Perspectives of facial aesthetics

Introduction

Aesthetic surgery of the face, especially when the focus is to alter the facial skeleton, requires a thorough facial analysis before devising an operative plan. Surgical intervention alongside orthodontic treatment helps achieve an optimal and predictable result. In this chapter, we have incorporated an overview of facial aesthetics into facial analysis to make it more useful for surgical planning.

History

First, the patient’s perspective and desires should be sought and clarified during the initial evaluation. Not uncommonly, the patient’s perceptions differ from that of the surgeon’s. In addition, detailed information about the patient’s current and prior medical problems should be gathered. Family history is also pertinent because family members may have similar facial abnormalities. History of speech problems or congenital craniofacial abnormalities is important to consider and monitor postoperatively.

Comorbidities, such as preexisting cardiac or renal dysfunction, require consultation with a specialist to secure clearance for surgical management. Patients with diabetes or immunocompromised patients are at a greater risk for infection and may have difficulty with wound healing. Last, patients with bleeding tendencies or those who bruise easily should be evaluated for any coagulation disorders, such as Von Willebrand’s disease. ^, Patients with coagulation disorders may not be aware of their condition and might require treatment intraoperatively for adequate hemostasis. Controlling blood pressure, whether it is high after surgery or low during surgery, is also key to preventing postoperative complications associated with bleeding, such as hematomas. As for any surgical procedure, patients should discontinue the use of nonsteroidal antiinflammatory medications and aspirin-containing products 3 weeks before the procedure.