Sam P. Most, M.D., F.A.C.S. is Chief of the Division of Facial Plastic Surgery at Stanford University in Stanford, Calif.– a distinction that speaks volumes about his credibility, techniques and skill set. He is widely sought after in the Bay area, where he is known for his integrated approach to facial aging and natural-looking results.
Dr. Most chatted with Beauty in The Bag about his approach to facial plastic surgery, the effect Facebook and celebrity worship is having on his patients and the importance of being honest about what a procedure can or can’t do.
Here’s what he had to say:
1. Tell us about your practice and the types of patients you treat.
My practice is primarily aesthetic surgery of the face and neck. I treat patients from young adults to seniors interested in improving their facial appearance. My philosophy is that no two individuals are alike. Each of us has a unique set of physical features and cultural identity that must be respected. I enjoy meeting new patients and working with them to help them make informed decisions about what procedure(s), if any, would work best.
2. What is your most-requested procedure?
My most requested procedure is probably rhinoplasty or revision rhinoplasty, although my facelift techniques have been getting much more attention lately.
3. What is evidence-based medicine and what role should it play in facial plastic surgery?
Evidence-based medicine simply means the application of the best available evidence gained from science to patient care. This is rather straightforward in fields such as cancer treatment, as many well-done studies have been performed and are available for evidence. Unfortunately, in the field of facial plastic surgery, we do not have as many rigorous studies to use as an evidence base. In this day and age, the media (internet, TV, social networks) contribute much misinformation regarding the effectiveness of procedures. Take radio frequency facial rejuvenation (e.g., Thermage). Back in 2002, this technology was featured on Oprah and immediately was heralded as the end of facelift surgery. As we now know, the evidence did not back this up but was largely ignored by both the public and, unfortunately, practitioners. The same can be said of ‘threadlifts’, which were popularized in the early 2000’s as well, and quickly fell out of favor. I believe is imperative for surgeons such as myself to be honest with patients in communicating what we know and don’t know about a given procedure’s risks and benefits. While I am excited to help develop new technologies, we must temper our enthusiasm until real results can be demonstrated.
4. What new products/technologies are you most excited about?
I am most excited about advances in our understanding of facial aging vis-à-vis volume changes in the face. In the ‘old days’, we were taught that the facial aging was simply due to gravity. We then understood that aging is also due to changes/shifts in the position of fine and large deposits of face in the face. What we’re now starting to understand that it goes even deeper—the bone itself re-organizes as we age. What does this mean for facial aging treatments? Combinations of facial tightening and volumization are already being used to improve our results. I see this evolving into less invasive surgical procedures, with much more emphasis on three-dimensional rejuvenation.
5. Do you see more requests for facial plastic surgery due to social media and ‘selfies’?
Yes, we most definitely see more and more patients concerned about their appearance in photos posted on social media sites. It is very common for patients to show me their tagged photos on Facebook, for example, to point out issues that they find distressing. The fact of the matter is that we are all photographed much more often, and more people are seeing our faces than ever before. Several groups have been examining this phenomenon, and certainly this trend is likely to continue.
6. Do many patients come in requesting procedures to look like celebrities? If so, which celebrity and what do you tell them.
This is a great question and probably applies best to prospective rhinoplasty patients. This is something I see quite often, especially from my patients that travel up from Los Angeles to the San Francisco area to see me. Interestingly, patients tend to choose stars that match their skin/hair color. For example, many of my patients with olive skin and dark hair tend to choose Kim Kardashian’s nose. I appreciate that my patients have taken the time to investigate what types of noses they like and dislike. To me, this is an opportunity to try to understand more about my patients’ desires. I make it clear that no-one can recreate any given celebrity’s nose on another’s face, nor would it necessarily look appropriate on another’s face. Still, we can use such images as a guide to determine what would look good and see what’s possible.