FULL FACIAL REJUVENATION SURGERY IN MIAMI

Dr. Rivera-Serrano’s facial rejuvenation philosophy is as follows: If you want to maximize the chances to reverse aging, you need to address the major three anatomical aspects of aging, using three completely different and independent approaches.

The three major changes of facial aging are:

1. Descent of the soft tissues of the face (skin, muscle, ligaments, etc.) due to years of gravity and loss of elasticity. This is the most obvious sign of aging, which results in sagginess, extra skin, jowls, a long upper lip, etc.
2. Loss of soft tissue volume, mainly fat. If you look at younger people, let’s say in their 20s, they have fuller faces in general. Facial fullness (without excess as in overweight people) is characteristic of youthfulness, health, and attractiveness. When we age, the bags can form in the lower eyelids, and immediately underneath them, the upper cheeks become hollow. This happens in some people more than others.
3. Thinning of the skin and formation of fine wrinkles. When we age, the skin loses elasticity, and the dermis (the deeper layer of the skin) becomes thinner.

Given the above, the only logical way to maximize the rejuvenation of a face is by addressing those three components in addition to a healthy diet, lifestyle, and good skincare. Now that you understand the three major aging components, let’s talk about how to address them.

1. > Descent of the soft tissues of the face. Surgical techniques, such as facelifts, are the only way to improve this aspect with high quality and for the longest possible duration. Therefore, a facelift is still considered the “gold standard”. Thread lifts could somewhat elevate the facial tissues, but only for a limited amount of time and for patients with mild to moderate facial aging. In facial aging, there is excess skin due to the stretching of tissues by years of gravitational forces. It is fundamental for excess skin to be removed if you want the best possible result, and only surgery will allow this to happen. Moreover, surgery also allows sculpting fat and repositioning the deeper tissues of the face upwards to establish a more solid and youthful foundation. There are not any non-invasive devices or technologies (peels, fillers, micro-needling, lasers, radiofrequency, ultrasound devices) that will remove excess skin and reposition the deeper tissues of the face. Some devices may shrink the skin slightly in some patients, but results are nearly always very subtle and not meaningful enough for most patients and typically require multiple treatments to see any benefit. In the end, many of those treatment costs can add up to the cost of surgery, with less than 1/5 of the improvement. Of note, fillers do not meaningfully elevate the soft tissues, if at all. This is a common misconception. They do “fill” and give the illusion of elevation and may perhaps do it by a very marginal amount in some cases. Simply put, there is no replacement for surgery now and for the foreseeable future. If you hear otherwise, that is incorrect.

2. > Loss of soft tissue volume. Fat transfer and fillers are the mainstays of treatment for this. In simple terms, lost volume is replaced with new volume. The idea is to get the volume back where you lost it. For instance, here is where fillers and fat transfer shine! Surgery, such as a facelift, cannot replace volume. Hyaluronic acid fillers and fat grafting are not exclusionary but complementary to surgery. They have similar characteristics in terms that they both fill, but they are quite different. Fat transfer is great for the deep volume foundation but lacks the power to efface more superficial folds and wrinkles. On the other hand, hyaluronic acid fillers excel more superficially. Dr. Rivera-Serrano typically recommends starting with fat grafting first and then complementing with fillers or doing both at the same time. Nevertheless, some patients may benefit from fillers only, placed both deeply and superficially.

3. > Thinning of the skin and formation of fine wrinkles. The keyword here is resurfacing. This is carried out by being very controlled and limiting injury to the most superficial layers of the skin, using different methods. For instance, mechanically (sanding the skin, also known as dermabrasion, done with sandpaper or power tools), chemically (peels), or with heat (lasers). Once the superficial layer of the skin regenerates, the textural changes improve along some of the superficial wrinkles. Microneedling also falls in this category and can improve skin texture. Neurotoxins such as Botulinum toxin are not strictly in this category, but they can temporarily and very effectively improve wrinkles, although they do not directly improve the skin.

Dr. Rivera-Serrano’s facial rejuvenation philosophy is as follows: If you want to maximize the chances to reverse aging, you need to address the major three anatomical aspects of aging, using three completely different and independent approaches.

The three major changes of facial aging are:

1. Descent of the soft tissues of the face (skin, muscle, ligaments, etc.) due to years of gravity and loss of elasticity. This is the most obvious sign of aging, which results in sagginess, extra skin, jowls, a long upper lip, etc.
2. Loss of soft tissue volume, mainly fat. If you look at younger people, let’s say in their 20s, they have fuller faces in general. Facial fullness (without excess as in overweight people) is characteristic of youthfulness, health, and attractiveness. When we age, the bags can form in the lower eyelids, and immediately underneath them, the upper cheeks become hollow. This happens in some people more than others.
3. Thinning of the skin and formation of fine wrinkles. When we age, the skin loses elasticity, and the dermis (the deeper layer of the skin) becomes thinner.

Given the above, the only logical way to maximize the rejuvenation of a face is by addressing those three components in addition to a healthy diet, lifestyle, and good skincare. Now that you understand the three major aging components, let’s talk about how to address them.

1. > Descent of the soft tissues of the face. Surgical techniques, such as facelifts, are the only way to improve this aspect with high quality and for the longest possible duration. Therefore, a facelift is still considered the “gold standard”. Thread lifts could somewhat elevate the facial tissues, but only for a limited amount of time and for patients with mild to moderate facial aging. In facial aging, there is excess skin due to the stretching of tissues by years of gravitational forces. It is fundamental for excess skin to be removed if you want the best possible result, and only surgery will allow this to happen. Moreover, surgery also allows sculpting fat and repositioning the deeper tissues of the face upwards to establish a more solid and youthful foundation. There are not any non-invasive devices or technologies (peels, fillers, micro-needling, lasers, radiofrequency, ultrasound devices) that will remove excess skin and reposition the deeper tissues of the face. Some devices may shrink the skin slightly in some patients, but results are nearly always very subtle and not meaningful enough for most patients and typically require multiple treatments to see any benefit. In the end, many of those treatment costs can add up to the cost of surgery, with less than 1/5 of the improvement. Of note, fillers do not meaningfully elevate the soft tissues, if at all. This is a common misconception. They do “fill” and give the illusion of elevation and may perhaps do it by a very marginal amount in some cases. Simply put, there is no replacement for surgery now and for the foreseeable future. If you hear otherwise, that is incorrect.

2. > Loss of soft tissue volume. Fat transfer and fillers are the mainstays of treatment for this. In simple terms, lost volume is replaced with new volume. The idea is to get the volume back where you lost it. For instance, here is where fillers and fat transfer shine! Surgery, such as a facelift, cannot replace volume. Hyaluronic acid fillers and fat grafting are not exclusionary but complementary to surgery. They have similar characteristics in terms that they both fill, but they are quite different. Fat transfer is great for the deep volume foundation but lacks the power to efface more superficial folds and wrinkles. On the other hand, hyaluronic acid fillers excel more superficially. Dr. Rivera-Serrano typically recommends starting with fat grafting first and then complementing with fillers or doing both at the same time. Nevertheless, some patients may benefit from fillers only, placed both deeply and superficially.

3. > Thinning of the skin and formation of fine wrinkles. The keyword here is resurfacing. This is carried out by being very controlled and limiting injury to the most superficial layers of the skin, using different methods. For instance, mechanically (sanding the skin, also known as dermabrasion, done with sandpaper or power tools), chemically (peels), or with heat (lasers). Once the superficial layer of the skin regenerates, the textural changes improve along some of the superficial wrinkles. Microneedling also falls in this category and can improve skin texture. Neurotoxins such as Botulinum toxin are not strictly in this category, but they can temporarily and very effectively improve wrinkles, although they do not directly improve the skin.

 The reality is that many people, including some surgeons and aesthetic service providers, do not understand the above. It is not that one category is better than the other. The three are complementary. Not everyone ages the same, and some patients may have mild changes in one category and severe changes in another. Therefore, the facial rejuvenation approach should be tailored for each patient. Nevertheless, for moderate to advanced facial aging patients, a facelift is the most powerful technique and the best return for investment.

One of the problems with aesthetic practices that do not offer surgical services is that they do not understand the concepts above and don’t have all the treatment tools. I like to make a comparison with the famous Abraham Maslow’s quote, “If the only tool you have is a hammer, you tend to see every problem as a nail.” Therefore, as an example, some aesthetic providers may overfill patients trying to lift (which, as discussed above, is not the right approach). This is why many patients and celebrities look odd because the treatment approach was incorrect, to the degree that the treatment was overdone.

What is the ideal approach for someone with moderate to severe facial aging?  Surgery such as facelifts (+/- eyelids and brows) to remove excess skin, lift the deeper tissues and establish a solid foundation, followed by volumization with fat grafting and resurfacing, then by a touch-up with hyaluronic acid fillers once recovered. Dr. Rivera-Serrano often performs facial rejuvenation in two stages (surgeries): The first stage is a facelift (including a neck lift if needed) +/- additional smaller procedures in selected patients. As a reminder, the facelift mainly improves the middle and lower thirds of the face and neck. The second stage is centered on the remaining areas of the face (center and upper third) by performing eyelid surgery, eyebrow lifting, lip lifting, fat transfer, and skin resurfacing. The reason for sometimes having staged surgeries is to increase safety by decreasing surgery times. Nevertheless, the above is only a guide given the approach to each patient is individualized, and not every patient may need all the procedures.  Alternatively, everything may be done in a single stage/surgery. A personal consultation will determine what is best for you.

You want to reverse the signs of facial aging and restore a more youthful appearance. Your face and/or neck are sagging, and you are losing volume in your cheeks. You feel that your face (and neck) do not reflect your energy levels, youthful character, or spirit. You show signs of facial aging that do not match your age. You believe that your facial aging, excess skin, and sagginess are a career, professional, or social handicap. You look aged but want to look refreshed.