Before leaving Korea I visited a plastic surgery clinic to watch a nose job. I had a student, Chris, who was a rhinoplasty surgeon. Chris was my student for over a year so, of course, we became close. With my background in biology, I was always interested in his experiences in cosmetic surgery as well as during his military service when he worked for Accident and Emergency. Chris is one of the people who I've met that remind me that I could never be a doctor. He, like other doctors I've met, seem to have an advanced ability to absorb, analyze and process information in a logical and efficient manner.
About one year ago, Chris opened his own clinic in Apgujung, a neighborhood famous for celebrity hangouts and cosmetic surgery. Despite his modesty, it was obvious Chris' new business was already very successful. I let him know that I'd love to visit someday and perhaps even watch an operation if possible. I've never been good at the sight of blood and almost fainted once in Japan when I bravely, no, stupidly, tried to watch a nurse taking blood from my arm. But, despite a weak stomach, my own morbid curiosity pushed me to make the most of this unusual opportunity. So when Chris called me last month to ask which days I was available, I enthusiastically said any day was fine. And two days later, at 10 am, I walked into his clinic slightly nervous and quite excited.
The big smiles of his attractive reception staff as I entered the lobby made me realize two things. Firstly that Chris had informed them that I would visit, and secondly that they all thought I was very handsome and wanted to smile at me. I soon realized I was wrong on both counts. The staff gave the same warm, welcoming smiles to a young lady who walked in after me. And then one of the staff brought me a folder and pen and asked me to fill out some forms regarding my health. "No, no, no" I said, telling them I was a friend of "Chris", unable to remember his Korean name. When they realized what I meant, they called Chris and brought me to his office. It was all quite amusing when we realized what had happened, though I quizzed Chris on why they could make such a mistake as my nose is already perfect. But Chris bluntly pointed out that it was too high, but that he could "fix it" if I wanted. Uh, thanks Chris.
I was surprised to find out that I was the only guest to watch surgery that day. I had presumed that I would be invited along when other surgeons or medical students would also be observing, which is quite common according to Chris. Being only me I felt quite flattered to have been invited, but I also felt some pressure.
Before entering the operating room, I was adorned in a gown, a surgeons hat and a horrible-smelling mask. When Chris came back from getting changed, he looked like someone from 2050 - very cool and very futuristic. A surgical top with vents and stripes that made it look like Nike body armor and a bad-ass bandana instead of the granny hat I was wearing.He was also kitted out in a pair of clear glasses that could compete with Oakley in the extreme sports market, with a lightweight, platinum colored lamp attached to the bridge of the glasses and sitting comfortably above Chris' own perfect nose (although now that I think of it, maybe his nose is also a little high).
Entering the operating room, the patient was already unconscious and her face looked yellow. At closer inspection I could see that her face was covered in a yellow latex or rubber which had been cut away around the mouth and nose. I sat just behind Chris who sat next to the patient's head. The surprising proximity as well as the smell from the mask had me feeling queasy already. But I put on a brave face as Chris told his attractive assistants that I studied biology at University. Little did he know that the closest to surgery Lancaster University ever brought me was a dead frog already drained of blood. And even that almost cost me my breakfast.
The first step Dr Chris had to take, as the assistants had already done some preparation, was to cut the nose between the nostrils. Using a toothpick and some dye, he drew a zigzag line across this small piece of skin. The reason for cutting in a zigzag line is so that the skin slots back into place later and can be stitched together again in perfect alignment. This would be harder to do if just a straight cut was made. Chris then took a scalpel and slowly, part by part, cut across the tissue. I enthusiastically watched each detail ignoring the sweat already rising the surface of my skin. But when the incision was complete and Chris pulled the nose up and back, I had to look away. Looking back, i could now see into her nose. The whole nasal cavity was right there in front of me. From where I was sitting I could have reached out and touched where her nose should have been. There was blood, but not a lot. And the assistant had a device similar to what a dental assistant uses for removing saliva during treatment. But this sucker was catching the blood and pulling it through transparent tubes into a transparent glass jar.
At this point I became overwhelmed. The sound and sight of the sucker taking away the blood, although it was just a little. The young lady on the operating table, whose nose had looked just fine to me minutes ago, now looked like something from a horror movie. Plus the stench of the mask. The increasing slow saturation of my clothes with sweat didn't bother me, but I was feeling so queasy that I though I might vomit or faint. Both But options worried me as I was in a sterile environment and my collapse or projectile puke might jeopardize the whole procedure. So after five minutes or watching but mentally trying to go to my happy place, i stood up, mumbled an excuse me, and wobbled out the door. Taking off the mask, I squatted in the hallway and tried to gain focus. We were only twenty minutes into the two hour operation and I was already curled up in the hallway wondering why the heck I was there.
Soon one of Chris' reception staff came to see if I was ok. "Just hot", I told her. She opened the door in front of me to a small room with a bed and chair and kindly turned on the air conditioning. I declined her offer of water thinking that the less that's in my stomach, the better. I sat there for a couple of minutes fantasizing about just lying on that bed for the next hour and half and then joining Chris for lunch. I convinced myself there would be no shame in it as he had told me it is quite common for medical students to faint or or vomit during their first experience. Soon after, one of the assistants came in to check on me. She was very kind and concerned and spoke a some English. We chatted briefly about her experiences studying in Brighton and that change of topic helped me relax and compose myself. Then she went back to the operating room and I gave myself a talking to. Frankly speaking, I didn't want to watch any more. But the thought of looking like a sissy in front of a girl urged me on. Plus I knew Chris had went out of his way to invite me and I didn't want to let him down or look silly since it was me who asked to be invited. And I knew this was a once in a lifetime opportunity that I shouldn't waste. So I took a deep breath, pulled that stinky mask back over my face and reentered the operating room.
Sitting around the still-unconscious and occasionally snoring patient, we all had a laugh about my queasiness as I tried to ignore the unusual movements in my stomach. Chris carried on with the procedure. I had only been out of the room for seven or eight minutes, but Chris had cut into the tissue between between the nostrils to pull out cartilage to build a new nose tip later. Unbeknownst to me, Chris' assistant had placed some gauze into the nose to soak up blood. When she reached into the nasal cavity with some tweezers, pulled out the blood soaked, soft piece of goo and threw it into the waste tray, I almost vomited right there and then. I though it was part of the patient. It took a few minutes before I was brave enough of open my clenched jaw to ask what it was. When Chris explained that it was just gauze that was put in while I was hunched down in the hallway, we all had another good laugh at my stupidity.
Soon after, I was feeling much better and had stopped sweating. Chris patiently explained each step in excellent English (though I won't take full credit for that) and answered all my questions. I could tell by the speed and ease with which he handled the complex tasks at hand that he was well experienced and competent. It was fascinating and horrific to watch. He pulled out a not-so-small, but thin cartilage from inside the patient's head. He assured me that it's not needed for structural support of the nose. So it's fine to take it out and use it in other places. Setting that to the side for later, he next started to detach the nose skin from the bridge of the nose in preparation for a silicone implant. I had heard that this step involved a chisel and hammer, but didn't actually believe I until I saw it. Up until this point, I had been witnessing science and technology. But as he took a small medical chisel and positioned it for the assistant to tap with a small metal mallet, I felt that they had transitioned into carpentry. Chris held the chisel as the female assistant tapped the end of it toward the top of the nose, bringing all the skin away so that soon the whole inside was exposed. The assistant was obviously very experienced and confident as she sometimes looked around the room while her hand automatically tapped on the chisel. Amazing and scary.
Following the science and carpentry, the art phase began. With the nose skin back and everything open and ready, Chris now had to two things to do. Firstly, carve and insert a piece of silicone to give a nice, high, uniform bridge. And secondly, cut up the cartilage from earlier into small pieces and sew them onto the tissue that separates the nostrils in order to provide a new, strong tip which will protrude further and align with the higher bridge. These stages where fascinating. I had no idea how artistic one needed to be. I could never do anything like that. Even carving the silicone implant would take me days. Wearing rubber gloves, Chris used a scalpel to cut, scrape and shape that it. But it must have been so slippery as he continually placed it inside the nose, pulled the patient's skin over her, and checked for size and shape. I'm amazed he didn't cut his fingers as he whittled the implant with a razor sharp scalpel using just his eyes and experience to determine the size and shape that would best suit his patient.
Cutting up the small piece of cartilage also seemed to require a great deal of expertise. There was only enough to build the support for the new tip and the actual new tip. If Chris had made any mistakes when cutting out each shape and size, he would have needed more cartilage which involves cutting into the ear or rib cage. But with over two thousand the operations under his belt, he made it all look easy and was soon stitching the new, higher, prettier nose back into place. It was hard to see the final result clearly as there was some swelling and bruising. However, the aesthetic improvement was obvious, and two weeks later, I'm sure she would be very happy with the result.
I was very, very impressed with the procedure. I was also impressed with myself for managing to observe almost the whole thing. What most impressed and surprised me was not the science and technology involved, but rather the art. So much of this operation was relying on the doctor's judgement, hand-skill and foresight. I've so much respect for Chris and other plastic surgeons for their ability to balance all this. Before meeting Chris, I didn't have a favorable view of cosmetic surgery, arguing that if you focus too much on the outside, the inside will suffer. But that's an easy position to take as a white person. We naturally have double eye lids, high noses, defined jaw and cheek bones as well a variety of eye and hair colours and skin complexions that help us to look individual and attractive. Koreans, however, do not. And in their culture, appearance is considered more important. Photos are included with job applications and resumes. Professional face-readers are employed when companies are hiring new recruits. And I guess if my future and/or job prospects were dictated by the shape of my face rather than my ability, education and experience, I might also fancy a nose-job or something else. So I'm reconsidering my earlier thoughts of people being shallow or superficial for having cosmetic surgery.
