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Plastic Surgery

If, after you've finished the work of a reality retouching, more drastic work is needed, you can move on to plastic surgery. First, do everything you can to give the image a finished appearance. I don't like to cut and paste parts until the basics are done. Also, note that you can make dramatic changes by stretching highlights and deepening shadows. This simple technique can change the shape of a cheekbone or nose. When I do my initial retouching layer, I pay close attention to the light and shadows. This becomes especially important in some lighting conditions and with older models. You can recontour someone's face by widening and lessening shadows and highlights. Pay close attention to where these shadows fall on the face, and how dark they are, and you'll be able to take years off someone's face without needing to change anything in the underlying structure.

When you open this file, it will already have a retouching layer in it. You'll clearly be able to see where the highlights and shadows have changed. I have included this so that you can see exactly what this layer looks like. In a soft yet dramatic lighting situation such as this one, there are shadows on the right side of the face that do not enhance her face structure. I blended the contours, took a little tuck in on the outer edge, and lightened the nose shadow. If you turn the layer on and off, you will see the dramatic difference it makes in her overall appearance. Just this technique alone will take years off. But wait...there's much more.

Image 32Image 32 Before and after plastic surgery collagen injection.

Collagen Injections

With the initial retouching out of the way, it's time to move on to the surgery section of this image. Image 32 shows the before and after of reality retouch with some additional plastic surgery. Unfortunately, the model's lips were not as full as the client wanted, so we're going to work on them a bit, removing some wrinkles and enlarging them.

To work on the lips, pop them into their own layer. Create a rough selection around the lips, making sure you have a good amount of skin on the outside as well (see Image 33). Feather it at about 5, and then use the Layer via Copy command (Ctrl+J) to create a new layer from your selection. We'll do our work on the lips in this newly created layer.

The first thing to do with these lips is remove the wrinkle on the left side of the lower lip with the Healing Brush. To do this, Alt+click above the wrinkle to establish a sample point, and then click the wrinkle to heal one small section at a time. To make the lips look fuller, continue to heal the other wrinkles that go horizontally and vertically across the lip. Don't remove them all, but definitely eliminate the larger ones. Just removing these wrinkles gives the lips an appearance of more fullness.

Image 33Image 33 The selection used for working on the lips.

Image 34Image 34 After using the Heal Brush on the lower lip.

The next step is to adjust the shape of the lips. The shape in the original image is good but a little bit thin. To fix the problem, use the Free Transform command to stretch the layer ever so slightly.

Press Ctrl+T to launch the Free Transform command, and then, while holding down the Ctrl key, pull the center-top handle slightly up and to the left, as shown in Image 35. This action increases the smirk a little and makes the lips slightly fuller. You must reposition the lips slightly by using the arrow keys to nudge the layer. Move them back down so that the upper lip on the transformed top layer fits over the original. The following figure shows an example of the new lip superimposed over the old.

As you can see from Image 36, the upper lip stays anchored in its original position, and the bottom lip is now extending slightly below the original lower lip.

Now that you have the new lip in place, you need to become a dentist for a moment. Switch back to your original layer. Go in with the healing brush and adjust the shape of the teeth, eliminating the gaps.

Image 35Image 35 Transforming the shape of the lips to add fullness.

Image 36Image 36 The transformed lips superimposed over the untransformed lips.

Image 37Image 37 Areas to work on the teeth.

Image 38Image 38 Before and after work on the teeth.

Next, redden the lips. Choose your Polygon Lasso tool and draw an outline of the lips. (Note that you also can use the Pen tool to make this selection.) The outline here is critical because it will define the shape of the mouth and the form of the lips, so take the time to make a really great selection, tweaking where necessary to ensure the lips have a perfect shape.

After creating your selection, feather it by 4, and then add an adjustment layer for Selective Color. Now you can begin to adjust the different colors.

I have made most of my adjustments to the red. You also can play around with the neutral. Again, having these changes in an adjustment layer means you can use a different color later if the art director requires changes.

Image 39Image 39 The selection for adjusting lip color.

Image 40Image 40 The Layers palette showing the adjustment layer for Selective Color.

Image 41Image 41 Using the Selective Color options to redden the lips.

The Eye-Lift

In this next image, we are going to fix the model's right eye. Even though this model is quite young and beautiful, her right eye appears smaller than the left due to the angle of the shot. The task here is to transform it so that the eyes look more even. First begin by lassoing the area around the model's right eye (see Image 43).

Image 42Image 42 Before and after images of a plastic surgery eye-lift.

Image 43Image 43 Selecting and transforming the eye shape.

Feather the selection by 5, and then use the Layer via Copy command to create a new layer from your selection. Next enlarge the eye and lift the eyebrow in one transformation by pulling the upper-left corner up, and the lower-left corner out (see Image 43). After doing so, you must lower the Opacity of the layer so that you can line up the transformed layer. Lowering the Opacity enables you to see the two layers simultaneously. Line up the new layer with the original so that the bottom of the eye on both layers is in the same place. After placing it where you want it, reset the Opacity to 100%. You'll probably have some cleanup to do on the outer edge. Get your Eraser tool and, with an Opacity of 50%, use a large soft brush to work the edges. This technique creates a flawless and invisible eye-lift.

As you can see in the final retouched image, the model's right eye seems less puffy and more symmetrical with the other. Even though this difference is subtle, it gives a more fresh and appealing look.

Image 44Image 44 The before and after of the final retouched image.

The Nose Job

This next image was initially shot for stock, and was picked up by Bombshell Studio Make-up ( for their campaign. Even though the model has stunning looks at certain angles, her nose photographed unevenly. As with all of my images, I begin with the basic retouching. After the standard smoothing and cleanup, using my mental checklist as discussed earlier, I move on to the nose.

Image 45Image 45 Before and after images of plastic surgery with a nose job.

Image 46Image 46 Before the retouch, with notes on areas needing work.

I first assess what work needs to be done. In Image 46, I marked the parts of the nose I wanted to see fixed in the final image. On the right side of the model's nose, I must add definition, because it isn't clear where the bridge of the nose is. I also need to lessen or remove the knob on the right side of the model's nose. Finally, I will reduce the width of the nostril on the right, which will in turn lessen the nose's overall width.

In this next image, I have done all the necessary retouching to the eyebrows, lips, and skin. I also have lessened the shadow on the right side of the nose using the Dodge tool and burnt the edge, using the Burn tool, with a very small brush. The goal was to make the bridge more defined.

Now we will begin working on the right side of the model's nose. Notice that the basic retouching techniques—smoothing the skin, making the shadows less dark—have already reduced the appearance of the knob on this side, taking us halfway to the desired result.

Start on this side by copying the right half of the nose. Be sure to grab enough skin on the right side—when you transform this, you'll need the extra to cover.

Feather the selection by 5 so that you have a smooth edge, and then create a new layer from the selection.

Image 47Image 47 After the initial retouch, before plastic surgery.

Image 48Image 48 The selection for narrowing the nose.

Image 49Image 49 After transforming the nose.

Next we're going to free transform the shape of the right side of the nose to lessen the overall width. We don't really need to change much. Because this is a small adjustment, make small changes until you have reached the desired effect. First drag the right side of the transform box toward the center. This action reduces the width of the nostril as well as the bridge of the nose. When the width of the bridge looks good, drag the lower-right corner of the transform box in to further reduce the size of the nostril while leaving the width of the bridge the same.

The Sanity Check

When working on individual parts, I always turn on and off the layers a few times to see the before and after of the change. This is helpful to see whether it's looking realistic and whether the placement of the transformed part is correct.

Finish off the tip of the nose by creating a new, empty layer for retouching, and then use the Clone tool to smooth out the bump on the tip.

The final step is to even out the nostrils. Because the model's head is at an angle, the nostrils appear to be two different sizes. I think the discrepancy between the two is too large and needs to be a little more even. So first select the model's right nostril, feather it by 3, and create a new layer from the selection (Ctrl+J).

Image 50Image 50 The selection for transforming the nostril.

Free transform this new layer by holding down the Alt key while dragging the handles to stretch and enlarge the nostril, paying close attention to angle of the nose (see Image 51).

Now move on to the other side. Transform this nostril in the same way. This time, however, just reduce the size ever so slightly.

As you can see when you compare the two images side by side in Image 52, the difference is noticeable, but it's unnoticeable if you don't have the original image as a reference point. Obviously, no one will have seen the before, so the goal is to make a great-looking image regardless of where you started.

Image 51Image 51 The transformation to enlarge the nostril.

Image 52Image 52 Before and after the retouch.

Xtreme Hair

I have one other item I want to show you in the plastic surgery category. It's not really plastic surgery, but more like a really big bottle of Rogaine. We're going to add heaps of hair!

Image 53Image 53 The original shot before the hair extension treatment.

As you can see from Image 53, the model already has plenty of beautiful hair. However, I want to add even more to get the "extreme hair" effect I want in the final image.

Image 54Image 54 The final image with more hair.

I work with hair using three basic moves: Copy/Paste, Transform, and Twirl. Let's start by copying chunks of hair from other source images from the shoot. Here are the three images to use as the hair transplant sources.

Image 55Image 55 The first hair transplant source image.

Image 56Image 56 The second hair transplant source image.

Image 57Image 57 The third hair transplant source image.

Select chunks of hair from the source images that will more or less match the underlying hair in the target and fill out the shape and size desired. In addition to the size and shape, look specifically at the lighting and color tone. For example, notice the blue light hitting the model around the hairline—you want to make sure that all the hair emanating from this area has the same bluish cast. (Note that you also can use this technique by copying from within the same image if you don't have other sources to use.)

Believe it or not, this seemingly painstaking process is very forgiving. When you feather the edges of the pasted selections, no one will really be able to tell where one chunk starts and the other stops.

Image 58 shows a shot of the selection from the first source image. I grab as much hair as possible from this shot because it will make up for a lot of missing pieces in the original image. Also, it's nice to get a lot of coverage from one piece because it gives me less cleanup work to do.

Image 58Image 58 The selection of the first chunk of hair for copying.

First, duplicate your background layer and turn the bottom one off. Then, extend your canvas (Image > Canvas Size) so that you have room to work. Anchor the image to the right side and create extra space on the left. Using the Eyedropper tool, sample the color from the existing background, and fill in the new background space using the Paint Bucket.

Image 59Image 59 The target image with the first chunk of copied hair pasted in.

After copying and pasting the selected hair into your file, you should have something that looks like Image 59. Next you are going to copy a chunk for the top portion of the hair from the second source image and paste it into the file as well.

Image 60Image 60 The target image with the second chunk of hair pasted in.

As you can see from Image 60, this is not far off from where you want to be eventually. Now you paste one more piece from the third source file and begin the transforms and twirls.

Image 61Image 61 The target image with the third chunk of hair pasted in.

Now you twirl the ends of the hair to better match the existing hair and give it a softer, more fluid effect. Using the Lasso, grab just the parts that you want to change. Then use the Twirl filter (Filter > Distort > Twirl) to add a slight swirl effect to the selected hair (see Images 62 and 63).

Image 62Image 62 The image after some initial twirling, showing a selection for twirling.

Image 63Image 63 The Twirl dialog box.

Play with the Angle slider until the flow feels like that of the other pieces in the image.

Your initial selection is key to how your final effect will appear. If you grab a larger chunk of the same piece, you get a different effect when you twirl.

The last step is to free transform the shape of each piece you have pasted in. Stretch, pull, and move the pasted fragment until it blends in with the flow of the original hair. You're not going for perfection, because you will touch up in the next step. Instead, try to make the overall direction orientation match the rest of the hair in the image. Use your original as the guide to what the direction should be (see Image 64). Repeat this process for each of the layers containing the fragments you have pasted in.

For final touch up, use the Erase tool to blend each piece into the background. Erase around the edges of your pasted-in piece until you find places where the new hairs match up with those in the original hair layer below.

Image 64Image 64 Transforming the pasted fragment to fit.

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