Category Archives: facial rejuvenation

Recreating the Lateral Convexity of the Upper Face: How and Why

Applying art to facial rejuvenation is key to making a face appear optimally youthful and at the same time completely natural. I have spent my lifetime studying faces to determine what are the qualities that make a face look younger or older. I particularly like to look at mother and daughters’ photos on social media […]

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 […]

Glass of Water Emptying: The Way I Explain the Aging of the Face

Glass of Water Emptying:  The Way I Explain the Aging of the Face When people ask me whether fat grafting is permanent, I say yes and no.  Yes, it is permanent because if done well by an expert injector (which I consider myself one) then once the graft gains formal blood supply over a period […]

Breaking down the Cheek into Aesthetic Subunits: Avoiding Chipmunk Cheeks

Breaking down the Cheek into Aesthetic Subunits: Avoiding Chipmunk Cheeks There is nothing uglier than big, chipmunk cheeks other than perhaps a devil looking arched brow or a duck-like lip.  How do you avoid this problem?  Should one not fill the cheeks at all then?  The answer is no since the cheek is one of […]

Type 1 and Type 2 Eyelids

Type 1 and Type 2 Eyelids One of my colleagues came up with the distinction between two types of youthful eyelids.  Type 1 is a very full upper eyelid that hangs almost over the eyeball itself (not quite).  Type 2 eyelid is an eyelid that is much hollower but at the same time still distinguishes […]

Breaking the Brow into Subunits: Designing a Brow for Cosmetic Improvement

Breaking the Brow into Subunits: Designing a Brow for Cosmetic Improvement In a previous blog we discussed why low, full brows are sexy, youthful and attractive. In this blog, we will delve into the exact subcomponents of a brow that need to be filled to achieve that look.  I break the brow into multiple points depending […]

Botox: Understanding Balance

Botox: Understanding Balance One of the most common things that I hear when I am working on a new patient for Botox is either “Don’t give me those Spock eyes” or “Don’t make me look too frozen.”  Although Botox has become one of the most commoditized items in the cosmetic world, I believe that by delivering […]

When Do I Do an Upper-Eyelid Blepharoplasty and How?

When Do I Do an Upper-Eyelid Blepharoplasty and How? But should we always just add fillers or fat to the upper frame of the eyelid and never remove any tissues?  The answer is no.  If the eyelid skin is above the eyelash margin, I rarely if ever remove skin.  Filling fat or fillers into the […]

When Do I Do a Lower-Eyelid Blepharoplasty and How?

When Do I Do a Lower-Eyelid Blepharoplasty and How? Like the upper eyelid, I find myself performing many more fat transfers to correct the aging process than traditional eyelid surgery.  Further, if I perform a traditional lower-eyelid procedure I will almost always use some fat transferred to improve the result.  In fact, I look at […]

Survival of the Prettiest Part 3: The Uncanny Valley

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 […]

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

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., […]

Recovery and Cost of Fillers vs. Fat Grafting

Recovery and Cost of Fillers vs. Fat Grafting I would like to focus on two specific pros and cons with fillers and fat transfer: cost and recovery. In the younger patient (under 35 years of age), fillers typically are the most affordable way to make a face look more youthful. The reason for this is […]

Juvederm is My Preferred Choice for Facial Cosmetic Blending

In my effort to find the best filler experience for an individual, I am constantly evolving my injection filler methods and the preferred products that I use to accomplish those goals.  In the past, I was a big advocate of Restylane injectable fillers but of late have found a real passion for Juvederm Ultra Procedures.  Is Juvederm great […]

Top 10 Things People Worry about After a Fat Transfer (During the Recovery Period)

Top 10 Things People Worry about After a Fat Transfer (During the Recovery Period) When I call one of my patients the night following a fat transfer procedure, I usually mention the top few things that can make them alarmed that will resolve over the period of the next couple of weeks.  Here is that […]

High or Low Brows?: What is Sexier for Men and for Women?

High or Low Brows?:  What is Sexier for Men and for Women? I am reading a book called Survival of the Prettiest by Nancy Etcoff in which she says studies have shown that a higher brow actually looks less attractive to subjects who viewed various individuals with different brow heights.  A low brow was considered […]

The Outer Face: Converting Double Concavities into Convexities

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 […]

Cannulas for Facial Fillers: The Evolution of My Technique

Cannulas for Facial Fillers: The Evolution of My Technique Although I would estimate that only 1% of injectors currently use cannulas rather than standard needles to perform facial fillers, I truly believe that they have become the standard of care in my practice and I would hope the industry soon. I have been using cannulas […]

Fat Grafting: A Little Everywhere

Fat Grafting:  A Little Everywhere Good taste with clothing means that the items one wears are in harmony, possess style, cut well, and made of good material.  Good cosmetic facial surgery is very similar.  The products (materials) one uses can determine the outcome and certain fillers, e.g., fat, Restylane, and Juvederm, work better in certain […]

The Happiness Hypothesis and Plastic Surgery

The Happiness Hypothesis and Plastic Surgery The Happiness Hypothesis and Plastic Surgery A great book that I read last year was Jonathan Haidt’s The Happiness Hypothesis in which the author outlines many parameters for happiness.  One of his points in the book is that great happiness that can last for years following cosmetic surgery.  Unlike […]

Fill vs. Lift in Facial Cosmetic Enhancement

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 […]

The Two-Finger Rule

The Two-Finger Rule Almost every day a patient comes to me holding up the sides of her face and asking, “Can you do this for me?”  The answer almost invariably is no, and I would like to take this blog to have you understand why that is.  I like to call this the “Two-Finger Rule” […]

Downturned Corners of the Mouth: How To Fix Them

Downturned Corners of the Mouth:  How To Fix Them One of the banes of women’s existence is the downturned corners of the mouth. Whether they are mildly present or severe, almost every woman regardless of age is overly focused on them to their own detriment. I often think that the reason for this is that […]

Understanding the Brow as a Balloon: The Role of Fat Grafting to the Brow

Understanding the Brow as a Balloon:  The Role of Fat Grafting to the Brow One of the most confusing things that I do is to inflate a brow/upper eyelid with fat or filler when someone instinctively thinks that her brow is already too heavy and sagging.  If someone really does not get it, all I […]

Why I don’t use Sculptra

Why I don’t use Sculptra First, let me say that I truly do not believe Sculptra is a bad product. In fact, I have many trusted colleagues who use it and use it well.  However, I have used it in the past but I do not anymore for several reasons.  The motivation behind this blog […]

Understanding the Role of Artistry in Cosmetic Surgery and Enhancement

Understanding the Role of Artistry in Cosmetic Surgery and Enhancement Pablo Picasso Studio One of the greatest compliments that I received was from an Italian plastic surgeon who flew from Italy trusting me to work on his wife’s face, which I performed in front of him.  I undertook a fat transfer on her face to […]

Accent XL: Skin Tightening as an Important Adjunct to Cosmetic Enhancement

Accent XL:  Skin Tightening as an Important Adjunct to Cosmetic Enhancement Sometimes skin tightening is overrated and sometimes it simply does not work. In the past I used infrared technologies but abandoned it due to short-lived results. I have instead relied on radiofrequency work with the Accent XL to achieve skin tightening with increasingly better […]

Kenny Rogers and Bad Blepharoplasty and Browlift Surgery

Kenny Rogers and Bad Blepharoplasty and Browlift Surgery Obviously, there is quite a bit of brouhaha about Kenny Rogers’ facial work. His alien appearance has clearly become the poster child for bad facial plastic surgery. If you are wondering what I see as far as his bad work is concerned, I can break it down […]

Eyebags, Shorelines, and Rocks

Eyebags, Shorelines, and Rocks When we talk about eyebags, we are focused on the obvious, which is that there is a protuberant bag of tissue. However, is this really the case in the majority of situations? My answer is no. What I oftentimes see is that the lower orbital bony rim becomes exposed over time […]

How I use Permanent Facial Fillers: Fat, Silicone, Bellafill(Artefill)

How I use Permanent Facial Fillers: Fat Transfer, Silicone, Bellafill(Artefill) In my clinical practice I use both temporary and permanent facial fillers depending on a mixture of budget, desires, and safety. Although permanent fillers carry the risk that they are indeed permanent, I believe that it is important to delineate safety guidelines and also to […]

Differentiating Type 1 from Type 2 Eyes When Considering Fat Transfer to the Upper Eyelid/Brow Complex

Differentiating Type 1 from Type 2 Eyes When Considering Fat Transfer to the Upper Eyelid/Brow Complex A colleague of mine really got it right when he created a new perspective on seeing youthful eyes.  He called them Type 1 and Type 2 eyes.  I cannot recall which one was which, which is not important.  Suffice […]

Leveraging the Hardness of Products in Cosmetic Injectable Fillers

Leveraging the Hardness of Products in Cosmetic Injectable Fillers How hard an injectable product is can be a very good thing or a not so good thing. In any case, I try to use products based on its hardness factors for differing effects on the face. One of the softest materials that I use is […]

Fillers versus Fat: Shifting Sand Concept

Fillers Versus Fat: Shifting Sand Concept Many of my patients try to weigh the merits of fat grafting versus fillers since they both seem to be equally beneficial to fill in the hollows of an aging face.  However, I would disagree.  For younger faces still replete with enough fat and in whom I worry about […]

Understanding The Anterior Chin: The Upside Down U

Understanding The Anterior Chin: The Upside Down U Aging of the chin area is one of the most confusing areas because people I believe focus on the wrong thing. Most oftentimes the concern is about a jowl or about a sagging puppet line. Alternatively, it is about the fine lines that can circumscribe the lips, […]

Dismissing Fat Grafting Myths

Dismissing Fat Grafting Myths After speaking with patients who are vaguely familiar with fat grafting I have encountered a lot of misunderstanding about how fat grafting works and a lot of this misunderstanding comes from other surgeons who do not understand it.  Here are some of the top myths on fat grafting that I would like […]

Blink Effect: How We Perceive Beauty and the Role of Cosmetic Surgery Enhancement

Blink Effect:  How We Perceive Beauty and the Role of Cosmetic Surgery Enhancement One of the most important things that a woman typically wants fixed is the fine lines around her mouth.  I have found this to be the case no matter if she is 33 years old or 85 years old.  Why is this […]

Fat Grafting Recovery: Things You Need To Know Following Your Procedure

Fat Grafting Recovery: Things You Need To Know Following Your Procedure One of the biggest concerns in our busy workaday America is “What is my recovery like after fat grafting?”  This is something that I will try to explore in this brief article to help prepare a prospective patient who is interested in having this […]

Stem Cells and Fat Grafting: My Thoughts

Stem Cells and Fat Grafting: My Thoughts Perhaps the hottest topic that we have today in cosmetic surgery is stem cells.  Do they exist?  How do we use them?  What are they good for?  Are there risks?  Unfortunately, even the most dogged proponents or detractors do not have clear answers to the above points.  I […]

Fat Grafting Eyelid Series Part 2 of 2: Rethinking the Lower Eyelid

Fat Grafting Eyelid Series Part 2 of 2:  Rethinking the Lower Eyelid This second article in the series focuses on techniques for lower eyelid rejuvenation.  The traditional way to manage the lower-eyelid aging was through a cutting procedure that involved either a skin cut or involved taking fat out from inside the eyelid without an […]

Fat Grafting Eyelid Series Part 1 of 2: Rethinking Aging of the Upper Eyelid and Brow

Fat Grafting Eyelid Series Part 1 of 2:  Rethinking Aging of the Upper Eyelid and Brow Traditionally, we have looked at the aging of the upper eyelid and brow through a gravitational model, i.e., we believe that the aging of the upper eyelid and brow sag over time.  This is not always the case.  In […]

The Importance of the Buccal Zone: Joining the Mid to Lower Face

The Importance of the Buccal Zone: Joining the Mid to Lower Face The buccal area is defined as the part of the face where if you sucked in your cheeks they would suck inward.  It is the area that in a very skinny person can make one look gaunt, and the buccal area resides in […]

Recent Fat Grafting Video Testimonials

Recent Fat Grafting Video Testimonials I have had several recent video testimonials by patients who have had my fat grafting services that I thought I would post here in this blog in addition to putting them in the video testimonial section of this Web site. I would truly like to thank my patients for their […]

Fat Grafting Using a Hair Transplant Model for Understanding Part 3: Donor Dominance

Fat Grafting Using a Hair Transplant Model for Understanding Part 3: Donor Dominance A new concept that really did not mature fully until I was preparing for my Vegas lecture in mid-2010 and then refined further as I was finishing my prep work for my St. Louis lecture in November 2010 was the concept of […]

Fat Grafting Using a Hair Transplant Model for Understanding Part 2: The Dip

Fat Grafting Using a Hair Transplant Model for Understanding Part 2: The Dip The early swelling of fat grafting that dominates the first 1 to 3 weeks after a procedure can be misconstrued as a result when it in fact is a mixture of engorged fat cells and postoperative swelling. Sometimes the stretched out appearance […]

Fat Grafting Using a Hair Transplant Model for Understanding Part 1: Graft Growth

Fat Grafting Using a Hair Transplant Model for Understanding Part 1:  Graft Growth Looking at my fat grafting results I was puzzled initially as to why I saw results continue to improve in patients somewhere between 6 months to 2 years after a procedure.  Being a very careful student of my own work by photographing […]

Balance vs. Symmetry

Balance vs. Symmetry We have all heard that symmetry is one of the cardinal signs of a beautiful face.  Studies in the animal kingdom have led us to believe that symmetry truly makes all the difference when selecting an ideal mate.  However, I would like to propose that symmetry is not as important as we […]

Rethinking Facial Implants

Rethinking Facial Implants When considering a cheek augmentation, consider truly what would benefit you most.  In many young individuals with weak bone structure, a cheek implant made of silicone or other material can be an ideal choice since it is reversible, easily inserted and can provide a better, more attractive structure to the face.  However, cheek […]

Fat Grafting: Rethinking Aging of the Face

Fat Grafting: Rethinking Aging of the Face A revolution is upon us today in how we see aging of the face and how we understand the aging process. In the past, the gravitational model held that all things fall including the brows, the eyelids, the cheeks, and the jawline. Using rigorous computer modeling and matching […]

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