Primary Care Otolaryngology

Facial Plastic Surgery

nostrils and entails realignment of the septum into the midline. Changing the external contour of the nose is called rhinoplasty . The most important part of rhinoplasty is maintaining or improving the airway, so a septoplasty is often performed as part of this procedure. Common indications for rhinoplasty include previous trauma, with result- ing crooked nose as well as a dorsal hump. Many patients undergo rhinoplasty to achieve better proportion between the size of their nose and their face, or to improve the shape of the tip alone in an otherwise attractive feature. Rhinoplasty can be accomplished using incisions that are entirely inside the nose (closed) or combined with a small incision across the columella (open) for improved access for placing grafts and sutures. Facial Rejuvenation Rhytidectomy Rhytidectomy or “facelifting” is a much more common procedure than in the past. There are many variations in technique, but most involve an incision hidden around the ear, with undermining of the skin and tightening of the muscle and tissue layers underneath. This is commonly combined with other procedures for more thorough facial rejuvenation. Blepharoplasty Blepharoplasty is often performed by otolaryn- gologists who perform facial plastic surgery. When the upper eyelid skin becomes redundant, it can actually obstruct the upper field of vision. When this is the case, the skin can be removed to allow better vision. While this is the main func- tional benefit of a blepharoplasty, patients often also desire some cosmetic changes around their eyes. Bulges that occur below the eyes consist of orbital fat pressing against a weakened orbital sep- tum. This fat can be resected, along with extra

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Figures 13.3 a, b Pre- and post-op photographs of a woman who has undergone facial rejuvenation. She has had surgery to her eyelids (blepharo- plasties), removal of fat from her neck (liposuction), and resection of excessive facial skin (facelift). Improvement in facial appear- ance is often dramatic (as in this case), and secondary benefits through enhancement of self- esteem may be even more dramatic.

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