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Facial plastic surgery deals with improving the form, function, and appearance of the face. Blepharoplasty (ie, eyelid surgery) is the most commonly performed surgical procedure in men and women 65 years and older. It has been shown to be effective for improving attractiveness and eyelid function (eg, improved visual field). Indications for upper and lower eyelid surgery include aesthetic concerns, ptosis, and peripheral field vision impairment. Facelift procedures resuspend, reposition, and release underlying facial structures and excise excess skin to improve the appearance of the face. Facelifts mainly involve manipulation of the superficial musculo-aponeurotic system (SMAS), a group of muscles in the lateral face. Types of facelifts include subcutaneous facelift with SMAS manipulation to allow for facial shaping of the deep soft tissue. Such manipulation can include SMAS-ectomy, SMAS plication, and SMAS flap creation. Deep plane facelift involves the SMAS and release of the facial and cervical retaining ligaments. Hematoma is a common serious complication of facelifts. Less common complications include skin flap necrosis, nerve damage, and scarring. Rhinoplasty is another commonly performed facial surgery. The two main forms are open rhinoplasty and closed rhinoplasty.

Case 2. Lucas is a 25-year-old man with a history of difficulty breathing through the nose, which is worse at night. In childhood, he was diagnosed with a deviated septum by an otolaryngology subspecialist. He is self-conscious about the appearance of the bridge and tip of his nose. He expresses interest in a “nose job” to correct these issues. He asks for a referral to a plastic surgeon. He also asks whether this procedure will be covered by his health insurance, and about the length of the recovery period after surgery.

Facial plastic surgery deals with improving the form, function, and appearance of the face. The field was developed out of reconstructive procedures and now encompasses an array of facial, oculoplastic, reconstructive, and cosmetic procedures. According to the American Board of Plastic Surgery (ABPS), “plastic surgery deals with the repair, reconstruction, or replacement of physical defects of form or function.”52

The primary age range of patients who undergo plastic surgery is 35 to 50 years.1 Blepharoplasty is the most commonly performed surgical procedure in men and women 65 years and older.


Blepharoplasty has been shown to be one of the most effective surgical interventions for improving attractiveness, followed by facelift.8 Blepharoplasty procedures consist of upper and/or lower eyelid surgery, including surgery to address aesthetic concerns, such as excess upper eyelid skin (ie, dermatochalasis), lower eyelid fat herniation, and contour irregularities, as well as ptosis and peripheral field visual impairment (Figure 5).

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