The first rule of good plastic surgery is a lot like the first rule of Fight Club: you never talk about it. It’s easier to keep it to yourself when no one can tell you’ve had anything done, which many say is the true measure of good plastic surgery. Having said that, an experienced eye can tell. So, we asked the pros, how can you really spot the signs of exemplary work with the scalpel? Here, they break down the best indications of really good “face work.”
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Facelift
“I look for the attachment of the ears to the sides of the face, no signs of scarring, and if the earlobes are in good position and not pulled, or what we call a “pixie ear.” There should be no redness around the ears. The hair line— especially the sideburns and the hairline behind the ears— should remain in a normal position. Other things I look for is if the face moves the same from one side to the other. There should be no unnatural movement, smiling or sweeping of the skin over the cheeks or lower face. There should be no lateral creases under the cheeks either.”
—New York facial plastic surgeon Dilip Madnani, MD
Necklift
“Just like facelifts, necklift results should appear natural and not have an overtightened look. A bad result would be one that showed a “cobra deformity,” where the center of the neck looks caved in and with hanging jowls on either side. When I see a patient, who looks much younger than his or her chronological age, but I cannot readily decipher if there was a surgery done or not, this is a great surgical result in my book.”
—Short Hills, NJ facial plastic surgeon Alexander Ovchinsky, MD
Upper Blepharoplasty
“For natural-looking upper eyelid surgery outcomes, a major factor is achieving the right height to the eyelid crease—known as the supratarsal platform. As we age, the upper eyelid skin loosens and will begin the change the shape to the crease, often times obliterating the crease all together. To correct for this naturally, the surgeon must account for the proper amount of skin to excise to create a natural eyelid crease. Sometimes this requires incorporating procedures to create the crease, known as double eyelid surgery, or to address a weakened muscle that opens the eyelid which we call ptosis surgery.”
—New York facial plastic surgeon Edward S. Kwak, MD
Lower Blepharoplasty
“For lower eyelid surgery, the incision should be very difficult if not impossible to see. The puffiness of the lower eyelids will have been flattened. The lower eyelids should not look hollow if the surgeon avoided removing too much fat. Also, the lower eyelids should not look rounded, like a ‘hound dog,’ which would imply that there is too much downward pull on the eyelid. This would happen if too much skin and muscle has been removed.”
—Westborough, MA, facial plastic surgeon Min Ahn, MD
Browlift
“The first sign of a good browlift is that the person does not end up with a deer in the headlights or a surprised look as a result of brows that are too high. Another good sign is that the hairline appears to be in a normal, natural-looking place and has not been pulled back too far. Excessive space between the medial brow and the head created from a browlift can make people look unnatural and not like themselves.”
—New York facial plastic surgeon Lee Ann Klausner, MD
Rhinoplasty
“The best rhinoplasty outcomes are sometimes the hardest to identify as there are no ‘tells’ which indicate surgery occurred. There can be a range of shapes which look good, leaving room for individual diversity. But there are certain common features which make a nose look attractive and natural: 1) The nose should be smooth with even highlights and shadows creating gradual transitions from one area to the next; 2) The nose should take on a rounded triangular geometry from every angle; and 3)The nose should be centered on the face with symmetrical contours between the two sides.”
—San Francisco plastic surgeon David W. Kim, MD
Fat Transfer
“Fat transfer is an amazing tool to reverse facial aging and improve facial contours when done well. A good fat transfer will recreate the ogee curve, or natural curve, of the youthful face while adding fullness to the eyes, cheeks, jawline and lips. Results should be subtle, natural and imperceptible to the casual observer without over-inflation of any structure like the cheeks or lips which can be a dead giveaway and frightening to other patients. It’s especially important to avoid too much fat in the anterior cheek which can give a patient a heavy or ‘simian’ or monkey-like look.”
—Smithtown, NY facial plastic surgeon James C. Marotta, MD
