Hi there:
Hope everyone and those close to you are well in every sense of the word. Between war in Ukraine, the pandemic, the MU5735 tragedy and natural disasters, there doesn't seem to be a lot of good news these days.
In this issue we feature Yuxiang, a recent university graduate who penned this empathetic and compassionate account of working as a plastic surgery photographer. We Are People with Stories published the story on March 7.
Take care and see you soon.
—ML
Manufacturing Beauty: My Days as a Plastic Surgery Photographer
By Yuxiang
Edited by Meteor Shower
1.
In 2020, I was a fresh graduate with a degree in film and TV production. My graduation coincided with the COVID pandemic, which dimmed job prospects in the industry considerably, especially for a green newcomer like myself. After putzing around for a few months, I decided to secure a job—any job—ASAP, because unemployment meant starvation. One thing led to another and I became a photographer and cameraman for a plastic surgery clinic.
"Hi there. I'm Xiao (Junior) Zhang, the clinic's photographer. I'll be shooting still photos and video of your face before and after the surgery." Camera in hand, that was the official line I recited to the patient before me in line with protocol.
The young woman gave me a vacant stare. She was probably reluctant to be photographed, but she had no choice because it was part of her deal with the clinic. The clinic had obtained the rights to her images for promotional purposes. A written agreement was signed to avoid legal backlash. As compensation, the client received a nearly 90 percent discount.
I suppose that made for a win-win situation.
I gleaned from the signed consent form that the patient was a 26-year-old woman surnamed Li. That made us contemporaries. She was in for a nose job that involved transplanting ear cartilage and a silica gel implant.
Xiao Li struck me as a down-to-earth young woman who gave off girl-next-door vibes. She stood in stark contrast to the celebrities or Internet sensations we commonly associate with plastic surgery. She had a round face and chubby cheeks. Her eyes weren't small, although her nose was a bit flat. You could barely see her nasion. That's what she was eager to change.
"Our Xiao Zhang is very professional. Don't be nervous," Dr. Li, the surgeon in charge, said with a smile in an attempt to defuse the tension.
I then led Xiao Li to our studio. The standard shoot for a nose job entails seven angles—a frontal view, side 45-degree and 90-degree shots from both sides, as well as shots from below and above the nose. My job was to keep taking the same shots post-surgery after the sutures were removed or a month later, all the way up to six months or a year. The goal was to document the success of the surgery accurately and objectively.
During the shoot, I was extremely tempted to ask Xiao Li why she wanted a nose job. But in the end I restrained myself—because I had figured out the answer in my head. The upbeat answer would be she wanted to look prettier. Among the more cynical options was her friends made fun of her nose, or even her boyfriend had dumped her because she looked ugly.
I also didn't want to ask because if I upset her, I could offer neither solution nor consolation. Not to mention what purpose would the question serve? What was its meaning? All it did was satisfy my curiosity, plus no one seemed interested in the question apart from me.
After the photo shoot, the nurse took over. She usually followed up by planting an intravenous port on the back of the patient's hand. That's where the anesthesia would be injected. At that point, I'd be in the changing room suiting up like the medical staff, donning a blue surgery gown, a disposable cap and switching into slippers before heading into the OR.
Xiao Li lay prone on the operating table. I had to shoot another set of pre-op photos, followed by a second set for contrast right after the surgery. Then the primary surgeon got to work, marking his lines of incision, while the anesthesiologist tinkered with his medical devices and put the patient under. After nurses disinfected the location of the procedure, the surgeon moved in. The gist of a nose job involved extracting ear cartilage and planting it in the nasal cavity to prop up the nose. The length of a nose job varied from one or two hours to up to five or six.
My job also entailed documenting the surgery with both still photos and video, so I spent a lot of time in the OR watching the medical personnel at work. I saw how surgeons made meticulous cuts and how blood seeped out of patients slowly. I saw how surgery wounds were sutured just like one would go about sewing a piece of clothing.
Once I overcame my squeamishness, I started picking up medical knowledge and surgical techniques, like how puffy eyes are diminished and exactly how noses are lengthened and propped up in nose jobs, and so on. Sometimes the surgeons and nurses joked I had seen so much action I was a quasi-expert.
The early days, however, weren't easy.
2.
My first time in the OR came out of the blue. My boss said he just wanted me to get a feel of the surroundings. Even though I braced myself, the scenes that followed were still deeply unsettling.
The procedure being performed was a liposuction. The surgery was already underway when I entered the OR. A chubby male doctor was in charge. At the time he was sucking away at the patient's tummy with a liposuction tube from an incision. The thin tube was made of stainless steel and measured half a meter long. The surgeon held the liposuction tube with his right hand and pinched the patient's belly with his left, I could see clearly where the tube was inserted.
Blood gushed from the surface of the patient's belly, which was covered with blue markings and a brown layer of antiseptic solution. I suddenly felt like I was in a slaughterhouse. Meanwhile, the liposuction machine hummed along, emitting a sharp slurping sound. A cream-colored gel-like substance laced with blood flowed along a transparent rubber tubing toward a bottle with a capacity of about 3,000 milliliters. The nurse told me the surgery was expected to last another hour, but at that point the bottle was already half full—the equivalent of a 1.5 liter bottle of Coke.
Even though I was wearing a surgical mask, I could still detect the smell of blood and the sweet smell of body fat permeating the air. I had no time to savor. Afrer shooting a bit of footage, I retreated to the door, where I lingered briefly before deciding to bolt. It then started to dawn on me the crudeness behind and even the bloody, violent cost of becoming refined and pretty.
But even rawer spectacles were to follow.
There was the nose lift, or rhinoplasty, using rib cartilage. My colleagues warned me the surgery was extremely gross and terrifying. One of my predecessors quit shortly after shooting the procedure. Yet the warnings piqued my curiosity instead. How exactly was a rhinoplasty performed? I was keen to find out, as curiosity trumped fear.
Pre-op was no different from other surgeries. It was the procedure itself that stood out.
There are two major components to a rhinoplasty. First up is the removal of rib cartilage, followed by the opening up of the nasal cavity for the placement of the reshaped cartilage. The cartilage is obtained from an 1 to 2-centimeter incision under the thorax. The scalpel used is extremely sharp. Layer after layer is peeled back neatly—the epidermis, then dermis, then fat and muscle. The rib cartilage, which emerges in a milky white color, is broken and extracted by machine.
The patient does not feel any pain during the surgery. Most are completely knocked out by the anesthesia. Some even snore. But the opening of the nasal cavity an instinctively off-putting sight. The anatomy is completely exposed as the nose is reduced to a bloody blot. The image reminded me of the skeletons and zombies in horror films—except this was the real thing.
3.
Even though our medical personnel are all professionals, mishaps were inevitable. For the medical staff, this is simply par for the course, but for someone without a medical background like myself, incidents stirred a great deal of anxiety. Uncertainty begets fear. All I could do was trust the surgeons unconditionally, just like the aspiring beauties who lay "asleep" on the operating table.
One such occasion occurred during a nose lift. The patient woke up suddenly, despite being under general anesthesia. Her head began twitching, her legs shifted and she started moaning in a deep voice. She looked like someone struggling to get up to an alarm clock.
The chief surgeon seemed to be a bit taken aback. He dropped his scalpel and alerted anesthesiologist, who was seated nearby. The anesthesiologist showed no sign of panic, calming pushing the half-syringe worth of semi-transparent chemical in his hand. Soon the young woman went limp again.
Meanwhile, I froze during the process, camera tucked behind my back. I was terrified that shooting would interrupt the surgeons and doom the procedure. I took pictures and filmed quietly in the OR, but my heart was always thumping. I couldn't help but wonder what drove these seemingly fragile young women to endure their wounds, to pass out in the OR and entrust their lives to another person, and also put up with discomfort after the surgery that lasted anywhere from a week to six months or a year.
The second incident also came out of the blue. It was another nose job using rib cartilage. The surgreon had already removed the cartilage and sutured the wound, but he was reluctant to move onto the next step. He kept examining the closed wound and pinched it with his fingers. The doctor seemed extremely nervous, even though he did a meticulous job of suturing the wound, constantly fidgeting with the skin and muscles near the wound.
The surgeon said the closed wound was a bit bloated and that he was worried about pneumothorax. I didn't know what that was, but the mood in the OR suggested it was an extremely serious complication. After pondering the matter briefly, the surgeon decided to reopen the wound and suture it again as a precaution. He then had his assistant double-check his handiwork. Only after several inspections did the surgeon move on and open up the patient's nasal cavity.
Gradually I began to appreciate the amount of pressure the surgeons faced. Any negligence on their part would have huge consequences for their patients, even endangering their lives. A bit of obsessiveness is most understandable and even necessary in a high-stakes situation like this.
4.
Xiao Li returned in 10 days. Her nose was still stabilized by a earth-grey colored splinter and the pristine white of the cotton stuck in her ears had faded. Overall, she looked bloated, her appearance disheveled. Her loose hair was oily and clumped together. That's because she needed to keep her wounds dry for the week or so before she had her sutures removed, so as to prevent infection. Now the wounds on her nose and behind her ears had more or less healed.
It took about half an hour to remove the sutures. Next I led her to our studio for a final shoot. During the shoot, I could clearly see the joy in her eyes through the camera lens. I asked her to tuck her chin for her last photo. If all went according to plan, she wouldn't need to visit the clinic ever again.
Back in my office, I uploaded the photos onto my computer and dug out Xiao Li's pictures from before the surgery. I created a full set of before and after contrast images covering every single camera angle. Undeniably, Xiao Li's nose was much taller after the surgery and looked prettier by mainstream aesthetic standards.
Most women visit our clinic for surgeries all by themselves. Only the rare patient has company, even when the procedure is one that requires general anesthesia and takes three or four hours. I'm blown away by not only the tremendous buying power of our clients, but also the level of cruelty they direct toward themselves. The amount of pain they're willing to endure in the name of beauty is stunning.
If you include all beauty treatments as plastic surgery, such as freckle removal by laser beam, then we are talking about a huge client base. Almost all of my female colleagues have had some sort of skin treatment performed, such as photorejuvenation, hydro lifting, face lift or leg slimming. Although only a select few will opt for nosejobs or eyelid surgery, such topics are hardly taboo.
At the outset, the prevalence of beauty treatment and talk of it shocked me and made me feel out of place. But as time went on I felt a certain camarderie with my colleagues. After all, we worked side-by-side, joked around, bitched about our workload, discussed celebrity gossip and agonized over lunch takeout choices together. Gradually it dawned on me that plastic surgery isn't as bad as people make it out to be and that the men or women who choose these procedures aren't out of their minds. They're merely ordinary people in pursuit of beauty.
In the time I have held my job, our client base has broadened beyond women. Beauty is no longer the prerogative of the ladies. Among our newer patients are young men seeking nose lifts and middle-aged men asking for botox shots. Ma Dong, the host of the popular debate show Let's Talk, sparked online discussion a few years ago by having surgery on his puffy eyes. Compared to women, plastic surgery on men appears to be more controversial. Even plastic surgeons themselves tend to tell men to think twice about having work done.
These days I don't carry prejudice toward plastic surgery, nor do I despise it. The fact is we live in a superficial age when looks matter more than ever, when anxiety over personal appearance is at its peak. People have no choice but to conform to the times. It's simply unfair for us to pass judgment on the decision to have plastic surgery or not.
I genuinely hope a time will come when we no longer set harsh standards for looks and value kindness more than anything else. Our hearts will only be liberated when we tolerate each other and stop judging people by their faces.