FACE AESTHETIC SURGERY
A modern approach to the aging face may include progressive and tylored procedures as long as an armonic balanced result with no operated look are generally required. In fact, SOFT SURGERY is the actual tendency regarding how the face has to be treated as we want carefully avoid every surgical stigmata and long lasting recovery time. Secondly, every face feature is considered in order to obtain a GLOBAL IMPROVEMENT rather than focusing on a single detail giving, as a consequence, innatural and partial results. In conclusion, the three main aspects of facial aging: skin deterioration, volume deflection and tissues descent need to be taken in consideration and addressed at the same time but keeping in mind that armony must be the final goal.
1 / SKIN DETERIORATION
Improvement of skin superficial layer by restoring epidermal and dermal layers with final aim of treating photoaging issues as skin texture problem, fines wrinkles and spot by chemical (acid), physical (temperature) or biological (revitalisant substances). Chemical (PEELING) and Thermal (LASER) injury to the skin with resultant wound healing: reeptithelialization through proliferation of epidermis cells, while increased collagen synthesis and reorganisation of elastic fibres determine skin contraction. Biological restructuring, also known as skin tightening, consists on the insertion of REVITALISANT SUBSTANCES as injectable no cross linked Hyaluronic acid (HA) or reasorbable threads in dermis context.
2 / VOLUME DEFLECTION
There are severals dermafillers. Everyone has his own tipical car but we can mainly distinguish between adsorbable and non adsorbable. Non adsorbable have shown hight rate of side effect and complications, so that only absorbable filler are nowadays considered safe to use. At the moment we consider Hyaluronic acid the top standard of dermafiller, and we largely emploie in facial ageing in many different versions and concentration. HA is a dermal filler used to fill facial wrinkles or to provide volume and fullness to the face. Hyaluronic acid is crucial for normal function of the dermis, providing the skin with fullness and elasticity accomplishing improvement of wrinkles , furrows and folds. Morover acting as water linker at highter concentraction, can be also injected to add volume where lack for example in malar, labial and mental areas.
The attractive malar eminence is an important component of the western concept of facial youth and beauty. Flat, hypoplastic cheekbones can make a face look dull and aged, whereas prominent cheekbones contribute to a fresh, youthful appearance. Deficiencies in the malar region can be secondary to trauma, congenital defects, inherited ethnic bony structure, and aging. Facial analysis is a critical part of patient selection for malar augmentation. Several techniques of facial measurement analysis of the malar region exist; however, the exact location for augmenting the malar eminence is not universally agreed upon, because the type of malar deficiency varies from patient to patient. Hyaluronic acid (HA) filler supports the malar area and can counteract the aging sign due to fat atrophy, restore volume loss and achieve a more youthful appearance. Malar deficiencies more severe or asymmetries can be corrected by autologous fat transfer, implants or midface lift.
Cosmetic lip augmentation consists of the enlargement and reshaping of otherwise normal upper and/or lower lips to improve their dimensional relation with the patient’s nose, teeth, and surrounding facial structures. The appearance of the lips is determined by the spatial relation of the lip structures with the teeth in a 3-dimensional space and by their function during animation and speech. Cosmetic deformities of the lips include both congenital and acquired etiologies. Some patients never develop adequate fullness in the lips; others develop atrophy of the soft tissue of the lips as they age. Lip augmentation consists of the reshaping and/or enlargement of the visible portion of the lip, the vermillion. Alteration of the shape of the Cupid’s bow and of the relation between the vermillion and the skin underlying the nasal columella also fall within the category of lip augmentation. Lip augmentation can be commonly achieved by injectable fillers HA. Others surgical lip otions are: advancement, roll, or lift.
Botox is not a dermal filler but a medication for the treatment of wrinkles of the forehead known as “frown lines” as well as “crow’s feet”. Botox is also used to reduce the appearance of wrinkles or to prevent wrinkle formation altogether and can help elevate the eyebrow in some women to give them more of an arch. Botox can help reduce the size of the platismal bands and lines of the neck. Botox reduce mimic muscles, and in different concentration, often in association with dermal filler, bring to a successful rejuvination of face and neck in middle aged people.
3 / TISSUES DESCENT
In the majority of cases this ageing process related situation can not be adressed with no- surgical procedures. Brow lift-upper blefaroplasty, and midface lift-lower -blefaroplasty, volume enhance by autologous fat transplantation or chin/malar implantation in addition to a rhytidectomy.
Are further option in more advanced ageing face tightening and resupporting the tissues of the upper, middle and lower third of the face. Rhytidectomy (FACE LIFT) treat in particular facial features caused by aging as sagging cheeks, jowl, nasolabial and buccolabial folds, bulky submental and cervical tissue. The goal of plastic surgeon is to determine the characteristics that are contributing to the patient’s aging appearance and which of them are reversible in order to change the individuals appearance into a more youthful one. The main surgical criterion is which rhytidectomy tecnique can change properly the individuals appearance.
DESCENT OF TIPICAL FACE ELEMENTS AS BROWS, CHEEKS AND JOWLS is properly adressed with short scar multi-layers lifts acting where sub cutaneous adesion systems are damaged by the gravity effect. Obviously every treatment, even applied as a standard technique, has to be personalised for each patient taking into account singular peculiar aspects and expectations always keeping in mind everyone’s concepts of beauty.
Blepharoplasty (AESTHETIC OCULOPLASTY)
The eyes and periorbital area are commonly the focal point during human communication, change of eyelid appearance caused by aging diminish the aesthetic appearance of all face and may convay an inappropriate message of tiredness or sadness. Features as dermatochalasis (excess eyelid skin) and bag (pseudoherniation of orbital fat) are evaluated in the assessment of the eyelid and in performing blepharoplasty isolated or in combination with rejuvenation of the upper or lower face, in particular aging process affects the position of the foreheads brows and cheek complex. These all contribute to the position and appearance of the eyelids. If you have surgery on your upper and lower eyelids, the surgeon generally works on your upper lids first. He or she cuts along the fold of the eyelid, removes some excess skin, muscle and possibly fat, and closes the cut. On the lower lid, the surgeon makes a cut just below the lashes in your eye’s natural crease or inside the lower lid. He or she removes or redistributes excess fat, muscle and sagging skin, and closes the cut. If your upper eyelid droops close to your pupil, your surgeon may do blepharoplasty with a procedure called ptosis (TOE-sis) that provides additional support to the eyebrow muscle.
Postop and recovery.
These procedures are now sometimes performed on an outpatient basis (Day surgery); inpatient hospitalization for up to 2 days if required. Rest at home 1 week, refrain from physical exertion at least 4 weeks, avoidance of the sun for 2 months Note that you may not begin to “look your best” for 3-4 weeks fallowing surgery The process of deep scar tissue development and resolution takes as long as 6-12 months. Wound care is important in order to prevent scar hypertrophy.
Rhinoplasty is the procedure of plastic surgery in which the nose shape is changed in order to obtain a purely cosmetic improvement as well as a functional correction when needed. Unsatisfactory aesthetic appearance of the nose is one of the main reason that bring a patient to a plastic surgeon disappointing by a facial feature. Nasal surgery often involves structures related to the contour (tip and dorsum) and to the airway function (septum) so that is common in a same session to achieve both functional and cosmetic enhancement. A rhinoplasty surgeon must focus on every case considering ideal facial proportions, identifiing corrispondence between the disconfort and misshapen nasal structure. Related to sex, age, race, psycological asset, every surgical procedures must be depply discuss for the best resulting purpose. Rhinoplasty may be done inside your nose or through a small external cut (incision) at the base of your nose, between your nostrils. The surgeon will likely readjust the bone and cartilage underneath your skin. The surgeon can change the shape of your nasal bones or cartilage in several ways, depending on how much needs to be removed or added, your nose’s structure, and available materials. For small changes, the surgeon may use cartilage taken from deeper inside your nose or from your ear. After these changes are made, the surgeon places the nose’s skin and tissue back and stitches the incisions in your nose. Rhinoplasty procedure requires two to three hours to be performed and may be different depending on every single case.
The procedure is sometimes performed on an outpatient basis (Day surgery); inpatient hospitalization for up to 2 days if required. Rest at home 1 week, refrain from physical exertion at least 4 weeks, avoidance of the sun for 2 months.Note that you may not begin to “look your best” for 3-4 weeks fallowing surgery. The process of shape assessement takes as long as 6-12 months.
What should I look for in a surgeon?
Plastic surgeons, facial plastic surgeons or otolaryngologists (ENT) perform most rhinoplasties. Training and board certification in one of these specialties is a good starting point. You’ll likely want a surgeon who often performs rhinoplasty. Make sure that your surgery will be performed in an accredited surgical facility or hospital. You likely should also feel comfortable with your surgeon. Look for a surgeon who can explain to you in understandable terms what is going to happen during your surgery. Only a hight level of experience and expertise insure accuracy in results.
Dr. Gianmario Prinzivalli specializes in Rhinoplasty, is a Certified Plastic Reconstructive and Aesthetic Surgeon and Member of ISAPS (International Society Aesthetic Plastic Surgery) and RSE (Rhinoplasty Society Europe).
OTOPLASTY PROMINENT EARS
Otoplasty – also known as cosmetic ear surgery – is a procedure to change the shape, position or size of the ears.
Why it’s done.
You might consider otoplasty if:
- Your ear or ears stick out too far from your head
- Your ears are large in proportion to your head
- You’re dissatisfied with a previous ear surgery.
Otoplasty is typically done on both ears to optimize symmetry. Otoplasty can be done at any age after the ears have reached their full size — usually after age 5. Otoplasty won’t change the location of your ears or alter your ability to hear.The external ear makes only a tiny contribution to the function of hearing. The main function is to “look normal.” Normal is, of course, a subjective judgment with a cultural bias. The first step in assessing the patient for otoplasty is determining the anatomic causes of protrusion of the ear. The most common causes of protrusion of the external ear are (1) underdevelopment or effacement of the antihelix, (2) overdevelopment of the deep concha, or (3) a combination of both of these features. Auricular protrusion may be one element of a more complex auricular deformity . Many procedure options are effective in reducing the prominence, it’s important deciding the appropriate timing for the surgery. Otoplasty procedure requires one to two hours to be performed as it may be different depending on every single case. The procedure is now frequently performed on an outpatient basis (Day surgery); inpatient hospitalization if required. Rest at home 1 week, refrain from physical exertion at least 4 weeks, avoidance of the sun for 2 months.The process of shape assessement takes as long as 6-12 months.