In a 2003 article in Vanity Fair, Tim Russert’s widow Maureen Orth wrote that Michael Jackson’s nose was prosthetic and that “his face is caked with white makeup, which conceals a prosthesis that serves as the tip of his nose. One person who has seen him without the device says he resembles a mummy with two nostril holes.” (Orth lays out a very compelling case against Jackson, and sadly after reading her series of articles about him, written around the time of his trial, I’m not as sure he was innocent of the charges. I almost dismissed this passage as untrue as it sounds too sensational, but I believe it now.)

Given the urban legends about how Michael’s nose has fallen off during concerts I was a little reluctant to believe his puppet-like nose wasn’t real. It just seemed like stories that kids made up to make fun of him. According to Jackson’s dermatologist Dr. Klein, his nose wasn’t prosthetic exactly, but was made up of injectable fillers. Dr. Klein helped Jackson rebuild his nose after other doctors whittled it away to nothing. Klein told this to Larry King last night, and he also discussed the sad state of Michael’s health after he lost his hair in 1984 when his scalp was burnt during that Pepsi commercial:

DR. ARNIE KLEIN, MICHAEL JACKSON’S DERMATOLOGIST: I met Michael because someone had brought him into my office. And they walked into the room with Michael. And I looked one — took one look at him and I said you have lupus erythematosus. Now, this was a long word…

KING: Lupus?

KLEIN: Lupus, yes. I mean, because he had red — a butterfly rash and he also had severe crusting you could see on the anterior portion of his scalp. I mean I always am very visual. I’m a person who would look at the lips of Mona Lisa and not see her smile. I would see the lips.

KING: Was he there because of that condition?

KLEIN: He was there only because a very close friend of his had told him to come see me about the problems he had with his skin. Because he was — he had severe acne, which many people…

KING: Oh, he did? KLEIN: Yes, he did. And many people made fun of him. He used to remember trying to clean it off and he’d gone to these doctors that really hurt him very much. And he was exquisitely sensitive to pain.

So he walked into my office. He had several things wrong with his skin. So I said — and you have thick crusting of your scalp and you have some hair loss.

He says, well, how do you know this?

I said, because it’s the natural course of lupus. So I then did a biopsy. I diagnosed lupus. And then our relationship went from there.

KING: Grew from there.

You — let’s fast forward. You saw him the Monday before he died.

KLEIN: Absolutely. Yes, sir.

KING: What was the purpose of the visit?

KLEIN: He came to me because, basically, I was sort of rebuilding his face, because he had severe acne and scarring. He had scarring from having a lot of cosmetic surgery. And my expertise is — like it is with every one of my patients. My patients are my treasures. And I was rebuilding his face so he looked much more normal. And contrary to what people said, he could not take off his nose. His nose was attached. But it looked too small. And I just was trying to get him ready to do the concert, because in the way he looked in his face, he wanted it to be absolutely as perfect as it could be.

KING: Did he consult you when he was doing his plastic surgery?

KLEIN: No. I mean I came onto the scene long after he’d begun plastic surgery. In fact, what I wanted to do is, you know, stop it, because I felt that, you know, we were losing body parts in the situation…

The subject is Michael Jackson — the changes to his nose.

Why did he do that?

And is it true that he wanted to look like Peter Pan? KLEIN: I don’t think he wanted to look like Peter Pan. I didn’t see him implanting wings on the back of his back or doing anything like that, right?

KING: All right, what about the nose?

KLEIN: The nose was a very special thing, because his father and his brothers supposedly, from what I’ve read, made fun of his nose all the time. So he was very sensitive to the nose. And…

KING: What was wrong with his nose?

KLEIN: I originally didn’t think there was much wrong with his nose.

KING: Yes.

KLEIN: I thought he had a nice-looking nose. But in the beginning, it was never able to come off his body. But it got to the point where it was far too thin. It didn’t look natural to me.

KING: Now, you helped him rebuild it?

KLEIN: I rebuilt it, yes.

KING: How?

KLEIN: Using fillers. I used Rezulin. I used hydronic acids because — and they worked very well. And it’s not — it’s an arduous procedure, because you don’t want to put too much in. And you have to do it exactly, so you can flow the material so it’s perfectly smooth.

So we rebuilt them. And I’m telling you that he was beginning to look like the nose was normal again. And that’s all I wanted — and regain the breathing, you know, passages of his nose, because there was a total collapse of the cartilage.

KING: In the last photos that we’ve seen, his nose has been built up, right?

He’s looking better?

KLEIN: Yes.

KING: Was he still working at that?

KLEIN: No, because I think we got to the point where he was very happy with the way he looked and he filled in the cheeks a little bit and did a lot of little things.

But I mean what I do to an individual patient is what I do. And what I do is just restoration work, because I don’t think people should look, again, like anything has been altered.

KING: Well, you’re — you’re not a plastic surgeon.

KLEIN: No, but…

KING: So are you extending yourself when you’re doing a nose like that?

KLEIN: No, I invented all this. I mean it’s — I’m not a — I invented injectable esthetics, I mean, for better or for worse, it’s what I’ve been doing since 1979. So I’m not extending myself whatsoever.

[From Transcripts.CNN.com]

Dr. Klein also talked about how Jackson coped with his hair loss after his scalp was badly burnt. He was using something called a tissue expander to try and get rid of the scarring but it just made him more bald. It sounds painful:

KING: Did he have hair?

KLEIN: He had lost a great deal of it. You forget this first fire…

KING: That was the Pepsi fire, right?

KLEIN: Yes. But then what happened is he used a great deal of what are called tissue expanders in his scalp, which are balloons that grow up — blow up the scalp. And then what they do is they try to cut out the scar.

Well, because he had lupus, what happened is every time they would do it, the bald spot would keep enlarging.

So, I mean, he went through a lot of painful procedures with these tissue expanders until I put a stop to it. I said no more tissue expanders, because he had to wear a hat all the time and it was really painful for him.

KING: So what would his — without the hat, what would he look like?

KLEIN: Well, he had a big raised ball on the top of his head because of this device. It would expand the tissue, which you cut out.

But (INAUDIBLE) would you — (INAUDIBLE) too much stretch back in the scar, you understand?

KING: Did you see him one other time?

KLEIN: Of course I did. But he would have a stretch back on the scar. I mean the scar would get worse after they removed it. And I had to put a stop to it. So I told Michael, we have to stop this. And that’s when I fired this plastic surgeon altogether. And I said I can’t deal with this anymore. We’re going to deal with me as your doctor or you’re going to have to find another doctor if you want to work with him.

[From Transcripts.CNN.com]

When Jackson came to Dr. Klein, he said that “he had done a decent bit of surgery by then,” and that it wasn’t “done poorly, but I think that there’s a time — the magic is not knowing when to begin the big game. The secret is knowing when to end it.” He also said the surgery was at Michael’s request but the plastic surgeon didn’t know when to stop.

Jackson went to excess in just about every facet of his life. He was a phenomenal performer and entertainer because he gave everything for his fans and didn’t let up. He couldn’t turn off that tendency though, and he sadly went way overboard with his spending and with the drug use that took his life. Regular sleeping pills weren’t good enough for Jackson – he had to have the best anesthesia drugs. Klein says he wasn’t involved with any of that, though, and that he knew that Jackson was using Diprivan (the drug which is thought to have killed him) “when he was on tour in Germany… with an anesthesiologist, to go to sleep at night. And I told him he was absolutely insane. I said you have to understand that this drug, you can’t repeatedly take. Because what happens with narcotics, no matter what you do, you build a tolerance to them.”

Then you need more, I guess, and eventually your body can’t take it.

Photos are from 3/6/09, 5/15/09, and 5/21/09. Credit: WENN.com. You can see how his nose appears fuller in the pictures from May.