Webster dictionary defines matrix as an “array of elements” (in this case facial implants) that are arranged to “provide support” (in this case the facial skeletal foundation). Using this concept, Dr. Ramirez enhances the entire facial bony structure with the insertion of implants introduced through very small incisions.
The size and shape of the facial bony structures determine the way the soft tissues of the face are molded. The relationship between the bony framework (skeleton) and its enveloping soft tissues determines if a face is seen as beautiful or unattractive. Of these two components the skeletal foundation is the most important. In other words, a face is beautiful if a person has s strong facial skeletal support. On the other hand, the face is less attractive when the facial skeletal support is lacking. Looking more generally, Dr. Ramirez argues that facial beauty is “bone deep.” This is a common observation among painters, sculptors, photographers and plastic surgeons. (Look at the sections of this site dealing with the Golden Ratio.) If you read glamour magazines, you will notice that the most beautiful people regardless of sex and age are the ones who have convex foreheads, round and projecting orbital rims, nice cheekbones, and strong chins and noticeable mandibular projections.
Nowadays, more frequently than ever, facial implants are used with the dual purpose of beautifying the face and providing bone support to the aging face. The reason for this is the observation that people with a strong skeletal foundation age “later in life” and “more graciously.” For those who do not have good support the facial soft tissues sag quicker and more severely.
Dr. Ramirez believes, as many other scientists and doctors, that people with better and stronger facial skeleton features look much younger at any age than those with poorer facial bony support. There have been studies showing that some parts of the facial skeleton decrease with aging. Therefore it makes sense to restore the facial bone volume lost with aging. Looking at this issue from a different perspective, some of the signs of aging such as the sagging of tissues are due to a loss of the facial skeletal support; hence, the restoration of this support will delay the droopiness of the soft tissues and will make the sagging less evident and less prominent.
There are two groups of patients in which the answer to the first two options are straightforward. The first group consists of patients who have bone contour deficit without much sagging at a younger age. These are typically patients in their late teens or early twenties who will benefit greatly from implant placement alone. The other group are patients who have excellent bone support but have developed premature soft tissue deflation and sagging. These patients are typically in their late thirties early forties. They will get benefit from a tridimensional soft tissue manipulation via endoscopic lifting with minimal incisions combined with fat grafting. They will usually not require implants unless they request further enhancement. However there are a third group of patients who have a combination of both problems: soft tissue sagging and a deficit of skeletal support. These patients will require a combination of facial implants with endoscopic lifting of their soft tissue.
Note that in any of these groups the problem may be regional, such as the midface or the chin or the jaw, etc. And note that the some cases the same face might be treated with a combination these procedures. For these reasons Dr. Ramirez will individualize a treatment plan specifically for you. Dr. Ramirez does not follow a “one size fits all” approach.
The use of general versus local anesthesia will depend on the extent of the surgery, whether facial implants will be used or not, the location of the facial implant insertion, and the type of implant used. Most often, Dr. Ramirez performs his surgeries under general anesthesia. Localized implant placement such as the one in the chin or the temporal area can be done under local anesthesia.
The length of the operation will depend on the procedure(s) being performed, and if the surgery is primary or secondary. Secondary or tertiary surgeries will be longer.
Most of Dr. Ramirez’s aesthetic procedures are performed on an outpatient basis at a doctor’s surgical center. If the patient has some health issues, it is better to perform the procedure on an inpatient basis. Patients will stay overnight under the care of a qualified health provider such as a certified registered nurse with a postsurgical care experience. We will arrange for this. Regardless of the type of surgery, patients are required to have a companion or a sitter for several days postoperatively to help with the postoperative care. It is the patient’s responsibility to arrange for this care. If no family member is available our center will provide you with information to arrange for a nurse.
Although all surgical procedures have risks and complications most aesthetic operations have a low rate of risk and complications. Smoking, obesity, previous health problems increases the risk of complications including life-threatening complications such as cardiac problems, pulmonary emboli from clots in the legs and others. Patients coming from other Continents or living in the U.S.A. West Coast should be aware of a condition called “coach flight syndrome.” This occurs in patients who travel for many hours (mostly from overseas or long distances) sitting in the same position for many hours. Those patients can develop clots in the legs, which may dislodge. Patients traveling long distances should have a program of exercising and stretching the lower extremities and walking every hour or two during the flight. Likewise, patient’s traveling by car for many hours should make a stop at least every two hours to do the same type of exercise to prevent clots in the lower extremities.
Post surgical recovery times will depend on the extent of the surgery and the specific characteristics of each patient. Not all patients recover at the same speed and not all procedures have the general same recovery time. The majority of patients who have facial implant or endoscopic surgery can return to work in two to three weeks. If you are having a more complex or combined surgery you should allow at least four weeks before you can engage in social activities.
In general, secondary surgery is more difficult and more time consuming than primary surgery. This is because those patients present with harder soft tissue attachments, thickening, capsular tissue formation, scarring, etc. Another important issue is the timing of the secondary surgery. Ideally if the patient can wait for the secondary surgery, this should be performed after six months or a year from the original surgery. At this time the tissues are softer and more pliable.