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.

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.