The American Journal of Cosmetic Surgery

Treatment of unwanted periorbital facial veins is a challenge. Common modalities used to treat facial veins include electrocautery, radioelectrosurgery, laser, and microsclerotherapy. Periorbital veins resistant to electrocautery, difficult to safely target with laser, or at risk for sclerosant flow to ophthalmo-cranial anastomotic circulation may be treated with a vein ligation technique in properly selected patients.

Patient selection, preoperative evaluation, exclusion criteria, and anatomic considerations are described in detail. The surgical technique is described in conjunction with intraoperative photos.

Patient selection and characteristics of ideal target vessels are reviewed to optimize results. Less than ideal patient and target vessel characteristics are reviewed in relation to inclusion and exclusion criteria for periorbital vein ligation technique.

This ligation technique provides a useful approach for treatment of cosmetically unwanted 1.5- to 3.0-mm facial veins in properly selected patients. Partial to full resolution may be expected for individual veins. Postoperative photographic documentation shows the typical improvement obtained.

Periorbital facial vein ligation is a useful technique for addressing the problem of cosmetically unwanted periorbital facial veins in properly selected patients.

The addition of cervicofacial lipodissection to the procedures used with facial osteotomies has been shown to markedly improve the cosmetics of the cervicofacial complex and the results of orthognathic surgery.

A technique, including instrumentation, is described as a combination of liposuction and dissection of the tissues, and photographs of 2 surgical cases are included.

The benefits of orthognathic surgery and facial osteotomies include improvement of the occlusion, preservation of the dentition, and better function of the temporomandibular joint.

This article is intended to review the anatomy, patient evaluation, and use of lipodissection to improve the cosmesis of the submandibular and neck tissues. The indications for orthognathic surgery are reviewed. The advantages of cervicofacial lipodissection in correcting the submental, neck, and lateral jowl fullness, which accompanies mandibular setback surgery or reduction genioplasty and neck soft tissue fullness not corrected with orthognathic surgery alone, are reviewed. The cosmetic benefits to the older adult patient with aging in the cervicofacial area are described. The benefits of maxillary and mandibular osteotomies, the shortcomings of facial osteotomies in correcting the adverse cosmesis in the neck and submental areas, and a review of the procedures used in treating neck soft tissue redundancy are discussed. The importance of preoperative soft tissue evaluation and a review of the anatomy is presented.

The addition of lipodissection of the cervicofacial areas may result in a greatly improved neck contour. Considering the large number of surgeons performing orthognathic surgery and the increasing number of surgeons interested in cosmetic surgery, this technique combines the 2 surgical modalities.

Male gynecomastia is popularly treated with liposuction. This article examines a combination surgery of tumescent liposuction and scissors dissection as an alternative to liposuction.

A 3–4 mm cannula is used to test gynomastia tissue and develop planes above and below the dermis. If indicated, incisions are made with a 15 blade and planar tissue is excised with facelift scissors through a periareolar incision. A Jackson-Pratt drain is sutured into the incision and compressed, draining 15 mL per day for 48 hours. Additional compression is worn for 2 to 4 weeks.

With skilled surgery, breasts look smooth; nipple discoloration and scarring may occur.

The combined liposuction-dissection technique may reduce the complications and revision surgery that can occur as a result of liposuction.

Facial dyschromias, particularly in Asian skin, represent a challenge to cosmetic surgeons. Intense pulsed light (IPL) has been reported to clear a number of pigmentary alterations, but we have found the results variable and the efficacy of treatment difficult to predict.

To use epiluminescent microscopy (ELM) to predict the clearing of clinically pigmented lesions in Asian patients undergoing “fotofacials” with IPL.

Clinically similar pigmented lesions on the face were photographed with standard techniques and with ELM before, during, and after multiple IPL treatments in 5 patients. Patients and physicians were asked to grade cosmetic improvement after 5 sequential treatments. ELM photographs were then evaluated after treatment to correlate clinical success with the type of lesion.

ELM was able to discriminate among several clinically similar lesions. Lentigines responded to IPL treatments, whereas macular seborrheic keratoses, melasma, and junctional nevi responded poorly.

Careful evaluation of pigmented lesions in Asian skin before IPL treatment can predict the efficacy of treatment.

Enhancement of facial beauty is one of the primary goals of patients seeking facial rejuvenation treatment. The lower third of the face, which is affected by the dentoalveolar complex, has a major impact on the perception of facial esthetics. This article aims to educate cosmetic surgeons about the impact that cosmetic dentistry can have on creating facial harmony and esthetics.

A simple method of bioesthetic dental evaluation of the patient and common cosmetic dental procedures are discussed.

The importance of a multidisciplinary and multimodality approach by both the cosmetic surgeon and the cosmetic dentist toward creating a more complete, harmonious facial esthetic is emphasized.

As demonstrated by figures representative of typical cases, a combined cosmetic surgery and cosmetic dental approach yields excellent esthetic results.

The incorporation of fundamental principles of proper smile design and dental esthetics into a facial enhancement treatment plan can achieve excellent results on a consistent basis.