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Facial Plastic Surgery: FPS

Tsutomu Mizuno
Augmentation rhinoplasty is commonly performed to raise the nasal dorsum in Asian individuals. However, materials used for dorsal augmentation are associated with various surgical challenges and complications. In this article, the authors present a novel dorsal augmentation technique combining hybrid autologous costal grafts with septal extension grafts. The records of 28 patients (19 women and 9 men; mean age: 27 years; range: 18-43 years) who underwent augmentation rhinoplasty (primary or revision) with our novel technique from December 2007 to December 2016 were retrospectively reviewed...
November 2, 2018: Facial Plastic Surgery: FPS
Daniel H Coelho, Eric N Appelbaum, Prem Darji, Joe Niamtu
As the incidence of rhytidectomy and cochlear implantation increases, so does the likelihood that an individual patient will undergo both procedures over their lifetime. This is particularly relevant as the US population not only ages but ages well. The purpose of this paper is to describe cochlear implants and to characterize pre-, intra-, and postoperative considerations of rhytidectomy in patients with cochlear implants. A thorough understanding of the relevant anatomy and physiology is crucial to the avoidance of potentially serious complications in patients with cochlear implants...
November 2, 2018: Facial Plastic Surgery: FPS
M Sean Freeman
In this article, the interested reader will learn when and how to apply different techniques on their patients, with the goal of safe, effective, natural looking, and long-lasting midface rejuvenation.
October 2018: Facial Plastic Surgery: FPS
Sinehan B Bayrak, John D Kriet, Clint D Humphrey
The periorbital region is a focal point on the face. Dermatochalasis, fat herniation, blepharoptosis, brow ptosis, deep tear troughs, and malar fat pad descent are all age-related changes that occur around the eyes, and successful rejuvenation involves addressing all of these changes. Restoring a youthful, vibrant appearance to the eyes and periorbital areas can often only be accomplished with a combination of surgical and nonsurgical interventions. Facial plastic surgeons should have a comprehensive knowledge of all of these options and their applications to ensure good patient outcomes and satisfaction...
October 2018: Facial Plastic Surgery: FPS
C Ian Newberry, Steven Mobley
Successful management of the crooked nose can be a formidable task and requires a systematic approach that begins with an understanding of the patients' aesthetic desires, expectations, and functional symptoms. Dividing the nose into thirds and organizing a plan to correct each region individually can simplify the preoperative planning. There are two broad philosophical strategies of surgical management: engineering (reconstructive) and artistic (camouflaging). While the camouflaging technique is helpful for minor asymmetries, protrusions, and depressions, the engineering approach is best for more extreme corrections...
October 2018: Facial Plastic Surgery: FPS
Julia L Frisenda, Paul S Nassif
Rejuvenation of the lower face and neck strives to reverse signs of aging while optimizing the patient's natural anatomy. Common features of an aesthetically pleasing lower face include a well-defined and appropriately balanced mandible and an acute cervicomental angle. Correction of the aging lower face and neck is accomplished through multiple surgical interventions, performed either alone or in combination. Determination of appropriate procedures is based on individual anatomic pathology. Intimate knowledge of facial anatomy and the complexity of the aging process is paramount to achieve a natural and aesthetic result...
October 2018: Facial Plastic Surgery: FPS
Michael Somenek
In the last several years, there has been an increasing demand for surgical facial feminization or masculinization to treat the gender dysphoric patient. However, while aesthetic ideals for facial rejuvenation are well described and taught, there is a relative paucity of literature on how to achieve a feminine or masculine morphology. It is thus becoming increasingly important for facial plastic surgeons to understand patient goals regarding facial feminization or masculinization, and to have a systematic approach for analyzing the female and male face...
October 2018: Facial Plastic Surgery: FPS
Demetri Arnaoutakis, Benjamin Bassichis
The periorbital and forehead regions are among the most expressive parts of the face. A thorough understanding of the complex facial anatomy and aesthetic norms are essential when evaluating and treating a patient for facial brow rejuvenation. Not only will knowledge of the anatomy enhance facial injection and surgical outcomes, but will also diminish potential complications. Combining nonsurgical and surgical techniques, including laser and skin rejuvenation, can yield the most natural and effective aesthetic brow improvements...
October 2018: Facial Plastic Surgery: FPS
Hope Bueller
Analysis of the face is an essential component of facial plastic surgery. In training, we are taught standards and ideals based on neoclassical models of beauty from Greek and Roman art and architecture. In practice, we encounter a wide range of variation in patient desires and perceptions of beauty. Our goals seem to be ever shifting, yet our education has provided us with a foundation from which to draw ideals of beauty. Plastic surgeons must synthesize classical ideas of beauty with patient desires, cultural nuances, and ethnic considerations all the while maintaining a natural appearance and result...
October 2018: Facial Plastic Surgery: FPS
Christopher Ian Newberry, J Regan Thomas, Eric W Cerrati
Scars are a natural part of dermal healing following lacerations, incisions, or tissue loss. The ideal scar is narrow, flat, level with surrounding tissue, and difficult for the untrained eye to see due to color match and placement parallel to relaxed skin tension lines; however, scarring that is dyspigmented, hypertrophied, widened, contracted, or atrophic can be aesthetically displeasing or causing functional limitations. When the scar has unfavorable characteristics, scar revision is often indicated and the cosmetic surgeon must be knowledgeable of the minimally invasive as well as surgical techniques to improve aesthetics, reduced reoccurrence, or correct functional limitations...
October 2018: Facial Plastic Surgery: FPS
Gary Linkov, Gregory Branham
Creation of a pleasing dorsal nasal profile in the anterior and lateral views requires proper analysis and planning to determine the required series of steps to accomplish the desired outcome. The widened nasal dorsum is a common esthetic complaint of the patient seeking rhinoplasty. Often patients seek an unrealistic result that, if accomplished, would leave them with a restricted nasal vault and nasal airway compromise. Nasal function must be balanced with the patient and surgeon's desire to narrow the nasal dorsum...
October 2018: Facial Plastic Surgery: FPS
Anthony P Sclafani, Jiahui Lin
Scars and flaps represent a disruption of the normal skin contour, shape, and texture. Successful reconstruction of facial defects with local flaps requires prior planning to choose the correct reconstructive method. However, thorough preoperative planning should include consideration of adjunctive procedures to improve expected postoperative results as well as potential procedures to improve less-than-ideal results. Approaching facial reconstruction holistically allows the surgeon to soberly assess his/her reconstructive results and attain outstanding appearance...
October 2018: Facial Plastic Surgery: FPS
J Regan Thomas
No abstract text is available yet for this article.
October 2018: Facial Plastic Surgery: FPS
Marion San Nicoló, Klaus Stelter, Haneen Sadick, Murat Bas, Alexander Berghaus
The safety and effectiveness of an absorbable implant for lateral cartilage support have been recently demonstrated in subjects with nasal valve collapse (NVC) at 12 months postprocedure. This follow-up study aimed to assess whether the safety and effectiveness of the implant persist in these patients for 24 months after the procedure. Thirty subjects with Nasal Obstruction Symptom Evaluation (NOSE) score ≥ 55 and isolated NVC were treated; 14 cases were performed in an operating suite under general anesthesia and 16 cases were performed in a clinic-based setting under local anesthesia...
October 2018: Facial Plastic Surgery: FPS
Chelsea A Obourn, John L Frodel
Facelifts remain a critical part of a facial plastic surgeon's cosmetic practice. Techniques continue to evolve, while at the same time patients demand less invasive procedures with less morbidity. The authors present a facelift plication technique using wide purse-string sutures placed into the superficial musculoaponeurotic system and platysma. This is a retrospective review with a level of evidence 3 set at a medical spa and tertiary referral center designed to assess a purse-string suture technique using an inner followed by an outer purse-string, with refinements being made during the timeframe of the review...
October 2018: Facial Plastic Surgery: FPS
Emily A Spataro, Sam P Most
A key concept in successful rhinoplasty surgery is maintaining or increasing tip support, and addressing tip projection and rotation. The tongue-in-groove (TIG) technique is a method to achieve this goal using sutures to create a strong connection between the septum and medial crura to change tip rotation and projection. Criticisms of this method include that it may cause stiffness of the nasal tip and columellar retraction. TIG is routinely used by the authors during anterior septal reconstructions (a modified extracorporeal septoplasty technique), as well as in primary and revision aesthetic and functional rhinoplasties...
October 2018: Facial Plastic Surgery: FPS
Sridhayan Mahalingam, Anton Alatsatianos, Lisa Pitkin, Alwyn D'Souza
The cosmetic outcomes following thyroid and parathyroid surgery is a priority for patients as the surgical scar is in a visible area of the body. Although some have advocated the use of minimally invasive and robotic surgery, these are not without risks and it has been suggested that the scars are not necessarily more favorable. The three most common means of skin closure include the use of subcuticular sutures, clips, and tissue adhesive (with or without deeper subcutaneous sutures) and there are no previous reviews of the published evidence...
October 2018: Facial Plastic Surgery: FPS
Ryan A Bartholomew, Joseph Zenga, Derrick T Lin, Daniel G Deschler, Jeremy D Richmon
Combination anterior palatectomy and rhinectomy defects result in complete loss of midface and nasal support and present a significant reconstructive challenge. A novel use of the scapular tip free flap-the tip-on-tip scapula flap-was developed to provide both palatal repair and restoration of intrinsic nasal support. The scapular tip bone is split into a large proximal segment for the anterior palate and a smaller distal bone segment for nasal framework reconstruction. Two patients undergoing reconstruction of both total palatectomy and partial rhinectomy defects at a single academic tertiary care center were reviewed...
August 2018: Facial Plastic Surgery: FPS
Anthony Bared
Hair restoration can be an integral addition to the facial plastic surgery practice. As surgeons dedicated to reconstructive and aesthetic surgery of the head and neck, hair restoration is a natural complement to a facial plastic surgeon's practice. This article presents the keys to adding and starting hair restoration to one's facial plastic surgery practice.
August 2018: Facial Plastic Surgery: FPS
Ian-James Malm, Monirah Albathi, Patrick Byrne, Masaru Ishii, Lisa Ishii, Kofi Boahene
Consistent and objective evaluation of the paralyzed face is imperative for documenting preoperative findings and assessing postoperative outcomes of reanimation techniques. Static and dynamic facial asymmetry are the key features of the paralyzed face. To date, there is no consensus among surgeons on how best to document facial asymmetry. The authors propose a Facial Asymmetry Index (FAI) as an objective measure of facial asymmetry and validate its use and reliability across numerous reanimation techniques...
August 2018: Facial Plastic Surgery: FPS
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