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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
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.