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The
Face
The search for cephalometric relationship
in pictures that have been recognized as beauty symbols in
every epoch permits identifying constant values that may be
found both in Renaissance paintings as well as in today's
beauties.
Beauty
contains the idea of proportion, a word that derives from
the Latin pro portio (the correct
ratio between the parts) that provides it with
a universally comprehensible meaning.
Especially
during the Renaissance, a true geometry
of beauty was attained, following the "rule
of three" inspired by Euclid. The cephalometric planes
were identified by Leonardo da Vinci who translated the ratios
between the physiognomic regions into intersecting lines and
showed the simple rule of the multiples 
that reveals the shape of the profile: three spaces, equal
to the height of the ear or nose are the same as the distance
between the menton and the trichion.
The
constant ratio in regular profiles between the nasion, the
subnasale and the pogonion, these being cephalometric points
susceptible to change after surgery, suggested including the
profile in a triangle divided in two equal parts.
To
make surgical planning simpler and more rapid, we created
a fan
ruler that instantaneously carries out the
cephalometry of the profile, which can be subject to modification
depending on the surgeon's aesthetic taste an experience.
In
fact, the variety of the face morphology and, therefore, corrective
surgical techniques thet are selected case by case cannot
be limited to an oversimplified geometric
interpretation. Moreover, cephalometric rules must
be interpreted in light of various factors: the plastic property
of the tissues, their ability to change in time and the age
and sex of the patient.
In
the young female
patient it may be appropriate
to overcorrect the nasal dorsum, in view of the tendency
of the nose to change shape in the course of the time, while
a decrease in volume is preferable in the adult,
with respect to the physiognomic identity.
Therefore,
surgical planning is neither
a simple measure of the facial size nor a mere question of
aesthetic taste, but rather a general evaluation of the relationship
between the soft tissue, the skin quality, the age and sex
of the patient and, lastly, the patient's expectations.
The
current tendency to perform corrective rhinoplasty with the
help of computerized
images or cephalometric evaluations is justified
by the need to adapt the amount of correction to all the cephalometric
ratios and draw on indications regarding the exact quantity
of tissue to remove or add, however "precision
rhinoplasty" is not a synonym for an absolute
foreseeable result, except in cases thet require a very small
amount of tissue removal (up to 3 mm, considered as the average
between the maximun width of the portion removed from the
dorsum and caudal septum). Beyond these limits, the operation
itself involves structural alterations thet may escape even
the most careful operation analysis.
The
Body
Anthropometric analysis,
the starting point of surgical planning, detectes irregularities
of the body shape, in reference to standardized models.
Readjustment of the body's topography and restoration of its
proportions also allow for the remodeling of furrows
caused by adherence between skin an deeper layers,
such as facial wrinkles
as well as submammary and subgluteal
creases, which define and characterize the physiognomy
of the corresponding anatomic areas.
Currently,
female beauty encompasses more elongated
shapes than in past eras. The perineum is in the
middle of the body. The ideal ratio between hips and waist
is 0,6 to 0,7, and three equal equilateral triangles circumscribe
the dorsum and lower limbs.
The buttocks can be inserted into a rectangle drawn according
to Euclid's golden rule. The diagonals of the golden rectangle
intersect each other over the sacrum, which, in turn, mirrors
the triangular area of the pubis.
Surgical Sculpture
Anesthesia
The patient is subjected to surgery under local
anesthesia with preoperative nonnarcotic analgesics.
Frozen metal plates are placed over the points at which tumescent
infiltration will be performed with an automatic injection
syringe.
Anesthesia
of the abdomen by automatic injection syringe
Instruments
Vacuum
pumps are suitable for deep-layer
liposuction. For superficial touch-ups,
syringes are used. Facial lipofillings is performed using
cannulas 2-mm in diameter; whereas 3-mm cannulas are used
for the body.
Cannulas
for liposculpture
Needles,
cannulas and rhytisectors are used to lyse the wrinkles
and stimulate fibroplasia. Human body aesthetics
are characterized by an alternation of concave and convex
forms and by lines that define the different physiognomic
areas. On the basis of anthropometical
models, preoperative planning determines the use
of one ore more of the many available techniques so as to
reconstruct harmonious body proportions.
Facial
wrinkles
The
effects of atrophy and gravity, combined with muscle action,
cause wrinkles to form.
Restoration
of subcutaneous tissues by means of fat
grafting expands the skin and returns
it to smoothness. Lipofilling, like kiposuction takes cephalometric
ratios into account because the aim of surgical remodeling
is to restore the correct facial
proportions, not merely to erase wrinkles.
Augmentation
of the labial, glabellar and zygomatic regions restores harmonious
cephalometric ratios. In line with the general antigravitary
formula that inspires the surgical techniques for
body remodeling, the suctioned cervical hypertrophic fat may
be transferred to the hypotrophic zygomatic area.
Buttocks
Liposuction
may cause sliding in areas surrounding the treated part. Simple
reduction of the preiliac and pretrocanteric fat masses may
trigger two consequences: lowering of the buttocks and an
apparent lengthening of the subgluteous crease.
These
gravity induced effects can be counterbalanced by lipo-filling
strategic areas.
In
conjunction with rhytidolisis, lipofilling can shorten the
subgluteal crease. This successful technique used in slim,
young patients with firm gluteal mass contributes to the lenghtening
effect of the silhouette.
Rotular
Folds
Modeling
of the lower legs is essentially an overall volumetric reduction.
Fat hypertrophy produces sovrarotular
transversal folds. Liposuction an skin detachment
enables their depth to be reduced, restoring the knee's natural
shape.
C
E N T E R F O R R E S E A R C H I
N T O T I S S U E P L A S T I C I
T Y
Copyright
© 2008
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