How To Use CT3+V: An Equation For Creating Facial Beauty

CT3+V = A simple equation for creating or restoring facial beauty.

We all know that "Beauty" is in the eye of the beholder. When it comes to creating and restoring facial beauty, we collaborate and negotiate with our patients (and sometimes their family and friends) to optimize the result and reduce the risk by using more conservative aliqotes of different techniques and technologies. Each practitioner brings their own unique skill-set and biases to the procedure room. We (hopefully) listen to the patient requests, evaluate what the underlying structure, tolerance for downtime and discomfort, economic consequenses and duration of effect is, to be able to offer the patient a scientifically valid, safe, sensible treatment plan. Then, we present a palette of procedures, techniques and technologies to consider.

What sets successful docs with many happy patients apart from the rest of the competition is attention to detail, listening to their patients (and sifting out the unrealistic ones) and having a plan that is recreated in some form (it's never the exactly the same twice) again and again.

My equation (tool) for discussing and creating facial beauty (or re-creating a more youthful appearance) is CT3+V = Beauty... short for Color, Texture, Tone, Tightness and Volume (in proportion or re-establishing proportion)

When the patient (on request) brings pictures of their face and neck that show them in yourthful repose, it is a strong tool to build consensus of what procedures and when in the scheme of possiblities, to pursue. Compare the old photos to current digital pictures obtained in 5 views-front-quarter and side views against a solid background with decent lighting and a portrait lens. Now diagnose the changes and educate the patient on the many ways you have to enhance and revitalize the issues you uncover in a systematic manner:

Color-pigment mottling and broken blood vessels respond well to various IPL's, NdYAG's, PDL's and KTP lasers depending on the patient's heritage (Fitzpatrick or Lancer skin type);

T3 (Texture, Tone and Tightening)-decide if the issues are epidermal, dermal or sub-cutaneous and treat with chemical or laser peels, focused ultrasound or radio-frequency and remember the skin looks better when "on-stretch", so Volume and surgery fit here too.  Toxins soften the dynamic wrinkles and shape the brow, but should be delivered in a artful manner that yields a natural, rather than "done" result;

Volume-Pierre Fournier, MD (Paris) taught us that "the look of youth is full" and the current saying "size matters" comes in to play here too.  Youthful features are generally softer and rounder, age makes them more severe and hollow.  Surgery helps take the luff out of the sail or the sag out of the jowl and neck, but does not effect volume very effectively.  Volume is at least as (and maybe more) important long term.  Fat and fillers (I prefer fillers for face) are a great way to go as long as you educate the patient as to how much it will really take and offer them permanent fillers (like Artefill in the USA) that can serve them well long term, once they find the look they want to preserve.

So-with every patient: define the issues, make a mutually agreeable long term plan, track the progress with digital pictures and keep an open dialog and flexibility, so that both you and your patient achieve happiness and WOW results long term. Happy patients refer their friends. Surviving aesthetic medicine these last 15 years is no accident....it's all been done with mirrors and this equation!

Interview: Lila Bratani MD, Plastic Surgeon In Germany

AA look at plastic surgery in Germany with Dr. Lila Bratani.

Physician:  Dr. Lila Bratani
Location: Karlsruhe, Germany
Website: www.drbratani.com, http://www.estheticon.de/chirurgen/dr-lila-bratani

That's interesting: Dr. Lila Bratani is recognized as a member of Stanford's Who's Who for having demonstrated outstanding leadership and achievement in her field.

How did your cosmetic medicine training kick off?

Back when I was a teenager, I was attracted to aesthetic medicine and of course beauty and anti-aging. My first step in Plastic Surgery was when I got a good training by my teacher, Prof. Muehlbauer, one of the leading aesthetic surgeons in Germany and recognized worldwide. I also completed a fellowship in advanced aesthetic medicine and got trained in cadaver courses in Brazil (Sao Paulo and in Brasilia). I was working with great colleagues and I am still learning a lot of new techniques in the aesthetic medicine field. The art of this profession gives the ultimate satisfaction.

Can you tell us more about your surgical clinic and how it's organized?

I’m the chief of the Plastic and Aesthetic Department in a private clinic. The owners are dermatologists and it works perfectly. We offer plastic surgery, hand surgery as well as non invasive treatments such as laser. We also have 3 cosmeticians in our skin cosmetic center. The clinic consists of: 1 plastic surgeon (me), 6 dermatologists, 3 cosmeticians, 1 practice manager, 1 PR and clinic manager, 1 OR nurse, 3 frontdesk assistants and 8 physician assistants. We serve to a mix of private and state health care patients.

The requirements for hiring staff in our plastic and aesthetic surgery clinic are very high. PA’s and nurses have to understand that they need to have this extra “service” for extraordinary plastic surgery patients. We like them to have a corporate identity that represents our clinic well and of course a fabulous attitude and behavior.

We use commission on the cosmetic sales.

What laser technologies are you using? What are your thoughts about the technologies you’re using now?

We don’t use IPL, but we are using Alexandrite, Ruby, NdYag laser and Fraxel, CO2-Laser. I like most of the Fraxel  and new devices of Radiofrequency (Thermage and BodyTite). I have a lot of experience on the smooth liposuction with radiofrequency using the BodyTite device and so far, I'm seeing great results with skin tightening.

Where do you spend money on advertising? What works best for your practice?

We have websites, social media as Facebook, publications on newspapers and  journals such as Vogue. We also distribute e-newsletters for existing patients via email. In the waiting rooms, we showcase programs with different techniques of aesthetic procedures. This kind of advertising works much better than handing out external flyers or ads. 

(Sponsored: See Frontdesk waiting room videos for plastic surgeons and dermatologists.)

What are the in demand treatments in your clinic? Are you planning to add something new?

All kind of aesthetic surgery procedures like breast augmentation, facelifts, liposuction and face skin rejuvenation with radiofrequency as well the small procedures as fillers such as Botulinum toxin therapy.  I will be adding more fat grafting and liposculpturing techniques soon.

What have you learned about practicing cosmetic medicine? What stories can you tell?

I have learned to offer what I think is good for the patients and not to please the unrealistic demands of someone. Sometimes patients bring their own drawings of unrealistic body parts. I’m aware of dysmorphophobic patients and refuse to do anything on those. 

What advice would you give to other physicians based upon your experiences?

Working hand in hand with other colleagues is a benefit for starting into aesthetic medicine. You may share the cosmetic lasers and IPLs (which are very expensive) when starting your own clinic. Never underestimate the non-invasive procedures, even we plastic surgeons love it than being in the operating room with the scalpel in the hand.  Set your own “branding” so that patients will be pleased with your work and aura and will bring you more patients via word of mouth, which is also a great marketing tool.

About: Dr. Lila Bratani completed her Craniofacial and Plastic Surgery fellowship in Nova Southeastern University. With over 10 years of experience in Plastic, Aesthetic, Reconstructive, Laser and Hand Surgery, she is a university lecturer, medical manager and an esteemed health care consultant in New York,USA. She specializes in burn surgery and tissue engineering. Other than that, she is an active member of the Society of Plastic Surgeons of Germany DGPRAEC, WOSAAM (World Society of Anti Aging Medicine), IPRAS (International Society of Plastic Reconstructive and Aesthetic Surgeons) and DGBT (German Society for Aesthetic Botulinum Toxin Therapy.

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.