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When it comes to making decisions about having plastic surgery, [cost is undoubtedly part of the equation](https://aedit.com/aedition/how-much-cosmetic-surgery-costs). Of course you need to understand your aesthetic goals, possible results, and [find the right provider](https://aedit.com/aedition/finding-the-right-plastic-surgeon-dermatologist-or-cosmetic-dentist), but your budget will play a big role in determining which solutions will best treat your needs. *How are you going to fund the surgical or non-surgical procedures? Which ones will prove to be most cost-effective in the long run?* 

Consultations with [board certified](https://aedit.com/aedition/medical-board-certification-in-plastic-surgery-cosmetic-dermatology) dermatologists and plastic surgeons are the best way to get a sense of what treatment options exist and how much they will set you back based on your unique anatomy and vision. But, to give you a general sense of how to maximize your budget to correct common facial aesthetic concerns (think: [eye rejuvenation](https://aedit.com/concern/aging-and-tired-eyes), [lip volume](https://aedit.com/concern/lip-size), [fine lines and wrinkles](https://aedit.com/concern/fine-lineswrinkles)), we’ve asked two top facial plastic surgeons for their take.

## **How to Discuss Your Budget with Your Provider** 
If you’ve seen our guide to the [best questions to ask](https://aedit.com/aedition/questions-to-ask-your-doctor-during-plastic-surgery-consultation) during a plastic surgery consultation, then you know we suggest inquiring about a range of topics — from the [provider’s background](https://aedit.com/aedition/medical-board-certification-in-plastic-surgery-cosmetic-dermatology) to [post-op care](https://aedit.com/aedition/preparing-for-a-smooth-recovery-from-plastic-surgery) — and the cost of your procedure(s) is on that list. While your doctor or surgeon may present all possible treatment options available, understanding how much you are willing and able to spend will allow them to recommend the best course of action given your aesthetic goals, anatomy, and budget.

Since the majority of cosmetic surgeries and procedures are [not covered by insurance](https://aedit.com/aedition/insurance-coverage-for-plastic-surgery-cosmetic-procedures), providers are very accustomed to having conversations with patients about finances. Some practices work with companies that offer financing options, and it’s not uncommon for candidates to save for months or even years before moving forward with their procedure. According to [Farad Ardesh, MD](https://aedit.com/provider/farhad-ardesh-md-19202), a double board certified facial plastic and reconstructive surgeon in Los Angeles, many patients decide to cut back on discretionary spending (think: their daily cappuccino order) and put the savings towards making an investment in their appearance. 

## **Non-Surgical vs. Surgical: What’s Most Cost-Effective?**
Generally speaking, non-surgical procedures cost less than surgical ones, but, when you factor in the maintenance many of them require, the savings may turn out to be nominal. Even so, a patient’s age, medical history, and aesthetic concerns and goals should all be taken into consideration when developing both short- and long-term treatment plans.

On the non-surgical end of the spectrum, injectables like [Botox®](https://aedit.com/aedition/comparing-neurotoxin-botulinum-type-a-injections-botox-dysport-jeuveau-xeomin) and [dermal fillers](https://aedit.com/aedition/everything-you-need-to-know-about-dermal-fillers) are often the first things that come to mind. “Botox® and other fillers have a place in the market,” says [Thuy-Van Tina Ho, MD](https://aedit.com/provider/thuyvan-ho-md-25248), a double board certified facial plastic and reconstructive surgeon in Philadelphia, but she also acknowledges that these procedures are “a temporary solution only.” Depending on the candidate, such procedures may be used [preventatively](https://aedit.com/aedition/can-you-be-too-young-for-botox) or to complement more invasive ones. “Botox® is a necessary part of most rejuvenation plans, in order to reduce wrinkles and give a youthful, fresh appearance,” Dr. Ardesh notes. “The secret to Botox® is to have a little placed in all parts of the upper portion of the face, which creates a balanced and natural enhanced look.” 

It’s important to note that while it may be tempting to [search for a bargain](https://aedit.com/procedure/botox/cost) on recurring treatments such as neurotoxins and fillers, now is not the time to Groupon. Finding a skilled injector who has a deep understanding of facial anatomy is the best way to prevent potential complications. While these procedures may seem routine, an untrained practitioner could inject into a blood vessel or damage a nerve, which would have lasting effects. 

But injectables aren’t the only minimally invasive treatment options on the market. From non-surgical fat reduction to energy-based skin tightening, there are plenty of ways to avoid going under the knife. So, how can you get the most bang for your buck? Our experts share their thoughts on a few of the most popular facial treatment areas:

### **1. Eyes** 
Even before [COVID-19 face coverings](https://aedit.com/aedition/influence-of-covid-19-face-masks-on-medical-aesthetics-trends) put our collective attention squarely on the [upper third of the face](https://aedit.com/aedition/popularity-of-eyelid-surgery-cosmetic-eye-procedures-during-covid-19), the eyes have always been a cause of cosmetic concerns. Dr. Ho says that [periorbital neurotoxin treatments](https://aedit.com/procedure/periorbital-botox) and [under eye filler](https://aedit.com/procedure/under-eye-filler) can temporarily address crow’s feet and bags, while [laser treatments and chemical peels](https://aedit.com/aedition/best-aesthetic-procedures-to-minimize-dark-circles) can help resurface aging (read: crepey) skin. To consistently treat dark circles, Dr. Ardesh says [prescription skincare](https://aedit.com/aedition/eye-creams-serums-to-treat-crows-feet-dark-circles-puffiness) may be best.

As an alternative to synthetic filler, which Dr. Ardesh says “can create irregularities and strange, unwanted appearances” in patients with lower eyelid hollows or bags,” both he and Dr. Ho like [fat transfer](https://aedit.com/aedition/comparing-dermal-fillers-vs-fat-grafting-for-facial-rejuvenation-contouring) as a means to restore volume. While the fat is ultimately placed like an injectable, fat grafting is technically a surgical procedure because it involves harvesting fat from a donor site via liposuction before transferring it to the desired area. In this case, Dr. Ardesh likes to perform a nano-fat transfer where fat is taken from the belly button region before being processed into a fine liquid and injected around the eyes. “This procedure can help with hollows and also improve skin color and quality,” he says.

Unlike hyaluronic acid-based dermal fillers that need to be touched up every six to 12 months, fat transfer is permanent after the initial recovery period. For the first three to six months, the fat must become established in its new location, and the body reabsorbs a portion of it (usually about 30 to 50 percent) during that time. As such, providers may suggest a revision down the line to address volume loss.

But fat grafting isn’t the only way to enjoy a long-lasting solution. Dr. Ho recommends [eyelid surgery](https://aedit.com/procedure/blepharoplasty-eyelid-surgery), which can easily be combined with a [neck lift](https://aedit.com/procedure/direct-neck-lift) or [facelift](https://aedit.com/procedure/facelift-rhytidectomy/cost). Depending on the patient’s concerns, Dr. Ardesh says the most cost-effective eye rejuvenation procedure may be removing a small amount of lower eyelid skin through surgery. A [lower eyelid blepharoplasty](https://aedit.com/procedure/blepharoplasty-eyelid-surgery/cost) can be performed as an outpatient procedure in under an hour and correct common age-related eye concerns, like dark circles and bags.

### **2. Lips** 
Whether your concern is [lip shape](https://aedit.com/concern/lip-shape) or size, [lip augmentation](https://aedit.com/procedure/lip-augmentation-solutions) procedures are consistently among the top-performed in the United States every year. [Temporary lip fillers](https://aedit.com/procedure/temporary-lip-fillers) are the perhaps the most well-known treatment option (check out our guide to what to know before your [first time getting lip filler](https://aedit.com/aedition/what-to-know-before-getting-lip-filler-for-the-first-time)), but fat transfer is an option here as well. “Filler enhancement can be performed in the office during a 20-minute visit and costs about $800,” Dr. Ardesh says, noting that they usually last up to a year. 

[Lip augmentation with fat transfer](https://aedit.com/procedure/lip-augmentation-with-fat-transfer), on the other hand, rings in at about $5,000, he shares, but you can expect permanent results. When you consider that one syringe of filler can cost up to $1,200, fat transfer may prove to be more cost effective. Dr. Ardesh transfers between 10 and 60 milliliters of fat and estimates 50 to 70 percent of it survives. “The benefits of fat transfer include that the fat can also be transferred to other parts of the face that need volume at the same time, like the cheeks, jawline, and temples,” he adds. 

### **3. Chin & Jawline**
Speaking of the jawline, Dr. Ardesh says temporary filler is a popular way to add definition here, too. At about $900 per one milliliter syringe, however, the cost of maintaining those results adds up quickly. In addition to fat transfer, he often recommends a permanent implant to patients looking for [chin and jawline enhancement](https://aedit.com/aedition/best-chin-augmentation-enhancement-procedures). “A chin implant is the equivalent of at least four vials of filler, so the [chin implant surgery](https://aedit.com/procedure/alloplastic-chin-implant) can be significantly more cost-effective for about $4,000,” Dr. Ardesh says. Not only can the implant prove to be more budget-friendly in the long term, but it also may yield more satisfactory results. “The chin implant may have better aesthetic outcomes than getting jaw filler injections every year,” he says.

### **4. Neck**
We can save the lecture on how craning over our electronic devices is speeding up the aging process for another day, but there is no denying that the [neck](https://aedit.com/concern/neck-and-jawline-definition) often raises a host of aesthetic concerns for patients of all ages. “Procedures such as [Kybella®](https://aedit.com/procedure/kybella), [CoolSculpting®](https://aedit.com/procedure/cool-sculpting), and neck liposuction can all be costly and provide mild, temporary improvement of double chins and neck fullness,” Dr. Ardesh says. While these minimally invasive treatments address the superficial fat under the skin, they do not correct the “deep fat under the loose muscle,” he cautions. 

As a result, a [surgical neck lift](https://aedit.com/procedure/neck-and-jawline-definition-solutions) often proves to be both cost-effective and the best way to achieve the look a patient desires. “The vast majority of patients that come to see me for a neck lift surgery have had previous non-surgical treatments within the last one to two years,” he explains. “These patients would have saved significant money and achieved the result that they originally desired, if they first had surgery.”

### **5. Skin** 
The most budget-friendly way to care for your face in the long run? A healthy lifestyle and good skincare routine. “Regular [sunblock](https://aedit.com/aedition/how-to-apply-sunscreen-and-not-miss-a-spot) and sun avoidance are a must, in addition to [good nutrition](https://aedit.com/aedition/best-diet-for-healthy-beautiful-skin), [avoiding tobacco products](https://aedit.com/aedition/impact-of-cigarette-smoking-vaping-on-skin-hair-teeth-health), [reducing stress](https://aedit.com/aedition/impact-of-stress-on-skin-acne-wrinkles-dryness), and [getting enough sleep](https://aedit.com/aedition/impact-of-beauty-sleep-on-skin-health-nighttime-skincare-products),” Dr. Ardesh says. When it comes to your skincare regimen, reach for tried-and-true active ingredients (think: [retinoids](https://aedit.com/aedition/guide-to-vitamin-a-retinol-retinoids-in-skincare), [vitamin C](https://aedit.com/aedition/guide-to-topical-vitamin-c-in-skincare), [hyaluronic acid](https://aedit.com/aedition/guide-to-hyaluronic-acid-in-skincare-dermal-filler), and [peptides](https://aedit.com/aedition/guide-to-topical-peptides-in-skincare)) and consider updating your arsenal through your [twenties](https://aedit.com/aedition/best-skincare-routine-products-ingredients-for-20s), [thirties](https://aedit.com/aedition/best-skincare-routine-products-ingredients-for-30s), [forties](https://aedit.com/aedition/best-skincare-routine-products-ingredients-for-40s), and [after 50](https://aedit.com/aedition/best-skincare-routine-products-ingredients-for-50s-60s-70s) to keep up with the evolving needs of your complexion.

Because [at-home skincare can’t do it all](https://aedit.com/aedition/aesthetic-skin-aging-concerns-skincare-cannot-treat), our experts recommend a [chemical peel](https://aedit.com/aedition/guide-to-superficial-medium-deep-chemical-peels) once or twice per year to improve skin tone and texture. Starting off a [preventative Botox® routine](https://aedit.com/aedition/everything-you-need-to-know-before-getting-botox-for-the-first-time) in your late twenties and early thirties, meanwhile, can help prevent deeper wrinkles from forming down the line. How will you know it’s time? When your expression lines no longer disappear like they once did. 

## **The Takeaway**
While this article hopefully shed some light on the different procedures that exist at different price points to address any number of facial concerns, every patient is entirely unique and there is no such thing as one-size-fits-all in aesthetic medicine. In order to be sure you are maximizing your budget and possible results, be honest with your provider about your budget and what you hope to achieve. They will be able to walk you through all of your treatment options. Ultimately, it’s important to remember that no professional procedure will replace the virtues of a healthy lifestyle, so investing in your physical and mental wellbeing will pay dividends when it comes to maintaining a youthful appearance.

Expert Opinion

When it comes to making decisions about plastic surgery, cost is undoubtedly part of the equation. To give you a sense of how to maximize your budget, we’ve asked two top facial plastic surgeons for their take.

Cost Effective Cosmetic Procedures For The Face, Eyes, Lips

The Best Ways To Invest In Your Face According To Facial Plastic Surgeons

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From facial thirds (and fifths!) to the infamous golden ratio, pop culture has been seeking facial harmony’s magic formula for millennia. Between the ancient Greeks, Renaissance artists like Leonardo da Vinci, and [today's social media set](https://aedit.com/aedition/march-2020-study-shows-relationship-between-social-media-cosmetic-surgery), there's no shortage of hypotheses about what constitutes a well-balanced countenance. But the whopping number of requests for Kate Middleton’s nose (once deemed to be the “world’s most perfect”) proves that many people still don’t have an accurate grasp of the concept.

In a nutshell, facial harmony is about [ideal proportions, not perfection](https://aedit.com/aedition/plastic-surgery-results-are-about-proportion-not-perfection). “It’s not so much about direct measurement; proportions are way more important,” says [Jason Roostaeian, MD](https://aedit.com/provider/jason-roostaeian-md-449), a board certified plastic and reconstructive surgeon and associate clinical professor at UCLA. “When we’re evaluating a face, you’re really looking at that face relative to itself.” In other words, the measurements of individual facial features are less important than the interaction between those features, and we’ve gone straight to the experts to better understand what that means for facial aesthetics.

## **What Is Facial Harmony?**
When we think of facial harmony, most of us think about beauty — but it’s really much more basic (in every sense) than that. “It really comes down to the fact that the most attractive faces are those where everything falls into the average,” Dr. Jason explains. “Philosophically speaking, when one part falls out of the norm, it’s alarming for potential disease.” If a person has a deficient jaw, for example, it’s an indication of certain ailments, he adds.

And, when it comes to attraction, it’s all about survival of the species. “If, in essence, what we’re doing is looking for a partner to mate with, the ideal mating partner is somebody who seems ‘normal’ across the board,” he says. In the most primal sense, we’re programmed to gravitate toward facial symmetry and harmony because they convey good health.

As it relates to aesthetic medicine and plastic surgery, providers have — no surprise here — a very precise understanding of facial proportion. “We mean balance and a subjective sense of normalcy,” explains [Jacob Unger, MD](https://aedit.com/provider/jacob-unger-md-2649), a Nashville-based board certified plastic and reconstructive surgeon and assistant professor of plastic surgery at Vanderbilt University. “If you overly highlight a feature or ignore a feature in the face, it will draw the eye negatively.” 

Sure, a surgery or procedure may focus on one part of the face, but the goal of said treatment is balance. “We aim for improvement in facial aesthetic surgery, but the key to doing it well is understanding facial anatomy and relationships,” Dr. Unger says.

### **Facial Harmony vs. Beauty**
Before we move on, you might be wondering: is facial harmony the same as beauty? According to our experts, the basic tenets of facial harmony have remained largely unchanged. Beauty standards, on the other hand, are infamously ever-changing. “Harmony is less subjective than beauty,” Dr. Unger shares. As he explains it, beauty evolves with the times and trends, but harmony and proportion are less beholden to what is en vogue. “Balance, harmony, and the golden ratio has indicated what is naturally aesthetically pleasing to the human eye and mind since it was first described — and that was thousands of years ago,” he says.

But how do modern beauty trends (think: super plush pouts) fit in with the idea of facial harmony? “There are certain features that you may want to augment compared to average because they have some underlying innuendo with them,” Dr. Jason explains. “But it’s very clear to see that, when it gets too out of proportion, you lose the attractiveness again.” In other words, cosmetic surgery can push certain boundaries to meet beauty standards, but only to the point where the enhancement or augmentation is not disrupting the overall harmony of the face.

## **How Does Plastic Surgery Achieve Facial Harmony?**
“We, as plastic surgeons, must take a holistic approach towards facial beauty and harmony,” Dr. Unger explains. And that often requires a bit of patient education. “We have to make sure we are not just improving the one item that may be the focus for the patient, but explaining how the structures of the face are interrelated,” he continues. As such, candidates must understand that “gentle adjustments in the surrounding areas” may be needed in order to ensure the desired results of more refined shape will look, as he describes, “elegant and balanced.” 

That holistic view ensures facial features remain proportional to each other. “Within a structure like the nose, any expert will explain that just because you don’t like something — a [dorsal hump](https://aedit.com/procedure/nose-bump-solutions), for instance — doesn’t mean that correcting that one issue will look good,” Dr. Unger says. “In fact, it will probably look very unnatural, unbalanced, or not harmonious if you impact one particular concern. This is because everything is interrelated.”

If you’re getting the sense that facial plastic surgery is like aesthetic Tetris, you’re on the right track. “Once you make one move, it may change the proportions and, therefore, you have to make the other move to make the two meld together better,” Dr. Jason says. Essentially, it's all about finding the sweet spot between enhancement (whether it's highlighting or downplaying a feature) and rejuvenation. “This deep understanding of the face is what sets [board certified plastic surgeons](https://aedit.com/aedition/difference-between-plastic-surgeons-and-cosmetic-surgeons) apart from untrained practitioners who do not have deep training or experience in overall facial shape, anatomy, and symmetry,” Dr. Unger adds. That lack of expertise is what leads to “many of the strange looking faces, lips, and cheeks we see walking around all the time,” he says.

The net net: When it comes to finding facial harmony, the whole is indeed much greater than the sum of its parts. Below, we break down some of the most common surgical combos that achieve a more balanced facial appearance:

### **NOSE + CHIN**
Evaluating patients for [rhinoplasty surgery](https://aedit.com/aedition/reinventing-rhinoplasty-whats-different-about-modern-nose-jobs) provides a perfect example of how surgeons consider facial harmony on both a macro level (how a feature relates to all of your other features) and micro level (how a feature’s individual elements relate to each other). “When you fine-tune or reshape a feature that the patient does not like, it will likely require changes to the related parts of the nose or face to ensure everything is balanced and looks appropriate together,” Dr. Unger notes. An example? “A big dorsum, when reduced, will likely expose a too broad nasal tip or too full tip because the relationship will be off,” he says.

Changing the nasal proportions can also [highlight the eyes](https://aedit.com/aedition/popularity-of-eyelid-surgery-cosmetic-eye-procedures-during-covid-19) and make the [chin appear more prominent](https://aedit.com/aedition/best-chin-augmentation-enhancement-procedures). It may happen naturally — “sometimes, adjustments to the nose alone are sufficient to meet a patient’s aesthetic goals,” Dr. Jason says — or it may require a bit more refinement. “Other times, we also need to perform a [chin augmentation](https://aedit.com/procedure/chin-enhancement-solutions) to get the results they want,” he adds. “A nose looks more or less prominent based on where the facial plane sits relative to it, so bringing the chin forward can also make the nose look less prominent.”

### **EYES + BROWS**
Another common area where proportions are particularly important? The eyes. [Blepharoplasty](https://aedit.com/procedure/upper-eyelid-blepharoplasty) (a.k.a. eyelid surgery) is one of the most popular surgical procedures for both women and men seeking to restore a more youthful, awake appearance. But removing eyelid skin isn’t always the best (or sole) solution. “Some patients who come in thinking they want blepharoplasty don’t actually have much excess eyelid skin,” Dr. Jason explains. “Instead, what they have is a sagging brow that’s making the lids look heavy.” If the surgeon simply cut away the skin without elevating the brow, the results will not be optimal, he says. As a result, [eye rejuvenation](https://aedit.com/procedure/eye-rejuvenation-solutions) often involves pairing eye and brow procedures.

### **UPPER + LOWER FACE**
The term ‘facelift’ can be confusing because the procedure focuses on restoring the lower to midface and jawline (i.e. the dreaded jowls) — not the entire face. [Facelift surgery](https://aedit.com/aedition/popularity-of-facelift-cosmetic-surgery-for-aging-sagging-neck) alone works well for patients whose concerns are relatively isolated to those areas. But, for those who also have significant signs of aging in the upper face (think: above the cheekbones, the eyes, and brows), a facelift by itself may leave them looking unbalanced. 

As Dr. Jason explains, if you’re getting a facelift, a [brow lift](https://aedit.com/aedition/theres-more-to-a-brow-lift-than-meets-the-eye) often makes sense, too. “You don’t want to make it look piecemeal or unharmonious because you lifted one part and left the rest,” he shares. Patients with a sagging brow, for example, may end up looking, as he describes, “squished in the middle” without the complementary treatment. 

## **Is AI the Future of Evaluating Facial Harmony?**
[Artificial intelligence](https://aedit.com/aedition/study-shows-how-artificial-intelligence-is-bringing-objectivity-to-aesthetics) (read: machine learning) is emerging as a compelling tool for objectively evaluating the elusive trifecta of beauty, youth, and proportion in the human face. But, according to our experts, automated facial analysis still can’t replace the eye of an expertly trained plastic surgeon — and it maybe never will. 

“It is still an analog approach that is honed with education, training, and experience to create shapes and contours that highlight and accentuate without overly stylizing and, thus, looking artificial,” Dr. Unger says. So, while he admits AI may help us better articulate what experts create with their eye and technique, he maintains that we are “likely very far away from a complete algorithmic or pre-planned approach that can be easily enacted on an actual human created from a computerized map.”

At the end of the day, the ‘art’ of plastic surgery cannot be underestimated. “This is what I tell my patients all the time — especially with rhinoplasty — it truly is art, and it doesn’t really matter what anybody else says,” Dr. Jason explains. “At the end of the day, only you can decide what you think looks good.” Regardless of how far the technology comes, honestly portrayed [before and after results](https://aedit.com/aedition/importance-of-before-and-after-photos-in-plastic-surgery) are still the most important factor when [choosing the right plastic surgeon](https://aedit.com/aedition/finding-the-right-plastic-surgeon-dermatologist-or-cosmetic-dentist) and, by extension, the right aesthetic for you.

Facial harmony is about proportion, not perfection, and we’ve gone straight to the experts to better understand what that means for your next plastic surgery consultation.

Importance Of Facial Harmony And Proportion In Plastic Surgery

The Importance Of Facial Harmony In Aesthetic Medicine

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Facelifts are one of the most transformative plastic surgery procedures, and the rejuvenated and refreshed look of a [facelift](https://aedit.com/aedition/popularity-of-facelift-cosmetic-surgery-for-aging-sagging-neck) makes it an attractive option for anyone looking to banish the wrinkling and sagging that comes with aging. But facelifts are generally reserved for patients in their [late forties and beyond](https://aedit.com/aedition/best-cosmetic-procedures-plastic-surgery-to-consider-in-your-50s-60s-70s), and many people younger than that wish to replicate the toned and tightened look.

Enter facial tape. Usually made of latex, silicone, or polyethylene plastic, the tape can either be used to give a ‘snatched’ look during the day or employed at night to [fight wrinkles](https://aedit.com/concern/fine-lineswrinkles). Sold everywhere from eBay to Amazon, facial tape further entered the lexicon when people began emulating the queens seen on *RuPaul’s Drag Race*, who often use tape to both secure their wigs and to lift the face. 

But, make no mistake, the practice has been around for years. “Face taping is not a new technique and has been used for years as a potential solution for some people looking to reduce the appearance of wrinkles, specifically to provide an immediate lifting effect,” explains [Dendy Engelman, MD](https://aedit.com/provider/dendy-engelman-md-312), a board certified dermatologist in New York City. “It originally gained popularity in the film industry, when actresses would wear tape under wigs to make their skin appear more firm on camera.” 

While this practice isn’t new, it’s mostly been an insider secret — which means there has been a lack of information about the longer term ramifications and risks of the seemingly instant lift. We’re breaking down what you need to know about the ins and outs of facial tape.

## **Using Facial Tape for an ‘Instant’ Facelift**
Snatching your face with tape can be achieved by applying packing tape or another kind of thick tape on one side of your face (behind your ear), then pulling it across your head to the other side. Another option are kits that include a silicone tab on an elastic band, and are applied similarly to the packing tape method.

And while using these methods intermittently shouldn’t do too much harm for most people, there are still some risks. Dr. Engelman advises against using tapes for long periods of time because they can actually have the inverse effect. “Extended usage of these adhesive tapes could cause exaggerated stretching to the skin and actually accelerate signs of aging,” she cautions. “There could be increased skin laxity induced from tight taping techniques and/or prolonged wear.”

## **Using Facial Tape for Wrinkles**
Using facial tape to tackle wrinkles is controversial, as most dermatologists and aestheticians agree that tapes, patches, and bandages will not effectively reduce, remove, or prevent wrinkles. Wrinkle tapes are said to work if you directly place them on, say, your crow’s feet or forehead lines and leave them on overnight, but the main issue here is that the smoothing effect only lasts as long as the tape is on. Once you wake up and remove the tape, you’re back to square one.

Another concern? While rare, some people can have a reaction to the tape. “The adhesive itself is not dangerous to your skin, though wearing it for prolonged periods of time can result in the skin not getting enough air or natural moisturization, which isn't ideal in any situation,” Dr. Engelman shares. “There are cases where people develop an allergic contact dermatitis to ingredients that make up the adhesive.”

## **Alternatives to Facial Tape**
While facial tape can offer temporary benefits in a pinch, Dr. Engelman doesn’t suggest it as a long-term [lifting](https://aedit.com/procedure/facial-skin-firming-and-lifting-solutions) or [wrinkle-smoothing solution](https://aedit.com/procedure/skin-smoothing-solutions). “I would recommend readers try to avoid facial tape, certainly on a regular basis,” she says. Instead, consider the at-home and in-office options that offer lasting benefits. “If they are looking for real, permanent anti-aging solutions, there are many more viable cosmetic and medical treatments that will safely and truly provide greater reductions in wrinkle visibility,” she shares. An added benefit? “You don't want to be tugging so aggressively on the skin on a regular basis,” she adds.

Here are three at-home and in-office wrinkle-reducing solutions that will have you saying ‘so long’ to your facial tape:

### **Skincare**
Yes, [skincare has its limits](https://aedit.com/aedition/aesthetic-skin-aging-concerns-skincare-cannot-treat), but starting a quality skincare routine before wrinkles and sagging start to show up is a recipe for maintaining flawless skin. In addition to a [broad spectrum sunscreen](https://aedit.com/aedition/best-lightweight-non-greasy-sunscreens-to-wear-indoors), look for products that feature [collagen](https://aedit.com/aedition/guide-to-collagen-in-skincare-supplements-aesthetic-medicine) and elastin-boosting ingredients (think: [retinol and retinoids](https://aedit.com/aedition/guide-to-vitamin-a-retinol-retinoids-in-skincare)), brightening antioxidants (hi, [vitamin C](https://aedit.com/aedition/guide-to-topical-vitamin-c-in-skincare) and [vitamin E](https://aedit.com/aedition/guide-to-topical-vitamin-e-in-skincare)), and exfoliating hydroxy acids (i.e. [AHAs](https://aedit.com/aedition/guide-to-topical-alpha-hydroxy-acids-in-skincare), [BHAs](https://aedit.com/aedition/guide-to-beta-hydroxy-acids-salicylic-acid-in-skincare), and [PHAs](https://aedit.com/aedition/guide-to-topical-polyhydroxy-acids-in-skincare)). Don’t know where to start? Check out our guides to the best skincare routine for your [twenties](https://aedit.com/aedition/best-skincare-routine-products-ingredients-for-20s), [thirties](https://aedit.com/aedition/best-skincare-routine-products-ingredients-for-30s), [forties](https://aedit.com/aedition/best-skincare-routine-products-ingredients-for-40s), and [after 50](https://aedit.com/aedition/best-skincare-routine-products-ingredients-for-50s-60s-70s).

### **Injectables**
Once you have your skincare regimen down, you may want to consider how professional treatments can fit into your routine. [Cosmetic neurotoxins](https://aedit.com/aedition/comparing-neurotoxin-botulinum-type-a-injections-botox-dysport-jeuveau-xeomin), like Botox®, Dysport®, Jeuveau®, and Xeomin®, reduce the look of fine lines and wrinkles. When injected into an affected area (horizontal forehead lines, glabellar lines, crow’s feet, etc.), they temporarily limit muscle contractions, which, in turn, prevents the face from forming lines. Results generally last three to four months. It is increasingly common for patients in their late twenties and early thirties to begin routine neurotoxin treatments as a [preventative measure](https://aedit.com/aedition/i-was-practicing-prejuvenation-before-it-was-a-trend) to ward off deeper wrinkles down the road.

### **Laser Skin Resurfacing**
The most invasive option of the bunch can also yield the most dramatic results. Ablative lasers — the gold standard in [laser skin resurfacing](https://aedit.com/aedition/guide-to-ablative-laser-skin-resurfacing) — create a controlled burn to the skin to stimulate the natural healing process, which jumpstarts elastin and collagen production and, eventually, produces new skin cells. These powerful lasers can treat everything from sun damage and pigmentation to scarring and deep wrinkles.

Beauty

Long employed for its lifting and wrinkle-reducing properties, here’s why facial tape may not be as useful as you think.

Alternatives To Facial Tape For Reducing Wrinkles, Lifting The Skin

Here’s What Dermatologists Think About Facial Tape

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If you’ve ever read an article about aesthetic procedures on The AEDITION, you know we *always* encourage you to look for or ask to see before and after photos during the research and [consultation process](https://aedit.com/aedition/questions-to-ask-your-doctor-during-plastic-surgery-consultation). Why? Because they offer the chance to visualize a provider’s experience and aesthetic, in addition to being a great way to better understand what kind of results are possible. 

With the rise of [social media](https://aedit.com/aedition/march-2020-study-shows-relationship-between-social-media-cosmetic-surgery) (specifically, Instagram and TikTok), images and videos of patients before and after a procedure have become an indispensable educational and marketing tool for aesthetic providers. But how do you know if you can trust what you see? From what to look for to best practices, we’re breaking down everything you need to know about before and after photos in aesthetic medicine.

## **The Value of Before & After Photos in Aesthetic Medicine**
As it turns out, before and after photos are as much for the provider as they are for the patient. “Photos are critical in plastic surgery,” says [Jason Roostaeian, MD](https://aedit.com/provider/jason-roostaeian-md-449), a board certified plastic and reconstructive surgeon in Los Angeles. “They show the result in part so we can see it but also so we can be better surgeons.” As he explains, plastic surgery is a “visual art,” and before and afters give providers a chance to critically view their work and their technique across patients. 

And then there is the patient component. The imagery allows patients to get a sense of how often a provider performs the procedure(s) they are interested in, if they operate on people who share similar traits, and what their overall aesthetic is. In some cases, these photos — especially the ones featured on social media or a provider’s website — may serve as the patient’s first impression of the provider. They are looked at during the research and discovery phase (i.e. before a consultation is scheduled). The commercial value of these photos means there could be pressure to make results look as optimal as possible. Balancing business interests with [transparency and ethics](https://aedit.com/aedition/how-plastic-surgeons-balance-patients-cosmetic-surgery-desires-and-safety) is, needless to say, crucial. 

## **Are Before & After Photos Regulated?**
There are rules that govern patient photos, including before and after images. Firstly, patient confidentiality means that the provider must ask the patient for permission before sharing any photos. The gray space existis in how the photos are taken and where they can be shared once patients sign off.

In a [2018 article](https://journalofethics.ama-assn.org/article/when-advertising-plastic-surgeons-individual-brand-unethical/2018-04) in the *AMA Journal of Ethics*, the authors examine the issues of social media advertising for plastic surgeons in particular. The current lack of regulation surrounding the promotion of before and after photos on social media means that the onus is on the providers to represent their work honestly. In turn, it’s up to patients to look at the images with a level of caution. While there have been varying efforts to regulate the practice, no formal guidelines have been enacted to standardize the practice of taking and sharing before and after photos of cosmetic surgery results.

With that said, many providers take great care to ensure their photos are as accurate as possible. Practicing so-called ‘photographic hygiene’ is a good start. This includes:

- Setting up a dedicated photo space 
- Using a standardized backdrop
- Having controlled lighting 
- Maintaining consistent space between the patient and camera
- Taking and sharing multiple angles 

These steps go a long way toward allowing prospective patients to look at a provider’s work in a more complete manner. 

## **How to Look at Before & After Photos**
If you are wondering whether or not you can trust the before and after photos you see on social media, the answer is not simply yes or no. Instead, you should look at the images critically, and Dr. Roostaeian recommends the following: 

### **1. Be Mindful of Editing**
“As a doctor, you know when people use photoshop,” he says. But how is a patient to know? Try to compare several different photos of the same procedure; it can often help you spot which ones have been manipulated. Natural skin texture is a good indicator, too. If skin appears unnaturally smooth, it could be an indicator that the photo has been edited.

### **2. Look for Multiple Angles**
Best practices indicate that providers will take multiple photos from multiple angles of the same patient. “Look for six angles, including side views,” Dr. Roostaeian notes. “And make sure the photos are taken straight, not crooked.” While providers may only post a single angle on social media, they often feature more on their website. If you are interested in seeing more, message them or call their office.

### **3. Be Wary of the Zoom Effect**
We’re not talking about [the Zoom effect](https://aedit.com/aedition/aedit-survey-reveals-how-2020-altered-aesthetic-landscape) from our increased time on video calls, but rather the impact zooming in or out can have on how the before and after will present. As Dr. Roostaeian explains, using zoom can distort features, making them look bigger. On the flip side, zooming out can make features look smaller. A good rule of thumb is to observe whether all the photos of a particular procedure have been taken from the same distance.

### **4. Value Video**
“Video tends to be lower quality, so it’s more difficult for the patient to see results than in a still photo,” Dr. Roostaeian says. So while videos should not replace before and after photos, they can complement them. Even if you might not be able to see the patient in the same level of detail, you may be able to get a better sense of proportion and perspective. 

### **5. No Makeup Makeup**
Is the patient wearing makeup in some photos but not others? The reality is that it isn’t always possible for providers to get makeup-free before and after photos of every patient (and it may not even be necessary to). It is, however, worth keeping in mind that the results of some procedures may be affected by makeup.

## **The Takeaway**
When viewing before and after photos on social media or on a provider’s website, it’s important to do so with an informed eye. While the imagery is undoubtedly important, there is another important factor to consider when choosing a plastic surgeon or cosmetic dermatologist: [recommendations](https://aedit.com/aedition/category/how-i-found-my-plastic-surgeon). Dr. Roostaeian suggests reaching out to your network for referrals and to hear directly from patients about their experience.

Aesthetics

With the rise of social media, before and after images have become indispensable tools for aesthetic providers to attract patients. But how do you know if you can trust what you see?

Importance Of Before And After Photos In Plastic Surgery, Aesthetic Medicine

Everything You Need To Know About Before And After Photos

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From laser skin treatments to laser hair removal, tone matters — skin tone, that is. Laser therapy procedures are not one size fits all and the wrong treatment can cause lasting damage. So, how can you tell which laser treatments are right for [darker skin tones](https://aedit.com/aedition/the-best-skin-treatments-for-dark-complexions)? Here, we caught up with top dermatologists and an aesthetic nurse to find out why skin tone affects the outcome of certain laser procedures and the best [skin refining](https://aedit.com/aedition/ultimate-guide-to-skin-resurfacing-procedures) and [hair removal](https://aedit.com/aedition/how-to-use-at-home-laser-hair-removal-devices) laser options for those with darker complexions. 

## **The Relationship Between Lasers & Skin Tone**
Not all laser and light therapies are safe for all skin tones. Generally speaking, those who fall above type IV on the [Fitzpatrick Skin Phototype](https://aedit.com/aedition/guide-to-fitzpatrick-skin-types) scale (the go-to measure of skin type for dermatologists) need to be careful when choosing a treatment. For the uninitiated, the Fitzpatrick scale was developed in 1975 by Harvard dermatologist Thomas B. Fitzpatrick, MD, to classify a person’s tendency to burn (erythema) versus tan (induce pigmentation) — providing an estimation of the amount of melanin present in skin cells. The original scale had four types and was later broadened to six. 

The best way to determine your Fitzpatrick skin type is to visit your dermatologist, but below are the general classifications for each: 

- **Type I**: Pale skin; light blue or green eyes; red or blonde hair; always burns, never tans
- **Type II**: Fair skin; blue or green eyes; blonde hair; burns easily, tans poorly
- **Type III**: Light brown to olive skin; hazel or light brown eyes; dark blonde or light brown hair; burns mildly, tans gradually
- **Type IV**: Olive to brown skin; dark brown eyes; dark brown hair; burns minimally, tans easily 
- **Type V**: Dark brown skin; dark brown to black eyes; dark brown to black hair; tans easily, rarely burns
- **Type VI**: Dark brown or black skin; dark brown to black eyes; black hair; never burns, tans easily 

Aesthetic lasers target water, red hemoglobin, or brown melanin in the skin. Skin types IV to VI have a higher concentration of melanin, which means there is a greater risk of damage if the laser is used incorrectly. “Patients with darker skin tones and who are tan are more susceptible to complications, which is why it’s essential to see a board certified laser expert and someone with many different tools in their kit,” says [Paul Jarrod Frank, MD](https://pfrankmd.com/), a board certified dermatologist in New York City. The damage caused by improper laser treatments is often permanent and ranges from [burns](https://aedit.com/aedition/how-to-treat-first-second-third-degree-burns) and [scars](https://aedit.com/aedition/minimizing-scars-after-surgery) to hypo- and hyperpigmentation. 

But that’s not to say there aren’t cosmetic laser therapies that can safely be employed on a wide range of skin tones. When performed by a well-trained professional, there is an array of skin refining and hair removal treatment options. To ensure you’re visiting a provider with the right level of experience, Dr. Frank recommends [asking the following questions](https://aedit.com/aedition/questions-to-ask-your-doctor-during-plastic-surgery-consultation): 

1. Do you have more than one technology in your office to treat the various skin types?
2. Do you have experience with treating people with my skin type?

“Those are the two most important questions you can ask,” he says. And don’t be shy about asking to see before and after photos of patients who look like you — it can help you get a sense of how much experience the provider has. 

## **The Best Laser Treatments for Darker Skin**
Now that you have a better understanding of the relationship between skin tone and lasers, it’s time to learn more about which treatments are safe and effective. When it comes to refining skin tone and texture, [non-ablative](https://aedit.com/procedure/nonablative-laser-skin-resurfacing) (read: non-wounding), picosecond, and Q-switched lasers are the way to go for darker complexions and there have been some notable technological advances in the last decade. “The skin stays intact, so patients can use makeup during recovery and they can be used on darker skin types,” Dr. Frank says. 

### **Non-Ablative Lasers**
- Clear + Brilliant®
- Fraxel® Dual 
- Lutronic Ultra™

### **Picosecond Lasers**
- Enlighten®
- Pico Genesis™ 
- PicoSure®
- PicoWay®

Generally speaking, Dr. Frank says longer wavelength technologies tend to be safest for darker skin tones. Tara Garrick, nurse and aesthetic laser specialist at [Neinstein Plastic Surgery](https://neinsteinplasticsurgery.com/) in NYC, likes the Lutronic Ultra™ because the non-ablative, thulium laser works deeper in the skin without damaging the surface layer. “It’s a customizable, comfortable laser with minimal downtime,” Garrick says. It can for address fine lines and wrinkles, melasma, [hyperpigmentation](https://aedit.com/aedition/what-its-like-to-treat-hyperpigmentation-with-skincare-cosmetic-treatments), acne and body scars, large pores, actinic keratosis, even [stretch marks](https://aedit.com/aedition/how-to-treat-stretch-marks) in all skin tones, she notes. 

### **Laser Treatments to Avoid**
Those with darker skin tones should avoid [traditional resurfacing lasers](https://aedit.com/aedition/guide-to-ablative-laser-skin-resurfacing), like ablative [Fraxel®](https://aedit.com/aedition/guide-to-fraxel-laser-skin-resurfacing-treatments) and [carbon dioxide (CO2)](https://aedit.com/procedure/ablative-co2-laser) devices, because there is a risk of permanent hyperpigmentation, says [Dendy Engelman, MD](https://aedit.com/provider/dendy-engelman-md-312), a board certified dermatologist in NYC. 

Other light therapies that are best to steer clear of? [Intense pulsed light (IPL)](https://aedit.com/procedure/ipl) and broadband light (BBL). “We need to be extremely cautious, as IPL and BBL are really not safe for dark skin tones,” Dr. Frank says. He often sees complications in patients inappropriately treated with IPL devices by inexperienced practitioners. “You need to have laser-specific technology that works well on darker skin tones,” he explains, adding that those typically include the longer wavelength therapies mentioned above.

## **Laser Hair Removal for Darker Skin Tones**
For many years, [laser hair removal](https://aedit.com/procedure/laser-hair-removal) technology wasn't sophisticated enough to work for dark skin. “Traditionally, lasers work by beaming intense light at the follicle, which causes permanent damage so the hair no longer grows there,” Dr. Engelman explains. “The key was the contrast between the follicle and the skin.” That means people with fair skin and a dark hair follicle enjoyed the best results, while people with dark skin and dark hair or light skin and light hair didn’t have many options. 

In the case of patients with darker complexions, Dr. Engleman says the devices weren't able to distinguish between the skin pigment and the pigment of dark hair follicles. As a result, there was a risk of damaging the skin and causing hypopigmentation (light spots), blisters, or even scarring. Fortunately, the technology has come a long way. “I'm excited about the Nd:YAG laser, which safely penetrates deeper into the dermis, totally bypassing the pigment of the skin,” she shares, adding that the Q-switched device is the safest option for laser hair removal for darker skin tones.

The Deka Motus AX is another Q-switched laser that can effectively remove light *and* dark hair from all skin tones. “The one-of-a-kind wavelength used by the Motus AX allows for the treatment of fine and light hair, whereas most lasers are only effective for dark hair,” Dr. Frank explains. “Additionally, it is also effective for darker skin tones, which are not able to be treated with some other lasers.” Another benefit? It’s painless and requires half the number of sessions compared to standard treatments. “This laser is unique because it treats and heats the area very slowly, instead of the classic stamping technique of hair removal,” he says. “It also features a cooling system for increased comfort.”

## **The Takeaway**
While patients with darker skin tones should take special care in finding a provider, laser treatments (of all kinds) carry risks for everyone. “They are just instruments that rely on the performer,” Dr. Frank cautions. Generally speaking, you need to be careful using lasers on people with a history of [eczema](https://aedit.com/aedition/best-skincare-products-to-treat-eczema-flare-ups-in-the-winter) and [psoriasis](https://aedit.com/aedition/what-its-like-to-live-with-and-treat-psoriasis) or any type of skin disease, he says. Taking the time to [research and consult with](https://aedit.com/aedition/finding-the-right-plastic-surgeon-dermatologist-or-cosmetic-dentist) several providers will help ensure you get the best treatment for your needs.

From laser skin treatments to laser hair removal, tone matters — skin tone, that is. Here’s what you need to know about laser safety and efficacy.

Best Laser Skin Resurfacing And Laser Hair Removal Treatments For Darker Skin Tones

The Best Laser Treatments For Darker Skin Tones

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As the plastic surgery and aesthetic procedure industry continues to grow, so, too, does the demand for solutions that keep it as safe, simple, and affordable without sacrificing results. And many are answering the call with so-called ‘awake’ surgeries. Performed under local or regional anesthesia and often in combination with oral or IV sedation, awake procedures are a way to avoid pain and discomfort without [general anesthesia](https://aedit.com/aedition/everything-you-need-to-know-about-anesthesia). 

Some critics say providers are simply using the option in an attempt to bypass the role of the anesthesiologist for convenience’s sake, but the board certified plastic surgeons who offer such procedures see benefits that make it feel like the best option in some cases. Below, the basics of what you need to know about awake surgeries. 

## **What Is ‘Awake’ Surgery?**
While general anesthesia renders a patient fully unconscious, ‘awake’ options leave the patient, well, awake. But that doesn’t mean they are aware. Some procedures can be done with just local anesthesia (often lidocaine or a tumescent solution containing lidocaine, saline, and epinephrine) to numb the area being worked on. But many also involve twilight or IV sedation, which, as [Julius Few, MD](https://www.fewinstitute.com/), the board certified plastic surgeon behind The Few Institute in Chicago, explains, brings on a state in which “the patient is able to breath on their own for a comfortable, non-memorable surgical experience.”

And Dr. Few should know — not only does he offer awake procedures, but he also authored the [first peer-reviewed, large study](https://pubmed.ncbi.nlm.nih.gov/26446058/) on facial cosmetic surgery under local anesthesia with oral sedation in a fully accredited surgery center. “The procedures performed included [facelift](https://aedit.com/procedure/awake-facelift), [blepharoplasty](https://aedit.com/procedure/upper-eyelid-blepharoplasty), and even tip [rhinoplasty](https://aedit.com/procedure/nose-shaping-solutions),” he says. The results showed the option to be safe.

## **Why Stay Awake?**
There are a few major reasons a patient may prefer the ‘awake’ route. The first is to simply to mitigate any fear that arises about the concept of going under. After all, there are complications associated with general anesthesia that run the gamut from nausea to ([very rarely](https://health.clevelandclinic.org/safe-anesthesia-5-things-know/)) death. And then there are certain conditions that may make going ‘awake’ the better option for your health. “Risk factors for general include allergies to anesthesia, diabetes, heart disease, high blood pressure, kidney problems, lung conditions, and obesity,” Dr. Few notes.

But it’s not as if one type of anesthesia carries potential side effects while the other does not. While local anesthesia is generally considered to have lower risk of complication, “[it] needs to be managed very carefully, as there could be toxic side effects of overuse,” explains [Kevin Tehrani, MD](https://aedit.com/provider/kevin-tehrani-md-91), a double board certified plastic surgeon of Aristocrat Plastic Surgery in New York City. He does, however, see a psychological upside for some patients. For those more anxious about the outcome of their surgery, “the biggest benefit is one’s perception of not giving up control,” he says. 

In some cases, surgeons actually feel the awake patients leads to better results. Thomas Su, MD, founder of [Art Lipo Arm Liposuction & Plastic Surgery Center](https://artlipo.com/) in Tampa, FL, exclusively offers what he calls “interactive lipo.” “I actually stand my patients up after completing part of the surgery to check my results because gravity and laying on the table distorts what you can see,” he shares. His method of awake surgery skips sedation via Valium or Xanax so his patients can, as he explains, “move in different positions and also hold their muscles tight and firm.” This allows for “much better control during the sculpting,” he adds. 

Dr. Tehrani sees similar benefits. “[For] more limited areas like [arms](https://aedit.com/aedition/cosmetic-procedures-for-slimmer-sculpted-arms) or buttock liposuction, I prefer [operating] under local anesthesia, as I like to have the patients actually activate their muscles so I can sculpt around it,” he says.

And then there’s the [cost savings](https://broadway.aedit.com/aedition/how-much-cosmetic-surgery-costs). If you opt for local anesthesia alone, it’s cheaper, as it doesn’t require the presence of an anesthesiologist. In some cases, the same is true of twilight sedation. Dr. Few understands this can be an alluring benefit for patients, but he warns to not make cost a primary deciding factor. “Bottom line, I will never put financial consideration ahead of patient safety or comfort,” he emphasizes. “If general anesthesia is needed, it is needed.”

## **What Procedures Can Be Performed Awake?**
The treatments doctors offer as awake surgeries vary, however, they tend to be in finite areas. “In general, smaller areas are preferred under local anesthesia, so that the extent of anesthetic given does not get to a toxic level,” Dr. Tehrani says. Common examples include:

- Awake facelift
- Awake blepharoplasty
- Awake liposuction (neck, arms, buttocks)

Some [research shows](https://journals.lww.com/annalsplasticsurgery/fulltext/2019/10000/aesthetic_breast_surgery_under_cold_tumescent.6.aspx) that breast surgery can also be safely performed under tumescent anesthesia as well. To mitigate risk as much as possible at his own practice, “general anesthesia is reserved for more aggressive surgical cases that involve complex or multiple treatment areas,” Dr. Few says. That includes full body liposuction, [mommy makeovers](https://aedit.com/aedition/the-mommy-makeover-how-to-bounce-back-after-a-baby), and body lifts. “These kinds of surgical procedures require significant commitment overall,” he adds.

## **What to Expect From Awake Surgeries**
Though the area is numbed, there may be some level of pain involved with awake procedures. It is similar to what you might feel at the dentist. Here’s how Dr. Su breaks down the experience of his awake, local-only liposuction treatments: “During the procedure, there is some stingingness and weird movement sensations while the local anesthetic is being dispersed in the fat layer.” Once the fat layer is numb, he says there may be “occasional stings” during the liposuction step, but it is generally “pretty tolerable.” Additional lidocaine may be able to be administered, but it’s rarely necessary. “Fortunately, the instances where patients really don't tolerate this well is fairly infrequent,” he shares.

After surgery, he says, “the local anesthetic provides a more comfortable gradual tapering off of anesthetic compared to general, which wears off very quickly and leaves patients needing pain medication immediately.” For those who combine local anesthesia with IV or oral sedation, you’ll be awake but, well, out of it. [When administered correctly](https://www.surgery.org/consumers/plastic-surgery-news-briefs/patient-safety/awake-aware-undergoing-surgery-1031012), the patient comes away with no memory of their procedure.

## **Are You a Candidate for Awake Surgery?**
Ultimately, the type of anesthesia you receive comes down to what you and your surgeon think is best. If your doc provides a local option for the procedure you’re having done, a few questions should help him or her determine if you might be a candidate. The first often goes back to that dental analogy. “Typically, I ask about their dental anesthetic experience in the past and whether or not that’s been something that he or she has tolerated well,” Dr. Tehrani says. That will give you some indication of whether you might experience discomfort. 

Dr. Su also makes sure to get a feel for how skittish a patient is. “If there is a downside to awake liposuction, it is that the occasional very nervous or anxious patient may have a more difficult time during the surgery,” he cautions. “If someone thinks that they are too scared, they have a choice and may be better off being put to sleep.” Beyond that, “the requirements to safely do liposuction awake are not much different than doing any other plastic surgery,” he says.

## **How to Find a Provider**
The first rule of plastic surgery is to look for a [board certified provider](https://aedit.com/aedition/medical-board-certification-in-plastic-surgery-cosmetic-dermatology) who offers both general and local anesthesia. That way, you can be sure you’ll have access to what’s best for your needs. Beyond that, do your research. “There are reports of bad experiences with all surgeries whether awake or asleep,” Dr. Su says. His advice: Ask to see lots of before and after images. “The more results and the better the quality of photos, the more believable,” he shares. “And videos of live patients with their actual results is even more impressive and indisputable.”

All about the trend of aesthetic procedures done with local anesthesia.

A Guide To Awake Plastic Surgery Procedures Without General Anesthesia

Awake Surgeries: What To Know About Not Going Under

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When I received an email invite from a publicist friend about trying a medical-grade chemical peel in the comfort of my own home, I don’t even think I blinked before writing back that I was in. From [Fraxel](https://aedit.com/procedure/nonablative-fractional-lasers) to [tattoo removal](https://aedit.com/procedure/laser-tattoo-removal), I’ve been a guinea pig for all sorts of skincare treatments over the course of my career — but this was different. 

[Medical-grade chemical peels](https://aedit.com/aedition/difference-between-medical-grade-chemical-peels-at-home-exfoliators) are usually only enjoyed in a professional setting, yet I was being offered the opportunity to mix and apply the peel myself under the close watch of an aesthetician via FaceTime. I’m not sure if I was more excited to play skincare mixologist or to see the results. While there have been plenty of COVID-19 quarantine horror stories about [dangerous DIY dermatology treatments](https://aedit.com/aedition/dangers-of-diy-at-home-dermatology-beauty-treatments), this felt like a unique opportunity to enjoy in-office results at home in a safe and effective way.

Here’s everything you need to know about my experience from the first consultation through recovery and results (spoiler alert: they lived up to my expectations).

## **Step 1: The Consultation**
The plastic surgeon offering this treatment is [Kevin Tehrani, MD](https://aedit.com/provider/kevin-tehrani-md-91), a board certified plastic and reconstructive surgeon and founder of [Aristocrat Plastic Surgery & MedAesthetics](https://www.aristocratps.com/) in New York City. I worked closely with his medical aesthetician, Louisa Agate, who was very empathetic and cared about my results just as much as I did. The process included a [virtual consultation](https://aedit.com/aedition/virtual-consultations-telemedicine-plastic-surgery-dermatology-cosmetic-dentistry), where we spoke about my skin and the concerns I have. My biggest skincare concern has always been [hyperpigmentation](https://aedit.com/aedition/what-its-like-to-treat-hyperpigmentation-with-skincare-cosmetic-treatments), but lately it’s acne (hi, [maskne](https://aedit.com/aedition/how-to-treat-prevent-acne-caused-by-covid-19-masks-face-coverings)) and texture as well.  

## **Step 2: The Prep**
Once I received the products and tools for my customized peel, Louisa and I got back on the phone to discuss the ingredients, pre- and post-peel care, and what I could expect in regards to peeling. I learned the peel would have three layers consisting of:

1. A [vitamin A](https://aedit.com/aedition/guide-to-vitamin-a-retinol-retinoids-in-skincare) solution
2. A kojic acid and [vitamin C](https://aedit.com/aedition/guide-to-topical-vitamin-c-in-skincare) lightening oil
3. A mask made up of hydroquinone, vitamin C, kojic acid, and arbutin  

After application, she told me I would leave the concoction on for six hours.  

## **Step 3: The Treatment**
On our third and final FaceTime, Louisa walked me through applying the peel. Before getting started, she instructed me to wipe my cleansed face with alcohol and apply a bit of Aquaphor to the inner and outer corners of my eyes, corners of my mouth, rim of my nose, and lash line to protect them from any solution that may drip or spread. If the peel were to settle in those areas, it could burn the skin or cause a rash. Together, we mixed and applied the three steps — layer by layer. After 20 minutes of application, it was time to wait. Six hours later, as instructed, I washed it all off.

## **Step 4: The Results**
I expected to start seeing flakes around my mouth on day three and peel for up to 10 days.  However, Louisa mentioned that, since my skin was used to retinol, I may not peel all that much. As a matter of fact, I didn’t peel at all. Instead, I experienced a breakout around my chin, which cleared up in about a week. Overall, I’m really happy with the results. My skin looks brighter and healthier. The tone is more even and my pores appear smaller.

<CaptionImg url={https://images.ctfassets.net/zw35sfestf1t/2k25y7OiOgAUbV9Z5PlY9a/9e0dbb52d82cc843f911df04b8363f25/AEDIT-Tehrani-Peel.png}>
  The writer's skin before (*left*) and one week after treatment (*right*).
</CaptionImg>

Dr. Tehrani is offering this at-home service to remote patients. If you’re interested in learning more about his medical grade chemical peels and booking your own, [request a virtual consultation](https://aedit.com/provider/kevin-tehrani-md-91).

Patient Perspective

Typically performed in a doctor’s office, one New York City-based plastic surgeon created a socially distant way to treat his patients virtually.

What It's Like To Try A Medical-Grade Chemical Peel At Home

What Happened When I Tried A Medical-Grade Chemical Peel At Home

ayo-ogunseinde-THIs-cpyebg-unsplash

In a perfect world, every plastic surgery patient would be thrilled with the outcome of their procedure. In reality, there are an array of both functional and aesthetic reasons why someone [may not be completely satisfied](https://aedit.com/aedition/what-to-do-if-you-are-unhappy-with-your-plastic-surgery-results) with the results. This is especially true of [rhinoplasty](https://aedit.com/aedition/difference-between-cosmetic-rhinoplasty-vs-functional-rhinoplasty) and surgical alterations for the nose. 

Just like there are many reasons why a patient might decide to get a nose job, there are numerous ways to perform rhinoplasty. Due to the complex nature of the procedure, it might not always go as planned. “It is not surprising then that people seeking revisions of their initial rhinoplasty is quite common,” explains [Andrew Frankel, MD](https://aedit.com/provider/andrew-frankel-md-275), a Beverly Hills-based double board certified facial plastic and reconstructive surgeon. “Although the rate of patients who seek out revisions is not published, it is generally accepted that it is around 20 to 25 percent.”

To better understand why a patient might want or need a revision rhinoplasty, we’ve talked to two specialists about the ins and outs of the procedure.

## **What Is Revision Rhinoplasty?**
As its name suggests, [revision rhinoplasty](https://aedit.com/procedure/revision-rhinoplasty) (a.k.a. secondary rhinoplasty) is a corrective surgery that aims to address the function and/or appearance of a nose that has already been operated on. “Revision rhinoplasty is the most difficult of all plastic surgical operations,”  Dr. Frankel says. 

One such reason is because of how rhinoplasty techniques have evolved over time. “Older rhinoplasties were reductive where a lot of cartilage was removed, which decreases support,” explains [Jason Roostaeian, MD](https://aedit.com/provider/jason-roostaeian-md-449), a board certified plastic and reconstructive surgeon at UCLA. “This created less support and can create asymmetry in the shape of the nose.” Another issue? “The procedure used to be very cookie-cutter and may not look natural on all face shapes and sizes,” he says. 

Since revision rhinoplasty requires revisiting a wound created by a previous procedure, there are several factors a plastic surgeon must consider before operating:

- **Scar Tissue**: “There is often a great deal of scar tissue present that has distorted the underlying delicate anatomy to the point of being unrecognizable — if it is not missing entirely,” Dr. Frankel says. 
- **What Lies Beneath**: “Once the anatomy has been uncovered, it needs to be reshaped and there might not be any cartilage left to do this,” he explains. In such cases, grafting is required, but grafted tissues “are not necessarily ideal for the needs each case warrants.”
- **Skin Condition**: Past scarring can impact the skin, too. “The internal lining and skin might be too scarred and may not be able to stretch and re-drape over the structure that cannot be replaced,” Dr. Frankel says. 
- **Functionality**: Needless to say, the nose still needs to function, too. “The airway must always be considered and maintained, which can be challenging in patients who still want a smaller nose but who need additional structure,” he notes. 

To restructure the external shape and internal workings in alignment with the patient’s desires, a precise and individualized procedure plan is needed. 

## **Why Patients May Seek Revision Rhinoplasty** 
When consulting with new patients, plastic surgeons emphasize that [results can take six months to a year](https://aedit.com/aedition/how-long-does-it-takes-to-recover-from-cosmetic-surgery-procedures) (or more) to be fully realized. Rhinoplasty falls into the ‘year or more’ category. But what if you still don’t like the outcome? Or what if there is an underlying complication? These are just a few of the reasons patients may seek a revision rhinoplasty:

- **Complications**: “Rhinoplasty is a delicate and complicated operation and is fraught with potential for asymmetries, irregularities, prolonged swelling and functional problems such as difficulty breathing and runny nose,” Dr. Frankel explains. The anatomy may not heal the way it intended to, which can be an issue moving forward. 
- **Aesthetic Goals**: For some, a change in taste may lead to revision — especially if a patient underwent the procedure as an [adolescent](https://aedit.com/procedure/youthteen-rhinoplasty). “The outcome is highly subjective, and, in our current society, the expectations of patients are increasing due to [social media](https://aedit.com/aedition/march-2020-study-shows-relationship-between-social-media-cosmetic-surgery) and the idealized versions that they are comparing themselves to,” Dr. Frankel says. 
- **Past Experience**: “The patients who are in search of a revision specialist are often fragile due to having prior bad experiences,” he shares. “This makes them wearier with greater scrutiny on every detail.” A previous negative outcome should not deter a patient from seeking out a highly skilled, [board certified](https://aedit.com/aedition/medical-board-certification-in-plastic-surgery-cosmetic-dermatology) provider. 
- **Innovations**: In the rhinoplasty world, there have been [updates to technique and strategy](https://aedit.com/aedition/reinventing-rhinoplasty-whats-different-about-modern-nose-jobs), which may lead some to feel that a secondary experience could yield a more favorable outcome. 

All of these are valid reasons for a patient to consider a revision surgery, though consulting with a board certified plastic surgeon is the best way to determine if you could be a candidate.

## ** The Right Candidate For Revision Rhinoplasty**
Revision rhinoplasty isn’t just about a second procedure. In some cases, patients have already undergone multiple surgeries. “Revisions make up about 30 percent of my practice,” Dr. Roostaeian shares, adding that he has consulted with patients who have had seven or eight previous corrective procedures. Neither of our experts has a specific number of past surgeries that will count a patient out of future work. Instead, they examine the physical state of the nose and the patient's health. [Smoking](https://aedit.com/aedition/impact-of-cigarette-smoking-vaping-on-skin-hair-teeth-health), lifestyle, expectations, and, of course, the internal damage from past surgeries will all factor into a candidate's prospects.   

## **What To Do If You’re Interested in Revision Rhinoplasty** 
You know you’re not happy with the results of your rhinoplasty, but what comes next? Arriving at the decision to undergo a revision may require even more thorough research and vetting than any of your previous procedures. Here are seven things to think about before going under the knife again:

### **1. Consider The Timing**
“There is no specific amount of time any patient must or should wait before having a corrective surgery,” Dr. Frankel says. “This depends on the type of problem.” In fact, you might not even want to wait until the previous procedure is fully healed. “For example, patients who have a bump or irregularity on their dorsum two months following their operation or those who feel their nose is too short are better off having their revision sooner than later because the wound contraction will only make matters worse over time,” he explains. In other cases, patience is necessary. “If the issue is that the nose still looks too wide or big, time will often work in that patient's favor,” he notes. “Things might improve to the point where further surgery is not necessary.” Depending on where you are in the healing process, a conversation with your surgeon can shed some light on what to expect.

### **2. Do Your Research**
A revision rhinoplasty requires a highly skilled aesthetic surgeon to address the issue at hand and will likely cost more than the first rhinoplasty. “[Meet with at least two surgeons](https://aedit.com/aedition/how-i-found-my-plastic-surgeon-its-surgery-not-a-spa-appointment) and try to determine if you are a good fit,” Dr. Frankel encourages. Consider whether or not the provider communicates well, has presented a clear plan, and is upfront about any potential limitations. Another suggestion? Ask to see lots of before and after images from each prospective surgeon, Dr. Roostaeian recommends. At that point, you should be able to assess the risk and determine what is best for your needs and goals.

<RelatedContent
  title={15 Questions To Ask Your Doctor During A Consultation}
  slug={questions-to-ask-your-doctor-during-plastic-surgery-consultation }
/>

### **3. Check Your Medical History** 
If you find a new provider for your revision rhinoplasty, make sure they have all the necessary details about your previous surgery. There are several types of rhinoplasty that a surgeon can perform and, because rhinoplasties of the past were often reductive, Dr. Roostaeian says having this information is advantageous to the new provider. Those who underwent rhinoplasty after an accident or traumatic event should also disclose this information.  

### **4. Know Your Concern** 
Be as specific as possible when consulting with providers for revision rhinoplasty. “Mentally, know what shape, size, and changes you want and verbalize it,” Dr. Roostaeian says. “The more specific you are, the more it helps us.” As he explains, being able to clearly articulate what’s bothering you will allow your surgeon to better understand what they need to do. “We want to be goal-oriented when we operate, so you shouldn’t be ambiguous,” he notes.

### **5. Understand the Risks**
There is risk involved with any surgery, and that’s even more so the case with revision procedures. It’s important to recognize that creating further trauma in the nasal area will leave behind additional scar tissue, and the cumulative scarring may make it difficult to achieve the results a patient desires. There is the added risk of complication as well. 

### **6. Know When to Walk Away**
Depending on the patient’s history, an experienced surgeon will not sugar coat the truth if a patient’s health will not allow for further revision. “I once consulted with a woman who’d undergone 34 prior rhinoplasties. Her skin was in jeopardy of necrosing altogether, so that was the deal breaker,” Dr. Frankel recalls. And it’s not just about physical health. Mental wellbeing must also be taken into account. “The operation becomes more technically challenging with each successive attempt and patients become more and more [frustrated or depressed](https://aedit.com/aedition/treatment-for-post-plastic-surgery-depression-blues-during-recovery), so there is much to consider,” he says.

<RelatedContent
  title={Managing Expectations: Achieving Desired Outcomes Safely}
  slug={how-plastic-surgeons-balance-patients-cosmetic-surgery-desires-and-safety }
/>

### **7. Plan For Recovery** 
Since revision patients have already undergone at least one rhinoplasty, they know what to expect from the [recovery process](https://aedit.com/aedition/preparing-for-a-smooth-recovery-from-plastic-surgery). Generally speaking, [healing from the revision](https://aedit.com/aedition/what-its-really-like-to-get-a-nose-job) will be a familiar experience. With that said, it’s important to follow any pre- or post-op care instructions laid out by your surgeon for best results. 

## **The Takeaway**
Those who are unhappy with the results of a previous rhinoplasty may be good candidates for revision rhinoplasty, but it should be approached with careful consideration and realistic expectations. “There are an infinite number of ways that a nose can become disfigured after a poorly performed rhinoplasty, and there is an unlimited number of nuanced techniques for handling them,” Dr. Frankel concludes. “It comes down to the artistry and creativity of the revision specialist and their commitment to rendering the best possible outcome.”

Rhinoplasty may not always yield desired results, which is where revision surgery comes into play. The experts weigh in on what to know about going back for another procedure.

Revision Rhinoplasty: Guide To Safety, Surgery, Recovery

Considering Revision Rhinoplasty? Here’s What You Need To Know

shutterstock 1637496319

Nowadays, in-person doctors’ appointments have more considerations than ever. With abundant [telehealth offerings](https://aedit.com/aedition/virtual-consultations-telemedicine-plastic-surgery-dermatology-cosmetic-dentistry) and stay-at-home orders encouraging patients to remain inside, it’s easy to access healthcare from the couch. But when patients *do* decide to opt for an [in-office appointment](https://aedit.com/aedition/plastic-surgery-dermatology-cosmetic-dentistry-practices-reopening-during-covid-19), it’s a good idea to make every moment with your provider count. “No one has time to go to their plastic surgeon [or dermatologist] multiple times,” says [Roxanne Grawe, MD](https://www.roxyplasticsurgery.com/about/meet-dr-grawe/), a board certified plastic surgeon in Powell, OH. “With kid’s activities, work, and running errands, it is impossible to make multiple visits — and that was before coronavirus pandemic precautions.” 

To help you make the most of your time in the office, we asked the experts how to safely stack skin, face, and body treatments for maximum results in minimum time. In addition to saving you another trip to the office, opting for multiple treatments at once also concentrates downtime. Here are some of the most popular combos of the moment.

### **1. Skincare Treatment + Botox + Filler**
The “burger, fries, and a shake” of cosmetic treatments, this combination is one of the most common — and one you may have already tried. “Many patients stack their skincare treatments with [Botox®](https://aedit.com/aedition/comparing-neurotoxin-botulinum-type-a-injections-botox-dysport-jeuveau-xeomin) and [fillers](https://aedit.com/aedition/everything-you-need-to-know-about-dermal-fillers),” Dr. Grawe explains. Her Ohio office schedules patients with an aesthetician first for treatments such as [Hydrafacial®](https://aedit.com/procedure/hydrafacial) or [dermaplaning](https://aedit.com/procedure/dermaplaning), then sends them to a doctor’s procedure room for injectables like Botox® that tackle upper facial wrinkles. “Then, if they decide to get their lips plumped, we can do that too,” she says. “We have seen an increase in these types of facial balancing treatments during the pandemic, since you can don your mask during your [swelling or bruising](https://aedit.com/aedition/how-to-treat-prevent-bruising-after-lasers-filler-botox) phase.”

### **2. Liquid Facelift**
In Dr. Grawe’s office, she often combines a variety of injectable neurotoxins and fillers for a non-surgical facial makeover known as the [liquid facelift](https://aedit.com/procedure/liquid-facelift). Aimed at creating better [facial balance](https://aedit.com/aedition/plastic-surgery-results-are-about-proportion-not-perfection), the patient and doctor will sit together in front of a mirror as the patient describes their concerns. “It may be that the lower eyelids appear hollow and they want to look well rested, or that they don’t like their forehead wrinkles,” Dr. Grawe says. “We look at the entire picture — how the nose fits with the chin, how the cheek bones project, or if their upper lip and bottom lip are balanced — then the treatment plan takes shape.” Depending on the patient’s desired results, each combination of neuromodulator and filler will be different, but the goal is typically to create a more youthful and refreshed look, without looking “fake” or overfilled. 

### **3. Chemical Peels + Ultherapy**
“Now, patients will bundle additional treatments into their routine Botox® and filler appointments,” says [Lesley Rabach, MD](https://lmmedicalnyc.com/), a double board certified facial plastic and reconstructive surgeon in New York City. Before the injections, Dr. Rabach’s patients often stack [chemical peels](https://aedit.com/procedure/superficial-chemical-peels) or [Ultherapy®](https://aedit.com/procedure/ultrasound-skin-tighteningultherapy) in one appointment, instead of coming back for these toning and tightening services later. With all these treatments at once, a patient can leave the office with skin that’s deeply exfoliated, plumped, and tightened. 

### **4. Laser Skin Treatment + Laser Hair Removal + Kybella**
Once the numbing cream is on, might as well make the most of it, right? Dr. Grawe’s patients often opt for laser skin treatments and [laser hair removal](https://aedit.com/procedure/laser-hair-removal) in one fell swoop. “We can do BroadBand Light treatments for brown spots, which are very popular during these wintery months when our tans have faded, then do laser hair removal with the same laser,” she says. On top of the laser work, patients can also add on facial fillers or [Kybella®](https://aedit.com/procedure/kybella) injections to melt excess fat around the chin, neck, and jaw.

### **5. EmSculpt + EmTone**
“For patients seeking body contouring, a common combination therapy we use in our office is EmSculpt and EmTone™,” says [Dendy Engelman, MD](https://aedit.com/provider/dendy-engelman-md-312), a board certified dermatologist in NYC. [EmSculpt](https://aedit.com/aedition/why-everyone-is-talking-about-emsculpt), she explains, is a non-invasive toning and strengthening treatment that uses electromagnetic energy to stimulate the muscles, causing 20,000 muscle contractions in 30 minutes — far more than possible in a typical exercise routine. That’s easy to combine with EmTone™, which uses targeted thermal and mechanical energy to smooth [cellulite](https://aedit.com/aedition/qwo-cellulite-injectable-treatment-fda-approved). “Combining these therapies maximizes the results in the areas treated by addressing the underlying muscles with EmSculpt and the overlying tissue with EmTone™,” she says. Since both tackle the body, it’s also easy to stack them on top of any facial treatments, making for a head-to-toe appointment. 

### **6. PRP + Microneedling**
“There are treatments that I combine for patients because they will actually see better results with the combination,” Dr. Engelman notes. One such combo is platelet-rich plasma (PRP) and microneedling. [PRP treatments](https://aedit.com/aedition/prp-and-stem-cells-are-changing-the-face-of-the-cosmetics-industry) utilize plasma from your own blood, spun in a centrifuge to concentrate the platelets, and then injected back into the treatment area (which can include face and [scalp](https://aedit.com/aedition/kourtney-kardashian-prp-injections-to-treat-hair-loss)) to trigger the body’s natural healing process and boost collagen production. [Microneedling](https://aedit.com/aedition/difference-between-professional-microneedling-at-home-dermarolling), meanwhile, uses a device made up of fine needles to create micro-wounds in the skin, which also stimulates collagen growth and can improve the appearance of scars and wrinkles. [PRP and microneedling](https://aedit.com/procedure/microneedling-with-prp) work well together, she says, because “the micro-injuries to the skin from microneedling heal will more quickly thanks to the growth factors in our own PRP.”

### **7. Eye & Lip Surgery + Jawline Contouring**
“There has been a surge of patients who are opting for more than one surgical procedure at once, so as to have the same surgical downtime and healing process,” Dr. Rabach shares. She routinely performs [blepharoplasty](https://aedit.com/aedition/what-its-really-like-to-get-eyelid-surgery-blepharoplasty) on the upper *and* lower lids to address drooping eyelids. “Many patients who once would opt for either upper or lower blepharoplasties are now having both done at the same time,” she says. She’s also had patients combine eyelid surgery with [lip lifts](https://aedit.com/aedition/lip-lift-procedure-instead-of-lip-filler) and [jawline contouring](https://aedit.com/aedition/8-ways-to-get-a-more-defined-jawline), all of which require [local anesthesia](https://aedit.com/aedition/everything-you-need-to-know-about-anesthesia). 

## **The Takeaway**
As you can see, some of these combinations work together for one desired result, others tackle different areas of the body, and some put numbing cream to good use. While our experts have seen high levels of patient satisfaction with the pairings above, think of your appointment as a chance to choose your own adventure. Talk to your own doctor about how to stack and combine treatments to best serve your aesthetic goals and needs.

To help you make the most of your time with your aesthetic provider, we asked the experts how to safely stack skin, face, and body treatments for maximum results in minimum time.