Aesthetics or Aesthetics? Part V


Since more and more medical aesthetic offices open their doors, it becomes exceedingly difficult to choose the best one for your facial aesthetics. There are very few valid criteria one can rely on; on one hand we all hear about the disastrous results of non-qualified injections of fillers and Botox, DIY stories, products coming from suspicious  sources, a habitual dilution of products etc. On the other hand, we see all around us the disturbing results of “aesthetic” procedures coming from the offices of certified and licensed physicians.

So, how to make a decision? How to be sure that all that may be done is all that needs to be done and the results will be natural and enjoyable ?

First, and the crucial step, is a self-education. Define what bothers you the most and start with searching the options to correct it. Never say that everything in your face bothers you; you are setting yourself up for a quite expensive trip.

Read as much as you can about your problem, talk to your friends who are familiar with aesthetic services, identify possible steps in achieving your goal. Try to be prepared as well as you can before making an appointment.

One of the most popular websites is There, you will find plenty of information just about every procedure that is used in aesthetic medicine and plastic surgery. Although you will read frequently the self-serving comments of aesthetic physicians, this website will give you enough information to ask an informed question.

Remember that not everyone needs laser resurfacing, filler or Botox just because these are available and others do it.

Second, which aesthetic place to choose? Look for an independent review of local aesthetic offices such as comments on City Search or local forum.  Your friends, most likely, will serve as an excellent, if not the best resource. Talk to them about their experience and satisfaction with the results.

Remember, the Aesthetic Medicine is a business and you may expect the traditional selling practices. Ask your friends about these; if they feel pressed, scratch the place off your list.

The most important part in decision making is the choice of a doctor. And here too, your friends will help you by relating their experiences and impressions.

Make always sure that a doctor is on premises full time and actively involved in more invasive procedures. Many “medspas” have a “supervising” physician who is not always present. Avoid these for your safety.

If you are interested in Botox or filler injections ask who does them. If these procedures are not done by a physician but delegated to the staff members you may safely disregard that physician’s credentials and certifications since the results of these procedures dependent only on the skills of the injector. Doctor’s supervision in this situation is completely immaterial in your decision making process.

If an expensive procedure is offered, such as laser resurfacing, body contouring or skin “tightening”, ask if the doctor will be doing these. If not, consider the alternatives.

Many Aesthetic Medicine offices advertise their services emphasizing a particular specialty and certifications of the doctor. If the more invasive procedures are done by that doctor than the place should be on your list; if not, than you may logically dismiss the importance of that doctor’s credentials.

The best you can do is to educate yourself as much as you can. Never be afraid to say no to a proposed treatment plan if you are not sure.

Medical Aesthetics is exciting and incredibly creative part of medicine. It is not, however, a sublime brain surgery and I doubt it will ever be. It is not very difficult to understand the major procedures and their effectiveness. Ask always about the chances of having no visual improvement or pleasing results, especially if the proposed treatment is expensive.

Take your long-term skin care step by step; do not rush with decision regarding expensive procedures. If these are so good they will always be available; if not, than these were of no value  to begin with.

Most of the time there are less expensive alternatives.

Third, seek the initial consultation. It will give you a feel for the practice. Ask questions. Then ask more. Remember, it is your face and your money.

If Botox is considered always ask about number of units you are to receive. I am still amazed how few patients that have been using Botox for years know the dosage they were receiving!

Ask about the concentration of Botox. Botox comes as a powder; it needs to be reconstituted with sterile solution to make it injectable. If too much solution is used, Botox becomes more diluted and may easily diffuse beyond the injected area. With few exceptions this is never desirable.

If you are interested in a dermal filler make sure you clearily understand the recommended volume. One syringe of almost any available filler can go a long way. You can always add more later .

Always ask for Lidocaine to be mixed with your filler unless you are allergic to it. The vast majority of fillers in the US are not pre-mixed with lidocaine; mixing it takes a moment but provides you with much more comfortable experience.

Make sure you understand beforehand the aesthetic reason for filler injection in a given area. The filling of a fold is not a good enough reason; ask what it will accomplish aesthetically other than having a…filler in the fold. The most common injection site are so called naso-labial folds running from your nose toward the corner of your mouth. It happens that in the majority of cases injecting these folds will bring you a negligible aesthetic effect. However, if the same filler is injected in a more strategic place you may have the most spectacular and immediate aesthetic improvement.

The only objective decision any patient can make with the choice of facial aesthetic practitioner is through the experience of other patients and detailed research of what’s available. The most practical approach tells us that f you need an eyelid surgery you want a surgeon who not only specializes in a blepharoplasty but also has the best aesthetic results. That surgeon could be the worse choice for liposuction but if he is great with the eyelids I would definitely vote for him.

If there is a practitioner who is great with fillers and Botox and his patients have the best and consistent aesthetic results I wouldn’t care whether he is also able to interpret ECG, treat successfully psoriasis or is certified in organ transplantation. Why would I?

The most important of all is your gut feeling when talking to the doctor. There is nothing more comforting than the feeling of honesty and concern. You will do much better if you are being led through the smallest steps rather than forced to make a one big jump. Look for someone who does not use difficult to understand medical and technical terminology. This sad practice is still used to intimidate the patient and avoid any further questions. Do not agree to anything until you understand at least the basics of the proposed treatment.

Does it matter whether the Aesthetic Medicine physician who does the facial aesthetics is a Plastic Surgeon? Yes, if a surgical intervention is considered. One of my favorite Plastic Surgeon whose work we all see everyday on the screens has replaced a significant percentage of rhinoplasties – his hallmark- with non-surgical reshaping on the nose using noninvasive and creative combination of filler and Botox. So, even if a surgery is contemplated, ask for the alternatives and if these exist ask your doctor to help you decide.

Always look for a consistent and, above all, aesthetic outcome and the long term results rather than  for a number of certifications on the wall.

Overall, I agree with that French Plastic Surgeon I described in Part I. Those who create an assembly line of grotesque distortions should not be allowed to perform these procedures and the rest should be qualified based on the outcomes.

Of course, it will never happen that an aesthetic physician will have to be judged based on his/her aesthetic results. It is a shame since if the Aesthetic Medicine is truly a part of medicine, the results should be scrutinized and those with poor outcomes “reformed”.

The future, however, appears to be bright. There is a growing number of patients that begin to recognize the faults of the “old school” of aesthetics and overwhelmingly opt for the aesthetic results with less fillers, smaller breasts, no permanent implants and controlled effects of non-industrial doses of Botox.

Personally, I encourage all to look at the magazines, observe their friends, identify not only the obvious, man-made malformations but to attempt to recognize anything that is “non-aesthetic. These exercises fortify the awareness and make patients more prepared for their decisions in aesthetic treatments.

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