to non-animal material that no longer requires allergytesting. These fillers are injected into lips and facialrhytids to augment lips and efface rhytids. A firm knowl-edge of topical and local anesthesia as well as facialanatomy is paramount for the proper use of these prod-ucts.

Fillers can be broken down into multiple classes andhave different injection targets and carry various advan-tages and disadvantages. Most fillers are resorbable, butnewer fillers contain hydroxylapatite or methylmethac-rylate microspheres. These fillers persist longer or aresometimes permanent. Due to this, proper injectiontechnique is paramount.

Botox is the first mass marketed botulinum toxin A(BT A) used for cosmetic purposes. BTA prevents therelease of ACH from the motor neuron which disruptsnerve transmission and hence muscle movement. Treat-ing patients with BT A involves simple techniques butrequires a significant knowledge of facial musculatureand injection techniques. Again, OMS are uniquely qual-ified to perform BT A injections for the aesthetic andfunctional treatment of muscles of the head and neck.Many BTA treatments are technique sensitive and pro-vide excellent temporary cosmetic improvement.

References

Niamtu, J: The use of Restylane in cosmetic facial surgery. J OralMaxillofac Surg 64:317, 2006

Niamtu J: New lip and wrinkle fillers. In: Minimally Invasive Cos-metic Surgery Oral and Maxillofacial Surgery Clinics of North America.Saunders, Philadelphia 17:1, 2005, pp 17-27

Niamtu J: The cosmetic use of botox in maxillofacial surgery se-lected readings in oral and maxillofacial surgery 12, No. 2, Apr 2004,pp l-22

Noninvasive Lasers: Skin and VascularRejuvenationBruce N. Epker, DDS, MSD, Weatherford, TX

The currently available selection of lasers is such thatit is extremely confusing and complex with regard towhat they do, how they do it and predictability of out-come. The spectrum of laser treatment has changedconsiderably in the past decade from the conventional,yet invasive CO2 lasers that affect major skin rejuvena-tion, but with significant down-time, to a large numberof minimally invasive and noninvasive lasers. This discus-sion will focus on the noninvasive lasers.

In the noninvasive laser group, there are a large num-ber of lasers that do indeed have different functions. Theprimary function I will address will be skin rejuvenationand elimination of facial vessels.

In this regard, I will primarily discuss two systems, oneto treat facial vessels and one for skin rejuvenation.Multiple systems in the 525 to 575 nm wave lengthsexist to treat facial vessels. These wave lengths target

exclusively red or oxyhemoglobin and are used for elim-ination of facial vessels. The details of the technology,techniques and results will be demonstrated utilizing a532 nm laser. Including minimizing thermal injury tosurrounding tissues by proper use of proper pulse dura-tion/thermal relaxation time.

Secondarily, I will discuss a laser system that affects, inthe author’s opinion, significant facial skin rejuvenationwith regard to the following:

1. Reduction and/or elimination of keratoses2. Reduction and/or elimination of dyschromias3. Improvement in skin tone, texture and color4. Minor reduction facial rhytids

Lasers are named after the constituents of the me-dium; gases such as Argon and CO2; liquids (pulsed dyelaser), solids (alexandrite, diode, erbirum, yttrium, ruby)or solid state (diode).

Noninvasive lasers, excluding vascular, are in the 1320- 1540 nm wave length. Cool touch 1320, Smoothbeam1450, and Ardmis 1540 are some of the more popular. Iwill discuss a noninvasive erbium-yag laser.

Some wrinkle reduction is possible with this laseralthough it is not a major component of the treatment.As with the vascular lasers, the mechanisms of action,the down-time and the results will be demonstrated.

Reference

Goldberg D: Lasers and Lights: Vol I; Elsevier Saunders, Philadelphia,PA, 2006 Goldberg D: Lasers and Lights: Vol II; Elsevier Saunders,Philadelphia, PA, 2006

Facial Liposuction and SubmentoplastyAngelo Cuzalina, MD, DDS, Tulsa, OK

Achieving a beautiful and youthful jaw line and neckcontour is a common desire for many cosmetic surgerypatients. Certain patients are candidates for isolated fa-cial or neck liposuction if their skin tone and muscletone are adequate. In addition, the role of chin augmen-tation to improve a weak chin projection is critical toobtain good facial proportion as well as maximum neckaesthetics particularly when a patient has an anterior orlow hyoid position. Often, isolated facelift surgery per-formed by an assortment of lateral pulling or liftingtechniques is performed as an isolated procedure toimprove the jowls and neck. A submentoplasty may bementioned briefly as part of the procedure, but it is notwell described and not given the credit it deserves for itsrole in long term aesthetic neck improvement.

Submentoplasty, liposuction and chin augmentationcan be invaluable tools to enhance lower face and neckrejuvenation with or without a facelift. In fact, there aremany instances where proper treatment planning canyield exceptional neck results with any of these basictechniques.

Specific techniques for isolated basic liposuction, chin

Symposia

22 AAOMS • 2006