WHAT IS DONE: Many people use less appropriate procedures and tools in reconstructive surgery, which can lead to suboptimal results and complications such as larger incisions and the development of noticeable scars, thus delaying the recovery process. WHAT I DO: I use techniques adapted to each patient, reducing incisions and being minimally invasive, which allows for precision in the procedure and speeding up the recovery process by significantly reducing scarring. I work with a team of professionals from different areas and use the latest technology available. The start of postoperative rehabilitation varies according to the individual needs of each patient, which helps to obtain optimal results and a more comfortable recovery.

WHAT IS DONE: A certain amount of skin is removed above the pubis, often not reaching the navel, which in plastic surgery is called a panniculectomy. WHAT I DO: I make an incision from side to side of the hip in the shape of a bicycle handlebar, lifting the skin in a triangular shape up to the xiphoid (pit of the stomach) exposing all the abdominal muscles. Next, I proceed to make a corset of the rectus abdominis muscles, that is, to join them to the midline (muscles of the quadriceps) which flattens and girdles the patient. Next, all the skin below the navel is removed, which is the one that contains the greatest amount of fat and stretch marks. Finally, the wound is closed with hidden and absorbable sutures and a new hole is made to remove the navel and special drains are left.

WHAT IS DONE: There are 3 incisions to place the breast implants: the axillary route, the periareolar route and the mammary fold route. There are 3 planes to place the implants: the submammary plane, which is preferred by most, including new specialists, the subfacial plane, which is a small, thin layer that covers the muscle, and the submuscular plane. Some companies offer variations regarding the volume, height and width of the implants, but this is discussed with each patient. WHAT I DO: In 30 years of experience, my access route to place the implants is in the submammary fold and my second option is periareolar. I do not use the axillary route very much because it is a bit painful for patients and the implants tend to move. I place the implants in the submuscular plane following the Tebbetts Technique, that is, Dual Plane, with part of the implant under the muscle and part of the implant under the breast. The advantages of this technique are that punctures can be made and biopsies can be taken, it makes the radiologist's job easier when interpreting X-rays and ultrasounds, it reduces the possibility of capsular contracture and there is no enlargement of the pocket, which means that the breast remains elevated for as long as possible. In my surgical practice, the implant is chosen by the patients and their partners using a series of testers.

WHAT IS DONE: Most surgeons use the Wise Pattern and a pyramid-shaped flap of tissue underneath called the Inferior Pyramidal Pedicle. WHAT I DO: I use different dimensions of the Wise Pattern and depending on the size and sagging of the breast I can use an upper pedicle (upper flap of tissue coming from above), a lateral or oblique pedicle, and if the breast is very large I use an inferior pyramidal pedicle, all with hidden and absorbable sutures.

WHAT IS DONE: Most surgeons and non-surgeons use an inverted T or an anchor on any patient with any degree of droop from the beginning without knowing that there are other alternatives depending on the degree of droop, according to the Renault Classification. WHAT I DO: I work according to the Renault Classification and may or may not have an implant. If it is a grade one droop, it will inevitably require an implant. The removal of excess skin is done with a donut around the areola and then some purse-string sutures are placed to give a peri-areolar scar. If the droop is grade two, what I do is a common variant (gulyas) surgery. The implant is placed in the sub-muscular plane via a peri-areolar route and the suture is closed so as not to have to continue exposing the implant. Then, a skin removal is done with a donut around the areola and with a V at the bottom, which results in a peri-areolar scar and a vertical scar. If it is a grade three droop, we do a Wise Pattern, which can be done with or without an implant. In this case, a portion of skin is removed around the areola with two lines that move away from the circle imitating a keyhole. The result will be an inverted T or an anchor with the breast raised and sutured with hidden absorbable threads.

WHAT IS DONE: Nowadays, many patients who reach a certain age are tired of having to undergo surgery every 10 years or because they no longer want to have implants for whatever reason, and decide to remove them. What is done is simply to remove the implants and leave the deformity of the stretched tissue. WHAT I DO: We remove the implants, use the Wise Pattern and with the same tissue we form a moderate-sized breast. In addition, if necessary, we perform liposuction and with the patient's own fat we give more volume to the breast.

WHAT IS DONE: Some people only glue the skin to the back of the head skin, or only make the ear fold. WHAT I DO: I use the Mustardee Techniques, that is, make the ear fold from the back and furnas, that is, reduce the height of the ear (shell).

WHAT IS DONE: The septumplasty and turbinates are done separately and then the rhinoplasty is done. The rhino-septumplasty is done by a single specialist, whether an ENT specialist or a plastic surgeon. WHAT I DO: I can do open or closed rhinoplasty, reduction or augmentation, with either your own or artificial tissue, and it is always done in conjunction with an ENT specialist. The idea is to make the nose look good aesthetically and functionally. I do not do rhinoplasty.

WHAT IS DONE: The offer by different means is to remove only skin on the upper eyelid or only skin on the lower eyelid without considering the anatomical structures of the eyelid. WHAT I DO: In the upper eyelid, starting from the crease, we remove an ellipse of skin and muscle to deepen the groove, in addition we remove all the excess of the two bags that are in that eyelid. In the lower eyelid we remove 3 millimeters of skin and muscle and the excess of the 3 bags that are in that eyelid, only if the patient is very thin we push them and reconstruct the wall. In very young patients without excess skin, a transconjunctival blepharoplasty can be done, that is, removing the bags of the lower eyelid from the inside of the eye. If required, we can remove a tarsal triangle, a tarsal strip, we can treat ectropion “eyelid outwards” and entropion “eyelid inwards” and many other eyelid conditions as a reconstructive surgeon.

WHAT IS DONE: Most surgeons are still stuck in old techniques where very large incisions were made from the front of the hair, continuing to the edge of the ear and crossing, leaving a stigma scar until reaching the hair on the nape of the neck. Large detachments were made with the risk of damaging nerves and vessels and increasing complications. WHAT I DO: I use the MACs Lift Technique which has short incisions that go from the sideburn to the earlobe. The detachment of the cheek is minimal because the muscles are raised with three tobacco-shaped sutures that pull them up. This surgery has reduced the surgical time by half.

WHAT IS DONE: Placing the implants in the subcutaneous plane, in the subfacial plane or very deep in the muscle, which produces unnatural results. WHAT I DO: I place the implants designed by Dr. Vergara, a Mexican who dedicated his life to this surgery. A double, almost invisible incision is used in the gluteal groove and through this means the gluteus maximus muscle is accessed, under which the implants will be placed, giving a very natural result.

WHAT IS DONE: Medpor or silicone implants can be placed, they can be placed through the eyelids, upper mouth or through a rhytidectomy incision. WHAT I DO: I do not place Medpor implants and my preferred access is the eyelids, which I use to fix them with two microplate screws.

WHAT IS DONE: Silicone and Medpor implants can be used, they can be placed orally and under the chin. WHAT I DO: I use only silicone implants and place the implants orally in a 2 cm incision in the lower lip.

WHAT IS DONE: Large wounds are sutured with chromic acid or threads are placed. WHAT I DO: Wounds measuring half a centimetre and no sutures are placed so as not to injure the salivary duct. We sedate the patient.

WHAT IS DONE: Using toxins from different countries with questionable permits, high dilutions. WHAT I DO: I only use original Botox® and only use half or one bottle for a full face.

WHAT IS DONE: Multiple questionable and short-lasting brands are used. WHAT I DO: I do not use Restylane because it has no antidote. I only use Juvederm, which is from the same company as Allergan as Botox®.

WHAT IS DONE: Do them with local anesthesia and with the patient awake. WHAT I DO: I take the patient to the operating room and then perform neck liposuction with microair.