What We Know About Facial Volume Restoration with Autogenous Fat.

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.

Extending the "Reach" of the Short-Scar Facelift with Energy Devices-An Early Report.

Facial rejuvenation has become more popular. A wider breadth of the patient population is seeking procedures to preserve their youthful facial attributes and to remedy age-related deleterious changes. Along with this increasing interest in facial rejuvenation is also the expressed desire for any interventions to be relatively low risk, with limited recovery, and with achievable positive results. Many new technologies have become available in an attempt to improve age-related facial changes. The radiofrequency (RF)-based technologies are largely directed toward skin tightening and toward reducing and remodeling subcutaneous fat. It can be contemplated that the combination of RF-based technology with limited surgical procedures may extend the patient selection for less invasive procedures while improving potential results. This is a report of the combination of radiofrequency technologies-percutaneous and transcutaneous-with short scar face techniques in facial rejuvenation.

Another Look at Platysmaplasty in Facelifting.

Over the history of facial rejuvenation surgery there has been a progressive assimilation of knowledge about the anatomy of neck structures that are central to the manifestations of the aging neck. These advances in knowledge have been accompanied by the innovation and introduction of several surgical techniques to restore the neck to a more youthful appearance. The rejuvenation of the aging neck frequently incorporates a consideration and execution of accepted methods to restore the platysma muscles to a more aesthetic form. Lasting and dependable surgical techniques remain somewhat elusive and late failures in the neck continue to be a frustration for both patients and surgeons.In this manuscript, the author reviews some of the more enduring and innovative methods to manage the platysma in facelifting and cites the rationale and limitations of the various techniques. The concept of the restoration of an effective platysma "sling" in the upper neck to eliminate platysma bands and recreate a defined jawline is highlighted. A framework of patient evaluation and decision making is presented, and a suggested individualized application of accepted surgical maneuvers is suggested.

Different Faces: Different Facelift Techniques.

The introduction and evolution of different rhytidectomy techniques has spawned an exciting era of facial rejuvenation in modern times. To provide patients with the best customized approach to surgery the facial aesthetic surgeon must have familiarity and understanding of the fundamental differences between these techniques. Here we set forth to provide some historical and anatomical perspective, followed by reviewing and comparing some of the key aspects of the most commonly utilized facelift techniques.

The Rejuvenation of the Aged Central Lower Face: A Contemporary Perspective.

Aging of the central face is typified by several common characteristics such as generalized volume loss, the appearance of a mental crease and marionette lines, thinning of the lips, and fixed and dynamic rhytids. These result from several processes such as atrophy of adipose and bone, changes in the support of the mandibular septum, and a loss of skin elasticity. There are many methods available for the improvement and rejuvenation of this facial anatomical area. Options include traditional surgical techniques, the application of volume and the use of laser, light, and energy-based devices. The recent application of biological interventions offers the possibility of cellular-based therapies to usher in a new era of true tissue regeneration. Optimal correction of the abnormalities may be accomplished through an understanding and identification of the causes of the observed abnormalities and targeting with the best available intervention. There are a growing number of techniques and technologies to accomplish this.

The Trichophytic and Lateral Temporal Lifts: Application to the Focal Elevation of the Aging Lateral Eyebrow.

Rejuvenation of the upper face is a key component of overall facial rejuvenation. The upper face is probably the most important purveyor of our sense of well-being and our primary transmittal of nonverbal social interaction. There are many aspects to the aging changes in the area. Central to these concerns is the level and shape of the eyebrow. Ptosis of the lateral brow begins at a relatively young age and tends to worsen over time. This article describes an adaptation of modifiable techniques to address focal issues of the lateral eyebrow.

Augmenting the Prejowl: Deciding between Fat, Fillers, and Implants.

The prejowl sulcus is a complex anatomic structure that results from several age-related changes in the lower face. These changes include the localized atrophy of a segment of the mandible inferior to the mental foreman, fat atrophy, and dehiscence and laxity of the ligamentous and muscular components of the region. The correction of the prejowl sulcus is rarely accomplished through rhytidectomy alone. Instead, the volume deficit of the sulcus usually requires the replacement of volume. Solid implants, fillers, and fat transfer may be used to improve the contour of the lower face. These can be used in isolation and in conjunction with rhytidectomy. The decision of what method to be used depends on the severity of the deformity, the patient's adjacent anatomy, the patient's wishes, and the skill set of the surgeon.

A Multidisciplinary Evaluation of Prescribing Practices for Prophylactic Antibiotics in Operative and Nonoperative Facial Fractures.

BACKGROUND: Evidence supports short-term perioperative prophylaxis for facial fractures. It is unknown, however, whether there is any professional consensus on how to manage these injuries. No multidisciplinary evaluation of the prophylactic antibiotic prescribing patterns for neither operative nor nonoperative facial fractures has been performed. AIM: To evaluate the prophylactic antibiotic prescribing patterns of multiple specialties in operative and nonoperative facial fractures. METHODS: A 14 question anonymous online-based survey was distributed to members of the American Society of Maxillofacial Surgeons (ASMS) and the American Association of Facial Plastic Surgeons to evaluate current practices. RESULTS AND CONCLUSIONS: 205 respondents, including 89 plastic surgeons, 98 otolaryngologists, 12 oral and maxillofacial surgeons, and 7 with double board certification practicing throughout the United States with ranging experience from 11 to 30 years. As expected, preoperative, perioperative, or postoperative prophylactic antibiotics are either "always" or "sometimes" prescribed, 100% of the time with more varied practice upon further inspection. A total of 85.1% either "always" or "sometimes" use antibiotics while awaiting surgery. Dentate segment fractures are the most frequent type of facial fractures to receive prophylactic antibiotics for both operative (90.5%) and nonoperative (84.1%) fractures. Duration of antibiotic use is more varied with the majority providing 3 to 7 days despite current evidence. First generation cephalosporins alone are prescribed by 49% of respondents, which may not adequately cover oral flora. There is no multidisciplinary consensus for prophylactic antibiotics for specific operative fracture types or nonoperative facial fractures, an area with little published evidence.

Essential Grafting in the Traumatized Nose.

Corrective rhinoplasty after significant nasal trauma is a much different entity than elective rhinoplasty or rhinoplasty after minor trauma. The more significant the degree of trauma the patient is subjected to, the greater the deleterious effects will be on the soft tissue and skeletal elements of the patient's nose. With this disruption of the anatomic integrity and dynamics of the nose, the patient experiences deformity and dysfunction of the nose. This may be minor and transient or may be lifelong and disabling. In this article, the authors review some of the more long-term aspects of nasal trauma and provide the reader with insights to the use of cartilage grafting techniques that are useful in the management of posttraumatic nasal deformity and airway obstruction.

Management of the middle vault in endonasal rhinoplasty.

The management of the middle vault has become a crucial consideration in esthetic and functional rhinoplasty. Central to this management is an acknowledgment of the importance of the anatomic features and functional integrity of this nasal region. The diagnosis of middle vault insufficiency and techniques to prevent and repair such collapse have been widely reported. Many of these descriptions are based on the management of the middle vault using an open rhinoplasty approach. The purpose of this article is to describe various options for the management of the middle vault using an endonasal approach that have been used by a single surgeon in a university hospital-based setting.

The difficult neck in facelifting.

The management of the neck often presents the most challenging aspect of the facelift procedure. The aesthetic neck has a well-defined jaw line, a pleasing and adequate cervicomental angle, and visible definitions of the deeper lateral and midline structures, such as the sternocleidomastoid muscles and trachea. Several unfavorable anatomic characteristics will present that will compound the challenge. These characteristics are contrasted with ideal features and include the following: an excess of adipose tissue, an excess of either thin or thick inelastic skin, marked relaxation of the suspension structures of the neck with resultant platysma banding and jowling, and unfavorable skeletal features such as microgenia and hyoid malposition. These patients present for rhytidectomy with inadequate chin projection, an obtuse cervicomental angle, sagging skin, and a heavy neck. To maximize rhytidectomy results in these patients with difficult neck anatomy, special attention to the anatomy and application of recognized techniques in an individualized manner is recommended. This article reviews the issues encountered in the management of the difficult neck in facelifting, with special attention given to patients with a heavy neck.

Evaluation and Treatment Planning for the Aging Face Patient.

Facial aging is a multifactorial process that occurs due to alterations in the skin, soft tissue, and bony skeleton. When considering treatments for the aging face and neck, a multifaceted approach targeting each of these areas should be considered. Although surgical intervention remains a key component to the holistic care of the aging face patient, a multitude of minimally invasive techniques is now available to optimize the care of the patient seeking rejuvenation. Proper patient evaluation and counseling on realistic expectations are critical and will be discussed here. A brief overview of common minimally invasive treatments will be presented.

Managing the neck in the era of the short scar face-lift.

A recent trend in rhytidectomy has included the introduction of various short incision techniques, particularly the S-lift, the minimal access cranial suspension lift, and other short scar methods. However, this trend has not been without a criticism that these minimally invasive techniques might be limited in what might be achievable by such surgery. As with more traditional face-lift surgery, the management of the neck often presents as the most challenging aspect of the procedure when using short scar techniques. This article will present a brief history of cervical rhytidectomy and relevant surgical anatomy, as well as the authors' algorithmic approach to surgical assessment and management of the neck, the short incision operative techniques, and potential complications. In the authors' experience, attention to both the selection criteria and operative modifications in the execution of short scar techniques are critical to optimizing outcomes in cervical rejuvenation.

Evaluation and Treatment Planning for the Aging Face Patient.

Facial aging is a multifactorial process that occurs due to alterations in the skin, soft tissue, and bony skeleton. When considering treatments for the aging face and neck, a multifaceted approach targeting each of these areas should be considered. Although surgical intervention remains a key component to the holistic care of the aging face patient, a multitude of minimally invasive techniques is now available to optimize the care of the patient seeking rejuvenation. Proper patient evaluation and counseling on realistic expectations are critical and will be discussed here. A brief overview of common minimally invasive treatments will be presented.