Becoming More Beautiful: The Scientific Approach to Facial Aesthetics

Announcer (00:01):
You are listening to Head On with your host, board certified plastic surgeon, Dr. Bahman Guyuron, the pioneer of a life-changing surgery for permanently eliminating migraines and a specialist in plastic surgery of the face, head and neck.

Dr. Guyuron (00:20):
Beauty means harmony by visualization and it would apply to everything in the nature. It is not just a face, it applies to the buildings, flowers, to anything that there's enough balance and coordination between the different segments of any element, and this applies to the face. And there's actually, there's a scientific base for the harmony of the face, and that's what exactly what we do. We actually create harmony between different segments of the face and there's a process called cephalometric analysis that we use life size pictures and analyze the entire face and decide what is out of position that is causing less than pleasing feeling when we look at something. Again, we apply that same principle to the face. For example, when we decide to do rhinoplasty, we take life size pictures and match the nose to the rest of the face. When we work on the chin, there is a scientific way of deciding how much we need to lengthen the chin or bring it forward to look good on that face.

(02:00):
And when there's harmony, we get again, sense of satisfaction that otherwise would not be achieved. And that applies to the music. Notes if they're not coordinated, it's not going to sound good. The same principle applies to, again, to the face, and that's what we use to coordinate the difference segments of the face to match with each other. The things that can happen to the face to look less than ideal or imbalance can happen in the skin level, can happen in the thickness of the soft tissues, can happen in the bones, and by looking at the skin that it is discolored or has acne scars, you don't get the same sense of pleasing feeling that you will get to when you look at this skin that looks smoother. So that one aspect, or if somebody has a chin that it is not projected in other word long enough for the face, it is a disharmony and that needs can be corrected. If somebody has, for example, prominent forehead or receding forehead, when we look at that person, we immediately detect that, and we don't even have to look at the profile. Even on the looking at the front view, we can see that patient has less than ideal forehead and there's a scientific way of, again, detecting exactly how much the forehead is too prominent or too receding to fix that, or the eyes could be further apart or closer to each other. In general, the eyes that are further apart are a little bit less disturbing than the eyes are too close to each other, to the harmony of the face. So those are the examples, or if the nose has a hump or they shifted one side or the lips that are too thin or even too thick, but too much volume is not good, also it distorts the balance. The size of the eyes could be too small, too large.

(04:42):
If the eyes are too close to each other, they can actually be separated from each other. It is a major craniofacial surgery and it would have a huge impact, although you can actually camouflage some of that. Meaning if somebody has really prominent nose, meaning nose that knows that is really excessively projected and it goes straight from the forehead to the nose, those individual may appear to have eyes closer to each other. If we shave the nose down and set it back, there's going to be an optical illusion that the eyes were pushed apart without really pushing the eyes apart. That is actually one of the most impressive and impactful aspects of rhinoplasty that a good rhinoplasty results actually reflects on the eyes more than anywhere else in face. And again, a too narrow of nose is going to make the eyes to look too close to each other.

(06:05):
If we can widen it, it is going to make it better. The reverse is true also, if the nose is too wide may make the eyes ostensibly look further apart, but they're not further apart. And when we narrow the nose, all of a sudden the eyes look prettier without even touching the eyes. And it is one of those dynamic changes that occur that I've been focused on for four decades and writing articles about it and studying it. And it is incredible what the nose, a good nose can do to the face without really changing the other structure. So it is not always necessary to do complicated surgery to achieve some of the objectives of harmonizing the face and making the face to look prettier than it is actually. There's a distinction between beautiful and cute. A person who's beautiful is the person whom all of the structures of the face are harmonized, or if they are any flaws they're very minor flaws. And a cute person is somebody who has very pretty dominant features of the face, and two of the facial features are very dominant and one is the eyes and the other one is the mouth and the lips. Cute people are individuals who have really attractive mouth and the tooth relationship, pretty eyes, but the rest of the face may not look great and there could be some even major flaws with the other parts of the, but they look good and they're cute. But on the other hand, again, beautiful individuals are those who have all of the facial features, even non-dominant features, or most of them at least are aligned nicely and there's a good harmony between different segments of the face. The reason that younger individuals in general look good is because the facial harmony is better than those individuals and the younger individuals. As we get older, in most incidences that balance is distorted. And for example, the nose that used to look nice becomes larger. The kids usually never have a hump. The kids usually never have too wide of nose, and that's the difference, that's the distinction. And it is just part of the aging that some of the imbalances occur and the oval shape of the face becomes more of a rectangular because the jowls develop and that's not good. That's not really a balanced face.

(09:32):
As we look at ourselves in the mirror day after day, subconsciously we ignore some of the flaws, asymmetries particularly. For example, a patient who has a deviated nose often doesn't see the deviation while when they have their picture taken, they see the deviation. And the reason that pictures are not usually as attractive as we think we are is because the picture depicts the flaws that we get used to it, not only on us in our spouses, in our children. And parents usually don't see the symmetric on their children's faces. And when we consult these parents about the child who has craniofacial deformity and point out some of the flaws, they say, we don't see it when we need to print a picture and show them, then they see it because they get used to it. And it is an incredible phenomenon in the nature that we have the power not to see the flaws and be focused on the prettier part of the face and see ourselves very differently.

(11:05):
And that's again, is something that we deal with all the time. And what we have, many of us who has been in practicing for a long time, we have a mirror in our office that is called a true mirror and it reverses the image. So when the patient look at that mirror, they see themselves the way I see them, which is very different from the way they see themselves in the mirror. And I don't sit across people and tell them what else they need unless the reason that they're in my office to see me or surgery that I'm going to be doing for them is going to be suboptimal because of something else. If the patient comes to see me for the nose surgeon, they have prominent ears, I'm not going to discuss the prominent ears. Or if they need some facial rejuvenation, I'm not going to discuss that.

(12:13):
And this is something that we face every day, so we have to have some ethical rules about it, and we don't want the patients to become concerned about something, they're not concerned about it unless again, it is going to interfere with our ultimate goals. As a person who is specializing in the face, we absolutely have to be aware of one entity and that is body dysmorphic disorder. These are the patients who do not see themselves the way the others see, the way I see it, and they keep asking for something to be done. As long as the requests are realistic and the patient has healthy frame of mind, it is gratifying to deal with the patients. But when we get to a situation like what I'm suggesting, that the patient's going to require something else, as soon as you fix one thing, they're going to find something that they're not, that they're going to be unhappy about.

(13:36):
Those are the situations that we really need to seek advice of healthcare practitioner who's focused on the psychologic issue. And these are the patients that they're not going to really be happy with the face because they don't see their face again, the way we do it, and there's something that we all have to be aware of it and care for these patients differently. Sometimes I suggest a patient to go to see a psychiatrist, and if they refuse to do that, then I'm not going to operate on that patient. And sometimes they do, and then I've helped the patients in a different way. I've served the patients in a different way. There are patients that sit across me and ask me, what is that you can do for my face? And whether this is a rejuvenation or beautification, which is again in my view is a good part of beautification, I'm going to analyze the entire face.

(14:46):
We have actually a systematic way of analyzing even visually, and as I mentioned with the life size, pictures, measurements, and angles. And by adjusting those structures, we can make the face to look prettier. Today, particularly with the availability of fat injection, a good number of our goals can be met with just fat injection on patients who have hollowed lower eyelids or less than ideal prominence, the cheek area or thin lips, or even slightly under projected chin on a slightly asymmetric chin, I can actually adjust those with fat injection. You earlier talk about the fillers. Obviously the difference between a fillers or two and, fat injections are main differences are two. One is that fat is more lasting and essentially permanent. Nothing is permanent. And the other advantage of fat is that it has stem cells and restores the glow to the face that we cannot get from just skincare products or even lasers.

(16:13):
That's an amazing benefit. So a good number of facial unattractive features can be made more attractive just by fat injection. But we use also, we move the bones. We had to adjust the frame of the nose if we need to. And earlier I mentioned that we can't even move the eyes apart closer to each other, but most of the time other prestige that we do help us to achieve those major objective as camouflage some of the major flaws without resorting to very complicated procedures. But the analysis part is visual assessment of the phase and supplemented with the cephalometric analysis using life-sized pictures that we do actually measure the different distances from every surgery that we do that has a function. The goal should be improving the form and function, and the reality is that good form always translates to good function. So facial beautification is something that actually we can do it in the childhood, meaning boys or girls who have very prominent ear and that doesn't change the function of the ear so much, but it is so protruding that they're getting teased about.

(17:51):
So we starts from that age and usually they do that operation around age seven, meaning set the ears back. So that would be an example of, again, beautification. Obviously we are not even talking about craniofacial deformity or cleft lip, hair lip situation. We talk about individuals that they otherwise have perfectly normal face, but they have flaws that can be distracting and can be a source of teasing can be corrected. So in teenage, the most common operation that we do is nose surgery. But I have had teenagers that have bags under the eyes and that sometimes runs in the families, or I have done removal of fat under the chin on teenagers that runs in the families. And no matter how much weight they lose, they're going to still have that fat protruding. I remove that and that creates an imbalance on the profile, makes the chin enough to look as defined as otherwise it would be. Every plastic surgeon is trained to do facial plastic surgery to see the flaws of the face, to understand what beauty is about and is qualified to do work on the face. But particularly as we gain experience, it takes us in a different direction and we narrow our field. Some plastic surgeon, they just do breast and body contouring, do not touch their face. Some plastic surgeons do hand surgery and there are a bunch of us that we have limited our practice to the face area. And what we do is just focus on the beauty of the face and aging of the face, and even some reconstructive aspects of the face. But as I indicated earlier, all plastic surgeons are trained to eliminate the flaws of the face and create more harmony to the face. If anyone is interested in a consultation, you can call our clinic, Zeeba Clinic, (440) 461-7999. Again, 4 4 0 4 6 1 7 9 9 9. Or you can go to my website, drbahmanguyuron.com, and you can actually make your appointment through the internet. We're here to serve the patients.

Announcer (20:41):
Links to learn more about Dr. Guyuron and anything else mentioned on this podcast are available in the show notes. Head On is a production of The Axis, theaxis.io.