I have interviewed many people during my 18 years in aesthetics, but sitting down to chat with industry legend Dr Arthur Swift was a real highlight. While Swift is widely regarded as one of the top injectors in the world, he couldn’t be more humble, warm and open.
A plastic surgeon by trade, Swift has been in aesthetics since 1984, but it was in the 1990s that he first started offering injectables to his patients.
Vicky Eldridge: As a plastic surgeon, you really embrace non-surgical treatments. Why is that?
Dr Arthur Swift: I’m a student of beauty. I love beauty and I want to create beauty. As I have said so often on the podium, “Every day you create beauty is a fantastic day.” And so, I’ll use everything that I have in my armour to do it.
In 1991, botulinum toxin first became available on the market for aesthetic purposes. I said, “Wow, they’re injecting the most potent neurotoxin in the world into people. They’re going to kill people.” I watched for a year, and they didn’t kill anybody so I thought, “Maybe there’s something to this.” I began with injections in 1992. Every time I did a facelift or some eyelid surgery, the patient would come back for the post-operative follow-up, and I would say, “Would you like me to bust out that number 11 that you have between your eyebrows?” So, I started to give it, without charging, as added value.
It didn’t take more than a month before people were calling my office and saying, “I want to see Dr Swift to get those lines removed.” The demand was such that I had to start cancelling a day of surgery every week to handle patients coming in for that. I wasn’t planning it, it just happened.
VE: What about dermal fillers?
AS: I was initially a fat injector. I began injecting fat in the late 80s; myself and Dr Sydney Coleman. The problem was that fat wasn’t predictable, reliable or reproducible, but we got good results in some patients. So, it was a natural transition for me when fillers came out.
We started using fillers like fat, which was a mistake. I was thinking only in terms of volume, I wasn’t thinking in terms of structure.
That went to the wayside when I realised that that’s not what the product was designed to do. The natural process was to go ahead and figure a way to do it more economically for patients. And that’s why we started to cut back and try to figure out how to develop structure in the face rather than just blow up the whole face with volume.
VE: You earned the name “The Phi guy” after a paper you wrote back in 2008. How did that come about?
AS: Everybody sees themselves in two dimensions. You see yourself in a mirror, a photograph or on a screen, it’s all in 2D. That’s why patients are always focused on lines. They look at themselves in the mirror, they see a flat image, and they come in and say, “Fill my lines.” But everybody else sees you in 3D.
The challenge was figuring out how to take somebody stuck in the 2D world and switch them over to the 3D world. We didn’t have the 3D imaging systems we have now back then, so I was trying to figure a way to get patients to see shadows, shapes, contours.
That’s when I turned to Da Vinci. I went back, and I learned everything about Da Vinci and I started reading about the divine proportion – the golden ratio. I then came across the work of a maxillofacial surgeon named Steve Markot. He came up with a mask that he said fitted over the perfect face. The problem was it worked well for Caucasians and some Asians, but not other races. There was something that just didn’t fit. This was gnawing at me for five years, and I couldn’t figure it out.
So I started to measure photos of every beautiful actress in the world, trying to figure it out. It wasn’t until I came across an article by [plastic surgeon] Steve Hoefflin where he wrote about the fact that the distance between your eyes (the intercanthal distance) doesn’t change as you go through adult life (unless it’s involved with disease). So I thought, if I use that as the initial measuring point and then look for 1.618 on the face, I can duplicate my results every time because I have the same starting point to measure.
I remember sitting at my kitchen table with pictures of Halle Berry, Angelina Jolie, Lucy Liu and Aishwarya Rai, all these stunning actresses, with my little measurements, trying to figure out what was going on. And then I had a Eureka moment.
I called to my wife, and I said, “I think I found something. When I measure Angie’s face, the distance between her eyes over here and then the distance over here, it’s one to 1.618. I think I found the golden ratio on the face.” And she says, “You’re such an idiot.” She tells me this every day to keep me where I belong. I said, “Why?” She says, “It’s only one person. How could you tell just by measuring one person?”
So, I made an appointment to go to a modelling agency. Over the next three days, I must have measured 300 models and every single one seemed to fall within this pattern. So, I thought, “I’ve got to get myself a golden calliper.” I found one on the internet. The only ones that existed were for the automotive industry, and they looked like a pentagon, but I didn’t care, I was so excited and I ordered it. I got this thing through the post and the following Monday, when my first patient walks into the office, I said, “Can I measure your face? There are certain beautiful features and proportions in your face. Do you mind if I mark them down on my chart?” To my surprise, she said, “By all means, go ahead.”
So I took out my calliper and I started to measure. I looked like Edward Scissorhands going at her. But I started doing this for all my patients and my whole consultation process changed. Suddenly, I wasn’t talking about toxins and fillers anymore, I was talking about beauty, mathematics; where’s the anxiety in that? It changed my idea of how to create beauty.
That’s a perfect example of how small, little things can change the direction of your life and your practice serendipitously.
I started to see that patients were giving me that one word that is the same in every language, “Wow.” They’d pick up the mirror, and they go, “Wow, I don’t look different, but I looked the way I remember looking 20 years ago.” That’s what we have to create. That’s the trick.
VE: You are over in the UK at the moment for the launch of Revanesse. Can you tell us why you like this range so much?
AS: First off, [Prollenium] is a Canadian company; it’s the only North American company producing a HA. I followed what they were doing very carefully because I wanted to support my countrymen. I liked their ideas and the way they think outside the box, like me.
When you have a HA, the more you crosslink it, the more it doesn’t look like you [in its composition]. And the more it doesn’t look like you, the more your body will react to it. So the least amount of modification you can do to it, the better it is accepted by the body.
Instead of the typical shards that you see with most HA, [Revanesse uses] spherical particles. When you inject a product, you’re injecting a smooth implant and the body says, “Hey, I have a house guest, but I’m cool with it, no problem”. Over time the natural hyaluronidase in your body starts to eat away at that product. It starts nibbling at it from the outside, and it takes that smooth surface and turns it into a rough surface.
But, the body says, “You know, I’ve had that house guest for the past six months, so I’m not going to say anything about it.”
But then something happens that kicks up your immune system and the filler gets caught in friendly fire. The body says, “I don’t want this house guest anymore. Time to take your luggage and get out of here”, and the patient blows up.
When we look at all these delayed inflammatory reactions we are seeing, there’s always some sort of inciting event. It might be some dental work; it might be an aeroplane flight; it might be like we see with covid-19; a vaccine, anything at all.
With the spherical type of product that you’re talking about with Revanesse, this doesn’t happen. It maintains its shape and smoothness as it degrades. In my experience [with Revanesse], which dates back about eight years now, I haven’t had a single case that I know about of delayed inflammatory reaction.
VE: If you could go back to when you first started in aesthetics, what advice would you give yourself?
AS: You have to stop, breathe and take it in. That brings back the passion of it. Sometimes you get so caught up in developing your practice and doing so many other things that you lose sight of the fact you should be enjoying yourself.
Take 15 minutes of the day just to stop, breathe it in and ask, “How privileged am I to do this?” And you’ll enjoy it so much more. When you enjoy something, you can’t wait to get into work in the morning. We’re really privileged to do what we do. If you have that passion when you start off, it will carry you through.