London, Asharq Al-Awsat—Some view the signs of aging as an inevitable part of life and are proud of the lines that time has etched on their faces. These people live in peace with the wrinkles that represent their past life. Others, however, do not share this outlook and will happily resort to cosmetic surgery as well as non-surgical cosmetic procedures for help. But if they do make that choice, what’s important is to choose the right surgeon at the right time.

Doctor Olivier Henry de Frahan is regarded as one of the best cosmetic surgeon in the world and is ranked one of the top 10 doctors globally. He has two clinics, one in Wilbraham Place, close to upmarket Sloane Street in the heart of London, and another in Paris. Recently, he spoke to Asharq Al-Awsat about cosmetic surgery, facelift methods, how to get rid of bags under the eyes, procedures to tighten eyelids and liposuction.

When we arrive at his London clinic there is already a queue of men and women waiting to see him. His time is precious, especially as he splits his days between the two clinics. After waiting more than half an hour, Dr. de Frahan appears, tall, slender and lean-faced. After greeting the patients in the waiting room he approaches us cautiously, claiming he does not like interviews very much and believes that a good doctor should appear infrequently in the media, and successful doctors should focus mainly on their work in light of the severe time constraints they face.

We start by talking about the doctor’s nicknames: “The No, No Doctor” and “Dr. No.” He smiles and says they arose from the fact that he is “very frank, and I say ‘no’ to patients who do not need surgery.”

In his French accent, Dr. de Frahan adds he will sometimes tell women who do not need surgery, “Go change the lights in your house.” And if the reason for her wanting surgery is that other people have told her she needs it, he will say, “Go change them, too.” But what if it’s the man in her life telling her she needs a facelift? He stops for a moment, and I ask him, “Would you tell her to get rid of him?” He answers, laughing, “No comment.”

When we ask him how he can refuse to perform operations when as a doctor he has to make a living, his answer is, again, very frank: “My family is rich.” He adds that some doctors who do cosmetic work these days do so only to make money and not because of their love of medicine. He says: “When I see that the patient needs surgery of any kind I do it without hesitation, but when I see that he or she does not need an operation, I apologize and advise him or her to see another doctor who will perform it. When there is a real need, the practical result will be better. Everything must be done within its time. It is not helpful to do an eyelid lift too early or too late. I decide to perform the operation when I am 99 percent confident that I must do so. Otherwise, I won’t do it.”

He talks about his role in choosing what is appropriate for an individual’s face, using the example of enlarging lips. He says he does not like to impose his views on a patient, but he does choose what fits best with a person’s facial structure, including the amount of product used and the style of the procedure. These are key to the success of any cosmetic procedure.

When asked about the types of patients he encounters, Dr. de Frahan laughs again, saying: “The question is complicated. There are several types of patient, ranging from celebrities to active and successful people within the community who know what they want. There are also people who refuse to succumb to the aging process. My patients come from all over the world, from New York, Russia, France, Britain, Turkey and the Middle East.”

Dr. de Frahan says one problem for many of his patients in the Arab world is the excessive and random use of facial injections, which do not completely dissolve with time. This is known as the ‘soft technique’ in the Middle East, and most often the problem lies with the materials used, as filler injections differ from one doctor to another. A large percentage of Middle Easterners come to him to look younger, repair errors or eliminate material injected in the face. This type of work is the most difficult, because the doctor has to both reshape the face to its previous form and improve it at the same time.

He rejects the recent phenomenon known as the “Frozen Look,” which erases facial expressions completely and makes one’s face look, in his opinion, like a “wax statue.” He continues, saying, “I believe in natural beauty, which does represent a contradiction because I perform facelifts, but my philosophy is based on surgical and non-surgical procedures that retain the patient’s original facial features . . . It is very important to work in a way that complements each patient individually based on customs or other considerations. The same technique cannot be applied to all patients, as facial forms vary and each person has a different percentage of fat in their body.”

When asked about the optimal age for operations to remove under-eye bags, Dr. de Frahan says there is no fixed age because genetic factors play a large role in the aging process. It is possible, he says, to find people with bags under their eyes at the age of 20, and in his view the operation could be performed then. Several problems other than under-eye bags require surgical intervention, such as excess skin around the eye and droopy eyelids at the corners. The solution is not always an operation: sometimes the problems can be addressed using Botox, which Dr. de Frahan claims does not have negative repercussions so long as appropriate quantities are used. But he says Botox injections should be administered only twice a year.

On the topic of whether he prefers dealing with faces that are already beautiful, Dr. de Frahan says starting out with a beautiful face leads to special results. When working on a less beautiful face, he says, the result will be satisfactory, but not as impressive as work done on an already pretty face. “When I work on a pretty face, I feel challenged because you have the key to the details of the original beauty, then refreshing or restoring them without changing them.”

It is well-known that many stars deny they have had cosmetic surgery and Dr. de Frahan says he resents this—in fact, he says when he sees a star who has had one of his operations on television denying they have had cosmetic work done, he wants to smash the screen. However, at the same time he feels proud because it means he was able to improve this person’s appearance without making drastic changes. “In the past I was upset when I met a celebrity at a public event and she acted like she didn’t know me, but today I feel that this type of denial is actually paying homage to my work, which strives to produce a natural form,” he says.

Cosmetic surgery is not a profession like sewing, the doctor continues. He observes that the seamstress may produce many dresses from one pattern, but the plastic surgeon must devise a different plan for each operation. Faces and cultures differ, and that’s what makes his job beautiful, he says, because he is eager to see the result every time he performs a new operation.

Twenty percent of his patients are male. It is a significant proportion compared to figures in the past, and the most common procedures undergone by men include facelifts, tightening up the area around the eyes and both traditional and laser liposuction.

Liposuction is one of Dr. de Frahan’s specializations, along with facelifts and eyelid work. He says that the traditional way is best, because skill and technique is more important than technology. He spends hours on these procedures because it helps him achieve better results in terms of both the resulting form and reducing the patient’s pain after the operation.

He claims that many misconceptions exist about liposuction. Some think it will help them lose lots of weight, but he stresses that the operation should not be considered a weight-loss method but as a “reshaping” surgery. Losing weight happens through exercise and a healthy diet, he says, and it is very important for patients to heed their doctors’ advice, so maintaining a healthy weight after undergoing liposuction is very important.

On defining beauty, Dr. de Frahan says the issue is a complex one and that there is no one standard for beauty. It is defined by personal preferences and sense of taste.

Maintaining beauty is important, but it is not important that we look 20 years younger, he claims. In his opinion, after plastic surgery some stars, whose names he said he cannot reveal, look younger in age but don’t actually resemble their younger selves. When a person looks this dramatically different, it means, in Dr. de Frahan’s opinion, that the operation has failed.

He says that he looks at women through the eyes of a man. When he sees a woman in the street, he often thinks to himself, “She would look better if she removed the pockets under her eyes.” He does not get upset when women ask him about his work and whether they need a cosmetic procedure at private parties. However, he stresses that he refuses to perform surgery on his partner, saying, “This is my style. Other surgeons are proud to perform surgery on their partners.”

As for non-surgical procedures such as heat facelifts, Dr. de Frahan says he does not perform them. He believes these procedures are being carried out too early and that a minimum of two years is required to understand the side effects. He reasons that, in the end, a facelift cannot be completed without cutting the skin and working to restore muscle and fat distribution in a balanced way.

At the conversation comes to an end, Dr. de Frahan advises the use of hyaluronic acid fillings instead of utilizing materials that are irreversible. He only uses uronic acid when injecting into the face or lips and does not use it at all when enlarging cheeks. He also advises that patients meet with their doctor before agreeing to undergo a procedure, as it is essential the patient feels comfortable with the surgeon. The best way to find a seasoned practitioner is to ask friends and acquaintances about their positive experiences with surgeons. Patients should also check the doctor’s certification and ask to see pictures of patients the doctor has worked on before and after the operation.