The Aging Face: A Different Perspective on Pathology and Treatment

1998 ◽  
Vol 15 (2) ◽  
pp. 167-172 ◽  
Author(s):  
Mark Berman
Keyword(s):  
Fat Grafting ◽  
Volume Correction ◽  
Brow Lift ◽  
Aging Face ◽  
Photo Damage ◽  
Lifting Techniques ◽  
Orbital Rim ◽  
Over Time

Probably because the thrust of the pathology of the aging face has been attributed to the effects of gravity (skin and muscle loosening and falling), treatment of such is generally directed toward lifting procedures. Indeed, results from such procedures are generally beneficial, but in many cases the patient appears unnaturally skeletonized. A brow-lift may eliminate some wrinkles and frown lines, but does anyone (naturally youthful) really have eyebrows a centimeter above the orbital rim? Our goal has been, and continues to be, to strive for excellence, and in the case of the aging face, this would be an improved and more youthful appearance. This paper will discuss the main pathology of the appearance of aging, which is the general dissipation of facial fat over time. It will also provide discussion as to thoughtful correction of the problem not only with lifting techniques but also with consideration to filling procedures. The judicial use of fat-grafting and various synthetic implants serve as the principal tools for volume correction. It is acknowledged that the skin undergoes photo-damage, which also contributes to the appearance of aging, but this is treated by treating the skin in a multitude of ways.

Transblepharoplasty Brow Lift

1997 ◽  
Vol 5 (3) ◽  
pp. 166-170
Author(s):  
Adrien E Aiache
Keyword(s):  
Frontalis Muscle ◽  
Brow Lift ◽  
New Concepts ◽  
Orbital Rim

The new concepts of endoscopy have taught plastic surgeons to rely on the frontalisgalea-occipitalis unit for brow elevation through inferior release of the frontalis attachment. After proper elevation of the complex through scalp incisions, the technique consists of re-entering the periosteum from below and releasing it from the orbital rim, thus allowing frontalis muscle retractiontotake place without being hindered by the tissue's attachment to the periosteum. Elevation is assured by sutures, screws or skin plication.

scholarly journals Secondary Composite Breast Augmentation: Concept and Outcomes, Introduction to a Layered Approach

2020 ◽  
Vol 40 (9) ◽  
pp. 981-986 ◽  
Author(s):  
Eric Auclair ◽  
Alexandre Marchac ◽  
Nathalie Kerfant
Keyword(s):  
Soft Tissue ◽  
Revision Surgery ◽  
Breast Augmentation ◽  
Revisional Surgery ◽  
Treatment Plan ◽  
Fat Grafting ◽  
Level Of Evidence ◽  
Soft Tissue Envelope ◽  
The Mean ◽  
Over Time

Abstract Background Secondary procedures following breast augmentation are often more difficult than primary cases because the soft-tissue envelope changes over time. Objectives This study was conducted to confirm the utility of a composite technique in breast revisional surgery. Methods This was a 9-year retrospective chart and photographic data study of one surgeon’s experience with the combined use of fat and implants in revisional cases. The 148 patients had a follow-up at least 1 year after surgery. Our approach consists of a detailed analysis of the different layers covering the implant and yields a treatment plan addressing all issues involving the secondary breast. Results On average, revisional surgery was performed 8.66 years after the first augmentation. The mean age of the patients at revision surgery was 42 years (range, 22.2-70.7 years). The mean fat harvest was 600 mL (range, 100-3000 mL) and the mean volume of fat reinjected was 153 mL (range, 60-400 mL). The mean volume before and after revision was the same (288 mL vs 289 mL). At the original surgery, the breast implants were located in a subpectoral pocket in 78.7% of the patients and, at the revision surgery, in a subglandular pocket in 74.8% of the patients. Within the first 2 years, 13 patients (8.7%) underwent reoperation for additional fat grafting. Among 45 preoperative breast capsular contractures, there were 8 recurrences in the first 3 years resulting in 4 reoperations. Conclusions Secondary breast augmentation cannot rely solely on implant exchange. Because the soft-tissue envelope also ages over time, fat grafting is mandatory in the vast majority of secondary cases. A rigorous preoperative analysis enables breast defects to be treated appropriately. Level of Evidence: 4

Rejuvenation of the Forehead and Eyebrows

2011 ◽  
Author(s):  
Stuart Seiff ◽  
Bryan Seiff
Keyword(s):  
Upper Eyelid ◽  
Facial Beauty ◽  
Lateral Canthus ◽  
The Face ◽  
Upper Face ◽  
Upper Lid ◽  
Facial Anatomy ◽  
Superior Sulcus ◽  
Orbital Rim ◽  
Over Time

The eyes and upper face impart more emotion than any other part of the human body and can communicate temperament through a variety of complex movements and expressions. The influence of the eyebrow on facial anatomy is subtle but critical in establishing mood as determined by facial expression. Upward-slanting eyebrows suggest surprise or sadness, downward-slanting eyebrows denote anger, flat eyebrows hanging over the eyes suggest fatigue, and eyebrows with a proper arch suggest happiness. Concepts of facial beauty continue to evolve over time, yet certain aesthetic principles invariably define the youthful brow and upper face. The head of the brow should begin at a point directly above the alae of the nose, and the tail of the brow should end on a line drawn from the alae of the nose through the lateral canthus. Classical aesthetic principles held that women have eyebrows with a high, graceful arch, accompanied by a deep superior sulcus and well-defined lid crease. The head of the brow began 1 to 2 mm above the supraorbital rim and the lateral third was elevated up to 1 cm above the rim, with the high point of the arch directly above the lateral aspect of the limbus. Current fashion seems to prefer flatter brows with a subtle upward slanting of the brow tail, rather than a high, accentuated arch. The tail of the brow thins as it elevates laterally. Fullness of the brow tissue and a less shallow superior sulcus has also become en vogue, reflecting the overall trend toward facial fullness as a sign of youthfulness. Men tend to have a straighter brow that lies at or slightly above the orbital rim, with a shallow superior sulcus and a more subtle lid crease. As the face ages, thinning skin and tissue laxity diminish the youthful appearance of the brow and upper eyelid. The eyebrows become ptotic, resulting in vertical redundancy of the upper lid skin. The drooping brow and inelastic skin combine to cause upper eyelid tissue to drape over the lid margin, often obstructing the superior visual field.

scholarly journals Autologous Fat Grafting to the Breast: An Educational Review

2021 ◽  
Author(s):  
Nicole S Winkler ◽  
Alexander Tran ◽  
Alvin C Kwok ◽  
Phoebe E Freer ◽  
Laurie L Fajardo
Keyword(s):  
Fat Grafting ◽  
The Body ◽  
Breast Cancer Surgery ◽  
Safe Procedure ◽  
Imaging Features ◽  
Imaging Findings ◽  
Fat Necrosis ◽  
Autologous Fat Grafting ◽  
Autologous Fat ◽  
Over Time

Abstract Autologous fat grafting (AFG) is a technique that is increasingly utilized in breast cosmetic and reconstructive surgery. In this procedure, fat is aspirated by liposuction from one area of the body and injected into the breast. The procedure and process of AFG has evolved over the last few decades, leading to more widespread use, though there is no standard method. Autologous fat grafting is generally considered a safe procedure but may result in higher utilization of diagnostic imaging due to development of palpable lumps related to fat necrosis. Imaging findings depend on surgical technique but typically include bilateral, symmetric, retromammary oil cysts and scattered dystrophic and/or coarse calcifications when AFG is used for primary breast augmentation. More focal findings occur when AFG is used to improve specific areas of cosmetic deformity, scarring, or pain following breast cancer surgery. As with any cause of fat necrosis, imaging features tend to appear more benign over time, with development of rim calcifications associated with oil cysts and a shift in echogenicity of oil cyst contents on ultrasound towards anechoic in some cases. This article reviews the AFG procedure, uses, complications, and imaging findings.

Endoscopic Forehead and Brow-Lift Surgery for Male Patients

1996 ◽  
Vol 13 (4) ◽  
pp. 315-319
Author(s):  
Anthony J. Geroulis ◽  
Bryan J. Kemker
Keyword(s):  
Wound Healing ◽  
Hair Loss ◽  
Endoscopic Technique ◽  
Nerve Injuries ◽  
Male Pattern Baldness ◽  
Brow Lift ◽  
Chief Complaints ◽  
Male Patients ◽  
Orbital Rim ◽  
Male Pattern

We describe endoscopic forehead and brow-lift surgery for male patients. The endoscopic approach to the male forehead and brow-lift differs distinctly from the female lift. One difference is the consideration for placement of the incisions with respect to male pattern baldness. Another is the elevation of the brow on the orbital rim. Men often possess deeper forehead rhytids which are resistant to flattening out. The approach described allows for an easy solution by scoring of the tissue parallel to the rhytid in the subgaleal plane endoscopically. Our endoscopic technique uses both subgaleal and subperiosteal planes in a composite dissection. With this approach, the surgeon has the ability to regulate the elevation of the brow and deal with rhytids. Our experience with this method involves five male patients aged 44–56 years. Their chief complaints were excessive wrinkles of the forehead and a scowl appearance. To date, there have been no complications including infections, hair loss, or nerve injuries. All of the scars are well camouflaged within the hairline, with good wound healing. All patients have been pleased with the results of their surgery.

scholarly journals Direct Brow Lift - An Update of Current Literature

2019 ◽  
Vol 3 (1) ◽  
Keyword(s):  
Surgical Procedures ◽  
Current Literature ◽  
Surgical Techniques ◽  
Endoscopic Technique ◽  
Brow Lift ◽  
Lifting Techniques ◽  
Coronal Incision

Eyebrow ptosis is the earliest manifestation of the aging forehead. Surgical procedures to lift the ptotic brow were first published in the early 1900s and since the introduction of the direct brow lift technique, there have been numerous minor refinements to this procedure, as well as some major developments in surgical techniques. It was modified to utilize a mid-forehead or a coronal incision, and then superseded by the endoscopic technique of brow lifting. Yet, with the armory of brow lifting techniques that currently exist, there still is a major role for the direct brow lift, herein described in detail.

Investigating Long-Term Brow Stabilization by Endotine-Assisted Endoscopic Brow Lift with Concomitant Upper Lid Blepharoplasty

2021 ◽  
pp. 000348942199765
Author(s):  
Paloma Belle Perez ◽  
Anne Elizabeth Gunter ◽  
Minhee Pak Moody ◽  
Aurora Grace Vincent ◽  
Christian Rene Perez ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Control Subjects ◽  
Brow Lift ◽  
Significant Difference ◽  
Upper Lid ◽  
Upper Blepharoplasty ◽  
Endoscopic Brow Lift ◽  
Over Time

Objective: To determine whether Endotine-assisted endoscopic brow lift with concomitant upper lid blepharoplasty provides long-term brow elevation. Methods: Pre- and post-operative photographs from 35 patients who underwent endoscopic brow lift using Endotine Forehead 3 mm implants with concomitant upper lid blepharoplasty were measured to determine changes in brow height with surgery and up to 55 months post-operatively. Photographs of 20 control subjects who did not undergo periorbital surgery and 11 control subjects who underwent upper blepharoplasty without brow lifting were also measured to provide a basis for comparison. Emotrics software was used to perform automated brow height measurements in order to determine elevation and longevity achieved with endoscopic brow lifting in conjunction with upper lid blepharoplasty. Results: There was a statistically significant increase in brow height post-operatively, averaging 1.6 mm ( P < .0001, 95% confidence interval 0.95-2.18 mm). Fifty-four percent of patients had follow-up beyond 6 months post-operatively and 40% had follow-up beyond 1 year. Elevation remained stable over time with no statistically significant change across all serial post-operative visits. There was no statistically significant difference in brow elevation based on gender or age, or between right and left sides. Conclusion: Endotine-assisted endoscopic brow lift in conjunction with upper lid blepharoplasty provides modest brow elevation and long-term brow fixation as demonstrated by stable post-operative brow height measurements for up to 55 months.

Social transmission bias and the cultural evolution of folk-economic beliefs

2018 ◽  
Vol 41 ◽  
Author(s):  
David Hirshleifer ◽  
Siew Hong Teoh
Keyword(s):  
Cultural Evolution ◽  
Social Transmission ◽  
Cognitive Approach ◽  
Economic Problems ◽  
Economic Attitudes ◽  
The Social ◽  
Economic Beliefs ◽  
Over Time

AbstractEvolved dispositions influence, but do not determine, how people think about economic problems. The evolutionary cognitive approach offers important insights but underweights the social transmission of ideas as a level of explanation. The need for asocialexplanation for the evolution of economic attitudes is evidenced, for example, by immense variations in folk-economic beliefs over time and across individuals.

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