Thoughts on Beauty from Some of the City’s Leading Cosmetic Doctors, Now Open for Business
When you search an official, peer-reviewed directory for leading physicians in Coral Gables, (see our guide) like the national Top Doctor list kept by Castle Connolly, you will see a dominant category: Beauty specialists, be they dermatologists, plastic surgeons, or cosmetic dentists. Just driving around the city you see the signs: The Plastic Surgery Institute, Allure Plastic Surgery, Gables Perfect Smile, the Dental Studio (as though it was an artist’s workshop), the Miami Skin Institute, etc.
“I wanted to practice here, in this environment,” says cosmetic dentist Dr. Jose Abadin. “Looks are important here, so people are more inclined to do cosmetic dentistry.”
The same can be said about plastic surgery and cosmetic dermatology. “Your appearance is important in the workplace here, too,” says cosmetic dermatologist Dr. Oscar Hevia. “You want to look young and fresh because [then] you look like your performance would be better. You don’t want to look tired.”
In essence, is the philosophy of most doctors who work the aesthetic side of the street: It’s not about looking like someone else. It’s about looking like yourself, only younger, better, fresher.
“It is a perfectly reasonable thing if a patient wants a change, but I don’t like to make any drastic changes,” says Dr. Stephan Baker. “You don’t want people to pick up on it. The goal is to look like you haven’t had anything done, but you look better. The stretched look is an esthetic failure.”
In essence, says Baker, less is more. This has to do with breast augmentations, as well as facial rejuvenations. Dr. Baker says he is now performing numerous breast reductions, especially among women in their 40s and 50s “who prefer to go smaller. It makes them look lighter and younger. At a certain age large breasts make you look matronly.”
A New Approach
Dr. Baker, like other Gables plastic surgeons, is part of the movement toward volume restoration – as opposed to the old practice of cutting and pulling. “That look, where you look tight, is turning people off. Natural looks are what people want. In the past we over did it,” he says. Replacing volume by itself can lift the skin and give it a youthful plumpness. Also, if your own fat is used as the filler – as opposed to synthetic fillers – there are benefits that come from the stem cells in the fat that help erase wrinkles and restore a youthful glow.
“The fat can help with skin appearance – you can see improvement in the quality and texture of the skin,” says Gables plastic surgeon Dr. Daniel Careaga. While Careaga uses a patient’s fat as a filler during a face lift procedure, he is also concerned that it may not be as consistent as a synthetic filler because some may be re-absorbed by the body. “A certain percentage doesn’t survive so it’s not entirely predictable,” he says.
Careaga says he is therefore inclined to use synthetic fillers, which have gotten better in recent years. “Facial rejuvenation has changed a lot with the development of better fillers,” he says, so much so that “fillers today can postpone the need for a facelift. And once you do [get a facelift] they help give better results.”
One thing that cannot be helped by fillers, however, is the excess skin that sometimes creates jowls as we get older. “The reality is that humans are living longer. Now people in their 80s can be the picture of health.” That does not mean, however, that they can avoid sagging neck skin – which if removed dramatically restores a youthful appearance. “Most of my patients were happy with how they looked before,” says Careaga. “They want to take a couple of years off, but they want to look like themselves.”
While plastic surgeons like Baker and Careaga also perform body contouring and breast augmentation procedures, when most people think of beauty they think of the face. That is the focus for cosmetic dermatologists – as opposed to dermatologists who are helping rid you of skin cancer or a pernicious rash. And what they offer is rejuvenation without the knife.
Dr. Hevia says the two trending areas in his practice are eyes and jaw lines. “People are understanding that as your eyes age, so does your face. This is becoming more and more recognized,” notes Hevia, who says that under-eye filler is becoming a popular procedure. “With the hollow under-the-eyes tissue we can do wonders non surgically,” he says. “If you use filler around the bag you can make it look much better.”
The other new tool is “a nice non-surgical way to help define the jawline, which improves the appearance of the neck,” says Hevia. As we age, he says, the chin starts to recede and we start to lose definition of the jawline. This results in “a blurring of the jaw and the neck,” which loses the “youthful frame” of the face. “We can’t correct the goose neck, which does require surgery. But we can make the person look more youthful and refreshed with a sharper jawline.”
For that sweet blush of youth, of course, a rosy complexion is a must. And that is, ultimately, the specialty of the cosmetic dermatologist. At the offices of Dr. Flor Mayoral, who practices in the south Gables with both of her daughters, there is an arsenal of high-tech gear to augment the use of fillers – from lasers that can resurface damaged skin to intense pulsed-light devices that improve skin texture.
While volume replacement is important, says Dr. Mayoral, what her patients also want is “a creamy complexion, with a pink vibrant color to the skin.” In other words, they want a smooth face that is absent the brown, red or purple spots, patches and freckles that come with aging and years of exposure to the sun.
While laser and pulsed light can get rid of the surface blotches, Dr. Mayoral also uses tools such as a radio frequency device that tightens the skin and gives it a better tone. It works by heating the collagen beneath the skin’s surface, which damages those fibers and causes them to renew. “The new fibers are tighter and will change the contour of the face,” she says, and you won’t need another treatment for a year and a half.
When You’re Smiling…
Of course, no amount of smooth skin or defined jaw line can impart an impression of beauty if your teeth are in bad shape. Nothing worse than the look of grey, yellow teeth, let alone teeth that are misshapen or missing.
“Miami in general is a particularly image conscious place. People are very caught up in their appearance and cosmetic dentistry is a big part of that,” says Dr. Gordon Sokoloff of Coral Gables Dentistry. “Teeth are way up there in what makes us look young. In general people look at our eyes and then our teeth. I look at teeth first of course – and on dating sites, you will see ‘Must Have Nice Teeth.’”
The challenge, says Sokoloff, is trying to convince people that a natural looking smile is more important than a perfect looking smile. “You can cross the line with people that want teeth that are too perfect looking…. You get people who choose a color we call toilet bowl white, or snow white. I try to talk them out of it.”
Dental technology, meanwhile, is making strides. The old, heavy-duty X-rays are being replaced with digital scanning technology that uses hand-held scanners. The materials used to cap teeth or create veneers has also gotten better, with different kinds of ceramics, porcelains, and silicates, which are stronger and more durable. Dentists are also using platelet rich plasma, taken from a patient’s own blood, to accelerate the regrowth of gums.
“Dentistry has changed significantly the last 10 to 15 years. There is a lot more emphasis on appearance and beauty, and to compliment that is the feature of your smile,” says Abadin. The omnipresence of cell phones has also driven the demand for dental beauty “through the roof,” he says. “With selfies, people have a mirror of themselves at all times. And there is nothing better than having a beautiful smile to compliment the whole face.”
Except, perhaps, the whole face itself. And for that, besides returning the patient to a more youthful version of him or herself, it comes down to a matter of balance. Even in the realm of teeth, says Dr. Abadin, “there is a certain proportion that you need to look good.”
Before going to medical school, Dr. Careaga was an undergrad majoring in the branch of philosophy that deals with aesthetics. “What critically defines beauty in humans, art and nature, is a combination of notes that sound beautiful, versus those that make your neck hair stand up.
There is a component of symmetry, the golden ratio, that translates into a beautiful appearance… It’s not so much that I am making a patient look beautiful, as it is that I’m finding a way to bring back that aesthetic balance.”