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Physicians address various treatment plans for rejuvenating the aging face

Article-Physicians address various treatment plans for rejuvenating the aging face

Key iconKey Points

  • Determining a suitable plan includes anatomic structure of the face, skin condition, patient's age, gender, occupation, medical history and a host of other considerations, one clinician says
  • A physician incorporates a 12-step aesthetic assessment of the aging face
  • One surgeon explains to patients he plans to discuss with them four major components: upper face, mid face, lower face and neck, and skin

Q: When developing a treatment plan for the face, we know that one size does not fit all. How do you approach each individual face to determine your aesthetic approach?

Harris S. Hausen, M.D.
Long Island, N.Y.

Dr. Hausen
"I have heard it said that everyone has a double, a doppelgänger, another individual, somewhere on this planet, who could be that person's long-lost twin. However, in my years of practicing cosmetic medicine, I have yet to see any two patients who are identical. One's genetics, lifestyle, experiences, traumas, choices regarding diet and exercise, and countless other factors all exert subtle influences upon the structure of one's face. Accordingly, bony and muscular architecture, the extent of subdermal adipose, and the quality of the skin vary dramatically among individuals, even between monozygotic (identical) twins. "After obtaining a detailed medical and surgical history from a patient — but before examining her — I wish to get a better understanding of the cosmetic concerns my patient has come to address and what her goals and expectations of a proposed treatment plan might be. Consideration of a suitable plan for a given patient incorporates not only the anatomic structure of one's face and the condition of the skin, but also the patient's gender, age, occupation, medical history, previous experience with cosmetic procedures, budget, acceptance or discomfort with downtime, and requirements for immediacy of results.

"Although two patients may each present, for example, for a dermal filler and a neurotoxin to reduce the appearance of rhytids, the appropriate course of action for a woman in her 30s, a professional ballroom dancer who tells me she needs "to sparkle like the rhinestones on (her) costumes for a competition this weekend," will differ substantially from that recommended for a woman in her 60s, a conservative attorney who tells me she "would like to look less angry" but does not "want anyone to notice (she's) had 'work' done." Both are actual patients I have seen, and physiology and anatomy notwithstanding, how aggressively I chose to treat each was informed by our conversations and insight toward desired results.

"Similarly, as many cosmetic procedures can be feminizing, the approach I will offer a gentleman may be less aggressive than that offered to his female contemporary. Retaining masculinity to preserve a man being perceived as handsome, not pretty, is a necessary and fundamental aspect of selecting his proper plan of management.

"Frequently, patients present unsure of which procedures they may require to achieve certain effects and ends. Patients also present with misconceptions regarding the safety or efficacy of various cosmetic procedures, or they present misidentifying those procedures they think will most benefit them. As a physician, it is my responsibility to guide my patients toward the most valuable course of action or, conversely, to decline undertaking any course of action if I believe it to be unsafe or unnecessary for a given patient.

"My recommendations in addressing the needs of each patient vary as greatly as individuals vary. One constant, consistent component of my approach is the very recognition that each patient is a unique individual with unique structure and unique mindset and unique circumstance. My treatment must, therefore, be customized to fit that one patient, and only that one patient, seated before me in consultation."

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