Is cosmetic surgery really the only way to turn back the clock in a way that will last? To get the inside information on how nonsurgical options really measure up against their full-scale surgical approaches, we talked with Dr. Paul Stallman, a facial plastic surgeon who performs a full complement of surgical – and nonsurgical – procedures to keep people looking young.
Younger.com: You have a great deal of experience as an oculoplastic surgeon, yet many of the procedures you perform are noninvasive or minimally invasive. Why is that?
Dr. Stallman: Well, to be clear: in many cases a patient will need some kind of surgical procedure, but in general I try to avoid unnecessary surgery. If I know the patient will get acceptable results with a less extensive approach, I'll give them that option.
For example, I don't think many patients realize how invasive a full facelift actually is -- it involves manipulation of important facial muscles, repositioning facial fat, and then tightening the skin. Sometimes an approach that isn't quite as direct or aggressive will actually yield subtler, softer results and look more natural. I perform a lot of neck lifts and endoscopic brow lifts, and both of those are much less invasive.
Younger.com: What examples can you give us of patients who would do well with a nonsurgical approach instead of surgery?
Dr. Stallman: Most of that will have to do with skin quality. I think there's a misconception out there that the small-scale options all work like clockwork, exactly the same for everyone, but in reality there's a bit of variation. The "perfect" patient is not any particular age – most of what I look for is healthy skin and good nutrition, etc. Laser treatments are a good example – most patients will see a very nice improvement, but a few will get such great results, you would swear looking at the photos that they had had facelifts. Part of that is genetics, but part of it has to do with how well they have been taking care of themselves.
Younger.com: How does an endoscopic brow lift work, and how does that compare to, say, BOTOX(R) Cosmetic?
Dr. Stallman: BOTOX tightens tissues by immobilizing them, but a browlift will actually lift and tighten the brow muscles. It reverses the effects of gravity and puts the muscles back into the position they used to be in, and then at the same time it corrects loose skin. BOTOX is a good choice when the patient still has good skin elasticity, and the problem is mainly those deeper facial lines from muscle movement.
Younger.com: Can you give us an example of a very effective surgical or nonsurgical procedure that many patients just don't know about?
Dr. Stallman: There's one procedure I perform -- an advanced type of eyelid surgery (blepharoplasty) -- where I will take excess fat from the lower lid, and instead of removing it altogether, I will just flip it downward and reposition it so it fills out the "tear trough" below the eye. The fat is still living and healthy, so in many ways this is a much more "natural" approach to padding that area than using a tissue filler. But obviously that only works if the patient has large lower-lid fatty packets; the average patient will still get very nice results with Restylane® or another filler.
Dr. Paul Stallman (http://www.stallmancosmeticsurgery.com) is a facial plastic surgeon offering procedures like laser skin rejuvenation, endoscopic brow lift, and blepharoplasty for patients from the San Luis Obispo area and as far away as Fresno. Dr. Stallman is board-certified in otolaryngology (surgery of the head and neck) and has years of training and experience in eye surgery and oculofacial plastic surgery. He earned his medical doctorate from the State University of New York at Stony Brook and is one of an elite group of surgeons to have earned fellowship in the prestigious American Society of Opthalmic Plastic and Reconstructive Surgery.
Younger.com: You have a great deal of experience as an oculoplastic surgeon, yet many of the procedures you perform are noninvasive or minimally invasive. Why is that?
Dr. Stallman: Well, to be clear: in many cases a patient will need some kind of surgical procedure, but in general I try to avoid unnecessary surgery. If I know the patient will get acceptable results with a less extensive approach, I'll give them that option.
For example, I don't think many patients realize how invasive a full facelift actually is -- it involves manipulation of important facial muscles, repositioning facial fat, and then tightening the skin. Sometimes an approach that isn't quite as direct or aggressive will actually yield subtler, softer results and look more natural. I perform a lot of neck lifts and endoscopic brow lifts, and both of those are much less invasive.
Younger.com: What examples can you give us of patients who would do well with a nonsurgical approach instead of surgery?
Dr. Stallman: Most of that will have to do with skin quality. I think there's a misconception out there that the small-scale options all work like clockwork, exactly the same for everyone, but in reality there's a bit of variation. The "perfect" patient is not any particular age – most of what I look for is healthy skin and good nutrition, etc. Laser treatments are a good example – most patients will see a very nice improvement, but a few will get such great results, you would swear looking at the photos that they had had facelifts. Part of that is genetics, but part of it has to do with how well they have been taking care of themselves.
Younger.com: How does an endoscopic brow lift work, and how does that compare to, say, BOTOX(R) Cosmetic?
Dr. Stallman: BOTOX tightens tissues by immobilizing them, but a browlift will actually lift and tighten the brow muscles. It reverses the effects of gravity and puts the muscles back into the position they used to be in, and then at the same time it corrects loose skin. BOTOX is a good choice when the patient still has good skin elasticity, and the problem is mainly those deeper facial lines from muscle movement.
Younger.com: Can you give us an example of a very effective surgical or nonsurgical procedure that many patients just don't know about?
Dr. Stallman: There's one procedure I perform -- an advanced type of eyelid surgery (blepharoplasty) -- where I will take excess fat from the lower lid, and instead of removing it altogether, I will just flip it downward and reposition it so it fills out the "tear trough" below the eye. The fat is still living and healthy, so in many ways this is a much more "natural" approach to padding that area than using a tissue filler. But obviously that only works if the patient has large lower-lid fatty packets; the average patient will still get very nice results with Restylane® or another filler.
Dr. Paul Stallman (http://www.stallmancosmeticsurgery.com) is a facial plastic surgeon offering procedures like laser skin rejuvenation, endoscopic brow lift, and blepharoplasty for patients from the San Luis Obispo area and as far away as Fresno. Dr. Stallman is board-certified in otolaryngology (surgery of the head and neck) and has years of training and experience in eye surgery and oculofacial plastic surgery. He earned his medical doctorate from the State University of New York at Stony Brook and is one of an elite group of surgeons to have earned fellowship in the prestigious American Society of Opthalmic Plastic and Reconstructive Surgery.
