Plastic surgery

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A wide variety of facial surgery procedures exist. They can vary greatly in their cost, efficacy, intrusiveness, and results. A skilled surgeon will generally produce more favorable results than an unskilled one. Some famous surgeons, such as Dr. Eppley and Dr. Yaremchuk, and know for producing high-quality aesthetic results. Facial plastic surgeries fall into a few basic categories: Maxillofacial surgery, Implants, Soft Tissue surgery, and others.

Maxillofacial Surgeries

These surgeries tend to be the most complex and invasive type of facial cosmetic surgery. In many cases, they improve both function and appearance. They are performed by osteotomy, or bone cutting. Some portion of the facial bone structure is cut off, moved into a new position, and reattached using metal screws.

LeFort 1 osteotomy

The LeFort 1 procedure is relatively simple and frequently performed. It is most frequently performed on people who have had braces to correct a malocclusion (faulty bite). The LeFort 1 involves cutting the bone underneath the nose to separate the lower maxilla from the rest of the face. The maxilla can then be moved into a more ideal position and screwed into place. There is a great deal of flexibility in possible movement of the maxilla. It can be moved forward (to correct maxillary retrusion), backward (to correct bimaxillary prognathism), and, if a slice of bone is removed, even upward (to reduce the distance between the nose and mouth).

When the maxilla's position is changed, the mandible's position will change along with it. This is because the teeth must come together, and when they do, the mandible will move along with them. This usually will end up creating a more functional and attractive result for both the maxilla and mandible. Sometimes, in the case of maxillary advancement, however, the mandible is not able to fit the maxilla's new position. In this case, a bisaggital split osteotomy can be performed to adjust the length of the mandible and create a better fit. This combined procedure is known as maxillomandibular advancement.

When the maxilla is moved forward, this is called maxillary advancement.

Maxillary impaction is a surgery which shortens the maxilla by cutting off a slice of it in the transverse plane.

Counterclockwise rotation or CCW rotation rotates the maxilla counterclockwise. It fixes a convex face.

A counterclockwise rotation combined with maxillary advancement often produces superior results compared to a so-called "straight" maxillary advancement.

During a LeFort 1 procedure, it is possible to split the palate in half and re-attach it so that its width increases. This must be held in place by a palate expanding splint placed inside the mouth until the surgery is healed. A variant of this procedure is known as surgically assisted rapid palatal expansion or (S.A.R.P.E.).

Although the LeFort 1 is the simplest of the LeFort procedures, it is still a fairly invasive and serious procedure. It is therefore rarely performed on people who only have slight maxillary retrusion and desire a subtle change.

LeFort 2 osteotomy

The Lefort 2 is a similar concept to the LeFort 1, except in this case, the cut is made not under the nose, but above the nose. This means that the position of the nose can be adjusted along with the upper jaw. The procedure is more invasive than the LeFort 1 and carries a greater risk of complications. However, many individuals with maxillary retrusion have not only a problem with lower maxillary retrusion, but also with retrusion around the nose area. The LeFort 2 surgery can address this problem. It is generally only performed on those with a serious deformity. A person who only qualifies for a Lefort 1 but still desires enhancement of the paranasal region can simulate this effect with Paranasal Implants.

LeFort 3 osteotomy

A LeFort 3 involves making the cut such that the separated area includes the cheekbones and entire midface region. This allows the entire face to be altered in position. Normally, this is performed only on people with severe deformities. It is very invasive and has higher risks of complications.

Bisaggital split osteotomy

Also called BSSO for short, this surgery is often performed in conjunction with the LeFort 1. Its purpose is to adjust the mandibular border length (distance from the chin to ramus). This is done by cutting through the lower part of the jaw and shifting it forward, or removing a slice of bone and shifting it backward. As with the LeFort procedures, the jaw's new position is held in place with screws.

Genioplasty

This procedure involves cutting off the chin and moving it into a new position. It may be used to fix a receding chin, which is a common aesthetic defect.

Rhinoplasty

The rhinoplasty is a broad term which encompasses many types of nose plastic surgery. It can straighten deviated septum, remove a bump from the nasal bridge, create a pointier nasal tip, among other possible changes.

The nose is one of the least important facial features for determining aesthetics, as long as it is not severely deformed. Many people who are unattractive in general focus on their nose as the culprit because they have no understanding of the other, more important reasons why they are unattractive. They then end up getting a rhinoplasty and are unsatisfied with the results, because their other, unnoticed features still look bad, and/or because the surgeon did not do a good job creating a nose that is harmonious with their face.

Many people, like David Gandy, look attractive despite having a hooked nose. Fixing other facial flaws should usually occupy a higher priority than improving the shape of the nose.

Implants

There are a wide variety of facial implants which can serve to increase the prominence of various features.

Chin Implantation A weak or recessed chin is a common aesthetic defect. It creates a weak, submissive, feminine appearance from the profile view. Strengthening the chin may be addressed by a genioplasty or by placing an implant into the chin. In severe cases of chin recession, both surgeries may be needed to create a normal-looking result.

Jawline Implantation A jawline implant can increase the width of the jaw and/or increase the angularity of the gonial region and length of the ramus.

Orbital Rim Implantation A common (and usually unnoticed) aesthetic deformity is called a negative orbital vector. This deformity is caused by a weakly developed lower orbital rim (bottom of the eye socket, directly above the cheekbones). It causes the eyes to look tired and overly protrusive or bulging. Sometimes, it leads to scleral show. This means that the whites of the eyes are visible underneath the iris, since the lower orbital rim is too weakly developed to hold the lower eyelid in its ideal position. An implant can be placed directly under the eye, through an incision made into the lower eyelid, to correct this problem.

Cheekbone Implantation This involves using an implant to augment the malars, or the front of the cheekbones. It is not common to augment the zygomatic arches, or sides of the cheeks, through implants. Unfortunately, this procedure does not always produce quality results. They are often too subtle to make much of a visual impact, or they may create an unnatural shape to the cheeks.

Brow Implantation An implant can be placed underneath the eyebrows to enhance the brow ridge protrusion, which will improve facial masculinity.

Paranasal Implantation Paranasal hollowing is a common facial defect. It is often related to maxillary retrusion. With paranasal hollowing, the bones around the base of the nose are weakly developed, leading to the appearance of a sunken midface. This can be addressed with implants placed around the base of the nose.


Hair Transplantation

People suffering from Balding can have a hair transplant done. This involves moving androgen-resistant hairs from the back of the head into areas affected by baldness, namely the hairline and the crown of the head. Because there is no way to create new hairs, the end result will still have fewer hairs than there originally were. This means that even after a hair transplant, the hairline will be higher and weaker than it was prior to the onset of Norwooding. Despite this, it can still produce a fair improvement in looks.

Strip Harvesting In this procedure, a strip of skin is removed from the back of the head, and then the resulting wound is sewn back up, creating a single line scar that is easily covered by hair. The strip is put under a microscope and the follicles are removed from the skin and loaded into a syringe-like tool, which "injects" the follicles into the desired areas of the scalp. Hairs themselves are not transplanted, only the follicles. It takes around 3 months for the follicles to settle into their new environment and begin producing hairs.

Follicular Unit Excision Also called FUE for short, this procedure involves using a punch to remove individual follicles from the back of the head and then inserting them into the desired area. This results in the hair becoming thinner in the back of the head, and many small dot scars appear. In the early days of hair transplantation, this was done using large plugs which each held many follicles, resulting in an unnatural appearance of "clusters" of hairs in the hairline. Today, a smaller punch is used to work with individual follicles and create a more natural-looking result.

Some people will have a strip harvesting procedure performed first. Later, when more hair falls out, they will find new bald spots, which they can have filled in using an additional FUE procedure.