Heidi Montag Plastic Surgery:  What Are My Thoughts

Obviously, when a famous celebrity gets plastic surgery, there is a thunderstorm of opinions that surround that event.  Mostly these opinions originate from the lay press, and at other times these opinions appear as sound bites from a media-hungry or media-savvy plastic surgeon.  My goal in this blog article is to express my thoughts on Heidi Montag’s plastic surgery and what may have motivated the procedures and what perhaps could be the long-term consequences of the surgery.

When an individual has a significant number of plastic-surgery procedures at a very tender age, the red flag that comes to my mind is a condition known as body dysmorphic disorder (BDD).  Obviously, I am not saying that is what Ms. Montag has since it would be gross speculation and unfair.  However, I would at least venture to state that it would be a sincere concern of mine.  BDD as a definition in short is a psychological condition in which someone has an obsession over a body part that is disproportionate to what in actuality it may appear to be and that may in turn socially cripple that person.  When an older person seeks a fat graft, a facelift, and related procedures to aging, I am not as concerned if that person fits the psychological profile of someone who is reasonable and not socially handicapped by his or her looks.  However, when someone in her early 20s has a significant number of procedures, then the question certainly must be raised or at least properly investigated.

Safety of having so many procedures all at one time regarding anesthesia risk should also be considered.  The occasion of individuals having experienced anesthetic risk has arisen when facial procedures were combined with extensive body surgery.  Body procedures, especially aggressive liposuction, alter body fluids and chemistries and poses risk when extended surgical times are required.  Again, surgeon judgment and patient selection are mandatory here when deciding the right, safe combination of procedures to be performed at any given time.

Finally, this is a big one for me:  how are all of these procedures going to age for Ms. Montag.  My opinion, not well.  Aggressive rhinoplasty with a revision procedure can lead to unfavorable nasal changes over time.  To me (I may be wrong) she appears not to have had a conservative approach to her nasal surgery, as indicated by some early nasal notching that I see. In addition, if you know me, you know that I have come to despise browlifts.  With the fullness in her brows now, they don’t look too bad (but in my opinion not very good either).  I think as her brows hollow out, she will look particularly bad by her late 30s.  Fat grafting is my specialty and I am very careful in selecting the right patient for this procedure.  I believe that her having had this procedure done at such an early age with future metabolic changes and bearing children could lead to the fat aging very poorly.  How?  The fat may enlarge if she gains significant weight with further aging, and the remaining part of the face that was not transplanted will probably look unusual as the areas that were transplanted start to separate from untransplanted areas.  In general (but not always) I prefer to operate on women for fat grafting who are at least mid-thirties in age.  For all of the above reasons, I remain circumspect about Ms. Montag’s motivations and the safety in the long run of her many procedures that she underwent.

Samuel M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. For more info about Dr Lam’s fat transfer procedures, or to schedule a consultation please call (972) 312-8188. If you would like to ask Dr Lam a question please visit our plastic surgery forum.

Forgiveness in Cosmetic Surgery

Many times I have individuals who come to me who are very depressed about a previous cosmetic surgery procedure that they elected to have done.  I can see that for me to help them with anything new that I would first have to help them overcome their previous relationship with their plastic surgeon and what they perceive as a negative outcome.

What I focus on is the concept of forgiveness.  Many times these patients have a lack of forgiveness toward their previous plastic surgeon due to a perceived bad outcome and/or a bad relationship.  Either way they can’t get over it.  What is also interesting is that the lack of forgiveness needs mainly to be directed at themselves, i.e., many times individuals are simply sad and angry that they did not do sufficient research on the cosmetic surgery procedure or the surgeon to let them be duped resulting in their untoward outcome.  I typically say to the patient that 25% of their forgiveness needs to be directed at their previous plastic surgeon and 75% needs to be directed at themselves.

Without being able to get over a previously bad relationship, there is almost nothing that I can do to “fix it”.  The reason for this is that a patient’s regret almost always clouds his or her judgment to the point that the defect is perceived to be present regardless of whether in fact it is or it is not still there.  Oftentimes a previous problem cannot be entirely corrected but just improved so therefore it is important to emphasize this, because without doing this the patient will never be fully satisfied.  Offering forgiveness to oneself for making a previous mistake and forgiving one’s previous surgeon are the first steps to healing so that a new relationship and new intervention can properly flourish.

Samuel M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas, specializing in facial plastic surgery procedures. For more info, or to schedule a consultation please call (972) 312-8188. If you would like to ask Dr Lam a question please visit our Plastic Surgery Forum.

Joan Rivers Plastic Surgery: From Overlifted to Overfilled

Joan Rivers, From Overlifted to Overfilled

Joan Rivers has been the poster child of bad plastic surgery for quite some time now.  She was one of the most overlifted individuals that anyone has ever witnessed, but I believe that she may have gone overboard in the other direction, which is overfilling. The LA Times recently stated that Joan Rivers, now 78 years old, had her 734th cosmetic procedure.

Like anything in cosmetic surgery, taste and discretion using artistic judgment are paramount when working on the sensitive nature of the face.  Just because fat grafting maybe a good thing, it certainly can be a bad thing in the wrong hands making people look overbloated, unbalanced, and unnatural.

Samuel M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To see more celebrity plastic surgery blog posts, or to learn more about Dr Lam’s plastic surgery procedures please call (972) 312-8188 to schedule a consultation. If you would like to ask Dr Lam a question about facial plastic surgery please visit our Plastic Surgery Forum.

Avoiding Bad Eyelid Surgery: Preserve the Canthus At All Costs

I oftentimes hear a patient come to me to say, “I don’t want to look like celebrity…” who has had too much surgery done or a friend that has been subject to similar bad work.  If the surgery has to do with the eyes, there is almost always some component of distortion of the outer eye canthus (where the upper and lower eyelids meet) that causes the observed problem.  I truly believe that canthal distortion accounts for the majority of unnatural identity changes that occur following eyelid cosmetic surgery.

This blog article will discuss what causes canthal distortion and how to prevent it.  The cause of canthal distortion is simply put lower eyelid surgery that tucks or manipulates the outer canthus.  This onerous result arises from cutting the lower-eyelid skin, which causes a loss of tone and strength to the lower eyelid that must be reconstituted.  Subsequently, the canthus must be suspended to the lining of the bone so that the lower eyelid then does not sag.  Unfortunately, swelling during the surgery and variable scarring after the procedure can cause the canthus to drift either too far in, too far out, too far up, or too far down; any direction of which can cause an unnatural distortion and result.  Just take a finger to the outer canthus (again where the upper and lower eyelids meet on the side closer to the ear not the nose) and pull up, down, in, or out and look at the way that it completely changes the way that you appear.

Corrective fat transfer to correct bad previous eyelid surgery that distorted the can thus and bad cheek implants (removed) that distorted the cheek areas.

How do I avoid this complication?  Simply put, I never cut on the lower eyelid skin except in major trauma cases, which fortunately I do not do anymore.  I prefer to use fat grafting to manage the aging lower eyelid with or without non-incision based eyebag fat removal, Botox, and/or skin laser treatments.  However, despite all of these treatments methods I entirely avoid cutting the lower eyelid skin and thereby almost entirely eliminate risk of cutting on the outer canthus and the related problems that can ensue.

Samuel M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To learn more about Dr Lam’s eyelid cosmetic surgery, and fat grafting procedures please call (972) 312-8188 to schedule a consultation. If you would like to ask Dr Lam a question about facial plastic surgery please visit our Plastic Surgery Forum.

Priscilla Presley and Bad Silicone

Unfortunately, celebrities seem to be victims of shysters and crooks.  As far as what I have heard, Priscilla Presley had silicone injected into her face by an unlicensed individual leaving her permanently scarred.  As you can see in this photo, her cheeks were made way too large, whereas her upper and lower face was left relatively untouched (except for the bad lip work of course).  The problem with this is that she already looks unnatural and will continue to look even more unnatural as she ages.  The reason she looks unnatural now is that the cheeks are too full for her age and they stand out because they are not blended in with the rest of the face.  As she ages, this situation gets even worse because the rest of the face continues to lose fat and soft tissue whereas the cheeks will remain the same size making her face even more disproportionate.  The best solution for her would be to have fat transferred into the brow and upper face and into the buccal zone and lower face so that the face can look more balanced since silicone really is impossible to remove.  I recently saw a lady from New York who suffered the same problem with fat grafting, too much of which was placed into the cheek area and nowhere else, in order to correct acne scars of all things.  Ouch!  I used Restylane to sculpt her brows, temples, buccal area, and chin to make the cheeks look less chipmunk like and to make her face more balanced.

Priscilla Presley and Bad Silicone

Silicone has had a bad rap in the media because most people think that it is unsafe.  In the quantities used for Priscilla Presley I would definitely agree.  By performing only small amounts in discreet areas of the face like the lips slowly with repeated small injections, the silicone should not lump up or age poorly as you see in this case.  I use silicone all the time for lip enhancement procedures but in select patients with proper technique and in very small, subtle amounts.  This case clearly is one of poor judgment and frankly was illegal, as the provider was unlicensed to perform the procedure.

Samuel M. Lam, MD, FACS is a board certified plastic surgeon. To learn more about Dr Lam’s facial rejuvenation procedures in Dallas, Texas please call (972) 312-8188 to schedule a consultation. If you would like to ask Dr Lam a question about face rejuvenation please visit our face rejuvenation forum.