What is discussed in a cosmetic consultation with Dr. Ginsburg?
We all know when someone is beautiful, but rarely do we analyze “why”. One of my main responsibilities during a cosmetic consultation is knowing what would make someone look more attractive. What makes someone look older and what can I improve in a safe and predictable way? Although almost nothing in life is 100% predictable, my reputation as a cosmetic surgeon is based on my ability to deliver what I promise in a high percentage of the cases.
I think that most people would agree that the face pictured to the right is youthful and attractive. The features are outlined in the picture. Another aspect of beauty and attractiveness is what makes a face look masculine or feminine. The picture below shows a male patient on the left and a female picture on the right with similar looks.
- A male has a square broad chin while a female has a more pointed chin. There is more fullness on the lateral mandible.
- The male eyebrow is lower over the orbital bone and is flatter, and less raised over the lateral brow.
- The male hairline is flatter; the female hairline is more rounded.
- A Male’s ears show more from the front because their cheeks are less full laterally.
- a Male noses are generally broader at the base and tip. The female nose is more petite.
Being more masculine will not necessarily make a man more attractive, and many studies have shown that a more feminine face can actually improve a man’s appearance.
Cosmetic Consultation with Dr. Ginsburg
A cosmetic consultation begins with asking a patient what they would like to change or improve. What bothers them most? Many patients ask me what they need. I cannot answer that question because cosmetic enhancement is not a need. They ask “Do I need to fix my frown line?” or “Do I need to tighten the skin on my neck?” My answer is simply that if it is bothersome enough, then you need to get it fixed.
Sometimes my consultation is simply having a patient look in a mirror, and then I will go over what treatments I can do to change various features, or to change aspects of their appearance that bothers a person. Sometimes patients come in with a specific issue, and I address the options in improving their problem.
Types of Cosmetic Enhancements
When someone considers cosmetic improvement, the overriding factor that directs me is cost and down time. If someone has a very limited budget, it will narrow what can be done. If someone cannot take any down time, then that also limits their options.
First it must be decided whether we are going to try to rebuild the foundation if necessary, by injecting deeply. This will restore the youthfulness of the face, However, sometimes I just treat the superficial wrinkles. Restoring the fullness as is described in the photo above is obviously the preferred way to begin, but the initial cost may be greater. Just treating the wrinkles will greatly improve one’s appearance, but the results will not be as dramatic and not as long lasting. The analogy is if you have a leaky roof that is causing damage to your carpet you can repair the carpet, but the more permanent solution would be to patch the roof first, then repair the damage. You will save money in the long run.
The most recent advances in cosmetic enhancement involve procedures that require little or no downtime. To accomplish this, I utilize cosmetic fillers and Botox, botulism toxin. I will help you decide which filler is most suited to give you the results you desire.
Facelift or cosmetic fillers
Facelifts, laser resurfacing, and deep chemical peels are much less popular today than they were twenty years ago. The use of cosmetic fillers to restore youthful volume and contour has become the latest trend in today’s modern esthetic world. The fillers that are available today consist of synthetic particles or hyaluronic acid. Some fillers also restore volume by stimulating collagen production.
The position of the chin; relative to the lips and nose is also very important. A line drawn from the chin through the upper lip should gently touch the junction of the nose and the lip on the lateral view. If your chin is “weak”, (meaning the line will go through the tip of the nose or not even touch the nose), the chin can be augmented by fillers injected on to the chin bone. (See photo above). If the chin protrudes too much, then surgical intervention would be necessary to correct the chin or nose.
After the foundation has been restored or if the decision is made to only treat the superficial lines, there are a number of options. The superficial fillers are injected into the expression lines or wrinkles directly. Their longevity depends on the characteristics of the filler and the amount of movement of the line it is injected into. The effect will not last as long in dynamic lines, (the lines that are caused by muscle movement), like the nasolabial fold.
Treating expression lines with Botox
A more appropriate treatment for expression lines is botulism toxin in the form of Dysport and Botox. Expression lines are caused by muscle contraction, and when paralyzed, the lines can no longer form. The muscles that form the frown lines serve no other important purpose, so paralyzing them will have no affect on function. An injection of toxin will paralyze these muscles for several months. Botulism toxin can also be safely used for forehead lines and crow’s feet. It cannot be used as often in the lower face because these muscles are also used in chewing and closing the mouth. These treatments are very safe as the amount of toxin injected is much less than the amount that can cause systemic
Facial proportions and symmetry
A very important factor in facial beauty is symmetry. Most people are asymmetrical, but they do not realize this until they are analyzed. One side of the lip may be different than the other, one cheek bone may be fuller, and the nasolabial folds may be deeper. If I did a computer comparison of a face and compared two right sides of the face with two lefts, the resulting pictures would look similar, but not identical.
The picture in the center is the original. The picture on the right is reproduced from 2 left sides and the picture on the right is produced from two left sides. When I analyze a face I try to find the asymmetry and correct if when possible. Often, filler injected to make one cheek fuller, will improve one’s looks by making them more symmetrical.
Another aspect of facial beauty is based on proportions. It is called PHI, the golden dimension and I will refer you to their website for a full discussion (www.goldennumber.net/index.htm ). The golden number is 1.618 to one. PHI appears throughout life and the universe. The appearance of PHI in all we see creates a sense of balance, harmony and beauty in all we find in nature.
When looking at facial proportions I use the distance between the inner canthus as my starting point as this is the only measurement that does not change with age.
Treating facial disproportions with cosmetic fillers
When I inject fillers I try to correct the disproportions often using the PHI concept. A few examples of facial proportions are:
- The high of the head is 1.68 times the width, with the eyes in the center of the height and width
- The distance between the inner canthus of the eye is the same as the distance between the outer nostrils.
- The distance from the center of the nose to the highest point of the cheek bone is 1.68 times the distance between the eyes (inner canthus)
- The face is divided in thirds: forehead, mid pupil to upper lip and upper lip to bottom of chin.
- The distance between the inner canthus is the same as the distance from the inner canthus and the highest lateral point of the eye brow.
- The distance from the pupil to the far side of the nose is 1.68 times the width of the bridge of the nose
- The distance from the tip of the philtrum (highest point of the lip under the nostril forms lateral aspects of cupids bow) to the lateral lip is 1.68 times the distance between the philtrum.
There are many more examples in architecture and nature and I encourage you to explore this on their site. By appropriately adding volume or moving tissue with botulism toxin, we can give a face more attractive proportion.
Skin resurfacing and treatments
The final component of facial analysis is the skin surface. As we age, the color, texture and tone of our skin changes. These changes are due more to environment factors than aging. Smoking and sun damage cause wrinkles and give the skin a sallow appearance. To improve the skin surface I perform an array of treatments. The simplest treatment is a light chemical peel and the most advanced is fractional laser resurfacing. I recommend products such as retinoic acid to reverse sun damage and improve the appearance of wrinkles.
If you are interesting in learning more or scheduling a cosmetic consultation with Dr. Ginsburg, contact Ginsburg Dermatology in Birmingham.