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304 North Cardinal St.
Dorchester Center, MA 02124

Posttraumatic facial restoration—a philosophy for repair

Key points • Look at the patient: Your eye is the best tool to evaluate both the premorbid injury as well as your repair. It is imperative that you learn how to really “see” the anatomy and appreciate the subtle characteristics of each patient’s facial form. Always evaluate preinjury pictures of your patient because they can both guide your restoration. • Consider form and function: Recognize…

Evaluation and treatment of the adult patient presenting with facial asymmetry

Key points • Accurately identify the etiology of the asymmetry. • Ensure that facial growth is complete before definitive treatment. • 3D photographic imaging is an invaluable tool to educate the patient regarding the clinical findings and the anticipated outcome. • Evaluate the contribution of both hard and soft tissues. • Dermal fillers and structural fat can compensate for some skeletal volume deficiency, but there is…

Facial feminization surgery

Key points • The male skull is longer and broader compared with the female skull, whereas the female skull has a more pointed chin and tapered jaw. • Frontal bossing of the male skull generally extends from the region of the nasion medially to the supraorbital region extending laterally to the zygomaticofrontal suture of the lateral orbital wall on each side. • From an anatomical perspective,…

Microsurgical augmentation of the facial skeleton

Key points • Skin, fat, muscle, fascia, tendon, and bone can all be differentially carried on vascular pedicles from various donor sites in the provision of vascularized tissue to the face. • Soft tissue, muscle, and bone flaps will all be reviewed with a focus on their use for facial soft tissue or bony augmentation of the face for both aesthetic and reconstructive purposes. • Each…

Skeletal considerations in facial rejuvenation

Key points • The facial skeleton provides the underlying frame for the face, and its configuration influences the facial rejuvenation surgery that should be done. • Age-related changes in the periorbital area are significant and must be accounted for during rejuvenation procedures. • The overall shape of the face can be categorized on a continuum—from wide or round to long and thin. Different facelift techniques are…

Perioral considerations in facial aesthetic surgery

Key points • The appearance of the lips may be considered to represent an individual’s youth, sensuality, and fertility. Consequently, their appearance is of prime importance to connote these qualities and imbue confidence in those seeking facial plastic surgery. • Before undertaking lip-reshaping surgery (LRS), it is important to understand and recognize age-related and congenital aesthetic dysmorphologies of the lips. • The key to successful aesthetic…

Structural fillers of the face

Key points • Structural fillers are very useful in Asian patients to create an oval face with a tapered lower facial third. • Blunt injection cannulas have been associated with a lower risk of embolus formation and less pain and bruising. • HAs are associated with a lower rate of embolic complications, and if an embolus is noted, it can be reversed with hyaluronidase. • Always…

Lipostructure for the facial skeleton

Key points • Facial aging is characterized by fat atrophy and gravitational descent of facial soft tissue. • Careful facial analysis is crucial for optimal outcomes. • Fat grafting provides a minimally invasive technique to improve facial contouring in aesthetic and reconstructive patients. • The Coleman technique for harvesting, processing, and grafting provides a reliable strategy for consistent results. • Fat grafting is an effective tool…

Soft tissue assessment, optimization, and planning

• Soft tissue evaluation is a crucial step in planning any aesthetic facial procedure. • Patient assessment of all aging components and selection of procedures that address specific patient concerns are important. • A combination of surgical and nonsurgical procedures for global soft tissue rejuvenation is common practice and improves the overall result. • The surgeon should set up clear expectations regarding realistic results and explain…

Aesthetic orbital surgery

Key points • The anterior and posterior ethmoid foramen are the intraoperative anatomical landmarks to visualize for the level of a subcranial osteotomy. Violation of the frontal bone via an orbital osteotomy above these landmarks carries the risk of cerebrospinal fluid leakage due to exposure of the dura of the frontal lobe. • The lateral canthus can be reliably resecured, but restoring the medial canthus can…

Anaplastology and facial prosthetics

Key points • An implant-retained prosthesis has an average expected lifespan of 18-36 months. • Successful rehabilitation with osseointegration requires the presence of viable bone in the area of reconstruction and a good surgical candidate. • Maintaining realistic expectations of prosthetic reconstruction throughout the treatment process is crucial to the patient’s overall rehabilitation because treatment can be lengthy and has inherent technical limitations. • Prosthetic rehabilitation…

Osseointegration and prosthodontic considerations

Key points • Prosthodontics is the art and science of the aesthetic and functional restoration of the hard and soft tissues of the oral cavity. • Osseointegration is arguably the most significant contribution to prosthetic dentistry and has become a routine consideration in any dental treatment plan that involves tooth replacement. • Because it is rare to see the mandibular dental midline at a social distance,…

Aesthetic cranioplasty

Key points • Augmentation, feminization, masculinization, and other adjustments to the cranium can be done with implants, osteotomies, hydroxyapatite bone cements, and autogenous bone grafts. Soft tissue can further be augmented with fat grafting, filler materials, or free tissue transfer. • Virtual surgical planning has enabled the surgeon to engage in the custom fabrication of implants. • Polymethylmethacrylate (PMMA) can be used as a low-cost material…

Principles of rhinoplasty

• Preoperative evaluation must include assessment of nasal function as well as aesthetic goals. • Each approach should be individualized to the patient. Surgical planning must take into consideration form, function, age, gender, and ethnic background. • Computer imaging and preoperative photographs facilitate discussion between the surgeon and the patient regarding surgical goals. • The patient should be counseled extensively on the risks of postoperative recovery.…

Rhinoplasty: Dimensional analysis and planning

Key points • Thorough analysis of the whole face and the nose, along with full understanding of the nasal dynamics, are required for planning a successful rhinoplasty outcome. • An optimal rhinoplasty outcome requires congruity between the nose and the rest of the face, as well as harmony among the different aesthetic units of the nose; thus, a circumspect analysis of the entire face is essential.…

Osseous genioplasty: Dimensional control of the lower facial third

Key points • Osseous genioplasty is a more versatile procedure compared with chin implant surgery. • The chin can be advanced, set back, narrowed, widened, lengthened, shortened, centered, and leveled with genioplasty. • Osseous genioplasty gives the surgeon control of the labiomental crease. • Perioral facial rejuvenation is much more powerful with osseous genioplasty than with a chin implant. • The facial shape can be profoundly…

Alloplastic augmentation of the chin and the mandible

Key points • Chin augmentation can often result in asymmetry, an irregular transition between the implant and the underlying bone, excessive width, or unaesthetic disproportion. • Optimization of results requires careful preoperative analysis, refinements in surgical technique, and appropriate implant design. • With 3D CT imaging and/or models, bone irregularities, deficiencies, asymmetries, any prior implant, and the soft tissue envelope can be visualized. • Many patients…

Orthognathic camouflage

Key points • Skeletal discrepancies leading to malocclusion are frequently treated with compensatory orthodontics. • Dental compensation of skeletal discrepancies frequently leads to facial imbalance. • Camouflage procedures may be an option to restore facial harmony without the need for orthognathic surgery. • Procedures such as rhinoplasty, genioplasty, or alloplastic implantation are options to restore skeletal balance. • Dermal fillers, dermal fat grafts, and autologous fat…

Alloplastic augmentation of the midface

Key points • Skeletal augmentation and soft tissue augmentation can be complementary but are not interchangeable. • Patients with deficient infraorbital rim projection can be predisposed to lower lid malposition after blepharoplasty and can benefit from augmentation of the infraorbital rim. • If any history of trauma, surgery, or abnormality of the midfacial skeleton is reported or suspected, computed tomography (CT) is useful to assess the…

Maxillary–mandibular skeletal contouring surgery

• Skeletal contouring can add convexity to the profile and narrow the face from the frontal view. • Procedures on the zygoma, mandible, and chin are usually combined to obtain optimal results. • Skeletal contraction will result in increased soft tissue laxity, and secondary skin-related procedures may be necessary in older patients. • Orthognathic surgery is a powerful aesthetic technique, which is indicated as the primary…