Secrets Your Plastic Surgeon Wishes You Would Know

While it feels as if everyone thinks they are an expert on plastic surgery and other cosmetic procedures because there is just so much information out there, doctors always know best. While Botox or a boob job might not seem like a bigger deal than a bikini wax these days, that is just not true. 

I asked several prestigious plastic surgeons what they wish their patients would know and understand before coming in. Their answers will not only surprise you, but may also clear up any misconceptions you might have had about some of the most common cosmetic procedures. They also shared some of their best tips to stay looking young.

Contrary to what so many people think, Botox and fillers do not do the same thing. While they are both injected into the face, these substances are chemically different and serve different purposes. 

Dr. Fred G. Fedok, who is the President of the American Academy of Facial Plastic and Reconstructive Surgery, explained the difference to me. "Botox is a specific brand name for a drug that is part a group of drugs that are otherwise known as neuromodulators. These neuromodulators include Botox, Dysport, Xeomin, among others. They are patented variations of botulinum toxin. The neuromodulators temporarily weaken or paralyze the specific muscles that are injected. They are used to diminish muscle action and thus improve small folds or wrinkles of the skin secondary to the underlying muscular activity."

Botox does not fill out wrinkles, but fillers do. "Fillers are used to fill out deficiencies or voids in the soft tissues," Dr. Fedok explained. "These can be fairly superficial and are truly dermal changes. They can also be deeper and represent voids in the underlying fat complement in the facial soft tissues."

Some people will ask a doctor for a specific brand of filler because they heard it is good or it is what their friend used, but that is not the way to go about it. Different fillers are formulated to work on various parts of the face for a variety of purposes, as Dr. Theda C. Kontis, who is the Secretary-elect of American Academy of Facial Plastic and Reconstructive Surgery, explained to me.

"Fillers can be thick or thin in consistency and permanent or temporary in longevity. Thicker fillers are used for deeper creases and folds and to provide more lift. Thinner products are used for finer creases and lines and provide less support," Dr. Kontis said. "There are three main classes of product. Hyaluronic acid, such as Restylane and Juvederm products, can be dissolved with an enzyme. Calcium hydroxylapatite, such as Radiesse is thicker and cannot be dissolved. Polymethylmethacrylate, such as BellaFill is permanent, but requires a skin test."

The brands and types of fillers that Dr. Kontis mentioned are available in the U.S., but Dr. Fedok divulged that different fillers are available in other parts of the world. "There are a variety of these substances that are approved for use in other countries and are not yet approved in this country," he told me.

We all know that facial injections should make you look better, but sadly, that is not always the case. However, it is not the fault of the person who had the procedure, rather, the blame should be placed on the injector.

It's very important the person injecting your face is qualified to do so. While various medical professionals, such as doctors, nurses, and even dentists inject Botox and fillers, Dr. Kontis believes there is more to providing the best results possible than just having a degree. "Your injector must understand facial anatomy and the aging process in order to give you a natural-appearing result. There are not bad filler products, just bad injectors. [So if] someone looks overdone with fillers, they probably are."

Too much Botox can also pose a problem, such as not being able to move your face. But that is not the fault of Botox itself. "Botox does not freeze the face," Dr. Kontis explained. "Fillers and Botox won't make you look like a 'freak,' they were designed to make you look natural." 

A lot of people wonder when you should start getting Botox and fillers, but the determining factor is not age so much as the condition of your skin. According to Dr. Babak Dadvand, who is a double board certified plastic surgeon in Beverly Hills, California, "There is not really a right age to start fillers or injections like Botox."

Dr. Dadvand's philosophy is to start early, even as young as 20 years old. "I think the best thing is to start earlier and start treating the early signs of aging," he said. "For Botox, the lines on the forehead especially, the angry scowl line, the 'elevens' between your eyes on your forehead and even the crow's feet. Those things can help a lot to smooth out those areas. Particularly for fillers, in the smile lines and the nasal labial folds, [starting young] can't prevent needing surgery later, but it can delay it." 

Getting Botox and fillers improves your appearance in the short term, but they also prevent you from potentially needing or wanting plastic surgery in the future. Dr. Dadvand explained to me that, "From a standpoint of lines and such, [getting fillers injected] can delay the need for plastic surgery later."

Furthermore, a benefit of getting injections now and opting for future surgery is that your results won't be shockingly different. So, your family and friends might not even be able to recognize you had work done, as Dr. Dadvand explained to me. 

"When your lines are not as bad, people look at you and comment you look well rested, as if you have been on vacation. If you have deep lines everywhere and come in for fillers and injections, people will know you've done something. For a lot of patients, they do not want people to notice they've had something done, but they want people to notice they look better."

Sometimes we can forget that surgery and even injections are not like getting a manicure or a haircut. There are times when a doctor has to say "no." Dr. Fedok told me there are many reasons why a doctor may decline. "The reasons may involve multiple aspects of the procedure, the doctor's practice of medicine and experience, and the candidacy of the patient themselves. In general, if a specific doctor declines to perform a specific procedure on you, it is good to take his advice."

However, if you really think you are a good candidate for a procedure, Dr. Fedok says you might not be wrong. "If you are a firm believer that you are a good candidate for the specific procedure you are seeking, it is probably best to seek consultation with another physician, rather than compelling the physician to do something that for whatever reason he does not want to do."

Dr. Kontis' approach to this problem is about managing the expectations of her patients. "Doctors must assess if patients have the right expectations for the results that can be achieved with each procedure. Communication between doctor and patient is extremely important. I ask patients to explain to me the changes they would like to see, and then I tell them what can or cannot be done. If they want a result that cannot be achieved, I may suggest they not proceed with the treatment."

Sometimes one procedure just won't cut it and multiple procedures may be necessary. This really isn't unusual for Dr. Fedok. "To maintain or to optimize your facial rejuvenation, usually several different procedures must be carried out in order to rejuvenate every aspect of your anatomy that has aged undesirably," he said. 

"For instance, it can be very disappointing to go through the rigors of having an extensive facelift if nothing else is done, i.e. facial soft tissues are repositioned and lifted without addressing volume deficiencies in the face or without addressing a poorly aged skin tone and texture. You may look tighter, but not youthful and rejuvenated. In order to optimize the rejuvenation effort, that patient might be best served by having not only a facelift, but fat transfer and volume replacement, and some form of skin resurfacing."

Multiple procedures don't always take place on the same day, but instead may be required over time. "As we see in the population of celebrities with frequent media documentation, it is important that patients look forward to having an occasional touch-up procedure to keep things maintained," Dr. Fedok advised.

If you've been thinking about getting breast implants by just picking a cup size and getting cut open, it doesn't exactly work that way. Dr. Dadvand explained that it has to be the right fit for a woman's body. "You have to select an implant that is going to fall within the conventions of the natural breast, especially the width of the breast. You don't want it to be wider than their natural breast, but at the same time you don't one that is too narrow."

It's also not about cup size. "A lot of women come in and say they want to be a particular cup size. I tell them not to worry about their cup size. I'm not here to augment their cup size. I'm here to augment their breast size. If you are happy with the size of your breasts, who cares what the cup size is? You will be happy with that too. It should match your anatomy and not cause it to get stretched out too soon."

Dr. Dadvand also advised that there are different types of implants. "[The new] silicone implants are highly cohesive and made of a liquid gel silicone. In the '80s and '90s the silicone was more of a liquid silicone and they would leak, so they were taken off the market. I rarely do saline implants [anymore] because a lot of women want a more natural look and feel. Silicone has a more natural feel." 

According to Dr. Dadvand, sunscreen will save you a lot of hours and dollars at a plastic surgeon's office. Fine lines and brown spots are often due to the sun. "I tell patients, if you can do one thing, it is wear sunscreen. You don't need anything higher than SPF 50. All it does is cost more. It doesn't give you any more protection, but you have to reapply it several times a day. It wears off even indoors. There is also no such thing as waterproof. If you go in the water, you need to reapply."

Dr. Dadvand is also a big proponent of retinols. You don't need to spend a lot of money at a department store for a good retinol product. He suggests getting a prescription for Retin A or buying an over-the-counter retinol at the drugstore. Differin is an example of this kind of a product. He also suggests moisturizing to manage any dryness that occurs as a result of using retinol. His pick? Old fashioned Oil of Olay does the trick.

If you are going to have a medical procedure, it is very important to listen to your doctor because many substances can create complications and prevent healing. Dr. Dadvand gives his patients a long list of things to avoid both before and after surgery. 

"I tell patients there are things they should avoid for a few weeks before and after surgery, such as alcohol, anti-inflammatory medication, such as Advil, and fish oil pills. These are things that can cause you to bruise or bleed more easily," Dr Dadvand said, elaborating that one thing tops the list of pre-surgery do-nots. 

"As far as surgery is concerned, smoking is the worst thing you can do. I make all my patients stop a month before and usually for a month after. There are two issues. Nicotine constricts the blood vessels, so you don't get enough blood flow to the area being operated on. Also, all the carcinogens in the smoke make the airways really inflamed so there is a higher chance of getting bronchitis or having a coughing fit when they wake up from the anesthesia. Smoking is the number one thing I tell them not to do."

So, if you want to look your best, just understand that doctors know best. If you are considering any kind of procedure, it is important to have realistic expectations and understand that just one procedure may not cover it all. And if you want to look younger, but fear needles and knives, it's pretty simple. Listen to Dr. Dadvand. Wear sunscreen every single day and do not forget to reapply.