When?

Yes, cosmetologists can stop the process of reduction of collagen and elastin even in deep layers of the skin, and slow down its fading and withering… But the moment comes when the tissues lose their plasticity to such an extent that they cannot overcome the force of gravity, that is the “gravitational ptosis” (drooping of soft facial tissue) and prevent the formation of deep wrinkles.

As a result, the brows hang over the eyes, a clear nasolabial fold appears, and the line between the neck and the chin is erased, the features of the face lose their clarity… It’s hard to answer the question “When does this happen?” For some people it happens after 50, for some after 30, depending on their genetic features, way of life, and the ecology… In any case, as soon as you find that apparatus methods or cosmetic methods are insufficient, it’s time to go to the surgeon.

Thanks to Hollywood, plastic surgery has an aura of mystery and power to it. So it is not surprising that the decision to have an operation involves an unconscious or even conscious expectation of a magical transformation. In fact, there is no such thing as miracles. And the best result of a plastic operation is when patients recognize themselves in the mirror as looking a certain number of years younger, but the people around them only notice that they look young and fresh, but don’t even guess that this was caused by plastic surgery.

On the whole, plastic surgeons are not to be envied. Firstly, they realize full well that people expect miracles from them, and they have to tell the patients what needs to be changed, and for what result. Secondly, the approach of general surgery (“Cut it all away!”) is not appropriate for plastic surgery. Physically healthy people undertake plastic surgery, and if they have any problems, they are only of a psychological nature. Patients are not called “sick” here, but they are still asked: “What seems to be the matter?” But not in the sense of “What is troubling you?” but “What don’t you like about your appearance?” Some people may have a wrinkle right across their forehead, but it may not worry them at all, while for other people this wrinkle has ruined their whole life…

What?

The most popular plastic surgery is rejuvenating operations for the face: endoscopic face lift, rhynoplastics (correction of the form of the nose) and blepharoplastics (correction of the eyelids). The development of endoscopy has made facelifts a non-traumatic and effective means of fighting gravitational ptosis – drooping of facial tissue. Surgical intervention through minimum cuts leaves minimal scars, which are hidden in the hairy part of the head, behind the ears and in the mouth, in such a way that they are unnoticeable. But if you are assured that you will not have any scars, don’t believe it, this is impossible. Surgery cannot do without them. With the help of an endoscopic face lift, the facial tissues are lifted and returned to the physiological place where they were destined by nature. However, this facelift is not recommended to everyone. For example, the more flaccid the tissues become, the less “energy” the skin has to hold them and they droop. A standard facelift is needed, when the excess skin and muscle is removed. The more noticeable the aging processes are, the more traumatic the surgery will be. And you shouldn’t think that if you go to a surgeon to have your double chin removed, and the surgeon recommends that you also lift the tissue of your forehead and brows, and also the middle part of your face, it is only because he wants to make more money.

This is not out of the question, of course. But it is probably an exception. True professionals will not propose surgery where it is not needed – they simply often see things that their patients do not notice. For example, that the face, as a part of the body created by harmonious nature, also droops harmoniously, from the top – the forehead. You could, of course, remove the double chin with liposuction and a facelift, but then the flaccid skin of the neck, the droopy brows, and the deep nasolabial folds will remain… A surgical facelift is a difficult, comprehensive operation, in which the surgeon creates a kind of muscle frame of the entire face, thus turning back time by 10-12 years. Unfortunately, no cosmetological procedure is capable of achieving this result.

The Michael Jackson syndrome

People say that after one plastic surgery operation, some women keep going back to the surgeon again and again: if they have a facelift, they become dissatisfied with the shape of their nose or the flaccid skin of their neck, and then they want to get back the form of their lips, which always give away age even after a perfect rejuvenating operation… We all know the phenomenon of Michael Jackson, who went to surgeons again and again to reshape his nose.

Generally, correcting the form of the nose – rhinoplastics – is considered to be one of the most complicated in plastic surgery. On the one hand, the doctor listens to the patient’s wishes and proposes changes which will be harmonious for this face by size and form. On the other hand, if a person has problems with breathing through the nose, then the doctor must also deal with these. Many clinics offer to model the form of the nose using a computer, in order to show the clients what they will look like. However, during the operation unforeseen, individual peculiarities are often revealed, and the nose may end up different from the expected result. So many doctors don’t show computer “models of the future”, and explain to the patient all the features of the very precise and difficult procedure.

The truth, and nothing but the truth

We are so used to the fact that dentists can give us a beautiful smile that we often forget that the charm depends not only on white, even teeth, but also on the lips. After a rejuvenation operation, age changes are particularly noticeable, when the lips become thin and flat, and radial wrinkles appear around the mouth. The volume of the lips and the state of the skin around the mouth can be restored both during the facelift and after it. Up to a year later this can be done using hyaluronic acid, and for a longer period with lipofilling – implantation of the patient’s own fat, if the body does not reject it. Both these procedures are conducted with local anesthetic. The peculiarity of plastic surgery is that the result is not visible immediately, and it can only be judged several months later. And in the first days, the sight in the mirror will be quite a shock – bruises and scars…

Often patients treat plastic surgery as a simple procedure, like a cosmetological procedure, and believing the advertisements, they believe that they do not face any traumas or scars. And when they discover the scars and bruises after the operation, they become very stressed. Although everyone knows that surgery, including aesthetic surgery, always leaves a trace. It is very important that at the first consultation, the doctor tells the patient the whole truth, however unpleasant it is, about what the situation is and what will happen. That is, about the restrictions that the patient should observe before the operation, and what the rehabilitation period will be like.

For example, there are patients who are inclined to refuse an operation when they discover that two weeks beforehand and two weeks afterwards they are not allowed to smoke, so that they do not create problems in the body connected with the blood circulation and lack of oxygen. However, there are some patients who conceal this habit from the doctor, and after the operation they hide their cigarettes from the medical staff, like teenagers…

Before and after

Before starting the operation, the doctor should know everything about the state of the patient’s health. This does not mean that the patient may be refused the operation because of some chronic disease. If there is not a worsening of the condition, this is not contraindicated.

A check-up is mainly important for the anesthesiologist, who selects the anesthetics on a strictly individual basis. There are clinics in Petersburg which refuse to carry out an operation if the patient does not want a check-up. The rehabilitation period needs to be endured stoically, during everything the doctor recommends – the success of plastic surgery depends on this by at least 40%.

Among important advice which will enable the patient to avoid poor-quality scarring and necrosis, there will be cosmetological procedures prescribed by the doctor. Plastic surgery solves a general problem but cannot cope with small ones, such as dryness of the skin, minor wrinkles, hyperkertosis (thickening of the skin from photoaging) and pigmentation spots. In other words, in the battle for the quality of the skin, which omnipotent surgery cannot affect, cosmetologists are needed, with their apparatuses, injections, peeling and creams. A course of cosmetological procedures is prescribed both before the operation (to improve the circulation and lymphodrainage) and afterwards.

Immediately after intervention, the state of the skin improves, because surgery is a mechanical process, and the tissues suffer from the manipulations of the surgeon. A course of apparatus cosmetology is required to increase the circulation, and for active and careful healing of scars. To improve the color of the skin, and return it to a healthy, fresh appearance, peeling is needed. For biological rejuvenation of the skin, i.e. to restore the level of processing of collagen and elastin, mesotherapy is required… The results of fundamental rejuvenation using surgery should be supported constantly using cosmetological procedures, otherwise all the expenses and trouble will very quickly prove in vain.

Optimists believe that neither cosmetology or plastic surgery has any future, despite the swift development of the beauty industry in recent years. They hope that when studies into cell technologies are finally completed, several injections will be sufficient to return the youth of the skin not just to the face, but to the entire body. In the meantime, while we wait for revolutionary changes – and so as not to delay a visit to the surgeon – we should not forget about cosmetology.

Irina Baglikova

AESTHETIC SURGERY: FOR AND AGAINST

BETWEEN THE SCALPEL AND PEELING

Good cosmetologists are like good dentists. If they’re something that can be saved without removing it, they will also try to do so.

At a time when dozens of television projects – and also the personal example of many stars – try to persuade us of the magic of plastic surgery, an increasing number of women (and men), regardless of their age, try to change their appearance radically – to look younger, to improve the from of their noses or ears, to make their lips more sensitive, not to mention their breasts, which are a separate topic altogether.

Naturally, there are cases when an operation is the only solution. Sticking-out eras, a nose that dangles down to the chin and other freaks of nature which ruin the patients’ life can be considered to be if not medically, then certainly psychologically indicated for surgical intervention.

Nevertheless, in aesthetic surgery, as in any other branch of medicine, there are numerous pitfalls. But even the best surgeon can guarantee that you will get exactly the nose you want – or the right face. A lot depends on individual features, and also on the patient’s readiness to follow all the recommendations before and after the operation period.

According to cosmetologists, there are two types of people – those who haven’t cared for their face for many years, and then when they watch films such as “Return to Eden”, they decide to solve all their problems with one cut of the scalpel – and those who have taken care of their skin from a young age, and have turned 50 looking quite fresh.

Patients in the first category, even if they can revert the aging process with an operation, but afterwards return to their former lazy ways, risk squandering the effect gained. Cosmetology, even if it does not replace aesthetic surgery, is still its first assistant before and after the operation period – even the most naïve people realize that surgical intervention is not possible without bruises, scars and other side-effects, and everyone has different skin. “Parchment” skin, if it is not regularly moistened, is soon covered with wrinkles. “Thick” skin will soon start drooping again under the influence of gravity. So before resorting to a facelift, you should discuss other possibilities with the cosmetologist, because diverse peeling, mesotherapy, injections, LPG and skin tonic – all these swiftly developing techniques make it possible to maintain a good condition of the surface and deeper layers of the derma over the course of many years.

But if conservative methods don’t help, then you should approach the problem carefully and chose the most reliable clinics and surgeons. Thank heavens, there are plenty of them in Petersburg.

T. I.-I.

Natalya Mikhailovna YASTREBOVA, plastic surgeon, doctor at the RAMI clinic:

Rejuvenation operations to the face, neck and eyelids are usually made in the age from 40 to 50. This is all quite conditional, as in any operation there may be medical indications: i.e. when an operation may be indicated at the age of 30, or sometimes a 50-year-old woman may require conservative cosmetic procedure. Because of the fashion for plastic surgery operations, increasingly younger women go to surgeons today – but if there is no indication for operational intervention, then there is no need to resort to this! Life doesn’t end at 30.

As for “partial” operations I can say the following: I am positive about them, because all faces are different, and everyone has their own problems: sometimes the neck suffers, more rarely the chin, and so why operate on the entire face? Sometimes blepharoplasty is sufficient, and sometimes a correction of the middle section of the face or the eyebrows. As for the cost, the price of a facelift in St. Petersburg varies from 100,000 to 200,000 rubles.

Irina Khrustaleva, head doctor at the Akademiya beauty clinic, plastic surgeon, PhD, full member of the International Society of Aesthetic Plastic Surgeons (ISAPS)

Modern technology offers such an individual approach that it is impossible for even two patients to have identical faces after the operation, as was the case 10-15 years ago. Modern rejuvenating surgery is not about banal facelifts, but a three-dimensional sculptured modeling of the face, which returns lost harmony and youth, while preserving individuality. One of the main tasks is to avoid scars when possible, and this is helped by modern endoscopic methods and the professionalism of the surgeon. And a correctly organized program of post-operational rehabilitation will help a person to return to an active life in the minimum amount of time.