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    Facial Plastic Surgery

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    The search by scientists for the elixir of youth is reported from times prior to Christ. This search continues until today, since it is not yet possible to stop the marks left by time.

    Practically every human being, and mainly women, feels unsatisfied, to a larger or smaller degree, with the aging process of the face and body.

    Plastic Surgery offers the possibility of making the face look young again through the technique called Facial Ritidoplasty, commonly known as Face Lifting, whose primary objective is a natural looking result.


    Anatomical Definition

    Craniomaxillofacial Surgery, which is also one of my areas of specialty, studied the facial aging process concluding that facial aging also involves a weakening and sagging of the musculature besides that of the skin.

    Among the factors of this sagging includes the force of gravity weighing upon the muscles and dragging them down the face. With this concept in mind, it is easy to study your face in the mirror and the face of older persons, (see photograph), imagining the position of their cheek muscles, considering or not the effects of gravity.

    The sagging of the facial musculature is evident by:

    Dados anatomicos site mariangela

    • 1. Aging of the orbital region (around the eyes);
    • 2. Formation of the lower eyelid furrow (dark rings);
    • 3. Formation of the nasolabial furrow (diagonal line which begins adjacent to nostril wings and runs down and outwards beyond the lip corners);
    • 4. Loss in definition to the jaw line;
    • 5. Excess skin and sagging of the face and throat area;


    Based on these concepts, we treat facial aging in a global scope, through the anatomical repositioning of the musculature of the middle and lower third of the face.

    The repositioning of the musculature of the central region of the face (middle-third), produces an elevation of the cheek muscles and improves the nasolabial furrow and the lower eyelid furrow.

    In the lower region, the muscular repositioning produces a definition of the jaw line and improves the angle of the jaw.

    After the repositioning of the facial muscles (the deep structures) the pulling of the skin is slight. The pulling of the skin is a consequence, not a principal factor, since the major cause for facial rejuvenation is the correct positioning of the supporting facial muscles.


    Objective of the Surgery

    Opposed to what some people think, the principal objective of the surgery is not to leave people prettier but to make the face look younger… which is different.

    To make the face look prettier (which really translates to “more symmetrical”), we employ additional techniques which help to improve the proportions of the face.



    Depending on the extent of the procedure, we may use general anesthesia or local anesthesia along with a sedative.



    Again, depending on the extent of the procedure, we generally prefer an overnight stay at the hospital with the patient returning home the next day.




    • – A part of the scar will be within the scalp, hidden by the hairs;
    • – Another part will follow the natural contour of the ear, positioned to blend with the normal folds of the area;
    • – It will bend around the ear-lobe, closely following the back of the ear, hidden from view;
    • – It will continue with a horizontal scar that will again be hidden within the scalp. For most of persons, the horizontal scar will be also hidden by the natural fall of the hair.

    Post-surgical Care

    1. After the surgery a gauze bandage in the form of a helmet will be placed to wrap the head and neck. THE EYES WILL NOT BE COVERED. This bandage will be replaced or removed the day following the surgery;
    2. During the following five days, wet gauze compresses with either cold chamomile tea, filtered water or physiological saline solution, will be placed over the eyes a few times during the day;
    3. Depending on the patient, there may be some swelling, red splotches, hipper sensibility around the eyes and on some places on the face. There may be a feeling that the face and neck are taut or tied. These reactions or feelings will vary from patient to patient, nevertheless they form a normal part of the post-operation healing process.
    4. It is important for you to have patience, some patients may show a brief period of “emotional depression”, due to an anxiety to see the end result. Remember that the results from aesthetic surgery of the face should be not judged before a healing period of three months.


    It is possible for us to obtain natural facial rejuvenation results because we do not place excessive traction on the skin to correct the muscular sagging.

    Those procedures that pull the skin excessively or erroneously are responsible for the “fish face” look or results that show obvious plastic surgery.

    Our extensive experience has shown that it is necessary to treat each anatomical layer of the face individually.

    We use a household analogy: Pulling just on the skin is like pulling just on the bed cover while leaving the bed sheets underneath wrinkled.”


    Surgical Results

    They may last over years depending on each person.

    We know that face surgery, neck and eyelids, clearly contribute to the person look younger, but it doesn’t interrupt the natural aging or genetic process, which carries on.



    1. Formation of bruises due to high blood pressure;
    2. Necrosis of the skin on patients who smoke, because of the effect of the nicotine on the walls of the blood vessels;
    3. Injury to the nerve that controls the facial musculature (causing temporary or permanent paralysis) (rare occurrence)

    Personal Observations from the Feminine View

    Front scar

    I take great care in maintaining the front scar (the scar that circles around the front of the ear) within the natural ear folds for minimal visibility.

    Ear Lobe

    When the ear lobes are large, I may slightly reduce their size so that they may be in harmony with the rest of the face.

    I also take care to leave the lobes rounded ad loose. Besides being the natural position for ear rings, attached ear lobes are a sure sign of a plastic surgery of the face.

    Posterior hair line

    Normally there will be a small angled line that is respective to the amount of skin that is removed by traction from the neck. I always try, when possible, to maintain a uniform appearance to the line so that the patient can wear their hair naturally. In other words, if this line were done incorrectly, the hairline in the back of the head could become uneven, looking unpleasant for a woman.


    Contact us for more details…


    Dr. Mariangela Santiago. – CRM 45138 states that this is a spontaneous and illustrative deposition procedure performed after medical consultation and indication of surgery and all medical and laboratory exams required as CFM’s recommendation.

    Even though this one was a successful case, no conclusion can be drawn based on this evidence, moreover, as in any case of plastic surgery, medical consultation with a Plastic Surgeon Specialist is required for making any decisions

    Following the rules of the Brazilian Federal Medical Council, to illustrate the results with photos made before and after procedures is not allowed.

    Dr. Mariângela Freitas Lima Santiago
    CRM-SP 45.138 (São Paulo Regional Medical Council)
    Plastic Surgery - RQE nº 11476 | General Surgery - RQE nº 7678

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