The Ideal Look®  series provides information about cosmetic surgery so that patients know what to expect. Patients do not like surprises. Patients need to know what to expect during the recovery period. They need to know how long it will be before they are back to normal. How long do they need to be off work? They need to know about complications.

It is not unusual for me to introduce a patient being seen in consultation in my office to another patient who is returning for a follow-up appointment. Almost invariably, patients do not mind sharing their experiences. Patient-to-patient communication is the most credible type of patient education. Patients benefit from the experience of others, which is the reason I have included their testimonials. I want the reader to hear from patients themselves.

My website includes only actual patients and testimonials. There are no models. Although some photographs show patients with makeup and jewelry, most do not. Effort has been made to standardize photographs and let the results speak for themselves. Some optimal results are shown, but average results are also displayed. Although plastic surgeons like to show their “greatest hits,” and I am no exception, patients need to see the middle-of-the-road outcomes too.

Procedures are described in language that I hope is not too confusing, but at the same time is not overly simplified. Patients are better-educated today than they have ever been. I find myself increasingly using medical terms with patients who already have some understanding of their meaning.  The techniques should not be difficult to understand. If the information seems confusing, the fault lies with the surgeon, not the patient.

When it comes to opinions, it has been said, only partly in jest, that if you ask 10 different plastic surgeons a question, you will get 15 different answers. My job is to present the facts in the plainest way I can and rely on my patients to come to the conclusion that makes sense for them.


Here are 10 promises I make to the reader:

  1. All before-and-after photos depict actual patients treated by me. No models or photos provided by other surgeons or product manufacturers are included.
  2. All procedures the patient had are disclosed, including subsequent procedures (such as touch-up liposuction).
  3. Early postoperative photos are included to show the patient’s appearance shortly after surgery.
  4. There has been no artificial enhancement of before-and-after photos.
  5. Attention has been given to photographic standardization, including photos that are not embellished by makeup, jewelry, different lighting, poses, or postoperative smiling (although such photos are included as well).
  6. Complications are described, including photos of many common complications.
  7. Long-term results are included, with follow-up times in all cases.
  8. The majority of photos include scars, which are not concealed by clothing.
  9. Recovery times, discomfort levels, rating results, and changes in apparent age are based on patients data obtained from surveys, not the surgeon’s opinion.
  10. I have no financial conflicts of interest with manufacturers of devices or pharmaceuticals.

The Importance of Full Disclosure

A personal financial interest impairs the objectivity of the plastic surgeon. Today many plastic surgeons have financial relationships with manufacturers. Whether it is for no-downtime laser-liposuction machines (or alternatives such as Coolsculpting), “gummy bear” breast implants, radiofrequency “skin-tightening” machines, or skin care products containing growth factors, to name just a few examples, such payments affect the bottom line for these practitioners, who are no more immune to the financial realities of life than the rest of us and no more likely to bite the hand that feeds them. Just purchasing a piece of equipment may color the operator’s patient recommendations. When a physician purchases a piece of equipment, which might cost $100,000, there is great pressure to promote it, regardless of how effective it is.

I have no financial interest in any product or procedure. I pay for my medical supplies. I purchased my lasers and all other medical equipment I use. None are leased, so that I have no undue financial pressure to use them. All research expenses were paid by the Swanson Center, with no outside funding.

All Photos are of Actual Patients

All photographs are of actual patients of the Swanson Center and show actual results. Photographs have not been artificially enhanced. All testimonials are actual statements made by these patients. Patients are usually presented youngest to oldest, women followed by men.

Giving Patients Options

You can think of yourself as a student of cosmetic surgery. When you embark on your studies, you often have one treatment in mind. For example, a prospective patient may feel that he or she needs one specific treatment—for example laser treatment for her wrinkles. It is my job to educate her about options that she may have not considered. She might be an excellent candidate for Botox, or eyelid surgery, and I will not hesitate to tell her about other options, smaller ones and larger ones, their capabilities and what to expect from each procedure. Patients often come out of their consultation with a broader perspective than when they went in. They have the information they need to make their decision.

Patients today are much better educated about cosmetic surgery than they were in the past, largely because of the internet. Many of the cosmetic surgery sites that you will find on your information quest will be blatantly marketing driven. I have spent years developing this body of research to serve your need for an accurate online resource about what cosmetic surgery has to offer today, the pros and cons, alternatives, and what to expect afterward—the good and the bad. I want you to have the right facts to inform your decision. We have a mutual interest in your satisfaction.

Why Have Cosmetic Surgery?

As human beings, we appreciate beauty. We stare at a sunrise. We are awed by the human form and features, our spirits are lifted, and we are drawn by the beauty of a flower in bloom or the grace of a beautiful work of art.

For almost all of human history, human beings have tried to make themselves more attractive through adornments of the face. But, the ability to actually change the face and erase signs of age and gravity has only become possible in the last few decades. In fact, this capability is so new its power is only now being appreciated.

People have aged gracefully in the past for one reason only—they had no alternative! To age gracefully was simply the best they could do under the circumstances. We still age, and cosmetic surgery cannot stop aging. But we don’t have to look old. Some people view aging as a part of the part of the cycle of life. This may be true, in the same way that our teeth decay and turn yellow, hair turns gray, and our vision deteriorates—but do we accept these changes as inevitable? No, we go to the cosmetic dentist, have our teeth whitened, color our hair, and have corrective eye surgery. If you are interested in maintaining or recapturing your youthful Ideal Face, you were born in a very fortunate time. Today, plastic surgery offers safe and effective ways to improve your appearance and maintain it, with the same pride you take in maintaining your health, your body and your lifestyle. You do not need to let your appearance slide. Looking old is no longer inevitable.

Risks of Cosmetic Surgery

Beware of procedures marketed as:

  • Nonsurgical
  • Minimally Invasive
  • Lunchtime
  • No Down-Time

Non-surgeons and even some plastic surgeons appeal to the natural apprehension that most people share for surgery. They often attach the scary words “invasive” and “radical” to describe surgery. Sure, the promises are appealing, but the catch is that the results are not. Most people understand that dramatic results are simply not possible without surgery.

Almost all surgery is invasive, by definition. Even a procedure some consider nonsurgical—laser resurfacing—causes an open wound and cannot be considered noninvasive. There is no rule that you have to look altered if you have surgery. No one wants a radical difference (appearance altering), but a dramatic change (appearance enhancing) is welcome.

Nothing Ventured; Nothing Gained

A large part of living consists of deciding what risks to take and which to pass up. There is no reward for the non-risk-taker. If you are willing to accept some level of risk to obtain the reward, then you may well be glad you did. The only way to avoid risk entirely is by not having surgery.

Unpredictability of Surgery

Anyone who has ever had a medical procedure or given birth understands that no two patient experiences are 100% alike. When you hear people discussing their symptoms, side effects and the recovery process, there is a wide range of experiences. An individual’s genetic makeup, lifestyle choices (smoking, excessive exposure to sunlight, diet, etc), stress level, environmental factors, the aging process and general health vary dramatically, and contribute to the unpredictability of the surgical result.

To an observer in the operating room, plastic surgical operations look almost identically performed from patient to patient, but the results can be much different and it is usually impossible to predict who will experience a complication.

Unlike a sculptor, the surgeon manipulates tissue on a human being. The surgery is only part of the story. The other part is the patient’s own healing characteristics. Living tissue differs from inanimate materials that we are used to working on. A sculptor molding clay can see the result right away, but the plastic surgeon has to wait and watch as the process evolves. Tissues change as they heal. They swell, the swelling goes down, the skin readjusts and tightens or doesn’t tighten, scar tissue forms under the skin and gradually softens, scars contract or stretch wide. It is a dynamic process that generally takes about a year. Your healing mechanisms are as unique as you are.

Who Is a Good Candidate for Surgery?

People from all walks of life, both genders and every income level enjoy the benefits of a more youthful appearance! Who among us would not want to return to our youthful taut skin, luminous complexion, open eyes, pert breasts and “pooch-free” profiles?

I have to admit that it is hard for me or anyone who has worked in a plastic surgery office to stroll down a shopping mall without thinking, “He could use a chin augmentation and liposuction under the chin”, or, “Has she considered a breast reduction? Even the famous and beautiful invariably have some feature that they are self-conscious about, which is a favorite subject for the tabloids. As baby boomers retire, they are noticing the fat under the chin, the baggy eyelids, the love handles, and the poochy tummy.

Candidates do share one trait—they don’t like the way they look and they would like to look better. They often tell me they were okay with their appearance when they were 40, but now, “I don’t look like myself anymore.”

Positive Characteristics of Cosmetic Surgery Candidates

Patients likely to have a favorable reaction to cosmetic surgery share these characteristics:

  • They’ve been thinking about it for a long time.
  • They don’t want to look different, just better.
  • They want the surgery. Their spouse loves them the way they are.
  • They think they would feel more attractive with the surgery.

Is It Okay to Want to Be More Attractive?

Of course it is. A statement I often hear from women is, “My husband is not in favor of this at all, but he doesn’t have to live in this body!” Often, spouses are passive or even reluctant about their partners having surgery. Women and men are doing it for their own reasons. Their motivation is not frivolous. An unattractive tummy can cause a woman to lose self-esteem, feel that she has to hide her body and even have the “lights off” when she is intimate with her husband. She is less motivated to stay in shape because exercise does not seem to help. An aging appearance has marital, social and professional implications that can be very real and very serious.

Professional Reasons

It almost goes without saying that a youthful or fit appearance offers a professional advantage. Numerous studies have established that good-looking people have a step up on the rest of us. Is it any surprise that almost every news anchor, particularly women, is physically attractive and youthful?

One of my patients, a 54 year-old female telecommunications executive, told me  “I work in a youth oriented business. Heck, I’m older than the chief executive. I don’t want people to think I’m over the hill.” Another facelift patient thanked me for giving her another 10 years in the work force. Is it fair that society treats older people or, perhaps more accurately, older-looking people differently? Of course not. But that’s the way it is. People expect you to make the most of what you have. Just as you would hone your skills, honing your appearance is expected. Those who do it well get credit for it and reap the rewards.

The Goal

In a nutshell, we want to achieve three goals:

  • Make you look better, not different.
  • No telltale signs of surgery.
  • No artificial look.

Can all plastic surgeons achieve these goals? No. For a reality check, just visit plastic surgery websites, bearing in mind the surgeon’s best results are typically displayed. If you think the pictures look odd or artificial, be aware that your result will likely be no better. In some cases, differences in lighting, makeup, facial expression and jewelry may be of more consequence than the surgery.

Rule of 10

Among the factors you might consider in choosing a surgeon, none is as important as simply looking at your surgeon’s work. If you cannot find examples of acceptable results among the before-and-after photos, you should probably reconsider your choice of surgeon. On the other hand, if you find 10 or more (not just one or two because they may be outliers) sets of before-and-after photos that appear acceptable to you, and you would be satisfied with a comparable results, you can be much more confident in your selection. If your surgeon cannot show you plenty of examples of his or her own work, that is a red flag. There is no substitute—no credentials, no society membership, no personal authority—for results. You would not hire an architect or a builder without seeing pleasing examples of his or her work, and the same goes for your plastic surgeon.

Surgery Earlier Rather than Later

Why now? Why not wait until I’m older and I really need it? Here are the reasons:

  • You can have the results sooner.
  • There is no reason to wait except from a financial or personal priority point of view (and this is a good reason to wait).
  • We can prevent or reduce many of the changes of aging by doing the major procedure (facelift) now and then maintaining the result with smaller procedures in the future (touch-up fat injection, laser skin resurfacing).
  • Lines become more etched with time and more difficult to remove.
  • Cosmetic surgery has never been safer or more affordable or offered such natural-looking results.
  • There are no burnt bridges. Treatment now does not jeopardize having treatments in the future. For example, laser resurfacing can be repeated.

What is the Difference between Plastic Surgery and Cosmetic Surgery?

The word “plastic” derives from the Greek word “plastikos”, which means “to mold.” In fact, “plastic” surgery predates the introduction of “plastic” materials.

During residency training, plastic surgeons are trained in techniques to repair or rebuild body defects caused by injury, disease, or a birth defect, such as a cleft lip. Typically, plastic surgery residents have minimal exposure to training in “cosmetic” surgery, which is defined as surgery undertaken to enhance a normal appearance, rather than surgery undertaken in an effort to make a normal appearance from an abnormal one (such as breast reconstruction after a mastectomy), which would be considered “reconstructive” surgery.

Most plastic surgeons get most of their cosmetic surgery training after their residency, in additional fellowship training and in practice. Most of what I know about cosmetic surgery, I learned after starting practice. Such techniques as laser skin resurfacing, endoscopic forehead lifts, fat injection, ultrasonic liposuction and vertical breast lifts were all introduced or popularized after 1988, the year I finished my residency.

Sometimes, reconstructive and cosmetic plastic surgery come together in the same operation. For example, it is not unusual to open a nasal airway (called a septoplasty) during a rhinoplasty. The patient breathes better and looks better. Will insurance pay? Just for the part of the surgery to improve the airway. A breast reduction can be both functional and cosmetic. It can alleviate back and shoulder pain while improving the appearance of the breasts.

What Happens to Our Skin as We Age?

Of course, individuals age differently and, as the saying goes, the most important thing to do is to choose the right parents. Your ethnicity makes a difference. Caucasians wrinkle earlier than Blacks, Hispanics, or Asians. As we age, our facial skin loses its elasticity, thins, and lightens. Age spots develop.

Sun exposure accelerates skin aging, a process called “photoaging.” In whites, there is less melanin to protect the skin from ultraviolet light damage, which eventually makes the skin dry and leathery, and stimulates the appearance of sun-related skin spots, which may turn cancerous. Sunblock protect the facial skin so that photoaging is minimized. The most important element of any skin product is sunblock. The other ingredients make little difference. Many costly ingredients are of dubious benefit and may not even penetrate the skin to produce any effect. It is worth keeping this in mind at the cosmetics counter to avoid paying exorbitantly for such products, regardless of the advertised claims. Beware of products that contain expensive “growth factors.”

There are products that do have some merit for helping to smooth fine wrinkles, including alpha hydroxyl acids such as glycolic acid, topical vitamin A, also called tretinoin (Retin-A); and vitamin C.

Many of us have had considerable sun exposure in the past. Is it too late to start protecting the skin? Absolutely not. The skin quality will improve if you start using sunblock now. It is never too late to start protecting your skin.

Why do we develop wrinkles? They are caused by the action of the underlying muscles. Each wrinkle in our face forms perpendicular to the action of the muscle below. For example, the wrinkles of the upper lip form vertically because of the underlying action of the sphincter muscle that squeezes the skin from side to side. Frown lines between our eyes form from the action of the appropriately-named “corrugator” muscles. It is therefore perplexing to understand how any activity or electrical stimulation of these muscles could favorably affect wrinkles. Yet such a device is marketed even today (TENS unit). For the same reason, facial muscle exercises make no sense.

Who is Not a Good Candidate for Cosmetic Surgery?

Some people suffer from Body Dysmorphic Disorder (BDD), which is a condition characterized by excessive concern for a body part beyond what might be considered reasonable, such that it consumes an inordinate amount of the patient’s time and interferes with their normal activities of daily life. These patients are not only disappointed with the surgical result, but also feel victimized and blame the surgeon. All busy cosmetic surgeons have encountered such patients. We wish we could spot them all before operating on them because they are notoriously difficult to manage. They are not good candidates for cosmetic surgery.