Seen as one of the biggest targets of complaints and discontent in plastic surgery offices, the nose plays a very important role in a person's appearance, mainly because it is part of the face's composition and occupies a prominent position in the centre. In addition, it is fundamental for the balance and harmony of the entire face, having a direct connection with the patient's self-esteem. A nose with an unsightly or disproportionate appearance ends up retaining all attention for you, in addition to causing discomfort and embarrassment.
As we age, our faces lose volume. This is due to bone absorption and also due to loss of fat and muscle in the face. In the past, the facelift was limited to just lifting what had fallen. More recently, with a greater understanding of the aging process, the replacement of this lost volume with the patient's own fat has been increasingly performed. Dr. Zamarian performs a small liposuction in one of the best areas for fat collection - in order: inner thighs, lower abdomen and, finally, flanks -, prepares this fat, washing and centrifuging it, and separates the fat into three sizes: millifat, microfat and nanofat. Each one has a different characteristic and also a different use in facial rejuvenation.
Our facial expressions can tell others how we feel inside and can make all the difference in the first impression we leave, as the visible signs of aging play an important role in those first impressions. With advancing age, the skin loses its elasticity and firmness, in addition, external factors such as sun, smoking and gravity can drastically influence our appearance. Wrinkles, furrows, sagging, crow's feet and excess skin on the face and neck can make you look older than you really feel, giving everyone an image of tiredness.
Mainly the sagging, which becomes villainous by erasing the beautiful contours and angles we once had in our youth. The angles and contours of the face, when well demarcated, represent beauty and guarantee joviality. No matter what situation we find ourselves in, whether we are meeting new people or spending time with friends and family, we all want our face to look young, beautiful and rested. The facelift, also known as rhytidoplasty, facelift and face plastic surgery, allows the facial beauty lost over the years to be highlighted again, always conserving the facial structure and maintaining natural expressions, promoting not only the aesthetic change but also a great mental change, so that the body can come into balance with the mind.
Ritidos, from the Greek rhýstis or rhytidós, means wrinkle. At the Zamarian Clinic in Londrina, Dr. Walter Zamarian Jr., a plastic surgeon who stands out for achieving excellent results, offers the highest quality facelift to help you get the look you want, with the most natural appearance possible. It can help you reduce the prominence of wrinkles, creases, sagging, creases and other visible signs of aging that can overshadow your natural beauty. The results allow impressive changes in the appearance, leaving a rested appearance and without showing stigmas of the surgery.
The history of facial plastic surgery has become somewhat obscure due to the culture of the time. Many face surgeries were performed for the purpose of facial reconstruction, even before thinking about performing surgery to improve the aesthetic aspect of the face. When the facelift for a purely aesthetic purpose had its first impulse, the doctors of the time considered it as the "surgery of vanity" and little esteemed it, as it was seen as trivial, for creating unnecessary risks and trying to avoid the forces of nature, like the weather. The first cosmetic plastic surgery of the face was performed in Berlin by Eugen Holländer in 1901. It was a time of great changes, but the plastic surgeons who mastered the technique did not want to divulge it and kept it under lock and key. The ancient technique of facelift consisted of elliptical excisions of excess skin, made at the hairline. In addition, the lack of antibiotics, which was not yet present in people's lives, made the procedure very difficult, which often ended with some complication, such as infections.
The old technique was improved in the early 1950s by WA Swanker, currently known as classic rhytidectomy, which basically consisted of a large rotating and advancing skin flap, that is, it involved only the relocation of the subcutaneous layer and of the skin of the face. In 1974, Dr. Tord Skoog decided to dare even more, advancing the technique with the description and development of subfascial dissection. Two years later, in 1976, Dr. Mitz and Dr. Peyronie identified and described the SMAS (Superficial Muscular Aponeurotic System) which is the fascial layer that connects the frontal muscle with the platysma muscle, then publishing it to the world, something revolutionary. Dr. Owsley, in 1977, made one of the first publications showing the benefits of SMAS treatment in the facelift. All this has allowed the standards of face surgery to rise more and more, with the SMAS as the main target for correction during the procedure. Between 1970 and 1980, there were great discussions about the use of the long flap or the short flap and about which one would be the most beneficial technique, not reaching an exact and concrete conclusion. Around 1990, with a lot of research and studies, we see the facelift being performed in deeper planes with great success, like the S-Lift - for less complex cases – and how Dr. Sam T. Hamra, who developed the facelift with compound detachment. Currently, with all the technology in their favour, plastic surgeons are increasingly performing facelift, which has become a very safe and effective surgical procedure. Although this surgery has its procedure developed over a century ago, it was only recently, around 25 years ago, that it gained strength and had its techniques improved. Currently, the facelift is one of the most performed plastic surgeries in Brazil.
The parameter of what is considered the ideal to be achieved with facelift is the young profile. However, it is important to remember that, as it is only a parameter, during the procedure, Dr. Zamarian only improves the features based on this youthful profile, but without altering the patient's natural structure and expression, so that the results are natural. A youthful profile shows a strong jaw that separates from the neck providing a shading along its lower edge. The cervicomental angle must be 90 degrees or less with the hyoid bone positioned at its apex, in the plane or above the plane of the mandible. This, in turn, should be well demarcated between the face and neck. In this youthful profile described, the individual should not have many facial wrinkles, sagging or very deep furrows.
A frequent question from patients is about which signs of aging will benefit from facelift surgery. Dr. Zamarian explains that patients have a different aging pattern, which can be determined by genetics, bone support and other external factors. However, some of the signs of facial aging affect all patients in general. Most signs of aging that can be improved with facelift are:
It is very common that the patient, when considering undergoing facelift, also consider the association of other plastic surgeries and procedures non-surgical. Precisely because facial surgery has certain limitations, some patients who wish to further optimise the results end up associating other procedures, such as:
The ideal candidate for the facelift does not smoke, aims for realistic results, has good demarcations and bone structure, has the hyoid bone well positioned, good elasticity in the skin and little subcutaneous fat. Obviously not all patients fit this expected profile, but that is what, amongst other things, the different techniques to be used are for. Patients who smoke will have recommendations to stop the addiction fifteen days before and fifteen days after surgery and must receive special care during the facelift. If the patient has significant asymmetry, Dr. Zamarian will explain the possible treatments, which will require different techniques for each case.
Surgery is performed on both women and men who feel some discomfort in relation to their face due to sagging, deep furrows, wrinkles, etc. Often, premature aging can lead to a tired look that does not match the patient's actual age. The facelift is the most important, beneficial and effective individualised treatment for patients over 35 years of age who wish to improve facial changes due to aging. In addition, patients who have sagging and sagging cheeks, as well as those who have lost beautiful facial contours, such as the cheekbone, jaw demarcation and who have lost the contour of the cervicomental angle, who have fine wrinkles around the lips, eyes and chin, which have excess skin in the eyes and large pockets, drooping eyebrows, amongst other possible signs of aging, are excellent candidates for a facelift. Not only for aging, but the faceliift also offers the correction of important sagging resulting from massive weight loss. When losing a lot of weight, the patient starts to have excess skin all over the body, consequently, also on the face, which looks droopy and tired. So, overall, Dr. Zamarian recommends a facelift in cases of significant facial aging signs (sagging, wrinkles, deep furrows, etc.) of skin.
There are some cases where patients who want to have face surgery are somewhat limited by some factors. Dr. Zamarian explains that some patients, because they are carriers of certain diseases, or because they are in an unfavourable health condition, require special care. Patients with uncontrolled diabetes, with CVD, who use steroids, who have uncontrolled high blood pressure, psychiatric history or are addicted to cigarettes (smoking), should be observed very carefully. These factors do not prevent the patient from undergoing the facelifting, however, requires both the patient and the plastic surgeon to be aware. In these cases, before performing the surgery, Dr. Zamarian makes some recommendations, like:
Not only does the patient improve self-esteem and self-confidence after performing the facelift, but there are also some incredible changes in the appearance of the entire face and neck. All the signs of aging that can benefit form an important set to provide the patient with a youthful and attractive face again. There is another more complex benefit to define: it lifts the tissues that were flaccid and hanging on the face, improving the volume of the middle and upper third of the face, leaving the lower third narrower, producing the “jovial triangle” of the face. This surgery is a treatment that brings results that no other can. The face, which used to look flaccid and tired, in the form of the senile triangle, characteristic of older patients, has once again a beautiful facial contour, well-defined and demarcated angles.
Contrary to what many people may think, the facelift is not designed to improve the quality of the skin and has no effect on the quality of the skin. It is indicated to correct sagging, ptosis and atrophies of facial tissues. Therefore, it is important to remember that it is not a treatment for dyschromias, wrinkles, actinic keratoses (sunspots), very deep folds, amongst other unsightly defects that involve the quality of the skin. It is clear that fine wrinkles, folds and some irregularities have an important improvement with face plastic surgery, as it pulls the muscles and removes excess skin. But still, some deep grooves, folds and wrinkles may remain. For patients who underwent this surgery and still want an improvement in skin quality, Dr. Zamarian indicates treatments with chemical peels, Botox application or even filling with Restylane depending on the case. There are numerous procedures that can be associated with facelift.
Fat has the ability to restore the volume lost to the face during the natural aging process. In addition, this wonder manages to improve the quality of the skin under which it is grafted, rejuvenating the face as a whole. It is a modern and indispensable complement to obtain the best possible result in a facelift, whose skin is wrinkled and lacking service. A complete understanding of how aging occurs is necessary to understand that this fat graft is the icing on the cake that was missing for the old technique of facelift with SMAS treatment. "Fat is gold!" - sums up Dr. Zamarian.
The trend of facelift is to provide increasingly natural results. Moderate use of volume and tension is essential for good results. Dr. Zamarian, always valuing the patient's naturalness and satisfaction, redistributes and gives volume to the face, in addition to performing delicate plications (small folds), providing slight tension in the muscles. When the plastic surgeon uses only tension in the skin, he ends up using it in excess, leaving the face looking very “stretched”, resulting in an artificial face without expressions. In addition, the lack of common sense can lead to great distortions and unsightly scars.
Dr. Zamarian does not use the deep plane facelift or with detachment, as they are very invasive techniques, which prolong recovery time and can pose high risks to the patient, such as nerve damage. facial. Therefore, Dr. Zamarian uses the plication of the SMAS and platysma, minimally invasive techniques that provide excellent results and do not require a long recovery time.
The purpose of facelift is to improve the patient's appearance and not leave him looking disharmonious or stigmatized from having undergone surgery. Excessive use of tension, excessive removal of fat, too radical changes and highlighting only one area of the face, leaving the others aside, can result in a result far from natural. Dr. Zamarian explains that the face must be analyzed and manipulated together with all its elements, along with the body as well, because starting from an individual analysis of each element can make the results not look harmonic and natural.
The aging process not only involves sagging of tissues and skin, but also involves atrophy of tissues, especially adipose tissue, in some areas. The surgeon's refined aesthetic sense counts a lot when evaluating the patient. When detecting the problems and defects to be corrected, there are patients who were very well served by the correction by the subtle removal of fat, while other cases may require increasing the volume of certain regions with fat, when it is atrophied. Dr. Zamarian meticulously evaluates the patient during the consultation so that he can accurately detect the patient's defect. From there, with his refined aesthetic sense and deep knowledge of anatomy, he starts to decide which maneuvers and techniques he will have to use.
The pre-operative consultation is essential so that the patient can get to know the plastic surgeon better and he will know the patient's anatomy and wishes. It is at this time that the patient must learn about the surgeon and find out if he is really specialised and certified to work in the area. All doubts should be cleared, anxieties and fears about the surgery should be resolved. The patient must be confident and decided that he will undergo a facelift surgery, which will transform him, creating harmony between body and soul.
Supplements, herbal medicines, Vitamin E, Ginkgo Biloba, green tea, over-the-counter medicines, etc. This seems harmless enough, but it may not be, for someone who is about to have facelift surgery. There are some medications that Dr. Zamarian recommends its suspension fifteen days before and fifteen days after surgery, as it directly interferes with blood clotting, sedatives, anaesthesia, adrenaline and especially with patient healing. Even medicines that appear to be “harmless”, such as natural ones, may have their restrictions. Therefore, it is very important that the patient informs his plastic surgeon about all the medications he is taking. These are some of the medications that should be discontinued:
So that Dr. Zamarian can assess the health of his patient, as well as the conditions he is in, he will request some tests that are essential for safety during the procedure, without exposing the patient to risk involving his health. He must know the conditions of his patient, so that everything goes well during the surgery.
Dr. Zamarian requests the following exams:
It is essential to carry out the exams to perform plastic surgery, as they allow us to discover changes that could jeopardise the patient or the result.
The routine of a facelift performed by Dr. Zamarian has changed. Today, he begins the surgery by performing a small liposuction - most often performed on the inner thighs -, preparing the fat by washing and centrifuging it, and separating the fat into three sizes: nanofat, microfat and milligram. Each one will have a specific function and will be grafted in certain regions of the face, according to the needs of each patient. This step precedes the facelift itself, and greatly enhances the results of the facelift.
During face surgery, Dr. Zamarian makes incisions inside the hair and in natural folds of the face. Then the skin is separated from the underlying fat and muscle tissue. Liposuction of the submentum is performed to improve the contour of the neck. Then, the deep tissues are repositioned and, finally, only the excess skin is removed, leaving a natural and lasting result.
Professor Ivo Pitanguy, renowned plastic surgeon and author of the famous technique called round lift, describes his technique with details, emphasising the need for a sense of traction from the tragus to Darwin's tubercle and posterior rotation of the flap to improve the neck and its anterior advancement to decrease the step at the hairline. Dr. Zamarian uses the technique that learned with Professor Ivo Pitanguy, with the plication of SMAS, obtaining excellent results in Londrina, Paraná, Brazil.
In face plastic surgery, the incision can be divided into three segments:
It is important to remember that the entire incision of the face is positioned in such a way as to maintain the naturalness of the result, while at the same time making it inconspicuous and concealed. Thus, it is not the scar from this surgery that bothers patients in the postoperative period.
In most cases, Dr. Walter Zamarian Jr uses the plication technique of the SMAS. It is one of the most performed approaches and with the highest satisfaction rate amongst patients who underwent facelift. In addition, it is much more effective than a simple facelift performed only in the subcutaneous part and less invasive than a rhytidectomy with compound detachment, which exposes the patient to high risks of damage to the facial nerve. The facelift with plication of the SMAS is one of the most efficient techniques to correct ptosis (drooping) of the deep plane of the middle third of the face and the nasolabial fold, promoting good elevation of the corner of the mouth, which was previously drooping, and improving the definition of the contour and facial angles, especially of the jaw and neck. This is all due to the fact that it consists of traction of the SMAS, and this, in turn, promotes longer-lasting support of the face. Attraction of the SMAS reduces the need for excessive tension on the facial skin, thus avoiding results with an artificial appearance, with stretched skin. One of the best advantages that this technique provides is the minimal tissue ischemia, that is, it barely restricts the blood supply to the tissues and, consequently, reduces the chances of incidence of epidermolysis and gangrene of the detached skin flap almost to zero. In summary, the facelift with plication of the SMAS is a safe technique that allows the suspension of the deep structures of the face, providing a good postoperative recovery, with a low incidence of complications and lasting results.
Many patients have significant sagging of both the skin and the neck muscles. In addition to the lateral traction of the platysma muscle, which covers the neck internally together with the SMAS, Dr. Zamarian often chooses to make a complementary incision in the submentum (below the chin) to medially approximate the platysmal bands, sectioning (cutting) the muscle bands, and even removing a triangle from each band, to avoid recurrence. This results in an improvement in the neck angle and an elevation of the submental floor, allowing a more refined result of this surgery. In addition, neck liposuction reduces the fat accumulated over the years and improves the contour of the jaw.
The forehead, or frontal region, can be addressed together with the facelift, in order to handle the following structures:
Front wrinkles can be caused by too strong a frontal muscle, resulting in deep frown lines over the years. This muscle can be weakened with facelift surgery, resulting in attenuated wrinkles and preventing them from increasing. If the wrinkles are already very deep, they can be softened, but not completely eliminated.
Glabellar wrinkles can be vertical, denoting an appearance of fierceness and seriousness, caused by the corrugator muscles, or horizontal at the root of the nose, caused by the procerus muscle. In both cases, the treatment consists of weakening the referred muscles, aiming to attenuate the signs of the exaggerated action of these muscles.
Elevation of the eyebrows can be achieved by deeply releasing the lateral tissues and ligament that hold the eyebrows in position or pull them down. With this release, they are free to obtain a lift in the tail of the eyebrows, resulting in a less sad and less tired expression on the part of the patient.
The forehead approach in facelift is only performed when necessary, and when the patient's forehead is not too long.
As a complementary procedure to the facelift, eyelid surgery (blepharoplasty) can be performed and is an important factor for a complete result, since the eyelids represent about 60 % of the result of this surgery.
Only the upper, lower or both can be treated, and excess skin or fat pockets can be removed, when necessary, resulting in a more rested and youthful look.
Lip wrinkles are more common on the upper lips, and can be improved in three ways: fat grafting, dermabrasion, or filling with hyaluronic acid. Dermabrasion treatment consists of sanding and definitively improves wrinkles, as long as they are not too deep, but it can result in dyschromia (whiter skin than the rest of the face). Filling with hyaluronic acid does not have the inconvenience of dyschromias, but it has to be reapplied approximately every 18 months.
Dr. Zamarian has some recommendations for his patients in order to have a smooth and peaceful recovery, without any surprises. They are:
Within a month after the surgery, you can sleep on your side and perform light physical efforts. At two months, you can perform any physical effort, taking care of the sun. It is recommended to avoid sun for three months. Between three and six months, you can get sun from the beginning morning and evening, and after six months there is no longer any danger of the sun staining the skin or scars.
How does the beard look in male patients who have a facelift Dr. Zamarian explains that the surgery he performs doesn't leave a beard inside the ear, as he makes a pre-tragal incision, which leaves the scar from the facelift in front of the tragus. However, as most patients have a lot of skin in the neck area, this can result in a little beard behind the earlobe after surgery. Most of the time, patients end up adapting: they shave until the region behind the ear. In some cases, when the patient is uncomfortable with this change in shaving, laser hair removal can be performed in this region.
The choice of laser hair removal after facial surgery should take into account some details:
When the face still doesn't show the signs of time, but the neck has excess skin or fat, you can perform a procedure just to treat the neck, the neck lift, which restores the contour of the neck, corrects sagging and restores its youthful appearance. Plastic surgeon Dr. Zamarian, performs neck lift surgery to minimise the effects of time on the neck, restoring its contour, giving greater tension to the platysma muscle that composes it.
During the medical consultation with the plastic surgeon in Londrina, Paraná, Brazil, Dr. Walter Zamarian Jr., he will assess if there is:
It is started with the patient under general anesthesia. Then, incisions are made behind the ears, continuing forward just close to the earlobes, so that they are not directed backwards at the end of the surgery. The detachment of the skin begins behind the ears and then in the front, on the neck. Liposuction of the submentum (double chin) is associated in the neck with a very thin cannula to avoid trauma and mental paresis. Soon after, the submentum is incised (incision below the chin), with detachment also in this region. Sutures with absorbable 4-0 Vicryl threads are performed on the submentum to bring the bands of the platysma muscle together (closing the famous folds in the double chin) and also sutures laterally, below the ears, pulling the platysma muscle laterally, giving a new tension to the neck muscles, restoring its contour. Then the excess skin behind the ears is removed. The result is a young neck, with its contour restored, without visible scars, with the platysmal bands close together.
Basically, the neck lift is one third of the facelift. What does that mean? The full facelift is composed of a scar that starts in the temporal region (to treat the corner of the eyes), extends in front of the ears (to treat the middle third of the face) and continues behind the ears (for neck treatment). Thus, the cervical neck lift is composed only of the component behind the ears, for the treatment of the neck, leaving the middle third of the face and the region of the corners of the eyes and eyebrows untreated. It has, therefore, its main indication in patients who have flaccidity or wrinkles in the neck, or platysma bands (vertical folds in the neck), with the face with little or no flaccidity.
As mentioned above, the neck lift is for patients who have a firm face but a disproportionately sagging neck. This surgery aims to remove excess skin from the neck, give more firmness to the neck with the treatment of the cervical muscles, soften or eliminate the visible bands of the platysma muscle, soften neck wrinkles (but rarely eliminate them completely), restore the contour of the jaw and elevate the tissues of the neck to restore the cervical angle, present in youth. It is worth remembering that this surgery does not promote results above the mandible, and for that, a full facelift, would be necessary.
The surgery is performed by Dr. Zamarian in the operating room under general anaesthesia, and the patient could be discharged the next day, after the drain was removed. The period that follows after the surgery is quite peaceful, painless and with a little swelling, and some signs of ecchymosis (purple) may appear, especially on the fifth day. The dressing used in the operating room is removed the next day, when the patient is allowed to shower. It is recommended to sleep a month on your back, without physical exertion and gym. The food should be pasty for about four days, so as not to force the worked muscles. You can eat fish, minced meat, well-cooked meat, puree, rice, beans, but nothing hard to chew.
With age, the neck loses its definition. The part of the mandible where the tissues fall off (Bulldog) is treated with liposuction with a thin cannula to restore the contour of the mandible. The neck itself presents an increase in muscle flaccidity (platysma) that must be treated during cervical neck lift to optimise results.
The platysma is a flat muscle that covers the deep structures of the neck and that normally has a hiatus in the midline, that is, a space between the right and left platysma in the central part of the neck. The sagging of the platysma muscle causes there to be two vertical folds (one on the right and one on the left) in the neck of some people. During the neck lift, through an incision in the submentum (below the chin), the central region of the neck is detached and the bands are brought together medially with Vicryl 4-0 . This makes the folds disappear, in addition to elevating the entire submentum, making the "chap" rise and have a more youthful appearance.
Similarly, during lateral detachment in the neck lift to remove excess skin behind the ears, another lateral platysma plication is performed (one on each side) to give more firmness to the neck and better show the result of the median plication.
Without the treatment of the platysma muscle, the result would be inferior, leaving the remaining vertical folds and not elevating the submentum sufficiently. Lateral plication also helps with skin removal, as it allows for greater removal of excess skin.
Some patients report improvement in snoring, most likely because they had a very significant neck flaccidity that interfered with the floor of the mouth. Despite this, this surgery is not intended to treat snoring or nocturnal apnoea, which is only an occasional benefit.
Dr. Zamarian recommends a team of physiotherapists who perform lymphatic drainage and endermologie which, in the case of neck lift fifth day.
As time passes, the tissues of the face become looser, causing certain structures to fall, including the eyebrows (or eyebrows). The drooping of the eyebrows results in a sad and dull look. As a stand-alone procedure or as an adjunct to eyelid or facial plastic surgery, the Londrina eyebrow lift can be performed with a small incision close to the eyebrows (Mini Chestnuts) or with an incision inside hair, depending on each case. As a result, the weight of the tissues on the upper eyelids is reduced, in addition to having a younger and brighter look, without visible scars.
During the consultation with the plastic surgeon Dr. Walter Zamarian about brow lift in Brazil, he will evaluate, amongst other things, the following aspects of your eyebrows:
Botox is actually the simplest treatment for lifting low brows or lowering very high brows that create a frightened look. In the same way, Botox can give the effect of lifting, mainly on the lateral part of the eyebrows (also called the tail of the eyebrows), when the more lateral application of Botox is avoided.
The Castañares technique was first described by its creator, the plastic surgeon Salvador Castañares in 1964, and consists of removing a skin spindle close to the upper part of the eyebrows, with greater removal in the lateral region, which causes a greater lifting effect of the eyebrows tail. The results of the Castañares technique have always been indisputably excellent, with the only scar-based reticence that could be a little apparent, especially on the medial (most central) part of the eyebrows. Plastic surgeons from Campo Grande – MS, Dr. Giovanni Pires Viana and Dr. Giovanni André Pires Viana brilliantly conveyed to Dr. Zamarian the technique of suspending only the tail of the eyebrows which they called Minicastañares, where the removal of skin is performed only on the side of the eyebrows, thus leaving less scars and solving the main problem, which is the suspension of the lateral part of the eyebrows. Dr. Zamarian does not use the Castañares technique very often, but uses the Mini Castañares technique described above for eyebrow tail suspension whenever indicated.
The temporal lift is a part of the full facelift, being the one that performs the traction and consequent elevation of the tissues on the lateral part of the eyebrows. Thus, a temporal lift, with removal of skin inside the hair, causing a resting effect on the side of the eyes. The question to the technique is that the further away from the area where the result is desired the skin is removed, the lower the result in the target region, that is, a surgery with incisions far from the eyebrow tends to have less result than Minicastañares, for example.
During face plastic surgery, you can join the incisions in the frontal region, three fingers inside the hair and perform the frontal lift. In this technique, the complete result is obtained, treating the frontal muscles, procerus, corrugators, the entire eyebrow is raised and not only the caudal or lateral region, in short, it is an important complement to facelift that effectively treats the upper third of the face, in indicated patients. As it is a larger surgery than Minicastañares, it is performed in a surgical centre. The only possible downside is possible itching (pruritus) from the coronal incision at the top of the scalp, which occurs in 10 % of Dr. Zamarian, but that improves in up to six months. The results are excellent, like the Minicastañares, and the best technique indicated for each patient is chosen by Dr. Zamarian together with the patient in their consultation at the Zamarian Clinic in Londrina, Paraná, Brazil.
Schedule your appointment for a facelift with Dr. Walter Zamarian Jr., specialised in facial rejuvenation in Londrina, Paraná. Contact Zamarian Clinic and speak with one of our secretaries, who will be happy to assist you and answer your questions before your evaluation.
Cosmetic plastic surgeon in Brazil
Rua João Wyclif, 111, Sala 1702
Londrina - PR