Mary Bright didn’t like to consider herself a regular customer. And she absolutely detested me calling her a regular patient. But the crooked curliness of her signature on my appointment sheets through the past three weeks pointed towards the obvious fact: Mary Bright was, beyond all doubt, my most regular patient and my highest paying customer. Before her consultation with me I was puzzled. She’d called in, made an appointment, but didn’t have a specific procedure in mind. The day of the appointment she came tip-toeing into the office. An astonishingly average looking woman. Tall, but no model height. Skinny, but strongly built. Shoulder length hair without layers and in terms of bone structure, quite a square shaped face. I greeted her with my name, but got nothing in reply. The whole vibe of her nervousness was disturbing at first, but I guess I got used to it.
"I need work done."
My automatic response was to say that from anyone’s point of view, she didn’t need anything done. I hurried myself to make that clear, but added that since she had contacted the clinic and asked for me specifically, that obviously wasn’t the answer she wanted. I asked her instead what she had in mind. What followed was, well…unreal. I had never heard any "normal" person speak with such an extensive knowledge about plastic surgery. Mary Bright talked of operations I’d barely heard of and despite the fact that she was talking about having them done on her own body, she didn’t leave out any of the gory details. Most patients prefer not to hear every step. First, she wanted a breast augmentation with 600 CC implants, then rhinoplasty to fix her crooked nose. She also wanted a breast lift, rib removal and something she described as a "hip carving," where parts of her hip bones would be shaved off on both sides and smoothed out in order to make a perfect hourglass shape. Besides that, I could, in her own words, "do my thing." At the end of the day, she wanted perfection.
"And maybe some liposuction and a little excess skin removal on the hips just to tie it all together," she added.
The normal thing to do in my position was to play it by the book. Have a real talk with her, tell her that maybe we should start with the part of her body she saw as the greatest problem area. See how she liked that to begin with and take it from there. But I had never seen such a profound passion for something this bizarre. She had this sparkle when she spoke, as if this had been her lifelong dream, as if every event in her life had led up to just these 30 minutes in my office. To be frank, I didn’t want to rob her of it. The whole thing brought me back to the small interest I used to have in my student years. It was an interest in surgeons I would go as far as to call insane, but who had obsessions of sculpting the perfect body. I used to spend hours hunched over computers, books, patient records, looking at other surgeons who’d worked towards this goal.
Some photos of failed procedures had been chilling to look at. Rib removals gone wrong, cheek bone implants using plastic that had ended up ripping through the patient’s face. What fascinated me about the subject was that the procedures had an almost improvisational feel to them. They seemed to have been made up by the surgeons themselves without research. Research on the specific operations didn’t exist. The patients had gone through with them knowing that their chances depended on luck. All for the sake of looking good.
However, the protocols were there, and would always be there, for a reason. Mary’s main concern was her breasts and her nose, and those were the areas I would tackle. She had quite a define hump right above the tip of her nose. She herself didn’t like the width and the way the tip was facing down. I prepared the details for a full refinement, where the hump would be shaved down and smoothed, the tip lifted up and the nasal bridge made narrower. Rhinoplasty was quite easy and fast, but I would be working on a lot of delicate cartilage. The challenge was to remove just enough of it, while still keeping the nostrils from collapsing.
Then there was the breast augmentation and liposuction. 600 CC was a lot, considering her current size. Most patients go for 330-400, which is a healthy change for most sizes. Mary wished to stay in the extreme range, which meant a massive recovery process. I wouldn’t say I tried to talk her out of it, but I did try to show her implants in a more reasonable range.
"A saline implant would be more flexible, although in a smaller size. Or we could do a 400 CC, but in high profile, which is a more protruding option?"
"600 CC in both, high profile. I’m paying for this."
No way of turning her around.
I feel like I’m bombarding you with foreign expressions, but this is the way my conversations with her actually went down. Mary wasn’t a newbie to this world. She had years of research behind her, talking to surgeons, looking up clinics, watching footage of procedures. I found myself wondering if something had happened in her past to make her so obsessed with her appearance. From time to time, you meet a patient who doesn’t want a change for the right reason. The problem might be low self-esteem, anxiety, depression, a partner pushing them to do it. The strange thing is that even though some of her ideas were a bit far fetched, Mary Bright seemed down to earth. She seemed to be at peace with how she looked now, and with the changes she wanted to make. In some ways, I couldn’t tell if the changes were wishes and needs for her, or results of extreme fascination. The point is, Mary wanted these changes herself and for herself. I didn't feel the need to ask any questions.
Before the surgery, Mary came in for a couple of minor face adjustments. I gave her some botox to smooth the few fine lines on her forehead and cheeks and to prevent further aging. She also asked for some lip fillers, top and bottom. Quite a pout, but with an amount within the limits of the clinic’s policy. She didn’t say much, just grabbed a handheld mirror and told me to leave her alone for a while. She stayed in that white, sterile room until closing time.
I invited her for coffee after and she accepted. I know it isn’t exactly usual, but it wasn’t a date. More of a nice, polite conversation between two people with the same field of interest. We didn’t talk about my past or hers, not about what her profession was or why she preferred her coffee black. We just sat there discussing fillers and implants, different types of anesthetic and why all surgeons’ frocks and caps are green. People around us must have assumed we were work colleagues. We had one coffee, I gave her some paperwork to read through for preparation, and we left each to our own. It was the last time I saw her before surgery day.
I wish I could have explained what happened in a way that would have made sense. But honestly, the whole chain of events is almost blurry to me. Every time I think about it, I feel like my mind is a teenager’s room right before the teenager comes home to mess it up. I know it’s a horrible simile, but that’s what it feels like. The thought of that day messes with my head.
When she came in at nine the next morning she seemed different. A sort of absent minded nervousness I hadn’t previously seen in her. She didn’t talk, but stayed dead silent from the moment I called her in from the waiting room. All the routine questions such as "Have you eaten since midnight?", "Have you taken your 500 mg of Ibuprofen like we said?" were answered with a few quiet, distracted nods. She gulped down the pills given with any procedure to keep the swelling to a minimum, and dressed up in the light blue hospital gown. Measuring out the points of incision with a black marker was an awkward affair. I could hear every breath, each movement in her body. She still kept quiet, but had obtained a quirky half smile, as if she marvelled at the fact that everything from now on would be better. Of course, that is an accurate reaction, but most patients have to be soothed before an operation. Most people don’t keep quiet, but ask all sorts of questions about risks and pain related to recovery. Mary Bright asked no questions. She stood in front of me smiling and made all the movements I told her to make in an almost robotic fashion.
The majority of my patients wonder why I don’t have an assistant to put them under anesthesia. I do all my procedures alone, as I’m just as much an anesthetist as I am a plastic surgeon. I went through my usual routine of explaining, she shrugged her shoulders for an answer, and I put her under.
"Are you going to make me beautiful?" she sighed as the anesthesia started kicking in.
"That is my job."
The two parts of the procedure went as planned. Mary’s breast tissue was wide enough for the implants to go over the muscle, which meant a massive chunk of time taken off her recovery. The cartilage in her nose cooperated just fine, making me able to shave the lump down a few millimetres and lift her nostrils just a little bit to fix the droopy tip. It all took a total of two hours, including stitching and bandaging.
God knows I’ve tried wrapping my head around everything to create an understandable explanation. I’m still not able to. Operation rooms are nightmare fuel. Sterilised, all furniture covered in sheets, instruments on a tin tray. The bright ring light above your head is the last thing you see before completely surrendering yourself in the hands of someone else. A steel dungeon you sleep in. I would lie if I said it didn’t mess with me sometimes.
I was about to roll her out to recovery when something came to me. A wicked thought creeping in through the back of my head like a tiny black river. Trust. That’s what it’s all about, leaving yourself to trust. Letting someone put you in a state where you can’t move or feel, then allowing them to change you and hoping that the change will be for the better. That’s why these rooms are the stuff of nightmares, that’s why experiments and body horror is used in stories to freak people out. It works because it’s real.
Even though I’d already made the planned changes, I couldn’t help myself from looking at Mary Bright’s pale, lumpy body without seeing areas of improvement. I wanted to fix her, to keep my promise about making her beautiful, but without it just being words. Five minutes of just staring down at her made the thought take over. I couldn’t stop there. So I put her under another round of drugs and continued.
Her face had been taken to its best state. She was too young for a face or brow lift, and the botox I had injected earlier had done the job with removing the few wrinkles she had. Her lips looked plump and voluminous due to the fillers, and the swelling had disappeared. The nose would heal into its post-op condition, and already, it fit her face beautifully compared to its previous shape and size. The area I wanted to adjust was her body, in particular her waist, hips and thighs.
I worked as good as unconsciously, as if my arms and hands were moving without the help of my mind. Making an incision at her hips, I went in and shaved away inches of bone, until her hips had reached the narrowness of someone who constantly wears a corset. After stitching this part up, I made a smaller incision by her ribs, dug my hands through the opening and carefully slit off three of them. The monitor that kept her vitals under surveillance beeped frantically in the background. It slowly faded into a faint ringing sound in my ears. I was absorbed, all my movements confined to the action of my work.
Removing ribs and shaving away inches of bone meant quite an amount of excess skin. To get rid of the majority of it and tighten up her waist, I switched between a scalpel and a burner to keep the amount of scarring to a minimum. Although Mary’s body could be described as a bit bulky, the amount of skin I shaved off didn’t fill more than a cup.
All that was left was the last stage. Surprisingly, it was one that had been planned from the very beginning. Liposuction. This procedure, how ever scary it may sound, is viewed by plastic surgeons as one of the most harmless. I went through with this quickly, touching up and tightening areas on Mary’s stomach and thighs. A liposuction is exactly what it sounds like, a procedure where excess fat underneath the skin gets "vacuumed" out. Mary’s thighs contained a surprisingly large amount, but her body cooperated nicely, letting me put the final touches down with little effort.
It feels wrong to even say it, but I knew she would have been happy. Even a "tears of joy" level of happy. I had done exactly what she wanted. Her body was beautiful, porn star and model beautiful, but not even that. Her body had been designed like a drawing, a lingerie shop mannequin. She was drop dead gorgeous, and by using all her time to recuperate and heal, she would become even more beautiful. Her lips stood out from her face, luscious and full, her beak-like nose now looked tiny and delicate. Her waist and thighs were no longer limp and bulky, but tight and slender. What most people would view as complete destruction, I saw as my way of keeping my promise to her.
Mary Bright died on the 12th of November at 12:43 pm., 33 years old. The potential causes of death is a list too long to even mention. I’m guessing that the primary reason was blood loss. The version I told my nurses was that she was sent home with a prescription for pain killers. In reality, I needed to get rid of her, but I’m guessing that the way I made that happen is a little too much for anyone to stomach at this point.
Mary is still with me, keeping me company in my office. She reminds me of something beautiful, and that, at least for me, makes it worth something to keep her around. Most patients don’t ask about it. When someone occasionally does, I tell them it’s a plastic skeleton.