Making changes to one’s face is always a big consideration that requires a good deal of thought from surgeon selection to the final choice of operation(s). While there are lots of facial procedures to consider, they can be divided into those operations that treat aging changes (skin and soft tissue sagging) and those that can change structural shape of the face. (bone and cartilage)
From a psychological standpoint, these two facial procedure categories are not the same. Reversing aging changes of the face is about making one look younger…turning back the clock so to speak. Facelifts, blepharoplasties, and browlifts, for example, aim to return one to something that is familiar…a younger you. That is an easy decision to make for most. The desire to return to what once was is deep seated. The biggest fear in anti-aging surgery is that the operation may be overdone and look unnatural. (not like oneself)
Structural changes of the face, however, pose different psychological considerations. Rhinoplasty, facial implants, and any facial bone changes head one to something unfamiliar…a changed face and a new look. This can create much greater uncertainty because one doesn’t always know what to expect. While one may have a great desire to improve one’s appearance, there is always the trepidation that one won’t like it or it may not turn out well…and then forever be stuck with it. These concerns are magnified in that many of these procedures are often done in younger patients whose sense of self-image is less established and more fragile.
Structural facial changes are usually done in one or two areas at a time This is most commonly seen in rhinoplasty alone or rhinoplasty in combination with chin augmentation or other facial implants. Making a male’s face more masculine or defined often involves the trifecta of structural facial surgery… chin, cheek, and jaw angle implants. Derounding the face usually involves neck and buccal fat removal with a chin implant for women, men may get jaw angle implants as well.
In my Indianapolis plastic surgery practice, I have seen many patients over the years who have come to me because they were unhappy with the results of their structural facial surgery done elsewhere. In listening to their concerns, it has become clear that in some cases there was a fundamental misunderstanding or miscommunication about objectives. Sometimes it was the ‘wrong’ operation for their concerns. (e.g., treating submalar and lateral facial concavity with jaw angle implants) Other times, it was an operation that was over- or underdone. (e.g., too large a facial implant or a nose that didn’t have enough of a change) Most of the time, their operations were done well…but the patient’s aesthetic target was missed.
While no plastic surgery operation is an exact science, one’s objectives prior to surgery should be. The use of computer imaging is absolutely essential for structural facial surgery. This is a critical method of visual communication that often unravels the specifics of a patient’s objectives. Looking at combinations of procedures and amounts of changes can almost always avoid an unexpected outcome. While predictive computer imaging is not a guarantee of outcomes (I think of it as Photoshop plastic surgery), it does put the plastic surgeon and the patient at least closer oto the same ‘page’.
When considering any form of facial structural surgery, it behooves the patient and the plastic surgeon to meet either online or in person for several discussions. Computer imaging plays a vital role in setting the surgical plan and helping with postoperative expectations. The emotions and psychological implications that come with forever changing one’s facial appearance is a high stakes proposition that should not be taken lightly. This type of facial surgery is associated with much higher rates of patient dissatisfaction than with more commonly performed anti-aging facial surgery procedures.
Dr. Barry Eppley
Indianapolis, Indiana