ASSOCIAZIONE ITALIANA RICERCHE SULLA PLASTICITA’ TESSUTALE PASQUALE FRUSCELLA

ISCRIZIONE AI CORSI AIRPT

ANTIAGING-ANTICANCEROGENESI

THE FACIAL AND BODY SURGICAL MODELING




The Face


The search for cephalometric relationship in pictures that have been recognized as beauty symbols in every epoch permits identifying constant values that may be found both in Renaissance paintings as well as in today's beauties.

Beauty contains the idea of proportion, a word that derives from the Latin pro portio (the correct ratio between the parts) that provides it with a universally comprehensible meaning.

Especially during the Renaissance, a true geometry of beauty was attained, following the "rule of three" inspired by Euclid. The cephalometric planes were identified by Leonardo da Vinci who translated the ratios between the physiognomic regions into intersecting lines and showed the simple rule of the multiples that reveals the shape of the profile: three spaces, equal to the height of the ear or nose are the same as the distance between the menton and the trichion.

The constant ratio in regular profiles between the nasion, the subnasale and the pogonion, these being cephalometric points susceptible to change after surgery, suggested including the profile in a triangle divided in two equal parts.

To make surgical planning simpler and more rapid, we created a fan ruler that instantaneously carries out the cephalometry of the profile, which can be subject to modification depending on the surgeon's aesthetic taste an experience.

In fact, the variety of the face morphology and, therefore, corrective surgical techniques thet are selected case by case cannot be limited to an oversimplified geometric interpretation. Moreover, cephalometric rules must be interpreted in light of various factors: the plastic property of the tissues, their ability to change in time and the age and sex of the patient.

In the young female patient it may be appropriate to overcorrect the nasal dorsum, in view of the tendency of the nose to change shape in the course of the time, while a decrease in volume is preferable in the adult, with respect to the physiognomic identity.

Therefore, surgical planning is neither a simple measure of the facial size nor a mere question of aesthetic taste, but rather a general evaluation of the relationship between the soft tissue, the skin quality, the age and sex of the patient and, lastly, the patient's expectations.

The current tendency to perform corrective rhinoplasty with the help of computerized images or cephalometric evaluations is justified by the need to adapt the amount of correction to all the cephalometric ratios and draw on indications regarding the exact quantity of tissue to remove or add, however "precision rhinoplasty" is not a synonym for an absolute foreseeable result, except in cases thet require a very small amount of tissue removal (up to 3 mm, considered as the average between the maximun width of the portion removed from the dorsum and caudal septum). Beyond these limits, the operation itself involves structural alterations thet may escape even the most careful operation analysis.


The Body


Anthropometric analysis, the starting point of surgical planning, detectes irregularities of the body shape, in reference to standardized models.
Readjustment of the body's topography and restoration of its proportions also allow for the remodeling of furrows caused by adherence between skin an deeper layers, such as facial wrinkles as well as submammary and subgluteal creases, which define and characterize the physiognomy of the corresponding anatomic areas.

Currently, female beauty encompasses more elongated shapes than in past eras. The perineum is in the middle of the body. The ideal ratio between hips and waist is 0,6 to 0,7, and three equal equilateral triangles circumscribe the dorsum and lower limbs.
The buttocks can be inserted into a rectangle drawn according to Euclid's golden rule. The diagonals of the golden rectangle intersect each other over the sacrum, which, in turn, mirrors the triangular area of the pubis.

Surgical Sculpture


Anesthesia

The patient is subjected to surgery under local anesthesia with preoperative nonnarcotic analgesics. CRYOCAPS are placed over the points at which tumescent infiltration will be performed with an automatic injection syringe.


Anesthesia of the abdomen by automatic injection syringe

Instruments

Vacuum pumps are suitable for deep-layer liposuction. For superficial touch-ups, syringes are used. Facial lipofillings is performed using cannulas 2-mm in diameter; whereas 3-mm cannulas are used for the body.

Cannulas for liposculpture

Needles, cannulas and rhytisectors are used to lyse the wrinkles and stimulate fibroplasia. Human body aesthetics are characterized by an alternation of concave and convex forms and by lines that define the different physiognomic areas. On the basis of anthropometical models, preoperative planning determines the use of one ore more of the many available techniques so as to reconstruct harmonious body proportions.

Facial wrinkles

The effects of atrophy and gravity, combined with muscle action, cause wrinkles to form.

Restoration of subcutaneous tissues by means of fat grafting expands the skin and returns it to smoothness. Lipofilling, like kiposuction takes cephalometric ratios into account because the aim of surgical remodeling is to restore the correct facial proportions, not merely to erase wrinkles.

Augmentation of the labial, glabellar and zygomatic regions restores harmonious cephalometric ratios. In line with the general antigravitary formula that inspires the surgical techniques for body remodeling, the suctioned cervical hypertrophic fat may be transferred to the hypotrophic zygomatic area.

Buttocks

Liposuction may cause sliding in areas surrounding the treated part. Simple reduction of the preiliac and pretrocanteric fat masses may trigger two consequences: lowering of the buttocks and an apparent lengthening of the subgluteous crease.

These gravity induced effects can be counterbalanced by lipo-filling strategic areas.

In conjunction with rhytidolisis, lipofilling can shorten the subgluteal crease. This successful technique used in slim, young patients with firm gluteal mass contributes to the lenghtening effect of the silhouette.

Rotular Folds

Modeling of the lower legs is essentially an overall volumetric reduction. Fat hypertrophy produces sovrarotular transversal folds. Liposuction an skin detachment enables their depth to be reduced, restoring the knee's natural shape.


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