About Photographic Results
Cosmetic plastic surgery is a highly visual field. [Nearly 600 patient photographs are presented throughout this Results section as well-matched before-and-after photographic comparisons]
Dr. Little believes that philosophical and technical discussions of cosmetic facial surgery that include a large number of photographic results of real patients are far more meaningful than those that include only a few results (or none). Certainly, a learned lecture to an audience of plastic surgeons would be unthinkable without extensive pictorial data (photographic results) that would allow the listener to properly evaluate the message of the presenter. To be effective, such photographic results should be of sufficient number, longevity, consistency, and size to permit meaningful comparison and evaluation.
A sufficient number requires a convincing body of data (enough different patients, each presented in all three photographic poses) to reassure the viewer that the proposed techniques would perform predictably over a range of facial types and would not be limited to sporadic or occasional good results, that could then be selected out and shown in small numbers (by the way, Dr. Little is able to present far more photographic results during the private office consultation than can be presented here on the website). The three photographic poses that should be shown for each patient include: the forward or AP pose (this most important view–the one in which we socially interact with one another in life–is also the most difficult photographic view in which to document an appearance of convincing rejuvenation); the three-quarter or oblique pose (which provides the best architectural or shape analysis of the face); and the profile or lateral pose (which reveals the contour of the neck, but also that of the under-eye region and lips). When only one of the three photographic poses are presented on a website for any given result, it can be reliably assumed that the other (omitted) poses were neither admirable nor natural–and were therefore not shown.
Sufficient longevity requires that “after” photographs be taken only after an appropriate time has elapsed beyond the surgery, such that the results have stabilized and are likely to hold up well over time. Facelift results that are shown only weeks or months after surgery may frequently appear disappointing six months or a year later. All of Dr. Little’s results are shown at least six months after surgery, most a year or more after, and some as late as four to five years after. And during the private office consultation, Dr. Little (almost uniquely) reviews many facelift results ten to twenty years after surgery (that remain prettier and “younger” than before surgery).
Sufficient consistency demands that the patients be positioned in the same manner and the photographs be taken with the same lighting and photographic technique in both the “before” and the “after” views. A few examples of the many misleading inconsistencies that can misrepresent post-operative appearances include: smiling faces (bringing artificial elevation to the cheeks and mouth), elevated chin positions (bringing artificial improvement to the neck profile), and over-exposed lighting (obliterating remaining creases, such as nasolabial or marionette lines). Of these, smiling results are probably the most frequently abused; Dr. Little believes that any smiling “after” image (moving or still) next to a non-smiling or frowning “before” image is likely evidence of an intentional effort to mislead. [One should not confuse a reposed or relaxed view of the mouth that shows dental display or teeth with willful, active smiling.] Dr. Little’s “superimposed faded views” require an especially high standard of consistency in order for them to “work” properly, as they fade back and forth between well-matched pre-operative and post-operative views. [In a perfect world, all makeup would also be eliminated in both views. But this nicety would impose a significant inconvenience on the busy post-operative patient, and most surgeons choose not to make such an imposition (most are pleased that their patient has come all the way in to the office for their post-operative photographs and are reluctant to insist that all makeup now be scrubbed away, as well). Dr. Little, along with his more observant patients, can easily see beyond any such makeup differences, which (in his practice, at least) tend toward the subtle and restrained.]
Sufficient size demands that the patient’s face fill as large a viewing space as possible; the small before-and-after facial images seen on many websites (with large displays of hair and clothing included) defeat meaningful comparison, in general, and make analysis of the finer aspects of rejuvenation all but impossible. Dr. Little, therefore, prefers the larger screens of desk- or lap-top computers for site viewing; nevertheless, the smaller screens of mobile devices continue to present the basic photographic results very satisfactorily.
Photographic results are presented on this specialized website in three different formats: a photo gallery of basic results, video-highlighted results, and highlighted results with video comparisons.
The photo gallery presents basic, side-by-side, before-and-after photographs typical of other websites. What distinguishes them from those of most other sites, however, remains their particular consistency (positioning, lighting, size, etc.) and avoidance of distracting elements (clothing, hairstyle, etc.).
Video-highlighted results present these same precise images in flash videos, but this time as superimposed (or stacked) images that can then be faded between pre-operative and post-operative views, such that important (but frequently subtle) changes can be highlighted and tracked precisely by the eye. In a similar manner, changes in contour can be contrasted by silhouette lines running along the soft-tissue profiles evident within the fixed side-by-side photographs. The net effect provides the interested viewer with far greater insight into the multiplicity of subtle changes that constitute a successful facial rejuvenation than can the study of side-by-side images alone. These flash videos, however, are viewable only on the larger screens of lap-top and desk-top computers, where they remain available to the more committed visitor.
Highlighted Results with Video Comparisons
Highlighted results with video comparisons present the same flash-video highlighted results that are then uniquely followed by embedded, side-by-side, before-and-after patient videos. These animated outcomes allow us to compare facial gestures and smiles, as we confirm the naturalness of the post-operative movements. But they do something even more important: they show us some of the enhanced improvements brought by “sculptural” rejuvenation that are typically appreciated only in real life. The volumetric improvements to the under-eye and cheek areas, in particular, become more evident in these moving pictures taken without “flash” photography. As other surgeons who use fat grafting have observed: the enhanced improvements and naturalness of volume-added facelift results are more evident in the real-life patient than in her still photographs. Moving pictures taken without flash lighting reveal more of this “real-life” quality; they are “truer-to-life.” These flash videos are also viewable only on the larger screens of lap-top and desk-top computers, where they remain available to the more committed visitor.
Just as Dr. Little has performed all the surgery evident within this photographic Results section, he has also assembled and prepared all the presentations on the website, including all text and all patient flash-movie results, as well as the simplified, dynamic surgical illustrations.
Wide Spectrum of Patients
Also, most patients hope to see photographic results in patients similar to themselves. Therefore, instead of a handful of highly-selected results, a wide spectrum of outcomes is presented here of a full range of patients of varying ages, facial shapes, skin types, and rejuvenation goals. Some of the patients present routine challenges in facial rejuvenation, with skin laxity their main aging concern; but most present with what plastic surgeons consider the greater challenges in facial rejuvenation: structural aging with an altered facial shape and advanced cheek, jowl, jawline, and neck deterioration, typically accompanied by hollowed eyes and fallen mouths. Dr. Little and the office are indebted to their patients who have allowed their pre- and post-operative images to be shared here, so that prospective patients can better appreciate the wide range of results available through a “sculptural” approach to facial rejuvenation. While we disclose neither patient ages, the fact of prior surgeries, nor other particulars, such as the specific nature of individual surgeries, such information remains available in the private context of an office consultation (each of the more than 250 before-and-after photographic pairs is indexed by a small number above-right, below-left or below-center, allowing later reference for potential questions during the consutation).
All Techniques Represented
All of Dr. Little’s key rejuvenation options are represented here, including the basic XJ lift; the XJ lift with malar (cheek) fat graft; the “malar imbrication” mid face lift alone; the combined (XJ with mid face) lift; the cable mini lift; the composite micro lift with fat grafting; and structural fat grafting alone. In some results, photographs have been reversed “mirror-image” so that all oblique and profile rotations are presented in the same direction (to the patient’s left), for greater ease and consistency of viewing. All are Dr. Little’s patients, operated on by Dr. Little (incidentally, Dr. Little performs all details of his surgery personally, down to the “last stitch”). One can appreciate a range in the “degree” of result from patient to patient: some appear to have moved from an appearance of established or impending “old-age” to one of “middle-age,” others from a look of “late middle-age” to one of comfortable “early middle-age,” while still others have achieved less a “younger” look than a “better, prettier, or more energized” look; some (who may or may not have had prior surgery) have moved from an “unnatural” look to one of harmony and naturalness.
Wide Spectrum of Results
Undoubtedly, some viewers will find that certain results show more “change” or rejuvenation than they themselves would have sought, while just as surely others will feel that certain results show too little or too subtle a rejuvenation than they would have hoped for; similarly, some results will present cheeks or lips too full for some tastes, but not full enough for other tastes. But that is exactly the point in presenting a wide spectrum of results among patients undergoing a variety of surgeries, from the very limited to the more involved; when “sculptural” philosophies and techniques are embraced, a powerful range of results becomes possible, from the more dramatic to the very subtle (some results that appear especially subtle in standard still photographs come alive with a look of impressive rejuvenation in the “truer-to-life,” moving-picture views of the photographic Results > Face with Video subsection). But for each of the patients included here, the amount or “degree” of rejuvenation was correct; each had effectively communicated their goals and aspirations, and each was pleased with their outcome. A key reason for the length of the consultation process with Dr. Little is to facilitate this kind of precise communication between patient and doctor.
Illustration: modified details from Leonardo da Vinci, “Profiles of an Old and a Young Man,” ca. 1495, Galleria degli Uffizi, Florence.