Face the change

DR. ARTUR DÍAZ CARANDELL

Maxillofacial surgeon expert in facial aesthetic surgery, facial feminization, and hair transplant at the Instituto de Benito.

The face is our calling card, it is the part of the body we prioritize from an aesthetic point of view. An attractive face boosts self-esteem and facilitates communication with others. But when we talk about facial beauty, we must consider that we are not referring to perfect features, but rather to proportions and harmony. Beauty is a whole, an integrated whole consisting of the bone support, the tissues that envelop the bones, and the expression or personality. Facial rejuvenation techniques, facial feminization, correction of asymmetric or deformed structures, facial westernization (trendy among Asian patients), among others, are more accessible than ever thanks to new technologies and the latest non-invasive treatments.

What are the facial proportions considered as exponents of beauty?

Facial surgeons place great importance on proportionality and measure the distance between facial structures, as well as their length or width. Facial beauty and harmony are based on a well-proportioned face. Some of the distances we measure in the frontal analysis of the face are the facial thirds. We divide the face frontally in a vertical sense into three thirds: upper, middle, and lower, which must be of equal dimensions to be proportionate. Then we study the facial fifths. In this case, in the frontal analysis, but in a horizontal sense, we divide the face into five fifths. These must also be similar to be harmonious. Finally, we assess the relationship between the vertical and horizontal dimensions of the face. It is considered that the ratio between the vertical length of the face and the horizontal should be approximately 1.6.

Does the beauty of a face depend on anatomy or are there other determining factors?

Anatomy is essential to achieve harmony. The distance between facial structures depends mainly on the bones. Depending on our bone structure, we will be more or less proportionate. With surgery, we can act on the bone structure to harmonize proportions.

What is today's beauty standard?

The answer to this question is very broad. Beauty standards vary according to historical moment or culture. For example, not long ago, being overweight was considered beautiful, and being thin was unattractive, a sign of weakness. In certain cultures, very fair skin is a sign of beauty, while in others, it is quite the opposite. In our society now and since ancient times, more than perfection, we are attracted to proportionality and symmetry.

The jaw plays an important role in the face, not only functionally, as it conditions facial harmony. Sometimes it even causes psychological problems.

How are these cases treated?

The jaw is the largest bone in the face, and altering its dimensions can cause significant facial disproportion. In addition to fulfilling many other functions, it houses the teeth; therefore, when we need to reduce or enlarge it, we must make changes to the dentition so that the lower teeth fit perfectly with the upper jaw teeth. This is what we call orthognathic surgery. A meticulous, thorough, and complex operation that corrects the most important facial disproportions. Sometimes we use it to achieve true facial feminization.

What is mentoplasty?

When the chin is very retracted or protruding, the best way to correct it is mentoplasty; a surgery aimed at increasing, reducing, advancing, retracting, or lowering the chin. It is a very quick procedure, barely forty minutes, performed under local anesthesia with a short postoperative period. We achieve facial harmony, making it appear more beautiful.

What role do the latest technologies play today?

The latest technologies with 3D CT and simulation in software allow us to perform virtual surgical interventions at our desk weeks before performing them in the operating room.

Where are the first signs of aging noticeable?

The first signs of facial aging appear with the loss of jawline definition, the appearance of dark circles, and the increase in nasolabial folds.

What facial details are considered symbols of youth?

The eyes and the smile. A full gaze, with a thick eyebrow and full cheeks, best defines a young face. A smile involving full lips and a short nasolabial distance is also another facial characteristic that symbolizes youth.

How are the different stages of aging treated?

Both things. We must treat aging from the perspective of de-aging. It is useless to remove eye bags if we do not restore the structures we had years ago in that place. For example, in eye surgery, when we remove fat and skin, the eye looks more sunken and with more shadows. If we do not place fat in the eyebrow to make it fuller or move the soft tissues of the cheek upwards to remove the dark circles, we will not be performing rejuvenation surgery; instead, we will be altering an anatomy that may look more or less aesthetic but will not restore the youthful gaze we had. These surgeries should be aimed at each area, but in many cases, it will be very convenient to perform them with the rejuvenation of the rest of the facial structures. In fact, what surgeons like most is to be able to rejuvenate the entire face to achieve the most optimal result.

What techniques can be used to harmonize or rejuvenate the face?

There are techniques for each facial structure, but in general, the most notable are the face lift and neck lift, lower eyelid surgery or lower blepharoplasty, and eyebrow lifting through endoscopic lifting.

There is talk of the rise of operations to westernize a face. Have Asians adopted the Western beauty model?

Without a doubt, nasal dorsum augmentation surgery and eyelid blepharoplasty are the most demanded facial interventions among Eastern people. There is a tendency to westernize the face, but within certain parameters.

What is Mid Face Lifting?

Mid Face Lift is the surgical technique we use to restore the area from the lower limit of the eyebrows to just below the nose. It involves lifting the sagging soft tissues and musculature to attach them around the bone of the periorbital area, returning the tissue and musculature to where it was a few years ago. At the same time, we address the loss of cheek definition caused in the upper maxillary area. It is the best intervention to restore a youthful gaze to the face, enhance the cheeks, and rejuvenate the entire mid-third, with a simple postoperative period.

Is the choice of these surgical specialties a response to market demand or professional concerns?

Both. When you want to achieve excellence in facial surgery, it is essential to offer the best solution to the problem the person presents during the consultation. I am not satisfied without proposing the most advanced surgical technique, no matter how much training it requires.

How has plastic and reconstructive surgery evolved in recent years?

In facial rejuvenation, I would say that anti-aging treatments will be the best solution to delay aging. In a short time, we will continue to be young for longer, thanks to medical treatments that delay aging and cellular death.

Do you think Spain has a good level of development, training, and education in this sector?

We are one of the most prepared countries in the world for plastic surgery. The training of professionals, dedication, and healthcare system favor the emergence of great figures in world surgery. We fall a bit short in research and publication capacity due to the healthcare pressure in hospitals.

Why are women undergoing surgery at an increasingly younger age?

Currently, women have a more active work and social life and start taking care of themselves much earlier than the previous generation as a prevention and to maintain their physical appearance at the same level as their inner self. Additionally, there are new surgical techniques and very quick non-invasive treatments to improve appearance at all ages. On the other hand, the concept of 'virtual beauty' has entered our lives.

What process do you follow with the patient when they come to your consultation?

It is essential that the first visit is a sincere dialogue between patient and surgeon. From the first moment, we try to provide solutions to their problem, and when it has no cause or is overvalued, we try to make the person understand why in their case the surgical solution is not the best option.

Have you ever refused to perform certain interventions?

Yes, of course, it is common for patients to come with false or biased information. We cannot perform techniques that will not satisfactorily meet the patient's expectations.

What treatment do you recommend for those who prefer minimally invasive options?

Endoscopic lifting and mini-lifting are two of the best techniques performed under local anesthesia plus sedation and on an outpatient basis.

Hair transplant

We perform hair transplants using the FUE technique, which aims to relocate hair follicles by extracting them one by one, avoiding long and visible scars. Whenever the patient is indicated, we perform it through the ARTAS robot.

Has the pandemic affected these treatments?

The increase in demand continues to rise. Patients find more time for interventions they have always wanted to undergo.