Surgery: Doctor strives to make subtle changes

• Before and after (graphic)
• Woman decided risk worth taking
• Thinking about surgery?

By Tanya Bricking Leach
Advertiser Staff Writer

After recovery, the four healthcare workers meet again to compare results. Left to right are Alicia Yamada, Deidri Noble, Summer Esmeralda and Kelley Rivas. Deborah Booker • The Honolulu Advertiser

Summer Esmeralda is prepared for surgery by plastic surgeon James Penoff at his office at Straub Hospital. Jeff Widener • The Honolulu Advertiser

They push the skin up around their eyelids and then watch it fall, a technique they've obviously practiced in front of the bathroom mirror.

The women make a pact that they will grow old attractively, so they find a plastic surgeon who will take them under the knife and make them look young again. They schedule their surgeries within weeks of one another and promise to hang in there together through recovery.

That, minus a little glamour and Manolo Blahniks, would be close to real life for healthcare workers Deidri Noble, Summer Esmeralda, Kelley Rivas and Alicia Yamada. (As well as a fifth friend, who asked not to be named.)

"We're vain and we want to look good," said Esmeralda, half-jokingly. "If I can't have the size-5 body, I want to have beautiful eyes."

Eye of the beholder

Around the time TV personality Greta Van Susteren made headlines with her eye-lift, Esmeralda and her gal pals were raising their eyebrows at the prospect of looking like candidates for "before" pictures.

Esmeralda, 42, a Kapolei wife, caregiver to her parents and part-time entertainer at Paradise Cove Luau, is one of those Type-A personalities who wants to do it all and look good doing it. And Noble, a 50-year-old former actress living the single life, could see the effects on her skin from too much time in the sun. They stopped talking about it and rallied to do something.

They decided to join the ranks of 8.3 million people who underwent cosmetic surgery in the United States in 2003, a statistic the American Society for Aesthetic Plastic Surgery says is 20 percent higher than the year before.

The five friends did some research and consulted with Dr. James Penoff, a Honolulu plastic surgeon they ultimately chose to do their procedures.

Everyone opted for an eye lift, the third most popular surgical cosmetic procedure for women nationwide, just behind liposuction and breast augmentation.

Esmeralda wanted a sleeker neck, and Noble wanted a chemical peel.

Yamada, 54, a veteran of prior surgeries, decided on even more, including a facelift from her ears down and a procedure that would remove fat from under her chin. And Rivas wanted an overhaul we'll get into later.

Penoff was matter-of-fact about what they could expect. He explained the risks and told them about his experience, which includes plenty of eye-lifts, among the most common surgery his office performs. Eye-lifts cost anywhere from $1,500 to $4,500, he said, depending on the extensiveness of the surgery.

One of his goals is to make subtle changes.

"People will recognize they look better," he said. "But it won't stand out what is distinctly different. The casual observer is a lousy observer."

His clients pay close attention and find ways to justify the cost.

"I turned 50 in February," Noble said. "That was my motivation. I thought, 'If not now, when?' "

Hot mamas (and grandmas)

Rivas wanted people to stop asking if her husband is her son.

The Waipahu woman is 48, and her husband, a police officer, is two years younger.

"I want to look pretty again," she said in the weeks before her surgery. "I want to feel pretty. It's not just for me. It's for my husband."

Rivas, a grandmother of four, also decided it was time to make some, let's say, adjustments.

She wanted to have her eyes done, but there was something else she wanted to keep secret at first. Now she's ready to get it off her chest, so to speak. Everybody who knows her has noticed, so she said she might as well spill it. She went from a Size 34 B to a 38 C.

Her friends aren't sure if her eyes are beaming because of the eye lift or the other lift, but she has been getting plenty of compliments lately.

"It just makes me feel good," she said after her recovery. "I like going out with people now. Before I looked really, really old."

'Nice to wake up'

Truth be told, their transformations did not come without pain or unflattering "in recovery" snapshots.

They confess they looked like aliens when they came out of surgery, and spent weeks waiting for their bruises and numbness to go away. Some plan to go back for modifications.

The friends say plastic surgery isn't any magic formula for battling middle age. But going through it together made them bond even more as women expecting more out of life than their AARP cards.

"I get a lot of, 'What have you done differently?' from people I know on an acquaintance level," Noble said. "It's gratifying. I'd do it again in a heartbeat."

For Yamada, who had gastric bypass surgery to shrink her stomach five years ago, this was another milestone worth the misery.

She has become someone who runs marathons, and she's empathetic to people who look the way she did when she felt almost invisible to the rest of the world.

"I'm a different person now," she said. "I'm more positive. It's nice to wake up in the morning and feel happy I'm alive."

Tanya Bricking Leach writes about relationships for The Advertiser. Reach her at 525-8026 or tbricking@honoluluadvertiser.com.

Woman decided risk worth taking

It didn't take news of the recent death of "First Wives' Club" novelist Olivia Goldsmith from complications during plastic surgery to remind Alicia Yamada that a face-lift could be fatal.

Her stepdaughter, Angie Umeda, died 15 years ago during breast-implant surgery in Florida because her doctor had given her too much lidocaine, a local anesthetic used to control irregularity in the heartbeat.

It was years before Yamada could go to the dentist or walk into the children's section of a department store without crying.

A decade after Umeda's death, when Yamada was considering a radical weight-loss procedure that could change her own life, she became adamant about researching the pros and cons of going under the knife.

She decided it was worth the risk.

"I woke up and I decided I wasn't going to spend the rest of my life overweight," said Yamada, 54, a healthcare worker who lives in Pearl City. "If I had to live that way, I'd rather die than be ignored by half the population."

She had gastric bypass surgery in 1999 to shrink her stomach and has lost more than 85 pounds since. She had surgery after that to remove flaps of skin on her arms, and her latest improvement has been having her eyes done, undergoing a facelift and removing fat under her chin.

Even though she's wanted to have a chiseled chin all her life, she said it wasn't all about vanity. It was about becoming healthy and feeling better about herself.

"I don't find myself avoiding mirrors anymore," she said. "I don't stare at them all the time, but I don't avoid them. I have all good mornings now."

Physically and mentally, she is transformed. She exercises with a vengeance and is training for a triathlon in July.

"I'm still learning how to ride a bike," she said. "I haven't ridden a bike since I was a child. To me, it's like climbing Mount Everest."

She knows that if she doesn't work at it, her weight could come back.

"Every day I don't exercise," she said, "I know I'm taking a step in the wrong direction."

More often, though, her thoughts are focused more on how far she has come. Her family and friends notice the way she walks with her head up higher. She smiles more easily and indulges in $200 Botox injections for special occasions.

As a Catholic, she says, during this season of Lent Yamada tries to be reflective and has thought about whether this is all too superficial. She's careful to avoid becoming addicted to cosmetic procedures, but she knows for certain that surgery can give people an emotional lift.

"I think my life is a lot happier," she said. "My only regret is I hadn't done it sooner."

Thinking about surgery?

Then start asking questions. The American Society for Aesthetic Plastic Surgery recommends discussing the following points with your doctor:

• What experience does the doctor have in performing this procedure? Ask what training has been completed, especially in new techniques, as well as how often he or she performs the procedure. Ask to see certificates of training.
• What are the possible risks? Find out what they are, how often they occur and how they will be handled if they do occur.
• What is the expected recovery for the procedure? Ask if there are any restrictions on activity and typical time periods for resuming work and social activities.
• What is the doctor's policy on surgical revisions? A small percentage of cases may require surgical revisions to achieve the desired result. Find out about any costs for which you may be responsible.
• How much will the surgery cost? Cosmetic surgery is not covered by insurance, and payment usually is required in advance. Costs include the surgeon's fee and fees for the surgical facility and anesthesia. Other possible costs are the preoperative physical and blood work, medications, surgical garments, and private-duty nursing. While it is tempting to "bargain shop," the training and experience of your surgeon are the most important factors in the success of your surgery. Do not compromise.

Source: American Society for Aesthetic Plastic Surgery