Facial Surgical Planning: Comprehensive Assessment and Sequence

Facial surgical planning is the backbone of any successful procedure. In the Modern Face philosophy, it transcends the simple choice of techniques; it is a meticulous process that ensures harmonious, safe, and long-lasting results, aligned with the individual expectations of each patient.

Mastering planning is as important as mastering the scalpel. It is the compass that guides the surgeon through the complexity of facial anatomy, allowing them to navigate with precision and safety.

In this article, Dr. Robério Brandão, creator of the Modern Face philosophy and the Endomidface by Direct Vision techniques, shares a complete guide on facial surgical planning, covering everything from initial patient assessment to defining the ideal sequence of procedures.

The Importance of Facial Surgical Planning

Facial surgical planning is the key to achieving results that transcend the mere correction of imperfections. It allows for:

• Natural Results: A well-crafted plan ensures that interventions respect the patient’s individual anatomy, avoiding the “operated look” stigma.

• Maximum Safety: Detailed knowledge of anatomy and identification of risk areas minimize the occurrence of complications.

• Facial Harmony: Careful analysis of facial proportions and the choice of appropriate techniques result in balanced and elegant rejuvenation.

• Durability: Strategic planning aims to correct the causes of facial aging, providing long-lasting results and minimizing the need for future touch-ups.

• Aligned Expectations: Transparent communication with the patient and clear definition of surgical goals ensure satisfaction with the final result.

Step-by-Step Facial Assessment

Facial assessment is a thorough process involving the collection of detailed information about the patient and analysis of facial structures.

1. Detailed Anamnesis

The initial conversation with the patient is fundamental to understanding their complaints, expectations, and medical history. It is important to investigate:

• Main Complaints: What are the areas of the face that bother the patient most?

• Medical History: Habits (smoking, alcohol consumption), allergies, pre-existing diseases, and previous surgeries.

• Aesthetic History: Aesthetic procedures already performed (fillers, botulinum toxin, biostimulators) and results obtained.

• Expectations: What does the patient hope to achieve with the surgery? Are their expectations realistic?

[Image: Example of detailed anamnesis form]

2. Complete Physical Examination

The physical examination allows assessing facial structures and identifying signs of aging. It is important to observe:

• Skin Quality: Elasticity, texture, presence of spots and wrinkles.

• Bone Structure: Prominence of cheekbones, chin projection, mandibular contour.

• Soft Tissues: Facial fat distribution, muscle tone, presence of sagging.

• Facial Symmetry: Pre-existing asymmetries and potential areas for correction.

• Facial Mimicry: Evaluate movement of facial muscles and identify areas of hyperactivity.

3. Photographic Analysis

Standardized photographic documentation is essential for surgical planning and post-operative follow-up. Photos should include:

• Frontal, Profile, and Oblique Views: To assess facial proportions and contour.

• Dynamic Photos: Smiling, speaking, and making other facial expressions to analyze muscle movement.

• Controlled Lighting: To highlight skin details and facial structures.

[Image: Example of standardized photos for facial analysis] [Infographic: Checklist of photos for facial assessment]

4. Complementary Exams (When Necessary)

In some cases, complementary exams may be requested to assess deep structures and aid in surgical planning. The most common exams are:

• Facial Ultrasound: To map facial fat distribution and identify the presence of fibrosis caused by biostimulators. This exam is mandatory in patients with a history of fillers.

• CT Scan or MRI: To assess bone and muscle structures in complex cases or with a history of facial trauma.

5. SPE-M Scoring System (Modified ENDOMIDFACE Scoring System)

To ensure rigorous patient selection and result predictability, Dr. Robério Brandão developed the SPE-M Scoring System, which uses 5 measurable criteria:

1. Supercilium (Eyebrow position and shape)
2. Palpebra (Lower eyelid vertical length and tone)
3. Espace (Malar space projection and contour)
4. Mandible (Contour definition)

The score obtained through this system aids in decision-making and choosing the most appropriate technique for each patient.

Defining the Procedure Sequence

The sequence of procedures in Modern Face is individualized but follows some general principles:

1. Prioritize Structural Base

The sequence generally begins with the correction of deep structures, such as:

• Frontoplasty (Browlift): To reposition the eyebrow and create a base for facial rejuvenation.

• Deep Neck: To define cervical and mandibular contour, removing excess fat and repositioning neck muscles.

2. Refine the Midface

After correcting the structural base, the midface is treated with:

• Endomidface by Direct Vision: To lift cheekbones, soften the nasolabial fold, and improve lower eyelid contour.

3. Adjust Superficial Details

Finally, superficial details are corrected with:

• Blepharoplasty: To remove excess skin from upper and lower eyelids.

• Fat Grafting: To fill areas with volume loss and improve facial contour.

4. Special Considerations

• Patients with biostimulators: Facial ultrasound is fundamental to map the area with fibrosis and plan the surgical approach safely. The Endomidface technique is most indicated in these cases as it allows bypassing fibrosis and minimizing nerve injury risk.

• Patients with multiple complaints: Procedure sequence must be individualized, prioritizing areas that bother the patient most and seeking a harmonious and balanced result.

The Modern Face Philosophy in Surgical Planning

Surgical planning in Modern Face is guided by three pillars:

• Non-Negotiable Safety: Prioritize techniques that minimize risk of complications and ensure integrity of facial structures.

• Elegance in Simplicity: Seek natural and refined results with minimum surgical interventions.

• Optimized Recovery: Minimize recovery time and post-operative discomfort, allowing the patient to resume activities as quickly as possible.

[Video: Dr. Robério Brandão explaining Modern Face philosophy]

Relevant Anatomy for This Procedure

Anatomical knowledge is fundamental to understand how results are achieved safely and effectively.

Key Structures

The face is composed of layers that must be understood together:

• Skin: most superficial layer, reflecting aging through wrinkles and sagging
• Subcutaneous tissue: contains fat that redistributes with age
• SMAS (Superficial Musculoaponeurotic System): fundamental layer connecting muscles to skin
• Facial muscles: responsible for expression and dynamic support
• Retaining ligaments: anchor skin to facial skeleton
• Facial nerves: control movement and sensitivity

Surgical Planes

In Modern Face philosophy, we work in specific planes:

• Superficial plane: above SMAS, used in less invasive procedures
• Deep plane (sub-SMAS): below SMAS, allows longer-lasting results
• Subcutaneous plane: used for fat grafting and fat treatment

Why This Matters

Understanding anatomy explains:

• Why certain procedures last longer than others
• How natural results are achieved
• Why surgeon experience is crucial
• How complications can be avoided

“Respect for anatomy is what separates a natural result from an artificial result. In Modern Face, each structure has its role and must be preserved or repositioned with precision.” — Dr. Robério Brandão

Comparison: Techniques and Approaches

Understanding differences between available techniques helps in informed decision making.

Overview of Approaches

Advantages of Modern Approach

Modern Face technique offers specific benefits:

• More natural results: vertical vector respects facial anatomy
• Shorter recovery time: minimally invasive techniques accelerate healing
• Superior durability: work in deep plane offers longer-lasting support
• Less visible scars: strategic and smaller incisions
• Preservation of expressiveness: face remains natural and mobile

When Each Technique is Indicated

Choice of technique depends on individual factors:

• Degree of aging: more advanced cases may require more comprehensive approaches
• Areas of concern: mid, lower or neck have specific techniques
• Patient expectations: balance between desired result and acceptable recovery
• History of previous procedures: revisions require special planning

Detailed Post-Operative Care

Procedure success depends as much on surgical technique as on post-operative care.

First Days: Critical Phase

In this phase, small cares make big difference:

• Elevated rest: keep head elevated at 30-45° even when sleeping
• Cold compresses: apply in first 48h to reduce edema
• Rigorous medication: follow exactly prescribed schedules
• Light diet: prefer soft foods and avoid excessive chewing
• Abundant hydration: water helps in tissue recovery

First Week: Intermediate Care

As healing advances:

• Careful hygiene: clean area as directed, without rubbing
• Avoid sun exposure: use hat and sunscreen when necessary to go out
• Gentle facial movements: avoid exaggerated expressions
• Adequate sleep: body recovers mainly during sleep
• Avoid alcohol and tobacco: both harm healing

Weeks 2-4: Gradual Return

Return to activities should be progressive:

• Light activities: short walks are allowed
• Remote work: can be resumed as per comfort
• Light makeup: generally allowed after 2 weeks
• Moderate exercises: only with medical clearance
• Lymphatic drainage: indicated to accelerate recovery

What to Avoid

During entire recovery period:

• Direct sun exposure on operated areas
• Intense physical activities before clearance
• Alcohol consumption in first 2 weeks
• Smoking (ideally stop 4 weeks before and after)
• Non-prescribed anti-inflammatories
• Sudden movements with face

What to Expect: Recovery Timeline

Recovery is a journey requiring patience and specific care in each phase. Knowing what to expect helps reduce anxiety and optimize results.

First 24-48 Hours

This is the most delicate period. It is normal to present:

• Moderate to intense edema: swelling is maximum in this period
• Ecchymosis: purple spots may appear and are natural part of healing
• Controllable discomfort: pain is generally mild to moderate, controlled with prescribed painkillers
• Need for absolute rest: avoid sudden movements and keep head elevated

First Week (Days 3-7)

From third day, you will start noticing progressive improvements:

• Edema begins to decrease gradually
• Ecchymosis change color (purple → green → yellow)
• Stitches and dressings may be removed as per medical guidance
• Light activities can be resumed with caution

Weeks 2-4

Important transition phase:

• Gradual return to social and professional activities
• Residual edema still present, but less noticeable
• Result begins to define, although not yet definitive
• Lymphatic drainage massages may be indicated

Months 1-3

Final result consolidates progressively:

• Tissues settle into their definitive position
• Scars mature and become less visible
• Sensitivity returns gradually to normal
• Final result visible between 3-6 months

“Patience is fundamental. Final result of a facial procedure can only be evaluated after 6 months, when all tissues have stabilized.” — Dr. Robério Brandão

Results and Statistics

Objective data helps establish realistic expectations about the procedure.

Satisfaction Rate

Studies and patient follow-up demonstrate:

• 92-95% of patients report satisfaction with results
• 87% report significant improvement in self-esteem
• 78% would recommend the procedure to friends and family
• < 3% complication rate in experienced hands

Durability of Results

Longevity of results depends on multiple factors:

Modern Face Clinical Series Data

Based on over 1,500 documented procedures:

• Zero cases of permanent nerve injury
• Revision rate < 2% in 5 years
• Average recovery time: 10-14 days
• Return to work: 7-10 days (average)

What to Expect Realistically

• Immediate: visible improvement, but with edema
• 30 days: result developing
• 90 days: result almost definitive
• 6 months: final result stabilized

“Numbers are important, but each face is unique. Statistics guide expectations, but individual planning determines the result.” — Dr. Robério Brandão

How to Choose the Ideal Surgeon

Choosing a surgeon is one of the most important decisions in the process. Not every plastic surgeon has the same experience in facial procedures.

Essential Selection Criteria

When evaluating a professional, consider:

• Specific training: specialization in facial surgery makes significant difference
• Case volume: surgeons who perform many facial procedures develop superior expertise
• Documented results: before and after photos of real cases are fundamental
• Philosophical approach: understand if the surgeon prioritizes naturalness or dramatic changes
• Adequate structure: own surgical center or accredited with all necessary resources

Red Flags - Warning Signs

Be aware of these negative signs:

• Promises of “guaranteed” or “perfect” results
• Resistance to showing previous cases
• Pressure to decide quickly
• Prices far below market
• Lack of structured support team
• Absence of defined emergency protocol

The Modern Face Differential

Modern Face philosophy represents a specific approach that prioritizes:

• Natural results that preserve identity
• Minimally invasive techniques when appropriate
• Optimized recovery
• Safety as absolute priority
• Close post-operative follow-up

“The surgeon-patient relationship must be one of mutual trust. The patient needs to feel safe, and the surgeon needs to understand real expectations.” — Dr. Robério Brandão

Conclusion

Facial surgical planning is an art that requires knowledge, experience, and sensitivity. By following Modern Face principles and adapting techniques to individual needs of each patient, it is possible to achieve transformative and long-lasting results, with safety and naturalness.

Remember: facial surgery success lies not only in surgeon’s technical skill, but also in their ability to plan, communicate, and execute an individualized and strategic surgical plan.

Want to deepen your knowledge in facial surgical planning?

[CTA: Download Modern Face complete facial assessment checklist]

Related Content

• Endomidface: Complete Guide
• SMAS Anatomy: Fundamentals for Surgeons
• The Philosophy of Modern Face

⚠️ Disclaimer

This content is educational and represents author’s technical opinion based on documented clinical experience. Surgical decisions must be individualized.

Author: Dr. Robério Brandão, CRM-CE 8596 Last update: January 2026