‘I will never have the face I used to have.’
One warm mid-December night in 2011, Hanifa Nakiryowa received a text message from her estranged husband. He asked her to come pick up their children from his apartment. The pickup went horribly wrong when an unidentified man, hired by her husband, threw a vat of acid at her head. Her face as she knew it was gone forever.
“I will never have the face I used to have,” she says nearly eight years later. Nakiryowa, 37, is among the tens of millions of women and men around the world who have fallen victim to domestic violence. In the United States alone, according to the National Domestic Violence Hotline, an average of 24 people per minute are victims of rape, physical violence or stalking by an intimate partner—a total of 12 million a year.
At the time of the attack, Nakiryowa was living with her two young daughters in their hometown of Kampala, Uganda, and struggling to break away from her abusive husband.
The acid burns would change her life and face forever, but plastic surgery gave her a glimmer of hope.
“My wish then was that I could get the plastic surgery that I needed to give me functionality,” she said over the phone from Pittsburgh, where she now lives. Her voice is soft and measured. “To me, it became a need, not a want.”
Every year, more than 17.7 million cosmetic procedures are performed in the United States, including 5.8 million reconstructive procedures. Nakiryowa is one of many survivors of domestic abuse who have turned to plastic surgery as a means of healing external and internal wounds, rather than fixing imperfections.
Within the glittery confines of Beverly Hills, where breast augmentations and rhinoplasties are the norm, there is a small but dedicated group of surgeons who are working to reshape the way we look at plastic surgery. These are the doctors of Face Forward, Face to Face and other pro-bono groups who perform free operations for survivors of domestic violence. For survivors like Nakiryowa, successful recovery must be more than skin deep. These surgeons are often the first step to helping them return to normalcy.
‘We don't just fix the scars.’
As an in-demand plastic surgeon in Beverly Hills, Dr. David Alessi often rushed to the emergency room to operate on women suffering in abusive relationships.
“They had trauma, domestic violence, stuff like that, but they didn’t have any money,” he recalls. When he would return from an emergency surgery, his wife, Deborah, would express her worry about the women who received treatment. Even after receiving emergency care, these women would have to return to abusive homes.
Eventually, Deborah Alessi approached her husband with an idea for a side project. As a survivor herself — she was thrown down a flight of stairs by a previous partner — she told her husband that she wanted to do something to help other people who suffered through abuse. He was on board, and in 2007 Face Forward was born.
What started as a side project for the Alessis quickly grew into a full-fledged operation, with Deborah serving as chief executive and David as director of its Physician Advisory Board.
Face Forward treats 25 to 30 new patients a year with more than $1 million in donated surgical services. Patients are given fully comprehensive treatment, including the cost of reconstructive surgery — which can range anywhere from $8,000 to well over $100,000, depending on the complexity of the case, David Alessi says — hotel and flight fares for international patients, and the required mental health therapy to be taken before and after physical treatments.
“I basically tell our patients, look, when you come you just have to feed yourself,” says Mandi Edwards, Face Forward’s executive director. She is the only full-time employee of the nonprofit, which operates out of David Alessi’s Beverly Hills office.
Face Forward takes a holistic approach to healing, completely relieving its patients of potential economic burdens, and instead allowing them to focus on the daunting emotional and physical wounds that come with being a survivor of abuse.
“We have a very strict, ‘no therapy, no surgery’ policy, so all our patients have to be in therapy pre- and post-surgical care,” Edwards says. Patients must be out of the abusive relationship and active in therapy for at least one year before receiving treatment from Face Forward. The recovery process is more complex than fixing external wounds. As Edwards puts it, patients have to be willing to do the work.
Face to Face, a worldwide humanitarian group operated under the auspices of the foundation of the American Academy of Facial Plastic and Reconstructive Surgery, has a similar approach to recovery as Face Forward. “We want them to heal mentally and physically,” says Karen Sloat, Face to Face’s operations director.
Face to Face, which also performs pro-bono surgeries for veterans and patients with facial deformities caused by birth or trauma, operates a program called the Domestic Violence Project. In 2018, Sloat says, the program was able to support 48 survivors.
“We don’t just fix the scars,” David Alessi says of the approach at Face Forward. “You can’t just give someone a fish — you give them the fishing rod. What makes this place very unique is that everybody who comes in has to agree to do something great with their life.”
Past patients of Face Forward, Nakiryowa being one of the most notable, have gone on to use their stories and struggles to inspire the masses. “You can help to change the tide a little bit,” Alessi adds.
‘You can find a lot of charity-minded people here if you look for them.’
Face Forward is uniquely positioned in a city that enables it to be funded by celebrity star power, and benefit from the talent of some of the world’s most-sought-after plastic surgeons. Los Angeles is one of the top cities for cosmetic procedures: According to a 2018 study by online plastic surgery hub RealSelf, Los Angeles has an estimated 7.6 plastic surgeons per 100,000 residents — the second highest in the nation, following only Miami with 8.3. This proximity to medical providers grants the nonprofit an expansive network to provide its patients with the best possible care, Edwards says.
The network of specialists is what makes Face Forward so capable of providing its patients with holistic care, Edwards says. With its large pool of skilled doctors and surgeons, the team at Face Forward connects patients with the right specialist for their needs. Some require skin grafts, for example, while others require dental work, nose reconstruction or scar remediation.
The selection process for Face Forward treatment is rigorous. “They have to fall under the mission of what we do,” says Edwards. Survivors can either apply through the Face Forward website, or the nonprofit can reach out to a survivor if it becomes aware of their case. Face Forward then conducts phone and Skype interviews in order to ensure that the person in question is a good fit for surgical treatment.
There are a few requirements for a survivor to be selected, says Edwards. The potential patient must agree to be in therapy and be out of their abusive circumstances, and they need to agree to be advocates and raise awareness by sharing their story in whatever way it is safe to do so. Edwards explains that the latter requirement isn’t always easy because sometimes the survivors may be in hiding, or their case may still be in the court process.
Face Forward takes recruiting doctors just as seriously as they take selecting patients. The nonprofit hosts an annual open house for doctors who are interested in being a part of the organization. “You can find a lot of charity-minded people here if you look for them,” Alessi says of Beverly Hills, adding that sometimes reconstructive operations can be an intriguing change of pace for doctors who typically perform cosmetic enhancements.
The recruiting process allows Face Forward to partner not only with local specialists, but also with other nonprofits like the cosmetic dentistry program Give Back a Smile and therapists around the world, which is especially important for international patients who may not be proficient in English.
Besides access to a talented base of plastic surgeons, Los Angeles also grants Face Forward access to support from celebrities. Today, it boasts annual donations of more than $1 million, which mainly comes from the star-studded benefits and fundraisers that the nonprofit hosts. Its annual gala costs several hundred dollars to attend, and past galas have included musical performances by Nelly, Ne-Yo, Robin Thicke and Chaka Khan.
At a recent Face Forward fundraiser at the Comedy Store on the Sunset Strip, board members and survivors mingled with the general public, while comedians offered their own pro-bono talent: stand-up routines. Attendees paid a minimum of $35 to attend the show, all of which went toward treatment and operations.
“You hear about this stuff, but you think it can’t happen to you,” said Tehran Von Ghasri, the comedian who emceed the show. “But the more I learned about it, the more I realized that everybody knows somebody, or knows somebody who knows somebody, who’s been affected.”
“A lot of celebrities who get involved with supporting our cause are survivors as well,” says Edwards, the executive director. In working to help survivors of domestic violence, the Alessis are careful to emphasize that domestic violence is pervasive across all races, genders and social classes. At the glitzy benefits and galas, David Alessi says, several members of Hollywood’s elite have confided in him that they, too, have been victims.
‘I don't know if you ever really get over it.’
Though the city of Los Angeles provides upsides for plastic surgeons, including the proximity to Hollywood and its focus on physical appearance, it can also create some misconceptions. Dr. Alexander Markarian, director of facial plastics at USC’s Keck School of Medicine, says that most of the public fails to differentiate between the different types of operations that fall under the umbrella of plastic surgery.
“Reconstructive surgery, in general, is to restore form and function — restoring it back to normal, or as close to normal as you can get,” he says. He believes that some of the confusion surrounding plastic surgery stems from the fact that cosmetic work is more widely publicized than reconstructive operations.
“People think plastic surgery is more of a vanity and kind of look down upon it,” he says. “But they don’t always understand that some of it is reconstructive, and is just to help people be able to go outside and not look different.”
Like many board certified plastic surgeons, Markarian says, he has the skill set to perform both cosmetic surgeries (like rhinoplasties, abdominoplasties and breast lifts) and reconstructive surgeries (such as repairs for facial trauma, treatment for burns and removal of tumors). Physicians who promote themselves as cosmetic surgeons, however, don’t have the same formal training. According to the American Board of Plastic Surgery, any licensed physician can perform cosmetic surgery regardless of how or for how long they received training.
Markarian, who completed much of his training in Beverly Hills under top cosmetic surgeons, says that being in Los Angeles is a particular boon to the reconstructive work he does.
He says these types of surgeries are as much of an art as they are science: “It’s more than just putting bones together. It’s making sure that the soft tissue around the bones is attached properly, and that things look aesthetically appropriate.”
Much like the surgeons at Face Forward, Markarian does pro-bono work to treat victims of domestic violence and abuse, in his case under the Victim Intervention Program at Los Angeles County/USC Medical Center. He recalls one patient in particular whose story was especially moving: a stalking victim who was shot in the face.
“She ended up getting shot several times, which caused a jaw fracture and deformities related to that,” Markarian says. Psychologically, the attack scarred the survivor; it would take several years before she felt ready to seek help from him.
“Gosh, I don’t know if you ever really get over it,” Markarian says of the psychological wounds from abuse. He does note, however, that his work had a noticeable impact on this particular patient. “She turned almost into a different person afterward. It just came out of this confidence that she had in feeling better about herself.”
The work these plastic surgeons are doing to restore functionality is actually what these practices were originally intended for, according to the American Society of Plastic Surgeons. Some of the earliest procedures were performed on disfigured World War I veterans. It wasn’t until the 1930s that plastic surgery morphed into more of an industry of enhancement.