Mastering Beauty features wisdom and inspiration from highly regarded doctors of aesthetic medicine who are uniquely introduced in both personal and professional contexts. Of the 15 contributing doctors, three have been elected to the esteemed American Society for Aesthetic Plastic Surgery’s office of president. The doctors represent a diverse geography, from Honolulu to New York City, Vancouver to Florida. Beautiful environmental portraits capture the doctors doing what they love most—practicing medicine, spending time with their families, and engaging in leisure activities. Profiles present the doctors’ backgrounds and philosophies, while additional chapters highlight their opinions on important topics, like how to choose a doctor; the benefits and drawbacks of surgical and nonsurgical procedures; and tips for staying youthful. Readers will especially enjoy recommendations and cautionary tales regarding popular procedures, and a section devoted to outrageous requests. Intended for readers with varying levels of knowledge on the subject, Mastering Beauty has plenty of inspiration for navigating the ever-changing world of cosmetic medicine.
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About the Author
Beth Benton Buckley has conceptualized, designed, and curated dozens of titles in myriad subjects including: architecture, celebrity event design, hospitality, interior design, travel, and wineries. She is the author of I Do… Destination Florida and Love Is Love. She lives in Delray Beach, Florida.
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DR. ASHLEY GORDON
IN THE COURSE OF ASHLEY GORDON'S INTERNATIONAL food and wine experiences, she has realized that "great chefs and winemakers are cut from the same cloth as plastic surgeons. They're creative, technical, intense, meticulous, uncompromising, and relentless in their pursuit of delivering a great dish or vintage." Ashley aims to embody all of those characteristics through her pursuit of natural, beautiful results for her patients. "The best chefs and winemakers would never bastardize the ingredient or the grape by making it something that it's not; they elevate it and let it shine." So, too, does Ashley. She strives to enhance what's there without changing what makes it unique and special.
For Ashley, being able to carry out a variety of surgical procedures with exacting precision, fabulous results, and delighted patients isn't enough. As a perfectionist, she's always on the lookout for a better way — a more effective method to speed up the healing process, improve comfort before and after the procedure, minimize scar tissue, and maximize quality of care. She and her staff care about their patients' feelings as much as achieving the looks they desire. They ask questions and take the time to listen as patients share the depths of their experiences. When the team learned that most patients cite drains as the number one complaint in tummy tuck recovery, Ashley delved into the problem at hand — even though many in her industry didn't even acknowledge the problem, much less desire to change the long-held protocols — and discovered a way to avoid drains altogether in most cases. She turned an unthinkable idea into a best practice by listening and being emotionally invested enough to re-envision the possibilities.
GREAT CHEFS AND WINEMAKERS ARE CUT FROM THE SAME CLOTH AS PLASTIC SURGEONS.
Ashley cares deeply about how her patients feel throughout the process. She openly shares her experience of undergoing breast augmentation surgery many years ago. Her surgery did not go according to plan and the immediate results were not as she'd dreamed, so she was eager for a revision. Her healing process took longer than most, yet in the end she is very pleased. She is grateful for the uncomfortable experience and intense trust exercise that she had with her surgeon because it has made her a better doctor. Ashley knows what it's like to prepare for and recover from surgery, and she's all too familiar with the process of getting comfortable with the look and feel of larger breasts. She has empathy for what it's like to wonder, question, anticipate, heal, and keep wondering when the results will settle into their long-term look.
The wish list of travel destinations is so long that Ashley and her husband rarely repeat a trip, the exception being the famed Amalfi Coast, where they exchanged vows. Amazing food and wine are at the center of Ashley's world travels — she always confirms her dinner reservations before booking flights and hotels. But even though she has been to more than half of the listed "World's 50 Best Restaurants," she also enjoys experiencing local eateries and even street vendors. Ashley believes that food is one of the most universal and fundamental connections we have to each other and the world and appreciates how a fabulous meal with loved ones can create a lasting memory.
NOT SURPRISINGLY, ASHLEY IS extremely forthcoming with her patients about everything. In the case of breast augmentation, she and her patients work together to determine an ideal size and shape, yet everyone is aware that during surgery Ashley will do whatever she needs to do to achieve the best look possible. Figuring out the best placement and size, not to mention how the existing breast tissue will support the implants long term, can only be perfected once surgery is underway. A good portion of Ashley's patients come to her needing complex revisions after other doctors have performed breast augmentations, lifts, and reductions. These patients in particular appreciate the breadth of her experiences — personal and professional — and her thoughtful yet candid approach to medicine. Because of Ashley's policy of openness and honesty, she is uniquely able to take on the dual role of respected doctor and trusted girlfriend. Patients know that she'd never suggest something that she wouldn't choose for herself.
While breast enhancement procedures have undoubtedly become her specialty, Ashley is well-versed in a variety of procedures. Whether enhancing the face, the body, or something in between, she focuses on identifying the patient's best features and accentuating them. Certainly, she appreciates traditionally held philosophies on beauty, though she fully recognizes that perfect symmetry isn't for everyone. Sometimes slight asymmetry gives a patient's face interest, really great shadows, and the kind of depth that somehow conveys his or her personality; Ashley loves telling these lucky patients that they are beautiful just the way they are — and coming from a surgeon, it's high praise indeed. Many doctors take an additive approach — fillers, implants, makeup — yet Ashley likes to look at the full picture and employ a less-is-more philosophy. "When cosmetic surgery and even noninvasive procedures are done right," she says, "everyone will notice, yet no one will know."
ASHLEY IN HER ELEMENT
A breast cancer reconstruction was part of Ashley's first rotation in general surgery. She'll never forget the awe-filled realization that she had just participated in the process of removing cancer and reconstructing a new breast with the patient's own tissue so she'd never have to wake up with a feeling of loss. Another inspiring time in her career was telling a prospective patient that having a facelift while going through a divorce was a bad idea; Ashley's advice empowered the woman to find herself before changing herself.
SURGICAL OR NONINVASIVE
"Surgery and noninvasive procedures all have their place in the cosmetic surgery/medicine armamentarium."
HOW DO YOU KNOW WHEN A NONINVASIVE SOLUTION IS THE BEST CHOICE FOR YOUR PATIENT?
Clyde Ishii: Noninvasive treatments may be the best choice in the following situations: the patient has limited concerns and just wants a simple quick fix; the patient is on the younger side and is just starting to show the early signs of aging; the patient never wants to have cosmetic surgery but is open to noninvasive modalities; or the patient is a candidate for cosmetic surgery but is not ready to proceed from an emotional, financial, or scheduling standpoint.
Ashley Gordon: When the patient's tissues fit the criteria for a noninvasive treatment and the surgeon has the skill and technology to deliver a predictable, awesome result. Almost all patients would prefer a noninvasive option, but many are not great candidates. It's our responsibility to educate them on why they are or aren't and to be honest about how many noninvasive treatments they may need to even come close to a surgical result. For example, with some treatments, the cost and the downtime is actually less for a surgical procedure than it would be for five noninvasive treatments claiming only a few days of downtime for each treatment. I've seen this time and time again with neck injections to dissolve fat versus submental liposuction, or fat freezing versus liposuction.
Richard Warren: Every surgical and nonsurgical intervention has its own specific indication. To give proper advice, plastic surgeons need a complete understanding about what the various surgical and nonsurgical interventions are and what they can do. In the end, it is really a matter of a surgeon taking the time to listen to a patient and formulate an appropriate treatment plan. If the best solution is nonsurgical, then that is what should be recommended.
Charles Thorne: Since surgeons do both invasive and noninvasive procedures, my bias is that surgeons are best equipped to make that judgment. If you only do noninvasive procedures then that's what you'll recommend. If you have a hammer, the whole world looks like a nail.
Armando Soto: This requires understanding both the anatomical changes that are causing the patient's concern and the desired outcome. Sometimes these decisions can be quite challenging, because patients will — at the time of their consultation — minimize their goals, hoping to undergo a more minor procedure with reduced cost, recovery, and scarring. If I'm not careful to fully understand their dreams for their appearance, they may end up disappointed with their outcome. When there seems to be a good fit and harmony between the degree of improvement I know is possible through a noninvasive procedure and what the patient is hoping to achieve, I will discuss these options with them. I always emphasize that, even in 2018, the smaller the intervention, the more subtle the improvement will usually be.
ETHICALLY, SHOULD ALL SURGEONS OFFER NONINVASIVE PROCEDURES?
Armando Soto: I think the important question is really a bit broader than this. I think that all ethical providers of aesthetic care should be able to offer a patient multiple options for the management of their problem, or have a referral relationship with someone who can.
Ashley Gordon: No. Surgeons should only offer services and procedures they truly believe in and are trained to perform. Many jump on the noninvasive bandwagon because patients are attracted to noninvasive options and because ancillary staff can perform many noninvasive procedures. Some unethical surgeons are drawn to these technologies because they are so-called moneymakers in the practice. If you are going to offer noninvasive procedures, you must have a passion for technology, be willing to spend a lot of time educating yourself on what devices actually work and why, and have a commitment to delivering predictable and great results.
Richard Warren: In the same way that most surgeons do not offer all the possible cosmetic operations, I don't think surgeons should necessarily offer all the noninvasive procedures. They may offer some of the noninvasive procedures, and they certainly need to understand what all these techniques can do so they can refer patients to the appropriate person who does them. In this era, very few doctors will have every laser, every skin-tightening machine, and every possible injectable, so interprofessional referral is common and expected.
Clyde Ishii: Surgeons should offer noninvasive treatments only if the patient is likely to have a satisfactory result. In patients with advanced facial aging, surgery is the better option because noninvasive procedures are not likely to make a significant difference. Patients must be counseled up front so they don't spend a lot of money on noninvasive procedures only to need cosmetic surgery when the noninvasive procedures fall short.
Charles Thorne: No. Of course not. But if they think a patient is best treated with a noninvasive procedure, they should recommend that the patient see someone who offers those treatments.
HOW CAN PATIENTS CONSIDERING SURGERY PLAN FOR A POSITIVE EXPERIENCE?
Armando Soto: Often, patients are quite committed to a procedure that their extensive internet research has led them to believe is going to make them happy, even though (after an examination and consultation) I know the procedure they are asking me for is going to make them look funny or strange. They already know the operation they want — they just need to find someone to do it for them — and they have made this determination without an adequate understanding of how their starting anatomy and their desired appearance will affect the procedure chosen. This is a little like choosing a road out of town because you've read it's a smooth road with little traffic, but without consideration for whether or not it will take you where you want to go! The most important thing when planning your plastic surgery — other than choosing the best surgeon for you — is understanding that you should choose your experience and your outcome. I say it often: the most important three factors are not related to costs, scars, or recovery, although these are obviously very important. The most important three factors are: who will be your surgeon; what experience you are likely to have in their practice; what is the outcome you are likely to achieve in their hands. If you choose the first properly, the other two will often follow; it is important to realize that having a good experience and the appearance you desired trump everything else.
Jim Grotting: Patients contemplating surgery should have a fully developed idea of what changes they think will make them happier with their appearance. Consultation with an expert will help guide them in their decision-making. Plastic surgeons should help educate and offer options. Not everyone wants to have all possible procedures to maximally move themselves in the direction of the ideal. Communication is the key to help patients feel fully informed and confident that they will have a positive experience.
WHAT IMPORTANT QUESTIONS SHOULD PATIENTS ASK IN A CONSULTATION?
Robyn Siperstein-Paul: Ask if the doctor understands what your goals are and have him or her repeat these to you. To ensure your expectations will be met, it is also imperative that you ask if the doctor believes the procedure will make you more attractive, more youthful, or both. I would also recommend asking if the doctor believes a particular procedure is the best course of action to achieve your desired results, or if there are other procedures the doctor recommends. Your expectations of the outcome and possible side effects as well as potential downtime that might be required post-procedure should be discussed candidly.
HOW MANY PROCEDURES CAN BE PERFORMED SAFELY DURING ONE SESSION, AND WHICH ARE THE MOST COMPLEMENTARY?
Charles Thorne: Impossible to answer. There are some patients whose facelift takes 90 minutes and can be combined with several other procedures. There are other patients whose facelift will take four hours, which places a greater limitation on the concomitant procedures.
Richard Warren: The number of surgeries than can be done at once depends completely on the magnitude and nature of the procedures involved. Sometimes two operations cannot be done at the same time because one of them will interfere with the other. One example in my practice of noncomplementary procedures would be a rhinoplasty requiring nasal bone fracturing and lower eyelid surgery with orbital fat transposition. However, many operations are complementary, especially when they are done in the same anatomic zone. An example of a common complementary surgery is facial rejuvenation involving brow surgery, eyelid surgery, and a facelift. Other examples would be breast augmentation in conjunction with mastopexy. Perhaps the most common reason to avoid multiple surgeries in one session is the time involved. Excess surgical duration can be hard on a patient and may be associated with an increase in postoperative complications, such as infection and deep vein thrombosis.
Clyde Ishii: There is no specific limit on the number of procedures that can be performed safely in one sitting. Instead, the surgeon must think in terms of the physiologic burden or trauma from multiple procedures, and this must be balanced against the patient's preoperative health status. A patient with multiple significant medical problems is not a candidate for cosmetic surgery. On the other hand, a healthy younger patient has a deeper physiologic reserve and can usually tolerate multiple procedures without difficulty if the surgeon takes into account operative time, blood loss, and other variables that affect recovery.
Armando Soto: This would really depend on the details of the patient's needs and the surgeon she chooses, in the sense that an operation that might take one surgeon three hours takes another four or five. The data shows that the risks of elective surgery really start to climb after about six hours, so the limit I hold myself to is procedures that I believe will take me about five hours, in order to have a bit of a safety cushion. If I know I can complete the combination of procedures in less than five hours — also taking into consideration the health of my patient — I'll say yes. If it's likely to take longer than five hours, I will explain that it is probably best to divide the procedures into two operations. As far as which are most complementary, this would depend highly on the details of my patient's anatomy and goals. Generally, "mommy makeover" procedures are amazingly positive transformations because the breast and tummy areas are the most affected by changes frequently experienced by women due to pregnancy and childbirth, and because they are on the same aspect of the body.(Continues…)
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Table of Contents
DR. CHARLES THORNE,
DR. ASHLEY GORDON,
DR. JAMES GROTTING,
DR. CLYDE ISHII,
DR. JOHN KOUTSOYIANNIS,
DR. CHARLES LEE,
DR. SHEILA NAZARIAN,
DR. ANNA PETROPOULOS,
DR. TRACY PFEIFER,
DR. MARTA RENDON,
DR. ADAM RUBINSTEIN,
DR. ROBYN SIPERSTEIN-PAUL,
DR. ARMANDO SOTO,
DR. JENNIFER WALDEN,
DR. RICHARD WARREN,
SURGICAL OR NONINVASIVE,
THE DISTANT FUTURE,