A growing number of oral and maxillofacial surgeons (OMSs) are taking their training and experience in facial trauma and reconstruction into the elective cosmetic realm as age-conscious Baby Boomers seek remedies for their drooping eyelids and developing jowls, according to surgeons who will speak at the American Association of Oral and Maxillofacial Surgeons (AAOMS) 85th annual meeting, September 10-13, in Orlando, Fla.
“Cosmetic surgery now represents about 10 to 20 percent of our specialty, and that percentage will increase as Baby Boomers continues to age and the demand for cosmetic surgery continues to grow,” says Jerry L. Jones, D.D.S., M.D., an Albuquerque, NM, oral and maxillofacial surgeon and an associate attending physician in the Division of Plastic and Reconstructive Surgery at the University of New Mexico. Dr. Jones will moderate a symposium on soft tissue cosmetic procedures at the AAOMS meeting.
The escalating demand for cosmetic services in the United States is fueling a growth in the number of cosmetic surgery fellowships offered to OMSs and other specialists through such organizations as the American Academy of Cosmetic Surgery, he says.
In addition, Dr. Jones believes the increase in OMS involvement in facial cosmetic work reflects a broader overlapping of anatomic boundaries among the various medical and dental specialties over the past 10 to 15 years.
Their unique combination of dental and surgical training provides OMSs with a natural affinity for cosmetic reconstructive surgery. OMSs are the leading experts in orthognathic surgery, the surgical repositioning of the upper and lower jaws to achieve facial balance and other functional problems, such as breathing and chewing. They are often the first surgeons called into the hospital emergency room to assist in cases involving facial trauma.
Although orthognathic surgery still represents a significant portion of what OMSs do, “OMSs have become more soft tissue-conscious in recent years, while plastic surgeons have become more bone-conscious,” Dr. Jones says.
“The anatomic definitions of the specialties are no longer as rigid as they once were. That is a good thing, because traditional anatomic boundaries are not what matter most. What matters are training, experience and competency,” he says.
As the first on-call specialists in emergency rooms for patients with facial trauma and as experts in the surgical correction of congenital facial deformities, OMSs have a deep understanding of facial structure and harmony. Their knowledge and experience prepare them very well for the facial cosmetic arena, Dr. Jones says.
It was an OMS, in fact, who pioneered one of the most important recent advances in facial cosmetic surgery, Dr. Jones notes. The technique, known as the four-dimensional facelift, represents a significant improvement over conventional surgical procedures, which primarily lift and tighten the skin from the outside.
Developed by Stephen Watson, D.D.S., M.D, of Plano, Tex, who will speak at the symposium, the four-dimensional facelift repositions and lifts all four layers of facial tissue, producing more attractive, natural and enduring results. The surgeon manipulates the skin, the subcutaneous layer (tissue immediately under the skin surface), the facial muscles, and the periosteum, the membrane of nerve- and blood-rich tissue covering the bones. Laser skin resurfacing can be performed at the same time to reduce wrinkling.
Other key advances in soft-tissue cosmetic surgery to be highlighted at the symposium include the use of endoscopy, which allows surgeons to see and manipulate the facial soft tissues by entering through small incisions near the hairline.
Conventional techniques involve the manipulation of tissue just under the skin. Endoscopy allows the surgeon to go deeper and to manipulate and tighten facial tissue by elevating tissue off of the bone, producing a younger, fresher appearance.
The surgeon places a small, wand-like instrument called an endoscope through an inch-long incision. A tiny camera in the scope sends a real-time image to a video monitor. Using the video display as a guide, the surgeon inserts small instruments through the other incisions to lift and reposition tissue to achieve the desired results.
This less invasive approach preserves more facial blood supply than conventional techniques involving larger incisions; reduces scarring, bruising and postoperative pain; speeds healing; and produces more natural, lasting results.
In addition to four years of postgraduate dental education, OMSs complete a minimum four-year hospital-based surgical residency, rotating through other services, including internal medicine, anesthesiology, general and plastic surgery, and emergency medicine.
“Our dental, medical and surgical training allow us to approach facial cosmetic surgery from the bone up, and our experience in the treatment of trauma and congenital deformities gives us a solid grounding in the surgical improvement of facial appearance,” Dr. Jones says. “So much of what OMSs have done traditionally has focused on making faces look better. Our expanding involvement in elective cosmetic procedures is a natural progression.”
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