Welcome to Stirring the Aesthetic Pot, where beauty trends get questioned – and occasionally roasted.
I’m not a doctor. But I spend every day with two of the best in the business-and a team of master estheticians who live, breathe, and lose sleep over skin health. What I bring to the table is honest curiosity, lived experience, and a front-row seat to what actually works… let’s stir, shall we?
THERE’S A NEW PATIENT IN THE CONSULTATION ROOM.
They’ve done their research. They arrive with edited images, often AI-generated, showing a sharper jawline, a tighter neck, more definition through the lower face. It’s presented as a before and after, except the “after” was created without ever accounting for anatomy.
And yes, it usually looks good. That’s what makes it convincing. These tools operate on the surface of a photograph. They refine contours and smooth transitions, but they have no awareness of the structures that actually create a jawline or define a neck. Bone, muscle, fat compartments, skin quality, the position of the hyoid bone and the voice box, all of the fixed anatomy that determines what a lower face can become, is simply not part of the equation. So the software does what it’s designed to do. It idealizes.
The problem is that the lower face and neck are not abstract shapes. They are structural systems. The angle between the underside of the jaw and the neck, what we refer to as the cervicomental angle, is one of the primary markers of a defined neckline. When it’s sharp and well supported, the jawline reads clean and distinct from the neck.
But that angle is not something you can just draw in. It is shaped by mandibular projection, the tone and position of the platysma muscle, the presence of submental fat, and the elasticity of the skin.
Just as importantly, it is influenced by deeper, non-negotiable anatomy, specifically the position of the hyoid bone and the larynx, or voice box, which sit at the base of the tongue and anchor the upper neck. If those structures sit lower or more forward, the neck will naturally appear fuller and less angular, regardless of how much tightening is performed. That is anatomy. Not a limitation of technique.
AI removes all of those variables. It assumes ideal structure, perfect support, and full correctability. It gives you a neckline that exists independently of the framework that has to carry it. That’s where the disconnect happens.
In reality, surgical planning is about working within those constraints, not ignoring them. The goal is not to impose a perfect angle, but to refine what is already there in a way that is anatomically sound and holds up outside of a photograph.
That’s why we photograph patients in-house and review potential outcomes directly with the physician, adjusting images based on their specific structure rather than a generalized template. Same face. Same anatomy. Just moved toward its best version. Technology has made patients more visually articulate, and that’s useful. But there is a difference between recognizing what you like and understanding what your anatomy will support. Aesthetic surgery lives in that distinction.
And the most important thing a surgeon brings to the conversation is not better software. It’s the judgment to know where the image stops and reality begins.
FROM THE CHAIR:
Dr. Austin Adams
“Patients today come in with plenty of visual references, which helps, but the consultation is about translating that into a realistic outcome. Setting expectations is everything. AI images don’t account for anatomy, so they’re not a reliable guide. Older photos of yourself are far more useful. They’re a far better guide to what your anatomy will support.”
