The work of a plastic surgeon is like jewelry, when you have to tweak and polish natural beauty. The unique experience of the Guggenheim Merlin from Swissparc Clinic, the rich arsenal of methods to combat age-related changes – from injections to operations, allow him to work with the look of client like with a piece of art..
He knows exactly what to propose to a specific person at a specific time. Perhaps that is why Merlin Guggenheim’s schedule changes, literally, by the minute.
– Doctor Guggenheim, many people start to worry about their appearance when they see the first signs of ageing, and try to delay the need for plastic surgery. What can be done about this?
– Yes, this trend is international. Now we are starting to provide light, not very invasive, treatments to young patients, in order to delay as much as possible the point of no return, when only surgery can improve their looks. However, now there are plenty of methods to correct and minimize the signs of facial ageing. We honestly warn you that we do not perform magic or some secret, arcane mystery. I want to underline one very important thing – all that we do is based on scientific data, verified and supported by solid evidence of its efficiency.
– What corrective methods do you use?
– We use Botox and it works well on light wrinkles – for instance, on the forehead, when they haven’t settled in. When they have settled in, it is much more difficult to get rid of them. We restore facial volume lost over time by using various fillers. Lipo-fillers made from the patient’s own fat cells reap especially good results. This is a great product with no drawbacks. It contains stem cells that work by improving skin quality. Usually, fillers are used annually or bi-annually, while lipo-fillers are used once every several years.
– Are they also injected?
– Yes, there are injections that help to fill in the skin areas that have lost volume – most often the cheeks, the areas around the eyes and under the eyes. Where to inject is a very important question, since each face has a unique anatomy and different muscle tissue and muscle mobility. This filler spreads evenly under the skin with no side effects that other fillers may have (since fillers are foreign agents in your body and leave bumps and swells that can be felt or even seen when the patient smiles). The fat cells leave no visible traces. Technically, it is a slightly more difficult product to work with, but when everything is done correctly, the results are beautiful.
– Where do you extract the fat cells from?
– Normally, we extract them from the abdominal area or the thighs. We need very little, just a few millilitres, so it is not a liposuction-like procedure.
– What do you consider when deciding what procedure your patient needs? Do you have some age-related guidelines – say, one set of procedures is applied after the age of 35, and another after 45?
– It depends not on age but on the preferences of a patient. Esthetic medicine follows a different route – we do not issue a diagnosis followed by a recommended course of treatments. Patients request an improvement to his or her appearance. Each case is considered individually. If one woman at the age of 30 uses fillers or Botox injections it does not mean her girlfriend of the same age automatically needs to have the same treatment. First, we will listen to the patient, and then provide recommendations. Botox and hyaluronic acid are so popular also because they give a temporary effect. Permanent fillers or implants are more serious and require certain skills.
– Can a woman after 50 or 55 remain beautiful without plastic surgery? Or do you always think of possible improvements when you see a mature woman?
– Of course, not everyone needs the help of a surgeon after 50. Sometimes corrective treatments can be sufficient, if they work for this person. If the woman is 35, however, and had four children, her body can sometimes only become slender again with abdominal surgery.
There are no two identical patients. For all of us, ageing is individual. If a woman over 50 has good genes and leads a healthy lifestyle, she will only need to have small corrective treatments to look beautiful. The goal of each of us is to improve our appearance as much as we can, and it depends a lot on genetics.
– 50 percent or more? What part of it is genetic?
– I think about 70 percent. The rest depends on lifestyle: whether you smoke or not, if you get enough sleep, etc. Smoking and lack of sleep are two important factors influencing the appearance; the skin gets weaker and thinner. Also, it is very important to protect the facial skin from solar ultraviolet rays with SPF 15 and over.
I would say that you can significantly ruin your natural potential with an unhealthy lifestyle, and improve it with healthy living.
We first look at the patient, his facial volume, his skin quality, and then offer a solution. Moreover, we start with small things that cause patients most distress – the eyes or something else, and then we move to the next issue.
– What is the most popular request in your clinic? What causes patients most stress? The eyes?
– It varies. The best case scenario is when the patient knows what he or she wants to correct – wrinkles on the forehead or chin or drooping eyelids. If the patient doesn’t know what he or she wants, but is generally unhappy about his or her looks, it will certainly be more difficult for us to make them happy. So, the best advice is to formulate what you want. Our goal is not to create a new face, but to make the patient look younger and refreshed, so that people will look at them and think, «He must have had a really good vacation» rather than, «He must have done something with his face».
– With such a wide variety of choices: hyaluronic acid products, Botox etc.—how does the patient decide what is best for him?
– Of course, we give recommendations to our clients. The patient comes and says, «I have three weeks and I need to look good.» We can, for example, tone up his chin line and make his face look firmer—there are injections that can burn fat that has accumulated under your chin over the years. If more time is available and the patient is in no hurry, we can offer lipo-fillers. This procedure is done under local anesthesia and is a very light treatment, but with a much better effect.
– Rumor has it that firm facial contours take off a minimum of 5 years…
– I don’t think things are that simple. Everyone has a different facial structure, skin condition etc. Someone can look younger on account of a range of factors. One of the most noticeable signs of aging, one that makes the face look older, is a loss of volume, in particular in the central parts of the face. Additionally, gravity pulls the lateral areas downwards. So the face that has volume, with no depressions, will look younger. Skin quality is also an important factor – sometimes the patient needs to have peeling and wrinkle-smoothing treatments… Nourished, pampered skin makes people look younger. That’s why this issue has to be viewed from many perspectives.
– Are there any side effects after injections, for example, after correction of the chin line? Can you go public right away, or do you need to stay home for some time?
– Yes, it is better to avoid important meetings for about 10 days. You may have hematomas and facial swelling, so you have to keep this in mind when planning your activities. This procedure can be done prior to the weekend, then the patient stays at home during the weekend, and masks the signs of treatment with a scarf or turtleneck or make-up during the next working week. This is realistic.
– What do you think about homeopathic injections? Many people believe they improve skin health.
– I think they are wrong for the most part. In fact, there is no scientific proof that homeopathy really works and has any lasting effect. If 100 patients undergo this treatment, some of them will see an improvement and some won’t. It is very subjective. Some people believe that they look great after homeopathy. Wonderful, that confidence can give a person an additional boost and can trigger positive processes within the body. But this doesn’t happen with everyone.
For example, with Botox, we know what effect it has. With homeopathy, we are not so sure.
– Botox has raised many discussions, and many still think it is a toxic drug…
– No, it is absolutely safe. It is used in such small doses that it can do absolutely no harm to a human being. By the way, Botox has for some time been used not only in esthetic medicine, but in other medical fields. It is well studied, we know how it works, how long the effect lasts, how it is absorbed and discharged from the body etc. There is nothing unstudied about this product. In fact, it is one of the safest treatments we administer—the material is easily tolerated and accepted by the body Usually it causes no issues; problems arise only if the patient is unhappy with the resulting effect. In that case, corrections may be done in about 6 months, after the Botox starts to wear off.
– When do you suggest a surgical procedure?
– Not all patients need surgery, and we try to delay it as much as possible. But the moment comes when surgery is necessary. There are beauty salons that provide cosmetic services such as injections, peelings, laser treatments etc, but do not offer surgical treatment. They sell their services, and for some time these treatments give good results. However, over time patients need to have more injections to see positive changes, and they are less noticeable. The patient spends money – a lot of money, by the way – but does not get the result he wants. At that point we can offer a more efficient surgical treatment with a noticeable result. This is our advantage – we offer a surgical procedure too, if necessary. We look at the client and we offer him several options. If he wants a guaranteed effect, lasting 10–15 years, then he needs surgery.
– Some time ago it was popular to inject golden threads under the skin of the face, and there were many opinions on this. What about mesothreads? Do you work with them?
– No. We do not work with them now, and we don’t plan to in the future. They are half-measures that are being used to try to correct issues that require proper surgery. Often they have no effect. The face is injected with alien material and threads injure the skin, they are noticeable to the touch. I believe that if we need to treat a particular defect—to restore volume, eliminate wrinkles, whatever, then we can use injections. If the face needs lifting, then surgery is required and no half-measures will do. It is like giving someone a bicycle instead of a car to drive from one city to another.
I recently participated in one of the largest esthetic medicine congresses and my colleagues had the same opinion about mesothreads. We are not interested in clients throwing their money away and we don’t want to make them come back every six months to correct something. Our work is based on the following principle: we offer the correct solution at the right time.
Merlin Manuel Guggenheim
Doctor of Medicine, specializing in plastic and esthetic surgery and hand surgery. Since 2015, he has been a Partner at the Swissparc Clinic.
He graduated from Zurich University in 1998 and worked as assistant surgeon (2000–2001) at the Reconstructive Surgery Department at the Zurich University Hospital, then (20022005) at the Plastic and Reconstructive Surgery Faculty of Hannover Medical School in Germany. From 2006 to 2013 he was Senior Doctor at the Department of Plastic Surgery and Hand Surgery at Zurich University Hospital, and in 2013 and 2014, Vice Chairman of the Department. He is the author of many scientific articles and publications.