Category Archives: Facial Esthetic Surgery

Hair Restoration

Hair Restoration

Although predominately associated with male pattern baldness, hair restoration can also be performed on women with alopecia. With improvement of surgical techniques that avoid a “plugged” appearance, hair
restoration has increased in popularity. Hair follicles are harvested from the posterior scalp below the vertex and prepared into micro- arid minigrafts of one to four hairs per graft (Fig. 26-31). The grafts are then meticulously placed into the desired locations to restore -the hairline. Preoperative planning is important to avoid an inappropriate looking hairline as the patient ages, and to ensure the patient has adequate hair
density to obta in a good result. Surgical treatment mayneed to be performed in stages to complete the treatment  plan: The grafted hair units are typically moreresistant to the balding hormorral effects of testosterone
and androgens . Postoperative healing is complete in about 2 weeks,
but the transplanted hairs do not begin to grow until about 3 months, and a final mature result is not achieved until 9 to 12 months after surgery (Fig. 26-32, A and B).~3.H Complications can include infection, loss of preexisting
hair, poor  graft growth, inappropriate hairline placement” and scarring,

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Scar Revision

Scar Revision

Facial scars can be caused by severe acne, facial trauma, or incisions needed for other surgery. Factors making scars noticeable include: hypertrophy or keloids,  uneven margins that cast shadows, color .mismatch with surrounding skin, and tethering to underlying soft tissues that accentuates the scar during facial animation.  Although a scar can never be totally eliminated, t can be altered and blended to signiflcantly camouflage  its appearance. Depending on the scar, it can beimproved in appearance by reexcision, altered by redirecting its alignment to better hide, it in a natural facial crease, or blended with a skin-resurfacing procedure (Fig. 26-30, A to E). Recovery time varies with the  extent of the scar and the method of treatment-ZI,n. Possible complications include infection and hypertrophic scarring.
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Botulinum Neurotoxin Therapy

Botulinum Neurotoxin Therapy

Although first used for treatment of eye muscle spasms  .and eye muscle-dysfunction, botulinum neurotoxin canalso be used to reduce facial wrinkles of the forehead and the crow’s-foot· region (i.e., wrinkles emanating from the
lateral canthus)’ around the eyes. Botulinum toxin is produced by the anaerobic microorganism Clostridia botulinum and is responsible for botulism food poisoning, The toxin blocks neurotransmitter release at the neuromuscular  junction and thus temporarily paralyzes the muscle. The temporary paralysis creates long-term muscle weakness and atrophy, The most common region i!ljected for facial rhytids is the forehead and glabellar
region. ,  Very dilute doses can be safel injected with a 30-gauge’needle to selectively paralyze specific facial muscles whose

lip Augmentation orReduction

lip Augmentation or Reduction

Lip augmentation can increase the thickness and vertical exposure of either the upper’ or lower lip. However, this  procedure is most commonly performed on the upper lipto accent the perioral region. Generally the lower lip is 30% larger in vertical dimension (i.e., vermilion to wetline) than the upper ‘lip. Many methods for lip augmentation are available and include implantation of synthetic materials, bovine collagen, human cadaveric dermis,  and autologous fat or dermis. Each material has its ownadvantages and disadvantages. The selected material is placed to plump the lip’s central vermilion and to define  the vermilion border.Although less commonly performed, lip reduction, or cheiloplasty, is also possible. Excess tissue is removed from the intraoral portion of the protuberant lip and the lip’ mucosa undermined and sutured in a more internally-rotated position (Fig. 26-28, .-i and B). Recovery  ranges from days to weeks, depending on themethod used.>
Potential complications include’ infection, .asymmetry, and over- and undercorrectlon. Additionally many of the’ natural materials placed in the lips resorb with time and  may require further augmentation,

Otoplasty

Otoplasty

Otoplasty is altering the appearance of the ears. The most common ear

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cupped 1his deformity can be a source of awkwardness, eSI”‘cially in school-age children. Adults may also choose otoplasty for ear deformities not addressed while they were younger. Overly prominent ears are either
caused by hypertrophy of the conchal bowl cartilage (i.e., lower one half of the base) or lackof formation of the  antehelic fold (Fig 26-27, A and B).
Surgical correction involves exposig the ear cartilage through a postauricular incision. The cartilage is then partially excised or reshaped using cartilage scoring, sculpting techniques, and retention sutures (see Fig.
26-27, A and B) (Fig. 26-27, C to E). A molded protective dressing is worn for} week, and the patient then uses a ~headband to protect the ears during sleeping for a number of months. Possible complications of otoplasy include infection, asymmetry, hematoma, and recurrence of the
initial deformity. 10. 19

 

 

 

 

Chin Augmentation or Reduction

Chin Augmentation or Reduction

Chin projection and contour influences neck definition and nasal size appearance. ‘Noses look larger if the chin is recessive and necklines are more defined with a more prominent chin, Decisions to augment or reduce the chinare decided by evaluating the facial proportions, similar to the treatment planning that takes place with orthognathic surgery or a patient undergoing comprehensive prosthetic rehabilitation that alters’ the vertical dimension .. Augmentation of the’ chin can be performed using alloplastic implants or ‘bv advancement of the inferior border of the mandible (i.e., genioplasty). Advancement genioplasty is discussed in Chapter 25. Alloplastic chin augmentation is not as popular with oral and maxillofacial
surgeons because of lack of remodeling (i.e., edges may be felt) •..potential for underlying bone resorption, and increased risk of infection. Fig. 26-26 demonstrates the use of an alloplastic implant for chin augmentation.
Simultaneous liposuction can enhance the esthetic results of chin advancements. .Potential genioplasty complications include infection
and lip numbness, Recovery time is about 1 week, withthe final result fully appreciated in about 6 weeks.16,17

Cheek Augmentation

Cheek Augmentation

Cheek augmentation provides for higher, more defined,  prominent cheekbones and more youthful cheek fullness. Cheek augmentation is usually accomplished using a synthetic or alloplastic implant placed through a maxillaryvestibular incision. The malar or cheek implants are supplied precontoured by the manufacturers. and available in varying sizes,  hicknesses, and configurations(Fig. 26-25). These can also be custom made from three-dimensional (3-D) models of the patient’s facial

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bone structure made from reconstructed computerized tomography (CT) scans. The surgeon selects the implants  based on the’ patient’s existing anatomy and desiredresult. Generally the implants are partially malleable ajid can be custom contoured in’· situ then stabilized with bone screws to the underling maxilla and zygoma or

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Facial Liposuction

Facial Liposuction

Facial liposuction is used to reduce submental and neck fullness. These excessive fat deposits are typically located superficial to the platysma. This can be detected by having the patient “tense their neck” or attempt to move their chin inferiorly against finger resistance then

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gentllsping the suhmcntnl area or neck fold with the thumb and forerinucr I i.e .. pinch test). The purpose oi liposuction it hunderlying coalesced fatty deposits allowing the overlying Skin to redrape over a newly formed neckline. This occurs partially because of the direct removal of fat. further “shrinkage” of fat deposits occurs as a result of circumferential scarring of  the fat as <\ result of instrumentation with the suctioncannula during tat removal. Younger patients often have facial liposuction as a single procedure because they

 

Skin Resurfacing

Skin Resurfacing

Skin resurfacing eliminates wrinkles, pigmentary discoloration, and slgnificantly ttghtens the skin, resulting tn a more youthful appearance. Patients may begin to notice perioral rhytids during restorative or prosthetic treatment. They may complain to their dentist that terior  prosthetic restorations do no adequately fill out theirlips. Women may remark tha their lipstick “bleeds” or “runs outward into the skin of he lips. This occurs in the

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fine i:haIllH’+’ of the vertical pvrroral rhytlds. The dentist h limited. by the supporting [aws and occlusal relation-  hip~’ as to how far the underlving frame (i.e, teeth) canstretch and support the overlying canvass ti.e., lips).
Although excision methods such as ble pharoptasty orface-lift eliminate skin excess and contours, skin resurfacing treats tile fine rhytids or wrinkles. Skin resurfacing is often performed after forehead and face-lifts and blepharoplasties to achieve even more dramatic results. Skin resurfacing colle ctively refers to chemical peels,  ermabrasion, or laser-skin ‘resurfacing, Chemical peels use agents such as trichloroacetic acid (TeA), glycolic acid, , or pj1enol. These chemicals cause the old superficial skin to peel off a.s if it were sunburned, This occurs after thenew skin has reformed beneath the more superficial  slaughing layers. Dermbrasion is a mechanical sanding

 

Septorhinoplasty

Septorhinoplasty

l surgery, or rhinoplasty, can alter a patient’s  appearance and correct nasal obstructive svmptorns. When the-nasal septulT!. is also ‘modified the procedure i~ called a septorhin?plasty. Appearance changes rnav include modifying the nasal profile, the nasal bridge  width, removing a dorsal hump, or improving nasal tipdefinition (Fig. 26-15 ort page 612). Patients of all ages
may undergo nasal surgery. Younger patient s usually seekto balance. their nasal proportions with their existing facial features and eliminate nasal obstructive symptoms.  Older patients often hav rhinoplasty to rejuvenate a
drooping nasal profile. With aging the upper lateral cartilagescan separate and drift away from the nasal bones  above them, causing an apparent nose lengthening anddrooping nasal tip. This occurs more commonly in men.
Nasal surgery is performed most  ‘often with all internal nasal incisions (Fig. 26-16 n page 612). More extensivenasal surgical procedures may require an “open”  approach,” which uses an’ additional columellar skin

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