A fresh look for your face

We cannot deny that every face tells a unique story, especially as we age. While we each may have specific concerns, a common thread is the fear and anxiety many feel when it comes to the battle against time.

Cosmetic surgeon Dr. Gerald Wittenberg helps alleviate his clients’ anxiety by reminding them that enhancing or rejuvenating one’s natural look goes hand-in-hand with remembering that real beauty lies in embracing what they already have.

When it comes to cosmetic treatment options, there are many non-surgical and mini-surgical techniques to consider. But whatever approach you decide to take, the key to success is to make it look natural.

He says the only comments he wants his clients to receive is:
“You look great, well-rested,”

“Did you do something with your hair, you look good,”

or

“You lost weight? Looks great on you.”

Wittenberg’s successful transformations focus on an examination of the entire facial structure of each patient, as bone framework and tissue cells are also a part of his skill repertoire. “If the underlying bone and facial structures is well-balanced, the aging process is much delayed,” he says. “ For example, if you have weak cheek bones, you will develop ‘bags’ under the eyes at a young age, which definitely ages the person.” Also, he explains that a small chin will highlight small accumulations of fat under the area, making patients look a bit overweight. Having good jawline definition is one of the key features of a well-balanced face, the doctor adds.

Understanding how to restore or enhance one’s features so that they are in balance with that person’s facial bone structure is key, he elaborates. “This is a focus we have,” says Wittenberg. “There’s no sense in enlarging someone’s cheekbones if you have a small nose, or small chin, and so on. The key to enhancing the facial bone structure with procedures such as cheek implants, lip fillers, chin and jawline augmentation or liposculpture of the double chin is to ensure the enhancement is balanced with the remainder of the face.”

Just as important, the doctor notes the Hollywood look of rejuvenation needs to be re-thought. The look of certain “overdone” celebrities, he says, tends to give the facial cosmetic surgery industry a bad reputation. Aging, Wittenberg says, is really a loss of skin volume, combined with a sag in the position of numerous facial tissues and muscles. So, if doctors can simply re-place the tissues to their original position, rather than stretch them to gain tightness, this will make for a very natural makeover. “It looks like you turned back the clock 10 to 15 years and the results stay, so you will always look 10 years younger than your peers,” he says. “That is because if you simply reposition the muscles and sagging fat where it came from, it looks like you, only a bit younger.”

Non-surgical rejuvenation is another method for those who are wary of or do not require surgery to treat their rejuvenation concerns. The use of tissue fillers such as Juvederm and Restylane to fill out the tissues, restoring the volume lost during aging, can be a good short-term treatment, says Wittenberg. “Fillers are now being touted as a ‘non-surgical facelift,’ which is an overstatement but popular in its use,” he says.

The treatments must be repeated yearly at least but provide an alternative to surgery, or a temporary solution to boost confidence.

The effects of treatment, reminds Wittenberg, is also closely related to lifestyle changes. The two main lifestyle factors are environmental — such as sun and pollution — and genetic, which includes oily versus dry skin, pigmentation and the skin’s elasticity.

“Prevention with good sunscreen is obvious and more people are getting it these days,” says Wittenberg.

But, he adds, a part of the look of skin is based upon the lack of underlying tissue fullness. In other words, if you have less fullness as you age, the skin will wrinkle and fold and show more irregularities

“It is more common to see lack of freshness to the skin of a patient who loses facial fullness/volume than a person who has great natural fullness genetically,” he says.

No matter what treatment option patients are seeking, the doctor also advises it is never too early to begin considering skin care.

“The younger patient (25 onwards) can consider actual treatments to maintain or even enhance their look. For example, using Botox to freeze the muscles around the eyes will actually prevent wrinkles,” says Wittenberg. “The concept is that if the skin continues to bend in the same area time and time again, it will form a wrinkle. Botox prevents the bending of the skin.”

For the more mature patient, the doctor notes fillers work wonders for all ages, but are perfect for thirtysomethings who are showing some initial loss of facial volume and develop lines and folds and bags under the eyes.

“The fillers will literally restore an ideal, natural ‘you.’ Mature patients can also have a filler ‘lift’ but they often need some repositioning of the sagging tissues as they age towards their late forties,” says Wittenberg.

In the big world of cosmetic rejuvenation, it is easy for one to get lost, especially when weighing the benefits of short-term versus long-term treatment options. “Short-term treatments are often desirable by the public, since their perception of the marketing by companies often leads them to reject surgery,” says Wittenberg. “Of course, they do not have to have the poor Hollywood Joan Rivers results, but that is their fear. They are willing to have treatment every three months for Botox or every year for wrinkles, folds, cheeks, et cetera, and spend an amount that will easily exceed the surgery within a couple of years. It seems foolish, but often the patient does not have a proper picture to decide which is better for them.

Wittenberg says his approach is to educate them and allow them to make an informed decision. “There are so many misconceptions about facial surgery, and we always want to properly explain just what it is about. It can be virtually painless, localized to specific parts of the face, done in stages, et cetera. But the key is that we want the client to understand why one treatment may be superior to another ‘marketed’ approach.”

Wittenberg also notes that some people believe that they will only do just a bit of treatment “only once.” In reality, they may like the result too much to stop. This is more common nowadays with the field of cosmetic treatment expanding to other doctors, nurses, and storefront clinics. A danger, says Wittenberg, is that some of these providers may not have the licence to perform surgery and they do not have the detailed knowledge of anatomy to properly place the filler to avoid complications. “They convince the patient to do non-surgery techniques that are short-term, but it is financially advantageous to the clinic, not to the patient,” he says.

Wittenberg recommends that a proper total facial analysis be done of the patient. “Examining the underlying facial bone structure, the quality of the tissues and the genetic facial development pattern will allow me to propose the best treatment for the patient, specific to their age,” he says. Once the examination has been completed, the clinic will explain to the patient the cost of non-surgical fillers versus surgery repositioning over 10 years. The objective is for the patient to participate in the decision to proceed with either a short- or long-term treatment with the consideration of both clinical and financial factors.

“We provide both treatments, but only after the patient has the information to decide,” the doctor says.

His specialization in facial bone structural analysis is what sets Wittenberg apart from his fellow cosmetic surgeon colleagues. He adds that simply tightening the facial skin and tissues to make them smoother, for surgeons who do not do the same analysis, can be quite disastrous.

“The approach ignores the critical relationships of the muscles and the natural movement of the tissues/face with smiling/animation. A ‘mask-like’ appearance is the result,” says Wittenberg.

Based upon his anatomical knowledge and surgical training in reconstruction facial bone surgery and facial soft tissue surgery, the doctor examines each muscle of the face and determines where it has to be repositioned or re-placed in order to re-establish what the patient had in the first place. Without abnormally stretching the tissues, the patient truly look like themselves, but younger, Wittenberg explains.

In fact, he says this approach will create a tighter bond at the original location of the re-placed tissue and make the procedure more long-lasting.

“Naturalness is the key. No one wants to look like they had surgery,” says Wittenberg. “Everyone feels the same inside as they age, but they look different on the outside. The key in rejuvenation is simple. Put everything back in its place.” •

 

Counting down the Days
Dr. Wittenberg shares with Lifestyle readers just how long it takes to recover
 

”I tell patients there are two recoveries. The first recovery is physical, as in, when will I have good energy back and feel good. That takes 3 to 6 days, depending upon the surgery. (Lips, 2 days; chin, 3 days; jawline, 4 days; facelift, 6 days.)

“The second recovery is when will I look good to go back to work? That feature is primarily dependent on swelling and bruising. These are surgeries with minimal pain, as hard as it is to believe as a patient. Patients will always comment that they could not believe it, once recovered, but it is true. However, bruising takes 14 days, whether you bruise your knee or face. Swelling is maximum after 4 days and resolves down to 7 to 10 days, but facelifts take about 3 to 4 weeks before the patient has enough confidence to appear at a social event or wedding.”