With the New Year almost always come new plans for our habits, our attitudes, our appearance or any number of different aspects of our lives. My practice of course, deals with improving the appearance of our faces, but often the conversation in the exam room turns to seemingly unrelated subjects. I love to read and I love to help my patients in any way I can. This has eventuated in my writing down book names for people numerous times, mostly on the back of an appointment card. So to start 2016 I thought I’d share some of those titles with you in hopes that you’ll find the same delight and inspiration in those you choose as I did.We’ll start with some well-researched and ultimately beautiful books that pull together the science that proves our connectedness. This is a particularly important subject this year as the upcoming elections are going to pull us into a quagmire of vitriol from both sides. After over 22 years and thousands of patients, I wish to remind us all that good people can come to different conclusions, and the more we appreciate our collective connectedness in the midst of our differences, ultimately the more peaceful our lives will be.Three of my favorites are by an American journalist living in the U.K. She has interviewed scientists from all over the world and has pulled their information together in a well-referenced book called simply, The Field. After writing this excellent book, so many people wanted to know how to apply its discoveries to their own lives that she wrote a great follow-up, The Intention Experiment. Her third book, which specifically articulates the science behind our connectedness is called The Bond.There is a fabulous author, Gregg Braden with whom many of my patients have been unfamiliar, but his books are amazing, fun to read and fascinating page-turners. He is a former aerospace computer systems designer who has been all over the world to gather as much information on “who we are” as he can. A quick Google search will give you a list of all his books, but my favorites are:
Gregg Braden’s good friend, Bruce Lipton, PhD, is a molecular biologist who has written an inspiring and science-based book called The Biology of Belief.I’m always glad to offer interesting sources on diet, exercise and health in general. But I wanted to start the year with nourishment from the inside. May every happiness be with you in this exciting coming year!
There’s a little axiom among many of my colleagues who specialize in facial rejuvenation, and it goes like this:
What do women stress out about most when they look at themselves? Their necks.What is everyone else looking at? Their eyes.
That’s true, but it’s only partially true. There’s plenty of research out there now that’s been facilitated by our friends the computers. Basically, researchers will throw up a photograph of a person from the shoulders up and show the photos to observers. With the computer, the researchers can track the eye movements of the observers to see what they’re looking at and where their eyes settle for the longest amount of time when shown the photos.
As it turns out, the area that people are looking at is in the shape of an inverted triangle that essentially has its base across the brows and has its tip at the center of the chin. The features that observers look at the most are the eyes and the lips.
This is not to say that our concerns about our necks aren’t important. Especially from the side, someone can look much more vital with a firm, smooth neck. Also, the healthiest reason to have rejuvenation procedures done is for our own sense of well-being. Moreover, our skin is what people notice first. That said, this research may help us to prioritize when we’re thinking about “having something done”.
Reading all the kind reviews from my clients makes my job so much more rewarding. Thank you to all who take the time to submit your feedback and kind words. Here are some client testimonials from recently.
• Doctor Barbour treats me as if I were her only patient. I know in my heart all others entering this door receive the same care and feel the personal attention I experience upon each visit. It's a joy to know I'm in the most professional care.
• Everything Dr Barbour does is EXCELLENT. Not only is her work excellent but her personality and understanding makes the experience extremely gratifying.
• Dr. Barbour is a delightful person and an outstanding surgeon, sculpting and correcting the neck and face.
• Dr Barbour is without a doubt one of the most professional and yet personable doctors I have ever had the pleasure of having contact with. She is a true artist in her profession. I would recommend her to anyone that wants a beautiful, believable radiant look! Thank you Dr. Holly Barbour for your wonderful skill, God given talent and my new confidence.
• Dr. Barbour is so wonderful and very knowledgable. Another bonus is she is sweet and kind. She is very unique she spends time with you and really listens to your needs. I have been with her for seven years and I will continue coming to see her. I drive over an hour to see her she is that wonderful. I would highly recommend anyone to visit the office, I know they will be wowed at the experience. The entire staff is just wonderful and they all go above and beyond. They are all wonderful and help make your experience unique by working as a great team.
I just returned from a national conference of the Foundation for Facial Aesthetic Surgery, a symposium attended by physicians in the three core specialties trained in this field. They are Oculofacial Plastic, ENT/Facial and General Plastic surgeons. This is a forum where generally the more enlightened surgeons, those who believe that instead of being competitors and guarding our “turf” (so last century) we and our patients benefit more by our getting together and sharing ideas from our various perspectives. Because this kind of mindset requires confidence, there were many nationally and internationally known surgeons in attendance, and the meeting was absolutely fascinating.
I had been asked to speak on integrating fillers and “neuromodulators” (BoTox, Dysport, etc.) for restoration of the face, but I asked to speak instead on permanent fillers, knowing that it would be a much more controversial and compelling topic. Besides, the issue of permanent fillers is one I feel more passionate about, both pro and con. Here are a few of the pros:
PROS• I’m happy to stand corrected on this, but I have conferred with a few surgeons regarding the statistic, and they agree that after the age of 30 we lose about 1cc of volume from the face each year. That’s 5cc per year (this would include both bone and soft tissue). Each syringe of filler that we use to correct volume loss contains between 0.8 and 1.5cc of product. Depending on the filler, these syringes run between about $450 and $1,000 a syringe for our patients. It doesn’t take much arithmetic to realize that this becomes prohibitively expensive for our patients unless they have unlimited resources, are content to chase their tails forever, or eventually just give up and/or age out of the process with little to show for it if nonpermanent fillers have been used.
• People generally don’t like having needles in their faces.
• Sadly, I do a considerable amount of “repair work” on poorly done surgery and fillers. Having suffered the results of that work usually involves some psychological trauma for the patient. Where fillers are concerned, the advantage of permanency is that once the repair work is done the patient can put the event behind them and move on rather than having to revisit the memory over and over as the “repair” wears away.
• We’re going to age anyway, and replacing lost volume in smaller increments rather than having to start essentially from square one each time, especially as the aging process becomes more profound, results in a better outcome.
• Most people want the attractive facial curves of youth, but they don’t necessarily want the world to know that they’re having something done to get them. With permanency, again we can do little bits at a time so that the upkeep attendant to the aging process is virtually undetectable.
We’ll look at the arguments against permanent fillers in our next blog. Check out our website to see client testimonials and to learn more about how permanent fillers could be right for you.
As I've told so many patients, this practice exists for your happiness. Fortunately, quite a few of my dear patients have rated this practice and the reviews can be found online. To make it easier to see them, for any of you who don't know us, we are posting links right here so you can be more easily directed to the various review sites. If you are one of my existing patients and you've reviewed our practice, thank you so very much for your support and for the generosity of the time it took you to write your comments. There is no advertising like word of mouth, and when it goes into cyberspace I am particularly grateful.
•Holly Barbour is a Superstar! I am a 58-year-old man. I had a facelift and my ear lobes trimmed down. Its not obvious that anything was even done, however, my friends are telling me how great I look! Dr. Barbour is a consummate professional with a very experienced team. My procedure took several hours and Dr. Barbour nor any of her team ever left my side. Unbelievable commitment and dedication to her patients. Dr. Barbour is a perfectionist. My wife is in awe that she cannot see any scaring at all. I would recommend Dr. Barbour and her entire team! 5 Stars!
• Dr. Barbour is consistently wonderful. She is extremely thorough and patient in her office visits and I was very pleased with the results of the surgery she performed. She does not pressure or rush her patients and I always feel she is totally honest and realistic.•I cannot express in words how unbelievably thrilled I am with my results. I look beautiful, stunning and so refreshed. There is no other Dr. that I would have touch my face. Dr, Barbour is beyond skilled, professional, she goes above and beyond what any one would ever do. I wish you could see how happy I am, I am gorgeous because of her. Thank you doesn’t express my gratitude enough.
This is a common question among people who are considering a facelift. When facelifts look “bad”, it’s usually because they look like facelifts instead of a face that exists naturally. In medicine we call these problems the “stigmata” of facelifts. As an Oculofacial Plastic Surgeon, I can tell you that it’s difficult to go out to an event – or even dinner -- without seeing at least one example that almost breaks my heart.
This is because the stigmata that screams, “I’ve had a facelift!” is almost always completely avoidable. Here are the problems I see most often:
1. A facelift was performed on significantly sun-damaged skin or skin that lost its collagen for other reasons, like smoking. This shouldn’t be done for two reasons. One is that there’s a disconnect between the perceived age of the skin and the perceived age that the contour is signaling. Also, the skin can get drapey looking once any swelling subsides. Thus, even if it’s subconscious, the observer is getting a what’s-wrong-with-this-picture message and that in turn stimulates a recoil reaction (it really does – there’s plenty of research on this). Second, and let’s be clear: a facelift will not pull the wrinkles out of your skin (at least not for long) even if it looks as though it should when you pull your face back with your fingers at home in the bathroom mirror. Wrinkles are from collagen loss in the skin and no amount of pulling can restore that. Collagen can be restored by other means, but that would not include a scalpel.
2. A facelift was performed without regard to the fact that significant volume had been lost in the face. This is a good part of why that “too tight” look exists or why a facelift can look like skin sitting right over a skeleton, the “Cruella de Vil” look. This can also result from the use of some outdated techniques. Arguably worse is when too much fat was injected, and it happened to “take” and the face looks disproportionate and like a chipmunk.
3. The person flexes their neck down and there’s that weird crease running up behind the angle of their jaw that just does not occur in nature. Again, poor technique.
4. The ears look strange. This can be what we call “pixie ears” (so very not as cute as it sounds) in which the surgeon has put too much traction on the skin and not enough anchoring underneath, causing the earlobes to pull down and almost disappear as they run into the jawline. Even more common is when the ears have been set too far forward and look pasted on. And even more common is a thick flap of skin right in front of the ear instead of that little dip that occurs in nature.
5. Easily visible scars. Everybody heals a little differently, but placement of the incision lines and a great deal of care in sewing those incisions closed is crucial. With rare exceptions, incision lines should be something noticeable only with a search. Furthermore, the incisions should be placed and closed so that the person with the facelift isn’t restricted regarding their hairstyle.
I do a significant amount of “revision work” in my practice on facelifts done elsewhere, and most of these problems at the very least can be improved. I would advise that seeing someone’s work tells you a lot more than their advertising, which can be woefully misleading. Also, the core specialties that are well-trained in doing facelifts are Oculofacial Plastic (or Oculoplastic) surgeons, ENT/Facial surgeons, and general Plastic surgeons. None of these specialties has a lock on technique, talent or most importantly, outcomes. (Some surgeons want to think their specialty does, but that’s just greedy, egotistical and political.) Your surgeon should come out of one of these three core specialties, but beyond that they should have the drive to keep up with this evolving field, the ethics not to cut corners or worry about their pocketbooks more than your well-being, a passion for their work and your result, and the artistic vision to know what your best version of yourself can look like and how to get there.
1. You look in the mirror and see your mother... -This happens not to be a good thing, as far as you're concerned.2. Your skin is in reasonably good condition, but you're getting/have gotten jowly. -Gravity and an accumulation of fat at the jowl area are usually the major culprits.3. Your skin is in reasonably good condition, but you're getting/have gotten a saggy neck. -Gravity, an accumulation of fat under the chin and/or prominent muscle edges (the vertical bands down the center of the neck) are usually the major culprits.4. You realize that a facelift is about the contour of your face and neck and not about pulling out wrinkles. -See #2 and #3. Notice that we didn’t mention wrinkly skin as a culprit. Wrinkles are the result of a loss of collagen and elastin in the skin. No surgery is going to put that collagen and elastin back. This is what lights and lasers are for, however the creases that result from the fat, gravity and loose muscles will be helped.5. If you've been losing weight or are planning to lose weight, you're within 20 pounds of where you realistically think you're going to land for the long haul. -This is a slightly arbitrary number – we're all a bit different – but you certainly don't want to invest in a lift and then lose 50 pounds, because you may need another lift after that to look your best. Conversely, if you want to lose 50 pounds, but the reality is that you won't lose more than 20, you could be waiting forever.6. You want to look refreshed and revitalized, but you're not looking to take off a specific (huge) number of years. -There are all sorts of little structural changes that take place over the years, not the least of which is that we lose about 20% of our skull volume over the course of our lives. Since on the face, every little millimeter shows (really - there's research that proves this), there is just no way that a 50 year old will ever look 20. But you no longer have to be a nymph to look absolutely gorgeous.7. You're in generally good health and are confident that your family medical doctor would clear you for the procedure. -This eminently elective surgery doesn't happen unless you're healthy enough for it. A facelift does not qualify as a last ditch attempt to save your life, no matter how we may think of it.8. You're moving up, moving on, starting a new page in your life, and you want to boogie into it looking your very best. -A good facelift is a real confidence-booster and should make you look just like you - the very best version of you.9. But you realize that a facelift isn't a guarantee of The Fabulous Job, The Fabulous New Boyfriend, The Fabulous Husband -- and a Fairy Tale Life Forever and Ever. -Confidence really does start from the inside out. Cultivate your mind and your spirit as well as the body you're living in. Any modern physicist will tell you that we're all energy. Make it good and the rest follows.10. You're willing to keep up/adopt healthy lifestyle choices and take good care of your wonderful self afterwards, so that this investment in yourself gives you years of rewards. -Enjoy!
THE BIGGEST CONCERN ABOUT BOTOX: “I DON’T WANT MY FACE TO LOOK FROZEN”
This is a common – and certainly understandable – concern that newcomers to BoTox have expressed. Here’s the scoop:
For the majority of the muscles we treat, the aim is not to “freeze” the muscles but to relax them enough so that they don’t bulk up and create lines and furrows where they’re attached to the skin. Furthermore, we generally want to relax only those muscles that pull the face down and in (the sad, angry muscles), allowing the muscles that pull the face up and out (the happy ones) to stay strong and work unopposed.
There are some exceptions though. For instance, the muscle in your forehead (the frontalis) that raises your eyebrows and creates those horizontal furrows also happens to be the only muscle that keeps your eyebrows from sinking down to your kneecaps. Relax that muscle too much and you can look a bit Neanderthal-esque. An experienced doctor who knows what she’s doing will be able to find that “sweet spot” in terms of BoTox dosage and placement to relax the furrows without dropping the brow.
We can do some wonderful things with BoTox. If your doctor has an intimate knowledge of facial anatomy, a lot of experience and a truly aesthetic approach to the face, there never should be a compromise to your expressiveness. Also, find someone who is willing to take the time to assess your needs with you, explain their plan of treatment and follow up with you to make sure you’re happy with the result.
And remember, if you stumble into a bad treatment, it does wear off.
The eternal facelift conundrum for almost everyone goes somewhat like this:
“I want to look better, even way better. I want to look in the mirror and see that I look awake and happy instead of tired and sad. I really want that change to happen, but I don’t want people to notice that I’ve had a facelift.”
If this is what you’ve thought, you have a lot of company. If you feel a little embarrassed about saying that, you have a lot of company. The good news is that you can have it both ways – and the reasons are twofold.
First, and most importantly, the facelift must look natural, but the road to natural has to be through the vision and skill of your surgeon, not just doing less. We could do nothing and get natural, but that’s not what you’re signing up for. You’re signing up for skilled surgery, artistic vision and the ethics of someone who will treat your face as if it were their own. Let’s say you’ve found that with your doctor and you get a result that makes you look more as you did in your youth. The vitality, radiance, lift and definition of your face are back, but what will people think????
Here’s the reality. Just to bring it into perspective, let’s look at a situation most of us have experienced. You go to a gathering. You wear a lovely outfit. A couple months later, a similar event is to take place with some of the same people. You agonize because while the outfit you wore to the first event is perfect and you feel fabulous in it, you’re a little embarrassed to wear the same thing again. But think of the people who were at that event. Can you remember what they wore? Chances are that unless something particularly stood out, you can’t.
For better or worse, human nature is engineered to make us a bit more self-absorbed than we’d like to admit.
Now back to the facelift. If it looks natural, most people will just subconsciously register that you look great, or they will consciously register that you look great and will ascribe it to just about anything but surgery on your face. They will think you changed your hair. (If you actually changed your hair around the time of the surgery, all the better.) They will think you lost weight, fell in love, went on a long vacation, retired, began working out, whatever. Of course there are exceptions to this, but mostly these will be people who either have had facial work done themselves and are now primed to notice these things or people who have been thinking about it and want to have some of what you got. And in the latter case they may pull you aside and ask where you had it done. In any event, the bottom line is that if it looks good, if it looks natural and if it looks like the best version of you, your face will cause endorphins to be released in those that look at you – and that’s all good.
One of the facts of life that surprises a lot of my patients (although they invariably say something like, “Oh yeah, that’s right!” when I bring it to their attention) is just another of Mother Nature’s little ironies:
As women age, they tend to become more masculine looking in the face. Features harden and sharpen, and the soft curves of the face of their youth morph into angles.
As men age, they tend to become more feminine looking in the face. The chiseled jaw softens, sometimes into oblivion, and the strong virile features that defined their masculinity in youth seem to melt and sadden.
That is one of the reasons why facelifts, lid surgeries and even BoTox and fillers can go so awry. It’s why women can look “harder” after they’ve had work done and why men can look sort of “weird”. Those of us who treat faces need to understand that you don’t just follow your Doctor Book and approach people like a technician. It is our responsibility to understand the subtle differences that give femininity or masculinity to the face and to be able to translate that into the work we do with our patients.
The aim is to restore softness, sweetness, perhaps even a bit of an angelic look to the woman’s face. On the other hand, the aim with a man is to restore a look of strength and virility to his face. This requires an almost 180 degree turn in our approach to the two genders. And this is one of the ways we make our “work” look natural.
Oculofacial Plastic Surgeon, Sarasota, Florida
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