Working with the face

FASHION NEWS № 5, October 2010

More and more often, a modern woman trusts the plastic surgeon her most valuable thing - her face.

The woman gets more and more convinced that the risk of taking this step has been entirely justified. Today's achievements of plastic surgery in the field of rejuvenation operations allow, let’s say if not miracles, then "to stop time" for a few years on the face of an individual. One of these Ukrainian "magicians" of Plastic Surgery Pavel Denishchuk, a member of the International Association of Plastic and Aesthetic Surgeons ISAPS, a member of the Ukrainian and All-Russian Association of Plastic Reconstructive and Aesthetic Surgeons.

In his clinic, "ANA-COSMO" he has managed to achieve quite impressive results of the fat face rejuvenation surgery and stabilization effect of the operation for many years. Hence, the worldwide medical community has become interested in his developments. And at the recently concluded 20-th Congress of Plastic and Aesthetic Surgeons ISAPS in San Francisco in August this year for the first time a report on this subject from a representative of the CIS countries was presented. By the way, Pavel Denishchuk was the first surgeon from Ukraine, who had the opportunity to make a speech at such a respectable international forum of Plastic Surgeons.

- Unfortunately, the problem of obesity in the world has moved to the edge of being a pandemic but not an epidemic. There are countries where obesity affects about 70% of people. Earlier in this list, the U.S. (about 66%) was the leader, now Mexico is on the first place. It is natural that every branch of medicine offers different methods of dealing with the disease according to its competence. So, plastic surgery is seeking appropriate techniques as well. I have been involved in this field for about 7 years and developed my own technique of working with patients who are overweight because they, like everyone else, want to look good! By the way, the same method of correcting the fat face can be applied not only to people who are overweight, but also to those who have a round face by nature.

– What is your ‘know-how’ that caused so much interest in the West?

- I use a three-level method of rejuvenation operations for people who have a fat heavy face, or a "round" type. The operation has three phases, which are performed at once. First step is removal of the subcutaneous fat that creates excess capacity in the neck, chin and cheeks with the help of ultrasound.

The second step is removing so-called Bichat fatty pads. They primarily create heaviness, weight in the cheek area and tend to severe descent and as a result of it nasolabial wrinkles, sagging skin appear in the area of lower jaw. Therefore, it is so important to reduce their volume to prevent premature aging. By the way, readers who are interested in this information can test themselves and check for the availability of increased Bichat fatty lumps. One needs to check the thickness of the cheek somewhere in the middle with the help of the index finger and thumb through half-open mouth in a standing position. After that, one needs to lie down in a horizontal position, and again feel the thickness of the cheek in the same place. If the thickness of the cheek gets smaller in a horizontal position, it means that you have enlarged fatty lumps that create weight and volume and may soon lead to an abnormality of the contour of the face and apparent nasolabial wrinkles. To the point, I often perform an operation where I just remove fatty lumps, and it significantly improves the person’s appearance.

The third step is a face-lift with SMAS-plasty, which also has its own nuances. All the steps together give a harmonious and, what is very important, a long-term effect. I should say that the development is very important nowadays. Over these years, I have performed about 500 successful rejuvenation operations, and 17% of the people just had a fat face. The advantage of my method is that even if a person gains some weight later, the effect after the operation is stable for many years.

– What do you mean by "For many years"? After all, the phrase "10 years later" frightens people who underwent a plastic surgery on the face.

- My practice shows that even after 7 years, gaining some weight, the woman looks younger than many years ago before the surgery. Just a usual lifting of the fat face is not as effective. Even if we just pull up heavy fat mass, the skin under the weight inevitably will sag again.

– Anyway, many people are convinced that if you once have a plastic facelift, then every other year you will have to be operated again to "consolidate the gains."

- I think it is mass delusion that was created by celebrities who do often abuse the possibilities of plastic surgery. In fact, it is not true. If the operation was successful, then the result is stable for many years. Of course, the patient can come to the plastic surgeon after the first operation again, just to realize the desire for other areas of their body. In general, it is normal, and I come across this fact quite often. The first successful operation opens up new horizons for their own excellence, enables them to realize themselves as a person. The person becomes different, not only externally but first of all internally. Complexes disappear, the person becomes more confident, joy appears in the life, relationship problems get solved. People begin to re-build their life, career.

As for the "stars" they, if you believe the tabloids, do not leave the table of a plastic surgeon. But there is such a moment here. First, believe me that the rumors about the number of operations are greatly exaggerated. Secondly, we should understand that public people, like actors, singers, earn money with their talent and good looks. They should keep themselves in shape all the time in order not to disappoint their fans, who want to see their idol young forever and always beautiful. Moreover, the public person has more stressful situations and therefore is more vulnerable for aging. Constant moving, lack of sleep, make-up, workload, active facial gestures influence their face. Many people believe that the permanent facelifts and other aesthetic improvements are the fault of unprofessionalism of surgeons who are not able to perform an operation "once and for ever. It is a problem of natural aging and skin sagging, and this process for public people is just more dynamic for the reasons I have already mentioned. So, they really have to use plastic surgeons’ services with some frequency because they are working "with face".

– Until what age can a surgeon work with a full face effectively?

- In general, fatty lumps can be removed at the age of 18. I have such cases in my experience. This operation is quite simple and not traumatic, and the effect of it is very good. Age does not have special significance for plastic surgery. The person’s appearance is more important, i.e. the original data which the plastic surgeon is going to work with and the challenge that should be complete. An operation can be performed at the age of 35, and after 70. However, many women have an opinion and they say, ”I am 40 now; I can stay as I am for another 10 years and then will be operated on. But the point is that in 50 years to get the result that she wants is much more difficult. The structure of skin loses its opportunity. And the younger the patient is, the more sparing techniques can be applied to achieve a particular result.

However, I have a 70-year-old patient, who underwent a facelift 30 years ago in Moscow. And so, she came to my clinic asking me to perform a second facelift, explaining that she has a new boyfriend. At first, I was surprised, but when talking to her and watching how much she is energetic and cheerful, I realized that her desire is completely normal and justified. And if it improves women’s self-esteem, mood, then they will definitely benefit from the operation

– How many facelifts can be done for one person’s life? Is there a limit for such operations?

- Theoretically, this "standard" does not exist. You can have a good whole face-lift, and then, after 8-10 years, perform the second operation. After another 5 years, you can adjust certain elements, work, for example, with the volumes, put the zygomatic implants. Today there are a lot of options and opportunities. Each person is different. I have never had even two identical operations. Approach to the patient should be very flexible and diverse. I never address the situation like "Doctor, could you do exactly the same as she has?", because everybody is very individual. Therefore, a good surgeon must possess a variety of methods to apply their best one according to the appearance and the tasks. Professionalism means a flexible approach and applying all available methods. For example, in some cases, one does not need to lift the skin, but with the help of cheek implants and fillers, according to the facial features to create a rejuvenating effect, improving contours and removing wrinkles.

If a young woman gained weight, and then she lost it dramatically, there might appear roughness along the contour of the lower jaw and nasolabial wrinkles, and her skin sags a little. In such cases, we can offer so-called ligature lifting or filting. This method can not be ranked as operation because there are no incisions there. Through the punctures, special tools are held the threads that make it possible to tighten the tissue and fix them. However, this method of ligature lift is suitable only for patients with thin face. This effect is kept for 1,5 - 2 years, sometimes up to three years provided a stable weight. Although I know from my experience that if a woman can see a great result, it is disciplined her very much in terms of nutrition and weight gain, and she doesn’t have a problem to put some weight.

As for the neck, here there is also a whole arsenal of opportunities for operations, from lipoaspiration to plastic surgery of neck muscles to form a nice angle of the neck and chin.

– Are there any health risks when having a facelift?

- Before any operation, the surgeon must carefully examine the patient and then The patient should be consulted by related professionals - an endocrinologist, general practitioner, cardiologist. Only then, can the date of the operation be discussed. I tell all my patients: “Any operation takes a risk and one needs clearly define the line between the fear of risks and the desire to change something in their appearance and their lives. If fears prevail, then it is worth waiting. But if you believe in yourself, and what is more important, in the surgeon, then you can plan the operation and its result will be good. In any case, today, the risks of plastic surgery are minimized.

The percentage of complications after plastic surgery is immeasurably lower, than in general surgery. Moreover, these operations are much less traumatic. Yet we can not ignore the fact that any case of complications in plastic surgery, especially if it concerns a well-known person, gets blown up and exaggerated by media. But they are not interested in complications in general surgery.

Today in the plastic surgery in the world, and in Ukraine, there is a clear tendency to minimize the trauma of operations, reducing the risk with getting maximum effect. For example, before age wrinkles in the forehead area and apparent eyebrows ptosis were corrected by using so-called "coronal" incision, from which a scar on the scalp from one ear to another remained forever. To do this, the surgeon had to cut off some hair, and what is more hair follicles were damaged. Today, two cuts one centimeter in length are done, and the operation is carried out using endoscopic technology.

– As an aesthetic surgeon, what can you say about the situation when, after intensive work over a person’s face the patient is not like what he used to be. Do you agree that there are many of such examples among the people of show business. Perhaps the person looks younger, but it is unlikely the same person...

- The situation is like this. Generally speaking, to make the patient unrecognizable is not the task of a plastic surgeon. The person should be like he used to be, but become younger. The personal features, which constitute his individuality, should be preserved. Just professionalism of a surgeon consists in the fact that the facial features should be kept and only what spoils appearance, a sign of age should be removed. But there is such a moment, it is very possible that if the patient is a celebrity the result of the operation may be the requirement of the patient. If the patient is a star, he can afford a diktat. And, by the way, even if others think that the surgeon has done something "too far" from ideal, the patient may be quite satisfied with the result and enjoy his appearance. Very often when the patients are asked the question why they agree on a surgery, they respond:" That is in the first place to please themselves."