Archive for the 'facial plastic surgery' Category
While patients usually come in for a specific facial concern, it is hard to see the face as a single part. Aesthetic facial surgery is all about creating facial balance and proportion. Sometimes, the correction of a single facial feature does put it into good balance…but other times it requires adjustment of multiple features to get the best result. This can be a difficult and awkward situation as the patient may have come in for just one concern, but how do you tell them about other issues that they have not brought up without offending them? I have found that being direct is always best and most patients usually express appreciation as they are coming to me as the expert…and want an expert opinion. I like to discuss facial features and potential procedures in the spirit of obtaining the best facial balance…..not necessarily to improve one’s looks or make one more handsome or prettier.
A good way to think about aesthetic facial surgery is to relate it to a symphony. Like a pleasing musical piece, it usually takes the coordination of multiple instruments or elements to create a good composition that is pleasing to the ears. Sometimes a solo is adequate and acceptable, but most of the time the playing of the symphony is preferred. Similarly, changing the aesthetics of the face oftens needs to be an orchestrated event, changing several features during a single procedure to get the best result.
While there are specific facial measurements and angles to go by in deciding what to do, many plastic surgeons by experience have developed a feel for coordinating facial movements. For a potential patient to understand these proposed changes, however, they must see how such manuevers affect the look of the face. This is where computer imaging is so valuable…as a forum for communicating potential results. I make it a point that every patient has a visual understanding of what their outcome may be. This is particularly important in combination facial surgery where the option of one or several procedures are possible. A common example of this would be rhinoplasty with or without chin augmentation.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
While many types of implant materials have been tried for use in the face, only a limited few have enjoyed a history of good clinical success. Today’s facial implants are composed of the synthetic polymers dimethysiloxane (silicone), polyethylene (Medpor), polytetrafluoroethylene (Gore-tex), and polyester. (mersilene)
The use of solid silicone rubber (solid, not liquid silicone) have been used as facial implants material for nearly four decades. Silicone implants are by far the most type that are used in the face. Silicone is a essentially a form of plastic created from interlinking silicon and oxygen into a compound known as dimethylsiloxane (SiO(CH3)2) . Its chemical advantage is that it is very resistant to breaking down to the very strong and stable silicon-oxygen bonds. When converted into a polymer and vulcanized, a solid silicone rubber which is elastic and very flexible is formed. When shaped into a facial implant, it has the advantages of ease of placement through small incisions due to its flexibility, can be easily cut and shaped if necessary during surgery, and are of low cost.
Like the material used in coats and shoes, Gore-Tex has been used as a facial implant since 1994. It has been used as more traditional shaped implants for the cheeks and chin as well as soft tubes to be used right under the skin as a soft tissue filler. Gore-Tex is really polytetrafluoroethylene, a fluorocarbon which has a carbon ethylene backbone to which is attached four fluorine molecules (PTFE). The bonding of highly reactive fluorine to carbon creates an extremely stable biomaterial which the body can not break down due to the lack of any known human enzyme to disrupt the fluorine-carbon bonds. The material is extremely flexible and is easily cut and shaped. The fabrication of Gore-Tex results in small interconnected pores on its surface and throughout the material which may allow for some tissue ingrowth. The advantage of tissue ingrowth is probably more theoretical than of any practical significance.
Medpor, known chemically as polyethylene (PE) has been used in the face for over a decade. It is different than Gore-Tex (PTFE) as it has no fluorine molecules in it. The chemical structure may be simple but it has a very firm consistency that makes it the hardest facial implant used. It comes in different facial shapes and sizes and, although it can be shaped, it is not easy. The material does have small channels through it which allows for tissue ingrowth into it. That makes it harder to remove if necessary due to the sticky scar.
Mersilene is a knitted plastic mesh material most commonly used to fix abdominal hernias. It has been historically used in facial surgery where it has been used as a chin implant. The mesh material is rolled onto itself, shaped, and then sewn together to create the implant. Because the implant is a mesh, it has lots of holes in it for tissue ingrowth. The few surgeons who use mersilene do it because they like to fashion their own implants and can do so at a lower cost than buying other off-the-shelf implants.
Your plastic surgeon may use any of these materials for your facial implant surgery. While silicone rubber is the most commonly used, all other materials are acceptable and very well tolerated by the face. Tissue ingrowth into facial implants with pores or channels, while theoretically appealing, has not been proven to offer any advantages over completely solid silicone rubber implants.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
Chin, cheek, and jaw angle implants are very commoni cosmetic plastic surgery procedures to effect a change in one’s facial profile and appearance. Implants work well in the face because they are well tolerated. Let us not confuse that with them becoming part of the body. That they never do. Implants do not integrate and become a natural part of your body. The end stage healing response to all synthetic materials is that they are walled off and surrounded by scar, otherwise known as fibrous encapsulation. This serves to separate the body from the foreign material, saying you are not a part of me but I can live with you. (as long as we live in separate areas!) All synthetic materials implanted in the face will develop this surrounding scar tissue, regardless of the material’s chemical composition or physical shape.
Good quality and quantity of soft tissue around a facial implant is the most critical factor in their long-term success, usually far more important than the implant’s chemical composition. Soft tissue coverage over an implant should be as thick as possible. Those facial implants that are more deeply placed (i.e., next to the bone) rarely implant-related problems such as infection, exposure or extrusion. Implants placed immediately under the skin or in areas of the face where the tissues are thin with little muscle or fat have a much higher incidence of postoperative complications.
Another important principle of facial implant use is that antibiotics should be given during the surgery.The reason for antibiotic use is to prevent or eliminate any bacterial sticking to the implant during its insertion. And those few that might will then be killed. Most plastic surgeons will also wash or soak the implant in antibiotics prior to its insertion. They may be some patients, or surgeons for that matter, who may be concerned about the overusage of antibiotics. But the risk of developing an infection, and losing the whole reason the surgery is being performed, isn’t worth it.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
The use of implantable synthetic materials plays a critical role in a number of cosmetic strategies for improving the shape of the face. Significant advances in materials science and facial implant designs during the past two decades have made certain types of synthetic implants critical for the esthetic augmentation of facial landmarks and contours. Their popularity today and their increasing frequency of use is a direct result of increased patient demand for facial improvement, the limitations and complications of trying to do the same thing with bone grafts and the remarkable tolerance of the face to any implanted material due to its excellent blood supply.
There are some patients, of course, who are adverse to the concept of a foreign material being put in their face. But once the procedure is explained and they can actually see and feel a real facial implant, these fears are usually washed away. Particularly when the alternative (moving the bone or trying to build the area up with bone) treatment strategies are far less appealing and not nearly as reliable….and cost a whole lot more!
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
Plastic surgery encompasses a wide variety of procedures for the face and body. From nose jobs to breast implants, we perform a broad scope of body changes. While the vast majority of these procedures do very well and patients have an uncomplicated after surgery course, some patients will experience complications. The occurrence of complications in plastic surgery, of the minor variety, are not rare. Major complications in plastic surgery, fortunately, are very rare.
Interestingly, there is a vast difference in the occurrence rate and types of complications between plastic surgery of the face and that of the body. While patients understandably place a greater emphasis on procedures done to their face, the actual rate of significant complications from facial plastic surgery is quite low. There are several reasons for this that include; the tremendous blood supply to facial tissues which is quite resistant to infection and allows most wounds to heal quite quickly (including the clearing of bruising and swelling), cosmetic surgery of the face is really ’superficial’ surgery and does not enter any major body cavities or cause major pain and surgery on the face does not disrupt the body’s physiologic functions (like temperature control and fluid shifts) like body plastic surgery does. For these reasons, facial plastic surgery procedures do not pose the same systemic risks as body plastic surgery such as deep vein thromboses, pulmonary embolisms, and infection. Most complications in the face, short of bleeding and hematomas, are mainly about appearance, symmetry, and scarring. Not that these are not significant, but they rarely are life-threatening or invoke major medical problems.
Body plastic surgery, conversely, carries with it bigger risks in my opinion. First, body plastic surgery is ‘bigger’ and involves more surface area of the body than the face. Whether it be liposuction or a tummy tuck, large body areas are being opened or manipulated. As a result, the issues of blood loss, adverse temperature changes, and fluid shifts are real potential issues and expose the patient to greater medical risks such as fluid collections (seromas) and blood clots. Second, the blood supply below the neck to any one body part is not as great as any part of the face. Therefore, infection rates for body plastic surgery are definitely greater than that of the face. While patients are more tolerant to small differences or asymmetries on the body as opposed to the face, the chances of more significant differences is also likely because the surgery site is much bigger and the changes being made are bigger. No where are these issues more evident than in bariatric plastic surgery, the extreme end of body plastic surgery, where big skin cutouts, long incisions, and extended operating times test the ability of any patient to heal in an uncomplicated manner.
Potential complications are part of any form of plastic surgery and fortunately most are relatively minor and are often just a bump (aggravating as that is) along the way of recovery. However, body plastic surgery is associated with longer recoveries (for many of the procedures) and higher rates of complications such as wound dehiscences, seromas, and asymmetry between body parts. This is in contrast to plastic surgery of the face where the surgical sites by comparison are smaller and healing is much quicker and less complicated.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis