In the back of our minds, we all have a secret wish of how we could reshape our bodies and faces to match our ideals of what we think of as “beauty.” The face is one of the first physical signs that we, and others see as an expression of our youth, vitality and health and it is no surprise that many popular plastic surgery and cosmetic procedures are still requested from the neck up. One of the industries top plastic surgeons, Dr. Richard Ellenbogen of Beverly Hills, explains his specialty in facial reshaping with insight into this surgical trend and achieving a natural look.
Q: What are your specialties and some of the key considerations when it comes to facial reshaping procedures?
Dr. Ellenbogen: I now consider all facial operations I do either for reversal of aging or to improve the appearance — essentially facial reshaping. One of the most obvious and popular procedures is rhinoplasty, or reshaping the nose. Interestingly, I’ve presented to the Rhinoplasty Society, composed of the top nose surgeons in the world, and in many cases, simply reshaping the nose is not enough to create beautiful facial proportions and the inherent qualities of beauty that we are genetically predisposed to look for in a friendly face or a mate, namely symmetry. Beauty is tied to balance, and a key part of reconstructing the nose also involves balancing — injecting fat in the cheekbones and under the eyes in many cases so the nose looks more proportioned. All surgeons have known for years that a retrusive (recessive) chin makes the nose appear larger. I have found through my surgical practice, that other aspects of the face need adjustment to create a harmony between facial features. Important aspects of facial reshaping also involve lowering the high forehead or raising the low forehead and filling in the temple hollows with fat to achieve a less gaunt appearance. The same applies to that a flattness under the eyes, which can also make the nose appear out of proportion.
Q: Tell us about additional surgical options and considerations for achieving a youthful appearance through facial reshaping.
Dr. Ellenbogen:The most youth restorative operation in my opinion is to fill in deep upper eyelids in a woman or man showing deep aging or previously unsuccessful procedures to restore youth to the face. This technique, of carefully placing fat in the face, is the most important to attain optimal results, and it’s not generally practiced, but should be. Fat can be injected to create high cheekbones, fuller cheeks, a more prominent chin, and a more aesthetic jawline. I am considered the “father of fat grafting” and have 30 years of experience reshaping the midface and the lower face.
Additional important facets of facial reshaping include the chin and the angles of the jaw, which can be altered to a patient’s preference. Common complaints, such as, ears that stick out, will by optical illusions created by imbalances between the facial structures. These are easily repaired.
Probably the most important advancement in facial reshaping is the use of adipose stem cells (ASC), which not only change the shape, but have a restorative and reparative effect. We have been using stem cells to augment our operations for years. It appears from what I said that all I use is fat, but fat is the most versatile and most natural. I do use also implants in the chin, cheeks, jawline, and nose whenever necessary. I also use fillers including Juvederm, Artifil, Restelyn, and Sculptra when the are indicated.
What innovations in facial reshaping have you been responsible for/involved in?
Dr. Ellenbogen:I started Facial Fat Grafting in 1978 and taught it to hundreds of doctors to use in reshaping. I have taught courses on this and nasal balance in the face. I introduced volumetric facelift in 2000, and published the first combination of facial fat grafting along with actual facelift surgery. I won the award from the American Society of Aesthetic Plastic Surgery (ASAPS) for correcting asymmetrical, high, and low nostrils, a technique to improve rhinoplasty. Since symmetry is the basis of all beauty. Besides making noses symmetrical, I also published on creating eyelid and facial symmetry.
What makes your techniques/approach so revolutionary?
Dr. Ellenbogen:To my knowledge, I was the first to publish my techniques for fat grafting in a peer-reviewed journal. I was the first to use true stem cells in the face. A technique many surgeons are scrambling to add to their repertoire. I was the first to add fat to improve rhinoplasty results and facelift results as well as eyelid surgery results. Also I was a student of Leonard Epstein, MD, who revolutionized facial surgery by popularizing the buccal lipectomy or “chubby-cheeks” operation. I use it in conjunction with lower facial jowels or the chubby-face.
Q: How do you achieve such natural results? Why is that such an important goal for you and your patients?
Dr. Ellenbogen:I think that my great skill is being able to translate my artistic training to surgery. I studied portrait formally at the University of Florida when I was an undergraduate as well as sculpting. As a student, I did portraiture in Miami and worked as a published cartoonist. I understand the balance of the face as well as how lighting accentuates the features. Only a trained artist knows this. I show every patient on the computer what their result will look like. And I have extreme confidence that I can duplicate what I achieve on the computer. Through computer imaging, I can translate the image to actual surgiical results. The course I used to teach (“faster healing operations”) has almost totally eliminated pain, and post operative bandages and bedrest.
Q: How does restoring a youthful appearance to the eye fit in with facial reshaping and how is your approach different?
Restoring youth in the eyes has been a passion of mine for years. To effectively de-age the “windows of the soul” we have to add back in what was lost – the fat. Many of the current methods for eyelid surgery actually make the aging around the eyes look worse. As we age, the skin becomes lax and wrinkly in the upper eyelid, and most plastic surgeons remove the drooping skin, usually with some underlying muscle and fat. This results in a deep-set eye that in fact creates an eyelid identical to that of an aged woman’s eyelid. For years, women and some men, have depended on the plastic surgeon to help make their eyes appear younger but have unfortunately accelerated the process through surgery. As a woman ages she loses the fullness from the loss of fat in and under the upper eyelid, the same mechanism by which the face loses fat and sags. Her eyes get deeper and hollower. They look old due to loss of fat. My operation carefully replaces the lost fat, almost identically simulating the appearance of a younger woman’s eyelid. Not only can it be used to reverse aging but also to repair a deep hollow eye secondary to surgery. It is as dramatic as a good facelift.
How is your eyelid surgery performed?
The operation can be performed under general or local anaesthesia. There is no actual cutting just injection of a patient’s own highly purified fat. It requires experience and extreme precision in the placement of the fat and I have yet for a patient to require pain medication. There is no bandage and the early swelling is generally gone by 2 weeks. Other procedures can be performed at the same time such as facelift, lower eyelid surgery and any other body and facial surgery
About Dr. Richard Ellenbogen
Dr. Richard Ellenbogen is the CEO of www.BeverlyHillsBody.com and has served as a consultant and guest plastic surgeon on numerous television programs, including: The Oprah Winfrey Show, Dr. Phil, The View, CNN, Doctor 90210, The O’ Reilly Factor, Good Day LA, Inside Edition, Entertainment Tonight, Access Hollywood, Extra and The Early Show (CBS).
Dr. Ellenbogen is a ongoing contributor to a variety of print publications and has been featured in The Wall Street Journal, USA Today, Newsweek, Time Magazine, The Aesthetic Surgery Journal, The Los Angeles Times, The Los Angeles Business Journal, WebMD, Cosmetic Surgery Times, Askmen.com, Forbes.com, People, GQ, Bloomberg.com, Healthday.com, Los Angeles Family Magazine and Angeleno Magazine.