plastic surgery - basic - bastaninejad

7/25/2019 Plastic Surgery - Basic - Bastaninejad

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Basic Principles of theBasic Principles of the

Facial Plastic SurgeryFacial Plastic Surgery

Bastaninejad, Shahin, MD, ORL & HNS, TUMSBastaninejad, Shahin, MD, ORL & HNS, TUMS

Amiralam HospitalAmiralam Hospital



Presentation OutlinePresentation Outline

Suture Materials & TechniquesSuture Materials & Techniques

Neurovascular NeighboursNeurovascular Neighbours

Relaxed Skin Tension LinesRelaxed Skin Tension Lines

Facial Aesthetic UnitsFacial Aesthetic Units

Scar Revision PearlsScar Revision Pearls

Post!" #aresPost!" #ares



Suture Materials andSuture Materials and

TechniquesTechniques

Suture material of choice for the skin

surface of the face is 6−0 or 7−0 NylonNylon or

ProleneProlene®Monofilament on a very fine cutting needlefine cutting needle

For subcutaneous tissue !icryl or P"S #$!icryl or P"S #$

0 to %$00 to %$0Sim&le interru&ted suture is mostSim&le interru&ted suture is most

commonly usedcommonly used



For dee& 'ounds 'e use S( sutures and

interru&ted vertical mattress suture to

coa&t the 'ound edges

)e generally use continuous suturescontinuous sutures for

lid area

long traumatic 'ounds

behind the ear in auricular reconstructions



Neurovascular NeighborsNeurovascular Neighbors

* +,ternal carotid artery

- Facial artery

-.* /nferior labial artery

-.- Su&erior labial artery

-. 1ngular artery

2ransverse facial artery

# 3ygomatico$orbital artery

% Su&erficial tem&oral artery

%.* Frontal branch

%.- Parietal branch

6 4cci&ital artery

7 Su&raorbital artery

5 Su&ratrochlear artery

"orsal nasal artery



Relaxed Sin Tension !inesRelaxed Sin Tension !ines

S28 is the reflection of the molecular

orientation in the dermal level

2hey are usually run &er&endicular to the

muscular fibers beneath them



Facial "esthetic #nitsFacial "esthetic #nits

Ma9or units are based on skin thickness:

color: te,ture ; underlying structural

contour

Precise &lanning of surgical incisions ;

reconstructions: re<uire: analysis of the

entire subunit

/ncisions/ncisions &arallel&arallel to S28 ;to S28 ; 'ithin'ithin unit orunit or

subunit borders result in the mostsubunit borders result in the most

favorable scarsfavorable scars



Facial +sthetic =nits



$ndications for Scar Revision$ndications for Scar Revision)idened Scars

Per&endicular to S28)ebbed

Pin$cushioned

8ong ; linear and misaligned 'ith S28

>y&ertro&hied

/nterru&ting an aesthetic unit of the face

?ausing distortion of facial features or anatomic

function

1fter -$ 1fter -$momo &roceed 'ith revision surgery&roceed 'ith revision surgery



Scar Revision TechniquesScar Revision Techniques

$xcision$xcision @-$mo after scar maturation and

thereafter A

$x"ansion %ith $xcision$x"ansion %ith $xcision

rregulari'ationrregulari'ation

(er)abrasion(er)abrasion @6$5'k after in9ury or surgeryA

Steroid in*ectionSteroid in*ection



%xcision%xcision

)ith regards to the facial subunits: &lace

incision in S28 or &re$e,isting facial 'rinkles

Pearls

Fusiform sha&e 'ith 0 degree

Slight vertical bevel out'ard

*$- cm undermining

Buried S( sutures

Monofilament interru&ted suturesFor ma,imiCing eversion: use vertical mattress

sutures



+,am&les of &ro&er &lacement of fusiform incisions 'ith 0 degree angled ends



Tissue %xpansionTissue %xpansion2issue e,&ansion is the ideal &rocedure for

reconstruction of S#ALP de+ectsS#ALP de+ectsectangular e,&anders are mostly used

Previous scars and incisions can be used for

&lacement of the &rostheses @do not harm your

future fla& designsA?reate a subgaleal &lan

?are should be taken to +ix the in+lation+ix the in+lation reservior reservior

+,&ansion 'ith NDS bi'eekly: starting -'ks

&ostinsertion @continue u& to 6$5'ksA



rregulari'ationrregulari'ation

Makes scars less noticeableless noticeable 'ith humaneyesE

2echni<ues

3$Plasty?lassic 60 degree 7% scar lengthened

#% degree %0 G G

0 degree

-% G G)$Plasty

Heometric Broken 8ine ?losure @HB8?A



,-)) ar)s. one ar) )ust be,-)) ar)s. one ar) )ust be

"arallel to the RSTL"arallel to the RSTL

Attention to the /"last0 angles and the scar inclinationAttention to the /"last0 angles and the scar inclination



&er'abrasion&er'abrasion

?andidates

8ighter com&le,ions

1void in >/! and >e&atitis

Perform this &rocedure: 6$*-mo after treatment'ith*$cis$retinoic acid

=se antiviral &ro&hyla,is for &atient 'ith a history

of her&etic infection

Penetrate a little bit more dee&ly than su&erficialPenetrate a little bit more dee&ly than su&erficial&a&illary dermis @to see the strands of 'hite$colored&a&illary dermis @to see the strands of 'hite$colored

collagen fibersA ;collagen fibersA ; $T#111$T#111



SteroidsSteroids

/n scar revision: in &articular &atients:

'henever &ersistent tissue edema detracts'henever &ersistent tissue edema detractsfrom the 'oundIs a&&earance: you can use

triamcinolone *0mgDml: 'ith (( or a &lan

bet%een ( & S2bet%een ( & S2 route: in9ections



Post(Op )aresPost(Op )ares

emoving the sutures on &osto&erative day

five: sixsix: or seven

>ydrocortisone ointment is massaged into

the scar for *% minutes in the morning and

evening for -'eeks

/f the &atient is &rone to hy&ertro&hic

scarring: 'e 'ill in9ect intralesional2riamcinolone *0mgDml @use NDS for

dilutionA



ReferencesReferences

?ummings?ummings 48;>NS %48;>NS %thth edition$-0*0edition$-0*0

econstructive Facial Plastic Surgeryeconstructive Facial Plastic Surgery

@@)eerda)eerda$-00*A$-00*A

Plastic Surgery @Plastic Surgery @MathesMathes$-006A$-006A

Facial Plastic Surgery @Facial Plastic Surgery @ParkPark$-00%A$-00%A

plastic surgery - basic - bastaninejad

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