Observations

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I have made many observations regarding the face and body over the past several decades. My occupation as a plastic surgeon and the fact that nothing in nature is perfect keeps the perfection frontier elusive, or we can rest on our past laurels and never try to improve, which should not be an option.

Regarding the face, years ago I had a reverse-mirror that showed us not the mirror image of our face, but our real self as others see us. When you think about it, you have only seen your mirror image (the reverse of your image) except in photographs, and maybe this is why we generally dislike our pictures. No one ever liked looking into the reverse-mirror mentioned above. Like it or not, our faces are not symmetrical, and it starts with the support of the bony skull. After looking at 100,000 or more faces, I noticed that one side of our face is smaller than the other. This can be demonstrated by looking at the eye that is lower--not the eyebrow or skin on the upper lid, but the orbit itself. How do you tell? The pupil on the smaller side of your face will be lower. And, for some reason, it is usually the right side in both males and females. Strangely, it is slightly unusual to find that it is the left side. On the smaller side of a face the skull, the main supporting structure, is actually smaller, and this is more common than otherwise.

For a plastic surgeon, this observation is important, because we want faces to be symmetrical after surgical or non-surgical treatment. This is particularly important when volumizing with fillers. Just the realization that faces are asymmetrical means that we must study each individual face we are treating a little more acutely in our effort toward achieving symmetry.

Another observation is that the cheek in a young person and the nasolabial fold (the fold that just outside of the smile lines) are one mound without the concavity that divides them with aging, referred to as the "tear trough." Also the cheek mound in youth goes all the way to the lower eyelid, leaving no hollowness below the lid. And, the cheek mound goes all the way to the nose and down to the upper lip, further than one would think. In youth there are minimal hollows and shadows in the face, and these shadows increase with facial volume decreases. When you lose this volume you also lose support, much like the sagging and wrinkles in a deflated beach ball. Refill the beach ball with air. and the wrinkles and sagging disappear. Faces respond similarly to more volume. Fillers or fat grafts are used for this purpose, but first the asymmetry must be accurately assessed to achieve the best result.

I had a beautiful lady as a patient recently who had not had anything done to her face at age 63, and she was a lucky lady because still looked great. But her cheek had diminished to a small mound, and she had very hollow cheeks. She said that she liked the high cheek bone look. I showed her photos of several beautiful women who one would think have high cheek bones, but they really don't at all. They simply have round, beautiful cheeks. Her daughter told her to have an injectable filler. After injecting several syringes of a product, Sculptra in this case, all she could say was "Wow!" over and over, and this is a common response. Proper knowledge of the aging face, individual assessment, and volumizing can turn the clock back an easy 10 years or more.
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Savannah Plastic Surgeon