Aesthetic Surgery Concepts

Principles & Key Facial Procedures - Fab Foundations

• Core Principles:
  • Patient assessment: Medical, psychological, expectations.
  • Informed consent: Risks, benefits, alternatives (RBA).
  • Facial analysis: Proportions (thirds, fifths), symmetry.
  • Asepsis, meticulous technique.
• Key Facial Procedures:
  • Rhinoplasty:
    • Indications: Aesthetic, functional (e.g., deviated septum).
    • Approaches: Open, closed. Grafts: Septal, conchal.
  • Blepharoplasty:
    • Indications: Dermatochalasis, steatoblepharon.
    • Upper: Skin/muscle/fat excision. Lower: Transcutaneous/Transconjunctival.
  • Rhytidectomy (Facelift):
    • Indications: Jowls, neck laxity.
    • Key: SMAS manipulation.
  • Brow Lift: Corrects brow ptosis (e.g., endoscopic).
  • Genioplasty: Chin augmentation/reduction for harmony.

⭐ The Frankfort horizontal line (inferior orbital rim to superior auditory meatus) is a key reference in facial analysis, vital for rhinoplasty and orthognathic surgery.

Facial Rejuvenation & Breast Aesthetics - Uplifting Updates

• Facial Rejuvenation:
  • Rhytidectomy (Facelift): Addresses jowls, neck laxity. SMAS manipulation (plication/imbrication) is crucial. Incisions: pre/post-auricular.
    • Complications: Hematoma (most common, ~1-8%), facial nerve injury, skin necrosis.
  • Brow Lift: Corrects brow ptosis, forehead rhytids. Endoscopic technique common. Targets corrugator/procerus.
• Breast Aesthetics (Mastopexy):
  • Corrects ptosis; NAC repositioning. Regnault Classification (Grades I-III, Pseudoptosis) guides technique.
  • Incision patterns: Periareolar, vertical (lollipop), inverted-T (Wise). Choice based on ptosis severity.
  • Augmentation-mastopexy for volume + lift.

⭐ Hematoma is the most frequent complication post-rhytidectomy, potentially compromising flap viability.

Body Contouring Techniques - Shaping Sprees

• Liposuction: Removes localized fat deposits.
  • Techniques: Suction-Assisted (SAL), Ultrasound-Assisted (UAL), Power-Assisted (PAL), Laser-Assisted (LAL).
  • Tumescent infiltration: Saline, epinephrine (vasoconstriction), lidocaine (anesthesia). Max lidocaine dose 35-55 mg/kg.
• Abdominoplasty (Tummy Tuck): Addresses skin laxity, fat, diastasis recti.
  • Variations: Mini, full, extended, fleur-de-lis based on extent of excess tissue.
• Brachioplasty (Arm Lift): Corrects "bat wing" deformity of upper arms.
• Thighplasty: Medial or lateral approaches for inner/outer thigh skin laxity.
• Body Lift (Belt Lipectomy): Circumferential excision, often post-massive weight loss.

⭐ SAFE Liposuction technique (Separation, Aspiration, Fat Equalization) aims for smoother results and reduced contour irregularities, enhancing safety and aesthetic outcomes.

Minimally Invasive Options - Subtle Shifts

• Botulinum Toxin (BoNT-A)
  • Mechanism: Blocks ACh release (NMJ).
  • Indications: Dynamic rhytids (glabella, crow's feet, forehead lines).
  • Effect: Onset 3-7 days, lasts 3-6 months. Glabella: ~20U.
  • ⚠️ Ptosis, asymmetry, diffusion.
• Dermal Fillers
  • Hyaluronic Acid (HA): Most common, reversible (hyaluronidase). For volume (lips, cheeks), static lines. Lasts 6-18 months.
  • Others: CaHA, PLLA (collagen stimulators).
  • ⚠️ Vascular occlusion (emergency!).
• Chemical Peels
  • Types: Superficial (AHA, BHA, Jessner's, low % TCA), Medium (TCA 35-50%), Deep (Phenol-Croton oil).
  • Depth: Epidermis to reticular dermis.
  • Uses: Photoaging, dyschromia, acne scars.
• Microneedling: Collagen induction therapy; improves scars, texture.

⭐ Hyaluronidase is the antidote for HA filler-induced vascular occlusion, a critical emergency that requires immediate intervention to prevent tissue necrosis. Dosage varies, typically 150-200 units per affected area, repeated as needed based on clinical response (e.g., capillary refill improvement).

High‑Yield Points - ⚡ Biggest Takeaways

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