Facial contouring surgery combined with the clinical application of minimally invasive tunnel separation and lifting technique / 中华医学美学美容杂志

Objective:To explore a simple and effective clinical method for improving facial sagging while performing maxillofacial contouring surgery.Methods:From October 2020 to October 2021, 50 patients with mandibular angle and malar surgery in the Plastic Surgery Department of Sichuan Friendship Hospital were selected, aged 30-43 years, with the average age of 37 years, including 44 females and 6 males. Maxillofacial contouring surgery was performed under transnasal intubation general anesthesia, the interorgual jaw groove incision was performed with a swing saw for bilateral long arc osteotomy, and the maxillary gingival groove incision and sideburn skin incision were performed for zygomatic osteotomy reduction and zygomatic arch incision. A small incision about 3 mm long was taken 1 cm from the edge of the temporal hair; a special conical cannula stripper was used to perform subcutaneous tunnel peeling to the zygomatic fat pad and masseter muscle ligament, anterior appendage ligament, then a two-way barb line was placed through the casing to lift vertically upwards, pierce above the posterior papillae of the ear, and the excess thread was cut off.Results:Following-up for 3-12 months, all recipients recovered well after surgery, the skin of the middle and lower parts of the postoperative body was lifted to varying degrees, the cheek fat pad was lifted, the jaw contour line was clearer, and the nasolabial fold was significantly improved as compared with that before the operation.Conclusions:At the same time as facial contouring surgery, the use of minimally invasive tunnel separation and lifting technique can effectively improve the skin sagging in the middle and lower parts, and it is simple and effective, and the clinical application effect is good.

Comprehensive correction of maxillofacial bone deformity-consideration and combined application of orthognathic surgery and facial contouring surgery / 华西口腔医学杂志

The maxillofacial skeleton is the basis of the contour of the face. Orthognathic surgery and facial contouring surgery change jaw tissue and affect facial appearance in different manners. Orthognathic surgery is the main method to correct dental and maxillofacial deformities. It changes the shape of the jaw and improves the occlusal relationship by changing the three-dimensional position of the jaw. Facial contouring surgery mainly adopts the method of "bone reduction", which changes the "amount"of the jawbone by cutting a part of the bone tissue to improve the facial appearance, generally without changing oral function. The combined use of orthognathic surgery and facial contouring surgery is becoming increasingly common in clinical practice. This also requires oral and maxillofacial surgeons to have a holistic consideration of the comprehensive correction of maxillofacial bone deformity, and to perform comprehensive analysis of jaw deformities and jaw plastic surgery to achieve the most ideal results. The author's team has been engaged in the clinical work of orthognathic surgery and facial contouring surgery and accumulated rich clinical experience in the comprehensive correction of maxillofacial bone deformity. In this article, the indications, treatment goals, treatment modes, treatment methods, and key points in the surgical operations of comprehensive maxillofacial bone surgery were summarized.

Application of autologous fat grafting for facial contouring and rejuvenation—a report of 450 cases / 中华整形外科杂志

Objective@#Report the experience of autologous fat grafting forfacial contouring and rejuvenation patients.@*Methods@#Retrospective analysis the treatment of 450 facial contouring and rejuvenation patients with global optimization autologous fat grafting in Plastic Surgery Hospital of Chinese Academy of Medical Sciences from January 2011 to December 2017. Using low negative pressure liposuction technical and blunt cannula (diameter 2.5 mm and 2.0 mm), different fat particle was harvested and concentrated by a cotton pad. The one-hole blunt cannula was used for fat grafting with multi tunnel and multi-point and two layer(deep and superficial)injection ways, regularly following up and taking picture for imaging evaluation.@*Results@#All patients were successfully performed with fat grafting. Grafted fat volume was 15-65 ml. There were 132 cases of local skin bruising after operation, which gradually subsided about 2 weeks, no severe complications occurred. 450 patients were followed up for 6-12 months. Facial contour and skin texture were improved without subcutaneous nodules and irregularity. The outcome of all patients were satisfactory. Of a total of 450 patients, 319 (70.89%) were evaluated as very good result, 94 (20.89%) as good result, and 37(8.22%) asregular result.@*Conclusions@#Optimization autologous fat grafting can improve the facial contouring and rejuvenation with little complications and satisfactory results.

Inferior alveolar nerve cutting; legal liability versus desired patient outcomes

OBJECTIVES: Mandibular angle reduction or reduction genioplasty is a routine well-known facial contouring surgery that reduces the width of the lower face resulting in an oval shaped face. During the intraoral resection of the mandibular angle or chin using an oscillating saw, unexpected peripheral nerve damage including inferior alveolar nerve (IAN) damage could occur. This study analyzed cases of damaged IANs during facial contouring surgery, and asked what the basic standard of care in these medical litigation-involved cases should be. MATERIALS AND METHODS: We retrospectively reviewed a total of 28 patients with IAN damage after mandibular contouring from August 2008 to July 2015. Most of the patients did not have an antipathy to medical staff because they wanted their faces to be ovoid shaped. We summarized three representative cases according to each patient's perceptions and different operation procedures under the approvement by the Institutional Review Board of Seoul National University. RESULTS: Most of the patients did not want to receive any further operations not due to fear of an operation but because of the changes in their facial appearance. Thus, their fear may be due to a desire for a better perfect outcome, and to avoid unsolicited patient complaints related litigation. CONCLUSION: This article analyzed representative IAN cutting cases that occurred during mandibular contouring esthetic surgery and evaluated a questionnaire on the standard of care for the desired patient outcomes and the specialized surgeon's position with respect to legal liability.

Inferior alveolar nerve cutting; legal liability versus desired patient outcomes

OBJECTIVES: Mandibular angle reduction or reduction genioplasty is a routine well-known facial contouring surgery that reduces the width of the lower face resulting in an oval shaped face. During the intraoral resection of the mandibular angle or chin using an oscillating saw, unexpected peripheral nerve damage including inferior alveolar nerve (IAN) damage could occur. This study analyzed cases of damaged IANs during facial contouring surgery, and asked what the basic standard of care in these medical litigation-involved cases should be. MATERIALS AND METHODS: We retrospectively reviewed a total of 28 patients with IAN damage after mandibular contouring from August 2008 to July 2015. Most of the patients did not have an antipathy to medical staff because they wanted their faces to be ovoid shaped. We summarized three representative cases according to each patient's perceptions and different operation procedures under the approvement by the Institutional Review Board of Seoul National University. RESULTS: Most of the patients did not want to receive any further operations not due to fear of an operation but because of the changes in their facial appearance. Thus, their fear may be due to a desire for a better perfect outcome, and to avoid unsolicited patient complaints related litigation. CONCLUSION: This article analyzed representative IAN cutting cases that occurred during mandibular contouring esthetic surgery and evaluated a questionnaire on the standard of care for the desired patient outcomes and the specialized surgeon's position with respect to legal liability.

Evaluation of the Effects of Mandibular Angle Sagittal Ostectomy and Botulinum Toxin Type A Treatment using Facial Golden Mask

PURPOSE: A lower facial contouring surgery has become a commonly performed procedure in Asia. Currently, mandibular angle sagittal ostectomy and botulinum toxin type A treatment are main procedures for aesthetic correction of a broad lower face. There are a few data to show the differences in the mandibular contouring changes between mandibular angle splitting ostectomy and botulinum toxin type A treatment. Facial golden mask is easy to apply, inexpensive, and relatively objective in evaluating facial contour analysis. This study was designed specifically to compare the changes in lower face width after two different forms of lower facial contouring procedure using facial golden mask. METHODS: Seventeen patients, with the ages ranged from 18 to 55 years(mean, 28.6 years), 15 women and 2 men, consented to the study and receive a contouring procedure of lower face. The patients were classified into 2 groups. In group A, the sample consisted of 10 patients with a prominent squared mandibular angle and mandibular angle splitting ostectomy was performed. In group B, the sample consisted of 7 patients with masseteric hypertrophy and botulinum toxin type A treatment was performed. Photographs of the face were taken to record the facial change at preoperative and postoperative. The postoperative photographs were taken to considered maximal effect in 2 years after the surgery in group A, and 4.8 months after the treatment in group B. The authors applied the facial golden mask to preoperative and postoperative photographs and horizontal ratio, which compares facial width with golden mask width, were calculated. We made an analysis of the result of horizontal ratio using SPSS. RESULTS: Overall average horizontal ratio of pre- and postoperative photos of group A were 1.24 and 1.11, whereas overall average horizontal ratio of pre- and postoperative photos of group B were 1.19 and 1.12. The horizontal ratio decreased 10.24% in group A and 5.93% in group B. There was a statistically significant changes in before and after treatment, but there was no significant change in comparing the group A and group B. CONCLUSION: The results from this study suggest that mandibular angle sagittal ostectomy and botulinum toxin type A treatment showed relatively satisfactory clinical effects on lower facial contouring treatment. There were no statistical significant differences within two lower facial contouring treatment. Facial golden mask is easy to apply, inexpensive, and relatively objective, so we think that facial golden mask is a good method for evaluation of lower facial contouring treatment.

Adjunctive facial contouring surgery in combination with orthognathic surgery

Clinical Experiences on the Facial Contouring Surgery for the Last 15 Years

Facial contour consists of facial bony frame, skin and soft tissues overlying facial bone. Facial contouring surgery is a surgery that is perfomed on the face(bone and/or soft tissues) in order to achieve better facial proportion by balancing overall facial lines. During the last 15-years period, we perfomed many facial contouring surgeries. The main surgery perfomed in our clinics were mandible angle resection, zygoma reduction, chin augmentation or reduction, forehead augmentation or reduction. The subsidiary surgery for the purpose of better improving facial balance with main sugery were augmentation or reduction rhinoplasty, double fold formation, epicanthoplasty, augmentation mammoplasty, hair transplantation or removal, facial fat injection or liposuction. It was rare to perfome just one kind of facial contouring surgery. Rather, we perfomed two or more than kinds of facial contouring surgery on different facial parts at the same time together. The reason was that it was convenient to coordinate total balanced facial beauty and achieve a better result. So, we summarized factors to be considered in planning the facial contouring surgery. First, in zygoma reduction, we must do not make a cheek droop. If there was a cheek droop, we must lift the cheek to the line which connecting both tragi. Second, in mandible angle resection, facial contouring line should maintain oval shape without straight line and there should be no remaining angle in the front of mandible. Third, we must consider relationship between face and body (especially breast). Fourth, as much as possible, it is more advisable to perform necessary operations all at the same time.

Microvasclar Free Tissue Transfer for Aesthetic Facial Contouring

The facial contour deformity can cause significant handicaps in social life and a psychological stress to the patient. From January 1991 to November 1998, ten patients were operated on for correction of facial contour deformities with three types of free flap: deepithelialized scapular (n = 6), deepithelialized groin (n = 3) and omental free flap (n = 1). The distribution of diseases were Romberg's disease (n = 3), hemifacial microsomia (n = 2), facial lipodystrophy (n = 1), sequelae after surgery (n = 3) and post-traumatic deformity (n = 1). The patient ages ranged from 12 to 42 years. An incision was made at preauricular (n = 3) or submandibular area (n = 7). After making a subcutaneous pocket just above SMAS, the flap was placed within the pocket. The microvascular anastomosis was performed using superficial temporal vessel (n = 3) or facial vessel (n = 6) as a recipient. The flap margin was sutured to the fascia or periosteum and fixed by bolster sutures to reduce gravitational migration. There were no flap loss. Flap revisions consisting of minor contour corrections were performed in eight patients. A stable restoration of facial contour was achieved in all patients. Microvascular free tissue transfer has the advantages that it can be used on the irradiated bed and restore a large defect of facial contour. The deepithelialized groin free flap is suitable for correction of generalized defect of facial contour such as hemifacial microsomia because of its abundance of fatty tissue. In the deepithelialized scapular free flap, the dorsal thoracic fascia can be folded and tailored into variable width and thickness to correct subtle deformity of facial contour such as Romberg's disease or facial lipodystrophy. The omental free flap is not considered the first choice in facial contouring surgery as it requires laparotomy and has a greater tendency to gravitational migration.