Filling, roundness, softness, plumping are all desired goals within the latest volumetric philosophy that has permeated plastic surgical literature and discussions.
In the past decade, a new generation of plastic surgeons has turned upside down the traditional thinking about aging, beauty and the aesthetic ideal. It used to be assumed that aging effects were due to gravity and stretching, and that tissues sagged and fell over time. While this may be true to a certain extent, there is another fundamental process at work: loss of volume.
Technological breakthroughs in 3-D imaging, CAT scanning and MRI’s clearly demonstrate a decrease in the amount of bone, size of fat pads, quantity of muscle fiber and thickness of skin over time. In contrast, high-definition photographs show that skin landmarks such as moles and freckles do not descend appreciably as a person ages. These studies suggest that the wrinkling and hollowness that characterize old age are similar to a grape becoming a raisin, or a helium balloon that has deflated — it is due to volume loss from deeper within the body, and not just sagging of the skin itself.
This new understanding has major implications for the treatment and prevention of aging. The facelift provides an excellent example. The old mantra was to lift, tighten, stretch and smooth the skin, but now we know that the skin is merely redraping over less underlying tissue. If only the skin is tightened, the effect may appear as if a patient is standing in a wind tunnel — the skin is swept back smooth and tight, but overlying a hollowed and sunken framework. The more pure anatomic approach is to rejuvenate the face by restoring inner volume where it has faded. This may include the addition of fat grafts, duplication of underlying fascia and muscular tissue, placement of implants, and/or injection of hyaluronic acid filler such as Restylane and Juvéderm in combination with a facelift. When the deeper tissues are filled, then the skin is pushed out and wrinkles smooth more naturally.
Dr. Jeffrey Donaldson is a champion of this new volumetric philosophy. He uses fat transfer, fillers and advanced multi-plane surgical techniques to restore volume and create youthful, soft, natural effects in the face and body for patients in Columbus, Ohio. Cosmetic surgery has rapidly evolved with these recent discoveries, and Donaldson Plastic Surgery offers you the most up-to-date results.
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