Facial Plastic Surgery最新文献

The surgical approach to facial rejuvenation has evolved significantly over the last century. As surgeons have deepened their understanding of facial anatomy over the last half century, so have their surgical approaches to the rhytidectomy, with increasingly extensive manipulation of the underlying soft tissue in the face. While these procedures have become more comprehensive and natural in their approach, the risk of temporary facial palsy also appears to be on the rise. In this text, we review the technique for deep plane facelifts and neck contouring with an emphasis on the facial nerve anatomy and methods to preserve the intricate facial nerve network during tissue dissection and modification. Careful execution of the surgical steps involved, including deep neck contouring, SMAS (superficial musculoaponeurotic system) suspension, and skin management, is essential to achieve the authentic aesthetic outcomes that patients desire while ensuring patient safety.

The aged neck is the most common motivator for patients seeking facial rejuvenation. Unlike the deflated midface, surgical treatment is still the gold standard for optimal outcomes. It is our view that the majority etiology of both the aged neck and deflated midface is gravity's effects on the superficial soft tissue envelope, leading to soft tissue redundancy. It is also our view that the deep-plane rhytidectomy is supported by anatomy, embryology, and clinical evidence as the best methodology to treat soft tissue redundancy without producing the aesthetic and longevity issues associated with superficial musculoaponeurotic system techniques. As one of the early pioneers in deep-plane rhytidectomy, the lead author will define contemporary advances in deep-plane technique such as dissection entry point, flap design, and flap fixation concepts that allow aggressive approach to treating both the aged neck and deflated midface.

The accurate determination of the nasal tip's spatial location is crucial for achieving symmetry in rhinoplasty. Even minor deviations can result in asymmetrical lengths and configurations of the nostrils. Our approach centers on defining the nasal tip position by establishing the midline of the nasal base and projecting an isosceles triangle. This triangle, with the tip as the vertex and alar creases as angles, ensures symmetric sidewalls. The symmetry axis, derived from the isosceles triangle, guides the placement of the tip sidewalls and columella. To implement this, we use anatomical benchmarks such as the implantation of the nasal base and position of the alar creases, considering inherent facial asymmetries. We introduce a laser gadget as an auxiliary tool, projecting perpendicular lines to guide precise midline alignment. Marking specific points, including interbrow midpoint and alar creases, ensures accuracy. In the past 12 months, we applied this methodology in 247 rhinoplasty cases, observing improved outcomes and patient satisfaction. Our proposal of utilizing isosceles triangles provides a streamlined approach to achieving symmetry. The laser device, while beneficial, should be viewed as supportive rather than an absolute guiding measure.

Assessing the proportionality of extended facelift surgery across surgeons is not an easy task. Risks and assumed benefits need to be weighted, yet, especially the latter is difficult to objectify. Reverse engineering the pathway of two leading facelift surgeons suggest that excellent training and focused high-volume facelift surgery preceded their leadership. Yet these conditions are not available to all surgeons. Hence defining extended facelift techniques as the professional standard, could promote novice surgeons into a path that may not correspond to safe practice.

The aim of this study was to examine the role of forehead flaps in the reconstruction of orbital defects after exenteration. Patients undergoing orbital exenteration and reconstruction using median forehead flaps from January 2002 to August 2019 were enrolled in this retrospective study. All the patients were evaluated for wound complications, functional results, and tumor relapse. In total, 105 patients completed the study. Twenty-nine complications in 24 of these patients were assessed. The most common complications were wound dehiscence (11%), partial necrosis of the flap (6%), and bleeding (4%). A major complication occurred in two patients (2%), necessitating surgical correction. Only one patient had a local relapse. Sixty patients received osseointegrated implants, and 58 of them were treated with facial prostheses. The follow-up periods ranged from 6 to 189 months. Thus, forehead flap reconstruction after exenteration is a reliable method with a low complication rate. This technique can be used for primary or secondary reconstruction, and excellent long-term functional results can be achieved. A relapse-oriented follow-up is certainly possible.

I converted to the extended deep plane facelift and neck lift with a shorter skin flap elevation in the face to achieve a more complete release of the facial ligaments to obtain more mobilization of the skin/superficial musculoaponeurotic system composite flap, and a more medial suspension resulting in improved correction of the midface, nasolabial fold, marionette fold and jowl. Treatment of the deep neck structures allowed for more refinement of the submentum in the deep neck lift procedures as well. In this article, we shall review the surgical technique of the deep plane facelift and neck lift as well as postoperative management pearls, the management of complications from the procedure, and the incorporation of ancillary procedures.

The diagnosis and management of intracapsular condylar fractures (ICFs) are crucial, and if left untreated, they can cause facial asymmetry, limited mouth opening, and even temporomandibular joint (TMJ) ankylosis, which may affect the physical function and mental health of patients. Various procedures have been described for the ICFs, but there is no consensus on the therapeutic methods. This study aimed to compare the clinical efficacy of conservative and surgical management of ICFs.

Creating tight and durable profile neck results has perhaps become the principal objective of many surgeons. On social media such results are quickly recognized by colleagues and potential clients alike, much more so than "en-face" results. Yet individual patient characteristics play an essential role in determining if such results are technically possible and also dictate which techniques are required to achieve it. In many patients, these techniques involve manipulation of the deeper neck structures and are oriented more laterally than the direct submental region. Each surgeon needs to decide which technique feels proportionate in terms of an individualized risk-benefit analysis.

Pterygium colli or webbed neck is a congenital deformity mainly found in Turner syndrome. It appears as a bilateral triangular fold extending from the mastoid to the acromion with hairy skin abnormality. Structural variation of the fold, as described by Mehri Turki's webbed neck classification, implies appropriate surgical repair. Despite the availability of a range of surgical techniques, it remains difficult to choose the most suitable one. Thus, this report aims to compare the lateral approach techniques by selecting those providing the best results. A literature search using PubMed and Google Scholar Database identified lateral approach techniques for pterygium colli. A critical reading led us to select criteria for comparison, linked to procedures and results. Moreover, according to aesthetic results, surgical techniques were classified into three categories. A total 16 articles were published from 1937 to 2020 and enrolling 48 patients were selected. The neck contour was obtained with all procedures. However, scars were hidden at the posterior neck in only 10 reports. Otherwise, the posterior hairline was corrected in only 6 reports. According to these outcomes, a classification of surgical technique was made allowing their pragmatic assessment. An objective assessment of lateral approach techniques was realized to help surgeons choose the most convenient one. From this study, a classification arises, based on aesthetic results, distinguishing three groups of surgical techniques and allowing their comparison. Techniques belonging to Group 2, using cervical advancement flap, were the most suitable, mainly both techniques described by Reichenberger and Mehri Turki.

While Asian noses are generalized as having smaller bones and softer cartilages, thicker skin and soft tissue envelop (SSTE), there exists a diversity of morphology amongst Asian noses. The oversimplification of Asian noses diminishes the validity or generalizability of rhinoplasty research findings and makes comparison of outcomes challenging. A classification system is proposed that reflects the different structures and SSTEs of the nasal subtypes, the techniques required in the management of each of the subtypes, the challenges the surgeon will face intra- and postoperatively, allows for preoperative counselling of expected outcomes, and facilitate valid and fair comparison of study outcomes by comparing like for like. The classification system stratifies noses into four subtypes based on (1) the size and strength of the nasal bone and cartilages, and (2) the thickness of the SSTE. Type I noses have thinner SSTE and stronger structure. Type II noses have thinner SSTE and weaker structure. Type III noses have thicker SSTE and stronger structure. Type IV noses have thicker SSTE and weaker structure. Interrater variability in classifying noses among rhinoplasty surgeons was found to be very high with a kappa coefficient of 0.933 (95% confidence interval: 0.852-1.014; variance 0.013).