By Ruth J. Katz
"Climb every mountain,” as intoned in The Sound of Music is a mantra that plastic surgeon Dr. Andrew Jacono has embraced as gospel. The dual-boarded (otorhinolaryngology and facial plastic and reconstructive surgery) physician—who operates only from the neck up—has already summited, along with his son, to the peaks of three of the classic seven summits.
You might ask when he has time to train…but more significantly, you might inquire when he can chisel out a few weeks each year to participate in not one, but two, annual missions to Third World outposts. Here, he operates on children with facial defects (mostly cleft palate issues), as part of a surgical team, organized by Healing the Children, the HUGS Foundation, or T. H. A. I. Children (Through Healing All Indigent Children). To date, Jacono has operated on over 500 children, and he acknowledges that it is one of the most gratifying experiences of his life. Just when did he find the time to write two books, with a third, The Park Avenue Face debuting in 2019?
But, of course, his priority is operating five mornings a week—three to four days in his AAASF-certified surgical suite in his new Park Avenue office and one to two days a week in his Great Neck facility. And still, there is time to teach, as Associate Clinical Professor, Division of Facial Plastic and Reconstructive Surgery, at Albert Einstein College of Medicine. New York Lifestyles managed to squeeze a little time from his schedule to discuss some “fast facial fixes” for the busy spring social calendar.
Spring is traditionally one of the two busy social whirlwinds on the calendar. Is there any magic in your toolbox to make your patient look camera-ready?
If you have a wedding in June, it’s too late for a traditional surgical rhinoplasty, but I can do a non-surgical rhinoplasty that has satisfying, even remarkable, results. We can achieve an impressive, camera-ready effect with fillers. With the right amount of filler at the nasal tip, we can give the nose a lift, raising it and defining it better; you’d be surprised what it does to the face. Additionally, we can smooth out a bump on the bridge of the nose with filler. These are painless and fast procedures with very gratifying results that can easily last a year.
You mentioned being camera-ready, so what can a patient do for a better smile for those upcoming selfies and reunion photos?
Lip augmentation is another relatively fast fix. In older women, the lips tend to get thinner, and the appealing cupid’s bow of the upper lip flattens. A little filler goes a long way here, too. But fillers need to be injected carefully and require a skilled eye and hand so that the result is natural and appropriate for the face. Additionally, as the face ages, the upper lip starts to droop. It becomes more simian-looking, and the sagging often hides the upper teeth, even when smiling. We can do variations on a lip lift, with maybe only a week’s recovery time, with tiny incisions, and no anesthesia. We numb the skin with a local anesthetic, and through minuscule incisions, we lift the muscles, removing extra skin, and voilà! A broader smile, a more youthful look. This makes a dramatic difference, and yet requires little downtime and the procedure is barely 45 minutes.
Any other kinds of “simple” tricks you might suggest to take some years off the face?
In the late 30s and early 40s, we start to lose elasticity and the cheeks begin to fall. Again, gravity is the enemy. We can raise the cheeks a bit, filling them in, returning a fullness that softens the nasolabial lines, winning a few years, at least visually. Voluma can work well here, and it is long-lasting—you get perhaps a year from it and photographs will definitely look better. Of course, there is Botox, too, which if used poorly, can make you appear stunned and startled. It needs to be subtle, and when it’s done right, you get a softer look around the eyes, lifting them and the brow, making the eyes appear brighter and more prominent. We can also do micro-needling, under the skin, with platelet-rich plasma (PRP), in which we use the patient’s own blood; it is better than a light chemical peel, requires less recovery time, and it helps build collagen under the skin.
Is there anything you can recommend that has a more lasting effect, but that doesn’t sideline a patient for weeks?
As the skin gets lax with age, we tend to increase the amount of injectable(s) we have to use, but ultimately we get less and less improvement. It is at this point that I recommend my new M.A.D.E. (Minimal Access Deep Plane Extended) hybrid facelift, a minimally invasive, rapid-recovery facelift, requiring about seven to ten days’ recovery downtime. It offers a more permanent solution and lasts for 10 to 12 years. It has very satisfying results; this less invasive facelift is likely to be less expensive than the ongoing costs associated with fillers that will be less effective over time. When is it time to consider this? It is not a function of age, but instead, it depends on how much improvement a patient is looking for, weighing that against the downtime and associated cost.
What part of your practice is devoted to male patients?
Today, 20 percent of my practice is comprised of men and that number is growing steadily. Eighteen years ago, I saw a male patient once every three weeks; today, I see a few each week. In a competitive playing field, men often wear their resumes on their faces and they want to appear strong and take-charge, not tired and stressed-out. If they are in their 60s, they want to look like they are in their 50s and so on. They want to get rid of bags or dark circles, which we can address with filler, through the tear duct. They also want a strong jawline, an earmark of leadership abilities. We have several ways to achieve that chiseled jawline—fillers, or a relatively easy chin implant, with little recovery time.
For more information on Dr. Andrew Jacono, visit newyorkfacialplasticsurgery.com.
© 2018 All Rights Reserved Ruth J. Katz
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