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Italian
Association for Research into Tissue Plasticity
CREASES,
FOLDS AND WRINKLES
MORPHOGENESYS, MORPHODYNAMICS AND SURGICAL
CORRECTION
PASQUALE
FRUSCELLA M.D. ©
2007
Ettore
Lalli - 1920
The
role of anthropometric analysis in plastic surgery
Surgical
body modelling must be planned in conformity with anthropometrical
parameters.
Before commencing work, the surgeon, like a sculptor, must
draw up plans according to the principles of beauty. Anthropometric
analysis, the starting-point of surgical planning, detects
irregularities of body shape referred to standardized models.
Readjustment of the body's topography and restoration of its
proportions also allows for the remodelling of furrows caused
by adherence between skin and deeper layers - such as facial
wrinkles, sub-mammary and sub-gluteal creases - which define
and characterize the physiognomy of the corresponding anatomic
areas.
Plastic
surgery and the bio-dynamics
of the human body
Remove and add, the two fundamental theorems inspiring figurative
arts and aesthetic plastic surgery, are combined into an action
whose goal is to restore the body's proportions; with the
difference that the material with which the surgeon works
has an in-built, autonomous reason to change shape, due to
continual cell replacement. Surgical techniques must therefore
be integrated into the bio-dynamics of the human body, accomplishing
a remodelling task that, wherever possible, prevents as well
as corrects defects and irregularities of the body contours.
Since the surgeon operates on a body in evolution, the quality
of the results will also depend on a number of
adjustments and additional touches. Restoring of the
body's symmetry and harmony are the goals of aesthetic plastic
surgery.
Anthropometric
relationships
The
aesthetics of the human body is a balance of furrows and orifices,
and artists of every period have studied the distance
between ear and eye, eye and nostrils, nostrils and mouth,
nipple and sub-mammary crease, sub-gluteus folds and iliac
crest and so on, to create a code for all body proportions.
Today,
female beauty encompasses more elongated
shapes compared to past eras: the perineum is in
the middle of the body, the ideal ratio between hips and waist
is O.6/0.7, three equal equilateral triangles circumscribe
the dorsum and lower limbs.
The
face had cephalometric relationships  that
can be simplified using the length of the nose and the width
of the eye as parameters. The face is divisible into three
parts, each equal to the length of the nose
(Leonardo's rule).
Instruments
Where
it is not expected to perform fat-grafting, and if the amount
of fat to be aspirated exceeds one litre, a vacuum pump is
suitable for deep layer liposuction. For superficial touch-ups
a metal syringe may be used; this consists
of threaded parts. The serrations on the plunger enable the
vacuum pressure to be regulated according to the technique
and body area being treated. The vacuum pressure is adjusted
via an easily accessible button. The cannulas are screwed
onto the cartridge, which contains a 60 cc. disposable syringe.
Fat-Grafting
The
suctioned fat, stored in disposable syringes ,
rises rapidly to the top of the aspirated liquid, which can
be expelled simply by pushing the plunger. The fat can be
washed with Ringer-Lactate solution and again extracted by
decanting.
Facial lipo-filling is performed using 2 mm. diameter cannulas,
while 3 mm cannulas are used for other body areas.
Rhytisection
A 16 G needle with tip bent to 90° is used to
undermine facial wrinkles. The needle is mounted on
a handle and pushed forward and back through the subcutaneous
tissue to lyse the wrinkles, and rotated to stimulate fibroplasia Morphodynamics
and Surgical Correction of the Body's Creases, Folds and Wrinkles
The gluteal sulcus is undermined by cannulas and rhytisectors
with V-shaped or spatula tips.
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.
Lipo-filling, like liposuction, takes cephalometric ratios
into account, because the aim of surgical remodelling is to
restore the correct facial proportions, not merely to erase
wrinkles
Additive techniques in aesthetic plastic surgery increase
the distance between the anthropometric points, and this must
be considered during surgical planning. Augmentation of the
labial, glabellar, and zygomatic regions restores harmonious
cephalometric ratios.
In line with the general antigravity formula inspiring surgical
techniques for body remodelling, when appropriate, the suctioned
cervical hypertrophic fat may be transferred to the hypotrophic
zygomatic area
Buttocks
Picasso gave a modern interpretation of the shape of the buttocks
in his 1907 studies of Demoiselles d'Avignon. He stylized
the buttocks by drawing an upside-down triangle, set in a
similar width, U shaped figure. The buttocks can be inset
into a rectangle drawn following 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
Liposuction
may cause sliding in areas surrounding the treated part. Simple
reduction of the preiliac and pretrocanteric fat masses might
trigger two consequences: a) lowering of the buttocks, b)
an apparent lengthening of the sub-gluteus crease.
These gravity-induced effects can be counter-balanced by filling
strategic areas.
Rotular Folds
Modelling
of the lower legs is essentially an overall volumetric reduction.
Fat hypertrophy produces sovra-rotular transversal folds.
Liposuction and skin detachment enables their depth to be
reduced, restoring the knee's natural shape. Moreover the
disappearance of the folds contributes to a slender appearance
of the leg
©
2007 PASQUALE FRUSCELLA
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