Wednesday, 29 January 2014

The frozen face

“Doctor, please don’t make me look as though I’ve been through a wind tunnel”

“My husband has no idea I’m here, and we’ll keep things that way please”

“My friends cannot ever know I have been to a (cough cough) cosmetic clinic”

How many versions of “I don’t want to walk out of here looking plastic” have we heard? Is it because of the Silvio Berlusconis and Joan Rivers of the world? If everybody looked like them, believe me I wouldn’t be so fearless either! ... And, I’d probably be on job-seekers allowance!

So, we are approaching an era when it will be soon considered socially unacceptable to join the in-laws at table with vertical frown line between the eyes. Linear facial souvenirs of times, aka wrinkles will be about as yesterday as greying hair. While it is common knowledge that hair pigment is not retained well into our fifties and sixties, and therefore chemically enhanced, modern society as a whole somehow decrees that age-defiant facial beauty should solely be the result of a naturally fabulous stress free life and a providential gene pool.

Like the hues of our tresses becoming more drab, short of wearing a bland expression for the rest of our days, lest the wrath of the wrinkle later wreaks its havoc upon us, facial ageing is largely unpreventable. Of course the rate of acceleration can be reduced and somewhat controlled. As gravity pitilessly and unceremoniously takes its toll allowing creases to mar previously supple skin and jowls to make their debut appearance on what used to be smooth jawline, some form of intervention is inevitable should the plum be stopped from morphing into a prune.

Yet how do we reassure our patients that we wont turn them into eerie-looking waxworks? Facial rejuvenation or enhancement does not necessarily translate into faces totally devoid of movement and a frozen expression. We unanimously agree that expression is a requisite of normal social interaction and I know no practitioner worth his salt who would be proud to claim ownership of Wildenstein-esque feline visage. We are well aware that such results would tarnish our hard-earned reputations!

A quandary I have often come across is with those patients who wax lyrical about how they absolutely depend on natural looking results, yet return for top-up after top-up until every hint of movement is well and truly abolished. Sometimes the explanation that trying to get your money’s worth of toxin is NOT a good idea and a forehead so smooth that it resembles a polished marble egg does nobody any favours, just doesn’t seem to penetrate.

There also exists a cohort of patients who purposely desire the exaggerated look, and too often onlookers will immediately blame the treating practitioner. This is especially so with regard to lip enhancement and augmentation. I must have heard at least fifty times “I’d never have my lips done, as it’s always so obvious”. What the public fails to realize is that some of our patients specifically request the eversion of a pout and the increase on volume of their lips to such an extent that they feel the unnatural “done” look is in fact attractive. This tends to be predominant in some cultures more than others. I’ve had many requests from Iranian ladies (who are reputed to be among the world’s most beautiful women) to raise the lateral part of the eyebrow as much as possible (and this they further augment with eyebrow pencil) and to boost the lip considerably. Just take a walk in Knightsbridge and observe the ladies from the Gulf, piecing together their facial work together with their hair, make-up and exquisite attire.

Freezing and filling used alone or in combination have infamously hit the headlines countless times, thanks to the likes of Leslie Ash’s trout pout, and Madonna’s commendable effort to popularize the pillow face a few years ago. Lower face and mid face volumization procedures are often the easiest routes to crossing the bridge over to “too much work”. To our advantage (as opposed to permanent surgical implants), we can employ dermal fillers incrementally, using both our eyes and the patients’ as a judgment of the results, which are immediate.

Another area notorious for betraying the evidence of our intervention is the crow’s feet. Poor Nicole Kidman epitomized the unsmiling eyes. With the eyes being the window to the soul and all that carry on, this is probably the most delicate area when wielding our toxin. This is definitely a case of less is more and while softening deeply etched lines is highly desirable, erasing all traces of movement results in a flat expression. The upper face not moving in accordance to the expression of the lower face is a dead giveaway, and all in all a procedure badly done.

Another telltale sign on an otherwise smooth forehead are those annoying lines which would have previously never bothered the patient prior to treatment, yet persist after the effects of the injected toxin are evident. I’m referring to the solo appearance of bunny lines and mephisto lines. It is often difficult to predict the exact dose of toxin and the exact reaction. Hence it is often a case of titration with necessary modification at the two-week follow-up. While most ladies laud the raised eyebrow, the Berlusconi-style permanently surprised look is to be avoided at all costs. It doesn’t suit anyone, not even him!

When it comes to treating our male patients, I found that it is only a very small group of them who are comfortable with being open about their attendance to our practices. Hence while the gentleman usually consumes more toxin for the same desired effect than his lady counterpart, aggressively reviving his youthful appearance will probably do him no favours in the long run. I find that with men I am especially cautious with the use of dermal fillers.

I am probably one of the most conservative aesthetic professionals around. However, this I believe goes a long way in preventing the “done” look. It is no advert if a patient walks out of my clinic, looking like she has just been there. Rather, the ideal look is a refreshed one, as though she has just spent a week at a spa! My advice to patients is to avoid the temptation to restore their faces to their original ravishing youthful looks in one session. Doing it in a stepwise fashion, that is every treatment separated by at least two weeks (to allow for any bruising or swelling to subside) often lets the patient to realize that all the treatments originally signed up for would have perhaps been a little much. It also generally isn’t a good idea to launch a major rejuvenation overhaul immediately before an upcoming cosmetically sensitive event, such as a wedding. It is wise to embark on such a mission at least 6 weeks beforehand.

A great result from any cosmetic intervention is largely dependent on the initial discussion. An aesthetic procedure is one that is taken to make the patient feel better about his or her outwardly appearance. So I guess it is pretty clear that we need to know what it is the patient is seeking to achieve, and in turn we need to be absolutely clear on what is realistically achievable! Any fears and concerns, the associated downtime, possible complications and possible contra-indications need to be addressed without ambiguity. As there is no such thing as a cosmetic emergency per se, if things are done unhurriedly and in a timely step-wise fashion, overstepping the mark is easier to avoid. The follow-up session is then the time to top up and perfect results, or add on procedures. The demand for noninvasive treatments that skip the scalpel and focus on replenishing youth to the face is skyrocketing internationally. The goal is to minimize wrinkles and restore facial volume without the patient needing to re-mortgage the house and with minimal recovery time.

It is not to our advantage that only the horror stories grace the tabloids. These over-the-top celebrities who as a result of cosmetic treatments could easily be passed off as Tupperware adverts, are the occasional result of one procedure too many, thwarted ideas of beauty, lack of insight and ill judgment on both sides (patient and doctor!) The best cosmetic interventions never make it to the headlines. This is because they result in natural looking fabulousness, through a thorough consultation and meticulous technical expertise.


  1. The practitioners who have taken proper botox course from professional aesthetic institute with hands-on experience can give natural results without creating a frozen expression.

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