Non-Surgical Alternative to Facial Liposuction

Face Engineering Exercises

Face engineering program combines the facial exercises with the acupressure workouts which work as magical ingredients to help do away with facial wrinkles, affirmer's face, and neck skin. The creator of this program goes by the name of Wendy Wilken who is a physiotherapist by profession. This program mainly focuses on making sure that your face glows every time with or without makeup. One primary tool used in this program as part of your facial exercise is by using your fingertips. Through this program, you will manage to remove all your face wrinkles, shape your lips, tighten your hanging cheeks and so much more. Wendy has taken a step further to ensure that you achieve all this as fast as possible, so she is giving out free bonuses to everyone who joins this program. This program is user-friendly as all the techniques used have undergone through clinical testing and have proven to work efficiently and guarantee positive results. I highly recommend this program to everyone who is out there and wants to have a smooth face, healthy and young as the program is open to everyone regardless of gender or age. More here...

Face Engineering Exercises Summary

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Author: Wendy Wilken
Official Website: www.face-engineering-exercises.org
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Highly Recommended

Of all books related to the topic, I love reading this e-book because of its well-planned flow of content. Even a beginner like me can easily gain huge amount of knowledge in a short period.

Overall my first impression of this book is good. I think it was sincerely written and looks to be very helpful.

Liposuction and Abdominoplasty

Liposuction, the most common cosmetic surgery procedure performed on men, is a procedure that can improve the contour of your body by removing stubborn pockets of fat that you have not been able to remove through exercise or diet. During the procedure, the plastic surgeon uses a vacuum device to suction these unwanted fat deposits from specific areas of the body. For men, these areas are usually the abdomen, the flanks ( love handles ), or the chest. Other possible neck. The best candidates for liposuction are men of normal weight with firm Cosmetic skin who have excess fat deposits in certain areas of the body. Liposuction is not Surgery a weight-loss method you should be at or near your ideal weight before surgery. Liposuction can be performed in a surgeon's office, in an outpatient surgery center, or in a hospital, depending on the amount of fat to be removed. If only a small amount of fat is to be removed, the procedure can be performed using a local anesthetic. Removing large...

Volumetric Maneuvers Below the Jawline Fine Tunneling and Superficial Liposuction

Submental Area

In the late 30s or early 40s with the beginning of the early stage of jowling, a wide soft-tissue undermining is not yet required. A detachment in the deep subcutaneous layer limited to the midcheeck and the lateral third of the neck combined with a submandibular and submental superficial liposuction 9 will provide a regular clean jawline with flattening down of the jowls (Figs. 44.1). The surgery is performed under general anesthesia with intravenous Propofol, the headrest allowing a smooth turning of the head to the left and the right side. The tumescence is performed with the following liquid 250 ml Ringer's lactate, 10 ml 1 Xylocaine, 0.5 mg adrenaline, 60-80 ml each side infiltrated to the cheek submandibular submental area before liposuction (Fig. 44.2). The periauricular incision and partial undermining and infiltration of the cheek-neck area proceeds with the introduction of a 2 mm liposuction cannula for in the submental and submandibular region (Fig. 44.3). The fine...

Liposuction in Face and Neck

Skin Fold Behind Ear

Since 1972 we have possessed a very simple and effective method of improving bodily contours through liposuction. The first person to attach a hollow can-nula to a vacuum machine was Ulrich Kesselring in Lausanne in 1972. The blunt tunnelling technique of liquid imbibed and anaesthetized fatty tissue was invented by Yves Gerard Illouz from France. The first cannulas were very robust, 1 cm in diameter. Now we have smaller-diameter cannulas - 5, 4, 3, 2, and even 1.6 mm - which allow us to do fine work with them. One started to dare doing liposuction in the neck and face area, when it is indicated. This helps us in achieving optimal contours. For the face and neck we use a cooled solution of the following ingredients This solution should be allowed to work for at least 30 min before we start with liposuction. We prefer VASER liposuction in other locations, but we do not use it in the face and neck. There is a danger of thermal damage to the nerves. If we do only liposuction, we make...

Liposuction

Submental Incision Platysmal Plication

Liposuction procedure beneath the skin and above the platysma. a Through submental incision. b The Illouz cannula is above the platysma and below the skin. c Through incision on mastoid area Fig. 39.2. Liposuction procedure beneath the skin and above the platysma. a Through submental incision. b The Illouz cannula is above the platysma and below the skin. c Through incision on mastoid area order to perform tunnelization all around. If the opening is turned to the deep raw surface skin flap it may damage the subdermal fat layer with its small vessels. The skin may become very thin and there is a risk of necrosis postoperatively. This maneuver is done even when liposuction is not performed, since it is an important step for the next step of the operation, which is a tunnelization procedure. According to the surgical planning, when a patient presents with localized adiposity, liposuction should be performed, then the machine is turned on and the regions with fat tissue are...

Rhytidoplasty Step by Step

Cutaneous Abscess Right Axilla

With local anaesthesia and preparation of subcutaneous separation with liposuction cannula of 2 mm diameter we can achieve optimal preparation of 2 mm of underlying fat attached at the skin flap. Juarez Avelar has produced very useful instruments for this purpose. After the incisions have been made, tumescent anaesthesia infiltrated, and the subcutaneous layer of fat determined by liposuction cannula or special dividing instruments (see Chap. 39 by Juarez Avelar and Yves Gerard Illouz), we start to elevate the skin. There are two sorts of surgeons one group prefers scalpel division of the skin flap and the other one prefers using scissors. Preparation by scalpel is faster, but requires virtuosity and absolute anatomical precision. After all, there is danger that even with very experienced surgeons the scalpel blade will run 1 or 2 mm Further preparation could be done by radiofre-quency or fingers, like Sherell Aston described for his finger-assisted facelift. Also Yves Gerard Illouz...

Skin Incision and Dissection in Primary Cases

Retroauricular Sulcus Define

This subcutaneous undermining is extended to 6 cm from the retroauricular sulcus (Fig. 47.2) and connected anteriorly with the mastoidal and neck dissection. On the face, our superficial dissection varies in its extent, but at the neck level, we do extensive undermining, getting close to the midline. When there is an excess of fat, we start with a medial liposuction. It is preformed though a 1 cm incision done in the submental fold, and after undermining of the medial submental area with scissors, always preserving a thin layer of fat under the skin, the liposuction is performed with a no. 8 transparent gynecological cannula. The lateral dissection is then connected widely with the medial one. We think that when a midline liposuction has been done, a wide neck undermining should be performed to flatten the neck.

Autologous Fat Transfer

Fat Transfer Lips

Charles Conrad Miller from the USA described his method with infiltration of fatty tissue through hollow metal cannulas in 1926. He wrote The end-results in free fat transplantation depend, aside from various local and general factors, on the method and technique. As Miller was some kind of controversial physician and not a real surgeon, his work was soon forgotten. The reinventor of this method was Yves Gerard Illouz (known as the father of liposuction) from France, but the real breakthrough was made by Jose Guerrerosantos from Mexico and Sydney Coleman from New York. not be bigger than 10 ml. Too high a negative pressure could denature fat cells. And we want to do lipofill-ing, not lipokilling , as one of pioneers in liposurgery Giorgio Fisher from Rome used to say. It is also important that our movements are gentle and we should not act against resistance - the same principle as in liposuction. Fig. 59.14. a Liposuction cannula between 2 and 3 mm in diameter with five to 15...

Partial Resection of the Submandibular Gland

Face After Submandibular Gland

The question arises as to whether complex procedures in the subplatysmal plane are worth the risk and whether or not there is added morbidity. The commonly practiced alternative of liposuction and or direct lipectomy in the neck, which we employ, is effective in contouring the neck however, it is not without its own problems. Liposuction can cause streaking, skeletonization, skin adherence to the platysma, and unmask deeper problems, all of which can be difficult to remedy. Indeed resection of the submandibular gland can be risky with the potential for bleeding, nerve injury, dry mouth, and dental problems. In our hands, partial resection of the submandibular gland has been a safe and effective adjunct to contouring the neck 5, 6 . Knowledge of the neck anatomy, an intra-capsular approach, and judicious surgical technique are imperative and have made this a technique that we both advocate and employ when indicated.

Bichats Fat Pad Excision

There are a subset of patients who present for facial rejuvenation that demonstrate chubby cheeks, significant bulk, and pseudoherniation of Bichat's fat pad, and good malar bone support. These patients benefit from excision of Bichat's fat pad rather than suspension. Dissection of the fat pad proceeds as previously outlined however, care must be taken during resection of the fat pad. Undue traction of the fat pad can result in injury to neurovascular structures and or Stensen's duct. Meticulous hemostasis should be obtained and can be facilitated by the use of bipolar cautery during Bichat's fat pad excision.

Discussion

There is a paucity of plastic surgery literature regarding the psychosocial changes in patients who undergo cosmetic surgery 15 . We are aware that surgery will not affect a positive psychosocial change in patients with BDD. BDD is now recognized as a specific entity similar to how the public and medical profession viewed anorexia nervosa in the 1960s and 1970s and we recognize the treatment of the disorder as psychiatric and not surgical. Efforts to screen for BDDs are coming into our plastic surgery literature 2 but this is usually in a university-based setting rather than in an individual private practice 10, 16 . Awareness of the pitfalls of operating on patients with BDD alerts us to the possible adverse psychosocial pitfalls and operating on other patients with related somatoform disorders and, in particular, obese patients. Obese patients might maintain their victim status and be dissatisfied with the ever-increasing services offered to them, including large-volume liposuction...

Deep Layer

Then interrupted and running 3 0 absorbable stitches reinforce and smooth out the SMAS flap. This flap is superposed in the temporal area. It can be thinned by liposuction if thick, but when one wants to avoid a too wide temporal area, the flap either can be resected in the overlapping area or its upper part can be folded upon itself, building up the malar area. When the SMAS - or the plication - has been done, the neck is reevaluated, and if necessary, a liposuction under the mandible level is performed.

Submental Manoeuvres

Obtuse Cervicomental Angle

Mostly we can achieve fairly good definition of the mento-cervical angle by lateral mobilization and fixation of skin and platysma and by liposuction of the submental region. Sometimes, however, it will not be enough to harmonize the entire neck. We can excise a spindle-like part of the submental skin and subcutaneous fat to tighten the skin. Fig. 54.5. a Exposing the mental attachment of the right digas- and d after face-neck-lift, liposuction of platysmal fat, and tric muscle through the skin and platysma layer and b detach- bilateral digastricus detachment ment with radiosurgery. Patient c before this type of surgery Fig. 54.5. a Exposing the mental attachment of the right digas- and d after face-neck-lift, liposuction of platysmal fat, and tric muscle through the skin and platysma layer and b detach- bilateral digastricus detachment ment with radiosurgery. Patient c before this type of surgery Fig. 54.6. a Heavy neck with platysma bands and visible submandibular glands. b Face and...

Summary

Because of the great demand in the last several years for aesthetic surgery and because of the impact of managed care in medicine in the USA, there have been many unforeseen changes. Managed care with its long-reaching problems has encouraged surgeons and doctors from other specialties to perform cosmetic procedures without adequate training. In addition, the need for marketing has sold the public on the advantage of short and simple procedures in facelifting that may allow only a few days of convalescence. With more public awareness of poor results, there appears to be less enthusiasm for facelift surgery as there has been a progressive drop in the number of facelifts in the USA for the past 50 years as compared with the increased popularity of breast implants, liposuction and other nonfacial techniques. Unfortunately the steeper learning curves for more sophisticated techniques make widespread use of these techniques impractical. However, surgeons with adequate facelift practices...

Tunnelization

Left Side Right Side Face Comparison

After liposuction itself or when creating small tunnels with a cannula without suction, we start tunnel-ization with nontraumatic instruments with progressive width, specially developed for this purpose (Fig. 39.5). These instruments are introduced one by one - first the thinnest one (Fig. 39.6) and then progressively a wider one (Fig. 39.7) until the widest one

Biplanar Face Lift

Polylactic Acid Hospital

In the cure of a double-chin pelican's neck, the SMAS is rotated up and inward, the platysma is advanced toward the mastoid area and pulled backwards after being freed. 5. Facial fat components may be useful as subdermal fat, nasolabial fat, or a submalar fat pad or may be detrimental as jowl fat, neck fat, or supraplatysmal fat in the neck area (Fig. 37.2). Liposuction with a 3 mm cannula is the best way to retrieve nonuseful fat compartments, prior to any dissection 1-5 . Thus, we use a mild liposuction though a tiny incision in the front of the ear lobe this liposuction is performed below the mandibular line and the submaxil-lary area This is the most difficult part to treat, and the first to relapse when the tissues have lost their good elastic properties. The treatment combines liposuction, pla-tysmal plication or horizontal separation, and skin redraping mostly along a 45 vector directed toward the mastoid and occipital area.

Dermography

Microlipofiling

It is possible to make drawings on the skin with special water-resistant felt pens. We have learned to use drawings in liposuction in different body areas because fat tissue has a different arrangement and form when we stand or lie. Also the face has a different shape when we are standing, lying on the back, or if we are in a forward prone position. As we grow older the changes will be more and more obvious. We can surround the areas where we will apply liposuction in the head and neck or mark the structures where we want to add some volume by autologous fat micrografting. We are advised to mark asymmetric structures to correct them in a proper way during the surgery. In the middle of the neck, we can mark the

Age Group

The treatment of the very heavy, fatty neck requires that the dissection proceed all the way to the other side under the mandible. With the advent of suction-assisted lipectomy, submental lipodystrophy is mostly addressed by liposuction, in a crisscross fashion Fig. 40.5. Liposuction has been useful to complement a facelift, and permits the removal of fatty tissue from the cervical region. This maneuver should be done in a crisscross fashion to assure an even plane of subcutaneous tissue Fig. 40.5. Liposuction has been useful to complement a facelift, and permits the removal of fatty tissue from the cervical region. This maneuver should be done in a crisscross fashion to assure an even plane of subcutaneous tissue Clinical Case 40.2. Submental lipectomy was a primary concern in this 58-year-old patient. This was done by ample liposuction, together with a round-lifting technique to reposition facial and cervical tissues. Left The patient is seen preoperatively. Right The patient is...

Deep Mental Crease

Images Skin Hypertrophies

Fig. 56.2. a Submental skin excision with simulating cannula for liposuction above the skin. b Liposuction performed below the skin. Witch's chin c before and d after its correction performed together with face-neck-lift If asymmetry is due to hypertrophy, we can correct it by gentle liposuction. Fig. 56.6. a Putting the implant over chin skin, we check if the implant size is appropriate. b Translabial approach of implantation. Patient c before and d after face-neck-lift, submental liposuction, and chin implant Fig. 56.6. a Putting the implant over chin skin, we check if the implant size is appropriate. b Translabial approach of implantation. Patient c before and d after face-neck-lift, submental liposuction, and chin implant

The Neck

We use close suction-assisted lipectomy (SAL) to defat the submental area and jowls, both close at the onset and open prior to skin redraping. Special attention is directed to fat deposits often found between and under the platysmal bands (subplatysmal fat). This fat cannot be addressed by liposuction and should be treated by direct excision using the electro-cautry needle as it is quite vascular.

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