My Conceptual Approach to Plastic Surgery
My goal with cosmetic surgery is to make a problem area a non-issue. There is no such thing as perfection. Everyone is beautiful in their own unique way. Sometimes things can not be any more beautiful, they can just be different.
When there is something in a person’s appearance that bothers them the goal of cosmetic surgery is to take that problem away. When you’re getting dressed, look in the mirror and no problem area catches your eye that is a cosmetic surgery success.
Cosmetic surgery results should look natural. My goal is that no one would know you had any procedure.
My goal for when doing liposuction procedures is to create the curve. I think this is the one most important thing that makes a woman look good. A flat stomach is good but SpongeBob has a flat stomach and that doesn’t look too good. The S-curve is the thing that makes the figure.
My goal with the Brazilian butt lift (fat injection) is again to create a smooth curve. As a smooth S-shaped curve from the waist to the outer thigh creates a great shape. Posteriorly a smooth C shaped our pear-shaped curve creates a good shape of the buttocks. The global change of the buttocks is what gives a good result.
Male liposuction needs to enhance the abdomen. A V-shaped truck gives a good muscular look. Enhancing the sixpack in the obliques also helps with this muscular look. Taking away the love handles is a key to the V-shaped. Another area that helps with the male trunk is enhancing the definition between the pectoralis major and the latissimus dorsi muscles.
Abdominoplasty my goal is to create a flat natural abdominal contour, low scar that is covered by the underwear or bikini and a natural appearing umbilicus with a minimally visible scar. A common problem, and a difficult problem to prevent it is a abdomen where the supra umbilical abdomen protrudes more infra umbilical portion of the abdomen. I call this an inverse pooch. Every supermodel has a pooch, meaning that the top of the abdomen is flatter then the bottom of the abdomen(pooch). A stomach is flat as a board with a punched out bellybutton is not attractive. The abdomen with normal contours shape is a more attractive a more natural appearing abdomen.
Facelift patients are the patients where a natural appearance is more important than any other surgery. In a facelift surgery is important to use the fascial components to lift the age induced descended fat pads back to their positions in youth. The skin should not be a major player in this procedure. When the skin is overtaxed and pulled too tight on the wrong directions the patient has an appearance of having a facelift. The ears need to look natural with hidden scars. If the ears are changed this is also a dead giveaway that a facelift is the done. The hairline also needs to look natural. When the headline is elevated or disturbed in the patient looks surgical. Again a facelift patient is the patient that needs to look younger but not surgical.
My goal with breast augmentation is to again deliver a natural appearing augmentation with a minimally visible scar. The surgical goals are to decrease inflammation in order to decrease the most common complication of scar tissue formation around the implant. If the diameter of the implant chosen is narrower than the diameter of the patient’s breast a more natural appearing augmentation will occur.
A natural appearance is also the major goal in breast reconstruction. The main concept that I have when I do breast reconstruction is to preserve as much of the patient’s own skin envelope and to try to replace with tissue or an implant the same size and shape of the breast tissue removed. If you can add tissue or an implant of the exact same shape of the specimen removed and you can preserve the skin you will have a normal symmetrical appearing breast reconstruction.
My goal with mastopexy and breast reduction is to create shape, cleavage and a sustained lift. I no longer use a horizontal incision for any breast surgery. I believe this incision makes a flat breast. Incision I use is a lollipop type of incision. A scar around the nipple in a vertical scar(short scar). The advantage of this incision is that a vertical incision creates a cone and the shorter scar causes less weakness but a long scar. Weakness in the bottom of the breast allows the breast to drop over time. Another concept that I have with mastopexy and breast reduction is to shape the breast mound like a breast implant. If you do this you can create cleavage without implant. A patient’s own tissue is much better than anything made by man. The last concept of my breast reduction and mastopexy cases is to save the bottom half of the skin and use this to create a slang that is used to support the bottom of the breast this creates two layers of the skin on the bottom half of the breast which increases the strength supporting the breast and gives the breast more lift and more longevity.
In summary the way I approach cosmetic surgery starts with the belief that all people are beautiful. And I see my goal has helping my patients to feel comfortable with themselves. There is no such thing as perfect and there is no such thing as an ultimate beauty. When there are two beautiful things they’re both beautiful but they’re just different.
Wendell Perry M.D.