Raise your hand if you never caught yourself in front of the mirror, pulling the skin just above your cheekbones up and back, just to see “what it would look like”. Thought so.
Sagging skin, droopy eye-lids, fat deposits and other amenities we thought would never happen to us are now on our doorstep. For many years I was securely ensconced in the camp of “I will never have any work done”, sitting high atop the perch of my taut body. I have now shed my judgement and I am even less critical of celebrities whose faces don’t move a muscle any longer: if your career and longevity are built on your image, it must be even scarier than for the rest of us to face the mirror. Or to age so publicly.
My newly found open mind does not stem from my residing in the mecca of youth and beauty, even if it’s fairly impossible to walk into any LA restaurant and not be surrounded by “fake” or altered body parts. Rather, it’s a by-product of coming face to face with diminishing returns every morning and, who knows, by the time my tissues will have travelled even farther along the South Highway, I might reconsider my former indifference towards plastic surgery. I have certainly seen very pleasing results on more than one girlfriend.
To satisfy my curiosity, that of my girlfriends and our readers, and to shed some light on what is possible or advisable, I turned to one of Los Angeles’ best known plastic surgeons, Dr. Malcolm Lesavoy who may not be my doctor (yet) but is my friend and neighbour and who, over the years, I have come to appreciate as a patient, kind-hearted and giving human being, all qualities that would not go amiss in a good surgeon. Dr. Lesavoy, who still practices reconstructive surgery at UCLA Medical Center in Westwood, in addition to cosmetic surgery at his Encino clinic, is a leader in his field. You can read his full biography here
The following is the condensed version of a much longer conversation – Dr Lesavoy, clearly still in love with his chosen profession, was kind enough to explain procedures, answer my neophyte questions (and some of yours) and much more. I chose to focus on face related surgery and liposuction as, by now, if we had wanted our boobs or noses done, we will have probably done so already.
Dr. Lesavoy is a Board Certified certified plastic surgeon and, knowing that not all plastic surgeons are created equal, I asked what credentials a woman interviewing a plastic surgeon should look for.
“In the US, definitely board certification. To become a plastic surgeon, one needs 4 years of college, 4 years of medical school, 5 years of general surgery and 2 to 3 years of plastic surgery. Basically, any plastic surgeon will not start practicing until he or she is in their mid-30’s. Then they need to collect cases for about one year before sustaining the written examination for board certification. A year later, if the written examination is passed, they will face the oral exam (Dr. Lesavoy is a senior examiner for the oral part). The reason it’s important to ask for certification is because, in this US, a majority of those who call themselves plastic surgeons are not – they are usually ear and throat doctors, ophthalmologists, dermatologists or gynaecologists. During my 35 year career in the field, I still see an average of 3 to 4 cases a month of plastic or reconstructive surgery gone wrong I am asked to fix. So do your research and don’t rely on the “he is such and such a celebrity surgeon” word of mouth advice. (To check if a plastic surgeon is board certified, you can check the database of American Board of Medical Specialties)
Plastic surgery comprises all kinds of reconstructive surgery: burns, hands, congenital anomalies, orthopedic reconstruction and the like. Cosmetic surgery is just a small part of it, albeit the one that gets the most notoriety and, for surgeons, the easiest to perform and the obvious moneymaker.”
Walk me through the consultation process
“The consultation process is extremely important. Often, women, or men, come to me after having done their homework and research. Still maybe 10% of them ask “What should I do?” I think that’s the wrong question to ask. Sometimes I will walk into the consultation room and will see a patient with a huge nose and will think to myself “I could do a really nice nose for him” and then the patient will ask me to remove a small growth on his ear. His nose is not a problem at all for him. I can’t impose my aesthetic on a patient.
Most patients come in because of a sagging in the jowls or neck, droopy eyelids or bags under their eyes.
Once I hear what a patient would like to achieve and we agree on what can be done, I walk them to a mirror and explain what they can expect.
The end result of good plastic surgery should be a more youthful, healthier, relaxed appearance – not severely taut skin. Sometimes patients will complain that “nobody can tell I had a face lift”. Good, I say. No one should notice – then I have done a good job. Cosmetic surgery should never look artificial.”
Have you ever turned anybody down?
Definitely. Anyone who is looking for a fake look, or overly large breasts, I will not do it. I will most certainly not get a referral from such a job.
Not at all. The way we age is mostly determined by our genes and, to a certain extent, by factors such as smoking or prolonged sun exposure. I have seen 40 year olds who could be good candidates for a face lift and 70 year olds who don’t need it. It’s mostly what your parents passed on to you.
You can expect a face lift to last for a good 8 to 10 years.
Nowadays it’s done as an outpatient procedure, lasting about a couple of hours, although you will not be presentable before two weeks after the surgery. Stitches will be removed after about 10 days. It can be done with either sedation and local anesthesia or with general anesthesia.
How about liposuction on the jowls?
To remove extra fat it can be effective.
How effective is a mini-face lift or S lift? (a less invasive procedure that focuses on the lower part of the face and the neck)
Minimally effective and, in my opinion, a waste of time. It will not have the lasting effects of an actual face lift, especially if one’s aim is to get rid of sagging jowls.
Blepharoplasty tends to last longer than a face lift, an average of 15 years and it can easily be repeated. The key to a good blepharoplasty is that the distance between the upper and lower eyelid does not change, so you don’t look as if you are sitting on a block of ice or extremely surprised. The same goes for brow and forehead lifts – they should not look artificial.
Frequently, as we age the upper eyelid skin starts to fall down and many women need to lift that skin up in order to put their make up on.
Also, our eyeballs sit in a bony socket and around it, within the orbit, is fat which acts as a shock absorber. This shock absorber is held back by muscles we have underneath our eyelids and, when we are particularly tired, or as we age, these muscles relax, making the fat protrude and creating the notorious “bags”. (also the reason why, if you pull an all-nighter, at any age, you will wake up with tired looking eyes).
The surgery is an incision underneath the lashes: we then remove some of the fat, tighten the muscles and remove some of the crepiness of the skin, so the skin looks nice and smooth but understand we can’t remove every single line.
Botox and Fillers. What are the differences and benefits?
Botox, manufactured botulism, is a toxin that relaxes muscles. It works best on horizontal furrows on the forehead or vertical ones between the eyebrows. We put minute amounts of Botox in the muscles that produce those furrows so they are minimized. If you put too much, the muscles won’t work at all and you will have that mask-life effect we often see.
Fillers are hyaluronic acid, much like collagen, but synthetically manufactured as it turned out many patients were allergic to collagen. It fills in concavities or fine lines and it works best for laugh lines or marionette lines. You can’t have too much injected or it will interfere with your speech – which I have seen on patients who come in trying to have it fixed; there is nothing to do but wait until the effect fades.
Both Botox and fillers last around 6 months – in some cases a bit longer (Restylane, for example).
How about laser therapy?
Laser burns the top layer of the skin and, as the burn heals, it heals by contraction, making the skin smoother. It doesn’t take care of the contours but it does help the fine little lines – around the upper and lower lips for instance, or crow’s feet around the eyes.
Dermabrasion is a way of sanding the skin – like laser therapy, it takes off the top layer of the skin (it’s wonderful to remove acne scars). It has the same results as laser but I prefer it because I can have more control on it and, also, it heals faster.
On what parts of the body is liposuction most effective?
Underneath the skin is fat, which protects the skin and gives it nutrition. And underneath the fat is muscle. With liposuction, we make a little incision, 4 or 5 mil, and, with a hollow tube, we suction out some of that fat. But it’s not like sucking out air from a balloon. I like to use the sponge analogy: if you wet a sponge, and make some more holes in it, then leave it overnight with a book on top, the next day the sponge will be half the size. That is what liposuction is: the combination of making all these holes and compressing them so they stick to the skin.
If you have a lot of crepiness on your skin, it will actually make it worse and if there is a lot fat, it might take more than one session – liposuction is not a fat removal procedure but a contouring one.
It works better on certain areas than others. For example, liposuction of the calves is possibly the worst, because the skin is very thick and doesn’t compress as well. In the areas of the outer hips and flanks and upper outer thighs it reaches a 60/70% improvement, and 50 to 60% in the lower abdomen. While the upper abdomen, the upper arm or upper inside thigh do not respond as well because the skin is too thin.
How effective is smart lipo?
It’s just a marketing tool that uses a laser to burn some of the fat. I personally don’t like it.
Our conversation covered much more I can fit into these pages – if you have any questions, please contact us and we will do our best to address your topics.
For more on these and other cosmetic surgery procedures view Dr. Lesavoy’s website