Basic Principles of Facial Plastic Surgery

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Basic Principles of Facial Plastic Surgery

• ?.?.??.?????? ??????????????
  ?.?.,?.?.(ENT),?.?.(Facial Plastic)
• ????????????????????? ??? ????? ????????????
• ????????????? ?.?????????? (???????????)

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The skin epidermis

• 1.stratum corneum2. stratum lucidum3.
  stratum granulosum4. stratum spinosum5.
  stratum germinativum basal cell

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(No Transcript)
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 Dermis corium

• 1.papillary layer
• 2.reticular layer
• subcutaneous

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Basic principles of wound closure

• closure approximate the soft tissue
• accurately and gently
• 1.instruments
• 2.suture material
• 3.surgical technique

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Instrument

• short 4-6 ???? lightweight needle holder
• fine skin hooks
• fine sharp teeth tissue forceps

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Suture material

• stainless steel
• monofilament synthetic strands prolene,nylon
• braided synthetic sutures vicryl, dexon
• silicone-coated silk
• regular silk
• plain catgut and chromic catgut
• produce tissue reaction ?????????

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Subcutaneous tissue closure

• ???? neck ??? simple interrupted suture 3-0
  ???? 4-0 dexon ??????? 1 ?.?.
• ???? face ??? ????? 4-0 ???? 5-0 dexon sutures
  ???????????????????????? ???????????? Dog ear
  ?????? ?????????????????

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• skin closure ????????????? ??????????????
  ????????????????
• interrupted suture
• continuous suture
• subcuticular suture
• staples
• steri strips
• ????????? skin slightly evert ??? 6-0 nylon
  ????????????

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General principle of wound closure

• ???????????????? ??????????????? ??? ??????????
  ???????? ??? ????????
• ??? crosshatch ????????????? ????????????????????
  ????????
• ??????? ????? ??????? ??????????? ???????
  ????????
• surgical knots ???? ??????? ??????????
• ??? headlight ???????????????? ?????????????

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Wound closure

• ??????????????????? aseptic technique
  ???????????? ??????????? ?????????????
  tattooing ??? foreign material
• ???????????????? ????????? injury ??? tissue
  ?????????? ?????? ?????? ?????????????????????
  ???????????????? ??????? bipolar ????????
  unipolar
• ??? deep space ?????????????? ????????????
  ??????????? ???????? space ??????? penrose drain
  ????pressure dressing ???

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??????????? ??????????? ????? 2 ?????????
peroxide ?????? ointment ?????????????????????
???????????

• ??? ???????????? ?????? ?????? 3-4 ???
  ?????????????? steri strips
• ???????? ?????? ?????? 5-7 ??? ????????
  delayed wound healing ???? infection ????
  delayed ??????????????

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Minimizing the visual impact of scarring

• hide incision ?????????????????? ???? ???? ,????
• incision ??? wrinkle ???? skin crease relaxed
  skin tension line

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• incision ????????????? ???? ??????????
  ??????????

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• ?????? Z-plasty technique ???????????????????
  (RSTL)
• Zigzag plasty ?????????????? ????????????????????
  ???????????? ?????????????????????

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Local flaps

• ????????????? relaxed skin tension lines
  ???????????????????????????????? Local flaps
• Blood supply ??? local flaps ????????????
  random pattern ??? surviving ??? flaps
• ??????????????????????? flaps ??? base

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Classification

• advancement
• rotation
• transposition
• interpolation

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Design

• Advancement flaps
• rectangular
• fusiform

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• Rotation flaps

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• simple rotation
• v-y rotation
• o-z rotation

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• Transposition flap
• simple transposition
• bilobed

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• Rhombic
• z-plasty

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Application

• central forehead
• temporal
• medial canthus and cheek
• lateral cheek
• nose

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Rhinoplasty

• Asian nose broad , flat dorsum
• associated wide lobule
• Anatomy of most asian noses requires for
  augmentation rhinoplasty ??????? reduction
  rhinoplasty ????? caucasian

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Silicone
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• augmentation rhinoplasty using silicone
  implants
• ??????????? anatomy ??? nose
• Nasal proportion ??????????? ?????? 1/3
  ?????????

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• bony pyramid
• Maxillary ascending process
• nasal bone
• bony septum
• cartilaginous pyramid
• quadrangular cartilage
• upper lateral cartilage

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mobile nasal tip

• paired alar cartilages
• surrounding soft tissue

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Surgical technique

• ????????????? ??? lacal anesthesia
• ?????? 2 xylocaine adrenaline
• ??? ?????? dorsum , alar , nasal tip

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• ?????? midline pocket ?????????? marginal
  incision ???? extend into columella
• ??????? ???? silicone ??????? ?????? ????
  ??? ???????? autoclave 20 ????

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Post operative rhinoplasty
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Complication

• implant malposition
• infection
• extrusion
• skin discolaration
• alar asymmetry