|admin ||03-19-2008 02:20 PM |
Interview with Dr. Palmer
On the cutting edge of technological advancements in cosmetic surgery, Dr. Francis Palmer has been the Director of Facial and Plastic Surgery for the Head and Neck Surgery Department since 1991 at The University of Southern California School of Medicine. He also runs a world renowned private practice in Beverly Hills. Celebrities and world leaders alike trust him to rejuvenate and improve their appearances through his unique knowledge and skill of surgical techniques using state-of-the-art technology. His work is known both internationally and nationwide as he lectures and teaches about his methods regularly, as well as appearing often as a guru on cosmetic surgery in both scholarly and general media. Recently he was named "One of the World's Best Aesthetic Plastic Surgeons" by Britain's Tatler Magazine. Dr. Palmer has been featured on NBC, FOX, ABC, CBS, CNN, KTLA News, The View, Hard Copy, E! Channel, Good Day Britain - "Diary of a Facelift" featuring his "Facial Contour" Facelift, Allure, Us Weekly, USA Today, Newsday, Cosmopolitan, LA Times, New York Times, and numerous other media outlets. Dr. Palmer spoke with PlasticSurgerySpot to answer our questions.
Today many patients are frustrated with their cosmetic surgeons for not giving enough personal attention. A common complaint we hear is that patients feel like they’re treated like a number. With some practices, the doctor/patient communication is almost entirely outsourced to patient care coordinators and stitching or sutures are assigned to nurses instead. How do you feel about the cosmetic community’s overall growing trend of giving patients less personal attention?
Yes, I’m sorry to hear that as plastic and cosmetic surgery is a service oriented business. Over the past 20 years that I have been in practice here in Beverly Hills, I have strived to provide personal service to an international clientele but have heard rumors of this eroding industry wide. I believe this is due to several factors:
Then there are those of us, who remain committed to top notch service and have decided to offer the best that we can and yes, you will pay more for the expertise and attention. I spend an hour or more with prospective patients during consultation and charge a minimum of $150 for every consult.
I’m here to act as their plastic surgery advisor… to tell them what will and will not make them more attractive, regardless of who performs their plastic surgery. I am not here to convince, pressure or persuade anyone to have plastic surgery and I do turn people away if I don’t believe that they are suitable candidates for surgery. That’s what has changed over the past 20 years. The plastic surgery business, right now, is “Buyer Beware” and it is the responsibility of the consumer to beware that they don’t get surgery that they don’t need or want.
Similarly, be careful what you ask for… there is a plastic surgeon or cosmetic surgeon out there that will do it for you no questions asked. Problem is... will that procedure or surgery make you more attractive? Plastic surgeons shouldn’t do what’s asked but what is right!
You have the power to choose the type of plastic surgeon you want… do you want a Hyundai or a Bentley type experience? I like to think that I hand build every patient’s surgery like the Bentley. I’m not interested in bringing the assembly line to the operating room. In fact… I’m an artist who happens to be a plastic and cosmetic surgeon and as such I refuse to compromise on my aesthetics or the quality of the surgery I perform. It’s true that because I do all the surgery myself, I can’t do as many surgeries but I’d rather do 1 well than 10 any other way.
- If a plastic and cosmetic surgeon bases his/her practice on cost-cutting, they must make up for these lower prices by increasing the number of surgeries that they perform per day, week, and month. This means less time for each individual patient... this may also mean that part of each surgery, like the suturing may be passed off to a nurse or surgeon-in-training so the plastic surgeon can start another surgery. I have always done the entire surgery, from the initial incision to final suture myself… why? Because, I believe that’s exactly what my patient would want me to do. I have always felt that it’s just not appropriate to allow a nurse or another doctor to suture up the patient, especially if the patient hasn’t been told pre-op and agreed to such an arrangement.
- There are two types of plastic surgery practices and you have to understand the differences and what you’ll get and not have in each type. There’s the plastic surgery mills that churn out case after case at low prices. We see them advertised in the papers, magazines, on radio, television, even in the movie theatres. They offer low prices, free consults and who knows what else as come-ons to get you in. You really can’t be surprised once you’re there that the plastic and cosmetic surgeon spends less time with you and passes you off to a salesperson to close the deal…can you?
Recently The View featured your “Celebrity Lift” which can be performed without general anesthesia. It has little to no bruising, swelling or downtime. Can you tell us a little bit about this popular revolutionary face lift you’ve invented?
The “celebrity Lift” came about as a natural evolution of a Facelift and Necklift. In 1999 Tatler Magazine voted me one of the “World’s Best Facelift Surgeons,” a distinction offered to only two plastic surgeons in the world. I performed many 5-6 hour long facelifts. Over the subsequent 5 years, the age of my facelift patients kept decreasing from 57 to 50 to 45 and even younger. These patients came in asking for rejuvenation of the face and neck at a much earlier stage to avoid the severe signs of facial aging. The Facelift procedure itself needed to evolve to keep pace with the changing times. Patients wanted smaller incisions, less surgery, quicker healing times and no general anesthesia. I was challenged by a male celebrity to come up with a facelift that would fit all those criteria… for him. I decided to make the “Celebrity Lift” a minimal incision variation of a larger face and necklift and it has proven highly effective.
The “Celebrity Lift” can be performed under a local anesthesia, takes 90 minutes or less, has very small incisions, dissolvable sutures with limited tissue dissection which means less bruising, swelling and a recovery time that’s measured in hours not days or weeks... and the best news is you can look 10 years younger.
Judging from the appearances of some face lifts we see, a number of doctors apparently must feel the solution to an aging face is just “pulling” the skin tighter. Although skin tightening is indeed needed, often just “pulling” doesn’t address the loss of facial volume we experience from aging. How important is it for plastic surgeons to utilize facial implants (cheek/mid-face implants or injectable fillers) in conjunction with face lift surgery to combat the loss of volume?
Over 18 years ago, I discovered that the key to facial rejuvenation wasn’t how hard you pulled the facial tissues, but rather the shape of the face at the conclusion of the Facelift. The shape of the cheeks determine if a face is seen as young, old, male, female, attractive or less so. The tissues of the face literally hang from the cheeks and if the cheeks are small in volume, the face appears elongated, aged and relatively masculine. The cheek shape and volume must be taken into account during any facial rejuvenation procedure.
If the cheeks are full, but the nasolabial folds are full of fat blocking the anterior edge of the cheeks, microlipo of the folds should be performed along with the facelift. If, on the other hand, the cheeks are relatively flat, the cheek volume must be properly and aesthetically increased to make the face appear more youthful and attractive. This can be done with the proper size and shaped cheek implants or with an injected moldable paste like Radiesse or Perlane. The implants are permanent and the injected material is temporary but both will make the cheeks more attractive and should be a part of every aesthetic analysis of the face by the plastic and cosmetic surgeon.
One quick word of caution however, the cheeks are the most important aesthetic feature of the face and making the cheeks too large, too full or the wrong shape can lead to disastrous and very unattractive results. Manipulating the cheek shape, in my opinion, requires a quantum level of more astute aesthetic judgment by the plastic surgeon.
Mid-face or submalar implants, which rest just below the cheekbone, are relatively new to the market just within the last couple decades. Cheek and midface implants have one of the highest satisfaction rates for patients among all cosmetic procedures. However the procedure is nowhere near as popular as rhinoplasty, which tends to have a relatively high dissatisfaction rate in comparison to other procedures. Why do you think this is and where do you see the trend of cheek and mid-face implants heading in the future?
Hopefully there will be an aesthetic awakening of the consumer to the fact that the cheeks dictate the aesthetics of the face and the nose should be sleek and unobserved. Facial implants, especially cheeks, are very well received if the proper size and shape is identified prior to the surgery. The #1 complication of facial implants, in my opinion, is choosing an aesthetically incorrect size or shaped cheek implant.
I do not like the aesthetics of sub-malar implants but I recognize that other plastic surgeons are happy with what these implants do to the face. That is the difference of opinion and aesthetics from plastic surgeon to plastic surgeon. I prefer a malar/submalar combination cheek implant that literally takes over the shape of the cheek to create a new an improved aesthetic shape. I believe these offer superior aesthetic predictability and results.
- You don’t need a perfect nose, an 8 out of 10 is just fine. No person is deemed attractive based on a perfect nose alone. The nose should be sleek, unobserved and thereby disappear from view allowing the cheeks, eyes and lips to be the focal point of the observer.
- In the most experienced rhinoplasty surgeon’s hands and with the very best outcome, the nose can go up 2 points on a 10 point scale with 10 being perfect. That means if you start out with a 6, you get an 8 and so on.
Remember, the enemy of good, is better… and disaster may result from continued revision rhinoplasties. Having said that I have performed many revision rhinoplasties as “the last one” for patients that have undergone 2, 3, 5, even 9 prior rhinoplasties elsewhere. These can be done but require another level of experience, skill, and understanding of the nose and what is achievable.
Within the cosmetic and celebrity circles here in Los Angeles, many refer to you as “The Cheek Doctor” since you are so well known for doing cheek implants. As a leader in this field, what’s the most important advice you can give to people who are considering or about to undergo the procedure?
Yes, that’s true… I seem to have that title now; I’m “the cheek doctor.” It may be a result of the many articles and TV appearances I’ve had on the subject of cheeks and cheek implants. I want everyone to realize that 75% of what makes their face look attractive is determined by the shape and size of their cheeks. If you want someone to analyze your face and make you more youthful and attractive, be sure that the plastic and cosmetic surgeon has the proper aesthetic insight to give your face the cheeks they need to reveal your hidden beauty. Cheek augmentation is one of those procedures where a little is really good and more is really unattractive.
Seasoned cosmetic patients know that finding a truly competent rhinoplasty surgeon is no easy task. What’s even harder is finding a plastic surgeon that can do a revision rhinoplasty surgery right. Often surgeons utilize techniques that may give the patient an aesthetically pleasing result for a few months or even a year after rhinoplasty, but five or ten years later that patient is left with nose deformities such as collapsed nasal valves, supratip breaks, skin “shrinkwrap” on the tip revealing the underlying grafts, and many others. What are the best surgical techniques today to correct (or prevent) these types of results and provide the patient with a nose that will last their lifetime?
That’s the million dollar question. Experienced rhinoplasty surgeons will definitely be more expensive, so price may be a good guideline. If your rhinoplasty is inexpensive, chances are your surgeon has less experience. Rhinoplasty is, as I stated previously, the most technically difficult plastic surgery procedure that takes years and many cases (in the thousands) to master. In plastic surgery, like life in general, there are no free rides, you get what you pay for. My advice:
- Pay for your consultations.
- Do not choose a rhinoplasty surgeon based on a computer enhanced image.
- See 2 or 3 very well trained/experienced rhinoplasty surgeons and get one that has the proper aesthetics… even if you need to travel away from your home. The expense of the travel is definitely less than the cost of a revision rhinoplasty.
- Become an informed consumer. Learn the aesthetics of plastic surgery and rhinoplasty so that you can adequately judge the aesthetic values of each prospective rhinoplasty surgeon.
- Some things just don’t make sense. For example, L-shaped silicone grafts to build up the nasal bridge erode through the skin (100%) within 15 years. In my opinion, these should not be used, but I see these fairly often and have to remove them in revision rhinoplasty. Bone, rib cartilage and, banked cartilage also has a nasty habit of dissolving irregularly over a 10 or 15 year period and I don’t like to use these materials either... yet they are being used in rhinoplasty every day.
All these points illustrate the need for a specialist experienced in performing rhinoplasty.
Before and after rhinoplasty photos from surgeries performed by Dr. Palmer.
After many years of experience as a leader in cosmetic procedures, you have developed the “Palmer Beauty Principles,” which allows beauty to be defined. These principles have been featured in People Magazine’s “50 Most Beautiful People” edition where they were recognized as ground breaking. It was fascinating reading about these principles, which can be viewed in their entirety on your website.
Do you consider some aspects of the beauty equation relative to the time period or culture? For example, the Aztecs would have considered Barbara Streisand’s face appealing with her nose and close-set eyes. Shaving the forehead to give the illusion it is bigger was once a trend. There was a time in Britain when long faces with weak bone structure and thin lips were considered ideal. Now in recent history, even from decade to decade, some say there have been variations in valued traits. From sleek “ski-sloped” noses in the early days of rhinoplasty, to the straight noses desired today. From rugged masculine male faces to the more androgynous male faces with softer, fuller cheeks. Many Asian cultures desire minimized facial bone structure, while Western cultures desire the opposite. Are these variable aspects of the aesthetic value time stamped relative to the period or just culture induced?
That’s a great question. I believe that my “Palmer Beauty Principles” govern current thinking of the majority (not all) of modern cultures. There are exceptions where plates in the lip, or scarred tattoos are deemed attractive. Having said that, there are fads within these modern cultures like “twiggy,” the “wafe look” and “thin lips” but these aesthetically unattractive trends quickly disappear and are replaced with full cheeks, sleek noses and full lips which seem to be the preferred shape of modern beauty. This is the topic of my upcoming book.
These two pictures illustrate the differences between the ideal cheeks on men and women according to Dr. Francis Palmer and his revolutionary “Palmer Beauty Principles.”
As the director of Facial Plastic Surgery for the Head and Neck Surgery Department at the USC School of Medicine since 1991, you are on the frontlines of plastic surgery frontiers. Where do see the technology of cosmetic surgery heading? Do you think we will ever reach the point where enhancement of a body part will be possible using genetic manipulation instead of surgery?
I’m a consultant for venture capital firms and other companies that are working on the “next big advancements” in Aesthetic Medicine. In the very near future there will be non-surgical fat removal, treatments for Cellulite and stretch marks, natural breasts and facial implants (your own tissue, not man-made substances) and plastic surgery performed in virtual reality from a remote site. That means that you can be in Illinois and have a Beverly Hills Plastic Surgeon perform your rhinoplasty, Facelift or breast Augmentation through virtual reality and robotic surgery. I’m here to tell you that the future of aesthetic medicine (plastic and cosmetic surgery) will be more exciting than any of us can imagine. I have no doubt that we will replace aged parts and enhance others… it’s not a question of if, but when and how much.
The later decisions will be reflections of society’s morals and values but science continually marches on pressing new frontiers and boundaries. In the future, plastic surgeons, as we know them today, will go the way of the dinosaurs and become extinct. No cutting, no sewing, just a vast array of non-invasive manipulations of the body at any age. What’s science fiction today will be science fact tomorrow.
To learn more about the Palmer Beauty Principles, see additional before and after pictures, or to speak with
Dr. Francis Palmer and his staff, visit his website at: www.drfpalmer.com Here is the contact info for Dr. Palmer's private practice: 8500 Wilshire Blvd
Beverly Hills, CA 90211
Fax: 310-652-0009 Dr. Palmer also has a fascinating blog which he writes in regularly. We recommend checking it out: Your Plastic Surgery Blog - Nip This Tuck That