Preface: Advances and Refinements in Asian Aesthetic Surgery xiii
Lee L.Q. Pu
Minimally Invasive Approach to Facial Rejuvenation: The Authors' Preferred Approach 1
Haiyan Cui and Guobao Wang
Video content accompanies this article at http://www.plasticsurgery.theclinics.com.
The highest level of esthetic treatment serves not only as a procedure but also as an artistic creation under the limitations of medicine. Based on oriental esthetic and anatomic features, the authors have proposed the “未来 Future Codes” design in Chinese calligraphy describing the art of facial rejuvenation in Asians to help doctors perform well. The concept encompasses a systematic overall design for the art of facial rejuvenation in Asians, associated with beautiful meanings and is easy to learn and perform safely, including the 5 principles of minimally invasive facial rejuvenation: adding, subtracting, tightening, brightening and flexing.
Facial Beautification and Rejuvenation with Injectables: My Preferred Approach 11
Wilson W.S. Ho
Asians are of different ethnic origins. Nevertheless, they share the common facial structural deficiencies and consequences of the aging process that create the opportunity for esthetic intervention. As a result, Injectables are widely used in young Asians to achieve an oval facial shape with increased facial height and projection. In mature Asians with lifelong structural deficiencies, the beauty treatment plan is more complex than removal of signs of aging. Therefore, apart from injectables, other treatment modalities for tissue repositioning, neocollagenesis and skin quality improvement are also required to obtain the optimal result.
Fat Grafting Combined with Liposuction Improves Cosmetic Facial Contours in Asians 19
Dong Wang, Ming Ni, Min Gong, and Chao Yang
Video content accompanies this article at http://www.plasticsurgery.theclinics.com.
Autologous fat grafting and facial liposuction are widely used to reshape facial contours. But up to now, there is no surgical design idea for Asian women. The article aimed to provide a facial esthetic design to guide the combined operation of facial liposuction and fat grafting for Asians, that is, the "three-line and nine-point" design method. In retrospective reviews, the surgical results of clinical practice were satisfactory, and a more attractive facial appearance was obtained. Our technique can easily be learnt and can be mastered by the most well-qualified plastic surgeons for satisfactory outcomes.
Facial Rejuvenation with Fast Recovery Suspension Technique 33
Dejun Zhu, Haiyang Yu, and Kai Liu
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Minimally invasive facial rejuvenation techniques are gaining attention because of their advantages such as less trauma, quick recovery, high safety, obvious results, and repeatable operation. In this article, the principle, the operation method, advantages, and disadvantages of the new fast recovery suspension technique modified by the authors are described in detail, and the clinical cases are listed to further illustrate the efficacy of the modified operation. The authors also compared this procedure with other common facial rejuvenation techniques. It is hoped that our article can provide a reference for clinicians to better use facial rejuvenation technology.
Facial Rejuvenation and Contouring with Radiofrequency-Assisted Procedures in Asians 43
Yuneng Wang, Bo Yin, and Facheng Li
Radiofrequency (RF)-assisted liposuction treatment is a minimally invasive skin-tightening technique for the patient population with skin laxity. The authors recommend facial liposuction combined with the RF procedure for the treatment of skin laxity. Minimal-invasive liposuction creates working channels for RF treatment and sufficiently exposes the subdermal fibrous septal network tissue so that the RF energy can directly act on the collagen of the fibrous septal network for thermal shrinkage, leading to better surgical results. In this article, the authors describe their preferred technique and experience for face rejuvenation and contouring.
Advanced Endoscopic Techniques in Asian Facial Rejuvenation 51
Chia Chi Kao and Dominik Duscher
Video content accompanies this article at http://www.plasticsurgery.theclinics.com.
Asian anatomy and concepts of beauty differ from whites. Traditional SMAS face-lifts are developed based on a white patient population and not ideal to achieve the aesthetic goals of Asian patients. The characteristics of the ideal facial rejuvenation techniques for Asians comprise hidden incisions to avoid hypertrophic scarring and cultural stigma. The authors’ approach addresses the Asian face in all dimensions using minimally invasive modalities combined with skin regenerative methods. This surgical technique is called the “Ponytail Lift.” It simulates the vertical lift of the face when having the hair pulled up in a high ponytail.
Facial Rejuvenation with Open Technique After Previous Filler Injection 61
Daping Yang
The complications associated with polyacrylamide hydrogel injection including tissue infection, nodular formation, and migration along tissue planes have been well-documented. Complete removal of injected material is seldom possible. Patients who underwent removal of injected material were significantly more likely to express interest in facelift. We provide an open surgical technique with facelift incision to deal with the removal of polyacrylamide hydrogel and complication due to volume deflation and tissue descent.
Current Practices for Esthetic Facial Bone Contouring Surgery in Asians 71
Li Lin, Wenqing Han, Mengzhe Sun, Byeong Seop Kim, Xiaojun Chen, Zin Mar Aung, Ziwei Zhang, Yanchun Zhou, Xianxian Yang, Gang Chai, and Haisong Xu
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In this article, authors mainly introduce new digital technology in facial bone contouring surgery. In our experience, these new technologies are crucial in ensuring the satisfaction of surgical accuracy. Our previous studies have shown surgeons can use precise pre-operative design to reduce operative time, reduce bleeding during surgery. Additionally, augmented reality can enhance the perspective perception of surgeons combining virtuality and reality. What’s more, robot-assisted surgical technology also has a strong application prospect in facial contouring surgery. In the future, the combination of soft tissue contouring surgery will make the facial bone contouring surgery safer and more effective.
Orthognathic Surgery to Enhance the Smile 81
Alan Yan and Yu-Ray Chen
An esthetic smile is an integral feature of beauty. Improvement of the smile can be achieved by a combination of orthognathic surgery, orthodontics, and cosmetic dentistry. Preoperative evaluation serves to address a patient’s surgical goals; it allows a surgeon to perform a detailed facial analysis and identify patients who are contraindicated for surgery. LeFort I and bilateral sagittal split osteotomy are performed to minimize the risk of complications. Injuries to the inferior alveolar nerve are the most common complication after orthognathic surgery, in which 90% of patients experience transient sensory disturbance of the lower lip in the postoperative period.
Periorbital Rejuvenation for Asians 91
Yun-Nan Lin, Yi-Chia Wu, Shu-Hung Huang, Chih-Kang Chou, Hidenobu Takahashi, and Tsai-Ming Lin
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A primary concern in facial aesthetics is the rejuvenation of periorbital areas through soft tissue recontouring, skin texture improvement, and harmoniousness with souring anatomic tissues. Currently, the ease of harvesting, abundance in volume, and lack of immune rejection make autologous fat transplantation a disruptive strategy in aesthetic medicine. The evolution and improvements made by myriad surgeons have contributed to the popularity of periorbital rejuvenation and have highlighted its indispensability in Asian patients. Lin and colleagues have advocated the technique of microautologous fat transplantation since 2007 for facial recontouring and rejuvenation. This article illustrates more in-depth technical details and innovative concepts for the improvement of the periorbita.
Asian Upper Blepharoplasty: A Comprehensive Approach 101
Chunmei Wang and Lee L.Q. Pu
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Asian upper blepharoplasty is one of the most popular cosmetic procedures for Asians, but less optimal result is still common. The authors’ comprehensive approach to Asian upper blepharoplasty includes (1) to determine both the height and length of the upper skin crease; (2) to create more ideal anatomy of the upper eyelid; (3) to reconstruct the desirable anatomic structure of the upper eyelid skin crease; and (4) to add a medial epicanthoplasty if needed to enhance cosmetic results.
Revision of Asian Upper Blepharoplasty 111
Chang-Chien Yang
Revision of Asian upper blepharoplasty can be extremely challenging to surgeons when encountering cases with multiple complications and very limited tissue sources. In this article, the author is going to guide the newcomers or revision Asian upper blepharoplasty by showing the theory of double-fold formation to help them to make a workable surgical plan when dealing with revision Asian upper blepharoplasty cases. The pathogenesis of complications of upper blepharoplasty can be classified systematically and the solution to each individual complication is also illustrated. Typical clinical cases of revision Asian upper blepharoplasty are then sampled as integrated practice.
Advanced Approach to Asian Lower Blepharoplasty 121
Chin-Ho Wong
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The lower eyelid is one of the commonest areas Asian patients present for rejuvenation. The spectrum of patients presenting for treatment ranges from the young to the more mature. Young patients present with “premature” aging due to an anatomical predisposition. These are patients we figuratively call those who “do not age well.” Even patients with strong skeletal support manifest aging, in a predictable and progressive manner. Such patients eventually benefit from quality esthetic surgery of the lower eyelid and mid cheek.
Primary Rhinoplasty Combined with Pyriform Aperture Augmentation in Asians 133
Zhao Jianfang, An Yang, and Li Dong
To explore a pyriform aperture augmentation method that is suitable for Asian patients with mid-face concavity, we designed a novel prosthesis to perform pyriform aperture augmentation. Three different rhinoplasty schemes are designed according to the degree of mid-face concavity: (1) simple implantation around the pyriform aperture, (2) implantation around the pyriform aperture and augmentation rhinoplasty is performed concurrently, and (3) implantation around pyriform aperture combined with nasal extension technique. Comprehensive rhinoplasty with pyriform aperture augmentation can substantially improve the aesthetic relationship between nasal and facial areas. This technique is suitable for comprehensive rhinoplasty of Asian patients with mid-face concavity.
Revision Rhinoplasty in Asians 141
Jiao Wei, Chuanchang Dai, and Shengli Li
The demands of the revision rhinoplasty in Asian populations are increasing nowadays. Rhinoplasty-related complications frequently occurred in clinical practice, for example, implants deviation, extrusion, infection, nasal contraction deformities, and skin necrosis after primary or multiple surgeries. To obtain a successful revision rhinoplasty in Asian, early detection, prompt management, and appropriate treatment of complications are essential for minimizing postoperative adverse consequences. In revision rhinoplasty for Asian patients, autologous tissues play an important role as new support grafts for nasal structure reconstruction.
Endoscopic-Assisted Transaxillary Breast Augmentation 151
Jie Luan
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Breast augmentation with implants is becoming a more widely accepted and popular procedure in Asia. The axillary approach remains the preferred incision for Asian women. Endoscope technique is the best option for transaxillary breast augmentation. It greatly increases control over the process, avoids various drawbacks, reduces the incidence of complications, and improves the stability of clinical effects of transaxillary implant breast augmentation. Freestyle endoscopic technique may greatly improve the flexibility and efficiency of the endoscope operation through the axillary approach. This article introduces the freestyle endoscopic-assisted transaxillary breast augmentation with high position dual-plane technique.
Endoscopic-Assisted Abdominoplasty 163
Cheng-Jen Chang
Advantages of standard endoscopic surgery include diminished incidence of scarring, numbness, bleeding, and edema, making endoscopic surgery preferable to the conventional suprapubic approach. Endoscopic-assisted abdominoplasty can also treat diastasis recti deformity with minimal excess skin. For enhanced results, a learning curve is expected to achieve optimal technical expertise.
Buttock Augmentation with Fat Grafting 171
Weigang Cao and Lingling Sheng
Refined buttock augmentation with fat grafting in Chinese women during the past decade is introduced. The ideal buttock contouring outcome and figure silhouette come from the proper individualized plan and meticulous maneuvers through fat grafting to the buttocks combined with liposuction procedures on the surrounding areas of the buttocks as well as on the other body parts. The fat grafts are collected, filtered, and condensed by gravitation in a sterilized canister during liposuction. It is recommended that fat grafts were only transplanted into the subcutaneous layers and with no injection into the musculatures of the buttocks. High patients' satisfaction was obtained with no major complications and fewer minor complications.
Vaginal Rejuvenation with Acellular Dermal Matrix 181
Yunzhu Li, Ruijia Dong, Jiuzuo Huang, Yiding Xiao, Jie Chen, Hailin Zhang, and Xiao Long, Xiaojun Wang
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Female genital cosmetic surgery consists of multiple procedures, usually including labiaplasty, clitoral prepuce reduction, labia majora augmentation, and vaginoplasty. The reasons for women to undergo these surgeries can be categorized as functional and aesthetic ones. In this study, we introduced the modified vaginoplasty with acellular dermal matrix (ADM) and briefly reviewed our experience in the combination of multiple procedures to achieve the optimal effect.
Primary Breast Augmentation with Fat Grafting 189
Jeng-Yee Lin and Lee L.Q. Pu
With the increasing demand of breast augmentation with fat grafting in the past decade, the techniques of fat grafting have been continuously improved or refined and the science behind has been extensively investigated. Therefore, the safety and efficacy of fat grafting to breasts have met the standard for primary breast augmentation. The key to a successful outcome and reducing fat necrosis is meticulous fat harvesting, graft processing, and injection. In this article, authors propose our preferred techniques of rimary breast augmentation with fat grafting and an algorithmic approach for the management of fat necrosis based on the most scientific studies.
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