Year Level 7 [Otorhinolaryngology Module]
FACIAL PLASTIC SURGERY
Cesar V. Villafuerte, Jr., MD, MHA, FPSO-HNS [Surgery]
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
OUTLINE
I. Facial Plastic Surgery
II. Aesthetic (Cosmetic) Surgical Conditions
III. Augmentation Rhinoplasty
IV. Septorhinoplasty
V. Facelift
VI. Chin Augmentation
VII. Double Chin Surgeries
VIII. Otoplasty
Learning Objectives:
1. Have an overview of common facial plastic surgery
conditions
2. To enumerate the common aesthetic facial plastic surgical
procedures
B.
I.
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FACIAL PLASTIC SURGERY SUBSPECIALTY
Head and Neck Reconstruction
Facial trauma
Congenital Defects
Aesthetic (cosmetic) facial surgery
II.
Management of the wound should be holistic and take
into account factors like:

Occupational circumstances of the patient and likely
period of time off work

Co-morbidity

Likelihood of success

Donor morbidity

Functional outcome

Risk of surgery and anesthesia
III. Reconstructive ladder

Reconstructive surgeons use the concept of a
reconstructive ladder- the more problematic the
wound the higher up the ladder the surgeon has to
climb

Simple wounds may be closed by primary suturing,
sometimes in the primary care setting

Others may require complex reconstruction including
free tissue transfer
IV. AESTHESTIC (COSMETIC) SURGICAL CONDITIONS
 Low nasal profile (Oriental Nose) – Augmentation
Rhinoplasty
 Baggy eyelids – Blepharoplasty
 Aging face – Rhytidectomy
 Microgenia – Chin augmentation (Augmentation
Mentoplasty)
 Fine facial wrinkles – Minimally invasive procedures
 Double chin
o Submental liposuction for young adult with taut
skin
o Submentallipectomy for older patients with
sagging submental skin
V.
AUGMENTATION RHINOPLASTY
A. Complications

Persistent pustules, granuloma, vesicles

Implant deviation
Team 1 | Auran, Avic, Bugs, Cla, Joey, Karlo, Mooch, Nikki, Tope
September 8, 2010
Implant extrusion
Implant rejection
 Several materials used: silicone implant,
goretex or autologous cartilage
 Use of autologous cartilage is safer and has
less complications however, it can only
provide a limited contouring unlike in
silicone implant
 Silicone implant can be done under local
anesthesia
 Rejection can happen in 1 to 2% of the cases
 Augmentation: most common type all over
SE Asia
New Trends

Goretex (e-PTFE)
o 0.5 Expanded Polytetrafluoroethylene
o Discovered in 1958
o FDA approved in 1975
o 3.2% infection rate
o 0.5 – 30 micron diameter

Autologous cartilage graft
 Own nasal septum, ear or rib cartilage is
used to augment the nose

Medpore
 Not available in the Phil. Order from
Singapore
 Is a polyethylene plastic implant.It has a
porous framework that allows the patient's
tissue to grow into the material.
C. Comparing different augmentation materials
Augmentation
Advantage
Disadvantages
Cartilage
No rejection
Another incision/
Long lasting
operation
Lesser
Longer surgical time
complications Augmentation is not
optimum
E-PTFE
Material is not
More expensive than
(Goretex is a
rigid
silicone
brand of ELesser
Worldwide experience
PTFE)
complications
is not yet that long
Silicone
Operation is
Rejection, implant
implant
simpler
displacement
Shorter duration
Complications even
Least expensive
several years or
decades after the
surgery
D.
Sample Operations

Tip Plasty (with chin reduction)

Alarplasty (Alar Base Reduction)

Rhinoplasty with Alarplasty

Bulbous tip (Tip plasty)

Tip and Columellar Work
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FACIAL PLASTIC SURGERY
Year Level 7 [Otorhinolaryngology Module]|September 8, 2010
Figure 1. An example of
alarplasty

SMAS operations: aging face repair by pulling SMAS to
create a younger look
Minimally invasive: endoscopic forehead, brow lift

VI. SEPTORHINOPLASTY
 Neglected nasal bone fractures (Crooked nose)
 Large Caucasian/Arab nose
 Removal of nasal dorsal “hump”
 This can be done for the crooked nose and wide nose
base.
 Problems with Silicone Injection (Siliconoma)
o Hyperemia (persistent redness)
o Swelling
o Pigmentation
o Severe reaction to injected material
o Migrating deformity (up to glabella)
o Skin necrosis – need to do a forehead flap to cover
the nasal defect
o Siliconomaccccc
VII. FACELIFT
Aging Face
 Rhytidectomy (facelift operation)
 Involves the removal of excess facial skin, with or
without tightening of underlying tissues.
 Rhytidoplasty
 Rhytides
 The medical term for wrinkles
 Neck lift
 Browlift
 Temporal lift
 Is a procedure done to address signs of aging
around the eye.
 Endoscopic face / browlift
 Unlike the traditional facelift, Endoscopic facelift
is a procedure done using an endoscope to
minimize scars. This procedure is reasonable for
a patient who has very little extra skin or laxity.
But in patients with saggin skin, looseness and
extra fat in the neck, a traditional face lit will give
better results.
Figure 2.The muscle layer (SMAS) is tightened in the direction
shown to enhance the immediate and long term result. Skin is
redraped (with little tension) over the tightened muscle layer in
direction shown.
 SMAS: superficial muscular aponeurotic system:
becomes lax as we age
Team 1
Figure 3. Endoscopic forehead dissection (not discussed)
Figure 4. Sequence of fixation (not discussed)

Mini-endoscopic Face Lift
 Also known as the “weekend facelift”, this is a
procedure that can be done to minimize
downtimes and can be performed under local
anesthesia with no general anesthesia. Recovery
time is as little as 2 days. It focuses on specific
reas like the neck and folds of the nose. Small
incisions using endoscopic facelift technology is
used to remote and reposition facial tissue so the
face looks firmer.

Malar lift
 Also called “Mid-facelift”, this is a procedure
done to resculpt the cheeks (malar area) by
repositioning or raising up sagging fat into the
cheekbones.
 A suspension suture is done to hold the
repositioned tissue in place.

Laser Assisted Skin Resurfacing
o Carbon dioxide laser or ErbuimYag Laser
o Indicated for acne scars
o Fine facial, peri-orbital and peri-oral wrinkles
o May be done as an adjunct to rhytidectomy
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FACIAL PLASTIC SURGERY
Year Level 7 [Otorhinolaryngology Module]|September 8, 2010
 Liposuction – suction assisted fat removal
 Lipectomy – excision of a localized area of subcutaneous
adipose tissue
 Rhinophyma: hyperactivity of the sebaceous glands of the
nose
VIII. CHIN AUGMENTATION
 Dental consult: (bite might not be even) retrognathia or
prognathism
o Retrognathia – is a type of malocclusion which refers
to abnormal posterior positioning of the maxilla or
mandible relative to the facial skeleton and soft
tissues.
o Prognathism – is a term used to describe the positional
relationship of the mandible or maxilla to the skeletal
base where either of the jaws protrudes beyond a
predetermined imaginary line in the sagittal plane of
the skull.
 Radiofrequency: shaving of nose
 Retrognathia: lower jaw retruded: upper and lower
teeth not aligned: corrected by fracturing mandible
and sliding it forward
 Prognathism: corrected by fracturing mandible and
sliding it and move maxilla forward
 If small chin and normal bite, just perform
augmentation.
 Intraoral or external approach
X.
OTOPLASTY
 Primary indication for otoplasty: to eliminate the
psychological effect the deformity produces
 For children, the “lop ear”
 Otoplasty (Auriculoplasty) – surgical repair of auricle
IX. DOUBLE CHIN SURGERIES
 Submental liposuction – younger age group
 Submentallipectomy – older
 Autologous fat injection/fillers
Team 1
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