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It is often said grief comes in waves. For me, it was a tsunami. It began with a phone call last year when my brother was diagnosed with lung cancer during a routine check-up. He was a committed runner and health nut and had also worked near the World Trade Center after the towers fell on 9/11, sertraline vs fluoxetine for anxiety breathing in the toxic dust that continues to kill so many. 

Though doctors initially thought they had caught the cancer early, it had already begun its inexorable spread. Despite 30 rounds of radiation, two rounds of chemotherapy, and immunotherapy, the cancer worked its way from his esophagus to his ribs, spine, brain, and finally, his stomach. I watched as he toughed it out when he was no longer able to tell left from right, grimacing when he bent over, though he tried to hide the pain. 

Before getting sick, he had taken on the role of the primary caregiver for my mother, who, though active and alert, was elderly. On the first day of my brother's chemotherapy, my mother fell and fractured her spine.

Luckily, I lived a few blocks away and was able to step in to help. What followed were countless middle-of-the-night trips to emergency rooms for them both, and assisting with showers, food, and bathroom duties. I slept with my phone by my pillow, ready to race over at a moment’s notice. Ironically, on this past anniversary of 9/11, I had to take my mother to the emergency room while my brother was with his oncologist, being told that his cancer was no longer responding to treatment. My mother never left the hospital and for the next few months, I ran back and forth between the two, sitting by their beds, managing their care, and working in nurses’ lounges while I witnessed my brother and mother's steady and painful declines.

My usual coping mechanisms deserted me. I stopped sleeping, working out fell by the wayside, and I had trouble eating. My brother died in hospice 10 months to the day from his diagnosis. My mother died six weeks later.

I was left physically and emotionally depleted — and it showed. My face had become gaunt and haggard, my sallow skin formed shadows etched beneath my eyes that no amount of makeup could disguise. Looking in the mirror only reminded me of what had happened.

"Your life experience is worn on your face, good and bad," observes Steven M. Levine, a board-certified plastic surgeon in New York City. "The reflection someone gets in the mirror is not just age, but what they've been through."

Loss these days is everywhere. "People are grieving, not just as a result of personal losses but because of the general sense of loss during the pandemic. People have lost their jobs, connections, and everyday life routines, all of which have been extremely stressful," says Vivian Diller, a psychologist in New York City, who studies the connection between emotion and appearance, and the author of Face It: What Women Really Feel as Their Looks Change. "When we face stress, our bodies go on alert. Anxiety increases, blood pressure rises, and our neurotransmitters can go awry."

The result can wreak havoc on our skin as well as our health. "Grief drives neurologic and endocrine responses," says Robert Anolik, a board-certified dermatologist in New York City, who says that prolonged activation of these responses can result in abnormalities of the immune system, increased free radicals, and subsequent DNA damage, all of which contribute to the deterioration of skin quality. “The sympathetic nervous system,” Anolik adds, "triggers the so-called 'fight-or-flight' response, which can lead to dull, dry skin without the same resilience or elasticity, more visible lines, pink blotches, possibly even sagging if the time period of grief is extended." Lack of sleep may also reduce your skin's ability to battle ultraviolet damage and free radicals.

Before I could address the toll the past months had taken on my appearance, I first had to deal with the emotional upheaval, including recurring nightmares, that continued to haunt me. "It's most important to seek help in times of severe grief, from a social network and psychologists or psychiatrists as needed," Anolik says. "Once the support is strong enough, moving on to cosmetic treatments can be helpful to the skin, but also even catalyze your return to acceptance and stability."

I know that he's right because I'd been there before. Years earlier, my husband had died suddenly, leaving me alone with a young child to raise. (Yes, I'm aware that I sound like the Typhoid Mary of family relationships.) For the first six months, I had no energy to do anything more than take care of my daughter and go to work, crying every moment I was alone. I soon developed bags under my eyes that should have taken years to appear. Finally, after getting therapy that helped me regain my footing, I saw a plastic surgeon to have the bags under my eyes removed. I didn't want the loss I had been through to be written on my face. I wanted it to be my story to tell — or not. 

The outpatient procedure, known as a lower lid blepharoplasty, reduces, removes, or repositions bulging fat of the lower eyelids. "The fat compartments of the lower eyelid can be approached and treated through an inconspicuous incision inside the eyelid, known as a transconjunctival blepharoplasty, that leaves no visible external scar," explains Adam Kolker, a board-certified plastic surgeon in New York City. (Kolker did not perform my procedure.) 

After 10 days of bruising that left me looking as if I had gone a few too many rounds in a boxing ring, the bags under my eyes were gone. For me, the procedure was an integral part of healing. It was an act of optimism.

Not everyone, of course, wants or needs plastic surgery after facing a loss. In fact, Kolker recommends an incremental approach. "The duration and sequence of the grieving process are different for everyone. When you feel ready to reengage, start slowly," he says. "At first, only at-home treatments should be considered. Fitness, nutrition, hydration, and a proper skin-care regimen (cleanser, antioxidant serum, moisturizer) should be resumed. Specifically, antioxidants and peptide products could be most helpful."

Anolik agrees with these ingredient recommendations. "Antioxidants reduce the impact of free-radical damage to the skin DNA, allowing for healthier development and consequently more beautiful skin," he explains. "Peptides, on the other hand, are fragments of proteins that can sink into the skin surface and are capable of triggering specific skin functions to promote new collagen production."

Following that, in-office procedures can be an effective and less-invasive option than surgery. Injectable neuromodulators such as Botox can treat furrowed brows, while fillers including Restylane and Juvederm can add volume and plump the skin.  

Carrieanne Reichardt recently lost her brother to cancer, and the constant worry left its mark on her face. "I'm in my 20s, but I had wrinkles in my forehead, which probably got worse from not eating and sleeping," she says. She went to Kolker for Botox. "It was something I knew I would do at some point, but this expedited it."

While no injectable can heal the pain of losing someone, it gave her back a sense of confidence. "I went from looking tired all the time to looking more alert and calmer," she says. 

After my mother and brother died, I sought treatment for post-traumatic stress disorder (PTSD) and slowly I began to sleep again. I started exercising and eating healthier, but my face didn't get the memo. No matter what I did, I looked exhausted, with loose, dull skin and jowls around my mouth. I was finally ready to seek help for the outside just as I had for the inside. I had no desire to look like someone else, but rather who I had been before the last two years had done such damage. (Okay, yes, maybe just a wee bit better.) 

I turned to Levine because he is known not just for his talent and his natural results, but for his empathy. As I sat in his office, he explained what I could expect from the procedure he recommended, a lower face and neck lift. "The purpose of the surgery is to lift tissue that has fallen into the lower face and neck and return it to the midface and cheeks," Levine explains. "The neck is addressed by tightening the muscles as well as sculpting the overlying fat and skin. The primary plane of operation is on the deeper tissue of the face and yields a natural and long-lasting result."

Levine made sure I understood the procedure itself, the risks that all surgery entails, as well as the healing time. "What I do is elective, but it’s still surgery," he says. "It shouldn't be a decision made quickly but be thought through by the patient and surgeon performing it. In situations of grief or a breakup, if you are still crying every day, it may not be the best time." I had done the work in therapy and now as I began to look to the future, albeit a different one than I had once imagined, I wanted to move forward from a place of strength.  

"Grief usually follows a period of selflessness from taking care of someone to mourning. Plastic surgery is something you do for yourself," Levine says. "There's nothing sad about it. It's empowering."

I made an appointment for surgery and as I waited for the day I felt a mix of anxiety (anesthesia!) and excitement (no more jowls staring back at me on Zoom!). On the morning of my surgery, as I lay on the operating table being prepped for the three-hour procedure, while the anesthesiologist was putting the IV in, she asked about the tiny swallow tattoo on my arm. I told her that I had wanted something to mark getting through the loss of my mother and brother, to honor the past and look ahead with a sense of hope, and that was why I was having the surgery as well. She smiled. "This is for you," she said. It is the last thing I remember before waking up.

I spent the next 48 hours being cared for by amazing nurses who changed my bandages, fed me, and soothed me. After so many months of caring for others, it was odd to be the one sitting in a chair in the shower and having a nurse wash my hair when I had done the same for my mother. I know, though, that my mother would approve. When she was down to 92 pounds and riddled with bedsores, she still put on red lipstick every morning because it made her feel better.

I was back at work in a week, a bit tender but overwhelmingly grateful to Levine and all who had helped me get there. Now, two months later, my skin is smoother and tighter, my jowls are gone, my neck is taught. My decision to have plastic surgery is not necessarily right for everyone, but it was definitely the best choice for me. My sense of loss isn't gone, but the scars are hidden, and I can face the future with newfound confidence.

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