The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Patrick K. Sullivan - One of the best experts on this subject based on the ideXlab platform.
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an anatomical evaluation and surgical approach to the perioral mound in Facial Rejuvenation
Plastic and Reconstructive Surgery, 2010Co-Authors: Patrick K. Sullivan, Erik A Hoy, Vineet Mehan, David P SingerAbstract:Background: Premature aging of the perioral soft tissues of the face is a common complaint of patients seeking Facial Rejuvenation, although its cause is unclear. The subcutaneous fat compartments of the face may be differentially affected by Facial aging. Despite efforts to study and rejuvenate the aging periorbit, midface, and jowls, the effects of aging on the perioral mound have been less studied. Methods: To better understand the cause of age-associated changes in the perioral area, a cadaver dissection study was performed. Eight fresh and fixed cadavers with evidence of perioral fullness were used in anatomical dissection. Anatomical observations and histologic examination were used to describe the age-related changes in this area. After describing the defect, the authors present a surgical approach to Rejuvenation of this region, tailored to the findings in this anatomical study. Results: Histologic sections demonstrated a lipomatous area without defined ligamentous attachments or encapsulations. Chambers of adipocytes in the hypodermis were separated by thin fibroseptations: a scaffold in the structural support of this region. Superficial lipodystrophy defines thisFacial region in the cadaver specimens. The end result is a fatty, ptotic perioral mound of tissue that is not well addressed by conventional rhytidectomy. Conclusions: The area of the perioral mound may represent a small, independent fat compartment or a differentially affected extension of the nasolabial compartment described by Pessa. This cadaver study has increased the authors' understanding of the perioral region and allowed them to improve results in its Rejuvenation. The senior author's preferred approach is liposculpture with fine-cannula liposuction.
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submandibular gland i an anatomic evaluation and surgical approach to submandibular gland resection for Facial Rejuvenation
Plastic and Reconstructive Surgery, 2003Co-Authors: David P Singer, Patrick K. SullivanAbstract:Submandibular gland resection for aesthetic reasons has been hotly debated. Detractors maintain that the procedure is dangerous because it puts too many important structures at risk, notably motor nerves. The present study was undertaken to elucidate the neurovascular and soft-tissue anatomy of the digastric triangle via cadaver dissections so that a surgical approach to achieve safe aesthetic submandibular resection could be performed. Fifteen digastric triangles dissections were performed in fixed and fresh cadaver specimens. The dissection focus was to understand the submandibular neurovascular relationships, capsule as well as fascial layers, and measurements to known structures. The marginal mandibular nerve is located external to the submandibular capsule, approximately 3.7 cm cephalad to the inferior margin of the gland. The hypoglossal nerve is posterior to the digastric sling in a position that is protected deep within the visceral layer of the neck. The lingual nerve is located underneath the mandibular border, crossing anterior to the submandibular duct. The vascular supply is variant, but with an average of one and a half vessels entering medially to the superficial lobe of the gland, one intermediate vessel entering medially to supply the superficial and deep lobes, and one deep perforator that runs from the central portion of the deep lobe to the superficial lobe. Appreciation of this anatomy is critical in the submental approach for partial resection. Although it can be technically challenging, the anatomy is straightforward and partial submandibular gland resection can be executed via a consistent, safe approach to optimize Facial Rejuvenation in certain patients.
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relevance of the lesser occipital nerve in Facial Rejuvenation surgery
Plastic and Reconstructive Surgery, 2000Co-Authors: Marcello Pantaloni, Patrick K. SullivanAbstract:Nerve injuries are possible during Facial Rejuvenation surgery. The great auricular nerve has been studied; however, little is known about the lesser occipital nerve and its relevance in Facial Rejuvenation surgery. To understand the importance of the lesser occipital nerve in a face lift procedure, the specific anatomy of the nerve was studied in the laboratory in 19 hemifaces, with additional nerve observations in the operating room. The course of the lesser occipital nerve, its branches, and the relationship with the surrounding structures were evaluated and recorded. The great auricular nerve was also dissected to compare the two nerve territories. In the majority of the dissections, the lesser occipital nerve supplied the superior ear and the mastoid area, whereas the great auricular nerve innervated the inferior ear and a portion of the preauricular area. The nerves, however, were variable in size and distribution. Five lesser occipital nerves provided the dominant supply to the ear, compensating for a small great auricular nerve contribution. Therefore, injury to the lesser occipital nerve can result in a major sensory deficit of the ear. We also found the lesser occipital nerve to have a subcutaneous course at a proximal and variable level. These nerve branches can be superficial, and therefore postauricular flap dissection can injure the nerve if the flap is dissected at the fascial level. We therefore suggest that the dissection be at a more superficial level to avoid nerve injury. And finally, if SMAS/platysma suspension sutures are placed, we suggest these be done in a vertical-oblique direction along the course of the lesser occipital nerve, because this should minimize the possibility of trapping terminal branches.
David P Singer - One of the best experts on this subject based on the ideXlab platform.
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an anatomical evaluation and surgical approach to the perioral mound in Facial Rejuvenation
Plastic and Reconstructive Surgery, 2010Co-Authors: Patrick K. Sullivan, Erik A Hoy, Vineet Mehan, David P SingerAbstract:Background: Premature aging of the perioral soft tissues of the face is a common complaint of patients seeking Facial Rejuvenation, although its cause is unclear. The subcutaneous fat compartments of the face may be differentially affected by Facial aging. Despite efforts to study and rejuvenate the aging periorbit, midface, and jowls, the effects of aging on the perioral mound have been less studied. Methods: To better understand the cause of age-associated changes in the perioral area, a cadaver dissection study was performed. Eight fresh and fixed cadavers with evidence of perioral fullness were used in anatomical dissection. Anatomical observations and histologic examination were used to describe the age-related changes in this area. After describing the defect, the authors present a surgical approach to Rejuvenation of this region, tailored to the findings in this anatomical study. Results: Histologic sections demonstrated a lipomatous area without defined ligamentous attachments or encapsulations. Chambers of adipocytes in the hypodermis were separated by thin fibroseptations: a scaffold in the structural support of this region. Superficial lipodystrophy defines thisFacial region in the cadaver specimens. The end result is a fatty, ptotic perioral mound of tissue that is not well addressed by conventional rhytidectomy. Conclusions: The area of the perioral mound may represent a small, independent fat compartment or a differentially affected extension of the nasolabial compartment described by Pessa. This cadaver study has increased the authors' understanding of the perioral region and allowed them to improve results in its Rejuvenation. The senior author's preferred approach is liposculpture with fine-cannula liposuction.
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submandibular gland i an anatomic evaluation and surgical approach to submandibular gland resection for Facial Rejuvenation
Plastic and Reconstructive Surgery, 2003Co-Authors: David P Singer, Patrick K. SullivanAbstract:Submandibular gland resection for aesthetic reasons has been hotly debated. Detractors maintain that the procedure is dangerous because it puts too many important structures at risk, notably motor nerves. The present study was undertaken to elucidate the neurovascular and soft-tissue anatomy of the digastric triangle via cadaver dissections so that a surgical approach to achieve safe aesthetic submandibular resection could be performed. Fifteen digastric triangles dissections were performed in fixed and fresh cadaver specimens. The dissection focus was to understand the submandibular neurovascular relationships, capsule as well as fascial layers, and measurements to known structures. The marginal mandibular nerve is located external to the submandibular capsule, approximately 3.7 cm cephalad to the inferior margin of the gland. The hypoglossal nerve is posterior to the digastric sling in a position that is protected deep within the visceral layer of the neck. The lingual nerve is located underneath the mandibular border, crossing anterior to the submandibular duct. The vascular supply is variant, but with an average of one and a half vessels entering medially to the superficial lobe of the gland, one intermediate vessel entering medially to supply the superficial and deep lobes, and one deep perforator that runs from the central portion of the deep lobe to the superficial lobe. Appreciation of this anatomy is critical in the submental approach for partial resection. Although it can be technically challenging, the anatomy is straightforward and partial submandibular gland resection can be executed via a consistent, safe approach to optimize Facial Rejuvenation in certain patients.
Moetaz Eldomyati - One of the best experts on this subject based on the ideXlab platform.
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combining microneedling with other minimally invasive procedures for Facial Rejuvenation a split face comparative study
International Journal of Dermatology, 2018Co-Authors: Moetaz Eldomyati, Hossam Abdelwahab, Aliaa HossamAbstract:Background The introduction of minimally invasive procedures has increased acceptance due to their efficacy, safety, and relatively long-lasting and natural results. At least two different and unrelated modalities are employed to consider a combination treatment. Objectives This study aims to evaluate and compare the use and effectiveness of combined microneedling with platelet-rich plasma (PRP) or trichloroacetic acid (TCA) peeling for Facial Rejuvenation. Patients/methods Twenty-four volunteers with photoaging were randomly divided into three equal groups according to performed procedure on each side of the face (microneedling by dermaroller alone or combined with PRP or TCA 15% peeling). They had received one session every 2 weeks for six sessions of treatment. Photography and punch biopsies were performed before and after 3 months of treatment for clinical, histometrical, and histological evaluation. Results Combined treatment of dermaroller and PRP or dermaroller and TCA showed significant improvement when compared with dermaroller alone. Significant increase in epidermal thickness was apparent in studied groups, especially after combined treatment with TCA. Organized collagen bundles with newly formed collagen formation and markedly decreased abnormal elastic fibers were noticed in the three studied groups. However, improvement of dermal structures was better demonstrated after combined treatment of Dermaroller and PRP than Dermaroller and TCA 15%. Conclusions Most volunteers showed significant clinical improvement after treatment supported by the histometrical and histochemical evaluation; however, the combined use of dermaroller with PRP is apparently more beneficial for Facial Rejuvenation.
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expression of transforming growth factor β after different non invasive Facial Rejuvenation modalities
International Journal of Dermatology, 2015Co-Authors: Moetaz Eldomyati, Tarek S Elammawi, Walid Medhat, Osama Moawad, Mỹ G Mahoney, Jouni UittoAbstract:Background Transforming growth factor-β (TGF-β) is a major regulator of the synthesis of extracellular matrix (ECM) proteins in human skin as it stimulates fibroblast proliferation and collagen production. Perturbed TGF-β expression may play a key role in the pathogenesis of skin aging. Objectives This study was conducted to objectively evaluate the effects of different modalities of non-invasive Facial Rejuvenation on TGF-β expression and to correlate its level with that of newly synthesized collagen. Methods A total of 36 patients with Fitzpatrick skin types III and IV were divided into six groups. Each group of six patients was subjected to a different non-invasive modality for the treatment of skin aging, including radiofrequency (RF), Nd:YAG 1320-nm laser and Er:YAG 2940-nm laser mini-peels, intense pulsed light (IPL), mesotherapy injection, and electro-optical synergy (ELOS). Skin biopsies were obtained before treatment, at the end of treatment, and at three months post-treatment. In addition, biopsies were obtained from 30 control subjects. Levels of TGF-β were quantitatively evaluated using computerized image analysis of immunostained sections. Results The expression of TGF-β was statistically significantly increased (P 0.05) were observed in TGF-β level in response to IPL or mesotherapy treatments in comparison with baseline. The level of TGF-β was positively correlated (P < 0.05) to that of newly synthesized collagen at the end of Nd:YAG 1320-nm laser and Er:YAG 2940-nm laser mini-peels, as well as at three months after RF and ELOS treatments. Conclusions Radiofrequency, ELOS, and Nd:YAG 1320-nm laser and Er:YAG 2940-nm laser mini-peels resulted in an increase in TGF-β expression, which may mediate the effects of these modalities in enhancing dermal collagen expression through the activation of fibroblasts and thereby reverse the photoaging of skin.
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multiple fractional erbium yttrium aluminum garnet laser sessions for upper Facial Rejuvenation clinical and histological implications and expectations
Journal of Cosmetic Dermatology, 2014Co-Authors: Moetaz Eldomyati, Hossam Abdelwahab, Walid Medhat, Talal Abdelraheem, Mustafa Al AnwerAbstract:Summary Background Fractional photothermolysis is a modern resurfacing technique, in which microscopic zones of thermal injury are created, stimulating turnover of both epidermis and dermis. Fractional laser Rejuvenation has been developed to overcome the drawbacks of traditional ablative laser. Objectives To objectively evaluate the effectiveness of multiple sessions of fractional Er:YAG laser Rejuvenation for aging upper face clinically, histologically and immunohistochemically. Patients/Methods Ten volunteers asking for Facial Rejuvenation were subjected to multiple sessions (3–5) of fractional Er:YAG laser. Clinical evaluation with both histopathological and immunohistochemical assessment for skin biopsies was carried out before, after 1 month and 6 months of laser resurfacing. Histometry for epidermal thickness and quantitative assessment for neocollagen formation, collagen I, III, and VII, elastin and tropoelastin were carried out for all skin biopsies. Results Comparing before, after 1 month and 6 months of fractional Er:YAG laser resurfacing resulted in improved clinical appearance with increased epidermal thickness (P < 0.001). Dermal collagen showed increased neocollagen formation (P = 0.006), with increased concentration of collagen types I (P < 0.001), III (P < 0.001), and VII (P = 0.001). Dermal elastic tissue studies revealed decreased elastin, while tropoelastin concentration increased after laser resurfacing (P < 0.001). An increase in collagen (I and III) and tropoelastin level and decreased elastin content was encountered with increasing the number of sessions, yet it was not significant. Conclusions Multiple sessions are effective in Rejuvenation of the aging face with high safety, short downtime, and no adverse effects. They stimulated formation of new collagen (type I, III, and VII) up to 6 months after treatment with better improvement in skin texture and fine wrinkles. The variable number of fractional Er:YAG laser sessions (3–5) showed no significant difference as regards efficacy.
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fractional versus ablative erbium yttrium aluminum garnet laser resurfacing for Facial Rejuvenation an objective evaluation
Journal of The American Academy of Dermatology, 2013Co-Authors: Moetaz Eldomyati, Hossam Abdelwahab, Walid Medhat, Talal Abdelraheem, Wael Hosam, Hasan Elfakahany, Mustafa Al AnwerAbstract:Background Laser is one of the main tools for skin resurfacing. Erbium:yttrium-aluminum-garnet (Er:YAG) was the second ablative laser, after carbon dioxide, emitting wavelength of 2940 nm. Fractional laser resurfacing has been developed to overcome the drawbacks of ablative lasers. Objective We aimed to objectively evaluate the histopathological and immunohistochemical effects of Er:YAG 2940-nm laser for Facial Rejuvenation (multiple sessions of fractional vs single session of ablative Er:YAG laser). Methods Facial resurfacing with single-session ablative Er:YAG laser was performed on 6 volunteers. Another 6 were resurfaced using fractional Er:YAG laser (4 sessions). Histopathological (hematoxylin-eosin, orcein, Masson trichrome, and picrosirius red stains) and immunohistochemical assessment for skin biopsy specimens were done before laser resurfacing and after 1 and 6 months. Histometry for epidermal thickness and quantitative assessment for neocollagen formation; collagen I, III, and VII; elastin; and tropoelastin were done for all skin biopsy specimens. Results Both lasers resulted in increased epidermal thickness. Dermal collagen showed increased neocollagen formation with increased concentration of collagen types I, III, and VII. Dermal elastic tissue studies revealed decreased elastin whereas tropoelastin concentration increased after laser resurfacing. Neither laser showed significant difference between their effects clinically and on dermal collagen. Changes in epidermal thickness, elastin, and tropoelastin were significantly more marked after ablative laser. Limitations The small number of patients is a limitation, yet the results show significant improvement. Conclusion Multiple sessions of fractional laser have comparable effects to a single session of ablative Er:YAG laser on dermal collagen but ablative laser has more effect on elastic tissue and epidermis.
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radiofrequency Facial Rejuvenation evidence based effect
Journal of The American Academy of Dermatology, 2011Co-Authors: Moetaz Eldomyati, Tarek S Elammawi, Walid Medhat, Osama Moawad, Donna Brennan, My G Mahoney, Jouni UittoAbstract:Background Multiple therapies involving ablative and nonablative techniques have been developed for Rejuvenation of photodamaged skin. Monopolar radiofrequency (RF) is emerging as a gentler, nonablative skin-tightening device that delivers uniform heat to the dermis at a controlled depth. Objective We evaluated the clinical effects and objectively quantified the histologic changes of the nonablative RF device in the treatment of photoaging. Methods Six individuals of Fitzpatrick skin type III to IV and Glogau class I to II wrinkles were subjected to 3 months of treatment (6 sessions at 2-week intervals). Standard photographs and skin biopsy specimens were obtained at baseline, and at 3 and 6 months after the start of treatment. We performed quantitative evaluation of total elastin, collagen types I and III, and newly synthesized collagen using computerized histometric and immunohistochemical techniques. Blinded photographs were independently scored for wrinkle improvement. Results RF produced noticeable clinical results, with high satisfaction and corresponding Facial skin improvement. Compared with the baseline, there was a statistically significant increase in the mean of collagen types I and III, and newly synthesized collagen, while the mean of total elastin was significantly decreased, at the end of treatment and 3 months posttreatment. Limitations A limitation of this study is the small number of patients, yet the results show a significant improvement. Conclusions Although the results may not be as impressive as those obtained by ablative treatments, RF is a promising treatment option for photoaging with fewer side effects and downtime.
Mustafa Al Anwer - One of the best experts on this subject based on the ideXlab platform.
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multiple fractional erbium yttrium aluminum garnet laser sessions for upper Facial Rejuvenation clinical and histological implications and expectations
Journal of Cosmetic Dermatology, 2014Co-Authors: Moetaz Eldomyati, Hossam Abdelwahab, Walid Medhat, Talal Abdelraheem, Mustafa Al AnwerAbstract:Summary Background Fractional photothermolysis is a modern resurfacing technique, in which microscopic zones of thermal injury are created, stimulating turnover of both epidermis and dermis. Fractional laser Rejuvenation has been developed to overcome the drawbacks of traditional ablative laser. Objectives To objectively evaluate the effectiveness of multiple sessions of fractional Er:YAG laser Rejuvenation for aging upper face clinically, histologically and immunohistochemically. Patients/Methods Ten volunteers asking for Facial Rejuvenation were subjected to multiple sessions (3–5) of fractional Er:YAG laser. Clinical evaluation with both histopathological and immunohistochemical assessment for skin biopsies was carried out before, after 1 month and 6 months of laser resurfacing. Histometry for epidermal thickness and quantitative assessment for neocollagen formation, collagen I, III, and VII, elastin and tropoelastin were carried out for all skin biopsies. Results Comparing before, after 1 month and 6 months of fractional Er:YAG laser resurfacing resulted in improved clinical appearance with increased epidermal thickness (P < 0.001). Dermal collagen showed increased neocollagen formation (P = 0.006), with increased concentration of collagen types I (P < 0.001), III (P < 0.001), and VII (P = 0.001). Dermal elastic tissue studies revealed decreased elastin, while tropoelastin concentration increased after laser resurfacing (P < 0.001). An increase in collagen (I and III) and tropoelastin level and decreased elastin content was encountered with increasing the number of sessions, yet it was not significant. Conclusions Multiple sessions are effective in Rejuvenation of the aging face with high safety, short downtime, and no adverse effects. They stimulated formation of new collagen (type I, III, and VII) up to 6 months after treatment with better improvement in skin texture and fine wrinkles. The variable number of fractional Er:YAG laser sessions (3–5) showed no significant difference as regards efficacy.
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fractional versus ablative erbium yttrium aluminum garnet laser resurfacing for Facial Rejuvenation an objective evaluation
Journal of The American Academy of Dermatology, 2013Co-Authors: Moetaz Eldomyati, Hossam Abdelwahab, Walid Medhat, Talal Abdelraheem, Wael Hosam, Hasan Elfakahany, Mustafa Al AnwerAbstract:Background Laser is one of the main tools for skin resurfacing. Erbium:yttrium-aluminum-garnet (Er:YAG) was the second ablative laser, after carbon dioxide, emitting wavelength of 2940 nm. Fractional laser resurfacing has been developed to overcome the drawbacks of ablative lasers. Objective We aimed to objectively evaluate the histopathological and immunohistochemical effects of Er:YAG 2940-nm laser for Facial Rejuvenation (multiple sessions of fractional vs single session of ablative Er:YAG laser). Methods Facial resurfacing with single-session ablative Er:YAG laser was performed on 6 volunteers. Another 6 were resurfaced using fractional Er:YAG laser (4 sessions). Histopathological (hematoxylin-eosin, orcein, Masson trichrome, and picrosirius red stains) and immunohistochemical assessment for skin biopsy specimens were done before laser resurfacing and after 1 and 6 months. Histometry for epidermal thickness and quantitative assessment for neocollagen formation; collagen I, III, and VII; elastin; and tropoelastin were done for all skin biopsy specimens. Results Both lasers resulted in increased epidermal thickness. Dermal collagen showed increased neocollagen formation with increased concentration of collagen types I, III, and VII. Dermal elastic tissue studies revealed decreased elastin whereas tropoelastin concentration increased after laser resurfacing. Neither laser showed significant difference between their effects clinically and on dermal collagen. Changes in epidermal thickness, elastin, and tropoelastin were significantly more marked after ablative laser. Limitations The small number of patients is a limitation, yet the results show significant improvement. Conclusion Multiple sessions of fractional laser have comparable effects to a single session of ablative Er:YAG laser on dermal collagen but ablative laser has more effect on elastic tissue and epidermis.
Rod J Rohrich - One of the best experts on this subject based on the ideXlab platform.
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fat grafting for Facial Rejuvenation
Seminars in Plastic Surgery, 2020Co-Authors: Kelly P Schultz, Anjali C Raghuram, Matthew J Davis, Amjed Abughname, Edward Chamata, Rod J RohrichAbstract:For optimal results, Facial Rejuvenation procedures should address both the tissue laxity and volume deflation associated with Facial aging. The lift-and-fill face lift, in which fat grafting provides volumetric Rejuvenation to the face while surgical lift effectively repositions and removes ptotic and redundant tissue, has revolutionized the plastic surgeon's approach to the aged face. An understanding of the intricate anatomy of distinct Facial fat compartments and a systematic method to assess areas of fat atrophy and volume depletion are keys to provide patients with a natural and youthful result. Fat grafting may be used to improve contour in any area treatable by nonautologous injectable fillers, including the temples, forehead, upper and lower orbit, cheeks, perioral region, nasolabial fold, jawline, and chin-with the benefit of a more natural contour and integration with native tissue.
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autologous fat grafting to the chin a useful adjunct in complete aesthetic Facial Rejuvenation
Plastic and Reconstructive Surgery, 2018Co-Authors: Rod J Rohrich, Kyle Sanniec, Paul N AfroozAbstract:The chin makes up the central unit of the face and neck, and is a significant factor in Facial harmony and aesthetics. Historically, correction of microgenia required surgical intervention with a sliding genioplasty, or placement of a permanent implant. However, these techniques require more extensive surgical intervention, prolonged downtime, with higher costs and complications. Furthermore, chin rhytides and descent of chin fat lead to an aged appearance of the chin and lower face that is difficult to correct with a chin implant alone. Autologous fat grafting in Facial Rejuvenation has expanded in its application and can serve as an effective technique to correct and enhance chin aesthetics, including lateral chin hollowing, asymmetry, mild microgenia, and correction of deep labiomental sulcus or a bifid chin. This article and accompanying video demonstrate the authors' technique for chin augmentation and refinement with autologous fat.
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face lifting in the massive weight loss patient modifications of our technique for this population
Plastic and Reconstructive Surgery, 2015Co-Authors: Kailash Narasimhan, Smita R Ramanadham, Rod J RohrichAbstract:Background:The authors evaluated their experience with Facial Rejuvenation in the massive weight loss patient.Methods:A retrospective chart review of the senior author’s (R.J.R) face-lift patients was conducted. Data on patient age and body mass index, surgical techniques used (when available), and
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the individualized component face lift developing a systematic approach to Facial Rejuvenation
Plastic and Reconstructive Surgery, 2009Co-Authors: Rod J Rohrich, Ashkan Ghavami, Joshua A Lemmon, Spencer A BrownAbstract:Background: Accurate preoperative planning combined with Facial fat compartment augmentation can improve precision and balance in Facial Rejuvenation techniques. Understanding the concept of "Facial shaping" with respect to symmetry and soft-tissue (fat) distribution preoperatively is critical to optimizing aesthetic outcomes in various face lift techniques. Methods: A review of 822 consecutive face lifts performed from January of 1994 to June of 2007 by a single surgeon (R.J.R.) was conducted. From this database, randomly selected cohorts of 50 preoperative and postoperative photographs were critically analyzed by three plastic surgeons exclusive of the senior surgeon (RJ.R.). Three Facial parameters were compared on each Facial side: Facial height, degree of malar deflation, and orbit size. Long-term improvement was evaluated to delineate factors contributing to success in creating an aesthetically balanced Facial shape. Results: Asymmetry between the two Facial sides was noted in every patient preoperatively with respect to the three study parameters and was improved postoperatively. There was no statistically significant interobserver bias in the evaluations (p < 0.005). Facial asymmetry dictated differential treatment of the superficial musculoaponeurotic system (SMAS) tissue between Facial sides to achieve the desired youthful Facial shape. The angle (vector) and extent of SMAS-stacking varied depending on the preoperative analysis. Similarly, the selection of SMAS-ectomy versus SMAS-stacking depended on the degree of malar deflation and resultant cheek fullness. Conclusions: Proper preoperative analysis for evaluating Facial shape should address (1) Facial height, (2) Facial width, and (3) overall distribution/location of Facial fullness. This method of evaluating Facial shape and symmetry is simple and reproducible, and can aid in formulating a comprehensive treatment plan.
