Archive for the ‘Chin and Cheek Augmentation’ Category
Facial cosmetic surgery is a very personal and monumental decision. Universally, all patients want the best outcomes. In today’s corporatized America, with heavily influential marketing spin, pharmaceutical companies, medical device companies, and even practitioners promote a less is more mentality to push products and services that often over promise and under deliver on the results. In no way can skin creams, injectables, or lasers deliver the types of results once can achieve with surgery. In a similar manner, minimally invasive sounding surgeries are in no way a substitute for time tested peer reviewed procedures that provide quality long lasting results.
Unfortunately not every person will achieve acceptable results with Botox or injectable fillers such as Juvederm, Restylane, and Radiesse. These products have their place in facial aesthetic practices, in properly selected patients, but in general should be viewed as temporary treatments with less impressive results when compared to surgery. Their primary advantage is that they have minimal social while providing a benefit. Botox is being used more and more as a preventative cosmetic medicine that delays wrinkle formation. Fillers camouflage initial signs of aging, but ultimately putting too much filler in a face, the liquid facelift, can alter ones appearance creating an artificial overinflated appearance. Using filler to augment facial structures can be useful to patients wanting to get a general idea of the appearance prior to permanent surgical procedures such as lip and cheek enhancements procedures. Creams reverse the signs of photo aging and contribute to collagen formation and production but are limited in their effectiveness. Lasers are an excellent option to delay the signs of aging and treat sun induced skin photoaging, but in no way can they tighten skin like facial cosmetic surgeries such as a facelift.
Surgical procedures are the best option for impressive endurable results. Rhinoplasty can dramatically affect ones facial appearance in a way that almost no other cosmetic surgery can. The nose can cause undue and unnecessary attention drawing attention away from other attractive facial features. Aging face surgery has many layers of effectiveness based on the surgical techniques used and how they are applied. In general, minimally invasive techniques can produce an artificial appearance and or short-term results. When considering aging face surgery most sophisticated patients are looking for surgeries that will last as long as possible with the most dramatic natural appearing results. There are no shortcuts to achieving optimal results and when applied, shortcut techniques frequently under deliver on the surgical results end.
Becoming an informed patient who understands the benefits of finding the right intervention or surgery for the right patient will ultimately save one time and money over the long haul. Getting things done right the first time is of paramount importance to achieving optimal outcomes with a high degree of patient satisfaction, while avoiding problems and bad outcomes.
Posted by: Benjamin C. Stong MD
Loss of facial fat volume and skin elasticity is a natural part of aging. There are many different ways to address these problems keeping in mind the patients goals and concerns as well as the capability and versatility of the practitioner. Today there is a minimally invasive, no downtime revolution. Many patients do not have the time or patience to undergo more invasive, technically challenging, effective procedures. This phenomenon coupled with more and more practitioners with little to no surgical training and effective marketing strategies, has led to a boom in the facial filler industry. The primary purpose of facial filler therapy is repletion of lost volume in the face or to augment naturally thin or small structures. The allure for injectable facial filler therapy to both practitioners and patients is the temporary nature of the treatment. Initially patients seeking facial rejuvenation procedures typically like to “test the waters” and take comfort in the knowledge that the procedure is temporary. Similarly, practitioners with less advanced training take comfort in the idea that the changes they effect are not permanent.
Collagen was the initial, biocompatible, completely absorbable facial filler introduced to the cosmetic industry. It has since fallen out of favor due to the 100% biocompatibility and more natural feel of haluronic acid fillers. The two most common haluronic acid fillers on the market are Restylane and Juvederm. Juvederm has significantly increased its market share in recent years due to studies that claim a longer duration of action (approximately 6 to 9 months), due to slower absorption and a more natural feel, because of a less granular texture. Radiesse uses calcium hydroxyapatite, a component of bone, that has a significantly longer absorption rate compared to haluronic acid fillers, but is not as smooth after injection. Consequently, Radiesse is generally injected deeper under the skin, in larger folds, and in patients with thicker skin to avoid feeling the substance after injection. Sometimes it is layered deep to haluronic acid fillers to provide longer lasting, more natural feeling results. It is reported to last approximately 1 year following injection. Sculptra is an additional injectable facial filler that is composed of small fragments of a suture material called vicryl. It is reported to have a more permanent effect because it uses inflammation to stimulate collagen deposition. It is still not widely used by many practitioners because it is less precise and predictable than other facial fillers.
The “Liquid or Lunchtime Facelift” has become a popular marketing technique in many practices promising superior results with no down time. Anytime a patient is going to have a facial filler procedure the amount of skin laxity must be taken into account. To use a common analogy, not only does the face deflate like a balloon as we age, but the skin is permanently stretched, as such with more advanced aging, filling the face with various substances without tightening the skin or facial structures can result in an over-inflated look. When used earlier on in the aging process, facial fillers can camouflage the effects of aging temporarily resulting in a more youthful appearance. As the process advances additional procedures such as skin rejuvenation and face lift procedures become necessary to achieve a more natural, youthful look. The most common areas treated in the aging face are the nasolabial folds, the tear troughs under the eyes, and wrinkles around the mouth. Augmenting facial structures in both younger and older patients is a very useful procedure to accentuate attractive features. The most common area augmented with facial fillers is the lips to improve an individuals feeling of sensuality and gain an idea of the outcome from a permanent lip augmentation procedures. Additionally, adding volume over the cheek bones is common to sculpt the face into an attractive, youthful heart shape. Most recently the term ”nonsurgical rhinoplasty,” has come in vogue and uses various combinations of the facial fillers to sculpt the shape of the nose. Although commonly marketed as a surgical procedure, in no way are the above facial shaping/augmentation procedures considered permanent or a surgical procedure.
Facial fillers offer a minimally invasive, temporary solution to reverse the effects of aging. Proper selection of the injection material and the areas to be injected is critical to good outcomes and satisfied patients. Many practitioners offer facial fillers when skin rejuvenation and face lift procedures may be indicated for optimal outcomes. Some patients may be adverse to additional, more invasive, permanent procedures electing to undergo facial fillers to gain an understanding of the possible outcomes from surgery. Also, some patients may never choose to undergo additional surgical procedures, instead choosing to continue facial filler treatments. When beginning facial fillers it is necessary for the patient to understand what is and is not possible and determine their goals collaboratively with their facial plastic surgeon.
Post provided by: Facial Fillers Atlanta GA | Benjamin C. Stong MD
Loss of facial volume is part of the aging process, along with loss of elasticity and photoaging. Correction of facial volume with autologous fat transfers is not a substitute for surgery. Rather, it should be viewed as a complimentary procedure and should be planned with a global perspective on the individual facial aesthetics. Facial fat volumes peak in the late teenage years and then begin to diminish with time. Interestingly, many women feel the peak of beauty is around 30 years of age, after some facial volume has already been lost. Facial fat transfers can be used to either restore facial volumes or augment certain features the patient desires to accentuate.
The fat is harvested from easily accessible areas of excess fat including: the buttocks, thighs, and abdomen. It is then purified and injected in directed areas of the face to fill folds and shape the face. Areas of the face that are commonly treated with fat transfers are the cheeks and cheekbones, the troughs underneath the eyelids, the nasolabial fold (or laugh line), the lateral brow, and lips. Whenever there is free transfer of nonvascular tissue, only a certain percentage of that tissue survives. Variability in harvest and purification techniques and the amount of muscle movement in the recipient area, affect the survival of the fat transfers. In general, survivability is improved by using smaller suction cannulas to harvest, isolating individual fat cells, and injecting into areas of the face with less muscle motion. As such, the nasolabial fold area and lips are less likely to have a successful transfer, and the troughs under the eyelids have a higher success rate.
Correcting laxity in the facial tissues with lifting and tightening procedures should be performed prior to, or simultaneously with fat transfers to avoid overfilling the face. Procedures that should be considered prior to having a permanent facial augmentation material injected include: a face lift, midface lift, and brow lift. Rarely are facial fat transfers indicated as an isolated, sole, procedure. Often patients use non permanent facial fillers to fill in troughs and folds during times when the facial laxity is still fairly youthful. The next logical step in a patient’s mind may be to get a permanent filler to avoid the need for repeated injections. The difficulty with this idea, is that the facial soft tissues will continue to lose support and drop with age, necessitating further rejuvenation surgeries. Following surgery, the areas that may require fat transfers may be different than the areas that were injected during youth due to soft tissue repositioning.
Facial fat transfers are an art form, with the most important aspect being able to understand the global facial aesthetic perspective. Understanding the areas most likely to have a good outcome and the decision of when to inject is not always straight forward. In general it is a good idea to perform fat transfers either simultaneously with additional surgical procedures or secondarily as an adjunctive procedure to restore youthful facial volumes. Overfilling can look awkward, resulting in unhappy patients. There is a subgroup of people who are good candidates for isolated fat transfers at an early age or patients who decide they will never be interested in future surgical procedures and elect to use transfers as their primary rejuvenation procedure. These patients may undergo multiple transfers during their lifetime to try and retain a youthful appearance resulting in an “inflated look.” When considering fat transfers, one should find a surgeon who uses contemporary techniques and understands the impact of fat transfers on future surgeries and facial aesthetics.
Post provided by: Facial Fat Transfers Atlanta GA | Benjamin C. Stong MD
The lower eyelids and midface are structures that should be considered together when planning rejuvenation procedures. There is a youthful transition from the lower eyelid that is lost with age resulting in a bulging lower eyelid and a trough, “a double contour deformity.” Proper restoration procedures must consider reconstructive principles when developing and perfecting techniques. Contemporary trends have moved away from making incisions just below the lash line in blepharoplasty to using incisions on the inside of the eyelid with fat removal and skin pinch excisions. The natural course of aging on the face results in a loss of facial fat volume and hollowing. The removal of fat from the lower eyelid can result in a sunken appearance. Contemporary techniques are now trending towards fat preservation and repositioning to conserve facial fat thus creating a natural transition between the lower eyelid and midface.
The aging process of the lower eyelid and midface is complex. The tear trough deformity is characterized by a fold that occurs between the bulging of the lower eyelid and upper cheek. Correction of this deformity requires a keen understanding of midface and lower eyelid anatomy. In the near future lower eyelid blepharoplasty will trend toward fat repositioning procedures to translocate the fat the bulges from the lower eyelid and orbit into the groove to create a natural youthful transition to the upper cheek. This can only be achieved through the incision below the lash line.
The nasolabial fold lies between the base of the nostril and the corner of the lip. It deepens with age due to dropping of facial fat pads. It is also one of the most difficult areas to correct. Because there are many procedures that attempt to address the issue, there is no perfect procedure. To date the two most effective procedures to lift the midface fat pads and smooth the nasolabial folds are the deep plane face lift and the transtemporal subperiosteal extended midface lift. The medical literature supports the idea that the effect of the deep plane face lift on the nasolabial fold is short when compared to its effect on the lower cheeks and neck. The extended transtemporal subperiosteal midface lift offers an anatomically advantageous procedure to effectively lift the central cheek area to reposition the facial fat pads to a more youthful position creating a more natural transition between the cheek and lower eyelid through very small incisions that are well camouflaged in the temporal hair. Many other attempts to perform midface lift surgery use the same access points but either ignore or inadequately release the soft tissues of the cheek, temple, and nasolabial folds leading to sub optimal results and early failure.
Others perform a midface lift through an incision in the lower eyelid and effectively release the tissues of the central midface, cheek, and nasolabial fold, but they uniformly fail to release the outer portions of the cheek and temple that results in tethering during repositioning and early decent to its original position with an unacceptably high rate of lower eyelid malposition. Expecting the lower eyelid, which should be considered a non load bearing structure, to support the weight of the midface can result in pulling the lower eyelid down, an unusual appearance, and problems with watery, dry eyes.
Optimal rejuvenation of the midface usually requires a lower eyelid blepharoplasty with fat preservation and repositioning with an extended transtemporal subperiosteal midface lift. Addressing the midface through traditional face lift incisions has been reported, but is not as effective at achieving maximal long term repositioning. There are several surgeries that are relevant to total midface rejuvenation. Except in younger people, rarely is the midface lift indicated as an isolated procedure. It can be performed in conjunction with a traditional face lift or brow lift procedure to avoid multiple surgeries and healing times. Performing safe effective midface surgery is challenging to even the most experienced surgeons. When considering a surgeon, understanding the procedure and how it will address a patient’s specific concerns is of paramount importance to meet expectations.
Post provided by: Midface Lift Surgery Atlanta GA | Benjamin C. Stong MD