A female plastic surgeon's take on beauty standards

This ran as an invited article for The Doctor Blog by ZocDoc on February 24, 2016.

I’m a Plastic Surgeon and a Woman. Here’s What Beauty Standards Mean to Me

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February 24, 2016 By Lara Devgan, MD

When I introduce myself as a plastic surgeon, I am often greeted with surprise. Between the slightly quizzical looks, the concerned head tilts, and the explicit queries, the question is clear: How could a woman of substance find herself in that line of work?

The truth is that real plastic surgery (in my world, at least) is nothing like its media representations. The nipped and tucked patients with outlandish requests, the salacious and provocative doctors, the ostentatious displays of wealth and consumption – these have nothing to do with my life or career. Plastic surgery, at its core, is an academic discipline that requires more than a decade of intense study, anatomic mastery of the entire human body, and precision surgical skills that are fine enough to sew a one millimeter blood vessel and strong enough to put the abdominal muscles back together. My patients are real, relatable human beings who have concerns about their physical appearances.

When I plan my surgical cases – whether they are reconstructive operations for breast cancer or broken facial bones, or cosmetic operations for facelifts or breast implants – I go through the same rigorous procedure. I examine, photograph, measure, and map out my incisions and approach. I review the patient’s medical history, prior surgeries, allergies, family history, and relevant habits. I consult with internists, anesthesiologists, radiologists, and hematologists to make sure each patient is optimized for surgery. Finally, I carry out the operation with attention to the highest standards of safety and quality. Plastic surgery, from the surgeon’s standpoint at least, is a serious intellectual field with a heavy dose of art and science.

Although a significant portion of plastic surgery procedures are reconstructive (for cancer, burns, injuries, and congenital anomalies), the majority of my practice is devoted to cosmetic surgery. And as a woman, wife, mother, expert in aesthetics, and board-certified plastic surgeon, I make no apologies for that fact.

Real, complex, intelligent women and men care about their appearances. It is part of the human condition to want to present yourself in the best way you can. There is no shame in wearing makeup, getting your gray hair colored, buying fashionable clothes, or working on your abs, and there should be no shame in getting plastic surgery either.

Elle magazine writer Elissa Strauss tackled this subject in an article she penned for Elle.com last year: “The way we talk about women who get plastic surgery is based on the assumption that caring about our looks and caring about our souls is a zero sum game,” she wrote. But the truth is that “[w]e are more than capable of searching for internal truths with lipstick on, being feminists with face lifts, or choosing something a little fake while also being very real.”

The beauty standards that are so prevalent in our modern zeitgeist are not abhorrent simply because they exist, but because they exist against a notion of effortlessness. You must be born beautiful, wrinkle-free, with a taut abdomen, a perfect nose, full lips, and the spoils of the genetic lottery, or else you are a superficial “plastic surgery junkie.” This concept that there is no solution to having something about yourself that you dislike is limiting, disheartening, and false.

The reality of plastic surgery is that it can be an incredibly empowering way to harness artistry and technology to help people feel better about themselves. It is this part of my job that I enjoy the most. You can be a brilliant lawyer and want larger breasts. You can be a successful businessman who dislikes his nose. And you can be a woman of substance and also be a plastic surgeon. I have a wall of diplomas and thousands of patients to prove it.

Click to read this article on ZocDoc's Doctor Blog

Click to read this article on ZocDoc's Doctor Blog

Dr. Devgan named to the RealSelf Top 500 for 2015

Dr. Devgan was honored to be named one of the top cosmetic doctors in the US in 2015 by RealSelf in the 2015 RealSelf 500 list.

The medical professionals that made the annual RealSelf 500 list are recognized for providing invaluable insight and expertise to those looking to make informed, confident choices around personal, highly considered health and beauty choices.
— RealSelf
Click to view the full list of the RealSelf 500 for 2015

Click to view the full list of the RealSelf 500 for 2015

Dr. Devgan named a Charlotte's Book Beauty and Wellness Expert

Dr. Devgan is pleased to have been named a Verified Beauty and Wellness Expert for the renowned aesthetic health and wellness guide, Charlotte's Book. Inclusion in Charlotte's Book is by invitation only. Charlotte's Book experts adhere to strict professional and ethical standards that go above and beyond board-certification by the American Board of Plastic Surgery (which is, of course, a prerequisite). 

Appropriate certification and training is obviously the most important part of choosing the right practitioner. But the other half of the equation is what we call the grey area: bedside manner, word-of-mouth, experience, and referrals. Charlotte is snobby when it comes to her beauty, health, and wellness.
— Charlotte's Book
Click to view Dr. Lara Devgan's listing in Charlotte's Book as a preferred expert plastic surgeon in New York City

Click to view Dr. Lara Devgan's listing in Charlotte's Book as a preferred expert plastic surgeon in New York City

Dr. Devgan featured on The Doctors TV Nationwide

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I was honored to appear on The Doctors, on CBS nationwide on February 11, 2016.

In this special episode, the audience met a brave, beautiful woman who suffered burns on over 85% of her body when her jilted ex-boyfriend set her house on fire. Miraculously, she not only survived, but she has become a powerful role model for others who suffer from domestic violence.

As a result of her devastating burns, she has severe disfigurement of her face and hands that will require extensive plastic surgery.

I was honored to be asked by The Doctors TV to participate in her care as her reconstructive plastic surgeon. Not only is this one of the most challenging cases of my career, but this patient is also one of the most profoundly moving women I have ever met. During taping, her story brought the studio audience to tears and inspired a minutes-long standing ovation. I encourage all of you to see how even the most horrific circumstances can be turned around in this uplifting story, which can be viewed online below. 

Part 1: Woman Set on Fire by Jealous Ex; click to view segment

Part 1: Woman Set on Fire by Jealous Ex; click to view segment

Part 2: Woman Survives Being Burned by a Jealous Ex; click to view segment

Part 2: Woman Survives Being Burned by a Jealous Ex; click to view segment

Part 3: Woman Burned by Jealous Ex Seeks Help from Dr. Lara Devgan; click to view segment

Part 3: Woman Burned by Jealous Ex Seeks Help from Dr. Lara Devgan; click to view segment

Part 4: Help for a Woman Burned by her Jealous Ex, donated by Dr. Lara Devgan; click to view segment

Part 4: Help for a Woman Burned by her Jealous Ex, donated by Dr. Lara Devgan; click to view segment

Submental liposuction: a powerful technique for getting rid of a double chin

Actual patient of Dr. Devgan, before and after submental liposuction

Actual patient of Dr. Devgan, before and after submental liposuction

Submental liposuction (or microliposculpture of the double-chin area) is one of the most popular aspects of my New York City plastic surgery private practice. While submental liposuction is a powerful procedure with an extremely high degree of patient satisfaction, it is also a complex topic. This was an invited article for online physician magazine Healio.com about the ins and outs of submental liposuction. The intended audience is medically oriented, so some portions of this article are more technical. -Dr. Devgan

Submental Liposuction: A powerful technique for sculpting the lower face

By Dr. Lara Devgan

How the face changes as we age

The young, slim face has a characteristic "inverted cone of youth"-- a triangular shape like that is narrow at the chin and wider at the cheeks.

As we age, gain weight, develop unfavorable patterns of fat deposition, and experience tissue laxity setting in, this cone becomes more of a square. The jawline becomes thicker and less distinct, a double-chin develops, and jowling becomes more apparent.

Traditional methods for addressing facial aging

Although facelift and necklift are considered the gold standard procedures for addressing facial aging as a whole, younger patients and patients who would like to have a quicker recovery with fewer incisions tend to shy away from these procedures. For this subpopulation, submental liposuction is an excellent option.

Submental liposuction

Submental liposuction, or microliposculpture of the area under the chin, is a minimally invasive contouring procedure for the lower face. Using one to three tiny 0.5 cm incisions placed in inconspicuous locations, an experienced plastic surgeon is able to refine and define the lower face.

Patient selection and technical considerations

The critical first step in submental liposuction is analyzing the patient. The best candidates for the procedure are those with excess pre-platysmal fat, a "double-chin," or the appearance of a heavy, square-shaped, bottom-heavy face. For those with platysmal banding, excessively thin skin, inelastic tissue, or minimal fat in this area, submental liposuction may not be as effective an option.

Marking

Once I have determined that a patient is a good candidate for the procedure, I mark the patient in a seated position while he or she holds a hand mirror to actively participate in the process. Problematic or bothersome pockets of fat are identified and circled. I also take a moment to mark the planned incision sites (0.5cm stab incisions at the submental crease and in the post-auricular sulcus bilaterally. Finally, I mark the angle of the mandible and the presumed course of the marginal mandibular nerve bilaterally.

Anesthesia

Submental liposuction can be done wide awake with tumescent local anesthesia only, or with IV sedation. For patients who are combining submental liposuction with another procedure (such as blepharoplasty-- a common pairing), I recommend IV sedation, or twilight anesthesia. For healthy patients who are comfortable with the idea of surgery, being awake is an acceptable option.

Surgical technique

After sterilely prepping and draping the patient, I infiltrate 50-100cc of tumescent solution composed of 1% lidocaine, 1 ampule of epi, and 1 liter of lactated ringers into the subcutaneous tissue of the neck. I let the tumescent solution sit for 5 to 7 minutes so that the vasoconstrictive effects of the epinephrine can take effect.

Next, I incise the previously marked liposuction access sites and dissect them open with iris scissors. At this point, I perform judicious liposuction of the preplatysmal fat according to my previously noted markings.

When performing liposuction of the neck area, it is important to use fine-tipped cannulae that are in a sufficiently deep plane so as not to create contour abnormalities or divets. I am also careful to liposuction in a cross-hatched pattern to ensure a smooth and aesthetically pleasing result. Liposuction is performed from one to three of the aforementioned access sites; using three sites is ideal because of the lower risk of creating contour problems.

Pitfalls and Complications

The most common complication of submental liposuction is contour abnormality, including notching, divets, and irregular appearance of the skin. This can be avoided by carefully performing liposuction according to the principles of ideal liposuction techniques.

Another complication is injury to the surrounding structures of the neck, in particular, the marginal mandibular branch of the facial nerve, as well as nearby arteries and veins. This is avoided by thorough anatomic knowledge of this challenging anatomic area.

Alternatives

The two major alternatives to submental liposuction are Kybella and necklift.

Kybella (deoxycholic acid) is a new injectable medication that will dissolve submental fat after several treatments. While Kybella has the advantage of offering no downtime at all, this treatment can take several sessions. In addition, patients experience profound swelling that can last for weeks. 

Necklift (including short-scar necklift) is a surgical technique that involves tightening the platysma, SMAS, and substructure of the face and facial skin. This is an extremely effective technique for rejuvenating the under-the-chin area, and I consider it to be the gold standard treatment. The downside of necklift is the fact that it is major surgery that requires a week of downtime from work.

Submental liposuction is an excellent intermediate option, between Kybella and necklift, and it carries with it many benefits from both sides.

For questions about this article, I can be reached via www.LaraDevganMD.com.

Click to read this article on Healio.com

Click to read this article on Healio.com