TORONTO’S PRICIEST COSMETIC SURGEON, ON THE (NON-)CUTTING EDGE OF FACELIFTING
by Matthew McKinnon
A TUESDAY MORNING in June. Toronto’s most expensive cosmetic surgeon, Dr. R. Stephen Mulholland, introduces me to a Canadian film and stage actor — let’s call her Alexandra — minutes before her starring role in his next liposuction operation. Alexandra has bright eyes, tight braids, and silky black skin. She began treatment at Mulholland’s clinic in March, starting with the Pan G Lift, his scalpel-free, ten-week, twenty-session facial workout that delivers many of the benefits of a facelift with a fraction of the pain and none of the downtime.
Mulholland wants me to guess Alexandra’s age. I stammer a moment. He reminds me to always guess low. I stammer some more. I’m on the edge of spitting out forty-four when Mulholland cuts in with the truth: sixty-four. Wow. Alexandra unfolds a wide smile and says she feels like a new woman. Mulholland wants to know what has changed for her.
“I’m brighter,” she replies. “My face used to be droopy, but now I’m up. I feel good.”
Alexandra is thrilled with her face, but bothered by the look of her legs in a skirt. Mulholland asks her to lift the robe she’s wearing, and uses a magic marker to trace the perimeter of the “rub zone” on her inner knees. “You’re going to do good because I’m going to do good,” he says, shaking Alexandra’s hand before he points her out of his office and towards his O.R.
Fifteen minutes later, she is out cold and splayed on his hospital-grade operating table. Alexandra has been prepped and draped, covered entirely, except for the area being contoured. Mulholland asks for music while he scrubs in. The room swells with Sinatra. “I always enjoy Frank after a cappuccino,” he says, pulling on a pair of gloves to help his nurse and two assistants roll Alexandra onto her stomach. By the time I’ve tied up my surgical mask, Mulholland has already made a three millimetre–long incision in the dark creases on the backside of each knee.
Liposuction begins with an injection — here, a mixture of saline, Xylocaine, and adrenaline — designed to distend excess fat. The fluid is pumped into the body with a cannula, a long, thin metal tube with a hollow core and a slotted tip. The base connects to a hose, which in turn joins a pump. Mulholland slides a cannula inside Alexandra’s knees and floods them with fluid. A moment later, a nurse reverses the pump while he switches instruments. Party time.
Mulholland slips the second cannula into Alexandra’s right knee and rapidly jerks his arm back and forth. He swings from the shoulder, elbow cocked at a right angle, plunging the cannula three and five inches into Alexandra’s flesh. It looks like he’s stoking a fire with a poker. The room fills with sloppy squelches as the pump sucks down a chunky broth of fat, blood and fluid. Everything plops into a sealed plastic tub at the foot of the operating table. The fat looks like mashed McDonald’s french fries; it floats on top of the blood and saline dribbling out of Alexandra’s leg.
Mulholland removes a scant 300 millilitres of fat (the average liposuction yields three litres), rolling Alexandra onto her back near the finish. “The front view is the icing on the cake,” he says. “We’ve already set the foundation.” He uses one hand to press and shape Alexandra’s new legs while the other works the cannula. When he stops, a nurse helps him dress Alexandra (still unconscious) in a spandex-Lycra compression garment. Mulholland fits silicone-backed foam pads between the garment and her body to apply pressure on her deflated knees. Alexandra will wear the stocking twenty-two hours a day for the next two weeks, followed by three weeks of daytime-only use. She will need three or four days of bed rest, and a full month before beginning the regular exercise that she will need to keep the fat off.
“Body contouring is part science, part art,” Mulholland says. “The science is getting the fat out. The art is in how much you leave behind.”
ROBERT STEPHEN MULHOLLAND has a broad chest that makes him seem taller than his height, five foot seven, which happens to be the reason why he’s a doctor and not a retired NHL star. Mulholland grew up a hockey prodigy — high-scoring center, captain of every team he ever played on — but forever too small for a shot at the big dance. His soft hands proved useful, though, when he turned to medicine. He had thoughts of becoming a team doctor for a pro hockey team and living the Slap Shot life a while longer. But, at med school (class of 1988, University of Toronto, ranked second out of 280), he discovered a flair for surgery, then sharpened his skills as a head and neck consultant at a Hamilton hospital, slicing tumours out of people’s faces and necks and rebuilding the areas cosmetically. His plastic practice came later, after he grew weary of watching cancer come back to claim half his patients within eighteen months of his touch.
Mulholland’s own face collected fifty-two stitches over the course of his hockey career, most of which have faded. He is forty-three, old enough to “intellectually understand” aging, but only beginning to live it. He has a soft smile but still carries an athlete’s swagger: in one breath, he will admit that his prices offend many of his peers; with the next, he will boast that his practice is growing exponentially. Mulholland speaks quickly but clearly, holding every syllable for a full beat, often using expensive words where cheap ones will do. His diet, because of his busy schedule — surgery on Mondays and Tuesdays, patient consultations on Wednesdays, seminars and speaking engagements in assorted American cities for the latter part of most weeks — is “haphazard, sporadic, poorly thought out, and heavily weighted in simple carbohydrates.” He shops for clothes in two, ten-minute bursts once or twice per season, stopping first at a master tailor to collect his shirts, then on to Harry Rosen to choose from a selection of suits pre-arranged by his favourite salesman.
The doctor is mildly paranoid about cleanliness. He keeps his fingernails short and cleans them four times a day when operating. He washes his face without soap, but moisturizes twice daily with a cream from his own line of soon-to-be-released facial products. Mulholland doesn’t like anyone touching his food, and cannot enjoy a meal at a restaurant if he can see into the kitchen. When he lunches at the Subway franchise near his clinic, he will sometimes bring a pair of surgical gloves for the counter jockey to wear while preparing his sandwich. SARS is among his favourite topics of conversation. “I think that perhaps handshaking is on its way out,” is the sort of thing he will say, throwing in a little smirk to make you wonder if he’s serious. He thinks sleep is an evolutionary defect.
Mulholland is equal parts doctor and entrepreneur, a wildly talented surgeon who treats flesh like religion and his practice like a Nasdaq firm. His clinic, SpaMedica, is in Yorkville, Toronto’s toniest shopping district, barely a block up the street from the Four Seasons hotel, where many of Mulholland’s celebrity clients stay while recuperating from his scalpel (typically, he says, registered under pseudonyms). Mulholland estimates that twenty percent of his surgical patients are “dependent on the media in some way” — actors, politicians, television anchors. The same holds for him: Mulholland employs a public relations firm to promote SpaMedica and his assorted other ventures. He has appeared on The View, The Other Half, and health reports on newscasts for almost every Canadian and American network; he progressed through two rounds of pre-production with Oprah before the show’s schedule was scrambled by the war on Iraq.
Mulholland is in the process of opening eight to ten clinics in Southern Ontario, all “catering to skin in a non-threatening way:” Pan G lifts, Botox fillers, laser hair removal. If you ask how much money he makes, he will tell you that the top three cosmetic practices in Toronto — a list that includes SpaMedica — gross between $2- and $4-million a year. Then he will remind you of his manufacturing, training, and consulting commitments, “all very lucrative, all very profitable,” and lean back in his chair. His ultimate goals, he says, “are to continue innovating new methods for developing beautiful skin, and to then control or shape their delivery.”
AFTER TENDING TO ALEXANDRA, Mulholland lets me tag along on a series of follow-up visits with some of his facelift patients. “You can never be too thin, and you can never pay too little tax,” he tells a fifty-something woman while inflating her lips with Restylane, a Botox-like filler that lasts six months before deflating like a blown tire. The woman is here tuning up for her stepson’s summer wedding. Mulholland asks about her prospective daughter-in-law.
“I’d like to get her in to have her nose done.”
Mulholland pokes her with a needle, one of twenty (plus four for freezing) she is receiving in today’s session. “You should make it part of the prenuptial,” he suggests.
The woman looks like she wants to smile but can’t convince her lips to move. “Yes.” A drop of blood rolls out of her upper lip and onto her teeth.
ANOTHER TUESDAY, this time in May. I feel pretty. I’m at SpaMedica, lying inside a milk-white plastic egg that most closely resembles an (a) tanning bed, (b) bobsled, or (c) hyperbaric oxygen chamber like the one Michael Jackson used to sleep in. Vibrating motors tickle the length of my body. Climate controls hold the interior tempature at twenty-six degrees Celsius, offsetting the heating pad that warms my lower back. Miniature speakers hum classical music at a modest volume; aromatherapy ducts swirl basil and lavender. Only my head, swathed in soft towels, rests outside the pod. Silent fans cool my cheeks and brow.
I am being tended to by Dawn Sinclair, SpaMedica’s “medical aesthetics co-ordinator.” She could be thirty-five, forty, fifty or more — it’s difficult to guess age here, where every face glistens with the sheen of vitality or recent treatment. Sinclair wears only the hint of makeup. Her skin is smooth as melted chocolate, although she gently complains that her round cheeks are sliding south, transforming her face from oval to rectangle.
In a moment, Sinclair will give me a SonoPeel-CaviFacial, the first element of Mulholland’s Pan G program. Pan G is short for pan-germinal, a term Mulholland uses to describe all the living cells (epidermal, dermal, subcutaneous, and muscular) that make up the face. Meted out twice a week for ten weeks in forty-five-minute sessions, the Pan G is intended to cleanse, tighten, and strengthen skin and underlying muscles. A Pan G course can yield four to eight millimetres of lift in the brow and upper eyelids; overall muscle size, strength, and tone can increase by as much as fifty percent. It leaves no marks, so there is no temporary disfiguration. Patients come and go over their lunch hours. Most report looking five to seven years younger.
Sinclair wets my face with sterile mist. Next, she slides a wide titanium knife across my skin, its blade pulsing at 30,000 cycles per second. The knife is dull, but its ultrasonic movement causes cavitation. Tiny oxygen bubbles swell and implode, sloughing dead cells by forming microjets that plunge through my epidermis like needles. It is painless, enjoyable even — similar to rolling the barrel of a pen across your forehead.
She hovers over me now, dabbing gel near my right eye and temple. This is Pan G’s second phase, myofacial resistance treatment. Sinclair uncoils a pair of cords from M.E.D.U.C.E. (pronounced medusa, short for muscle epidermal dermal ultrasonic cavitational electrical system), an R2D2-sized cart that Mulholland devised to deliver the Pan G. Each cord is topped by a rounded metal prod. Sinclair touches prods to gel. Electricity ripples through my face, twitching the muscles above and below my eye. She counts ten repetitions and stops. Myofacials are delivered in three sets of what feels like increasing amperage (but really isn’t). The first feels like a light tug at the sleeve; the second is more insistent; the last is a hard pull. “This is going to the gym,” Sinclair says. “You do it twice a week. We make sure there is a gap between visits so the muscles have a chance to rest.”
Step three, the sonofacial. Sinclair slathers my face with another gel, this one a thick mixture of Vitamins A, C, and E. Sonofacials hydrate and nourish skin, pushing nutrients deep below the surface through an ultrasonic process called dermtophoresis. Sinclair traces circles across my face with a M.E.D.U.C.E. wand that looks like a kitchen sink hose; its gentle heat feels like a rubdown after the myofacial’s heavy lifting.
The Pan G is good medicine because it is good business and vice versa. Mulholland charges about $25,000 for a full-on facelift (the competition, he says, asks for as little as $4,000); twenty Pan G sessions cost $3,550. His master stroke is maintenance: after a Pan G lift, patients return for monthly myofacials, sonofacials every six weeks, and semi-annual Botox refuelings forever after — or at least until they decide to have the surgical work that Mulholland is only too happy to perform. What’s more, he owns a piece of the Florida manufacturing company that makes M.E.D.U.C.E., so he gets a cut of every US$65,000 sale. His seminar pitch package boasts that the Pan G converts patients into “year-after-year . . . in-perpetuity revenue.” One of the discussions describes “how to generate and how to retain $1,500–$3,000 per Pan G patient per year.”
“Steve does facial rejuvenation, and so do I,” says Dr. Tom Bell, one of the few Toronto plastic surgeons with a price list to rival Mulholland’s. “His approach is different than mine. [The Pan G] is not for the type of person who wants something that is going to last for a long time. You have to come back on a frequent basis.”
Dr. Lorne Tarshis, another competitor, calls Mulholland “an extremely bright man. He’s respected, he’s very capable — but if I had to pick one adjective to describe him I would say that he is controversial. Doctors as a whole tend to be conservative, especially surgeons. Steve is approaching things from an angle that has not been traditional for them.”
My test drive is over. Sinclair opens the egg and asks me to stand. I don’t want to. The egg is a frill, in no way essential to performing effective medicine. It belongs in a Belair spa, not a doctor’s office. SpaMedica has three, one for each Pan G treatment room. Mulholland’s way is to pamper patients: make the Pan G a total body experience, the best exercise they’ve ever had, and be assured that they will come back — to you, and no one else — wanting more, month after month for years on end.
Has anyone, I ask Sinclair, ever come to SpaMedica for the Pan G and quit after a single treatment?
MULHOLLAND WAS BORN in Vancouver in 1960. He learned to skate at age four and left home at fifteen to join the West’s major junior hockey league. When his body stopped growing, he hit the gym, lifting weights to compensate for the missing height. “I was obsessive compulsive about optimizing my genetically challenged vertical status,” he says. “I could benchpress 310 pounds.”
At eighteen, Mulholland accepted a scholarship from Michigan’s Lake Superior State, the NCAA’s smallest Division I university. He remains the only player to lead the school in scoring for four consecutive seasons, and was an All-American academic in 1983, the year he graduated with a degree in biology and chemistry. Mulholland signed a professional contract with a team in Sweden. He travelled Europe for a year, playing on and off the ice. “It was a fairly limited slapshot lifestyle,” he says with a shrug, “focused around hockey and scoring and extending that prowess off the ice. I liked meeting new women, and back then it wasn’t a fatal pastime.” Colorado came next. Mulholland toiled there, part of the Calgary Flames’ farm system, waiting for a call that never came.
When Mulholland applied to med school, he turned down Stanford to attend University of Toronto, partly because several of his hockey buddies lived in and around the city. He liked the women here too, so much that he decided to marry one. “It was the right time,” he says. “I wanted to stabilize my social life. I was about to start a residency. And she was very bright: Bay Street lawyer, writer.” (Sylvia Mulholland is the author of Lingerie Tea, The Thirty-Two Teeth Smile and Woman’s Work: Is There Life After Birth?) “It didn’t work out, like sixty-four percent of all marriages. We have two great kids. She lives in Los Angeles and I live here.”
In 1995, a year before they divorced, Sylvia wrote an essay for the Globe and Mail detailing the rigours of Stephen’s residency in Hamilton. “It’s a Wednesday evening, 8:30. My husband has just arrived home. He left this morning at six, unshaven, hair greasy, after stumbling into some rumpled greens (those baggy bile-coloured tops and pants in which nobody looks good). So far, it’s been a standard work day. In the fifteen minutes since he’s been home, he’s been paged three times. (He was also paged, in his car, on the way home.) As he inhales his warmed-over dinner, our two young children climb all over him, desperate for his attention. They have not seen him since Sunday. He leaves home in the morning before they are up; seldom returns before they are asleep.”
Mulholland spent a year deciding if he could carry on with reconstructive work, then abruptly quit the hospital and moved to Toronto. “It sort of culminated with some social circumstances around family issues,” he says. In Toronto, Stephen began his transition into aesthetic surgery. His marriage, however, proved beyond repair.
Sylvia moved to L.A. to concentrate on her writing career. The kids stayed behind in Toronto with Stephen and a nanny. He was happily raising them as a single father when he met his second wife, Ann Kaplan. Kaplan was (and is) CEO of Medicard, a Vancouver company that finances cosmetic surgical and dental procedures for clients who are short on money and long on wanting to be beautiful. (Then as now, she spends two out of four weeks on the West Coast tending to Medicard.) Kaplan was Canadian Woman Entrepreneur of the Year in 2001 (awarded by the Bank of Montreal and the Rotman School of Management); last year, she organized a Toronto aesthetic industry trade show called “New You” and was named the Bank of Montreal’s Finance Woman of the Year.
Mulholland and Kaplan spent a year building a friendship before their relationship turned romantic. “It culminated in a merger-acquisition, followed by a non-hostile takeover,” Mulholland says. “We merged her two kids with my two, then had our own child.” The newborn is six months old. Kaplan is pregnant again; her husband is hoping for Irish twins.
This will be as close as I get to Mulholland’s personal life. “It’s not that I want to keep my family private,” he says. “I just don’t want you to come over and meet everybody.”
IN 1997, MULHOLLAND was driving through central British Columbia with his two kids when his rental car hit a patch of black ice and flipped over an embankment, knocking him unconscious. His oldest, now fourteen, climbed to the road to summon help. Mulholland woke up in the back of an ambulance, unable to move his left arm. Bad news for a left-handed surgeon.
Tests revealed a brachial plexus injury, and Mulholland spent eight weeks wondering if he would regain full use of the arm. Unable to operate, he travelled to San Francisco to work with Dr. Patrick Bitter, Jr., a dermatologist who was experimenting with intense pulsed light therapy as a means of treating minor skin issues: rosacea, flushing, ruddy complexion, broken capillaries, spider veins. Bitter and Mulholland shared a passion for beautiful skin — and a desire to make money creating it. They teamed up to perfect the FotoFacial RF, “a synergy of intense pulsed optical and radiofrequency energy” that is one of the fastest-growing non-invasive aesthetic procedures in North America. (Basically, a flash of near laser-like light zaps imperfections in the skin, evening tone and decreasing redness; heat generated by the blast stimulates collagen growth.) Mulholland likes to brag that there are 10,000 FotoFacials performed in the U.S. every day. “The FotoFacial is as important as Botox, although not quite as hyped,” he will say. “Three Canadians [Botox’s aesthetic use was discovered by Vancouver dermatologists Dr. Jean and Alaister Carruthers in 1987] have had more impact on skin enhancement than most Americans combined, at a grassroots level.” (FotoFacials are frequently packaged as a Pan G add-on at SpaMedica. The clinic’s Pan G Plus program includes six FotoFacial treatments; it costs $4,650.)
Mulholland’s arm came all the way back. He bought out his partners at the Toronto clinic where he had been working and renamed it SpaMedica. His timing was ideal. Six years ago, cosmetic surgery was on the cusp of revolution. Non-surgical options began and ended with collagen. Botox was only beginning to catch on. Once it hit, though, much of the stigma that used to envelop plastic surgery disappeared. In 1992, the year that the American Society of Plastic Surgeons began keeping statistics, 400,000 North Americans had some form of aesthetic enhancement. Last year’s total was almost 6.6 million, with more than seventy-five percent of patients opting for non-surgical procedures (filler injections, chemical peels, laser hair removal, microdermabrasion, and so on).
SpaMedica’s upper floor is doctor’s office as luxury resort, complete with babbling waterfall and Botoxed receptionist. A magazine rack stocked with fashion and beauty titles takes up a wall by the entrance; a two-inch binder in the waiting area is filled with laminated copies of Mulholland’s press clippings. A series of black-and-white Robert Mapplethorpe photos hangs on several of the walls. The pictures are chaste studies of flowers, although a discerning eye will notice their petals growing further into bloom the deeper you travel into the clinic.
The vibe downstairs is more W Hotel than Four Seasons: the entrance is all frosted glass and cool grey, with a waterfall that is larger and louder than the one upstairs. Everything here is stop and go — non-invasive procedures that last an hour or less, with no telltale redness or swelling to prevent a same-day return to office or boutique. Registered nurses administer Pan G treatments and laser hair removal in four examination rooms; Mulholland has a pair of back offices used by local dermatologists. He shows me the latter on a tour of the clinic. “There is $2 million worth of equipment in here,” he says, sweeping a hand past the array of gadgets inside. We pause for a moment while I whistle, then carry on to a dressing area with big mirrors and high windows. Makeup of every colour and kind lines its walls. Mulholland installed the room after he grew frustrated watching his female patients cover up his surgical work with poorly applied cosmetics. “I’m always amazed that for so many women of means, their only experience with makeup has been over the counter with a high-school dropout at Holt Renfew,” he says. Mulholland now pays a Toronto film industry makeup artist to teach his post-op patients how to prepare their new faces. “Some of these women have no fashion sense, but I don’t go that far. I do let them dress themselves.”
All but one of SpaMedica’s employees are female. Four in five of his patients are women. (When he opened the clinic, male patients were rare — less than one percent of his practice. He now treats a long list of men, gay and straight. Many come for sweat-supressing Botox injections in their palms and armpits; some of them used to need a half dozen shirts per workday.) He operates 200 times per year, inflating breasts, deflating love handles, shaping new faces. He meets with surgical candidates three times before their procedures, and spends a lot of time discussing motivations, desires, expectations. He asks about lifestyle, whether they will have enough time for a proper recovery.
“I used to be an anatomist and a denominating tension lifter — pull this nerve, pull that nerve and you’re done,” Mulholland told me once, during one of several soliloquies on the art of aesthetic surgery. “True facelifting is so much more — it is three-dimensional, it is achieving an ogee, which is an architectural term for an S-shaped curve. Every part of the human body is about ogees, subtle shapes and curves. It’s the breast coming out to the deltal pectoral groove, then coming in at the waist and out at the hip again. Linear shapes are unattractive to western civilization.”
On their third visit, Mulholland takes patients into a closet-sized room built into his office. There’s little inside save two chairs, an enormous mirror, and the world’s least flattering flourescent lights. “It’s a very hideous room,” he says. “You can’t escape what you don’t like.” Doctor and patient spend half an hour studying problems and potential solutions in the mirror. Then he asks to see pictures of what they looked like at twenty, twenty-five, thirty. “We’ll go through their aging process to see if what they once had was attractive. There’s in no point in recovering what they had if they hated it. Patients help create their own canvas.”
That done, Mulholland hands the candidates off to his surgical co-ordinator, a trim and tailored nurse who handles all financial discussions. Mulholland claims not to know the exact price of his services, preferring to say instead that his facelift costs “more than a Dodge minivan but less than a fully loaded SUV.” Talking about money, he believes, sullies the doctor-patient relationship.
Post-op patients spend the night in a recovery room outfitted with a cable television and two beds — one for them, one for the overnight nurse who wakes every two hours to moisturize their wounds. A back door connects to a passageway and private elevator, which in turn leads to an underground garage and two shielded parking spots. High-profile patients use the elevator to rendezvous with their chauffeurs, safely beyond the reach of prying camera lenses.
SPAMEDICA AGAIN. I have agreed to try the FotoFacial. Mulholland leads me to an empty office and asks me to sit while he attends to a backlog of patients. While waiting, I make notes and poke at the half-dozen breast implants left out on a coffee table. (First time. Can’t figure how they’re supposed to feel like the real thing.) Fifteen minutes later, Mulholland returns carrying a jar of white cream.
“Do you have any social engagements in the next two nights?”
Don’t think so.
He rubs the cream onto my cheeks and nose, explaining that it will numb my face. A moment later, he dashes away to tend to another patient. I go back to fiddling with the boobs and writing in my notepad. By the time he comes back, I can’t feel anything from my lips up.
Mulholland leads me into an examination room and has me stretch out on a padded table. He waves an airhose over my face and asks me to shut my eyes. (The FotoFacial generates a burst of heat; the hose is used to cool the skin before and after its zaps.) His opposite hand holds a blue-and-white plastic handpiece. Mulholland says something about a snapping elastic band, and suddenly I feel a hard slap on my cheek. Everything pulses red for an instant. I feel the hose again, followed closely by another slap.
This lasts for about ten minutes. Mulholland works from right to left, slapping and cooling, cooling and slapping. I smell burnt hair when the flash drops below my beard line. Finished, Mulholland looks over my face and tells me to expect two hours to two days of redness.
He’s leaving for Florida tomorrow for another Pan G seminar, so we shake hands and say our goodbyes. I walk halfway home in the rain, catching stares from strangers all along the way. After boarding a streetcar, I open the window and point my cheeks into the wind. It stings less when we go fast.
At home, I lean into a mirror, fingering the array of small cuts that now covers my right cheek. (They aren’t supposed to be there, but would turn out to last nearly a week before fading. Not so much bad news for me as it is for Mulholland, I suppose: like spilling soup on a restaurant critic.) I try to recall why I wanted the procedure in the first place, and wonder if I’ll be willing to go through this again when I’m old and actually need it. Probably not.
Later that night, I put one beer in my belly and hold another to my face. It doesn’t hurt so much anymore, and skin around the cuts looks firm and tight. Or maybe it was like that before. I never really checked.
I remember something Mulholland told me the first time we met: “In the truly advanced civilization, we would all go boldly forward as we are, saying love me for who I have become,” he said. “Thank God I don’t live in that world. I would be unemployed.”
© 2003, Matthew McKinnon