It goes without saying that looking at a photograph is not the same as seeing something in real life. A two-dimensional snapshot simply cannot capture the nuance of a three-dimensional world, yet selfie and social media culture too often fails to respect that important distinction. Whether it’s through makeup, lighting, or face tuning apps, the photos that fill our feeds are not necessarily indicative of reality. But, increasingly, people are turning to cosmetic treatments to recreate a specific aesthetic that might look great in a picture but doesn’t translate to a natural-looking appearance in person because it lacks the movement and expression we expect to see. This is where an additional dimension of beauty – one that accounts for life in 2D and 3D – comes into play.
Recently, we hosted an Instagram Live with Julius Few, MD, a board certified plastic and reconstructive surgeon in Chicago and creator of Aforé Beauty, to learn more about his concept of “four-dimensional beauty” and how it influences his approach to aesthetic medicine to achieve the most natural and holistic results for his patients. Watch the entire conversation below or read on for a breakdown of five key takeaways.Embedded content: https://www.youtube.com/watch?v=6QcFwi8ptxQ
1. Defining Four-Dimensional Beauty
Dr. Few has been in practice for over two decades. While the original outpost of The Few Institute is in Chicago, he has a satellite office in Los Angeles where he tends to some very famous faces. As he explains, treating public figures has taught him a lot about our understanding and perception of attractiveness. “One of the things that struck me was how I could see a household-name celebrity, who, in a photograph or in a movie, looked a certain way and by all accounts was attractive,” he shares. “But you saw them in person and they went to even a more dramatic and more appealing level.”
It’s that dichotomy between what he calls the “in-person encounter” and the “print version” that led him to formalize the idea of four-dimensional beauty. “What that represents is the concept that we deal with the three dimensions we all know – length, width, and distance – and the fourth dimension is time and moments in time,” he explains. “We're not talking about days, hours, minutes – we're talking about microseconds of movement and what is communicated both in terms of verbal and non-verbal communication.”
While there are extreme examples of people overdoing it, even just a little too much filler or neurotoxin can look off if it impacts the natural movement of the face, he says. “That really is what four-dimensional beauty represents – that transition from moment to moment in interpersonal interaction that can either make or break a moment,” he shares.
2. Photo vs. Video
Even if your in-person schedule is not quite back to pre-pandemic strength, days spent in Zoom meetings, scrolling through TikTok, or rolling your eyes at Instagram’s ever-conspicuous push for video content are a reminder that we do, in fact, live in a three-dimensional world. The best way to look your best IRL is to consider how the result of whatever you are having done is going to impact your features and expressions.
Dr. Few says the onus is on the provider to properly assess the patient. “Probably the most important thing that any cosmetic plastic surgeon, dermatologist, or provider of any kind really needs to hone in on is the idea that you have to look at animation during that in-office visit,” he shares. One way to educate the patient and further drive home the point is by supplementing traditional before and after photos with video. “I've started to incorporate more and more videography into the assessment, so I can show people,” he says. “I do believe that's going to become the norm in many ways.”
With the ability to put a smartphone with a 4K camera into the palm of anyone’s hand, all providers need to do is standardize their lighting setup and positioning (à la traditional B&A photos). Dr. Few and his team recently published a study in the Aesthetic Society Journal based on the clinical results of using the Aforé Beauty CR Emulsion – a serum that blends 0.2 percent retinol, cannabidiol (CBD), peptides, and hyaluronic acid to improve skin tone, texture, and hydration – that included a dynamic video component. “It gave us a platform to develop the videography assessment tool, which is in its infancy,” he says. “We're still working on it in terms of validating and putting it together, but we're well on our way.”
Long term, Dr. Few sees video as “a great equalizer” that will foster transparency. “There will be more and more of a demand for influencers and the like on social media to have videography versus a static picture,” he notes. “What different people got away with just because they had a great 2D picture, that's not going to be good enough.”
3. The Rise of Prejuvenation
It’s usually easier to prevent something than correct it, and that is certainly true of age-related skin and aesthetic concerns. There is a lot to be said about rejuvenating procedures, but, in the last decade, the conversation has expanded to include the idea of ‘prejuvenation’ (i.e. preventative treatment). “I kind of came up with that term ‘prejuvenation’ at a multi-specialty meeting probably 10 or 11 years ago,” Dr. Few shares. “The whole concept came up during a panel because, at that time, I was just starting to really kick into taking care of a lot of models and actors, and that group really was keen on the idea of avoiding the knife.” Instead, they were interested in less invasive solutions that they could start earlier in life to potentially delay or eliminate the need for more invasive measures down the line.
But it’s not just celebrities who want to get ahead. Dr. Few says he has long had patients who are predisposed to deeper frown lines or have a family history of jowling and want to address them as early as possible. “You can preempt that whole phenomenon just by simply targeting that area when it first starts to form, and then you hold it in suspended animation,” he explains, adding that it’s not about stopping the clock or dramatically altering someone’s appearance. “I believe if you try to take that given point where things are transitioning in maybe not the most positive way and hold it, well then that’s mission accomplished,” he says. “You've now made somebody achieve their goal of looking naturally beautiful and aging in the most graceful way, which, in my opinion, is the way to go.”
Returning to those four dimensions of beauty, it’s all about enhancing what is already there in the most natural way. “It's not about aging ungracefully or in any artificial way or even not aging at all,” Dr. Few explains. “To me, where the artistry of cosmetic medicine and surgery comes through is in creating subtle contrast.” For example, “you have somebody who maybe has gray hair but, at the same time, has a youthful kind of very subtle cuteness that shines through,” he says. “That's their own individual expression.”
4. Blending Surgical & Non-Surgical Solutions
Just because Dr. Few is a plastic surgeon doesn’t mean that every patient of his is going under the knife. “I am somebody who's kind of formed an expertise in both the surgical and non-surgical space – especially for facial rejuvenation and prejuvenation,” he says. In his view, it’s not so much surgical versus non-surgical but rather a continuum. “I try to position things in a way so that if somebody is not sure which direction they want to go, it's easier to do something that's a bit more temporary – that's non-surgical – that then can lead into a surgical option if that's what they want,” he explains.
Generally speaking, prospective patients fall into three categories:
- I definitely want surgery.
- I definitely don’t want surgery – regardless of what I need.
- I’m undecided and want to know my options.
After determining which bucket someone falls into, there are a trio of factors Dr. Few considers during a consultation to formulate a treatment plan: skin quality, volume loss, and facial laxity. “When you look at those three components, then I get to go into my toolbox and decide what are the options that work for it,” he shares. “For the skin, it may be different forms of resurfacing lasers, peels, etc., and then you look at non-surgical versus surgical lifting.” Seeing as he remembers the days when Restylane® was only one hyaluronic acid-based filler on the market, today’s innovation – especially in the non-surgical space – means there are now “more options than you could even hope to use.” As such, “it becomes much like picking the right paint brush for the component of the canvas you're painting on,” he says.
Finding the right balance between surgical and non-surgical has actually spurred hybrid solutions over the years. Dr. Few cites the evolution of the so-called Nefertiti neck lift as one such example. While injecting neurotoxin into neck bands can have a dramatic impact on texture and contour, the effect is temporary. For a longer-lasting result, Dr. Few developed a slightly more invasive neck band procedure. “That's where I can use a special needle that's called a no cord needle to actually go in and break up the bands of the muscle – much like the Xeomin®, Dysport®, or Botox® would do – but it does it in a more permanent way,” he says. “You can marry these concepts, which is what makes it fun.”
5. The Benefit of ‘Stackable’ Treatments
Long before the pandemic made the idea of maximizing in-office time with your provider a must, Dr. Few was honing the technique of what he calls “stackable treatments.” “When I first came up with ‘stackable treatments’ as a concept, it was the combination of Ulthera® and lasers and fillers – doing that all in one setting,” he shares. As he explains, the combination approach was, initially, “purely out of necessity.” “When I first started seeing patients in New York, I didn't have the luxury of trying to space it out over six months,” he notes. But then he realized the multimodal nature of the appointment was more than just convenient. “There's synergy in it,” he shares, that actually improves the results that would be possible with each treatment individually.
But not all stacks need to happen at once. Lately, one of the popular pairings at his practice involves combining Dr. Few’s signature thread lift with Sofwave™, a new non-surgical skin-tightening treatment that uses ultrasound waves to firm the skin, and Kybella® to address an array of age-related concerns in the lower face. “I'll do thread lifting, get a result, and then we can come back and do Sofwave™ to further enhance,” he explains. “It seems to really play on that matrix that has been created by the thread lifting.” But that’s not all. “If they still have a little bit of jowl fat, I can do a bit of off-label Kybella® injection to shrink it down,” he adds. “All of a sudden we're creating this approach that can deliver a progressive result.”
Perhaps most importantly, this trio is not designed to create a trendy, overly snatched jawline. “Always bearing in mind four-dimensional beauty, we’re not trying to do anything just for the sake of a photograph on social media,” Dr. Few says. Instead, the procedures subtly-yet-substantially sculpt the lower face and neck for a more youthful countenance. The result: You’ll look like a rejuvenated version of yourself.
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