Understanding Facial Enhancement

In Ottawa

By Dr. Howard Silverman

Welcome back, faithful followers!

As mentioned during my last entry, one of the things that I am doing with my free time during the COVID-19 crisis is to catch up on some of the posts that I would like to share with you. I know that aesthetic surgery is not foremost on people’s minds right now, but this will end one day – so I thought you might enjoy some of my thoughts on a variety of topics in aesthetic surgery, while enjoying our forced vacation time!

I wanted to discuss my approach to facial aesthetics today, as I receive many requests about this. There are a myriad of techniques and approaches available, and it can be very confusing for patients (and surgeons!) to wade through the available information, and my impressions on each. The first part of this entry will address general approaches to aesthetics and minimally invasive procedures, and a second future post will address surgical approaches.

Firstly, what is facial enhancement? This is a descriptive term applied to beautification or rejuvenation of the face and neck. By its very nature, approaches to the face and neck are unique and different for each of us, as none of us have the same face! Because of this, a standard approach will not apply to everyone and must be individualised. I find that the most important step in the process of considering what will work for each patient lies in the understanding of each patient’s concerns, and then performing a careful analysis of each patient’s individual facial features and anatomy. Once an understanding of exactly what is desired is obtained, a plan is then formulated on how best to address the concern, using the correct techniques and tools.

As with all aesthetic procedures, I like to begin with simple solutions that are effective and low risk, and then progress to more complex alternatives, only as needed. This means that we begin with lifestyle modifications, such as avoidance of smoking and sun exposure, and addressing weight fluctuations. We then move on to aesthetic procedures, such as chemical peels and gentle laser resurfacing, along with skin care regimes. These will address superficial, skin-related concerns such as texture, tone, and pigmentation.

The next step is to consider minimally invasive techniques, such as neuromodulators (e.g. Botox) and fillers. These can relax the tight muscles that cause frown lines and add volume to depleted soft tissues, which can otherwise lead to sagging and a deflated appearance. These are temporary but highly effective and safe solutions, and will effectively address the concerns that they are meant to address.

I have heard some patients relate that a certain procedure did not work for them. While it is true that occasionally a procedure does not do what it was supposed to, I find that usually the problem is that the procedure offered was not the correct procedure to address the intended concern. This can happen from either a breakdown in communication between the patient and provider, or a failure in precise diagnosis of the underlying issue. As an example, Botox will do a great job with frown lines or crow’s feet, but will not do anything for a lax and loose neck. This is not because Botox doesn’t work on necks, but because concerns in the neck are rarely due to the excessive muscular forces that neuromodulators can treat, and therefore need a different tool for correction.

Another example commonly seen is when a filler “doesn’t work”. There are a few patients who absorb fillers quicker than others, but this is unusual. More commonly, not enough filler was used to address the degree of volume depletion intended to correct, or the filler was placed either too deeply or too superficially in the target area, lessening the effect or leading to surface irregularities or visible product.

Obviously, dissatisfaction can be avoided by seeking out providers who are truly experts at the use of these modalities. This means that during a consultation, the right questions are asked, and the practitioners understand the precise indications and expected results that can be achieved with minimally invasive or aesthetic procedures. Trying to fix a face or neck that needs a surgical lift with inappropriate use of fillers and neuromodulators or lasers/peels will surely lead to odd appearances, wasted funds and unhappy patients.

Unfortunately, there are many “practitioners” of varied skill sets and backgrounds who are now offering and using these products, as relatively minimal training is required to give someone the courage to inject a substance with a needle and describe themselves as an expert. While somewhere along the line a doctor is needed to purchase these controlled products, there are some MD’s who are willing to lend their name in a supervisory capacity without actually being directly involved in the patient interaction, and some of these MD’s have only a modest understanding of facial aesthetic needs. There are many weekend courses and observerships that are available to doctors, nurses and aestheticians to receive this minimal training. To make matters even worse, some aesthetic injectable products are available through unorthodox channels that do not require an MD’s involvement, allowing almost anyone to obtain aesthetic products of varied quality.

In my opinion, to truly understand the safe and precise use of these techniques, years of experience in facial surgery and aesthetics and specific supervised surgical training in all aspects of facial anatomy and aging are required to describe oneself as an expert.

We at Ottawa Plastic surgery have that expertise. Our aestheticians and our RN nurse injector Christena work under my direct surgical supervision, and each aesthetic patient is reviewed with me in order to formulate a precise plan. As such, we are able to offer you the full range of aesthetic treatment, all the way from skincare to full surgical rejuvenation, such that our patients can receive a well thought out and precise care plan.

Hope to see you all soon, stay safe!

— Dr. Howard Silverman

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