Complications in Lower Face Rejuvenation: Avoiding, Minimizing, Recognizing, Dealing with Them, and Helping the Patient through the Process of Fixing the Problems.

All surgical and minimally invasive procedures carry a risk of complications. It is imperative that the facial plastic surgeon and his/her staff are well educated in recognizing and managing all the possible problems that could arise. They must also be ready and able to deal with and correct any problem. The patient undergoing surgery or a procedure also needs to be informed of all possible sequelae and complications. Sequelae will happen after almost all procedures. These include soreness, swelling, bruising, and so on. If the patients understand that these are to be expected, they will be less likely to be overly concerned about them. They also must be educated about all the possible complications. They should be told that while complications are very rare, they could nevertheless happen. If a problem should arise, the surgeon and his/her staff should correct it and see that the patient receives the best care possible. This article examines the complications that could occur after rejuvenation surgery and minimally invasive procedures of the lower face and neck, what measures can be undertaken to reduce the risks, and how to recognize and manage them.

Aging changes of the periorbita, cheeks, and midface.

The periorbita, cheeks, and midface are an area of complex facial form and function. There is a particular pleasing visual harmony of these regions in the youthful face. With time, the robust glow and fullness of youth fades and diminishes. The skin is the first component to show the passage of time as it dulls, wrinkles, and blemishes. This is followed by a slow loosening and sagging of soft tissues as they descend from their once-fixed points of the skeletal foundation. The smooth transitions between regions are separated and hollows and ridges appear. These processes continue throughout life and eventually are accompanied by the visible consequences of bone resorption. The faces age, and as the countenance of the human spring turns through summer into autumn, function follows form, and symptoms accompany signs. A thorough understanding of both youthful and elder anatomy as well as the stigmata of aging is prerequisite to perform rejuvenating procedures. This article discusses these changes and how the older anatomy becomes the new norm.

Reducing Surgical Risks in a Rhytidectomy.

Complications after rhytidectomy will occur even in the best of circumstances. Establishing a good rapport with the patient, taking a thorough history and physical exam to elicit potential risk factors such as hypertension or a bleeding diathesis, enlisting staff members to help understand a patient's goals, psychology, and supports, as well as setting realistic expectations help both the surgeon and the patient navigate the journey of surgery toward a successful outcome. Lastly, understanding how to manage potential complications when they arise, in a supportive and caring manner, is vital to the patient relationship and end result: a happy and satisfied patient.

Prescription Skin Care Products and Skin Rejuvenation.

Beauty of the face is dependent on many factors, measurable and intangible. The concept of a beautiful face varies from era to era and culture to culture. Maintenance, improvement, and creation of beautiful skin benefit from procedures, prescriptive topicals, cosmeceuticals, and cosmetics. Current science and art are children of the efforts of previous practitioners of past generations. A thorough understanding of how the skin ages is necessary for choosing the appropriate therapeutic approach to halt and reverse signs of aging. The concept of beauty, history of skin treatments, skin anatomy, aging process of skin, and prescriptive skin care products are examined herein.

From "Hello to Goodbye"-Guiding the Patient of Her Journey Through Facial Rejuvenation Surgery.

Facial plastic surgeons need to be very much more than excellent surgeons. They need to understand and have the ability to bring each patient into the practice family of the surgeon, the administrative and clerical staff, the nurses, the technicians, and the aestheticians. The entire staff must "own" the practice and the patient management philosophy of the surgeon. This article is the author's philosophy and method of guiding his patients through their journey of rejuvenative facial surgery based on 44 years of experience.

Approaches to Reducing Risk in Rhytidectomy Surgery.

Please verify edit, "complications could". All operations have sequelae. These are to be expected and must be told to patients. With surgery, the risk of complications is ever-present albeit infrequent. Facelift surgeons have ethical and intellectual duties to fully inform patients of these risks. Surgeons also must have strategies to reduce the risks, knowledge in how to manage each potential risk, and ability to help patients understand how complications could have occurred and how to cope with them. This article discusses facelift complications, the causes thereof, and how to assess a problem, manage each complication, and comfort a distraught patient.

The Superficial Musculoaponeurotic System and Other Considerations in Rejuvenation of the Lower Face and Neck.

This article addresses several facelift challenges involving anatomic conditions, including platysma banding, endomorphic facial habitus, and midface hypoplasia. In addition, patient counseling and conveying realistic expectations about limitations of facelift alone, with and without adjunctive procedures, are presented. In addition, a few technical modifications of the facelift procedure contributing to more uniform success and longevity are discussed.

Using permanent implant materials for cosmetic enhancement of the perioral region.

The aging of the perioral region continues to challenge facial plastic surgeons. Numerous rejuvenating surgical techniques, resurfacing methods, fillers, augmenters, and implants have been and continue to be developed. The drive for minimally invasive procedures that have a lasting effect has led to the development of several permanent injectable materials and implants to soften the melolabial grooves and marionette lines and augment the lips. These devices and their availability, usefulness, and practicality are examined.

Dual-porosity expanded polytetrafluoroethylene soft tissue implant: a new implant for facial soft tissue augmentation.

OBJECTIVE: To illustrate problems observed with low-porosity expanded polytetrafluoroethylene soft tissue implants and to describe a new dual-porosity implant, the technique for insertion, and this author's preliminary experience. METHOD: A review of 175 pieces of SoftForm (Collagen Corporation, Palo Alto, Calif) placed in 69 patients over 3 years was performed. Between October 1, 1997, and September 30, 2000, 106 Advanta implants (Atrium Medical Corporation, Hudson, NH) in 42 patients have been carried out. A new instrument for implant insertion and the procedure used is described herein. RESULTS: The low-porosity expanded polytetrafluoroethylene implants demonstrated a significant amount of problems with shrinkage and migration. CONCLUSIONS: Preliminarily, the dual-porosity implants would appear to offer a lower incidence of these complications. They are subjectively softer to feel once in place. Insertion is quick and easy using the method described herein.

Gore-Tex chin implants: a review of 324 cases.

Augmentation of the chin is a long-standing and effective technique for facial enhancement. We have used preformed expanded polytetrafluoroethylene (Gore-Tex) implants for chin augmentation for several years. For this study, we collectively pooled data detailing our experiences with this material. From January 1, 1998, to March 30, 2001, a total of 324 Gore-Tex chin implants were placed. No resorption or visible movement of any implant occurred. Two (0.62%) of the 324 implants became infected and were ultimately removed. No other complications occurred. This complication rate compares favorably to other reports. Five implants (1.5%) were removed or changed in size due to patient requests. All remaining patients (97.8%) were satisfied with their result. We also describe technical points and procedure modifications that have helped us achieve beneficial results for our patients. Gore-Tex is a reliable implant material that helps the surgeon to achieve a high degree of patient satisfaction in chin augmentation.

Combining fractional carbon-dioxide laser resurfacing with face-lift surgery.

The human face ages in three different ways: tissues descend; the skin develops rhytides, dyschromia, and numerous lesions; and facial volume is lost. Face-lift surgery and skin resurfacing are two of the mainstays of facial rejuvenation. Today, carbon-dioxide laser resurfacing is, arguably, the gold standard for resurfacing the skin. This article describes the rationale and application of simultaneous fractional laser resurfacing with face-lift surgery. The discussion includes the author's technique, preoperative and postoperative regimens, and experience.

Lip augmentation: discussion and debate.

Brian P. Maloney, William Truswell IV, and S. Randolph Waldman, address questions for discussion and debate: