Choose the Surgeon, Not the Procedure

Recently, a patient came into my office asking for a deep-plane facelift. She was not seeking a consultation or an evaluation; she simply named the procedure she wanted. When I asked why, she described spending months researching the procedure online, explaining she had watched videos, followed surgeons on social media, and become convinced that this particular operation represented the pinnacle of facial rejuvenation. 

I smiled because I have been hearing versions of this same conversation for years from both my patients and those whom I have been privileged to train. Today, it is the deep-plane facelift; a decade ago it was the mini facelift; before that, the minimal access cranial suspension (MACS) lift, composite lift, or short-scar facelift. 

In nasal surgery, today’s favorite is preservation rhinoplasty. A decade ago, it was open structural rhinoplasty; before that, closed rhinoplasty. The names change, but the enthusiasm remains. 

Spend a few minutes on social media and you’ll quickly find yourself immersed in a world of named procedures. Much of it stems from practitioners seeking ways to distinguish themselves in an increasingly competitive market. I see nothing inherently wrong with that. Many surgeons associated with particular techniques are exceptional physicians, gifted technicians, and true artists. Their dedication to refining specific procedures has advanced our specialty and benefited countless patients. 

The problem arises when patients, and increasingly young physicians in training, begin to believe that the secret to a great outcome lies in the procedure rather than the surgeon. I understand why this happens. Choosing a technique feels like a reliable formula for success. These trendy procedures are supported by polished videos, compelling before-and-after photographs, and endless online discussion. They feel objective. Yet after more than 20 years in aesthetic medicine, I have come to realize that success is rarely determined by the procedure itself, but rather by the skill, judgment, and artistic sensibility of the person performing it. 

This is not to suggest that techniques do not matter—they do. I am simply suggesting that no technique is universally right for every patient. The best surgeons do not rely on one procedure; they tailor their approach to the individual patient. 

THE BEST SURGEONS ADAPT TO THE PATIENT

I perform preservation rhinoplasties, open rhinoplasties, closed rhinoplasties, deep-place facelifts, superficial musculoaponeurotic system (SMAS) facelifts, and neck lifts. Sometimes I combine techniques and sometimes I modify them, not because I cannot decide which approach is best, but because every patient is different. Each patient presents with unique anatomy, goals, concerns, timelines, and expectations. A surgeon’s responsibility is not to remain rigidly committed to a technique. It is to identify the approach most likely to help a particular patient achieve the outcome the patient desires. 

One of the most overlooked aspects of aesthetic medicine is that anatomy alone does not determine the best treatment plan. Lifestyle, recovery tolerance, personality, and goals often matter just as much. A patient may be an excellent anatomical candidate for an open rhinoplasty or a deep-plane facelift, yet be unwilling to accept the recovery, time commitment, or tradeoffs associated with a more extensive surgical operation. 

During every consultation, I ask many questions and listen carefully to what the patient wants and why. Many patients, after the initial excitement, refine their expectations to an outcome that represents the best version of themselves. Often that means subtle improvement, minimal downtime, and an outcome that allows them to look refreshed and natural. 

Perhaps my patient population is skewed because I have published dozens of papers on natural results and attract patients seeking that outcome. But it is my belief that patients of all backgrounds and demographics ultimately want to look and feel better without anyone knowing exactly what they have done to achieve it. The best procedure we can offer is not simply the one that matches the anatomy or satisfies the surgeon’s ego, but the one that is aligned with the individual’s goals, temperament, and lifestyle. 

BEYOND TECHNIQUE: THE ART OF SURGICAL JUDGEMENT 

In many ways, aesthetic medicine resembles art. The most famous artists are often associated with a particular style or technique. Consider Pablo Picasso with Cubism, Claude Monet with Impressionism, and Leonardo Da Vinci with sfumato, to name a few examples. Yet each was highly skilled at rendering classical paintings, portraits, landscapes, and sculptures. What made them great was not mastery of a single named technique, but their ability to transcend technique and medium altogether. Great artists are defined by their vision, not their medium. Perhaps the same is true in aesthetic surgery. 

The surgeons who impress me most are rarely the ones who define themselves—or their careers—by a single procedure. They are the ones who understand anatomy, aging, restraint, healing, and perception—and draw from multiple techniques and philosophies to achieve the best result for the individual sitting in front of them.