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Upper facial rejuvenation: Open and closed techniques
Surgical Clinics throscopic approaches as well as techniques in advance triple puncture and endoscopic application of the HoYAG laser for indicated disease management. Anatomical consideration for joint puncture and arthroscopic treatments, as well as complications and managements will be reviewed. Pathophysiology of TMD progression and arthroscopic correlations will be given. The various components of team managements and the construct of routine therapeutic paradigms will be outlined for the participants such that they will be able to institute these principles within the framework of their practices to clinically manage the TMD patient with resulting enhancement of successful outcome predictability. Equipment considerations for both outpatient hospital and office-based arthroscopic TMD management will be given as well as fundamentals in intra-articular laser theory and surgical techniques. The participants will receive an abbreviated technique CD video to enhance identification of pathologies and initial puncture techniques. Upon completion of this course the participant will be able to: 1. Describe the pathophysiology of TMD 2. Describe TMJ arthroscopic management indications and techniques 3. Identify intra-articular disease staging and pathologies 4. Describe the fundamentals of laser technology applied to intra-articular TMJ disease via arthroscopic surgery. References Moses JJ: Articular pathology: Disc displacement and lateral impingement syndrome, in Bronstein T (ed): Arthroscopy of the Temporomandibular Joint. Philadelphia, PA, Saunders, 1991 Moses JJ, Sartoris D, Glass R, et al: The effect of arthroscopic surgical lysis and lavage of the superior joint space on TMJ disc position and mobility. J Oral Maxillofac Surg 47:674, 1989 Moses JJ, Topper DC: A functional approach to temporomandibular joint internal joint derangements. J Craniomandib Disord Fac Oral Pain 5:19, 1991
S302 Upper Facial Rejuvenation: Open and Closed Techniques
A key component to choosing the correct operation is an adequate preoperative diagnosis. Assessment of brow ptosis and asymmetry, and the position of the hairline and balding patterns should be noted. Also important is a standardized assessment of skin quality and the presence of active and/or passive rhytids. The effect of upper facial aging on the periorbital region should also be recognized, including the presence of lateral hooding and pseudodermatochalasis. This lecture will acquaint the surgeon with current techniques of open and closed upper face rejuvenation. A spectrum of surgeries are available from the minimally invasive, such as suture suspension techniques, to endoscopic lifting, to the more invasive open procedures such as the coronal lift and trichophytic hairline incision methods. These procedures will be covered in some detail, with particular attention to the endoscopic forehead lift. Conservative, non-surgical, options for upper facial rejuvenation are becoming more popular with the general public. Botulinum toxin injections, soft tissue fillers, skin care, and skin resurfacing clearly have a role that is often complementary to our surgical procedures. These procedures may be used alone to help the patient with minimal aging stigmata, or be used in conjunction with a lifting procedure to produce a truly outstanding result. Indications, advantages, and disadvantages of these materials will be discussed. With a solid understanding of diagnosis, and the surgical and non-surgical techniques available, a comprehensive treatment plan can be discussed with the patient. This allows for a proper informed consent and ultimately a happier patient. Finally, as with any procedure performed, it is important to be able to diagnose and treat any resulting complications and perform appropriate post-op care. Temporary or permanent asymmetries, relapse, muscle weaknesses and imbalances are all possible to be seen by the practitioner. Hematoma and visual disturbances should also be recognized and treated. The role of upper facial rejuvenation is critical to appreciate in order to achieve a balanced facial result and a pleased patient. The oral and maxillofacial surgeon is well suited to treat this area both conservatively and with a variety of surgical procedures.
Jon D. Perenack, DDS, MD, New Orleans, LA References
Although lower facial rejuvenation techniques might be well known to the oral and maxillofacial surgeon, such as traditional facelift surgery, it is essential to understand the options available to rejuvenate the upper face and thereby bring about a pleasing, harmonious facial rejuvenation. AAOMS • 2004
Matarasso A, Hutchinson O: Evaluating rejuvenation of the forehead and brow: An algorithm for selecting the appropriate technique. Plast Reconstr Surg 106:687, 2000 Isse NG: Endoscopic forehead lift: Evolution and update. Clin Plast Surg 22:661, 1995 Lemperle G, Holmes RE, Cohen SR, et al: A classification of facial wrinkles. Plast Reconstr Surg 108:1735, 2001
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S302 Upper Facial Rejuvenation: Open and Closed Techniques
A key component to choosing the correct operation is an adequate preoperative diagnosis. Assessment of brow ptosis and asymmetry, and the position of the hairline and balding patterns should be noted. Also important is a standardized assessment of skin quality and the presence of active and/or passive rhytids. The effect of upper facial aging on the periorbital region should also be recognized, including the presence of lateral hooding and pseudodermatochalasis. This lecture will acquaint the surgeon with current techniques of open and closed upper face rejuvenation. A spectrum of surgeries are available from the minimally invasive, such as suture suspension techniques, to endoscopic lifting, to the more invasive open procedures such as the coronal lift and trichophytic hairline incision methods. These procedures will be covered in some detail, with particular attention to the endoscopic forehead lift. Conservative, non-surgical, options for upper facial rejuvenation are becoming more popular with the general public. Botulinum toxin injections, soft tissue fillers, skin care, and skin resurfacing clearly have a role that is often complementary to our surgical procedures. These procedures may be used alone to help the patient with minimal aging stigmata, or be used in conjunction with a lifting procedure to produce a truly outstanding result. Indications, advantages, and disadvantages of these materials will be discussed. With a solid understanding of diagnosis, and the surgical and non-surgical techniques available, a comprehensive treatment plan can be discussed with the patient. This allows for a proper informed consent and ultimately a happier patient. Finally, as with any procedure performed, it is important to be able to diagnose and treat any resulting complications and perform appropriate post-op care. Temporary or permanent asymmetries, relapse, muscle weaknesses and imbalances are all possible to be seen by the practitioner. Hematoma and visual disturbances should also be recognized and treated. The role of upper facial rejuvenation is critical to appreciate in order to achieve a balanced facial result and a pleased patient. The oral and maxillofacial surgeon is well suited to treat this area both conservatively and with a variety of surgical procedures.
Jon D. Perenack, DDS, MD, New Orleans, LA References
Although lower facial rejuvenation techniques might be well known to the oral and maxillofacial surgeon, such as traditional facelift surgery, it is essential to understand the options available to rejuvenate the upper face and thereby bring about a pleasing, harmonious facial rejuvenation. AAOMS • 2004
Matarasso A, Hutchinson O: Evaluating rejuvenation of the forehead and brow: An algorithm for selecting the appropriate technique. Plast Reconstr Surg 106:687, 2000 Isse NG: Endoscopic forehead lift: Evolution and update. Clin Plast Surg 22:661, 1995 Lemperle G, Holmes RE, Cohen SR, et al: A classification of facial wrinkles. Plast Reconstr Surg 108:1735, 2001
97