Plastic Surgery: Before and After

By Darren M. Smith, M.D.Medicine Health & Fitness Education

Plastic Surgery: Before and After episodes

September 07, 2020 Who is the Best Plastic Surgeon in New York City?
Who is the best plastic surgeon in New York City? This episode's answer is that there is no single best surgeon for every person and procedure. Darren M. Smith, MD, a board-certified plastic surgeon in NYC, examines common shortcuts people use when choosing a surgeon and explains why each needs context.
Originally published September 7, 2020. This is an educational discussion of surgeon selection, not a ranking or an award claim.
Key takeaways
📚 Experience and volume
Years in practice and procedure volume can inform an assessment, but neither tells the whole story about an individual surgeon's approach.
💬 Online reviews
Online reviews can reveal patient experiences, while star counts alone do not establish the quality or suitability of care.
🧭 Referrals and priorities
A friend or physician's referral is a starting point. Ask whether the recommendation concerns the same procedure and the same priorities you have.
🔎 Visibility and marketing
Search placement, social media popularity and frequent mentions in online groups are visibility signals, not proof of surgical quality.
🏥 Office and care experience
The office experience and staff can matter to your overall care, but should be considered alongside the surgeon's experience, communication and alignment with your goals.
🎧 Episode guide
00:00 — Introduction
01:38 — Years in practice and procedural experience
06:32 — Online reviews and search results
08:51 — Personal and physician referrals
12:20 — Social media and other visibility signals
16:56 — Finding the surgeon who fits your goals
💬 Common questions
Should I choose whoever performs the most procedures?
Dr. Smith explains that experience can be valuable, but volume by itself does not establish quality. He encourages evaluating the surgeon from several perspectives and considering their experience with the particular procedure you want.
Is my friend's surgeon automatically right for me?
Not necessarily. Your friend may prefer a different aesthetic result, value different parts of the experience or have undergone a different operation. The episode uses that distinction to explain why a personal recommendation still needs an individual consultation.
Do followers or five-star reviews identify the best surgeon?
No. The recording discusses how these signals can be incomplete or influenced by marketing. They can help generate questions, but do not replace a thorough assessment of the clinician and proposed care.
🔗 Continue your research
The episode builds on the earlier discussion, “How Do I Choose a Plastic Surgeon?” For current practice information, read Dr. Darren Smith's training and background and browse the patient guides. You can also schedule a consultation to discuss your procedure, expectations, alternatives and questions.
About the host — current biography
Darren M. Smith, MD, FACS specializes in mommy makeover surgery, breast surgery, and body contouring in Manhattan. He was named to Newsweek’s America’s Best Plastic Surgeons 2026 and has co-authored authoritative peer-reviewed publications on combined breast surgery and abdominoplasty and the surgical care of postpartum patients.
Educational information, not individualized medical advice or a guarantee of outcomes. Show notes updated September 30, 2026.
Full transcript and related resources
18 min
September 04, 2020 How Do I Choose a Breast Implant Shape?
Does the shape of a breast implant determine the final breast shape? It is one factor among several. Darren M. Smith, MD, a board-certified plastic surgeon in New York City, explains how implant shape, size relative to the body and placement interact with a patient's preferred appearance.
Originally published September 4, 2020. Implant availability, practice preferences and safety statements in this recording reflect that time; current context appears below.
Key takeaways
🎯 Breast shape preferences
The episode distinguishes a gently sloping upper breast from a fuller upper pole. These are aesthetic preferences to discuss, not a single ideal everyone should share.
🔎 Implant shape options
Round and anatomically shaped implants distribute volume differently. Rotation of an anatomical implant can change its appearance.
📏 Implant size and coverage
Implant size and tissue coverage affect how prominent an implant looks; the implant's label alone does not predict the result.
📅 Historical implant preference
Dr. Smith describes his preference in 2020 for smooth, round implants and explains how he approached different aesthetic goals with them.
🔄 Healing and implant changes
Breasts can change during healing, but rupture, capsular contracture or implant movement can also change appearance and require evaluation.
🎧 Episode guide
00:00 — Introduction
02:02 — Shape, size and placement
03:47 — Rotation, texture and the 2020 safety discussion
05:47 — Implant size and tissue coverage
09:20 — Settling during recovery
10:34 — Rupture and other causes of shape change
💬 Common questions
Can round implants produce a sloping upper breast?
Dr. Smith explains that they can in an appropriately planned augmentation. The discussion centers on selecting dimensions and placement in relation to the patient's body and goals rather than assuming that only a teardrop implant can create that look.
Do implants change position after surgery?
The episode describes gradual settling during healing and notes that its timing varies. It also distinguishes settling from complications that can change shape. New or concerning changes should be assessed rather than automatically attributed to normal settling.
ℹ️ Current implant safety context
The FDA states that BIA-ALCL risk is higher with textured than smooth implants. The recording's absolute statement about smooth implants should not be taken as a current zero-risk assurance. Implant-specific risks and alternatives belong in an informed consultation.
For silicone implants, current FDA guidance on rupture recognizes ultrasound as an alternative to MRI for screening patients without symptoms. Confirm a follow-up plan for your implant; the original MRI discussion is not a complete current monitoring plan.
🔗 Related information
Read current information about breast implant options, breast augmentation, and augmentation recovery, or schedule a consultation.
About the host — current biography
Darren M. Smith, MD, FACS specializes in mommy makeover surgery, breast surgery, and body contouring in Manhattan. He was named to Newsweek’s America’s Best Plastic Surgeons 2026 and has co-authored authoritative peer-reviewed publications on combined breast surgery and abdominoplasty and the surgical care of postpartum patients.
Educational information, not individualized medical advice. Implants are not lifetime devices, and results and risks vary. Show notes updated September 30, 2026.
Full transcript and related resources
15 min
September 01, 2020 What's Better: CoolSculpting or SculpSure?
How do CoolSculpting and SculpSure differ? The episode compares cold-based and heat-based approaches to reducing localized fat, and adds truSculpt iD to the discussion. Darren M. Smith, MD, a board-certified plastic surgeon in New York City, shares his personal experience in 2020, including how treatment comfort can affect completing a protocol.
Originally published September 1, 2020. This is a historical clinical perspective, not a current head-to-head trial or a ranking of every device generation.
Key takeaways
🌡️ Cooling and heating
CoolSculpting uses controlled cooling, while the SculpSure and truSculpt approaches discussed use heat.
🎯 Fat and muscle goals
These treatments target localized fat. Dr. Smith distinguishes them from original Emsculpt, which he discusses primarily in relation to muscle tone.
📅 Historical device preference
His stated preference for CoolSculpting in this recording is based on personal experience with the devices and their tolerability.
⚖️ Liposuction comparison
He also compares noninvasive options with liposuction, which removes fat through small incisions and entails different risks and recovery.
🧩 Treatment selection
Matching the goal to the treatment is more useful than assuming every form of body contouring addresses the same concern.
🎧 Episode guide
00:00 — Introduction
01:03 — What body contouring aims to do
02:54 — Muscle toning versus fat reduction
03:58 — Cold-based versus heat-based treatment
05:05 — Personal experience and treatment comfort
08:08 — Comparing device treatment with liposuction
💬 Common questions
Does the recording prove that one device is best for everyone?
No. Dr. Smith explicitly presents his own clinical experience. His explanation focuses on comfort and completing the planned treatment, rather than establishing a universal result for every patient, device or applicator.
Is muscle toning the same goal as fat reduction?
No. The episode separates original Emsculpt's muscle-focused purpose from the localized fat-reduction goals of CoolSculpting, SculpSure and truSculpt iD. Anatomy and the desired change should guide the discussion.
ℹ️ Current safety context
Noninvasive body contouring is not a weight-loss treatment and is not risk-free. The FDA describes technology-specific risks, including paradoxical adipose hyperplasia after fat freezing: treated fat can enlarge instead of shrink and may require surgery. This context supplements the original discussion.
🔗 Related information
Explore current information about liposuction and the distinct, later-generation Emsculpt NEO, or schedule a consultation. Inclusion in this archival episode does not confirm current availability of every named device.
About the host — current biography
Darren M. Smith, MD, FACS specializes in mommy makeover surgery, breast surgery, and body contouring in Manhattan. He was named to Newsweek’s America’s Best Plastic Surgeons 2026 and has co-authored authoritative peer-reviewed publications on combined breast surgery and abdominoplasty and the surgical care of postpartum patients.
Educational information, not individualized medical advice. Benefits, risks and results vary. Show notes updated September 30, 2026.
Full transcript and related resources
10 min
August 29, 2020 What Can I Do About My Abdomen Post-Pregnancy if I Don't Want to Have A Tummy Tuck?
Can you improve your abdomen after pregnancy without a tummy tuck? Some people with more limited contour concerns may consider less extensive options, but these cannot reproduce every change achieved by an abdominoplasty. Darren M. Smith, MD, a board-certified plastic surgeon in New York City, explains a combination he was using in 2020 and the importance of selecting patients carefully.
Originally published August 29, 2020. The combination described uses original Emsculpt, not Emsculpt NEO. It is a historical discussion, not a current package offer or individualized treatment recommendation.
Key takeaways
🧬 Post-pregnancy tissue layers
Dr. Smith organizes post-pregnancy concerns into three layers: skin laxity, fat distribution and the abdominal wall.
🩺 Tummy tuck planning
A tummy tuck can directly remove excess skin and address abdominal wall laxity. Liposuction may be combined with it to address selected fat deposits.
🧩 Tissue treatment options
The episode explores BodyTite for selected skin-laxity concerns, liposuction for fat and original Emsculpt for muscle stimulation.
🔎 Incisions and access
Both liposuction and BodyTite involve access incisions. The entire combination is not a noninvasive treatment.
⚖️ Procedure limits
Dr. Smith repeatedly stresses that this approach does not replace a tummy tuck when more substantial correction is needed.
🎧 Episode guide
00:00 — Introduction
01:11 — Skin, fat and abdominal wall changes
02:23 — What a tummy tuck addresses
03:09 — Who might consider a smaller procedure?
05:35 — BodyTite and liposuction
07:12 — Muscle stimulation and the limits of the combination
💬 Common questions
Why discuss skin, fat and muscle separately?
Each layer can contribute to a different concern. The recording's central point is that a treatment aimed at one layer may leave another concern unaddressed, so the plan should follow the anatomy rather than a device name.
Is the combination equivalent to a tummy tuck?
No. Dr. Smith explicitly describes a more limited change for selected mild-to-moderate concerns. The muscle-stimulation discussion should not be read as a promise to surgically repair abdominal separation or remove substantial excess skin.
Does avoiding a tummy tuck mean avoiding surgery entirely?
Not in the approach discussed here. Liposuction removes fat through small incisions, and BodyTite uses an applicator beneath the skin. Those procedures still require a discussion of risks, recovery and suitability.
🔗 Related information
Compare current information about tummy tuck surgery, BodyTite, and liposuction, or schedule a consultation to discuss your anatomy, goals and recovery constraints.
About the host — current biography
Darren M. Smith, MD, FACS specializes in mommy makeover surgery, breast surgery, and body contouring in Manhattan. He was named to Newsweek’s America’s Best Plastic Surgeons 2026 and has co-authored authoritative peer-reviewed publications on combined breast surgery and abdominoplasty and the surgical care of postpartum patients.
Educational information, not individualized medical advice. Outcomes, risks and recovery differ between patients and procedures. Show notes updated September 30, 2026.
Full transcript and related resources
10 min
August 26, 2020 What are the Different Kinds of Liposuction?
Liposuction names can describe different parts of the same procedure: the numbing solution, a motorized cannula, or an added energy device. In this episode, New York City board-certified plastic surgeon Darren M. Smith, MD, FACS explains the vocabulary and why a device name alone does not determine the right plan.
Originally published August 26, 2020. The device comparisons reflect Dr. Smith's experience at the time. He explicitly distinguishes those preferences from comparative research evidence.
Key takeaways
🔬 The underlying procedure removes fat through a cannula.
Dr. Smith first describes access incisions, numbing medication, and suction before explaining the additional terminology.
🔎 Tumescent and power-assisted describe different features.
One refers to the fluid placed in the treatment area; the other to mechanical movement of the cannula.
🔎 Energy devices are not interchangeable labels.
The recording discusses laser energy with SmartLipo, ultrasound with VASER, and radiofrequency approaches including BodyTite and J-Plasma.
🔬 Fat removal and skin laxity are separate planning questions.
Dr. Smith discusses why easier fat removal does not automatically establish how much skin tightening an individual will achieve.
🎯 Patient selection remains central.
He explains that substantial loose skin may exceed what an adjunctive tightening treatment can address.
🎧 Episode guide
00:00 — Introduction
02:11 — Tumescent solution
02:56 — Power-assisted liposuction
04:10 — Laser, ultrasound, and radiofrequency devices
06:51 — Experience versus comparative evidence
08:49 — Skin tightening and patient selection
What does tumescent liposuction mean?
It refers to the solution injected into the treatment area as part of the procedure. In the recording, Dr. Smith explains how the term relates to the tissue becoming firm after that fluid is introduced.
What is power-assisted liposuction?
It uses a motorized cannula that moves rapidly to help the surgeon remove fat. Dr. Smith describes it as mechanical assistance within liposuction, rather than a separate approach to weight loss.
Will an energy device eliminate loose skin?
That cannot be assumed from the device name. The episode emphasizes the degree of laxity, patient selection, and the operator's experience. Its 2020 comparisons should not be read as a current ranking of every available device.
ℹ️ Current related reading
Liposuction technologies and the practice's current approach | Liposuction | BodyTite | Request a consultation
About the host — current biography
Darren M. Smith, MD, FACS specializes in mommy makeover surgery, breast surgery, and body contouring in Manhattan. He was named to Newsweek’s America’s Best Plastic Surgeons 2026 and has co-authored authoritative peer-reviewed publications on combined breast surgery and abdominoplasty and the surgical care of postpartum patients.
Educational information; the appropriate technique and expected outcome require an individual assessment. Show notes updated September 30, 2026.
Full transcript and related resources
12 min
August 23, 2020 Is Plastic Surgery Permanent?
Is plastic surgery permanent? The answer depends on the procedure and what you mean by permanent. A treatment can make a lasting anatomical change while aging, weight changes and tissue changes continue. Darren M. Smith, MD, a board-certified plastic surgeon in New York City, compares facial procedures, injectables, liposuction and breast surgery through that distinction.
Originally published August 23, 2020. Longevity estimates in the recording are historical examples, not guarantees or fixed replacement schedules.
Key takeaways
🗓️ Aging and facial change
Facial rejuvenation can reposition tissues or restore volume, but it does not stop future aging.
⏳ Injectable duration
Botox and fillers have temporary effects. Dr. Smith discusses how the product and treatment location can influence duration.
⚖️ Weight and body contour
Liposuction removes fat from a treated area, but later weight changes can still change its contour. The episode emphasizes maintaining results over time.
🔎 Breast implants and change
Breast appearance can change after augmentation, and implants can develop complications such as rupture or capsular contracture.
⏳ Breast lift over time
Breast lift results are also influenced by tissue quality and ongoing changes; a lifted breast does not become immune to future sagging.
🎧 Episode guide
00:00 — Introduction
01:03 — Facial rejuvenation and continued aging
03:14 — Botox and filler duration
05:35 — Liposuction and weight changes
07:36 — Breast augmentation and implant longevity
09:19 — Breast lift longevity and tissue quality
💬 Common questions
Does a facelift stop aging?
No. Dr. Smith uses the idea of resetting a clock to explain a change in appearance while time continues to pass. The number of years of visible benefit varies and cannot be promised from a general discussion.
Can weight gain change liposuction results?
Yes. The recording explains that fat remains after liposuction and that subsequent weight gain can alter treated and untreated areas. A lasting reduction of fat in an area does not mean its size and shape will never change.
Are breast implants lifetime devices?
No. Current FDA guidance on breast implant risks states that implants are not lifetime devices and that complications may lead to additional surgery. This current context supplements the recording; the life of an individual implant cannot be predicted from a single year estimate.
🔗 Related information
Read current information about liposuction, breast augmentation, and breast lift surgery, or schedule a consultation to discuss expected longevity and follow-up for your chosen procedure.
About the host — current biography
Darren M. Smith, MD, FACS specializes in mommy makeover surgery, breast surgery, and body contouring in Manhattan. He was named to Newsweek’s America’s Best Plastic Surgeons 2026 and has co-authored authoritative peer-reviewed publications on combined breast surgery and abdominoplasty and the surgical care of postpartum patients.
Educational information, not individualized medical advice. Recovery, risks and results vary. Show notes updated September 30, 2026.
Full transcript and related resources
12 min
August 20, 2020 How Can I Fix My Nipples?
Can nipple or areola shape be changed? Different procedures address excess nipple projection, inversion, areola size or a low position on the breast. Darren M. Smith, MD, a board-certified plastic surgeon in New York City, explains why identifying the specific concern matters and why sensation and future breastfeeding should be part of the conversation.
Originally published August 20, 2020. Surgical techniques and anesthesia examples in the recording reflect Dr. Smith's practice at that time.
Key takeaways
🧬 Nipple and areola anatomy
The nipple is the projecting central structure; the areola is the surrounding pigmented skin. Their size, shape and position are separate features.
🩺 Nipple procedure options
Nipple reduction and inverted nipple correction address different concerns. Dr. Smith notes that inversion can recur and may require further treatment.
💬 Sensation and breastfeeding
Nipple procedures can affect sensation and breastfeeding ability. These tradeoffs deserve discussion before surgery.
📍 Areola and breast position
Areola reduction or reshaping concerns the pigmented skin, while a low nipple-areola position associated with breast drooping may require a breast lift.
🩺 Anesthesia planning
Some isolated procedures may use local anesthesia. A breast lift is a more extensive operation, and anesthesia planning depends on the procedure and patient.
🎧 Episode guide
00:00 — Introduction
00:45 — Nipple and areola anatomy
02:17 — Projection and inverted nipples
03:39 — Recurrence, sensation and breastfeeding
04:33 — Areola size, shape and position
07:55 — Anesthesia and procedure scope
💬 Common questions
Can inverted nipple correction affect breastfeeding?
Yes. The recording specifically identifies possible effects on breastfeeding and nipple sensation as issues to discuss with the surgeon. The technique, anatomy and future feeding goals matter.
Is reducing the areola the same as lifting the breast?
No. Dr. Smith distinguishes making the areola smaller or more regular in shape from addressing a low position on the breast mound. He discusses breast lift surgery for the latter when breast drooping is the underlying concern.
Can men have nipple or areola procedures?
Yes. The episode notes that these concerns occur in men as well as women, although the appropriate plan depends on individual anatomy and goals.
ℹ️ Current health context
A new nipple or breast change should be medically assessed before assuming it is only cosmetic. Many breast changes are benign; the National Cancer Institute explains changes to discuss with a clinician. This context is separate from the cosmetic discussion in the recording.
🔗 Related information
Read about inverted nipple correction and breast lift surgery, or schedule a consultation.
About the host — current biography
Darren M. Smith, MD, FACS specializes in mommy makeover surgery, breast surgery, and body contouring in Manhattan. He was named to Newsweek’s America’s Best Plastic Surgeons 2026 and has co-authored authoritative peer-reviewed publications on combined breast surgery and abdominoplasty and the surgical care of postpartum patients.
Educational information, not individualized medical advice. Risks, recovery and results vary. Show notes updated September 30, 2026.
Full transcript and related resources
10 min
August 17, 2020 Can my Earlobe be Repaired?
Many torn or stretched earlobes can be repaired, but the operation depends on the remaining tissue and the type of change. In this episode, Darren M. Smith, MD, a plastic surgeon in New York City, explains repair of enlarged piercing holes, split earlobes, elongation and the larger openings left by gauges.
The discussion focuses on restoring contour through a repair designed for the individual ear. It does not make every repair the same procedure or promise an exact return to an earlier appearance.
Key takeaways
🔎 Stretching has different causes.
The recording discusses heavy earrings, changes in skin elasticity over time and deliberately enlarged piercings.
🔎 A split earlobe differs from an enlarged hole.
A tear extending through the lower edge changes the repair needed to rebuild the earlobe's outline.
🔎 Gauge repair can be more complex.
A larger opening and stretched tissue may require a more involved reconstruction than a straightforward piercing-hole repair.
🔎 Local anesthesia is often discussed.
Dr. Smith describes office procedures performed while a patient is awake, with the area numbed. The actual anesthesia plan depends on the case.
🩹 Healing instructions matter.
Soreness, sutures and follow-up are part of the recording's recovery discussion. The treating clinician should provide current wound-care and activity instructions.
💬 Questions answered
Can elongated earlobes be shortened?
Yes, the episode describes removing a planned amount of tissue to shorten an elongated lobe. Dr. Smith discusses this as either a standalone procedure or, in selected cases, part of a broader facial surgery plan.
What is recovery from earlobe repair like?
Dr. Smith describes temporary soreness and a follow-up visit for removal of non-dissolving sutures in the cases discussed. His specific showering, swimming, stitch-removal and return-to-work examples reflect the original practice discussion; follow the instructions for your own repair rather than a universal timetable.
📅 Historical cost discussion
In this August 2020 recording, Dr. Smith gives NYC examples of about $750-$1,000 for one earlobe and $1,500-$2,000 for both for straightforward repairs. He notes that gauge repairs can cost more because of their complexity. These are archival figures, not current prices or an individualized quote. Location, provider and the work required affect the estimate.
🎧 Episode chapters
00:26 — What earlobe repair can address
01:25 — Stretching, tears and gauges
02:39 — Local anesthesia and the office procedure
03:28 — Recovery and follow-up
04:42 — How repair differs by the problem
07:22 — Historical cost discussion
🔗 Related information
Explore earlobe repair information, facial plastic surgery, or request a consultation with Dr. Smith in New York City.
About the host — current biography
Darren M. Smith, MD, FACS is a board-certified plastic surgeon in Manhattan specializing in mommy makeover surgery, breast surgery, and body contouring. He was named to Newsweek’s America’s Best Plastic Surgeons 2026 and has co-authored authoritative peer-reviewed publications on combined breast surgery and abdominoplasty and the surgical care of postpartum patients.
Originally released August 17, 2020. Show notes updated September 30, 2026. This is general education. Current recommendations, suitability, risks and expected results require an individual assessment.
Full transcript and related resources
9 min
August 14, 2020 Why Do I Look Angry All The Time? (Part 2)
Downturned mouth corners and pronounced marionette lines can make a resting expression appear tired or unhappy, even when that does not reflect how someone feels. In part two of this discussion, Darren M. Smith, MD, a plastic surgeon in New York City, focuses on the lower face and explains why treatment depends on the feature involved.
The episode distinguishes the position of the mouth corners from lines extending toward the jaw. Muscle activity, tissue support, surface changes and deeper folding can call for different approaches.
Key takeaways
🔬 Mouth-corner position involves a balance of muscles.
Dr. Smith describes muscles that raise and lower the corners, and how changes in soft-tissue support can affect their resting position.
🔎 Mild concerns may prompt an injectable discussion.
The recording describes Botox directed at the depressor anguli oris (DAO), and selected uses of filler or fat grafting to support the area.
🔎 Surgery is a separate decision.
Dr. Smith reserves discussion of surgical mouth-corner repositioning for more severe cases and emphasizes a detailed conversation about risks and experience.
🔎 Marionette lines vary in depth.
The episode compares resurfacing for superficial lines with filler or fat grafting for some deeper concerns.
🔎 Substantial folds and jowling involve more than a surface line.
A facelift or extended neck lift may enter the discussion when tissue descent is the main concern.
💬 Questions answered
What are marionette lines?
They are lines or folds that extend from the corners of the mouth toward the jawline. Dr. Smith distinguishes them from the position of the mouth corners themselves.
Does everyone with downturned mouth corners need surgery?
No. The recording discusses less invasive options for selected mild concerns and a different risk-benefit discussion for surgical repositioning. The appropriate choice depends on anatomy, the degree of change sought and the limitations of each option.
ℹ️ Current context for this 2020 recording
The DAO Botox use described here is outside the approved indications in the current BOTOX Cosmetic prescribing information. An off-label treatment still requires individualized assessment and informed discussion of risks.
The episode also mentions Morpheus8. The FDA's October 2025 safety communication on certain RF microneedling uses reports serious complications including burns, scarring, fat loss and nerve damage. This update is separate from the original recording. None of the treatments discussed guarantees a particular expression or outcome.
🎧 Episode chapters
01:15 — Mouth corners and marionette lines
03:31 — Muscles and resting mouth position
05:43 — Injectable options for selected mild concerns
06:55 — Surgical mouth-corner repositioning
07:40 — Matching treatment to marionette-line depth
10:07 — Deep folds, jowling and lift surgery
🔗 Related information
Explore Botox information, dermal fillers, facial fat grafting, or request a consultation with Dr. Smith in New York City.
About the host — current biography
Darren M. Smith, MD, FACS is a board-certified plastic surgeon in Manhattan specializing in mommy makeover surgery, breast surgery, and body contouring. He was named to Newsweek’s America’s Best Plastic Surgeons 2026 and has co-authored authoritative peer-reviewed publications on combined breast surgery and abdominoplasty and the surgical care of postpartum patients.
Originally released August 14, 2020. Show notes updated September 30, 2026. This is general education. Current recommendations, suitability, risks and expected results require an individual assessment.
Full transcript and related resources
12 min
August 11, 2020 Why Do I Look Angry All The Time? (Part 1)
Why might your face look tired or upset when you feel fine? Brow position, forehead lines, excess eyelid skin and the contours around the eyes can all contribute. In part one of this discussion, Darren M. Smith, MD, a board-certified plastic surgeon in New York City, explains why identifying the underlying anatomy matters before choosing treatment.
Originally published August 11, 2020. The recording reflects treatment approaches and practice preferences at that time. Part two addresses the lower face.
Key takeaways
🔎 Resting and movement lines
Lines visible at rest and lines produced by movement are different findings. Dr. Smith explains why they may call for different approaches.
👁️ Brow position
A descended brow can make upper eyelids look heavy. Removing eyelid skin alone may not address the main cause.
👁️ Upper eyelid anatomy
Upper eyelid assessment includes skin, fat and muscle, as well as whether the eyelid itself lifts normally. Eyelid ptosis is distinct from excess skin.
🔎 Under-eye shadows
Under-eye darkness can involve pigment, contour-related shadowing or a combination. The episode discusses why treatment depends on the cause.
📷 Photography and lighting
Before-and-after photographs should have comparable lighting. Small changes in light can make eye-area shadows and contours look very different.
🎧 Episode guide
00:00 — Introduction
01:40 — Forehead lines and brow position
05:44 — Brow heaviness versus eyelid concerns
07:56 — Eyelid function and ptosis
09:08 — Lower eyelids and under-eye shadows
16:21 — Comparing before-and-after photographs
💬 Common questions
How do a brow lift and an eyelid lift differ?
A brow lift addresses the position and laxity of forehead and brow tissues. Blepharoplasty addresses selected eyelid tissues. Dr. Smith describes examining their relationship because brow descent can contribute to apparent upper eyelid heaviness.
Are dark circles always a pigmentation problem?
No. The recording distinguishes darker skin pigment from shadows produced by the shape of the lower eyelid and surrounding tissues. It discusses options such as adjusting fat or filling a depression when anatomy supports that approach, without presenting one treatment as appropriate for everyone.
What should I look for in eyelid surgery photographs?
Dr. Smith recommends checking whether lighting is comparable, including the reflections visible in the eyes. Images can help illustrate an approach, but cannot predict an individual's result.
🔗 Related information
Read about brow lift surgery, eyelid surgery, and facial fat grafting, or schedule a consultation to discuss the cause of your concern and the risks and limits of possible treatments.
About the host — current biography
Darren M. Smith, MD, FACS specializes in mommy makeover surgery, breast surgery, and body contouring in Manhattan. He was named to Newsweek’s America’s Best Plastic Surgeons 2026 and has co-authored authoritative peer-reviewed publications on combined breast surgery and abdominoplasty and the surgical care of postpartum patients.
Educational information, not individualized medical advice. Treatment suitability, recovery and results vary. Show notes updated September 30, 2026.
Full transcript and related resources
18 min

About Plastic Surgery: Before and After

From the publisher's feed

Welcome to Plastic Surgery: Before and After, where board certified NYC plastic surgeon Dr. Darren Smith dishes on the ins and outs of plastic surgery in today's world. We cover popular questions…