As we get older, the tissue of the face and neck relaxes, loses volume, and the skin wrinkles. This leads to loosen skin and loss of definition in the eyes, cheekbones, jawline and neck. However, not all faces age at the same rate; therefore, facial rejuvenation treatments are unique to each patient and depend on what they want.
See more LessThe neck can have a major influence on our aesthetic look. In fact, many believe that a well-contoured neck is the most important piece for a youthful appearance. An aging neck is characterized by skin laxity, submental fat excess, and skin band formation. Although aging is usually responsible for those changes occurring in the neck, there are other factors, such as weight changes, sun exposure, lifestyle qualities, and facial skeletal structures. For example, individuals can develop excess skin laxity following significant weight loss. Similarly, a patient can have a lack of definition of the neck angle because of lack of chin projection. Patients can develop or be born with stubborn fat in the submental region that is unresponsive to diet or exercise. Patients unhappy with the look and contour of their neck may be great candidates for a neck rejuvenation.
Dr. Couto is a Cleveland Clinic trained plastic surgeon, and one of the few plastic surgeons in Latin America to have completed an American Society of Aesthetic Plastic Surgeon (ASAPS) endorsed subspecialty training in Aesthetic Surgery and Medicine.
During his training, Dr. Couto had the privilege to have mentors that are considered top leaders in the field of facial aesthetic surgery. These includes, Dr. James E. Zins, Michael E. Lee, and Hunt E. Neurohr, major contributors to the field of facelift and necklift. Because of his strong passion for facial rejuvenation, Dr. Couto has co-authored multiple scientific articles and book chapters about facelift and necklift. Furthermore, Dr. Couto has been a faculty member of the annual American Society Plastic Surgery (ASPS) face and neck rejuvenation course.
Neck rejuvenation involves a variety of procedures, which main objective is to optimize the contour and the definition of the neck. These procedures can include fat removal through liposuction to excision and tightening of loose skin with neck lift or skin tightening energy-based device.
An individual that is unhappy with the appearance of their neck either by loose skin, excess fat, or skin band formations. Patients also exhibiting aging changes of the lower face, such as saggy skin, jowling, and accentuated facial folds may be candidate for a concomitant face and neck rejuvenation.
The consultation is divided into five parts:
1) Health and Medical History Evaluation
A comprehensive evaluation of your medical history is performed. During this part of the consultation, we focus on identifying any potential risk factors for the surgery. It is important to tell Dr. Couto if you utilize any nicotine products (eg cigarette, nicotine patch, vape, etc.), if you have uncontrolled high blood sugar levels (eg diabetes) or if you take any medications, supplements, or other drugs as these can have a big impact on your surgery. An example is aspirin or blood thinners, which can lead to the formation of a hematoma after your procedure. These are common risk factors that can be easily modified with lifestyle changes and can affect your surgical results. Although this procedure is low risk, your health and safety will always be our main priority. We like to set the patient for success, not for failure; therefore, modifying any potential risks is essential to obtain the best possible result.
2) Discuss with the Patient About Surgical Goals
Dr. Couto has a deep discussion with the patient to learn about their concerns and goals. Listening to their interest is crucial, since it is our priority to determine if we can meet their expectations. We focus on learning whether the patient is particularly interested in addressing an specific area of the face or if the patient is interested in a face and neck rejuvenation.
3) Physical Exam
Dr. Couto treats the face and neck as whole, not by areas. Therefore, a systematic analysis of the face and neck is performed. A youthful appearance is marked by smooth transitions between different areas of the face and neck. As a result, Dr. Couto not only examines the regions the patient is mainly concerned with, but also those surrounding areas and structures of the face and neck that could help achieve a balanced and refreshing look.
4) Recommendations & Surgical Plan
Following the physical exam, Dr. Couto develops a personalized surgical plan aimed to meet the patient’s expectations, achieve optimal aesthetic results, and maximize patient safety. During this time, Dr. Couto discusses with the patient the indicated surgical techniques and explains in detail everything pertaining to the procedure and its recovery.
5) Pricing and Scheduling Information
Once the evaluation has been completed, our team will provide an individualized price quote that is tailored to the procedure(s) discussed during the consultation and review the steps involved in booking the procedure with us.
Neck rejuvenation can consist of elimination of stubborn fat with liposuction or excision and tightening of loose skin either through a neck lift approach or the use of skin tightening energy-based devices.
There are different techniques that Dr. Couto uses to perform neck rejuvenation:
Several weeks before the procedure, a preoperative appointment will be scheduled. During this appointment, we will discuss the surgical plan again, and clarify any questions involving the surgery. Furthermore, we will thoroughly review with the patient the preoperative/postoperative instructions and medication regimen, and schedule your future post-operative appointments.
We always emphasize to our patients that medication (e.g. aspirin, ibuprofen), vitamins and herbal supplements (e.g. Fish oil, Omega-3, Garlic or Tumeric pills, Ginko Biloba) should be stopped at least 3 weeks before surgery, as this increases the risk of bleeding. Furthermore, we remind them that smoking, vaping, or using any nicotine products will affect the results and recovery. There is significant scientific evidence that patient actively using of nicotine (eg. cigarettes, vaping, chewing, etc) have 12 times higher risk of complications following facelift/necklift surgery when compared to non-smoker patients (reference). Nicotine affects a person’s capacity for healing; thus, affecting your wounds and scars. During the initial consultation, Dr. Couto will ask the patient to stop smoking at least 8 weeks before the operation to reduce the risk of complications. Patients with a history of diabetes mellitus must have a glycosylated hemoglobin (HbA1c) of 7 or less to be able proceed with surgery. If the HbA1c is above this level, Dr. Couto will refer the patient to their primary care physician or endocrinologist to optimize your medications or diet to help lower the HbA1c levels. Lastly, nutrition is crucial for an effective healing and recovery process. Therefore, we recommend to our patients to optimize their protein intake and avoid foods high in salt/sodium after any surgical procedure. This could be easily achieved with supplements available in our practice.
We provide our patients with a detailed postoperative protocol to ensure that they have a comfortable and quick recovery. Surgical drains are only required for patients undergoing an extended necklift, for all other techniques, drains are not necessary. Surgical drains help prevent fluid collection in the neck and expedite the recovery. They are typically removed 48 hours after surgery. The patient will wear specialized face and neck compression garments that help minimize swelling and skin contour irregularities. Swelling and bruising are to be expected, and they can be noticeable for a week. Rarely, patients experience pain or discomfort following this surgery. It is very unusual for a necklift patient to require narcotic pain medications. We normally recommend our patients to take 7 days off from work (less if working from home). The same day after surgery, Dr. Couto always instructs the patient to have a couple of walking laps around the house or neighborhood. Patients can resume their aerobic exercises (eg. running, spinning, biking) 4 weeks after surgery and strengthening/abdominal exercises 6 weeks after surgery.
There isn’t! Every person ages in a different way and at a different rate; therefore, there isn’t a correct age to undergo a facial rejuvenation. The timing of a necklift is mainly determined by the skin quality and elasticity of an individual. These intrinsic skin characteristics are not only influenced by age, but also by genetics, weight changes, sun exposure, history of smoking and other lifestyle qualities. It is for that reason that during the consultation we perform a systematic analysis of the entire face and neck. This enables us to develop customized surgical plan that are based on your facial features, personal needs, and aesthetic desires.
The only technique that requires placement of surgical drains is the extended necklift. The drains prevent fluid from accumulating in the neck region and helps expedite the recovery. Furthermore, they are commonly removed 24-48 hours after surgery.
Uncontrolled diabetes can affect the ability of the body to heal wounds properly. Therefore, it is crucial for diabetic patients to have their blood sugar levels under control for this procedure. Patients with an HbA1c of 7 or less are candidates for this procedure.
Patients undergoing an extended necklift need to stop smoking or use nicotine products at least 6 weeks before surgery. There are numerous scientific studies showing that smoking cigarettes and/or using nicotine products increase your risk of postoperative complications. Nicotine affects the vascularity, and thus prevents the body from healing wounds properly following surgery.
Facial aging not only consists of tissue descent and skin laxity, but also loss of fat volume. These changes are commonly appreciated in the areas of the temple, cheek, and nasolabial region; thus, causing loss of definition of the cheeks and accentuating facial folds. Loss of facial volume can be treated non-surgically or surgically. Non-surgical interventions involve facial filler injection, such as hyaluronic acids. The benefit of this treatment is that it can be quickly performed in the office. The disadvantage of facial fillers is that they are not permanent, and it can become very expensive for patients requiring significant volume restoration. An alternative to filler injections is facial fat transfer. It is a minimally invasive procedure where your own fat is used to restore facial volume. The advantage of this technique is that it can provide permanent volumization and it is cost-effective.
Dr. Couto is a Cleveland Clinic trained plastic surgeon, and one of the few plastic surgeons in Latin America to have completed an American Society of Aesthetic Plastic Surgeon (ASAPS) endorsed subspecialty training in Aesthetic Surgery and Medicine.
During his training, Dr. Couto had the privilege to have mentors that are considered top leaders in the field of facial aesthetic surgery. This includes, Dr. James E. Zins, one the largest contributors to the field of facial aesthetics. Furthermore, because of his strong passion for facial rejuvenation, Dr. Couto has co-authored multiple scientific articles and book chapters about facial aesthetics. Furthermore, Dr. Couto has been an invited faculty member of the annual American Society Plastic Surgery (ASPS) face and neck rejuvenation course.
Facial fat transfer is a permanent therapeutic modality used to treat loss of volume commonly associated with facial aging. Fat harvested from the abdomen or thighs is injected in those areas of the face mostly affected. Although this procedure can be performed as an isolated procedure, it is typically performed in combination with other facial rejuvenation procedures, such as facelift. It is important to note that fat grafting is not a substitute for facelift procedure.
Individuals exhibiting facial aging changes associated with fat volume loss. These findings include poor definition of the cheeks and accentuated facial folds.
The consultation is divided into five parts:
A comprehensive evaluation of your medical history is performed. During this part of the consultation, we focus on identifying any potential risk factors for the surgery. It is important to tell Dr. Couto if you utilize any nicotine products (e.g cigarette, nicotine patch, vape, etc), if you have uncontrolled high blood sugar levels (e.g. diabetes) or if you take any medications, supplements, or other drugs as these can have a big impact on your surgery. An example is aspirin or blood thinners, which can lead to the formation of a hematoma after your procedure. These are common risk factors that can be easily modified with lifestyle changes and can affect your surgical results. Although this procedure is low risk, your health and safety will always be our main priority. We like to set the patient for success, not for failure; therefore, modifying any potential risks is essential to obtain the best possible result.
2) Discuss with the Patient About Surgical Goals
Dr. Couto has a deep discussion with the patient to learn about their concerns and goals. Listening to their interest is crucial, since it is our priority to determine if we can meet their expectations. We focus on learning whether the patient is particularly interested in addressing an specific area of the face or if the patient is interested in a face and neck rejuvenation.
3) Physical Exam
Dr. Couto treats the face and neck as a whole, not by areas. Therefore, a systematic analysis of the face and neck is performed. A youthful appearance is marked by smooth transitions between different areas of the face and neck. As a result, Dr. Couto not only examines the regions the patient is mainly concerned with, but also those surrounding areas and structures of the face and neck that could help achieve a balanced and refreshing look.
4) Recommendations & Surgical Plan
Following the physical exam, Dr. Couto develops a personalized surgical plan aimed to meet the patient’s expectations, achieve optimal aesthetic results, and maximize patient safety. During this time, Dr. Couto discusses with the patient the indicated surgical techniques and explains in detail everything pertaining to the procedure and its recovery.
5) Pricing and Scheduling Information
Once the evaluation has been completed, our team will provide an individualized price quote that is tailored to the procedure(s) discussed during the consultation and review the steps involved in booking the procedure with us.
This procedure consists of two parts: fat harvesting and fat transfer. Fat is harvested from the abdomen or thighs using liposuction (yperlink) techniques. Once the fat is harvested, it is cleaned and processed. This ensures that the fat being used is of utmost quality. Then we proceed to do the fat transfer. Using specialized fat grafting cannulas, the harvested fat is injected in a gradual amount in those areas most affected by volume loss. Although fat transfer can be performed as an isolated procedure, it is typically performed in combination with facelift and eyelid surgery.
Several weeks before the procedure, a preoperative appointment will be scheduled. During this appointment, we will discuss the surgical plan again, and clarify any questions involving the surgery. Furthermore, we will thoroughly review with the patient the preoperative/postoperative instructions and medication regimen and schedule your future post-operative appointments.
We always emphasize to our patients that medication (e.g. aspirin, ibuprofen), vitamins and herbal supplements (e.g. Fish oil, Omega-3, Garlic or Tumeric pills, Ginko Biloba) should be stopped at least 3 weeks before surgery, as this increases the risk of bleeding. Furthermore, we remind them that smoking, vaping, or using any nicotine products will affect the results and recovery. There are significant scientific evidence that patient actively using of nicotine (eg. cigarettes, vaping, chewing, etc) have 12 times higher risk of complications following facelift surgery when compared to non-smoker patients (reference). Nicotine affects a person’s capacity for healing; thus, affecting your wounds and scars. During the initial consultation, Dr. Couto will ask the patient to stop smoking at least 4 weeks before the operation to reduce the risk of complications. Patients with a history of diabetes mellitus must have a glycosylated hemoglobin (HbA1c) of 7 or less to be able proceed with surgery. If the HbA1c is above this level, Dr. Couto will refer the patient to their primary care physician or endocrinologist to optimize your medications or diet to help lower the HbA1c levels. Lastly, nutrition is crucial for an effective healing and recovery process. Therefore, we recommend to our patients to optimize their protein intake and avoid foods high in salt/sodium after any surgical procedure. This could be easily achieved with post-operative supplements available in our practice.
We provide our patients with a detailed postoperative protocol to ensure that they have a comfortable and quick recovery. Rarely, patients experienced pain or discomfort following this surgery. It is very unusual for a patient to require narcotic pain medications. We normally recommend our patients to take 5-7 days off from work (less if working from home). The same day after surgery, Dr. Couto always instructs the patient to have a couple of walking laps around the house or neighborhood. Patients can resume their aerobic exercises (eg. running, spinning, biking) 4 weeks after surgery and strengthening/abdominal exercises 6 weeks after surgery.
Advantages:
1) Fat harvested from your own body is being used to restore volume. Although filler injections are made of safe biological materials, these are synthetically produced.
2) Fat is more cost-effective than facial fillers injections. Fat is readily available.
3) Fat provides a permanent volume restoration. On the other hand, filler injections are temporary as they typically last 8-12 months.
4acbht52) Facial fat transfer is a quick and minimally invasive procedure.
Disadvantages:
1) Unlike facial fillers, facial fat transfer is a minimally invasive procedure.
2) Recovery time can be greater when doing fat transfer, since patients can experience facial swelling and bruising.
As we age, the tissue of the face and neck relaxes, producing saggy skin, jowls, and deepening of the facial folds. In addition, there is volume loss, which results in poor definition of the cheek and jawline. Patients exhibiting gravitational changes of the face and neck, such as loose skin, prominent jowls, and deep facial folds require surgically lifting the descended tissue and removing the excess lax skin. For this reason, a facelift and necklift is considered one of the pillar procedures in the field of facial aesthetics, since it is the most effective means of reversing those changes caused by age, specifically in the area of the cheek, jawline, and neck.
Dr. Couto is a Cleveland Clinic trained plastic surgeon, and one of the few plastic surgeons in Latin America to have completed an American Society of Aesthetic Plastic Surgeon (ASAPS) endorsed subspecialty training in Aesthetic Surgery and Medicine.
During his training, Dr. Couto had the privilege to have mentors that are considered top leaders in the field of facial aesthetic surgery. This includes, Dr. James E. Zins, one the largest contributors to the field of facelift and necklift. Furthermore, because of his strong passion for facial rejuvenation, Dr. Couto has co-authored multiple scientific articles and book chapters about facelift and necklift. Furthermore, Dr. Couto has been an invited faculty member of the annual American Society Plastic Surgery (ASPS) face and neck rejuvenation course.
The facelift is one of the most comprehensive procedures performed to reverse facial aging. This operation removes excess skin, softens skin wrinkles, and repositions descended facial soft tissue into an aesthetic pleasing position. The facelift is commonly combined with a necklift , since both areas complement each other. Therefore, achieving a smooth transition between the face and the neck is crucial for a youthful appearance. In addition to skin laxity, facial aging is marked by tissue volume loss; thus, adding volume to the face with fat transfer or hyaluronic acid fillers can aid in a more rejuvenated look.
The consultation is divided into five parts:
1 )Health and Medical History Evaluation
A comprehensive evaluation of your medical history is performed. During this part of the consultation, we focus on identifying any potential risk factors for the surgery. It is important to tell Dr. Couto if you utilize any nicotine products (e.g cigarette, nicotine patch, vape, etc), if you have uncontrolled high blood sugar levels (e.g. diabetes) or if you take any medications, supplements, or other drugs as these can have a big impact on your surgery. An example is aspirin or blood thinners, which can lead to the formation of a hematoma after your procedure. These are common risk factors that can be easily modified with lifestyle changes and can affect your surgical results. Although this procedure is low risk, your health and safety will always be our main priority. We like to set the patient for success, not for failure; therefore, modifying any potential risks is essential to obtain the best possible result.
2) Discuss with the Patient About Surgical Goals
Dr. Couto has a deep discussion with the patient to learn about their concerns and goals. Listening to our patient’s interest is crucial, since it is our priority to determine if we can meet their expectations. We focus on learning whether the patient is particularly interested in addressing an specific area of the face or if the patient is interested in a global face and neck rejuvenation.
3) Physical Exam
A complete systematic analysis of the face and neck is performed. Dr. Couto treats the face and neck as whole, not by areas. A youthful appearance is marked by harmonious transitions between different areas of the face and neck. Consequently, Dr. Couto not only examines the regions the patient is mainly concerned with, but also those surrounding areas and structures of the face and neck that could help achieve a balanced and refreshing look.
4) Recommendations & Surgical Plan
Following the physical exam, Dr. Couto develops a personalized surgical plan aimed to meet the patient’s expectations, achieve optimal aesthetic results, and maximize patient safety. During this time, Dr. Couto discusses with the patient the indicated surgical techniques and explains in detail everything pertaining to the procedure and its recovery.
5) Pricing and Scheduling Information
Once the evaluation has been completed, our team will provide an individualized price quote that is tailored to the procedures discussed during the consultation and review the steps involved to book the procedure with us.
Individuals exhibiting gravitational changes of the face and neck, such as skin laxity, prominent jowls, and loss of definition of the jawline and cheek. In order to correct these aging changes, the excess skin must be removed and soft tissue repositioned through a facelift & necklift procedure.
Facelift operations have evolved over the last decades. First generation techniques were skin only facelift, which consisted in addressing the loose skin by simply excising and tightening it. The problem with this approach was that it resulted in a pulled, unnatural look. Consequently, modern facelift surgery has transitioned to focus not only on the skin, but mainly in the tissue layer below the skin. This layer is called the “SMAS”, and it is manipulated in order to lift and reposition droopy facial tissue and improve the cheeks and the jowls. Furthermore, this technique facilitates the excision of that loose skin in a tensionless fashion; thus, preventing that overtightened look, and instead producing a natural and freshened appearance.
Dr. Couto selects the correct facelift technique based on the patient’s facial aging changes, anatomy, and previous facial aesthetic treatments. Dr. Couto only utilizes cutting edge facelift techniques, such as deep plane facelift, sub-SMAS facelift or SMAS plication facelift.
A facelift surgery usually requires a well-hidden incision that starts at the sideburn, it travels just in front of the ear, around the earlobe, behind the ear, and then partially into the hair behind the ear (illustration). Through this incision, the SMAS tissue is lifted and repositioned to better define the cheeks and eliminate the jowls. In younger patients, who have minimal neck skin laxity, a short scar facelift can be performed. This modification consists of omitting the incision behind the ear; however, we believe that this technique provides inferior results when compared to the traditional facelift.
Because a smooth transition between the face and the neck is crucial for a youthful look, a neck lift is commonly performed at the same time as a facelift. This usually requires an additional small incision below the chin, which allows the removal of fat and tightening of the neck muscles, also known as a platysmaplasty.
Once we have completed the facelift and necklift then we usually proceed with facial fat grafting . Fat harvested from the patient’s abdomen or thigh is processed and injected in areas of the face that have suffered fat volume loss, a common facial aging change. This technique helps enhance the cheek areas and better define the jawline.
Several weeks before the procedure, a preoperative appointment will be scheduled. During this appointment, we will discuss the surgical plan again, and clarify any questions involving the surgery. Furthermore, we will thoroughly review with the patient the preoperative/postoperative instructions and medication regimen, and schedule your future post-operative appointments.
We always emphasize to our patients that medication (e.g. aspirin, ibuprofen), vitamins and herbal supplements (e.g. Fish oil, Omega-3, Garlic or Tumeric pills, Ginko Biloba) should be stopped at least 3 weeks before surgery, as this increases the risk of bleeding. Furthermore, we remind them that smoking, vaping, or using any nicotine products will affect the results and recovery. There are significant scientific evidence that patient actively using of nicotine (eg. cigarettes, vaping, chewing, etc) have 12 times higher risk of complications following facelift surgery when compared to non-smoker patients. Nicotine affects a person’s capacity for healing; thus, affecting your wounds and scars. During the initial consultation, Dr. Couto will ask the patient to stop smoking at least 8-12 weeks before the operation to reduce the risk of complications. Patients with a history of diabetes mellitus must have a glycosylated hemoglobin (HbA1c) of 7 or less to be able proceed with surgery. If the HbA1c is above this level, Dr. Couto will refer the patient to their primary care physician or endocrinologist to optimize your medications or diet to help lower the HbA1c levels. Lastly, nutrition is crucial for an effective healing and recovery process. Therefore, we recommend to our patients to optimize their protein intake and avoid foods high in salt/sodium after any surgical procedure. This could be easily achieved with post-operative supplements available in our practice.
We provide our patients with a detailed postoperative protocol to ensure that they have a comfortable and quick recovery. Following surgery, the patient may have drain tubes placed, which helps prevent fluid collection in the face and neck and expedite the recovery. They are typically removed 24-48 hours after surgery. The patient will wear specialized face and neck compression garments that help minimize swelling and skin contour irregularities. Swelling and bruising are to be expected, and they can be noticeable for a week. Rarely, patients experienced pain or discomfort following this surgery. It is very unusual for a facelift and necklift patient to require narcotic pain medications. We normally recommend our patients to take 7-10 days off from work (less if working from home). The same day after surgery, Dr. Couto always instructs the patient to have a couple of walking laps around the house or neighborhood. Patients can resume their exercises (eg. running, spinning, biking) 6 weeks after surgery.
The truth is that there isn’t! Every person ages in a different way and at a different rate; therefore, there isn’t a correct age to undergo a facial rejuvenation. The timing of a facelift is mainly determined by the skin quality and elasticity of an individual. These intrinsic skin characteristics are not only influenced by age, but also by genetics, weight changes, sun exposure, smoking history and other lifestyle qualities. It is for that reason that during the consultation we perform a systematic analysis of the entire face and neck. This enables us to develop customized surgical plans that are based on your facial features, personal needs, and aesthetic desires.
A mini facelift is an ineffective version of the facelift surgery. This procedure was designed as a marketing stunt, which promises the patient a shorter recovery time, because of its short incision. Commonly, patients present to our clinic just a few months after a mini-facelift unsatisfied by the short lasting and underwhelming results. The reason for this is that the mini-facelift, unlike the facelift, is limited to only tightening of the facial skin. It does not address the SMAS, which is the soft tissue lying below the skin producing the droopiness of the face, and it does not address the neck. Consequently, not only does this create an unnatural, pulled facial look, but also produces results that do not last long enough.
The question is when to do fillers and when to do surgery. During the consultation, Dr. Couto will explain what changes are occurring on the face, and most importantly the reason why it is happening. This is crucial to determine if the patient is a candidate for a non-surgical or surgical treatment.
Non-surgical therapies, such as fillers are great for patients undergoing early facial aging changes where volume restoration and enhancement of shape are mainly required. On the other hand, patients exhibiting gravitational changes, such as a saggy skin, prominent jowls, and loss of definitions of the jawline and neck, require a surgical treatment. A facelift and necklift are procedures designed to specifically achieve those things: remove excess skin and lift descended soft tissue into an aesthetic pleasing position.
Dr. Couto specializes in both surgical and non-surgical facial aesthetic treatments. Therefore, an objective and unbiased recommendation will always be provided during your consultation. The ability to know firsthand what can be accomplished non-surgically and when a surgical intervention is a unique and essential quality in the field of facial aesthetic surgery.
Surgical drains are usually used for this procedure since it prevents fluid from accumulating in the face or neck region and helps expedite the recovery. Surgical drains are commonly removed 24-48 hours after surgery.
Uncontrolled diabetes can affect the ability of the body to heal wounds properly. Therefore, it is crucial for diabetic patients to have their blood sugar levels under control for this procedure. Patients with an HbA1c of 7 or less are candidates for this procedure.
There are numerous scientific studies showing that smoking cigarettes and/or using nicotine products increase your risk of postoperative complications. Nicotine affects the vascularity, and thus prevents the body from healing wounds properly following surgery. We recommend patients to stop smoking or use nicotine products at least 6 -8 weeks before surgery.
The eyelids are areas subject to changes not only associated with aging, but also with chronic sun exposure, lifestyle qualities and/or intrinsic skin characteristics. All these changes can result in a tired and fatigued appearance. In the upper eyelid, these changes are distinguished by development of droopy skin and fatty tissue resulting in puffiness. Unlike the upper eyelids, the lower eyelids play an important role in the transition from the eye area to the cheeks. As we age, not only does skin and fat accumulate, but the sagging of the cheeks causes noticeable demarcation in the under eyes. It is for this reason, in addition to removing excess skin and fat, one of the objectives of lower eyelid surgery is to create a harmonious transition between the lower eyelids and the cheeks.
Dr. Couto is a Cleveland Clinic trained plastic surgeon, and one of the few plastic surgeons in Latin America to have completed an American Society of Aesthetic Plastic Surgeon (ASAPS) endorsed subspecialty training in Aesthetic Surgery and Medicine.
During his training, Dr. Couto had the privilege to have mentors that are considered top leaders in the field of facial aesthetic surgery. This includes, Dr. James E. Zins, one the largest contributors to the field of facial rejuvenation. Because of his strong passion for facial rejuvenation, Dr. Couto has co-authored multiple scientific articles and book chapters about facial rejuvenation. Furthermore, Dr. Couto has been an invited faculty member of the annual American Society Plastic Surgery (ASPS) face and neck rejuvenation course.
Eyelid surgery or blepharoplasty is a procedure aimed to reverse aging changes that occur in the upper and lower eyelids, which typically produce a fatigued and tired appearance. This operation has three main objectives:
1) removal of droopy excess skin.
2) elimination of fat producing eyelid bags.
3) softening of the skin wrinkles around the eyes.
The upper and lower eyelids can be treated separately or at the same time, depending on the patient’s needs.
The consultation is divided into five parts:
1. Health and Medical History Evaluation
A comprehensive evaluation of the patient’s medical history is performed. During this part of the consultation, we focus on identifying any potential risk factors for the surgery. It is important to tell Dr. Couto of any recent eye surgery, such as Lasik or cataracts procedure. Furthermore, we need to be informed of any medications, supplements, or other drug intake, as these can have a big impact on the surgery. An example is aspirin or blood thinners, which can lead to the formation of a hematoma after your procedure. These are common risk factors that can be easily modified with lifestyle changes. Although this procedure has a low risk, our patient’s health and safety will always be our main priority. We like to set the patient for success, not for failure; therefore, modifying any potential risks is essential to obtain the best possible result.
2. Discuss with the Patient About Surgical Goals
Dr. Couto has a deep discussion with the patient to learn about their concerns and goals. Listening to their interest is crucial, since it is our priority to determine if we can meet our patient’s expectations. We focus on learning whether the patient is particularly interested in addressing an specific area of the face or if the patient is interested in a face and neck rejuvenation.
3. Physical Exam
A complete systematic analysis of the face and neck is performed. Dr. Couto treats the face and eyes holistically, not by areas, since a youthful appearance is marked by harmonious transitions between different areas of the face and eyes. Consequently, Dr. Couto not only examines the regions the patient is mainly concerned with, but also those surrounding areas and structures of the face and eyes that could help achieve a balanced and refreshing look.
4. Recommendations & Surgical Plan
Following the physical exam, Dr. Couto develops a personalized surgical plan aimed to meet the patient’s expectations, achieve optimal aesthetic results, and maximize patient safety. During this time, Dr. Couto discusses with the patient the indicated surgical techniques and explains in detail everything pertaining to the procedure and its recovery.
5. Pricing and Scheduling Information
Once the evaluation has been completed, our team will provide an individualized quote that is tailored to the procedure(s) discussed during the consultation and review the steps involved to book the procedure with us.
Individuals bothered by aging changes in the eyelids that produce a tired and fatigue appearance are great candidates for these procedures. These changes are characterized by droopy skin excess, eyelid bags, and skin wrinkles.
Upper Eyelid
This technique allows the removal of droopy excess skin and fat which produces a fatigued appearance through an incision that is hidden in the natural crease of the upper eyelid (Figure).
The upper eyelid lift is a quick procedure that can be either performed in the office under local anesthesia or sedation.
Lower Eyelid
Unlike the upper eyelid, numerous lower eyelid surgery techniques exist. Therefore, the treatment is highly individualized.
Patient’s exhibiting eyelid bags but no skin excess may be candidates to a transconjunctival or a “scar less” approach. Fatty tissue producing the puffiness appearance is removed through the inside of the lower eyelid. This technique requires no external incision and is appropriate only for the removal or redistribution of fat; it cannot be used to remove excess skin. Therefore, it is not the best choice if there is significant lower eyelid skin wrinkling.
Those patients exhibiting lower eyelid skin laxity will benefit from skin excision through a subciliary approach. This technique consists of placing the incision just underneath the eyelashes, which results in a scar that is unnoticeable since it gets hidden by the lashes and blends perfectly with existing skin creases.
Several weeks before the procedure, a preoperative appointment will be scheduled. During this appointment, we will discuss the surgical plan again, and clarify any questions involving the surgery. Furthermore, we will thoroughly review with the patient the preoperative/postoperative instructions and medication regimen and schedule the future post-operative appointments.
We always emphasize to our patients that medication (e.g. aspirin, ibuprofen), vitamins and herbal supplements (e.g. Fish oil, Omega-3, Garlic or Tumeric pills, Ginko Biloba) should be stopped at least 3 weeks before surgery, as this increases the risk of bleeding. Furthermore, we remind them that nicotine affects a person’s capacity for healing; thus, affecting wounds and scars. During the initial consultation, Dr. Couto will ask the patient to stop using nicotine containing products at least 8 weeks before the operation to reduce the risk of complications.
Patients with a history of diabetes mellitus must have a glycosylated hemoglobin (HbA1c) of 7 or less to be able proceed with surgery. If it is above this level, Dr. Couto will refer the patient to their primary care physician or endocrinologist to optimize their medications or diet to help lower the HbA1c levels.
Lastly, nutrition is crucial for an effective healing and recovery process. Therefore, we recommend to our patients to optimize their protein intake and avoid foods high in salt/sodium after any surgical procedure.
Several weeks before the procedure, a preoperative appointment will be scheduled. During this appointment, we will discuss the surgical plan again, and clarify any questions involving the surgery. Furthermore, we will thoroughly review with the patient the preoperative/postoperative instructions and medication regimen and schedule the future post-operative appointments.
We always emphasize to our patients that medication (e.g. aspirin, ibuprofen), vitamins and herbal supplements (e.g. Fish oil, Omega-3, Garlic or Tumeric pills, Ginko Biloba) should be stopped at least 3 weeks before surgery, as this increases the risk of bleeding. Furthermore, we remind them that smoking, vaping, or using any nicotine products may affect the results and recovery process. Nicotine affects a person’s capacity for healing; thus, affecting wounds and scars. During the initial consultation, Dr. Couto will ask the patient to stop smoking at least 6 weeks before the operation to reduce the risk of complications.
Patients with a history of diabetes mellitus must have a glycosylated hemoglobin (HbA1c) of 7 or less to be able proceed with surgery. If it is above this level, Dr. Couto will refer the patient to their primary care physician or endocrinologist to optimize their medications or diet to help lower the HbA1c levels.
Lastly, nutrition is crucial for an effective healing and recovery process. Therefore, we recommend to our patients to optimize their protein intake and avoid foods high in salt/sodium after any surgical procedure. This could be easily achieved with supplements available in our practice.
We provide our patients with a detailed postoperative protocol to ensure that they have a comfortable and quick recovery. The patient will need to apply cold compresses on their eyes to help minimize swelling and bruising, which are to be expected and can be noticeable for a week. It is rare for patients to experience pain or discomfort following this surgery and very unusual for a eyelid lift patient to require narcotic pain medications. We normally recommend our patients to take 7 days off from work (less if working from home). Patients can resume their exercises 3 weeks after surgery.
There isn’t! Every person ages in a different way and at a different rate; therefore, there isn’t a correct age to undergo an eyelid rejuvenation. The timing for an eyelid surgery is mainly determined by an individual’s skin quality and degree of eyelid bags. These intrinsic characteristics are not only influenced by age, but also by genetics, weight changes, sun exposure, history of smoking and other lifestyle qualities. For that reason, we perform a systematic analysis of the entire face, not only the region of the eyes, during the consultation. This enables us to develop a customized surgical plan that is based on the patient’s facial features, personal needs, and aesthetic desires.
A frequently asked question amongst patients is when to do fillers and when to do surgery. During the consultation, Dr. Couto will explain what changes are occurring on the eyes, and most importantly the reason why they are happening. This is crucial to determine if the patient is a candidate for a non-surgical or surgical treatment.
Non-surgical therapies, such as hyaluronic acid fillers are great for patients undergoing early aging changes around the eyes, where volume restoration and enhancement of shape are mainly required. On the other hand, patients exhibiting significant loose skin or prominent eyelid bags, surgical treatment may be more beneficial. Eyelid surgery is a procedure designed to specifically achieve those goals: remove excess skin and eliminate fatty tissue which produces a fatigued appearance.
Dr. Couto specializes in both surgical and non-surgical facial aesthetic treatments. Therefore, an objective and unbiased recommendation will always be provided during the consultation. The ability to know firsthand what can be accomplished non-surgically and when a surgical intervention is required is a unique and essential quality in the field of facial aesthetic surgery.
Uncontrolled diabetes can affect the ability of the body to heal wounds properly. Therefore, it is crucial for diabetic patients to have their blood sugar levels under control for this procedure. Patients with an HbA1c of 7 or less are candidates for this procedure.
There are numerous scientific studies showing that smoking cigarettes and/or using nicotine products increase your risk of postoperative complications. Nicotine affects the vascularity, and thus prevents the body from healing wounds properly following surgery. We recommend patients to stop smoking or use nicotine products at least 6 -8 weeks before surgery.
The eyebrows play a major role in our facial expressions; their shape and position can determine whether a patient has a refreshed or tired look. Female eyebrows are distinguished by their position in relation to the eyes and their arched shape, while male eyebrows are less raised and have a horizontal shape. As we age, the eyebrows descend and lose their natural shape. Not only does this produce excess skin on the lateral corner of the upper eyelids, but it also can give a tired appearance. Non-surgical treatments, such as Botox®, are typically used to restore the shape by raising the tail of the eyebrows. However, sometimes the effect is not strong enough or doesn’t last long enough. In these cases, a browlift may be the indicated procedure.
Dr. Couto is a Cleveland Clinic trained plastic surgeon, and one of the few plastic surgeons in Latin America to have completed an American Society of Aesthetic Plastic Surgeon (ASAPS) endorsed subspecialty training in Aesthetic Surgery and Medicine.
During his training, Dr. Couto had the privilege to have mentors that are considered top leaders in the field of facial aesthetic surgery. This includes, Dr. James E. Zins, one the largest contributors to the field of face and necklift. Because of his strong passion for facial rejuvenation, Dr. Couto has co-authored multiple scientific articles and book chapters about the topic. Furthermore, Dr. Couto has been a faculty member of the annual American Society Plastic Surgery (ASPS) face and neck rejuvenation course.
A browlift is a procedure that reverses the effects of gravity by lifting and restoring the shape of the brow into a youthful appearance.The brow lift is commonly combined with an upper eyelid surger, since both procedures work synergistically to achieve a youthful upper face.
Individuals exhibiting gravitational changes in the region of the eyes, such as eyebrows that have descended and lost their aesthetic shape, are great candidates for the procedure. In order to correct these aging changes, the position and shape of the brow must be restored through a browlift.
The consultation is divided into five parts:
1) Health and Medical History Evaluation
A comprehensive evaluation of the patient’s medical history is performed. During this part of the consultation, we focus on identifying any potential risk factors for the surgery. It is important to notify Dr. Couto about the intake of any medications, supplements, or other drugs as these can have an impact on the surgery. An example is aspirin or blood thinners, which can lead to the formation of hematomas after the procedure. These are common risk factors that can affect the surgical result, yet can be easily modified with lifestyle changes. Although this procedure has a low risk, our patient’s health and safety will always be our main priority. We like to set our patients for success, not for failure; therefore, modifying any potential risks is essential to obtain the best result possible.
2) Discuss with the Patient About Surgical Goals
Dr. Couto has a deep discussion with the patient to learn about their concerns and goals. Listening to their interest is crucial, since it is our priority to determine if we can meet their expectations. We focus on learning whether the patient is particularly interested in addressing an specific area of the face or if the patient is interested in a face and neck rejuvenation.
3) Physical Exam
A complete systematic analysis of the face and neck is performed. Dr. Couto treats the face and eyes holistically, not by areas, since a youthful appearance is marked by harmonious transitions between the different parts of the face and eyes. Consequently,Dr. Couto not only examines the regions the patient is mainly concerned with, but also those surrounding areas and structures that could help achieve a balanced and refreshing look.
4) Recommendations & Surgical Plan
Following the physical exam, Dr. Couto develops a personalized surgical plan aimed to meet the patient’s expectations, achieve optimal aesthetic results, and maximize patient safety. During this time, Dr. Couto discusses with the patient the indicated surgical techniques and explains in detail everything pertaining to the procedure and its recovery.
5) Pricing and Scheduling Information
Once the evaluation has been completed, our team will provide an individualized quote that is tailored to the procedures discussed during the consultation and review the steps involved to book the procedure with us.
There are various brow lift techniques, which involve different degrees of interventions, and objectives. Dr. Couto selects the correct surgical method based on the patient’s surgical goals and facial aging changes. We only utilize techniques that minimizes the length of the incision and hides the scar in hair-bearing areas, such as the scalp.
Several weeks before the procedure, a preoperative appointment will be scheduled. During this appointment, we will discuss the surgical plan again and clarify any questions involving the surgery. Furthermore, we will thoroughly review with the patient the preoperative/postoperative instructions and medication regime, and schedule the future post-operative appointments.
We always emphasize to our patients that medication (e.g. aspirin, ibuprofen), vitamins and herbal supplements (e.g. Fish oil, Omega-3, Garlic or Tumeric pills, Ginko Biloba) should be stopped at least 3 weeks before surgery, as this increases the risk of bleeding. Furthermore, we remind them thatuse of nicotine products (eg. cigarrettes, vaping, chew, patches, etc will affect the results and recovery process. Lastly, nutrition is crucial for an effective healing and recovery process. Therefore, we recommend to our patients to optimize their protein intake and avoid foods high in salt/sodium after any surgical procedure. We also offer pre- and postoperative supplements that aid in enhancing the recovery process.
We provide our patients with a detailed postoperative protocol to ensure that they have a comfortable and quick recovery.Swelling and bruising are to be expected, and they can be noticeable for a week. Rarely, patients experienced pain or discomfort following this surgery. We normally recommend our patients to take 5 days off from work (less if working remotely from home). The same day after surgery, Dr. Couto always instructs the patient to have a couple of walking laps around the house or neighborhood. Patients can resume their exercises (eg. running, spinning, biking) 2 weeks after surgery.
Although the volume that fat provides to our face plays a major role in a youthful appearance, some individuals can find that their face is round or “chubby.” This is commonly observed in patients that have prominent buccal fat pads. Buccal fat pads are pockets of fat located deep in our cheek region. Usually they are prominent during childhood, and as we get older it progressively decreases in size. However, in certain individuals, it can remain prominent. Unlike superficial facial fat, buccal fat pads do not respond to diet or exercise. As a result, patients with prominent buccal fat pads usually complain of persistent lower face fullness, despite losing weight. The best solution for this situation is to undergo buccal fat removal, also known as a “bichectomy.”
Dr. Couto is a Cleveland Clinic trained plastic surgeon, and one of the few plastic surgeons in Latin America to have completed an American Society of Aesthetic Plastic Surgeon (ASAPS) endorsed subspecialty training in Aesthetic Surgery and Medicine.
During his training, Dr. Couto had the privilege to have mentors that are considered top leaders in the field of facial aesthetic surgery. This includes, Dr. James E. Zins, one the largest contributors to the field of facial aesthetics. Furthermore, because of his strong passion for facial rejuvenation, Dr. Couto has co-authored multiple scientific articles and book chapters about the topic. Furthermore, Dr. Couto has been an invited faculty member of the annual American Society Plastic Surgery (ASPS) face and neck rejuvenation course.
A buccal fat removal or bichectomy is a minimally invasive procedure designed to reduce the fullness and roundness of the lower face. In this procedure, excess fat from the buccal fat pad is removed through a small incision inside of the mouth. Therefore, no visible scars are produced. This is a quick procedure that can be performed under sedation.
Individuals that are unhappy with the round and full appearance of their lower face are great candidates for this procedure. This patient population typically shows up to our office stating that no matter how much weight they lose, their face continues to look full.
The consultation is divided into five parts:
1) Health and Medical History Evaluation
A comprehensive evaluation of the patient’s medical history is performed. During this part of the consultation, we focus on identifying any potential risk factors for the surgery. It is important to notify Dr. Couto of use of any medications, supplements, or other drugs as these can have an impact on the surgery. An example is aspirin or blood thinners, which can increase risk of bleeding after the procedure. These are common risk factors that can affect the surgical result yet can be easily modified with lifestyle changes. Although this procedure has a low risk, our patient’s health and safety will always be our main priority. We like to set our patients for success, not for failure; therefore, modifying any potential risks is essential to obtain the best possible result.
2) Discuss with the Patient About Surgical Goals
Dr. Couto has a deep discussion with the patient to learn about their concerns and goals. Listening to their interest is crucial, since it is our priority to determine if we can meet their expectations. We focus on learning whether the patient is particularly interested in addressing an specific area of the face or if the patient is interested in a face and neck rejuvenation.
3) Physical Exam
Dr. Couto treats the face and neck as whole, not by areas. Therefore, a systematic analysis of the face and neck is performed. A youthful appearance is marked by smooth transitions between different areas of the face and neck.As a result, Dr. Couto not only examines the regions the patient is mainly concerned with, but also those surrounding areas and structures of the face and neck that could help achieve a balanced and refreshing look.
4) Recommendations & Surgical Plan
Following the physical exam, Dr. Couto develops a personalized surgical plan aimed to meet the patient’s expectations, achieve optimal aesthetic results, and maximize patient safety. During this time, Dr. Couto discusses with the patient the indicated surgical techniques and explains in detail everything pertaining to the procedure and its recovery.
5) Pricing and Scheduling Information
Once the evaluation has been completed, our team will provide an individualized price quote that is tailored to the procedure(s) discussed during the consultation and review the steps involved in booking the procedure with us.
A small incision inside the mouth is created to access the buccal fat pads. Once the fat has been encountered, it is meticulously resected. We always emphasize to our patients that the goal of this surgery is to reduce the volume of the buccal fat pad, not remove it entirely. This is accomplished by extracting only the excess fat. Aggressive resection of the buccal fat pad must be avoided, as this can produce unwanted facial deflation and accelerate facial aging.
Several weeks before the procedure, a preoperative appointment will be scheduled. During this appointment, we will discuss the surgical plan again and clarify any questions involving the surgery. Furthermore, we will thoroughly review the preoperative/postoperative instructions and medication regimen and schedule the future post-operative appointments.
We always emphasize to our patients that medication (e.g. aspirin, ibuprofen), vitamins and herbal supplements (e.g. Fish oil, Omega-3, Garlic or Tumeric pills, Ginko Biloba) should be discontinued at least 3 weeks before surgery, as they increase the risk of bleeding. Furthermore, we remind them that smoking, vaping, or using any nicotine products will affect the results and recovery process. Lastly, nutrition is crucial for an effective healing and recovery process. Therefore, we recommend to our patients to optimize their protein intake and avoid foods high in salt/sodium after any surgical procedure. This could be easily achieved with post-operative supplements available in our practice.
We provide our patients with a detailed postoperative protocol to ensure that they have a comfortable and quick recovery. The patient will wear a specialized face compression garment that helps minimize swelling. Mild inflammation is to be expected and can be noticeable for about a week. During this recovery process, patients rarely experience pain or discomfort. It is also very unusual for them to require narcotic pain medications. We normally recommend our patients to take 3-5 days off from work, or even less if working from home. Finally, patients can resume their aerobic exercises (eg. running, spinning, biking) and strengthening/abdominal exercises 2 weeks after surgery.
