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Changes in the Facial Skeleton With Aging: Implications and Clinical Applications in Facial Rejuvenation

Authors:
  • Centre for Facial Plastic Surgery
  • W Aesthetic Plastic Surgery

Abstract and Figures

In principle, to achieve the most natural and harmonious rejuvenation of the face, all changes that result from the aging process should be corrected. Traditionally, soft tissue lifting and redraping have constituted the cornerstone of most facial rejuvenation procedures. Changes in the facial skeleton that occur with aging and their impact on facial appearance have not been well appreciated. Accordingly, failure to address changes in the skeletal foundation of the face may limit the potential benefit of any rejuvenation procedure. Correction of the skeletal framework is increasingly viewed as the new frontier in facial rejuvenation. It currently is clear that certain areas of the facial skeleton undergo resorption with aging. Areas with a strong predisposition to resorption include the midface skeleton, particularly the maxilla including the pyriform region of the nose, the superomedial and inferolateral aspects of the orbital rim, and the prejowl area of the mandible. These areas resorb in a specific and predictable manner with aging. The resultant deficiencies of the skeletal foundation contribute to the stigmata of the aging face. In patients with a congenitally weak skeletal structure, the skeleton may be the primary cause for the manifestations of premature aging. These areas should be specifically examined in patients undergoing facial rejuvenation and addressed to obtain superior aesthetic results. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Electronic supplementary material The online version of this article (doi:10.1007/s00266-012-9904-3) contains supplementary material, which is available to authorized users.
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... The mandible borderline lifting technique has emerged as a solution that addresses these challenges while respecting natural anatomic boundaries and structures. [6][7][8] Understanding the complex interplay of anatomic structures in the mandibular region, particularly the platysma-auricular ligament and mandibular septum, is crucial for the successful implementation of thread-lifting techniques. This knowledge forms the foundation for safe and effective procedure execution. ...
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... Changes with age in the facial bones are most frequently observed in different areas: 1) Orbital zone, presenting lateral translation of the orbit, protrusion of the glabella, expansion of the supraorbital rim; 2) Malar zone, an increase in the depth and expansion of the cheeks; 3) Nasal zone, increase in the length, width, and vertical dimension of the nose and 4) Occlusal zone, with an increase in the vertical height in the occlusal region associated with the increase in mental prominence. The muscles and ligaments associated with facial aging are described in Image 1 [4,5,6]. ...
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Book
I-Principles.- 1 Treatment Planning: Aesthetic Goals.- 2 Treatment Planning: The Role of Facial Disproportion.- 3 Treatment Planning: Prediction Tracings and Model Surgery.- 4 Surgeon-patient Communications.- 5 Aesthetic Orthodontic Considerations in the Surgical Patient.- 6 Technical Considerations.- II-Surgical Corrections.- 7 Facial Concavity and Anterior Divergence: The Class III Deformity.- 8 Facial Convexity and Posterior Divergence: The Class II Deformity.- 9 Vertical Facial Excess.- 10 Vertical Facial Deficiency.- III-Adjunctive Considerations.- 11 Chin Surgery.- 12 Adjunctive Soft Tissue Surgery.- 13 Aesthetic Postoperative Considerations.
Chapter
The traditional and time-honored goals of any orthognathic surgical correction have attempted to address both stability and aesthetic concerns. Stability issues relate to establishing a healthy, functional occlusion, whereas aesthetic considerations have focused on normalizing facial balance and proportions as much as possible.
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