Dermatological implications of skeletal aging: a focus on supraperiosteal volumization for perioral rejuvenation.
ABSTRACT It is becoming widely accepted that volume changes in the skin and soft tissue contribute greatly to age-related facial reshaping. A significant contribution to these volume changes is the loss of craniofacial skeletal support to the overlying soft tissue. Gravity, once considered the major culprit in facial aging, is now recognized to determine the direction, rather than the extent, of tissue deflation. Although the sequence of events observed in aging is somewhat predictable, its pace among individuals is variable and may be influenced by both intrinsic (e.g., gender, genetics) and extrinsic (e.g., photoaging, smoking, stress) factors. Changes in different tissue layers within a single individual do not occur independently, but interdependently; changes in one tissue within an individual may influence subsequent changes in other tissues. Midfacial soft tissue descent has been observed in response to decreased craniofacial support in both congenital craniofacial hypoplasia and following trauma, leading to a hypothesis that the loss of underlying bony support for any reason, including aging, leads to soft tissue descent in the face. As craniofacial support (the "table") decreases, it leaves less surface area for the outer soft tissue envelope (the "tablecloth") causing it to fold or sag. Replacing this deep support with craniofacial implants has been shown to reposition the overlying soft tissue. Following a brief review of the current literature on aging changes in the skin, soft tissue, and bone; the authors describe their experience with the use of poly-L-lactic acid (PLLA), both as a soft tissue volumizer and as an injectable craniofacial implant in a supraperiosteal location to address both soft tissue volume loss and loss of craniofacial support. In the cases presented, the most striking result noted was the ability to restore a youthful proportion to the perioral area, which had not been achieved previously with soft tissue treatment alone.
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ABSTRACT: To determine the flap tension present for 2 different surgical approaches for midface lifts and whether a gingivobuccal incision for release of the midface periosteum will diminish the resultant load on the midface flap. Cadaver study. Anatomy laboratory at the University of Florida. Twelve fresh-frozen cadaver heads are subjected to a transblepharoplasty (TB) approach on one side of the cadaver head while a transtemporal (TT) approach is performed on the contralateral side. The tension (grams) generated by moving the midface flap a distance of 1.03 cm is recorded by a digital load cell. A gingivobuccal incision is made on each side to allow transoral periosteal release (TOPR) of the midface flap, and the experiment is repeated. Three trials are performed for each operation, and the average load is calculated. A paired t test is applied. The tension resulting from the TT approach (172 g) was not found to be significantly different from that of the TB approach (179 g; P = .75). Significant differences in the resultant tension were not appreciated when comparing standard techniques to TT with TOPR (141.5 g; P = .27) or for TB with TOPR (164.1 g; P = .45). An experimental method is described for determining flap tension in facial rejuvenation surgery. No significant difference is found between flap tensions generated in the TB and TT approaches to the midface.Otolaryngology Head and Neck Surgery 02/2011; 144(2):191-5. DOI:10.1177/0194599810391847 · 1.72 Impact Factor
Chapter: Suture Facelift Techniques[Show abstract] [Hide abstract]
ABSTRACT: Nonsurgical procedures improve hyperdynamic and static wrinkles, volume loss, and skin surface imperfections but do not address ptosis of deeper tissues including the malar fat pad and the superficial musculoaponeurotic system (SMAS). Although an open facelift remains the gold standard for sagging skin, fat, and the SMAS in older patients, less invasive measures using various suture systems and designs provide a novel alternative for younger patients with early signs of aging. The concepts of suture facelift and patient selection are discussed as well techniques with a variety of sutures. Suture facelift techniques offer a quick, safe, and effective rejuvenation by elevating soft tissues and restoring the youthful contours of the face and neck.12/2011: pages 279-313;
Chapter: Augmentation with Injectable Fillers[Show abstract] [Hide abstract]
ABSTRACT: Injectable fillers reduce and soften wrinkles, enhance features, and provide facial volume and contouring in procedures that are usually performed under local anesthesia in a matter of minutes. With appropriate use of fillers, either in the skin, subcutaneous, or supraperiosteal plane, all of the effects of aging due to volume loss are improved or corrected, without the need for invasive surgery. When surgical procedures such as rhytidectomy are appropriate, the complementary use of fillers provides a third dimension to facial rejuvenation with superior, more natural-looking results than lifting alone. The author discusses the various fillers and techniques of administering them.12/2010: pages 297-335;