Facial Aesthetic Surgery Research Articles

The Cause of the Difference in the Submental Region

The aberrant bundles' presence in the anterior belly of the digastric muscle is important in terms of causing asymmetry in the submental region, getting confused with some pathologic cases, radiologic examination, and aesthetic facial surgery. To provide data, aberrant bundles in the submental region were investigated in 30 cadaver heads. During the dissection of the submental region, origin, insertion, shape, and bilaterality of the anterior bellies of the digastric muscles and the aberrant bundles were investigated. The 20 heads with aberrant bundles were classified into two types based on the muscle arrangement: digastric fossa type and crossover type. The aberrant bundles, which did not cross the median line, were classified as being of the digastric fossa type, whereas those that crossed the line were of the crossover type. Fifteen of the heads contained bundles of the unilateral type and five heads contained the crossover type. In three heads, digastric fossa and crossover types coexisted. In this study, a wide range for incidence in the submental region was observed of variations. Some cases were not described in the classification of the previous studies of this muscle. It is also possible that the incidences may vary as a result of the ethnic differences of the populations studied. Bilaterality was frequently observed in this study. Anatomic variations of the anterior bellies of the digastric muscle can easily be confused with the pathologic conditions in ultrasonography, computed tomography, and magnetic resonance imaging; therefore, it is necessary to recognize that variants of the anterior belly of the digastric muscle occur to avoid confusion when diagnosis shows abnormal lesions in the floor of the mouth and submental region. Additionally, the possible occurrence of such anomalies should be remembered during the surgical procedures involving the submental region.

The wide nasal dorsum: Evaluation and management

Rhinoplasty is arguably the most challenging of all facial aesthetic surgery. With contemporary aesthetic ideals favoring the more petite and narrow nose, successful management of the wide nasal dorsum is crucial in obtaining favorable outcomes. This paper aims to define the underlying anatomical variances that contribute to the wide nose, as well as providing a process by which one can identify and address these components appropriately. We conducted a retrospective study of 543 consecutive rhinoplasty patients presenting to a busy inner city cosmetic practice in Sydney, Australia. Of these patients, 53 were identified whose primary complaint was dissatisfaction with their wide nose. Analysis of the fundamental causes for these patients' wide nasal dorsum was carried out, and the techniques used to manage these problems were tabulated. Two illustrative case studies are included. Of the 53 patients, 29 (54.7%) could be managed by the simple technique of single lateral osteotomies in conjunction with medial osteotomies or hump removal. In the remainder, a variety of techniques were required to achieve the desired result. These included multiple lateral osteotomies (32.1%), wedge osteectomies (11.3%), nasal bone sculpturing (1.9%), reverse spreader technique (1.9%), cartilage sculpturing (3.8%), dorsal onlay grafting (22.6%), and deep fatty panniculus excision (35.8%). Management of the wide nasal dorsum should begin with a comprehensive analysis of the underlying causative anatomy. Although most cases may be managed satisfactorily with simple lateral osteotomies, a large percentage of patients presenting to the rhinoplasty surgeon will require adjunctive or alternate techniques to produce optimal results.

Continuing medical education article—facial aesthetic surgery: Why do we age in our cheeks?

The cheeks are of one of the first regions of the face in which changes relating to age occur and are the facial area most prone to ultimately display the ravages of time. The purpose of this study was to determine (1) the subcutaneous fat mass in the cheeks both above and below the superficial musculoaponeurotic system (SMAS) relative to the facial and neck aesthetic subunits, and (2) the type and distribution of retaining ligament support of this subcutaneous fat mass within the cheeks relative to other aesthetic subunits. Anatomic dissections in 10 fresh hemi-cadavers with a mean age of 65.6 years (range 42-86 years) were performed. The face and neck were divided into 8 aesthetic subunits: (1) glabella, (2) forehead, (3) temporal, (4) anterior upper cheek, (5) middle cheek, (6) posterolateral cheek, (7) mental, and (8) anterior neck. The dermis was discarded, and fat superficial to the SMAS in each aesthetic subunit was dissected, measured in grams, and analyzed. Superficial mimetic musculature was discarded, and fat deep to the SMAS in each subunit was dissected, measured in grams, and analyzed. The retaining ligament types and distribution were dissected and analyzed within each aesthetic subunit. Histologic cross-sectional analysis of fat and fascia was performed in each aesthetic subunit by hematoxylin and eosin staining and Mason Trichrome Sections. Overall, 80% of total subcutaneous fat mass was found in the face and 20% in the neck. In the face, 57% of the fat mass was found above the SMAS, and 43% was found below the SMAS, whereas in the neck 65% of the fat mass was found above the platysma and 35% below the platysma. One half of the total face and neck fat mass was found in the cheeks, with one third of the total fat mass located in the anterior and middle cheeks alone. Of special note, 75% of the total deep facial fat mass was found in the anterior and middle cheeks. Two types of retaining ligaments were found. Primary supporting ligaments were found in 4 locations approximating the zygomatic and mandibular sutural interfaces. These ligaments only resided along borders between cheek aesthetic subunits and were observed to be mildly affected by cadaver age. Secondary supporting ligaments were found in 3 locations within the anterior, middle, and posterior cheek subunits. They were found only within borders of the cheek aesthetic subunits and were observed to be significantly affected by cadaver age. The anterior, middle, and posterior cheeks were noted to be laden with fat, containing roughly half of the total facial and neck fat mass in fresh human cadavers dissected according to aesthetic subunit principles. Slightly greater than half of the subcutaneous fat in the cheeks (57%) is above the SMAS, whereas slightly less than half (43%) is below the SMAS. The fat-laden cheek aesthetic subunits were found to have secondary supporting retaining ligaments located within their borders that provided poor support and primary supporting retaining ligaments along their borders, which provided strong support. These anatomic arrangements, along with the fact that the anterior and middle cheek subunits serve as lining and cover for the hollow intraoral cavity, account for the characteristic and reproducible saggy appearance of the midface and cheeks when subjected to the forces of gravity, motion, time, and the elements.

S411: Clinical Application of CO2 Laser in Facial Esthetic Surgery

Facial skin resurfacing via carbon dioxide laser can have a dramatic effect on the overall esthetic rejuvenation of the facial region. This powerful tool is an excellent complement to the more traditional methods of facial esthetic surgery such as cervicofacial rhytidectomy and facial augmentation surgery. This course will allow clinicians to become familiar with the basic physics of the CO2 laser as it relates to facial esthetic surgery. It will also highlight indications for facial resurfacing as well as the preoperative and postoperative management of the laser patient. Case presentations will show each step of the procedure as well as long term results of patients who have undergone CO2 laser resurfacing. Other applications of CO2 lasers such as scar revision and management of premalignant and malignant skin lesions will also be discussed.

Osseous genioplasty in facial aesthetic surgery – a personal perspective reviewing 54 patients

The chin is an important and often neglected feature of facial balance. Genioplasty is a useful procedure in aesthetic surgery and often can be combined with other procedures to obtain an optimal aesthetic outcome. A retrospective case note review of the senior author's (BMJ) experience of aesthetic genioplasty over an 11-year period was undertaken. Cases with non-aesthetic indications for genioplasty were excluded and overall 64 patients were included in this study. Our technique of intraoral osseous genioplasty is described and discussed. A total of 54 patients underwent osseous genioplasty, eight underwent alloplastic genioplasty and two underwent removal of a chin prosthesis only. Most of the patients who had an osseous genioplasty had a sliding advancement correction. Four of these patients required secondary surgery, five had additional minor complications and there were seven cases of transient numbness. Nine patients had a genioplasty alone, 26 had one additional procedure and 19 had more than one, with an average of 2.9 additional procedures. Twenty-four patients had a simultaneous rhinoplasty and 18 had a facelift. Osseous genioplasty is our preferred technique for its versatility and long-term stability compared to alloplastic methods. If performed correctly it provides excellent results with a high degree of patient satisfaction and few long-term complications.

Laser-assisted breast reduction: A safe and effective alternative. A study of 367 patients

Although several studies have been published documenting the safety of laser-assisted breast reduction, they have involved only small numbers of patients. The authors conducted a retrospective chart review of a series of 367 consecutive patients who underwent inferior pedicle laser-assisted breast reduction surgery at a single outpatient facility from 1995 through 2004. All patients received appropriate preoperative intravenous antibiotics and had sequential compression devices placed on their lower extremities before induction of anesthesia. Pedicle deepithelialization was performed using a carbon dioxide laser in continuous mode. Following deepithelialization, an inferior pedicle Wise-pattern breast reduction was performed in standard fashion. In approximately 20% of cases, breast reduction was combined with lipoplasty, facial aesthetic surgery, or abdominoplasty. Minor complications assessed included seroma, hematoma, infection, dog-ear, and incisional wound breakdown. Major complications were defined as >25% nipple/areola necrosis, blood transfusion, deep vein thrombosis, pulmonary embolus, myocardial infarction, or death. No major complications were noted in our series. Two patients with infections required short-term hospitalization for administration of intravenous antibiotics. A total of 47 minor complications occurred in 42 patients (11%), including 36 incisional wound breakdowns, 6 infections, 3 hematomas, 1 seroma, and 1 dog-ear revison. The incisional breakdowns included 25 minor T-zone wounds, 2 nipple-areolar complex wounds, and 9 wounds of the vertical and transverse incisions. No inclusion cysts were noted in any patients. Complication rates for our series of patients who underwent laser-assisted breast reduction surgery were consistent with those reported for non-laser-assisted procedures. These results, combined with the benefits and efficient operating time afforded by laser deepithelialization, indicate that laser-assisted breast reduction surgery can provide an alternative to standard methods of deepithelialization for those surgeons with access to a carbon dioxide laser.

Eight-fold Path to Happiness for the Cosmetic Surgery Patient

Division of Ophthalmic Plastic, Reconstructive, and Orbital Surgery, California Pacific Medical Center, San Francisco, California. Accepted for publication October 12, 2005. Presented whole or in part at The Aesthetic Facial Surgery and Rejuvenation Course, Jules Stein Eye Institute, Los Angeles, California, U.S.A., 2004 and 2005, and at The Multi-Specialty Facial Cosmetic Surgery Symposium, Las Vegas, Nevada, 2005. Address correspondence and reprint requests to Dr. Rona Z. Silkiss, 491 30th Street, Suite 103, Oakland, CA 94609. E-mail: [email protected]

History of Tissue Engineering and A Glimpse Into Its Future

History of Tissue Engineering and A Glimpse Into Its Future

Facial Liposculpture

Modern advances in rejuvenation of the aging face have minimized morbidity and recovery time and maximized natural aesthetic results. Liposuction and autologous fat transfer techniques have emerged as popular methods to achieve these ends. Used alone, or in conjunction with other modalities, lipocontouring will likely continue to play a prominent role in facial aesthetic and reconstructive surgery.

Better sex from the knife? An intimate look at the effects of cosmetic surgery on sexual practices

The positive effects of aesthetic plastic surgery with respect to body image and self-esteem have been reported in the literature. However, the possible effects of aesthetic surgery on the sexual practices and characteristics of patients have been largely unexplored. This paper seeks to examine the degree to which a major aesthetic procedure affects the patient's postoperative psychosexual life. An anonymous questionnaire regarding preoperative versus postoperative psychosexual health and sexual behaviors was mailed to 330 male and female patients who had undergone a major aesthetic procedure by the senior author (G.M.S). Major procedures were defined as breast augmentation and/or mastopexy; facial aesthetic surgery, including face lift, brow lift, and rhinoplasty; and body contouring procedures, including abdominoplasty with or without lipoplasty, or lipoplasty alone. Of the 330 surveys mailed out, 54 were returned as undeliverable. Seventy completed surveys were returned. All the respondents were women, with a mean age of 38 years. More than 95% of respondents reported improvements in body image. Eighty percent of breast augmentation respondents and 50% of body surgery respondents declared improvements in sexual satisfaction. Fifty percent of breast and 60% of body respondents had changed to more provocative attire. Approximately 70% of the breast and body group testified that their partner's sex life had been enhanced. More than 30% of breast patients and 50% of body patients reported an enhanced ability to achieve orgasm. When body and breast respondents were compared with face surgery respondents, statistical significance (P < .01) was found among most psychosexual variables investigated. The results of this study affirm that cosmetic surgery patients overwhelmingly tend to feel better about their body after surgery. The sex lives of both patients and their sexual partners can be strikingly enhanced after elective cosmetic surgery, particularly if the surgery is focused on the breasts, abdomen, and thighs.

Aesthetic Facial Surgery of Male Patients: Demographics and Market Trends

Evaluation of member survey data from the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) and the American Society for Aesthetic Plastic Surgery (ASAPS) from 2000 through 2004 reveals several procedure-specific as well as overall trends regarding utilization of aesthetic facial enhancement services. This gender-specific 5-year retrospective review indicates that males undergo significantly fewer procedures than females except for surgical hair restoration and otoplasty. There is a slight general trend toward decreased surgical but increased nonsurgical facial enhancement procedures. On a case per physician basis, AAFPRS physicians performed significantly more procedures for both males and females for every procedure and every year evaluated. Evaluation of age group data indicates that the 40- to 59-year-old age group accounts for the majority of surgical and non surgical facial enhancement requests. Despite anticipated growth of the 60- to 79-year-old age group, the 40- to 59-year-old age group is projected to remain relatively stable. Although continuing to pursue aesthetic facial enhancement services in significant numbers, men still represent a vast untapped market. This study yields important demographic and trend information that has implications for the current and future delivery of aesthetic facial enhancement services.

Aesthetic Facial Surgery for the Asian Male

Cosmetic surgery of the Asian face has become increasingly popular in the Far East and the West. The Asian male identity has undergone an evolution in Western media toward a more positive change. The standards of beauty have also changed, being defined by more multicultural models and styles of dress than before. To undertake cosmetic surgery of the Asian face, particularly of the Asian male, requires a different psychological understanding of the individual as well as an entirely different surgical technique in most cases. This brief article does not delve into the technical details of each procedure but concentrates on the salient differences in how to approach the Asian male patient for each of the different procedures, including Asian blepharoplasty, augmentation rhinoplasty, lip reduction, dimple fabrication, otoplasty, facial contouring and aging face procedures, and hair restoration.

Male Aesthetic Facial Surgery

Male Aesthetic Facial Surgery

Continuing medical education article—facial aesthetic surgery: Septal reset in midface rejuvenation

Septal reset in midface rejuvenation creates a youthful lower eyelid-cheek junction, shortening the vertical height of the lower eyelid. The author recommends this technique in secondary procedures to correct hollow lower eyelids and lateral sweep of the lower face, and in primary procedures to prevent these face lift stigmata.

Chirurgie faciale de rajeunissement

Aging brings about anatomical changes that are undesirable. Senescence is consequently one of the most powerful stimuli for aesthetic surgery. The face, responsible for the myriad expressions of human experience, is constantly subject to exposure and also suffers from the perennial action of environmental factors and gravity. Frequently, the face is the main focus of anxiety in individuals who have attained a certain age, presenting skin flaccidity and loss of tone, marked lines of expression and fat deposits. Expectations of both the patient and the surgeon, regarding facial aesthetic surgery, have increased considerably over the last two decades with the advent of newer procedures and equipment. While experience allows the surgeon a better selection of techniques, at the same time he must be knowledgeable in details of different surgical approaches and variations to attain the best result for each individual case. The anatomy of the aging face should be examined carefully for a personalized treatment plan. Currently, a satisfactory result of an aesthetic facial procedure is obtained when signs of an operation are undetectable and no anatomical landmarks have been altered. The bond created between the patient and surgeon will be frustrated if there remain signs that reveal the "secret" that surgery was performed.

Postoperative Camouflage Therapy in Facial Aesthetic Surgery

This study investigated the effectiveness of makeup camouflage procedures for patients who have experienced social problems because undesirable ecchymoses and edemas after aesthetic surgery, The impacts of camouflage procedures for such patients also were studied. For this study, 46 rhinoplasty patients were divided into two groups: postoperative camouflage makeup was used for 23 patients, whereas the other 23 patients were assessed as the control group, Additionally, 18 blepharoplasty patients also were divided into two similar camouflage and control groups. The State-Trait Anxiety Inventory test given to the patients postoperatively indicated that postoperative makeup provided positive effects for patients. The current clinical study investigated the effects of cosmetics on the psychological state of patients during the postoperative period and included the application of camouflage makeup for postrhinoplasty and postblepharoplasty patients with edemas and ecchymoses. Psychologically, the patients felt better.

Laser Techniques Associated with Facial Aesthetic and Reparative Surgery

Chronological aging is a natural biological event that is seen particularly in the face. Attempts to correct the results of this facial loss of structural form are sometimes successful. The skin itself is usually neglected, and surgery sometimes fails to achieve the goals expected by the patient. The surgical laser offers an extremely elegant and powerful solution to this problem to complement or enhance the results of selected surgical facial aesthetic procedures as follows: (1) ablative full-face CO2 laser resurfacing in combination with facelifting; (2) laser surgical technique for upper eyelid ptosis; (3) lower eyelid blepharoplasty with the aid of the CO2 laser; (4) full-face resurfacing following minilifting of the lower part of the face; (5) endoscopic eyebrow lifting combined with laser resurfacing; (6) perioral CO2 laser resurfacing in combination with facelifting; and (7) several miscellaneous procedures (e.g., treatment of upper and lower xanthelasma with laser upper blepharoplasty, laser resurfacing in combination with fillers, and laser resurfacing of periocular wrinkles after surgical blepharoplasty). In the hands of the authors, the combination of laser and standard surgical procedures presented herein has consistently produced good results and high patient satisfaction. The complication rate is low and the recovery rate is excellent. Laser treatment enhances the natural look obtained by conventional surgeries.

Endobrow-Midface Lift

The introduction of endoscopes is responsible for the surge in many of the aesthetic facial plastic surgeries in the past decade. This relatively new technology is widely used in upper-third facial rejuvenation and created a natural evolution into the rejuvenation of the central midthird of the face. After careful patient selection and evaluation, several key maneuvers are accomplished to achieve forehead and midface rejuvenation: (1) a subperiosteal dissection of the scalp to the level of the superior and lateral orbital rims and zygomatic arch, (2) incision and release of orbital periosteum, (3) selective myectomies of the glabella muscles, (4) subperiosteal dissection of the midface (from infraorbital rim to the inferior aspect of the maxilla and laterally over the entire zygomatic arch to the gonial angle beneath the masseteric aponeurosis), and (5) suspension and reposition of the malar fat pad, suborbicularis oculi fat, and soft tissue overlying the angle of the mandible. Endobrow-midface lift is a safe and reliable method to rejuvenate the upper two thirds of the face with excellent results while minimizing the morbidities and complications associated with the traditional open procedures.

Collagen Fillers in Facial Aesthetic Surgery

The search for an ideal facial augmentation agent continues. Patient evaluation, choice of augmentation agent, and injection technique are discussed.

Endoscopic-assisted face lift: review of 200 cases.

The use of endoscopic techniques in facial esthetic surgery has gained increasing popularity in the last decade. Endoscopic forehead rejuvenation became a reliable technique and an attractive option for both the surgeon and the patient. The use of the endoscope in face and neck lift surgery did not gain the same popularity, as explained by the relative few indications for this technique. In this study, we retrospectively review a series of 200 patients who underwent endoscopic-assisted face-lifts alone or in combination with other esthetic procedures. We divided the patients into 4 groups according to the type of incisions and the surgical approach used in each of them. We also reviewed the current status of using the endoscope in face and neck lift surgery. The technique described in this study uses limited access incisions (limited postauricular, submental, and temporal scalp) to reposition the ptotic facial elements, while avoiding the preauricular and postauricular scarring when indicated. Under endoscopic visualization, the composite face-lift flap elevates the malar fat pad above the zygomaticus muscle to the nasolabial fold. The lower-lid orbicularis oculi muscle is incorporated and lifted with composite flap through the lower blepharoplasty incision. The jowl area is contoured by tangential excision and tightening of the lateral platysma. Pretunneling and hydrodissection defines the plane of dissection and helps to reduce the bleeding during facial and cervical flap elevation. In this study, endoscopic techniques were applicable in selected patients undergoing facial rejuvenation with goals of decreased scarring. Indications for using the technique include young patients (eg, less than 50 years) with a relatively small amount of skin excess or older patients with thick skin and minimal skin redundancy. The technique is particularly attractive to the male patient, by avoiding the preauricular incision and the disruption of the beard line. Patients with excess skin underwent the standard cervicofacial incision. In this group the endoscope was used as a tool for better magnification and illumination.