Contoura Facial Plastic Surgery - The Confident Choice Podcast #5: What does a “natural look” mean Dr. Roberto Garcia

Transcript

You’re listening to the Confident Choice Podcast with me, Dr. Roberto Garcia, a double board-certified facial plastic and reconstructive surgeon. Honest conversations and expert advice about the decisions that make you feel your best.

Welcome, everybody. It’s Friday, April 3rd, and we are filming our next episode—episode five—of “The Natural Look” and how we get to that appearance.

It’s interesting because I really came into this business at the right time, when plastic surgery was undergoing a major transformation. It was a huge shift that we were going through. I think plastic surgery has had two or three major transformations in its birth, so to speak, in its genesis.

Originally, plastic surgery was described around 1200 BC by an Indian surgeon named Susu. Don’t ask me how I remember that. He actually replanted people’s noses using tissue from their arms because, as punishment for stealing or adultery, individuals would have their noses cut off. So, the first major reconstructive work considered under the plastic surgery realm was nasal reconstruction. Patients would walk around with their arms attached to their faces for six weeks while the tissue integrated. That’s how it started.

The first major figures in plastic surgery were in the nasal world. That was the big focus. The term “plastic” means “to mold.” It’s a Greek word. For the longest time, patients would tell me, “I don’t want anything plastic.” I would say, “There’s nothing plastic—it’s about molding.” There was a major misconception about how that molding should be done.

Aesthetic surgery of the face didn’t gain popularity until the 20th century. Then all of a sudden, it became almost an elitist concept—something to show others that you had wealth and opulence. It became a surgery of obviousness. While that may have initially had some appeal, over time it became so extravagant and over the top that things had to change.

The major shift toward the natural look really began about 25 to 30 years ago. As I was going through my training, I saw that transition—from overly drawn, unnatural faces to a more subtle result where someone might say, “Wow, you look really good. I would never guess you had something done, but something has changed.”

If you look at movie stars or newscasters from the 80s and 90s and compare them to today, you’ll notice a big difference. I see this all the time—I’ll look at someone and think, “There’s no way this person is 72 years old,” because they’ve had procedures done appropriately.

Two major figures in Hollywood who embodied this approach are Sophia Loren and Jane Fonda. They followed what I believe is the best way to manage facial aging: doing small things over time—through their 40s, 50s, and 60s—rather than trying to hit a home run. They made subtle tweaks along the way. As a result, when you fast forward to age 75 or 80, they look incredible.

I’ve always tried to implement that philosophy with my patients. The idea of the natural look is centered on never having a procedure draw attention to itself.

Everyone has some type of imbalance. Sometimes you’re born with it—large ears, a small chin, or a prominent nose. The purpose of plastic surgery is to balance those features, so they no longer stand out.

When I see a patient, I identify their “beauty point”—what really defines their face. If someone has a large nose, it may be drawing attention away from their eyes. My goal is to adjust the nose so that attention returns to the eyes, and the nose is no longer the focus.

Leonardo da Vinci, centuries ago, studied facial aesthetics. You may have heard of the Vitruvian Man—the figure with arms and legs extended within a circle. He described facial proportions in terms of horizontal thirds and vertical fifths. When features fall outside these proportions, they become distracting.

Our goal is to understand how the face has aged—what has changed over the last 10 to 15 years. I look at the brows, jawline, and neck and evaluate how they’ve shifted. If I try to reverse aging without understanding its direction, I create an unnatural look. Instead, I work in the opposite direction of how the face has aged, essentially restoring it to where it used to be.

The goal is to correct only what has changed—not everything. One of the biggest challenges for plastic surgeons is knowing when to stop. You don’t need to fix six or seven things—correcting one or two can reestablish balance without making it obvious.

That’s the concept behind the natural look: adjusting something negative so that something positive stands out.

If you begin addressing aging earlier—typically between your mid-40s and mid-60s—you can make small changes that lead to long-term benefits.

Let’s talk about facial balancing, particularly in women. Women experience significant changes in their 30s and 40s, largely driven by collagen loss. The skin becomes thinner, more fragile, and more discolored. By the time a woman reaches her 40s, she may have lost around 10% of her collagen.

This loss isn’t just in the skin—it affects the muscles and deeper structures that support the face. As collagen decreases, features begin to descend.

Then, during the perimenopausal years, estrogen levels drop, leading to fat loss in the face. The face deflates. When you combine collagen loss with fat loss, you accelerate the aging process.

Facial balancing involves addressing three main factors: restoring collagen, replacing lost volume, and correcting the effects of gravity.

If you compare a person in their 80s to a photo of them in their 30s, you’ll notice that the older face appears more skeletal. Fat provides softness and roundness. As it diminishes, the face becomes gaunt.

Techniques like structural fat grafting, developed in the early 2000s, focus on restoring that volume to create a more youthful, heart-shaped appearance.

When you combine volume restoration, collagen improvement, and lifting against gravity, you reestablish facial balance. The face still ages—but it ages better.

One of the best indicators of success is when patients attend a class reunion and say, “I couldn’t believe how old everyone looked.” The difference is that they’ve slowed their aging process.

The goal isn’t to look 30 forever—that’s impossible. The goal is to always look younger than your age. Combined with a healthy lifestyle, the results can be very impactful.

Our industry is moving toward facial balancing rather than dramatic transformations. You don’t want people asking, “What did she have done?” You want them asking, “Did you change your hair?”

You can often see this philosophy in a surgeon’s work. They’re not focused on the procedure—they’re focused on the outcome.

As we wrap up what I think has been a fantastic episode, thank you for listening. I hope this helps you feel more informed and empowered to make better decisions.

I like to close each podcast with something my father taught me. He immigrated from Cuba in 1960 after surviving a firing squad. He came to this country with seven dollars hidden in his shoe.

He was a self-made man. He worked his way through school and built his life from nothing. Along the way, many people helped him—strangers who opened doors for him when they didn’t have to.

He always emphasized appreciating those who came before us—the people whose struggles made our lives possible. He wanted his children to stand on his shoulders and be better than him.

We live in a world where it’s easy to be critical, but sometimes we need to stop and appreciate what we have. No place is perfect, but this country gave my father opportunities he never would have had otherwise.

He taught me to help others along my path, just as others helped him. And he reminded me that while we want to make life easier for our children, we also have to allow them to face challenges so they can grow.

It’s a more serious note, but an important one—especially in today’s world. We should be thankful for what we have rather than focusing on what we don’t.

Remember, wherever we are, we are there for a reason. Our job is to make the best of it.

Thank you again, and as always, remember—good decisions.