Visiting Dr. Sam Hamra: Dallas Baylor Medical Center 2013
Visiting Dr. Sam Hamra:
Dallas Baylor Medical Center 2013
This is an original article written by Dr. Minhee Ryu from RNWOOD Plastic Surgery in Seoul, South Korea, translated in English for convenience:
Dr. Minhee Ryu’s visit to Dallas Baylor Medical Center in 2013 was driven by a desire to learn directly from Dr. Sam Hamra, a pioneer in facelift surgery and the originator of the SMAS, Deep Plane, and Composite Facelift techniques. Dr. Hamra’s philosophy centers on achieving full facial harmony through fundamental dissection and comprehensive rejuvenation, emphasizing that lasting results require thorough anatomical correction rather than minimal or superficial methods. His revolutionary “under-eye fat repositioning” technique in lower blepharoplasty reshaped global standards by preserving and redistributing fat for natural results.
Observing his precise, efficient, and harmonious surgical approach left a profound impression on Dr. Ryu, reinforcing the belief that mastery in facial rejuvenation stems from deep anatomical understanding, technical excellence, and sincere dedication to patient-centered artistry.
Please enjoy the full article below:
The reason I came to Baylor Medical Center in Dallas for my internship was to experience Dr. Sam Hamra's philosophy firsthand.
Dr. Hamra completed his internship at NYU (New York University), the world's mecca for plastic surgery in the 70s, and was the first in the United States to present the SMAS (straight muscle layer inside the skin). He then developed it into a method called the Nasolabial Fold Deep Plane Facelift in 1990 and presented the composite face lift as a full-face method in 1992.
The methods he presented were based on sufficient peeling of the facial ligaments (retaining ligaments) for fundamental improvement, and they have established themselves as a legend in the field of facelifts due to their excellent and amazing surgical results.
In 1995, he presented the surgery on “under-eye fat repositioning” in Lower Blepharoplasty, which is widely known to the general public.
In the past, the most common way to solve the problem of bulging fat under the eyes was to remove it. This would improve the bulging, but it would also reduce the volume, causing the area around the eyes to look hollow. His “Lower eye fat repositioning" method preserved the fat under the eyes while filling in areas that looked sunken, such as tear ducts, which resulted in excellent results. Although it is commonly performed now, this was a revolutionary method that went beyond conventional wisdom, and I think his achievements in first inventing this and changing the paradigm of lower eyelid surgery are worthy of respect.
(Choucair RJ, Hamra ST. Extended Superficial Musculoaponeurotic System Dissection and Composite Rhytidectomy. Clin Plastic Surg 35 (2008) 607–622)
The phrase that best reflects Dr. Hamra’s philosophy regarding facial wrinkle correction is “The composite facelift is my contribution to facial harmony.”Ultimately, facial aging occurs as a whole, so it is important to approach it as a whole rather than looking at it individually, and the essence of it is “harmony”. He said that up until now, his surgeries have been developed with the “harmony” of the entire face as the highest value.
Additionally, “more is more, less is less”.
It means that if you improve a lot, it will get a lot better, and if you can improve a little, it will get a little better. In the end, it means that to expect continuous and satisfactory results, fundamental dissection must be done. Otherwise, it is strongly criticized that getting continuous and good results with insufficient dissection methods using only threads or minimal incisions is deceiving patients and exaggerated advertising focused on psychological purposes. Simple and fast recovery methods can be satisfactory with short-term effects and slight changes in the early stages of facial aging, but when aging has progressed to a certain extent, these methods are not natural, and the results are also unsatisfactory. And these results do not appear right away, but start to appear after a few months, and most of them regret it and come to Dr. Hamra for a fundamental improvement.
He said that not one surgery can satisfy everyone and that there is no absolute surgery, but it is important to honestly suggest an appropriate method depending on the patient’s condition and circumstances.
Regarding the surgery, he considered the face and neck as a whole for “harmony” according to his philosophy, and the physiognomy system. There are cases where a bicoronal Forehead lift, Facelift, Neck lift, Submentoplasty, and Upper and Lower blepharoplasty are performed together.
Most of them were from pre-operative hair care to the surgical process, and even the final hair washing.
I personally performed all the procedures, including dressing, and performed only one surgery per day to ensure stable results.
(Choucair RJ, Hamra ST. Extended Superficial Musculoaponeurotic System Dissection and Composite Rhytidectomy. Clin Plastic Surg 35 (2008) 607–622)
The reason for his outstanding surgical results, which were ahead of their time, can be attributed to the extensive and fundamental dissection, including the retaining ligaments of the face. In order to perform this procedure stably, a deep understanding and experience of the surgical anatomy of the face, along with the facial nerve, are required. I familiarized myself with his surgical methods and concepts in advance, and prepared with curiosity about how he would solve them.
I pondered over the basis for each procedure, such as design, incision, and dissection,by comparing it with my own surgery. According to his concept, the fundamental and detailed aspects of each lifting surgery became the subject of the Indsi Shiryeong, and he did not easily overlook the detailed delicacy alone. However, along with the explanation of each concealment, he generously accepted all of my questions and did not hesitate to give specific explanations and discussions. Despite this, the entire surgery took less than 4 hours to complete, so I checked the clock several times to make sure it was not wrong when the surgery was finished. In my case, I thought it would have taken at least 6 hours no matter how quickly it was done.
In fact, it takes a lot of time to do a wide dissection and meticulous geothermal treatment with details, but it is literally a dream of surgeons to complete the surgery in an incredibly short period of time without showing even a little gap. In fact, I had pride in my own wrinkle surgery, but after experiencing Dr. Hamra’s surgery myself, I couldn't help but get on my knees and be humbled.
I pondered for several days with a pounding heart about how such a surgery was possible and I concluded that it was due to a deep understanding of facial anatomy, unstoppable hand movements accompanied by immediate judgment of the situation (decision), long conversations with the assistant, and active and skillful use of various instruments. I would like to express this master’s surgery, which tries to pull everything together with any gaps, in one word, “Flawless”!
I thought that not even one of these could be created in a short period of time and that it would require a great deal of effort, passion, and time in every aspect. It was a meaningful time where I was able to find a clue to solving several issues that I had been thinking about, along with a method to reduce postoperative hematoma.
My first impression of him was that he was a dignified older man in a nice suit, and even when he was wearing his family coat or scrubs, he seemed like a relaxed gentleman. He took me to his hotel in his car, and I was surprised to see the latest sports car. The old gentleman, who had a slightly hunched posture and walked away slowly, said, “ The German Autobahn is the best on the road”, and his face was so bright. Thanks to this, I was able to enjoy a sense of speed when driving on the highway.
The most memorable thing was when I asked Dr. Hamra for advice on my presentation at an American academic conference.
My thesis on "The Surgical Correction of Crow's Feet Deformity Using Radiofrequency Current," which was devised by the goddess of eye plastic surgery, Dr. Shin Yong-ho, and which I perfected together with him, was presented as an oral presentation at the American Society of Aesthetic Plastic Surgeons (ASAPS) held in New York, USA in April 2013. (https://rnwoodplasticsurgery.blogspot.com/2013/04/presentation-on-crows-feet-using.html)
As soon as I arrived in the US to ask for advice on that, I showed him the slides I had prepared and asked him to play a supporting role. He asked me a few questions about the observation period and the conglomerate, and said that it looked good and only gave me positive comments. Then, on the last day, while taking me to his hotel, he gave me specific advice. He said that for a good presentation, it is important to emphasize the key points completely rather than talking a lot! He also said that it is better to express it simply by focusing on key words rather than describing it at length on the slides. He also said that the basis for supporting the argument, along with the entire content, namely the pictures, is important, and that he was well prepared for them, so he expected a great presentation. He was worried about my poor English, so I encouraged him that if he had confidence, he would do well.
When it came to this, I thought he had just isolated me as a courtesy and let it pass, but I was deeply touched when he gave me sincere advice and encouragement at the end after thinking about it inside.
He told me several times that he would be happy to help me if I had any questions or concerns during the surgery, and that I should feel comfortable by sending him photos or letters. I bowed my head deeply in gratitude for his warm concern and consideration.
There are various methods of facial wrinkle plastic surgery, but the purpose and essence that Dr. Hamra pursues is "Harmony." In "Hybrid Facial Reconstruction," which he focuses on, he considers harmony and balance of the entire face as the essence, and he strives to get closer to continuous and fundamental improvement.
I believe that the experience of breathing closely and having a heartfelt communication with Dr. Hamra, a living legend in the history of facial rejuvenation surgery, will be a major turning point in my future path. I will have to think deeply about how to sublimate his philosophy and his near-flawless surgery into my own method.
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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