Facelift, technically known as rhytidectomy, is a surgical procedure to improve visible signs of aging on the face and neck, such as:

• Sagging in the middle third of the face.
• Deep wrinkles below the lower eyelids.
• Deep folds along the nose that reach the corner of the mouth (nasogenian grooves).
• Fat that has atrophied or has been removed.
• The loss of muscle tone in the lower area of the face which can give an image in bulldog.
• And loose skin and excess fatty deposits under the chin and jaw that can make even a normal-weight person appear to have jowls.

The goal of the facelift or rhytidectomy is to get a rejuvenated and natural-looking face. It is not about looking like another person, but about recovering a younger version of oneself, maintaining expression and identity.

With the lifting we fight sagging, grooves, jowls and wrinkles by lifting the muscles and skin of the face and neck. It is currently the most effective and long-lasting treatment for facial rejuvenation.

The surgical lifting allows to obtain results in terms of sagging or facial and cervical sagging that other techniques cannot achieve. The most important evolution in the lifting has been the inclusion of deep tissues of the face and neck to achieve more natural and lasting results. Surgery is currently being combined with lipofilling and skin resurfacing techniques to achieve better and more harmonious results.

It is indicated in patients from 40 years of age with signs of sagging or facial or cervical sagging who need more definition of the mandibular border, who have jowls or have vertical bands on the neck. The procedure consists of performing a dissection of the skin, the superficial musculoaponeurotic system and the platysma, stretching according to different vectors and removing the excess skin.

The incisions are hidden in the hairline and under the chin. What we always look for is the naturalness of the results and that is easier to achieve, although it seems paradoxical, through surgical treatment since it allows us a comprehensive treatment and solve more areas involved in aging than if aesthetic medical treatments are carried out that partially camouflage aging (In surgery we talk about “patches”).

In the integral rejuvenation of the face and neck, the lifting can be combined with eyelid surgery and eyebrow lift by endoscopy, achieving spectacular and lasting results over time.

A variety of other procedures can further improve the outcome of a rhytidectomy. They include:

• Facial Lipofilling (Autologous fatty tissue implants obtained from another part of the body and injected after a laborious process of filtration and centrifugation).
• Techniques to improve the tone and texture of the skin of the face such as resurfacing, peeling, skin laser etc.
• Greater reduction of wrinkles by injection of hyaluronic acid.

Endoscopic front lift:

The endoscopic front lift is a minimally invasive procedure that raises the eyebrows, giving a rejuvenated look to the forehead, improving the drooping of the eyelids and eliminating the appearance of sad or tired look.

The endoscopic technique allows the intervention to be performed with small hidden incisions in the scalp without leaving visible scars and with a short postoperative period. Through these incisions, an endoscopy device is introduced that allows to accurately treat the placement of the eyebrows and the small muscles that cause wrinkles. Currently with these procedures it is avoided to have to perform a broad approach in the frontal area (coronal approach).

Facial lipofilling combined with face lifting:

The combination of the lifting with lipotransfer or fat grafting is one of the most outstanding advances in facial rejuvenation. The tensor and lifting effect of the lifting are joined in the same intervention with the recovery of the volumes provided by the fat extracted from the patient himself. This technique allows us to perform more moderate dissections avoiding unnecessary risks.

In addition, there is a regenerative effect on the skin that is believed due to the action of stem cells and plasma growth factors that are diluted in fat. This multiplies the effects of the facelift providing smoother and more vitality to the skin. Formerly in the most aggressive liftings there was sometimes an atrophy of the skin and this was due to the excess of dissection and stretching of the skin of the face.

Short scar facelift:

This type of facelift in which we can avoid the retroauricular scar and also a very wide detachment of the skin allows us in cases with good skin quality a faster surgery (sometimes with local anesthesia and sedation) and a recovery also faster maintaining the good results.

What the facelift doesn’t do:

This surgery cannot stop the aging process.

Preparing for Facelift Surgery

• Quit smoking long before surgery.
• Avoid taking anti-inflammatory drugs such as aspirin as they can increase bleeding.

Procedure steps:

Step 1 – Anesthesia

Options include local anesthesia + intravenous sedation and general anesthesia. Your doctor will recommend the best option for you.

Step 2 – The incision

Depending on the degree of sagging and elasticity of the skin, options include a traditional facelift or short-incision lifts.

The traditional incision often begins at the hairline, continues around the ear, and ends at the scalp.

The underlying tissue is repositioned, commonly the deeper layers of the face and muscles are also lifted.

The skin is readapted on the raised tissues and the excess skin is trimmed. A second small incision under the chin may be needed to further improve tension at the neck level.

Step 3 – Closing the incisions

Once healed, the incision lines of a cosmetic surgery will be hidden within the hairline and in the natural contours of the face and ear.

Step 4 – Bandage

When we finish the procedure we will place a soft compression bandage.

Recovery:

You will be given specific instructions that may include: how to care for the incisions, medications you should take orally to aid healing and reduce the chance of infection, and when to make a follow-up visit with your plastic surgeon.

Recovery is variable depending on each patient.

Eyelid cosmetic surgery also known as blepharoplasty improves the appearance of the upper eyelids, lower eyelids, or both. Cosmetic eyelid surgery will give you a rejuvenated look around your eyes, making you look more rested and alert.

Treatable conditions:

Upper eyelid surgery can remove excess fatty deposits that appear as inflammation in the upper eyelids.

It can also treat loose or sagging skin that creates folds in the natural contour of the upper eyelid and can sometimes make it difficult to see,

Lower eyelid blepharoplasty can remove excess skin and fine wrinkles from the lower eyelid as well as correct bags under the eyes that give a tired appearance to the sufferer.

Directions:

Blepharoplasty can be performed on adult men and women who have healthy facial tissue and muscles as well as realistic goals of improving the upper and/or lower eyelids and surrounding area.

Good candidates for cosmetic eyelid surgery are:

• Healthy people.
• Non-smokers.
• People with a positive attitude and specific goals in mind.
• People without serious eye conditions.

You should tell your doctor if you have any of these conditions:

• Eye diseases such as glaucoma, dry eye or retinal detachment.
• Thyroid disorders, such as Graves’ disease, hypothyroidism or hyperthyroidism.
• Cardiovascular disease, high blood pressure or other circulatory disorders or diabetes.

Steps During Eyelid Surgery:

Step 1 – Anesthesia

Medications are given for your comfort during the eyelid surgery procedure. Options include local anesthesia, intravenous sedation, or general anesthesia. Your doctor will recommend the best option for you although usually if we perform only upper blepharoplasty it will be performed under local anesthesia and if we act on the lower eyelids or perform complementary treatments such as lipofilling of cheekbones we also perform sedation so that the patient is calmer.

Step 2 – The incision

Incision lines for eyelid surgery are designed so that scars are well hidden within the natural structures of the eyelid region.

Excess skin from the upper eyelid can be corrected through an incision in the natural crease of the eyelid that also allows the repositioning of fat deposits and the tightening of muscles and tissues.

The treatment of the lower eyelid can be performed through an incision just below the line of the lower eyelashes when in addition to the fat you are interested in removing the excess skin or more frequently through a transconjunctival incision that is, inside the lower eyelid so that there is no visible incision.

Step 3 – Closing the incisions

Eyelid incisions normally close with:

Resorbable sutures and adhesive skin stitches.

Results:

The results of eyelid surgery will appear gradually as the swelling and bruising disappear. Although after two weeks there is already a notable improvement, the result improves until the 3rd or 4th week when the bruises have completely disappeared and the scars are concealed.

Ear surgery, also known as otoplasty, is a surgery that seeks to improve the shape, position, or proportion of the ear.

Otoplasty can correct a congenital defect that becomes apparent with development or can treat deformed ears from injuries.

Ear surgery creates a natural shape and pursues the balance and proportion of the ears and face. Correcting even minor deformities can have profound benefits for appearance and self-esteem.

Specifically, ear surgery can treat:

• Ears that are too large – a rare condition called macrotia
• Ears too small – microtia.
• Prominent ears that affect one or both sides We also talk about handle ears or blow ears.
• Adult dissatisfaction with previous ear surgery.

Otoplasty Candidates:

• Children usually from 8 years of age as long as they are able to communicate their feelings and agree to have surgery.
• Healthy, non-smoking adolescents and adults with a positive attitude and realistic goals for ear surgery.
• Ear surgery is a highly individualized procedure and has to be done by oneself and not to fulfill the wishes of another person or to try to adapt to any type of ideal image.

Steps of Surgery:

Step 1 – Anesthesia

Otoplasty is a surgery that is usually performed under local anesthesia although if you want it can also be done with sedation or general anesthesia.

Step 2 – The incision

Correction of prominent ears uses surgical techniques to create or increase the fold of the antehèlix (just inside the edge of the ear) and to reduce the width of the atrial shell (the largest and deepest concavity of the outer ear). Depending on the structure we treat, we can use retroauricular approaches (behind the ears) or also through the atrial shell. In any case, the incisions are usually practically invisible in a short period of time.

Step 3 – Correction is performed by folding or cutting the cartilage in excess and subsequently adapting the skin.

Step 4. Suture

Step 5. Bandage

Results and perspectives:

Ear surgery offers almost immediate results in cases of prominent and visible ears when dressings that support the new ear shape are removed during the initial phases of healing. With the ear permanently positioned closer to the head, scars are hidden behind the ear or hidden within the natural folds of the ear.

Postoperative:

Immediately after ear surgery it is normal to feel discomfort and pain controllable by analgesics. There may also be an itching sensation under the bandages.

The stitches are usually removed between 6 and 9 days. During the first two weeks we will recommend sleeping with a bandage to avoid twisting of the ear and loss of the result.

Rhinoplasty is surgery aimed at changing the shape of the nose. The motivation for rhinoplasty may be to change the appearance of the nose, its function, or both.

Rhinoplasty is one of the most performed procedures of plastic surgery and is surely the most complex. To perform a rhinoplasty successfully the surgeon must have a very clear concept of nasal aesthetics, must be able to predict the changes that will result from the alteration of each anatomical element and must also be able to perform the operation with the maximum guarantees.

The ultimate goal should be to contribute to the well-being and happiness of the person who wants to be operated.

The decision to perform a rhinoplasty involves a great responsibility. The objectives of the operation are not only to achieve a good aesthetic and functional result but also a satisfied patient. It is very important not only to recognize the technical limitations that occur in some cases but also the expectations of the patient. In this last section it is very important to assess the emotional stability of the patient. Sometimes we find patients with minimal or non-existent problems that magnify their situation or patients who expect the rhinoplasty intervention to radically modify their way of being or acting.

Now we will try to solve the doubts that logically are presented to any person who considers performing a rhinoplasty for aesthetic or reconstructive reasons.

When planning rhinoplasty, the surgeon considers your characteristics, the skin of your nose, and what you would like to change. The upper part of the structure of the nose is bone, and the lower part is cartilage. Rhinoplasty can adjust bone, cartilage, skin, or all three. 

Directions:

Rhinoplasty can change the size, shape, or proportions of the nose. It may be done to repair deformities from an injury, correct a birth defect, or improve some breathing difficulties.

Preparation:

Before scheduling rhinoplasty, you should have a visit with your surgeon to discuss the important factors that determine whether the surgery is likely to work well for you. In the medical consultation we will assess:

• Your medical history including a history of nasal obstruction, surgeries, and medications you take. If you have a bleeding disorder, such as hemophilia, you may not be a candidate for rhinoplasty.
• A physical exam. Your doctor performs a complete physical exam, including lab tests, such as blood tests. We will also inspect your skin and the inside and outside of your nose. The physical exam helps your doctor determine what changes need to be made and what your physical characteristics are – for example, the thickness of the skin or the strength of the cartilage at the tip of your nose – can affect your results. The physical exam is also critical in determining the impact of rhinoplasty on your breathing.
• Photographs. Your doctor uses these photos for before and after evaluations, reference during surgery and long-term checkups. Most importantly, the photos allow for a specific discussion about the goals of the surgery.
• A discussion of your expectations. You and your doctor should talk about your motivations and expectations.

Before rhinoplasty, it may also be necessary to avoid certain medications. Avoid medicines containing aspirin or ibuprofen for two weeks before and after surgery. These medicines can increase bleeding. Take only medications approved or prescribed by your surgeon.

We also recommend stopping taking infusions and natural remedies that could affect increasing intraoperative bleeding.

If you smoke, quit. Smoking slows the healing process after surgery and can make you more likely to get an infection.

Surgery:

Rhinoplasty is a unique and individualized procedure for each patient. In each patient the execution will be different because always the start is different as well as what each patient wants to obtain.

Rhinoplasty can be performed through an incision inside the nose (closed rhinoplasty) or through a small external incision at the base of the nose, between the nostrils (open rhinoplasty).

Your surgeon will likely readjust the bone and cartilage under the skin. We can increase or decrease the bone or nasal cartilage in a variety of ways. In the case of augmentation rhinoplasties we can use septal cartilage, rib material or we can use external materials that integrate perfectly.

Rhinoplasty is usually performed under general anesthesia, although in some patients it can be performed under local anesthesia or with local anesthesia and sedation.

When in surgery in addition to performing a treatment on the shape of the nose we act on the septum because it has a deviation we talk about rhinoseptoplasty.

Ultrasonic rhinoplasty:

We currently perform most rhinoplasties helped by piezoelectric surgery equipment.

Equipment for piezoelectric surgery or ultrasonic rhinoplasty allows us to:

• Progressively file the bone minimizing trauma to the bone and adjacent tissues.
• Practice osteotomies in the nose (cutting the bone of the nose) using ultrasonic micro vibrations which involves cutting bone only cleanly and precisely without damaging the soft tissue.
• Selective cuts to protect soft tissues such as nerves, blood vessels and mucous membranes.
• It also helps plastic surgeons to have a blood-free field and that allows us to improve the accuracy of the surgery.
• Having less swelling after surgery.
• Decreases postoperative bleeding and bruising.
• Faster and less traumatic postoperative recovery.

Conservative or preservation rhinoplasty:

For a few years rhinoplasty has evolved and there is a new way of approaching the treatment of the nose that has forced us to make an effort to plastic surgeons to achieve better results, minimal aggression to the tissues and faster recovery. In conservative or preservation rhinoplasty there are many differences with traditional rhinoplasty but the three pillars or basic principles are the preservation of the skin covering (including in it the ligaments that anchor it to the deep structure), the back and the wing cartilages.

Principles of the technique:

• Elevation of coverage in a subperichondric – subperiostatic plane.
• Preservation of the osteocartilaginous back.
• Maintenance of the wing cartilages with minimal excision and achieving the desired shape through sutures.

1. Subperichondric plane – subperiosteal. For many years and even today many plastic surgeons separate the covering to work the back and cartilage in a sub-smas plane. This plane implies greater trauma and bleeding which would lead us to a worse postoperative period with more unpredictable results, possibility of chronic inflammation and greater bleeding. On the contrary, a subperichondric-subperiosteal plane minimizes bleeding and injury to structures obtaining a result with less bleeding and inflammation and more predictable.
2. Back. In most rhinoplasties, the osteocartilaginous back is removed, leaving an “open roof” that requires breaking the bone at the lateral level to close the defect. In contrast, dorsal preservation consists of lowering the height of the back without altering the roof (that is, sectioning the bone at the lateral level and the septum at the central level).
3. Wing cartilage. The wing cartilages are the cartilages that define the shape of the nasal tip. Traditionally what has been done is the radical section of the cartilage and placement of grafts to define the shape of the tip. Currently we perform remodeling of the cartilages achieving a harmonious shape without destruction of these. This action not only achieves better results, but also facilitates secondary rhinoplasties if necessary.

Recommendations:

• In the first postoperative days avoid intense exercise.
• During the shower prevent the splint from getting wet.
• Do not blow your nose.
• Avoid over-laughing for the first few days.
• Wash your teeth gently to limit the movement of your upper lip.
• Wear clothing that is fastened in front to avoid the possibility of manipulation of the splint when removing clothing.
• It is necessary to avoid the placement of glasses during the first 4 weeks to avoid compression in the nasal bridge.
• It is necessary to use extreme sun protection on the nose during the first postoperative month when you are outside.
• Use SPF 30 sunscreen when you’re out, especially on your nose. Too much sun can cause permanent irregular discoloration on the skin of the nose.
• Limit salt in the diet to help bloating go away faster.

Although it is true that rhinoplasty improves with the months and that to have a definitive result you have to wait almost a year with the new techniques you can see your result much earlier.

In cases where old techniques are used especially in the separation of skin coverage the result is not only more difficult to predict, but also much slower in its recovery.

Facial lipofilling is a surgical procedure that allows to reposition increase the volume of facial volume by transferring fat obtained by liposuction. It also favors a rejuvenation of the skin thanks to the action of the stem cells that contain the processed fat. It is frequently associated with other facial procedures such as blepharoplasty or lifting. On many occasions it allows a less aggressive cervicofacial lifting with better results thanks to the rejuvenating effect it provides.

Directions:

The indication of facial lipofilling at the aesthetic level is facial rejuvenation returning the lost volume in the face with the aging process. In reconstructive surgery, its use in facial lipoatrophies such as Parry-Romberg syndrome or facial lipoatrophy associated with retroviral treatment in HIV patients is indicated.

Anaesthesia:

The intervention is performed under local anesthesia – sedation or under general anesthesia but only occasionally requires hospital admission.

Previous recommendations

Before lipofilling surgery we advise you:

• Topical hydration of the area to be treated.
• Medicines for after surgery.
• Quit smoking immediately.
• Avoid taking aspirin.

Surgery:

Its procedure involves the following steps:

• The doctor will recommend whether you should undergo intravenous sedation or general anesthesia.
• Liposuction. Liposuction is the process by which fat is identified and removed from specific parts of the body that the patient has in excess or wants to reduce. Please refer to the liposuction page for detailed information on this procedure.
• Purification. Once a sufficient amount of fat has been removed, it is centrifuged or purified by cleaning with serum. This procedure seeks to separate impurities and toxins from fat.
• The tissue obtained is placed by means of microcannulas in the specific area where the patient wants an increase.

Recovery:

After receiving lipofilling it is expected that the treated area presents inflammation, fluid retention and even bruising for a period of 2-3 weeks We will recommend wearing a compression girdle to reduce inflammation and compress the skin in the liposuctioned area.

Most patients recover from lipofilling quickly. Most people return to work within a few days.

Facial implants are used to improve facial contouring. Often these implants help to give a more harmonious balance to your facial features so that you feel better with your appearance.

There are many implants available, made from a wide variety of materials. These implants can straighten the jawline, advance a chin or cheekbones, helping to balance the rest of the face.

This text describes some of the facial implants available as well as the techniques for their use. With this data you can familiarize yourself with these procedures but for more details that may be relevant in your particular case it is preferable that the information is personalized.

What can we expect from a facial implant?

Facial implants can improve your appearance and self-esteem. If you are looking for an improvement, not perfection, of your appearance and are realistic in your expectations, performing a facial implant may be the right choice.

We often use these implants to get a better balance of a young patient’s traits. For example, a teenager may need to reshape her nose and advance her chin a little so that her features are more proportionate. More mature patients generally use implants in conjunction with other treatments. For example, during a facelift the implants placed on the cheekbones contribute to a more youthful appearance. Implants can also be used to improve faces that seem sad or tired.

Facial implants produce changes that clearly improve features. Problems are rare but must be informed of them. In this text we will expose the most frequent.

In the first place, an implant may move slightly from its position and a second attempt may be necessary in order to place it correctly. Infections can occur in any operation. If it presents around an implant and cannot be cleaned after antibiotic treatment, the implant may have to be temporarily removed and replaced later. Other less frequent risks may be associated with other implants. In each particular case we will explain the particularities of each procedure.

Surgery planning:

When considering each treatment it is important to be sure that your expectations are well understood. We will help you determine if the treatment and goals you propose are possible. It can be useful to provide photos of people who have similar features to those you would like to have.

You should be sure that you have understood the details of the proposed surgery, including the cost and the recovery and postoperative process that is expected.

If the surgery requires an incision in your mouth, it is important that we know if you smoke or if you have dental or gum problems. If this is the case, we will inform you of the risks and the treatment you need prior to surgery.

When preparing the intervention, you must be sure that someone will accompany you to take you home. You should also follow our instructions regarding foods and drinks before and after surgery and also regarding medication you are taking, including aspirin and similar drugs. We will give you oral antibiotics before and after treatment to prevent infection.

Where the surgery is performed:

These types of interventions are performed in an operating room. In case you need to be admitted one night in the hospital we will tell you. This recommendation is usually based on your medical conditions or whether another aesthetic procedure is performed at the same time as facial implants.

Types of anesthesia:

In some cases, facial implant surgery may require only local anesthesia or is combined with sedation. However, general anesthesia is sometimes recommended.

Surgery of the cheekbones or malar implants

Malar implant surgery usually takes between 30 and 45 minutes. When malar implants are performed in conjunction with other cosmetic procedures, such as facelift, facelift, or eyelid surgery, the implants can be inserted through incisions made for those purposes. In another case, an incision is made either inside the upper lip or in the lower eyelid. A pocket is dissected and the implant is inserted.

After surgery, a bandage is applied to minimize edema and discomfort. The severity and duration of these effects can vary, especially if another cosmetic procedure is performed at the same time.

Recovery after malar implants

We will give you instructions on postoperative care. There will be limitations on diet as well as restrictions on normal activity. Either way these instructions vary, especially if another procedure is performed with the implants. Your ability to move your mouth and lips may temporarily decrease. The sutures used to close the wounds inside the mouth are removed after ten days or progressively dissolved.

Recovery after surgery:

Edema is sometimes important immediately after surgery. It usually peaks at 24 or 48 hours. Most of the severe swelling is lowered in a period of a few days, however a little edema may persist that does not allow to appreciate the final facial contour until a few months later.

During the healing phase, your activities and diet will be restricted. Your ability to smile, speak, or move your mouth is a little limited for a few days or weeks after surgery. We will inform you about oral and dental hygiene counts during your recovery.

Getting back to normal:

Remember, that with any facial surgery, you can feel better and look nicer in no time. However, it may not be advisable to participate in certain activities for a few weeks, especially those in which the treated areas are involved.

Your new look:

You may not be able to appreciate your final appearance for a few weeks or months. This is because the body needs some time to completely eliminate the swelling. Have a little patience when evaluating its final appearance. You will be surprised that most people will not recognize that you are wearing a facial implant only that your appearance will have improved.