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Issue Date: July 2012

Image Conscious

In a social media- and camera phone-dominated world, you're constantly reminded what you look like. In the past year, Greater Cleveland plastic surgeons have seen a jump in procedures aimed at putting your best face forward.
Lynne Thompson

A strong chin has long been associated with a pleasing profile and strength of mind, body and character. Conversely, a weak jawline can be a source of stress for some now that video conferencing, cell phone cameras and Facebook are part of our daily lives.

"When people have a weak chin, they look dumpy and tired," says Dr. Michael Wojtanowski of the Ohio Clinic for Aesthetic and Plastic Surgery in Westlake. "People see their profiles when they're taking their own pictures [on cell phones] and sending them to people. They're like, •God, I don't know if I like the way I look.' "

Wojtanowski has noticed more people requesting the procedure at his practice, but he isn't alone. According to the American Society of Plastic Surgeons' 2011 Plastic Surgery Statistics Report, chin augmentation is the fastest-growing plastic surgery trend among all major demographics, up a whopping 71 percent from 2010.

Wojtanowski says part of the chin implant's appeal lies in its less invasive nature. The solid-silicone prosthesis is slipped through an incision inside the mouth, just behind the lower lip, during an hourlong outpatient procedure. This process usually requires no more than local anesthesia or sedation and a couple days of downtime.

The increase was not enough to put the chin implant on the American Society of Plastic Surgeons' top five cosmetic surgery procedures last year, but another facial surgery — the facelift — returned to that list for the first time since 2004.

Dr. Mark Foglietti of the Cosmetic Surgery Institute in Beachwood confirms that facial rejuvenation is hot in this region. He estimates that his trademarked Natural Vector facelift, which redirects skin and muscle in eight different directions to achieve a natural look, now accounts for 20 percent of all surgeries he performs. He attributes the increase to growing health consciousness.

"People are exercising more," he says. "They feel better. They want to look as good as they feel."

Dr. Steven Goldman of Beachwood Plastic Surgery & Medical Spa also reports a rise in facelift requests, along with nose reshaping and breast augmentation. He says he believes the nation's slowly improving economy plays a role in the increase in procedures as well.

"People are feeling secure enough to spend again," Goldman says.

Ironically, the economic downturn that began in 2008 also yielded one of today's newest facial-rejuvenation trends, according to Dr. Frank Papay, chairman of the Cleveland Clinic Dermatology and Plastic Surgery Institute. He says patients' need for a more affordable facelift that required less time off work spurred the development of less aggressive techniques — surgeries with fewer and smaller incisions in which tissues are folded back instead of raised and tightened. Papay says even patients who can afford the full facelift routinely opt for the less invasive because it requires less time to heal.

"A full facelift totally heals within a month and a half," he says. "You're bruised and swollen for at least two to three weeks. But with these minimally invasive ones, you're not very swollen or bruised at all. Within a week, you're back to work full time."

Injections of soft tissue fillers such as Juvederm, Restylane, Radiesse and fat were among the fastest-growing minimally invasive procedures in 2011 (up 7 percent from 2010), while shots of botulinum toxin type A (frequently referred to by the trade name Botox) increased 5 percent.

Dr. Renuka Diwan of The Laser & Skin Surgery Center in Westlake attributes the ongoing popularity of these to an economy that, although improving, hasn't recovered as quickly as some had hoped.

"With people being concerned about time away from work, job security and so on, recovery time has become important," she says. "And people are interested in more natural results. They don't get this •Aha!' factor where they go back to work and it's obvious to everybody that they've had something done."

According to Foglietti, injectables are commonly used in tandem to perform what is known in the industry as a "liquid facelift." He says this nonsurgical option is a good choice for those who aren't quite physically or mentally ready for a traditional facelift. Botulinum toxin softens or eliminates wrinkles, while fillers such as Juvederm replace fatty tissue lost from the cheeks, folds extending from the corners of the nose to the corners of the mouth, the chin and the jowl area. Foglietti says 30 to 40 percent of clients in his injectable practice schedule the procedure at some point.

"In 20 minutes, you can look better and buy yourself a couple years," he says. "I see a lot of people coming in prior to weddings or major social events. They don't have the time to heal to have the Natural Vector lift."

But the injectable generating the most buzz — both in facial rejuvenation and breast augmentation — is fat, according to Dr. Bahman Guyuron, chairman of the department of plastic surgery and professor at University Hospitals Case Medical Center.

"I've run two symposia this year, and both of them were dominated by fat injections," he says. (According to the American Society of Plastic Surgeons, fat injections were up 19 percent last year.) The fat cells, which are harvested from a donor site on the patient's own body, are rich in rejuvenating stem cells that increase skin elasticity and reduce sun-related color changes. Results are often permanent, Guyuron says.

While working with fat is more challenging — fat cells survive better in some areas of the face, such as the frown lines between the eyes — Guyuron says the benefits are well worth the effort.

"This is really a revolution in facial rejuvenation happening right under our eyes," he says.

Dr. Gregory Fedele of The Art of Plastic Surgery in Beachwood says those desiring a nonsurgical procedure with more lasting effects are also turning to laser skin resurfacing. The number of such treatments rose 9 percent last year, according to the American Society of Plastic Surgeons.

He says resurfacing procedures done with the relatively new Pearl-brand laser improve skin texture, reduce pore size, eliminate dark spots and fine lines around the eyes and mouth, and even soften deeper furrows without the raw redness and discomfort associated with its predecessors. Patients walk out of the office looking like they've experienced nothing more than mild sunburn, according to Fedele.

"You have some peeling for three to four days," he says. "Over the course of the next few weeks, that pinkness will continue to fade."

Diwan notes that the most minimally invasive facial-rejuvenation option of all — prescription topical treatments and skin care systems designed for in-home use with no downtime — is also attracting a greater following.

"They don't work overnight, " she says. "Sometimes you see optimal results in four months or so. But they're impressive nonetheless."

She singles out the Obagi-brand Nu-Derm system, which consists of a cleanser, toner, an exfoliant containing alpha hydroxy acids, a prescription-strength lightening agent, sunscreen and bedtime applications of Retin-A.

"The way they're combined, they're more effective than writing a prescription for any individual component," she says.

Although cosmetic procedures (both facial and otherwise) are traditionally considered a female indulgence, Dr. Lu-Jean Feng of The Lu-Jean Feng Clinic in Pepper Pike counts a growing number of men among her clients.

"Before, it was more like 5 percent or 10 percent," she says. "I'm seeing more like 15 percent."

Her figure surpasses that of the American Society of Plastic Surgeons. Although the number of male patients nationwide rose 6 percent in 2011, they still accounted for only 9 percent of all cosmetic procedures tallied last year. 

Feng says the male patients she sees are frequently highly visible executives, professionals and entrepreneurs in their 50s and 60s who are still intent on advancing their careers and businesses.

"They don't want to retire," she says. "And they don't want to look like they're ready to retire."

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