You want them to be HOW big?

By Gregory A. Buford, MD FACS

Gregory A. Buford, MD FACS When I was asked last year to describe the Before Baby Body makeover, the economy was slowly heading into a deep recession. At that time, many were noticing a drooping of the economy (so to speak) but the proverbial stuff hadn’t yet hit the fan. And then it did. And when it did, a majority of Plastic Surgeons noticed a steep drop-off in the number of patients asking for comprehensive makeovers worried more about losing their homes than losing their lovehandles.  In my practice, the makeover patient soon became replaced by the breast augmentation and BOTOX Cosmetic patient and I noticed a substantial shift in not only the number of surgeries and procedures I was performing but also in the type. Shorter surgeries and less invasive procedures became the norm nationwide and the Before Baby Body Makoever became less sought after.  In essence, there was a national reshuffling of priorities and suddenly a lax abdominal wall and drooping breasts didn’t seem such an emergency as they did the year before. 

But now the economy is showing signs of improvement. And with it, the protective cocoons that many of us walled ourselves in for over the last six months are slowly being taken down and the Before Baby Body is slowly gaining ground once again. And along with this desire for transformation, the makeover seemingly has been transformed itself, as well. Several of the less invasive procedures such as BOTOX Cosmetic, fractional laser resurfacing, facial fillers, and medical skin care are now being requested along with traditional body contouring and breast enhancement combinations. A changing appetite for less invasive rejuvenation has now been effectively blended with surgery to create an even more dynamic and more effective approach to whole body rejuvenation. 

And so Before Baby Body Makeovers have been changed forever…but this is a good change and one that will no doubt bring even greater satisfaction to our patients. 

“So Doc, what would you do?”

I am continually asked this open-ended, carte blanche question by Baby Boomer female patients. Looking to refresh themselves, most are unsure of exactly what they want. Yet, they know they can look better and they’re willing to pay for it. Many of these patients had kids and were left with breasts that somehow didn’t make it through pregnancy without a little droop and shift in volume. Many were also left with tummies that just don’t look the same in that two piece bikini and with that big vacation coming up, they simply need to optimize. Others look in the mirror and don’t recognize the face staring back at them. While they may be happy inside, their folds and hollows suggest otherwise.

So where do you start? As a plastic surgeon, my job is not only to accomplish great results but also to figure out what results these patients are actually looking for. So many times, my role is less surgeon than mind-reader, sculptor and counselor. Most are looking for something that has been lost along the way, but want to do so in a way that will not make them feel uncomfortable or altered. They are vocal about wanting to achieve results that none of their friends can detect, but when it comes right down to it, even the most conservative client actually doesn’t want upgrades that aren’t noticeable. They want a result that looks natural. They want that handbag that no one else has and they darn well want to show it off to everyone. Generally they do too.

My epiphany when I began practicing Plastic Surgery was the fact that I wasn’t the only one to view my patients’ results full scale. Their friends were privy to every nip and tuck as well, and these unveilings were literally being performed with bravado at cocktail parties and other public gatherings. It was then, when I realized that every post-op patient exiting from my door was literally a walking billboard advertisement of my results—displaying a clear and stated message of what I as the surgeon thought was a good result. I had to take a hard look at the message I wanted to send out into the local community about my idea of rejuvenation. Achieving more optimal form was simply not going to cut it; I needed a branded look and feel that would meet my patients’ needs and, at the same time, showcase and define my abilities.

When I meet a patient for the first time, the initial consultation covers multiple levels. My first goal is to listen to what this person says they want. My next is to figure out what it is they really want. The second part is not always easy.

Breast enhancement is usually the trickiest. Everyone one of my clients says she doesn’t want her breasts to look like she’s had anything done. Yet the size of the implants most women choose are anything but conservative. It doesn’t matter which age, background, character the patient is…all of them seemingly want to go bigger after surgery. The biggest challenge I have as a surgeon is to address my patient’s needs while staying true to my own. Choosing too big an implant, no matter what the patient says, sends a clear and simple message to all of her community of friends that Dr. Buford likes big breasts and wants all of his patients to have big breasts. That is simply not the case.

Breast enhancement is easily one of the most powerful ways to transform the look of a woman’s body. Too small an implant and the breasts are lost and out of proportion with the hips and buttocks; too big and they become the single object of focus when she walks into the room. Done correctly, they can transform her torso and achieve proportion in even the most demanding of fashions. The right size can slim a figure and restore proportion to the entire body. And it doesn’t stop there.

No other procedure has such a dramatic effect on a woman’s confidence as breast enhancement. Plastic Surgeons often remark that this seemingly simple endeavor always results in a tan. And it generally does. My patients can’t wait for that next sunny vacation when they can unveil the proverbial goods and show the rest of the world that they are back in the game, taking no prisoners. If you think enhancement is simply for the vain, cowardly, and weak of spirit, think again. It was only after I performed breast augmentation on a minister’s wife that I realized this seemingly simple procedure had hit the mainstream. The end goal was not about bigger breasts; it was about gaining back something that was lost and doing so with bravado and acceptance that clothing was never going to fit the same way again…in a good way!

Another area of focus is the face. While I no longer do face lifts or noses, in the last few years my patient population interested in minimally invasive facial rejuvenation has absolutely exploded. Many are looking to wipe away wrinkles from that last bad relationship or facial damage from a few too many jaunts to Miami Beach without sun block but they want to do it without looking “done”. In this area, less is more and more can be catastrophic. While most women would choose a larger cup size, few are so cavalier about results of their fillers, injectables or resurfacing. The face is an entirely different animal and must be treated as so. Results in this area must be more subtle and blended to look as if nothing was done…yet at the same time should illuminate a specific feature that was previously hidden or softened by time.

I like cheeks. Cheeks are the bridge between the eyes and the jawline. And while the eyes are the window to the soul, cheeks are the means to view them. By adding just the right volume to the cheeks, the eyes become more properly framed and the entire rest of the face softened. One procedure I use, which I coined Deep Cheek Volumization, restores volume to the cheeks and, in turn, emphasizes the cheek hollows below while softening and smoothing transition to the eyes above. And I can achieve these results in less than an hour with minimal bruising and swelling.

Over the years as I have grown from trainee to trainer, I have gained knowledge not only about Plastic Surgery but more importantly about the way in which we all think. What we say we want is not always what we want and so proper questions must be asked to elucidate what endpoint we are striving to achieve. Over time, I have become more adept at asking the right questions and thus rewarded with the right answers. The perfect result is always there…it must simply be discovered.

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