Dr. Steven Fagien & Dr. Elbert Vaca

Dr. Vaca Before & After Gallery

Face

Case 1: Face & necklift, facial fat grafting (5 months post-op)

Case 2: Secondary face & necklift (patient had a prior facelift 16 years ago by another surgeon), upper lip lift, facial fat grafting (3 months post-op)

Case 3: Face & necklift; facial, periorbital and lip fat grafting (3 months post-op)

Vaca - Case 1 - Facelift 1

Vaca - Case 1 - Facelift 2

Vaca - Case 1 - Facelift 3

Case 4: Face & necklift; facial and periorbital fat grafting (3 months post-op)
Vaca - Case 2 - Facelift 1

Vaca - Case 2 - Facelift 2

Vaca - Case 2 - Facelift 3

Rhinoplasty

Case 1: Rhinoseptoplasty, submental liposuction, chin fat grafting (3 months post-op)





Case 2: Revision Rhinoplasty (performed by Dr. Vaca; patient had 2 prior rhinoplasties by other surgeons) + Upper Blepharoplasty (performed by Dr. Fagien); 2.5 months post-op





Upper Blepharoplasty

Case 1: Bilateral upper blepharoplasty and upper eyelid fat grafting (3 months post-op)



Browlift

Case 1: Browlift, 35% TCA Facial Chemical peel (performed by Dr. Vaca); Secondary (had prior eyelid surgery 20+ years ago) Upper and lower Blepharoplasty, Myomodulation – fillers + neuromodulators to forehead and glabellar/ frown line region (performed by Dr. Fagien); 4 months post-op.


Case 2: Browlift


Case 3: Browlift

Case 4: Browlift & upper eyelid fat grafting

Lip Lift

Case 1: Lip Lift (3 months post-op)

Case 2: Lip Lift (3 months post-op). Of note, patient also had a facelift.


Breast Augmentation

Case 1: Breast augmentation - 295cc moderate profile silicone implants, subfascial [i.e., above the chest muscle], inframammary incision (4 months post-op).



Case 2: Breast augmentation - Left 325cc, Right 295cc moderate profile SoftTouch smooth silicone implants, subpectoral [i.e., below the chest muscle], inframammary incision (10 months post-op).




Case 3: Revision breast augmentation (prior saline breast augmentation beneath the chest muscle by another surgeon complicated by “animation deformity” and wide distance of between her breast implants). Moderate profile silicone implants (375cc right, 360cc left), subfascial peri-areolar incision, subfascial (4 months post-op).





Breast Augmentation Mastopexy

Case 1: Patient with a history of saline breast augmentation above the chest muscle by another surgeon with concerns of asymmetry, ptosis (i.e., drooping of the breasts) and rippling (i.e., visible implant shell ridges). Patient underwent saline implant removal and exchange with 450cc high profile SoftTouch smooth silicone implants & anchor-pattern mastopexy (4 months post-op)



Case 2: Patient with concern of loss of upper pole fullness, large areola size, breast asymmetry and axillary fold fullness. Patient underwent breast augmentation with moderate profile SoftTouch smooth silicone implants – Left 310cc, Right 405, anchor-pattern mastopexy & liposuction of her anterior axillary fold. (4 months post-op)



Body

Case 1: Abdominoplasty & Flank Liposuction (6 months post-op)
Vaca - Case 1 Abdominoplasty 1

Vaca - Case 1 - Abdominoplasty 2

Vaca - Case 1 - Abdominoplasty 3

Case 2: Abdominoplasty & 360° liposuction (5 months post-op)
Vaca - Case 1 Abdominoplasty 1

Vaca - Case 1 - Abdominoplasty 2

Vaca - Case 1 - Abdominoplasty 3

Vaca - Case 1 - Abdominoplasty 3

Case 3: Abdominoplasty (6 months post-op)

Injectables

Myomodulation: Fillers + Neuromodulators
By using a combination of neuromodulators and fillers, smoother and more aesthetically pleasing contours can be attained. Fillers help restore volume to select areas, as indicated (such as the smile lines, lips, chin, cheeks and temples). Neuromodulators can help smoothen skin texture and wrinkles by selectively inhibiting muscle contraction (such as the forehead, glabella, crow’s feet and chin). Neuromodulators can also help decrease the overall size of certain muscles, such as the masseter muscle (one of the muscles of mastication) – decreasing the size of the masseter muscle can result in a pleasing and more feminine tapering effect of the jawline, particularly in women.

Case 1: Voluma (cheeks, chin), Juvéderm Ultra Plus (smile lines), Botox (forehead, glabella, crow’s feet)
Vaca - Filler & Botox - Case 1a

Vaca - Filler & Botox - Case 1b

Vaca - Filler & Botox - Case 1c

Case 2: Voluma (cheeks), Juvéderm Ultra (lips), Botox (forehead, glabella, crow’s feet, masseter)

Fillers

Case 1: Juvéderm Ultra (lips), Botox (upper lip)
Case 2: Voluma (cheeks), Juvéderm Ultra Plus (smile lines), Volbella (lower eyelids)
Vaca - Filler - Case 2
Case 3: Juvéderm Ultra Plus (lips)
Vaca - Filler - Case 3

Neuromodulators

Case 1a – Glabellar Frown Lines

Patients more often present with either existing frown lines or to prevent inevitable frown lines with neuro-toxin treatment to the glabella (between the eyebrows) region. Treating this area can both give a smoother appearance and shape the eyebrow while also given this region a more glowing effect on the skin appearance.

Neuromodulators – Case 1b – Forehead Lines

Case 1b – Forehead Lines
Patients usually present for treatment with neurotoxins in several areas of the face and another common area to treat are the horizontal forehead lines. The effects can be dramatic, and the position and contour of the eyebrow can be improved. This area can be tricky with understanding the balance of line reduction while preserving or improving eyebrow shape but understanding the patient’s unique anatomy.

Neuromodulators – Case 1a – Glabellar Frown Lines

Case 1c – Lateral Canthal Lines (Crow’s Feet)

Patients usually present for treatment with neurotoxins in several areas of the face and the second most common area to treat are the areas on the outer part of the eye called Lateral Canthal Lines (or Crow’s feet). Treating this area can also reduce or eliminate lines in these areas as well as shape the eyebrow.

Neuromodulators – Case 1c – Lateral Canthal Lines (Crow’s Feet)

Case 2: Chemical Browlift

It is common for the brow position to drop with age, otherwise known as “Brow Ptosis”. While surgery is also an effective option, neuromodulators like Botox can be used to temporarily help improve symmetry, enhance the curvature and raise the position of the brows.


Case 3: Neuromodulators
In this example, Botox was used to treat the forehead lines, crow’s feet and glabella.

Case 4: Ptosis Improvement

Ptosis (i.e., drooping of the upper eyelid), is common with aging and can worsen forehead lines due to compensatory contraction of the frontalis muscle in an attempt to open one’s eyes. In addition, ptosis can worsen a hollowed appearance of the upper eyelids. In this case, neuromodulators were used to help temporarily improve this patient’s ptosis. In addition, neuromodulators were used to treat this patient’s forehead, glabella, crow’s feet and bunny lines.






Meet Dr. Vaca

Dr. Vaca

Dr. Elbert E. Vaca is a Plastic & Reconstructive Surgeon who completed his medical training at The Johns Hopkins University School of Medicine and Northwestern Memorial Hospital.
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Meet Dr. Fagien

Dr. Fagien

Dr. Steven Fagien is one of the foremost oculoplastic surgeons in the United States and the world. He completed his medical training at the University of Florida and a fellowship in oculoplastic surgery at the University of Illinois Eye and Ear Infirmary.
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