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Secrets of a Beverly Hills Cosmetic Surgeon

with Robert Kotler, MD, FACS

Dr. Kotler's blog has now been retired. We appreciate all the wisdom and support he has brought to the WebMD community throughout the years.

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Monday, August 1, 2011

Facial Fads

One of my patients, for whom I had done a neck sculpture procedure several years ago, as well as her upper eyelid and brow lifting, came in to ask my opinion about a facial procedure she had learned about at another plastic surgeon with whom she was consulting about a possible tummy tuck.

I should tell you that this patient is a very savvy lady.  She does her homework — she does the research before proceeding with anything.  She went to see the surgeon for a tummy tuck, and he then migrated into the subject of the face lift.  The surgeon recommended that she have a procedure where stitches are placed under the skin to lift the muscle layer up and back, as a way of lifting the cheeks, and at the same time, softening the nasolabial crease.  The nasolabial creases are those “shaped grooves” that run from the lower side of the nose and go down to the corner of the mouth.  As we all get older, there is some shrinkage of fat around the mouth first, and therefore, the grooves appear. 

The patient asked me what I thought of the procedure and asked me to take a look at a journal article, a copy of which was given to her. The article was published in a first-class medical journal.  It was well-illustrated and easy to understand.  I was familiar with the concept anyway.  However, as I told the patient, there were two issues that concerned me.

First, that particular procedure had been discredited over a period of time.  Also, she needed to note that the paper was published in 1999.  The discrediting of the procedure occurred since then. One of the surgeons whose original work led to the development of this procedure, and who became quite well-known for it, has now become less enthusiastic about the procedure.  At the time the article was written, he was still a major force behind it.  But, that was 12 years ago and 12 years is a long time in the world of medical science and surgical procedures.  Our knowledge base accelerates very quickly these days.  It is important to know that an operation promoted early in its lifetime may, in fact, over time, lose its luster.

Secondly, the procedure tended to make people look unnatural.  They had a change in shape around the eyes, which is not what most people want.  Some people were unhappy because they started to look Asian-like.  Lifting the cheek tissue higher, with an inadvertent shifting of the tissues around the eye, was not what most people signed up for. As a matter of fact, I was shocked to see one of my own relatives look rather Asian after having the surgery done. Without her having shared with me that she had the surgery, there is no question that that is what happened.

The bottom line for you, my reader, is that you need to be very careful about procedures that may change the natural shape of your face.  We have seen the “Cat Lady” in New York who is an abomination and a discredit not only to her judgment, but the common sense and ethics of her surgeon.  We see other people who are described as looking like “the Joker” in Batman because they have a surgeon-imposed horizontal groove on their face, which is due to that same over-tightening of the facial tissues.

Remember that once done, it is hard to undo imperfect facial surgery.  The word “facelift” is probably not an appropriate title for what can be done to make you look better.  The reality is that it should be called a face and neck lift, and often, it is the neck lift that counts more than the face lift.

~Robert Kotler, MD, FACS

Posted by: Robert Kotler, MD, FACS at 10:43 am

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