For many women, the New New Face begins in their thirties and forties with a little Botox here, a little filler there. To extend the handbag metaphor a bit further, it is the dermatological version of the mini-Birkin. A starter bag. But real, serious, grown-up New New Face business cannot—at least at my friend’s age—be achieved with fillers and Botox alone, something she’s been doing for years, with disappointing results. For women in their fifties and sixties, New New Face construction begins far below the surface of the skin.
A cursory history of the face-lift is probably necessary at this point. In about 1905, surgeons figured out that they could make an incision in front of the ear, cut away a bit of skin, and sew it back up to make the face look less old. Then, in the twenties, the “skin flap” was invented, a procedure that involves peeling the skin back like a bedsheet, allowing for much more skin to be cut away for a tighter result. In 1976, a surgeon discovered the SMAS (or superficial musculoaponeurotic system), a cellophane-thin lining just under the skin that is part of the musculature of the face. If you lifted the skin and tightened the SMAS, you got a much bigger correction in the jawline. To this day, the SMAS operation remains the workhorse face-lift. In the mid-eighties, a Swedish doctor began to go under the SMAS, the beginning of a process that led to the deep-plane face-lift of the early nineties.
But even as surgeons worked with deeper layers of the face, the aesthetic was still a superficial tautness. “When I was in early training,” says Rosenberg, “I kept hearing the phrase, ‘This doctor makes the neck really tight.’ And that was a good thing. That was the operative word. Tightest neck out there!” The surgeries were obvious and, in some cases, seen as status symbols. “It’s like wearing a big shiny Rolex,” says Rosenberg. “ ‘I have enough money that Dr. X did it.’ ” But tight is no longer the operative word. “Eighteen-year-olds, they are never tight. What they have is definition.” (Her again: that round-and-soft-and-also-somehow-perfectly-defined teenage girl!)
Past a certain age, to paraphrase Catherine Deneuve, it’s either your fanny or your face—unless you spend two hours a day in the gym and pay someone to “volumize” your face.
What has transpired in the past ten years, says Rosenberg, is “further dissection of the deeper layers” for a face-lift that is almost entirely muscular. Rosenberg and surgeons like him go under the cheek-fat pad and disconnect the platysma, which is a sheet of muscle that supports the lower face, then they resuspend it higher with stitches under the skin. “That’s how you fix the surface—from below,” he says. “I am working on the undersurface, and everything gently comes with it. So there’s a feminine quality, it’s soft and smooth. When it heals, you don’t see tension on the outer surface.”
Rosenberg is also subtly shifting the shape of the New Nose. “Unlike a face-lift, where you are restoring what someone once had, with a nose you are absolutely changing it, making it completely different,” he says. The nose on the New New Face is strong and architectural and straight. Neither flared nor pointed. More Greek than Roman. It’s also the kind of nose job that you’d never notice without before and after pictures (note Angelina Jolie’s very slightly slimmed masterpiece). What it is most certainly not is the cute little ski-jump nose that was ubiquitous in the sixties and seventies—and even popped up again recently on Ashlee Simpson’s face. The “Diamond Nose,” as it was known 30 years ago, was named after a Dr. Howard Diamond of Manhattan, who supposedly did more rhinoplasties than any surgeon before him.
When I tell Rosenberg that a prominent fashion editor told me that people in her crowd are talking about the “Rosenberg Nose,” he is visibly moved. “Awwww. That is crazy.” He looks away for second, apparently misting up. “Nose surgery is so … hard. So technically difficult to master. You have to plan for adjustments with healing. Things settle, it’s almost like making a … a … wine.” He smiles broadly. “This is the first time I’m hearing this. You don’t know how exciting this is.”
Rosenberg didn’t do Angelina’s nose, although he wouldn’t admit it even if he had. Plastic surgeons are very careful not to talk about their famous clientele, because it is the last secret that celebrities try to keep. The stars still require after-hours appointments with an empty waiting room and a special back entrance at Manhattan Eye and Ear, where he does all of his surgery. But it’s difficult to talk about the changing aesthetics of plastic surgery without, well, examples, so reluctantly he agrees to apply his highly trained eye to the faces of Meg Ryan and Demi Moore, Old New Face and New New Face. “Meg may think she looks beautiful,” he says carefully. “But what we are picking up on is a sense that maybe there is an overinflation of the lips, there’s an overabundance of fillers in her face.” He pauses. “What I see with Demi is more of an operation. Let me say it this way: I see preservation of definition, a preservation of facial architecture. Angularity. Very pretty.” He mentions Madonna admiringly as well. “You see the architecture of the jawline, you see the architecture of the cheekbones.”