Dr. Lindsey's Newsletter #48 -What I've Had Done: My Story as a Plastic Surgeon

What I’ve Had Done: My Story as a Plastic Surgeon

As a plastic surgeon, body modification is my trade. However, my aesthetic is not to create a body that screams 'modified.' My goal is to achieve results that appear natural and preserve the identity of each patient. With proper skincare, injectables, procedures, and surgery, you should look like the best version of YOU.

The meaning of natural beauty is intuitive. The meaning of identity preservation is also self explanatory. I want to explain what objective beauty is. This is a concept we have touched on in previous newsletters, but I don’t think is widely understood. The principles of beauty are objective. This means that there are certain measurements, features, and characteristics that universally the eye will interpret as healthy and beautiful. Even if you do not realize how your brain is processing beauty, your brain has been hard wired for many generations to interpret favorable features as beauty. As a plastic surgeon I use my education in human development and aesthetics to guide my treatment plan for each patient.

The meaning of natural beauty is intuitive. The meaning of identity preservation is also self explanatory. I want to explain what objective beauty is. This is a concept we have touched on in previous newsletters, but I don’t think is widely understood. The principles of beauty are objective. This means that there are certain measurements, features, and characteristics that universally the eye will interpret as healthy and beautiful. Even if you do not realize how your brain is processing beauty, your brain has been hard wired for many generations to interpret favorable features as beauty. As a plastic surgeon I use my education in human development and aesthetics to guide my treatment plan for each patient.

We always start with skincare. This is the alphabet, the foundation that must be laid for every procedure to be optimized. If you don’t ever plan to have plastic surgery, your best shot at aging well is to invest in medical grade skincare. This list is my holy grail of skincare. I frequently experiment with different formulations, brands, and also add in different products for specific needs. But what you will always find in my routine are the medical grade components above.

We always start with skincare. This is the alphabet, the foundation that must be laid for every procedure to be optimized. If you don’t ever plan to have plastic surgery, your best shot at aging well is to invest in medical grade skincare. This list is my holy grail of skincare. I frequently experiment with different formulations, brands, and also add in different products for specific needs. But what you will always find in my routine are the medical grade components above.

I prefer Dysport for my own face and neck. I personally have a better and longer lasting effect compared to the other brands of tox. This can vary across patients but I find that Dysport works better for most. I started at age 30 and have kept up with it since then every 4-6 months. My experience as the pateint is that after having consistent treatments for 8 years I have softened my pre-existing lines and they don’t come back as strong.

Q: Hypothetically speaking, if you develop resistance to tox or it isn’t within your future budget means, then is it worth doing now if you know you can’t have it in the future?

A: A resounding YES. Each tox treatment benefits you permanently.

Let’s say, hypothetically, that I can no longer receive tox treatments due to an unusual resistance or budget constraints. Each time you invest in a neurotoxin treatment, you benefit, and that benefit lasts forever. Even if neurotoxins stopped working for me tomorrow, I have still gained 8 years of 'frozen time' for my face. This means that for 8 years, my facial muscles were prevented from pulling on my skin, effectively taking 8 years off the aging process. This is a win all around.

On that note, the only people in studies that developed resistance are patients who were administered very high doses at short intervals. Common circumstances where this may happen include medical treatments for large muscles - like spastic diseases of the muscle. I have known aesthetic patients that developed resistance to tox because of improper treatment timelines and injecting large doses in large muscles. This is just one reason why I do not promote for others, nor myself, injecting large muscles (like trap tox) for aesthetic goals.

I prefer Dysport for my own face and neck. I personally have a better and longer lasting effect compared to the other brands of tox. This can vary across patients but I find that Dysport works better for most. I started at age 30 and have kept up with it since then every 4-6 months. My experience as the pateint is that after having consistent treatments for 8 years I have softened my pre-existing lines and they don’t come back as strong.

Q: Hypothetically speaking, if you develop resistance to tox or it isn’t within your future budget means, then is it worth doing now if you know you can’t have it in the future?

A: A resounding YES. Each tox treatment benefits you permanently.

Let’s say, hypothetically, that I can no longer receive tox treatments due to an unusual resistance or budget constraints. Each time you invest in a neurotoxin treatment, you benefit, and that benefit lasts forever. Even if neurotoxins stopped working for me tomorrow, I have still gained 8 years of 'frozen time' for my face. This means that for 8 years, my facial muscles were prevented from pulling on my skin, effectively taking 8 years off the aging process. This is a win all around.

On that note, the only people in studies that developed resistance are patients who were administered very high doses at short intervals. Common circumstances where this may happen include medical treatments for large muscles - like spastic diseases of the muscle. I have known aesthetic patients that developed resistance to tox because of improper treatment timelines and injecting large doses in large muscles. This is just one reason why I do not promote for others, nor myself, injecting large muscles (like trap tox) for aesthetic goals.

I have two parameters that I use when choosing filler for my face. First, I want to preserve my identity. Second, I want to set myself up for the best possible outcome when I am ready for my first facelift.

The Lips:

When I was an intern in plastic surgery I had our aesthetic fellow inject my lips. He did a beautiful job, they looked natural (after the swelling went down). At the time I was working at the VA taking care of our Veterans. I remember rounding on my patients the day after lip injections (pre-mask era) and looking like a baseball bat hit me in the mouth. My swelling was extraordinary and I think I scared a few Veterans that day. My surgery teammates would not stop laughing. My boyfriend at the time (now my husband) panicked when he saw me and told me that he could not continue dating me if I pursued an unnatural appearance (and I didn’t blame him). One week later my swelling had abated, my lips were soft and natural appearing, just a little more plump. I loved my results, the vets were no longer scared, and my boyfriend was no longer embarrassed to be seen with me. I loved my lip filler experience, but to me that was it. I had achieved a subtle change and I was done. I didn’t think more was better and now 7 years later I am happy with my natural appearing lips and I do think I still have a bit of an enhanced lower lip despite the 7 years passing. As I age my lips will thin and I will probably either have more lip filler or do a dermal fat graft to the lips. We will see.

The Jawline:

Like everyone else on this planet, I have asymmetry between the right and left halves of my face. My mandible is a little smaller on one side and so I have had conservative amounts of filler placed along that side for facial balancing. I have purposefully not placed enough to try to make the sides equal, just enough to get a boost and soften the difference between the sides. This treatment went unnoticed by my husband and everyone else, just the way I like it!

I have two parameters that I use when choosing filler for my face. First, I want to preserve my identity. Second, I want to set myself up for the best possible outcome when I am ready for my first facelift.

The Lips:

When I was an intern in plastic surgery I had our aesthetic fellow inject my lips. He did a beautiful job, they looked natural (after the swelling went down). At the time I was working at the VA taking care of our Veterans. I remember rounding on my patients the day after lip injections (pre-mask era) and looking like a baseball bat hit me in the mouth. My swelling was extraordinary and I think I scared a few Veterans that day. My surgery teammates would not stop laughing. My boyfriend at the time (now my husband) panicked when he saw me and told me that he could not continue dating me if I pursued an unnatural appearance (and I didn’t blame him). One week later my swelling had abated, my lips were soft and natural appearing, just a little more plump. I loved my results, the vets were no longer scared, and my boyfriend was no longer embarrassed to be seen with me. I loved my lip filler experience, but to me that was it. I had achieved a subtle change and I was done. I didn’t think more was better and now 7 years later I am happy with my natural appearing lips and I do think I still have a bit of an enhanced lower lip despite the 7 years passing. As I age my lips will thin and I will probably either have more lip filler or do a dermal fat graft to the lips. We will see.

The Jawline:

Like everyone else on this planet, I have asymmetry between the right and left halves of my face. My mandible is a little smaller on one side and so I have had conservative amounts of filler placed along that side for facial balancing. I have purposefully not placed enough to try to make the sides equal, just enough to get a boost and soften the difference between the sides. This treatment went unnoticed by my husband and everyone else, just the way I like it!

Microneedling:

Microneedling is a no brainer. There is not a significant risk profile, all skin types can benefit, and it builds the collagen you lose as you age. Everyone should do it. I do it and I use the SkinPen because it is the only FDA approved device. I offer this service to all of my patients.

Moxi:

Moxi Laser is a different story and falls on my list of both loved and regret. All lasers must be approached with great respect. I am fortunate to have trained in a plastic surgery residency that pioneered the field of lasers in the aesthetic industry. Most literature on safety and outcomes has been written by my mentors. Because of this I have a very strong education and approach to choosing laser treatments for my patients. I cannot emphasize this enough, skin type matters. I will spare you the details here - we need a whole newsletter on this topic, but it is absolutely important to analyze the skin type prior to laser use. Now let’s talk about my skin. I am genetically diverse. From family tales + 23 and Me I have determined that I am British, Irish, German, Scandinavian, and American Indian. I tan easily but also will burn if not protected in the sun. All of this makes me low risk for laser treatments except the American Indian component. The more melanin, the more melanocytes, and the more care and attention you must have to fine-tuning a laser treatment. The American Indian heritage puts me at risk for hyperpigmentation after laser treatments. Where my story gets confusing is that there is no evidence of indigenous genes in my 23 and Me and so I relaxed on my laser parameters. I thought maybe my family tales of Cherokee blood were fables. I underwent 2 Moxi laser treatments at settings that were probably perfect for someone with all caucasian genes, but not for my melanin rich genes. Immediately after Moxi treatments my results were incredible, my skin looked like a baby, and then the hyperpigmentation came. Over a year later after my laser treatments I started developing a fine grid of hyperpigmentation where I had been lasered. My lesson from this is, when in doubt, always be conservative on settings and don’t trust your 23 and Me. I am now treating this pigment with Hydroquinone and my usual tenants of skincare.

Microneedling:

Microneedling is a no brainer. There is not a significant risk profile, all skin types can benefit, and it builds the collagen you lose as you age. Everyone should do it. I do it and I use the SkinPen because it is the only FDA approved device. I offer this service to all of my patients.

Moxi:

Moxi Laser is a different story and falls on my list of both loved and regret. All lasers must be approached with great respect. I am fortunate to have trained in a plastic surgery residency that pioneered the field of lasers in the aesthetic industry. Most literature on safety and outcomes has been written by my mentors. Because of this I have a very strong education and approach to choosing laser treatments for my patients. I cannot emphasize this enough, skin type matters. I will spare you the details here - we need a whole newsletter on this topic, but it is absolutely important to analyze the skin type prior to laser use. Now let’s talk about my skin. I am genetically diverse. From family tales + 23 and Me I have determined that I am British, Irish, German, Scandinavian, and American Indian. I tan easily but also will burn if not protected in the sun. All of this makes me low risk for laser treatments except the American Indian component. The more melanin, the more melanocytes, and the more care and attention you must have to fine-tuning a laser treatment. The American Indian heritage puts me at risk for hyperpigmentation after laser treatments. Where my story gets confusing is that there is no evidence of indigenous genes in my 23 and Me and so I relaxed on my laser parameters. I thought maybe my family tales of Cherokee blood were fables. I underwent 2 Moxi laser treatments at settings that were probably perfect for someone with all caucasian genes, but not for my melanin rich genes. Immediately after Moxi treatments my results were incredible, my skin looked like a baby, and then the hyperpigmentation came. Over a year later after my laser treatments I started developing a fine grid of hyperpigmentation where I had been lasered. My lesson from this is, when in doubt, always be conservative on settings and don’t trust your 23 and Me. I am now treating this pigment with Hydroquinone and my usual tenants of skincare.

Stay tuned for my story about how I met my plastic surgeon, the impact he had on me, and how my life changed forever.

As always, here's to choosing how we age, on our own terms!

Stay tuned for my story about how I met my plastic surgeon, the impact he had on me, and how my life changed forever.

As always, here's to choosing how we age, on our own terms!