Alloplastic facial contouring: Surgery of the fourth plane

Abstract

Plastic surgeons are now better prepared to fulfill the primary goal of facial aesthetic surgery. By manipulating and combining the various new techniques, they can restore, rejuvenate, or enhance facial form and affect aging changes. Infinite variations in facial contour can now be achieved with alloplastic facial implants. By using techniques based on the concepts of zonal anatomy, the facial skeleton can be augmented with a minimum of complications. Alloplastic onlay techniques significantly improve facial contour to correct both hereditary deficiencies in youth as well as aging changes. The use of implants in the "fourth" skeletal plane, as defined by the author, represents the newest favorable manipulation of volume.

Injectable Hyaluronic Acid Implant for Malar and Mental Enhancement

“…A variety of alloplastic implants have been used for enhancing the malar and mental facial zones. [6][7][8][9][10][11] These implants have been of a variety of materials including silicone rubber 9,10 and Silastic (Dow Corning, Midland, MI) material. 11 There have been a variety of techniques used including a transbuccal approach.…”

“…Some of these solid implants have also been noted to lead to underlying bone resorption. 6 The use of this more viscous injectable implant has proved to be successful in the patients treated, The use of Restylane and Restylane Perlane since 2000 has been associated with very few (less than 1:2,000) delayed reactions. 1,4 The authors are hopeful this will also be the case with SubQ.…”

“…We believe that this injectable device may have safety and delivery advantages over some alloplastic implants previously described. [6][7][8][9][10][11]…”

Lift-and-Fill Face Lift

“…The concept of facial volume restoration is not new and has long been advocated by previous surgeons as an important concept in facial rejuvenation. [1][2][3][4][5][6][7][8][9] Fat grafting can serve as an isolated rejuvenation technique or as a powerful complement to "lifting" of the facial structures. Evidence for deflation as a primary Disclosure: Dr. Rohrich receives instrument royalties from Micrins Instruments and book royalties from Quality Medical Publishing.…”

Evolution of Midface Rejuvenation

“…This concept was first addressed in 1992 by Terino 16 when he published his concept of facial rejuvenation using alloplastic facial contouring. He felt that by using techniques based on the concepts of zonal anatomy, the facial skeleton could be augmented with a minimum of complications.…”