Monday, 18 Jun 2018

Change Your Face. First Steps Before Facial Plastic Surgery

A good face is the best letter of recommendation.

Lasers, peels, face-lifts, eyelid lifts, rhinoplasty, Botox—so many options and so much confusion. Facial analysis is the cornerstone in deciding what the appropriate treatment is for your particular concerns. Only after an appropriate analysis can we provide the ideal treatment. This chapter is designed to help you see your face in a much more analytical manner. After all, you are here to explore, discover, and, we hope, uncover the secrets to dozens of your most burning questions about the human face.

We can tell you with confidence that even if we haven’t personally met you yet, we’ve seen you before. The human face is our medium for obtaining ideal results for people of many ages, ethnicities, and socioeconomic statuses and with all sorts of problems. One of the greatest things we can offer our patients is familiarity with their concerns. Every day, we see people who want to improve their appearance, and now we will turn our full attention to you.

plastic surgeon

Our readers, like our patients, are individuals with individual needs. Some questions to ponder include the following:

What do you want to change about your face?
• Why are you reading this book?
• What made you pick it up? Was it something that happened in the last few  years or something that’s been nagging at you your entire life?
• What can we do to help?
• What knowledge can we impart?

In this chapter we will discuss the following key elements to answer the universal question, “What would you like to change about your face?” They include the following:

• The “Quick, If You Could Change Just One Thing, What Would It Be?” test
• The diagnosis
• Our facial analysis

facial plastic

These vital sections will help both of us to understand why, what, when, and how you want to go about changing your face. It’s not a simple question, we know. We see people struggle with it every day, but the more information we can provide, the easier that struggle becomes.

The following sections will help you to understand what a professional consultation with a dermatologist or a facial plastic surgeon must entail.

The “Quick, If You Could Change Just One Thing, What Would It Be?” Test


You are the only person who knows your face best

The most important person in the process of facial rejuvenation is you. You are the only one who matters, and your concerns are of utmost importance.

If you’re being honest, you’ll know right away what you’d change about your face. (If you’re really being honest, you knew the minute you saw the title of this section.) There are areas that are overlooked by most individuals when they analyze their own faces, such as brow drooping and small chins. However, no one knows your face the way you do. Even your mother or your spouse, as often as they look at your face, won’t know it the way you do.

Thus, ask yourself the question, then answer it. That’s all you have to do—for now. Later in this chapter, we’ll have a more conclusive quiz to help fine-tune your answers as well as your reasons for having aesthetic enhancements in the first place.


Hyaluronic acids

Hyaluronic acids and collagen products are the most commonly used methods for lip augmentation

Improvement and enlargement of lip contour is commonly desired. There are multiple ways to approach this goal. The treatment options include the following:
1. Hyaluronic acids: Juvéderm, Restylane
2. Collagen: Cosmoplast, Cosmoderm, Evolence Breeze (pending FDA approval)
3. Lip implants: Gore-Tex (SoftForm), AlloDerm, VeraFil (not FDA approved for this area; used off-label)
4. Fat grafting
5. Silicone (not FDA approved for this area; used off-label)
6. Cymetra
Hyaluronic acids and collagen products are currently the most commonly used methods for lip augmentation.

The Diagnosis: What’s Going On?

This chapter is about your face: what you like about it, what you don’t, what you’d change if you could, and what you wouldn’t. It’s natural to have strong feelings about one’s own face. Hair may dull and gray, arms and legs get bigger and smaller, breasts and buttocks change shape, but our faces are forever—or so it would seem. That’s because the thing we see every day is hard to see objectively. It’s kind of like watching a trickle of water turn a valley into a gorge and then into a canyon over years and years of erosion. Unfortunately, that’s just what happens to our faces over time; they erode.


The thing we see every day is hard to see objectively

As much as we’d like to avoid it—and as hard as we work to prevent it—age happens, whether we like it or not. Age also changes us. From top to bottom, your entire face is affected by age. For instance, your forehead may furrow and host a series of creases. Your brows can droop. The skin around the eyes is sensitive and thin; changes here range from wrinkling to sagging to bags to a puffiness that never seems to go away. Even your nose can seem longer and more “hooked” as it droops with the gaining years. Loose facial skin can create jowls; lips can grow thinner and more discolored with each passing year. The chin grows weaker, at least in appearance, due to the erosion of the jaw bone and the loss of chin fat. Then there are the ravages of sun damage over time.

It all happens slowly, minutely, taking days and weeks and months and years, until the changes are so noticeable they can no longer be ignored. That is why so many people tell us, “I don’t know what happened; one morning I just woke up and looked old!” That’s when they take the path to our office. One day you too might take the path to your doctor’s office. What will you find when you get there? What are the first steps, and how can anyone help you to find the face you’re looking for if you’re not sure where to start?

Age changes

Age changes us

The road to facial rejuvenation always starts with the diagnosis. Once the diagnosis is established, the therapy is naturally born. It’s a two-part process, like washing your face before you dry it or drying it before you put on your makeup. You simply can’t do one without the other, yet so many people try by making assumptions about how quick and easy some procedures are or how severe or simple their problems may be.

In many ways this book is a how-to, self-help guide to learning all there is to know about your face. We are simply trying to give you as much material and provide as much knowledge as we can before you take the next logical step, which is consulting a medical professional.

In evaluating the aging face one may see aesthetic changes in four broad
terms: laxity (type A), furrowing (type B), rhytids (type C), and facial atrophy—
facial volume loss—(type D). (See the illustrations at right.) Rhytids are superficial wrinkles, whereas furrows are deeper, valleylike expression lines.

Aging face

Aging face one may see aesthetic changes in four broad terms


Diagnosis – Treatment

Rhytids (wrinkles) – Skin care, peels, laser

Furrows – Injectables (Botox and facial fillers)

Laxity – Mild: Thermage; Titan; fillers and fat grafting

Moderate to severe: surgery

Facial atrophy – Fillers and fat grafting

Other factors that contribute to an aging appearance are color irregularity and loss of skin luster. The interplay among various aging processes often makes it impossible to obtain a complete therapeutic effect from any one modality. Two examples are the marionette folds that remain below the corner of the mouth after face-lift procedures and the poor resolution of crow’s feet around the eyes after laser resurfacing.

Every face is unique in its elements of aging

Every face is unique in its elements of aging

Every face is unique in its elements of aging, and every area may have several pathologies that contribute to the aging problem. The marionette folds and crow’s feet have complex etiologies and therefore require several modalities in order to address them appropriately.

As a result, noninvasive techniques are of great value for some aging defects but not for others. Skin and muscle laxity of more than a moderate degree requires surgical intervention, whereas fine rhytids, furrowing, and volume loss are preferably treated by lasers and noninvasive injectables, either separately or in combination.

Our Facial Analysis: Diagnosis Leads Simply to Treatment

We will fully discuss the many available treatments on the market today in subsequent chapters, and we will have much more to say about your initial consultation in this chapter. No matter what the treatment or when the consultation occurs, however, make sure that you are clear about everything your doctor is telling you. If something stumps you, ask a question. If something still stumps you, ask more questions.


It’s hard for many cosmetic specialists to keep current with technology and techniques. Here is a step-by-step procedure to help you make sure that your doctor is up-to-date.

your doctor

Make sure that your doctor is up-to-date

• Confirm board certification in any one of the following:
1. American Board of Dermatology (
2. American Board of Facial Plastic and Reconstructive Surgery                     (www
3. American Board of Plastic Surgery (
4. American Board of Otolaryngology (
5. American Board of Ophthalmology (

• Confirm society and academy memberships:
1. American Society for Dermatologic Surgery (
2. American Academy of Facial Plastic and Reconstructive Surgery
3. American Society of Plastic Surgeons (
4. American Society for Aesthetic Plastic Surgery (
5. American Society of Ophthalmic Plastic and Reconstructive Surgery

• Determine board-certified specialty associations for the above fields (for
dermasurgery, for example, it would be the American Society for
Dermatologic Surgery).

• Determine committee membership in the different academies and
societies: these specialty committees (such as New Technologies or
Liposuction) are the recognized experts in these procedures.

• The surgical specialist should have operating privileges for the procedures
that you are seeking at an accredited hospital.

• Find out about their education and surgical training.

The doctor-patient relationship is a democracy, not a dictatorship; treat it as such. Remember, this is your face—forever. Although many of the advances in dermatology and plastic surgery have made the majority of these procedures safe and effective, nothing is foolproof, and not every one is right for you. That’s what the diagnosis, analysis, and consultation are for: deciding which procedure is right for you—and why. If you understand only one part of that equation—be it the “which” or the “why”—you’re not ready to have the procedure. It’s just that simple.

The doctor-patient relationship is a democracy, not a dictatorship

It’s easy to become intimidated by the man or woman in the white coat. Doctors’ offices are sacred places, quiet and serious, but don’t let the wall charts and the “medicalese” intimidate you. You are paying for the privilege of our time, expertise, attention, and, most of all, advice. So get your money’s worth!

You wouldn’t pay for half a box of cereal or one hour of a movie, would you? So why would you settle for anything other than full disclosure with your plastic surgeon or dermatologist?

Although many of the advances in dermatology and plastic surgery have made the majority of these procedures safe and effective, nothing is foolproof, and not every one is right for you.

Beverly Hills Beauty Secrets by DOUGLAS HAMILTON, MD, and BABAK AZIZZADEH, MD


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