How to Avoid A Bad Face: How to Avoid Buyer’s Remorse After a Facelift, Laser, Filler or Botox

How to Avoid A Bad Face:  How to Avoid Buyer’s Remorse After a Facelift, Laser, Filler or Botox

You are starting to see some things that make you unhappy.  You’re thinking of getting some plastic surgery –surgical or non-surgical but what is the right way to find the right doctor and right treatment?  There are many, many options today for treatment and provider.  That is a good thing, having options but the greater the choices, the tougher the decision-making.

How should you start?  Look at qualifications and experience.  There are four specialties that have formalized didactic and clinical training in aesthetic treatments.  Plastic surgery, facial plastic surgery, dermatology and oculoplastic surgery.  These are the fields with known training and known experience.  That is basically the prerequisite then followed by clinical practice for refinement of techniques and predictability of results.  A good place to look is online at The American Board of Plastic Surgery, The Aesthetic Society and your state licensing body to verify a valid medical license.  This is just a matter of verifying the validity of credentials.

Next, pick an individual doctor who is a good fit.  Realism is important.  Do you want guidance mostly from the doctor or more of a partnership in care –learning about options and deciding together?  Some patients really want to rely on the doctor to decide.  Other people are more consumerist and want to understand the options and partner with their provider.  Do you have a good feel for the plastic surgeon’s honesty and technical excellence?  Do you want a leader -a chairperson, researcher, or lecturer?  This provides expertise in particular areas but perhaps less availability.  You have to decide what your priorities are.  In the end, it is all about experience and results.  No one can guarantee a result with any particular treatment and whether a given result will make you happy is a lot about state of mind.  There is no one right provider for everyone.  Matching personalities and styles is necessary since you will be working together to restore and maintain beauty and need to be the right fit.

What treatment is right?  Do you want an expert in the latest new treatment?  New technology  is great and often adds an important new option.  I do a lot of new technology research and am typically familiar or even expert with new options as they come on the market having worked with them for a few years during development.  Some of these options are revolutionary, really a significant step forward.  Others are evolutionary, refinements of older options to help optimize them or improve them in some fashion.  No one option is a panacea or cure-all for all patients.  What is right for you may be entirely different than what is hot or touted in media as an amazing fix.  Patients come in all ages, shapes, sizes, skin colors and personal preferences. A new technology, even if really important or useful, is never a fit for all variations of clinical needs.

Finding  a provider who will listen to your concerns and treatment preferences will increase the likelihood of making your beauty dreams come true.  But also listen to their suggestions.  Surgeons know what can reasonably be expected and what techniques work best in their hands to get there.


Too much of a good thing:

Plastic surgeons and plastic surgeon patients are perfectionists by temperament but we must accept that we never achieve perfect in practice –in anything in life, not just plastic surgery.  A natural look is, in my view, essential.  The common sentiment that if a little is good, more is better is definitively not true for plastic surgery and aesthetic medicine.  It’s more like Goldilocks and the Three Bears –not too much, not too little, just right.  There are a few typical ways to overdo things:  doing a treatment too often –a lot of tissue trauma with no time to the skin to heal between treatments.  Doing ttoo much is another problem –can look overbuilt or unnatural –most treatments have limits to how much correction can be obtained short of 100%.  We have to accept this or we will end up looking unnatural or having more complications.  Too many types of treatments –too much at once is bad.  Multimodality treatments often enhance the degree of correction that can be obtained or address multiple aging changes that simultaneously need improvement.  But too much can be unnecessarily traumatic or distorting.  Finally, using a treatment to address a problem it was not designed for will be unlikely to meet your goals and pushing a treatment harder to make it do something it is not intended for greatly increases the risk of complications and an unnatural look –a bad place to go.

The artistry of the provider is important.  It’s not simply what treatment you select insuring a great result.  The technologies are merely tools in the hands of the provider.  A simple example is putting a paint set in the hands of a grade schooler versus a master painter like Rembrandt.  Either way you’ll get a painting but they won’t be the same quality –the master painter has years of experience, acquired skill and will invest much more time and attention to the final result.  The quality of the painting will, of course, be affected by the quality of the paint but much more so by the skill and artistry of the painter.

Too little of a good thing:

Underdoing treatments is another way to predictably be disappointed.  If you do one treatment out of a series of 3, an inadequate response will be obtained.  If a result could be produced in one treatment 3 would not be routinely provided.  Before you commit to a series be sure you are willing to complete the suggested amount.  Filler is similar.  Undertreating a feature or area with too little filler or trying to treat multiple areas  with a single syringe of filler will predictably produce a limited correction.  As we age, the severity of the features increases requiring an increase in the amount of filler used or number of treatments required.  There is still often great benefit in improving appearance to be obtained without resorting to surgery or recovery based treatments but more is likely to be required.  A person in their 40’s may often be able to treat one or two features with a single syringe of filler.  A person several decades older is likely to need more volume.  Under-doing things is predictable failure.  If you are not able to do what it takes based on what the plastic surgeon suggests, save the waste of time and money that results from just trying a little.

Overall, making your beauty dreams come true is about focusing on what features bother you, being analytical and specific.  Then, partner with your plastic surgeon to select the best option.   We need to actually take a critical look at ourselves rather than going by our mental impression of how we look, which is more based on how we looked in our 20’s than the reality of today.


A promised result that sounds too good to be true probably is –be realist.

A provider who isn’t listening carefully to your concerns is unlikely to successfully address them in treatment.

Compromise is OK as long as you are aware of the tradeoffs and decide it is the best fit.

The Goldilocks Principle is controlling in getting to the sweet spot of maximum improvement with the least possible intervention –not too much, not too little, just right.



Doreen Wu (00:00):
Welcome back to Park Avenue Plastic Surgery Class, the podcast where we explore controversies and breaking issues in plastic surgery. I’m your co-host Doreen Wu. And I’m here with Dr. Lawrence Bass Park Avenue plastic surgeon, educator, and technology innovator. We have an exciting episode in store for you today. The title of this episode is “How to Avoid A Bad Face: How to Avoid Buyer’s Remorse With A Facelift, Laser, Filler, or Botox.” We all have a few beauty projects on our wishlist. For some, it might even be more than a few, regardless in order to make our beauty dreams come true. We need to ask the question. What’s the best way to approach things. How do we get to the right doctor and arrive at the right treatment to get what we want?

Dr. Lawrence Bass (00:51):
It’s a tough challenge to go down this pathway and come out successfully. Uh, the nice thing is there are many, many options today, and there are many, many providers, but that also creates challenge to find the right answer and the right option. So to make your beauty dreams come true or as close to it as possible with the current state of the art is a real job that requires some commitment and time upfront so you don’t wind up frustrated, sad, broke, or even worse. Just looking bad. That of course is the last thing we want. When we do any kind of plastic surgery treatment or procedure, the goal is to get you looking better. So the first consideration is how to pick the right doctor and that’s really about qualifications experience and verifications that those qualifications are real. There are several different specialties that as part of their baseline training have formalized didactic and clinical training in aesthetic treatments and procedures.

Dr. Lawrence Bass (02:09):
These are called the core four specialties, plastic surgery, dermatology, facial plastic surgery, and oculoplastic surgery. There are other providers who did not formally train in aesthetic treatments that have picked up the treatments later. And some of those individuals can really be excellent, but it’s harder to know what experience they had that made them qualified to do the treatments and whether that was a lot of experience or a little experience, even after that training, having experience in clinical practice to refine your techniques and get predictable results is really important and makes a big difference. Finally, there are a few providers out there who are either putting up a credential that doesn’t really represent something significant, like a board certification. That’s not from an accredited board or that just have out now fraudulent qualifications. Now the nice thing about that is nowadays with the internet, it’s easy to go on the state licensing website for medical licenses to go to the board website of the American board of plastic surgery and see if that person in fact has an active, valid license. See if that person is board certified and has maintained their certification in the specialty, you believe them to be providing.

Doreen Wu (03:49):
Okay. It sounds like there are a lot of excellent qualified providers out there. And part of the onus is on the patient to go out there and research and see which provider has the qualifications and the experience necessary. How can I tell which doctor is going to give me the results that I want and actually make me happy?

Dr. Lawrence Bass (04:11):
Well, that’s really a loaded question, Doreen. I mean, happy is a state of mind and it doesn’t really relate to any particular technical qualification. But there are some questions you should ask when you’re looking for a provider. And as you start to meet them to see if they’re in fact the right fit for you as an individual, because there are many providers who are really excellent at what they do, but you are not going to enjoy working with them better to find somebody that you can partner with for the long term, who’s going to take an approach that you find comfortable. First thing is I always like someone who is real about what the treatments are. So there are real world treatments, which help, but are not perfect and there’s no magic wand treatment. Some people are looking to be told they’re going to get the magic wand treatment that everything’s going to be perfect.

Dr. Lawrence Bass (05:08):
But of course that doesn’t really exist. When you look for a doctor to work with some people want someone who will tell them what they need. They’re not comfortable partnering in the decision-making. They want the expertise of the doctor to supplant their view of what is good or bad about their appearance. And that’s okay if that’s who you are as a person. And you want a doctor who will just guide you through the process. That’s okay. Other people want to partner in the decision-making with their, with their doctor. And that’s sort of a consumerist approach. That’s an approach that I take in my practice. And I tend to like people that read, have information and want to understand what’s happening so that we partner together to make a decision amongst all these different options that are available nowadays, which decision is the right one for you as an individual, of course you want someone who’s honest, who’s going to give you an honest and real world answer, someone with technical excellence.

Dr. Lawrence Bass (06:18):
Some people look for leaders, a department chairman, or a very notable plastic surgeon who lectures quite a bit. I spend a lot of time doing research and lecturing and there are pluses to that. That means I’m a super expert in certain things, but there are also minuses on out of town part of the time and not as available as a local plastic surgeon who doesn’t spend time in academic activities. So there are trade offs there to having someone who’s a high flyer, so to speak. And then you have to decide how much of a priority is having a lot of experience. And of course the priority always has to be about the results because this is about getting good results and looking better at the end of the day,

Doreen Wu (07:13):
It seems like there’s no one right provider for everyone. It really depends on what you’re looking for. That leads me to my next point. How should I go about picking the right treatment or procedure? I read about all of these great new things in beauty and fashion magazines and on the internet. Sometimes I wonder if I should be looking for a provider who is an expert in the latest new thing I spotted, but then I get overwhelmed by all of the choices and information. Tell me how can I sort through this?

Dr. Lawrence Bass (07:43):
Well, new technology is great, but it’s not always the right answer for your individual problem. I do a lot of research in developing new technologies and figuring out how to apply them. So I like new technologies, but I like to pick what’s best for the individual patient. Not necessarily what’s new. Some new things are revolutionary. They really change what we’re able to do for people. And a lot of new things are just evolutionary. They’re similar to what we did before, but a little bit refined. So we like that, but that doesn’t magically transform what we can do for people. I think the most important thing is to pick a provider who listens to you and hears your needs. That’s your best bet to get your beauty dreams to come true because if the provider doesn’t hear what you’re looking for, or if you are just chasing down a hot new technology, then you’re, you’re more likely to pick a procedure. That’s not going to really give you the best result or really drill in on the problem you’re trying to solve. Uh, it’s always a good idea to be open to what providers suggest plastic surgeons, um, each have their own approach and they know what they can best do, which may be different from what another plastic surgeon does for the same problem. But both surgeons may get great results.

Dr. Lawrence Bass (09:24):
So that’s, that’s an important point. And, uh, as long as we’re realistic about what the limits are for each treatment, because we’d like to make everything completely back to the way it was when we were 20, but we’re not able to do that with most of our treatments, although we can make really substantial improvements that are very worthwhile. Everyone hears that and they say, oh, I don’t need to be 20 again. But what that means is the future you don’t like that you are spending the time, the money to correct is better, but it’s not all better. Some of it’s still going to remain. So that’s what I mean when I say realist.

Doreen Wu (10:08):
Speaking of limits, it’s really easy to look over done. We’ve all seen the photos of people who go a little overboard and have too much done or who no longer look real or like themselves. It almost makes me want to opt for the safe route and do the simple treatment to avoid any inconvenience. And then there’s that balance between not doing too much, but also not doing too little. It feels like I’m being asked to control my diet without knowing how many calories are in the food itself. I’m curious in your opinion, what’s the best way to avoid doing too much? How can I create the look I want, but keep it subtle enough so as to not warrant unwanted attention after all, I want people to admire my appearance, not criticize them.

Dr. Lawrence Bass (10:56):
Yeah. This is a critical issue. Um, and it’s an American sentiment that if a little is good, more is better. And of course that’s not always true. And very often in plastic surgery, it’s not true. The way people get into trouble is by doing treatments too often. That’s bad for a number of reasons because it’s a lot of trauma to your tissues. Uh, there’s a standard typical increment of time between treatments and when you’re doing it considerably more frequently, you’re risking looking overdone and starting to create tissue damage. There’s doing too much. Again, if a little is good, more is not necessarily better. But we want to push as hard as we can get as much correction as we can while looking perfectly natural. But there’s a point where we have to accept that we’re not yet perfect. As we said, every treatment leaves a little bit of under correction by doing more.

Dr. Lawrence Bass (12:08):
We don’t get more perfect. We just start to look unnatural. So it’s natural to want the most correction we can get, but we have to accept a lack of perfection. This is a hard thing for plastic surgeons and plastic surgery patients, we’re all perfectionists by temperament or we wouldn’t be here, but this is a reality of life, not just in plastic surgery, it’s universal and we get into trouble when we push too hard. Some people do too many types of treatments. They’re putting energy and fillers and, and skin products and needling and all kinds of things in the same skin at the same time. Now multimodality treatments in proper amounts are actually a really good way to maximize the clinical result. But again, too much at once in the same place is another way to look overdone.

Dr. Lawrence Bass (13:08):
Also the last two things I want to mention is, you know, each treatment has its expected intended result. And if that’s what you’re hoping to get out of the treatment, you’re likely to succeed. But if you’re hoping for something that the treatment is really not designed or intended to do just by pushing harder with it, almost for sure, you’re going to look unnatural and you also increase the risk of complications. So that’s a bad place to go. The final thing is the artistry of the provider is really, really important. It’s not just that filler is good or filler is bad, but it’s how skillfully it’s applied. And that frankly makes a really big difference. And a simple example of that is if you gave a paint set to Rembrandt or a paint set to a seven year old, either way, you’d get a painting, but the paintings are really not going to be the same quality. And that’s not really the fault of the paint. It’s the fault of the artist.

Doreen Wu (14:10):
That’s a great metaphor and that’s really sound advice about how to rein things in, but now I’m worried what if I’m not doing enough to look my best,

Dr. Lawrence Bass (14:20):
This is much tougher. There’s much more variability here and there’s no bright line between what’s good. And what gets you into trouble? Different factors affect how much you’re going to choose to do your budget, how your beauty thermostat is set. You know, how much of a beauty issue makes you upset, uh, exactly where you are in the progress of aging and your lifestyle and capability to spend time and recovery time, uh, for various treatments still, there are a few keynote ways that, that people perennially underdo things, uh, and get an inadequate result. And you know, that’s, that’s typical. If you do one laser treatment, when it’s typically done as a series of three or four, predictably, you’re going to get an inadequate result. If you could get the result in one treatment, people wouldn’t be recommending four. So it’s really important to accept that upfront.

Dr. Lawrence Bass (15:30):
If you commit to do that series, you’re not going to get where you want to go. If you don’t complete the series, the same idea with filler, you know, if you’re 30, 35 years old, you may only need a small amount of filler. But if you’re 50, 60, 70, 80 years old, the volume of filler that’s going to be needed to create an adequate correction, is predictably going to be greater? So underdoing things is predictable failure. If you can’t do what it takes, avoid the waste of time and money of just trying a little. You see the same thing with surgery. Sometimes a 75 year old will come in and say, uh, they, they don’t really think they need a facelift or a neck lift yet. They just need a little skin tightening. Well, at that stage, they’re not really a good candidate for a lot of the energy based treatments, because skin tends to be less responsive.

Dr. Lawrence Bass (16:32):
And most people, if they followed average aging actually have more than enough laxity that they’re a good candidate to benefit from a surgical lift. So it’s important to understand what features of appearance bother you, be analytical and be specific and then partner with your plastic surgeon to figure out the best option. Unfortunately, our body image is fixed in how we looked in our late twenties. So when we picture ourselves, that’s what we’re seeing in our mind’s eye. And if we’re 50 or 60 years old, we know we don’t look that way anymore. But when we think about ourselves, we still think that same appearance. So we have to accept that we’re not in that place anymore. And if we want to make a positive change, we have to look realistically at what our appearance is like to the outside world.

Doreen Wu (17:30):
So Dr. Bass, now that we have explored some common pitfalls that patients encounter in plastic surgery and how to prevent them, what do you think are the most valuable takeaways for our listeners from today’s episode?

Dr. Lawrence Bass (17:43):
Well, again, in, in picking a provider, it’s always good to remember if a result that’s promised is too good to be true, it’s probably not real. If a provider’s not listening to your issues and your perceptions, they’re probably not going to focus and drill in on a treatment that’s appropriate for correcting it. It’s okay to compromise with treatments as long as you’re aware of what the trade offs are in that compromise. And I like the Goldilocks principle overall, not too much, not too little, just right. A good provider will help you hit the Goldilocks sweet spot for your individual needs and circumstances.

Doreen Wu (18:32):
This is Doreen Wu, thanking you for joining Dr. Bass and me for this discussion of how to avoid buyer’s remorse with a facelift laser filler or Botox. Be sure to check out our next episode, where we discuss doctor shopping and the pitfalls of switching doctors for each treatment or getting too many second opinions.

Speaker 3 (18:52):
Thank you for joining us. In this episode of the Park Avenue Plastic Surgery Class podcast with Dr. Lawrence Bass Park Avenue plastic surgeon, educator, and technology innovator. The commentary in this podcast represents opinion. This podcast does not present medical advice, but rather general information about plastic surgery that does not necessarily relate to the specific conditions of any individual patient. No doctor patient relationship is established by listening to or participating in this podcast, consult your physician to advise you about your individual healthcare. If you enjoyed this episode, please share it with your friends and be sure to subscribe to our podcast on Apple Podcasts, Google, Spotify, Stitcher, or wherever you listen to podcasts.

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