I recently attended my favorite annual conference, The Masters of Aesthetics, in San Diego. I look forward to this symposium every year, as it is presented by the most influential and talented cosmetic dermatologists from around the country. These doctors are the some of the original innovators in the industry, hailing from leading institutions, such as Harvard and UCLA. This year’s conference was no exception. I came away with a better understanding of facial aging anatomy, the way in which our face ages, and multiple clinical pearls on how and where to intervene in this process.
There is one speaker, in particular, that I look forward to learning from each year. Her name is Rebecca Fitzgerald, M.D. She is truly an artist with an amazing eye for facial aesthetics. She spends her days studying the effects of aging on our appearance and uses these clues to determine her aesthetic “game plan” for correction. She began her presentation with an Albert Einstein quote:
“If I had an hour to solve a problem, I’d spend 55 minutes thinking about the problem and 5 minutes thinking about solutions.”
This is true in aesthetic medicine. When a patient comes to see me asking for my help, they often have an issue that is bothering them, like thinning lips or drooping eyelids, however, as a professional, I cannot stop there. I have to take a step back and assess the whole problem, not just the bits and pieces. I need to ask myself why the lips are appearing thinner or the eyelids appearing heavier? What is happening, holistically speaking, to create these issues? Ultimately, what patients are asking for is for me to help them look more youthful and attractive. If I were to simply plump their lips with dermal filler and raise their brow with Botox®, it might solve the problems they came in with but it might not make them look much better, overall.
By studying the facial anatomy and how it changes overtime, the patients face will dictate to me how and where correction is needed. For example, everyone has a ‘good side’ to their face, the side they prefer to show in photos. That side will appear plumper, more oval shaped, eyes wider with less under-eye hollowing, fewer lines and wrinkles, etc. For the majority of people in the United States, it’s their right side, simply due to sun damage from driving, but other factors can play a role as well, such as sleeping on a particular side, genetics, trauma, and surgical alterations. Take a look at your face, I am sure you can easily pick out which is your ‘best side’, but really take a minute to study your face to pinpoint the differences. What makes your best side, your best side? When I look at my patients facial anatomy, I take note of these asymmetries and use the ‘good’ side to determine how best to correct the ‘not-so-good’ side, creating symmetry.
I find this study of faces fascinating. I could look at faces all day. It’s like those magazine games where they show two, almost identical, photos and you have to find the various differences. There is a famous photographer named Martin Scholler who has taken some of the best photos of faces I’ve ever seen. He once did a study of twins, showing identical twin faces side-by-side. If you look closely at these identical faces, you’ll be able to see subtle differences. Typically one twin will be more attractive than the other. Ask yourself why.
Martin Scholler has also taken amazing photos of famous faces, such as Jack Nicholson and Julia Roberts. These are beautiful, intriguing faces, yet all of them have facial asymmetries, some more subtle than others (Jack Nicholson’s eyebrow is not-so-subtle). My favorite example is that of Angela Merkel, the Prime Minister of Germany. Take a look at her face, it’s definitely aging with some obvious asymmetries. Her right jowl is larger, right cheek is more deflated, the marionette line and under-eye hollows are deeper, and the brow is lower on that side.
These facial asymmetries offer me a road map on where and how to make my patients appear more youthful. One other interesting study was performed using 3D facial mapping using a Vectra® camera. The study was done by a physician named Val Lambros, M.D., and it shows, in amazing detail, how our face ages over time. You can see the images by going to his website at Vallambros.com. Using these tools has helped me to become a more astute aesthetic physician, to be able to recognize the exact processes that are taking place, which will lead me directly to the solution for correction.
At the end of the day, facial aesthetics is a blend of artistry and anatomy. Not only do I have the tools to treat my patients, such as lasers, Botox® and dermal fillers, I have worked diligently throughout my career to develop my eye for detecting the subtleties of facial aging. I feel honored to be part of this fascinating field of medicine and I am proud to say that, by continuing to educate myself and paying attention to the details, my skill set as a cosmetic physician is improving every day.