PEER-REVIEW | FACIAL CONTOURING |
infiltration and through this analgesic action reduces the patientÕs stress. A major hydrotomy results in great adipose tissue
tumescence. Quantities of 250–400 cc are usually administered. This also results in being able to safely work on deeper planes and avoids damaging noble elements at the levels of the neck and face.
Surgical technique Two punctiform incisions are made at the jugal level (i.e. zygomatic) with a n 11 surgical scalpel blade in the lower third of the nasogenian groove, and 2 cm ahead of and within the tragus in the pre-auricular area. Three incisions are made under the chin: under the chin tip; under the mandible; and opposite the branch travelling upward from the inferior maxilla. Depending on the shape of the neck, the author will
slow tissue stretching associated with the
vaso-constrictive adrenaline action creates a tourniquet at the level of the SACS arteriovenous system, and thus reduces the risk of anaesthetic products infiltrating the intravascular bolus. Skin colour becomes white, proving that the adrenaline has worked. Infiltration is limited at the top by the orbital edge
and within by the nasogenian grooves, and outside by the pre-auricular area. It goes beyond the mandible and spreads to the under chin area as far as the sternum. The Klein solution infiltration is administered at
400 cc. Once the infiltration is over, wait for at least 30 minutes in order to let the solution work at the tissue level. 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
Figure 6 57-year-old male patient (A) before and (B) after liposculpture of the neck and mandibular line
Figure 5 63-year-old patient (A) before and (B) 6 months post-treatment
decide whether to make an incision at the tip of the cervicoÐ chin angle. In some cases of a closed angle, this additional incision is necessary to allow regular work in a cross-section and obtain a satisfactory retractile cicatricial fibrosis. As Fournier taught, Ô it is necessary to get as close as possible to the default to be treatedÕ 5
. Too
distant a treatment with a long cannula risks being unlevel to the cutaneous plane and can damage the vessels or subjacent nerves. However, FournierÕs entry points do not allow the
physician to efficiently treat the lower cheeks. The entry point at the lower third of the nasogenian groove allows for an efficient treatment of the lower cheeks through the tunnelisation crossing at that level. The first step of the operation requires a careful
tunnelisation, or cannulation, that is non-aspirated and in cross-sections, with a 2 mm cannula. The free hand is used to stretch the tissues by spreading the thumb and fingers on the skin, limiting a subjacent effraction risk. One hemiface is treated first, making it possible to appreciate the oval of the face that has been redesigned by lipodestruction induced by tunnelisation. The second hemiface is then symmetrically treated. The second step of the operation comprises a
46 ❚
lipoaspiration adapted to the shape of the face. The author will usually use a 1 mm olivary-tipped cannula, which allows a gentle and neat aspiration that is also quite precise ® avoiding bleeding ® and a 5 or 10 cc luer lock syringe fitted on a blocker. The area under the chin is carefully treated, then a degressive action is applied from the mandible contour to the malar area. Naturally, liposculpture is more important on the mandible contour and insists on thicker areas. Skin sagging traction and pinching make it possible to control the fat resection: elasticity must be retained. The path of the cannula must also be parallel to the cutaneous plane; both entry points made at the jugal level make it possible to cross the tunnelisation planes. The surgeon operates either by Ô touchingÕ the tissue between thumb and index finger, or by a palpate and roll massage that guides the cannula trajectory and thus allows the surgeon to work on both the surface and at depth at the same time.
January/February 2013 |
prime-journal.com
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