Facial Plastic Surgery Not Written by a Physician

I Read One of the Best Books on Facial Plastic Surgery Not Written by a Physician

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:

  1. Titanic
  2. Armageddon
  3. Saving Private Ryan
  4. There’s Something About Mary
  5. The Waterboy

The following is a list of the top five selling records (in order) of 1998:

  1. Titanic: Music from the Motion Picture by James Homer
  2. Let’s Talk About Love by Celine Dion
  3. Sevens by Garth Brooks
  4. Backstreet Boys by Backstreet Boys
  5. 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.

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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.

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This blog post is for educational purposes only and does not constitute direct medical advice. It is essential that you have a consultation with a qualified medical provider prior to considering any treatment. This will allow you the opportunity to discuss any potential benefits, risks, and alternatives to the treatment.