It’s a fact: we’ve never had so many possibilities to change the way we look. Today, we can alter proportions, reposition tissue, restore volume, and address practically any feature that has ever made us stop in front of the mirror. But what if the most interesting evolution in plastic surgery isn’t everything it can do? Perhaps it’s learning to decide what is actually worth doing.

For Dr. David De Rungs, a plastic, aesthetic, and reconstructive surgeon, that decision begins long before the operating room: by asking what someone wants to change, what they actually need, and, above all, what should remain untouched. Exclusively for Topics That Transform, we spoke with him about natural-looking results, filters, aging, and why contemporary surgery may have less to do with transforming ourselves and more to do with continuing to recognize who we are.

What No One Should Notice

There’s something almost contradictory about the way we think about plastic surgery. As the possibilities for changing our appearance continue to grow, the result many patients are looking for seems to be moving in the opposite direction. They want the change to show. The surgery? Not so much.

“To me, a good result isn’t when someone can tell you’ve had surgery; it’s when they can tell you look better,” explains Dr. David De Rungs. Over the years, even his own definition of a successful procedure has evolved. “Facial surgery shouldn’t erase a person’s identity. It should restore the version of themselves that time has gradually changed.”

And that’s exactly where his approach to surgery becomes more interesting. Preserving someone’s identity doesn’t mean keeping every feature exactly as it was. It means understanding the proportions, expressions, and characteristics that allow a face to still feel like their own after surgery. “Today, I’m less interested in ‘transforming’ and more interested in repositioning, harmonizing, and preserving,” he says. “Surgery should be practically invisible to the person looking at you, but deeply meaningful to the person experiencing it.”

Still Looking Like Yourself

Talking about a natural result may sound simple. But from a medical perspective, naturalness isn’t only about how much you change a face. It’s about understanding how that face is built. “Naturalness doesn’t depend solely on how much you tighten the skin. It depends on respecting the anatomy,” De Rungs explains. “A natural-looking face retains movement, expression, volume, and proportion.”

But understanding anatomy is only part of the conversation. What we consider desirable has changed, too. A few years ago, there was a stronger tendency to pursue certain beauty standards. Today, many patients arrive with a different request: “I want to look better, but I still want to look like myself.” “I think we’re moving from an aesthetic based on perfection to one based on harmony and individuality. To me, modern surgery is precisely about understanding that difference.”

The Face Behind the Filter

Although, let’s be honest, developing our own sense of reference becomes harder when we’re constantly surrounded by altered versions of ourselves. Photos, cameras, angles, lighting, and filters have changed not only the way we show our faces, but also the way we’ve learned to look at them.

And that follows us into the consultation room. Today, we can see our own faces hundreds of times a day, often through a screen that doesn’t necessarily reflect how other people see us. “An important part of my responsibility is helping patients distinguish between a genuine aesthetic concern and a perception distorted by constant exposure to their own image.”

When the Standard Enters the Consultation Room

But filters aren’t the only reference that can influence us when we consider surgery. Today’s beauty trends can also end up defining what we believe we need to change. When that happens, De Rungs tries to understand where the desire is coming from in the simplest possible way: by talking. “I listen a lot before I talk about surgery. I ask what bothers them, how long they’ve noticed it, what they hope to achieve and, most importantly, why they want to do it now.”

Put simply, a trend can be a reference, but it should never become a diagnosis. “My job isn’t to follow a trend; it’s to determine what can genuinely improve that person and what will probably lose relevance over time.” And sometimes, that means the answer may be no or not yet.

Because perhaps one of the hardest decisions—amid all the possibilities aesthetic surgery offers today—isn’t choosing what to change, but recognizing when not to change anything at all. “A good surgeon needs to know how to operate, but also when not to operate,” he says.

Aging Without Erasing Time

Getting older is inevitable. Looking as though we hadn’t, for a long time, was almost the promise behind rejuvenation. But something begins to shift when we talk less about “taking years off” and more about aging well. Reaching a certain age and still looking rested, healthy, and balanced, without pretending our face belongs to another stage of our life.

That way of thinking about aging is precisely what lies behind techniques such as the Deep Plane Facelift. Unlike a treatment focused solely on tightening the skin, this technique “works on the deeper planes of the face, releasing and repositioning tissues that have descended over time.” The skin, then, follows that movement rather than being the starting point of the lift.

And that brings us to another question: if we’re not trying to erase our age, when does it actually make sense to intervene? The answer isn’t necessarily found in the number on the calendar either. “I don’t operate on an age; I operate on an anatomy.” Skin quality, tissue descent, cheek position, the jawline, neck, and fat distribution are all part of what he considers before making a decision. “The right question isn’t, ‘How old are you?’ but, ‘What has happened to your face?’”

Before the Operating Room

In front of the mirror, we tend to look at ourselves in parts. A double chin, a jawline that has changed, or a face that simply feels different from the one we remember. The medical perspective, however, tries to understand what lies behind what we’re seeing and determine what actually makes sense for each patient. What bothers them, what they want to preserve, what they hope to change and, above all, why they’re considering aesthetic surgery in the first place.

Perhaps that’s why a transformation doesn’t begin when we decide which procedure to have. It begins much earlier. With that first conversation, where what we want to change meets what we actually need. “Surgery begins long before the operating room. It begins with that conversation.”

Epilogue

After more than 15 years of working with people who have chosen to change some aspect of their appearance, De Rungs has learned something about what we’re really looking for when we decide to make a change. “People don’t want to become someone else. They want to recognize themselves again.” And perhaps that’s where we find the most interesting transformation of all.

It isn’t about discovering how much more we can change about the way we look, but learning how much we actually need to change in order to still feel like ourselves.