About Face

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About Face

Chapter One The Facial Assessment Balance and Proportion The Possibilities

As for young people and Rhinoplasty, my first concern is whether or not the patient has stopped growing. Some kids stop as young as fourteen, others don’t stop until they’re sixteen or even older. If I operator on a youngster who hasn’t stopped growing, the growth centers of the nose might be damaged, or affected, and the nose will continue to grow, but in an odd way. For the ten-year-old whose nose has been bashed in a school-yard fight, I can do a preliminary operation to keep the bones and cartilage as straight as possible for pre-puberty growth spurt. Then we wait until the child stops growing before doing the final cosmetic work.

After we’ve agreed on the work to be done during the vacial assessment, I try to illustrate exactly how I will do it. I start by introducing patients to the eight “regional aesthetic units” of the face - all anatomic areas that must be considered separately by the cosmetic surgeon: scalp, forehead, eyes, cheeks, nose, lips and mouth area, chin, and neck. I have a number of illustrative aids, such as before-and-after photographs, medical texts with detailed drawings, some slides of previous patients, and even pen and paper. I’ve prepared sheets of paper with the outline of a face on it so that I can make notes about the assessment for future reference. As I mentioned before, I can “see” three-dimensionally, so I make use of a miniature plaster face with a cutaway section to show a patient what will happen under the skin during an operation. (I was once challenged by an artist to produce a Plasticine facial sculpture, and sure enough, I found it easy to do, but the ability to sketch a face on paper is beyond me. I can’t draw worth a bean.)

Part the reason I go to such lengths to illustrate the process is to instill confidence in my patient. A patient offering up his face must know that he can trust his surgeon to stay with him, even if complications arise. And they do. The law of averages dictates that if I do one hundred rhinoplasties, a certain percentage of them will give me trouble. This is what I meant by making sure that you get along well with your surgeon. If, despite all the planning, an unforeseen problem comes up - the cartilage in your nose twists due to the return of its intrinsic “spring” (this might happen if the nose was damaged in an accident) or if there is persistent post operative swelling due to delayed healing - your surgeon must be there for you. The rule of thumb here is, don’t be afraid of a doctor who tells you about all the things that might go wrong, because they just might.

You should come out of a facial assessment session with a pretty good idea of the prince you’ll have to pay for your surgery, and money isn’t the only currency. In the appendix at the back of this book you’ll find some guidelines as to what you might spend on various procedures, but there are some other considerations. Pain, for example. With modern anesthetics, there is no cause for pain during any procedure, outside of a pinprick sensation during the “freezing” or numbing injections, but there can be uncomfortable periods during healing. The good news is that you’ll rarely need anything more powerful than Tylenol 3 to deal with it, and that some patients experience no pain but only pressure or tightness during healing.

Generally speaking, even the most extensive facial plastic surgery - for example a Rhinoplasty - allows you to be socially active in about two weeks. There will be some colorful bruising and swelling in the meantime, but after two weeks, often with no makeup, you should be able to go to a party and no one will know you’ve had your nose done, unless you tell them. Some operations do require follow-up procedures like wearing headbands or chin slings for a while, which I’ll elaborate on in the relevant chapters.

The thing to remember is that the true healing process, below the skin, takes much longer than two weeks. In the case of a Rhinoplasty, it takes about a year. You and your doctor need to arrange a schedule of follow-up appointments over this longer period of time to make sure everything is healing the way it should.

A thorough facial assessment, then, is an essential first step toward facial cosmetic surgery. It should lay to rest any myths or misconceptions you might harbor about what can or must be done. You should walk out of a n assessment fully confident that you know exactly what is going to be done, why and how it is to be done, how much it will cost, when it will be done, and over what period of time it will heal. You’ll probably also have found out some fascinating new things about yourself, just by the way you interact with your surgeon and the way you respond to his probing and assessment of that most personal calling card - your face.
And now, let’s talk about skin.

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