Total Facial Plastic Surgery

 

700. Total Facial Plastic Surgery
Facial plastic surgery refers to all surgical and non-surgical procedures related to the face. While most people may think only of eye, nose, contour, or lifting procedures, true facial surgery encompasses a much wider spectrum.

From front to back (surface to deep), it includes:
– Skin surgery,
– Fat surgery,
– Fascial surgery,
– Muscle surgery, and
– Bone surgery.

From top to bottom, we divide the face into:
– Upper face (e.g., forehead surgery – see 660mm),
– Midface (e.g., cheekbone surgery – 670mm),
– Lower face (e.g., jaw surgery – 680mm).

By anatomical region:
– Eye surgery (620mm),
– Nose surgery (630mm),
– Mouth surgery (640mm),
– Ear surgery (650mm).

Choosing the right procedure shouldn't rely solely on the patient’s request, but must be based on objective analysis by the surgeon, then matched with the patient's goals.

For example, if a patient wants deeper, symmetrical double eyelids due to asymmetry, but has protruding eyes causing the imbalance, and this isn’t acknowledged or understood, the eyelid surgery alone will likely fail. The crease may loosen or become asymmetrical. In this case, the surgeon must first correct the eye protrusion and asymmetry, then perform double eyelid surgery 3 months later for stable, symmetrical results.

Another case:
If a patient wants a facelift to look younger due to sagging skin, but has prominent cheekbones and angular, asymmetrical jawbones, lifting alone won’t be effective. In such cases, combining facial contouring surgery (to reduce cheekbones and jaw size) with the facelift maximizes the effect—allowing more excess skin to be removed and enhancing the lifting vector, especially since facial ligaments are already detached during contouring.

Without this insight, performing a facelift alone based on the patient’s wish could result in poor outcomes and low satisfaction.

Another example:
A patient with mandibular prognathism comes for jaw surgery but wants only a single-jaw (mandibular-only) surgery to save cost. If the surgeon follows this without checking the airway on CT, the patient may suffer sleep apnea post-op. An expert should analyze airway width and recommend double jaw surgery if needed. Also, since double jaw surgery can widen the nose, patients should be informed of possible changes and consider simultaneous rhinoplasty.

Using submental intubation, both procedures can be done together. Instead of synthetic implants, rib cartilage particles can be used to shape the nose and stored for future touch-ups like cartilage fillers. This prevents nasal collapse, addresses sleep apnea, and allows for future refinement, improving both safety and satisfaction.

Facial plastic surgery is not just about the outer layer—it requires understanding the anatomy from bone to skin, from upper to lower face, across eyes, nose, mouth, ears. A truly complete approach requires knowledge of ophthalmology, ENT, and dentistry to ensure precise results and proper management of any side effects.

[Facial plastic surgery is total surgery—from the inside out, top to bottom, with comprehensive anatomical and interdisciplinary knowledge.]
– 700 mm Growing Pine Tree 🌲

Oro-Facial Plastic Surgery

 

699. Oro-Facial Plastic Surgery
Oro-facial plastic surgery is not simply about reshaping the lips—it’s a comprehensive approach that considers the harmony of the lower face structure and the overall facial proportions when correcting issues around the mouth.

For subtle correction of protruding lips, TADs (Temporary Anchorage Devices) can be fixed to the alveolar bone to precisely move teeth in the desired direction—allowing retraction of front teeth even without extractions. In more pronounced cases, anterior segmental osteotomy (ASO) may be performed, instead of or in addition to orthodontics.

For open bites, orthodontics alone is often insufficient, and orthognathic (jaw) surgery may be necessary. In severe cases, triple jaw surgery (maxilla, mandible, and ASO) is needed to achieve proper alignment.

When there is facial asymmetry due to one-sided mouth corner elevation, orthognathic surgery helps align the upper and lower jaws. In mandibular prognathism (prominent lower lip or chin), correction may involve mandibular setback or rotation jaw surgery (rotational orthognathics). For receding chins with protrusive upper lips, options include orthodontic retraction of the upper teeth, chin advancement surgery, or counterclockwise jaw rotation, which can also improve sleep apnea by advancing the airway space.

When the gums are overly exposed while smiling, and the midface is long enough to show the upper teeth even at rest, severe cases may require maxillary impaction (upper jaw elevation) via jaw surgery. Milder cases can be treated with botulinum toxin injections targeting the elevator muscles of the upper lip and depressor muscles of the nasal tip.

For retruded mouths, the angle of the upper teeth may be corrected with orthodontics, but if the maxilla is recessed, maxillary advancement through jaw rotation surgery is required to correct midface depression.

Factors such as:
– Whether the mouth is protruding or sunken,
– Whether the lip corners are symmetrical,
– The relationship between upper and lower teeth,
– The presence of overbite, underbite, or misalignment,
– Whether the dental axis is tilted—
all determine the right treatment plan. This may include orthodontics, TADs, ASO, orthognathic surgery, or even triple jaw surgery.

These decisions are made after analyzing medical facial photos, dental models, and 3D facial CT scans.

Oro-facial surgery is not just about changing the shape of the lips—it’s about correcting the relationship between the upper (maxilla) and lower (mandible) facial structures.

[Oro-facial surgery is about analyzing and correcting both mouth-related and mid-lower facial issues together.]
– 699 mm Growing Pine Tree 🌲

Oto-Facial Plastic Surgery

 

698. Oto-Facial Plastic Surgery
Oto-facial plastic surgery is not just about correcting the ears—it’s a comprehensive facial surgery concept that considers the harmony of the midfacial side profile and overall facial proportions.

The ears significantly influence the side view of the face. While they’re barely seen from the front, they complete the facial image when viewed at a 45-degree angle. Folded ears may appear youthful but can lack maturity. Protruding ears make the face look inward or narrower from the side. The ears’ size, position, and angle are closely linked not only with the eyes, nose, and mouth, but also with the skull contour and jawline.

Uneven ear height can make wearing glasses or sunglasses difficult. Ear asymmetry can further highlight facial asymmetry. In flat-head syndrome (plagiocephaly), one ear may be more forward and the other more backward, exaggerating imbalance.

The ears are closely related to the jaw. Smaller ears often accompany smaller jaws because both originate from the first pharyngeal arch during embryonic development. That’s why people with microtia often also have a recessed chin.

For example:

• Treacher-Collins syndrome features bilateral microtia, receding chin, and underdeveloped cheekbones.

• Goldenhar syndrome shows unilateral microtia with one-sided chin deficiency and facial asymmetry.

• Nager syndrome presents with microtia, chin and cheekbone deficiencies, and limb deformities.

• CHARGE syndrome can involve microtia with mandibular hypoplasia, heart defects, coloboma, choanal atresia, and genital abnormalities.

Underdeveloped ears often correlate with smaller temporomandibular joints (TMJ), which play a vital role in chewing. If TMJs are small or dysfunctional, chewing becomes inefficient—affecting digestion and energy intake.

Thus, oto-facial surgery may include:

• Chin advancement surgery for recessed chins,

• Orthognathic surgery for facial asymmetry,

• Ear reconstruction with rib cartilage for microtia,

• and fat grafting for facial volume enhancement.

In summary, smaller or painful ears tend to be associated with smaller jaws and more convex facial profiles, while larger, healthy ears are often linked with larger jaws and concave profiles. Ear development directly affects facial volume and shape, forming one of the two structural axes of the side profile along with the jaw.

[Oto-facial surgery is about correcting ear-related and side-profile facial issues together.]
– 698 mm Growing Pine Tree 🌲

Rhino-Facial Plastic Surgery

 

697. Rhino-Facial Plastic Surgery

Rhino-facial plastic surgery is not just simple nose surgery. It is a comprehensive facial surgery that considers the harmony of the midface structure and overall facial proportions. While rhinoplasty focuses on improving the nose—raising a low bridge, lowering a high one, or straightening a crooked nose—rhino-facial surgery also examines surrounding features. Is the nose sunken? Are the areas around it flat? Is the midface lacking projection, making the face appear long or flat depending on the nose height?

Orthognathic (jaw) surgery often causes nostrils to widen. Also, in cases of dorsal humps, jaw surgery alone sometimes corrects them. Therefore, patients considering jaw surgery should always think about rhinoplasty, either simultaneously or afterward.
For drooping noses (so-called “arrow noses”), maxillary advancement during jaw surgery naturally rotates the tip upward. At the same time, rib cartilage can be grafted to refine the tip and bridge.

When the midface is sunken, rotational jaw surgery can make it fuller. Using submental intubation helps avoid nasal widening and enables simultaneous rhinoplasty. Maxillary advancement ultimately creates a more convex, balanced profile.

In patients without occlusal issues but with a sunken midface, micro-rib cartilage grafts around the nose (nasal base augmentation) and rhinoplasty can be done together to transform a hollow appearance into a more projected one.

Smiling habitually on one side can deepen nasolabial folds and hollow the nasal base on that side. Over time, this causes the nasal tip to collapse asymmetrically, leading to a deviated nose. Continuous unilateral muscle use (levator muscles, zygomatic muscles) gradually bends the nose—twisted expressions creating a twisted nose. Rhinoplasty in such cases is often motivated by a desire to correct not just appearance, but the emotional distortion reflected in it. However, unless the smiling habit is also corrected, recurrence is possible.

If the brow bone is overly prominent, the nasal root may appear too low. One might wish to match the nose to the high brow bone, but this can result in an avatar-like, oversized nose. Rather than augmenting the nose to cover the issue, it’s better to surgically reduce the brow bone directly.

Rhino-facial plastic surgery, therefore, spans from the brow bone to the upper teeth. It involves not only rhinoplasty, but also brow bone surgery, cheek lifting, perinasal augmentation, and jaw surgery—all of which influence the nose and midface. It is crucial to analyze the whole face to determine what underlying issues are causing nasal problems, and to correct them first or simultaneously to prevent recurrence.

[Rhino-facial surgery is about correcting the facial causes behind nasal problems.]
– 697 mm Growing Pine Tree 🌲

Eye-Face Surgery

 

696. <Eye-Face Surgery>

Eye-face surgery goes beyond basic eye procedures—it's a comprehensive approach that considers the entire facial structure and proportions when correcting or enhancing the eye area.

Double eyelid surgery simply creates creases, and canthoplasty (epicanthoplasty, lateral, and lower) enlarges the eye. However, these can affect facial harmony—for instance, inner corner surgery can make the eyes look too close together, unintentionally making the nose look taller and the midface appear wider. Eye-face surgery offers proportion-based solutions, not just desired changes.

For patients with protruding eyes, it’s essential to first correct the asymmetry and wait for swelling to subside before performing eyelid surgery. This reduces the risk of asymmetry or relapse.

In cases of ptosis (droopy eyelid) with facial asymmetry, correcting eye protrusion first allows for more accurate and balanced ptosis correction.

A prominent brow bone can make the eyes look deep-set and the nose flatter. Reducing the brow bone can reveal the actual eye depth, helping plan the most suitable eyelid design through 3D CT and photo analysis.

If the forehead is asymmetric, correcting it with fat grafting or implants first helps assess true eye symmetry.

Ultimately, eyelid surgery should follow careful analysis—and, if necessary, correction—of the forehead, brow bone, and orbital bone asymmetry. Otherwise, repeat surgeries are more likely.

Many patients seek under-eye fat repositioning, but if the eye is protruded, correcting the protrusion alone often improves the bulge without touching the fat.

The best eye surgery is not needing one—but if you're going to do it, do it right. Analyze the full face, understand what caused the eye issue, and fix the underlying cause first to avoid recurrence.

[Eye-face surgery means correcting facial causes behind eye problems.]
– 696 mm Growth Pine Tree –

Facial Fat Grafting

 

695. Facial Fat Grafting

Facial fat grafting adds volume and shape by injecting your own fat into hollow or flat areas. Common areas include the forehead, front cheeks, and chin—where fat is placed near bone for better stability. Areas like the lower cheeks (deep buccal fat) are usually avoided, as fat there can sag over time.

Sunken temples or upper eyelids can also be treated. In people who overuse their eyelid muscles, fat tends to burn away faster, making grafts reabsorb quickly. These patients often need a second or third graft.

Forehead grafts should subtly recreate the brow bone to look natural. A too-round forehead can appear artificial. Fat between muscles and skin also reduces forehead wrinkles by increasing the skin-muscle distance.

Under-eye fat grafting helps smooth uneven bulges when muscle tone is weak. But areas like the nasolabial folds move constantly, so fat there doesn’t last long and may disappear within weeks.

Fat is energy. It’s harvested from low-activity areas like the abdomen or thighs and placed in high-activity areas like the face, where it may get used up. That’s why some reabsorption is natural.

To improve fat survival: limit facial movement, avoid stimulation, and sleep early—growth hormone released at night supports healing. If needed, preserved or fresh fat can be used for touch-ups.

Facial fat grafting is the art of transferring body energy to the face—to restore and reshape.

– 695mm Growth Pine 🌲

Facial Wrinkle Surgery

 

694. Facial Wrinkle Surgery

Facial wrinkle surgery includes various treatments to improve wrinkles and sagging skin due to aging.

At the early stage of aging, non-surgical methods are often enough:

• Botox reduces forehead, frown, and crow’s feet lines by relaxing overused muscles.

• Fillers restore volume to deep wrinkles like nasolabial folds.

• Thread lifting helps with sagging in the jawline and lower face.

When sagging becomes more obvious, surgical facelifts are more effective. Depending on the area, techniques include:

• Upper face: forehead or brow lift, upper eyelid surgery

• Midface: cheek lift, mini-lift, lower eyelid surgery

• Lower face: lower facelift, neck lift

Mini facelift uses short incisions in front of the ear, lifting the SMAS layer at a 45° angle. It's less invasive, good for the lower face, with low nerve risk.
Extended SMAS facelift lifts the SMAS flap to improve the lower face but is less effective for the midface.
Deep plane facelift lifts skin and muscle together below the SMAS, offering excellent improvement in both mid and lower face. It heals fast and is more durable, but requires advanced surgical skill.

Intraoral dissection can release key ligaments (zygomatic, mandibular, masseteric) from the bone, helping with facial lifting, especially when combined with facial contouring surgery.

But why do faces sag again over time? It’s not just skin — facial bone loss plays a major role.

To maintain long-lasting results:
✔ Do facial blood flow exercises
✔ Sleep deeply to support bone regeneration
✔ Eat whole, natural foods to slow bone loss

Facial wrinkle surgery is about remodeling the skin and fascia over a shrinking bone structure.
– 694mm Growth Pine Tree 🌲