And the nasolabial folds?”

Monks smiled as he studied her face. “Four hundred.”

“A brow lift?” she asked.

“Frankly, I don’t think you need that, but our standard fee for a full brow lift is four thousand.”

“Not that I’m considering it, but what does a full face-lift cost?”

“Twenty-five thousand.”

“Oh,” Steve said, probably thinking that four of those a week would equal his annual salary. Also wondering who would pay.

“Yes, it’s expensive, but consider the fact that in New York the same procedure can be thirty-five thousand and in Los Angeles you can pay as much as fifty. By comparison, in, say, Big Horn, Montana, you might find a clinic that advertises face-lifts for under three thousand.”

“Yeah, and probably end up looking like a sheep,” Steve said.

Monks laughed.

“Frankly, what do you think I need?” Dana asked.

He studied her for a few moments. “Well, you came in here for your upper eyelids in the hope of creating a rejuvenating effect. You also mentioned rhinoplasty. Then you asked about the brow and frown lines, then crow’s- feet and nasolabial procedure. You then speculated about a full face-lift.” He rocked back in his chair and glared at her. “I don’t think I can operate on you.”

Dana felt her insides drop. “What? Why not?”

“Because you’re not settled on what you want.”

Steve tried to repress a self-satisfied grin.

“But what about just the upper lid lifts?”

“Given your expectations, you might be dissatisfied. Your eyes would look great, but they might appear incomplete with your nose and brow. Or you may start wondering about chin work or something else. I can’t live with that.”

Dana was dismayed. “I was just speculating about the other procedures. I think I want the upper lid lift and maybe a nose job if I can afford it.”

“Then maybe you should settle in your mind what exactly you want and can afford.”

“So, where does that leave me?” She could hear pleading in her voice. She could not believe that the same man who did pro bono work for street people was playing hardball with her.

“When you’re settled, we’ll schedule another appointment. Meanwhile, we’ll both think it over.”

Christ! In her ambivalence he had decided she was too flakey to operate on. “Okay, then let’s make another appointment.”

“Okay.” Monks picked up his phone. “May Ann, when can we see Mrs. Markarian again?” He nodded as May Ann checked. “September sixth? Is that the earliest?”

That was three months from now.

“Okay, if that’s the best we can do.” He hung up. “Sorry. We’re booked solid until then.”

Dana felt as if the wind had been punched out of her. “I was hoping to get this taken care of while I’m still on summer vacation.”

“Isn’t there a chance of a cancellation or something?” Steve asked.

“If there is we’ll call.” He made a slight shift in his body to say the consultation was over.

“Is it possible we could meet sooner? Please, I think I can decide in a day or two.”

Monks put his hands together as if praying and brought them up to his chin as he studied her. Suddenly she felt a tinge of desperation. She had not yet turned in her resignation and was scheduled to return to Carleton High in the fall.

“It’s out of the ordinary, but perhaps we could meet after-hours. I often work late, especially since I’m going