Pathophysiological factors in aging, associated with the need for implants for the face

It is generally accepted that patients endowed with strong, well-balanced skeletal characteristics better tolerate the destructive effect of age. Analysis of the faces of young people reveals the abundance of soft tissues, which are the basic harmonious structure of a young face. Its main characteristics are full cheeks and soft, symmetrical contours without sharp, uneven protrusions, notches or wrinkles, and without skin color irregularities. The facial structures, like the rest of the body, are constantly changing and are influenced by many factors (insolation, weight change, trauma or disease). Even physical exercises are involved in the formation of certain persistent and identifiable defects in the contour of the face. The development of lines and wrinkles is the result of hereditary factors, insolation and other environmental influences, smoking, concomitant diseases, gravitation and muscle contractions.

Depending on the underlying skeletal formations, the involutional changes in the soft tissues associated with the aging process cause different, but characteristic outlines of the face, which become more and more obvious and expressed with time. Identification of these various defects and configurations caused by aging is an integral part of successful corrective interventions. Such changes are the development of a common flattening of the middle zone of the face, thinning of the red border of the lips, the slackening of the cheeks, the formation of deep depressions on the cheeks, deep folds of the skin and wrinkles. Other, specific changes in soft tissues consist of an increase in the severity of nasolabial folds, a flattening of the soft tissue component of the chin, and the formation of an anterior cerebral groove.

Among the many techniques used in anti-aging facial surgery, there is still a lack of the ability to continuously recover the volume of soft tissues, in sufficient quantity and with a lasting effect. The new popularity of fat transplantation led to a reassessment of tissue replacement as a key moment in the rejuvenation process. However, if the auto-fat is not present, in the presence of atrophy of the soft tissues of the face, which can not be corrected by movement, the choice is limited to the replacement with alloimplants. Methods of alloplastic volume compensation can solve these problems by smoothing out acute angles or impressions, lifting the underlying surfaces to wrinkle, and correcting inadequate skeletal formations.

Surgical approaches to nasal enlargement

Relatively thin skin on the back of the nose often can not provide sufficient concealment of poorly contoured replacement tissues. The nose is enlarged using various materials. Currently, implants from silicone, PPTFE and polyethylene are most often used. Silicone over time causes a slight atrophy of the skin covering it and should be fixed to prevent displacement. Both PPTFE and silicone can cause the development of infectious processes, but implants from these materials are easily extracted and replaced. Polyethylene (Medpore) implants, as well as any other that allow significant ingrowth of tissue, can be removed, only with significant damage to surrounding tissues. Gomohryashch has a high percentage of resorption, and the autostability can be deformed.

Since human hyaline cartilage has limited ability to regenerate, effective long-term reconstruction of the nose remains problematic, despite constant attempts to use various autografts, allografts and allo-plastic materials. A suitable replacement implant designed to reconstruct the original profile of the nose must have a number of unique characteristics. It should be of adequate length and have a constant curvature, thickness and wedge-shaped edges, so that it can be well mounted over the bridge of the nose and have a smooth transition to the surrounding soft tissues and bone. In addition, it must be flexible and flexible to withstand the loads and injuries for a long time.

The use of an autocar tissue eliminates the problem of biocompatibility, but sometimes it is incapable of providing a volume sufficient to restore the shape and size. A more suitable substitute for the missing skeletal structure, especially in the region of the back of the nose, may be a graft from a new cartilage derived from autostructures that closely mimics the original skeletal contour. Such cartilaginous implants are synthesized using tissue engineering. The concept consists in using the tissue of the donor septal cartilage, which is taken and divided into cellular components. The cells are cultured in vitro. By pressing, a synthetic alginate framework is formed in the form and an m -plant for the back of the nose. Cells are introduced into the gelatinous framework, which is implanted under the skin of the mouse, where it is given the opportunity to develop, in vivo, to the final form. During this period, the alginate scaffold gradually dissolves and is replaced by a viable hyaline cartilage. Then the cartilage is taken as an autograft. This technology in the near future promises to be a good addition to the modern possibilities to restore volumes on the nose and face (personal communication, G. Tobias, 1999).

Surgical approaches to the correction of the middle third of the face

Achievements in aesthetic correction and facelift of the middle part of the face increased patient expectations. Our ability to rejuvenate the middle part of the face and solve the problems of lack of tissue volume in this area has increased significantly. The rhytidectomy has become just one of the components of the rejuvenating effect on the face. Now, when developing a surgical plan, you should consider eyebrow lift, procedures for replenishing volumes, tightening the cheeks, lifting the middle third of the face and the technique of grinding and peeling. If possible, the main task of improving the middle part of the face is the combination of two key components, rejuvenation and enlargement. If any of these surgical possibilities individually can not move the soft tissues that have fallen down or compensate for the loss of volume, then in order to provide the most comprehensive approach to solving the problem, the alternative approach must be individually combined with other methods. There are special criteria for determining areas of aesthetic deficiency and their correction with alloimplantation. In addition, it is necessary to identify other characteristics of aging and imbalance in the middle part of the face. These are signs of aging around the eye sockets, omission and loss of the volume of the middle part of the face, as well as deficiencies in the development of the bony structure of the face, accompanied by an imbalance of soft tissues, ptosis and asymmetry.

Aging near the eye sockets. With age, weakening of the orbital septum and bulging of the ophthalmic fat, leading to the appearance of bags under the eyes. The circular muscle of the eye drops, especially at its lowest part. The use of conventional blepharoplasty can aggravate the stretching of the lower ligament of the angle of the eye gap, which contributes to the formation of trough-like deformation or, in severe cases, to cause senile ectropion. Aging is accompanied by atrophy of the subcutaneous tissue, which is most strongly manifested in the area of very thin infraorbital skin, giving the eyes a sunken appearance.

Skeletal insufficiency and imbalance usually have as a basis for hypoplasia and the expected imbalance of the facial skeleton, which is aggravated by the aging process.

The omission and loss of the volume of the middle part of the face. The omission of the middle part of the face includes ptosis of the subcutaneous tissues below the eye socket, the zygomatic fat pad, the fat under the circular eye muscle, and also the circular muscle of the eye. When the cheek descends and creeps onto the upper part of the nasolabial fold, the thicker tissues of the zygomatic cushion are also shifted downward and leave the infraorbital area with a thin soft tissue covering. Thus, the nasoscular region begins to protrude, the lower part of the orbit looks empty and its lower edge is contoured. Loss of subcutaneous tissue occurs throughout the body, but affects the middle part of the face, including the fat pad of the cheek, the cheekbone fat pad and fat under the circular eye muscle, to the greatest extent. With the loss of volume and descent, signs of aging appear in the infraorbital region and on the cheek.

In the middle part of the face, the greatest deficit of tissues is found in the interval described as a "subcutaneous triangle". This area, having the appearance of an inverted triangle, is confined to the top by a cheek-like elevation, medial-nasolabial fold and lateral-to the body of the masticatory muscle. In patients with severe degenerative skin changes, loss of underlying fiber and deficiency of underlying bone structures, the gravitational effects of aging are intensified and cause further deepening or confluence, wrinkles and wrinkles. In patients with particularly prominent cheekbones and a lack of hypodermic or deep fat, the face on the face will be emphasized even more. These changes give the healthy people a grim or gaunt look. A severe form of such degeneration can be seen with anorexia nervosa, fasting, or in a newly identified group of HIV-positive patients receiving inhibitors of proteolytic enzymes for a long time. In combination with the primary disease, the intake of protease inhibitors and other new-generation drugs for the treatment of AIDS leads to the destruction of the fat of the middle part of the face and the buccal cushion. This state of soft tissue loss, also associated with the aging process, often prevents the rejuvenation procedure of only one rhytidectomy and is currently successfully treated with computer-assisted individual implants.

Operations in the middle third of the person: multimodal, "multi-level" approach

For successful rejuvenation of the face, the omission of tissues, as well as the loss of their volume, should be hidden, corrected or replaced. In modern conditions, this requires a multilevel and multimodal approach to the pathophysiological mechanisms of aging. Hiding techniques, such as blepharoplasty of the marginal arch, cause blunting of the nasoscut groove by fixing the infraorbital fat behind the marginal arch. Techniques of mid-level tightening of cheeks Corriguerus lowering the middle part of the face by raising the tissues of this area and fixing them in the upper-lateral direction. The methods of alloplastic or autologous enlargement correct the effects of lowering the middle part of the face by replacing the volume of tissues and providing soft tissue support from the depth. Since there are many elements of structural deficiency and aging, laser resurfacing and many other additional techniques are used together with rhytidectomy, as well as facial implants as an essential part of restoring and achieving the aesthetic qualities of a young person. Disadvantages associated with the superficial, soft tissue component of the face, whether it be the epidermis, dermis, subcutaneous fat or, in some cases, muscle, are corrected with the help of autothyskans and synthetic implants. Autogir, gomotransplants and xenografts, such as AlloDerm (Life Cell, USA) and collagen, as well as alloplastic materials such as PPTFE, are just a small part of the materials used. A significant number of fillers for soft tissues, available in the modern world market, suggests that an ideal substitute for soft tissue components of the face has not yet been found.

[1], [2], [3], [4]