I had the opportunity to interview Dr. Bryan Forley who is one of the top plastic surgeons in Manhattan and one of the few doctors leading the industry with non-invasive technology. Dr. Forley is a surgeon who truly cares for his patients and wants the results to be natural looking and will refuse anything but that. His work is of an artist and is known by his patients as being a true perfectionist and after having the pleasure of interviewing him, I totally understand why. I look forward to sharing all the up-to-date technologies and to continue to share more interviews with Dr. Forley.
AF: Can you share your background with us?
Dr. Forley: I am a plastic surgeon certified by the American Board of Plastic Surgery and have specialized in aesthetic surgery of the face, eyes, nose, breast, and body since opening my practice in Manhattan in 1994. After graduating from Brown University with a degree in Bio-Medical Ethics, I attended the Mount Sinai School of Medicine. My general surgery prerequisite training was undertaken at NYU Medical Center and Mount Sinai. I relocated to California to complete my training in plastic surgery at the Saint Francis Memorial Hospital in San Francisco. I pursued additional fellowship training in both aesthetic surgery and craniofacial surgery in California and London before starting my private practice in New York.
My hospital affiliations are with the Mount Sinai Beth Israel Medical Center, New York Eye & Ear Infirmary, and Mount Sinai West. I also am a member of the American Society of Plastic Surgeons and The Aesthetic Society, a fellow of the American College of Surgeons, and a member of the American Society for Laser Medicine and Surgery.
AF: Let’s get into your day to day. How many procedures do you do per day?
Dr. Forley: Each day is different as I have a mix of surgical and non-surgical options. I am very meticulous in my surgical technique so I never book more than 1 or 2 patients per day. The non-surgical procedures are less time consuming so we usually mix injectables with energy skin tightening devices and lasers. Consultations with new patients and seeing follow-up patients makes for a very full day.
AF: Can you discuss the aging process of the face and different procedures that would work during those stages.
Dr. Forley: Facial aging is a progressive accumulation of changes in the skin and the deeper layers of fat, muscle, and to some degree bone. Although skin wrinkles and sagging are often what drive people to my office, the descent and atrophy of facial fat is what truly underlies what many of us perceive as aging. Using injectable fillers to blend and thereby camouflage folds or creases that are the byproduct of a downward displacement of facial fat compartments can result in an instant improvement in some of the most obvious early stigmata of aging. Restoring a youthful convexity to the cheek that has flattened over time creates a lifted appearance to the face without surgery. Various neurotoxins can be used to complement fillers by selectively reducing the wrinkle creating repetitive contractions of specific muscles resulting in a smoother appearance of the overlying skin. Energy based procedures for qualitative skin improvement and tightening using lasers and radiofrequency devices provide additional modalities to keep the aging process in check as it advances over time. Finally, when the sagging and redundancy of skin worsens and the displacement and deflation of facial volume becomes more pronounced, it is time to consider a surgical solution to yield the greatest benefits. Non-surgical interventions are often used excessively in older patients in a misguided effort to avoid surgery and can result
in a very obvious, overtreated look. It is actually a paradox, but the most natural, least obvious outcome as we get older is frequently produced by surgery.
AF: I know many people come into your office with photos wanting to look like a specific celebrity. How personalized is plastic surgery?
Dr. Forley: Plastic surgery is very specific and personalized. The idea that you can alter the underlying anatomy and basic characteristics of your face and body to match those of a celebrity is often misunderstood. Photos or examples of a desired result can give the surgeon guidance as to the aesthetic goals of the patient. The underlying anatomic characteristics of each individual will be the determining factor in how well those goals can be achieved.
AF: Are you usually able to talk a patient out of a specific procedure or is it difficult?
Dr. Forley: I won’t do a procedure that a patient may request if I don’t believe it is in their best interests. I spend time explaining my reasons and most patients will accept my judgment but I’m sure some will keep looking until they find someone who agrees to do what they want. Sometimes they come back to me later and ask me to fix the problem that resulted from the procedure they had done.
AF: What are some of the latest technologies you’re working with that are minimally invasive.
Dr. Forley: The current generation of radiofrequency energy devices such as FaceTite, Bodytite, and Morpheus8 have enabled us to offer minimally invasive procedures for skin tightening and lifting with no scars and minimal downtime. This has provided a meaningful alternative to surgery for many patients.
AF: Do you see the future of plastic surgery relying on non-invasive tools?
Dr. Forley: I see increasing advances in both non-invasive and minimally invasive non-surgical options that will appeal to a broad demographic of patients.
Many of these developments will supersede the more traditional surgical approaches to treatment.
AF: Do you find more people are turning toward or against plastic surgery i.e., facelifts?
Dr. Forley: I think the advent of effective non-surgical skin tightening and lifting procedures has enabled us to offer anti-aging benefits to a broader range of patients that I might have previously told to come back and see me in a few years for surgery. I think the indications for a surgical approach have narrowed but it still remains the gold standard for treating advanced signs of facial aging.
AF: When do you let a patient know that they’ve had enough non-invasive procedures and fillers and time for a facelift?
Dr. Forley: I explain to patients that non-invasive and minimally invasive procedures are wonderful techniques for improving aging changes up to a point. When these procedures are used for more advanced signs of aging, they are frequently overdone and can result in an unnatural appearance or the perceived benefits are limited with less-than-optimal results. As a plastic surgeon, I have all treatment options available to my patients so they know that I can offer them the best choice to meet their needs.
AF: Will facelifts have the same outcome after the results of the other procedures have went away?
Dr. Forley: Facelifts are quantitative procedures that lift and tighten the sagging tissues of the face and neck while removing redundant skin and restoring youthful facial contours. If someone had a non-surgical procedure prior to the surgery, the surgeon will take that into account when planning the facelift.
AF: Let’s talk about liposuction. When is this recommended and what is the result of this procedure.
Dr. Forley: Liposuction is an excellent technique for treating areas of the body that have excessive fat deposition. It is important to understand that it is not designed for weight loss but for contouring problem areas. It is not a substitute for diet and exercise which must be part of any regimen following the procedure in order to maintain the results long term. As far as the result, Liposuction can be quite dramatic for contour but has limited benefits for loose skin. We now have an innovative, non-excisional skin tightening option available with the addition of BodyTite to traditional liposuction. It delivers subdermal radiofrequency energy to tighten and lift skin for those who need more than just fat removal.
AF: Any advice for the younger generation who are self-conscience about their skin?
Dr. Forley: Avoid excessive sun exposure and use sunscreen. Lifestyle choices are not without consequences and eventually we see the outcome of choices we made in our 20’s and 30’s in the aging changes and skin cancers that occur later in life. Prevention is always better than treatment.
IR: What do you enjoy doing most when you are not in the operating room?
Dr: Forley: I have a passion for adventure travel and have visited all 7 continents. Scuba diving in Antarctica and the Arctic, climbing Mount Kilimanjaro, seeking out the mountain gorillas of Uganda, visiting tribal groups in Ethiopia, hiking in remote corners of Bhutan, cycling through Laos, and photographing the enchanting wildlife and landscapes of Madagascar are just some of my most recent experiences. Examples of my interest in portrait, wildlife, and landscape photography are posted on Instagram.
AF: How can our readers contact you? Please share social media sites as well.