Cosmetic Surgery

1. COSMETIC SURGERY
Dr. Hadi Munib
Oral and Maxillofacial Surgery Resident

2. OUTLINE
 Facial Aging and Analysis
 Non-Surgical Procedures
 Surgical Procedures
 References

3. COSMETICS VS. ESTHETICS

4. INTRODUCTION
 According to the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS):
 The most popular facial cosmetic surgical procedures were rhinoplasty, face lift, and
blepharoplasty.
 The most common cosmetic nonsurgical procedures were botulinum toxin (Botox) and
hyaluronic acid injections

5. FACIAL AGING

6.  Facial aging involves skin, subcutaneous tissues, fat pads, the musculo-aponeurotic
system and even the facial skeleton.
(1) Sun exposure
(2) Smoking; accelerate collagen and elastin degradation and disorganization.
(3) Ultraviolet (UV); increased risk of skin cancer
(4) Gravitational forces lead to ptosis of the facial soft tissues.
(5) Volume loss; Rhytid Formation

8. SKIN ANALYSIS
 Symmetry and facial proportions.
 Skin is the most abundant tissue of the face.
 Pigmentation greatly affects the degree of photo-aging, as melanin is skin’s main
defense against damaging UV radiation.
 The Fitzpatrick skin classification scale is often used to categorize skin type in
association with outcome of UV exposures.
 Darker skin people are resistant to Photoaging compared with Light skinned
individuals.
 Thicker skin envelopes will tend to hide or mask small irregularities but are usually
associated with more problematic scarring.

11. FITZPATRICK SKIN CLASSIFICATION

12. FILLERS
 Minimizing wrinkles
 Treating areas of facial atrophy either related to aging or disease.
 The most common types of fillers are:
1. Autologous fat; Harvested from abdomen or thighs; Semi-Permanent; 30 – 80%
2. Hyaluronic acid (HA); Reversed by hyaluronidase enzyme;TF
3. Calcium hydroxyapatite;TF
4. Polymethylmethacrylate (PMMA) microspheres
5. Silicone oil.
 They are very safe and have extremely low allergic potential and do not require allergy testing

13. FILLERS
 Below the eyes in the tear trough area or malar grooves as well as the smile lines or nasolabial
folds.
 LA.
 Fillers in the lips, tend to break down more quickly versus the periorbital areas.
 HA is clear and can be used more superficially than calcium hydroxyapatite (White)
 Highly purified silicone oil is a permanent filler that is reserved for use by only the most
experienced doctors.
 Silicone oil is well tolerated by the body and the microdroplets once injected eventually become
encapsulated by collagen, which leads to volume gain.

14. FILLERS

16. BOTULINUMTOXIN
 Neurotoxin.
 Clostridium Botulinum; responsible for botulism.
 BotulinumToxin A and B
 Decreasing superficial Muscle activity, Periocular wrinkles or Rhytids and Hyperdynamic smile
 Blepharospasm (abnormal blinking of the eyelid)
 The most common areas are the glabella, the forehead, and the crow’s foot area
 Effective for 3 – 4 months, repeated for results’ maintenance
 The most common complications associated with neurotoxin use are bruising, asymmetry, and
brow or lid ptosis

18. BROW AND FOREHEAD LIFT
 Severe brow ptosis, a long forehead, or receding hairline.
 A trichophytic incision (avoiding damage to hair follicles) behind the hairline and a full thickness
scalp dissection is used.
 Endoscopic surgery is performed using multiple small incisions within the hair-bearing area.
 In females, it is critical to lift the lateral third of the brow more than the medial third.
 In men, more even elevation over the entire length of the brow is necessary.
 Recovery from an endoscopic brow lift takes typically 5 to 7 days.
 Discomfort is typically mild.
 Complications may include hematoma, asymmetry, excessive elevation of the head of the brow,
relapse, paresthesia, and temporal nerve branch weakness.

23. RHINOPLASTY
 Functional and cosmetic purposes
 As early as the teenage years.
 Performed either through the open approach or the closed approach.
 In the closed approach, all incisions are intranasal, and much of the manipulation
is performed blindly.
 The open approach incorporates similar intranasal incisions with a columellar
incision, which allows full uncovering of the nasal skeleton

24. RHINOPLASTY
 Septoplasty; alteration of the nasal septum is commonly performed
simultaneously to harvest cartilage for grafting purposes.
 Nasal dressing usually includes taping of the nose and placement of a rigid
external splint for 1 week.
 Recovery typically requires 1 to 2 weeks.
 Subtle changes to the nasal tip can occur as late as 1 year; most results are fully
appreciated at 2 to 3 month.

27. REFERENCES
 Chapter 27: Facial Cosmetic Surgery

28. THANKYOU