Beth Kender’s first experience with Botox delivered humdrum results. She had injections to reduce the fine lines under her eyes. A local dermatologist recommended it—along with facial peels. “Neither produced notable results,” says Kender, who lives in Wayne. “Nothing terrible happened, but nothing great happened, either.”
A year later, Kender went to Bryn Mawr Dermatology’s Dr. Christine Stanko—who also used Botox, but in a different way. Kender was so thrilled with the outcome that she asked Stanko about her nasolabial folds—so-called laugh lines. Again, her doctor had a distinct approach, using Botox in the jawline and filler in the cheeks.
“I was ecstatic,” Kender says. “My face immediately brightened and lifted. People told me I looked great, but they couldn’t pinpoint what was different because it looked so natural.”
How could Botox produce such vastly dissimilar results? “Sometimes, it’s not the paint but the painter,” says Stanko.
Or, patients ask for one procedure or brand-name product when what they really need is something else entirely. Eyes are a great example, Stanko says. Patients may complain about the wrinkles around their eyes, but they actually could use filler in their cheeks.
They’re the trendiest targets of cosmetic enhancement—but over-plumping the lips creates an unnatural look. “You have to consider the person’s facial bone structure,” Stanko says. “You can’t put big, plump lips on a face that won’t tolerate it.”
And yet, many people do just that—and they often come to Stanko for damage control. “Some people buy a whole syringe of filler and want to use it all, but that doesn’t always create a better result,” she says. “Baby steps are the way to go. We can always add a little more.”
Less is also more with breast enhancement. Most patients request a much larger cup size than necessary. To make sure patients know what they’ll be getting, Dr. Paul Kim sends them home with a special bra and sample implants in various sizes. “Patients who told me they want a DD usually end up with a C cup,” he says. “Generally, they go up two sizes.”
Kim spends a significant portion of his time on breast revision, fixing problems created by other plastic surgeons. Asymmetry is one of the most common mistakes he sees at Plastic & Reconstructive Surgery of Chester County. One breast could be higher, or both might be too high or too low. Many times, the botched work was done by surgeons who aren’t board-certified. In some cases, they aren’t surgeons at all. Kim has had patients whose original breast enhancements were done by gynecologists and dermatologists. Breast implant companies now offer lifetime warranties, so some patients can get financial help toward corrective surgeries.
Revision rhinoplasty is a specialty of Dr. Mark Ginsburg of Providence Facial Plastic & Cosmetic Surgery. “Preserving the natural architecture of the nose while making a cosmetic change is the goal,” he says. “Cutting away too much cartilage is a recipe for disaster. The more you distort the anatomy of the nose, the more chance there is of scar tissue forming.”
That tissue can pull and contract the skin, creating ripple-type wrinkles and other malformations. “How patients heal is important, but so are the maneuvers we’re using,” Ginsburg says.
Much has changed from the days of one-nose-fits-all rhinoplasties, when patients requested thin tips and surgeons complied. “Now, people realize that’s not a natural look,” Ginsburg says. “Plus, overly pinched tips can cause trouble with breathing. Functionality is first, cosmetic is second.”
When it comes to healthy skin, functionality and cosmetic appeal also go hand-in-hand. “Large pores, facial redness, dyspigmentation, sagging skin, and fine lines and wrinkles are the five signs of aging,” says Dr. Eric Bernstein of the Main Line Center for Laser Surgery.
Lasers can go a long way toward reducing those. But Bernstein has seen the disappointing results when the wrong lasers are used. He has more than 30 lasers; many doctors have only one or two. “If you only have a hammer, everything looks like a nail,” he says. “I see patients whose previous doctor clearly used the wrong device—or the right device was used in the wrong way.”
Emily Meyers is a big fan of lasers. “If you want to look natural and kick your skin’s butt, use lasers,” says the Paoli resident.
Over the past six years, Meyers has had 12 laser sessions at Bryn Mawr Dermatology. “The recovery is not cool,” she cautions.
But Meyers has seen significant changes in her skin. It’s healthier and more youthful looking. She’s also had Botox and filler injections under her eyes and in her forehead, lips and cheeks. Her best advice: Do one thing at a time. “People look crazy when they do a ton of stuff all at once,” Meyers says. “You can turn back time—just do it slowly.”