Forget tummy tucks and nose jobs ‑ New York's latest trend is fat transfer. Edward Helmore met Patricia Wexler, skin doctor to the stars.
January 1995

Pat prepares a patient for “bo-tox”. A procedure that paralyzes the frown muscles.

I feel like an overbooked restaurant,' says Dr Patricia Wexler, cosmetic fix-mistress and dermatologist to the heavy‑schedule women of New York. 'I'm getting calls from London, Rio, Mexico, Puerto Rico, everywhere... it's getting to the point where it is becoming embarrassing because a doctor is not a celebrity and I consider what I do valid, not like a fashion statement.' At 6pm, after 10 hours of non‑stop appointments, she flops down, exhausted. 'I'm dealing with everybody's wish‑list all day long ‑ call it the Dorian Gray syndrome: I'm the picture‑the one getting wrinkled as they are getting plumpened.'

Pat is famous for her fat. Forget breast implants and silicone makeovers; forget the facelifts, the tummy tucks and the nose jobs. Wexler's specialist cosmetic techniques run from dermabrasion to liposuction and collagen, but the must‑have of the moment, the treatment for which she has a four‑month waiting list, is fat transfer. This is cosmetic surgery without the scalpel ‑ no knives, just an elephantine syringe brimming with fat taken from your very own thighs, which is then injected into the clefts and lines of your face to give you a fuller, more wholesome appearance. It's quick (each fat injection takes just 10 minutes), it's easy (no scars, no hospital beds) and it's two treatments for the price of one ($3,000 for the reduction on the hips and a year's course of face‑filling).

The procedure is not unique to her, but the Wexler touch is preferred in high‑society circles, and she enjoys a word‑of‑mouth reputation that keeps her appointment book thick with recognisable names. Although she will never discuss her client list, her patients are known to include Donna Karan, Barbra Streisand, various supermodels and around 1,500 greater and lesser mortals in between.

Injecting collagen into a patient’s lips.

A continuous stream of uptown women, clad in black Calvin (and Donna) and nimble Manolo Blahniks, beat a path to Wexler's office on the fifth floor of an unremarkable building in the East 30s section of Manhattan. One woman recently managed to make it in for her appointment with two broken legs. 'They will be in here today, in Washington tomorrow, on a film set, on a magazine shoot... I have people who will go airport‑office‑airport,' she says, with pride. 'They are career women in industries where youth is paramount‑where it's not necessarily vital to be sexy and alluring but where you need a healthy look.' Dr Wexler has a natural affinity with her celebrity clientele: she doesn't pamper them, but she understands and she is very discreet. A 10‑minute consultation‑ a little tweaking here and there ‑can make the difference between low self-esteem and confidence, between employment and the junk heap.

It's 6:30 pm and she's back in the tiny surgery giving a new client, an estate agent in her mid‑40s, a procedural overview. 'All women in their 40s start to lose fat in their faces ...some women sink and some jowl and you're a sinker,' she says candidly. 'We will harvest fat from the thighs and transfer it to the face ‑fat is an excellent volume replacement.' As she describes the transfer operation in her sing‑song New York cadence, fat begins to sound like an attribute: 'When I give the injection I correct you to perfection'.

'It is better for cosmetic improvement to be a continuous process than to try to catch up all at once, 'she advises her clientele, most of whom start the fat injections in their mid‑30s. 'These women don't have the time to recuperate from surgical procedures. They want to know what they can do to keep the way they are ‑they're slim, they exercise regularly, they have low‑fat diets and they want their faces to reflect the rest of their lives.'

Once the fat has been removed under local anaesthetic, it is cleaned, purified and stored in a fridge, and once a month a portion of it ‑ the consistency and colour of chicken lard ‑ is injected, again under local anaesthetic. The procedure is alarming to watch ‑the needle is big, a size 16 ‑ but the serious work is kneading and sculpting the fat into place. 'My strong thumbs are my most valuable asset,' she says, holding them up triumphantly. 'I don't ski with poles because I'm afraid of dislocating them.' About five per cent of the fat 'takes' each time, so by the end of the 12‑month course what was once a deeply scored line will be plumped up like a cushion. 'I never tell a woman she should look younger. I tell her she should look the best she can for her age.'

Two treatments for the price of one: in the fat transfer procedure, fat is 'harvested' by liposuction from the thighs and injected into creases in the face.

Doll‑like, with red, fluffed‑up hair and a rounded, albaster‑like face, Dr Wexler fits her patient profile perfectly. She follows the cosmetic advice she gives ‑ no smoking, little sun ‑and occasionally treats herself to her own fat when, she says, she has five minutes and is 'in the mood'. She lives an hour outside the city, by the sea; she has a chauffeur and a stack of invitations to fashion shows and fundraising events; she skis in Colorado, summers in France.

She never wears a lab coat (sometimes when she's doing the messy liposuction she wears a set of surgical greens), preferring the designer‑black and navy‑based uniform of her customers. In her office, which she shares with her urologist husband, she does her consulting from a Chippendale chair. 'We laugh in the waiting‑room, we have great fun -it’s playful, everyone is hanging out,' she explains. Afterwards, most of them become her friends: 'You have shared something important to them, but it's also a professional relationship, not as social as "Come to LA for the day and we'll do lunch and fat".'

As a child, Patricia always felt a bit awkward about her looks ‑ something she feels has given her an affinity with her patients. 'I never had looks that would be terrible to lose, so I feel sorry for women who are so beautiful that losing their looks leaves them empty.' Instead, she studied hard and went into medicine, originally as an infectious‑disease clinician, working with HIV patients when it was still called GRID, or gay‑related immune deficiency. She transferred to dermatology when she found that she was unable to detach herself emotionally from her patients.

If it is Wednesday it must be bo‑tox day, an abbreviation for botulism toxin ‑ a procedure that paralyses the muscles responsible for frowning. The toxin, stripped of the bacteria that are the common cause of chronic food poisoning, is injected into the corrugator muscle that lies under the eyebrow, and Wednesday is when it comes in fresh from the laboratory.

Each shot lasts for three to six months and although there is a one per cent chance that the toxin may float and cause a temporary droop of the eyelid, it has only happened twice to Dr Wexler: 'I get more upset with the complications than they do. I won't do it on someone whom I don't feel is intelligent enough to understand the risk.' But isn't a frown a useful expression? Apparently not. 'A study found that a frown is never a positive statement ‑ it has no benefit and it's unnecessary, ' she says, vainly attempting to look severe.

“A doctor is not a celebrity,” says Pat. “I consider what I do valid, not like a fashion statement.”

In pursuit of perfection she has developed a defoliant, moisturiser, cleanser and sunscreen with Donna Karan (whose signature New York Formula is now the hottest range on the market). 'Women are over‑marketed too,' she confides, explaining that she and Donna share the same philosophy of simplicity. 'It's abusive to women, you don't need eye-creams and the rest.' She 'often' turns away women who want big lips, or their nasal‑labial folds filled to the point that they become flat and stretched. 'I will not do anything aesthetically inappropriate because then my name is on that procedure.'

Wexler believes that it is the doctor's responsibility to protect the client from the excesses of cosmetic surgery: 'I see celebrities who've been operated on far too many times ‑Michael Jackson for instance‑ and somebody should have just said no. Somebody had the right and the obligation to say no. If I have a very thin woman come in who wants abdominal liposuction I will tell her that this is something exercise will take care of or that she should re‑evaluate her expectations. I will only work on women who are within 10 lbs of a goal weight but have a body contour problem or a genetic predisposition to a bad area.'

She will go a long way to help models, including weekend emergencies ('I've had cover girls come in with a rash the night before the shoot') and actors and actresses who need their features altered to fit a certain role. 'There's no real difference between having your lips plumped for a part and having special hair and make‑up,' she says with conviction. 'It's very common now, like Barbara Hershey, who can play an uptight role in one film and then a very sensuous one in another ‑the hair changes, the make‑up changes, the clothes change and certain features on the face can be accentuated. If you want to feel sexy, you put on high heels, sheer stockings and a slinky dress ‑ it's the same thing, like a prop.'

She escorts a newly youthful‑looking music‑business executive to the door of the surgery. The woman thanks her profusely. Dr Wexler beams with pride. 'Now, does she look like she's just had four horse needles in her face?'