“The surgery of the aging face is minimally invasive and enhances its volume, the aim is to restore the original shape of the face”
The surgery of the aging face was many years very aggressive (invasive and ablative), the main goal was to tighten the skin and remove fat, resulting sometimes in an unexpressive and unnatural facial expression. Today, we understand, that the aging face is the result of a depleting process, which is pronounced differently in all patients; the trend now is, to build up the face. The surgical approaches (brow-face-neck-LIFT) become smaller and the contour of the face is not only defined by tightening of soft tissues but also by volume enhancement achieved by re-draping the lost fat layer under the skin and the supplemental injection of autologous fat. The surgery of the aging face is multimodal and volume enhanced.
Nose correction/ Rhinoplasty
Aesthetic and functional disorders of the nose can be corrected relatively easy. Computer simulation is a crucial tool in surgical planing and very valuable in order to set goals together with the patient. The quality of the skin, the configuration of the nasal dorsum (hump or depression), the nasal tip (projection), the nasal wing (broad, narrow), the nasal entrance (broad, narrow) and the nasal septum (deviation) are some of the criteria to be taken into account for surgical planning.
The surgical access to the bony and cartilage framework of the nose can be done via a “closed approach”. It means, that the incision is set in the inner part of the nasal wing. Nasal bone and cartilage can be corrected. This technique does not leave visible scars.
The “open approach” in rhinoplasty (skin incision at the columella) has the advantage of a wide surgical view, which is very helpful in complex rhinoplasty, such as correction of the nose tip and malformations as the nose deformity in cleft lip and palate.
The rhinoplasty in patients with cleft lip and cleft palate initially requires the correction of the facial skeleton (nose aperture), which is often underdeveloped. After correction of the facial skeleton a classic rhinoplasty can be performed.
The analysis of the nose in profile, taking into account the angle to the upper lip and chin, are valuable criteria to achieve a good aesthetic result; for this reason, chin correction in combination with rhinoplasty is often performed. For more information read “Functional and aesthetic surgery of the facial skeleton”.
Protruding ears are typically addressed in the childhood in terms of an otoplasty. This operation can also be done in adults. Some years ago cartilage and skin were removed routinely, nowadays, modeling of the cartilage by weakening without loss of tissue gain in importance providing good results.
Signs, Symptoms & Treatment (Common description vs. Medical description)
· Signs and Symptoms: Sagging brow, frown lines; Medical description: Brow ptosis.
· Treatment: Forehead lift, brow lift; Medical description: Temporal lift by fasciapexy.
· Signs and Symptoms: Aging lids, crow’s feet, eye bags, tear troughs, hollow eyes; Medical description: Blepharochalasis, herniation of orbital fat, marked eyelid-cheek junction.
· Treatment: Eyelid surgery (remove of fatty deposits, fat injection for correction of volume loss), optionally combined with face lift; Medical description: Blepharoplasty (transcutaneous and transconjuctival approach), lateral canthopexy, micro fat injection, fat transposition over the infraorbital rim. Optional: midface-lift (for centrofacial rejuvenation) and face-lift.
· Signs and Symptoms: Nose hump, saddle nose, crooked nose, large nose, long nose, wide nose; Medical description: Nose deformity.
· Treatment: Nose correction; Medical description: Open and closed septorhinoplasty, nose tip correction using autologous cartilage grafts, extracorporeal septoplasty in selected cases, lipofilling.
· Signs and Symptoms: Protruding Ears
· Treatment: Ear correction; Medical description: Otoplasty (scoring-suture-technique); antihelix plasty, cavum reduction, lobulus plasty.
· Signs and Symptoms: Jowls, marionette grooves, deflated cheeks; Medical description: Cutis laxa faciei, cheek ptosis, inframalar hollow, marked nasolabial line, loss of jawline
· Treatment: Facelift, fat injections (for cheek & hollow eyes), neck liposuction, laser (or chemical peilng); if necessary, combined with neck lift, eyebrow lift and eyelid surgery; Medical description: Rhytidectomy (Short-Scar Facelift | eventually posterior extension), chemical peelin, lipofilling. Concomitant therapy: Brow lift, blepharoplasty, plastysma suspension and liposuction.
· Signs and Symptoms: Wrinkled and thin lips; Medical description: Lip rhytids, lip atrophy.
· Treatment: Lip enhancement using fat graft (or fillers), chemical peeling with croton oil; Medical description: Lipofilling, chemical peeling, fillers (in some cases).
· Signs and Symptoms: Double chin, neck laxity; Medical description: Cutis laxa colli, neck and submental laxity, platysma bands, loss of cervico-mental angle.
· Treatment: Neck lift, liposuction; Medical description: Platysma suspension, submental liposuction.