One of the biggest concerns that I have from prospective patients is that they not look weird, the fear stemming from seeing unnatural celebrities that are frightening to them in magazines and on television.  The question I get all the time is “If celebrity X has all the money in the world, how can she look so bad?”  Great question.  I think the answer is that the celebrity went to a physician who lacks artistic taste and therefore is incapable of seeing that his work is ugly.

In Nancy Etcoff’s book, Survival of the Prettiest, she talks about something called the “Uncanny Valley”.  On one side of the valley, we have normal-looking human beings that obviously do not garner any negative physical reaction from the average human viewer.  On the opposite side of the valley, we have things that do not look human at all like a robot, which also typically does not engender any negative sentiment.  In between, we have an “uncanny valley” in which we have quasi-looking humans that can create revulsion, fear, and dread in us.  That is why bad plastic surgery can elicit so many bad stares even though one may not be able to pinpoint exactly what is so “uncanny” about the person.  It is important as always when I see an individual that even when that person comes in for something else that I help him or her determine what would be the best procedure because sometimes one may not know one is already in the uncanny valley and certainly one should not be requesting a procedure that will land one in that dreadful valley.

Sam M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To schedule a consultation please call (972) 312-8188. To Learn more about Dr Lams’ plastic surgery procedures or to ask Dr Lam a question please visit his plastic surgery forum.

Survival of the Prettiest Part 2:  Do Blondes Have More Fun?

As a follow-up to the blog on how we relate to babies, Nancy Etcoff in her book, Survival of the Prettiest, argues that men are more attracted to blonde women than to darker haired women, whereas women are attracted to the polar opposite, i.e., a darker-shaded male.  The reason that she argues that men are more attracted to fairer-skinned women is that men are more attracted to younger women who are in turn more fertile in nature and women are naturally lighter in color when they are younger when estrogens levels are higher.  Women, on the other hand, are attracted to men who are darker in shade because men have naturally a higher hemoglobin content that is closer to the skin making men naturally darker.  Are all men attracted to fairer-skinned women and are all women attracted to darker-complected men?  Obviously, the answer is no; and I am not trying to be racist.  As you know, I am Asian so I am not trying to betray my own race but just reporting some of Etcoff’s thoughts, which I find fascinating whether they are 100% accurate or not.  Along those lines, women are deemed more attractive when they appear younger, which is perhaps the single most primary drive that I have in my business is to make women appear more youthful.  I know most women come in and declare up front, “Doctor, I am not trying to look 20.” And I get that.  I understand that my goal is not to try to make a woman look ridiculous.  However, with that being said, I do try to shoot for as much youth as I can attain within reason since it is a vital factor in building attraction from other men and women alike.  If we forget wrinkles and jowls and other specific facial features, the larger goal is to make a face look more attractive to another person viewing it and thereby build self-confidence and related happiness.  Happiness from looking better?  Is that possible?  In Jonathan Haidt’s book, The Happiness Hypothesis, he argues that good plastic surgery can actually bring years of happiness to an individual.

Sam M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To schedule a consultation please call (972) 312-8188. To Learn more about Dr Lams’ plastic surgery procedures or to ask Dr Lam a question please visit his plastic surgery forum.

Survival of the Prettiest Part 1:  Babies and Attraction

I am reading Nancy Etcoff’s book, Survival of the Prettiest, and recommend it to all as a good read for someone who wants to understand the biological impetus for our desire for all things pretty.  I heard Ms. Etcoff speak in Washington D.C. at our annual Fall Meeting of the American Academy of Facial Plastic & Reconstructive Surgery (AAFPRS) and found her talk riveting.

One thing that I thought particularly interesting is how we relate to babies and how babies relate to us.  Studying mothers who had more attractive babies found that they would spend more time with the baby staring at him or her, whereas those mothers who had less attractive babies would still spend considerable time with them but would be engaged in busy work that did not involve mindless staring at the child.  Even more fascinating is how babies respond to attractive adult faces as compared to unattractive ones.  Babies would stare for significantly longer periods of time at attractive faces and much less time at those faces deemed unattractive.

As humans, we are hardwired to be attracted to beauty.  Women were given photographs of beautiful and unattractive men and women, and they stared for exceptionally longer times at the beautiful people, both at the men and the women.  Men, on the other hand, only stared longer at the beautiful women.  Despite these gender differences, you can see we are all attracted to beauty at a subconscious and conscious level.  This is why what I do is so important because my objective in my work is to build attraction at a fundamental social and professional level because that is what is important when it comes to spending your hard-earned money on cosmetic services.

Sam M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To schedule a consultation please call (972) 312-8188. To Learn more about Dr Lams’ plastic surgery procedures or to ask Dr Lam a question please visit his plastic surgery forum.

The Outer Face:  Converting Double Concavities into Convexities

The one thing that I cannot stand is seeing a face that appears disjointed, i.e., part of the face has been over augmented relative to another.  Perhaps the two biggest problem areas that I see are the lips and the cheeks.  In fact, I have come up with the title, “Lip an Cheek Syndrome” for these malformed faces that I oftentimes see on the streets and in my conferences.  The isolated augmentation of the cheek in particular is a misunderstanding of how to enhance a face naturally.  I have come to truly see that many parts of the face must blend into the cheek to make it look natural and attractive.  In 2011, I was very focused on the buccal area (the area where if you suck in your cheeks you see it go inward, or the area just below the central anterior cheek.)  A carefully augmented buccal area can help make a face look considerably more youthful and attractive and it helps to blend the face.

This year I have been obsessed with the temple and “subzygomatic” area, which are two concavities above and below the zygomatic or cheek arch.  You can see these concavities from the frontal view, which is the most important view because that is how you see another individual when you look at him or her.  Many times, individuals believe that these concavities do not have major impact on the face’s youthfulness and attractiveness but they are very wrong.  They make a major impact on how the face appears and allows one to truly look youthful, bright and attractive.  It affects the soul of the subconscious and allows one to see that the face is beautiful.  It acts as an outside frame, if you will, and it has become a major if not the major obsession in my work this past year.  By filling in these shadow I am able to create a smooth oval arc for the face that is simply very attractive.  Using new improved microcannulas, I have been able to sculpt the face with considerable accuracy and finesse.  I have particularly liked using Artefill and Juvederm to do the trick.  As with all things, subtlety is what provides the brilliant result and differentiates it from an ugly, unattractive one.

Sam M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To schedule a consultation please call (972) 312-8188. To Learn more about Dr Lams’ facial rejuvenation procedures or to ask Dr Lam a question please visit his facial rejuvenation forum.

Fill vs. Lift in Facial Cosmetic Enhancement

This article is a corollary to my other article called the “Two-Finger Rule”. In the article on the “Two-Finger Rule”, I argued that taking two fingers and gently pulling up on the skin would not be achievable with any type of cosmetic procedure since it cannot be exactly reproduced by any lifting or filling technique. Similarly, when a patient asks me whether filling a part of the face in will help to lift that structure up I respond simply, “No.” The two are not the same thing. Filling a part of the face will not lift it and if it is reasonably filled up also should not make it heavier to create any sagging.

The most common question is if I fill the cheek in will that lift the smile line.  The answer is emphatically no.  It won’t.  Sometimes just filling the cheek in can cast a greater shadow on the fold and at times make it appear deeper but not substantially so.  It seems intuitive that if you enlarge something that it would stretch out the areas around it to lift it but this simply is not the case.  I had also a question on my forum that if an injectable filler could be placed near the bone so that it would provide more structure as compared with placing it close to the skin where it would add more weight.  I countered this by explaining that a filler placed deeply should not provide better structure and one placed close to the skin should not provide greater weight.

This patient had facial fillers to fill areas of hollowness. Even though the face looks lifted, it is an optical illusion of the filling.

The optical illusion that is created is that something filled in changes the way that light reflexes on it making it look lifted just by virtue that there is now more light and less shadow on the structure.   But there is no net lifting effect.  In summary, this article is intended to dispel a misconception and to provide a better understanding for a prospective patient that filling fills and lifting lifts but one does not help the other.

Sam M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. Call (972) 312-8188 to schedule a consultation or to ask Dr Lam a question about facial rejuvenation procedures please visit his plastic surgery forums.