- 1 day ago
THR senior vp sales and brand strategy Liz Culley moderated "The Comeback: Restoring Balance, Beauty and Trust" panel with Dr. Babak Azizzadeh, Dr. Darren Smith and Dr. Sarmela Sunder, which touched on the intricacies of facelifts, upper blepharoplasty procedures and the so-called "mommy makeover."
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00:05I need no introduction but if it's okay with you all I'm just going to give a little bit of
00:09bio on everybody and then I'm going to ask everybody their own question so you have your own time to
00:14answer and you don't cheat you know okay well Dr. Aziza Day is the director of the Center of Advanced
00:23Facial Plastic Surgery and the clinical chief this is going to scare me can we say this one together
00:30next surgery okay next surgery thank you sir at thank you for giving me that one at Cedars-Sinai and
00:40he is globally recognized by his peers and patients as the foremost expert in facial plastic surgery specializing in deep
00:47plane facelifts facial reanimation which is the most fascinating thing ever and rhinoplasty you can clap that's pretty impressive
00:59and actually to make it less awkward I'm going to go ahead and ask your question and then I'll read
01:03everybody's bio before I do that
01:05so five years ago I don't think the average person knew that there were even different types of facelifts out
01:13there and now I think a lot of people do
01:15and being that you are the OG of deep plane facelifts how often do you find yourself correcting a deep
01:24plane facelift or are you mostly using deep plane facelift techniques to correct prior work
01:30and as a leader in expert facial reanimation surgery how often do you use those techniques in revisit revision surgery
01:40for plate for facelifts sorry that was a lot
01:43and I wrote that and I wrote that all by my little self so you did a great job thank
01:47you so great job thank you it's really an honor being here
01:51so uh I appreciate it we're usually talking at academic environments like lecturing to our I don't give you
01:58academia vibes like super cool okay super cool so obviously I think facelifts are having their moments
02:05uh over the past couple years we're seeing it all over the place there's some confusion about techniques and so
02:12forth
02:12and um just like anything else in medicine sometimes surgeries performed results are outstanding
02:20patients are happy and they go on their way nothing's permanent but you know for the most part facelifts
02:27um do have a very significant longevity compared to some of the other things that we do and a lot
02:35of times
02:35patients have had surgery 10 15 years ago facelifts and they're coming back for another what we call
02:43secondary facelifts they're happy they were happy they want to have another one um but occasionally I think
02:51regardless of the technique used and it could be a smaz facelift which is a technique that uses um kind
02:58of
02:58pulls the tissue planes whereas a deep plane facelift repositions the tissue planes regardless of what
03:06technique sometimes patients are not happy with the results they look done or they don't look like
03:11themselves or they've had a complication related to it to their nerves and so forth those are definitely
03:19much more complicated both psychosocially emotionally because they thought they were going to go have a
03:24facelift and they're going to have this great result and all of a sudden they didn't get what they want
03:29and so they're emotionally traumatized and physically they're not happy so those procedures tend to be a
03:37little bit more complicated from a variety of different factors and yes I like generally to use deep
03:44plain facelift techniques to correct those because it gives us better opportunities to correct let's say
03:51someone doesn't like their appearance their the way their shape of their faces maybe the appearance isn't
03:57what they were looking for it gives us better techniques and opportunities to correct those it doesn't mean
04:03that's the only thing they will need sometimes we use other techniques like fat grafting or lasers or
04:10you know work in the deeper neck in their in their glands to kind of make the appearance better so
04:16deep plain facelift is only as good as the surgeon performing it and that is very very important to know
04:24do you find that most people because deep plain facelifts are very much in the jargon now people just
04:32come in and say this is what I want and you have to assess if that's actually what is necessary
04:37I mean my
04:38patients generally come seeking I guess my advice for what they should do that's that's a good start
04:44it's a good start um and you know but when you do mention that you know deep plain technique is
04:52the way
04:53that I'm going to approach it they're like oh yeah I've heard about that and there are times that
04:57patients come and say oh my god I only want a deep plain facelift technique and that's really probably
05:02not the best way to go in it's better to go in find the trusted doctor for any treatment by
05:09the way
05:09any aesthetic treatment find a doctor that you feel like you can trust trust their judgment and together
05:15come up with a game plan that's appropriate for your goals and their skill set great thank you
05:23fascinating um we have Dr. Darren Smith all the way from Manhattan here today he is yes got some
05:31New Yorkers in the house he is a fellow of the American College of Surgeons a designation award to
05:37surgeons meeting rigorous standards of education and ethical practice Dr. Smith operates his private
05:43practice in the Ritz Tower of Manhattan which feels very fancy and specializes in everything from high
05:49precision facial rejuvenation to body contouring and expert breast augmentation so give a round of applause
05:55for Dr. Smith you have been coined the master of the mommy makeover which I have a seven month old
06:05so I would
06:05like your cellular telephone number which can include liposuction this is what I tell my wife liposuction
06:13tummy tuck fat transfer breast augmentation and more that's what I'll be needing with so many
06:18mothers looking to quickly get back to pre-baby body many are rushing to book these makeovers
06:25what would you say you are correcting and revising the most when it comes to mommy makeovers and what
06:31do you wish women did to prep for these surgeries to avoid revisions first of all thank you so much
06:38for
06:38having me it's really an honor to be here great questions and I think that I'll answer the second
06:44question first which is when you're kind of prepping for these procedures they're a big deal
06:49and you really need to be ready you know from all kind of facets of life from you're not going
06:56to be
06:56at work for a little while you need child care you need to make sure everything is kind of set
07:00to go
07:01and once you've kind of done everything that you can actually control it's really important to do your
07:07research to have the best possible grasp in deciding things that you can't necessarily control meaning
07:12once you decide to have surgery you know ultimately you're going to trust your surgeon's judgment so
07:18you have to make sure that you're selecting a surgeon who is truly expert in what they're doing
07:24and with whom you have a good rapport and there could be a fan technically fantastic surgeon who you just
07:31don't kind of jive with for whatever reason and that's why you know it's really important to kind of
07:36meet a bunch of surgeons and really do your homework and I think maybe the two core things that I
07:43would
07:43say everybody should look for is when you're selecting a mommy makeover surgeon is someone who's board
07:48certified by the American Board of Plastic Surgery that's the only board recognized by the American
07:54Board of Medical Specialties for people that do mommy makeovers and then the other thing that can be
08:00very useful is to look at just the broad internet footprint right because there are so many sources
08:11of information and misinformation that I think it's really important to kind of take everything into
08:17account and not everybody has the benefit of having a friend or a physician who says hey go to so
08:24and so
08:24and that certainly is great when you can have that first level data but if you can't and you are
08:29going to
08:29go to the internet it's really important to kind of look at the whole variety of sources yeah in terms
08:35of what I'm kind of correcting most frequently I think that a lot of people are maybe inappropriately
08:46counseled towards less of a procedure than they really need to get the results they want in an effort
08:54for a surgeon to say book a procedure right so if a woman comes in and wants to you know
09:01restore her
09:02abdomen for example to its pre-pregnancy status it's especially for a surgeon starting out looking to
09:08build volume it's much easier and more palatable for a patient to say okay you can just have some
09:14liposuction and you'll do great I mean that you can really create a disaster that way because
09:19relatively speaking disaster right but you can have a lot of skin laxity that is not addressed
09:26and you can make someone look a lot worse than better and the kind of underlying kind of structural
09:31issue with the postpartum abdomen is the separation of the rectus abdominus muscles the six-pack muscles
09:39or the rectus diastasis which is when the two vertical muscles separate in the midline to make room for an
09:45expanding uterus and pregnancy they don't go back afterwards and liposuction I can confirm that
09:54and liposuction that is true right dr. Smith and liposuction won't touch it and in fact if you do
09:59liposuction without correcting it you can make it more obvious so what I find myself doing is an
10:04abdominoplasty a lot of the time in people that have had liposuction that should have had an
10:08abdominoplasty in the first place but I guess it's difficult to educate that is less well known
10:15you know what I mean so I think that's what you know really percent and so people are thinking
10:20they're just going in for all of the things I listed but I'm like oh my taking it off um
10:26but
10:27that is you know is the recovery for that surgery much longer than just liposuction it is so I mean
10:35my liposuction patients can generally get back to the office in 48 hours uh yeah it's pretty cool
10:41long weekend yeah exactly exactly yeah memorial day hey yeah okay um but abdominoplasty is a bigger
10:51deal right and a lot of my patients are busy executives and what I tell them is they can
10:55kind of be on a zoom from home in about a week and they'll be comfortable in the office in
11:00most cases
11:00in two weeks uh but we've actually even in the past year have had access to some technologies that
11:06have made recovery a lot more comfortable and faster than it has been in the past so wow that's
11:11fascinating obviously I didn't have any personal you know questions in there so thank you so much
11:17well we also have Dr. Sarmela Sunder here today who I'm so excited to meet in person I was all
11:24I'm
11:24obviously a fan of all of you but I you know can't but I'm number one you're number one
11:29I mean girl look at you I mean hello um you have dedicated over 13 years studying the face and
11:36neck
11:37specializing in advanced techniques for optimal results for mid-face lifts which I'm interested
11:42about face lifts neck lifts eye lifts and rhinoplasty Dr. Sunder's I mean your resume is beyond it's
11:51beyond impressive you've studied at John Hopkins University you continued your medical education
11:55at Cornell there was Stanford and I mean it's goes on it's three of these it's out of control
12:01um and you uh are here in Beverly Hills uh with your private practice uh I want to talk about
12:09something that I feel like again is also really talked about on the internet and that is upper
12:13bluffs and I think you know you see it all over TikTok you see it all over Instagram especially with
12:19younger women um and it feels like a nice toe dip into facial plastic surgery uh especially from a
12:28recovery standpoint price point etc um however we've seen a few famous men get some pretty questionable
12:36upper bluffs recently I don't know who that is that I don't know I just wrote the question uh
12:43is revision but truly I'd like to know is revision possible for an upper bluff because it seems like
12:51such a small area obviously of fat um and a sensitive area as it's your eyes and so how would
12:59you approach
13:00that and then also what can people do to avoid some a questionable upper bluff yeah well thank you for
13:05having me first of all it's a great question I think the way to avoid that first of all is
13:13to
13:13seek out someone not just someone that's experienced and has expertise in um plastic surgery of the eye
13:22so that could be an oculoplastic surgeon a facial plastic surgeon a general plastic surgeon with special
13:27attention to the eye but also someone that understands the nuances of um ethnic variation
13:36gender variation I think that's where a lot of these mishaps have happened where
13:42these masculine faces have ended up looking feminized because when I was training there was
13:48just one maybe two ways of doing an upper blepharoplasty and it was usually on a female face and so
13:58if
13:58you're just going to try to copy and paste that on every single patient that's when you run into trouble
14:03so I think obviously technique is important but understanding these nuances and even in a female
14:10face there are very noticeable ethnic variations so a south asian eyelid and even within a south
14:19asian eyelid there are multiple variations is different than an east asian eyelid which is
14:23different than a nordic eyelid versus a general northern european eyelid so you really need to find
14:31someone that understands that and also wants to look at photos of what you look like previously
14:40and then has a realistic conversation with you about what your results are going to look like
14:45so oftentimes and I think with some of these these uh masculine uh lids that now look feminine but also
14:54in some female celebrities where we've seen where they've naturally have a hooded lid have always had
15:03a hooded lid even when they were teenagers and you have someone that turns that into a non hooded lid
15:10and traditional teaching is you want to take out as much skin you want to be aggressive you want to
15:16remove
15:16fat you want to remove muscle that's great in someone that's never had a hooded lid but develops hooding
15:23due to aging that's a great result but in someone like me I've I've had a hooded lid since I
15:29was 10
15:30if you go in and remove excess skin I'm going to look like someone else yeah and so the end
15:36result might be
15:37fine but as a patient that wouldn't sit right with me you know um and I I tell this to
15:44patients all the
15:44time I do a ton of facelifts a ton of necklifts but the eyes millimeters can make a huge difference
15:52you can make this the smallest difference in someone's eyelid surgery and everyone will notice
15:58you can have the most dramatic lower face and neck lift and people will be like oh you look refreshed
16:03but when you do your eyes people really notice so I think you just have to pay you need to
16:09find
16:10someone that can pay particular attention to these subtleties yeah that's great because I think you're
16:16right the eyes they're the window into the soul but they once somebody does adjust their eyes in any way
16:22I think it's a clear indication that something has happened and I can't imagine how much rigor and
16:28studying how to manipulate the eyes to make them refresh but keep them the same has I mean that
16:34seems bonkers and the second part of your question about the revision yes it's possible to revise but
16:42it will never be a hundred percent so you can improve on it but you are so much better off
16:50finding the right
16:51surgeon the first time around so you know a lot of times the difference is financial a lot of people
16:57say oh so and so can do it for this much less I'm going to go to them or so
17:03and so can do it
17:05you know without all the pre-op work I'm going to go to them but this is it's your face
17:12right and it's
17:13so windows to your soul so you really want to invest that extra in having quality work the first time
17:20around because it's always more challenging to revise it sure I also think that this is where
17:28exactly piggybacking surgeons can be technically gifted but their aesthetic eye no pun intended can
17:36be very different than what you're looking for so you have to make sure that not only are they
17:42amazing on social media amazing surgeons and so forth and safe but their aesthetic eye the way
17:50they're looking at the face eyes are the same as your goals the second thing I think with eyes
17:58especially is a lot of people think about skin hooding but it's not just that it's the volume
18:04as well as the position of the brows that are really important so if the brows are a millimeter or
18:09two
18:10elevated sometimes like in men I don't love brow lifts because it really changes the the entire appearance and
18:18I actually like very very nice and hooded brows because much more masculine
18:25and then you lift the brows you start seeing the you know bony ridges and you're getting a lot of
18:32opening of the upper eyelid crease then you start looking so the volume
18:37as well as the position of the brows are also really really important with eyes
18:42as well that that gives me a lot to think about
18:49thank you all so much for being here today thank you thank you
18:53thank you
18:55you
18:55you
18:55you
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