Gone (mostly) are the days of the post-injection frozen face, the seemingly emotionless Botox-bot shopping its way down Madison Avenue. As highly trained plastic surgeons in Manhattan’s upper east side beauty mecca, our needlework is getting much more subtle, “smarter”, and more customizable! Over the past year, I have seen a huge increase in younger patients, hoping to incorporate a little Botox into their regular beauty regimen to help prevent the development of fine lines and wrinkles, and to set the stage for lovely, natural, beautiful wizening (I don’t like to say “aging”). My patients, both men and women, want to look natural, just a little more refreshed and less stressed. They want to be able to express themselves with their faces- to laugh, get mad and even cry.

Introducing Protox

Often, as part of their jobs, they must be able to express themselves with their faces to be effective and successful. Lucky for us all, with some experience and knowledge, Botox is highly customizable! Introducing what I’ve dubbed “Protox” – custom Botox designed with your professional goals in mind. A personal brand identity is key to one’s career and the face often says it all.

The Case of The Lawyer

Attorneys must have the ability to look disapproving. This patient always needs to maintain a little corrugator movement (this is the muscle group that give you the vertical “11 lines” between the eyebrows, and furrows the brow) in order to successfully argue a case or negotiate a mediation.

When The Psychiatrist is the Patient

A Psychiatrist needs to maintain a sympathetic demeanor without displaying a disapproving, “frozen” look. In contrast to the lawyer, this patient needs to seriously weaken movement in the corrugators so they can relax and listen to what their patients are saying without looking judgy, but keep a little movement in the frontalis muscle (the muscle that raises the eyebrows) so they can still look like they care about what they’re hearing.

Let The Teacher Teach

He needs to maintain the ability to look surprised and to be sympathetic. This patient needs to retain almost all movement of the frontalis muscle that raises the eyebrows, but can often benefit greatly from Botox used to soften the crow’s feet and raise up the arch of the eyebrow.

The Poker Player

This patient needs Botox to retain her poker face and help eliminate the look of surprise (frontalis muscle) and some of the most common facial “tells” such as clenching the jaw and flexing the masseter muscle at the angle of the jaw. (masseter muscle Botox) It’s important for poker players to be able to keep all emotion under wraps.

The Actor Needs to Emote

Performers need to be able to express all emotions, but must also look permanently airbrushed with subtle touches of Botox in a number of areas.

No matter your personal or professional goals, subtle, natural, customized Botox is possible in the hands of an experienced injector!

The “face” of the plastic surgery conversation is changing. Slowly, cosmetic surgery discussions are becoming more frank, and the details of Botox, filler, and cosmetic surgery – which used to be the secret of the Manhattan and Los Angeles elite – are becoming less secret. In his recent TIME Magazine article entitled, “Nip. Tuck. Or Else.”, Joel Stein comments that, “cosmetic surgery has become the new makeup”.  While I think this is a bit of an overstatement, there is a kernel of truth in it. Little tweaks of Botox and filler, even rhinoplasty, and facelift surgery, are becoming more talked about, thus losing their stigma. Celebrities and civilians alike are speaking more openly about the procedures they’ve had done. We can thank Betty Ford (facelift and blepharoplasty), Joan Rivers (lots!), Ashlee Simpson (rhinoplasty), Renee Zelwiger (blepharoplasty), and most recently, Caitlyn Jenner (facial feminization and breast implants) for speaking frankly about cosmetic surgery.  We can thank sites like RealSelf for helping demystify the logistics of cosmetic procedures, as well as helping people become more educated cosmetic consumers.

Have No Doubt:

Cosmetic surgery is happening all around you. According to the International Society of Aesthetic Plastic Surgery (ISAPS), more than 20 million cosmetic surgical and nonsurgical procedures were performed worldwide in 2014, with the United States ranking number one for most cosmetic surgical and non-surgical procedures performed in 2014 (Brazil was briefly number one in 2013, but Brazilian Butt Lift be damned, we managed to regain the number one spot this past year). Cosmetic surgery technology is advancing, and procedures are becoming more minimally-invasive, with short, or no, recovery time required. As the technology advances, procedures become more common, and the cost is coming down, making procedures affordable to more people. Surgeons are also becoming more skilled, and more subtle, making results more predictable and less scary.

Along The Beauty Continuum

More and more in my practice, I see cosmetic procedures, particularly Botox and filler, regarded as regular maintenance rather than narcissistic indulgences. I even have many patients that come in for treatments with friends and make a day of it. I’ve seen that, with time, the idea of beauty and personal upkeep is becoming a continuum, with haircuts and shopping on one end and facelifts on the other. There are no longer any hard stops. If you have no reservations about coloring your hair with chemical dyes when it turns gray, why shouldn’t you take advantage of anti-aging treatments for your face? If you buy clothing and accessories in order to convey your personal style – to portray to others the way that you see yourself – why not take advantage of available procedures to do the same for your face and body?

The Shame Of Beauty Routines Is Long Gone

As Stein points out, in the 19th century, makeup was often sold under the counter because it was considered a tool of prostitution. In the 1930s, when hair dyeing was new, women got their color done in the basements of beauty parlors so no one would see them and continued to do so for decades. The shame of these beauty routines is long gone, and I hope that in the same way, we can soon say that the days of plastic surgery shaming are over.

The best plastic surgery is plastic surgery you can’t see. I often have patients who say, “when I walk down the street I can tell when someone has had filler, or a facelift.” I say that the only plastic surgery you can see is badly-done plastic surgery. Well done Botox, filler, peels, or even surgery should leave you guessing why your neighbor looks so well-rested, or why your college friend has looked the same for the last 15 years. A good rhinoplasty makes you notice your cousin’s beautiful eyes rather than her new nose. A good facelift has you hoping you’ll inherit your aunt’s great skin.

You and Your Plastic Surgeon Should Be a Team

You should feel heard, and you should choose a surgeon whose aesthetic and philosophy of beauty you share. I like to look at my relationship with my patients as a partnership. I am the plastic surgery expert, but you are the expert with regards to your face and your lifestyle. We not only need to work together to optimize results but we also have to trust one another and agree on what is beautiful. My philosophy of beauty is that “less is more.” My goal is to optimize your natural beauty, and to achieve an effortless-appearing, simple and timeless beauty that preserves the face as a fresh, clean palate.

Timeless Beauty

It transcends trends. It’s clean and it’s fresh. So if you want to experiment, do it with your hair, clothes, make-up – even nails. But please don’t experiment with your face! Just like any other aspect of fashion and beauty, trends in facial plastic surgery come and go. Unlike other aspects of fashion and beauty, you can’t shed a surgery like last season’s stilettos. Dramatic “reduction rhinoplasties” of the late 60s and early 70s have made many a pinched ski-slope nose on Madison Avenue. Extreme blepharoplasty (eyelid surgery) in the 70s has left many otherwise gorgeous ladies with hollow-looking eyes as they’ve aged. Plucking the eyebrows down to fine lines in the 80s has left models looking for eyebrow hair transplants now that the trend is for fuller brows (Yes! You can do that!).

Desperately Seeking Surgery

People seek out cosmetic surgery for many reasons, and that motivation is important. I have found that the happiest patients after Botox, filler, peels, or surgery are patients that chose to have a treatment, or surgery for themselves. This is the right motivation. I have no problem telling patients that I don’t think a treatment or surgery is right for them. Just because I’m a plastic surgeon, doesn’t mean that everyone should have surgery. Surgery has its place, and can produce fantastic results, but there are MANY other tools and tricks as well. You can always do more; but once you do too much, you can rarely do less.

Ralph Waldo Emerson said, “Love of beauty is taste, creation of beauty is art”. The perfect partnership between patient and surgeon respects the art of less is more.

What is a SELFIE?

This word, first used in an Australian internet forum on September 13, 2002, is used to describe an often unflattering photograph, typically taken by the subject either with a camera held at arm’s length or in a mirror, and often shared on social media. It was the Oxford Dictionary’s word of the year in 2013, and was added to Merriam-Webster Collegiate Dictionary’s 11th edition.

Selfies Driving Increased Plastic Surgery

Believe it or not, according to a new study by the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), the rise of the selfie is having a huge impact on the facial plastic surgery industry. The study showed that one in three facial plastic surgeons surveyed saw an increase in requests for procedures as a direct result of patients being more self-aware of their appearance in social media selfies. In 2013, more than half of surveyed facial plastic surgeons (58 percent) saw an increase in cosmetic surgery or injectables in those under the age of 30, and this may be due in part to social media.

Is Social Media Making Us More Self-Conscious?

Many social media platforms, including Instagram, GroupMe, Snapchat and the iPhone app Selfie.im, are image-based. Our presence on these platforms forces us to see our own image repeatedly, and to look at our image with a more self-critical eye than ever before. Gone are the days of a morning farewell to ourselves in the mirror and a quick passing glance at our reflection in the Bergdorf Goodman window during the day. We are now forced to gaze at, and compare, our self-selfies and the selfies of others on a constant basis. We are more aware than ever that our photos are often the only first impressions available to prospective friends, colleagues, romantic interests and employers, and we want to put our best selfie-face forward.

In the article “Why Selfies Sometimes Look Weird to Their Subjects”, Nolan Feeney points out how the selfie can be a set up for disappointment.

Our Mirror Image Has Turned On Us

Whether or not a selfie is reversed after being shot is a major factor in how we perceive our photo. If you’ve used multiple mobile apps to take pictures of yourself, you’ve probably noticed that some, like Snapchat, show you the view of yourself that you would see in a mirror, and that others, like GroupMe, flip the image horizontally and save your selfie the way others would see you. We are used to seeing our image in the mirror, and we’ve grown accustomed to our mirror faces, and familiarity breeds liking. When our mirror image is flipped (this is what others see), it often looks strange and less attractive to us.

Our Faces Are Not Symmetrical Works of Art

Part of that is because everyone’s face is asymmetric. As photographer Julian Wolkenstein illustrates with his portraits, which duplicate each side of a face to create strikingly different versions of the same person, everyone’s left and right side is different.

Close Proximity Breeds Distortion

The close proximity of our faces to our smartphone lenses makes matters worse. Selfies exaggerate certain features, such as the nose. The parts of your face that are closer to the camera seem larger than other features in comparison to non-selfie photographs, where the distance from the camera to your face is longer and has more of a flattening effect on your face. Some people describe this as the “fisheye effect” of smartphone lenses. Bottom line? You don’t really look like that!

Do It for You, Not Your Selfie

I often have patients ask me, “What do I need?” with reference to Botox, facial fillers or plastic surgery. As I tell all my patients, you are the judge and jury as to what you “need” (and by “need” I mean “want”) in terms of cosmetic surgery. If you do decide to take the plunge, make sure to select a board-certified surgeon who specializes in plastic surgery of the face, head and neck, and make sure you’re doing it for yourself, and not just for your selfie.

Dr. Dara Liotta has recently joined Travel Beauty’s panel of experts.

About Dr. Liotta

An Ivy League-educated and fellowship-trained facial plastic and reconstructive surgeon, Dr. Liotta is dedicated not only to her own practice, but to continued education, research, and innovation in the field of facial plastic and reconstructive surgery. In her offices on the upper east side of Manhattan, Dr. Liotta performs a wide variety of facial cosmetic and reconstructive procedures, including laser treatments, Botox, facial filler, and cosmetic and reconstructive surgery. Dr. Dara Liotta is committed to helping her patients achieve beautiful, natural results that will last a lifetime. We can say first hand that her work and her bedside manner are top notch, which is why we asked her to join our esteemed panel of experts!

Travel Beauty sat down with Dr. Liotta for an exclusive Q & A session:

TB: What is the best/most rewarding part of what you do?

DL: I have an amazing job. I consider it an incredible privilege to be able to help my patients feel and look like the best possible versions of themselves.

TB: How does your background as an ENT surgeon inform and enhance your cosmetic practice?

DL: Having spent 5 years training in Ear, Nose and Throat and Head and Neck Surgery, before going on to complete fellowship training in Facial Plastic and Reconstructive Surgery, I’m intimately acquainted with, and comfortable manipulating, the delicate and complex anatomy of the face and neck from its most superficial to its deepest layers.

Four of our five senses are housed in this area, and I’ve been trained to appreciate and respect the vital structure and function of each. As a Board Certified ENT surgeon as well as a Facial Plastic and Reconstructive surgeon, I believe that my job is not complete until everything looks good, functions well, and feels healthy.

TB: What are some common misconceptions you hear about injectables?

DL: With regards to facial fillers, patients tell me all the time that they are afraid of looking puffy, and having the pillowy, over-injected look of so many unfortunate celebrities. While everyone is different, the average patient may use 1 or 2 syringes of filler total. I like to point out that 5 syringes of filler like Juvederm are equal to only one teaspoon, so 1,2, or even 3 syringes can’t possibly make you look puffy. So don’t worry about that!

TB: Getting injectables and/or having plastic surgery is such a high stakes endeavor. What guidance can you give on picking a good surgeon? What should people steer clear of?

DL: It’s vital to be comfortable that you and your surgeon are on the same page in terms of the goals of surgery and what you consider to be a beautiful result- that you share the same idea of beauty. Assuming that you are comparing reputable, well-trained, talented surgeons, one of the most important things is choosing a surgeon whose aesthetic and opinion you trust. Cosmetic surgery is a little bit science and a little bit art.

Steer clear of physicians or surgeons who don’t have time to answer your questions, are hard to talk to, or are unavailable to you before your procedure.

TB: Any exciting new developments in your field that we can look forward to?

DL: Of course! The quest for beauty gets more high-tech, more minimally-invasive, and less painful every day. Stay tuned. . .