Recycling might be a funny word when one thinks of Plastic Surgery, but it‘s really quite descriptive about several techniques that are commonly, and not-so- commonly used in practice. Perhaps a “Robin Hood” descriptive might work better: we take from the richly endowed areas of the body and give to the less fortunate parts.
Your mind is probably already envisioning fat: in fact, most of us have more fat than we want in certain areas, and other areas where a little more volume would be nice.
Good thinking, but not what I’m writing about…at least not yet. This blog piece is about taking tissue that would ordinarily be discarded and re-inserting it in a useful and esthetically pleasing manner. In this case, I’m thinking of the deep layer of the face, the SMAS layer, consisting of muscle, the fascia and the fat. In a modern facelift the SMAS is pulled up quite snugly, then trimmed, and secured fast to the boney attachments. This maneuver allows the skin to simply drape over the newly tightened infrastructure without any tension, thus avoiding a “pulled” look.
I hate throwing anything away…I am a collector, a curator, and a general packrat. Years ago, after I trimmed the excess from that deep layer, I would just discard it and move on. One day, in a moment of unexpected enlightenment, it occurred to me that it was a shame to throw away such healthy, strong tissue. Where could I utilize this strip of muscle, fat, and attached fascia (the skin of the muscle) that would enhance my patient’s appearance?
I noticed that many of my facelift patients’ lips were quite thin, and in some cases, almost non-existent. Lips do lose bulk with age, and fillers like Restylane and Juvederm are often used to correct, (and too often way overcorrect) that condition. Besides, those fillers usually only last between 6 and 12 months. Perhaps, this tissue could be fashioned into a graft that would offer a more permanent lip enlargement?
Voila!! The tissue can be fashioned into a strip of variable thickness, depending on the amount of corrections desired, and inserted into a little tunnel that runs across the red part of the lips. I tried it and to no one’s surprise, it works beautifully.
I first published this lip augmentation article (Plast Reconstr Surg. 2002 Jan;109(1):319-26) in 2002. It actually followed my earlier article (Plast Reconstr Surgery. 1996: 97(6): 1249-1252) describing this graft’s usefulness in smoothing out the ridge of the nose in patients who had poor results from unfortunate nose jobs (I never use the word “botched.” Oh wait, I just did.)
This material has many useful applications in both aesthetic and reconstructive plastic surgery. It would be a great universal source for tissue augmentation…except for the fact that a facelift is required to obtain it. And not everyone is a realistic candidate for a facelift (Life-style Facelift advertisements to the contrary.)
So now, whenever I do a facelift, which is a lot of the time, I first evaluate the patient to see if the lips (or another structure that is a bit deficient) could use some help. And I know where to go for my building materials.