Cosmetic facial surgery
Dr. Lapalorcia performs masterfully treatments aimed at rejuvenating the face: face-lift of the face and neck, eyelid and oculoplastic surgery, eyelid surgery, forehead lift, skin resurfacing. Also performing delicate operations to correct facial features you do not like the patient: aesthetic and functional surgery of the nose, ear surgery, increasing the volume of cheekbones and chin through implants or Lipofilling, increased volume of the lips and soft tissues typically using fillers like Restalyne ®, Perlane®, Juvéderm® and Radiesse®, Belotero®.
It’s a type of the described face lifting and popularized in recent years in Europe to allow for a quicker recovery.
It represents a good compromise between effectiveness of the outcome and duration of convalescence. The platysma muscle is not fully repositioned and low-cut back and up but is plied with slow resorption sutures with the same purpose.
Recovery times are shorter because the incisions are small, hidden by hair and the disconnect is less.
This intervention takes place in about 1 hour under local anesthesia in combination or not with other interventions (Lipofilling face, lipostructure or liposuction).
The intervention of the upper or lower eyelid surgery is performed with the aim of giving the eyes a rejuvenated appearance, on and lively. It removes the excess skin of the upper eyelid skin, trying to give more definition to the shape doing a resection of the orbicularis muscle and cantopessi to position the side singing in anatomically correct position, above the medial.
The lower blepharoplasty can be made electronically or subciliare transconjunctival (without skin scars) and across the street subciliare also gives access to the midface with the opportunity to proceed to a repositioning of orbital fat that protrudes from the septum and a orbitae dell’arcus marginalis release with the purpose of correcting sunken eyes, bags and dark circles rejuvenating the whole orbit.
This intervention takes place in about 1 hour under local anesthesia in combination or not with other interventions (lipofilling face, lipostructure or liposuction).
Rhinoplasty, corrects the morphological and functional defects of the nasal pyramid. If the patient preoperatively reveals the surgeon a respiratory difficulty caused by an obstruction of the nostrils, probably even the nasal septum can be deviated and the intervention is called rhinoseptoplasty.
A manipulation of the septum with cartilage levy it is almost always necessary in the case in which, even in the absence of deviation, it is necessary to have the material to be used as a graft to modify the architecture of the nose.
architecture speak because in modern rhinological surgery are considered the anatomical features of the nose as they were viewed very differently from in the past:
- You tend to avoid distorting the more the profile of people with an important nose.
- The tip must have its normal symmetry with supratip and infratip (typ = tip) regularly positioned.
- The columella must have a good support capability to be able to support the tip.
- The patient after surgery “must” breathe better since, surgical site, you have an opportunity, with minor surgical procedures, to intervene in the septum and turbinates place, preoperatively, the proper diagnosis is made.
- Any “humps” are to be reduced or removed according to the demand of patients trying to leave no surface irregularities on the nasal dorsum.
For its front and central location in the face, the nose is the first point that is illuminated by light rays and the slightest irregularity or disharmony is perceived by the patient and then by the people who surround it therefore must be meticulous in the execution of the intervention, in the dressing and the patient’s postoperative follow-up.
The multiplicity of races that make up the demographic reality of our society, is changing the aesthetic characteristics of the nose “European” today.
As we all know the Asian nose is different from Caucasian nose, Negroid or Mediterranean and in each race the structural characteristics (bone and cartilage) of the surface (thickness, color, level of hydration and sebaceità skin) can vary widely.
This is the concept of ethnic rhinoplasty that today’s surgeon must know what the patient’s physical examination suffering from nasal dimorphism must be complete and accurate to be able to adapt the surgery.
The approach to nose surgery stands out in the open (internal and external incisions-visible transcolumellare) or closed (internal incision type marginale- intracartilaginea and intercartilaginea). There is no better than the approach being employees results skill of the surgeon. A good surgeon will have good results with any technique. Note that the patient preparation work must be done before the operation during the preoperative talks which assess the expectations, driving on the stages of the postoperative period, and s’ illustrate the strengths and potential complications of the post.
The help of a professional photography and analog or digital simulations are today a tool that allows you to see a good approximation of what will be the end result.
I can only add that my approach varies depending on the patient and the type of work to be done. In cases of secondary rhinoplasty, that is when the person has already been made, it may be convenient to have a full view of the nasal cartilage structures achievable only with the open technique, which allows us to practice delicate surgical procedures necessary to restore the form, harmony, function and symmetry.
In front of the frequent request of a minimum of retouching an almost perfect nose you can use a closed approach to minimally invasive, but do not underestimate the difficulty of meeting a patient who could have definitely higher expectations. The surgery takes place under general anesthesia and usually lasts for 90 minutes.
Lipofilling & facial lipostructure
By the term lipostructure it includes the removal of a certain amount of fat from certain areas of the body where this is present in excess and its transplantation, once suitably purified, in other areas of the face (but also of the body) in order to correct wrinkles, furrows or scar depressions. This surgical technique established use for decades now is widespread and commonly practiced by plastic surgeons in all parts of the world. The more classical donor sites include the abdomen, buttocks and thighs for obvious reasons distribution of adipose tissue in the human body.
Depending on the needs it is intuitive that this type of intervention is of course matched to the intervention of liposuction or liposculpture which has the purpose of removing localized fat deposits in excess and to sculpt certain aspects of the body behind the patient’s specific request. The sampling and purification technique must be performed rigorously using atraumatic cannulas that damage fewer fat cells possible if the fat cells to be transplanted.
The presence of stem cells in lipoaspirate (ASC adipose derived stem cells) has been well documented in scientific studies and esisitono variety of methodologies to concentrate this type of “regenerating” cells in the fatty material. The evolution of lipofilling (English term which is defined such technique) is based on the adipose tissue preparation techniques to be injected which is first filtered and then centrifuged to remove the unnecessary component (oil, serum and blood) from lipoaspirates trying to concentrate the cellular component. In the injection we have instead witnessed a refinement of techniques iniezieno (nano fat grafts and micro lipofilling) techniques in which microcannulas with 0.7, 0.8 or 0.9 mm are unable to infiltrate the eyelid and orbital area, the contour of the mouth, the region zygomatic and nose genieni grooves minimizing complications such as the formation of nodules, granulomas, and in spite of irregularities, in those areas the epidermal layer is particularly thin.
The transplanted cells play in this way their action bringing volume and renovating in a natural way the treated fabrics. The birth of this technique is done in reconstructive surgery where it is widely used to treat outcomes of burns, depressed scars and disfiguration of regions such as breast reconstructed after mastectomy or depressions created in the course of previous liposuction procedures performed too casually or aggressively. From here has been gradually also used in cosmetic surgery of the body to increase the buttocks, enlarge or reconstruct the breast up to also be used on the male and female genitals are the most sensitive areas to be treated. The intervention takes place in almost all cases and under local anesthesia in each case with anesthesia care. The result is stable over time because the transplanted cells acquire a new own life in the tissue where they were inoculated diversifying through the action of specific growth factors. The advantage compared to the common hyaluronic acid-based fillers is that the results are more stable in time and that the material to be injected is abundantly available in the human body.
The increase of volume of the cheekbones is done through the insertion of zygomatic implants silicone or by the Lipofilling of the malar region. The adipose tissue volumes grafted must obviously be commensurate with the desired result. In aggressive Lipofilling you can get to plant up to 12-15 cc of centrifuged fat to emivolto.
Lifting della faccia e del collo
Il volto di una donna è la sua caratteristica più evidente e racconta una storia: deve essere mantenuta e goduta anche quando i segni del tempo iniziano a farsi sentire. Questo non significa rimuovere e spianare ogni ruga in superficie ma riportare nella loro sede anatomica naturale le strutture muscolari e sottocutanee della faccia. L’invecchiamento facciale non è solo di tipo cutaneo.
Aree di adesione ai piani profondi ossei determinano congiuntamente con l’effetto della forza di gravità, il fotoageing e la disidratazione dei tessuti le caratteristiche del volto invecchiato che sono:
- guance cadenti con solchi nasolabiali pronunciati e non più correggibili con fillers e lipostruttura
- lassità cutanea a livello dell’angolo della mandibola
- bande di platisma anteriormente nel collo
La procedura chirurgica che propongo di solito per il massimo ringiovanimento del volto è un lifting non cutaneo ma di natura muscolare (CPMS complete plathysmal muscle suspension): si identifica il muscolo facciale platisma che ha una forma nastriforme che perde consistenza con l’età e si riporta in posizione posteriore e superiore secondo dei vettori contrari alla gravità.
Questo consente di dare definizione all’angolo mandibolare e al collo, riposizionare la regione zigomatica e le guance, ridurre il doppio mento e le bande di platisma. La convalescenza da questo tipo di intervento viene ridotta al minimo preparando il paziente preoperativamente, utilizzando farmaci come l’arnica che riducono gonfiore e infiammazione, e utilizzando una meticolosa tecnica chirurgica e medicazioni contenitive specifiche.
Le cicatrici vengono occultate nel cuoio capelluto, dietro al trago e posteriormente nella regione mastoidea. La durata dell’intervento è di circa 3 ore se eseguito congiuntamente all’intervento di blefaroplastica.
Per ottimizzare i tempi di recupero e per ridurre il costo di sala operatoria per procedura il Dr. Lapalorcia propone ed esegue agevolmente anche procedure combinate. Blefaroplastica superiore, liposuzione, lipofilling e lipostruttura sono le procedure che meglio si abbinano ad altri interventi potenzialmente più lunghi e delicati perché si eseguono in tempi relativamente brevi non appesantendo il lavoro del chirurgo.