Write down your concerns in order of importance

Bring photographs from younger days which show which parts of the face concern you and why

If you have photographs of others that show what you are after (tight neck, smooth jawline, position of brows, etc), please bring them with you. These are helpful but cannot be used as exact templates!

Come with time please. We do not like to hurry these consultations.

Please bring your husband/wife/family member with you so there are more than one pair of ears to listen and also to ask any questions

Botulinum Toxin-A products like Dysport, Botox, Xeomin, etc are neuromodulators: they affect the movement of muscles and work on the ends of nerves. Therefore, by using them, DYNAMIC lines are improved. For example, the frown lines which are called “elevenses” are caused by the movement (excessive movement in many cases) of the corrugator and procerus muscles which are weakened by the botulinum toxin-A, resulting in an improvement in these lines for three to four months. 

Dermal fillers essentially provide volume: there are many different fillers we use (Restylane, Radiesse, Voluma, Juvederm, etc, etc). They have different properties and are suitable for different parts of the face and for use at different depths. So fillers allow volume to be created: in the cheeks for example. Or they may be used to reduce the depth of lines or grooves (nasolabial folds are the grooves between your nose and your mouth). Fillers are best used to fill areas where there are static lines, grooves or there is volume loss. They are often used in conjunction with botulinum Toxin-A.

Faicial tissues (skin, deeper structures, muscles, etc), can be injected with various liquids that have particular properties. So, for example, muscles can be weakened with neuro-toxins like botulinum toxn-A. This improves forehead lines, frown lines, smile lines, and also allows the corners of the mouth to be brought up and, judiciously used, can be used to decrease smoker’s lines which are the vertical lip lines. In addition, fillers can be used to create fullness of brows, correct hollow eyelids, fill the hollows below fatty lower eyelids, be used to give fuller cheeks, be used to fill nasolabial and melolabial folds, be used to give the chin a better projection, be used along the jawline, etc, etc.

By using a combination of these different types of fillers and neuro-toxins, facial appearance can be changed. Certainly, a substantial improvement can be achieved in all the different facial zones with judicious use of these materials: when used in such a combination, it is sometimes termed a “liquid facelift”. Unfortunately, the word facelift is often misused in this respect because the use of these materials will not give you the type of improvement of your face, jawline and neck that a proper facelift would give you. Don’t fall for false promises (and false advertising). Understand the differences in results, the longevity, costs, etc, before deciding what is best for you. 

The “liquid facelift” needs to be repeated as the fillers get absorbed by the body and the neuro-toxins wear off: further injections are needed as soon as three months later and as late as 9 months later. Too many fillers can give you what I call “filler face” which is the over-filled, obviously unnatural face. One sees these faces all too often. 

There are certain standards of facial movement and appearance that MUST be maintained. Unfortunately, there appears to be a tendency to overfill faces, to over-paralyze facial muscles and create static faces with what can only be described as “weird smiles”!

A proper understanding of the anatomy, physiology, and, most importantly, the anatomy and physiology of aging is vital to the proper management of facial changes: whether this be with neuro-toxins, fillers, or with surgery.

We frequently see patients who are unable to move their foreheads, have no smile lines and have minimal movement of the lower face: these are “over-botoxed and over-filled” faces. Not desirable, not pleasant to look at and completely preventable. 

Judicious use of neuro-toxins and fillers can give what we term “invisible” results. To wit, there is a definite improvement in the appearance of the face but there is no obvious sign that anything has been done. What we call a natural look with movement possible in all parts of the face. I am always reminding patients who demand “no movement” and “full faces” that one can always do more if needed, but one cannot remove these materials. 

With surgery, it is experience and an artistic eye that are important. Word-of-mouth referrals are what we get as we do not advertise and we give our patients the natural look that leaves their friends wondering why our patients look so well but carry no stigmata of surgery. For example, unlike most surgeons, we never use staples (which are used for the purpose of speed), but use our surgical skills to place tissues and suture using fine non-scarring sutures. If you look at our facelift, browlift, blepharoplasty, etc photographs, you will note that even with close-up examination and photographs, incisions are almost invisible. Please remember, the operative word when looking at our work from two inches away is “almost”!!!

OUr advice to patients who come to see us: choose wisely, under-treat rather than over-treat, expect realistic results, and never go for broke! Never say “I want every wrinkle gone!” We can do that, but you will look like ……..

There are now several neuro-toxins available, each with its own small advantage and disadvantage, there are more than 50 types of fillers, more than 500 different lasers, and more than 500 different surgical procedures possible just on the face and neck. No wonder it is confusing. And advertising with “this is the best” never helps as the history of aesthetic medicine and surgery is littered with techniques and devices long-abandoned after claims of superiority.

Please remember that just because a company advertises directly to patients with their fillers or toxins or lasers does not make them the best. The same result may be obtained by using one of a number of different toxins, fillers or lasers. As the proof is always in the pudding, remember to look at before-and-after photographs of the surgeon’s patients and not just the photographs released by the manufacturer or sales person.

There is NO such thing as a “facelift in a bottle”, despite the continues claims ad nauseum on the internet. Believe them at your peril.

It is best to present the aspects of your body that bother you and please explain why they bother you. For example, is it something that everyone sees and comments on (“you look tired”, “why so you always look angry”, etc) or is it something that mainly bothers you? Based upon a detailed understanding of your and your friends’ and colleagues’ impressions, one can analyze and plan a conservative approach to trying to improve some of these changes. In some instances it may need surgery, but there are always options.

I always remind my patients that after a thorough discussion, the best option is to have nothing done! No risks, no scars, no side-effects, no expenses!

And it is your FACE, so choose wisely and do not fall for the high-pressure sales tactics that seem to have become so pervasive in all aspects of life, and, sadly, even in plastic surgery. It is fine to be presented with options and be allowed to think and decide, but it is not acceptable to be presented with a menu of items with high-pressure sales tactics. All too common, sadly. Resist capitalist salesmanship. It is YOUR face!

Finally, remember, all aspects of the surgery and what to expect should be discussed with you by the surgeon, not an assistant as the assistant is not the one who performs the procedures, nor has the experience. We encourage all our patients to come and see us at least twice (and more if necessary), with photographs from younger days and notes and questions. This way, we have a history of happy, satisfied patients. Remember, some things can need adjustments no matter who your surgeon: this is normal and the surgeon should give you the appropriate care, follow-up and attention.

So, no, you do not need to look plastic or frozen…….

Dr. Patel can guide you with do’s and don’ts and too much and just enough!