Facial Plastic Surgery最新文献

While rhytidectomy can yield remarkable results, some patients may subsequently require revision rhytidectomy due to either unsatisfactory outcomes from primary surgery or the natural aging process many years later. Like most other secondary plastic surgical procedures, revision rhytidectomy is a complex undertaking and fraught with potential pitfalls. This can be attributable to natural or postsurgical alterations that can occur with the facial skin, superficial musculoaponeurotic system/platysma muscle, and/or facial nerve landmarks. Additionally, complications such as cobra neck deformity, pixie ear deformity, and synkinesis can add an extra level of complexity to revisional surgery. Furthermore, as more surgeons are performing deep-plane facelifts and more aggressive neck procedures, the risks are further amplified in revisional surgery. In this article, we review the challenges that a facelift surgeon may face when performing revision rhytidectomy and the technical considerations to overcome these obstacles.

Facial rejuvenation involves a careful analysis of a patient's anatomic changes that are secondary to aging and then the application of several methods, tools, and technologies to reverse those changes. A central component of facial aging is the changes seen in facial soft tissue volume that occurs with atrophy and malpositioning of normal facial volume through several underlying aging processes. Although many surgical and nonsurgical interventions are available to remedy many of the sequela of aging, the restoration of volume is one of the most important goals that has to be engaged. Over the years, autogenous fat has emerged as one of the safer and reliable methods to restore the diminished volume of the aging face. The purpose of this manuscript is to relate some of the history, clinical practices, research, and current literature supporting the use of autologous fat in facial rejuvenation.

Perioral rejuvenation is a critical component in the comprehensive approach to the aging face. The perioral region-comprising the lips, philtrum, and areas surrounding the oral commissures-plays a significant role in an individual's perceived age, attractiveness, and emotional expressions. However, the perioral region is often the "forgotten area" and has the potential to undermine the success of otherwise outstanding rejuvenation surgeries. This article will shed light on 40 years of experience in perioral rejuvenation surgery, demonstrating techniques and methodologies that have consistently yielded long-term, reliable results in my practice.

Deep-plane or composite flap facelift techniques allow deep structural rejuvenation of the face by release of retaining ligaments in the subsuperficial musculoaponeurotic system (sub-SMAS) plane with elevation and fixation of the SMAS/platysma/skin flap as a single, "en bloc" unit. This means that in the cases with mild to moderate skin laxity, the preauricular incision serves the purpose of access only. The author therefore developed an endoscopic-assisted, en bloc composite flap face and neck lift without a preauricular incision. The technique uses the prezygomatic and premasseteric (facial) and subplatysmal (neck) spaces as ideal optical cavities for endoscopic dissection and ligament release. Verticalization of fixation vectors and modified concho-mastoid traction sutures are used to minimize preauricular skin redundancy. The surgical procedure is described in detail. Clinical experience in 41 consecutive cases and comparison to other techniques with respect to relevant anatomy are also presented. This endoscopic en bloc composite flap facelift technique consistently and safely produced results comparable to conventional, "open" composite flap facelifts done by the same surgeon on similar candidates during a prior period.

The deep-plane rhytidectomy was first described in 1990 and has gained traction in the past decade as supported by anatomy, embryology, and clinical evidence. Consumer dissatisfaction in facial rejuvenation procedures often occurs because procedures are too conservative and are undone. From the consumer's perspective, an outcome is a combination of the esthetic result, predictability, and the length of the recovery process. The length of the recovery process is often the limiting issue affecting the consumer's willingness to proceed with the procedure. As one of the early pioneers in deep-plane rhytidectomy, the lead author will define contemporary advances in deep-plane techniques such as dissection entry point, flap design, and flap fixation concepts that allow an aggressive approach to treating both the superficial soft tissue envelope and deeper facial aging structures. These technique modifications and insights will provide the surgeon with an understanding of how to achieve significant, natural, long-lasting results with predictable short recovery periods-maximizing outcomes and minimizing postoperative processes.

The surgical net technique, originally conceptualized to mitigate postoperative hematomas, has evolved into a versatile tool, transcending its initial purpose, and signaling a new era of surgical innovation. This article provides a comprehensive overview of the surgical net's journey from a targeted solution to a multifaceted surgical asset and explores its burgeoning applications, challenges, and future trajectories. Despite early reluctance due to anatomical concerns and unfamiliarity with the novel technique, the surgical net's consistent success in various surgical contexts from facial surgeries to gynecological applications has catalyzed its widespread global adoption. The technique's integration of the progressive tension method and enhanced skin redraping capabilities underscores its contribution to optimal aesthetic outcomes and improved surgical control. Noteworthy is its role in the innovative concept of gliding surgery, marked by procedures like the gliding brow lift and Glidelift, demonstrating the surgical net's adaptability and effectiveness in diverse surgical environments.Contributions from international surgeons have expanded its applications to areas like axillary space obliteration after breast implant, postmastectomy closure, and the management of postpartum hemorrhage, showcasing the surgical net's global impact and universal commitment to optimizing surgical outcomes. The article delves into the anatomical considerations essential for adapting the surgical net technique to various surgical contexts, emphasizing the need for continuous research, clinical trials, and multidisciplinary collaboration to navigate emerging challenges and ensure its sustained efficacy and safety.In conclusion, the article highlights the surgical net technique's unwavering potential for further advancements, greater procedural efficiency, and the continued elevation of patient care standards. The consistent evolution of its applications, paired with a dedicated approach to addressing emergent challenges, reinforces the surgical net's enduring contribution to surgical innovation and global patient welfare.

Facial feminization surgery includes a series of procedures that aim to attenuate the masculine features of the face and make the face more feminine and harmonic. During the past few years, several feminization techniques have been developed or adapted to this discipline. The current intervention of the forehead for feminization is based on the setback of the anterior wall of the frontal sinus and the remodeling of the supraorbital and glabellar region, associated to brow lift and hairline advancement. Primary forehead feminization yields high patient satisfaction, quality of life, and aesthetic outcomes, with few complications. Despite this, secondary forehead lift in feminization surgery has grown rapidly in recent years due to two main reasons: (1) patients that had their primary forehead surgery 5 or more years ago kept aging; and (2) there was also a great increase in the primary surgeries, which also comes with increased unsatisfied patients that want a revision. In the present study, we will present our current approach for secondary forehead lift in transgender women and tips to avoid a revision when performing the primary forehead reconstruction.

A deep comprehension of key anatomical issues, along with the targeted application of suitable therapies, is vital for attaining exceptional neck contours. Traditional surgical approaches often focus solely on modifying subcutaneous fat and, occasionally, the platysma muscle, neglecting subplatysmal structures. This narrow focus may yield less-than-ideal results and potentially exacerbate existing issues, leading to additional contour abnormalities that prove challenging to correct. In fact, in most cases, there are additional factors deep to the platysma-such as subplatysmal fat, the anterior bellies of the digastric muscles, perihyoid fascia, and the submandibular glands-that contribute to obtuse neck contours. For these patients, accessing the neck through a submental incision allows for precise management of these deep neck structures as required. Unfamiliarity with deep anatomical structures can deter surgeons from performing subplatysmal procedures due to unwarranted concerns about increased complication risks. However, both published clinical series and our clinical experience indicate favorable long-term outcomes with natural, refined, harmonious neck contours and a minimal rate of complications. This article serves as a comprehensive guide, describing indications, strategies, and providing a step-by-step description of the senior author's techniques for mastering deep neck contouring.

Hairline reduction surgery, also known as aesthetic forehead reduction, is a surgical procedure that aims to reduce the upper facial third and improve facial harmony. This article describes the anatomy of hairline advancement surgery and the surgical technique used by the author. The study included 21 patients from 2019 to 2023, and the forehead reduction length was on average 22.48 ± 2.64 mm. The most common complaint was hypoesthesia of the scalp, present in 100% of patients, resolving in all cases by 2 months after surgery. Forehead reduction surgery is among the procedures that provide more satisfaction to patients due to the great changes that it can achieve.