The Two-Finger Rule
December 12, 2008 by dr. lam
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!).
Comments
2 Responses to “The Two-Finger Rule”
Feel free to leave a comment...
and oh, if you want a pic to show with your comment, go get a gravatar!
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.
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.