The Two-Finger Rule

December 12, 2008 by  

I have been thinking about writing this blog for the past year but have forgone writing it because I had so many other ideas floating around in my noggin to write about. However, last week when a patient who came into my office for Botox said, “Dr. Lam, I was thinking of fat grafting but I really don’t want that. I just want this,” then she lifted two fingers on her skin to show me the lifting effect that she desired. Ugh! I knew at that point I needed to commit thought to paper (or thought to keyboard in today’s parlance).

We oftentimes think that our fingers can relay to the plastic surgeon a feasible, realistic goal. “Heck, if I can just take two fingers to pull up on a certain part of the face, why can’t a skilled surgeon replicate such a maneuver?” The simple truth is that is what the threadlift that came out a few years ago was purported to accomplish. It would pull the skin upward in the trajectory accomplished by one’s fingers. The aesthetic result of such a maneuver, the threads and the company were short lived and so was my patience for these touted results.

Without making this blog interminably long, suffice it to say that the two-finger rule simply does not apply to reality. Surgeons can’t reproduce it to your satisfaction, and oftentimes it bespeaks the wrong intuition to begin with. I can’t remove pores, acne scars, definitively smooth out folds with a lifting maneuver that in many cases you simply do not need and that would worsen your condition or not help it. As a summary of my thoughts on facial gravity, please watch my video “Rethinking Gravity” in full to understand why our a priori notions of facial aging are pretty much screwed up so is that of 99% of plastic surgeons out there and their thoughts about what constitutes facial aging (of course, i am unbiased in my comments…not!).

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6 Responses to “The Two-Finger Rule”

  1. lori on July 7th, 2009 6:54 pm

    I was wondering how come it wasn’t possible to take a small amount of skin from the area your two fingers were at and make a small incision at hair line, even if it were visible the results would outweigh possibly very unnoticable scar as long as you didn’t wait too long to have something done.

  2. dr. lam on July 7th, 2009 7:05 pm

    in one word, stretchback. what happens when you try to remove a sag by pulling back and cutting a small degree is that the result will not hold up. instead the skin will easily stretch back and then you only have a very ugly wide scar with no results. when facelifts are done, you lift the deep tissues to have any chance at durability. stretchback is the problem. to avoid stretchback with a facelift, the only extra skin that comes after all the muscle is suspended is removed and sutured because there is no tension. hopefully that all makes sense.

  3. bushra on August 3rd, 2010 7:13 pm

    my dermatologist also told me amini facelift would improve my scarring then microsilicone injections after ward i have done 9 profrax treatment and 2 laser resurfacing by the sciton laser and 4 sand abrasion and or dermabrasion it has been tough what is the best treatment for acne scarring out there?

  4. dr. lam on August 3rd, 2010 9:21 pm

    that is hard to say. it depends on what you have. if they are deep, i like to use silicone injections. if they are small tiny pits, then i use a deep acid to burn the little holes up called CROSS. if they are textural, then laser.

  5. Jessica Neal on April 17th, 2011 5:18 pm

    Why even have a facelift if it will not do anything ? What is the point to give $ to the surgeon. Why doesn’t someone come up with a way to freaking get rid of acne scars. It is too much to deal with !!
    Why can’t a surgeon figure out the two finger thing with no stretchback !!

  6. dr. lam on April 17th, 2011 6:04 pm

    the facelift helps lift jowls and sagging necks. it just does not stretch out folds and wrinkles. so it is important that a plastic surgeon give a prospective patient the correct information on what a procedure can do or what it won’t do. as far as acne scars are concerned, i have become pretty well known in the circles because of my unique approach of using silicone micro droplets for larger holes and CROSS acid treatments for ice picks and residual deficits. although i would like to emphasize that nothing is perfect for acne scarring, my techniques have shown to really work to at least give very nice improvements. :)

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