Plastic surgery and cosmetology are moving forward by leaps and bounds. Ten years ago, going for a fresh face was a feat. And today they go for Botox as easily as to the dentist, and go under a scalpel without any dramatic thoughts. What to do if the new face does not suit the client? And is new always better than old? Who is to blame, the doctor or the patient, when the latter does not like the reflection in the mirror? Industry leaders answered Forbes Woman's awkward questions.

Ruben Adamyan

Deputy Chief Physician for Plastic Surgery at Clinic +31, Doctor of Medical Sciences, Professor

Aesthetic surgery deals mainly with the problems of rejuvenation. Procedures such as lifts, liposuction, correction of the shape of the nose, ears, eyes can last up to 5-7 years.

In order not to be disappointed with the result, you must immediately turn to good specialists - with an academic degree, from an academic environment. Our clinic employs doctors who have completed the school of Academician of the Russian Academy of Medical Sciences Nikolai Olegovich Milanov, one of the founders of plastic surgery, laureate of the USSR State Prize.

At first glance, most aesthetic operations are extremely simple, but the lack of medical experience and knowledge often leads to the development of complications and “acquired deformities.” One of the activities of our department is correction of the consequences of previously unsuccessful plastic surgeries. We have developed a technique that reduces the risk of complications after such popular operations as face lift or forehead lift.

Complications occur in any area of surgery. In general, the doctor must explain to the patient during the consultation what awaits him, without concealing possible negative consequences.

Patients often confuse complications with side effects. Complications are inflammation, unsuccessful healing or even tissue death, and side effects are bruises, swelling, redness, which disappear after the rehabilitation period. From our point of view, the safety of the procedure and reduction of rehabilitation time are the main thing in plastic surgery.

Eteri Kriheli

General Director of the Klazko Group of Clinics

First, a woman needs to understand for herself what she doesn’t like about her own appearance. Wrinkles around the eyes, drooping eyelids, double chin, age spots - each has its own problems. But often people come to see a doctor with the words “I’m already 45, I need to do something.”

It is better to contact a cosmetologist first, rather than a plastic surgeon: today there are many methods and technologies that are alternative to plastic surgery (“alternative” does not mean “complete replacement”). Minimally invasive surgery, which is close to cosmetology, is very relevant. If previously many people had a facelift at the age of 40, now at the age of 50 they use minimally invasive methods: mesothreads, ligature and endoligature lifting. They are performed under local anesthesia, and the rehabilitation period is reduced to 2-3 days instead of the traditional 2-3 weeks.

There are clients who believe that it is better to undergo surgery once than to constantly undergo procedures. But for a good effect, in any case, you need a regular comprehensive approach. It is necessary to maintain and strengthen the skin at the first signs of sagging. We offer physiotherapy, hardware procedures that stimulate the synthesis of collagen fibers, mesotherapy, plasma therapy and much more. If you start doing this on time, a good doctor will schedule the procedures so that you will need to go to him not once a week, but approximately once every 3 months.

Of course, it’s bad if it’s clear that the patient had surgery, and even worse if the face has become unnatural. But often the patients themselves are to blame for this: they cannot stop or set an impossible task for the doctor. In this case, the doctor should not follow their lead. With contouring, there are no irreversible changes that change the face beyond recognition. The sutures dissolve, the swelling goes away.

If you do not get the desired result or think that your face has been ruined, consult the same doctor first. A good clinic will find additional specialists and offer adjustments. It is worse if the patient goes to another place where the doctor does not know either his characteristics or treatment history.

Legal claims brought against plastic surgeons in 70% of cases are due to a subjective assessment of the result. Then a medical commission is convened, which analyzes the treatment from a medical point of view, but not from an aesthetic one. Like or dislike is not a legal factor. So it is wiser to resolve controversial issues with a doctor than with a judge. By the way, now good clinics have their own lawyers who will advise the patient on what to do.

I do not recommend calling a cosmetologist or plastic specialist to your home. Some wealthy ladies who have expensive bags and dresses suddenly have a desire to “save a penny” on Botox injections and on their own health. The danger is that no one asks people who come to your home “on the recommendation of a friend” for certificates, and often they are not even doctors: good specialists do not go door to door, they see people in clinics.

Alexey Litvin

Chief physician of the Lege Artis aesthetic medicine clinic, plastic surgeon

Who should I contact if I want to “refresh my face”? A cosmetologist will usually recommend a cosmetic procedure, and a surgeon will usually recommend surgery. But cosmetology and plastic surgery are not an alternative to each other:

in cosmetology they work with skin quality, and in surgery - with quantity. The optimal consultation option is a simultaneous meeting with a plastic surgeon and cosmetologist. This is possible in our clinic. An integrated approach really helps to rejuvenate the face, and not just remove excess skin.

At the initial consultation, the doctor assesses the client’s psychological state and her readiness for the consequences. Surgery is not always necessary. Sometimes the surgeon simply has to talk her out of it. Firstly, a person breaks out of his usual rhythm: for a working woman, even three days of absence from work is a lot. Secondly, the patient cannot count on a solution to all her problems, often psychological: we, doctors, do not create a new appearance and a new life.

After surgery, bruises, stitches, and swelling inevitably remain for the first time. Frank discomfort is felt for the first week, then the condition improves. But for some, a temporary period of disappointment sets in. An experienced surgeon is always ready for this, and carries out the main work with the patient before the operation, and not after it, warning about all the consequences, including psychological ones.

We make sure to take photos in all projections before the operation, because people then forget how they came to us and do not notice changes in appearance. These photos demonstrate everything clearly, after which patients begin to sincerely thank the surgeon.

Unfortunately, among doctors there are also “storytellers”. And how many advertisements are based on the denial of surgery: “painless”, “without visible consequences”! An unscrupulous doctor often sees his task as obtaining the patient’s consent. But if you are immediately pulled onto the operating table, you need to urgently run. Real information about the qualifications of doctors is posted on the website of the Society of Plastic Surgeons (OSPS). And another important point: the doctor himself should be pleasant to you as a person.

Avicenna Abdulmajidova

Chief physician of the ART-Clinic plastic surgery and cosmetology clinic, plastic surgeon, Candidate of Medical Sciences

When turning to plastic surgery for the first time, I think it is best if the patient first consults with several specialists. And he won’t discount word of mouth.

If you come to a clinic, and not to an expensive beauty salon, then it is not so important who to consult - a surgeon or a cosmetologist. Surgery has become a combined profession that uses minimally invasive techniques. A cosmetologist works with the quality of the skin, and a surgeon works with the geometry of the face. It is the surgeon who sees what your face will look like in a few years and whether plastic surgery will be needed.

A good clinic should be academic: for example, “ART-Clinic” was created on the basis of the Research Institute of Neurosurgery named after. Burdenko, and its founder, professor, doctor of medical sciences, plastic surgeon Alexander Nerobeev still performs operations.

Indications for a particular procedure are determined exclusively during a face-to-face consultation; the doctor must talk with the client, and before, and not after, the operation. Computer prediction is used in maxillofacial surgery, but for soft tissues its reliability is no more than 30%. The result will not be as expected.

What you can expect for sure is bruising and swelling. These are not complications. You need to be prepared for such consequences within two weeks. The rehabilitation period is about three months, and this is not a reason for frustration. The scarring process can last up to 6–8 months, and the doctor’s instructions must be strictly followed. After all, even a brilliantly performed operation is only half the result. The other half depends on following rules derived from experience. For example, you need to use sunscreen, otherwise your skin may become scarred. Or go to physical procedures prescribed after surgery, which many patients consider unnecessary.

The patient should generally feel that he is being watched. Even the doctor’s phone number can become support: the patient just needs to be able to call, this does not mean that he will do it all the time.

Vladimir Zlenko

Plastic surgeon at the Beauty Trend Clinic of Aesthetic Medicine and Plastic Surgery, Candidate of Medical Sciences

People come for consultations with different psycho-emotional status, with different levels of internal readiness for plastic surgery. Sometimes we conduct a joint consultation with a cosmetologist. But if individual fragments of the skin “sag”, more than just injections are needed.

Today, minimally invasive methods (for example, mesothreads) are popular in surgery, giving an effect similar to a facelift. Traditional lifts (braces) have not disappeared anywhere, but they have also changed: the surgeon works not with a scalpel, but with an ultrasound machine - this is less traumatic and shortens the rehabilitation period.

Rehabilitation is necessary for any operation. Within two weeks, some sutures are removed, others dissolve on their own. But this is not the final result: further the volume of tissue will be redistributed. That is, add to the rehabilitation period the time during which the “new face” takes its final form. Seals can resolve within 1.5–2 months. At the same time, to improve the result, we can add hardware procedures.

As for liposuction, after it you need to wear compression garments for a month. The patient should be prepared for long-term work on his appearance, and not plan flights, business trips or active recreation the day after surgery.

In the event of a medical error (for example, muscle injuries), the surgeon should not abandon the patient. True, for some time, for medical reasons, it is impossible to interfere with the healing process; it is necessary to use hardware techniques. This “forced non-intervention” can last up to 4–5 months. However, hundreds of facelifts are performed every day in Moscow, and cases of failure are rare.

In our business it is difficult to guarantee anything at all. Therefore, trust in the doctor and the desire to cooperate with him are one of the most important things for the patient.

Text: Alena Voytenko

If the new face doesn't suit you