Discipline - Facial Plastics

 

Facial plastic surgery is the discipline of surgery focused on the diagnosis, treatment, and enhancement of the structures of the face, head and neck. This field encompasses both reconstructive and cosmetic procedures aimed at restoring function and enhancing the overall aesthetics of the face. Surgeons who specialise in facial plastic surgery come from both otolaryngology (ear, nose, and throat) or plastic surgery backgrounds (just like “spine surgeons” come from neurosurgical or orthopaedic training, and similarly with “hand surgeons” coming from plastic or orthopaedic training). Some will have additional fellowship training in facial plastic and reconstructive surgery. Their expertise spans a wide range of procedures designed to address congenital deformities, trauma, diseases, and age-related changes.

Otolaryngologists have a deep history as facial plastic surgeons and their story can be found here.          (https://www.theajo.com/article/view/4671/html)

Scope of Facial Plastic and Reconstructive Surgery

Facial plastic surgery covers a broad array of procedures and treatments. While the interventions are often categorised into reconstructive and cosmetic/aesthetic surgery, the intervention for many patients is often a mix of both goals.

Reconstructive Facial Plastic Surgery

Reconstructive procedures focus on restoring function and appearance following injury, disease, or congenital anomalies. Key areas include:

Trauma Repair

  • Facial Fractures: Injuries to the facial bones, such as fractures of the nose, jaw, cheekbones, or eye sockets, require precise surgical intervention to realign the bones and restore normal function and appearance.

  • Soft Tissue Injuries: Lacerations, abrasions, and avulsions of facial tissues need careful repair to minimize scarring and preserve facial contours.

  • Facial Reanimation: repair and management of the face when facial nerve function is lost.

 

  • Skin Reconstruction: After the removal of skin cancer through Mohs surgery, reconstructive techniques are employed to restore the skin and underlying structures, often involving skin grafts or local flaps.

  • Head and Neck Cancer: Surgeries for cancers in the head and neck region may necessitate complex reconstruction to rebuild areas affected by tumour excision, ensuring functional and aesthetic restoration. This includes periorbital tissues (around the eye), the nose, ear and mouth.

Cancer Reconstruction

Congenital Anomalies

  • Aural (Ear) Atresia: These congenital deformities require staged surgical interventions to correct abnormal formation of the ear and ear canal

  • Nasal Anomalies: Abnormal development of the nose and maxilla/mid face often involves surgical correction of the skull and facial bones to ensure normal development and appearance. This includes restoration of the nasal airway.

  • Otoplasty:

    • Ear Pinning: Corrects protruding ears by reshaping the cartilage, bringing them closer to the head.

    • Reconstructive Otoplasty: Repairs ear deformities due to trauma or congenital conditions.

  • Keloid and Hypertrophic Scars: Procedures to remove or reduce scar tissue, improving the texture and appearance of the skin.

Scar Revision

Structural Abnormalities

Functional Rhinoplasty: This procedure can correct breathing issues related to structural abnormalities like a deviated septum and nasal valve dysfunction
 

 

Cosmetic/Aesthetic Facial Plastic Surgery

Cosmetic surgery and procedures revise the appearance, colour, texture, structure or position of normal bodily features with the dominant purpose of achieving what the patient perceives to be a more desirable appearance.

Common cosmetic surgeries include:

Surgery to reshape the nose, changing its appearance and proportion relative to the rest of the face. This can include changes to the nasal tip, bridge, and nostrils

Rhinoplasty

Facelift (Rhytidectomy)

  • Traditional Facelift: Surgery to lift and tighten the skin and underlying tissues of the face and neck, reducing the appearance of wrinkles and sagging. This includes deep-plane and other techniques.

  • Mini-Facelift: A less invasive version focusing on the lower face and neck, to address less severe aging signs. Some of these interventions involve suture only, threads or limited incisions.

  • Upper Eyelid Surgery: Removes excess skin and fat from the upper eyelids to correct drooping and improve vision if obstructed by sagging skin.

  • Lower Eyelid Surgery: Reduction of bags and puffiness under the eyes.

Blepheroplasty (Eyelid Surgery)

Brow Lift (Forehead Lift
  • Traditional Brow Lift: Elevates the eyebrows, reducing forehead wrinkles and frown lines.
  • Endoscopic Brow Lift: A minimally invasive technique using small incisions and an endoscope to achieve similar results with less downtime.
  • Chin Augmentation: Enhances the chin's projection and shape using implants or surgical reshaping.
  • Cheek Augmentation: Adds volume to the cheeks using implants or fillers, improving facial contours and symmetry.

Chin and Cheek Augmentation

Neck Lift
  • Traditional Neck Lift: Removes excess skin and fat, tightening the underlying muscles to create a more defined neck and jawline. Liposuction of fat of the face is often performed to enhance the final outcome.