When it comes to turning back the hands of time, Alan Gold, MD, FACS, a board certified plastic surgeon with offices in Great Neck, NY, and Boca Raton, FL, knows that satisfactory results require more than surgical technique and artistry. The surgeon must also study and appreciate varied cultural standards of beauty. Understanding subtle ethnic anatomical differences incredibly enhances the surgeon’s artistic eye, he says.
After finishing his undergraduate studies at Colgate University, Gold received his medical degree from New York’s Downstate Medical Center Colleg, and completed his plastic surgery residency at New York’s Kings County Hospital-Downstate Medical Center. He has served as president of more professional organization’s than we can count, including the American Society for Aesthetic Plastic Surgery.
Here, Gold tells Beauty in the Bag how he creates customized, natural, and individual “looks” for his patients.
Tell us a bit about your background. How did you come to choose plastic surgery as your specialty?
Long before I entered medical school, I was fascinated by surgery and the ability of skilled surgeons to treat disease, injuries, and deformity. Once exposed to the various surgical disciplines during medical school, I found orthopedic and plastic surgery to be the most exciting surgical specialties for me. Of all orthopedic specialties, it was the necessary meticulous attention to fine detail in hand surgery that I found most stimulating. However, once exposed to the even more artistic and creative challenges of plastic surgery and the opportunity to employ my sense of aesthetics, my career path was clear. I was then, and remain to this day, excited by the opportunity to practice such an artistic specialty in which the demands for both form and function are equally critical.
What is your signature surgery/procedure/product/service?
My signature surgery or service would probably be “facial rejuvenation.” Patients who present for that surgery usually just want to “turn back the clock.” They most often want to look “like they used to look,” just a younger version of themselves, and don’t want to look “different.” While most people would usually consider that to require just the surgical reversal of the aging-related changes of the eyes and face, to be most effective I believe it frequently needs to include more. I perform a great number of rhinoplasties, more commonly on younger patients, who often wish a more significant change in their appearance. Often, however, even subtle changes in the appearance of the aging nose can also greatly enhance the overall result and “balance” of a facial rejuvenation procedure, so I will often address that as well. Another factor that many people don’t appreciate is that surgery alone has its limitations. Surgery can reposition or restore the “volume shifts or losses” and tighten the “excess” skin that has stretched and sagged with age. It reduces the “quantity” of that skin. However, it doesn’t address the “quality” of the skin, and both should most often be addressed for optimal “rejuvenation.” Chemical peels and/or a variety of “energy-based” treatments such as laser, intense pulsed light, radiofrequency, infrared, and ultrasound can significantly improve that skin “quality” and are often included as part of the treatment regimen.
Plastic surgeons must excel at both technique and aesthetics. What’s the best way for a surgeon to develop his/her aesthetic eye?
The study of art, especially sculpture and painting, an appreciation of the importance of balance and of the interplay between light and shadow, and very importantly the ability to see and reproduce what you see in both two and three dimensions are critical skills for an aesthetic plastic surgeon. However, to develop a true and clinically important “aesthetic eye,” aesthetic plastic surgeons require more than just a study of art, form, and structure. To be able to successfully address the concerns and needs of our patients, we also need to study and appreciate the varied cultural standards of beauty. While there are some patients who wish to change or obscure the physical characteristics of their ethnic identity, most wish to enhance and refine them. A knowledge of those diverse cultural standards as well as of the associated often subtle ethnic anatomical differences allows us to develop an “aesthetic eye” that can best see the potential in our varied patients and how to best achieve their desired “look.”
Do you think that injections and less invasive treatments like lasers or radio frequency devices will ever replace surgery?
Nearly all of the minimally-invasive or non-invasive treatment modalities available today can effectively address certain aspects of the inevitable aging process. “Fillers” can obliterate or soften lines and wrinkles as well as restore lost volume or camouflage shifted facial volume. As mentioned above, energy-based treatments can change the “quality” of the skin, reducing superficial rhytids, dyschromia and other signs of actinic and environmental damage, reducing pore size and acne scarring, and even stimulating the production of collagen, and possibly even restoring some degree of skin elasticity. All of these treatments may be helpful in delaying the “need” for surgery, especially in younger patients, and will often be able to add significantly to the overall result of surgery by producing a “healthier” and “younger” appearing skin…….but, no, I do not think they will ever replace surgery.
What’s exciting in the anti-aging space right now? Anything noteworthy coming down the pipeline?
One of the most exciting areas of research involves the many potential applications of stem cells. Unfortunately, many physicians are promoting treatments using the “buzz word” of “stem cells” without proof of the efficacy or safety of their proposed treatments. Patients need to be “educated consumers,” and carefully research and question both the physician and proposed treatments until the claimed results are validated by peer-reviewed research, but the potential to restore or replace damaged tissue with stem cell-stimulated “younger” and “healthier” tissue is certainly exciting. Other exciting but often overlooked progress is being made in developing improved transdermal delivery systems to permit “cosmeceuticals” and other topical applications to penetrate into the deeper layers of the skin were they can act most effectively.
Do you have any tips for patients to improve communication with their surgeons? What should they ask their doctor and how can they best explain what they want?
Patients need to be both educated and discerning “consumers” when seeking cosmetic surgery. There are many well-trained and talented surgeons for them to choose from, but they need to carefully research both the credentials and reputation of the surgeon as well as the procedures he or she recommends. They should be wary of advertising “hype,” claims that appear “too good to be true,” high pressure “sales” by the surgeon or staff, and should never pick a surgeon or procedure based on price. They should be comfortable with their ability to relate to and communicate freely with the surgeon and staff, and be sure that the surgeon realistically and clearly reviews the risks and benefits of the alternative treatments available to them. There can be complications with any surgery that may cause a less than optimal result, and they need to feel assured that the surgeon will “be there for them” if things do not go exactly as planned. If they’re not completely comfortable, they should not hesitate to seek another consultation. Cosmetic surgery, if done with skill and artistry, can produce dramatic and positive improvements in both appearance and quality of life, but patients must take care to choose a surgeon wisely.