Biomedical subjects
Publications and source records attributed to Richard D Gentile.
Upper lid blepharoplasty is the most commonly performed operation in patients seeking facial rejuvenation. When evaluating the patient, attention should be focused on the possibility of concomitant eyelid or eyebrow ptosis. Meticulous planning and technique are required to achieve high levels of patient satisfaction.
Patients requesting skin correction and rejuvenation are motivated by a number of clinical problems. Photo damage, abnormal pigmentation or vascularity, textural problems, rhytides, and laxity due to chronological aging are the primary complaints of the majority of patients. Advances in new technology in the past decade have provided the skin correction specialist with new options for treatment. Specialists with multiple technology options then face a new dilemma. What is the best treatment plan for individual patients when many options exist? Over the past five years we have developed an approach to our patients based on an individualized treatment plan consisting of a prescribed series of skin correction treatments utilizing the most specific rejuvenation techniques for each clinical problem. Multimodality aesthetic skin rejuvenation (MMASR) emphasizes the corrective process and utilization of the most appropriate technology for the patient's clinical skin problem as evidenced by the clinical examination. MMASR also takes into consideration patient bias, cost concerns, expectations of treatment, and feasibility of combining different technologies in the same treatment session. Combining skin rejuvenation techniques with surgical rejuvenation is also reviewed as an option for patients with both facial laxity and clinical skin problems.
Evaluation of member survey data from the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) and the American Society for Aesthetic Plastic Surgery (ASAPS) from 2000 through 2004 reveals several procedure-specific as well as overall trends regarding utilization of aesthetic facial enhancement services. This gender-specific 5-year retrospective review indicates that males undergo significantly fewer procedures than females except for surgical hair restoration and otoplasty. There is a slight general trend toward decreased surgical but increased nonsurgical facial enhancement procedures. On a case per physician basis, AAFPRS physicians performed significantly more procedures for both males and females for every procedure and every year evaluated. Evaluation of age group data indicates that the 40- to 59-year-old age group accounts for the majority of surgical and non surgical facial enhancement requests. Despite anticipated growth of the 60- to 79-year-old age group, the 40- to 59-year-old age group is projected to remain relatively stable. Although continuing to pursue aesthetic facial enhancement services in significant numbers, men still represent a vast untapped market. This study yields important demographic and trend information that has implications for the current and future delivery of aesthetic facial enhancement services.
The goal of this article is to explain both the options and the techniques that are available when considering the rejuvenation of the eyelid and brow complex. We first explain the relevant anatomy. We then list and explain the different techniques with both the brow lift and the blepharoplasty. During this discussion we also explain a newer technique that we have been using. This combines the endoscopic technique with a trichophytic incision. The selection of patients is discussed in reference to which technique is appropriate given each patient's particular anatomy and desired effects. We also highlight the unique differences that the male patient presents.
Techniques for facial rejuvenation have long involved specific remedies for each facial segment affected by the aging process. Traditional facial rejuvenation techniques have addressed the anterior neck and platysma complex as well as the acquired jaw deformity. These techniques often left the nasolabial complex and the "infraorbital hollow" un-addressed. Modern techniques, including the composite rhytidectomy, the subperiosteal midface lift, and the deep-plane and the triplane rhytidectomy, have contributed to redefining the challenge of correcting the problem of the orbicularis-malar soft tissue complex descent and as such focus on a particular segment of the facial rejuvenation. This evolution of the facelift demonstrates that one size does not fit all and that surgeons should consider their rejuvenations to be not a generic facelift but a midface, lower face, and neck lift. This concept has evolved into our appreciation of distinct surgical zones. This is especially important in males, and adjunctive techniques such as the ones we describe may add benefit and enhance the final result in male patients. As discussed, the male anatomy, because of its increased surface area and weight, is more difficult to gain leverage with in rejuvenation procedures. The author describes his preferred technique for facial rejuvenation in males, the subperiosteal deep plane rhytidectomy (SPDPR), which combines a deep plane rhytidectomy with a subperiosteal dissection. Although combining subperiosteal "release" of midfacial anatomy has been reviewed by other authors, the combination of subperiosteal release and deep-plane rhytidectomy has not been previously reported or advocated. The operative technique, complications, and results of this combined technique are reviewed. The procedure as described is used as an isolated procedure for midfacial descent as well as an incorporated technique when completing a "full" rhytidectomy.
Techniques and concepts for treatment of the aging neck have been evolving since the late 1960s and rely on two-dimensional anterior approximation with lateral imbrication of the platysma with or without submental fat reduction, However, the medial approximation can sometimes give a "boxy" appearance to the anterior neck, especially if anterior shifting of the platysma recurs after platysmaplasty with laxity redeveloping in this midline location. The "purse-string" platysmaplasty (PSP) is a new concept in neck contouring that facilitates an enhanced definition for the cervicomandibular transition to better simulate the well-defined contour of this transition that is present in youth. It aids in the contouring of difficult poorly defined necks and in male patients. The PSP adds a "third dimension" to neck recontouring by invaginating the platysma with a plication suture and pexing the platysma, without incising it, to deeper neck fascia with a technique that adds support and definition to the neck contour. The PSP can be performed in patients undergoing a full rhytidectomy as well as in individuals having isolated neck rejuvenation. The PSP is especially helpful in rejuvenating the male lower face and neck because of the relatively heavier deeper structures of the male neck and the need to enhance definition along the jawline.
The demand for laser facial plastic surgery for men has been increasing. Because men tend not to wear make-up and do not wish to take the time off from work associated with surgical procedures, they prefer laser type procedures that usually have minimal associated recovery. These procedures can be used to treat multiple conditions including: photoaging, acne, acne scars, superficial cutaneous problems, and rhinophyma.