The expectations of an increasingly aging population have
changed considerably over the past years: 60 year olds are still very active,
not only privately but also in their professional and public lives. And
plastic surgeons have developed a new idea of the face. The face is now
considered as a three-dimensional mosaic with five different levels and four
deeper layers. Numerous techniques are available to improve the arrangement
of the pieces in the mosaic. The combination of various techniques can
reduce the aggressiveness of every single method. We can achieve more
sustainable, harmonic results while also reducing the potential for risks
and complications.
The science of the human
face is called prosopology. For 3500 years the Chinese have studied and
learned "to read" the human face. They call it "xien mien". Ivo Andric, a
Nobel Prize winner for Literature, said: "You get never tired of looking at
a sky full of stars, nor from looking at the human face".
The face, a mysterious
medium for attraction and rejection, reveals a person's identity and the
current state of mind. Facial messages are transmitted and received by other
people by intuition. Feelings of sympathy or antipathy are developed within
the first 0,6 seconds of an encounter. It is usually hard to revise their
traces at a later time.
Constantly repeated facial
plays engrave stereotypical features into a person's face. A person's life
can often be read by reading their facial features - usually after around 35
years of age. Both Confucius and Albert Camus claimed that every human being
is responsible for his/ her face after a certain number of years. In other
words, our face is our business card.
The Australian plastic
surgeon Bryan Mendelson has worked out an impressive study which compares
the anatomy of the human face with facial features of animals and with faces
from ancient history. The faces of crocodiles and other reptiles, of fish
and of birds are relatively longer. The skulls of mammals and human beings
expand in accordance with the growth of the brain while the soft parts of
the face shrink. With the progression of age, the soft parts come loose and
bring about the typical characteristics of old age. This does not happen to
fish, crocodiles or birds.
Duncan Rowland of St.Andrew
University in Scotland defined the prototype of a "hyper woman": a female
face which suggests a need of protection due to the baby-face phenomenon
which consists of a small nose, big eyes and a close distance between eyes
and chin. Added to this "baby face" are high, curved eye brows, full cheeks
and a relatively big mouth, full lips.
The level of participation
of over 60-year olds in public life has changed remarkably over the past
century. While they used to withdraw themselves almost completely from
public life, the majority now maintains an active role in society;
especially in their private lives but also in their professional lives -
harvesting the fruits of their lives' achievements. Rejuvenation has become
a highly important factor for the quality of life.
Of all types of aesthetic
surgery, FACELIFTING is considered the "royal discipline". In the course of
the last three decades the results in face-lifting surgery have considerably
improved. We have been able to expand our anatomical and physiological
knowledge of the face. We have made out five different topographical- mimic
parts of the face: 1. forehead, 2. eye brows and eye lids, 3. nose and
middle face, 4. lips and chin, 5. double chin and neck. Four deeper layers:
upper skin, skin, SMAS with muscles and connective tissue elements and bone
skin (periost).
Plastic surgery can be
conducted in all facial "levels" and deeper layers (lifting eye brows,
lifting the eye corners, lifting mouth corners; correction of "lemon
wrinkles" around lips, of crows' feet around the eyes, of pudgy cheeks or of
radial necklaces, etc.). Softening facial contours, filling up volume,
harmonising mimic features, improving facial symmetry - harmonic
rejuvenation and beautification procedures have replaced methods of often
excessive stretching and tearing-back of skin.
The stretching of the
deeper layer has lasting effects. The skin is slipped over the ears and the
surplus is moderately removed in order to keep the skin suture without
tension. That way we achieve harmonic looks that do not leave traces of
surgical intervention - as opposed to earlier results: horrific images of
mask-like, mimic-less wind tunnel faces.
Most patients lament over
their "tired looks". Their self-perception does no longer correspond to the
image they confront in the mirror. Those people are usually denied the
characteristics of efficiency, and sometimes even a zest of life. As a
matter of fact, our patients usually do not want to look different - they
only want to look better.
Each face is unique. Every
person's face consists of many important details and therefore each face
requires a special "recipe". An analysis of the face must precede the
planings of an operation at the
centre of which should be
the patient's wishes. It is of utmost importance that the surgeon listens
carefully to his/ her patient's wishes and ideas. The result should be a
younger looking patient with more harmonic, more beautiful features and with
more dynamic facial plays. The relocated hairlines should not be visible,
ear lobes should not look as if they were amputated, scars should be hidden
if possible - and all that with lasting effects. Plastic surgery patients
will regain their social and erotic appeal by re-establishing their
self-esteem. We are happiest if our patients get to hear from their friends
and colleagues: "Well, you seem refreshed after your holiday."
On the opening day of the
last World Congress of Plastic Surgery in Sydney (15.08.03), an important
round table was initiated:
“New Concepts of Facial
Rejuvenation”
The subjects were: new
methods, refinement of traditional techniques, body fat transplantation for
volume increase as well as various wrinkle fillers, various tendencies, new
cutting techniques, etc. All global experts agreed on identifying the
follwing trends:
OUT:
stigma faces,
"surgery looks"
general anaesthetics
IN:
facial harmony
shorter scars
shorter recovery time
ambulant surgery procedures
Only 20 years ago,
face-lifting patients remained in hospital for a full week. Today, most
patients can opt for ambulant surgery. Those patients undergo surgery by
"dozing sleep" combined with local anaesthetics. Over 60 % of all plastic
surgery patients can return to their social lives after 7 days - in other
words: after the long threads have been removed, after the patient is
allowed to wash his/ her hair. Things have improved tremendously.
Yet something remains: the
biggest risk in any type of surgery is the surgeon. If a surgeon has not
received excellent education, if he/ she lacks sufficient experience -
especially if he/she is not aware of his/her own inadequacies-, the patient
is exposed to an enormous risk.
D.Panfiov
