Face the Facts

Created on 31st July 2008

Surgical guru on 10 Years Younger, Mr Jan Stanek gives us an insight into how a surgeon approaches the subject of facial aesthetics

It is difficult, for the average patient, to imagine how a facial cosmetic surgeon assesses his or her face and decides what to do to produce a visible and pleasing change.

It is a complex subject and is discussed rarely. Aesthetics, in its broad meaning, is a critical reflection on art, culture and nature. In the context of facial surgery it reflects on the surgeon's view of what is beautiful and therefore pleasing. It reflects on their cultural background, experience and values. This, in short, distinguishes between different practitioners, just as it does in architecture, theatre, music and art. The practical skill of surgery has a major contribution as well, but its execution is influenced by aesthetics.

Different cultures have different aesthetics when it comes to facial surgery. Large, hooked noses may be beautiful in one but judged to be ugly in another. We call it ethnicity. Thus the surgeon must take into account not just their sense of beauty but must also translate it into the ethnic background of the patient they are treating.

In practice there are two important events; one is the first impression and the other the patient's desire or perceived dissatisfaction.

The first impression is important because it gives an instant and complete analysis of what is right or wrong with the patient's face. It is easier for the trained eye but the observant amateur can do just as well. The amateur can recognize whether a person has an ‘operated' look. This is an instant analysis based on experience of the ‘normal'. Equally, they can also determine whether a person is beautiful or unattractive. Beyond that the amateur can go no further. It is the facial surgeon who can go beyond that and determine which individual features contribute towards attractiveness or lack of it.

Commonly, prospective patients say "I am looking tired" or "I am looking old". A simple assumption is that this is a result of ‘eyebags' or a ‘sagging face' and that the solution is eyelid surgery or facelift which may be quite erroneous.

The principal task of the facial surgeon is to make their clients more attractive and youthful. Improper assessment of facial features and inappropriate application of surgery can create an unbalanced face with some features more pronounced, making the face less attractive.

Having ascertained the target of their attention a decision has to be made about what changes are needed to produce a pleasing result, whether quantitative or qualitative. For example, a big nose has to be reduced to a size balancing the rest of the face, especially the chin. Beyond a certain size over-reduction of the nose can lead to a prominent chin. Equally, change of profile from hooked to a retroussé can feminize a male face.

Facial rejuvenation is also the subject of aesthetics, albeit more complex. The surgeon has to take into consideration the full picture before deciding what to do. Merely assuming that a facelift will make every person look younger is simply not correct. In many cases it will make a difference but the result will be recognizable as ‘facelifted'.

It is a common misunderstanding among facial cosmetic surgeons that the greater the degree of change the better the result and the more satisfied is the patient. Any intervention which outbalances the rest of facial features will be recognizable and therefore undesirable.

Commonly, patients undergoing multiple facial procedures are not satisfied with the result not because significant changes have not been achieved but because there is something missing, something odd. This is because a part of their face has been dissociated from the rest and their skin may still be looking old. In other words the appearance of skin has to match the rejuvenating effect of surgery.

The omission of face and neck surgery in some patients can lead to patient dissatisfaction and a recognizable ‘facelifted' appearance. This is because the upper and lower parts of the face are still looking old and more noticeable than prior to surgery.

To a certain extent, the current popularity of ‘minimalist' surgery is responsible. It is consumer driven and surgeons are willing to oblige because the techniques are undemanding and risks apparently lower. However, in the end the natural and pleasing outcome is what counts, irrespective of how it is achieved.

I believe that a successful aesthetic outcome in facial surgery can be achieved by thoughtful assessment of the problem and skilful application of many different techniques available to us through evolution of the last hundred years of cosmetic facial surgery. However, progressive evolution may not always result in improvements.
CSMUK