Dr. Edward Owen Terino shares his visions and innovation with the 'Somme Lift', an upper and midface suspension technique.

Name: Edward Owen Terino, M.D.
Location: Agoura Hills, CA
Website: terinomd.com

That's interesting: Dr. Terino is not only world renowned for his accomplishments as a plastic surgery practitioner, but also as an innovator in the specialized new techniques of three-dimensional facial contouring. He is one of the few pioneers to develop the latest upper and midface vertical lifting and suspension technology, which he calls Somme Lift. He also is the designer of natural looking cheek and chin implants which provide solutions for flat cheeks, small jaw lines, and weak facial contours. 

Can you share your career path as a plastic surgeon?

My private practice has always been that of general plastic surgery including reconstructive surgery. During the first 20 years, we took care of the accidents and injuries around the Conejo Valley of California in a radius of 60 miles. I also attracted patients by referral all the way from San Diego, Palms Springs, and North of Santa Barbara.

I embraced the latest medical plastic surgery technologies as they were developed including liposuction, carbon dioxide laser resurfacing, and up-to-date skin care management. Because of my experience at the Fort Sam Houston Burn Unit during the Vietnam conflict, I had a great deal of experience in burns and started a burn unit in the St. John's Hospital in Oxnard, California.

From early youth I have always had a strong interest in field of art and the humanities with an intention to incorporate this into my life. Out of economic necessity and a strong interest in helping people, as well as to learn about curing the medical physical problems of human bodies, I rejected going into the field or art and decided to go to medical school perhaps to become a medical illustrator as well.

I always had an interest in aesthetic beauty and especially of the human face. Therefore, I trained myself in the art of portraiture and caricature, of exercising my talents in portraying friends, teachers, fraternity brothers in college, etc. These artistic endeavors were placed into the yearbooks of my high school, medical school and college.

In the early years of my practice I had the opportunity to care for many patients with severe facial injuries including the bone structure. I had a strong interest in developing a medical device that could be inserted to imitate the skeletal anatomy of the face for reconstructing accidents and injuries. I carried this interest into the field of aesthetic surgery for improving deficiencies of volume in the major areas of the face relative to creating facial balance or beauty. Therefore, I was able to design and patent implants for the cheek, chin, premaxillary, and jaw regions and have them manufactured by a commercial company, Implantech, in Ventura California.

The development of this technology went hand in hand with resuspending the soft tissue elements which cover of the face over the facial skeleton for the purpose of further assisting in the improvement of aesthetic facial balance called beauty.

Since 1980, in developing these techniques I have prepared and presented over 300 to 400 scientific lectures and papers which were accepted for presentation at countless plastic surgery society, conventions, meetings, seminars, and symposia both in the United States and internationally including the prestigious Mayo Clinic, Cleveland Clinic, and universities such as UCLA, NYU, Stanford, USC, and others in Canada, Europe, and South America.

I am also the author of two major textbooks on the subject and approximately 20 book chapters for aesthetic plastic surgery publications edited by other noted plastic surgeons.

You've developed technique that you're calling the "SOMME Facelift" focused on upper and mid-face vertical lifting and suspension. Can you tell us how and why you developed a new technique and what separates it from other suspension techniques?

The upper and midface vertical lifting and suspension technique is an evolution of techniques, which were being developed by others as well in the mid 1990s. These included coronal brow elevation and vertical suspension techniques. Also published by other plastic surgeons. I applied the name "SOMME facelift" to the procedure that included all of my personal techniques because of its powerful resulting effects. The actual definition means Sub-Orbital Mimetic Muscle Elevation. This is because the muscles and soft tissues are elevated together from the bone in the malar midface region and from the skull in the coronal brow region. Through the use of sutures brought from the temporal muscles along the outside of the orbital rim down into the cheek region, the mimetic muscles of the face which move the mouth are essentially suspended and tightened with everything else to lift the face from the corner of the mouth upwards in a fashion which all other structures creates a more youthful aspect and beauty to the face while at the same time restoring position to some other structures, which look altered in a downward direction through the aging process.

The SOMME facelift includes a lateral canthopexy of the lateral canthus of the eye along the outside orbital rim to simultaneously elevate the outside corner of the eye into a more beautiful almond shape that has been universally accepted as the standard of fashionable eye attractiveness. The upper portion, which includes the temple and forehead tissues are further suspended with internal sutures from the eyebrow level onto the upper aspect of the temporalis fascia to also accentuate the arch of eyebrow, another feature of beauty that has become accepted in our culture. Yes there are other surgeons who have spent time working on the same technique.

In my hands what makes it more unique however is the fact that in my series of close to 400 cases I have observed additional permanent improvement through the years of my Terino Malar Shell silicone rubber implants, patented and approved by the FDA.

Many of these patients also benefit from an improvement in the chin and jaw by inserting my chin and angle of jaw implants as well.

Do you see a time when cosmetic surgery is going to be replaced at least in part by nonsurgical technologies? Is this an opportunity or threat for surgeons? Has this changed the type of patients that you're seeing?

Nonsurgical technologies have become popular over the last 20 years for a number of reasons, not the least of which is the worldwide economic recession.

Moreover, the appeal of not having to undergo the idea of surgical invasion of the face and body to achieve improved physical appearance and beauty is quite appealing. Therefore, cosmetic surgery has already been replaced in part by the external application of techniques such as ultrasound, radiofrequency, laser, chemicals, etc. in attempts to give significant benefit to the skin such as skin tightening in the aging process and fat reduction in the neck torso, abdomen, and legs from other external techniques.

I do not look at these technologies as a threat for surgeons because to date I have not observed a significant and lasting improvement from them for the most part. This wave of enthusiasm for nonsurgical technologies I believe has reached its crest and is starting to subside as people are spending significant amounts of money for them without experiencing the significant effects that they are led to expect.

The offices of plastic surgeons are certainly being flooded by patients who are interested in the nonsurgical technologies of Botox and injectable fillers to improve the movement and contours of aging faces. This is not all bad for surgeons who have experience and talent for these newer technologies, it is an opportunity instead to earn a living in a more relaxed fashion outside the operating room.

A large number of physicians who are not plastic surgeons or dermatologists have move into cosmetic medicine by focusing on nonsurgical cosmetic technologies like IPL and injectables. As a plastic surgeon, has this affected your practice?

The conventional, traditional, historical training of a plastic surgeon demands a 15-17 year medical training with 7-10 years of surgery training in order to qualify for the time honored original brand of plastic surgery title represented by successfully completing the board certification examination by the American Board of Plastic Surgery. To date, there are only some 7,000 physicians who have ever completed the long arduous training since the founding of the American Board of Plastic Surgery in 1937. The American Society of Aesthetic Plastic Surgery has barely 2000 members and requires extensive experience in aesthetic surgery prior to being admitted. The number of physicians, however, who are calling themselves cosmetic and plastic surgeons or practitioners, is presently close to 200,000. It is no wonder that the business of true accomplished and trained plastic surgeon has been severely affected. It is also no wonder that there is a rapidly mounting escalating population of dissatisfied patients who have had treatments by practitioners that have taken other paths to learn and exercise cosmetic surgery techniques and are not certified by the American Board of Plastic Surgery. Therefore, it also has affected the number of patients whose dissatisfaction leads them to the conclusion that they had negligent medical treatment causes to feel justified in litigation.

Is there any technology that you're looking to purchase in the future? What do you look for in deciding which technologies to purchase? 

I am always interested in purchasing new technologies, but I do not become involved with them until I observe them to be tried, true and effective with significant success and minimal morbidity.

At the present time, I have a practice that keeps me nearly 100% occupied with my facial implant and facial suspension technologies. The supplementation of the surgery to perfect the results with injectable fillers and Botox also adds a significant element of time, which I spend these days to utilize the newest and the most proven effective technologies.

Where do you see the most competition from other physicians in your area? How do you run your business in order to compete with them?

Unfortunately, to compete with the numerable physicians in the Southern California area who are trying to succeed in the same arena, it is necessary to utilize marketing and public relations technologies and most especially and effectively through the internet. In and of it self this is a very complicated and can be very expensive undertaking. Fortunately, because of my own specialized development of the facial contouring game, as well as my significant years of experience in that area I have a competitive edge on the younger men particularly the physicians who are not surgically trained for my type of work.

What is the best advice you've ever received as an entrepreneur and physician?

The best advice that I received as an entrepreneur and physician is to spend the bulk of your energy doing what you enjoy the most and have a talent for doing best. Also be very, very cautious when considering adapting newer technologies that are not yet tried and true.

About: Dr. Edward Owen Terino is a plastic and reconstructive surgeon certified by the American Board of Plastic Surgery in 1971 and the American Board of General Surgery in 1970. His background education includes graduating Cum Laude from Amherst College, completing medical school and six years of general surgery training at Yale University and one year of plastic surgery at the University of North Carolina and a final year at the University of Florida.

In the early 1970s, he migrated from an East Coast background and upbringing to Southern California to start a private practice.

He had experienced third world missionary surgery in the 1960s during his surgery training by having an opportunity to go to the country of Haiti and work in the Albert Schweitzer Hospital in the jungle taking care of reconstructive surgery, birth defects, and all types of general surgery for 3 months. This experience gave him the desire and impetus to continue missionary surgery training into his private practice years. During the initial 10 years of his practice, he worked with Stanford University and their residents training in plastic surgery to help establish and serve on the board of directors of the Interplast Organization. They went to Central and South American countries such as Honduras, Ecuador, Peru, and Panama to perform reconstructive surgery in children with a team of nurses and anesthesiologist. He also spent 3 months on the Hope Ship with Project Hope in Brazil in a poor area of Northern Brazil in the early 70s as well.

He was on teaching staff of UCLA and USC for many years in the early part of his practice. He has been a founding member of the American Society of Aesthetic Plastic Surgery and a member of the American Society of Plastic Surgery from the beginning of his practice.

This interview is part of a series of interviews of physicians running medical spas, laser clinics and cosmetic surgery centers. If you'd like to be interviewed, just contact us.