On Scars
From 2022. Ruth Ozeki's "The Face" and sitting in a mirror for three hours.
19 August 2022
The second time I woke up on Friday, August 12th, I knew it was from a dream, and I knew I was disappointed to be waking up. I don’t remember the dream, which is unusual for me and probably an effect of waking up from anesthesia. As I returned to awareness, I noticed for the first time that my mouth was fully closed. For most people, this would be unremarkable. I’ve never been able to close my mouth fully, though, without mashing it into a frown or scowl. I was waking up from a bilateral cleft lip revision surgery.
The surgery is meant to correct a large and unsightly scar on my top lip and a “whistle deformity.” A whistle deformity is defined “as a central vermilion notching due to complex causes.” In my case, this means when my face is at rest, my lips don’t meet. I have a large gap where the upper lip is drawn upwards. To close my mouth, I have to press my lips into a frown.
I have this deformity because I was born with a set of defects - a “severe” bilateral cleft lip and palate. The first part means that I had no top lip when I was born, more or less. There were some flaps of skin, is my understanding, but nothing one could call a lip. In the surgery waiting area, I asked my mom what had necessitated the adjective “severe” about my case. She supposed it was the extent of the problem. The cleft, for me, went all the way to the tip of my nose.
Looking at a regular person’s face, their lips are typically formed well. They have definition, a cupid’s bow to give them shape. The space between the lips and nostrils is called the philtrum, and sometimes there is a pleasantly defined philtral ridge. I just had a big hole in my face. The benefit to this is that my nose would never be clogged up if left unfixed.
If you looked into that big hole, you would see palate problems. Namely, the lack of one. Mine was split into a large canyon, failing to divide my mouth and nasal cavity in any meaningful way. The canyon went all the way back, even splitting my uvula into two (apparently, this is called a bifid uvula).
This set of defects presented problems immediately (there was no easy way to feed me, I used a special bottle). In the first years of my life, I had many surgeries to correct them. In one of the first, a stitch was missed. That stitch became infected and drew up the lip creating the whistle deformity. Then I couldn’t close my mouth naturally for about 27 years.
I think people pretend they don’t mind much about their appearance. We like to have this fantasy at the same time that we have unprecedented access to views of artificially perfected appearances and lives via social media. It is common to see magazines doctoring photos, op-eds on magazines doctoring pictures, social media sites providing filters, people altering their appearance via filters, and people posting long essays attached to un-doctored photos as to why doctoring is harmful. Most of these have to do with wrinkles, spots, weight, tan, teeth, eyes, eyelashes, etc. We’re spoiled for choice when it comes to things about ourselves with which to be unsatisfied. I’m often surprised to hear friends lamenting physical parts of themselves because it is rare for me to think anything negative about anyone’s appearance.
They say comparison is the thief of joy. I wonder if people forget what they look like, only to remember when they see a mirror and have their comparison with themselves be that thief. That’s what I do. I forget I carry these two large, pink, jagged lines on my lip. I just flat-out forget about them. My body doesn’t - I cover my lip without thought when I sit. I keep my mouth tightly shut - something that never looks friendly.
One thing that you frequently read about people with cleft lip & palates (CLPs henceforth) is that they have self-esteem problems. This is probably not the most self-obvious thing written on the Mayo Clinic’s website, but I imagine it has to be in the top 50. People with large scars, often requiring extensive medical treatment, have self-esteem problems? Shocking! We were pretty poor, so most of my treatment was done at a teaching hospital. I recall large (large!) groups of medical students or residents coming through and packing into the exam room to poke and prod at me. Self-esteem problems? Hard to imagine.
Perhaps unrelated, I’ve never been comfortable with my face. I mention that I forget about the scar until untimely reminders present. I started in the last few years to make an excuse for my facial expression, which I’ve always seen as very negative because of the frowning. I stole it from someone who believed themselves to have something called Resting Bitch Face (RBF). The person introduced themselves and said something to the effect of, “I know I often look angry or irritated, and I’m not; I just have that kind of face.” I thought that sounded pretty good and started using variations of it. Sometimes people would try to refute my claim, which made me suspicious of scar-induced pity.
I have a similar thing with my voice. Speech impediments are common in people with CLPs. I had to have some speech classes as a kid. I’m acutely aware that the way I pronounce certain letters sounds strange - aware enough that I don’t believe people who tell me I’m wrong. A reasonable person may take someone at their word when they say, “you always say you speak strangely, but you don’t,” but what person is reasonable?
A scar doesn’t really give you anything good unless there’s a good story behind it (and maybe not even then). Scar-induced pity is something I’ve made up and is probably not real, but it’s always been a little more irritating to me than scar-induced mockery. When someone insults you, you can be spiteful; you can demonstrate exactly what you are or who you intend to be and refute that. If you perceive someone as being piteous towards you, it makes you feel like nothing.
To my memory, I was never teased about my scar. A high school teacher once called me a harelip, but this wasn’t to my face. I relished it when I heard it later on. A good, direct confrontation. Just what the doctor ordered. Nothing ever came of it, though. The most I ever got were children staring and sometimes holding their fingers to their lips and asking, “What happened?” That never irritated me - and it’d be wrong to be upset at honest curiosity. When I worked in an acute psych setting, a patient once exclaimed, “Whose this big MF-er with the fucked up face?”
That’s about what I thought the first time I saw myself after my surgery last week. A tech wheeled my bed to the bathroom, and I got out and closed the door. I caught myself in the mirror and said out loud, “oh, god.” To say that I felt dread would be an understatement. I didn’t recognize the person in the mirror, with their stupid fishy face. I forgot that swelling happens after surgery and took my appearance as what would be permanent. I thought over and over to myself, “it’s swollen, it’s swollen,” as I sat in the chair waiting for recovery.
My lip was certainly ‘surged.’ There was no longer a gap. Instead, a large incision was below my nostrils and down the entire lip height. It was now much, much, longer than it had been before. It makes my face look longer. The swelling around the lip area makes the rest of my face look puffy and round. The incisions were caked in oozing blood, giving me an excuse to refuse a mirror. I sat with rags to my face the rest of the time I was in recovery until I could safely put a mask on to leave.
My mouth’s shape appeared different. The corners turned downward, with my mouth in a U-shape from the swelling. My first thought was that it reminded me of the tragedy mask from theatre, but then I realized I looked like a fish. I still look fishy three days later. I was relieved when the surgeon came in and confirmed that - yes, after being cut up, pulled, stretched, and sewn, my face and lip were swollen. She shared that the swelling will get worse before it gets better. Great news.
There is no moral or takeaway from this reflection. In six months, it may be that I wake up and feel like I know who it is when I look in the mirror, or it may not. Something that I thought about in the waiting area is that everyone I’ve known, I’ve had to explain the marks on my lip eventually. Now, maybe I won’t have to do that. Instead, I may have to explain where those marks have gone. It is a genuinely scary thing to have your face in flux. I won’t know how different it looks until the swelling goes down. Even then, it will take a while for the muscles that were cut and sewn to regain their strength and for me to re-learn their use. It’s strange to me that something I’ve had my whole life is gone. Even though I disliked it, even though it embarrassed me and made me doubt myself and everyone who interacted with me, it was me. I don't know what to do with that feeling.
31 December 2024
It has been two years since I wrote what preceded. I published it on a small squarespace site that I kept under a pseudonym for writing that I felt was too vulnerable to share. I only published three articles on that site: on scars, on home, and finally on reading. I made stylistic changes to my writing to obscure myself, as if that would matter on an unshared blog (that stylistic choice amounted to not hitting the shift key). I would not say I regret that, but because of past experiences I believe strongly that a thing written must be signed if it is going to be true. So, here I am signing my work.
The on home article, I will eventually post here. The on reading article is not interesting and I'm not sure I have anything to say or write on that topic.
On Scars, I do have more to say. Written days after my surgery, I was in an acute place. I was terrified my face would not reform, that I would be stuck looking like a guppy the rest of my life.
I moved to Washington DC about a month after that surgery. I found a little bookshop called Lost City Books. One of the first books I bought was Ruth Ozeki's The Face: A Time Code. Within, Ruth sits and stares at her face for three hours. It is a short but compelling little book, which moved me.
My furniture hadn't arrived from Chicago, yet. I sat on a pillow in my eventual-bedroom and stared at a floorlengthed mirror the previous tenants had left. I stared at my face for three hours, as Ruth had.
Meditation has never been my strong suit. I've thought in the last few weeks of revisiting it, and I find it a struggle. I have to watch thoughts come up on me from the dark aether and let them go over my head without grabbing out to them. And the urge to grab and fall with them is incredible. I say to myself, "there's no need to think about this right now," or "you have no evidence to support that, and all evidence against it," or some such.
I wonder if that sounds a little intense. It isn't that I'm always like that and always needing to manage myself, it's just a thing that happens when I'm going through a very emotional time. It's mindfulness. I will say that the days and weeks following my surgery, I was having a pretty emotional time.
Sitting and staring at my face. My stitches had been removed and the anxiety of repeating that error salved. The swelling began to subside after a few weeks, and in the mirror I was more recognizable to myself. Those jagged pink lines were no longer there, the little gap where my lips did not meet at rest was not there. There is a dim pinkish line there now, much less noticeable. Little kids still stare at me sometimes, but I think now it is just that little kids sometimes stare. Not that they are trying to figure out what happened to my face.
It's been more than two years now since I read Ozeki's book and tried the mirror meditation. It isn't something I'd be rushing to do again, but it was an interesting experience. I would say that where I used to hate my face, I am now more or less ambivalent. I still need some final dental work that will actually end all of the flaws caused by the initial defect, but having moved so often and so much else, I've put this off so far.
There are few things as personal as your face. It is a strange thing to see change. I have long been uncomfortable with mine, and I will say that the surgery helped that a lot, once all was healed. I have an affinity for other faces, I like seeing people be expressive. The face is what I remember of a person when they are gone, alongside the voice if I can find it in the long years of memory. I remember my great-grandparent's faces so clearly, but I don't always have their voices.
In the last paragraph of my original essay, I said that I doubt. I still doubt. I will write more about doubt, and soon. But what I will say is that I want to believe.
It is probably so that for people who knew me on both sides of that surgery (of which there are relatively few, as I timed it to be after grad school and before I moved to a new city), the change isn't stark. For me, the little things loom large. I see the differences, and sometimes I still forget. But that is what happens with scars. You forget about them, and then you see them and are reminded. That they fade does not dampen your sense of them, but it may be that our eyes see our scars more brightly than the eyes of those around us.
Thomas