Precision in Practice: Multidisciplinary Approaches to Cosmetic Facial Plastic Surgery

Podcast Transcript

Paul Bryson: Welcome to Head and Neck Innovations, a Cleveland Clinic podcast for medical professionals exploring the latest innovations, discoveries, and surgical advances in otolaryngology - head and neck surgery.

Thanks for joining us for another episode of Head and Neck Innovations. I'm your host, Paul Bryson, Director of the Cleveland Clinic Voice Center. You can follow me on X, formerly Twitter, @PaulCBryson, and you can get the latest updates from Cleveland Clinic Otolaryngology-Head and Neck Surgery by following @CleClinicHNI on X. That's @CleClinicHNI. You can also find us on LinkedIn at Cleveland Clinic Otolaryngology - Head and Neck Surgery, and Instagram at Cleveland Clinic Otolaryngology.

Today I am excited to have two facial plastic surgeons joining us, Dr. Peter Ciolek and Dr. Francis Papay, who will be discussing our multidisciplinary approach to cosmetic facial plastic surgery here at Cleveland Clinic. Dr. Ciolek and Dr. Papay, welcome to Head and Neck Innovations.

Peter Ciolek: Thanks for having us, Paul.

Francis Papay: Yeah, thank you.

Paul Bryson: Well, before we launch into some of the innovative and service line things that you're both doing, let's start by having you share some background on yourself for our listeners, where you're from, where are you trained, what your journey here at Cleveland Clinic has been, and some of just your interest in general.

Peter Ciolek: Yeah, so my name is Peter Ciolek. As you said, Paul, I'm a facial plastic and reconstructive surgeon here in the Head and Neck department. I'm actually a native Clevelander, so I've lived here most of my life. I did my residency training here in Head and Neck Surgery, five-year program. Following that, I did a fellowship in facial plastics and reconstructive surgery at Jefferson in Philadelphia. I've been on staff here since 2019. My practice kind of spans the entire breadth of facial plastics, so I offer cosmetic and reconstructive operations of the face, head, and neck. Probably 50% of my practice is cosmetic and functional rhinoplasty, and the other 50% encompasses aging face, reconstructive surgery for cancer, and facial paralysis.

Paul Bryson: Thanks, Dr. Papay?

Francis Papay: Yeah, I'm also another corn-fed Ohio boy. I grew up west of Cleveland around the Oberlin area and also trained here. I trained here first in otolaryngology, did a preceptorship down in New Orleans with Calvin Johnson, and then after that came back with a plastic surgery fellowship here, and then did a craniofacial fellowship first as a skull base in Switzerland and then at University of Utah Children's. And so my background sort of encompasses obviously facial aesthetics, but in addition to that craniofacial things like pediatric  craniofacial deformities and things like that. So that's my background.

Paul Bryson: Well, as you both were mentioning, with cosmetic plastic surgery, well people will often think of rhinoplasty, but that seems like it's really just a tip of the iceberg. There's quite a bit more for the listener who might be a patient or is somebody who is facial plastics. Curious, what are some of the common conditions that you see patients for and how is the landscape of these cosmetic or reconstructive procedures evolved over both of your careers?

Peter Ciolek: So we really offer the whole suite of procedures and services here at Cleveland Clinic as far as facial cosmetics is concerned. So that spans everything from minimally invasive treatments such as Botox and fillers and laser therapies, all the way to bigger operations such as facelifts, neck lifts, etc. So depending on the interest and specialty of the surgeon, I think we have it all covered here at the Cleveland Clinic, how we've seen things change over the years.

Certainly I think we're seeing facial aesthetics and plastic surgery in general become more accepted by the general population, and that's probably been driven in part by social media. But I'm seeing younger and younger patients in the office seeking early treatments to prevent aging, patients in their twenties and thirties looking for Botox and filler and even rhinoplasty, and then younger patients perhaps committing to what would be traditionally considered bigger procedures such as facelift in their younger years such as the forties and early fifties.

Francis Papay: Yeah, I kind of agree. If you look at TikTok and all the trends and you read some of these sort of “rag literature”, so to speak, there is a big trend towards younger and younger, especially with Botox and the fillers. So I think the trend to plastic surgery is getting more minimally invasive and then more microally invasive, so to speak, and offering much more. I mean, sort of the advent of fat transfers to the face is something recent. You're going to see fillers change, and then now with image recognition in AI, you're going to see the predictability of that, at least guiding what we do and aesthetic surgery. So I think it's being the change.

What I'm excited about what we're doing here in this multidisciplinary approach, especially at the new Landerbrook Aesthetic Center, is the fact that in addition to surgeons, in addition to dermatologists, in addition to eye oculoplastic surgeons, we're combining actually anti-aging. And so we're just setting up a program that hopefully they will also contribute to that. So you're getting a multidisciplinary approach to the whole gamut of aesthetics, not just one side of looking at it one way or the other. So how that's going to turn out, I mean, I don't know any other program in the United States like that, but to be seen.

Paul Bryson: Yeah, I mean, it's definitely exciting. I think in this era where we're getting into personalized medicine, or at least here at the Cleveland Clinic, I think we certainly do a good job of coordinating care and trying to create that platform or pathway for patients. In light of that, what do you think, what can someone expect, either a patient who seeks out your services individually or if someone's being referred, what can they expect when they come to Landerbrook or where have you? Who are they meeting with? How does this multidisciplinary team function? What do you both envision for that?

Francis Papay: Well, it all depends what they're coming in for. And I think in any aesthetic patient, it's basically a verification of understanding of what it takes to get the results they want to get, and weather their expectations. That's always the number one. And so I think depending on the relative sort of multidisciplinary approach to this, the expertise may lie with dermatology rather than plastic surgery or facial plastic surgery or anti-aging. So again, it's expectations and are you able to deliver, not just as a surgeon, but on the medical aesthetic end and verifying that and then partnering with them. And a lot of it is, I call it sort of the stepladder approach. You may want to start on the bottom rung. We certainly never want to sell surgery. We certainly never want to push surgery, but there's a gradation of how you can approach anti-aging over a period of time. So I think that's where I see the new aesthetic center going, coming in, getting a whole holistic approach to what the patient desires in a realistic expectation and verifying that expectation.

Paul Bryson: I wanted to ask, well, I'll ask you both. You kind of illuminated a little bit, but any strategies for navigating that balance between outcomes, functional improvements, and expectations?

Peter Ciolek: Yeah, a lot of it is just about listening to the patient. So I think with most of us, the first minutes of the visit are just meant to listen to the patient, find out why they're seeking care, what they're concerned about. And as a surgeon or a practitioner of cosmetic medicine, you have to match patient's expectations with what you can achieve either surgically or with minimally invasive therapies. So you have to be just as willing to say no as to say yes sometimes because you may not be able to meet those expectations, or they may not be an appropriate patient for cosmetic procedures or for surgery.

And so a lot of it's just putting the language together about, well, something bothers them about their nose. What exactly is it? Is it only in certain pictures in certain angles? Is this something that can be fixed surgically? Can it even be achieved through an operation? So it's really about listening to the patient and then having a conversation before jumping into any types of procedures or offering any types of procedures.

Paul Bryson: In this era where you both alluded to social media, lots of pictures, you hear about things with technology trying to prognosticate, maybe surgical outcomes or facial analysis, has technology been helpful here, do you think? I'm sure it's nuanced, or is it more challenging in terms of expectations when people maybe come with something that might be really challenging to achieve, or is it realistic to achieve?

Francis Papay: Yeah. Well, I think aesthetic surgery is what I call surgical self-esteem. And so how social media affects self-esteem in the general population is a big deal because the ideals are set out there. And as you know, those ideals change with culture. And so social media and news and what's on the cover or what's latest in TikTok is going to drive sort of the behavior of our culture. So yeah, I think it's a big change, at least in my tenure, in aesthetic surgery, and it does affect it.

Peter Ciolek: Yeah, I've seen technology as a double-edged sword in aesthetics. Oftentimes, I've had patients come in with either photos of themselves or photos of other people they've seen online that are heavily manipulated, and so the ideals that they're seeking are not of an actual person, but are of a person with heavily photoshopped or modified images. And so it turns into this whole different conversation that these pictures that you're showing me, this person in particular has had a lot of work, post-production work done on their Instagram, and this is not actually how somebody looks. And so that becomes a whole different problem to navigate. I've also seen in my practice many patients seeking care specifically just for how they appear in photos on social media. So they may be kind of comfortable with their presence and appearance in real life, but it may be certain angles that they see in photos or with a selfie that's driving them to try to manipulate something on their face or make it look better. So yeah, it's certainly an interesting time to be practicing facial aesthetics.

Paul Bryson: It's very interesting. We'll change gears here a little bit from the aesthetic, and we'll go into both of your reconstructive practices. Not my specialty, but as an observer I understand both of you do some challenging reconstructive work. Can you share a little bit about that? I know I’ve seen things as an observer. Again, total nasal reconstruction, trauma reconstruction, facial paralysis. What are these sort of elements of the practice for you both?

Peter Ciolek: I think one of the things that makes you an excellent cosmetic surgeon is total comfort and understanding of anatomy. And so as a reconstructive surgeon, part of my practice is to reconstruct and rebuild different elements of the face, head and neck. And oftentimes the anatomy that we're working with in those operations is kind of well beyond what you would see in a typical cosmetic operation, but along with that, it makes you extremely comfortable when it comes to abnormal anatomy that may come up during cosmetic procedures or especially revision cosmetic procedures. So in my opinion, patients should be seeking somebody that has kind of total comfort and understanding of anatomy because that's ultimately what's going to keep you safe and keep you out of trouble. A lot of the techniques we use in reconstructive surgery are applied to cosmetic surgery, especially in revision cases or in cases when a patient's anatomy doesn't fit the usual textbook. And so you have to have both the comfort and skills to improvise in those situations. So that's where I think the real blend of cosmetic and reconstructive surgery comes together.

Francis Papay: Yeah, I do agree. I think the more you do, the more you learn and just the experience over that period of time, you find out little things, like you say, nuances that really change things. Let's say a rhinoplasty, functionally that it's like a baby's mobile over a crib. You touch one things and five other things move, right? So with a period of time you realize that, and a lot of my redo reconstruction and noses is amazing that I see when I open it up and you look inside and you wonder what this person was doing or this or that. And so yeah, I kind of work backwards and learn from that. But every nose is incredibly unique, whether it's a primary surgery, the first time you've done a rhinoplasty, or what I call “reconstructive rhinoplasty” where you're looking at the valves and everything like that. And that's one of the things I truly enjoy is functionally how do you aesthetically reach your goals, but without injuring the function of it or improving the function of a rhinoplasty. I agree. It's not just knowing the anatomy, but it's knowing what can go wrong, how to prevent it from going wrong, and if it does go from elsewhere and you're seeing it secondarily, how do you correct it?

Paul Bryson: Well, I wanted to also touch base on a couple other, on another topic in terms of innovations, technology advances. You had mentioned earlier fat transfer. We talked about technology with imaging and facial analysis and prognostication. What are you both seeing in the innovation and technology space both for cosmetics and reconstruction that you think might help improve outcomes? Maybe this is in the regenerative space?

Peter Ciolek: Yeah, specifically in rhinoplasty, what we've seen over the last few years is an approach towards preservation of normal structures. So a lot of rhinoplasty in the past has been almost reductive in nature, taking away some of the natural support mechanisms, taking away some important parts and structures of the nose, which early on can look good aesthetically, but over time can really affect the patient functionally. And then there's some aesthetic consequences of that down the road. So a lot of the trends in rhinoplasty have been towards building a solid foundation and manipulating the structure in a way that not only looks good aesthetically, but will kind of stand the test of time as the years go on and keep the nose looking and functioning well along those lines. In rhinoplasty, there's been a trend towards using powered instrumentation to manipulate the bones and cartilage in the nose, which can reduce the amount of swelling and bruising and help us control those maneuvers more so than traditional techniques.

Francis Papay: And a lot of things in facial aesthetics are really, every year there's something new and mostly on the micro-invasive things such as radio frequency changing and trying to contract the underlying fat and dermis and things like that. And that's more for the aesthetic dermatology, and I think it's really changed recently from lasering, carbon dioxide lasering, to now and there's even more coming out at that with pouring out tissue and having that contraction happen. So that's on sort of the surfacing way. And the chemical peels have changed a little bit too, using different combinations of croton oil peel for around the mouth for those vertical lines around the lips in addition to different types of combinations of TCA peel. So sort of a matrix of peels on the face. As far as rhinoplasty is concerned, preservation rhinoplasty is an old thing that's coming back.

They all say if you think something's new, just look at the German literature 40, 50 years ago, and this is the same thing, in my hands, I think the indications for preservation rhinoplasties are smaller because again, because you cannot manipulate what you want to for the final aesthetic result. Some are good, I think, and I do agree with Dr. Ciolek that you want to minimize functional problems. So a preservation does do that, but I think sometimes aesthetically you have to combine the two. Okay. So I'm plus minus on that one. And again, and I just came back from a panel with a discussion on that where it's half the rhinoplasticians agreed and the other half didn’t. So I think that the debate is still out on preservation rhinoplasty, but anything that comes back or that is new again, so to speak, it will play out in time.

So I am waiting to hear that out. I've done a few, again, I still think the open approach, maybe I'm a little prejudiced because I worked with one of the guys that really sort of propagated that, I think the opener approach gives you more control on multiple levels rather than a preservation type. But yeah, we will see how that plays out. But it is, like you said, it's one of the things that in your modalities and all the tricks that you have, it's another great thing to have to use.

Paul Bryson: Yeah. Thank you both. It's been great to have you on the podcast. I wanted to just do another little plug. We're going to have this new center opening on the east side in the Landerbrook area. Hopefully more details for those interested to come, so for the listener, keep an eye on that. And just as another plug, we have aesthetic services across Northeast Ohio to try to make it convenient for patients in our east, west, south locations in addition to main campus. Any of those locations that either of you want to highlight or that certainly I'm not as familiar with, so I want to open up for you both.

Francis Papay: Well, I think they're all good. I think no matter where you go, I think the key center is going to be the Landerbrook center on the east side of town, and then the west side is probably Avon’s Cleveland Clinic. And I would say those are the two that should be highlighted. South, the Akron area, there's certainly an increasing amount, but I would say if you look at the demographics, I think Landerbrook is the perfect location for this new multidisciplinary center.

Paul Bryson: As we wrap up, any final take home messages for our listeners?

Peter Ciolek: Yeah, my message to patients listening would just be, find a surgeon you're comfortable with, find a surgeon that listens to you and that has a lot of experience with the operation you're seeking, and make sure you're a hundred percent in before you take the leap to surgery or some other procedure.

Francis Papay: I couldn't agree with that more. I think, again, I always get back to verification of understanding - understand what your doctor's saying and if you don't, stop and make sure things are very clear. So I agree with all the above.

Paul Bryson: Well, it's been great to have you both. Thanks for your time.

Francis Papay: Thank you.

Peter Ciolek: Thank you, Paul.

Paul Bryson: For more information on facial plastic surgery and cosmetic services at Cleveland Clinic, please visit ClevelandClinic.org/BeautifulYou. That's ClevelandClinic.org/BeautifulYou.

And to speak with a specialist or submit a referral, please call 216.444.4004. That's 216.444.4004.

Finally, be sure to follow our plastic surgeons on Instagram @ClevelandClinicBeautifulYou and @ClevelandClinicFacialPlasticSurgery.

Dr. Ciolek and Dr. Papay, thanks for joining Head and Neck Invasions.

Thanks for listening to Head and Neck Innovations. You can find additional podcast episodes on our website clevelandclinic.org/podcasts. Or you can subscribe to the podcast on iTunes, Google Play, Spotify, BuzzSprout, or wherever you listen to podcasts. Don't forget, you can access realtime updates from Cleveland Clinic experts in otolaryngology – head and neck surgery on our Consult QD website at consultqd.clevelandclinic.org/headandneck. Thank you for listening and join us again next time.