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A brief introductory note.  This is the first of many upcoming articles related to the field of cosmetic facial plastic surgery.  My goal is to provide members with relevant information about various topics within this specialty.  There is so much information out there that patients often feel confused about the numerous technologies, products or approaches.  Each of the upcoming articles will try to simplify and clarify these issues so that you can make an informed and effective decision.  

Why I chose this topic.  Cosmetic facial surgery is not for everyone.  Perhaps many of you have never considered it or felt the need to look into it.  This first article is about understanding the motivations of the patients who have considered it or have had it done.  There are many misconceptions and misunderstanding about this topic. I decided to write about this upfront to level the playing field by allowing everyone to understand the motivations and perspective of patients who choose to pursue cosmetic facial enhancement (surgical or non-surgical).  

Insight into the motivations of the facial plastic surgery patient: a surgeons view.

When I was a 1st year medical student I fell in love with the field of Facial Plastic and Reconstructive Surgery.  At that point, however, I never knew any actual patients.  Interestingly, the field of Facial Plastic Surgery was not very popular at that time.  People did it, but it did not have the same level of public interest.   My interest was based purely on three things.  

1) I loved surgery.  That's why I went into medicine in the first place.  I loved working with my hands and in my mind; surgery was greatest way of helping those in need.  It's immediate gratification.  

 2) I loved the idea of thinking through things and offering creative, unique solutions based on the case at hand.  In facial plastic surgery, there are very few patients who look the same or have the same problem.  

3) I loved the idea of helping someone enhance or restore his or her appearance.  Undeniably, the face is one of our greatest assets and it is so valuable to each of us. Even though, at that point, I had never met a facial plastic surgery patient, I could only imagine how important it would be for that person to get the greatest outcome possible. I knew the challenge and pressure of working on the face and meeting or exceeding my patients' expectations would keep me excited and enthusiastic throughout my career.  

These were all impressions I had early on.  After a decade of specialized training, I had finally started working with my own patients.   From very early on, one of my primary philosophies about plastic surgery has always been that it is 100% about the patient.  What I mean by that is that it so important to really understand the patient's motivation and goals for undergoing cosmetic facial surgery. I have always been one to spend a lot of time trying to really get a handle on their expectations and desires.  As I spent more and more time having these lengthy and interesting conversations, a few clear concepts came through.  First, no one approaches cosmetic surgery lightly.  Despite the reputations that cosmetic surgery patients are vane or superficial, most patients approach the decision with thoughtfulness and solid personal reasons. It is not a trivial decision. Whatever the problem, it is emotionally bothersome enough for them to seek the help of a plastic surgeon to correct it.   Second, 99% have a very clear idea about what they hope to achieve.  They are not simply saying, "Doc, just make me look younger or prettier." They typically know what it is that bothers them and they know if they correct it appropriately they will feel better about themselves. Third, 100% are worried about ending up looking un-natural and "operated-on."  

As far as why a patient would seek cosmetic surgery, a few themes have also become lucid. In a general sense, it falls into the category of something about their appearance really bothers them and it is impacting their quality of life either by affecting their self-image or self-confidence.  For example, the patient seeking rhinoplasty for a hump on the nose often feels self-conscious by it. They typically don't like to be photographed or seen in certain angles.  Many feel like the nose doesn't belong to them.  As a result, they spend a lot of time avoiding certain social and interpersonal situations. As you can imagine this type of constant self-awareness can be inhibiting and distracting for the individual as well as consume a lot of conscious energy.  Now, notice I said the "rhinoplasty patient" with a  hump and didn't say the person with the hump.  Because, not everyone with a nasal "hump" feels bothered by it or feels like they want to correct it. It is only those patients who are significantly bothered by that particular feature or appearance that seek cosmetic surgery.  When they have the surgery done successfully, they feel that their new nose was the nose they were meant to have.  It is really interesting how often I hear those sentiments.  They are finally at peace with themselves.  

I have recently learned something very interesting from my facial rejuvenation patients as well.  Procedures that are designed to turn back the clock are extremely popular.  I have been trying to get a real handle on what motivates patients.  Aside from the obvious, most people don't like to age or like the look of an aging face, but what I wanted to know was why. What is the core reason someone would seek a facelift, for example.  After listening to my patients as they describe their feelings and reasons for pursuing these treatments, I think I finally figured it out.  

The  #1 reason women or men tell me they want to pursue facial rejuvenation procedures is because they simply feel younger than they look.  

They say the image they have of themselves is that of a younger person.  Yet, when they look in the mirror and the jaw line and neck are sagging, or they see the bags under their eyes, they almost can't recognize the face that is staring back at them.   For those who land in my office, this sensation is so bothersome that their quality of life is literally affected.  For example, my mother-in-law, for whom I performed a facelift on, told me she would avoid the mirror as much as she could because the face she saw was depressing her.  This is a beautiful confident person with a tremendous amount of self-esteem.  Yet, she had grown tired of her aged appearance because despite being in top shape and full of energy and health she could no longer tolerate looking so different than her internal self-image.  Interestingly looking so much older than she felt was starting to make her feel older and act older.  It is an interesting, because this wasn't the first time I heard that.   What's truly wonderful is that once the procedure is performed successfully and the "problem area" is corrected, there is a fundamental change in their self-impression, which translates to many other positive changes in their life.  That has always been the best part of what I do.  

As great as the motivation is to address these issues, the fear of looking "plastic" or "operated on" is even stronger (for most patients).   A good chunk of the consultations are spent listening to their concerns then trying to explain that it's not the surgery it's the surgeon that creates those unpleasing looks.  Well-done plastic surgery is essentially unnoticeable.  Unnatural looking results occur because the anatomy has been distorted by inexperienced hands or an over zealous surgeon.  It has nothing to with the degree of change or correction.  In other words, one can have a dramatic result yet look totally un-operated.  This is actually the primary goal of excellent cosmetic surgery.  Many of my patients joke that most of their friends and coworkers tell them that their new hairstyle makes them look 15 years younger. No one knows that they just had a mini-lift!

Now, from my point of view, I am biased.   I see lots of wonderful stories.  I am fortunate to have a very happy practice, which makes my job so unbelievably rewarding.  I feel like I participate in changing and enhancing lives everyday... not just faces.  

So, people have asked me what do I think about Simon Cowell's recent comments about how every woman over 40 should have cosmetic surgery.  My feeling is clear.  Cosmetic surgery serves a specific purpose and that purpose is different for everyone.  It's extremely personal for each individual.  The desire and motivation has to come from the individual and no one else.  Those (Cowell's) type of general comments miss the point about what this important medical specialty is really about.  

In summary, I hope you find this insight as interesting as I do. My cosmetic patients have always been the most grateful and appreciative.  This has further reinforced my early impressions and ultimate decision to go into this specialty and dedicate myself to providing the highest level of facial plastic surgery to every one of my patients.  



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