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.

The Liquid Facelift Debunked

A term that has become the bane of my existence is the “liquid facelift” due to a recent appearance on Dr. Oz that has caused quite a media stir.  Although I perform a huge volume of facial fillers and fat grafting in my practice, it is not the same meaning of “liquid facelift” that has surfaced more recently in the media.

Debunking The Liquid Facelift

What I have heard from my patients is the claim that injecting the outer portions of the face will cause the neck to lift upward like a facelift.  Are you kidding me?  That is complete bunk.  First, that is literally impossible.  Second, I do not like filling the outer face unless someone needs it otherwise the face will just become fat looking and unbalanced.  Now, if someone has some early neck banding then I do like to use fillers around the edges of the neck bands to cover them up but that is a direct fill.  I do not believe you can fill a face to lift the neck.  This is simply a ridiculously grandiose comment that has no bearing on reality that has stirred more consumer misunderstanding than I would like.

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

Bruce Jenner and Thoughts About Bad Facelifts

Unfortunately, the time that plastic surgery gets publicized is when it looks bad.  I too often hear, “Well, I can always spot out plastic surgery.”  Two things.  First, if facial plastic surgery is done well you should not be able to tell.  Second, even if you cannot tell, I can tell certain cases that are borderline bad.  This article will explore in my opinion why people look pulled and what can be done to avoid this outcome.

To make it very simple, my philosophy is that all facial lifting is bad (not all but almost all).  When I am talking about facial lifting, I mean any lifting that is carried out above the jawline.  I think a neck lift is warranted when the neck is hanging a la a turkey-gobbler appearance.  However, in contradistinction browlifts and midface lifts can look atrocious.  I used to perform them and did so very conservatively, but fundamentally there is a problem with treating the area from the mouth upwards with a lifting procedure.  The first problem is that the upper and midface do not actually fall.  This is a very hard concept to grasp because you will take two fingers and lift your face up and say, “Don’t I look better?”  This is the trap into which we can easily fall.  There is a fellow colleague of mine who looked at 40-year time differences of individuals in their twenties and in their sixties using standardized digital photographs and found that there was almost no evidence of gravity in the mid to upper face.

If this is the case, then why do individuals look like they need something lifted?  The answer is that the brows, lower eyelids, and cheeks actually deflate and therefore look sagging.  The hardest area to understand this concept is the brow region.  Most individuals who think their brows are heavy need to go back and look at their own brows in their youth. They will see that their brows almost definitely were not higher but were actually fuller.  If you take it even further back in time to one’s teenage years, you will see that the brow probably looked almost too full.  I use the analogy of a balloon in youth (your brows and upper-eyelid area) that gradually deflates.  When it deflates, it starts to look heavy but the actual trick is not to lift it but to re-inflate it.  I hope that makes sense.

The second reason that lifting of the upper and midface can look fake is that when areas of the mouth and eyes become stretched there can be an unusual look to them.  So in summary lifting areas around the mouth or the eyes can look weird because they should not be stretched in any way at all.  Finally, the reason that these areas can look artificial is that lifting these areas when they should more properly be filled with fat grafting (which is my preferred method of rejuvenation of the mid to upper face) is that pulling deflated tissues around exposed bone simply does not look good.  If you take Bruce Jenner as an example, he fits all of these stigmata.  He is very bony looking and then has all the areas mentioned above pulled around this bony frame.  The distortion is evident because there are areas of overstretched tightness wrapped around a bony frame.  On the other hand, at grafting done with taste and discretion (not the way that people today look overfilled in Hollywood) would be the way to fix these terrible results, not entirely but at least in part.

Samuel M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To learn more about Dr Lam’s facial rejuvenation and facelift procedures please visit our website www.LamFacialPlastics.com or call (972) 312-8188 to schedule a consultation.

One of the nicest men that I have as a patient, Robert, who trains boxers, shows himself a bit beaten up a day after facial rejuvenation and a week after having a face lift, fat transfer, upper blepharoplasty (cosmetic eyelid surgery), and an extended large chin implant.  Thanks Robert!  You can find his video in the media center under “Video Journeys” or just click on the video below:

Carey films herself every day for a week following her facelift, fat transfer, and Rhytec Portrait plasma skin resurfacing to show you her recovery in depth.  Thanks Carey for helping me convey to prospective patients the dimensions of your recovery, including discomfort, swelling, and your perceptions.  Hopefully, this will reduce the fear of the unknown and to present realistic expectations for any patient deciding to have “everything” done.