Each year, the world over, millions of people undergo appearance-enhancing procedures. It is a way to “invest” in themselves—in improving their appeal index. A high percentage of these individuals are opting for procedures to reverse the visible signs of aging. Others undergo surgery designed to reconstruct a portion of the face that is not in harmony with its other features. Still others seek facial surgery to improve features deformed by an accident, tumor surgery, or a congenital defect.
A national survey (Psychology Today) indicates that 40% of Americans are dissatisfied with the shape of their noses and 25% are dissatisfied with their “chins” (really necks). Furthermore, 35% of all facial surgery is performed on men, and that percentage is increasing.
These are important facts that a facial surgeon can share with potential patients who may be teetering on whether surgery is right for them.
Enhancing one’s appearance can open doors to interpersonal relationships that might have otherwise remained closed, including doors of opportunity within the workplace. In Chapter 10, I address how people who do all the things required to look their best tend to find—and enjoy—better health, longer workspans, and higher incomes.
America in the 21st century is a youth-oriented, competitive society with a strong emphasis on appearance. Irrespective of “political correctness,” the business community seeks out attractive people to fill available positions. Those who have the responsibility of hiring new employees confirm that, when all other qualifications are equal, a pleasing appearance gives an applicant (or candidate for promotion) the advantage. A facial surgeon can help individuals from all walks of life improve upon their current station.
Although definitions of beauty have varied through the ages, the fact that favors are granted to individuals considered to be handsome or beautiful has never changed. But it goes farther back in history than the modern medical literature. Aristotle said, “Beauty is a better recommendation than any letter of introduction.”
Is it any wonder that many patients who have appearance-enhancing procedures do so for economic reasons? This is true not only for the fashion model, television and movie personality, corporate executive, or professional person, but also for anyone whose work or lifestyle requires interaction with the public.
Not only do people in the upper socioeconomic bracket undergo appearance-enhancing procedures, but so do people living on a budget. Most people plan for their procedures as they plan for a vacation, a new piece of jewelry, or an automobile. Improving their appearance is viewed as an investment in themselves.
Today, many sources of financing are available for plastic surgery. I recommend caution in this practice. No person should embark on a procedure that they cannot realistically afford. The dental profession has a saying, “The happy denture is the one that is paid for.” Facial surgeons can learn from other health care professionals. Especially when it comes to age-reversing surgery—and no matter who performs it—in a couple of years new aging can be detected in a person’s face. I have heard it said by a patient who financed her facelift with a company that provides such services, “I don’t have my first facelift paid off and already I’m beginning to see my face aging again.” Rhinoplasties and facial implants are a different matter. The results of such procedures are long-lasting.
Teachers, from kindergarten to professional institutions, affirm the longheld belief that—in the classroom—appearance matters. Many have told me that the young people they teach relate better to them after they undergo facial rejuvenation procedures that narrow the generational gap.
On both sides of the equation, a pleasing appearance provides advantages. Renowned psychologist Dr. Perry Buffington affirmed that “good looks affect school grades.” Furthermore, according to Dr. Buffington one’s looks also “determine who will become our friends, and enhance the probability of prosperity.”
Love, luck, confidence, fame, and fortune tend to favor the person who presents a more pleasing appearance. When one looks better, one’s pride and ego are bolstered, and surprisingly enough, it has been shown that when one feels good about oneself, one performs better, in all areas of life. And the world notices.
Corporate America certainly understands the value Americans place upon personal appearance. Billions of dollars are spent each year by people from all walks of life on cosmetics, accessories, fashionable wardrobes, vitamins, health foods, and weight control products. Many of these same individuals also have plastic surgery and care for their skin.
Aesthetic skin care encompasses a variety of methods designed to improve the quality, texture, and health of the skin. Medical aestheticians can also serve as consultants on healthy cosmetics, age prevention, improved toning of the muscles of the face and neck, and some medical skin conditions.
Facial surgeons have an opportunity to serve as life coaches. They are uniquely prepared to counsel patients without appearing solicitous in the process.
It is appropriate to inform patients that people (both male and female) who undergo an appearance-enhancement procedure also tend to
• Pay attention to their weight.
• Engage in physical activity that tones and strengthens muscles and improves cardiovascular health.
• Maintain hormones at levels consistent with those of youth.
• Visit a medical spa for relaxation and scientific skin care.
• Augment their diet with pharmaceutical-grade vitamins and supplements.
• Have their teeth whitened.
• Coordinate their clothes.
• Groom their hair.
• Engage in activities that enhance the mind and spirit, as well as the body.
• Associate with others who have adopted the same lifestyle habits.
Other facts should be shared with patients. Attractive people appear to be happy. And people who appear to be happy make others want to be in their presence. Regardless of age, attractive people are attracted to other attractive, and thus success-minded, people.
Facial surgeons deal with a high volume of people who are concerned about the undesirable signs and symptoms of aging. An in-depth understanding of this patient population will give one an edge over competitors.
Patients often ask if they are too young or too old to have surgery. Here is a way to answer the question. Every individual has two “ages”: the chronological one and the biological one. One’s “chronological age” is determined by how many years one has lived. One’s “biological age” is a reflection of how old one’s body actually is—and appears—in comparison to others who have lived the same number of years.
It is helpful to explain to patients that several factors determine whether one’s biological and chronological age are in balance. To help determine a patient’s biological age, I require preoperative laboratory testing and a note from the patient’s personal physician. In patients over the age of 40 this includes an electrocardiogram.
The best advice is to rely on the patient’s personal physician to determine if a patient is an acceptable candidate for elective aesthetic surgery.
Some patients with the chronological age of 60 years appear to be 70. Others with a chronological age of 60 appear to be 50, even those who have had no previous facial plastic surgery. Lifestyle and genome are contributing factors.
A patient’s psychological health is equally important. Facial surgeons should become familiar with psychological disorders that exist in some patients seeking appearance-altering surgery. The ability to distinguish between neuroses and psychoses is crucial. An undetected psychosis could lead to months—or years—of misery for the surgeon.
Following surgery, most patients experience some degree of depression and anxiety about the healing process and outcome of the surgery. Knowing how to shepherd them through the process can further solidify the doctor-patient relationship.
Refer patients suspected of having body dysmorphic disorder to a psychiatrist before agreeing to perform any surgical procedure.
An experienced facial surgeon is usually able to determine if younger patients (children or teenagers) are psychologically mature enough to undergo a procedure that is appropriate for their biological and chronological age.
Chapter 9 is dedicated to the power of thought—mind over matter. The reason for this should be obvious. Regardless of a patient’s biological or chronological age, a positive outlook on life cannot be underestimated. People who look for the good and positive in every situation tend to find whatever it is they seek. (They also tend to be easier patients to care for following surgery). In adulthood, those with a positive outlook usually appear—and act—younger than their chronological age. The reverse is also true.
A variety of factors are responsible for one’s biological age. It is not necessary that facial surgeons become experts in comprehensive health care; however, they must remain familiar enough with the subject to recognize when it is advisable to refer a patient to colleagues who focus on wellness and well-being.
As referenced in Chapter 11, balanced nutrition (with the appropriate supplementation) is a major factor in maintaining one’s weight and health and an ongoing attractive appearance.
Physical activity not only burns calories but also keeps circulation flowing and muscles strong. Weight-bearing exercise tends to keep bones strong and combats one of the “silent killers,” osteoporosis. Consider this little-known fact: 90% of individuals over the age of 70 who fracture a hip (and suffer from osteoporosis) die within a year of the incident. Many patients who seek rejuvenation surgery are in this age group. This fact makes osteoporosis a major health risk, one that—with preventive measures—can be affected in a positive manner.
In Chapter 11, I also address the importance of maintaining balance with the body’s hormonal system. I once consulted with a lady who had undergone a facelift and surgery to correct saggy/baggy eyelids just months previously. After spending a few minutes inquiring about health issues, I suspected that she suffered from a common condition in postmenopausal women—hypothyroidism. A series of laboratory tests confirmed my suspicion. Photographs (Fig. 6.1) demonstrate her appearance before and after thyroid replacement therapy. No surgery was performed. Her pretreatment symptoms were fatigue, feeling cold, and forgetfulness, along with the signs of fluid retention, dry skin, and a puffy face and eyelids. All disappeared once thyroid levels were normalized. The result: her appearance was enhanced, as were her spirits and well-being.
This case emphasizes the importance of a facial surgeon fulfilling the role of a physician first—a surgeon second. Another surgical procedure was not what this lady needed. She needed the expert care of a fellow physician who was qualified to offer condition-specific therapy I could not offer.
This is the final teaching point of this chapter. No doctor can be all things to all people. We facial surgeons must recognize our limitations and reach out to colleagues who are better trained and more experienced in treating conditions with which we are not so familiar.
Referring a patient to a colleague is never viewed by the patient as a sign of weakness or incompetence. Rather, it is looked upon as the professional—and caring—thing to do. More often than not a professional referral enhances the image of the referring physician/surgeon.
Fig. 6.1 (a, b) Prior to thyroid replacement. (c,d) After thyroid replacement.
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