Can some facial rejuvenation techniques cause iatrogenia?

The Aging Face: A Different Perspective on Pathology and Treatment

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.

A new concept in blepharoplasty

Apart from what may be considered complications, the intervention of any aesthetic surgery can have undesired effects (scar sequelae, normal regional dynamic disorders, edema, iatrogenic acceleration of the aging process in the area). The orbital region is particularly sensitive to these undesirable effects due to its situation and the importance of the eyelids in facial sign language. The sum of these undesirable effects and not infrequent complications often place the plastic surgeon in a compromising situation. It is for this reason that in recent years we have made a special effort to analyze causes, to design new techniques, and to evaluate the combination of different techniques in an attempt to minimize these undesirable effects, so as to be able to offer patients more natural and safer results. It is with this intention that this paper records some anatomical and functional details of the eyelids, analyzes the physiology of the aging process, and examines some classic and modern techniques.

Aging of the upper lip: a new treatment technique

The signs of aging of the upper lip, the pathogeny, and different treatments proposed up to now are discussed. A personal technique used since 1992 is presented. It is based on an earlier personal technique, described in 1970, which consisted of dissecting the skin from the orbicularis muscle and inserting a temporary (three weeks) silicone sheet. The present technique consists of a skin excision at the nasolabial junction, based on that described by Cardoso and Sperli in 1971. However, I dissect the skin of the vermilion border and insert a trapezoidal graft of the pretemporal areolar tissue, taken during rhytidectomy. The graft is fixed with Vicryl sutures at the level of the nasolabial folds. In a few patients this has been combined with a peel. The technique corrects both the superficial and the deep wrinkles caused by the retraction of the fibers that join dermis and orbicularis muscle. It achieves an eversion of the vermilion, enhancing its convexity and producing a fuller look, and shortens the lip, which adopts a concave, youthful appearance because of the improvement of the philtrum and of Cupid's arch. Our technique has been used in 15 patients who were satisfied with the results.