Search In this Thesis
   Search In this Thesis  
العنوان
Quantitative Evaluation of Orbital Aging
By Computed Tomography \
المؤلف
Ahmed, Wael Yahia Youssef.
هيئة الاعداد
باحث / وائل يحيي يوسف احمد
مشرف / مصطفى عبد الرحمن عوض
مشرف / عمر حسين عمر
مشرف / اشرف ماهر فريد
تاريخ النشر
2014.
عدد الصفحات
179 p. :
اللغة
الإنجليزية
الدرجة
الدكتوراه
التخصص
الطب البديل والتكميلي
تاريخ الإجازة
1/1/2014
مكان الإجازة
جامعة عين شمس - كلية الطب - جراحة التجميل
الفهرس
Only 14 pages are availabe for public view

from 179

from 179

Abstract

Original theories behind facial aging have focused on soft-tissue laxity, ptosis, and descent of the envelope over time on account of gravity.
Anatomical observational studies evaluating skeletal morphological changes of the midface, mandible, and orbit over time were done by authors such as Lambros et al in 1999, Pessa et al in 2000, and Shaw & Khan 2007& 2008 and confirmed facial bony remodeling over the course of one’s life.
Three-dimensional stereolithography and facial computer topographic scanning provided radiological evidence of the facial remodeling in young and old, looking at specific changes to the maxilla, mandible, pyriform, glabella, and orbits.
Lambros and Pessa et al uncovered the clockwise rotation of the midface in relation to the cranial base in separate younger and older individuals. These studies highlighted the characteristic changes in the aging facial skeleton, concentrating on the posterior displacement of the maxilla, lateral inferior shifting of the lateral and inferior orbital rim, creating a larger orbital aperture.
These skeletal changes create dramatic shifting of the overlying soft tissue and retaining ligaments of the face, and when combined with fat atrophy and volume loss, these provide a tangible explanation behind the complex, multifaceted etiology of facial aging.
These landmark studies opened new doors in understanding the complexities of facial aging and the pivotal role of facial bony resorption and remodeling. Changes to the bony scaffolding with time inarguably lead to significant facial change and act in concert with soft-tissue atrophy and laxity, creating the appearance of aging.
A graduated level of understanding of these changes leads to the development of specific treatment modalities designed to address the bony attrition with techniques such as focused midface and chin implantation and subperiosteally placed calcium hydroxyapatite filler.
The current results suggest that the bony elements of the periorbital region change dramatically with age and that the bony aging process is primarily that of contraction and deterioration and not expansion.
Thus, we feel that the most effective approach to facial rejuvenation should be two-fold: restoring volume to compensate for the loss of bony volume, and lifting and reducing the aged and less elastic soft-tissue envelope.
Restoring the volume can be done, as described by lambros and Pessa in 2000, that the fat preservation maneuvers like arcus marginalis release and draping of fat across the orbital rim are really ways of using fat as a bone substitute. (Another reasonable way to accomplish the same goal is to inject fat along the anterior orbital rim. The key to this procedure is to use small volumes and keep the injecting needle on periosteum.) Facial implants are a more direct way to the same goal.
A balanced approach to facial rejuvenation between volume augmentation and soft-tissue envelope repositioning and reduction
will possibly avoid the distortions of either approach alone.