Cheekbone augmentation
Malar Implants
Chin augmentation
Chin Reduction

About Aquamid please look below

The facial skeleton and its covering soft tissues shape the features of the face and the profile. The relationship between the different parts of the face has a fundamental aesthetic importance. Well-marked cheekbones give an aesthetic framing of the eyes, often illuded by a well-made make-up.

Principle: Bone reduction is done by abrasion or chiselling, sometimes by moving of a bony segment. Augmentation is done either with transplants of bone or cartilage, mostly, however, with synthetic implants.
A surgical pocket is created and during healing, the implants will be anchored at place by the surrounding connective tissues.

Some deformities and asymmetries of the face need extensive pre- and postsurgical treatment by different expert teams and these will not be discussed here.

• The most performed procedures are:
  - Shortening of the chin: Through an incision in the mouth to abrade or chisel off a peace of bone.
  - Elongation and widening of the chin: Through an incision in the mouth or below the chin, a suitable implant is inserted.
  - Hollow middle face: Augmentation through the mouth or the nose.
  - Augmentation of cheekbones: Augmentation through the mouth or during an eyelidoperation.
  - Narrowing or widening of the lower face: Either augmentation or removing bone of the angle of the lower jaw through the mouth.

Anaesthetic: Mostly local anaesthetic and conscious sedation.

Operating time: 1 - 2 hours.

What happens afterwards?

• When the anaesthetic subsides, a short intensive pain can be felt for about ½ an hour.
• The following discomfort is lessened with painkillers.
• A heavy swelling of the face evolves, that will dissolves in about 7-10 days.The breakdown can be accelerated with ice bags.
• After operations through the mouth, fluid food should be eaten the first 3 days. Otherwise mashed food.
• Prophylactic antibiotics are prescribed.
• Sleeping on the back is mandatory during the first 2 weeks. Normal social activities can be returned to after 10 -14 days.

Complications

Referred unwanted biologic events can occur with a certain low frequency and must be regarded as calculated risks. Other risks not mentioned can also occur. For patients this must be considered before a decision for plastic surgery is set.

Bleeding: All operations can cause postoperative bleeding. These risks increase by the intake of analgesics and Vitamin E. These should be avoided 2 weeks prior to the planned operation.

Infection: All operations can cause infections. The mouth is from surgical point of view heavy contaminated and in spite of prophylactic antibiotics infection can occur. An implant has to removed temporarily and can be reinserted after a few months.

Displacement of an implantat: A correctly placed implant is normally kept in place by scary healing to the surroundings. Occasionally an implant can be displaced before proper healing. In that case a reoperation is necessary.

Nerveinjury: Facial implants are placed in near proximity to nerveexits of sensory nerves. These nerves are protected during the operation. If the implant, however, is displaced, it can irritate or damage the actual nerve, which can cause numbness or pain in the corresponding area.

Smoking: Smoking does compromise bloodcirculation and healing. Smoking should be abandoned prior to a planned operation.

 

AQUAMID

Recently a new filler for permanent tissue augmentation by injection was introduced in Europe, Aquamid® . The information about this material is put in front of our normal information on facial implants, which of course still should be read by anyone seeking information about this type of operation. The clinic expects the treatment with Aquamid® to replace some of these operations.

As general tissue augmentation like breasts, lips, malars, chins and calf for a long time have been and still are demanded corrections, the industry has been seeking for a suitable substance for this indication. Through years injectables with time restricted durability like collagen and hyaluronic acid have been used. Due to resorbtion the injections had to be repeated. Allergic reactions have been reported.

Other injectable substances with more or less permanent durability have also been used. These are silicone and polymethylmethacrylate, which can aggregate and cause lumps or disappear depending on the molecular size. Again other materials as a permanent filler is the Gortex® tube. Autologous tissues with a variety of long term results have been used. Fat injections do mostly have a transient filling effect and are no alternatives for permanent augmentation. Fat-dermis or fascia implants do commonly have a permanent filling effect, although they can be absorbed. Acellular implants from corps does also exist for this purpose. Biologic auto transplants need vascular ingrowth to survive and if this does not occur, the material is partially or totally absorbed.

Bigger augmentations like breasts, muscle, buttocks etc. can only be achieved by implants today.

Aquamid® is a neutral hydrogel consisting of a stable chain of polyacrylamide in 90% of water. Polyacrylamide should not be confused with the poisonous acryl amide. The gel can be directly injected into the subcutis where it integrates with the tissues. If injected gel is to be removed, it can at least partially be aspirated or pressed out during the fist 8 months after injection. After this time there is an ingrowth of fibrous tissues into the gel which makes a surgical removal necessary to ablate it. Polyacrylamide gel has been used successfully for over 10 years in Ucraine, mostly for breast augmentation and facial corrections. The cosmetic results have been excellent with a very low frequency of side effects/complications of about 0,02%.

This information is related to facial corrections as the only officially cleared indication.

Method: With a very thin needle, the gel can be introduced into areas to be filled or enlarged.

Typical areas:
Malar region, chin, cheeks, lips and nose.

There will be a short swelling and erythema that will disappear within 12 hours.

There will be no pain.

The injected gel stays soft or hard depending of the injection technique and it does not migrate.

The treatment is done under local or bloc anesthetic. The anesthesia makes the face feel hard and big, but have no fear, it is invisible! The analgesia disappears within a couple of hours.

No after treatment is needed.

Side effects / Complications:

· No reports of any complications so far.
· Irregularities can occur. This can be corrected by massaging or secondary injections. It is important that the physician should be able to see and to manage these side effects.
· Infections can occur when the needle penetrates the skin. Antibiotics is then prescribed.
· Sometimes it is difficult to decide what volume is aesthetically needed. If one is in doubt, it is better to give a secondary treatment at a later time than to overinject.
· Injected Aquamid® can be firm for a month. It softens gradually with time.

Aquamid® will be cleared for other indications. At that time more information will be completed.
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