The Face as a Dynamic Mosaic Work Prosopoplasty

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Dimitrije E. Panfilov

The expectations of an increasingly aging population have changed considerably over the years: 60-year-olds are still very active, not only privately but also in their professional and public lives. And plastic surgeons have developed a new idea of the face. The face is now considered as a three-dimensional dynamic mosaic with five different levels and four layers of depth. Numerous techniques are available to improve the arrangement of the pieces in the mosaic. The combination of various techniques can reduce the aggressiveness of every single method. We can achieve more sustainable harmonic results while also reducing the potential for risks and complications. There are trends that more and more young patients are coming to us asking for plastic surgery of their faces. We cannot rejuvenate substantially somebody who is in their early 30 s, but we can harmonize and beautify such a person. The media would call these procedures face-styling. We would rather use the term "prosopoplasty" (prosopon in Old Greek means face). If we talk in eyelid surgery of blepharoplasty, if we talk of phalloplasty or mastoplasty, then beautifying rearrangements of featural structures should consequently be called prosopoplasty.

For a long time the only aim of facial aesthetic surgical was tightening of the skin, to reduce wrinkles and folds. Today, facelift is not only facelift, but is surgical makeover of the face: harmonizing, symmetrizing, beautifying. Overstretched skin with "surgery looks" and "facelift stigma" with visible scars, dislocated hairline, flattened or scary tragus, elongated, almost amputated earlobes, and retroauricular steps of hairline are out. In is:

  • Facial harmony
  • Intravenous sedation
  • Shorter scars
  • Shorter recovery
  • Outpatients procedures

Each face is unique. Every person's face consists of many important details and therefore each face requires an individual "recipe". An analysis of the face

Fig. 1.1. Prosopoplasty: facelift and necklift, microlipofilling, forehead direct excision, rhinoplasty and otoplasty. Instead of adding years to our life, we can add life to the years that have passed

must precede the planning of an operation, at the centre of which should be the patient's wishes. It is of utmost importance that the surgeon listens carefully to his/her patient's wishes and ideas. The result should be a younger-looking patient with more harmonic, more beautiful features and with more dynamic facial plays. Plastic surgery patients will regain their social and erotic appeal by reestablishing their self-esteem.

We are able now to analyse the face, to understand the mimic dynamics, to add beauty and harmony to different mimetic units in different layers of depth, to improve the facial outlook as a three-dimensional dynamic mosaic. Our patients do not want to become or look like somebody else. They just want to look better.

Another trend is noticeable: more and more men are asking for harmonizing, refreshing procedures for their faces to look more dynamic, because a "tired look" hides their inner energy and ability.

Only 20 years ago, facelift patients remained in hospital for a full week. Today, most patients can opt for outpatient surgery by intravenous sedation combined with local or tumescence anaesthesia. Over 60% of patients can return to their social lives after 8 days. Things have improved tremendously. We can also combine nonsurgical procedures, adding the advantages and reducing at the same time the risk of extended procedures.

Yet something remains: the biggest risk in any type of surgery is the surgeon himself/herself. If a surgeon has not received excellent education, if he/she lacks sufficient experience - especially if he/she is not aware of his/her own inadequacies - the patient is exposed to an enormous risk.

There is also a global phenomenon that surgically untrained physicians and even nonphysicians, dentists, and cosmeticians are offering aesthetic surgeries, resurfacing, and skin-filling procedures. Aesthetic or cosmetic surgery is enjoying ever-increasing popularity and social acceptance. Through public education we can focus the proof of the quality of plastic surgery education and improve ourselves. Those plastic surgeons who can offer more options for every patient will have the best success.

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