RATFACE OF THE ELDERLY

Mickey Murinian hated the reality of getting older. It wasn’t the aches and pains that caused him such angst. It wasn’t the difficulty playing tennis or inability to run with his grandkids that he disliked so much. It wasn’t even the fear of his own inevitable mortality that gripped his psyche.

Mickey Murinian was extremely vain. And whenever he looked in the mirror, he was witness to the ravages of age.

Once a fairly handsome young man, now his face was changing rapidly. He first noticed some sagging of the neck. But the neck was not sagging randomly. It sagged in the middle, producing a small vertical pocket or flap which swung to and fro whenever he turned his head to either side. He was horrified to learn that this flap had a name. In turkeys, it is called a wattle.

He noticed some other new features. His lips were getting thin, producing increased prominence of his front teeth. His cheeks seemed slightly sunken in as well. People had mentioned that he seemed to be losing weight, but in reality his weight had not changed.

He also observed that his nose appeared more pointed and spearlike, and his eyes had developed large bags underneath.

Saddled with vanity and perturbed by his wizened appearance, Mickey sought the services of a plastic surgeon in his local area. He simply could not tolerate the look of older age. He felt humiliated.

The next day, Mickey had his consultation with Dr. Phil Holz, a plastic surgeon who proclaimed in his advertisements, “Don’t let age and biology ruin your life. I can fix that!”

Dr. Holz greeted Mickey ebulliently, sweeping into the consultation room with a grand wave of his hand, white coat flapping.

“So, Mr. Murinian, what can I do for you? Liposuction? Breast reduction? By the way, we are running a special this month on penile enhancement, if you were thinking of that.”

Mickey said, “No, Dr. Holz. I was thinking of getting a facelift. I am really unhappy with the way I look.”

Dr. Holz immediately took off his glasses and donned a pair of magnification loops. He switched on an extremely bright overhead lamp which threw a beam of blinding light into Mickey’s eyes. Once the face was properly illuminated, Dr. Holz moved circumferentially, focusing intently and examining the target. He took Mickey’s head in his hands, shifting it from side to side, then up, all the while quietly vocalizing, “Mmmm, ah ha, OK, yes, mmmm.”

Dr. Holz then took a step backward and said, “OK, got it. Well, Mr. Murinian, I believe you are a perfect candidate for a level 6 facelift. That should solve the problem.

Mr. Murinian, let me explain what’s going on. You have a typical age-related change that is referred to as ‘rat-face of the elderly.’ You are developing the look of the rat, with the thin lips, sunken cheeks, prominence of the upper front teeth, and bags under the eyes, which give the eyes that characteristic beady and sinister appearance. The turkey wattle is not necessarily part of this constellation, but is an added, rogue feature, if you will. An aging face can indeed develop mixed features, such that a face may rat and may turkey at the same time.

In plastic surgery, we identify several typical age-related appearances. Rat-face of the elderly is one variant. The cuboid variant is another. That consists of a cubed or box-like head, often associated with heavier individuals. These are characterized by a thick jowl and downward arcing mouths, similar to a bullfrog or monkfish. The third common appearance type is the cadaver. That generally is associated with weight loss and a bonier countenance.

But, in your case, we can definitely help you. I propose a level 6 facelift, which consists of undermining and tightening of the skin of the face, straightening and stretching the nasolabial folds, resecting the turkey wattle and tightening the skin of the neck, filling the cheeks with fat derived from your flanks, suctioning out and repairing the bags under the eyes, raising the upper eyelids, applying lip fillers with silicone for a more natural feel, a rhinoplasty with repositioning and supplementation of the nasal bridge, dermabrasion for any cosmetic skin defects, a brow lift and botox treatment of the forehead. This surgical package is more or less guaranteed to remove your rodent-like appearance.”

Mickey thought about it for a moment and said, “OK, let’s go for it.”

The surgical procedure itself took about seven hours, and was accomplished without complications.

Sweeping into the recovery room, Dr. Holz came to the patient’s bedside, and announced, “So, let’s take off those bandages and appreciate the work of a fine artist.”

With that, the surgeon carefully unwrapped the white gauze in a circular fashion, remaining very vigilant of any areas of adherence. Once the bandages were removed, Dr. Holz proudly held up a mirror to give Mickey a look at the transformation.

Mickey stared into the mirror. What stared back at him was not initially identifiable. It certainly wasn’t anything Mickey remotely knew. To his best guess, it looked like a sheep.

“Dr. Holz, what on Earth am I looking at? I don’t even recognize myself. I look like a completely different person.”

Dr. Holz waved his hand. “No, no, no! You have to give your face time to settle in. There is a lot of swelling and inflammation. Give it at least 6 weeks to recover. Don’t forget, you just went through a fairly big surgery. Give it some time. You’ll see. Everything will be fine. But, you have to admit, you don’t look like a rat anymore.”

Mickey quipped, “No, I don’t look like a rat. Now I look like a sheep.”

Mickey remained dissatisfied with the outcome of the surgery, although willing to “give it more time," as the doctor recommended.

However, after three months of patiently waiting, Mickey decided to get a plastic surgery second opinion. He arranged to see a highly regarded surgeon at the local medical university hospital outpatient clinic.

After thoroughly examining Mickey and reviewing the medical records, the doctor advised Mickey.

“Mr. Murinian, I believe your first surgery was not done correctly. The plastic surgeon used too much filler, not enough smoothing agent, and left too much of the wattle. You are now suffering from a common complication of facelifts, something we refer to as ‘secondary sheep face.’ However, it can definitely be fixed with another surgery.”

Mickey pondered his choices. “Doc, is there a guarantee that the outcome will be good? What could I expect? What would I look like?”

“Well,” the doctor admitted, “there are never guarantees when it comes to plastic surgery. The outcomes are usually excellent, but results are often subjective, and what I think is a great result might not meet with your expectations.”

Mickey inquired, “What are the possible complications?”

The doctor continued, “There are some known complications of repeat surgery. For example, if the surgery is overdone, so to speak, there is the chance of ending up with what we refer to as ‘beaver face.’ There is also the chance of being left with ‘iguana face’ or ‘chihuahua face.’ The bottom line is that plastic cosmetic surgery is always a gamble, to a certain extent.”

Mickey thought about his options for quite a while. Finally, the decision was made. He could not risk another surgery. There were no guarantees of a favorable outcome, and it just wasn’t worth the risk.

Mickey went home, satisfied that he had investigated his options adequately. That evening, he curled up with a good book, Animal Farm, by George Orwell. He put on his favorite nightwear, a thick wool sweater, and made himself a large green salad for supper.