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Chapter 91 - Facial rejuvenation

from Section 20 - Plastic and Reconstructive Surgery

Published online by Cambridge University Press:  05 September 2013

Michael F. Lubin
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Neil H. Winawer
Affiliation:
Emory University, Atlanta
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Summary

Facial rejuvenation is a broad term that relates to restoring facial structures to a more youthful appearance. Generally, facial rejuvenation is categorized as non-operative or operative.

A thorough preoperative assessment and understanding of patient desires are important in order to optimize outcomes and to create realistic expectations of various treatment modalities. As with any initial patient encounter, a comprehensive history and physical should be performed. Since facial rejuvenation is performed electively, patients with significant comorbidities such as smoking, diabetes, and clinically significant bleeding states should be excluded in most circumstances. A basic psychological assessment that evaluates a patient's motivations for surgery should also be obtained. Adequate time should be allowed for questions and decision making focusing on the patient's specific concerns. Some plastic surgeons also incorporate the use of photographic software that can simulate the effect of specific procedures.

Skin quality is often the first characteristic that is noted on consultation. The general quality of the skin, including elasticity, wrinkles, and actinic damage is assessed.

It is beneficial to divide the face into thirds when examining a patient so as to systematically evaluate the entire face. In the upper third, or the periorbital zone, the forehead, brow, eyelids, and upper midface are evaluated. A complete investigation must include brow position, forehead height, glabellar creases, excess skin or wrinkles (crow’s feet) in the temporal region and in the upper and lower eyelids, and evaluation of the lateral canthal position and lower lid tone. The middle third , or perioral zone, is generally referred to as the lower face; an examination includes the nasolabial folds, the angle of the mouth, the upper and lower lips, chin, nose, and ears. Evaluation of the lower third of the face, the neck zone, includes an assessment of the neck with regard to platysmal banding, excess skin, as well as the jawline, submandibular gland, and digastric muscles.

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
, pp. 636 - 638
Publisher: Cambridge University Press
Print publication year: 2013

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References

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