The concern for aesthetics has been carried one step farther by Sherrell J. Aston of New York, who has augmented his practice with separate pre and post operative skin-care offices in the same Park Avenue building. There nurses and aestheticians apply and dispense custom-blended camouflage makeup, individually tailored peels to improve the look of pigmentation spots and dull skin, hydrating facial treatments for aging or sun-damaged skin, and specially formulated cleansers and conditioners for home use.
Other surgeons have raised their eyebrows at this commercial venture.
But Aston’s reputation is so far beyond reproach, these same doctors concede, they can’t cavil at the success he’s made of Apres Aston. He began performing the two-layer SMAS face-lift in 1976, shortly alter Swedish surgeon Tord Skoog introduced the revolutionary concept in the United States.
The current frontier of face-lift work, Aston says, lies at the center of the face, along the nasolabial folds that carve curved lines from the nostrils to the corners of the mouth. In Aston’s surgical approach to smoothing the middle of the face, he not only lifts and repositions the SMAS and platysma separately from the skin but also creates a third layer of tissue by severing the malar fat pads from the undersurface of the skin. The malar fat pads, which begin their life high on the cheekbones, slide forward and downward as time goes by, adding a look of heaviness to the nasolabial folds. By suturing them back where they should be, Aston can soften the nasolabial folds somewhat and highlight the cheekbones.
“We are getting better results from facelifts than ever before,” says Aston of the malar-fat-pad elevation. “But people with deep nasolabial folds have a tendency to re-create them a million times a day-every time they smile, talk, or eat,” he says. “I doubt that we will ever be able to totally correct the folds in these patients.”
Aston opens no photo albums, projects no slides, but describes his surgical technique and its outcome in words alone. He is a handsome man with a full head of blond hair; his Virginia drawl has been modulated by two decades in New York. “I’m not sure that the tissues of the face could stand up to manipulation that would really eliminate the nasolabial folds,” Aston muses. “And some people just wouldn’t look like themselves if you took away their nasolabial folds.”
In Aston’s waiting room, with its Roman pleated shades and huge vase of fresh flowers, the framed etchings over the plush couches depict botanicals on one wall, architectural details on another. Beauty and structure.
Their juxtaposition reminds the visitor that beauty in couture plastic surgery depends on structure-although the perception of beauty remains a subjective judgment in any surgeon’s office.