Category Archives: Facial Esthetic Surgery

Rhytidectomy

Rhytidectomy 

Rhytids are skin folds, creases,. or wrinkles. Rhytids can be referred to as coarse or fine depending in the depth andanatomic cause: Rhytidectomy, or “removal of skin wrinkles,” is more commonly called face-lift surgery, This procedure rejuvenates sagging neck skin, jowls (i.e., sagging skin and fat posterior to the labiomental crease), nasolabial folds, and cheek laxity. Face lift surgery can

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dissection of the various layers (Fig. 26-13 on page 610).  Frequently, the submuscular aponeurotic system (SMAS) layer is either partially resected or suspended superiorly (or both) and posteriorly to provide additional and longer-lasting effects. The excess skin is removed during wound closure
(Fig. 26-14, A to D, on page 611). To enhance neck contours, face-lift surgery often includes submental liposuction and platysma muscle tightening. Recovery from face-lift surgery takes about 14 days.” Potential complications include hematomal, facial nerve injury, and hypertrophic scar formation .

 

Forehead and Brow lift

Forehead and Brow lift

A drooping forehv.rd results in drooping eyebrow r.c brow lateral upper eyelid fullness 01 hooding.11(1 accentuated upper ‘eyelid bagginess.  skin. with blepharoplasty alone docs not adequately address this problemif the brows are also ptotic. The normal  or youthful eyebrow has the lower edge posif ioned ator slightly above the palpated bony ‘,upraorbital rim. The

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ideal esthetic female brow gently arches above the orbital  rim lateral to the iris (Fig. 26·8,_ The peak of the brow’sarch should be aligned over the junction of the lateral edge of the iris and the “Sclera. Women often pluck their brows to reproduce this pattern. Male brows are general- Iy flatter without an arch. Elevation of the brows to a • rejuvenated position may eliminate or reduce the need to remove upper eyelid -skin with blepharoplasty, Often a forehead and brow lift and upper lid blepharoplasty are combined during a single operation. Brow lifting reduces upper lid hooding by elevating the brow. Additionally brow lifting reduces forehead and nasal bridge creases.  Most brow elevation surgeries are presently performed end oscopically with video camera assistance. This approach uses multiple small scalp incisions for access. After the scalp is undermined and mobilized, the forehead  soft tissues are suspended and anchored in theirnew position. (Fig. 26-9). A continuous full-thickness : scalp incision within or at the hairline (i.e., pretrichial approach) is still used when required, such as with  extreme brow ptosis or when on-e does not wish to elevate the hairline (Fig. 26-10). Care is taken to. prevent injury ‘to the scalp’s sensory nerves (i.e., supraorbital, supratrochlear) and facial nerve branches supplying motor in-:  nervation to the eyebrow region.
Postoperative recovery is 7 to 10 days (see Fig. 26-7, A  and B).7 Possible complications of brow lifting include asymmetric ,appearance, paresthesia, facial nerve deficits, and excessive lifting resulting in a “surprised” look.

 

 

 

 

Blepharoplasty

Blepharoplasty 

Blepharoplasty (i.e., eyelid rejuvenation) is one of the most common facial esthetic procedures performed on women  apd men. Aging eyelids exhibit a puffy, drooping, andbaggy appearance. These are the result of eyelid skin laxity, orbicularis muscle hypertrophy, and orbital fat herniationout into the eyelids (Fig. 26-2). Redundant and folded skin of the upper eyelids is referr-ed to as dermatochalasis. When extreme, the folded skin can extend beyond the eyelash  margin and ‘create a mechanical block to vision. Patients.will typically notice this later in the day when their “eyes are tired.” This sagging, redundant, and folded upper eyelid skin over the lashes is termed hooding. The main cause,  of baggy lower eyelids is gradual thinning and laxity of the-fine collagenous orbital septum. This structure normally
separates the internal orbital contents from the eyelid.Over time this curtainlike structure bows outward hke a sail, then the intraorbital fat begins to herniate into the  100\’e~ eyelids. The upper eyelid has two fat pads and thelower has three (Fig. 26·3). Besides the pouch like filling of
tile lower eyelid, the outwad shift of the orbital fat can createar subtle posterior settling of the globe (. TJ1is adds to the appearance of sunken in, tired, and baggy eyes.  During a blephnrcplasty procedure, the surgeon removes skin and orbicularis oculi muscle and

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SURGICAL PROCEDURES

SURGICAL PROCEDURES

The procedures described in the following sections are presented as isolated surgical techniques. However, in practice, several of these are often combined and performed during a single surgical appointment.

FACIAL AGING

FACIAL AGING

Facial <lging Involves the changes to the skin resultant effects.on the skin’s appearance and those of tillunderlying sot; tissues. 0:atural aging combined with sun exposure produces  of skin changes. Natural aging results in Joss of skin elas.ticity and collagen. melanocyte pigmentations, and fat atrophy~ Sun exposure adQs photo aging caused by ultraviolet light. .Ultravlolet light from sun tanning damages the skin’ and eventuallv causes a wrinkled, pigmented, and weathered appearance. Solar radiation also leads to an increased incidence-of skin cancers. Gravitational changes-on the skin and underlying
tissues cause deep forehead lines, drooping brows, eyelid skin laxity and puffiness, loss of cheek roundness, and’ sagging neck and jaw lines (Fig. 26-1). . ‘ Although aging is an individual phenomenon, many factors can influence the appearance and rate of aging. These include general health, sedentary life style, sun exposurj, genetic influences, nutritional balance,  alcohol ‘consumption, and Cigarette smoking. Cigarette use, withits vaso ctive .effects of nicotine, accelerates skin aging  nd. reduces the body’s ability to repair wounds. The vasoactive effects can lead to poor healing in some esthetic

Facial Esthetic Surgery

CHAPTER OUTLINE

FACIAL AGING
SURGICAL PROCEDURES
Blepharoplasty
Forehead and Brow Lift
Rhytidectomy
Septorhinoplasty
Skin Resurfacing
Facial Liposuction

Cheek Augmentation
Chin Augmentation or Reduction .
Otoplasty
Lip Augmentation or Reduction
Botulinum Neurotoxin Therapy
Scar Revision
Hair Restoration

Patients are increasingly seeking procedures that enhance their appearance for personal and professional reasons. Esthetic oral and maxillofacial surgery is often included in a comprehensive treatment plan    complement restorative, prosthetic, and orthodontic treatment. etal treatment plans, especially ones involving cosmetic therapy, are enhanced if dentists remain aware of he wide variety of esthetic surgical options available to
patients. Orthodontists planning orthognathic surgerycomplete a careful evaluation of facial proportions that frequently includes the diagnosis of external nasal deformities and 0 her hard and soft tissue abnormalities. Prosthetic rehabilitation often involves attempts to increase support o he perioral region and can be enhanced with facial rejuvena lon procedures. Cosmetic restorative dentistry may provide he finishing touch to cosmetic surgical treatment. tat  dentistry patients  traumatic scars or congenal
rmi ies can also be helped. Oral and head and neck patients with skin cancers can be treated structed, and restored to both adequate function and socially acceptable appearance.Advances in medicine and nutrition, combined with increased public awareness of personal health care,
enable patients to live longer, healthier, and more activelives. However, social pressure to maintain a youthful appearance as one ages encourages more people each year to undergo some form of esthetic enhancement. This
trend is evident in members of the “baby boomer” generation, now in their 4Qs and 5o.s, who have grown increas ingly interested in these procedures. Research from the American Academy of Cosmetic Surgery indicates that the number of patients undergoing  esthetic procedures increased dramatically between 1990and 20.0.0..Body liposuction remains the most popular procedure, with a tenfold increase over the last decade The number of facial procedures, such as eyelid  face-lifts, and facial skin rejuvenation, has also increased dramatically (Table 26-11.

TBALE 26-11

Cosmetic Facial Procedures in the United States
(1990-2000)

Procedure 1990 2000-
Eyelid surgery 82,520 465,177
Face-lift 36,981 244,370
Forehead lift 26,436 145,881
Rhinoplasty 89,615 155,052
Liposuction 7″,632 672,793
Chemical peels n/a 1,.145,631
Laser skin resurfacing n/a 300,572
Hpjr restoration ?7,714 222,497
Malar auqrnentation 9,570 21,481
Otoplasty 6,135 ‘ 26,881
Botulinum injections n/a 737,787

Women sesking esthetic’ surgery outnumber men approximately 9:1. However, men are increasingly seeking esthetic procedures, including eyelid and forehead rejuvenation and hair restoration. As expected, the popularity of specific procedures is age related. Patients under 35 years of
age usually desire liposuction, rhinoplasty, chemical peels, and laser skin resurfacing. As patients age into their 40~, 50s and 60s, they seek liposuction, eyelid and Forehead rejuvenation, face-lifts and chemical or laser skin resurfacing. Surgical technical advances also contribute to the”
growth of esthetic surgery. New techniques and technical advances in equipment reduce surgical risks, recovery time, and incision visibility. Technical innovations include endoscopic or minimally invasive procedure  that use small incisions, liposuction with barely noticeable access sites, and  asers that enhance hemostasis and, allow precise control over-depth of skin removal. .  ppearance matters marc than many’ wish to admit,
and interperson l reactions are often influenced by  appearance. Improved self-confidence occurs in manypatients whohave undergone successful esthetic surgical and cosmetic dental procedures. It is common to notice
patients alter) ng  ‘their wardrobe, makeup, and hairstyleafter surgery: patients often are delighted in how others respond to their new image. However, it is important during the esthetic surgc’ry consultation for the surgeon to· attempt to determine if the patient’s desires for surgery
are based o r, 11(‘1.1(111111 motivation. without undue outsideinfluences or unrealistic expectations. Patients with  external pressure” and unrealistic  pectations are more ikelv to be dissatlsfled with the treatment outcome
despite.successful technical results.