Facial plastic surgery is a specialized field of medicine that focuses on the restoration, reconstruction, and enhancement of the face and neck. Procedures involve modifying or repositioning tissue, bone, and skin to improve both the function and the appearance of facial structures. The term “plastic” originates from the ancient Greek word plastikos, meaning “to mold” or “to shape,” and does not refer to synthetic material. This practice is dedicated to modeling living tissue to achieve a desired form. The specialty addresses congenital differences, repairs trauma damage, and performs elective procedures.
The Distinction Between Aesthetic and Reconstructive Goals
Facial plastic surgery is defined by two distinct missions: aesthetic and reconstructive. Aesthetic surgery, often called cosmetic surgery, is elective and focuses on enhancing appearance by altering structures that are otherwise normal. Patients pursue these procedures to improve symmetry, proportion, or reverse visible signs of aging. Reconstructive surgery is medically oriented, seeking to restore form and function to damaged or abnormal structures. This type of surgery corrects impairments caused by trauma, disease, or developmental conditions, with the primary purpose being to reestablish normal function, such as the ability to breathe or see clearly.
Common Procedures for Facial Rejuvenation
Facial rejuvenation procedures address the effects of sun exposure, gravity, and the natural loss of skin elasticity associated with aging. The facelift, or rhytidectomy, targets the lower two-thirds of the face and the jowls. This operation involves tightening the underlying muscle and connective tissue (the SMAS layer) and redraping the skin to create a smoother, more youthful contour.
Eyelid surgery, or blepharoplasty, focuses on the periorbital area, which often shows the earliest signs of aging. An upper blepharoplasty removes excess skin that can cause a hooded appearance or obstruct vision. A lower blepharoplasty addresses undereye bags and puffiness by repositioning or removing fat and tightening the skin.
A brow lift, also known as a forehead lift, corrects a sagging brow that creates a tired or heavy appearance over the eyes. Techniques like the endoscopic brow lift use small incisions hidden within the hairline to lift and anchor the forehead tissues. For the lower face, a neck lift (platysmaplasty) removes excess skin and fat while tightening the platysma muscle. This procedure eliminates vertical neck bands and defines the jawline, creating a slimmer profile.
Common Procedures for Structural Modification
Procedures for structural modification alter the bony or cartilaginous framework of the face rather than reversing aging effects. Rhinoplasty, commonly known as a nose job, reshapes the nose by modifying the bone and cartilage structure to improve appearance or correct breathing issues. The surgeon may reduce a prominent dorsal hump, narrow the bridge, or refine the nasal tip, sometimes using cartilage grafts.
Chin augmentation, or mentoplasty, modifies the size and projection of the chin to achieve better facial proportion. This procedure often uses solid silicone implants placed over the bone, or it can involve moving the patient’s own bone forward, a technique called genioplasty. A balanced chin profile is often considered in conjunction with rhinoplasty to ensure overall facial harmony.
Cheek augmentation aims to increase the prominence of the midface to create defined cheekbones or restore volume. This is achieved through the surgical placement of solid implants or by using the patient’s own fat harvested from another body area. Otoplasty, or ear pinning, corrects overly prominent or misshapen ears. The surgeon makes incisions behind the ear to reshape the cartilage, pinning the ear closer to the head to improve symmetry.
Reconstructive Applications
Reconstructive facial surgery focuses on restoring a patient’s health and quality of life. A common scenario involves repair following severe facial trauma, including complicated lacerations or the reconstruction of facial bone fractures. Surgeons utilize specialized techniques to manage these injuries, ensuring proper bone alignment to maintain facial structure and function, such as correct vision or jaw movement.
Post-oncological reconstruction is an important area, particularly after the removal of skin cancers like basal cell or squamous cell carcinoma. Following Mohs surgery, plastic surgeons repair the resulting defect using local tissue flaps, skin grafts, or other advanced methods. This ensures the wound heals while minimizing scarring and preserving the function of nearby features like the nose or eyelid.
Congenital deformities are also a focus, with the correction of cleft lip and cleft palate in infants being common. These procedures involve repositioning tissue and muscle to close the separation and establish normal lip and nasal form. This is necessary for proper feeding, speech, and dental development.