Bruce Jenner and Thoughts About Bad Facelifts

Unfortunately, the time that plastic surgery gets publicized is when it looks bad.  I too often hear, “Well, I can always spot out plastic surgery.”  Two things.  First, if facial plastic surgery is done well you should not be able to tell.  Second, even if you cannot tell, I can tell certain cases that are borderline bad.  This article will explore in my opinion why people look pulled and what can be done to avoid this outcome.

Bruce Jenner, Poster Child for Bad Plastic SurgeryTo make it very simple, my philosophy is that all facial lifting is bad (not all but almost all).  When I am talking about facial lifting, I mean any lifting that is carried out above the jawline.  I think a neck lift is warranted when the neck is hanging a la a turkey-gobbler appearance.  However, in contradistinction browlifts and midface lifts can look atrocious.  I used to perform them and did so very conservatively, but fundamentally there is a problem with treating the area from the mouth upwards with a lifting procedure.  The first problem is that the upper and midface do not actually fall.  This is a very hard concept to grasp because you will take two fingers and lift your face up and say, “Don’t I look better?”  This is the trap into which we can easily fall.  There is a fellow colleague of mine who looked at 40-year time differences of individuals in their twenties and in their sixties using standardized digital photographs and found that there was almost no evidence of gravity in the mid to upper face.

If this is the case, then why do individuals look like they need something lifted?  The answer is that the brows, lower eyelids, and cheeks actually deflate and therefore look sagging.  The hardest area to understand this concept is the brow region.  Most individuals who think their brows are heavy need to go back and look at their own brows in their youth. They will see that their brows almost definitely were not higher but were actually fuller.  If you take it even further back in time to one’s teenage years, you will see that the brow probably looked almost too full.  I use the analogy of a balloon in youth (your brows and upper-eyelid area) that gradually deflates.  When it deflates, it starts to look heavy but the actual trick is not to lift it but to re-inflate it.  I hope that makes sense.

The second reason that lifting of the upper and midface can look fake is that when areas of the mouth and eyes become stretched there can be an unusual look to them.  So in summary lifting areas around the mouth or the eyes can look weird because they should not be stretched in any way at all.  Finally, the reason that these areas can look artificial is that lifting these areas when they should more properly be filled with fat grafting (which is my preferred method of rejuvenation of the mid to upper face) is that pulling deflated tissues around exposed bone simply does not look good.  If you take Bruce Jenner as an example, he fits all of these stigmata.  He is very bony looking and then has all the areas mentioned above pulled around this bony frame.  The distortion is evident because there are areas of overstretched tightness wrapped around a bony frame.  On the other hand, at grafting done with taste and discretion (not the way that people today look overfilled in Hollywood) would be the way to fix these terrible results, not entirely but at least in part.

Samuel M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To learn more about Dr Lam’s facial rejuvenation and facelift procedures please visit our website or call 972.312.8188 to schedule a consultation.