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    Facial shaping with fillers an ‘artform’

    Consider symmetry, underlying structure and frame in facial rejuvenation


    It is sometimes said that medicine is both an art and a science. This could be particularly true of oculofacial plastic surgery, according to surgeon José R. Montes, MD, FACS, FACCS, ASOPRS.

    “Facial shaping with filler is a lot like painting in 3-D,” said Dr. Montes, professor, Department of Ophthalmology, University of Puerto Rico School of Medicine, and medical director of a clinic in San Juan specializing in eye and facial rejuvenation.

    Dr. Montes urged surgeons to think of facial shaping as art.

    “Get inspired by your patient,” he said. “Think of [the face] as like a block of marble stone, a lump of moist clay, a mound of beach sand, or an urban city wall. We are sculptors.”

    Before getting down to the actual clinical task of facial shaping, the surgeon should step back and get a broader perspective of the patient.

    “In theory, everyone has a signature feature. We can decide as doctors if we can do work on that salient feature to enhance it or whether we want to work around that feature to diffuse it,” Dr. Montes explained.

    Symmetry is often considered an important component of patient assessment and facial rejuvenation.  To illustrate this, Dr. Montes described using injectable fillers with a patient who had two signature features: a prominent nose and well-formed lips. His approach was to enhance the lips to minimize the nose prominence, striking a balance.

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