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The aesthetic surgery in the field of oral and maxillofacial surgery
aims at forming the patient’s appearance according to
the norm, therefore improving it. The treatment affects hard
as well as soft tissue structures: correction of maxillofacial
contours, correction of the eyelids, of the nose’s shape,
the facial soft tissue, the soft tissue of the throat, the
form of the chin, the correction of fat deposits, correction
of the skin structures and correction of the auricle. The
aesthetic assessment of the starting situation is exposed
to subjective criteria. The decision about what treatment
measures will be taken should be discussed in a dialogue between
patient and doctor that takes into account subjective and
objective criteria and assessment possibilities. Benefits
and risks should be weighed against each other.
For the therapy of facial soft tissue, the oral and maxillofacial
surgeon has a wide range of options. The methods used in the
aesthetic facial surgery were to some extent developed from
methods used in oral and maxillofacial surgery and are used
also for treating pathological changes in the facial area.
An intact and symmetrical structure of the skeletal hard tissue
framework is an indispensable requirement for achieving good
soft tissue results.
Whilst in other areas of the body the soft tissue, which covers
the hard tissue, can show a considerable thickness, the soft
tissue in many places of the facial area is extremely thin.
Therefore, the facial soft tissue follows the contour of the
underlying hard tissue much more than in other parts of the
body. Volume and contour deficits of the hard tissue can be
corrected only to a limited extent with soft tissue. In addition,
the facial soft tissue is in an area that has to meet very
high aesthetic demands. The quality of the facial soft tissue
determines whether a person looks young and dynamic or old
and tired.
While only a harmonious framework is required from the hard
tissue, as it is not directly on the surface, more differentiated
parameters have to be considered in the assessment of the
soft tissue. The soft tissue covers the viscerocranium
and consists of different histological tissues and functional
units, which can be exchanged or replaced with each other
only to a very limited extent. In contrast to the hard tissue,
the soft tissue is affected much more by the ageing process
and certain metabolism dependencies.
Soft tissue management includes total tissue and organ replacement
therapy after ablative surgery
in tumor patients as well as in
patients with traumatogenic defects and the improvement of the soft tissue
that has degenerated through the ageing processes.
For total tissue replacement, we use techniques of the free
autologous tissue transfer and microvascular
transplant surgery techniques. Recently, we have adopted some
of the techniques from tissue engineering as well, which will
probably at least outweigh transplant surgery,
if not completely replace it in the future.
In cases, where an organ or soft tissue replacement is not indicated
or not possible, an epithetic device can be mounted, which
can be fixed retentively with auxiliary structures (e.g. glasses)
or with transplants.
a) Total
tissue replacement
1. Free tissue replacement (split-thickness skin, hair transplantation,
liposculpture with inherent fat,
use of alloplastic materials)
2. Microvascular tissue replacement
3. Local flap plasty
4.Tissue Engineering
5. Epthetic Replacement
b) Soft Tissue Improvement
1.
Facelift
2.
Nose Corrections
3.
Eyelid Surgery
4.
Scar correction through surgical
techniques, dermabrasion, laser
or chemical ablation
5.
Rhytidectomy (face, throat)
6.
Auricle Correction
7.
Epilation
8.
Line treatment
9.
Tissue augmentation
10.
Soft- and hard
laser therapy
11.
Dermabrasion
12.
Liposculpture
13.
Chemical Dermablation
14.
Tatoos
15.
Physiotherapy
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