Planning: The Foundation of Success Facial surgery is not a single procedure — it’s often a combination of techniques adapted to individual needs. Meticulous planning determines which procedures are necessary, in what sequence, and what’s realistic to achieve.
“Poor planning leads to poor results, no matter how good the surgical technique. Dedicate time to assessment — that’s where the result is defined.”
- — Dr. Robério Brandão
Systematic Assessment by Thirds
The face should be evaluated systematically, region by region: What to evaluate: ))} Possible procedures: ))} )) }
Typical Surgical Sequence
When multiple procedures are performed, sequence matters: 1
Browlift / Frontoplasty
If indicated, start from top. Elevates eyebrow and defines how much excess skin actually exists in upper eyelid. 2
Blepharoplasty
Upper and/or lower. After browlift (if done), to avoid removing excess skin. Can be combined with canthopexy. 3
Endomidface / Midface Lift
Midface elevation. In Endomidface, can be done via temporal or transoral incision. 4
Lower Third Facelift
SMAS approach, jowl and mandibular contour. Via traditional pre/retro-auricular incision. 5
Deep Neck / Cervicoplasty
Neck treatment: Platysmaplasty, digastric shaving, glandular sling, liposuction if indicated.
Preoperative Protocol
Essential Documentation
- ✓ Standardized photos (5 angles minimum)
- ✓ Assessment form (SPE-M or similar)
- ✓ Detailed informed consent
- ✓ Written surgical plan
- ✓ Preoperative tests
- ✓ Cardiac evaluation if indicated
Patient Guidelines
- ✓ Stop smoking 4-6 weeks
- ✓ Stop aspirin/NSAIDs 7-10 days
- ✓ List of allowed/prohibited medications
- ✓ Preoperative fasting
- ✓ Mandatory companion
- ✓ Written postoperative instructions
Expectation Alignment
Patient satisfaction depends as much on results as on expectations. Unrealistic expectations lead to dissatisfaction even with excellent results.
Use old photos
Patient’s photos from 10-15 years ago show the “best them” as realistic goal, not an impossible ideal.
Show limitations
What facelift does NOT correct: spots, pores, fine wrinkles, bony asymmetries. Be clear.
Document everything
Surgical plan, discussed expectations, explained limitations — all in writing. Protects you and the patient.
Frequently Asked Questions
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