“Oh, but don’t worry, they’re fresh!” We were not talking about produce, and this was not reassuring. The conference speaker was scheduled to teach a Botox training session the next day – using cadaver heads. When I had initially signed up for this physician seminar on facial cosmetic rejuvenation, there was no mention of cadavers. I left the session wondering exactly how “fresh” he meant and feeling a sense of dread. And, oh yes, Halloween was only five days away.
The next morning, bleary-eyed from lack of sleep, I rushed to the conference. Joining a line of physician participants getting gowned and gloved, I could see centered on each of 16 tables a silver pan about the size of a turkey roaster. A blue cloth matching our gowns draped over each pan and discreetly covered a bulging mass underneath. A corpulent eye doctor with a Texas twang boasted cheerfully, “You would not believe the Peking duck I had last night – fantastic!” My stomach lurched.
Surveying the scene, I heard someone say, “Three to a table, please.” I quickly glanced around to see who my prospective partners would be. Most of the tables were filling with men, not surprising as ophthalmology was even more male-dominated at the time. Instinctively, I gravitated toward the one table occupied by two female physicians. We introduced ourselves and chatted, willing ourselves to ignore the cloaked centerpiece between us.
Sima, a lovely young eye doctor from Iran, practiced in notoriously youth-obsessed and disposable income-blessed Marin County. Her stylish rectangular eyeglasses and perfectly coiffed hair highlighted her fine bone structure and complexion. Donna, a sturdy and congenial eye doctor from Michigan, had brown, flyaway tresses pulled back with a plastic hairband. Displaying her own prominent asymmetric forehead crease, she explained, “I’m just learning Botox so I can do it on my girlfriends – a pulmonologist and a cardiologist.” (How thoughtfully Midwestern!) My guess is that Donna was not hoping for one of their procedures in return.
Marguerite, a petite oculoplastic surgeon and one of the lab instructors, joined our table. She whisked away the blue cloth, uncovering the very fresh decapitated head. I think we all gasped. This looked nothing like my medical school cadaver. It seemed one step away from being alive – reminding me of corpses that I had declared deceased as a medical intern. He was an elderly Caucasian man, with his prominent nose squashed to the side as if he had fallen on it. A bruised area with a fresh scab on the bridge of his nose may have been recently biopsied for skin cancer.
The head was trussed up under the chin with a disposable diaper, which sported pastel images of cartoon animals and a velcro tab. I felt grateful for that diaper as it spared us from viewing the severed neck. The skin was pale and chilly to touch but still supple. Under the nearly closed lids, I could see the eyes intact. With our goal of mastering facial enhancement, we were fortunate to have a head with significant wrinkles. Scanning the room, I noticed that most of the cadaver heads were male. Few had likely ever dreamed of getting Botox.
Marguerite showed us how to prepare and administer the Botox injections. She described the muscles between and above the brows, then used a black marker to make five dots between the cadaver’s brows. Those were the landing spots for our injections. Sima asked Marguerite where she would apply the injections on an actively frowning face. (The cadaver was ill-prepared to frown.) Marguerite obligingly prompted Sima to frown. She lightly touched the “eleven lines” between Sima’s eyebrows using the marker. Sima jumped back and shrieked, “You touched me! With that!” She pointed accusingly at the marker. There was a moment of tension mixed with disbelief, quickly broken by Marguerite reassuring, “No, no, the marker was capped. See?” Nonetheless, Sima was already grasping for an alcohol wipe. We resumed with the lab, but with a lingering sense of how we, even as doctors, were uncomfortable in the face of death.
We then took turns injecting the cadaver. With her lilting Persian accent, Sima peppered Marguerite with questions and did more than her share of injections. With Marin county matrons desperate for wrinkle relief, getting up to speed with Botox was apparently an urgent matter. When she was about to forge ahead with yet another practice injection, Marguerite suggested, “Uh, maybe Donna can take a turn now?” After a single attempt, Donna retreated. Perhaps it was hard to get too serious when the only patients she’d be injecting with Botox were her two best friends.
After Botox, we performed injections using cosmetic “fillers” that plump up facial wrinkles. After making her third injection to the “marionette” lines on the cadaver’s chin, Sima again recoiled and let loose a scream. I thought body fluids from the cadaver had splashed onto her face. Marguerite asked if she was okay. “Yes, yes. It’s just that suddenly, he seems so … alive!” We stopped to marvel at how the wrinkles had nearly disappeared. Rejuvenation, indeed. Framing the cadaver’s head between her two gloved hands, Marguerite cooed, “There, sir, now you look much better.”
Although I portray this 2009 experience with a light touch, I do feel that demonstrating such procedures on live models would be far preferable—from an emotional and practical standpoint. Participants can then identify active frown lines and observe the models’ reactions to the injections. Following the training conference, I sent two letters detailing my thoughts to the meeting coordinator. The letters have been unanswered.
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