MATTERS OF THE FLESH

How Trevor Born became the king of the invisible facelift

By Trevor Cole

(Originally published in Toronto Life)

He could have chosen the Cadillac Escalade SUV, the ride he favours whenever he’s transporting Finn, his perfect Rhodesian Ridgeback show dog. But today, for the drive from his One Balmoral penthouse condo to the York­ville clinic in which he works, Trevor Born picked the Porsche. It’s a car as sleek and black as the fine suits he wears to meet with clients. And because appearances matter to Trevor Born more than most—even, it might be said, more than to most plastic surgeons—the look holds even in surgery. Neither the anaesthetist from Toronto East General Hospital nor any of the nurses can remember ever seeing another surgeon wearing black scrubs. Born says he does it for his patients. Traditional blue or green make them nervous, apparently; fashion black helps them relax.

This morning the patient is a 55-year-old Yorkville woman, lying unconscious and chemically paralyzed in the clinic’s state-of-the-art, terrazzo-and-marble-floored operating room overlooking Ramsden Park. Mona, as we will know her, has been thinking about this moment for more than 10 years. A woman with an expressive, joyful face, she has watched the de­teri­oration of her features, the multiplying lines, the hollows, the encroaching haggardness of old age, with not so much dismay as an increasing determination not to let it go unchecked. Every day the face she presented to the world seemed a less accurate representation of the vibrant woman she was. When she decided she could take it no longer, she asked a friend of hers, an international movie star as it happens, for advice. Of all the cosmetic surgeons out there, she asked, who were people talking about? Who should she go to? The actress came back with the answer: Dr. Trevor Born.

He has posted two pictures, images that Mona considers cruel, on a large wooden easel near the operating table. Like a kind of anti-art, they show her face in its stark reality, from the side and front, every inch marked with the ink lines and arrows and circles Born has penned onto her skin to guide him in the artistry to come. What authors do with words or painters with colour, he says, “I do with needles and knives.”

Now, because the lines on Mona’s face have faded since the pictures were snapped, he takes the time to re-ink them as she sleeps. “The key to all of this,” he says, “is pre-op, and following your plan.”

“Follow your plan” could be Trevor Born’s motto. “Of all my friends,” says a man who has known Born for 30 years, “he’s the one living his dream life. He’s living the life he described to us.” It’s a life that includes safaris in Botswana, spas in India and Christmas in Aspen, heli-skiing and windsurfing and a great head of hair. It includes a New York wife even more famous and photographed than he is, and an international clientele important enough to become as mythic and unknowable as the Sasquatch. It’s a life lived with the belief that in this city, there is no one better at what he does than him.

“I’ve hit the jackpot,” he admits. And why? Because he’s the man who knows what aging uptown women want—the ability to, as Cher sings it, turn back time—and gives it to them without anyone being the wiser.

Plastic surgery has been around since before the age of Christ. In ancient India, adulterous wives had their noses lopped off, and so a technique was developed to build new noses from flaps of skin cut from the cheek or forehead. Through the First and Second World Wars, plastic surgery developed as a means to return disfigured men to a semblance of normalcy. But from the early days of the 20th century, there has been another side to the science, fed by women willing to pay surgeons to cut into their flesh in the hope that flesh could be made more beautiful. Western society became habituated to movie star beauty just as women were striving to fix a place for themselves in the modern economy. So women had unwanted moles and hair burned off by X-rays, their faces injected with carcinogenic mixtures of paraffin and goose grease or Vaseline. Doctors performed nose jobs and face remodellings onstage, for fainting audiences, like vaudeville routines. Many patients must have deemed the risks necessary. As early as 1927, Hazel Rawson Cades, the beauty editor of Woman’s Home Companion, wrote, “Being good looking is no longer optional.... There is no place in the world for women who are not.”

Today cosmetic procedures like Botox injections feel as common­place as teeth whitening. In the U.S., more than 11 million cosmetic procedures (with surgery accounting for nearly 2 million of those) were performed in 2006, an increase of 446 per cent since 1997. In Ontario, spending on cosmetic surgery hit an estimated $210 million in 2003 alone. How many of these procedures are performed by qualified surgeons is anyone’s guess. Within Toronto, there are 51 doctors who belong to the Canadian Society of Plastic Surgeons. (Besides Born, the most prominent names, catering to a similarly high-end clientele, include Sandy Pritchard, Tom Bell and Lloyd Carlsen.) Though British Columbia and Alberta have strict regulations governing the training required to do plastic surgery, lax rules in Ontario have allowed family doctors and even spa aestheticians to claim expertise and perform cosmetic pro­cedures on the side. It was only in the wake of real estate agent Krista Stryland’s death following a liposuction surgery that Ontario’s College of Physicians and Surgeons decided to toughen its standards, announcing this past November a plan to regulate who will be able to call him- or herself a “surgeon,” and what training will be required.

To protect themselves, wealthy patients form networks of whispered referrals, like secret orders, around the most trustworthy doctors. In each group of friends, one surgeon will become the go‑to saviour. And go they do, because the wish to ward off the stigma of age is a powerful, undeniable force.

“I was conscious that I was starting to disappear,” says Mona. She talks about something she calls The Gaze. It’s the look that falls on a woman—whether from a man, a woman, an acquaintance, a stranger—and makes an immediate assessment. “Women are mindful of The Gaze,” she says, “and we learn how to read it. It can be sexualized or not. It can be invited or not. It can be flattering or not. It can be threatening or not. But most often it is assessing beauty.”

When it comes to plastic surgery patients, The Gaze is particularly judgmental. To look “done” suggests a moral failing. Some of Mona’s feminist friends told her that people who have plastic surgery “don’t have souls,” while a well-to-do Rosedale mother confessed to me that after a tummy tuck and breast implants, she felt like an outcast from her family. Better, then, if people don’t know. Better that you go away for a while and come back looking—somehow, indefinably—improved, restored. And this is where Trevor Born comes in.

He looks a bit like a sandy-haired Roman Polanski. Just five-foot-eight, with an athlete’s physique and a nose broken a number of times during his university rugby days, he offers a bemused grin and a manner that manages to be roguish and professional all at once. He seems always contained and controlled. When he speaks, particularly around medical matters, his words come fast and compressed the way he might scribble a prescription. Several times during our interviews, I had to ask him to repeat himself. But he puts his clients entirely at ease.

It starts with the way he dresses—crisp black Hugo Boss suits accented with sharp-toed python-skin shoes, along with, say, a pink tie and pocket puff, worn with an informal cool even during outpatient procedures—which sends a clear and multi-layered message: I am of your world, my sensibility is modern and refined, I understand the importance of first impressions, I am master of The Gaze.

It continues with the way he listens to clients. The lighting in the consultation room is soft, even romantic; music filters down from somewhere above. He sits next to a 51-year-old woman we’ll call Lorraine. “Where are we going to start?” he asks. He could be talking about the evening to come.

He understands the vulnerability of these women. Unless he knows a client well, he resists making suggestions; it’s the patient’s goal he’s interested in. He hands her a mirror and lets her speak. “Sometimes you get comfortable with a patient,” he admits, “and say, ‘Maybe if we just do this.’ They go, ‘Whoa, I didn’t see that,’ and that can hurt the relationship. You have to be very careful.”

But once the client makes her goal known, Born takes over, and flaws the normal eye hardly registers are noted and planned away. In the case of Lorraine, a lithe and attractive interior designer who kick-boxes for fun, she wants to look less tired. Born explains how possible that goal is:

“The eyelids will be cleaned up immediately. The key is to have that skin look nicer and smoother. We will address the loss of volume in the skin, a natural process of aging. You can see the volume loss through here, volume loss here and here, and in the temple region and underneath here, as well. That volume will be restored by doing microfat grafting, taking your own fat and injecting it in small amounts to build up these areas. The use of fat will help raise this eyebrow without the need of a brow lift, and may help compensate for your eyelid ptosis—the fact that your left eyelid is sitting a half-millimetre lower than your right. The little indentation here will disappear. We want to make the cheek a little fuller so the transition from your eyelid to your cheek is nice and smooth, so you don’t have this bump here and here. And these are all nice, subtle things that don’t change how you look. That’s the key.”

He continues like this for 10 or 15 minutes, and perfection sounds not very difficult at all.

If anyone has experience with perfection, it’s Trevor Born, who has lived the life of many men’s dreams. As a little boy, travelling with his family in Lima, Peru, he was an object of awe among local schoolchildren. During a visit to a museum of Incan artifacts, they would not stop touching his then white-blond hair. As a student at Ridley College in St. Catharines, he was a competitive skier. As an adult, he became a world-class sailor. In the three-person “lightning” class of boats, Born won seven Canadian championships, two North American championships and a bronze medal in the 1999 Pan-Am Games. His long-time sailing partner, Larry MacDonald, remembers with admiration the way Born kept his focus on the task during competitions, despite the attempts of women to distract him. “Trevor was always sought after,” says MacDonald. “Women would throw themselves at him, and all the rest of the guys would be jealous. But he wanted to win. That’s what he was there for.”

He grew up in the shadow of one of Canada’s plastic surgery pioneers. In Hamilton, Gunther Born established one of Canada’s first burn units in 1966, to treat men injured in a Stelco fire. Born Sr. used advanced techniques to fix facial traumas, including microsurgery to repair severed blood vessels and nerves. And he introduced liposuction to the area, after studying the technique in France.

Larry MacDonald says Trevor Born talked of being a surgeon from the age of 13. But Born himself says school was just a way to go sailing (he financed his university and medical degrees with sailing scholarships). He claims he didn’t think about medical school until he realized he found science easy, never seriously planned to be a doctor until he wound up in a white coat at McMaster. But once there he wanted to associate with the best. One renowned infectious disease specialist was famous for taking only final-year students with him on rounds. But in their first year, Born and a friend convinced him to let them join a rotation, an experience Born remembers as “amazing” for this doctor’s focus on patient history. And when it came time to specialize in plastic surgery, Born again sought out the top name: Bruce Connell.

It was Connell, in Santa Ana, California, who developed many of the principles that cosmetic surgeons rely on today. His work helped push modern facelift techniques toward methods that restored the face’s natural shape. Fellowships with him were highly prized, and Born was selected out of a group of some 30 applicants to work with Connell for six months. Connell made his students study the faces they encountered in their day-to-day lives, to see what made them look good—the shapes of their features, the tissue volume, the relationship of the eyebrows to the eyes, the jawline to the mouth.

“I spent a lot of time looking at people,” says Born. And he continued to do so during his training in Paris, Marseilles and Zurich. Later, as part of his ongoing study of beauty, he learned to appreciate the differences between Greek and Roman sculpture and went to the Louvre to study the marble faces, to understand why the soft, realistic Greek style was inherently more appealing than the stylized Roman form.

All of this training comes to bear each time he slices open a neck, or shoves a long steel cannula under the skin of a cheekbone to redistribute a patient’s tummy fat in more becoming ways. Or when he sticks a 25-gauge needle into the cheeks and eyelids of women like Sue and Joan, two clients who have come in for Sculptra treatments.

In the wingback chair of one treatment room sits Sue, a 45-year-old stay-at-home wife and mother from the Kingsway neighbourhood who dresses like a Ralph Lauren ad and sports what appear to be two-carat diamond studs in her ears. When I remark on the diamonds, she grins up at Born. “He hasn’t seen Deb’s.”

Deb, Born explains, is a mutual friend.

In another room sits Joan, a veteran of multiple procedures and surgeries, including a recent breast lift and other facial contouring. Joan is fighting age with everything she’s got—her hair is youthfully coiffed, she plays tennis 10 times a week. But her face is drawn, with not much separating the skin from the bone. Born is trying to avoid giving her a facelift that would inevitably look pulled and tight.

“You can see that Joan has really loosey-goosey skin,” he says.

“I’m very old,” she tells me. “I’m going to be 70 next month. So act shocked.”

In addition to some 400 surgeries, Born performs about 1,500 injection treatments a year, using products intended to help patients restore their youth without surgery. Available since 2006, Born’s Sculptra treatments range from $5,000 to $8,000 (he’s considered expensive) and require three sessions, each involving dozens of injections of a solution that features suspended particles of the same ma­teri­al used in absorbable sutures. Introduced into the tissue, the particles promote the production of collagen to thicken the skin and help restore its volume. The effect lasts two to three years.

For 30 to 40 minutes in each room, after he has injected them with local anaesthetic, Born sticks needle after needle into the women’s faces, distributing the product with his left thumb and forefinger as a guide. Nearly every needle in Joan’s face makes her wince. “Nine out of 10 patients don’t feel anything,” says Born. “We zip right through it.”

“You brought in the wrong patient,” mutters Joan.

Sue handles the treatments without a flinch. “I like what Trevor does,” she says later, “because people will say to me, ‘Oh, did you have a facial?’ or ‘Your skin’s looking really good. Are you using a new product?’ or ‘You look really well rested.’ And I know that’s not what it is! He doesn’t change who I am, just enhances it.” The subtleness of the effect can be a problem, when the occasional patient examines herself and wonders just what she got for her thousands of dollars. “Most people forget what they looked like after a week,” says Born. “That’s why it’s good to have pictures.”

Sculptra injections take a while to work completely, but the immediate temporary effect is swelling. When Joan’s treatment is finally over, she sits up and inspects the swelling in the mirror. “Oh, it looks so nice,” she says. “Can it stay like this?”

It’s possible that Born understands his clients because he shares their fear of growing older. He gets Botox and Sculptra injections himself, along with other treatments, to deal with the effects of all those athletic years in the sun, and like some mid-career screen star, he refuses to give his age. When I suggest mid-40s he seems offended. “I’m not in my mid-40s!” He says the suggestion is “not very nice.” The fact is Born came into the world in January 1965. “I’m ageless,” he says. No, he’s 43.

If Born’s life is lived in the thrall of youth and beauty, its best expression may be his wife, New York dermatologist Lisa Airan. He was married once before, back in his residency days, to Alexandra Hamilton, a beautiful woman in her own right who worked in magazine publishing before joining Fairmont Hotels & Resorts, where she’s now a director in the marketing department. The relationship ended, says Born, because “we were on a different page.” But if there’s a woman suited to the same glossy stock as Born, it’s Airan.

She’s something of a media phenomenon. She’s been a guest on Oprah twice and seems to be as widely known for her wardrobe as her medical work, turning up regularly in the pages of Women’s Wear Daily, InStyle, The New York Times and, in particular, Vogue and its on-line sister, Style.com, where you can find an eight-page gallery of Lisa Airan images.

“She’s really quite a dynamic person,” Born says, clearly smitten. They met in 2002—a year later, in fact, than Born had intended. He’d held an event in his offices to introduce Botox to the Toronto media (the party was jointly hosted by three of his clients: Jeanne Beker, Chris Hyndman and Steven Sabados). Vogue had just featured Airan in an article about Botox, and so she seemed an ideal star attraction. But she declined the invitation and the meeting was delayed until the following year, when Airan wanted to consult with Born over the injectable filler Restylane, a product Born used but that hadn’t yet been approved in the U.S. He flew to New York and began to pursue her almost immediately. He loves her intelligence (“She must have an IQ that’s beyond,” he says, using a favourite descriptive), her ability to choose and wear fashions (“She can put on a gown from any designer and it’s going to look amazing”) and the way she enjoys life to its fullest (“without a lot of back-thought or guilt”).

Dark-haired, wide-mouthed and beautiful—the child of an Indian father and Irish mother—she’s a favoured client, even a muse, for such design houses as J. Mendel, Marc Jacobs, Lanvin and Rodarte. “She’s a key client for us,” says Laura Mulleavy, who with her sister, Kate, owns Rodarte and creates fashion-forward concoctions for as much as $40,000. “She’s someone who knows what looks great on her.” Accordingly, Airan sits in the front row of many of the biggest fashion shows in Milan, Rome and Paris, and Born can often be seen nearby, happily snapping pictures of his wife or the runway scene.

They married in 2006 on a beach in Tuscany in a cere­mony, naturally written up in Vogue, that acknowledged their separate religions (Born is Jewish; Airan, Catholic) as well as, apparently, their astrological charts. Various New York fashion editors (and one Sex and the City writer) were there, along with several of Born’s friends, including hairstylist Jie Matar and National Post society columnist Shinan Govani, all of whom were entertained by Airan’s multiple wardrobe changes, a theatrically lit outdoor dinner setting and an excess of Iranian caviar.

Govani speaks generously of Airan, likening her to the “classic New York swans that Truman Capote wrote about.” But some in Born’s circle seem more reserved, perhaps partly because she seems to be pulling him away. One long-time friend noted that he hardly ever sees Airan because she never comes to Toronto. “Might miss a party or something,” he said with some chagrin. “I perceive their relationship to be beyond the regular romantic relationship. They also have a specific business reason to be together.” Born and Airan have, in fact, co-authored a medical journal report, on nonsurgical lower eyelid lifts, and they’re both consultants to an Arizona pharmaceutical company.

It’s hard to know if Born would have made it into the pages of Vogue, as he did in a story in 2005, without the Airan connection. It’s a good bet, however, that he wouldn’t be spending his weekends in an upscale condo in Gramercy Park, and he wouldn’t be working as hard as he is to set up a parallel New York practice, with full hospital privileges, a leased space within Airan’s offices and an eager media contingent looking forward to his arrival. “I can’t wait for him to come to New York,” says Vogue’s beauty editor, Sarah Brown.

He insists that he has no intention of abandoning Toronto. “I’ve had many people ask if I am leaving,” he says. “The answer is no. I have a big practice here. I want to keep it going.” Still, in trying to predict a person’s future it can sometimes be useful to look at his past.

Earlier in his career, Born maintained a general practice at Toronto East General, where he did reconstructive surgery. For a day and a half each week, he worked on injured hands, did breast reductions and rebuilt faces after skin cancer—the kind of therapeutic, doctorly work that helps to balance out the superficiality of cosmetic surgery. But after five years of this, Born quit. Today, he says, the 30 per cent of his practice devoted to redoing or repairing the efforts of lesser cosmetic surgeons amounts to the only “reconstructive” work he does.

He found the hospital setting inefficient; surgeries would get cancelled or moved because of demands on the operating rooms. But a bigger problem was money. The overhead for his cosmetic practice, for which he leases space in a neo-classical building near the corner of Avenue Road and Pears, is more than half a million dollars a year. And in his view, the fees for reconstructive surgery, held by OHIP to a fraction of what he can charge for cosmetic work, don’t compensate him adequately for his time. “I need to focus on the economics,” he says. He will, however, be doing skin cancer reconstructive surgery as part of his New York practice, because there the fees are not regulated. And looking to the future, he wants to develop a line of topical beauty products that would extend the Trevor Born brand.

“I don’t want to do hourly work for the rest of my life,” he ex­plains. “I think having an alternative source of income is really important.”

Perhaps then it goes without saying that, unlike many other plastic surgeons, Born does no pro bono work. Maybe this year, maybe next, he hopes to give some time to Operation Smile, the U.S. volunteer group that provides reconstruction surgery around the world for children with facial deformities. But in this city, he contributes by attending charitable events and “donating to various organizations.” Friends of his are quick to say that Born, besides being a very fine surgeon, is a really nice guy. A total mensch. And there’s evidence of that. A few years ago, though he was in the midst of leaving East General, he responded to a colleague’s 2 a.m. request for help in the reconstruction of a cancer patient’s jaw. And once, he treated Jeanne Beker’s finger when she had a terrible infection and didn’t want to sit in emergency. But while he says he’d hate to be portrayed as someone just out to make money, he admits, “Obviously my end goal is to make a living.”

The business of restoring beauty can be ugly in the extreme. In Born’s operating room, I saw fat-grafting patients whose bellies and faces were repeatedly jabbed with cannulas the size of meat thermometers, and watched as breasts receiving implants were sliced, stretched and stuffed. It was easy to understand why many plastic surgery patients suffer nauseating pain during the weeks of recovery. (Though not Born’s patients, apparently, since he preloads them with what he calls “a cocktail of medication” and steers them toward naturopathic supplements to aid healing.) The facelift is more delicate, though no less invasive. Before walking into the OR for Mona’s surgery, the last operation I was to witness, I was handed fabric covers for my shoes, which I hadn’t had to wear before. “More blood,” the nurse explained.

On the table, unconscious and marked with ink, Mona had something of the peaceful beauty that comes with sleep, despite the folds, lines and jowls she meant to rid herself of. What you couldn’t see was the easy smile and love of life that did so much to define her and had helped, for a time, to make those lines disappear.

Ultimately, of course, even an infectious spirit isn’t weapon enough against aging, so now, over the course of five hours, as his iPod supplied music that ranged from droning Buddhist chants to “Zapp…Whut” by Def Harmonic, Born removed two decades from Mona’s face. He sliced through her skin along the right and then the left side, next to the hairline and along the ears, and worked to “undermine” or separate the upper layers of skin from the deep tissue below it. He didn’t hurry. Other surgeons may be faster, he said, but “Speed is the last thing surgeons should be boasting about unless it’s a ruptured aortic aneurism.” Gradually he cut and cauterized the tiny blood vessels, until the skin of Mona’s face lay draped upon her like an untucked bedspread. He cut what looked like a second mouth below her chin, and through this separated the skin of her neck, as well. Along the way, the gauze strips used to mop up blood were discarded onto the sheet that covered her and grew into a cherry-coloured mound.

Then Born did the lifting. Modern facelifts are no longer about tightening. That’s the “wind tunnel” effect, said Ann Marie, the operating room nurse, and it has been replaced by techniques that add volume. Fat-grafting is one of these, and Mona had some the previous day, in addition to eyelid surgery. Another technique is plication, in which the underlying tissue is cinched together, folded upon itself and stitched in place.

As Ann Marie used what looked like a tiny silver pitchfork to lift the blankets of Mona’s cheeks, Born cinched and secured the underlying layer of deep facial tissue until a kind of continental fault line curved across each side of her face. He did this to the tissue of her neck, as well. Then with another tiny spatula tool, he drew the severed edge of the covering skin back toward the hairline. He reshaped the edges with a scalpel, discarding little wads of pink skin as he went, and paid special attention to the ears. “It’s not uncommon that someone gets a facelift and no one does anything about the ears,” muttered Born. “It doesn’t look very nice.” As he neatly sutured the incision closed on each side, he carefully drew the ear in, toward the cheek, the way he might have pulled a sailboat closer to shore.

A month after her surgery, in her Yorkville apartment, Mona’s face had largely healed. She no longer had to hide the bruising with sunglasses and scarves. Her neck was firmer, her jawline clean, her eyes bright, and though there were still natural looking lines here and there, which she liked, there was nothing left of the haggard look from before. She touched her cheeks, still numb, and said, “I still have a little bit of swelling. I can feel it.” But that would settle. Before the surgery she was told she would look “fresher,” and she made jokes about the word. Now she thought, “It’s actually a very good way of describing it.” The result, she felt, was well worth the $25,000 it cost. And though it’s true that she has replaced the stigma of aging with the stigma of having had cosmetic surgery to erase it, she insisted, “I’m very happy with the decision I made about my face.”

Keats once wrote “Beauty is truth, truth beauty.” It’s a thought that seems to have no application to the cosmetic surgeon’s world. Before I met Mona, I asked Born if what he did for his patients, in making them look younger, prettier than they were, wasn’t in some way to obscure their essential truth. “No, no,” he said. “It’s about enjoying life. That’s what it’s about.”

It seemed simplistic at the time, a rationalization. But in the case of Mona, it’s easy to believe the beauty of her new face lies closer to the truth of who she is.

And the man who made Mona’s surface match the spirit underneath? Strangely, he sits behind the wheel of his Cadillac, thinks for a minute, and says if he had one goal, it would be to windsurf more. Because even though he’s fabulous at what he does, to him it’s just a job. “Everybody says I’m blind,” he admits—blind, perhaps, to how good he has it—“but I’d rather not work.”

You’d like to think of a doctor as someone with the ability, the opportunity and the desire to devote himself to some greater purpose than making millions by catering to vanity, and spending those millions playing in the surf, wearing designer clothes and hanging out with the stars of fashion. But maybe that’s as unreasonable, as judgmental, as thinking a woman who spends $25,000 on a new face could have found a better use for her money. Maybe we have to accept that anyone has the right to defend herself from The Gaze by whatever means necessary, and that in helping her, a gifted cosmetic surgeon does a uniquely modern kind of good.

By Trevor Cole