Every day someone comes in to consult with me for a procedure, and after discussing the surgery and making a plan, they look up at me and nervously ask, “I’m not going to look weird, right?” I actually welcome this question, because I, too, walk around the world noticing plastic surgery that looks weird; and I, too, am particularly averse to that phenomenon.
There are a few basic principles to aesthetics. For one, things must be balanced. The Golden Rule of thirds is a good guide, and establishing that ratio almost never fails to make things look harmonious. The second is symmetry, which is paramount to things feeling “right.” But, perhaps most critically, there is also the issue of whether or not things look “normal.” And normal is a very big deal.
You have all seen it before, the famous actress that you have been watching for decades, who evolved slowly and then disappeared one day, only to reappear later in an unrecognizable form. She returns to the limelight with a new hairdo, an unusual wardrobe, flawlessly smooth skin, and someone else’s face. And all you can do is stare at it, thinking, “Who are you and what have you done with my favorite singer?”
I have spent a lot of time considering why this happens, and keeping myself in check as a surgeon to maintain the integrity of my patients. If I narrow down individual procedures, I can see how the evolution may occur if you’re not paying attention to the overall picture. For the nasolabial folds, for example (the laugh lines on the sides of your nose and mouth), they do deepen with age. Early mild deepening can be treated with fillers, and deeper creases often need surgery. The youthful look is one where the fold is barely visible at rest and then only slightly deepens on smiling. People looking for rejuvenation often seek to soften these lines as much as possible, ignoring the fact that even a 10 year-old has some fold, and removing it entirely is not actually consistent with a human face. There is a slippery slope to making things flat, and when they tip over into the extreme, they also leave the world of normal.
The plastic surgery that you notice is usually the plastic surgery that has crossed this frontier. In some cases, the outliers can look nice, but they rarely look natural. As a designer, I feel most tuned in to shapes and forms that are consistent with what nature herself would do. As a long-time plastic surgeon, I also believe that patients are more likely to be satisfied if no one can tell that anything was done. The reason why most patients do not realize that there is a lot of good plastic surgery out there is that it is, in fact, invisible.
