Face contouring
Face contouring
Facial contouring is one of the fastest growing non-invasive and non-surgical facial reconfiguration technicues that’s currently taking the plastic surgery industry by storm. It’s a highly effective method of enhancing facial features and reducing the appearance of the signs of aging. As you age, your skin naturally loses elasticity causing it to sag and develop wrinkles. This is most noticeable in the face, which is why more and more people are proactively seeking preventative and reactionary treatments to help improve their appearances. Continue reading to learn all about how face sculpting procedures can help you achieve the effortless and youthful look you desire.
Cheekbone reduction
Have you ever thought about reducing your cheekbones? There are many people just like you who have thought about reducing their cheekbones and have undergone plastic surgery to get the look they want.
Cheekbone reduction is a procedure for smoothing the lines of wide cheekbones. More specifically, osteotomy on both the front and back sides of the prominent cheekbone in order to correctly and safely create a smooth bone surface.
Cheekbone reduction is operated through an incision on the scalp, which makes the scar barely visible and allows you to quickly return to your daily activities. Your face will look smaller and have better proportions.
Chin augmentation
A chin augmentation refers to refinement/improvement of the bone contour of the chin area. This is usually accomplished by placement of a fitted “implant” directly on the bone of the chin, well below the skin. This procedure is usually done to augment an under projected chin.
The restoration of facial harmony is the goal of chin augmentation. Chin augmentation can be used to define an underdeveloped chin, or give it more prominence. Interestingly, the shape of the chin is related to nose size. That is, a small chin may make a large nose more noticeable, and vice versa. Often, rhinoplasty and chin implant are done together. Chin augmentation can also be performed at the time of neck or facelift, to help better define the jawline.
Chin reduction
Chin surgery, or mentoplasty, is a surgical procedure to reshape the chin either by enhancement with an implant or reduction surgery on the bone.
Plastic surgery, and other minor office procedures, can often be performed on the lower jaw line and chin area to improve proportions of the face and to help with one’s confidence and self-esteem. These types of interventions are frequently suggested by board-certified plastic surgeons to improve the harmony of facial features and improve the chin/jaw/cheek/forehead balance.
Sometimes bone from the jaw itself can be moved forward in an operation called a mentoplasty or genioplasty. Alternatively, shaped silicone implants can be used to give more projection to the chin. Conversely, bone can be removed to decrease an overly projecting chin. Furthermore, modifications to the upper and/or lower jaw can be advised for improved chewing dynamics and occlusion – or how the teeth fit together. These operations can range from simple to very complex.
Many times, a plastic surgeon may recommend chin surgery or procedures to a patient having a rhinoplasty in order to achieve better facial proportions, as the size of the chin may magnify or minimize the perceived size of the nose.
Additionally, with recent advances in technology, and after obtaining informed consent after reviewing all options, risks and benefits, your plastic surgeon may suggest off-label use of FDA-approved gel filler material as an alternative for providing augmentation of the chin area that may last for a shorter duration.
Corrective Jaw Surgery
Orthognathic Surgery (Corrective Jaw Surgery) involves moving the bones of the upper or lower jaw or both. The jaws are lengthened or shortened, moved up or down, in or out, resulting in a more harmonious bite and facial appearance.
Orthognathic surgery is needed when jaws and teeth don’t meet correctly. Repositioning the jaws so that the teeth meet (occlude) correctly improves jaw joint function and chewing (mastication) ability, and can also improve speech, breathing, sleep apnea, periodontal (gum) health and facial aesthetics.
Orthognathic Surgery (Corrective Jaw Surgery) is a complex surgery and because of the intricacies of occlusion (the way the teeth bite) and the combined effect on the facial appearance when moving the teeth and jaws, orthognathic surgery must be carefully planned. Because of its complexity, a team approach is used. The team consists of your orthodontist and oral surgeon and occasionally your general dentist and other dental specialists including periodontists and endodontists.
WHO NEEDS ORTHOGNATHIC SURGERY?
People who can benefit from orthognathic surgery include those with an improper bite or jaws that are positioned incorrectly. Jaw growth is a gradual process and, in some instances, the upper and lower jaws may not match at the end of growth. Injury to the jaw during growth may be a cause for the incongruent growth of the jaws. The result can cause a host of problems that can affect chewing function, speech, long-term oral health, and appearance. Some bite problems can be corrected by orthodontics alone.
Orthodontics alone can correct bite problems when only the teeth are involved. If the jaw bones (maxilla and mandible) are not aligned then Orthognathic surgery should be considered.
To compensate for mismatched jaws by moving just the teeth can lead to periodontal problems, relapse of orthodontic movements, jaw joint problems, and poor or even disastrous facial aesthetics.
Fat Grafting
Fat grafting, also referred to as fat transfer or fat injections, is the surgical process by which fat is transferred from one area of the body to another area. The surgical goal is to improve or augment the area where the fat is injected. The technique involves extracting adipose fat by liposuction, processing the fat, and then reinjecting purified fat into the area needing improvement.
Since the 1990’s Plastic Surgeons have reliably used fat grafting as a way to improve and enhance the cosmetic appearance of the face, breast, hands, feet, hips, and buttocks. However, more recently, clinicians have documented the therapeutic benefits of fat grafting in the healing of wounds and scars, as well as fat’s ability to repair damage to breast tissue following radiation treatment.
History of fat grafting
The first ‘fat grafting’ procedure dates back to the late 19th century, 1893, when a German Plastic Surgeon, Gustav Neuber (1850-1932) transferred fat from the arm to the orbital (eye) region to correct scars formed from osteomyelitis
(Bone infection).
Only two years later, 1895, Dr. Viktor Czerny (1842-1916) transferred a lipoma to the breast to establish symmetry following a unilateral partial mastectomy.
However, fat grafting had trouble gaining acceptance during the next 100 years due to the many complications that routinely accompanied the procedure. Modern liposuction techniques had not yet been developed or standardized and the extracted fat was generally of inconsistent quality, which yielded poor results.
In the 1990’s, Dr. Sydney Coleman, a New York City Plastic Surgeon, began publishing papers describing standardized techniques for fat extraction, processing, and injection. Since that point in time, the procedure’s popularity has only increased along with a wider variety of clinical applications.
Who performs fat grafting and where?
Fat grafting is most commonly performed by Plastic Surgeons, as liposuction is a primary component of the procedure. Plastic Surgery residents get comprehensive training in the standards of care for the liposuction procedure and are fluent in managing complications.
Fat grafting should be performed in an accredited outpatient surgery center (AAAASF, JCAHO) or hospital. Facility accreditation is important as it guarantees that the facility is inspected at regular intervals to ensure patient safety and best practices.
Fat grafting process
The process of fat grafting involves three steps:
- extraction of the fat from the donor area with liposuction
- decanting, centrifugation, and processing of the fat
- reinjection of the purified fat into the area needing improvement
In the first step, fat is extracted from a donor area using liposuction techniques. This is best accomplished by manual methods using thin liposuction cannulas with small holes. Laser or ultrasonic liposuction should not be used for the extraction as it may destroy the fat cells.
The fat is then processed with decanting and centrifugation to separate debris, excess fluid, and dead cells from the viable adipose fat cells. An alternate method is to wash the fat with a sterile saline solution. The fat that is discarded are the fat cells which will likely not survive in the graft and they can even create problems for the good cells.
In the final step, the fat is reinjected in small droplets throughout the subcutaneous tissue of the recipient area. This is to ensure good blood supply to every fat droplet so that the fat graft can survive.
The amount of fat injected is measured in cc’s and ultimately varies according to patient case specifics and the area of the body where the processed fat is being injected.
Types of anesthesia used
Fat grafting is performed with a wide variety of anesthetics. The choice of anesthesia usually depends of the volume of fat that is extracted from the donor area via liposuction. Extraction of small volumes of fat can easily be tolerated using a local anesthetic. However, larger volumes (>500cc) almost always require that the patient be sedated with IV anesthesia or General Anesthesia.
While local anesthesia can be administered by the surgeon, IV anesthesia or General Anesthesia should be administered by a CRNA (Certified Registered Nurse Anesthetist), or better yet, a Board-Certified Anesthesiologist.
Common areas of fat grafting
A summary of common fat grafting applications and the associated volumes of fat injected is as follows:
Face (10cc – 100cc, total)
- Restores youthful appearance by adding volume to hollowed out or wrinkled areas such as the area below the eye and the nasolabial folds
- Helps repair scars
- Adds volume to the cheeks to create the appearance of higher cheekbones
- Improves the texture and appearance of the skin
Breast (25cc-400cc, each breast)
- Increases the breast size by one or two cup sizes
- Corrects breast asymmetry
- Repairs radiation tissue damage and can treat breast implant capsular contractures
- Helps correct scar deformities from lumpectomy or breast reconstruction
Hips (100cc-300cc, each side)
- Adds volume to achieve a more feminine profile and better waist-hip ratio
Buttocks (200cc-1300cc+, each cheek)
- Makes buttocks appear perkier
- Augments buttocks size (aka Brazilian butt lift)
Hands and Feet (5-10cc, per extremity)
- Reduces wrinkles and rejuvenates appearance
- Provides padding for bony feet
Fat grafting and adipose stem cells
Fat grafts have increasingly captivated the attention of Plastic Surgeons not only due to their aesthetic capabilities, but also because of their regenerative properties. The regenerative properties are due to the high concentration of mesenchymal stem cells (MSCs) resident in the fat tissue.
