AAO-HNSF Primary Care Otolaryngology Handbook

FACIAL PLASTIC SURGERY

changes around their eyes. Bulges that occur below the eyes consist of orbital fat pressing against a weakened orbital septum. This fat can be resected, along with extra skin and muscle. However, this must be done with great care, as there is little margin for error, especially around the lower lid. Occasionally, the eyebrows lie below the level of the superior orbital rim and may be a part of the problem as well. This is called brow ptosis and can cause an apparent excess of skin in the upper lid. Elevation of the brow with a brow lift can reduce redundant skin of the eyelids and is an important part of facial rejuvenation in some patients. Nonsurgical Facial Rejuvenation Improvement of facial wrinkles (rhytids) can be achieved through several methods. One of the most popular treatments is the injection of medi- cines known as neurotoxins to weaken facial muscle contractions and improve the wrinkles caused by them. Deeper rhytids or folds may be helped with the injection of fillers . Fillers can also be used to restore volume to the lips and other areas that have lost volume as part of the aging process. Chemical peels and laser resurfacing remove the outer layers of the skin, and the new skin formed with healing has less sun damage and wrinkles. Many types of lasers are now available to treat a variety of cosmetic concerns in the office setting with little down time for the patient. Improvement in sun spots, birthmarks, and unwanted hair are just a few of the problems commonly treated. All of these procedures are part of the office-based practice of many otolaryngologists or facial plastic surgeons. Otoplasty Some people have ears that stand out farther than normal from their head. This is usually congenital, and anatomically is due to an unfurled antihelical fold, a deep conchal bowl , or both. Many children are teased by their peers because of their prominent ears. Surgical correction of the ears is a rela- tively simple and very satisfying operation. Interestingly, many third-party payers feel this is “cosmetic” surgery and refuse to pay for it. They seem to ignore the tremendous difference between the person who looks normal and wants to look better (cosmetic surgery) and the person who looks abnormal and wants to look normal (reconstructive surgery).

75

www.entnet.org