The Knife Behind the Smile

My dad was the first in the family to get plastic surgery. He lost the tips of his fingers sixteen years ago in an accident at the paper factory where he worked when we first moved to America. My dad arrived on time and never made trouble with the other employees. Every morning saw him stepping out of our apartment in the same outfit: a tucked-in collared shirt with a small hole or two hidden in the armpits, faded dress pants, and a belt to hold up his pants on his skinny body. The clothes were all from Goodwill, just like his lunchbox, which was blue and white and had frayed plastic on the edges. Eventually, they promoted him to a management position, in which he had to watch over the cutting machine. It had a huge blade that cut giant cylinders of paper into smaller, more usable rolls. 

One day, the machine broke, and my dad was responsible for fixing it. While he was poking his hands in and out of the machine, something released, and the blade dropped down, slamming its edge onto his hands. It sliced off the tips of his four left fingers, cutting cleanly through the bones of the first metacarpals. What was left behind were bloody stumps with shriveled, blue skin at the tip and glistening hints of bone somewhere in that mess.

The doctors took chunks of meat from his thighs and sewed them on as fingers.

My middle sister came next when she decided to get a nose job and eyelid surgery. Then followed my eldest sister with her tummy tuck. Now, my mom is about to fall under the blade. 

We sit in the waiting room as the nurses shuffle around us. They wear heels and tight pink shirts emblazoned with jewels that spell out “BOTOX” across their over-sized breasts. The receptionist flashes us her abnormally white teeth and greets us with a face that is evenly powdered with thick, matte make up. All the nurses wear similarly sculpted faces. They maintain eternal smiles and speak with a tone too soft and sweet, like preserved cherries. I help my mom fill out the paperwork and translate some of the brochures into Vietnamese for her. We pass the time flipping through albums of Befores and Afters, page after page of magically shrunken bellies and tightened skin.

A nurse comes and escorts us to the screening office. A large mahogany desk takes up the far left corner of the room. On top of it sits a computer monitor set to a solid blue screen. A single bookshelf stands against the opposite wall, and a full-length mirror leaned casually adjacent to it. A few green plants dot the tops of the furniture, and certificates and paintings of flowers decorate the cream-colored walls. If it wasn’t for the breast implants lining the shelves of the bookcase and the examination chair sitting ominously at the center, the room could have passed for any middle-class family doctor’s office.

I remember such offices. I had gone with my middle sister to a consultation before she had her surgery. 

I think my middle sister chose the knife because my mom called her ugly all the time. Every time they met, my mom would criticize her nose or compare her to our ugly aunt, saying that they had the exact same face. Or sometimes she would joke, “Your nostrils are so big, you’ll never be able to be rich. Any money that you find will just slip right out of them.” 

Usually my sister doesn’t believe in superstition, but the jokes had some truth in them—of the three sisters, my middle sister was always the one who spent her money most lavishly on clothes and perfumes. Towers of shoes and once-worn gowns filled her closet. It didn’t matter that her boyfriend thought her nose was cute. It didn’t matter that she won a beauty pageant. It didn’t matter that my mom said she was just joking the whole time. These words entered my sister and tore her apart from the inside.

Of course I didn’t know how hurt she was until she told me late one night that she wanted a nose job, and I stayed up until morning trying to hold her back. I thought I could save her, but then I looked at her. Something in her eyes had already glazed over. I imagined her body being cut up into pieces by my mom’s words and reassembled into a different person by a stranger. I saw that my sister had already chosen to go down this path, and I cried.

That was four years ago. Now, I try my best not to let my emotions seep through as my mom and I go on with the consultation. We sit down in leather chairs, and the same pretty nurse with the BOTOX shirt sits down in front of us. My mom conjures up her best English and explains that she would like a facelift, tummy tuck, and perhaps eyelid surgery. The nurse smiles. She selects a few videos for us to watch on the computer and then excuses herself from the room. My mom and I go through them. The videos take us through a step-by-step methodology of each type of surgery. To perform a facelift, the surgeons make a long U-shaped incision that starts from the temples, reaches the base of the ear, and curves backwards to the hairline. This makes a pocket in the face. The surgeons pull up the skin, disconnecting it from underlying tissue, and scrape away any excess fat within the pocket. The skin is then pulled back to the ears. Any excess is removed, and the wound is closed. In cases when there is too much fat beneath the chin, they will also make a small incision at the base of the chin to suck it out.

To perform a tummy tuck, surgeons make three incisions in the body: a smile along the pubic line extending towards the hips, a frown below the rib cage, and a circle around the belly button. They cut the frowns and the smiles so that the ends meet each other, making an eye-shape on the stomach. This eye covers the areas of skin that will later be removed. The belly button is set free by the incisions surrounding it, so that it will not be ripped off from the body when the skin comes off. After these first three cuts are made, the doctors take a pair of clamps and peel off the skin starting from one corner of the eye. 

The videos present us with clean, spotless skin without any fat residues; seamless, bloodless cuts; and smooth, pink muscles in every diagram. When surgeons actually perform surgery, they have to tug hard because the skin is still alive and clings to the muscle throbbing underneath.

Human fat is yellow and clings to the skin in tumorous clumps, like gelatinous stalactites. All of the fat is removed, sucked out with tubes, cut away with knives. A considerable amount simply rips away along with the skin. Muscle is red, and its sinews run parallel to each other, forming tiny grooves in between the fibers of the meat. Blood sometimes gets stuck inside these grooves and clots, forming brown puddles during surgery. It looks as if someone threw embers onto the body, turning the flesh to ash in areas where the skin was burnt the most. 

Once the eye on the belly is removed completely, the surgeons lift it off the body. It looks like a sagging hide of road kill, though everyone knows that it belonged to something human. To finish the procedure, they pull the flap of skin above the gaping hole down, over the belly button, until it meets with the bottom lid of the recently removed eye. The skin is held in place as they suture the flaps back together. Finally, they locate the belly button hiding beneath the skin and cut a hole around it so that it can reemerge. To finish the operation, they secure the bellybutton with a few last stitches.

My eldest sister recently went through this procedure. I found out about it when I was roaming around Argentina. Sitting at an internet café, I opened an email from my middle sister explaining how she would be taking my eldest sister home after the operation. It would have been so easy if I could have just been mad. I wanted to place my sister into the paradigm of an insecure, needy middle-aged woman who complains too much. I wanted to be mad at her husband for agreeing, at my sister for being an ally. I wanted to have screamed in protest and written a long email in response. Then it would have been simple. But I couldn’t. Instead of words of rage, I found only sympathy.

I couldn’t blame her—not after having seen her real stomach. 

I had come to her house and found her lying down breastfeeding her youngest son. It looked as though she had taken a nap with the baby because the sheets were rumpled, her hair was tousled, and her shirt was pulled back from turning in her sleep. It revealed a small triangle of skin at her stomach. We started talking, and at some point during our conversation she saw me looking and lifted her shirt up to reveal the entirety of her scarred stomach.

It looked like a balloon that had been fully inflated and left to slowly deflate on its own, with wrinkles and dents and strange craters all over its sides. Stretch marks covered everything below the ribcage, and a smiling scar ran across her pubic line, the result of multiple caesarian sections. The skin sagged. It sank down the base of her pubic line. This was all the extra skin that her body had no use for after giving birth to three children. There was so much skin that when she clenched it with her hands, blobs rolled out from between her fingers, as if she were squeezing Play-doh. After her pregnancy, the skin realized its unnecessary role for the body and, on its own, willed itself to die—and turned brown, the color of rotting bananas. 

When my mom and I finish the videos, the nurse comes back and asks if we had any questions. We don’t. She smiles again, sweetly mutters some cordial phrases, and then leaves.

The doctor comes in, introduces himself, and asks us if we had any questions. My mom asks him about neurological dysfunction, which happens when the nerve endings are destroyed after surgery. In such cases, she would lose the ability to smile. He comforts her by saying that these cases almost never happened. 

My mom then asks if he could also do a brow lift and eyelid surgery. These were simple: a small cut above the temples along the hairline, a little tug to pull the skin up and lift the eyebrows. I watch him scan my mom’s face for a few seconds. His eyes give two quick glances over her eyebrows. “Yeah, it’s pretty simple—and to be honest it’s not that necessary in your case.”

In the prescreening, he asks my mom to sit on the examination chair. She is short—only five feet tall, so it is a bit difficult for her to get on. She wiggles onto the chair, sits, and then looks at him in anticipation. None of us spoke much. The doctor kneels down a bit to match my mom’s height, and then directs his professional attention to her face. With his left hand he guides my mom’s face up or down, left or right, depending on what he needs to examine. With his right hand, he places his thumb on her chin for support and uses two of his fingers to push skin back and forth in certain areas. After a few minutes he delivers his verdict:

“So in your case we would have to cut behind the ears and at the base of the chin.” He saw the puzzled look on my mom and directed his attention to me, “Your mom doesn’t need that much on the face. Just a bit of work on the chin should do it, and she doesn’t have that much in the first place. Here is a really extreme case on an elder lady who could not have surgery on her face.” He shows both of us a Before and After of an extremely old lady who got a chin tuck. The woman originally had so much fat beneath her chin that she had no neckline, only a large, sagging flap that formed a triangle where her neck should have been. The surgeons made only one incision on her chin, but they managed to suck out enough fat to give her a neck. My mom is impressed. 

The surgeon is now ready to examine her for the tummy tuck. “I’ll come back in a few minutes. For now, you can undress.” He hands her a white smock that opened up in the front. “Wear this, and you can keep your underwear on.”

When the door closes, my mom slowly takes off her clothes. She is slightly plump, with a bit of fat resting on her thighs, around her arms, and surrounding her waist. Her stomach swells out a bit, and it carries a few stretch marks and scars in it, the aftermath of carrying four children. After she finishes undressing, she wraps the smock around her body and climbs onto the examination chair again. I realize that this was the first time I have seen her this naked. She looks so soft. Her skin is pale and almost translucent, and I can almost map out the veins running up from her feet. She is sitting silently on the chair, dangling her feet, and staring expectantly at the door, and I have a sudden urge to cradle her in my arms. 

The door opens and the doctor returns. My mom opens her smock, exposing her little white belly, and he begins his second examination. After a few minutes of silence, he gets up and explains that my mom only needs a medium-size tummy tuck. “Again, it’s not that bad. After the surgery, we could reduce it to about half. You’ll definitely still be able to tell the difference though. The results will still be good. As for the rest, we can’t get to it because it’s located behind the muscle frame. But you can easily fix that by losing … maybe five pounds. It’s not that big, and that should do it.” With that, he shakes my mom’s hand and then leaves. My mom scurries to the door and put her clothes on. She avoids looking at the mirror as she passes it.

Perhaps my mom will someday be able to look at herself. My middle sister, after her surgery, claims that she, for once, feels beautiful in front of the mirror. She knows that the changes were very subtle, and that people can’t really tell the difference in most cases. She knows that being slightly prettier doesn’t affect her performance at work, but it doesn’t matter. She can smile at herself now. 

When my middle sister got her tummy tuck, she went to a family wedding dressed in a strapless, cream-colored gown that flowed to the ground. Small ripples of fabric ran across her torso and emphasized her curves. Her waist was tiny, and from the side, her stomach was completely flat. She hadn’t worn that dress in five years—not since she married and had kids. I told her how fantastic she looked. She smiled sheepishly and said, “Oh come on. It wasn’t like I exercised or anything.” That night we took many family photos, and my eldest sister gladly volunteered herself to take full-body shots. 

I thought of my dad, who never shows his hands. 

After his surgery, gravity pulled the meat to the sides as his fingers healed, and the tips look like they are about to slip off. The fingernail grew back on only one finger—the others have dents where the nails should be. They never regained their flexibility. They bend only slightly back and forth from the first joint, and when left unflexed, stick out like sock puppets craning their heads in jumbled directions. It’s almost as if the accident never happened because he hides his hands in every photograph. 

After his surgery he unwillingly joined my mom in the business and became a nail technician because there wasn’t anything else he could do. Work is more manageable now that he runs his own nail store. At first he started out working as a regular employee, performing basic manicures for customers. One time, he sat down to do a manicure for a young lady, but she recoiled and screamed when she saw his hand. Then she got up and left without a word.

Both he and my mom agreed that plastic surgery might be necessary if my mom was to continue working in the nail business. Her customers, when they come to the store, don’t know   that she works thirteen hours a day and comes home at eleven after thirteen hours of work, only to start cooking for tomorrow and do her accounting. They don’t know that she climbs into bed at two in the morning and wakes up at seven, and has been repeating this routine six days a week, all weeks of the year, for the past twelve years. They don’t see that she barely has time to put on her lipstick in the morning, never mind doing cardio exercise for half an hour three times a week. They only know that she has wrinkles, over-sized pores, white-hair, and pockets of fat forming at the base of her cheeks. Seeing this, how can they trust her to make them beautiful when she doesn’t seem to value her own beauty?

The last person to see us in the office was the manager of the clinic. Perhaps she thought I was stunned by her beauty, and perhaps she has received the same reaction many times. Her body had been cut, sewn up, altered, covered, pulled, twisted, and inflated in almost every possible place: a nose job, breast implants, facelift, hair-dye, heavy make-up, Botox, and a tummy tuck. She was around sixty years old, but packaged to be twenty. She looked neither old nor young. Her beauty wasn’t the sort of ageless beauty that some women gather as they age, when they manage to carry their gravity with grace. Her taut, flawless skin looked as if it could suddenly snap and spew out her contents. She turned out to be a sweet lady though, and an excellent businesswoman. She had been a patient at the clinic for sixteen years before she became its manager. Her surgeon was our surgeon.

She handed us the papers. The tummy tuck would be $6,000, and the facelift would be either $8,000 or $11,000, depending on whether my mother chose general or local anesthesia. The conversation drew to an end, and the lady asked us if we had any final questions. My mom wanted to see her scars. The manager stood up and showed us her belly, and we could see a very faint scar at the pubic line where they had performed the surgery years ago. Then she bent down and showed us the scars on her chin and face. My mom’s eyes lit up when she saw how faint they were.

In the car, my mom asked me, “Wasn’t that lady pretty?” I looked at my mom. She was looking at me. I turned my head back to the lines on the road, unable to say anything because of what felt like a knife in my throat. Instead, I kept on driving.