GENERAL CONSIDERATIONS
CLINICAL APPLICATIONS:
– REJUVENATION OF EXTERNAL GENITAL ORGANS (LIPOFILLING FOR SMALL AND LARGE LABIA, AUGMENTATION – PENIS THICKENING)
– HANDS REJUVENATION
– IATROGENIC CORPORAL DEFORMATIONS
– THE NASOLABIAL FOLDS AND THE MARIONETTE LINES
– LIPS
– CHIN AND MANDIBLE LINE
– NECK
– CHEEKS AND THE INFRAORBITAL REGION
– EYEBROWS, TEMPLES
1. GENERAL CONSIDERATIONS – The community of plastic surgeons has revised their attitude towards lipofilling (free fat transfer) over the past 10 years.
The reason plastic surgeons had doubts about lipofilling is that they have access to and have been trained to remove signs of ageing by: blepharoplasty, facial and frontal lifting, etc. They are relying on treatments involving excision and tissue suspension.
There are technical barriers, of course. Successful lipofilling involves an absolutely precise technique and attention to detail, as in the case of surgery. In addition, this technique involves a more precise photographing of patients before and after treatment due to sometimes very fine, millimetric changes. Aesthetic surgery is also rapidly transforming from the area of excision and tissue suspension treatments, extensive surgery to augmentation and rejuvenation procedures with rapid evolution and faster postoperative recovery. The reason? The first and most important factor in the ageing of the face is tissue atrophy and loss of facial volume. The obvious solution for atrophy is restoring facial volumes.
2. HOW DO WE AGE?
In all plastic surgery treatments, atrophy plays an important role, higher than that of ptosis, as a justification for lifting and blepharoplasty. Typically, the model for the ageing of the face is ptoza or lowering of the skin, muscles, fat, everything moves down. Anyone pulling up their skin, cheekbones, tissues, sees the signs of old age attenuating. Until recently, plastic surgery has been based on these simple principles: removal of signs of ageing by excision of the skin, fat, muscles and fascia, hardening and / or suspension of loose tissues.
Nowadays we can see facial atrophy also in people addicted to certain substances or drug treatments. These people, although young, do not necessarily look older because of tissue atrophy, but look sick, with very prominent cheekbones. Determining the specific amount of fat and the levels at which it is injected requires a very precise strategy. Prior to planning the surgery, the surgeon will assess the lifestyle and medical and social history, expectations, previous aesthetic surgery, local and general physical exam. With this information, the plastic surgeon can make their plan of treatment. Patients should understand in detail what the procedure involves, what they have to do during recovery, what complications and side effects it may have.
If patients are interested in rejuvenation procedures, they are advised to bring with them photos from the time they think they looked great, to determine the possible degree of augmentation. These pictures allow us to evaluate their facial contours from their youth, even though they now require a different look than the one in their youth, allowing us to establish treatment indications. This clarifies what aspects of their youth they like and what they do not. If patients have had facial lifting surgery in the meantime, then these photos are even more useful because surgeries sometimes alter certain lines of the face.
The required photos are where the patient does not smile because the smile distorts the lines of the face, especially in the poems, lower eyelids and lips – profile and front pictures.
If people want to change their traits, then we ask patients to bring with them pictures of people with whom they want to resemble, to figure out exactly what they want and tell the patient whether or not it can be done and to what extent what they want is achievable.
Usually, there are about 2 consultations with each patient before surgery. During the first consultation, insisting more on the patient’s lifestyle, medical history, expectations, history of previous plastic surgery, physical shape and general condition of the patient. Pictures are taken.
It is very important for the patient to understand what the intervention is and what is achieved through it.
Regarding the discussion of the medical history and especially the history of plastic surgery, it is essential that the patient be honest with the surgeon if they had prior injections (with fat, hyaluronic acid, silicone, or other fillers) or had surgical interventions of any kind on the face. Often, patients forget to mention certain operations, but if they are asked directly, they remember. Face retouching is important, even if it involves small surgeries.
DR. KLARA IULIA BANCILA PLASTIC SURGEON SPECIALIST