CREASES, FOLDS AND WRINKLES
AND SURGICAL CORRECTION
The role of anthropometric analysis in plastic surgery
Surgical body modelling must be planned in conformity with anthropometrical parameters.
Before commencing work, the surgeon, like a sculptor, must draw up plans according to the principles of beauty. Anthropometric analysis, the starting-point of surgical planning, detects irregularities of body shape referred to standardized models. Readjustment of the body's topography and restoration of its proportions also allows for the remodelling of furrows caused by adherence between skin and deeper layers - such as facial wrinkles, sub-mammary and sub-gluteal creases - which define and characterize the physiognomy of the corresponding anatomic areas.
Plastic surgery and the bio-dynamics of the human body
Remove and add, the two fundamental theorems inspiring figurative arts and aesthetic plastic surgery, are combined into an action whose goal is to restore the body's proportions; with the difference that the material with which the surgeon works has an in-built, autonomous reason to change shape, due to continual cell replacement. Surgical techniques must therefore be integrated into the bio-dynamics of the human body, accomplishing a remodelling task that, wherever possible, prevents as well as corrects defects and irregularities of the body contours.
Since the surgeon operates on a body in evolution, the quality of the results will also depend on a number of adjustments and additional touches. Restoring of the body's symmetry and harmony are the goals of aesthetic plastic surgery.
The aesthetics of the human body is a balance of furrows and orifices, and artists of every period have studied the distance between ear and eye, eye and nostrils, nostrils and mouth, nipple and sub-mammary crease, sub-gluteus folds and iliac crest and so on, to create a code for all body proportions.
Today, female beauty encompasses more elongatedshapes compared to past eras: the perineum is in the middle of the body, the ideal ratio between hips and waist is O.6/0.7, three equal equilateral triangles circumscribe the dorsum and lower limbs.
The face had cephalometric relationships that can be simplified using the length of the nose and the width of the eye as parameters. The face is divisible into three parts, each equal to the length of the nose (Leonardo's rule).
Where it is not expected to perform fat-grafting, and if the amount of fat to be aspirated exceeds one litre, a vacuum pump is suitable for deep layer liposuction. For superficial touch-ups a metal syringe may be used; this consists of threaded parts. The serrations on the plunger enable the vacuum pressure to be regulated according to the technique and body area being treated. The vacuum pressure is adjusted via an easily accessible button. The cannulas are screwed onto the cartridge, which contains a 60 cc. disposable syringe.
The suctioned fat, stored in disposable syringes, rises rapidly to the top of the aspirated liquid, which can be expelled simply by pushing the plunger. The fat can be washed with Ringer-Lactate solution and again extracted by decanting.
Facial lipo-filling is performed using 2 mm. diameter cannulas, while 3 mm cannulas are used for other body areas.
A 16 G needle with tip bent to 90° is used to undermine facial wrinkles. The needle is mounted on a handle and pushed forward and back through the subcutaneous tissue to lyse the wrinkles, and rotated to stimulate fibroplasia (Morphodynamics and Surgical Correction of the Body's Creases, Folds and Wrinkles).
The gluteal sulcus is undermined by cannulas and rhytisectors with V-shaped or spatula tips.
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.
Lipo-filling, like liposuction, takes cephalometric ratios into account, because the aim of surgical remodelling is to restore the correct facial proportions, not merely to erase wrinkles.
Additive techniques in aesthetic plastic surgery increase the distance between the anthropometric points, and this must be considered during surgical planning. Augmentation of the labial, glabellar, and zygomatic regions restores harmonious cephalometric ratios.
In line with the general antigravity formula inspiring surgical techniques for body remodelling, when appropriate, the suctioned cervical hypertrophic fat may be transferred to the hypotrophic zygomatic area.
Picasso gave a modern interpretation of the shape of the buttocks in his 1907 studies of Demoiselles d'Avignon. He stylized the buttocks by drawing an upside-down triangle, set in a similar width, U shaped figure. The buttocks can be inset into a rectangle drawn following 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.
Liposuction may cause sliding in areas surrounding the treated part. Simple reduction of the preiliac and pretrocanteric fat masses might trigger two consequences: a) lowering of the buttocks, b) an apparent lengthening of the sub-gluteus crease.
These gravity-induced effects can be counter-balanced by filling strategic areas.
Modelling of the lower legs is essentially an overall volumetric reduction. Fat hypertrophy produces sovra-rotular transversal folds. Liposuction and skin detachment enables their depth to be reduced, restoring the knee's natural shape. Moreover the disappearance of the folds contributes to a slender appearance of the leg.
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