Contouring of the lower face

Abnormalities of the lower face can be related to any or a combination of several anatomical structures. These include excessive skin, excess subcutaneous fat, platysma bands, subplatysmal excess fat, ptosis of submaxillary glands, malpositioned hyoid bone, micro or retrogenia and retrognathia. It is crucial to evaluate each of these anatomical elements individually and decide what, exactly, would most benefit the patient. It is not common for one abnormality to mask another. For example, significant excess fat might cover ptotic submaxillary glands, making the recognition of this problem difficult if not impossible. With careful examination, however, most imperfections can be detected and analyzed appropriately. The subjects of correction of excessive skin, platysmal band, sub - and supraplatysmal fat and ptotic submaxillary gland will be discussed by other authors. This writing will primarily address chin abnormalities and the role of the hyoid bone in dysmorphic necks.

Forehead rejuvenation

Guided by a better understanding of gravity and aging affects on different parts of the face, plastic surgeons are now able to direct attention to each facial zone individually and, more often, operate collectively. Generally, the affect of gravity and aging involves the whole face rather than a single zone. Although the different zones lack synchronization, eventually each zone will benefit from surgical rejuvenation. In this writing, emphasis will be primarily directed to the surgery of the forehead. The impact of forehead rhytidectomy upon the outcome of facial rejuvenation has only been realized within the past two decades. Correction of aging effects on the forehead has an integral role in achieving a complementary and proportionate youthful appearance, and, not uncommonly, it is the most influential part of this surgery. The mean and angered appearance often resulting in questions such as "Are you angry about something?" or "Why are you so serious?" inspires patients to seek the advice of a plastic surgeon. These patients are, not infrequently, young and sometimes unaware of the exact reason for such comments. It is the plastic surgeon who usually discovers the pathology. This results in the patient's surprise and dismay and requires lengthy explanation to convince the patient that the problem lies in the eyebrows and the forehead, not necessarily in the eyelids.