Perfection Perfected: Innovative Plastic Surgeon, Dr. Rian A. Maercks Introduces the Cold-Subfascial Augmentation With Anatomically Shaped Cohesive Silicone Gel Implants

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The perfect breast augmentation is now available in the United States. The groundbreaking innovator, Dr. Rian A. Maercks, is now able to deliver results to patients in his Miami practice that were until recently only available outside the United States. The Maercks Intitute in Miami Beach Florida is the only location in the world that Dr. Maercks offers his Cold-Subfacial breast augmentation. Now with the FDA clearance of anatomically shaped implants he is free to perform the operation to the ideals with which it was designed. The U.S. now can benefit from the most natural appearing and enduring breast augmentation.

Rian Maercks

Dr. Rian Maercks

The incorporation of these products with my Miami practice allows me to offer all of my patients true perfection in breast augmentation, there is no way to top the Cold Subfascial breast augmentation with anatomically shaped implants, this is true harmony

Dr. Rian A. Maercks M.D., a cherished gem in the world of rejuvenation and aesthetic interventions, enthusiastically announced that he is providing his multinational clientele with the best that breast augmentation has to offer. For years Dr. Maercks has been frustrated by the limited offerings in size and shape of implants in the United States. Dr. Maercks is known in Miami and throughout the world as a master of natural beauty, delivering his patients with results that appear consistently ‘unoperated.’ To achieve consistently natural results, Dr. Maercks had to work hard and rely on his international experience to overcome the limitations of the U.S. market. “Internationally there are all kinds of different shapes available which really allow the surgeon to select a size and shape that will look perfect on the patient. When I decided it was time to get serious about my Miami practice I had to learn to work with the available options.”

The limited options Dr. Maercks refers to are the singular shape that is available to most plastic surgeons, round. Internationally, Dr. Maercks’ colleagues often us a “shaped” or “anatomic” implant that is more tear drop shaped like a natural breast. To achieve similar natural appearing results, Dr. Maercks leveraged his experience with conventional American techniques and his vast international experience to develop the unique “Cold Subfascial Augmentation”TM( This procedure relies heavily on a natural supporting structure, the pectoral fascia. Dr. Maercks took a beautiful operation, developed by Dr. Ruth Graf of Curitiba, Brazil, and pushed it further in its ability to shape the breast( He changed the dissection technique from the heat and coagulative damage inducing electrocautery to what he calls “cold dissection.” “The entire operation is completed under direct visualization with sharp dissection of the pectoral fascia in its entirety. I couldn’t get the same shapes that endure over time if I did not respect the fascia in its entirety.” He uses surgical steel in the form of special scalpels and precision scissors developed for face lifts to accurately separate the fascia.
“The contiguous, full thickness preserved fascia allowed me to achieve shaping of the breast that I could have never achieved without this technique. The true goal of the Cold Subfascial operation was to create a naturally appearing tear drop breast with a round implant and years ago I was very proud to show the world that this is exactly what it can do.”
Dr. Maercks has followed the FDA approval process closely and was eager to work with Sientra once news broke of their FDA clearance of anatomically shaped breast implants earlier this year ( Dr. Maercks commented “The Cold-Subfascial breast augmentation is my baby and it was really designed for this type of implant. Unfortunately, until now I have only worked with these products internationally. The incorporation of these products with my Miami practice allows me to offer all of my patients true perfection in breast augmentation, there is no way to top the Cold Subfascial breast augmentation with anatomically shaped implants, this is true harmony.”

There have been serious concerns voiced about malposition complications with anatomic implants( While their round counterparts can spin and spin with no consequence, the spinning of a shaped implant can result in a devastating aesthetic result. When Dr. Maercks was asked about this concern, he replied “there is no question in my mind that we are going to see a large spike in malposition rates in the practices of surgeons who use a submuscular or dual-plane technique. It is my feeling that any implant should be supported for ideal aesthetics and longevity, but anatomic implants must be supported to prevent spin. Typical techniques use blunt dissection to open what is called a loose areolar plane, which can auto dissect. I think surgeons will try to place these implants in this manner and will be disappointed with the results. There will definitely be a learning curve for those not familiar with more advanced breast augmentation techniques and previous experience with anatomics.“ Dr. Maercks feels strongly that his Cold-Subfascial augmentation is the best technique but says that some have also had good results with anatomic implants in a subglandular position. He feels that for the “bottoming out” forces of dual plane are unacceptable with round implant and impossible with anatomics.

Dr. Maercks shared with us that in the distant future there will be even better implants available which he is personally developing. This talented surgeon is never satisfied with status quo, so when the right thing doesn’t exist, product or procedure, he invents it. The doctor has for some time recommended breast augmentation with his unique technique of breast augmentation by fat transfer to most applicable patients in favor of the unnatural round shapes so commonly used. For now he is delighted that he can return to using his beloved anatomic shapes at home in Miami and he feels comfortable using implant based augmentation in a larger proportion of his patients with these newly reapproved devices. With all of this brilliant innovator’s thought, time, experience and development it is easy to see why the Cold-Subfascial Augmentation with anatomically shaped implants is a no-brainer. Perfection may have just been perfected!

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