The Natural Result Threshold
Posted: 6:00 a.m. Sunday, April 30, 2017
By Anita Mandal, M.D.
Question: I’m ready for facial rejuvenation, but there are so many unnatural and strange looking people walking around. Some don’t even realize how obvious it is that they had a poorly executed cosmetic procedure. How can you prevent an unnatural result?
Answer: A natural result requires a very fine balance between over-correction and under-correction. This balance between doing too much vs. doing too little is the Natural Result Threshold. Over-correction is not necessarily a mere over-filling or over-pulling of facial tissues. Even if you are not overfilled or over-pulled, you can still look unnatural. This happens when the neighboring facial features, which are also aging, are not addressed at the same time as the patient’s isolated concern. For a natural result, it is important to assess the balance of surrounding facial features.
Unlike the body, our facial features are fine and close together. Correcting one feature can draw more attention to a neighboring facial area which has also aged. Facial aging is not restricted to single facial features since aging occurs in multiple areas of our face. When your surgeon targets the group of aging facial features that are in close proximity to each other, rejuvenation procedures can be much more effective. Too often patients come in for 1 or 2 isolated concerns that bother them and incorrectly believe if only those are fixed, they will look better.
As an example, a patient is bothered by his lower eyelid bags. The treatment of lower lid blepharoplasty surgically removes excess fat bags. If, however, the patient also has heavy or excess upper eyelid skin, then surgery to improve the lower lid bags alone may make the heavy upper eyelids more noticeable. In this case, both upper and lower eyelids should be addressed for a youthful, natural and balanced appearance.
Another instance is a patient who is concerned with droopy mouth corners and marionette lines. If the nasolabial smiles and the lip area also have deep wrinkles, then just improving the mouth corner region shifts one’s attention to the untreated upper lip wrinkles and deep nasolabial grooves. It’s important to treat the entire lower facial area rather than just target the mouth corners.
A last case is a patient who is mainly bothered by hollow cheeks but also has deep hollows under the eyes. Volumizing the cheeks with Bellafill, the 5-year filler, or a temporary filler like Voluma or Juvederm can improve the appearance of the cheeks, but could make one appear more tired or aged if the lower lid hollows are left untreated since they may look deeper with fuller cheeks. Careful assessment beyond the specific patient concern of hollow cheeks is key to a natural, more balanced facial appearance.
It is the surgeon’s duty to educate patients on their unique Natural Result Threshold. This is where it becomes important to seek a Board Certified Facial Plastic Surgeon who specializes in the face rather than a “jack of all trades” who works all over the body. There are also an alarming number of doctors, not even board certified in plastic surgery, performing cosmetic procedures. These doctors may have learned the technical aspects of performing cosmetic procedures, but they lack an in-depth understanding of aging facial anatomy and aesthetic balance of the face. Recognizing each patient’s unique Natural Result Threshold requires a specialist with a completely different and more, advanced skill set.