The faces of change
There is a big difference between open-heart surgery and plastic surgery, but Dr. Dennis Cirillo made that leap years ago.As a young man in medical school, Cirillo decided to make cardiac surgery the focus of his studies at a time when heart transplants were an emerging science. He studied a combination of general surgery, cardiac and chest surgery before realizing that plastic surgery would be a more personalized practice.”I went from treating people with more serious problems to a practice with more personality,” he said. “It’s the evolution of someone who likes people and always wanted to help them getting to the point where things are technical.”Compared to having a gall bladder removed, plastic surgery is more subjective by leaps and bounds. When you’re changing someone’s external features, there’s not a lot of wiggle room, Cirillo said. He either gets it right, or he doesn’t.”I like the real challenge of taking a problem and working it through with someone who enjoys the result,” said Cirillo, who opened The Aspen Institute for Plastic and Reconstructive Surgery 12 years ago and is Aspen’s only plastic surgeon. “It’s an artistic, creative process.”If I get what I want in plastic surgery, I ask the patient if what I have in mind suits them and what they want, we use visual aids to make sure they know what I’m talking about, and they get what they want. It’s emotionally satisfying.”Still, the question remains: Why are people willing to voluntarily go under the knife to change something about their appearance? It is a question Cirillo tackles with each patient.”If you lived in a cave with no mirrors would you ever do it?” Cirillo asked. “What is the drive behind it?”In talking with prospective patients, Cirillo has found a number of reasons, from wanting aging faces to look as youthful as fit bodies, to wanting to appear as fresh as younger people in the business world. He also examines the psychological reasons behind surgery with patients, sometimes turning them away.”A woman came in and said she’d like her ears fixed – I pulled back her hair and there was nothing wrong with her ears,” he said. “Kids can be quite viscous and in school had teased her about her ears. Years later, when her face had grown in, it was still an indelible, emotionally insecure spot for her.”It turned out the woman was going through a divorce, feeling more insecure about herself when those old feelings about her ears popped up. After talking with the woman, Cirillo elected not to “fix” her ears.”Ultimately there has to be a realistic set of discussions between the doctor and the patient – why to have something done, if it can be done or why not, and emotional reasons behind the change,” he said. “It involves a psychological and physical investigation.”In the end, a patient’s decision to get cosmetic surgery can be a weighty one.”You don’t have to do it – some people wonder if it’s crazy to undergo anesthesia and have a guy stand over me with a knife,” he said. “It’s a disturbing process, and people have to join in and think about if they want to take the risk.”Risk and rewardFive years ago, “Pamela” began thinking about surgery. (Pamela didn’t want to be identified by her real name, but is a middle-age Chicago resident and patient of Dr. Cirillo.)Last year, she got her eyes lifted and the sagging skin removed from her neck.”I got sick of people saying that I looked tired when I felt great,” she said. “I had these little bags under my eyes that didn’t go away.” She also disliked the extra skin she had on her neck, and how she wasn’t comfortable wearing shirts with low necklines. Pamela said she would have undergone the procedures sooner, but was terrified of volunteering for surgery. Also, when she started looking at other plastic surgery patients and their results, she didn’t have much faith in the doctors.”There was always something a little off about [their results],” she said. “They were pulled too tight, not symmetrical or a little skewed.”Pamela eventually ran into a longtime friend who had plastic surgery and looked terrific. Her friend recommended Cirillo, and when Pamela went to see him he agreed with the proposed eye-lift and lower face-lift for her neck.”You have to rethink how you feel about getting older, and whether you want to deny nature its toll,” Pamela said. “You have to think about whether your physical being is of such importance to you that you’d alter it to make yourself look better, and whether younger is better.”Then you say, ‘Oh what the hell.'”Pamela came to Aspen for two separate surgeries, each time staying at Aspen Valley Hospital as long as possible to recuperate. She said there was minimal pain and bruising.Needless to say, Pamela is thrilled with her decision to have surgery. And though she wasn’t comfortable disclosing her name for this article, she said she has told everyone she knows to explain why she suddenly looks more rested.”I’ve been an attractive person all my life, and as I was losing it, it was like my self-confidence was going along with it,” she said. “Now getting dressed is more fun, putting on eye shadow is more fun. I’m delighted I did it.”Cosmetic reconstructionThe decision to have plastic surgery wasn’t quite the same for Aspen resident Marissa Post, who was diagnosed with breast cancer in 2003. The disease was discovered early in one breast, but Post knew if she simply had the lump removed or went through chemotherapy, the cancer might come back.Those prospects didn’t appeal to her, so she made a more extreme decision – to have both breasts removed. A critical component of the surgery was breast reconstruction; knowing that was an option made all the difference in the world, she said.”They removed my entire breast tissue, so all I have is skin, implant and muscle,” Post said. “The implant goes in under the muscle, and the skin is sewn up. Over the next month or so, every few days they put more saline into ports, slowly stretching the skin [and muscle] out.”Post said it’s hard to tell a difference in her looks, even in the most form-fitting clothing; she continues to teach aerobics and takes dance classes.”I wanted to be the same, and to be healthy – to have more confidence that I can keep long-term health,” she said. “I’m not upset at any level about my appearance, but it wasn’t my focus. It’s just an added bonus.”Less-than-permanent changesWhen it comes to appearances, surgery isn’t always the first thing that springs to mind.Local family physician Dr. Tim Kruse has seen the aesthetics side of his practice, like Botox, Restylane and laser hair removal, flourish in recent months.He describes a satisfying feeling when he helps a patient take care of an appearance issue that’s been bothering them. Improvements people want to make to their own appearance aren’t necessarily a vanity issue, he said.”It’s not an issue of vanity as much as it is a personal thing a guy or girl decides to do for themselves, not to attract the opposite sex,” he said. “It’s for every morning you look in the mirror and say you’re sick and tired of looking at a brown little spot on your face, and you’re tired of feeling lousy about it. Maybe it’s something no one else even notices.”Kruse began to learn more about treating skin since there isn’t ready access to dermatologists in the Roaring Fork Valley. His interest in aesthetics grew as he noticed the frustration his wife and her friends were having finding a reputable clinic where they could get aesthetic work done.In November, Kruse opened Premier Care in Glenwood Springs; he is moving his practice to Basalt with a satellite office in Aspen in April. Already, though, he is treating patients for rosacia, acne, uneven pigmentation and hair removal. Women in their 40s and 50s come in for Botox and Restylane filler treatment, possibly to put off going under the knife, or avoid it all together. On the other hand, he has seen the occasional patient with a number of wrinkles who he says is the perfect candidate for a face-lift.”They will want Botox or something like that, and I’ll tell them that it’s not going to give you the result you want,” he said. But he also notes that he does a lot of education with patients about proper skin care – like wearing sunscreen regularly – so they can avoid wrinkle-formation earlier in life.”We want people to retain the youthfulness of their skin as long as they can,” he said.Naomi Havlen’s e-mail address is firstname.lastname@example.org
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