"Jowl Trowel" Treatment of Adjacent Tissues to Correct Jowls

One of the most challenging problems in aesthetic surgery has been how to treat the development of lower face jowls. There has been no successful localised surgery invented to directly address this issue. Face lifting attempts to pull the jowl outwards towards the lower ear but this does result in a rather stretched and anatomically incorrect appearance.




It should be appreciated that in the lower third of the face there is a volumetric loss of bone, muscle, fat and skin. This creates the so called  pre-jowl sulcus which may by subtraction represent the impression of a neighbouring and detested jowl as seen in this ageing rock icon.



However are we seeing true jowls or just deficient tissues adjacent to the jowl? Certainly it is logical to re-volumise this area with biological fillers-what I have termed "jowl trowelling".




Below is a commercial photo of successful treatment with a filler of the pre-jowl sulcus-jowl gone!

Generous Warm Lips

 

The lower third of the face is defined as the area immediately below the nose to the base of the chin.

In this region treating the lips in a manner that restores youthful definition and volume is the key target that can provide standout results.

The loss of volume and contour with lip ageing can impart an impression of unintended meanness or anger.
However restoration of lip volume and contour can reverse this tendency to convey a sense of warmth and generosity.

The reality is that we all tend to form an impression of people at least initially on their appearance and feminine attractiveness is founded on curvaceous form.

Last week I was watching the immortal movie classic "Casablanca" on TV and was once again moved by the captivating beauty of the female lead Ingrid Bergman.

Her beauty was characterised by an elegant screen persona complemented by her arresting femininity. Bergman was able to portray both strength and vulnerability into her character .

She had a striking face with a beautiful lip contour that added to the impression of a natural personal warmth. Her lips were well proportioned, curvaceous and balanced--- an aesthetic we try to emulate in clinical practice.

http://www.liveinternet.ru/users/4223781/post173721321/

A Revolution in Aesthetic Design. Beauty may well be "in the eye of the Beholder" but does the "Beholder" understand why?

"Beauty is in the eye of the Beholder" but does the "Beholder" understand why?

It is argued that beauty is an entirely personal or emotional interpretation.

Indeed all of us inherently recognise facial beauty.

However is is not generally appreciated that this recognition is founded on laws of nature related to mathematical dimensions and ratios known as "PHI".

There are certain characteristics in nature that are universally acknowledged to be aesthetically beautiful. This includes the face and is applicable across all ethnic boundaries. In fact such boundaries simply do not exist in this concept of beauty.

"Phi" is the basis for the "Golden Ratio" and in facial aesthetics it is truly an intriguing concept.   
 http://www.goldennumber.net/neophite.htm

Managing facial aesthetics in a way comply with these mathematical laws of nature enables contemporary cosmetic practitioners to beautify the face in a manner that is far more effective than simply filling wrinkles or stretching a face surgically with face-lifting. http://www.youtube.com/watch?v=oL0wpOXX5-k

The "PHI" concept is a wonderful tool that  illustrates to patients how treatments (while individualised and adjusted) can conform to this universal beautification principle.

Safe Liposculpture-Respecting Body Physiology

We have been safely performing liposculpture under tumescent local anaesthetic in our clinic procedure rooms for 10 years now without any significant complications. In my opinion the key to safe liposculpture (apart from good general technique principles) is to limit the number of tissue regions (and the amount of fat to be removed) in any one session. One should not test the limits of a patient's safe physiologic function with excessive liposculpting treatment and avoid combining liposculpture with other operations in the one session.

As is the case in many other cosmetic procedures, pleasing and safe outcomes are founded on the avoidance of overly agressive surgery.

An Australian colleagues gives an excellent summary on Liposculpture on his website and I link to it here: http://www.facialartistry.com.au/liposuction-tumescent_liposuction.html

2012!

Cosmetic practitioners are inclined to contemplate what surprises may be in the offering for 2012. In this exciting field treatment options can change rather swiftly but demand careful scrutiny.

Botulinum toxin treatments are likely to remain very popular. The injections are so tiny and in experienced hands the treatment session so quick.  Mainly used in the upper face what is not always appreciated is that while wrinkles are diminished an attractive  open-eyed appearance is achieved. This is the real magic of these injections.

Lasers treatments and alike are likely to further evolve although evidence of outcomes must be carefully evaluated for efficacy as sometimes outcomes fall well short of long term expectations.

Fillers for aesthetic facial volumisation and injectable aesthetic nasal corrections are set to replace the simplistic concept of just filling wrinkles. Although many casual injectors try their hand at these techniques, there will continue to be a widening gap between occasional injectors  and those practitioners who really understand aesthetic principles. Cheaply priced injection offers (eg. coupon entrepreneurs)  can equate with very disappointing aesthetic experiences.

Liposuction practice will continue to differentiate into those who remain classical "lipo-sculptors" or expedient thermal or chemical "lipo-meltors" (fat melting techniques-laser, ultrasound, chemical lipo-dissolving). Traditional "Lipo-sculpting" using variably sized and configured cannula is an art form that cannot be replaced by melting fat just as Michelangelo could not have sculpted his masterpieces with a blowtorch.

Plastic surgeons in Australia do not generally perform cosmetic injection treatments, often seconding these procedures to compliant medical or nursing injectors with variable experience. This trend is set to continue into the future unless more plastic surgeons accept the value and artistry of minimally invasive procedures. A recent very interesting review article about this topic "A Viable Future" http://www.plasticsurgerypractice.com/issues/articles/2011-10_01.asp
by Sarah Russel expanded on this topic when she interviewed US plastic surgeon W. Grant Stevens, MD, FACS, on the role of aesthetic education in a changing field. The following extract is very enlightening on this issue:-

Is he saying plastic surgeons will become insignificant if they don't embrace formal cosmetic plastic surgery training, nonsurgical body sculpting, and facial rejuvenation? "These patients want these nonsurgical procedures, and if they don't get them from plastic surgeons, they're going to get them from their other providers. Once they do, they will then be educated by those providers and they'll go to those providers for plastic surgery. Within a decade, they won't be going to plastic surgeons for facelifts, but to ophthalmologists or dermatologists, because they embraced those services wholeheartedly."

Creating Facial Passion

Virtually every woman desires to maintain an attractive face. An appealing face communicates many emotions including warmth, sincerity and perhaps most of all-"passion". The photo of the above celebrity demonstrates this engaging passion so convincingly. 

Passion is an expression that implies enthusiasm, desire and to feel intensely about something. From a creative perspective I am also passionate about achieving aesthetic beauty in my craft. 

Ideally the female face should demonstrate curvaceousness, accompanied by open/engaging eyes and warm lips expanded to reflect their own personal capacity for youthful contour.

A rejuvenated and aesthetically pleasing face is also well proportioned and balanced. If there is redundant fat or fullness in the neck under the jaw line, removing this can significantly enhance and  harmonise the face into natural, youthful proportions.

Carboxytherapy

I first heard about Caroboxtherapy for the treatment of cellulite some 9 years ago. I have never used or advised this treatment despite a recent resurgence about this treatment in the cosmetic "advert-article" media circuit. The adverse outcome report reproduced below speaks for itself. 

http://www.nydailynews.com/lifestyle/health/2009/10/01/2009-10-01_florida_woman_rohie_kah_declared_brain_dead_after_receiving_carboxytherapy_treat.html

Florida woman, Rohie Kah, declared brain dead after receiving Carboxytherapy treatment at a spa

BY Gina Salamone
DAILY NEWS STAFF WRITER

Thursday, October 1st 2009, 3:12 PM

A spa visit is meant to make clients feel refreshed - but a Florida woman left one spa brain dead.
Rohie Kah, a 37-year-old mother of three, visited the Weston MedSpa in Weston, Fla., Sept. 25 for a procedure to remove cellulite and stretch marks, ABC news reports. But things somehow went horribly wrong.
Kah, a registered nurse, is now on life support. "It's just a matter of time before she's dead," Michael Freedland, one of her lawyers, told ABC.
A regular customer at the spa, Kah reportedly often booked services like massages and manicures. Her lawyers say she was scheduled for a different service this time - a procedure called Carboxytherapy.
The spa’s Web site describes this particular “medical service” as injections of carbon dioxide that improve the appearance of cellulite or stretch marks. The cost ranges from $140 to $160 per injection.
Kah was taken by ambulance from MedSpa to a local hospital when she became unresponsive, her lawyers said. She’s been declared legally brain dead.

Sadly Treatments for Cellulite  remain very elusive. I'm still waiting to see a reliable treatment for established or mature (white pearly) cellulite. There is a lot of money spent on disappointing or even dangerous therapies.