Facial Trauma requires precise understanding of the anatomy for aesthetic reconstruction. The most dreaded complication of doing a facelift is cutting the Facial Nerve. It is possible to cut one branch, but it is almost impossible to accidentally cut all the branches. Here is a patient who was attacked and the left side of his face was slashed open, severing all the branches of the Facial Nerve. Repairing this requiered precise microsurgical reconstruction.
It is our personal opinion that surgeons who cannot perform microsurgical repairs of the FACIAL NERVE should not be doing FACELIFTS. As this case demonstrates, Dr. Knight demonstrates that he is capable of repairing not just one, but all the branches of the facial nerve if they are injured.
Facelift in men are challenging because there is very little place to hide the surgical scars. As such, there must be strict attention to detail in planning the procedure and placing the incisions.
One of the most complex and unforgiving procedures in the world of plastic surgery is the Facelift. You literally get one shot at doing it right the first time around. Following any operation, the normal atatomical planes become scarred and distorted, and the tissue does not stretch and move as easily as it should. This makes it very dangerous and difficult for less experienced or less talented surgeons. Given that this is your FACE...there is no room to hide the results...it is on display, there for all the world to see. Performing a facelift is a tour-de-force of technical precision at its best...UNDOING a botched facelift/necklift and getting great results is quite challenging. Doing this on a fellow medical professional...you guessed it...the stakes are sky high. I was able to deliver above and beyond the patient's considerable and educated expectations.
Rhinoplasty is a wonderful and predictable operation. It is one of the procedures in Plastic Surgery that is very predictable and precises in terms of correlating preoperative planning, intraoperative procedure and post-surgical outcome. While the technical aspects of the procedure are the same for men and women, the aesthetic goals are dramatically different. In addition, the nose must fit the personality and ethnicity of the patient. For example, a short upturned nose might be cute on a girl, but not so appealing on a man. A dominant dorsum, or Roman Nose, may be handsome on a man and symbolize masculine strength. However, it would be an epic aesthetic failure on a female. A curved hooked nose is not desirable for either gender. These are some of the aesthetic concerns that I consider in designing a rhinoplasty specifically for that individual patient.
Rhinoplasty is considered by many surgeons to be one of the most challeging procedures in Plastic Surgery. I disagree. I think it is one of the most predictable operations in all of Plastic surgery. In contrast to the breast and the body, the nose, like the ears, changes very little with time. The architecture is very straightforward, and in general there is a sense of anatomic predictability about the nose. It varies very little from person to person, despite our different ethnic backgrounds. There are mild variances in the texture and thickness of the skin, as well as the amount of glandular tissue present in the tip. The position of the radix, the dominance of the dorsum, the columella height, the definition of the tip, the orifice of the nasal passage and the ala contribute to varying attributes that constitute the character and ethnic context of the nose. While it is not "one size fits all", it does not have the wide variance in form and function seen with breast and body procedures that tend to change with the effects of time and gravity.
Functional Rhinoplasty focuses on the issues that contribute to Airway obstruction. These issues can be so severe that they can become occupational hazards for the patient or even evolve into life threatening situations such as falling asleep behind the wheel while driving or operating complex machinery. Many of these patients suffer in misery because they cannot breathe comfortably.
Traumatic injury to the nose can result in scar contracture and notching that may produce a prominent long-term deformity of the nose. For this reason structural reconstruction of the nose must take into accounnt the precise anatomical rearrangement, the fundamental architecture, and the behavior of the scar over time.
The ability to accurately sculpt the nose to aesthetic ideals requires a fundamental knowledge of the architecture, anatomy and physiology of the nose. It is also important for patients to understand the basic anatomy so that we can effectively communicate regarding the issues of concerns. It is essential that both physician and patient understand and agree on the issues as well as the plan for surgical intervention. For this to happen, both parties must communicate with common terms. Outlined below are a few of the fundamental facts and features regarding rhinoplasty.
Blows and traumatic injury to the ears can be complicated by hematomas which can produce a cauliflower deformity as the cartilage framework is destroyed by the injury, the presence of the blood, the inflammatory response to the blood, and the scar tissue from the deposition of collagen in the injury field. In addition, the cartilage must be protected from infection, and requires porper tissue coverage in order to heal well. To achieve the best long term results, the hematoma must be evacuated, the blood cleared from the area of injury, and the perichondrium must be properly restored. With the foundation restored, the overlying tissue layers can then be properly approximated to complete the repair.
This young man was involved in an accident in which he sustained lacerations to the left ear involving the inferior crus and the conchal bowl full thickness down to the perichondrium.
A necklift is usually performed in conjuntion with a lower facelift. Alternatively, it may be performed separately. Very often, liposuction or direct excisional debulking of the submental fat is performed in order to permit the restoration of a rejuvenated profile. The key to this is the creation of the cervicomental angle.