Sitting on a table in a waiting room at Longmont United Hospital are two portraits of Holly Buck.
In one, taken during her senior year in high school, sparkling eyes and cherubic features await all of life’s possibilities.
When that picture was taken, Holly was an honor student at Englewood High School and a member of the school choir and band. She was gregarious and often went dancing with a group of close friends.
“I was fearless when I got out of high school,” Holly recalled. “I looked good and I felt good.”
In the second photo, taken 16 years later, her deformed nose stands out against spiritless eyes and an expression of loneliness and isolation. It was taken in a doctor’s office, a blueprint for surgeons who would soon be trying to fix the physical deformity that had sapped so much of her life away.
Holly stopped holding her head high about five years ago, not long after noticing that her nose was slowly beginning to sink into her face. Instead of walking with confidence as she once had, she tucked her chin to her chest whenever she went out, hoping her face wouldn’t be the first thing people noticed.
It was the beginning of a vicious circle.
“The more I noticed people were looking at me, the less inclined I was to go outside,” she said, and the more she stayed in, the more she hid inside herself.
When she did venture out, Holly tried to be thick-skinned about people’s reaction to her appearance.
“It’s hard not to stare at people who are different. I understand that,” she said. “But being (someone who is different), I really notice it.”
Although doctors aren’t 100 percent sure what caused Holly’s deformity, signs point to Wegener’s disease, a difficult-to-diagnose condition that affects one in every 30,000 to 50,000 people and inflames the respiratory tract and sinuses. In one of its most severe forms, the disease erodes the bony structure of the sinuses, causing the nose to cave into the face.
“We know it’s an autoimmune disease, and it has attacked her respiratory system,” said Dr. Raj TerKonda, the surgeon reconstructing Holly’s face.
While other autoimmune diseases can cause damage like Holly’s, TerKonda says Wegener’s is the most common cause.
For years, Holly battled chronic sinus problems but had no idea the symptoms pointed to something much worse.
That realization didn’t come until she scheduled surgery five years ago to clear the sinus problem. While she and her husband were flipping through a series of profile pictures before the operation, they noticed that her nose appeared to be slipping into her face.
“I thought the sinus surgery would fix it,” Holly said.
After being given a probable diagnosis of Wegener’s disease following that surgery, symptoms began to manifest themselves more obviously. She increasingly had to breathe out her mouth, and she tasted and smelled less every day as her sinuses slowly were eaten away from the inside.
“People asked what the hell was wrong with me, basically,” she said. “But I put on a brave face.”
Despite the gradual deformation — the collapse of her nose into her eroded sinuses also caused her upper lip to protrude — Holly made no effort to change her appearance.
Her world shrunk. She stayed at home, resigned to put up with her condition and depend on her husband, Tom Dumler.
That changed when he died of heart failure in July 2003 — and left Holly alone.
Six months after her husband’s death, self-reflection goaded Holly into the decision that she could no longer live a lonely, timid existence.
“I had to make some changes,” Holly said. “My life was going nowhere.”
At the urging of a family friend, she entered one in a series of contests run by Denver radio station Alice 105.9 FM, offering a nose job as one of the prizes. Holly posted her photo on the station’s Web site, adding it to the dozens from other women who wanted new noses.
Her photo, however, stood out. It was clear that Holly didn’t enter the contest out of vanity.
In fact, other women who had entered the contest began asking people who voted for them to vote for Holly instead.
“That was very generous of them,” she said.
In February 2004, the radio station told Holly she’d won. With $5,000 in prize money, she began looking for a surgeon to take her case.
After talking to doctors in Denver — one of whom told Holly her nose could never be fixed — she found TerKonda, a facial reconstructive surgeon who practices in Longmont.
In all, the surgery and hospital stay could have cost an estimated $100,000, but with the help of TerKonda and his colleague, Dr. John Campana, who donated their services, and Longmont United Hospital, which cut its fees to make the surgery possible, Holly was able to go through with the procedure.
TerKonda said he chose to help Holly because of the extreme nature of her deformity.
“This is about as bad as it gets ...” he said. “I love seeing the changes in people. I love what I do.”
Holly feels blessed to have found TerKonda because of his generosity and his skill.
“He is my hero,” she said. “He is a wonderful human being.”
It’s 6:30 a.m. July 20, 2004, the day of Holly’s surgery. Her new nose is just hours away.
While she knows the risks of the surgery, for Holly, it’s time to get on with her life.
“He’s given me a chance to start over,” Holly says of TerKonda.
Two uncles and an aunt have come to her parents’ home, where Holly lives, to offer support. She paces around the house, filling the bag she will take to the hospital.
“It’s been a long journey to get to this point,” Holly’s uncle Gary Fuller tells her. “This is the start of something great.”
Twenty minutes later, in a room at Longmont United Hospital, TerKonda goes over notes and sketches he’s made in preparation for Holly’s surgery.
“It’s an all-day affair,” he says, explaining that the surgery is a “near total reconstruction.”
To build Holly’s new nose, TerKonda will make a triangular incision, pull a flap of skin from her forehead and scalp and flip it down to cover a molded titanium frame and two small pieces of skull that will form the structure of her nose. Once flipped down to cover her nose, the skin flap will remain connected to her forehead, giving it an adequate supply of blood.
After new blood vessels form, TerKonda will cut off the extra fold of twisted skin on the side of her nose.
Pieces of cartilage will be taken from the insides of Holly’s ears to form nostrils, and the inner nasal passages will be formed from what is left of her existing nose.
“It won’t look like her old nose,” TerKonda says, explaining that the goal is to help Holly be more functional socially and more comfortable in public.
“It’s hard to re-create Mother Nature,” he says.
“I’m kind of nervous now,” Holly says, lying in a hospital bed, an IV in her arm and her thick, curly, dark hair tucked behind a cap.
“You’re going to be fine,” says her mother, Gloria, leaning over to hug her daughter, wiping tears from her face.
“No cries,” Holly says, choking back her own tears.
Doctors will use a mold of Gloria’s nose as a foundation to form Holly’s new nose.
It’s nearly 9 a.m. when nurses come into the room to wheel Holly to surgery.
Her older brother, Brad, stoops to hug his sister and turns away as she is wheeled to the operating room.
“I’m on that gurney with her,” he says. “I feel like I’m right there with her.”
Halfway through Holly’s eight-hour surgery, TerKonda appears in the waiting room to provide an update, munching on crackers and sipping a small can of Coca-Cola.
“The structure looks great,” he says. “We’re about 60 percent done now.”
At this point, TerKonda leads Gloria into an exam room to make the mold of her nose. With a blue pen, he marks the contours of her nostrils and the bridge of her nose before placing a clear mesh over them. Once the mold hardens, TerKonda retraces the still-visible marks from Gloria’s nose onto the mold.
“If I was her, I wouldn’t want my nose,” Gloria says.
At 7 p.m., about an hour after her surgery ends, Holly is recovering, her brown eyes nearly swollen shut and her face covered in red bruises. Plastic ear muffs protect the incisions where cartilage was taken from inside her ears.
A nurse comes in to deliver a shot of morphine to Holly.
“You just instantaneously became my favorite person in the world,” Holly says groggily.
Her father, Bill, sits nearby as Gloria straightens the sheets on Holly’s bed. He wipes his eyes, shakes his head and looks at his daughter’s nose.
“It’s perfect. It’s just perfect,” he says.
Holly’s parents take turns holding her hand.
Four days later, Holly leaves the hospital. Her ears, scalp and forehead are still bandaged, but her nose and the black stitches holding it in place are exposed to the warm July air.
Her nose is packed with cotton, so she hasn’t been able to breathe through it yet.
She stops to look in the mirror but says she can’t imagine what her face will look like once TerKonda’s work is done.
Holly knows her appearance is shocking. She intends to cover her still-healing wounds when she goes out, but on a trip to the pharmacy a few days after arriving home, she forgets.
She pulls up to the drive-through window to avoid going inside but realizes her bandages are missing when she sees the pharmacist’s eyes grow large.
“She was totally shocked,” Holly says. “I felt really out of place and terrible.”
After that, Holly decides to stay at home until her next visit with TerKonda.
At a checkup six days after her surgery, Holly looks closely in the mirror for the first time. Nearly all of the bruising is gone from around her eyes, which are fully open and bright again.
“This is better than what I saw last time,” TerKonda says, a smile lighting his face. He pinches her nose between his thumb and index finger and wiggles it.
“I don’t think there’s any risk of this nose dying,” he says. “I think you’re out of the woods.”
He removes the packing from Holly’s nostrils, then uses a pair of tweezers to remove some stitches. Holly tells him not to worry about hurting her because she still has little feeling — in fact, because of still-active nerve connections, when she touches the tip of her nose with her finger, she feels it in her scalp.
“Every day, I’ve been able to watch the color descend into her nose. When she first got home, it was all gray, and every day it gets pinker,” says her father, who has come along on the checkup.
Another side effect of using the skin from her forehead: The end of Holly’s nose sports a thin veil of black hair. Once the tissue heals more, doctors will use lasers to kill the hair follicles.
No matter, her father says. “It’s just going to be gorgeous.”
Holly’s nose is still swollen, but for the first time in years, she can take a full breath through it.
And she can taste and smell.
“I could smell everything, and everything smelled amazing,” she says. “I could smell my dad’s cologne, and it smelled so good.”
Holly rejoices about gaining back two senses she lost long ago.
“Things tasted like gray paste for years,” she says. “The fact that (my nose) is really functioning well is wonderful.”
Every girl loves makeup.
But Holly hasn’t bothered with it in some time. Today, that will change.
Just before Christmas, she visits Jamie Wade, an aesthetician who works with TerKonda and specializes in helping patients camouflage scarring and skin imperfections with special makeup.
“You’ve come a long way,” Wade tells Holly when she sees her.
The gaping incision that once traversed Holly’s forehead has faded to a thin, red line.
Some women might shudder at the thought of plucking tiny hairs from the end of their nose, but it’s a cathartic experience for Holly.
“I am starting to feel it now,” she says, “and that’s a good thing.”
So is the makeup.
Using her fingers, Wade layers foundation over Holly’s scars, patting it to blend with her skin.
With blush and lip gloss as final touches, Holly holds up a hand mirror to see the result.
“It’s fairly amazing,” she beams. “That’s incredible.”
Examining her face from side to side and brushing her bangs out of the way, Holly smiles at the faintness of her scars.
A co-worker of Wade’s pops in to watch.
“Fabulous, darling, fabulous,” she says.
With her new nose healing externally, Holly, now 35, is celebrating deeper changes internally.
“I’m always saying I’m going to do things, but I never do,” she says. “I’m hoping that’s going to change.”
For one, with her sense of taste and smell returned, she plans to attend culinary school. She’ll have to wait until her nose heals completely — according to TerKonda, it may take as much as a year for the swelling to go down and additional surgeries will be necessary — but she’s set her sights on becoming a chef.
Holly and her parents have begun attending a nondenominational church because Holly says her outsides weren’t the only thing that needed mending.
“I hated God for a long time, but I believe in God now,” she says.
The pain Holly carried with her for so many years is slowly receding. She is no longer the timid woman who peered out from behind glasses that slid off her sunken nose.
She no longer hesitates when talking to strangers — shucking corn on a trip to the grocery store in November, she barely notices a child staring at her.
And on a recent visit to a Longmont sushi restaurant, Holly does something she hasn’t in a long time: She makes eye contact with a stranger and smiles.
“I’m still a little self-conscious of it sometimes,” she says, “but people don’t look at me like they used to.”
Amanda Arthur can be reached at 303-684-5215 or by e-mail at firstname.lastname@example.org.
Joshua Buck can be reached at 303-684-5229 or by e-mail at email@example.com.