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.

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.

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.

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.

Life in an Academic Practice Versus a Solo Private Practice: How Different Are They?

Facial plastic surgery has thrived in both academic and private settings. In this article, 3 surgeons comment on a variety of selected topics that are pertinent to their lives as academic and private practice surgeons.

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.

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.

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 Avoidance and Management of Complications, and Revision Surgery of the Lower Face and Neck.

Complications are an inherent occurrence in surgery. In rhytidectomy, many complications are avoidable with thorough preoperative assessment and optimal intraoperative and postoperative care. Nevertheless, complications do occur. In certain situations, avoidance of risks is the best way to decrease the occurrence. Once complications do occur, there is a large body of literature to aid in the correction.

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.

Treating Scars of the Chin and Perioral Region.

Lip and chin scarring occurs owing to reconstruction of congenital, cancer resection, or traumatic defects. Knowledge of lip anatomy and function is critical to optimize results. Realistic expectations should be established before intervention. Scar revision and reconstruction is ideally performed with a subunit approach, placing scars along aesthetic borders and performing subunit reconstruction to camouflage scars. Surgical techniques include direct excision, scar reorientation, local flap rearrangement, pedicled flaps, and regional or free flaps. Resurfacing/adjunctive procedures play important roles in the treatment of scars. This article reviews the anatomy, patient assessment, and techniques used in scar revision of the perioral region.

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.

Primary Rhinoplasty.

Rhinoplasty is inherently a difficult procedure given the complexity of its structure and the functional and aesthetic impact of this anatomy. This report explores some of the remaining questions regarding the use of spreader grafts and autospreader flaps in the management of the middle vault in rhinoplasty, the performance of the open approach versus the endonasal rhinoplasty approach, corrective rhinoplasty in the younger patient, the use of the rib and other cartilage donor sites for grafting in rhinoplasty, and the use of filler materials in rhinoplasty.