- Introduction: The Problem Nobody Talks About There is a secret that few plastic surgeons publicly admit: the techniques we learned in residency are becoming obsolete. Not because anatomy changed — it’s been the same for thousands of years. But because patients changed. Think about the last patient you saw seeking facial rejuvenation. What is the probability they never received a filler? That they never had Sculptra, Radiesse, or any biostimulator? Of having a face completely virgin of injectables? If you’re honest, the answer is probably: very low. Conservative studies estimate that 70-90% of patients seeking facial surgery have already received injectable treatments. Some multiple times, over years. And here’s the problem: all classic facial surgery literature — the books by Baker, Hamra, Mendelson — was written for patients with virgin tissue. Traditional Deep Plane assumes intact anatomical planes. SMAS-ectomy assumes predictable tissue consistency.
“We cannot continue operating the Modern Face with techniques developed for the Classic Face. The tissue changed. Our approach needs to change with it.”
- — Dr. Robério Brandão, creator of Modern Face® This article presents Modern Face® — a surgical philosophy developed specifically for this new reality. It’s not a single technique, but a complete framework for thinking and executing facial surgery in the 21st century.
2. What Is Modern Face?
Modern Face® is a surgical philosophy that recognizes and adapts to the reality of the contemporary patient. It was developed by [Dr. Robério Brandão over more than 18 years of clinical practice in Natal-RN, Brazil. The name “Modern Face” is not marketing — it’s literal description. It refers to the face we find today in offices: a face that has been treated, injected, stimulated. A face that has history, not virgin tissue.
Technical Definition
The Modern Face is characterized by facial tissue that has already received treatments with fillers (hyaluronic acid, calcium hydroxylapatite) and/or biostimulators (poly-L-lactic acid, polycaprolactone), resulting in alterations of classic anatomical planes through fibrosis, encapsulation and induced neocollagenesis. This has profound surgical implications. The sub-SMAS plane — the one classic Deep Plane uses — may be completely altered. You may find:
Granulomas: Inflammatory nodules around filler particles
Fibrosis: Scar tissue that adheres planes that should slide
Pseudocapsules: Encapsulation of biostimulators in unpredictable locations
Irregular neocollagen: Collagen production in non-anatomical patterns Modern Face® doesn’t ignore this reality — it embraces it. The techniques were developed to work despite these alterations, and in many cases, because of them.
- The Three Pillars of Modern Face Every surgical philosophy needs non-negotiable principles. Modern Face® is sustained by three pillars that guide every technical decision:
Pillar 1
Maximum Safety
The preservation of noble structures — especially facial nerve branches — is absolute priority. There is no aesthetic result that justifies compromising function. Each technical maneuver of Modern Face was designed with safety as primary requirement, not secondary consideration. In practice: The registry of 1,500+ surgeries with zero permanent nerve injuries validates this commitment.
Pillar 2
Elegance in Results
Rejuvenation is not stretching skin. It’s repositioning tissue following vectors that mimic young anatomy. Modern Face uses vertical vectors — elevating where gravity pulls down — instead of the lateral tension of classic techniques that create the dreaded “pulled look”. In practice: Patients look rested and younger, not operated.
Pillar 3
Optimized Recovery
Minimal dissection means less trauma. Less trauma means less edema. Less edema means faster recovery. Modern Face techniques allow use of local anesthesia with sedation, shorter procedures and earlier return to activities — without compromising results. In practice: Many patients return to social activities in 7-10 days.
- Biostimulators: The Silent Change To understand the need for Modern Face, we need to understand what biostimulators do to facial tissue — and why this changes everything for the surgeon.
What Are Biostimulators?
Biostimulators are injectable substances that stimulate collagen production by the organism itself. The most common include:
• Poly-L-lactic acid (Sculptra®) — stimulates gradual neocollagenesis
• Calcium hydroxylapatite (Radiesse®) — filling effect + biostimulation
• Polycaprolactone (Ellansé®) — biostimulating microspheres in carrier gel These treatments are effective for non-surgical rejuvenation. The problem arises when the patient eventually needs surgery.
The Surgical Impact
When you inject a biostimulator, you are creating a controlled inflammatory reaction that produces collagen. But this process also creates:
Iatrogenic Fibrosis
Scar tissue that adheres anatomical planes. The sub-SMAS that should slide easily may be completely adherent.
Foreign Body Granulomas
Localized inflammatory reactions around product particles, creating nodules in unpredictable locations.
Pseudocapsules
Fibrous encapsulation of biostimulator deposits that can be confused with anatomical structures.
Altered Planes
Neocollagenesis can create “false planes” that look correct but lead to dangerous structures. The surgeon who enters the sub-SMAS plane expecting textbook anatomy may have unpleasant surprises. Structures that should be at certain depth may be more superficial or deeper. Vessels and nerves that should be protected by fascial planes may be exposed. Modern Face recognizes this and works in safer and more predictable planes — such as the subperiosteal of the midface, where the presence of biostimulators rarely affects dissection.
5. Modern Face Techniques
Modern Face is not a single technique — it’s a set of approaches that share the same philosophical principles:
ENDOMIDFACE® by Direct Vision Midface Region Midface elevation technique using direct vision (without endoscopy), temporal and intraoral approach, working in the subperiosteal plane. Ideal for correction of nasolabial fold, flattened malar and lower eyelid. Direct Vision Vertical Vector Local Anesthesia
Deep Neck without Gland Removal Cervical Region Cervical rejuvenation that addresses platysma, subplatysmal fat and digastric muscle preserving the submandibular gland. Uses techniques like Platysmaplasty, Digastric Shaving and Glandular Loop for cervical definition without the risks of gland removal. Preserves Gland Platysmaplasty Lower Risk
Evolutionary Frontoplasty / Browlift Upper Face Region Brow elevation and frontal rejuvenation following principles of direct vision and appropriate vectors. Approach that avoids excesses of classic techniques while restoring natural brow position. Direct Vision Natural Personalized
6. Who Created Modern Face?
The Modern Face philosophy was developed by Dr. Robério Brandão, Brazilian plastic surgeon based in Natal, Rio Grande do Norte. With more than 18 years dedicated to facial surgery and more than 1,500 documented procedures, Dr. Brandão developed Modern Face from clinical necessity, not academic theory. In 2007, he became a pioneer in facial video-endoscopy in Rio Grande do Norte. Paradoxically, this experience with endoscopic surgery revealed its limitations — and pointed the way to the Direct Vision that characterizes all Modern Face techniques. His credentials include invited lectures at the National Congress of SBCP (2023) and Full Face Global Summit (2024), in addition to having trained more than 130 surgeons from 7+ countries.
Meet Dr. Robério Brandão
7. Who Is Modern Face For?
Ideal Indications
- • Patients 45-65 years old with moderate facial aging
- • History of fillers or biostimulators
- • Midface ptosis with nasolabial fold
- • Desire for natural result, not “pulled”
- • Preference for faster recovery
- • Patients who want to avoid general anesthesia
Limitations / Contraindications
- • Patients 70+ with great skin redundancy
- • Severe SMAS laxity (better traditional Deep Plane)
- • Significant cervical skin excess
- • Unrealistic expectations
- • Comorbidities that contraindicate surgery Appropriate patient selection is fundamental for excellent results. Dr. Brandão teaches extensively about indications and contraindications in his [mentorship programs.
8. Frequently Asked Questions
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