Destination beauty

Dr Shafer answers BBeyond reader questions

Dr Shafer is a NYC double board-certified plastic surgeon, a Diplomate of the American Board of Plastic Surgery and a Member of the American Society of Plastic Surgeons.

How often is it safe to have a facelift?

While there is no limit to how many or how often a patient can have a facelift, generally most patients only have one facelift in their lifetime. Signs that a facelift may be necessary are loose skin of the face and neck, prominent jowls, marionette lines or nasolabial folds around the mouth. Most patients feel that they look 10 to 15 years younger after having a facelift. While facelift surgery does not stop you from ageing, the procedure certainly turns back the clock significantly. Many patients also choose to have other procedures at the same time as facelift, such as fat grafting to replace lost volume, blepharoplasty to redefine the eyelids, brow lift to open the eyes and even breast rejuvenation.

What is the least invasive and most effective way to remove fat depositsfrom the abdomen?

Fat around the abdomen can be stubborn and resistant to diet and exercise. A persistent “muffin top” in women or “love-handles” in men can be frustrating. While most of the non-invasive procedures such as fat freezing are not effective, minimally invasive procedures such as Smartlipo or Power-assisted liposuction can have a huge impact with very tiny incisions. Under light sedation, stubborn areas of fat can be significantly reduced, forming a more youthful and slender contour to the abdomen. More invasive procedures, such as tummy tuck are only necessary if the patient has loose skin or separation of the rectus muscles (diastasis) which can only be determined during your physical examination and consultation. For minimally invasive procedures, such as Smartlipo, the patient can expect to see immediate results, but will need to wear compression garments for several weeks. Over the next several months, the results are even better as the swelling completely resolves and the skin tightens.

Most popular and life-transforming procedure for men?

30% of men suffer from gynecomastia or prominent breast tissue. This can lead to awkward situations when they are at the beach or in the locker room, as it appears that they have breasts. In most cases, the breast tissue can be significantly reduced through liposuction. During the procedure, the patient is sedated and the area of the chest injected with numbing medication. The fat and breast tissue are then suctioned out with special laser-assisted cannulas placed through very small incisions. The procedure takes about one hour and the results are fast and the recovery is minimal. After surgery, men feel more comfortable in clothes and with their shirts off.

When do men typically start having plastic surgery? Is it at a different age from women?

In our modern society, men are just as image-conscious as women. In fact, I was just featured in a Men’s Health article discussing liposuction for men. Age really is not a factor in seeking plastic surgery. The greatest factor is when the patient perceives that there is something about their body that they would like changed. In the teen years, it may be rhinoplasty. In early adulthood it may be breast implants for women and liposuction of the love-handles in men. In middle age, facial rejuvenations treatments like Botox and filler are useful in both men and women, and tummy tuck is always popular to regain that youthful stomach. As patients age, they then consider other surgical procedures such as facelift, blepharoplasty and breast rejuvenation (in women).

Is it true that ears and noses get longer with age and how can we remedy this?

Just as the skin of the face, breasts and abdomen loosens over the years, the perkiness of the nose and ears diminishes over time. Luckily there are a few non-invasive treatments for the nose and ears which can help with quick and effect rejuvenation. Botox treatments around the nose can help remove the bunny lines or wrinkles across the bridge of the nose and also reduce the downward pull on the nose which sometimes occurs when smiling. Dermal fillers such as Juvederm or Radiesse are effective at giving more shape and definition to an aging nose. For the ears, dermal fillers or fat grafting are a fantastic treatment to help plump up the earlobes and bring life back into an often neglected area of the face in plastic surgery. Additionally, if a patient is undergoing a more invasive procedure, such as facelift, it is an opportune time to also give a little nip or tuck to their ears.

Hollow sunken eyes are synonymous with advancing age. Do you have any specific surgical interventions that address this?

As we age, we lose volume in our face. Additionally, the fatty layer that cushions our eyeballs begins to herniate into our lower lids producing lower lid bags and loose skin of the upper lids. This trifecta (deflated cheeks, lower lid bags and upper lid skin) is a telltale sign of ageing. Dermal fillers such as Juvederm or Restylane are excellent at replacing lost volume of the cheeks and upper lids and camouflaging the lower lid/cheek junction in the early stages of ageing. However, every patient needs to be carefully evaluated to make sure they are having the appropriate procedure or treatment. In some cases, surgery may be the best option to achieve a long-lasting, natural rejuvenation of the face. A combination of upper and lower lid blepharoplasty with fat transposition and mid-face fat grafting can achieve excellent results.

What procedures exist for ageing hands?

As patients age, they lose subcutaneous fat or volume. This occurs in the face (hence the popularity of dermal fillers such as Juvederm, Restylane, Belotero, Sculptra and Radiesse), but also occurs in the hands. Hands can be a telltale sign of ageing. The same treatments that we use to rejuvenate the face can also be used for the hands. Sculptra injections in the hands can help replace lost volume, camouflage underlying veins and bones and give the hands a younger, smoother appearance. Chemical peels, which are popular to help reduce fine lines and pigmentation of face, can also be applied to the hands. Peels range from lower strength glycolic peels to deeper TCA peels.

If anyone wanted to have a quick fix procedure to look their best for Christmas and New Year, what would you recommend and when should they have it latest to have recovered by then?

It is best to plan ahead for plastic surgery procedures. Procedures such as liposuction, tummy tuck, facelift and breast implants may take several weeks to months to completely heal. So if you have a big event this Friday, it is too late to have an invasive procedure on the preceding Monday. However, many of our non-invasive procedures such as Botox Cosmetic, dermal fillers, and skin treatments such as chemical peels and laser facials can produce almost immediate effects. A combination of these treatments customized to the patient’s specific needs and desires can help smooth fine lines and wrinkles and give your face a natural look with a youthful glow.

Why is New York such a hot destination for age-defying, beautifying procedures?

NYC attracts the best-of-the-best in the financial, legal, cultural, fashion and entertainment industries. There is no question that this is true of plastic surgery as well. The NYC patient is smart, demanding, perfectionist and savvy. A doctor can’t survive if they do not meet their patient’s expectations. Patients don’t have time for treatments that don’t work, incompetent doctors, or prolonged recoveries. Our out-of-town patients travel to NYC with the same expectations. Whether you are having plastic surgery to perfect yourself for a walk down the runway, an appearance on TV or to fit into the perfect dress for a party, we strive to provide the best care to our patients. Given that we work with industry leaders on Fashion Week, television networks and the social scene, treatment protocols and procedures are perfected to achieve the most natural results with minimal recovery.