Dallas Plastic Surgery Institute (DPSI) 2013

 Dallas Plastic Surgery Institute (DPSI) 2013

This is an original article written by Dr. Minhee Ryu from RNWOOD Plastic Surgery in Seoul, South Korea, translated in English for convenience: 

The Dallas Plastic Surgery Institute (DPSI) is one of the leading centers for aesthetic surgery in the United States, renowned for its faculty from the University of Texas Southwestern Medical Center. During a visit facilitated by Dr. Suzie Chang, Dr. Minhee Ryu observed the work of esteemed surgeons including Dr. Steve Byrd and Dr. Jay Burns, both pioneers in facial rejuvenation techniques. 

Dr. Byrd emphasized endoscopic facelifts that achieve natural, lasting results through minimal incisions and precise anatomical dissection, while Dr. Burns demonstrated the integration of facelift surgery with laser resurfacing for comprehensive facial harmony. This experience reinforced the importance of combining multiple modalities—lifting, fat grafting, and skin rejuvenation—to achieve balanced, patient-centered results, inspiring Dr. Ryu’s continued development of the “Hybrid Facial Rejuvenation” approach.

Please enjoy the full article below:

Dallas Plastic Surgery Institute (DPSI), the leading institution in plastic surgery in the United States, is a clinic where professors of plastic surgery from the University of Texas Southwestern Medical Center (UTSW) mainly provide treatments for cosmetic patients.  With the help of Dr. Suzie Chang, a Korean-American currently serving as a professor of plastic surgery at UTSW, I was able to receive the opportunity to visit this clinic. Esteemed surgeons such as Dr. Fritz Barton, Dr. Steve Byrd, and Dr. Rod Rohrich, have made significant contributions to the advancement of plastic surgery in the United States, particularly in the fields of facelift and rhinoplasty.

While building my experience, Dr. Steve Byrd left a lasting impression on me. He is somebody who has presented in numerous academic conferences and published significant academic papers in the field of facelifts and rhinoplasty, and was known as the pioneer of “Septal Extension Graft.”

Dr. Byrd emphasized on the importance of balance and harmony of the face as a whole when treating aging symptoms rather than as individual procedures. For example, in cases where patients show somewhat of the symptoms of aging, facelifts can be done. However, even though the middle-to-lower areas of the face may show improvements, the upper areas and sagging eyelids will consequently lead to an overall disharmony in facial appearance. Thus, for cases in which patients show significant aging, he strongly recommends patients to consider the planning for an overall harmonious result.

Following that concept, the most impressionable patient that Dr.Byrd described has had an endoscopic forehead lift, midface lift, lower face and neck lift, submentoplasty, upper and lower blepharoplasty, and fat graft. She was the younger sister of someone who knew one of the plastic surgeons who worked at DPSI four years ago. The plastic surgeon mentioned above left due to a chronic illness, but I was able to greet him and directly hear about his situation at the lobby. Despite being a visiting trainee from abroad, I received warm encouragement and insightful guidance from him. It was also evident how deeply his fellow physicians trusted and respected Dr. Steve Byrd.

When I observe Dr.Byrd’s surgery, the only word I can think of is “Elegant”. He minimizes incisions yet still applies adequate dissections, ultimately pursuing fast recovery and fundamental improvement. It may seem contradictory that having less incisions ask for wider dissections, the main point of the idea lies in the freedom and flexibility of the endoscopy. In endoscopic forehead and midface lifts, retaining ligament release and secure fixation (both essential for fundamental improvement) were meticulously performed. Such a refined surgical approach is only possible with a deep understanding of facial anatomy and extensive experience with each specific technique.

It is impossible to be unable to properly dissect the retaining ligaments despite using just an endoscope, but it is common to encounter advertisements claiming successful outcomes through the use of specific materials, such as Endotine. However, it is important to recognize that the fundamental principle of such procedures is thorough dissection of the intended lifting area; the outcome is not determined solely by the fixation materials used. 

The biggest reason Dr.Byrd’s surgeries felt elegant was because he was able to minimize incisions yet be fully able to do all the necessary dissections with ease, showing long-lasting and fundamental improvements. Furthermore, in order to provide more satisfactory results, fat grafts using one’s own tissue during facelifts can be done. 

Another respected scholar includes Dr. Jay Burns. Using the same concept of overall facial improvement, he used the Laser Skin Resurfacing technique for facelifts, neck lifts, submentoplasty and upper blepharoplasty. He would use the High SMAS technique during his surgeries, which provides an advantage of lifting the midface, lower face and neck all together. Additionally, this method is effective in areas that are difficult to dissect, such as the nasolabial folds and marionette lines. This method fundamentally improves 

Dr. Jay Burns’ surgery was also impressive. Similarly, to achieve overall facial harmony, he performed a mid- and lower facelift, neck lift, submentoplasty (double chin surgery), upper blepharoplasty (eyelid surgery), and laser skin resurfacing.

He performed the procedure using a technique called the High SMAS Facelift, which he frequently uses. The advantage of this method is that it allows comprehensive lifting of the midface, lower face, and neck. It is also effective for improving nasolabial folds (smile lines) and marionette lines (lines around the mouth), which are typically difficult to correct.

This approach aims for fundamental improvement by sufficiently releasing each of the retaining ligaments, which is why such satisfactory results can be achieved.

Moreover, he simultaneously simulated the improvement of skin aging–one of the effects of facial aging. In general, there are various resurfacing methods ranging from chemical peeling to mechanical dermabrasion and laser resurfacing. Dr. Burns primarily uses lasers, particularly milder ones such as Fraxel and the Er:YAG (Erbium YAG) laser. In truth, Western patients generally have a much lower risk of post-procedure hyperpigmentation compared to Asian patients, so they tend to prefer more aggressive resurfacing treatments. However, Dr. Burns stated that he has achieved safe and effective results by using milder lasers multiple times.

He has been performing treatments in this manner for a long time and mentioned that he has never encountered any complications, with consistently satisfying outcomes. He strongly encouraged me to try this approach when I return to Korea. I was impressed by his careful and patient-centered approach, even if it takes more time and effort.

In addition, I had a great time exchanging thoughts on our areas of interest with Dr. Kailash, the chief resident in plastic surgery at UTSW.

Typical signs of facial aging include sagging of facial tissues, loss of volume, and skin aging. Common approaches to address these issues include facelift surgery, autologous fat grafting, fillers, Botox, and skin resurfacing. Generally, these methods are performed individually. Most prominently in the late 30s—when the signs of aging are just beginning to appear—even slight improvements with individual treatments can provide satisfying and natural-looking results. However, by the late 40s, when aging becomes more noticeable, I believe that a combined and integrative approach using multiple modalities tends to yield the most satisfactory outcomes.

Therefore, I have developed and actively performed a method called “Hybrid Facial Rejuvenation,” which combines overall facial lifting with autologous fat grafting and skin resurfacing in a single procedure. This approach is part of my ongoing effort to help patients regain a graceful, youthful appearance.

During my experience here, I observed that many of the world-renowned experts in facial rejuvenation also emphasize facial harmony and take an integrated approach by combining various techniques—aligning closely with the concept I pursue. Additionally, I believe that while it is essential to fully understand and freely apply surgical anatomy and facial rejuvenation techniques developed primarily for Western patients, it is now equally important to deeply consider the unique characteristics of East Asian patients. It is time to define the most appropriate theories and surgical techniques specifically tailored to them.

I would also like to express my sincere respect and gratitude to the masters who willingly shared their surgical techniques—techniques that are often the result of their passion and years of intense dedication—and generously offered their guidance. Lately, I have come to deeply realize that regardless of the purpose, openly demonstrating and teaching one’s surgical methods is only possible when there is genuine care and consideration for others.

Dr. Byrd’s surgery was a highly advanced procedure that demonstrated how proper release of the retaining ligaments—essential for fundamental and long-lasting improvement—can be effectively achieved using an endoscopic approach, rather than the traditional surgical route. I believe this technique offers many advantages, particularly for patients with less advanced aging or those who need a quicker recovery. I was also impressed by Dr. Burns’ careful approach of combining facelift surgery—aimed at fundamental correction—with laser resurfacing. It appears to be a stable and adaptable method that could be safely applied to East Asian patients as well.

Observing these masters of facial rejuvenation embrace the concept of integration and tailor their techniques to each patient reinforced my belief that the “Hybrid Facial Rejuvenation” I am currently developing is well aligned with global paradigms. 

It was a meaningful experience that reminded me: while there may be many paths toward the best possible outcome, the core essence we pursue remains the same.

Dr. Minhee Ryu, M.D.

RNWOOD Plastic Surgery

Seoul, South Korea

(Source: https://blog.naver.com/rejuvemaster )

Dr. Minhee Ryu is a World-Class FACELIFT Specialist and Global Educator, who is deeply committed to sharing his facial rejuvenation surgery and anatomy expertise. As a lecturer, tutor, and demonstrator, he is invited to deliver DEEP PLANE FACELIFT presentations and perform live surgery and cadaver dissection Demonstrations in more than 15 countries, including Korea, the US, Europe, Singapore, Australia, Japan, and beyond.

Recognized worldwide for his expertise in DEEP PLANE FACELIFT, Dr. Ryu is a Faculty Member at MAFAC since 2016, a guest Faculty Member at Mayo Clinic since 2023, and an Editorial Board Member for the Aesthetic Plastic Surgery Journal (SCI) since 2019. He is an active member of KSPRS, ASPS, ASAPS, and ISAPS. As a global top-tier leader in Facelifts, Dr. Minhee Ryu makes dedicated contributions to academic advancement and surgical education.

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