THE ART OF A FACELIFT
Leading surgeon Jack Zoumaras on why facelifts can and do change lives, where they can go horribly wrong, and why the cosmetic cowboys need to be stamped out
Wrinkles from an occasionally misspent youth – and sometimes misspent adulthood – give me character, I say. Laugh lines show I’ve laughed a bit. But after reaching a certain age I’m wondering if the teabag eye bags are such a good look. Is nip ’n’ tuck only for crazy Californians seeking youth, or is it something that can restore confidence, and keep people like me verging on codger status in the career game, in a society where so much revolves around youthful looks?
Is a facelift only for desperate Hollywood celebs trying to cling to youth, or is it as natural an extension of staying self-confident and relevant as make-up, hairstyle and clothes?
These questions and more I put to a man who grew up in Cowandilla, the much loved son of Cypriot immigrants, who trained for almost two decades to become an “artiste”, a specialist in facial plastic surgery, and is now one of the country’s foremost and respected plastic surgeons.
Artiste Plastic Surgery is the name of Dr Jack Zoumaras’s clinic. And the name of his new book is The Art of a Facelift.
“The name Artiste Plastic Surgery was chosen as it speaks of elegance, sophistication, professionalism and skill,” Zoumaras says.
“The word ‘artiste’ is French for artist, and plastic surgery is a perfect blend of art and science … as a facelift plastic surgeon I sculpt one’s eyes, nose, and face to give patients balance and empower them with confidence.”
It is a field of fascination for many. It holds the promise of near-eternal youth, and the fear you could end up like a celebrity horror story, or someone on “Botched” – a Foxtel show about cosmetic surgery gone wrong. Zoumaras dispels myths and sheds intriguing light on the field in his book and during an in-depth interview with Weekend. Some background. He grew up in Cowandilla, by far the youngest of five in a close-knit family, quipping he is “the living proof the oral contraceptive pill is 99 per cent efficacious because I am the 1 per cent”. Dad Nicolas was a slaughterman at the abattoirs, mum Joulia a full-time homemaker, and Jack was the first in his family to go to university after graduating from Adelaide High.
He wanted to study medicine since childhood and would “read the Adelaide Advertiser every year on those students who got into medical school”.
A honours degree in health sciences at the University of Adelaide was followed by a medical degree at Flinders University where he decided on plastic surgery, followed by years more training, work and study in New York, Paris and San Francisco to sub-specialise in facial plastic surgery. His qualifications are lengthy.
From Cowandilla, he is now based in Sydney’s ritzy harbourside Darling Point with wife Maria and son Nikolas, and his book makes it clear family and God are pivotal in his life.
He describes the birth of Nikolas, which occurred a few years after he became a plastic surgeon, as a pivotal moment which would inform his work from thereon in.
“... having Nikolas gave me purpose and zeal for life,” he writes.
“The moment I looked into his eyes I was overwhelmed with profound love. I was so proud of him and truly felt the calling to be the best role model for him, and this gave me a huge stimulus to step it up with my private practice.”
But enough background – if you are reading this you no doubt want to know about facelifts, and the book provides as detailed a breakdown of the procedure, its variations and history, as you are likely to find.
Some numbers from the book to mull over: The average age of a facelift patient is 55, but Zoumaras says it can “benefit patients from as young as 30 and certainly in their late 30s and early 40s, I am doing more and more facelifts in younger patients”. Just 20 per cent of his patients say they want a facelift “to look younger”. The “ancient golden ratio of phi which is
67 per cent” is a rule for beauty – the face should be divided into thirds and the nasal projection should be 2/ of the length.
3 A facelift plastic surgeon dedicates 6-8 hours for a full face and neck lift. The first documented modern facelift was on a German ballerina in 1901, then the reconstructive skills learned by surgeons in WWII repairing the form and function of the injured led to modern cosmetic surgery for aesthetics rather than function. A proper facelift takes in five concentric layers of the face going down to the bone, not just the outer layer of skin.
Zoumaras likens this final point to restoring a fallen tree, saying you need to work on ligaments, muscles and subcutaneous tissues as well as outer skin – the trunk, branches as well as the leaves.
“To lift a fallen tree you need to lift the entire tree from the trunk (ligaments), not just the leaves,” he says.
Father Time takes its toll and for many it shows in the face as the skin begins to lose volume and elasticity due to sun exposure, smoking, wear and tear, and even blinking thousands of times a day.
Zoumaras says you can tell the age of a person by the anatomy of their face.
“The reason for this is the descent of the face as we age,” he says.
While time marches on, Zoumaras observes men and women of all ages have an innate desire to look beautiful and, if attending a function for example, will shower and cleanse, put on make-up to conceal blemishes, style their hair according to trends and wear fashionable clothing.
“Plastic surgery is the final continuum of beauty treatment,” he says.
“Today this desire to look your best is influenced by social media with many 20somethings presenting to my office for enhancements of cheeks, lips and even surgery.”
So if there is a little sagging in the face, does it really need the entire “tree raising” or just a little skin lift?
“When I talk about a facelift, I mean, lifting and rejuvenating the entire face. The entire face includes the brow, eyelids, face and neck,” he says.
“Once upon a time, a facelift, simply and semantically speaking, was meant to lift the facial skin. Although lifting the skin is important, the skin is a mere cover for the face, and only contributes to 20 per cent of facial ageing deformities.
“What lies deeper in the skin – the muscles and ligaments – are what causes the true ageing deformity of jowls, lower eyelid hollowing, and deep naso-labial folds.
“Lifting the skin simply does not work well or last a long time. It’s akin to a Band-aid fix that is temporary as it does not address the underlying problem.”
Zoumaras freely concedes not everyone who
has jowls and loose skin seeks a facelift.
For some it creates a face full of character, but for others it can be an issue of concern every time they look in the mirror. And with each passing day, it is a one-way street.
This is where he says the decision for some facework can be due to “an internal calling that has everything to do with psychology”.
“A facelift empowers and gives confidence,” he says.
“Many patients value the way they look, and it forms an important part of who they are.
“Others have reached a point in their life where they want to do something for themselves and be confident.”
So bearing in mind that Medicare only covers essential reconstructive plastic surgery – you’re quite sure maybe a little cut-price skinonly nip ’n’ tuck is not the answer, Dr Z?
Not if the person values long-term results, is the reply.
“The modern facelift involves lifting the skin, reconstructing facial ligaments, augmenting facial architecture, and replenishing lost volume with fat,” he says.
“Ancillary procedures such as dermabrasion, chemical peeling, and post-operative skincare add luminosity and ‘icing and the cherry on top’ to the final result.”
Just 20 per cent of the people who walk into the Darling Point clinic openly admit they want a facelift to “look younger”.
Motivations range from improving confidence to staying relevant in the workplace, from maintaining desirability for a partner to refreshing a chronic “tired” look.
Then there is revenge. And guilt. Zoumaras counsels people who say they want revenge on a former partner to instead see a psychologist, as any facial work will not result in empowerment.
As for guilt, many clients carry this through the door. A facelift may be seen as the ultimate indulgence, one to be seen multiple times a day in the mirror of people who go in for a rejuvenation.
Younger clients may feel guilty such money could be spent on the mortgage or a family holiday. Older clients may feel they are spending the children’s inheritance and the grandchildren’s school fees.
And that’s OK, according to the surgeon. “I can honestly say that not one patient has regretted the money that they have invested in themselves,” he says.
“The very normal feeling of guilt is replaced by happiness, confidence, and self love.
“The new-found empowerment and confidence are real and priceless.
“A facelift will unleash your inner confidence
What lies deeper in the skin … are what causes the true ageing deformity. Lifting the skin simply does not work well
and empower you. It’s like hitting a refresh button on your face.
“You no longer look tired or worn down. You will look rejuvenated and fresh, and your skin will also look illuminated. This is a direct result of fat and stem cell grafting.”
Sounds good in theory, but what about those Hollywood celebs we laugh at for “having too much work” … is there a risk this sounds too good to be true?
Zoumaras says skilled plastic surgeons aim to rejuvenate and glamorise a face with dramatic results, but crucially while keeping the “natural” look.
“People often attribute ‘fake or plastic’ looks to plastic surgery but it is often too much filler or non-surgical work, or poorly executed plastic surgery that generates the fake/plastic look,” he says.
“Plastic surgery gets a bad rap for creating ‘fake looks’ in celebrities because people who don’t understand it love to hate plastic surgery.”
As a highly trained surgeon, he has no time for what federal Health Minister Mark Butler has labelled “cosmetic cowboys” – people claiming to be cosmetic surgeons whose cut-price work gives cut-price results.
His book details some of the short-term, cutprice and downright dodgy practices in the business of making faces look better, from fillers and anti-wrinkle injections to energy devices, “vampire facelifts” using plasma-derived growth factors and even what he labels the “magic potions” of skincare products.
He notes the industry is not well regulated, a point the health minister is pursuing.
Says Butler: “In the last several months I think all of us, health ministers and the general population, have been shocked by the litany of stories of damage being wreaked by unregulated cosmetic cowboys.
“These are people holding themselves out as surgeons without surgical training, charging huge amounts of money for cosmetic surgery, and in too many cases, wreaking often permanent damage to unsuspecting patients.”
Butler urges the public to check the qualifications of practitioners and notes he and state health ministers, including SA’S Chris Picton, have agreed to take “strong legal action to stop people holding themselves out as surgeons unless they have relevant surgical training”.
“These changes are designed to put a leash on the cosmetic cowboys,” he says.
“For too long this has been in the too hard basket – you’ve seen cosmetic cowboys out there charging huge amounts of money, wreaking often permanent damage on patients who understandably took them at their word when they told them they had surgical training.”
Zoumaras’s book includes testimonials from patients and concludes with a rundown of what is involved in a “patient journey”, from the onehour initial consultation, to the two week postoperative checks.
It has a final word for anyone weighing up the value of using a fully qualified plastic surgeon: “You can’t hide a bad facelift.”