| FACIAL CONTOURING | PEER-REVIEW On a motionless face, the signs
of youth are displayed in the absence of thickened contours on which skin drapes itself without folds or excess, a pure cervical and maxillary definition.
operation has a spectacular effect on making the face more youthful and beautiful. If it is easy to erase wrinkles at the upper third of the
Figure 1 38-year-old woman (A) before and (B) 2 months after treatment
on the cheeks and lateral sides of the neck, causing permanent metabolic exchanges; and a genetic or reserve fat, which is very stable and present under the chin and jaw, as well as the furrows from the side of the nose to the corners of the mouth. The fat tissue spreads over a number of facial areas:
■ Subcutaneous plane (subcutaneous fat) ■ Sub-platysmal fat ■ Zygomatic and sub-aponeurosis (BichatÕs lump). The skin and subcutaneous fat are ectodermic in
origin and together form the superficial adipo-cutaneous system (SACS)1
. At the periauricular area, the
subcutaneous layer thickens farther from the ear and constitutes the framework of the lower half of the face. Significant fat accumulations concern the areas under the chin and jaw.
Signs of youth and age On a motionless face, the signs of youth are displayed in the absence of thickened contours on which skin drapes itself without folds or excess, a pure cervical and maxillary definition; no furrows from the sides of the nose to the corners of the mouth; and no sagging. Even with the effects of neck inflection and gravity, the youthful face will show no sagging where the cheeks reach the lower cheeks; the furrows from the sides of the nose do not meet the bitterness fold; and there is no cervical contour sagging. With regard to the neck, it is impossible to lengthen a
neck that is too short, but aesthetic surgery is not totally powerless as it is possible to work on the cervical angle and give the illusion of a slighter neck. Therefore, transforming a sagging cervical chin angle into a right angle allows a thinning of the neck volume, giving an illusion of greater height/length. To do so, the surgeon carries out either a simple lipoaspiration, or lipoaspiration combined with a neck lift. Such an
neck, it is much more difficult to smooth out the skin at the middle and lower thirds. As for peelings or possible facial laser treatments, they are rarely carried out on the neck. Today, gentle peelings using fruit acids, KruligÕs dry peeling, or botulinum injections are the only treatments likely to give some improvement. At this level, however, a small roundness can be an asset. If the face deteriorates, sags or becomes limp, it will
lose its tension, structure, and its youth and radiance. Too much weight denatures it and too much age destroys it, losing the oval shape of the face. If a face is naturally square or triangular, there is no point in trying to make it oval; it will only be worked on if there is an obvious disharmony, which usually occurs at around 50 years of age, when the lower part of the face becomes heavier. The lower cheeks are enhanced and cheekbones tend to become flatter, lose their shape and sag. In some much rarer cases, when the oval is destroyed by fleshy cheeks, the surgeon can carry out a mini liposculpture that removes surplus fat and restores a more harmonious facial shape.
Figure 2 47-year-old woman (A) before and (B) 1-year post-treatment
prime-journal.com | January/February 2013
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