Cosmetic Facial Surgery

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Facial injuries and wounds of the face cause lacerations and fractures with or without loss of soft tissue and bone and with or without displacements resulting in malocclusion of the teeth. In few other injuries is the final outcome so directly dependent on early proper care. The bony and cartilaginous framework of the face provides attachment for the muscles of expression and mastication and support for the teeth. The character of the face, the emotional expression, and the functions of chewing and eating all depend on a normal anatomical and functional relationship between these structures. By early reduction of all fractures, adequate splinting of the bones, and accurate closure of the skin and underlying soft tissue, the normal contours of the face can be restored, function reestablished, and scarring minimized. Before the operation can be performed, hemorrhage is controlled and obstructions to breathing are relieved. The only reasons for delay then are brain damage or other severe or critical injury.

A close cooperation between the plastic surgeon and the dentist in establishing the proper relationship between the teeth ensures success in the treatment of jaw fractures when loss of normal occlusion has occurred. Great care is exercised in restoring jaggedly torn skin edges in order to avoid distortions from inaccurate fitting of the skin margins.

Fractures of the nose are reduced from within the nose, and they may not need splinting if the supporting septum is uninjured. Most facial fractures can be reduced by an opening into the sinus of the cheek (antrum) through which the zygoma and collapsed bones of the cheek are brought into normal position and supported, if necessary, with a packing in the antrum. Fractures of the lower jaw and severe transverse fractures of the upper jaw require wiring of the teeth in occlusion for several weeks. Occasionally, it is necessary to support the structures of the face with a wire attached to the skull and passed downward through the tissues of the cheek to the mouth.

Not infrequently following severe facial injuries, secondary or later correction of disfigurement may be desirable. Ugly scars and deformities of the soft tissues of the face require excision and readjustment. Depressions are corrected by the insertion of bone or cartilage transplants, and small losses of skin are replaced with free skin grafts or with local flaps. More extensive skin losses, particularly those through the full thickness of the cheek, and the total loss of a part require the transfer of flaps of skin from other parts of the body. Support for a paralyzed face is secured with a sling of fascia lata attached to the temporal muscle. Nonunion or loss of substance of the jawbone may require bone grafting.

Experiences by plastic surgeons have stimulated interest in the wearing of seat belts by occupants of automobiles. They have also prompted manufacturers to add cushioning on dashboards, windshields that pop out on impact, and other changes in design to provide better protection.

After severe injuries and even after secondary operations, the face is seldom restored to its original appearance. If the results of the surgery do not attract attention and the patient can carry on his normal pursuits, however, the goal of the plastic surgeon has been achieved.

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