Whine n Wisdom

Birth Defect

Tom Ford, a man renowned for his dedication to beauty, once told a journalist that he can't have a face-to-face conversation with a woman without analysing her every feature and how to improve them.

Tom Ford is not a man I want to come across in a hurry.

I was born with a cleft palate. In utero my palate, the roof of my mouth, didn’t join in the normal manner. I emerged from my mother’s womb with two startling and, I suspect for my mother, quite shocking gashes between my nostrils where the skin should have been a smooth, continuous join. My parents were put in touch with a leading plastic surgeon of the day and since then I’ve had a roll call of plastic surgeons to whistle up during the course of my life.

I have an entirely jaundiced view of run-of-the-mill plastic surgery. It is something many of us contemplate and covet but there are distinctions between plastic surgery for the sake of a sagging jaw line and plastic surgery for genetic defects like I have. I find it monstrously frustrating to read articles about the quest for the perfect breast or the sculpted nose. I’ve been playing catch up in the looks department for too long to feel empathy for such touch ups. Some of us are in a class of our own when it comes to plastic surgery and it’s equally provoking and damning to witness outcomes that show instant results instead of the slow and sometimes dead end process of the surgery that I’ve needed.

I’m seeing an interdisciplinary surgical team for another round of what I’ve dubbed the shall-I-shan’t-I appointments. It’s what I imagine a photo shoot would be like: I’m sitting with my back up against a white wall and lamps are turned towards me with their glaring and unmerciful light beaming onto my face. A team of people mill around me, someone holds a camera while others stand around staring intently at my features. All we need is Tom Ford to tweak my clothes and the illusion would be complete.

Plastic surgery these days is our god given right – but some of us have more of a right to it than others. And in my world they’re not plastic surgeons, they are maxillofacial surgeons – skilled in facial reconstruction from bone through to skin. My first surgeon was a kindly but godly figure by the name of Mr Dey and from a young age I knew to call him by his honorific of ‘Mister’. My Mr Dey was the first of a line of plastic surgeons to stitch and mould my face. And now I’m back again to see what else can be done for my looks. It’s quite the show these days, making an appointment with a hospital specialising in birth defects. In my case a mixed grill of medical professionals are arrayed before me – a casting call of the best and the brightest. Among us is an orthodontist, a speech therapist, a plastic surgeon and a few medical students who smile warily at me. I am relaxed with all these people, at home with their close scrutiny of my features.

The doctor lifts the camera up to his face and presses the shutter. He then swings around to my side and positions himself at precise right angles to my profile. I try not to wrap my lower lip into my mouth in the unconscious reflex to offer him my ‘better’ profile.

‘Do you think about having children?’ I’m asked by a fresh-faced man wearing jeans. My first reaction is to tell him to mind his own business but his question has a graver meaning in this forum. ‘I honestly don’t know; if I do should I be worried?’

‘In case you’re wondering what the chances are of having a child with the same condition,’ he tells me helpfully. For a moment I feel special to be singled out by these experts surrounding me but the question about children puts me firmly back in my place. My interrogator is a genetic ethicist and it’s him that brings my situation back in line with my fears. I’m different and I’ve wrestled with it for too many years not to pick up the subtle language of being ‘other’.

Meanwhile I’m asked to open my mouth, to face this way, now that, to arch my head to give the plastic surgeon a close look at the alignment of my nostrils.

Fingers manipulate my jaw line; someone throws up old x-rays onto a light wall and studies the images with a hand rubbing a chin. These people mill around me, discussing my options, waving away my doubts at someone’s proposal to break my jaw and then rewire into a different position. I’m asked if I want a different shaped nose and the speech therapist asks me to say she sells sea shells by the sea shore, the shells she sells are sea shells I’m sure. I do so with marvellous aplomb – the sibilant ‘s’ having been banished from my speech by my therapist when I was five. I raise an eyebrow and quell the urge to say – ‘surprised?’

The shutter clicks again as the surgeon takes further pictures. He swings himself back in front of me. I quietly release my pent up breath through my nostrils. I don’t like people scrutinising my profile. It’s not my best angle. I prefer people’s gaze head on. I’m never ready for my close-up and over the years I have developed the vigilance of Bette Davis in her waning years to present my better angles to the world. I prefer to sit in corners to give me control over people’s gaze. I don’t like my shadow projected onto walls. I don’t like anyone bringing up my defect unless I’ve initiated the conversation myself. I play a fool’s game because the evidence is written on my face no matter what angle you’re looking at me – from love, from dispassionate interest, from cruelty.

‘Michelle Pfeiffer? Not quite but we can get close.’ The plastic surgeon chuckles, believing he knows what image I covet. I can’t be anyone but me and it stings that the surgeon believes I need to be someone other than myself. He runs cool fingers down the hairline scars that run from my nostrils to my upper lip. If I close my eyes it feels like a caress if it were not for the faint smell of disinfectant on his fingers. He swings away again, looking over his notes with a practised eye. My eyes wander over the wall behind his head. There is a picture of him in Africa, nursing a child of five who has yet to have the operation to close his palate, the operation I had when I was a few months old. I feel a prickle of pettiness. Is it that necessary that I have further surgery when my looks, while interesting, do not quite have the effect of sending children howling from the room? But I don’t live in a distant village in Africa; I live in the 21st century, in a first world country where one’s physiognomy is its own status symbol.

The doctor continues scribbling his notes before looking across at me, ‘when do you want the operation – next Tuesday or the following month?’ So easy I think, I can be someone else from next week onwards. Suddenly I can’t answer such a simple and direct question. I say something non committal and he has the grace not to press further. The surgeon reaches over and gathers my file notes and I catch a glimpse of photos that I’ve had taken of my face over the years. I see a picture of my five-year old self. I’m wearing braces and I grin at the unknown photographer, as yet unaware that these photos are for a medical paper for maxillofacial surgeons and not for the family album. I want to reach down and rip the photo out of his reach.

Disfigurement makes you mute. It closes the mind when you most need it to open up. There is nothing poetic about my particular mutation. Some of our more outlandish defects have a certain beauty to their names: achondroplasia, Frederich’s ataxia, Osteogenesis Imperfecta. My particular disfigurement is lifted from the trailer trash section of the medical dictionary - harelip. It doesn’t speak of hidden deformity or heroic illness; it states—and rather too boldly for my liking—of physical ugliness. My likeness appears as the serial killer in Thomas Harris novels; Francis Bacon has painted fabulous portraits of my likeness. Strange and blurred visages, as if emerging from a nightmare, leap out of his canvases and in many of them I see the corrupted lines of my features. I used to flinch reflexively when coming across such references and also a pathetic satisfaction that the evidence was in: I’m inherently a very strange creature indeed with no redeeming features.

Living with a birth defect is a lifelong bargain you wage with yourself: can I be happy like this – should I be happy like this and if I can, does that cure me?

It is true, beauty is skin deep but there is a beauty beyond the obvious that is slowly setting me free. I can look at myself and my small flaw with something bordering on acceptance. My deformity has been the dark side of the moon for much of my life. I’ve used it as a crux but it has also made me reckless and cavalier. It has slowed me down and it has taken me to places that I may never have experienced if I had the complacent looks of normality. At least, this is how I explain it to myself.

And I can step into a fitting room in a clothing store and in the privacy of the cubicle, face the triptych of mirrors without flinching (too much) and look quietly at the image of myself – my seemingly unfinished profile, my blurred outline that hints of work yet to be completed and mostly I don’t wish to be something or someone else. There are some things in life that are irrefutable. For me, my face resists all change. It’s a complicated acceptance in this age of the quick fix.

I did not keep my appointment with my medical team – at least, not for now. But the spectre of Tom Ford does not rule out that possibility entirely. 

First published in Vogue magazine