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Chapter 13
Primary Care Otolaryngology
skin and muscle. However, this must be done with great care, as there is
little margin for error, especially around the lower lid.
Occasionally, the eyebrows lie below the level of the superior orbital rim
and may be a part of the problem as well. This is called brow
ptosis
and
can cause an apparent excess of skin in the upper lid. Elevation of the
brow with a
brow lift
can reduce redundant skin of the eyelids and is an
important part of facial rejuvenation in some patients.
Nonsurgical Facial Rejuvenation
Improvement of facial wrinkles (rhytids) can be achieved through several
methods. One of the most popular treatments is the injection of medicines
known as
neurotoxins
to weaken facial muscle contractions and improve
the wrinkles caused by them. Deeper rhytids or folds may be helped with
the injection of fillers. Fillers can also be used to restore volume to the lips
and other areas that have lost volume as part of the aging process. Chemical
peels and laser resurfacing remove the outer layers of the skin, and the new
skin formed with healing has less sun damage and wrinkles. Many types of
lasers are now available to treat a variety of cosmetic concerns in the office
setting with little down time for the patient. Improvement in sun spots,
birthmarks, and unwanted hair are just a few of the problems commonly
treated. All of these procedures are part of the office-based practice of many
otolaryngologists or facial plastic surgeons.
Otoplasty
Some people have ears that stand out further than normal from their head.
This is usually congenital, and anatomically is due to an unfurled
antihelical
fold, a deep
conchal bowl,
or both. Many children are viciously teased by
their peers because of their prominent ears. Surgical correction of the ears
is a relatively simple and very satisfying operation. Interestingly, many third-
party payers feel this is “cosmetic” surgery and refuse to pay for it. They
seem to ignore the tremendous difference between the person who looks
normal and wants to look better (cosmetic surgery) and the person who
looks abnormal and wants to look normal (reconstructive surgery).