Contemporary Rhytidectomy, An Issue of Atlas of the Oral & Maxillofacial Surgery Clinics (eBook)

Landon McLain (Autor)

eBook Download: PDF | EPUB

2014 | 1. Auflage
113 Seiten
Elsevier Health Sciences (Verlag)
978-0-323-28697-8 (ISBN)

Infos

Contemporary Rhytidectomy, An Issue of Atlas of the Oral & Maxillofacial Surgery Clinics,

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Techniques in contemporary rhytidectomy are covered in a highly illustrated Atlas format. Articles will include surgical anatomy of the superficial musculo-aponeurotic system (SMAS), management of the SMAS, evaluation of the aging lower face and neck, rejuvenation of the anterior neck: the when and why, short scar rhytidectomy techniques, combined rhytidectomy and alloplastic facial implants, the opportunistic rhytidectomy, revision rhytidectomy, adjunctive techniques in contemporary rhytidectomy, and more.

Inhalt

Front Cover 1
Contemporary Rhytidectomy 
2 
Copyright 3
Contributors 4
Contents 6
Atlas Of The Oral And Maxillofacial 
 
7 
Preface 
8 
Evaluation of the Facelift Patient 10
Good surgeons know how and when to say “NO” 10
The art of the consultation 11
The physical consultation 11
What exactly is a facelift? 12
Putting it all together 15
Tying up loose ends 16
Summary 16
Further readings 16
Surgical Anatomy of the Superficial Musculo-Aponeurotic System (SMAS) 18
Anatomy of the aging face 18
Skin, subcutaneous tissue, and SMAS 19
Suggested Readings 24
Management of the Superficial Musculo-Aponeurotic System (SMAS) 26
No active platysmal bands 26
Complications 30
Reference 32
Suggested Readings 32
Rejuvenation of the Anterior Neck The When and Why 
34 
Introduction 
34 
Effects on aging/variability of neck types 34
Patient expectations 34
Indications for neck rejuvenation 35
Surgical anatomy concepts 35
Nonsurgical techniques 38
Botulinum toxin 38
Laser resurfacing 38
Surgical management—noninvasive versus invasive 39
Liposculpture (liposuction) 39
Direct lipectomy 40
Platysmal plication 40
Cervicoplasty—direct lipectomy, platysmal plication, SMAS elevation 40
Operative techniques 40
Operative steps: noninvasive and invasive 40
Noninvasive liposculture 40
Invasive cervicoplasty 41
Chin implant 42
Submandibular gland 43
Fat grafting 43
Summary 45
References 45
Short Scar Rhytidectomy Techniques 46
Suspension sutures used in short scar rhytidectomy 46
The three “Ds” of facial aging 48
Short scar rhytidectomy techniques and evolution 51
S-lift 51
Simple MACS lift and the extended MACS lift 52
QuickLift 52
S-Plus lift 53
Short scar lateral SMASectomy 54
My operative overview and technique for short scar rhytidectomy 56
Complications 57
Results 59
Summary 59
References 61
The Opportunistic Rhytidectomy The Biplane Facelift 
62 
Biplane facelift 
62 
Clinical anatomy 63
Skin 63
Subcutaneous tissues 63
SMAS/muscle layer 63
Fascial layer 63
Facial nerve 63
Parotid and submandibular salivary glands 63
Retaining ligaments 64
Patient preparation 64
Consent, medical history, laboratory studies 64
Preoperative marking 66
Positioning 67
Preparation and draping 67
Anesthesia 67
Technique 67
Submentoplasty/anterior biplane dissection 67
Rhytidectomy incisions 68
Superficial (subcutaneous) dissection 68
Deep posterior biplane plane dissection 69
Skin excision and wound closure 71
Complications 74
Summary 75
References 76
Combined Rhytidectomy and Alloplastic Facial Implants 78
Introduction 78
Rhytidectomy 78
Alloplastic facial implants 80
Considerations for combined procedure 81
Summary 82
References 82
Adjunctive Techniques in Contemporary Rhytidectomy 84
Introduction 84
History of the facelift 84
Surgical anatomy of the face 85
SMAS 85
Vascular supply 87
Facial nerve 87
Adjunctive techniques for facial rejuvenation 89
Facial prep and local anesthetic infusion 89
Submental and lower facial/jowl liposculpture 89
Platysmaplasty 89
Brow lift 90
Upper and lower blepharoplasty 90
Fat transfer 90
Chin, cheek, and lip implants 90
CO2 laser skin resurfacing 91
Chemical peels and dermabrasion 91
Earlobe reduction 92
Botox and facial fillers 92
Rhytidectomy 94
Procedure steps 94
Procedure duration 96
Complications 97
Discussion: an improper paradigm shift? 97
Summary 98
References 98
Reoperative Face and Neck Lifts 100
Incisions and scars 101
Earlobe deformity 102
Hair pattern changes 102
Fat irregularities and deficiencies 103
Fascial laxity 104
The cervicomental angle and platysma 105
Presence of unusual rhytids 107
Face tuck 107
Complications with secondary/tertiary procedures 108
Summary 110
Supplementary data 110
References 110

Textauszug

Evaluation of the Facelift Patient

Joe Niamtu, III, DMD,     Private Practice, Cosmetic Facial Surgery, Richmond, Virginia. Email: [e-mail]

Keywords

Facelift

Consultation

Cosmetic surgery

Evaluation

Key points

• Facelift surgery is unique in many ways and for 100 years has stood the test of time as the most dramatic, effective, predictable, and accepted cosmetic lower facial procedure.

• From public misconceptions to patient confusion, a lot of information must be exchanged for successful diagnosis, recovery, and result.

• It requires a qualified surgeon that operates in a safe environment and knows his or her limitations.

• Any surgeon can make incisions and pull skin, but to truly master this procedure is a commitment.

Facelift surgery is the most comprehensive cosmetic facial procedure, and the most impressive and emotional cosmetic surgery anywhere on the body. Mediocre breast, belly, and buttock surgery can be easily camouflaged by clothing, but the face is always exposed. From an emotional standpoint, any cosmetic surgery procedure can improve self-confidence and provide a more youthful appearance, but it is the face that is seen and focused on in primary visual encounters. Giving an older person a younger face is an impactful experience.

The public is diverse on thoughts of surgical enhancement. Some people believe they have earned their wrinkles, whereas others disdain anything unnatural. Having said that, the average person with excess neck skin and jowls would jump at the chance to reverse them if they knew the outcome was natural and affordable.

This brings up the first tenant of cosmetic surgery diagnosis: “why is someone having cosmetic surgery?” Although this sounds trite and obvious, the answer to this question can have a lot to do with the success or failure of the biopsychosocial part of cosmetic surgery. My practice is limited to cosmetic facial surgery, so 100% of the patients that come to see me are doing so because they perceive defects in their appearance. Most of these patients have obvious defects that are normal signs of aging, such as excess eyelid tissue, facial wrinkles, jowls, and extra neck skin. We are all going to get it, so in that sense, there is no escape. The difference is how these aging changes play into the everyday life of patients. The key word to discern from the first several minutes of a facelift consult is “normal.” Is this patient’s assessment and motivation for having surgery normal? A normal scenario is a 46-year-old woman who presents for consultation and says, “Dr Joe, I exercise daily, I watch what I eat, I live a healthy lifestyle, but when I look in the mirror, these darn eyelid bags, make me look and feel older than I am.” An abnormal scenario is a 33-year-old man who presents with the chief complaint of a minor dorsal hump and states that he cannot maintain a female relationship because of his deformity. He may have lost jobs or done poorly in personal relationships because of his perceived horrendous nasal deformity. He may think that people avoid him socially or stop at traffic lights and make fun of him; that complete strangers continually stare at his deformed nose, or chin, or hair line, or mole or anything else that signals body dysmorphic disorder. If you have never personally experienced this condition, it difficult to sit and listen to someone who for all intent and purpose looks totally normal describe this litany of negative social encounters. Body dysmorphic disorder is a real condition, and if the surgeon is not astute enough to realize this disorder, these patients can become very negative, frequently litigious, and sometimes physically, even deadly violent.

Good surgeons know how and when to say “NO”

Everyone that performs facelift surgery has invested innumerable hours of education and hundreds of thousands of dollars to get to the point where they can offer these procedures. As any young, just into practice surgeon will attest to, it is hard to say no to a patient that has an aging face and a checkbook. We have strived to get to the point where we can perform competent surgery and here sits a patient with facial aging and $15,000. “How or why would I tell them no?” “They will just go to the guy down the street!” “I love surgery and could use the income.” These are all natural responses, but operating on unstable patients can be one of the worst experiences of a surgeon’s professional life. You may gladly pay twice the surgical fee to make them go away; they can and will make your life miserable. Always remember Niamtu’s first law of surgery: If things do not seem right, do not accept that patient. This is frequently a cascade where this type of patient is pushy or rude to the front desk, then they are demanding to the nursing staff, but they may be normal to the surgeon. It is important that all staff evaluate all interactions of patients because sometimes the surgeon gets fooled.

I occasionally encounter a totally normal patient that turns out to be a management nightmare, and conversely start out with a patient that has some warning signs but their surgical experience is an actual delight. You cannot win every time and we all get fooled once in a while. Some good “red flags” on patient behavior that may cause the surgeon to reevaluate taking the case include the following:

• Patients with known body dysmorphic disorder or psychiatric condition

• Any overly narcissistic or immature patient

• Unfriendly or impersonal patients

• Patients that do not smile or make eye contact

• Patients that are too busy or too important for surgery

• Patients that speak negatively about previous surgeons but are complimentary to you

• Patients that will not listen and just talk

• Patients that are having surgery for the wrong reason, such as a failing marriage, promotion, or in the midst of a loss

• Patients that cannot decide on a surgical plan or say “do what you think I need”

• Patients that are overly impulsive and want to book surgery at first evaluation appointment

• Patients with unrealistic expectations

• Patients that “know” more about a procedure than the surgeon

• Patients that tell the surgeon what procedure to do and in extreme detail

• Patients obsessed with online cosmetic surgery bulletin boards or cosmetic surgery sites

• Young patients that have already had numerous surgeries or request surgeries generally performed on older patients

• Patients overreacting to a small flaw

• Patients that complain about financial arrangements or are pushy about discounts or are otherwise “shoppers”

• Patients that insist on absolutely no photographic documentation or are resistant to give important information, such as cell phone numbers, and insist on “secrecy”

• Patients desiring surgery with intense familial disapproval

• Patients that you or your staff does not like (rude or pushy)

• Patients that have someone else speak or call for them

• Celebrities or patients that think they are celebrities

Although some surgeons ask these patients to first see a psychiatrist, I never do that. It is embarrassing and many patients are resentful. If I have a patient that I believe will be a management problem (and perhaps a future legal problem), I simply tell them “Mrs Jones, I have analyzed your entire case and I simply don’t think I can make you happy or meet your expectations. I think you are a fine person, but feel you would be better served by another surgeon.”

The art of the consultation

The actual physical facelift consultation is an important event in the patient experience because it is the introduction to the surgeon and vice versa. Because this is an oral and maxillofacial surgery text, I am writing under the assumption that most oral and maxillofacial surgeons (OMSs) do not have practices limited to cosmetic facial surgery as I do and therefore must make some adaptations to handling these patients. I began pursuing cosmetic facial surgery in 1997 and it became an increasingly larger part of my practice, until in 2004 I stopped doing any other oral and maxillofacial surgery procedures. This worked well for me but I have many OMS friends that incorporate cosmetic surgery with their traditional procedures. I believe that to do this well, the practice has to address some considerations for maximum efficiency.

It is sometimes difficult to be a...

Produkt-Details

• Erscheint lt. Verlag: 1.5.2014
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Gesundheitsfachberufe
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Anästhesie
• Themenwelt: Medizinische Fachgebiete ► Chirurgie ► Ästhetische und Plastische Chirurgie
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Pädiatrie
• Themenwelt: Medizin / Pharmazie ► Zahnmedizin ► Chirurgie
• ISBN-10: 0-323-28697-6 / 0323286976
• ISBN-13: 978-0-323-28697-8 / 9780323286978