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introduction

It is all about the concept and the underlying philosophy.

Why do you at a certain moment in time, stop with one technique? You may have been trained or thought a certain concept or technique and you have been performing the procedure for many years even decades. But what if the end results still not enough to meet the demands and expectations of your patients? What if I tell you that there are other modalities available that you could and should employ?

Think Cause Based.

aging face of a woman - drStevens

1.2.3.D illustration - drStevens

So before we elaborate on using living (fat) cells and intercellular signaling substances as Organic Surgical Medical Care modalities, as I like to call them, let me explain about the 1.2.3.Dimensional Concept first.

guarantee

To give you a garantee on post-treatment outcome is difficult.

Every case is different: the wish, expectation, demands, patient history .. treatment options ..

My way to do give you the best possible garantuee on a successful treatment is by being transparant about my previous results by having them assessed by independant colleagues, clinical and research fellows in particular and subsequently presenting about it scientific papers in peer-reviewed journals.

Over the last 30 years, we have now published over 40 publications and presented these data on over 80 (inter)national congresses and meetings.
Recently I have published the know-how that we gathered over the years in an eBook for medical professionals on How to Do It Yourself - a Handbook on Organic Surgery.

And in also this eBook the 1.2.3.Dimensional Concept and Organic Surgery are exactly what we talk about !

the 3 dimensions

The 1.2.3.Dimensional Concept stands for 3 sets of vectors and are all cause based.

In this concept there are 3 possible causes for facial ageing only. Quite simple, but not more simple than this at the same time. 
Treating one cause only will noty treat the other two, clearly.
Treating the wrong cause will not result in a beautiful well balanced face either.

1D cause and treatment

1D cause and treatment | Organic Surgery

1-Dimensionally
When gravity is pulling vertically downwards only, then any surgical transposition of tissue should be done vertically upwards. And perhaps an even more important caveat: to reposition only when there is any ptosis in the first place.

2D cause and treatment

2D cause and treatment | Organic Surgery

2 Dimensionally: 
The outside layer on top of your face is in this concept the skin as if it is a 2.Dimensional structure.
We all know, skin quality changes and deteriorates with aging: fine superficial wrinkels, dark spots, thining, loss of elascticty. In my surgical practice I felt the need to take this aspect more seriously in stead of ignoring the importance of treating skin issues, as if they were not the domain of the cosmetic plastic surgeon him/herself. Obviously my approach had to be ‘Cause Based’. With this understanding, I started looking for regenerative techniques on a cellular level.

3D cause and treatment

3D cause and treatment | Organic Surgery

3 Dimensionally;

Only in the last decade or so it has become widely accepted that aging also has a volume and contour related aspect. I would like to refer to this as implosion asking for a cause based treatment that has an explosive aspect (going inside out in 3 dimensions); deep lipofilling (with hypodens micro fat particles) and a curved cannula has my preference for over 9 years now and I will gladly share technical tips and tricks on how to do this yourself.; creating a vitality spot, performing 3D-meshing of the nasolabial fold, etc.

1D

The aging process of the face has been subject for discussion and debate for ages. Wise men have published their thorough analysis and opinions but felt they had to retract and change their first opinion soon thereafter.

One colleague in particular inspired me personally. I had the privilege to be in the audience and listen to Dr. Sam Hamra who was invited in 2001 to the Annual meeting of our Dutch Society of Aesthetic Plastic Surgery in Amsterdam. He shared this wonderful story of his wife and him dining in Dallas when an obviously face-lifted woman entered the restaurant. His wife whispered: ‘who on earth was she operated by?”. And yes he admitted it had been himself. The face looked unnatural, distorted and plastic. After reviewing all his results subsequently, he realized the vector had been wrong, all the time.

In 1995 this same man published a new paper stating that in the midface the vector had to be changed: no longer horizontal but vertical ! Putting it back were it belonged, vertically upward against gravtity, back to its natural position. 

Hamra ST, Plastic & Reconstructive Surgery 1999 (104)1:298-9; Frequent face lift sequelae: hollow eyes and the lateral sweep: cause and repair.

example of ptosis and lifting (1D)

When the component of ptosis is dominant in the process of the ageing face, then only lifting is necessary. 
In this case lifting of the forehead, a blepharoplasty and a short scar facelifting was performed.
A natural apearance was the obtained with treating ptosis only because skin quality (2D) and volume and contour (3D) were still adequate and did not need to be treated.

Example of 1.D concept by drStevens - Organic Surgery

2D

As depicted above, the supericial layer on top of you face, your skin can be considered a two dimensional structure that can be approached from inside-out and from outside in. If I would take you trough these options we have nowadays it becomes clear there are different treatment modalities that can support each other. Also this insight allows for a more personalised approach. Depending on your wishes and expectations less or more extensive treatments can be offered.

2D inside out

2D inside out | Organic Surgery

Today, I prefer superficial micro fat grafting with a curved cannula, putting hyperdense fat in a thin layer to the inside of the skin of the face (inside-out), adding Platelet Rich Plasma (PRP).

examples of treating skin damage (2D) inside-out only

example 1
a 48 year old woman, aged skin with superficial damage
Looking for improvement with the risk looking 'artificial'.

Example lipofilling face by drStevens - Organic Surgery1 week after superficial lipofiling with PRP: one week post treatment, looking good enough to resume social activities with just some camouflaging skin products on.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Example lipofilling face by drStevens - Organic Surgery4 months after the treatment: no make-up, clearly a more smooth radiatant skin, less hyper pigmentation, less fine wrinkles. Also deeper grooves around the mouth are less deep and less long. The curve towards the outer upper part of the cheek bones is improved, nicely accentuating the 'vitality spot'.

 

 

 

 

 

 

 

 

 

 

 

 

 

example 2
A 50 year old mother and her daughter  

The ideal most confronting comparison is putting the skin of a mother next to that of her daughter.
In particular when look much alike.
It will demonstrate whether your technique really brings back a natural appearance and to waht extent time can be reversed.
These pictures clearly demonstrate that the concept of Organic Surgery deserves further investigation.
Using your own living cells to restore volume and contour and regenerating skin damage, using also the intercellualr signaling substances to optimise this process: it seems truly possible ! Currently prospective randomised clinical trials are being conducted to determine to what extent this assumption is really true. 

Example 2.D concept by drStevens - Organic Surgery

Compare first the skin of the mother, pre versus post treatment.

  • reduced redness, less damaged superficial skin vessels (rosarea)
  • reduced fine wrinles (2D-effect)
  • improved continutation of nasolabial fold into the midface (3D-effect)
  • improved curve and contour to the latteral outer part of the cheek bones (vitality spot) (3D-effect)

Example 2.D concept by drStevens - Organic Surgery

Even more clearly, when the pictures of the skin of the mother are placed right next to those of her daughter.

example 3
A 36 year old woman feeling disturbed about her skin quality, being to textured with deeper lines.

Example 2.D concept by drStevens - Organic Surgery

  • pre-treatment detail of the skin
  • sun damaged skin
  • superficial redness
  • deeper line

 

 

 

 

 

 

 





 

 

 

Example 2.D concept by drStevens - Organic Surgery

  • after one treatent
  • one layer of superficial lipofilling, placed inside-out will give a certain amount of improvement

 

 

 




 

 

 

 

Example 2.D concept by drStevens - Organic Surgery

a second layer brought clearly more improvemenst

  • less fine wrinkles
  • more radiant skin, smoother
  • less redness, less superficial vessels damage
  • improved contour from midface into lower eyelid
  • 100% Organic Surgery

2D outside in

2D outside in | Organic Surgery

Further tightening and color improvement improvement is accomplished by  a 30% TCA-peeling (outside-in).

examples of treating skin damage (2D) outside-in also

example 1

A 66 year old woman with a lot of fine wrinkles on the outise of her face.  

Deeper filling only will never do the works. Even superficial lipofilling only will give a limited result. By adding an outside-in treatment, TCA-peeling, a whole new level of results could be achieved. 

Example 2.D concept by drStevens - Organic Surgery

Also a lot of the dark spots could be treated by this approach. TCA peeling will make skin lighter, smoother and more equal in color.
In particular the combination with the inside-out treatment, simultaneously, to the best of my knowledge, is reducing the risk attached to TCA-peelings as a stand alone treatment considerably. 

Example 2.D concept by drStevens - Organic Surgery

In the more than 400 cases of this combi treatment sofar prolonged redness of more than just a couple of weeks only occurred 2 times. Previously the risk for such akward sequelae could be easily over 20-30% of all cases.

Example 2.D concept by drStevens - Organic Surgery

 

2DDR

2DDR | Organic Surgery

Most recent activities focus on investigating whether increasing the concentration of Regenerative Cells (RCs) by using (Stromal Vascular FractionSVF will further ameliorate clinical outcomes. The SVF is now made available by mechanical dissociation and can be applied by injection transcutaneously. Preliminary results suggest adding SVF will further improve skin regeneration. Current results in my practice reach a complete new level, which I was never able to obtain before.

examples of treating skin damage (2DDR) adding more Repair Cells

Currently we are also investigating the effect of adding extra Repair Cells to the lipofilling +/- TCA peeling for possibly improving skin quality even more.

These pictures relate to the treatment where inside-out lipofilling + PRP was performed together with outside-in a 30% TCA peel and subsequently extra Repair Cells (previously called stem cells, now referred to as the Stromal Vascular Fraction of your adipose tissue or SVF or in short: the Stroma).

The combination of PRP + SVF is baptised PRS or Platelet Rich Stroma.

portis wrinkles PRS by drStevens - Organic Surgery

Objective computer analysis of ultra high photography is used to quantify results (VISIA, Canfield). Fine wrinkels can be measured for length and deepness. Here improvement is over 50% !

postis wrinkles prs tca by drStevens - Organic Surgery

The same for Ultra Violet spots representing photo skin damage.

portis mottle by drStevens - Organic Surgery

An other case reconfirming that the improvement of skin quality is really possible these days.

Results wrinkles by drStevens - Organic Surgery

If we let the computer program score the wrinkles ..

Results wrinkles by drStevens - Organic Surgery

results aprear impressive ! Even deeper damage to superficial blood vessels seems less. Please note more research is needed to fully understand all this new insight.

Results mottle by drStevens - Organic Surgery

In combination with the TCA peel the skin texture or smoothness is increased siginificantly.

Results texture by drStevens - Organic Surgery


examples of repair of tissue damage by lipofilling and it regenerative cells

Scars face woman- Organic Surgery

Two treatments of 3cc of lipofiling each time improved not only the loss of volme under this scar but also the skin quality.
A third treatment was not asked for as she was already satisfied by the results, more could have been achieved if more repair cells woudl have been added ?!

Tarsal tuck by drStevens - Organic Surgery

Scleral show refers to too much white of the sclera under the iris of the eye. In this case after overresection of skin after a lower eyelid correction elsewhere. 
Tarsal-tuck refers to the vertical repositioning (1D) and lipofilling was used to give back 3D support and a better curvature of the midface.
The results after one session only is presented here and turned the face into a much more healthy overall appearance instantly.

In short:

'Injectables, crèmes, thermage, mesotherapy, etc. They only work if the work' and if .. well they do not.
What do you think yourself ? Will they really repair on a cellualr level? Will they really address ptosis (which is a 1D issue as you now understand) ?
Feel welome to have your specific whishes and demands be analysed at a personal consultation and make your appointment here.

3D

3D | Organic Surgery

 Only in the last decade or so it has become widely accepted that aging also has a volume and contour related aspect. I would like to refer to this as implosion asking for a cause based treatment that has an explosive aspect (going inside out in 3 dimensions); deep lipofilling (with hypodens micro fat particles) and a curved cannula has my preference for over 9 years now and I will gladly share technical tips and tricks on how to do this yourself.; creating a vitality spot, performing 3D-meshing of the nasolabial fold, etc.

examples of loss of volume and 3D filling

example 1

A young woman with more loss of volume and subsequent hollowness in her face than desirable.
No ptosis, so no need to lift. 
No important loss of skin quality, so no need to do an extensive 2DDR treatment with a TCA peel.

Obvioulsy (now ?) one uses autologeous adipose tissue to give back what was once there: a natural fullness and better curve in her face from jawline to midface, from cheeks to vitality spot to temps.

Example 3.D concept by drStevens - Organic Surgery

Example 3.D concept by drStevens - Organic Surgery

Example 3.D concept by drStevens - Organic Surgery

Pictures after one year of treatment show stable results, even after one session of full face lipofiling.

all together

Normal aging in all three dimensions asks for treatment in all these three dimensions

When as well ptosis as loss of volume as loss of skin quality occur, obviously all three deserve a cause based treatment, preferrably all in the same session. 

3d concept by drStevens 22 vs 58 year woman - Organic Surgery

On the left: at 22 years of age; at the right, preoperatively at 58 years of age (and yes she looked much older).

Example 1.2.3.D concept by drStevens - Organic Surgery

Example 1.2.3.D concept by drStevens - Organic Surgery

Example 1.2.3.D concept by drStevens - Organic Surgery

One year post treatment: a facelifting (1D), restoration of volume and contour (3D) and improvement of skin quality (2D).

Another example demonstrating that combining these insights is the key to success and a non operated look;

Jaqueline lost 80kg af wheigt,

  • 1D: full face rhytidectomy, lower blepharoplasty, tarsal tuck  
  • 2D: superficial lipofilling + PRP
  • 3D: deep lipofilling

Example 1.2.3.D concept by drStevens - Organic Surgery

Example 1.2.3.D concept by drStevens - Organic Surgery

Another examples of restoring the balance in the face when ageing in all three dimensions in a natural way.

Example 1.2.3.D concept by drStevens - Organic Surgery

Check the video above and learn more about regeneration and its potential or make a booking for a personal advice.

media

To relive the moment procedures like these we shown on Dutch TV for the first time, click one of these videos. 

FAQ

What do procedure like these cost?
In general facelifting procedures and lipofilling of the face will not be re-imbursed by your insurence compagnies.
Here you will find prices per procedure
NB: all figures mentioned are indications and a personal advice should be obtained first during a personal consulation.

What is the average waiting tine before a procedure can be performed? 
After receival of your confirmation, usually, the procedure can be performed within 4 to 6 weeks thereafter.
If you are a smoker, preferably, you should stop smoking at least 6 weeks prior to the intervention. 

What can I expect from the result?
Obviously your surgeon and his team will perfrom to the best of their knowledge an experience. 
The procedures reffered to above, are part of a 18+ year experience in the field of cosmetic plastic surgery.
Results have become very predictably despite individual differences between clients.

The plan fitted to your personal situation will be made in a privite setting and with abundant time to really make it optimal for you and your wishes and expectations. 

Is the result everlasting?
The ageing process continous also after surgery. Our experience is that a natural well balanced way of ageing will make you confident and happy withi your body for many years after the procedure. 
At the same time it not uncommon that 5-10 years after the initial procedure new or extra procedures are considerd to allow for this well balanced natural way of ageing, in every 1D, 2D and 3D aspects of the changing face.