by dr. lam » Sat Nov 15, 2008 10:24 pm
yes, completely unnatural. did you see my recent video log? i couldn't upload it to LFP site because of some glitch due to the update. here is the youtube link minus the world wide web prefix: youtube.com/watch?v=isAEAPDvHMQ
the video is based on my blog from a few weeks ago. here is my thought about several problems of why WAY TOO MANY UNNECESSARY FACELIFTS ARE BEING PERFORMED:
1. "the two-finger rule": people are pulling things back and just assuming things look better. STOP DOING THAT. first, it does not represent how a facelift even will look like. lines and texture do not improve with a facelift. second, it does not make you look better.
2. "thinking in reverse": when someone gets even mildly older, he/she looks at the jowl and the marionette line. granted, when one gets significantly older or has more aging, the jowl and puppet lines can worsen to the point that things look bad. instead, the problem as i have discussed in my st.louis lecture (see that toward the end in st. louis) and which will be in my new book next year by elsevier on the aging face: new paradigm will discuss what i consider an original idea, i.e., the upside down U. Instead of seeing the "positive" problem, the existence of a fold and a jowl, you must see the "negative" problem, i.e., the absence of tissue in the anterior chin (right under the puppet line) and the prejowl, in front of the jowl. This bony protuberance is where it is at. I have this photo of 2 identical twins in my office. One of whom had my fat transfer at 38 and i have her photo at 37. comparing a shot of both twins standing next to each other at 41, one twin looks 48 and the other (the one i worked on) looks 28. when you look at the picture, both have the same smile lines, in fact the brow is higher on the non-operated twin, there are no jowls etc. but your eye can instantly pick up that she looks older. when i did a very careful analysis of the photo, i could immediately spot it: the upper anterior chin was bony and the upper cheek was empty accentuating the lower cheek prominence during smiling. this is hard to explain.
3. we all think gravity is the problem and our vocabulary check list focuses on: asymmetry, folds, creases, gravity. this is all crap! youth is defined by convexity, bone coverage, and uniformity (lack of transitions). i add balance (how parts of the face relate to each other) to the equation, which is artistry in a word.
okay, i'll get off my soap box but this is all bunk! i had a woman yesterday who is 2 years out from fat transfer and neck lift and someone who had not seen her in 10 years said, "Wow, you somehow look better than 10 years ago." Her physician said, "Wow, you look better than 6 months ago." (As you know, fat gets better with time from 1 to 2 years.) What got me crazy was that her friend was about to have eyelid surgery, a chin implant, and a facelift! I said, "Could you spare your friend from unnecessary surgery by telling her about me?" It was not to get extra business but spare someone from ridiculous surgery. A chin implant is important for someone with a small chin but it can actually deepen the hollow in the upper chin (part of the upside down U), which would actually make her look older. not to mention the bony quality of the chin exacerbated. i had a 38 year old in whom i had done a fat transfer at 35 and a chemical peel the year before, and her sister-in-law told her "Wow, you look so good I have to go get eyelid surgery and a facelift!" I said, "You didn't bother to tell her about what I can do?" Keep in mind: my intent was not to drum up more business but to say, "Hey, can you actually live with yourself for allowing a loved one to go through nothing short of a disaster for the simple sake of your ego not wanting to disclose what you had done?" I know this is harsh but I fix so many people so often that this just drove me crazy. Okay, now I'll get off my soapbox. If I offended anyone, I truly apologize. However, I am honest in my sentiments. And, yes, I love all my patients!
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