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Realistic aesthetic goals allow for natural-looking cosmetic rejuvenation outcomes

Article-Realistic aesthetic goals allow for natural-looking cosmetic rejuvenation outcomes

Key iconKey Points

  • Surgeon says aesthetic goals should include natural appearance in harmony with patient's age
  • Consider elements contributing to facial beauty: symmetry, proportion and pleasant expression
  • Nonsurgical options can address sagging, volume loss, deteriorating skin quality

Dr. Friedman
Beauty is in the eye of the beholder. However, different cultures and societies have varying ideals of beauty, and it is not uncommon that these differences in ideals result in highly variable aesthetic outcomes seen in cosmetic patients.

The divergence of these ideals are best exemplified in the sometimes-stark differences between the rejuvenation outcomes in cosmetic patients in the United States and those patients receiving cosmetic rejuvenation treatments

in other parts of the world. According to one overseas plastic surgeon, the aesthetic goal should be a more natural appearance that is in harmony with the patient's age.

"Performing measured rejuvenation procedures in cosmetic patients can be a very fine line to walk, and matching the level of rejuvenation performed in relation to the patient's age is key in achieving natural-looking aesthetic outcomes. As a rule of thumb, less is more," says Nimrod Friedman, M.D., a plastic surgeon practicing in Israel.

REJUVENATION PARAMETERS Consideration of six facial parameters can be instrumental in achieving a rejuvenated look in patients without compromising their true age. The three elements that influence facial aging include sagging, volume loss and deterioration in skin quality. The three elements that contribute to facial beauty are proportion, symmetry and a pleasant expression. According to Dr. Friedman, only by understanding all of these factors and how they relate to one another can the skilled surgeon achieve harmonious — and truly natural — aesthetic results.

"I analyze these parameters in all of my patients at their first consultation and try to see how I can improve on one or all of these aspects. However, there isn't a single treatment modality that can address all these goals," he says. "In my experience, the combination of several tools such as fillers, hydration techniques, muscle relaxants, tightening and lifting, as well as repair of skin texture, is the best holistic approach to achieve a natural rejuvenation and a timeless beauty."

Proportion is not only seen in different parts of the face, it is apparent in nature, as well. There is a fixed relationship, or proportion, between different parts of the body, such as from the upper lip to the lower lip and between the length of the nose and the height of the nose. Symmetry is a characteristic that is associated with good health and virility, which is why we subconsciously look for this trait in the opposite sex, Dr. Friedman says. Facial expressions and positive radiation are equally important, as a smile is more aesthetically pleasing than an angry-looking face. A happy face is a reflection of the radiation from within, and it reflects our positive feelings and disposition, Dr. Friedman says.

NONSURGICAL OPTIONS There are many nonsurgical cosmetic tools that can effectively address the sagging, volume loss and deteriorating skin quality often seen in the aging cosmetic patient. According to Dr. Friedman, tightening sagging skin can be achieved with a combination of laser and radiofrequency (RF) energy, such as what the eMax (Syneron) offers. In addition, the surgeon can use fillers or Botox (onabotulinumtoxinA, Allergan) to lift sagging eyebrows and jawlines. Volume loss can be corrected with fillers such as Juvéderm Voluma (hyaluronic acid, Allergan) or even fat grafting, particularly when stem cells are added to the mixture.

The degradation of the skin quality can be addressed with nonablative fractional resurfacing. Juvéderm Hydrate (hyaluronic acid, Allergan) works well in hydrating the skin and can be used in combination with other fillers for a longer-lasting, voluminous effect. A combination of RF, intense pulsed light therapy and lasers can also be used to address the various cosmetic problems seen in aging skin, Dr. Friedman says.

"Multimodality treatments can often prove to be the ideal approach in optimizing skin-rejuvenation outcomes. Many different and specific signs of aging areas may sometimes require several different approaches used together to optimally achieve rejuvenation of the patient's look on the whole," Dr. Friedman says.

Many modalities are not yet approved by the Food and Drug Administration, and U.S. physicians will probably benefit from their cutting-edge therapeutic value. However, according to Dr. Friedman, U.S. cosmetic surgeons seem to be less savvy to this holistic nonsurgical approach to rejuvenation compared to their overseas counterparts.

"I believe that this global and holistic nonsurgical facial rejuvenation and beautification concept is more commonly realized and performed on this side of the ocean and less so in the U.S. There is a palpable difference in the perception of beauty and how to cosmetically achieve it when you compare the ideals of beauty in the U.S. and the ideals of beauty in Europe, and the cosmetic surgeons are an integral part of this formula," Dr. Friedman says.

According to Dr. Friedman, the U.S. ideal of beauty sometimes leans towards the extreme. This can be seen in breast augmentation outcomes, where bigger is often considered better, and it can be seen in exaggerated browlift outcomes. Cosmetic physicians in the United States sometimes do more than is necessary and tend to use less means to achieve this look, whereas in Europe and Israel, physicians generally try to achieve rejuvenation with a more subtle and natural look, Dr. Friedman says.

"These deep-seated paradigms of beauty are slowly but surely changing in the U.S. and losing their popularity. The trend is going to more subtle procedures. resulting in more natural aesthetic outcomes, which are more compatible to the actual age of the patient," Dr. Friedman says.


Dr. Friedman reports no relevant financial interests.

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