Deconstructing fancy face lift terminology [Kiya Movassaghi, MD, Eugene]

Eva Sheie (00:04):
Welcome to the podcast Where Before Meets After. Submit your questions for our experts at wherebeforemeetsafter.com. I'm your host, Eva Sheie.

Dr. Movassaghi (00:15):
I am Kiya Movassaghi. I am a plastic surgeon and currently the president-elect of the Aesthetic Society and I practice in Eugene, Oregon.

Eva Sheie (00:26):
There's a multitude of facial rejuvenation and facelift surgery techniques. They have acronyms, they have fancy names. People come up with their own names, lifestyle lifts, SMAS, deep plane, all of these things sound great but are really confusing to patients. So even with an explanation, we don't always recognize how they're different. What is your approach and how is it different and how should we think about it?

Dr. Movassaghi (00:53):
You brought up a very good question, as you said, there are a lot of names out there and if you get 10 plastic surgeons on a panel, you're going to get 10 different techniques, and perhaps they all show very good results. So for the public, the confusion is what are all these terminology mean? And a lot of 'em unfortunately use for marketing purposes. But we do all also have, accomplished surgeons have their own acronyms and their own technique. The way I approach the problem is by first analyzing what the problem is, and to do that, I listen to the patient. I ask the patient what it is that they are bothered by and give me its priority list. So it's my face, I noticed your face, but specifically what part of your face? Oh, it's my eyelid, it's my jowls, it's my neck, lower eyelid, upper eyelid, so forth and so on.

Dr. Movassaghi (01:44):
So then I asked them to go in front of a big mirror and I say, I'm sure you've done this at home in front of a mirror in your own bathroom, but show me how you would fix it. And they usually take their fingers and they try to simulate in the best way they can. And that right there tells me what they're thinking. Now, they may be wanting this, but so I don't want a big surgery, but then I'm like, okay, the two don't go together. But based on that and over doing this for many years, I came up with this more of a simplified way of thinking facelift, what I call three levels of facelift, level one, two, and three. And we have actually submitted this concept, which is a new paradigm in thinking about facelift. Now, how is it useful? Number one, it allows the patient to understand what part of the face we are dealing with and we're going to improve on.

Dr. Movassaghi (02:39):
Has nothing to do with what you're going to do underneath the skin has nothing to do with the technique. It has to do with what part of the face is going to be the object here. Number two, it will be also a way to communicate easier with your own staff. So when I communicated the procedure with my staff, I say I'm doing a level two. When they want to have some numbers for the patient together, they just type in level two and they know what that means. It's also a good way to communicate with the OR staff. So when they have on the schedule a level two, if they know exactly what I want for level two in terms of materials. Lastly, I think it's a great tool for communicating among the surgeons. So especially you're sitting in a room and as surgeon, I'm doing a deep plane or I'm doing a SMAS flap and this and that.

Dr. Movassaghi (03:25):
I have my own technique called a U-SMASectomy Lift or USL. So if I say USL, nobody's going to know what it is, but if I present USL as a level three facelift, they know what it means. That means I am improving the area around the lower eyelid and the cheek. I'm improving the lower face and the jowl and I'm improving the neck. That's a level three. If I say I'm doing a level two lift, that means I am not going to address anything in the lower eyelid and cheek area, but I will address the marionettes and the jowls and the neck. And if I'm doing a level one lift, I am only improving the neck. Nothing's going to improve in the upper face. And based on that sort of a paradigm and the new communication way, the patient understand it. Sometimes patients go home and initially they say they want to do level three, call back, say, you know what? I decided to go with the level two.

Dr. Movassaghi (04:19):
They understand what level two is, and it is a very clear way of communicating with patients and I think it would be a clear way of communicating among surgeons. So you come up with a new acronym, a new technique, you got to tell me which level it is, then I know your technique is going to address these issues. Now let me see what the technique involves. So that's the way I approach my facelift, my practice. Now, not every patient is a candidate for all the levels. So there are other things that goes into it in terms of patient's quality of tissue, patient's aging, patients, underlying bony anatomy, and then their desire. And lastly, the health of the patient and the cost of the surgery. All those things will take, go into that decision making process.

Eva Sheie (05:03):
Are you teaching and writing about these three levels and are your colleagues catching on and starting to adopt this?

Dr. Movassaghi (05:09):
Every time I present this concept, I've had many people in the audience come after me, we should write this up, we should write it. So finally, we actually, my fellow and I submitted this concept to the Blue Journal for the Plastic Surgery Aesthetic Plastic Surgery Journal a month ago, and I should just run into the editor and he said, we're going to hear pretty soon about decision on that.

Eva Sheie (05:32):
Now, I'm going to take a little bit of a side journey here because I know this about you, that you are always trying to help your other, not just younger surgeons, but your colleagues and you spend a lot of time doing that. This sounds like another way that you're helping other surgeons make their lives easier.

Dr. Movassaghi (05:49):
Absolutely. I just said it is a way to communicate. Because I just said the field's very confusing and you don't have to be doing this for 30 years to become good at it. I always try to make things simple, whether I'm doing a breast surgery or face surgery, the concept's simple. Of course there are challenges during the surgery, but you have to understand the concept in a more simple version. We should not make it so confusing that the people don't understand what you've been talking about. Make it simple, so then you build on that building block. They understand where you're working in the face and then what you're doing, oh, okay, that's why you're doing this because it's going to improve this in the face.

Eva Sheie (06:29):
How long have you been using the system?

Dr. Movassaghi (06:31):
This concept? I think I've been working on it probably for the past five or six years. It actually got all started from a patient demonstrating, I went through it, I'm like, okay, let's make it simple. And I was doing all these procedures and based on my own terminology, I actually modified my own techniques. So I have different techniques for different levels now, and that's why I think about it because I'm trying to improve this portion of the face and I need a level three.

Eva Sheie (06:57):
It's very patient-centric too, which also makes it powerful and useful.

Dr. Movassaghi (07:02):
Very, I mean, as I said, simplicity is the name of the game. I use the same kind of a simple thinking when it comes to breast augmentation, which we're not going to get into now, but it is just that building blocks and projections. The patients understand it. They go home and they come call back and they actually tell me what I taught them and what they want as a result of the surgery.

Eva Sheie (07:22):
That's how you know it worked. If we are listening today, we want to find out more about you or come see you for a consultation, where should we look for you online?

Dr. Movassaghi (07:32):
So you can go to my website, kiyamovassaghi.com. You can go to my Instagram, Dr Kiya Movassaghi.

Eva Sheie (07:39):
Thank you for your wisdom today.

Dr. Movassaghi (07:41):
Thank you very much for inviting me again

Eva Sheie (07:45):
On this podcast, we be bring you directly to the doctors who are where before meets after. Links to our guest's website and contact info are in your show notes. Follow us on Instagram @wherebeforemeetsafter. If you're a board certified plastic surgeon and would like to be a guest or a sponsor of the show, go to wherebeforemeetsafter.com for more information. Where Before Meets After is a production of The Axis, the podcast agency for aesthetics, theaxis.io.