Know Your Cosmetic Procedures


Assuming that Sunday night's Oscars ceremony will bring out the best and brightest of Hollywood and with them, many a frozen forehead and taut temple, we thought it the perfect time to find out a little bit more about what people are having done. The work behind the face, if you will. Sure, saying you get Botox these days has the shock value of admitting to wearing contacts, but what is Juvéderm? (It is not, as you might think, an all-inclusive resort in Cancun for teenage misfits.) Restylane? (Note to locavore foodies: it's unrelated to purslane.) Luckily, we had the perfect plastic surgeon to call: the charming and whip-smart Jordan M.S. Jacobs, M.D., who also happens to be married to the gorgeous Glamour editor Maria Dueñas Jacobs (who will never need anything done, which is a kind of a waste considering her access, but this is besides the point). Here, Jacobs, a surgeon at the New York Group for Plastic Surgery and an Assistant Professor of Plastic Surgery at the New York Medical College, answers our pressing questions, in the most layman-y terms he could muster.

What's the difference between fillers (like Juvéderm) and Botox? This is an important distinction for patients to understand. Fillers, such as Juvéderm, Restylane, Perlane, Sculptura, Radiesse, etc., all work by replacing volume (increasing cheek fullness or filling in fine wrinkles around the mouth or eyes), while neuromodulators, such as Botox and Dysport, work by temporarily paralyzing the muscles that are responsible for producing wrinkles. One fills in a desired area (a deep line or upper lip, for example), the other temporarily 'freezes' the desired area.

What's a 'plumper'? Do certain products plump and others fill? I am pretty sure you are referring to the fact that some fillers are meant to be injected more superficially for the purpose of decreasing or obliterating wrinkles while other fillers are more effective when injected deeper in order to augment volume (a common example being underneath the eyes to fill in the tear trough, or over the cheek bone to help pronounce the bone structure).

Which things go where (on your face)? Great question. Fillers can be placed anywhere on the face where either you want to soften a wrinkle or increase fullness; the most common places fillers are injected are the nasolabial fold (the curved line from the nose to the corner of the mouth), the “marionette' line (line from the corner of the mouth to the bottom of the lower jaw), and the lips (the upper lip more commonly than the lower). Botox for cosmetic purposes is actually only approved for treatment of glabellar frown lines (the so-called “bunny lines' between the eyebrows). That being said, many physicians have expanded its application to the horizontal lines of the forehead, the “crow's feet' fine wrinkles around the eyes, and down-turning corners of the mouth (to literally “turn the frown upside down' [Ed. note: HA! Told you he was charming]).

Botox and Dysport: What's the difference? Pros/cons? This is somewhat controversial in the eyes of the respective manufacturers. Botox was the first Botulinum toxin to come onto the market and is still the most widely used neuromodulator. Dysport came onto the market in 2009, and is typically less expensive. I've used both and think they are both effective, quality products. That being said, I use Botox.

What's the Next Big Thing in cosmetic plastic surgery? What are you excited about? I am personally excited about fat grafting, A.K.A. autologous fat transfer. In cosmetic surgery, it has the potential to be a more permanent alternative to fillers such as Juvéderm. We've been fat grafting all over the body (breasts, buttocks, etc.) for several years and I've used it extensively in reconstructive surgery of the face for congenital deformities, and after trauma or surgery to remove certain types of cancer. The application of this therapy to cosmetic surgery has many benefits: it uses the patients own tissue to either replace or increase volume; it has the potential to integrate by having blood vessels grow into it and therefore be permanent; and the fat injected also contains stem cells, which can improve the quality of the overlying skin. While fat grafting is relatively low risk, it's only natural for patients to wonder what the downsides are. They are: 1) Not all the fat that is injected integrates; I usually tell patients approximately 50% will integrate and the other 50% will reabsorb, so patients have to be prepared for a second or third round if they want more volume and 2) The donor site (the site from which the fat is harvested) usually experiences some mild bruising, swelling, and pain; the upside is that patients get liposuction performed at the same time.

The process is pretty simple and has three main components: 1) Harvesting fat, usually from the abdomen, flanks, or thighs (or from wherever the patient wants) using standard liposuction techniques and cannulas, 2) Processing the harvested tissue (called “lipoaspirate'), which involves filtering out everything but the fat cells (this means removal of blood, oil, fluid) and 3) Injection (or transfer) of the isolated fat cells into the desired area, which is done using specialized instruments to inject very small amounts of fat at a time.

Do you have any rules when it comes to patients having these procedures, in terms of age, etc? I am pretty conservative when it comes to injectables in younger patients for strictly cosmetic reasons. The idea of “preventative' injectables—getting Botox for fine lines in your late-20s or 30s to prevent these lines from getting deeper later on in life—is a bit ridiculous. It's obviously very dependent on the patient, but for strictly cosmetic purposes, I don't see a need for Botox until signs of facial aging start to appear. On the other hand, fillers or fat grafting can be very beneficial for patients really bothered by their perceived flaws. For example, if a woman or man born with a thin upper lip wants it to appear fuller, I think that's reasonable. While the risks are low when it comes to injectables, I always think a good rule of thumb for physicians is to only offer those treatments for which you are well-trained/equipped to handle any potential complications. Patients should do their research and make sure the physician injecting them is appropriately credentialed.

And with that, set your DVRs, and stock up on popcorn: the Oscars are upon us! (Also, Tweet with us, won't you? We'll be live-tweeting the red carpet and show, but more on that later.)

Illustration by Lucy Han.