Secrets your plastic surgeon wishes you would know


While it feels as if everyone
thinks they are an expert on plastic surgery and other cosmetic procedures
because there is just so much information out there, doctors always know best.
While Botox or a boob job might not seem like a bigger deal than a bikini wax these
days, that is just not true. 
I asked several prestigious
plastic surgeons what they wish their patients would know and understand before
coming in. Their answers will not only surprise you, but may also clear up any
misconceptions you might have had about some of the most common cosmetic
procedures. They also shared some of their best tips to stay looking young.
Fillers and Botox are not the

Contrary to what so many
people think, Botox and fillers do not do the same thing. While they are both
injected into the face, these substances are chemically different and serve
different purposes. 
Dr. Fred G. Fedok, who is the
President of the American Academy of Facial Plastic and Reconstructive Surgery,
explained the difference to me. “Botox is a specific brand name for a drug
that is part a group of drugs that are otherwise known as neuromodulators.
These neuromodulators include Botox, Dysport, Xeomin, among others. They are
patented variations of botulinum toxin. The neuromodulators temporarily weaken
or paralyze the specific muscles that are injected. They are used to diminish
muscle action and thus improve small folds or wrinkles of the skin secondary to
the underlying muscular activity.”
Botox does not fill out
wrinkles, but fillers do. “Fillers are used to fill out deficiencies or
voids in the soft tissues,” Dr. Fedok explained. “These can be fairly
superficial and are truly dermal changes. They can also be deeper and represent
voids in the underlying fat complement in the facial soft tissues.”

Not all fillers do the same

Some people will ask a doctor
for a specific brand of filler because they heard it is good or it is what
their friend used, but that is not the way to go about it. Different fillers
are formulated to work on various parts of the face for a variety of purposes,
as Dr. Theda C. Kontis, who is the Secretary-elect of American Academy of
Facial Plastic and Reconstructive Surgery, explained to me.
“Fillers can be thick or
thin in consistency and permanent or temporary in longevity. Thicker fillers
are used for deeper creases and folds and to provide more lift. Thinner
products are used for finer creases and lines and provide less support,”
Dr. Kontis said. “There are three main classes of product. Hyaluronic
acid, such as Restylane and Juvederm products, can be dissolved with an enzyme.
Calcium hydroxylapatite, such as Radiesse is thicker and cannot be dissolved.
Polymethylmethacrylate, such as BellaFill is permanent, but requires a skin
The brands and types of
fillers that Dr. Kontis mentioned are available in the U.S., but Dr. Fedok
divulged that different fillers are available in other parts of the world.
“There are a variety of these substances that are approved for use in
other countries and are not yet approved in this country,” he told me.
Facial injections do not
always make you look better

We all know that facial
injections should make you look better, but sadly, that is not always the case.
However, it is not the fault of the person who had the procedure, rather, the
blame should be placed on the injector.
It’s very important the person
injecting your face is qualified to do so. While various medical professionals,
such as doctors, nurses, and even dentists inject Botox and fillers, Dr. Kontis
believes there is more to providing the best results possible than just having
a degree. “Your injector must understand facial anatomy and the aging
process in order to give you a natural-appearing result. There are not bad
filler products, just bad injectors. [So if] someone looks overdone with
fillers, they probably are.”
Too much Botox can also pose a
problem, such as not being able to move your face. But that is not the fault of
Botox itself. “Botox does not freeze the face,” Dr. Kontis explained.
“Fillers and Botox won’t make you look like a ‘freak,’ they were designed
to make you look natural.” 

You are never too young to
start the anti-aging process

A lot of people wonder when
you should start getting Botox and fillers, but the determining factor is not
age so much as the condition of your skin. According to Dr. Babak Dadvand, who
is a double board certified plastic surgeon in Beverly Hills, California,
“There is not really a right age to start fillers or injections like
Dr. Dadvand’s philosophy is to
start early, even as young as 20 years old. “I think the best thing is to
start earlier and start treating the early signs of aging,” he said.
“For Botox, the lines on the forehead especially, the angry scowl line,
the ‘elevens’ between your eyes on your forehead and even the crow’s feet.
Those things can help a lot to smooth out those areas. Particularly for
fillers, in the smile lines and the nasal labial folds, [starting young] can’t
prevent needing surgery later, but it can delay it.” 

Getting fillers and injections
can delay needing plastic surgery later

Getting Botox and fillers
improves your appearance in the short term, but they also prevent you from
potentially needing or wanting plastic surgery in the future. Dr. Dadvand
explained to me that, “From a standpoint of lines and such, [getting fillers
injected] can delay the need for plastic surgery later.”
Furthermore, a benefit of
getting injections now and opting for future surgery is that your results won’t
be shockingly different. So, your family and friends might not even be able to
recognize you had work done, as Dr. Dadvand explained to me. 
“When your lines are not
as bad, people look at you and comment you look well rested, as if you have
been on vacation. If you have deep lines everywhere and come in for fillers and
injections, people will know you’ve done something. For a lot of patients, they
do not want people to notice they’ve had something done, but they want people
to notice they look better.”

Sometimes plastic surgeons
have to turn a patient down

Sometimes we can forget that surgery
and even injections are not like getting a manicure or a haircut. There are
times when a doctor has to say “no.” Dr. Fedok told me there are many
reasons why a doctor may decline. “The reasons may involve multiple
aspects of the procedure, the doctor’s practice of medicine and experience, and
the candidacy of the patient themselves. In general, if a specific doctor
declines to perform a specific procedure on you, it is good to take his
However, if you really think
you are a good candidate for a procedure, Dr. Fedok says you might not be
wrong. “If you are a firm believer that you are a good candidate for the
specific procedure you are seeking, it is probably best to seek consultation
with another physician, rather than compelling the physician to do something
that for whatever reason he does not want to do.”
Dr. Kontis’ approach to this
problem is about managing the expectations of her patients. “Doctors must
assess if patients have the right expectations for the results that can be
achieved with each procedure. Communication between doctor and patient is
extremely important. I ask patients to explain to me the changes they would
like to see, and then I tell them what can or cannot be done. If they want a
result that cannot be achieved, I may suggest they not proceed with the

More than one procedure may be

Sometimes one procedure just
won’t cut it and multiple procedures may be necessary. This really isn’t
unusual for Dr. Fedok. “To maintain or to optimize your facial
rejuvenation, usually several different procedures must be carried out in order
to rejuvenate every aspect of your anatomy that has aged undesirably,” he
“For instance, it can be
very disappointing to go through the rigors of having an extensive facelift if
nothing else is done, i.e. facial soft tissues are repositioned and lifted
without addressing volume deficiencies in the face or without addressing a
poorly aged skin tone and texture. You may look tighter, but not youthful and
rejuvenated. In order to optimize the rejuvenation effort, that patient might
be best served by having not only a facelift, but fat transfer and volume
replacement, and some form of skin resurfacing.”
Multiple procedures don’t
always take place on the same day, but instead may be required over time.
“As we see in the population of celebrities with frequent media
documentation, it is important that patients look forward to having an
occasional touch-up procedure to keep things maintained,” Dr. Fedok advised.

Getting breast implants is a
very customized procedure

If you’ve been thinking about
getting breast implants by just picking a cup size and getting cut open, it
doesn’t exactly work that way. Dr. Dadvand explained that it has to be
the right fit for a woman’s body. “You have to select an implant that
is going to fall within the conventions of the natural breast, especially the
width of the breast. You don’t want it to be wider than their natural breast,
but at the same time you don’t one that is too narrow.”
It’s also not about cup size.
“A lot of women come in and say they want to be a particular cup size. I
tell them not to worry about their cup size. I’m not here to augment their cup
size. I’m here to augment their breast size. If you are happy with the size of
your breasts, who cares what the cup size is? You will be happy with that too.
It should match your anatomy and not cause it to get stretched out too
Dr. Dadvand also advised that
there are different types of implants. “[The new] silicone implants are
highly cohesive and made of a liquid gel silicone. In the ’80s and ’90s the
silicone was more of a liquid silicone and they would leak, so they were taken
off the market. I rarely do saline implants [anymore] because a lot of women want
a more natural look and feel. Silicone has a more natural feel.” 

You don’t need to spend a lot
of money on skincare products

According to Dr. Dadvand,
sunscreen will save you a lot of hours and dollars at a plastic surgeon’s
office. Fine lines and brown spots are often due to the sun. “I tell
patients, if you can do one thing, it is wear sunscreen. You don’t need
anything higher than SPF 50. All it does is cost more. It doesn’t give you any
more protection, but you have to reapply it several times a day. It wears off
even indoors. There is also no such thing as waterproof. If you go in the
water, you need to reapply.”
Dr. Dadvand is also a big
proponent of retinols. You don’t need to spend a lot of money at a department
store for a good retinol product. He suggests getting a prescription for Retin
A or buying an over-the-counter retinol at the drugstore. Differin is an
example of this kind of a product. He also suggests moisturizing to manage any
dryness that occurs as a result of using retinol. His pick? Old fashioned Oil
of Olay does the trick.

Self-care is very important
both before and after surgery

If you are going to have a
medical procedure, it is very important to listen to your doctor because many
substances can create complications and prevent healing. Dr. Dadvand gives his
patients a long list of things to avoid both before and after surgery. 
“I tell patients there
are things they should avoid for a few weeks before and after surgery, such as
alcohol, anti-inflammatory medication, such as Advil, and fish oil pills. These
are things that can cause you to bruise or bleed more easily,” Dr Dadvand
said, elaborating that one thing tops the list of pre-surgery do-nots. 
“As far as surgery is
concerned, smoking is the worst thing you can do. I make all my patients stop a
month before and usually for a month after. There are two issues. Nicotine
constricts the blood vessels, so you don’t get enough blood flow to the area
being operated on. Also, all the carcinogens in the smoke make the airways
really inflamed so there is a higher chance of getting bronchitis or having a
coughing fit when they wake up from the anesthesia. Smoking is the number one
thing I tell them not to do.”

Listen to the doctor

So, if you want to look your
best, just understand that doctors know best. If you are considering any kind
of procedure, it is important to have realistic expectations and understand
that just one procedure may not cover it all. And if you want to look younger,
but fear needles and knives, it’s pretty simple. Listen to Dr. Dadvand. Wear
sunscreen every single day and do not forget to reapply.

Kayode Ojo
Kayode Emmanuel Ojo is the Co-Founder and Managing Director at SHEFFA Limited. He is presently studying Computer Science at the National Open University, Victoria Island, Lagos.