Face plastic: the detachment of the skin is only necessary to perform the deep plicature. After plication, excessive skin is removed. The incision in the submento, which has been the habit, has been replaced by the closed platismotomy, associated to the lateral plication of the platysmal bands.

Years ago, when re-juvenessence facial surgery was first used, it consisted of displacement and traction of the skin, and simply correcting flaccidity and minimizing the wrinkles.

Although this procedure had its beneficial results, it could lead to artificial results since the outcome was a stretched skin and of younger aspect on a face that was with aged delineation and contours. For example, the double chin, the bags at the side of the chin (bulldog ears), remained still. From this initial stage, facial surgery has greatly developed in the last thirty years. Skin traction has been combined with the same surgical procedure, the contents modeled by delicate liposculpture of the face, plus the resource of sometimes working on the facial muscles. This is the result of modern technologies improving the texture of the skin by cosmetological treatments, based on the use of laser.

Regarding the shape and contours of the face, I had the opportunity to publish scientific work on the redefinition of the contour of the face through liposculpture in a specialized magazine in the USA, since I was a pioneer in this procedure.

At that time, there was a change of concept since a simple stretched skin, with fewer wrinkles was not seen as enough. It was necessary that the face contour to be compatible with youth. Liposculpture of the face became the new tool that allowed us to achieve this objective.

As in all procedures, facial surgery also requires incisions. It starts at the hairline (sideburns or somewhat higher) at the temporal area and inside the hairline, travels down in front of the ear following its contour, works around the earlobe, rising behind the ear at the angle formed by the ear and the skull, and enters horizontally a couple of centimeters into the scalp.

In 1988 Dr. Daher described 6 regions of the face that make atypical fat accumulations. He systematized the delicate liposuction of these areas, and the fat grafting of the wilting regions, such as the malar region and the lips.

It is interesting to notice that due to the abundant blood circulation of the face, scars are usually of very good quality and are seldom noticeable,  even in front of the ears.

The fat injection, suctioned from the face or other parts of the body, was ideal to fill in the areas of emptiness and depressions that appear with the aging process: such as the naso-genian folds, the cheeks that become empty and lose their healthy look, and the naso-jugal fold next to the nose, that we call “the valley of tears”.

By practical evidence from thousands of plastic surgeons throughout the world, the beneficial effects of fat injection have recently been demonstrated. This is not only to regain volume where fat is ” drained ” by age, but also by the huge improvement in skin texture that can be achieved.

We must consider that fat grafts on the surface are always absorbed according to the reactions of each organism, therefore there will always be fat tissue. Since the fat is sourced from the own individual, and there are no contraindications, the fat injection procedure can be repeated a few times, adding more and more incorporated tissue, thus achieving higher permanent volumes.

However, fat implantation in the face is usually much absorbed, and that is why plastic surgery is always seeking for new materials that can be used as filling substances.

The plastic of the frontal region is still done, but indicated only in cases where the forehead is too small or the wrinkles too deep. Today its indication has decreased due to the use of BOTOX, which temporarily paralyzes the frontal muscles that are responsible for the wrinkles on the forehead.

It seems to us that polymethilmethacrilate (PMMA), recently approved by ANVISA (Brazilian Health Department) for some kinds of deformities, has quite satisfied this need of filling in a definitive (non absorbable) manner, creating the field of BIOPLASTY, a subject of previous discussion in this article. However, as mentioned, several complications were shown at conferences attributed to PMMA.

It is not yet certain yet if these complications were produced by poor product sold on the market as if it were “approved” PMMA, or if this was incorrectly applied, because it is a product intended only for small and deep applications. Nevertheless, there was a great restriction to the widespread use of this product, although it is recognized by ANVISA and of great utility for definitive correction of small irregularities in the contour of the face, nose or other regions.

Facial surgery of the face demands 24 hours’ hospitalization after which, already free of bandages, the patient is released.

The most frequent complication of this procedure is hematomas, however, with a well oriented treatment these will cause no problems, except for delayed recovery.

Immediate recovery occurs in one week; the patient is allowed to resume almost all daily activities after 14 days and is totally liberated, including for sun exposure and sports, after 30 days.

Facial rejuvenation surgery: Used to be done with large detachments; These days detachments are becoming smaller each time..

The maximum result of this treatment will last – in all its exuberance – for about 6 months. During this period, it will be possible to use complementary resources such as Spectra (laser to improve texture and skin blemishes), or botox to remove wrinkles – or interventions for flaws which solely plastic surgery cannot remove.

Facial plastic surgery incisions are well positioned to make scars almost unapparent. The scars of facial plastic, from the position at which they are seen, are less important.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Facelift – Full

Facelift – Lower

Facelift – Mid

Facelift – Mini