Perspectives in Facial Plastic Surgery

Dr. Saman sits down with Dallas blogger Janan of for a Q&A on facial plastic surgery and specifically geared toward rhinoplasty.


Jay: That doctor completely destroyed my nose, and it took nine years and two additional surgeries for me to at least like my nose. Not love it, but it still is one of the biggest insecurities that I have.

Jay: Hi, guys, and welcome to the first official video for A Day With Jay. Today I'm sitting with Dr. Masoud Saman. Thank you so much for joining us.

Dr. Saman: My pleasure.

Jay: Also known as PlanoFaceDoc. He's a double-certified facial plastic surgeon and ENT doctor. In 2010, I decided to get a rhinoplasty. My nose was never an issue for me, but I just had the typical Middle Eastern nose that I thought was a little bit too sharp, and wanted to get a softer look.

Dr. Saman: Sure.

Jay: I was so excited about the process, so I actually ended up booking an appointment for a surgery with the first doctor I consulted with. Why is it so important for you to find the right surgeon, and why do you need to ask them the right questions? What questions do you recommend patients ask?

Dr. Saman: The first question would be is your surgeon board-certified? Are you board-certified? How many rhinoplasties have you performed? How many rhinoplasties would you say you perform per year or per month? How many revision or challenging rhinoplasties have you performed? Do you have a before and after gallery that I can go through and see noses similar to mine? Of whatever ethnicity the patient is, how many Asian, how many Latino, how many Middle Eastern rhinoplasties have you performed?

Dr. Saman: These are very specific to rhinoplasty. We're gearing it toward that, but this can be applied to any number of procedures: cheek augmentation, breast reduction or augmentation. All of these things can have the... Kind of the interview. Don't be shy about interviewing your plastic surgeon. That's very, very important, to interview, be assertive, be curious, and see results. This is your face, this is your body, and you want to make sure that everything's done in the best manner, in the most safe manner, and at skilled hands so you can get the results you want.

Jay: Three American females passed away in July during undergoing plastic surgery abroad. We've been hearing about this a lot in the news. It is more affordable to do it outside of the U.S. at times. But what do you have to say to females wanting to travel to get plastic surgery?

Dr. Saman: A lot of times when we talk about plastic surgery, I feel like we put a lot of the onus on the plastic surgeon and evaluating just the plastic surgeon, but there's more involved than that. The team, the techniques they use in sterilization, the effective techniques in infectious disease management, the anesthesiologist, the skillset, but also the equipment, the medicines they use. All of these things go through a rigorous process of evaluation in this country. We are fortunate to have those processes in place, and that tends to be the reason why the prices are a little bit elevated here.

Dr. Saman: And cost-cutting... Excuse me, cost-saving, rather, can be done in countries abroad sometimes at the expense of quality, and sometimes that quality could not be just aesthetics, but it could be a matter of safety. So, I would say if you're entertaining the idea of of doing that, then all of a sudden the responsibility of checking all of these aspects falls on you, whereas here you can keep the doctor and the hospital accountable for those things. Here we assume that the hospital would go through the safety processes and protocols, and over there that responsibility becomes yours, and so will the risk.

Jay: How do you determine when it's time for a patient, or the right time for a patient to undergo plastic surgery?

Dr. Saman: That's a very good question, and that's always a challenging one, because we have so many nonsurgical options now. First and foremost, it's about the patient's desires. If the patient comes to me and says, "I have some submental or chin excess fat and I'd like to get rid of it. I don't want surgery at all. I don't want any kind of anesthesia downtime," then I would recommend a nonsurgical. That's a gimme, that's an easy one.

Dr. Saman: But sometimes you've tried different nonsurgical things, and then you might have to resort to a surgical option. Where it gets a little bit more challenging is when you have the opportunity to perform a nonsurgical, but the patient desires a surgical procedure. That's when I have to evaluate the reasons to see why, what are the advantages and what are the disadvantages, and to spend really the time and effort to educate my patients so that they understand the basics, the pluses and the minuses of both nonsurgical and surgical, and together.

Dr. Saman: We're past that point when the doctor makes the decisions alone. We need to sit together. So, what I like to do is to empower my patient so that my patient can tell me, "Listen, based on what you've told me and the study and the research I've done, this is what I'd like," and together we come to a decision.

Jay: I believe that a lot of patients respect that. They want a doctor who's able to say no when something doesn't need to be done, and not just, "Okay, whatever you need, I'll do it for you." So, I think a lot of patients do appreciate that.

Dr. Saman: Absolutely. They do appreciate it, and I think it's a tenet of plastic surgery. I think it's very, very important to be clear about the expectations. I'm very transparent, and I think it's important to not overpromise, and I like to be clear and very transparent about what I say.

Dr. Saman: Now that being said, sometimes a patient requests something that you're kind of in the gray area. In those situations I decide that let's go think it over and have another consultation and talk about it some more, because a lot of times a patient sees something that I see, and they see as bothersome because they've been fixated on it for so long. Then we try to kind of deescalate that situation.

Jay: This next question is a study that I found out of Boston University I thought was very interesting. It said most people who use filters on social media, they use these filters to go to their plastic surgeons and kind of help guide them in their decision on what they want to get done, what surgeries they want to do. What is your opinion on that, the impact of social media and plastic surgery, and how does that... I'm sure it affects your role as a plastic surgeon. Sometimes it complicates it.

Dr. Saman: Back in the late nineties the facial recognition softwares were being developed, actually one of the biggest one here at UT in Austin. The idea was to identify the different facial features and be able to put together a full facial map. It was very helpful in the world of plastic surgery because we looked at studies of ethnicity. For example, in 2011 I looked at the Saudi Arabian nose, and I did all sorts of facial recognition measurements to be able to come up with protocols to treat that kind of specific nose.

Dr. Saman: Now that then got into the hands of the social media world, and they use that same social... Excuse me, facial recognition points to identify the points on your face and then modify them to fit a particular shape. That can be a funny shape or it can be the idealized female shape, et cetera. These come from majority Caucasian, 18 to 25-year-old college students who came in for this study that would give them a $50 voucher. They would come sit and their face would get scanned, and that's how we have that.

Dr. Saman: So now you could be a little bit older. Let's say you're in your thirties. You have a little bit of sagging jowls, you have a little bit of under eye changes, and they apply the 20-year-old college student, Caucasian... And let's say you're from a different ethnicity... filter to your face. It matches your face because it's through facial recognition, so it's a unrealistic distortion of reality. That's the part that needs to be deconstructed for the patient, to explain that, to explain that these high cheekbones don't fit your face, or they are difficult to achieve in a way that is still natural. So, we go through this conversation. Now, there are those who want to look like the filter, and that's just outside of my scope of practice.

Jay: Have you ever been put in that...

Dr. Saman: I have. I tend to not to do that.

Jay: How do you know when a patient is taking it too far, and do you ever suggest that they get a psychological evaluation? Have you ever been put in that kind of situation?

Dr. Saman: When I see those kind of warning signs: extreme narcissism or extreme depression or unhappiness and the wish for bigger life changes based on simple procedures, I tend to ask the patient to go for a second opinion so that they can express those wishes to somebody else as well. I don't tend to send patients for a psychiatric evaluation unless I find a reason that would be a matter of a safety issue to their health or somebody close to them. But simply for asking for a request, I don't recommend a psychiatric evaluation routinely.

Jay: A lot of people come to you to get suggestions from what do they need to change?

Dr. Saman: Right.

Jay: So, what do you often find yourself telling patients not to change?

Dr. Saman: You know, a lot of patients come in, especially in the more advanced years, coming frustrated with the skin tone, skin texture, or sagging of some of the tissue, et cetera, and some wrinkles. A lot of those things we can address relatively easily. When I find that a patient is fixated over something that is not unaesthetic or that it fits them and that is becoming of their face, I tend to discourage that.

Dr. Saman: A lot of times that ends up being the lower eyelids. A lot of patients come in and they're frustrated with the lower eyelid. They think that it's too much hollowing, too much black, etc. I tend to think that overdoing that area can give a puffy look. It doesn't look natural. So we have to meet a happy medium... median rather. But, yeah, other than that, the majority of patients are very reasonable and want very reasonable things.

Jay: What is the best way to tighten and lift the jaw under the chin?

Dr. Saman: Yeah. So, here you have a lot of options. Previously we only had the option of either go to a face and neck lift, which is a surgical procedure, incisions, downtime, anesthesia, et cetera. Then we started to look at more conservative approaches. We said, "Okay, well, the jowls are falling. Let's camouflage that with fillers." We put filler before it and after it, and that tends to straighten things out.

Dr. Saman: With the invention of threads that hit the market in the U.S. a few years ago and in Europe over the past 12 years, we've been able to achieve some skin pulling. There's downsides with that as well. If a face lift is a 10 out of 10 pull, thread is probably a three or a four. Just recently... And we're actually proud to be the first ones in DFW to carry this new innovative device... AcuTite has come out, made by a company named InMode, and that allows you to have a face lift-like results, but without surgery.

Dr. Saman: You're awake, there is no downtime. We numb this area and we apply bipolar radio-frequency to the skin, underneath the skin and over the skin. That allows the skin to shrivel up and tighten in very controlled fashion, similar to, I always tell my patients, throwing a steak onto the grill, how it shrivels up. Now imagine micro-shriveling underneath the skin in a very controlled fashion gives you a controlled lift. That's a permanent onetime deal, so that's another option.

Dr. Saman: We do liposuction in this area, all sorts of contour of the jaw line. I'm all about the jaw line. I'm all about angles.

Jay: Everyone's all about the jawline today.

Dr. Saman: Yeah, so we spend a good amount of time on that and make sure that that's awesome. And then if you need a chin, sometimes we need to do that. It's not just the one thing, it's a number of things.

Jay: There's so many options.

Dr. Saman: So many options.

Jay: Yeah.

Dr. Saman: You know, when you go to a restaurant, you have the option of letting the chef put together a nice plate for you, or you can do ala carte, like a little salmon, little of this, little of that. We have both options, but if you let the chef make your jaw line I think is probably the way to go.

Jay: Thank you so much again for taking the time out of your day to sit with me today.

Dr. Saman: Absolutely, thank you.

Jay: And if you guys have any more questions for Dr. Saman, you can visit us at Instagram at planofacedoc, or go on and schedule a consultation. He is one of the best here in DFW.