Midface and Neck Aesthetic Plastic Surgery_Vol 2

Description

CHAPTER XI - AGEING OF THE ORBITO-MALAR REGION The physiognomy of the malar region Our philosophy regarding midface ageing Midface = orbito-malar area Implants Implantech prostheses Some practical anatomical details Dissection of the malar region in an anatomical specimen Choosing the implant Indications for different implants Surgical techniques Intraoral approach The limits of the pocket The transpalpebral approach The preauricular approach Surgical techniques Closing the pocket without any manoeuvres on the S M A S Closing the pocket and associating a SMAS plication Closing the pocket and associating a SMAS plication A didactic-anatomical explanation Placing the lateral part of the implant in the deep subcutaneous layer covered by the SMAS fla p Increasing the volume in the lateral zygomatic area by creating a dog ear plication Contemporaneous fat grafting Lipofilling performed separately at a later s ta g e Lipofilling in the midface The orbital region Some examples of patients belonging to the first cla ss Some examples of patients belonging to the second c la s s Some cases of patients in whom a midface lifting was associated to augmentation malarplasty with some intraoperative images to show some of the manoeuvres exposed above Clinical cases A surgical sequence of a midface lifting with an associated augmentation malarplasty CHAPTER XII - SOME CONSIDERATIONS ON PROMINENT EYES Orbital and malar prominence Measuring the malar prominence Identifying the optimal treatment strategy for these cases Technical suggestions for the upper eye lid Lipofilling of the eyebrows area Limited or non-removal of cutaneous and muscular tissue Canthopexy Fat grafting Technical suggestions for the lower eyelid The vertical dimensions of the eyelids in patients with prominent eyes Lack of skin Hypotone of the orbicularis muscle Slackening of the fibro-ligamentous structures Shortness of internal lamella Fat grafting Improper fat positioning The formation of a bolus The “mulberry effect" CHAPTER XIII - SURGICAL TREATMENT OF AGEING IN THE NECK Criteria of beauty of the neck The various layers of the neck I - The skin Skin undermining 1st Class The extent of skin undermining in 1st class patients 2nd Class Extent of skin undermining in 2nd class patients 3rd Class The thickness of the flap Some considerations on treatment of the deep layers A didactic-anatomical explanation Some considerations on limited undermining technique II - The subcutaneous adipose tissue Infraauricular and submandibular lipectomy III - The superficial muscular layer (the platysma muscle) Undermining the muscle Some observations on the surgical anatomy of the platysma Undermining of the platysma: surgical techniques Why undermine the platysma Traction vectors The sections Lateral section Anterior section Complete section The level of muscular section Observations on neuro-muscular complications in the region Platysmal bands Sutures Anterior sutures Lateral sutures Central sutures Plication and imbrication Cranial suspension by undermining and imbrication The technique of cranial suspension by plication Application of plications and imbrications in special cases Plications and imbrications in particular cases IV - The deep adipose tissue Subplatysmal lipectomy V - The submandibular gland VI - The deep musculo-fascial layer The digastric muscles The mylohyoid muscles The perihyoid fascia The mandibular contour The anterior mandibular region Some psychosocial considerations An implant versus an osteotomy Implantech protheses for augmentation mentoplasty Mental ptosis (witch’s chin) The mid mandibular region Lateromental depressions Lateromental bulges The posterior mandibular region Surgical techniques An intraoperative photographic sequence of a cervico-facial lift Cervico-facial lifting with SMAS - platysma plication Cervico-facial lifting with imbrication of the SMAS and lateral section of the platysma Anterior cervicoplasty, complete section of the platysma, plication, deep lipectomy and corsetplasty Submandibular gland reduction Clinical cases BIBLIOGRAPHY ANALYTICAL INDEX