Saving Face 

When good drugs have disfiguring consequences

Thursday, Jan 9 2003

Even though my hairdresser’s makeshift salon doesn‘t have the sumptuous accouterments of a bona fide shop of beauty, an oversized mirror stares back at me as Lance meticulously cuts my hair, then mousses it and gooses it, attempting to conceal the thinner patches. “I’ve looked better,” I think to myself while I listen to Lance whine melodramatically about his own personal beauty crisis: He‘s worrying about the potential side effects of his medical regime for HIV.

“The worst one is when, after years of taking protease inhibitors, your face caves in,” he complains. “Can you imagine, honey?”

Lance lives in fear of lipodystrophy, a condition that results when ongoing drug therapies cause fat to be distributed abnormally. Lipodystrophy affects the face, legs, stomach and neck. In some instances, there is an excess of fat; in others, so much fat is lost that the empty tissue sags.

Later that evening, I plant myself in front of the mirror to study my face. I have been HIV-positive for 15 years, medicated for six with a cocktail of 22 pills, including Fortavase and Combivir. In slow motion, I turn my face to the left, then to the right, inching in closer to the glass, then pulling away. “What are you doing, Daddy?” asks my 8-year-old daughter, Tia, who doesn’t yet know my HIV status. Since I adopted her as an infant, I‘ve felt it was my job to protect her, so she’s unaccustomed to seeing me in such a state. But before I can come up with an explanation for my inquisitive kid, I hear Gloria Swanson as Norma Desmond whisper in my ear: “We had faces then.” Then. Faces then.

Oh, my God, I realize with a shock. I‘ve got it. I’ve got lipodystrophy. It looks as though my cheeks have been scooped out with a spoon. Were Lance‘s histrionics a subtle way to let me know my glamour days are numbered?

I am an actor. It’s my livelihood, my life‘s work. And if you’re an actor flailing about in Hollywood, even if you‘re called upon to play a homeless wino on Skid Row, you’re expected to be beautiful. And while the majority of my actor‘s life has been onstage rather than on celluloid, my face has paid more than a few months’ rent. Losing my face could cost me my career.

I have to do something. I‘ve seen a procedure advertised in the gay press, complete with dramatic before and after pictures, that promised to repair the damage. So vain, I think to myself. So shallow. So L.A.

I rip the ad out of the newspaper and secrete it under some papers on my desk.

A few weeks later, I’m sitting in the snazzy waiting room of the doctor‘s office, flipping through the pages of a magazine that features nationally respected political activist David Mixner on the cover. Inside, Mixner discusses the beginnings of AIDS and its relentless reverberations, which he began fighting some 20 years ago, before people with AIDS had such luxuries as sagging skin, buffalo humps and distended bellies brought about by the long-term use of protease inhibitors.

Reading about Mixner, I think back to Sean, an edgy musician whose career was beginning to heat up, the first person I actually knew who had contracted what had then been mislabeled as the mysterious “gay cancer.” I remember visiting him, watching him maniacally pace around his unkempt bed that was situated in the middle of his tiny one-room apartment. “Am I going to die?” he asked, not wanting an answer. “How soon?” There was a smell emanating from the bed that separated us. “I sleep and sweat, sweat and sleep,” he said. There were purple spots dotting his arms that would later be identified as one of the disease’s earlier disfiguring manifestations: Kaposi‘s sarcoma. What Sean would have given for a longer life with a falling face.

A voice interrupts my reverie: “Michael?”

I am ushered into a consultation with an office manager, who subsequently spells out the details. The transformation will be accomplished by making multiple injections of silicone directly into the areas where my face has hollowed. The results will not be immediately apparent, he warns; in fact, there are three visits spread out over a couple of months. “It’s not like a botox treatmenta to get you ready for the Academy Awards,” he kids.

I ask whether I should expect downtime, and how much. “The next day, there will be swelling and possibly bruising,” he informs me. He lowers his voice to a whisper: “You can tell people you had your wisdom teeth removed,” he advises confidentially. God knows you wouldn‘t tell anyone your face was caving in from HIV medication. That’s just not pretty.

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