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Serdev Clinic - MC "Aesthetic Surgery, Aesthetic Medicine". Rejuvenation and Beautification Without Scars.

Lip Augmentation – WY or VY plasty


WY plasty and VY plasty are methods for surgical lip augmentation with permanent effect. These outpatient operations increase the volume and pink surface area, without the use of implants. Dr. Nikolay Serdev has modified and improved the procedure in a way that allows for maximum increase, even with thin lips.

Оperative trauma is reduced to minimal. The lips heal fast, within 3-5 days. Hyposensitivity could persist for no more than 2-3 months. This is the only inconvenience of the procedure.

 

About the procedure

During the WY or VY plasty, the surgeon performs various manipulations to create the new look of your lips. The cuts are made from the inside of the mouth, pushing the musculature outward. In this way, the visible pink surface of the lips increases. This method can not only augment, but also to reduce lip volume.

After the permanent lip augmentation procedure, you should cover your lips with ice packs multiple times for the first 48 hours. This will stop any small bleeding and reduce swelling. You must not apply ice after this period, because vessels will contract, tissue regeneration will reduce and thus swelling will augment. We advise against excessive talking, smiling or laughing (i.e. moving and stretching of the lips) for about a week. Swelling is common and usually persists for 7-10 days. During the postoperative period, patients take analgesics to reduce the pain when necessary. They should avoid sunlight and solid foods and use lip care. Possible numbness around the lips will resolve mostly within 4-6 weeks.

For patients who prefer a non-surgical approach, we can offer lip augmentation with implants.

Even though we have no complications, every procedure involves possibility of such. The patient must discuss this with the surgeon prior to undergoing the procedure and so avoid performing actions which may infect the lips.

Read also – Overall beautification of the face Without Scars

 

Proportions of the Lips

Correct aesthetic proportions determine the beauty of the face and lips play a major part. In volume, the mouth should correspond to the volume of the eyes and eyebrows. Excess volume can have a harmful effect on beauty! The upper and lower lips should be equal in volume, juicy, with sexy borderline appearance. VY or WY plasty for surgical lip augmentation is one way of achieving permanently correct volume and proportions.

Most young patients seek lip augmentation as a strive to grace and way to better perceive themselves. For adults it is more important to create volume and block muscle pressure, in order to prevent or stop lip wrinkling, as well as dry and atrophy appearance.

Thin lips are often congenital. However, with age and atrophy of muscles, the lips lose their volume. They become dry and wrinkled, due to perioral muscle activity. In any case, it is important to express the lip contour and increase volume of the lips’ pink mucosa – the so called “kissing surface“.

Patients must be at least 18 years of age.

 

Lip Augmentation – Fillers, Implants, Transplantation


Correct aesthetic proportions determine the beauty of the face and lips play a major part. Their combined volume should correspond to the volume of the eyes and eyebrows. The upper and lower lips should be equal in volume, with sexy borderline appearance. Lip augmentation with fillers, implants or transplantation are some of the ways of achieving correct volume and proportions.

 

Reasons for Lip Augmentation

Most young patients seek lip augmentation as a strive to grace and way to better perceive themselves. For adults it is more important to create volume, in order to prevent or stop lip wrinkling, as well as dry and atrophy appearance.

Thin lips are often congenital. However, with age and atrophy of muscles, the lips lose their volume. They become dry and wrinkled, due to perioral muscle activity. In any case, it is important to express the lip contour and increase volume of the lips’ pink mucosa – the so called “kissing surface“.

Patients must be at least 18 years of age.

Read also – Overall beautification of the face Without Scars

 

Implants, fillers or surgical procedures?

Cosmetic surgery enjoys a variety of methods for lip augmentation: by fillers, by own tissue, implants or surgically – via  WY or VY plasty for permanent augmentation.

When using implants, either temporary or lasting, we can choose between injections or surgical implantation. Injectable implants can have temporary or lasting effect, but we do not recommend the latter.

Patients must be informed that the use of liquid silicone injections is forbidden and pursued by law.

After about two years of using injectable implants, it becomes more expensive than a single permanent operation. In addition, injectables has often led to addiction and abuse in both patients and doctors, with terrible anti-aesthetic results. This, in turn, can ruin people’s image and social life.

 

Surgically placed implants

GORETEX Band

GORETEX Band is used for permanent lip augmentation and anti-wrinkling protection.

This is a brief outpatient surgery under local anesthetic. Placement of the soft-elastic Goretex band along the contour of the lips is intended to prevent lip wrinkling. This is a permitted implantation material, which is used also in vascular and cardiac valvular prostheses. The material has a lip-like consistency and can not be felt when touching or kissing.

This band may be removed at any time and can be placed at any time again using only point punctures that do not leave a scar. The effect of increasing the lip volume is about 2-3 mm - this is the thickness of the band. Additional effect is that of lip juiciness.

This method is very important in early stages of lip wrinkling and is recommended for women over 35. It is also preferred by young women who prefer unobtrusive, but permanent effect with an implant that can be removed at any time, without negatives. With this method the swelling of the lips is invisible and patients can return to work and social life almost immediately.

Silicone Implants for surgical placement

Have similar application as Goretex Band.

Injectable Fillers

Permanent fillers (Lifelong)

Permanent, nonabsorbable injectable fillers should no longer be used, because of late reactions, displacement, and formation of granulations that require surgery.

Patients must know that the use of liquid silicone in the form of injections has been banned in most European countries from the end of XX century. Silicone for intraocular injection for short-term adhesion of retina have low purity and must not be used for permanent (lifelong) aesthetic purposes. All patients with silicone injections are subjected to repeated excisions of the lips. Silicone has one of the smallest molecules and once it has penetrated the tissues, it can never be removed entirely. It cannot be absorbed.

Temporary (up to 6 months)

Temporary injectable fillers are based primarily on hyaluronic acid. There are many products with different densities to fill lips or wrinkles. More permanent preparations are cross linked or double cross linked. The durability of the result, depending on the product, is around 6-12 months.

Fat Transplantation (Fat Graft)

Autologous fat, for the purpose of lip augmentation, is not an implant (foreign body) but a transplant (own tissue). This method does not alsways give the most aesthetic results - the organism's reaction is much more violent, large swelling and redness are present for days. Unfortunately, the result is neither stable, nor uniform. To live, fat cells must be vascularized. Only cells with good contact with the own tissues can receive blood supply. All other cells die and stay in fluid cysts. Thus, the effect decreases and is proven to retain alive maximum 30%-40% of the injected volume. Over-filling does not give aesthetic appearance and better survival. Fat transplantation could need repeated or adjusting procedures. Cysts should be removed.

Surgical Methods With Permanent Efect

WY and VY Plasty

WY and VY plasty is an outpatient operation under local anesthesia. It permanently increases the volume and the pink surface area of the lips, with a very good and stable result. Dr. Serdev’s modified method allows for maximum increase, even with very thin lips, and reduces trauma.

The lips heal fast - for 3-5 days. Hyposensitivity could persist for no more than 2-3 months. This is the only inconvenience of the procedure. This operation should be performed by a qualified cosmetic surgeon. 

You can read detailed information on this method here.

Lip Margin Skin Excision

It gives poor results with visible scars and should be abandoned. 

Scarless Lower Face and Neck SMAS Lift


When is Lower Face and Neck Lift necessary?

Ptosis and laxity of the “subdermal facial mask” (the SMAS) in lower face and neck reflect the signs of overall ageing, including ageing of the lower face. The primary goal of the lower face and neck lift is straightening and repositioning of the subdermal mask (the SMAS/platysma), to which the skin is attached. We thus achieve refreshing the facial appearance, as well as rejuvenation and beautification. The effect of the procedure should correspond to the aesthetic angles, proportions and anatomic position typical for youth.

We use the lower face lift to sculpt the jaw line, define the cervico-mandibular angle and soften the nasolabial and marionette folds. The procedure is necessary mostly in cases of minor and medium jowling, submental laxity and neck wrinkling. It is ideal in cases of beautification, associated with early or medium facial ptosis.

The result is visible immediately after surgery and is durable. Of course, we cannot stop the ageing process, but it will continue from the new, lifted and rejuvenated position.

Read more: Overall face beautification

 

What is SMAS?

Back in 1972, surgeons demonstrated that after classic open approach face lifting the skin is not stable and elongates in minutesSince then, lifting of the Superficial Muscle-Aponeurotic System of the face (SMAS) became the obligatory method for surgical face lift, in order to maintain a long lasting result.

The skin and soft tissue do not drop easily, thanks to their strong fixation to the SMAS. Therefore, if we separate the skinfrom the SMAS, it will age and drop faster, because it will have lost its stable support. As a result, a subsequent SMAS lift will not be able to pull and lift the skinThe consequences of separating the skinfrom the SMAS are a mask-like stretched appearance, changed hairline position behind the ears etc.Naturally, we strongly oppose such this approach.

"What if I have subdermal fat?"

Subdermal and submental fat in the lower face and neck causes square, "bulldog" appearance. Since it is superficial to SMAS and hangs from the skin, we cannot lift it with the SMAS lift. In such cases, a VASER ultrasonic liposculpture may be necessary to achieve the best possible lifting results. We will thus remove the fat depots, prior to or during the lower face and neck lift procedure. In addition, this procedure tightens the skin gradually.

Serdev Suture Method for Lower Face Lift

Thanks to the concept of transcutaneous Serdev Suture lifts, we tighten and elevate the lower face and neck without unnecessary incisions, thus leaving no scars. As explained above, the SMAS holds the skin and soft tissue. Therefore, lifting and fixating it to a higher position enables repositioning of soft tissue structures as well. We carry out the procedure only through skin puncture points, which heal and disappear in 2-3 days. Patients can immediately resume their sоcial life. There might be a tight, "pulling" sensation in the first week after surgery. Every surgical intervention leads to a reactive swelling. However, swelling after Serdev Sutures liftings is minimal and can be covereed by the hair.

We can apply the procedure to patients of almost any age, if there is sagging of the skin and wrinkling of the neck. This lower face lifting method is suible for men as well, because there is no excision of skin and scarring in front or behind the ears.

Cases when Lower Face and Neck lift might not be sufficient

In cases of more pronounced ptosis, the lower face and neck lift might be insufficient to achieve a satisfactory aesthetic result. In these instances, we have to combine it with temporal and mid-face lifts via Serdev Sutures method, in order to pull the skin from these higher levels as well. We will thus reduce sagging in the lower face and diminish the need to lift it. In this way we rejuvenate the entire face.

When we communicate, we look each other in the eyes. Their beautification is not less important than that of the lower face and neck. The correct approach with suture lifts is to start with upper lifting at a younger, as well as at an older age. In this way we open and rejuvenate the eyeslift the edges of the eyes and lips, restore the cheekbones etc. When we do simultaneously upper, mid-face and lower face and neck lift, we always start with the temporal upper lift.

Other areas which must not be overlooked when ageing are brows and cheekones. A cheekbone lift has a greater effect on the nasolabial and marionette folds.

When we begin the beautification process with some necessary lifts at a younger age (35-45 years), the skin and tissues are more elastic. The effect is more stable, with a more youthful appearance. Ageing is slower, with less sagging. Then, after the age of 55, we can add only a few smaller procedures. We will thus maitain the aesthetic result and will not need skin excision lifts. This is why patients must not wait for an overall facial ptosis after the age of 60 and undergo a classic excision lift. 

Thanks to Serdev Suture Lifts, patients maintain natural look, without the "operated on" appearance. This is a major difference in relation to the classic lifting methods. The latter are characterized with separation and excision of the skin from the SMAS. They are performed at an older age and leave scars, unsuitable for young and middle-aged patients.

Patient Testimonial

Lateral Canthus Lifting via Serdev Suture


Lifting the corner of the eye

We perform the lateral canthus lifting without leaving scars, using the Serdev Sutures Lifting method. This specific procedure is useful in cases of low lateral position of the eye or large round eyes, “scleral show” in thyrotoxicosis. These problems could be congenital or acquired with age. They can also be due to surgeries, such as excessive skin excision during blepharoplasty, incorrect facelift or after removal of tumors.

In the case of the first picture below, the patient had an eye tumor removed. This is why the tissues around the eye hang without support. We therefore lifted the lateral canthus (lateral corner) of the eye to a normal position by suture. The eye line is equalised. This allows the surgeon to place an artificial eye bulb, helping the patient to achieve a normal look.

Read also – Brow LiftLiftings of the face

 

Atraumatic Procedure

The suture lifting method of Prof. Dr. Serdev allows for lifting and stable attachment of the lateral canthus (corner) of the eye to the orbit periosteum. There is no cutting and separation of skin. Surgeon and patient plan the angle together. The procedure is performed through skin punctures, under local anesthesia. Thus, we cause no trauma. The result is durable and postoperative recovery is fast. Patients can resume their daily activities within 1-2 days.

 

Cheek Dimples Formation (Smiling Points)


Cheek dimples formation via Serdev Suture method is an easy and simple procedure. It consists of engaging the dermis at the point where the dimple should be located. We do this with the help of a skin puncture point at both ends of the dimple.

We do not cut skin and therefore, we leave no scars. The punctures visibly disappear within 1-2 days. Patients can immediately return to their social life.

The formation of smiling points can be performed as a standalone procedure or as part of cheekbone lift and volumizing and in simultaneous combination with other Serdev techniques.

 

Read more – Creation of chin dimpleOverall Face Beautification Without ScarsCheeks Liposculpturing

Chin Dimple Creation


Chin dimple creation is a scaless procesure, made possible by Dr. Serdev’s Suture method. It consists of attaching dermis to the periosteum (the firm membrane that covers the outer surface of the bones). We do not use implants, only skin puncture points. They are placed on both ends of the dimple, in order to capture the dermis between them. Additional punctures may be needed in case of additional chin enhancement (lifting, volume creation or position correction).

Read more – Cheek dimples creationOverall Face Beautification Without ScarsVASER Liposculpture of Double Chin

The chin dimple creation is an ambulatory procedure, done under local anesthesia. Puncture points heal and disappear in 1-3 days. Return to social life is immediate and the results are durable.

 

chin dimple creation

Chin Dimple Creation – Serdev Sutures method

Ear Pinning Without Incisions.


What is the correct age for ear pinning correction in children?

The best age for protruding ears correction (otoplasty) in children is pre-school age (5-6 years). The procedure is done as prevention from from ridicule from other kids and instilling a complex in a young age. Kids often bully and insult those with protruding ears. This condition is not a physical problem, but can spoil the overall appearance of the face. In very rare cases, patients undergo this procedure at an older age.

Read more – Acne TreatmentMicrodermabrasion

 

What causes protruding ears? How to correct them?

The reason for protruding ears is the absence of the antihelix fold of the ear.

The operative ear pinning treatment (otoplasty) consists in the creation of the missing fold. The procedure may be performed in two ways:

  1. with incision behind the ear and suturing the cartilage in a new position;
  2. using the Serdev Suture Technique, which involves no incision. We suture the cartilage into the new position, creating the folds of the ear with sutures through skin punctures that leave no scars.

In certain patients, when using the first method for otoplasty, we may remove some amount of concha cartilage.

 

After surgery

Usually, a tight bandage (tennis band) would be wrapped around the head to cover both ears. It is warn 24 hours a day for about a month, as it protects the ears against trauma while they heal. We prescribe painkillers for the first few days. Kids can return to school 1-2 days after the procedure, but must be careful not to remove the band and  to protect their ears. Patients must strictly follow our after-care instructions!

 

Permanent Blocking of Glabella Corrugation


Why use the Serdev Suture method instead of Botox for permanent blocking of glabella corrugation? The answer is – because of the durability of the result.

 

Permanent Blocking of Glabella Corrugation

The blocking of glabella corrugation using Serdev Suture method is a transcutaneous, atraumatic, scarless method for permanent blocking the muscles of the forehead between the eyebrows (glabella). The aim is to ligate the muscles, which leads to muscle separation by linear necrosis, thus blocking their ability to contract. The procedure is performed through skin punctures, leaves no scars and does not require hospitalisation.

The postoperative recovery is short, patients can return to their social life on the day after surgery.

Read more – Overall face beautification without scars

 

Botox

Over the years Botulinum toxin (in the form of Botox, Dysport or others) has proven its effectiveness and is the preferred non-surgical method for dealing with wrinkling in the glabellar area. This method avoids traumatic surgery of the face and its disadvantage is its temporary effect and often lifelong use.

We offer both methods, depending on patient’s requirements.

Blepharoplasty


Blepharoplasty is a cosmetic surgical procedure that aims to reshape and rejuvenate rejuvenate the unaesthetic appearance of bulging upper or lower eyelid. It can include removal and/or repositioning excess tissue, muscle and skin. It also reinforces the surrounding muscles and tendons.

With age, the fatty tissue surrounding the eye in the orbital cavity increases. It protrudes under the eyelids and is split in 3 herniations by ligaments.

Patients with a less severe amount of excess skin and those with more elastic skin may still wish to undergo similar transconjunctival procedure for cosmetic reasons, without removal of skin. Lower eyelid blepharoplasty is most commonly performed in elderly patients to improve puffy lower eyelid “bags” and reduce the wrinkling of skin.

The method selection and resulting cosmetic outcome of the procedure depends on multiple factors – the anatomy of the eyelid, patient’s age, skin quality, the bony tissues, and soft tissues which are adjacent to the location, where the blepharoplasty took place.

 

How is it performed?

There are two methdods for surgical blepharoplasty:

1. Through external incisions. Such location may be the creases of the upper lids or below the lashes of the lower lids.

2. From the inside of the eyelid, through the conjunctiva. This method is most often applied when the skin is still elastic and not dropping. The initial swelling and bruising might not be visible, but if present, it takes one to two weeks to disappear.

3. When there is only an upper eyelid sagging, in most cases we first do an eyebrow lift using Serdev Suture lifting technique. This is the most effective method, which eliminates the lateral sagging of the eye (as in the first image below). Thus, we postpone blepharoplasty with many years. Furthermore, if we first perform eyelid correction, it lowers the position of the eyebrows, which have already dropped at an elderly age. In case we first do a blepharoplasty, a subsequent brow lift often cannot be performed properly. This is because the excessive skin excision will not allow full closure of the eyelids, due to their initial shortening. In such cases, the eye gets dry and suffers.

 

Possible complications

There are factors known to cause complications after blepharoplasty. Failure to recognize their existance before surgery may result in undesired outcomes. Such factors are:

– Pre-existing dry eyes. Possible disruption of the natural tear film may worsen this condition after surgery;
Laxity (looseness) of the lower lid margin (edge), which causes dryness and consequences for the eye health.

 

Asian blepharoplasty

Upper blepharoplasty in Asian patients is termed Asian blepharoplasty or "double eyelid surgery". It is the most popular form of cosmetic surgery among those of East and Southeast Asian background, due to anatomical differences between the Asian and Caucasians. Asians are mostly born without a supratarsal eyelid crease and blepharoplasty can be used to artificially create a such crease above the eye. Another most common congenital lid condition in Asians is the epicantal fold - a semi-lunar fold of skin at medial canthus, which is operated using different techniqies of Z-plasty

Transconjunctival blepharoplasty

Transconjunctival blepharoplasty can be applied when there is no excess skin and there is prerserved skin elasticity. It involves removing lower eyelid fat through an incision on the back of the eyelid, eliminating the need for an external incision. Since there is no external incision, excess skin can not be removed during the surgery, but skin resurfacing with a chemical peel or carbon dioxide laser may be performed simultaneously. This allows for a faster recovery process.

 

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