Dr. Val Lambros is five years into a 20-year study of how the face ages.
Every five years, Lambros sits a group of study participants in front of a 3-D camera, maps out their faces, and then painstakingly aligns the images to see what time has wreaked upon their pores, wrinkles, and facial structures.
Lambros' "Longitudinal Facial Aging Project" culls its subjects from those who will most benefit from its results-aesthetic surgeons. "Plastic surgeons reliably show up to meetings every year throughout their careers," Lambros explains. At the annual American Society for Aesthetic Plastic Surgery (ASAPS) conference, held last weekend in National Harbor, Md., surgeons dutifully filed into Lambros' exhibit booth to face the camera.
Lambros' sample, while reliable, has one major limitation. "I need beautiful women!" Lambros called out to one female surgeon passing by his ASAPS booth, who agreed to get mapped. "The problem is, the vast majority of them are men," says Lambros, who estimates that less than ten percent of his aging faces are female. "It's a guy-dominated field. And men don't age in the same way that women do," he says. Lambros chalks that partly up to cultural perception, partly up to biology. "Society will see a 60-year-old guy as looking better than a 60-year-old woman," says Lambros. "But women's skin is thinner, too." And Lambros' female sample is not necessarily aging naturally: "Typically, female plastic surgeons will do fillers on themselves-the Botox and stuff," he says. "You'll be able to see that in the photographs, and it will invalidate some of the findings, but not all of them."
Over 90 percent of plastic surgeons are men; over 90 percent of their patients are women. Aesthetic plastic surgeons do not seem overly concerned with why that is. Despite the recession, the business model is strong-cosmetic procedures only decreased by 2 percent from 2008 to 2009. The demographics are shifting slightly-last year, women's procedures were down 3 percent, while men's were up 8-but the industry remains focused on the ladies. At the kick-off of the ASAPS annual conference, four male plastic surgeons convened at the head of a large, U-shaped table to announce the launch of "Project Beauty," ASAPS' new editorial arm focused on the way women look. After airing a few sample video testimonials from women-"I wanted to look more feminine in my clothes, and have more self-confidence!" one breast augmentation patient claimed before breezing down the street in a revealing top-the men took questions from the crowd.
When asked why the vast majority of plastic surgery patients are still female, there was an extended pause, followed by a collective shrugging of shoulders. Robert Singer, a short, balding surgeon who greeted everyone with a kiss on each cheek, took a stab at it: "There are a variety of reasons. Men don't want to give up control. They can't put aside the time. They have a resistance to change. They're not like women, who change their hair all the time." At least one consumer found fault with the idea of a bunch of men dictating beauty standards to a bunch of women. Joan Kron, an octogenarian Allure columnist who writes an aesthetic surgery column for the beauty magazine-and whose smoothed face reveals a personal interest in the industry-assessed the project from behind a pair of oversize sunglasses. "I would trust your opinion on plastic surgery," she told the men. "I wouldn't trust your opinion on beauty. And I certainly wouldn't trust your opinion on fashion."
The ASAPS conference was teeming with gatherings like this one-male surgeons discussing how best to fix women's bodies. During the conference, a panel of male surgeons convened to discuss the importance of jowl management, illustrated by a collection of middle-aged female jaws; a panel of male surgeons demonstrated how best to mark up a (female) face before a face-lift procedure; a male surgeon clicked through a series of photographs of the lower halves of women's bodies-all dressed in identical white thongs-and recommended the number of joules he'd apply to each one.
But on the exhibit floor, where the surgeons are inundated with new products and procedures to help augment their practice, women were everywhere. The floor was bursting with photographs of them-their faces wrapped in the latest in post-operative garment technology; their eyelashes fluttering from the effects of artificial lash-grower Latisse; their heads thrown back in ecstasy as their augmented breasts faced the camera. Across the floor, dozens of silicone breast implants were served up on platters, ready for prodding and squeezing; videos of their bloody insertion into women's bodies abounded. A couple of live ones in bikinis and wedge sandals were splayed out on exam chairs as a non-invasive body-contouring machine canvassed their asses and thighs. They were not the only pieces of meat in attendance: In the corner of the exhibit hall, a sweating slab of pork stood in for human flesh; a couple of Megadyne reps sliced away at it with an electrosurgical pencil.
Ronadró, a 75-year-old artist specializing in surgical art, has spent two decades casting the aesthetic surgery gender divide into bronze. On the exhibit floor, Ronadró displayed a dozen original sculptures specifically crafted for aesthetic surgeons. In New Dawn, a surgeon's gloved hands peel away a woman's wrinkled face, revealing a new, youthful visage. In Renaissance, a naked woman admires herself in a mirror as her discarded, old face piles on the floor with her robes. Art of Aesthetic Surgery depicts the aesthetic surgeon as an artist, creating a beautiful woman from a paintbrush; Magic Hands depicts him as a genie, conjuring a naked woman from a magic lamp. Ronadró's masterpiece, In His Hands, situates the surgeon as God; in it, Jesus places his hand on a surgeon's shoulder as the surgeon reaches out to touch the hand of his patient. "This piece was inspired by the Michelangelo on the ceiling of the Sistine chapel, where God is almost touching Adam's hand," Ronadró says. All of Ronadró's surgeons on display in his ASAPS booth were men; all but one of the patients were women.
Dr. Laurie Casas, a Chicago-area aesthetic surgeon, was one of the few female surgeons who had a visible role in the conference leadership this year. Casas, who is president of the Aesthetic Surgery Education and Research Foundation, says the gender divide in ASAPS is easily explainable. "The number of women in surgery is low. The number of women in plastic surgery is low. The number of female plastic surgeons who can meet the rigorous requirements to be a member of ASAPS is even lower." Why an estimated 94 percent of Casas' surgery patients are female requires a more complicated explanation. "It's not that men aren't interested in looking good-they wear nice clothes, they groom their hair. But unlike women, they're not conditioned into thinking about making a significant change. They don't even think of surgery as an option for altering an aging sign like excess eyelid skin or hanging neck skin," says Casas. "For women, over the years, we've watched other women have plastic surgery. We've seen other women go through major changes in the way they look. It's on our radar as an option. For men, I don't think there's a lot of open discussion about this. I think sometimes men are uncomfortable even thinking about the topic."
Women, too, have suffered from a culture of silence surrounding their aesthetic surgical procedures. In the ASAPS exhibit hall, a representative for Innogyn hawked a laser employed in a form of aesthetic surgery that has finally hit the mainstream: "designer laser vaginoplasty." "This has been going on for 80 years, behind closed doors," says the rep, who declined to provide his name. "A woman would come in after childbirth and say, hey, doctor, while you're down there, could you do a little tuck or a pull or a cut? Before, people thought that vaginoplasty was just for the Lifestyles of the Rich & Famous set, and strippers. Only now is it finally out in the open." The representative referred to this development as "empowering."
Finally, women are free to talk about our vaginas and what's wrong with them. Someday, men, too, will be empowered like us.