Predicting the best facelift results
Getting the best result from a facelift is a combination of factors.
First, picking the right procedure. Certain procedures will produce a certain look. A coronal browlift, for example, however cleverly done, will raise the hairline and sideburn in the wrong patient. No amount of skill can overcome a poorly designed facelift. A facelift without added volume will never replicate fullness in areas that have lost fullness. High vertical pull will never look natural. Ignoring the midface will produce a dysharmony, etc. etc. etc. There is no excuse for doing the same facelift as 20 years ago without any evolution at all.
Artistry. There are scores of areas of the face, each demanding attention. Attension to detail does not come by accident. It involves specific procedures or "tricks" in each area. The ears are a good basic place to start. Look closely at scores of before-after pictures and observe the appearance of the ears. Even in national publications, you may see things you like and things you decidedly do not.
Experience. There is no experience for having done thousands of facelifts. However as you point out in your question, quality is very important as well. A top facelift specialist will constantly innovate and advance the craft, not stay stuck in the same technical rut.
No 2 surgeons will give you the same facelift results
It is true, but many patients want to believe otherwise, that just because you call an operation the same thing as another doctor the results will be the same. This couldn't be farther from the truth.
So, how someone stitches isn't an indication of their artistic talent to sculpt your face. Stiching is technical, not art. Whose Board you have is not a guarantee of the result either. You can only tell where to go by loking at MANY photos of a doctor's work and seeing in those results the type of changes you would like for yourself. Of course, you need to do your research and feel comfortable with the doctor and their staff but the proof is in the photos.
Judgement is the most important part of a facelift.
I have trained many surgeons who had mediocre hands, but excellent judgement. The fact that it may take them a little longer is no problem, unless it takes them 2-3 times as long as a good technical surgeon. The best is having both. Look at the final results of the surgeon's work, not how well he stitches.
Technique and Experience Count in Facelift
A great Facelift surgeon must combine a range of abilities, which include excellent technical skills combined with the range of experience which allows appropriate action and when called for, appropriate restraint.
I think that Dr. Aldea's comparison of a surgeon to an excellent athlete or musician is very appropriate. I can assure you that some surgeons possess great technique and others simply do not; you know it when you see it. As for experience: you really can't do better than seeing a seasoned surgeon with great judgment. At the same time, I have seen many surgeons, with a long history of practice, and a long history of bad results.
Experience can be determined by the number of years in practice. Great results can be visually determined in a surgeon's portfolio. Good judgment is the sort of thing that will be conveyed to you in surgeon's reputation among colleagues, operative staff, and former patients. Good judgment is also determined by who the surgeon surrounds himself with. Professional, caring office staff don't frequently stay long with a surgeon who possesses questionable judgment.
How can I be confident I have chosen a surgeon likely to give me the result I want from a facelift?
I wholeheartedly agree with Dr. Aldea's answer to you. You will eventually need to make a leap of faith.
As regards making that leap as comfortable as possible for you, please read the following advice on finding someone you can trust:
In a previous entry, I described how common it is for patients who contact my Orlando plastic surgery center to make the mistake of thinking that:
Anyone offering a plastic surgery procedure MUST be appropriately trained and certified to perform that procedure; this is, unfortunately, not the case.
All plastic surgery training is equal, and so shopping for the best price is the best way to choose a surgeon
In that previous entry, I explained how not all people offering plastic surgery are Board Certified Plastic Surgeons, and in fact, many are not even plastic surgeons! There are now many doctors in other specialties offering to perform plastic surgery procedures without the benefit of the years of training a plastic surgeon receives, convincing their patients that a few weeks of training is sufficient for them to learn what we learn in YEARS.
I explained the potentially dangerous error of choosing based on price.
Finally, I explained how to properly choose not only a surgeon, but also the importance of choosing the facility in which the procedure will be performed and also the anesthesia provider.
For today's entry, we'll assume a healthy understanding of these issues. Having done your homework, and ascertained that the surgeons you are considering are all plastic surgeons Board Certified by The American Board of Plastic Surgery, the facilities in which they operate are all certified by the AAAASF or JCAHO, and the anesthesia providers are all well-qualified, how do you make the final decision?
Here are my recommendations:
Consider the relative quality of the surgeon's medical school educations. While it is true that most medical educations will cover the basics, there is a reason that some institutions grow international reputations and perpetually fight for the best students.
A medical school education among these "Best and Brightest" students and educators could reasonably be expected to produce (and historically has produced) America's finest doctors and surgeons. Ranking lists of medical schools take these things into consideration and are a useful resource. The most respected list, from US News and World Report, can be found here:
Find out where the surgeon completed his/her Plastic Surgery Residency. This is the critical and years long process of going from a medical student to a qualified plastic surgeon, where we learn to do plastic surgery by gradually taking on more responsibility under the watchful eyes of other, already trained and experienced surgeons. Just like medical schools, not all training programs are equal in the breadth, intensity and quality of training offered.
Generally speaking, those programs associated with the best medical schools also provide the best training, as they will be able to attract and retain the best, most experienced and reputable professors of plastic surgery- and the quality of our training will depend on the quality of those training us. For example, I completed my own Plastic Surgery training at Washington University in St. Louis, one of the top 5 medical schools in the United States- and it also happens to be the birthplace of American Plastic Surgery.
It bears repeating that you should be absolutely sure that the surgeon you are considering is Board Certified by The American Board of Plastic Surgery. This is easily done at the Board's site:
Know that surgeons who claim to be "Board Eligible" in plastic surgery are NOT board certified. This may be because they simply have not taken the examinations- but this is doubtfully the true explanation, as The American Board of Plastic Surgery specifically prohibits claiming ANY status with The Board until and unless you have passed all examinations. Much more likely is that they were unable to pass the examinations (or simply never took them), but realize they may lose patients if they don't find a way to fool them into thinking they have status with The Board. Are you starting so understand that not all doctors have integrity?
Spend some time thinking about the interactions you have had with the surgeon and his/her staff. You should realize that having a plastic surgery procedure is NOT a singular interaction, like buying a new handbag, in which once the bag is purchased (or the surgery completed) the interaction can be considered to be complete. Rather, you are choosing to enter into a very important relationship with your surgeon, the critical portions of which should be expected to last at least a few months beyond the date of your surgery, as you recover and heal. This very important relationship should therefore be approached with the same care you would give any other... think about whether you think the surgeon will be responsive to your needs and concerns, whether your personalities will allow healthy interaction, the approachability of his/her staff, etc...
Remember- you don't only want to have achieved a great outcome when all is said and done... you want to have had an uplifting and positive experience you can look back on and smile! You can have this in the best practices.
Finally, never forget that what you are really looking for is the very best OUTCOME you can achieve. Sometimes when I'm asked by friends and family how to sort through all the claims some surgeons make of being the best choice because they (the surgeon in question) were voted "the best" by some magazine, or because the surgeon simply says they are "the best", I am reminded of the first Clinton presidential campaign, in which the slogan "It's the economy, stupid" helped Mr. Clinton win the White House. Once you've done the homework outlined above, it's all about the OUTCOME...
Ask to see photos of the surgeon's previous work- and ask yourself if you would be pleased if you looked like the photos they show you. Think about how many good photos they show you. Do most of the outcomes just look funny, with only a few that you think are attractive and natural, or are all of their results pleasing and attractive, even if every one may not be what you specifically want? If the surgeon can't show you at least a few outcomes you find attractive and pleasing, you should look elsewhere.
Be sure to ask directly whether the photos you are being shown are the surgeon's own work (believe it or not, some actually do try to attract patients by showing them the work of others!)
I also always recommend communicating with a few of the surgeon's prior patients who have had the same procedure they are recommending for you. You can ask the surgeon's staff for a list of patients who may have agreed to be called, or find testimonials online at one of the many plastic surgery websites now available. My favorite, because it is objective, free (surgeons cannot pay to be listed higher, so more credibility exists), and allows you to get a feel for the surgeon's manner and personality, is RealSelf:
I know it seems like a huge amount of work, but after you've read this (as well as my prior post) a few times, you'll have a great understanding of the best way to proceed, and it will feel very comfortable and natural to you. Use the resources I've outlined, and use your gut- there are many great surgeons out there- with these guidelines you should be able to attain the outcome and experience you desire.
A Great Facelift depends on ...
A great Facelift surgeon is very much like a great musician, artist or athlete.
It requires years of Experience (seeing, learning, unrelenting self-criticism and redirection), perfectionism, unrelenting drive for self-improvement, honing of thinking skills and analysis as well as of manual operative skills, artistic vision and ability to visualize the desired result and finally - God given talent. It takes all of these qualities and more.
The problem is that there is no way you can tell if the surgeon facing you has all these qualities and how does he/she compare to other surgeons you have seen. That is where comfort and your intuition kick in. Pick and believe in the surgeon you are most comfortable with and you will have chosen well.
Dr. P. Aldea
Facelift results based on skill, technique, skin quality, expectations
With so many facelift options, getting a good result depends on several factors:
-your skin quality and degree of aging (sun damage)
-understanding the surgery proposed
-choosing the right type of face lift surgery
-treating the specific areas that you want to improve
-taking into consideration the recovery time
-the competence of your surgeon
-and most importantly what your expectations are for your post- face lift appearance.
Dr. Carlos Cordoba
MDCM, CSPQ, FRCS, FACS
Plastic & Esthetic Surgeon
4055 Ste-Catherine O. Suite 100
Montreal, QC. Canada H3Z 3J8
You ask a lot of great questions.
Skill, experience, judgment, and aesthetic eye are all important. "Beautiful" skin suturing is nice, but perhaps the least important.
What you did not mention is the patient. Perhaps most important is the patient. Skin quality, strength/elasticity, sex (females usually a better resit), health of the patient, genetics of healing, are all important.
Finally, post op course. If no complications occur, chance for a great outcome is improved. If you comply with Dr.'s orders, better.
Good surgery is the result of skills and judgment
Any operation is a function of judgment and skills. I wouldn't say that either one is more important that they other. They are both more important than "bedside manner" although it's nice to have a surgeon you like. But if I'm on the table for any procedure, even a simple cosmetic operation, I want my surgeon to have good judgment and good pair of hands.
Getting the best facelift for you
An excellent plastic surgeon must have both skilled hands and exceptional judgment. As a prospective patient, look at the training of a plastic surgeon, both the quality of training, and the duration of training. Of course look at many, many before and after photos.