PEER-REVIEW | FACIAL CONTOURING | elaborated by Ellenbogen et al3 and Karlin:
■ A well delimited mandibular edge ■ A visible under-hyoid depression ■ A visible thyroid cartilage feature ■ A well defined sternocleidomastoid anterior edge
■ A cervical chin angle of 105Ð 120 . In older patients, the rebuilding of a
three-dimensional image conveys the importance and consistency of the existence of fat in any thin face. The sagging of the skin itself is important, and is almost always associated with low cheeks. The quality of the skin will further deteriorate with dehydration. A normal cervical chin contour ensures not
patients as they have thicker skin and fewer wrinkles as a result of facial hair.
A cold facial mask is applied with the aim of bettering the vasoconstrictive effect through
the cold. The cold diminishes the residual pains linked to the infiltration and through this analgesic action reduces the patientÕs stress.
only a perfect facial oval from the front, but also guarantees a better profile. Correction of the under chin and under maxillary ptosis gives better chin definition. Liposuction is also an excellent indication for male
Preoperative assessment Undertaking an initial questionnaire is paramount before any procedure to record the patientÕs medication history, and also because it is common to find a poly-medication regimen among older patients, particularly with regard to anti- coagulants or the prescription of small quantities of aspirin with a preventive cardiovascular aim. The physician should also pay particular
attention to some harmful associations with lidocaine, such as beta blockers, for
example. Should anti-coagulants be taken, the patient should stop taking them 48 hours before the intervention and resume taking them the day after, pending the cardiologistÕs agreement The traditional check-up should investigate platelets,
activated partial thromboplastin time (APTT), glycaemia, HIV serodiagnosis, and hepatitis.
Patient preparation Disinfection is paramount, and the patient should shower with an anti-bacterial soap the day before and on the day of treatment. Preoperative markings are very important as they
provide excellent landmarks of the area to be treated once the hydrotomy is complete. Marking with potassium permanganate in a saturated solution presents two advantages. Firstly it avoids hyperpigmentation at the entry point, and secondly, this marking persists throughout the whole intervention, despite Betadine and draining of the solution on the skin. Marking should be carried out while the patient is in a reclining position. It is essential to clearly define the cervical thickening on the double chin and lower cheeks, which play an essential part in the final aesthetic result. Finally, locate the eventual hollows in order to be sure to suction at this level and avoid worsening any pre-existing conditions.
Anaesthesia technique The author uses KleinÕs tumescent infiltration technique4 with the following formula: ■ 1000 cc physiological serum ■ 600 mg xylocaine ■ 10 cc sodium bicarbonate at 1.4% ■ 1 mg adrenaline. The infiltration materials include an infiltration
cannula with a 2 mm diameter (or spinal needles), and a 10 cc luer lock syringe or infiltration pump. The author makes a number of 1% adrenalined,
44 ❚
xylocaine dermic spots. The Klein solution is slowly injected and remains at the subcutaneous plane. As soon as pain is felt, the area is gently massaged to allow for an homogeneous distribution of the solution and diminish any pain linked to tissue stretching. This
January/February 2013 |
prime-journal.com
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92