allergy testing to make sure I’m not using any topical
ingredients that exacerbate the eczema. Then she
pulled out a notebook: Zyrtec (to stop me from rubbing
my eyes all the time) and a prescription for hydroqui-
none, a skin-lightening agent.
Then it was back to business. Levin handed me a
mirror. We looked at my reflection together. Under
medical lights, I looked even more like a suffering
Caravaggio subject than usual. “So we have volume
loss,” she said. “Obviously.” I laughed, sort of. “You’re
quite sunken in the middle of your face.” Levin pressed
on the skin next to my nose, which moved the flesh of
my face upward. “When I give you a little volume here,
see how it helps? The eyebrow bone casts less of a
shadow.” I did have to admit that I looked better—
slightly. By “volume,” I came to
understand that Levin meant a
hyaluronic acid filler, like
Restylane-L or Juvéderm Vollure;
she described them as “robust
enough to lift but soft enough to
be used in a delicate area.”
There were other options—
surgery being the most extreme,
though Levin reassured me that I
didn’t need it (“yet”). Another
option was injections of PRP—
platelet-rich plasma. In this sce-
nario, the patient’s own blood is
extracted, spun in a centrifuge to
increase its platelet concentra-
tion, then injected back into her
skin to raise collagen production. Microneedling was a
possibility, too. Punching a few hundred tiny holes in the
skin also causes the body to produce more collagen, thick-
ening it enough that fewer blue blood vessels can show
through. And there was the option of lasering away dilated
blood vessels. But that involved “recovery time,” also
known as a period of at least a few days when I couldn’t
leave the house without terrifying children, repulsing men,
and eliciting judgment-tinted pity from knowing women.
Levin’s ultimate recommendation was a hyaluronic
acid filler. I might be a little swollen for a day, but for
that she’d prescribe a steroid. The results would last
about a year, though people who work out really hard,
she stipulated, “burn through fillers really fast.” She
guessed I would need two syringes to “fully correct” my
undereye circles but added that she prefers to correct
to 70 percent so as not to make friends suspicious. This
is when I became nervous.
“Will it be very obvious?” I asked. At this, Levin pulled
out an iPad and began scrolling through before and after
pictures of past patients, pausing at one randomly. The
change wasn’t obvious, but she did look better. “OK,
fine,” I said. “Let’s schedule an appointment.”
Under medical
lights, I looked even
more like a
suffering
Caravaggio subject
than usual.
Before returning to Levin’s office, though, I got a
second opinion. Haideh Hirmand, a New York City plastic
surgeon and a clinical assistant professor of surgery at
Cornell Medical College, was arguably even more of a
realist. She agreed that an eye cream wouldn’t produce
terribly impressive results for me, but neither, she speci-
fied, would filler solve the problem entirely on its own.
My circles were too deep and too dark. Fillers—which
she’s been using on patients under the eyes for over 15
years—can work miracles for those who have deepening
tear troughs but not for those who also have crepey skin
or protruding fat bags like mine, she said. If I really
wanted my circles completely gone, I’d also need a
“lower transconjunctival blepharoplasty,” i.e., the cour-
age to allow someone to take a tiny scalpel to the inside
of my lower eyelid and “reposition” what scant quantities
of fat remained in there. I laughed. No way.
Three weeks later, I went back to Levin. I couldn’t tell
if it felt like an act of cowardice or compromise, but a
“blepharoplasty” was beyond my powers of self-
reimagination. Levin’s assistant applied a numbing
cream to my face and left me to worry. Twenty minutes
passed. Levin came back in and warned me that I’d feel
a slight prick at the injection
site (midway between my eye
and cheek) and then a bit of
pressure. I felt both. She then
started to knead my face,
spreading the filler around, and
I began to feel ill. She gave me
an ice pack to place on my ster-
num, which helped a little. She
did the other eye. The assistant
entered the room to take my
insurance. “Wow,” she said.
“Already so much better!” Levin
gave me a mirror. The middle of
my face was red and puffy, but
even so, I didn’t appear to be, as
usual, suffering.
My three most attentive female friends confirmed I
looked a lot better, but only after I reported what I had
done to myself; my husband didn’t notice anything at all,
which, when I think about it, is exactly the reaction I had
wanted but not articulated. The dark circles are still
there—let’s not kid ourselves. But they’re less the result of
ever-worsening facial cavities and due more to the hyper-
pigmentation, which is slowly improving, thanks to the
prudent, intermittent application of the hydroquinone. I
now look a little tired rather than agonized. I’m happy
with the results—happy that I can look happy and also
happy to have my suspicions about truth and beauty con-
firmed: Nothing short of undergoing extreme-seeming
(to me at least) medical procedures at great expense has
any real result. Nothing short of needles and lasers and
maybe your own centrifuged blood is going to effectively
intervene in your biological decline. No lotion or potion or
semiprecious stone tool will erase veins or alter the struc-
ture of your face. You can see all this as depressing and
discouraging. I choose to find it liberating.
PERSONAL QUEST
52 ALLURE MAY 20 19
JOSEPHINE SCHIELE
