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phenomenon - named after the exaggerated expression of the infamous character. This occurs when pulling forces cause tissue around the mouth to rotate in unnatural directions, often downward then sharply upward toward the jaw, creating strange, attention-grabbing curves. While not always this extreme, the aesthetic disharmony is palpable: tight skin near the ears, persistent nasolabial folds, and corners of the mouth that droop or appear frozen. Unfortunately the past decades of academic facelift discussion and techniques have been fixated on vertical pull which tends to create these deformities. This is another reason why nuanced and thoughtful surgical planning are so important. The one-size-fits-all vertical pull limits the need for deep dissection to achieve neck improvements and is a very easy and quick procedure but comes with the cost of the above described unnatural findings and distortions. Vectors, or directions of pull, need to be customized for each patient and each plane of the face in order to achieve beautiful results. Why does this happen? Largely because most surgeons choose to avoid the deep plane altogether - understandably so, as it’s where the facial nerve branches run. These delicate structures sit adjacent to the very ligaments that must be released and resuspended for optimal, natural results. But avoiding this plane limits what can be accomplished and often forces reliance on tension-based techniques that distort the face rather than rejuvenate it. In contrast, my approach embraces this anatomy. I have deep respect for the facial nerve, and by working within the deep plane under direct visualization, I can precisely identify and protect these critical structures. In fact, I find this approach to be safer, not riskier. I’m not operating blindly - I see the nerves, I see the ligaments, and I know exactly what I’m doing at every step. When correcting previous facelifts, the process involves careful removal of old scar tissue, undoing the rotational misdirection of facial tissues, and reestablishing anatomically accurate, harmonious suspension. My goal is not just correction, but restoration - a return to a version of the patient that looks refreshed, elegant, and entirely natural. Revision work is one of the most rewarding aspects of my practice. These patients have often lost hope, and it’s deeply gratifying to help them feel not only like themselves again, but better than they imagined possible. Restoring natural beauty - especially after it’s been compromised - is both a challenge and a privilege I take very seriously. ML: Miami is such a vibrant, image-conscious, and diverse city. How has practicing in this environment influenced your approach to beauty, patient expectations, or even your own aesthetic philosophy? Dr. Maercks: Miami’s aesthetic culture is as vivid and unapologetic as the city itself. That kind of environment can be both inspiring and, frankly, challenging for a surgeon who is deeply committed to naturalism and timeless beauty. Rather than shifting my philosophy to conform, Miami has reinforced my resolve to remain grounded in what I believe: that beauty should never be loud, forced, or trend-driven. It should move with a whisper, not shout. Throughout my career, I’ve watched aesthetic trends come and go - sometimes dramatically. The “duck lips” era, the chipmunk cheeks, the exaggerated breast augmentations with hyper-round, high-profile implants that seemed to defy anatomy. More recently, filler placement trends emphasize projection at the sides of the face or overly forward on the zygoma, creating what I call the “Skeletor look.” I’ve observed these phases with a kind of fascinated discomfort. It’s not judgment so much as a deep concern for what happens when beauty is treated as spectacle rather than substance. Early on, these dominant trends made my aesthetic perspective feel almost out of sync with the local