There's a "new" doctor in town

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There’s a “new” doctor in town. Well known New York plastic surgeon and Fairfield resident, Dr. Andrew Kornsteinshares his perspectives on cosmetic enhancement with our readers. Are you ready for his prescription?

This is the first in a series of columns dedicated to answering commonly asked questions and exploring popular misconceptions regarding cosmetic enhancement.

“I know my appearance can be improved. I want to look natural and favor a less-is-more approach. Why did I leave the consultation with a more extensive surgical plan than I expected?”

The way in which this question is phrased demonstrates this patient arrived for a consultation with strongly held, yet fundamentally flawed beliefs about cosmetic enhancement. Let’s unpack the three points articulated as being important yet seemingly ignored. Her disappointment indicates a lack of satisfaction with:
  • Having the “prescription” of the consultation meet her expectations
  • The surgeon’s sensitivity to her interest in a minimal approach
  • The seeming contradiction between a desire for natural results and leaving with a more aggressive surgical plan
Beware the surgeon who gives you what you want and not what you need.
“The results of the consultation did not meet my expectations.”

Seeking appearance advice is a double-edged sword. Although one ideally wants to look and therefore feel better, hearing more things are “wrong” than anticipated can initially be upsetting. A certain amount of psychology and fear go hand in hand when discussing cosmetic enhancement. The fear may be well founded, but misplaced. In other words, patients are often afraid of the wrong thing. In resisting the very advice being sought, they handcuff the plastic surgeon into unwittingly writing a script that will end in less than optimal results. A consultation, by its very nature must be honest and straightforward if it is to be of any value. The question prospective patients must ask themselves is, “Am I ready to hear what the doctor has to say?” Often preconceived notions trump the physician’s opinion. After all, they look in the mirror every day. They know what they do and don’t like. The Internet, media and periodicals are sources of useful albeit unfiltered information. Patients arrive with an inflated sense of their ability to diagnose and propose a surgical plan. But who really knows best? Can you imagine visiting the cardiologist for chest pain and declaring you will take the beta blocker but you won’t take the water pills? Of course not. But one’s appearance is infinitely more intimate than a heart. Seeking the advice of a cosmetic surgeon should deliver information above and beyond what is merely on the surface. The bedrock issue is trust. Self-evaluation and outside, generic sources will never take the place of the inherent aesthetic sense and experience of a medical specialist. It’s a good idea to get the opinions of different surgeons, however, beware the surgeon who gives you what you want and not what you need.

There are many issues not immediately apparent regarding your appearance today and more importantly how your surgery will influence how you look tomorrow. If you are sincere in your desire for rejuvenation, be open to entertaining issues that may never have been on your radar screen. The consultation may bring a bit of a blow to the ego as well as the bank account but in the end, a thoughtful plan will provide dividends beyond what might have been imagined. Be open to new ideas as long as you trust the source. It might be more expensive now, but infinitely cheaper both in time and money than doing it later as separate procedure. The results will be better because multiple, related aspects were addressed simultaneously as a total package—not a patchwork quilt.

Sometimes less…is just less.
“I want a minimally invasive procedure.”

Liquid facelifts. Lunchtime fillers. Scarless “surgery.” No needles, no knives, no downtime. The injectable revolution has been so seductive it has put cosmetic enhancement on the same level as cosmetics. The concept of going from injectables to facial rejuvenation through surgery is a major step for most people. When the time comes, it’s easier for the patient to accept doing incremental improvements because it gives the impression of being less extreme. It also gives the patient an important sense of control. Yet, a slow and steady approach may be perfect for some cosmetic issues but will simply backfire for others. A good example of trading “optimal” for “minimal” is the request for “a-modified-lower-facelift.” What patients fail to recognize is that this tunnel vision will result in the lower face being anatomically stabilized leaving the upper untouched. As time marches on the upper face will age more rapidly than the lower face. So, what has been accomplished?

Operating on someone’s face is a responsibility to be taken very seriously. Patients are naturally more comfortable with limited or minimal changes; however, these potentially fail the intended goal of looking better when more intervention is necessary. Minimally invasive techniques and innovations in technology will continue to provide more options, however they are not a panacea. They may act as an important adjunct to rejuvenation, but need for properly performed surgery is not going away. Dealing withsymptoms of the aging process with surgery can in essence change poor genetics that play a large role in how you age. The bottom line is clear. Seek the advice of an honest, talented and well-versed artist who will deliver the right thing as opposed to the most expedient procedure or simply what sounds less dramatic. Sometimes less…is just less.
“I am looking for a conservative surgical plan so I look natural.”

Simply walking the NY streets can be a constant reminder of how a poorly created mask can be quite frightening, and unnatural. No one wants to wake up and see someone else in the mirror. “Natural” means “undetectable intervention.” Surgery doesn’t have to be synonymous with looking unnatural. In fact, the most common comfort zone procedures (fillers) when used in lieu of surgery can lead to outcomes as bizarre as or more bizarre than any surgical misadventure. The notion that a more comprehensive surgical plan is a recipe for less than natural results is not true. There are many instances where NOT combining the proper procedures will indeed telegraph more obvious intervention. Proper rejuvenation requires an understanding of how one improvement will necessarily influence the “unimproved.” Some procedures cannot be isolated. When considering nose surgery, it makes aesthetic sense to examine the chin, cheeks and forehead because those will impact how the nose is perceived. Likewise, a woman’s décolleté should be part of a breast augmentation. Beautiful breasts call attention to that area, so it makes sense to be certain it is aesthetically pleasing. Women who desire a breast reduction will soon discover smaller breasts may make their belly look out of proportion just as liposuction of the thighs without tapering the calves and ankles may look awkward. A good aesthetic surgeon looks at a patient with both a wide angle lens and a zoom to visualize how one enhancement will influence the total picture. A more comprehensive surgical plan can still be very conservative and natural. In fact, the plan might need to be expanded in order to protect the natural look you seek so as not to call attention to isolated improvements.

Ultimately the decision will rest with you. It should be predicated on the surgeon, the surgical plan, and the fee. You have to be comfortable with any tradeoffs or compromises. Know what those are before making a decision. A lower fee, a less specialized surgeon, intolerance for any downtime or a partial surgical plan of your own design is not the right approach. Cosmetic enhancement may have gone mainstream, but high quality results are the domain of boutique practices less interested in filling a surgery schedule and more interested in bringing true lifelong value to patients. It’s not as commoditized as you might think. The caring physician who still believes in the Hippocratic Oath:”above all do no harm” is still a reality. Find him, trust him and follow his prescription.
The notion that a more comprehensive surgical plan is a recipe for less than natural results is not true.
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New York Plastic Surgeon