Contact our face lift and neck lift surgeon serving Chicago, Winnetka, and surrounding communities and schedule a consultation.

737 North Michigan Avenue
Suite 760
151 East Chicago Avenue (Entrance)
Chicago, Illinois 60611
312-751-2112
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118 Green Bay Road
Winnetka, Illinois 60093
847-446-7562
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Face Lift, Neck Lift Chicago and Winnetka

Dr. Cook’s innovative approaches to rejuvenation of the face and neck have established him as a recognized leader in the field.  His naturalistic approach to facial aesthetic surgery is the product of years of study of the intricacies of facial form and motion.  This knowledge base has allowed Dr. Cook to develop an extensive repertoire of face lift and neck lift techniques, so that he can properly respond to each patient’s needs.

In some cases, the patient’s goals may be met by procedures that can be accomplished under local anesthesia in the office.  In other cases, more extensive surgery is required.  Patients trust Dr. Cook to provide them with optimal individualized solutions that take into account each person’s aesthetic sensibility and time available for recovery.

Our attentiveness to your needs extends to the recovery process from face lift or neck lift surgery at our Chicago or Winnetka offices.  Whether you are from the Chicago metropolitan area, outside the Chicago region, or from outside the United States, we will design a custom recovery program that will respect your taste and need for privacy.  Our office and surgical facility are located within a few minutes of the leading hotels in Chicago, a city which beckons to an increasingly international clientele.

To prepare for your face lift or neck lift consultation at either our Chicago or Winnetka office, please bring photographs that show your face in good detail at approximately 5-year intervals.  This will allow Dr. Cook to analyze how your face has changed over time and will emphasize the singular aspects of your facial identity.

The Whole Beauty Institute™ is committed to total facial rejuvenation.  In addition to Dr. Cook’s in depth analysis, we will provide you with advanced non-surgical solutions that will help to prepare you for your surgery and enhance the overall effectiveness of the results.

Please read the sections of this website concerning Ten Questions You Should Ask and 10 Things You Should Know about facial rejuvenation surgery.  These sections provide you with a detailed understanding of Dr. Cook’s naturalistic approach. For additional information about face lift and neck lift surgery and facial rejuvenation techniques, contact our Chicago or Winnetka offices to schedule a private consultation.

A WIDE RANGE OF SURGICAL SOLUTIONS

The facial aging process proceeds in ways that are generally predictable but that offer considerable variation from one person to the next.   There are some people in whom the facial aging process is concentrated in one area, while there are other people in whom the aging process occurs with uniformity in all regions of the face and neck.  Dr. Cook has also seen that in many people there is one key zone that is the focus of their attention, while other areas are of much less concern.  Fortunately Dr. Cook has a wide range of techniques that can be tailored to each patient’s individual needs.

Full Face and Neck Lift

When there is significant loss of tone in the major zones of the cheek, the jaw border, and the neck the best solution is often a full face and neck lift.  Dr. Cook’s technique emphasizes a vertical correction of the deeper structures and a rebalancing of the facial volume to correct the hollowness that often occurs in key regions, such as the upper cheek and the supporting zones around the lips.  The key is to avoid the distortion that so often occurs with face lifting techniques that tend to pull aggressively out to the side.  The length of the incisions in front of and in back of the ear will vary with each patient’s individual anatomy.  Dr. Cook respects the complexity of the ear and hairline and his techniques are designed to minimize distortion of these structures.

Temporal Lift

 In select patients the key zone of concern is a settled upper cheek, which gives hollowness to the area immediately beneath the lower eyelid.  There may also be a mild to moderate loss of definition along the mid cheek but the persistence of good definition in the neck.  For a patient with these changes, the temporal face lift is often a good choice.  Dr. Cook gains access through incisions that follow the curve of the upper ear and sideburn or are hidden along the temporal hairline.  The power of this technique is enhanced when it is combined with volume rebalancing of the upper cheek with the fat transfer technique.

Isolated Neck Lift

The isolated neck lift procedure is a good technique for the patient who is concerned with a loss of definition in the neck, but who has not experienced significant settling of the deeper structures of the upper or mid cheek.  Dr. Cook gains access to the neck through a short incision beneath the chin and incisions behind the ears, usually with a short extension in the crease in front of the earlobe.

Neck and Jaw Border Lift

This technique is well suited to the patient who is dissatisfied with the definition of his or her neck and who has noted a loss of the clean line along the jaw border, but who is reasonably happy with the tone of the upper regions of the cheek.  As with the isolated neck lift, Dr. Cook will make incisions under the chin and behind the ear, but there will also be an incision that follows the curves along the front of the ear and at the base of the sideburn.  This allows Dr. Cook to compensate for the upward shifting that occurs when the jaw border structures are brought back into good definition.

Facial Volume Rebalancing with Autologous Fat Transfer

Dr. Cook’s extensive experience with this technique is explored in detail in the facial volume balancing section of this website.  For many patients the loss of deep structural volume due to the natural atrophy of fat in key zones of the face leads to a hollow or gaunt appearance that cannot be corrected by lifting alone.  Dr. Cook frequently combines fat transfer with his varied face lift and neck lift techniques of face and neck lifting in order to obtain the most natural results.  Fat transfer is also a wonderful “booster” technique that can restore balance to the face several years after a lift has been performed.  Often this can be accomplished as a simple procedure in the office under local anesthesia.

Eyelid and Browlift Surgery

Many patients choose to combine surgery of the eyelids and brow region with the various face lift and neck lift procedures that are part of Dr. Cook’s repertoire.  These options will be explored in detail during your consultation at our Chicago or Winnetka offices.  Please visit the eyelid surgery and browlift section for more detailed information.

Facial Rejuvenation Surgery: Facelift, Necklift, Browlift and much more

10 Things You Should Know

View Dr. Cook's Gallery At its essence, facial rejuvenation surgery is the restoration of the dynamics and vitality that make youthful faces attractive.  This section of the website concerns itself primarily with those operations that affect the upper cheek, the jaw border, and the neck.  In a simpler and less marketing-oriented era, these procedures were usually called facelifts and neck lifts, but now it seems each surgeon must come up with a catchy name that imbues the procedure with a sense of magic.  Many of these names focus on trivial issues such as the incision length or the mechanics of the “lift.”  More important is the surgeon’s ability to achieve an understanding of how the three dimensional form of the face changes with the aging process and to develop a plan of restoration that is based on this understanding.  Most of the strange or disappointing results that occur after this type of surgery derive, in my opinion, from a fundamental failure of artistic conceptualization on the part of the surgeon.

This is incredibly powerful surgery in that it affects how others perceive us and even how we perceive ourselves.  I am humbled by the trust my patients place in me; that trust drives me to seek better understanding, better solutions.

1. FACIAL REJUVENATION SURGERY IS A NUANCED FUSION OF TECHNIQUE AND ARTISTIC EXPRESSION.

   The skills and sensibilities that are necessary to produce consistent high quality results in facial rejuvenation surgery require years of refinement.  Surgeons who shortcut this process do themselves and their patients a disservice.

   There is a remarkable beauty and complexity to the organization of the facial structures.  The surgeon should approach these structures with a respect that borders on reverence.  It is naive to think that the nuanced techniques necessary to address these structures can be easily mastered.   There is no endpoint in the process of technical refinement.  I believe that the surgeon learns something useful from each person that he cares for.  Every patient on whom he has performed surgery in the past contributes to the quality of the outcome of the current patient.

   Technique alone is sufficient for many kinds of surgery, but it is only the first step in facial rejuvenation surgery.  The amplifier of technique is artistic vision.  I am now going to say something that is a bit controversial.  As I look at articles in leading plastic surgery journals I am often struck by how horrible the “after” pictures of facelift patients appear!  The faces look different, but they don’t look better, and they certainly don’t look younger.  The surgeons who have written these articles often have impressive academic credentials and are technically proficient.  They haven’t harmed the faces in the way that a poorly-trained or disrespectful surgeon might do so, but the fact that they present these pictures as examples of their work makes me wonder about their artistic side.

   Artistic sensibility is inherent but can also be refined and strengthened with exercise.  Just as advanced practitioners of meditation techniques extend their perceptions, so can any artist who is involved in the creative process.  For each generation the artistic vocabulary changes, but the fundamental truth does not.  For plastic surgeons the first level of artistic visualization comes when the surgeon has internalized a vision of beautiful facial form.  The second more difficult level comes when he begins to understand the internal logic of each face and how it demands its own solution. 

2. FACIAL REJUVENATION SURGERY REQUIRES AN ADVANCED UNDERSTANDING OF THE DYNAMICS OF FACIAL AGING AND A HIGHLY INDIVIDUALIZED APPROACH TO EACH PATIENT

   Many of the less successful outcomes of facial rejuvenation surgery derive from a fundamental failure of diagnosis.   This surgery should not be about pulling the cheek skin back toward the ears and emptying out the fat from around the eyes.  The drawn, sunken look that results from this type of facelift and eyelid surgery cannot remotely be considered young or vital.  Then there are the various gadgets and threads that are supposed to tighten the skin.  This represents a conceptual step backward to a 1960’s concept of face lifting as a skin pulling or tightening procedure.

   When we age the deeper structures of the cheek and neck descend in paths that are generally predictable, but with specific variations for each face.  An effective facelift should reverse this structural descent.   The goal should be to restore key curves of beauty and definition to their original position.   A face that has been restored in this manner will not look strange or different to the friends of the patient, because they have already seen that face before.

   An accurate diagnosis of facial aging must also include considerations of volume.  If bone structure provides a face with its defining foundation, and skin provides its surface, then fat provides its attractive soft curves.  In retrospect it is hard to understand why for so many decades surgeons focused exclusively on removing fat from the face rather than enhancing it .  All the while there were the Katherine Hepburns of the world who were noted to age remarkably well.  Just look at the cheeks of Katherine in her sixties and even her seventies!

   One of my patients who is now a convert to fat volume restoration suggested that part of the problem is that the word fat carries negative connotations for so many of us.  We do become increasingly efficient at storing fat in certain problem zones of the body as we age.  Those of us who have devoted countless hours at the gym to eliminate undesirable bulges across the waist or hips have a hard time believing that we would want to add fat anywhere.

   For many patients a loss of fullness in key zones such as the upper cheek, the jaw border, and the supporting regions of the lips precedes significant structural descent or loss of skin tone.  The best answer for these patients is often volume replacement and nothing more.

   I hope that this discussion makes it obvious why assembly line face lifts are certain to be a failure.. There is no “one size fits all” facelift.  The surgeon who is serious in his approach to facial rejuvenation must consider the interplay between three key variables: skin tone, deep structural descent, and volume loss.  For each patient and in different zones of the same patient’s face, the relative importance of these variables will be different.

3. THERE IS NO SINGLE SOLUTION

   An individualized approach to each patient requires individualized solutions.  One of the reasons that I find facial rejuvenation surgery so captivating is that you never stop learning from your patients.  The only practical limitation is one’s own perception and imagination.  The face is so nuanced, that you could spend a lifetime studying it and really just be at the beginning.  All of the subtleties of facial contour, motion, and tone demand the surgeon’s respect.

   I am helping my patients the most when I have a repertoire of face lift techniques.  This repertoire has grown with each passing year. 

   Unfortunately we live in an era of hyperaggressive marketing.  Some surgeons insult their patients’ intelligence by placing undue emphasis on one aspect of technique and implying that this will be the final solution to facial rejuvenation.  For example, some surgeons prattle on about short scar facelifts or s-lifts, as if these are remarkable innovations.  In fact, variations of these operations were described in the 1920’s and before.  As we have already seen, skin removal is often the least important element in facial rejuvenation, so to place the entire emphasis on where incisions are made really takes the focus away from what is truly important.  The first thing that anyone who is serious about facial rejuvenation will tell you is that each patient needs an incision that is appropriate for him or her.  For some patients, the scar will be quite short; for others it will be longer.  This does not lend itself to catchy phrases for marketing, but it is the truth.  Remember too that a short scar produced by an unskilled surgeon is usually much more noticeable than a longer scar produced by an expert.

4. FACIAL REJUVENATION IS ABOUT MUCH MORE THAN TIGHTENING THE SKIN.  IT IS ABOUT RESTORING FACIAL STRUCTURES AND VOLUME TO THE POSITION OF DYNAMIC HARMONY.

   As a face ages it may present subtle miscues to those who observe it.  Patients often tell me on their initial consultation that even their best friends and spouses misperceive their attitudes and emotions.  People ask them, “Are you feeling tired?" or “Why are you so angry with me?”  when they are not feeling that way at all.

   When we look at a face, our eyes naturally scan specific regions that are rich in information, so that we can determine that individual’s state of mind.  These regions include the corners of the mouth and the zones around the eyes.  People who are particularly good scanners of this type of facial information are often said to be gifted at reading other people's emotions.

   As facial structures drop and facial regions lose their curves and volume, the resting attitude of the face may assume a sad or angry posture.  The dynamics of facial expression are also altered.  It may become more difficult for the face to convey subtle nuances of emotion, and certain expressions may require greater effort than before.

   It is my firm belief that when facial rejuvenation surgery is properly performed, it moves the face closer to its unique signature or identity.  This may also produce a beneficial feedback mechanism in the people who perceive that face.

5. FACIAL REJUVENATION SURGERY SHOULD NEVER PRODUCE A MASK

   The process that allows us to recognize a face is complex.  I believe that there are both static and dynamic components to facial identity.  Surgical and non-surgical treatments can alter these components for better and for worse. 

   What is a bad facelift or bad BOTOX®?  We can find plenty of examples if we turn on the television or go to a charity benefit party in a big city.   There is something awry in the posture and motion of these faces.  Sometimes the effect can be quite disturbing.

   On the other hand, a face that has been skillfully rejuvenated will call out to others in a different way.  A properly rejuvenated face will look more vital, softer, healthier, and more expressive.  It should not look manipulated.  The first thought that will occur to a friend is that you look rested and full of energy.

   Let me better explain for you what I mean by static and dynamic facial identity, so that you will understand why it is important to consider them in any form of facial rejuvenation surgery.  Static facial identity is the equilibrium position of the face, the resting posture that the face assumes when we are not in a process of active expression.  You might say that this is the posture that the face assumes during a moment of pleasant relaxation.    It is also the posture of the face when one engages in various relaxation techniques or in meditation.  As we have already seen, the aging process frequently alters the position of static facial identity, so that it may not appear “rested” or relaxed to the outside observer.  This may create an undesirable feedback loop between a person and those she interacts with.  If the resting position of the face conveys the impression of fatigue or anger, then the response of the outside world may cause that person to move the face out of its position of relaxation.  It is my opinion that this maladaptive response can have undesirable consequences and lead to a person feeling less relaxed.

   Dynamic facial identity comes from signature patterns of facial motions.  Some of the motions may be compensatory.  As we age and our facial structures descend, it is natural for us to animate in ways that bring our brows, our cheeks, and our lips into the positions that they once occupied.  There is a paradox, in that what once occurred with maximum relaxation now requires an effort.

   The core of dynamic facial identity is not compensatory.  It is learned from our parents and those who are key to us when we are little.  It is developed to a degree by imitation as we begin to copy those whom we admire during our adolescence and teenage years.  It is really a complex layering of experience that orchestrates the motion of facial identity.

   The importance of the dynamic facial signature is demonstrated by an experience that is universal.  An individual walks toward us in a crowded airport.  Deep in her own thoughts, she has not made eye contact with us.  Is this our friend whom we have not seen for several years or someone who looks like her?  We call the friend’s name, and as her face animates there is either a flash of recognition or an embarrassment.  The moment that the face animates, we know for certain whether it is or is not our friend.  We could not describe precisely what has happened, but we have searched for our friend’s signature of dynamic facial motion.

   These observations have relevance to any patient considering facial rejuvenation of any sort, surgical or non-surgical.  The surgeon who chooses to do this work carries a responsibility.  He does not have the right to be oblivious to issues of facial motion and posture.  Rather than creating a mask that obscures our facial identity, he should amplify and restore that identity.

6. IN THE OVERALL ANALYSIS, VOLUME IS AS IMPORTANT AS STRUCTURE

   During their consultations patients often tell me that they feel that their faces have become increasingly harsh in appearance as they age.  It is as if something that gave the face a wonderful softness has been diminished.  What these patients have perceived quite accurately is that their faces are losing volume in key zones of beauty.  This has the effect of throwing the face out of balance.

   One of the first zones in which patients notice change is the upper cheek.  Just look back at your high school or college yearbook.  Look at the wonderful curves of the upper cheeks, even in relatively thin faces! 

   Even in their thirties many people begin to lose the unbroken curves of their upper cheeks.  What was once a smooth curve becomes visually fragmented and hollow.  As the upper cheek loses its fullness, the structures of the lower eyelid are unmasked.   If a surgeon does not appreciate these issues he may compound the problem by performing an overly aggressive lower blepharoplasty.  If too much of the natural lower eyelid fat is removed, the lower eyelid structures are reduced to the level of the sunken upper cheek.  This gives the entire region a flat hollowed out look that simply cannot be considered rejuvenation.  In fact, the area is made less youthful in appearance by such injudicious maneuvers. 

   One of the paradoxes of rejuvenation of the cheek-eyelid junction is that the addition of fat to the upper cheek reduces the need to remove fat from the lower eyelid.  In the vast majority of the lower eyelid surgeries that I perform I will do something to add volume to the upper cheek.  It helps to restore the “magic” to this key expressive area and allows me to avoid the creation of a hollow eye. 

   The supporting zone around the lips and along the jaw border is also subject to volume loss, usually a little later than the upper cheek.  If this area is not addressed as part of an overall strategy of facial rejuvenation, the lips will look strangely out of balance when the cheek is lifted.  Just as with the cheek-eyelid junction, for decades many doctors really have focused on the wrong thing when it comes to the lips.  All that they could see were the creases and lip lines.   This led to extremely harsh methods of treatment- very deep dermabrasions, laser treatments, and chemical peels.  In order to have much of an effect, the treatment has to go so deep that the pigment structure of the skin is permanently altered.  I have seen many a “laser cripple” who can never leave home without a thick layer of makeup, to avoid detection of her “white moustache” of de-pigmented skin.

   A better answer for most people with lip volume loss is a combination of therapies.  Deep volume loss is addressed with fat transfer; issues closer to the surface are addressed with Restylane®, which is none other than the substance that naturally provides volume and resiliency to the deeper layers of the skin and tends to deplete with the aging process.  Gentler surface treatments can then be done to soften the remaining creases and wrinkles.

   Of course, the techniques that we use to restore volume to zones of the face can produce ridiculous results if the hand that does the injection is not linked to a mind that has judgment and experience and an eye with a good artistic sense.  I am absolutely baffled by some of the lips that have been created for certain people in the entertainment industry.  Lips are not supposed to look like cocktail sausages!

7. FACIAL REJUVENATION SURGERY CAN HELP TO MAINTAIN THE BALANCE BETWEEN A DYNAMIC BODY AND A VITAL FACE

   At a health club where I work out I recently overheard a conversation between two women who were observing a friend as she ran around the track.   “Mary is working out a little too much.  Her face is starting to look terrible.”  This snippet of conversation points to a mean little paradox of healthy aging. Beyond a certain age, those of us who keep our bodies trim and fit tend to look gaunt and hollow in the face.  The very energy that we put into maintaining optimum fitness seems to rob our face of its vitality.

   Facial rejuvenation surgery really comes to the rescue in a situation like this in that it frees us from the necessity of choosing between a beautiful body and a vital facial appearance.  When volume and balance are restored in a face, harmony returns between face and body. 

   In this sense, I believe that facial rejuvenation surgery can be an integral part of an overall plan for health and well being.  For many people facial rejuvenation removes a stumbling block on the road to fitness.  No longer does a person need to say, “When my clothes fit right, my face looks tired.” 

   When the face is brought into harmony with one’s inner sense of vitality, a positive feedback cycle occurs that further encourages healthy habits.  This simple truth is the reason that I have maintained for many years that facial rejuvenation surgery, when artfully performed, can be part of a holistic approach to healthy living.

8. DUE DILLIGENCE IS AN ABSOLUTE NECESSITY WHEN YOU EVALUATE A PLASTIC SURGEON ESPECIALLY FOR FACIAL REJUVENATION

   Medical marketing has exploded in the last decade, and this is particularly true in the field of cosmetic surgery.  There are good and bad points to this.  On the one hand, patients may be better aware of their range of choices than they were in the past.  It is easier to obtain relatively detailed information about various doctors on the internet, so that one can look beyond the immediate neighborhood when choosing a physician.  On the other hand, the doctor whose services you are buying may turn out to be very different than what he seems unless you really know what to look for.  Modern techniques of marketing can easily distract the patient away from meaningful credentials to meaningless ones. One of the most valuable services I can provide is to help the individual who is considering plastic surgery to distinguish between meaningful and meaningless credentials. 

9. THE NON-SURGICAL FACELIFT DOES NOT EXIST

   I feel fortunate to practice in an unprecedented era of expanding possibilities for my patients.  We now have available a wide range of non-surgical options to soften and mitigate facial appearance:  everything from BOTOX® which selectively relaxes frown muscles, to an expanding array of fillers, to various therapies to improve the tone and texture of the skin.  I use these wonderful tools every day in my practice.  They fit in well with my emphasis on facial rejuvenation surgery, particularly for patients with early facial aging or for those with more advanced changes who don’t want surgery and are willing to settle for a more limited result.  I also use the adjunct techniques to fine tune and embellish my surgical results as part of a program of total facial rejuvenation.

   It disturbs me when certain practitioners imply that these adjunctive techniques can be combined in a way that will obtain results similar to those of surgical facial rejuvenation.  Those who make this assertion either lack honesty or at the very least insight.  Why is it that when I go to meetings in the United States and Europe and sit through hours of presentations, I never see results from these “non surgical” approaches that obtain a fraction of the power of a skillfully performed facelift?  Unfortunately, some doctors so believe their own marketing that they will give presentations where they sing the praises of their own work while the audience can’t tell the difference between the “before” and the “after” pictures.

10. OPTIMUM RESULTS OCCUR WHEN A TOP TIER SURGEON WORKS WITH A TEAM THAT IS TOTALLY COMMITTED TO PATIENT CARE

    The quality of your surgical experience is strongly influenced by the quality of the team that your surgeon has assembled to care for you before, during, and after surgery.   During your initial consultation you will have the opportunity to meet a number of these team members.  How they relate to you tells you much about the “soul” of the organization for which they work.  Look for people who provide you with a sense of   confidence, compassion, and service.   Avoid organizations that emanate a sense of the “hard sell.”

    The surgical experience has three distinct phases: the preparation phase, the surgical phase, and the healing phase.  A well-functioning team will extend your surgeon’s ability to optimize your care during each of these phases.

    The preparation phase begins with a detailed assessment of your overall state of health, nutrition, and fitness.  Patients who are fit and optimally nourished recover more quickly from surgery than those who are not.  We have found that the period leading up to surgery can be an invaluable “inflection point” for our patients.  The habits that we encourage in preparation for the surgery can stay with you after the surgery and provide as much benefit to you as the surgery itself! 

    A great team is able to anticipate your needs and enhances your passage through the surgical experience in ways that pertain to a particular procedure, but which also relate to your distinct needs.  The simple, practical suggestions that they provide make the difference between a smooth recovery and one that can be frustrating.  Look for a team of individuals who are responsive and anticipatory during the preparation phase; these are the same individuals you will need to count on during your recovery.

    The surgical phase involves the operation itself.  It is the shortest and most intense phase of your surgical experience.  If you have followed my suggestions, you will have selected a leading surgeon to carry out the operation effectively and with artistic inspiration.  I know leading surgeons who operate in their own offices, in surgicenters, and in hospitals.  Regardless of the setting a truly leading surgeon will not allow for compromise in the quality of care.  It is not a trivial matter to put together a first rate surgical facility.  The team consists of recovery nurses, operating room nurses, surgical technicians, anesthesiologists and anesthetists.  How do you evaluate the quality of this team, since they may not be employed by your surgeon?  Look to section 7 of the companion piece, “Facial Rejuvenation Surgery – 10 Questions you should ask” that is available on this website.

11. The healing phase is significantly influenced by the quality of the team that cares for you.  For many years I have held to the principle that the critical first night after facial rejuvenation surgery needs the skills of a highly-experienced caregiver.   In our practice you will spend the first night in a boutique hotel near the surgicenters and care will be provided by an experienced caregiver.  This also allows for our clinical team to visit you the next morning in the comfort of the hotel room.   Our goal is to provide you with a seamless continuity of care.  In the early weeks after surgery you will have frequent contact with the clinical team.  It is essential that every member of the team is imbued with the spirit of service and compassion.

TEN QUESTIONS YOU SHOULD ASK BEFORE YOU UNDERGO FACIAL REJUVENATION SURGERY

View Dr. Cook's Gallery I hope that if you are considering facial rejuvenation surgery, you will read this section carefully. I have put together a set of questions that will help you select a surgeon who is not only competent, but also passionate about his work.

1. What are your credentials?

   This is the first question, since it provides the foundation on which the surgeon’s identity rests. One wonderful aspect of the internet is that it enables you to obtain this information without having to visit each doctor’s office. I would advise you to eliminate from consideration any plastic surgeon that does not demonstrate a consistent pattern of reaching for excellence in all aspects of his education and professional career. You should look at every possible credential including college, medical school, residency, and current hospital affiliation. These should not be merely adequate, but excellent. After all, it’s your face that will be in this person’s hands. There are no short cuts to excellence. Doctors who are certified by the American Board of Plastic Surgery, for example, have gone through anywhere from 5 to 8 years of advanced training after medical school. After training is complete they are subjected to two rigorous examinations and a screening for ethics in their practice. This certainly provides an excellent foundation from which a surgeon can eventually develop into a leader in the field of facial rejuvenation surgery.

2. What is your level of experience?

   I believe that there are many similarities in the career paths of leading classical musicians and leading plastic surgeons. Both fields require significant personal sacrifice in the pursuit of one’s art. Basic mastery of the instrument requires well over a decade of intense study and practice; virtuosity occurs as one acquires wisdom and nuance over a lifetime. For the plastic surgeon who is truly interested in mastering the field there is no endpoint. The process of visual and technical refinement never ends. Each patient adds to the mental data base of facial structure and form.

   What I am suggesting is this: the more experience the better. One might raise the objection that it is possible to do the same thing 1000 times and not do it well, but the other questions in this list should eliminate surgeons who are not serious about their craft. At a minimum, you should look for a surgeon who has done more than 250 facelifts and has been in practice the better part of 10 years.

3. What are you trying to achieve when you rejuvenate a face?

   This question gives you a window into a surgeon’s thought processes and visual aesthetic. If a surgeon cannot offer you a clear concept of what facial rejuvenation surgery is about, keep looking for another surgeon. It is impossible to accomplish anything of significance without a clear concept of one’s goals. This question should also help to prevent a mismatch between the doctor’s and the patient’s personal aesthetic. There are surgeons who consistently and safely produce results for their patients that I consider hollow and distorted. Their patients may very well be pleased with these results! I and my patients definitely would not want to achieve this outcome. The point is to make sure that your concept of facial aesthetics matches that of your surgeon before you undergo surgery.

4. How do you refine your artistic concept of facial beauty?

   This question may seem a bit esoteric, but it is not. Aesthetic plastic surgery in all its forms, but in particular facial aesthetic surgery, is a type of artistic expression. As such, it requires lifelong refinement. Our patients trust their faces to us, and this is a great privilege. I know many excellent plastic surgeons who perform facial rejuvenation surgery, and every one of them could answer this question without a moment’s hesitation. For each one the answer will be a little different, but in every case it will reveal a respect for the artistic basis of plastic surgery. The reason I place emphasis on this question is that it might help you unmask a doctor who has devoted so much energy to the marketing of his practice, that he has neglected his underlying craft.

5. How will you address issues of facial volume?

   Thank goodness our understanding of the facelift has evolved substantially from the days where it was all about pulling back on the skin. Most leaders in the field of facial rejuvenation surgery now realize that the key to success is the repositioning of the deeper structures of the face and neck. There are different technical solutions to this, but in my opinion, all of the truly effective techniques address this issue.

   For most patients, structural repositioning alone will not restore what is pleasing about the attractive youthful face. A second issue which must be addressed is the volumetric changes that occur with facial aging. The upper cheek, in particular, becomes sunken and visually fragmented with disturbing shadows that were not previously there. Surgeons who try to compensate for volume loss by over pulling the facelift produce the distorted masks that can give the operation a bad name.

   The issue of volumetric rejuvenation of the face has fascinated me for the better part of 10 years. Alone or in combination with structural repositioning, volume restoration has provided a key missing link in our repertoire. If you are looking to achieve a higher level result from facial rejuvenation, you will benefit from a surgeon who has significant experience with restoring facial volume.

6. How will you preserve my facial identity?

   Our ability to recognize faces is complex and nuanced. How do we know that the woman walking toward us is our best friend, and not merely someone who looks like her? Apart from basic issues such as facial shape, hair color, and eye color, there are cues provided by the position of key facial landmarks. These landmarks include the position of the hairline and sideburn, the contour and orientation of the ear, and the position of the eyes. There are also nuances of motion, the way we smile, for example, that immediately inform the world of our identity. The avoidance of distortion of these reference points and motions require a carefully thought out plan on the part of the surgeon that recognizes and preserves each face’s character.

   A prospective surgeon’s answer to this question will reveal how carefully he has thought about these issues and how much value he places on attention to detail. Each facial reference point can be protected with a specific technical solution. To ignore them does our patients a disservice.

7. Where will my surgery be performed and who will provide anesthesia?

   The setting in which your surgery will be performed influences both the safety and the quality of your experience. Over the years I have visited many colleagues and watched them operate at the highest standards in office surgical facilities, surgicenters, and hospitals. I am also aware of situations where standards of cleanliness and patient safety have been compromised.

   The challenge of this question is to obtain an answer that is meaningful to someone who is not “in the business” of delivering care to surgical patients. I submit that any experienced surgeon, anesthesiologist, or surgical nurse could spend 5 minutes in a surgical facility (office, surgicenter, or hospital) and obtain an accurate impression of its quality. Here are some suggestions to provide you with an “insider’s” insight.

   If the surgery is to occur in the physician’s office, you should ask to see the area where your surgery will be performed. Does it look like an operating room, or does it appear to be an afterthought? What are the credentials of the people who will be assisting the doctor during the surgery? Of course, they should either be registered nurses or certified surgical technologists. I have heard of office-based facilities where receptionists double as surgical assistants during office surgical procedures. These people simply do not have the proper training to maintain sterile technique. Any office-based facility that is above board will be proud to present you with a list of the specific individuals who work in the surgical area and their credentials. If you encounter any hesitation in the response, I would consider this a major warning sign.

   If a surgery is to be performed in a surgicenter or an office facility, make certain that the doctor has privileges to perform the surgery at an accredited hospital. This is one further indication that the surgeon is not operating away from the hospital to hide the fact that he does not have adequate credentials.

   If the procedure you are considering involves general or intravenous sedation anesthesia, you should insist that the facility has proper accreditation. The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) is the main organization that accredits hospitals in this country. It also has separate programs for the accreditation of surgicenters and office surgical facilities. There are other organizations with long abbreviations such as AAAAPSF and AAAASF whose prime emphasis is the accreditation of ambulatory surgical facilities.

   I would also suggest that your interests will be better served if there is a dedicated individual whose sole responsibility is to provide your anesthesia. This issue comes up most frequently when IV sedation anesthesia is given. The ideal, in my opinion, is for an anesthesiologist or nurse anesthetist to be present through the entire course of your surgery. There are some surgeons who will attempt to be both surgeon and anesthetist; in other words they will instruct someone else in the room to inject medications into the intravenous line to make the patient sleepy. The problem is that different patients have different sensitivities to intravenous agents; a dose that might make one person a little sleepy might take another person into a plane that approaches general anesthesia. How a surgeon is able to concentrate on the surgery and monitor his patient’s anesthesia is beyond me. Make sure you ask the question, “Who will monitor my anesthesia?” whether your procedure is in an office, a surgicenter, or a hospital.

   If your surgery is to be performed in a hospital or a surgicenter, insist on a facility that attracts the leading surgeons in your community. The same qualities that make a physician a leader in his or her field will compel that physician to find the best and safest facility for his or her patients. From a patient’s perspective the determination of quality is most easily made with hospitals. Look for hospitals that have an acknowledged position of leadership in your community. With surgicenters, one way to get a sense of quality is to look at the hospital affiliations of the doctors that use the facility. If a majority of the surgeons who operate at a facility are on the staff of leading hospitals in your area, this is one of the best indicators that the standards will be high.

8. Do you do all of your own work?

   The plastic surgeon is essentially an artisan, a highly skilled craftsman who fashions beautiful, finely worked creations out of his patients’ faces. The plastic surgeon is well compensated for his or her work, but there is a practical limit to how much work he or she can do without a deterioration of quality. Unfortunately we live in an era of over consumption, where greed is the driving force for a number of people. With greed in the driver’s seat, there is always someone whose trust ends up being betrayed. In the last few years we have witnessed many examples of betrayal of trust by various figures in politics, corporate management, and in the financial markets. Physicians, unfortunately, are not immune from this trend.

   There are two temptations that present themselves to the plastic surgeon who succumbs to the greed mechanism. The first temptation is to rush through his work; this increases his output at the expense of the quality of his work. Whether a surgeon succumbs to this temptation or not is a question of character. The second temptation is to employ “ghost surgeons.” This enables the surgeon to carry out several operations at once, but at a sacrifice of quality and honesty.

   If you have accurately researched the other questions in this list, you will probably avoid the problem of “ghost surgery.” The reason for this is that people who employ “ghost surgeons” tend to be cheaters. The surgeon who has shown respect for his craft by investing years in proper training at the highest levels and has developed his own approach by years of careful refinement possesses the type of character that would be uncomfortable cheating his patients.

   Even if all other credentials are in order, it never hurts to ask this question, not only of the surgeon, but also of his or her staff. A hesitant response or confusing body language might indicate that there is a potential problem.

9. Who is your employer?

   This might seem an odd question, but it is actually quite important. The quality of an organization is determined by its leader. Is this an organization that always puts the patient’s interest first or is it all about making money fast? The principled surgeon who mistakenly joins an organization with faulty principles will eventually face a moment of decision: either he lowers his personal standards to that of the organization or he quits.

   There are various business entities that have decided to enter the field of cosmetic surgery. Sometimes these are businessmen with no medical background; sometimes these are the surgicenters themselves. These organizations hire surgeons, often with very little experience, to be their “plastic surgeons.” They employ aggressive marketing techniques, which include direct phone solicitation and deceptive advertising to generate business. Frequently the marketing centers on a magic procedure with no scars and no recovery time. As you might expect, these organizations experience a high level of physician turnover, since the entire emphasis is on sales rather than service to the patient. Physicians who work for such organizations may be penalized if they turn down a patient who is not a good candidate for surgery, since this is simply viewed as a lost opportunity to make money.

   It is always the owner of the business who calls the shots and sets the standards. If you were to encounter a surgeon with reasonable credentials who works for someone with dubious credentials, you might seriously consider looking elsewhere.

10. What is the feel of this place?

    This is a question you should ask yourself after you have completed your visit to the doctor’s office. Consider the quality of interaction with the doctor and his staff. Are these people who you can count on to help you through the recovery from surgery or will they abandon you once the procedure is over? Does the emphasis seem to be on caring for you or is it on the hard sell? Are these people you would feel comfortable taking care of your best friend?

    Trust your instincts. Care and compassion cannot be faked. Almost every patient who comes to see me after a disappointing experience with another surgeon tells me, “Something told me it just wasn’t right.” Remember this is elective surgery. There are no emergency facelifts! That provides you with the freedom to keep looking until you find the doctor and the team who is right for you.

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