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Published in 1998, Lift: Wanting, Fearing, and Having a Face-Lift by Joan Kron is one of the best books I have read on facial plastic surgery written by a non-physician. It is also one of the best histories of facial plastic surgery I have read by any author, physician or not. The book is a time capsule of sorts, capturing a transition point in cosmetic facial plastic surgery before, for example, Botox© and hyaluronic acid fillers were Food and Drug Administration (FDA) approved and widely in use. The following blog post is a review of the book and a highlight of some of the wisdom the author imparts about her experience undergoing facial plastic surgery. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. The Reporter Joan Kron is a Phenomenal Writer with a Fascinating Career I discovered the reporter Joan Kron after reading her article "I'm 96 and I've Had Three Face-Lifts – Here's What I Learned" in Allure magazine. She began working for Allure in 1990 at age 63. She reports that she was one of the only individuals in the office at the time old enough to undergo plastic surgery. She would have a 25-year career in reporting for the magazine on some of the most famous plastic surgeons in the world. She quotes many of these individuals in the book, which lends to the authority of her writing. It also reflects the fact that readers enjoy stories much more than simple explanatory journalism bereft of personal human input. But while I do not agree with all her beliefs regarding plastic surgery, I respect the fact that she was willing and able to utilize a reporter's eye to analyze her personal experience with facial plastic surgery, communicating the following wisdom: "The most important lesson I can share may be that no two people have the same experience." Her resulting book and many articles are interesting, insightful, and well-written. In fact, I learned a lot about the history of facial plastic surgery that I did not previously know. Moreover, she communicated this history both through interesting stories and by quoting some of the individuals who participated in this history. Her description of the history of chemical peeling and its origins and popularization in early Hollywood was particularly interesting to me. The mystery behind these early "lay-peelers" and the physicians who would pursue these secret and well-guarded recipes parallel the often-dramatic lives of the movie stars who were treated. Only two years after the publication of this book - in 2000 – would the history of chemical peels be consolidated, and the true nature of deep phenol chemical peels she describes be elucidated. Lift: Wanting, Fearing, and Having a Face-Lift is Simultaneously Outdated and Timeless It is important to highlight just how long ago 1998 is – 26 years! For example, the following is a list of the top five grossing movies in the United States (in order) in 1998: Titanic Armageddon Saving Private Ryan There's Something About Mary The Waterboy The following is a list of the top five selling records (in order) of 1998: Titanic: Music from the Motion Picture by James Homer Let's Talk About Love by Celine Dion Sevens by Garth Brooks Backstreet Boys by Backstreet Boys Come on Over by Shania Twain Botox© by Allergan was not FDA approved for cosmetic use – in the frown lines – until 2002, four years after this book was published. Restylane© by Galderma, the first FDA approved hyaluronic acid filler, was not approved until 2003. I highlight all of this to contrast the previously mentioned treatments with some of the treatments she discusses which are not widely in use anymore. Specifically, she describes the extensive use of bovine (i.e., cow) collagen injections in the face, which have been replaced by hyaluronic acid fillers that have proliferated and diversified since first being approved. The book was published in an era in which the use of lasers for skin resurfacing to treat age-related changes to the skin of the face was just beginning. For example, she compares CO2 lasers unfavorably with chemical peels, another method of skin resurfacing. However, with the advent of the less powerful but safer fractional ablative CO2 lasers and Erb:YAG lasers, these devices have become the most common method of skin resurfacing. It was remarkable to hear how frequently individuals who underwent deep chemical peels experienced lightening of their skin (hypopigmentation) from the author, something that is much less common these days. I do, however, still hear from some of my patients who underwent deep chemical peels in this era about how common it was to see white patches of hypopigmentation on their friends and family who also received this treatment. Anesthesia services have advanced since 1998. For example, specialized monitors that track a patient's oxygen levels and end-tidal CO2 – a measure of air exchange in the lungs – had been available widely for only a few years but are now ubiquitous in hospitals, ambulatory surgery facilities and office-based surgery suites. Some medications that are now largely standard for anesthesia and have increased its safety (e.g., propofol) were not as widely used in the 1990s due to cost. Conversely, this was a time in which the use of prescription narcotic painkillers was first proliferating without a good sense of how addictive these medications can be. As a result, the author was taking narcotics for approximately 2 weeks after surgery, much longer than would be allowed or even recommended today. Overall regulation of the anesthesia services administered has improved greatly since this book was published with accreditation for all surgical facilities becoming standard – this was a requirement only in California at the time. Finally, while she correctly highlights the importance of the American Board of Medical Specialties (ABMS) and that a plastic surgeon is board certified in either the American Board of Otolaryngology – Head and Neck Surgery (ABOHNS) or the American Board of Plastic Surgery (ABPS), she ignores the importance of the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS). A facial plastic surgeon is board certified by the ABOHNS first followed by the ABFPRS years later after passing additional exams and accumulating a requisite number of procedures completed. Being certified by both bodies means you are a dual/double board-certified facial plastic surgeon. I believe those individuals who have undergone residency training in head and neck surgery followed by fellowship training in facial plastic surgery and who are dual board certified are uniquely qualified to care for aesthetic concerns of the face and neck, both due to the additional training required after residency (i.e., fellowship) and the additional board certification (i.e., ABFPRS). The Most Glaring Problem of Lift: Wanting, Fearing, and Having a Face-Lift is in the Mischaracterization of Broad Facelift Categories The most glaring inaccuracy, in my opinion, is in the way the author characterizes the different categories of facelift techniques. While she correctly identifies the earliest techniques for facelifting as well as the next iteration (i.e., SMASectomy), she largely glosses over the development of deep plane facelift surgery. In fact, she describes Dr. Sam Hamra's "composite" (deep plane) facelift approach in passing, though Dr. Hamra is now widely credited as pioneering deep plane facelift surgery – currently the gold standard in facelift techniques – with his 1990 paper. Instead, she describes a technique of facelifting developed by a French surgeon that has fallen out of favor and is not performed widely today. Joan Kron Speaks with Greater Authority Than Other Non-Physicians Because of Her Personal Connections and Experience with Facial Plastic Surgery There are many aspects of facial plastic surgery that are timeless. Among the many details about the technical aspects of surgery she clarifies are the differences between keloids and hypertrophic scarring – something I have noticed is very commonly confused. She emphasizes the importance of understanding whether eyelid and/or brow lift surgery is indicated rather than simply eyelid surgery alone. She also highlights the effects of skin tension on scarring. She pursues treatments with a healthy perspective, stating "I don't want to change the topography, I just want to prune the trees." This statement reflects wisdom. In addition, there are many universal patient experiences with facial plastic surgery that Joan Kron illustrates, noting "the conflicting emotions I had experienced…were strikingly universal" regarding her pursuit of facial plastic surgery. She explains that "most facelift patients have an idealized vision of themselves…it's usually a more grown-up face, maybe a picture of yourself from ten years ago" and "many patients find themselves emotionally vulnerable during recovery." All of this is true and requires the guiding hand of the surgeon and loved ones to help them through to enjoy their results once they have healed and reached this vision. Finally, she is honest about the fact that, with elective surgery, there are both rewards and risks. She explains that patients need to calculate the tradeoff themselves with the guidance of a well-qualified surgeon who you feel can maximize the chance of an excellent result but who can also handle any rare setbacks if they arise, explaining that "a competent surgeon knows how to treat them [complications], and will be there for the patient should problems occur." And while she explains that "credentials matter" (see above), she also explains that "so does reputation, taste, experience in the procedure in question, and results that can be verified, preferably by satisfied patients" She sums up her experience undergoing facial plastic surgery with the following: "Was it all worth it? Unquestionably, yes. Would I recommend it to friends? Absolutely, as long as they go into it knowing it's not makeup – it's surgery." Trust Your Face to a Double Board-Certified Facial Plastic Surgeon It is important to seek a fellowship-trained, double board-certified specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop searching "plastic surgery near me." Get in touch with us to learn more. Contact Us

I noticed the following excerpt from the personal essay I wrote for my facial plastic surgery fellowship application when looking through old email folders: "My passion for facial plastic and reconstructive surgery in many ways parallels my interest in modern architecture. Irving Gill, one of my favorite architects and a 'premonitory prophet of rationalist modernism' in early twentieth century Southern California, designed residential structures which predated the popularity of the modernist style by decades. I recognize the importance of the qualities he possessed in facial plastic and reconstructive surgery. These qualities include an appreciation of context, a creativity bound by the limits of material and structure, and an obsession with detail. A student of Frank Lloyd Wright, Gill was heavily influenced by his mentor's appreciation of how the environment communicated with his designs. Gill's work, as exemplified by the Dodge House, demonstrated a deep understanding of the historical, social, and environmental context in which it was constructed. Similarly, I appreciate the importance of context in facial plastic and reconstructive surgery. I am fascinated by the concept of the face as a vehicle for communicating emotions and health. I wish to better understand the context in which patients negotiate their surroundings through their appearance in order to provide a surgical result which best matches how they see themselves. The first rhinoplasty I participated in clarified the challenge of understanding how the limits imposed by tissue and anatomy affect cosmesis, just as Gill created residences that were not only fireproof and earthquake resistant but also beautiful. It was a formative experience for me, because it was the first opportunity I had to realize both a cosmetic and functional outcome for a patient. What excited me about facial plastic and reconstructive surgery was how this concept carried through the field." Architecture remains my favorite art form and a passion. In fact, if you look at the shelving behind my practice manager's desk you will see a book titled Architecture of the Sun: Los Angeles Modernism 1900 – 1970 by Thomas S. Hines, a famous architectural historian who taught at UCLA. I remain proud of the above portion of my essay, not only because I believe my argument holds true, but also because I believe architecture is not an art form - like sculpture - many have confidently argued has parallels with facial plastic surgery. Admittedly, the rest of my essay was uninspired. The remaining text included all the statements we are taught we are supposed to write in order to check the necessary boxes for fellowship directors. Irving Gill remains one of my favorite architects, not necessarily because his homes are the most beautiful, but because of the way he maintained the vernacular of Southern California while still pushing forward innovations in design, materials, and construction methods long before they became popular and widely adopted. This essay is meaningful to me because it freezes a moment in time prior to my embarking on the journey to become a facial plastic surgeon. I can reflect on my thinking then - which, of course, has changed - and contemplate the future. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. We Subconsciously Respond to Similar Features in Faces and the Built Environment The book Cognitive Architecture: Designing for How We Respond to the Built Environment by Anne Sussman and Justin Hollander provides additional insights into how facial plastic surgery and architecture relate. Human cognition includes a subconscious component which developed as an evolutionary survival mechanism to allow a rapid assessment of nearby dangers. Humans are hardwired to search for faces everywhere, including in the built environment. As a result, car designers design the front of vehicles look like human faces. It is also why humans tend to react more positively to buildings with a hint of an appearance of a human face. Humans intuitively feel more secure in environments with other humans nearby whose facial expressions are recognizable. As a result, humans intuitively prefer narrower streets because they feel safer. Humans prefer symmetry, balance, and gentle curves when looking at human faces. One example in the human face is the ogee curve, which is the s-shaped curve to the cheeks that is reflective of a youthful fullness of the superior cheek curving inward at the inferior cheek. Humans prefer these features buildings as well. These features of the human subconscious were intuitively understood by traditional - otherwise known as classical - architects. They were elucidated and measured only recently using modern biometric tools such as eye tracking which measures how frequently the human eye subconsciously focuses on areas in the visual field. A well-designed building elicits a positive emotional experience due to these subconscious processing mechanisms. Norman Crowe argues in Nature and the Idea of a Man Made World that "familiarity of some sort is a necessary component of 'beauty'." That familiarity is how humans perceive their bodies in relation to their natural environment. As previously explained, this translates to the built environment as expressed in classical architecture. Certain "familiar" facial features - such as a youthful ogee curve - elicit the same positive emotional response. I believe one of the goals of facial plastic surgery is to elicit such a positive emotional response in the patient and in others. Trust Your Face to a Facial Plastic Surgeon It is important to seek a double board-certified, fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon. Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us today to learn more! Contact Us

The definition of a kludge is a solution that is clumsy, inelegant, inefficient, and difficult to maintain. There are many kludges in facial plastic surgery that should generally be avoided. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. My Experience with a Kludge The above photo is of me at age 22 when I lived and worked as a science teacher at Weill Cornell Medical College in Doha, Qatar, a small country that is a peninsula off Saudi Arabia. I carry many stories from my time here, but one is relevant to the conversation. That story is the time the apartment tower I was living in caught fire with me in it. I lived on the twelfth floor of an apartment complex with two towers and a shared base. The trash chutes collected to a common area in the basement. I was sitting in my room one evening when a loud voice starting yelling in Arabic as if through a bullhorn. This occurred seemingly randomly and constantly. I do not speak Arabic and, as a result, had no idea what was being said. My inclination was to remain in my room. I stayed in my room for about 20 minutes before deciding I needed to go the hallway of the apartment to determine whether I needed to leave the building. I opened the door to billowing smoke. A fire had broken out somewhere in the building. I crawled to the exit stairs. The stairs were too hot to crawl on. Instead, I ran down twelve flights of stairs through smoke and out of the exit as quickly as I could. Fortunately, no one was seriously injured. We were even able to return to our apartment the next day because the fire had engulfed the opposite tower only. We later learned a tenant in the opposite tower had thrown a cigarette down the trash chute, which caught the basement on fire. Apparently, many individuals delayed leaving the building for the same reason. The tower had been built for the Pan-Asian games a few years prior. All the tenants at that time spoke Arabic. However, few-if-any current tenants spoke Arabic. The most reasonable solution to prevent this from occurring again would have been to change the language of the fire alert from Arabic to English or some combination of languages and to educate the tenants on the proper way to identify a fire in the building and exit safely. Instead, the building management hired individuals from Nepal, all of whom suffered from what was and still is an abusive environment for laborers, to sit on plastic chairs with air horns in the hallway. They were instructed to blow the air horns in the unlikely event that another fire broke out. These poor individuals had to sit in the dark, because the hallways lights are motion-activated, and the management would not keep the hallway lights on. This was a kludgy, incompletely effective solution that reflected what management had (i.e., inexpensive labor). Kludgy solutions are common in facial aesthetics as demonstrated by the following examples. Botulinum Toxin Lip Flip and Adding Too Much Filler Instead of Lip Lift Surgery A lip flip non-surgical procedure is performed by injecting botulinum toxin (e.g., Botox©) into the muscle surrounding the mouth, called the orbicularis oris, in the upper lip. This procedure is not recommended, because it is often ineffective and can cause problems with speaking and drinking through straws for weeks-to-months after the procedure. See this previous blog post for more detail on the non-surgical lip flip. Lengthening of the upper lip skin as well as the loss of definition and projection of the red upper lip is often addressed with hyaluronic acid filler to poor effect, largely due to too much volume being added and it being added to the wrong location. In fact, adding an excessive volume of filler to the upper lip can stretch the upper lip over many years. The non-surgical procedure can also over project the upper lip, leading to a "duck-lipped" appearance that looks unnatural. See this previous blog post about lip filler versus a lip lift. Lip filler can enhance the effects of a lip lift for deflated lips but should generally not be a substitute for a lip lift in the above clinical situation. Cheek, Nasolabial Fold, Marionette Line, and Jowl Filler Instead of Deep Plane Facelift Surgery A common solution to drooping cheeks with older facelift techniques is to add volume – often a great deal – using fat and/or hyaluronic acid filler. This can make patients look overly rounded because the body's natural fat remains hanging down and towards the center of the face. In contrast with other facelift techniques, smaller volumes of fat are added during the extended deep plane facelift procedure and only when the patient is volume-deficient in the cheeks prior to surgery. See this previous blog post about cheek lifts versus fat grafting to the cheeks. Fat grafting can be appropriate for some individuals, though not all. Hyaluronic acid filler is commonly used in the nasolabial folds and marionette lines to "blunt" or "soften" their appearance. While this non-surgical treatment can be appropriate in many circumstances and when added conservatively, the problem is these non-surgical procedures do not address the actual changes that occur with age (i.e., weakened ligaments, drooping fat, and loose muscle and skin). As a result, there are inherent limitations associated with them. Also, attempts to eliminate the nasolabial folds and marionette lines with hyaluronic acid filler can make patients look distorted and inflated by eliminating subtle transition points between the cheeks and upper lips that are present naturally, even in youth. When too much volume is added to the cheeks, nasolabial folds, and marionette lines at the same time the overall effect is extreme and does not appear natural. See this previous blog post for more detail about when jawline filler is not aesthetically appropriate. Energy-Based Devices Instead of Deep Plane Facelift and Neck Lift Surgery There are multiple devices available that utilize an energy source (e.g., radiofrequency, ultrasound, plasma) to heat up the fat and other tissue immediately deep to the skin in the face and neck. They are sometimes referred to as non-surgical facelift procedures. They are also sometimes referred to as an option for individuals who may not be ready to undergo a surgical facelift and/or neck lift. While there are some aesthetic uses for these devices I feel they should not be classified as non-surgical facelift procedures, nor do I believe they are appropriate as a "stepping-stone" to a surgical facelift and neck lift. These devices heat up fat and cause scarring in the targeted tissue for the stated purpose of tightening skin. Age-related changes to the face are primarily due to drooping fat, weakening ligaments surrounding the fat, and loosening muscle and deep fascia. A facelift and neck lift should not be considered simply a skin lift or skin tightening procedure. Furthermore, the scarring that these devices cause make a surgical facelift more technically challenging such that deep plane facelift surgery is even more appropriate to reduce the risk of healing problems. See this previous blog post for more detail on the different facelift techniques utilized by facial plastic surgeons. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon. Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us to learn more! Contact Us

I have the privilege as a physician and surgeon of helping patients "feel good about feeling good." I pride myself as being a well-trained facial plastic surgeon who can provide natural surgical and non-surgical results, safely. However, I often wonder if during my consultation with patients they are thinking: "sure, you know what you are doing, but do you truly understand what goes into making a decision to proceed with facial plastic surgery?" My answer to that question is yes, I do understand. I underwent a rhinoplasty at age 17. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. I Underwent a Functional and Cosmetic Rhinoplasty at Age 17 After an Injury I was injured at age 13 in the most embarrassing way. I was at a friend's house running from their backyard into their basement. I did not realize my friend had closed the glass sliding door to the basement. Another friend had called out from behind me just before I approached the door. My nose met the glass as soon as I turned my head forward. The pain was excruciating. I knew something was wrong immediately. My nose swelled. I had immediate difficulty breathing through it. My nasal bridge was deviated to the right. I iced my nose and, as the pain subsided, largely forgot about it, unconcerned with my appearance. The swelling resolved. The difficulty breathing through my nose did not. And while the nasal bridge was significantly less deviated than it initially appeared, I became more bothered by it as I progressed through high school. By age 17 my nose was bothering me enough – I was having difficulty breathing during difficult workouts and races as a rower – that I decided to consult with a head and neck surgery trained facial plastic surgeon. He recommended a septoplasty and rhinoplasty to correct my deviated septum and nasal bridge and to improve my breathing. I Underwent Surgery with a Facial Plastic Surgeon at an Office-Based Surgery Center I underwent surgery at an office-based surgery center. See this link for more information on our office-based surgery suite. I have only two memories of my experience. My first memory was lying on the operating room table with the anesthesiologist and the surgeon's head nurse at my side. I remember starting to count backwards and almost immediately going to sleep. My second memory was after surgery when I was changing in the bathroom to leave. I suddenly felt lightheaded and fell to the ground, almost hitting my newly operated on nose on the sink counter. My Recovery was Consistent with What I Counsel My Patients Like my patients I had a splint on my nose. Unlike my patients I had packing in my nose, which was extremely uncomfortable. More recent data and guidelines from the American Academy of Otolaryngology – Head and Neck Surgery do not recommend nasal packing after rhinoplasty. I spent one week largely sitting and sleeping in a recliner, anxiously waiting for the removal of my nasal packing. My head felt like an over-filled balloon, entirely due to the packing. I did take the prescribed pain medication once or twice, felt very nauseous, and discontinued its use. The packing was removed in clinic – along with the sutures – approximately 1 week after surgery. It felt so wonderful to have the packing and sutures out as well as the splint. My nose remained swollen after the cast was removed. I remember the most significant swelling resolved within two to three weeks. However. I noticed continuous improvements in the appearance of my nose for many months after surgery. My nasal breathing improved almost immediately after the packing, sutures, and splint were removed. This improvement continued over approximately the first month while all the interior swelling subsided. The change that took the longest to recover was normal sensation at the tip of my nose and the incision at the base of my nose. I remember a gradual onset of tingling and a slow improvement in sensation over many months. In fact, I believe it took a year before I regained all the normal sensation in my nasal tip and at the incision site. I Empathize with Those Considering a Rhinoplasty and Can Answer Their Questions from Experience I am very happy with the appearance of my nose these decades later. I am very grateful to the facial plastic surgeon who performed this procedure, though he retired and unfortunately passed away a few years ago. The sensation on my nose is normal. I am breathing well. I can feel some of the surgical changes made if I push hard on the skin overlying my nasal bridge, though there is no outward appearance of this due to the soft tissue envelope covering my bones and cartilage. In short, I answer questions about facial plastic surgery not only as a surgeon performing a procedure but also as a patient having undergone a procedure. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your nose. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon. Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us to learn more! Contact Us

Tirzah Thompson MS, RDN, LD Nutrition goes a long way when preparing for and recovering from surgery! Proper nutrition can be the key to a successful surgery. What you learn here should empower you while relieving some of the stress you may feel going into and coming out of your upcoming surgical procedure. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. Lifestyle The benefits from cessation of smoking could be an entire blog post on its own. It is highly recommended that you avoid smoking before and after a procedure. It is easier said than done, but it can make a huge difference. Smoking affects blood oxygen levels and the quality of blood circulation through the vessels. It decreases blood flow making surgical wounds less likely to heal well and more likely to become infected. Oxygen-rich blood and non-constricted arteries and veins are essential for healing. Avoiding excessive alcohol consumption is recommended as it is unhealthy and even in small quantities can cause blood thinning effects during surgery, which can contribute to bleeding and bruising. It is okay to drink alcohol in moderation until about two weeks before surgery. Within those upcoming two weeks and for a week or two post-operatively, it is best not to drink alcohol at all. Exercise is a wonderful thing for many reasons such as increasing blood flow, improving mood, boosting energy, and promoting better sleep. However, when you are having plastic surgery, it is advised to avoid any new or vigorous exercises. It is best to focus on maintaining your current level of fitness whatever that may be. I recommend focusing on stretching and strengthening. Yoga would be a great idea! Nutrition Avoiding or limiting highly processed foods and fast food is strongly advised to prevent inflammation and swelling from the high sodium content. If you usually cook with salt, try using spices instead! When you're at the grocery store next, try looking for "no salt added" versions of your favorite canned goods. Try cooking at home whenever possible to cut down on your sodium consumption. In addition to cutting back on processed foods, following a well-balanced diet is always recommended. That includes whole foods, adequate calories, adequate fiber, adequate macronutrients, and adequate vitamins and minerals. Inadequate caloric intake can increase your risk for slower healing and infection. While following a well-balanced diet, maintaining adequate hydration is also very important. I usually tell my clients to shoot for at least 64 ounces per day! Let us dive into the importance of adequate macronutrients before and after surgery. There are 3 macronutrients: carbohydrates, protein, and fats. Carbohydrates Carbohydrates are essential for wound healing. When you eat carbs, your body breaks them down into glucose which provides energy for white blood cells. While we need carbohydrates, we can be thoughtful when it comes to eating them. Simple carbohydrates have very few sugar molecules so are digested fast and absorbed into the bloodstream. This causes blood sugar levels to quickly rise and later be followed by an energy crash. In contrast, complex carbohydrates contain fiber and more complex chains of sugars which are digested and absorbed slower. They enter the bloodstream more slowly which allows a steady release of energy. This steady release is much more sustainable than the dips and spikes you see with simple carbohydrates, especially when you are eating simple carbohydrates alone. It is suggested to avoid "naked carbs" which are simple carbohydrates that are not paired with protein or fat that would otherwise slow digestion, reducing the spikes in blood sugar. "Naked carbs" cause more hunger and cravings. Some examples of simple carbohydrates include fruit or fruit juice, chips, crackers, etc. The following are some ideas of how to incorporate protein and/or fats with complex carbohydrates: Add cheese to crackers, eat with wine or beer Pair fruit with nuts, nut butter, yogurt, or chocolate hummus Swap out your fat-free milk when eating cereal Try topping your toast/bagels with avocado or peanut butter As we have learned, fiber slows digestion, which can smooth blood sugar spikes. At least 25 grams per day is recommended. When increasing fiber in your diet, be sure to increase fluid intake. Remember at least 64 ounces of water per day is recommended! The following are some ideas of how to increase fiber in your diet: Swap white pasta and rice for wheat Eat whole fruits and vegetables with the skin on them instead of drinking juice Ditch your chips and grab some popcorn, which is whole grain Add chia seeds and flaxseeds into oatmeal, yogurt, or cereal Proteins Proteins are comprised of amino acids that our bodies use to repair muscle and bones and produce hormones and enzymes. Protein can be used as an energy source and carries oxygen throughout your body. It helps make antibodies that help our bodies fight infections and illnesses. I encourage my clients to start their day off with protein. Great sources of protein include red meat, poultry, eggs, fish/seafood, dairy, and beans. Breakfast should include at least 10 – 20 grams of protein. The remaining meals of the day should include at least 20 grams of protein. Fats Finally, fat is essential to give our body energy and support cell function. Fats help protect our organs and keep our bodies warm. Fat also helps our body absorb nutrients and produce hormones. I encourage you to include fat at every meal. Some examples include avocado, eggs, nuts, nut butters, hummus, butter, etc. Most Americans do not consume enough omega-3 fatty acids which are amazing for reducing inflammation! Try to aim for fish twice a week as they are very rich in omega-3s. Other sources include flaxseed, chia seeds, walnuts, and edamame. Micronutrients Micronutrients are especially important for before and after surgery. They include Vitamin A, Vitamin C, Zinc, and Iron. Vitamin A is a fat-soluble vitamin that supports our skin, eyes, and immune system. It is required for epithelium and bone formation, immune function, and cellular differentiation. The average adult needs about 700 – 900 mcg daily. Excellent sources of Vitamin A include carrots, sweet potato, spinach, squash, pumpkin, apricots, eggs, liver, salmon, milk, and goat cheese. Vitamin C is a water-soluble vitamin that is required for the biosynthesis of collagen. Vitamin C supports the immune system, helps wound healing, and serves as an antioxidant. Most people recognize oranges as a source of Vitamin C, but other foods with more Vitamin C than oranges include kale, strawberries, broccoli, red and green bell peppers, brussels sprouts, kiwi, and chili peppers. Zinc is a trace mineral that is responsible for a variety of processes including gene expression, growth and development, and immune function. It is also great for wound healing. Some sources include red meat, seafood, poultry, legumes, whole grains, vegetables, nuts, and seeds. Trust Your Face to a Facial Plastic Surgeon It is important to seek a double board-certified, fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon. Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consult Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us today to learn more! Contact Us More About Tirzah Thompson MS, RDN, LD Book: Dietitian Website: Dietitian Tirzah Instagram: @dietitiantirzah *The information in the blog post above is the opinion of the author and does not constitute direct medical advice from or necessarily reflect the opinion of Dr. Jeffrey Harmon or Harmon Facial Plastic Surgery.

The term "Ozempic® Face" has been widely circulated and commented on on the internet. Its popularity parallels the increased popularity of the use of Ozempic® and its family of medications for weight loss. The term likely refers to the changes in the appearance of the face after the often significant, rapid weight loss associated with the use of these medications. The following blog post is not a comment on the clinical effectiveness or safety of the Ozempic® family of medications for weight loss or diabetes, its original indicated treatment. Internal medicine physicians and endocrinologists are the experts who should be consulted with regarding the use of these medications. Rather, this blog post discusses the likely features referred to as "Ozempic® Face" as well as the possible surgical and/or non-surgical treatment options for these features. This blog post also considers the potential concerns of this family of medications during anesthesia. As with all facial plastic surgery procedures, it is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. Ozempic® (Semaglutide) is a GLP-1 Activator Ozempic® is the trade name for semaglutide, one member of a family of medications called GLP-1 agonists. GLP-1 agonists bind and activate GLP-1 receptors all over the body, resulting in delayed emptying of the stomach, increased insulin release, decreased glucagon release, and increased pancreatic β cell growth (1). Ozempic® (Semaglutide) was Originally Used to Treat Type 2 Diabetes One effect of GLP-1 agonists is a decrease in the level of sugar (glucose) circulating in the blood (1). That is why Ozempic® is used to treat type 2 diabetes. One potentially beneficial side effect of this family of medications is weight loss. Ozempic® is Now also Prescribed for Weight Loss It is unclear what the primary mechanism of weight loss is, though the medication has been demonstrated to decrease food intake overall. It is possible the medication works to decrease appetite in the brain. It is also possible that the slowed emptying of food from the stomach makes patients feel full more quickly. "Ozempic® Face" is a Flashy Term Applicable to Any Individual Who Experiences Significant, Rapid Weight Loss The term "Ozempic® Face" simply refers to changes that can occur on the face of any individual who experiences significant, rapid weight loss, whether from the use of medications such as Ozempic® or through bariatric surgery. The loss of a large amount of fat in the face very quickly can make the face appear more aged due to loosening skin, a loss of volume in the temples and cheeks, and the development of more prominent folds in the face such as the melolabial fold and marionette lines. These changes can extend into the neck where loosening neck muscle and skin become much more visible. The Features Attributable to "Ozempic® Face" Can be Addressed with Facial Plastic Surgery The above features can be addressed with surgical and non-surgical procedures, though surgery is typically the most effective and longest lasting treatment approach. Surgical procedures that may be beneficial for patients who have experienced significant, rapid weight loss from medications such as Ozempic® or bariatric surgery include the extended deep plane facelift, neck lift, lateral temporal lift, and lip lift. As always, it is important to seek a consultation with a fellowship-trained facial plastic surgeon prior to considering any surgical or non-surgical procedure on the face and/or neck. The Potential for Delayed Clearance of Stomach Contents is an Important Peri-Operative Consideration What is more relevant specifically to treatment with GLP-1 agonists such as Ozempic® for weight loss is the known effect of delayed gastric emptying with use of the medication. Delayed gastric emptying means that food is slower to leave the stomach and move into the intestines. This has many beneficial effects for blood glucose maintenance and also decreases appetite by making people feel fuller, which is beneficial for weight loss. However, one peri-operative concern about delayed gastric emptying is the risk of regurgitating food while under anesthesia, resulting in aspiration. It is currently not clear how severe of a risk this is and what the considerations should be for patients, especially those using the medication only for weight loss who are also seeking elective cosmetic plastic surgery under IV sedation. Update 06/29/2023: New Consesus-Based Guidance from the American Society of Anesthesiologists (ASA) The ASA has recently release guidelines on preoperative fasting for patients who are being treated with GLP-1 agonists for diabetes mellitus type 2 and weight loss. The panel specifically refers to the risk of aspiration in patients undergoing IV sedation in addition to general anesthesia in their guidance. They highlight the fact that additional research is required to improve guidance on taking the medication peri-operatively. They recommend holding a GLP-1 agonist dosed daily one day prior to the procedure and holding a GLP-1 agonist dosed weekly one week prior to the procedure, regardless of the condition being treated with the medication (2). More Research is Required to Determine Universal Peri-Operative Recommendations in Plastic Surgery An article in the British Journal of Anaesthesia recommends against withholding GLP-1 agonists such as Ozempic® peri-operatively for patients with diabetes mellitus type 2. They argue that the benefits of blood glucose control peri-operatively outweigh the possible side effects. Moreover, they argue that long-acting GLP-1 agonists such as Ozempic® (once weekly dosing instead of once daily dosing) demonstrate less delayed gastric emptying, an effect which can also fade over time with use of the medication, called tachyphylaxis (3). Tachyphylaxis is the same process that occurs when patients become accustomed to the application of Retin-A (tretinoin) on the face and develop temporary redness and skin flaking. However, as with most subject matters in the world of plastic surgery - and as recommended by the ASA - more research is required to determine the peri-operative recommendations regarding the use of Ozempic® and other GLP-1 agonists in patients who are trying to lose weight in addition to undergoing plastic surgery procedures. For example, the fact that many patients undergo facial plastic surgery procedures under IV sedation may result in recommendations that the medication be withheld temporarily to reduce the risk of aspiration during the procedure, especially because the patients who receive GLP-1 agonists for weight loss likely do not have problems regulating their glucose. This is especially relevant because many of the studies evaluating gastric emptying with GLP-1 agonist treatment utilize a method that is not considered the gold standard and may, in fact, underappreciate the extent of delayed gastric emptying, especially with solid foods (1). It is important to have a discussion with the provider prescribing the GLP-1 agonist as well as the anesthesiologist administering anesthesia to determine the safest plan for any plastic surgery procedure. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop searching "plastic surgery near me." Get in touch with us to learn more. Contact Us References Maselli DB, Camilleri M. Effects of GLP-1 and Its Analogs on Gastric Physiology in Diabetes Mellitus and Obesity. Adv Exp Med Biol. 2021; 1307:171-192. Marchetti D. "American Society of Anesthesiologists Consensus-Based Guidance on Preoperative Management of Patients (Adults and Children) on Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists." American Society of Anesthesiologists, 29 June 2023, asahq.org/about-asa/newsroom/news-releases/2023/06/american-society-of-anesthesiologists-consensus-based-guidance-on-preoperative, Accessed 03 July 2023. Hulst AH, Polderman JAW, Siegelaar SE, van Raalte DH, DeVries JH, Preckel B, Hermanides J. Preoperative considerations of new long-acting glucagon-like peptide-1 receptor agonists in diabetes mellitus. Br J Anaesth. 2021 Mar;126(3): 567-571.

There are a massive number of books helpful to master the topics required to succeed in medical school and residency. Each medical specialty has their own sources, which range in size from large multi-volume texts to small clinical reference guides that include brief summaries of what are considered the most important, or high-yield, information "pearls." Facial plastic surgery clinical reference guides exist as a valuable, though insufficient, source for clinical information for training residents and fellows. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. Pearls Communicate Important Medical Knowledge Succinctly Residents of all specialties attend at least weekly lectures with experts in their field. Medical "pearls" include information distilled into bullet point form for these presentations. The purpose of medical pearls is to succinctly communicate the most salient information to new physicians who are often overwhelmed with clinical and administrative work during the day. The breadth and depth of information required to learn is so significant that most residents study late at night or early in the morning when their roommates or loved ones are sleeping. For example, I studied at night after my wife and son had fallen asleep. I found these clinical reference guides and presentations by attendings useful but insufficient. I always felt that the excluded context made it difficult to fully understand a topic. I also wonder whether some residents are less inclined to dive into the medical literature to confirm and expand on the information communicated because of the availability of these guides. Facial Plastic Surgery = Eliminate the Dog-Ear Deformity A friend and head and neck surgery co-resident at the University of Cincinnati who is an incredibly intelligent and insightful individual also recognized the limitations in depending on these "pearls" of knowledge as the basis for learning medical information in residency. He would joke that the knowledge required to understand each subspecialty in head and neck surgery could be distilled to a single sentence. His summary of the field of facial plastic surgery was "eliminate the dog-ear deformity." A dog ear deformity is a fold of skin than can develop at the edge of an incision after orienting and closing that incision. A dog ear deformity can occur with any plastic surgery procedure in which the location and/or orientation of skin and subcutaneous tissue is re-arranged. An example includes the repair of a defect on the face after skin cancer is removed. A dog ear deformity can also occur with cosmetic procedures such as facelifts as well if the dissection is not performed properly. I told my friend and colleague that I would have a book bound for him titled A Complete Overview of Facial Plastic Surgery with only one page. That page would include the sentence "eliminate the dog-ear deformity." This simple sentence does explain a great deal of plastic surgery. The practice of facial plastic surgery largely involves the creation and movement of tissue from one area of the face to another against the force of gravity. Proper incision and tissue flap design is key to allowing skin closure that is flush. Prevention and/or elimination of a dog-ear deformity reflects appropriate, considerate movement of tissue. However, it is also an incomplete description because plastic surgery involves the complex multi-vector movement of tissue in different layers requiring detailed knowledge of the surrounding superficial and deep anatomy to perform safe, effective surgery. There are also many other patient-specific considerations that require both exposure in training and experience performing to fully understand. Facial plastic surgeons are always learning and improving their craft. Surgical Pearls Are Valuable but Insufficient No ability to memorize pearls can replace the knowledge gained from experience in head and neck surgery residency, facial plastic surgery fellowship, and clinical practice. From the way to troubleshoot and address problems peri-operatively to the ability to evaluate a patient pre-operatively to determine the most appropriate treatment course for them, facial plastic surgery is filled with nuance. New information is coming out every day in the medical literature that may contradict what was previously assumed to be true and/or may complicate the picture of what is true, making decisions more difficult. In my opinion, the value of these pearls is as an exercise in analyzing and distilling information. They are a skeleton on which to flesh out the nuances of clinical practice. Our training and experience allow us to have a flexible mind when dealing with each individual patient because the answer to many clinical questions is not available in the textbook or in a scientific paper. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon. Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us to learn more! Contact Us

Visual aids assist in explaining complex facial plastic surgery concepts. The Back of the Napkin: Solving Problems and Selling Ideas with Pictures by Dan Roam provides a good system for assessing how to communicate complex concepts to an audience in a manner that is simple but is dense with relevant information. This blog post seeks to summarize the system as described by Dan Roam as well as how we at Harmon Facial Plastic Surgery applied his system to communicating our philosophy on addressing facial aging comprehensively with advanced surgical techniques. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. "The Real Goal of Visual Thinking is to Make the Complex Understandable by Making it Visible" - Dan Roam Dan Roam states: "the real goal of visual thinking is to make the complex understandable by making it visible." To that effect, he created a system to represent complex ideas visually. First, he suggests choosing an idea. Second, he suggests deciding through what framework the idea should be visualized. Third, he suggests deciding where on multiple scales this framework should be applied to an image. The framework through which the idea can be communicated includes who/what, how, and where, among others. The appropriate drawing, including visuals and tables/charts as needed, is largely based on this decision. More than one framework can apply to an idea. Dan Roam's "SQUID" scale concept is applied once the appropriate framework(s) is/are decided on. The "SQUID" scale concept requires choosing where on a scale the visual aid will fall in different dimensions including from simple to elaborate, qualitative versus quantitative, individuals to comparison, among others. The choice of framework and scale on each dimension is dictated by the idea as well as the intended audience. How Harmon Facial Plastic Surgery Developed a Visual Aid Using This Technique We at Harmon Facial Plastic Surgery sought to communicate the fact that we offer a suite of complementary, advanced facial plastic surgery procedures – including the extended deep plane facelift, neck lift, lateral temporal brow lift, and lip lift – that can address the signs of facial aging comprehensively* and in a way that is natural appearing. Moreover, we sought to highlight the extended deep plane facelift, a technique in which Dr. Harmon is one of the few surgeons in the world fellowship-trained by its creator. This makes him uniquely qualified in the Cincinnati area to perform this technique. First, we determined that the WHO? and the HOW? are the most appropriate frameworks through which the visual aid should be created. The WHO? are our patients, whose excellent care we value most. The HOW? are the surgical techniques and the way they can restore a great deal of the youthful balance to the face that is lost with aging. Second, we chose the following on the scale for each dimension: SIMPLE rather than elaborate, QUALITATIVE rather than quantitative, EXECUTION rather vision, INDIVIDUAL rather than comparison, and CHANGE rather than status quo. In effect, we chose to visualize a simple, powerful idea about facial plastic surgery in a way that intelligent people with little available time would be able to understand quickly and easily. How the Above Process Translates into a Draft Hand Drawn Visualization How did we translate the idea of addressing facial aging comprehensively through the Harmon Facial Plastic Surgery philosophy and method? Moreover, how do we visualize this simply, qualitatively, individually, and emphasize change? A drawing on a piece of printer paper formed the first draft of this: The Draft Hand Drawn Visualization is then Interpreted by a Design Professional The next step was to hire a professional designer to translate this into a more visually appealing design. See the poster that hangs in our office below: The above image utilizes our brand logo, icon, and color. Our motto Feel Good About Feeling Good is emphasized. And the four highlighted procedures are visualized simply and attractively. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop searching "plastic surgery near me." Get in touch with us to learn more. Contact Us *Not all procedures are indicated for every patient. There may be reasons why one or more procedures may not be appropriate for a specific patient.

"Do you want the bed up?" I heard these words frequently from the circulating nurse and anesthesiologist in the operating room during residency. I heard them rarely, not surprisingly, from my attending physician. It was an expression of concern for my back and neck because I looked so unnatural and uncomfortable operating as a new resident. I almost always replied that I would like the bed raised. However, I initially felt awkward asking. I was usually taller than the attending surgeon and staff. I knew they would need to adjust to accommodate me. It took time, but I grew increasingly comfortable and assertive requesting ergonomic adjustments that were less stressful on my neck and back. I have been interested in the topic since. The following blog post is a summary of what I have learned from research, experience, and conversation with professionals. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. Surgery is Physically Demanding Work Head and neck surgery is physically demanding, often because of the variety of positioning required to perform the multitude of procedures. Facial plastic surgery, the subspecialty I was fellowship-trained – and am double board-certified - in, requires standing and sitting, the back and neck flexed at multiple angles, throughout a single procedure. Endoscopic sinus surgery involves often-uncomfortable positioning of the arms at an angle to the trunk to be able to see the monitor, which shows the sinus anatomy the instruments are navigating. These instruments can be heavy as well, resulting in additional strain. Surgery of the larynx, otherwise known as the "voice box," requires the use of microsurgical instruments and precise movements on a fulcrum from the end of the long instrument to the wrist. Head and neck cancer surgery involves hours-long procedures with the head often weighed down by a headlight and a microscope attached to glasses, called loupes. As a result, the risk of developing work-related musculoskeletal disorders is high. In fact, work-related musculoskeletal disorders may be as prevalent among surgeons as some industrial tradesmen, including masons and electricians. A review of the literature (1) demonstrates a twelve-month prevalence of pain in the following locations in surgeons and interventional physicians: ● Neck – 60% ● Shoulder – 52% ● Back – 49% ● Upper Extremity – 39% Regarding head and neck surgery, between 47.4% and 97% of have reported musculoskeletal symptoms in the literature, with back and neck pain being the most frequently cited locations (2). Similar numbers are found among facial plastic surgeons specifically (3, 4). Pain tends to begin early in residency and persists, likely because there is not only little training but little understanding of good ergonomics in residency programs. As a result, 23% to 84% of head and neck surgeons report seeking medical treatment, which includes physical therapy, medications, massage, and/or acupuncture (2). Unfortunately, 2.4% to 28% report requiring surgery, 16% require time away from work, and 2% are forced to stop work or retire early due to work-related musculoskeletal disorders (5). A recent survey amount members of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) confirmed the above findings, with 67.8% of respondents reporting a work-related musculoskeletal disorder necessitating treatment, physical therapy, or a modification of practice patterns (6). Work-related musculoskeletal disorders are a prevalent and severe problem among surgeons and interventional physicians resulting in significant morbidity and lost time. What can be done to prevent and treat it? The following information is what I have learned from my conversations with Physical Therapists (PTs) who I know and who I have been treated by for the purpose of preventing musculoskeletal injury. While I want to emphasize that I am not a trained, licensed physical therapist – and, therefore, the following information should be considered educational only – I do believe prevention is the optimal approach to the above problems in surgery and would advise any surgeon with musculoskeletal problems or who has concerns they will develop them to consider evaluation by a licensed, qualified PT. Physical Therapists Explain Why Physical Therapy Can be Beneficial for Surgeon Musculoskeletal Health Between 85.7% and 93.6% of head and neck surgeons have reported improvements in musculoskeletal symptoms with physical therapy (2). Physical therapists can be utilized both preventatively and therapeutically. According to my physical therapy colleagues, the initial evaluation includes: Identifying areas of muscle and joint restriction Assessing strength and endurance in sustained positioning or with repetitive movements. The body is accustomed to taking the path of least resistance, which often results in pressure on the joints. This can be a source of injury and pain, because joints are not able to tolerate static load over time in the same way our muscle can. Therefore, the most important thing for physician surgeons to develop is improved positional awareness to choose positions with the least strain. It is for that reason that I started Reformer Pilates, both to strengthen muscles that stabilize my spine, but also to strengthen and activate those muscles I was instructed I will need to position myself in the least stressful way possible. Physical Therapists Explain Why Movement During Surgery is Important for Surgeon Musculoskeletal Health Some physical therapists will argue that no single position should be considered necessarily "bad" or "good." Positioning depends on the individual and the work demands on them. However, the general problem comes from maintaining one position for too long. Neck and trunk flexion as well as flexion and abduction of the shoulders create higher force and increased muscle strain. This positioning is common during surgery. To that extent, "micropauses" of 20 seconds or more – or short breaks in general – are advised by some physical therapists to reduce joint and muscle strain. Physical Therapists Argue Strategic Movement Before, Between and After Surgery is Important for Surgeon Musculoskeletal Health Some physical therapists will argue that what we do before, between, and after surgery is important as well. For example, building muscle strength and flexibility beyond the range of motion of the activity performed – in this instance, surgery – is important to reduce the risk of injury. In fact, many professional athletes adhere to this strategy in basketball and other sports. Other Common Preventative Strategies May be Less Helpful The feedback I have received from physical therapists is that biofeedback devices – those devices that are often worn on the back and send signals with changes in posture – are generally not effective absent other interventions as described above. One colleague explained that, while biofeedback devices can be used for training, they are less effective with daily use, primarily because they can take attention away from the task at hand (i.e., surgery). However, every individual needs to make the decision for themselves whether the above is indeed true for them. I was very interested in the feedback I received on postural chairs; chairs meant to force improvement in posture. I have colleagues who use these chairs during surgery. I was informed that, while postural chairs can be good to provide breaks for your body, they should not be a primary intervention. These chairs can reduce the usage of muscles whose strength is important to maintain good posture and, therefore, protect your musculoskeletal system. Again, however, the use of postural chairs and biofeedback devices should be a personal choice made in consultation with a licensed, qualified physical therapist. Trust Your Face to a Double Board-Certified Facial Plastic Surgeon It is important to seek a fellowship-trained, double board-certified specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop searching "plastic surgery near me." Get in touch with us to learn more. Contact Us References Epstein S, Sparer EH, Tran BN, Ruan QZ, Dennerlein JT, Singhal D, Lee BT. Prevalence of Work-Related Musculoskeletal Disorders Among Surgeons and Interventionalists: A Systematic Review and Meta-analysis. JAMA Surg. 2018 Feb 21;153(2):e174947. Walters ZA, Chang KY, Cervenka B, Collar R, Hsieh TY. Ergonomics in Otolaryngologic Surgery: A State of the Art Review. Otolaryngol Head Neck Surg. 2022 Aug 9:1945998221117095. Garg N, Xu V, Mandloi S, DeKloe J, Kumar A, McCann A, Chandna M, Tekumalla S, Krein H, Heffelfinger R. Ergonomics in Facial Plastic and Reconstructive Surgery: A National Evaluation. Facial Plast Surg Aesthet Med. 2024 Dec 20. Karasik D, Tranchito E, Welschmeyer AF, Gourishetti SC, Shipchandler TZ, Ponsky D, Rabbani CC. Improving Surgeon Well-Being: A Survey on Ergonomic Challenges and Solutions in Rhinoplasty. Facial Plast Surg Aesthet Med. 2024 Dec 26. Ryan MT, Montgomery EA, Fryer J, Yang AW, Mills C, Watson N, Noller M, Riley CA, Tolisano AM. Ergonomics in Otolaryngology: A Systematic Review and Meta-analysis. Laryngoscope. 2022 May 16. doi: 10.1002/lary.30216. Garg N, Xu V, Mandloi S, DeKloe J, Kumar A, McCann A, Chandna M, Tekumalla S, Krein H, Heffelfinger R. Ergonomics in Facial Plastic and Reconstructive Surgery: A National Evaluation. Facial Plast Surg Aesthet Med. 2024 Dec 20.

This blog post is adapted from multiple sources (references below) and summarizes some things I have learned over the years about aging well that I have tried to incorporate into my life. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. Aging Well Means Maintaining Function Fara and I had an opportunity to give a talk on aging well at a country club. It was very gratifying to impart whatever wisdom I could to interested individuals. The World Health Organization (WHO) defines healthy aging as the process of developing and maintaining functional ability with age. Genetics, the environment, and human behavior all contribute to healthy aging. Healthy aging is distinct from changes to our appearance which can occur with age. Functional decline may or may not parallel the development of an aged appearance. For example, there are many high-performance athletes, such as triathletes, who maintain high functional abilities into their old age but whose faces appear older due to factors that will be discussed. Lessons from the "Blue Zones" Have Been a Helpful Guide "Blue zones" as defined by the author of The Blue Zones: 9 Lessons for Living Longer from the People Who've Lived the Longest, Dan Buettner, are areas of the world where the number of people living into old age is much higher than average. The communities identified are in Japan, Costa Rica, Italy, Greece, and Southern California. The author and his colleagues visited these communities and distilled the qualities that they believe are likely contributing to their longevity into 9 "lessons" for others to follow. A Culture of Physical Activity is Essential The behavioral traits identified in these blue zones include a culture of physical activity. However, this is not simply regular exercise, though both aerobic and strength training are recommended. The individuals in these communities live in a built environment where exercise is easy and performed passively and physical activity is required to perform activities of daily living. This includes walking to school, the market, and friends' homes. I completed fellowship training in facial plastic surgery in New York City. My wife, son, and I lived in Queens during this time. The community we lived in was composed of medium-height buildings spaced close together. The nearby parks were beautiful, safe, and child friendly. Our friends lived within walking distance. All our necessities were within walking distance. I traveled to work on the subway system, which required walking a few blocks each day. The fact that we lived in a small apartment seemed less important because we could live our lives in the city. It was easy to maintain our physical health while enjoying our lives. A short commute was invaluable, because I worked very long hours and would otherwise been unable to see my wife and son before they went to bed if I had a long commute by car. The walkability of the community we lived in improved our quality of life greatly. In contrast, my time teaching in Doha, Qatar for Weill Cornell Medical College in Qatar provided a very different lifestyle. I lived in downtown Doha in a high-rise apartment. The university was located a 30-minute drive away on the outskirts of the city in the desert. Temperatures reached the 100s to 110s daily, even at night. As a result, outdoor activities were severely limited during the day. We lived inside air-conditioned buildings all day, albeit very nice ones. I scheduled time to work out in my building's gym to maintain my physical health. But it was not easy. Work was time-consuming and I wanted to take as much time to explore a part of the world I previously knew so little about. One consideration I would add to a culture of physical activity is optimizing ergonomics. A surgeon spends most of their day standing or sitting in somewhat contorted positions. The potential for this to put strain on the shoulders, back, and hips is significant. It is important to maintain an exercise regimen that keeps a strengthened core and to constantly focus on proper body positioning when operating. After all, we owe it to our patients and ourselves to maintain peak physical health to optimize our surgical outcomes. To that end, I practice pilates to maintain my core strength. Strong Social Support Contributes to Aging Well Some of my family and me at the Trains and Traditions Exhibit at the Krohn Conservatory in Cincinnati, Ohio. Another behavioral trait identified was a strong social structure. This includes strong family connections, friendships, and support from their community groups. When my wife and I returned to Cincinnati from New York City we realized how much we missed being near family. Our son, Babak, suddenly had his grandparents nearby. It was very helpful for us as we established Harmon Facial Plastic Surgery. The relationship Babak has built with his grandparents has meant so much to Fara and me. I believe it has help developed Babak's emotional intelligence and happiness. I hope our soon-to-be-born daughter, Roya, will have a similar experience. Good Nutrition is Whole and Balanced A third behavioral trait relates to their cultures of food and nutrition. I would like to reference this blog post on nutrition written by the dietician Tirzah Thompson who presented at our office in the past. Individuals in blue zone communities eat a well-rounded diet of whole foods, avoiding processed foods. They eat to contentedness only while maintaining adequate calories for nutrition. The information provided by Tirzah Thompson and the blue zone communities does not account for individuals with micronutrient deficiencies due to disease and/or food allergies and intolerances. Any diet should account for these differences and be culturally appropriate/sensitive. I have really enjoyed learning about Persian food and the culture surrounding it from my wife and her family. Persian food is complex and beautiful, consisting of stews filled with unusual spices. It takes hours to prepare but is well worth the wait. The wisdom gained from years of trial and error is evident in the combination of ingredients and the care with which it is prepared. My favorite dish is called ghormeh sabzi which consists of a mixed of herbs including parsley, cilantro, scallions, and fenugreek as well as kidney beans, beef and a special dried lime commonly used in the region in teas and to impart additional flavor to a stew. The stew is over over fluffy long-grain rice tossed with butter and saffron. The taste is slightly citrusy and bitter, and the aroma is unlike anything I have previous experienced. That is the case with most Persian dishes. Persian cooking, like cooking from all over the world, contains generations of embedded wisdom that make eating a well-rounded diet easy and the experience enjoyable. Adequate Sleep Can be Difficult but is Necessary An area unmentioned in the blue zones studies was the importance of sleep. The American Academy of Sleep Medicine recommends 7 or more hours of sleep per night regularly. The academy allows 9 hours of sleep per night for individuals who are recovering from an illness or who have been deprived of sleep. I understand that 7 hours of sleep per night regularly can be more difficult at different times in our lives. For example, our sleep can be limited when caring for young children and/or our elderly relatives whose functional capacity is limited. Our jobs can also limit our sleep. I have certainly felt this way during residency and fellowship training and when our son was just born and waking regularly to feed. I have learned that life is a long, beautiful journey. We cannot always be perfect to ourselves or for our loved ones. The Skin Ages Functional decline may or may not parallel age-related changes to appearance, including of the skin. The changes related to skin aging develop due to both external and internal factors. The internal factors are genetic and a relatively minor contributor to skin aging. Most age-related changes to the skin are due to external factors, none more so than cumulative sun exposure. Other external factors include smoking, excessive alcohol intake, poor nutrition, and pollution. These external factors contribute to skin aging by accelerating a chemical reaction in the skin that leads to a breakdown of its components. There are three components of skin whose changes contribute to aging. The first is collagen, which is the skin scaffold. The second is elastin, which imparts elasticity to the skin. The third are glycosaminoglycans (GAGs), of which hyaluronic acid is an example, which increases skin hydration and plumpness. Aged skin appears more fragile, thin, wrinkled, dry, rough, sallow, and with poor light reflection and pigmented spots. Necessary but not sufficient, good skin care can both treat and decrease the effects of aging on the skin. A good skin care routine is simple and includes agents that are pro-collagen, antioxidant/anti-inflammatory, and photoprotective. Topical Retinoids are Pro-Collagen Retinoids, which include retinols, are derivatives of Vitamin A that can be applied to the skin. Topical retinoids are pro-collagen, meaning they increase the production of youthful collagen and reduce the breakdown of collagen. Retinoids, a prescription medication, are the only FDA-approved treatment for photoaging. Retinols, a precursor molecule that is converted to retinoids in the body, are not FDA-approved; rather, they are a cosmeceutical. Retinols do not require a prescription. While not FDA-approved, there is extensive evidence for their effectiveness as well. Retinoids and retinols are unique among skin care products in that there is evidence both that they can reverse and prevent some of the signs of skin aging. Retinoids do have some side effects and may not be appropriate for all individuals or all skin types. A consultation with a dermatologist or plastic surgeon is recommended prior to considering the use of retinoids of any kind. Topical Vitamin C is Anti-Inflammatory and Photoprotective The most important topical antioxidant/anti-inflammatory product – the product with the most evidence for its effectiveness – is ascorbic acid, also known as Vitamin C. Vitamin C is an important component of collagen. There is strong evidence for its effectiveness as a topical antioxidant, which reduces the frequency of the previously described chemical reaction on the skin. It is also photoprotective, reducing the effects of ultra-violet rays from the sun. The problem with Vitamin C is that it requires a specific formulation to be adequately absorbed by the skin. It is also exquisitely sensitive to light and air, necessitating special packaging. Other ingredients are often added to Vitamin C that preserve the function and even potentiate its effects, including tocopherol (Vitamin E), ferulic acid, and pycnogenol. These ingredients, including topical Vitamin C, are all cosmeceuticals which are not FDA-approved to treat photoaging. All necessary precautions should be taken when using these ingredients as they may not be appropriate for all individuals or all skin types. A consultation with a dermatologist or plastic surgeon is recommended prior to considering the use of these treatments. Sunscreen is Photoprotective The best photoprotective product for the skin is sunscreen. The best sunscreen to use is a mineral-based sunscreen, such as one that includes zinc oxide. Chemical-based sunscreens rarely provide as strong and complete protection. Recommendations include a mineral-based sunscreen of at least an SPF of 30 or greater. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about age-related changes to your face and/or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon. Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us today to learn more! Contact Us References Baumann, L. (2014). Cosmeceuticals and Cosmetic Ingredients (1st ed.). McGraw Hill/Medical. Buettner, D. (2012). The Blue Zones: 9 Lessons for Living Longer from the People Who've Lived the Longest (2nd ed.). National Geographic.