DOCSLIB.ORG

Alloplastic Materials for Facial Skeletal Augmentation$

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Alloplastic Materials for Facial Skeletal Augmentation$ Facial Plast Surg Clin N Am 10 (2002) 325–333 Alloplastic materials for facial skeletal augmentation$ Craig D. Friedman, MD, FACSa,b,*, Peter D. Costantino, MD, FACSc aFrom Private Practice, Facial Plastic Surgery, 4 Greystone Farm Lane, Westport, CT 06880, USA bMedical Research and Development, Biomerix, Inc., 41 West 57th Street, New York, NY 10019, USA cDepartment of Otolaryngology, Roosevelt St. Lukes Hospital, 425 West 59th Street, 10th Floor, New York, NY 10019, USA Facial skeletal augmentation continues to be an etal augmentations are onlay in nature with the goals important clinical area for surgeons performing cos- of stability and symmetry paramount. Esthetic guide- metic and reconstructive facial surgery. This article lines have been developed and refined to guide reviews the current state of the art approaches utilizing correction of common facial skeletal deficiencies alloplastic materials. Surgical goals, biomaterials, [1]. Additionally, recent attention has been given to operative techniques, and complication management the role of skeletal changes in aging. Both Binder [2] are discussed. Any discussion of alloplastic materials and Pessa et al [3] have shown the value of skeletal ultimately relates tissue effects to long-term clinical augmentation to enhance other aspects of facial results. It may take a full generation (20 years) to rejuvenation, thereby increasing the importance of appreciate fully most if not all possible tissue effects skeletal augmentation in cosmetic facial surgery. of an alloplastic material; however, biomaterial sci- Inlay applications for skeletal defects (of a trau- ence has developed fundamental principles that matic or oncologic etiology) additionally require vol- should aide the surgeon in choosing the most appro- ume maintenance over time to preclude defect priate alloplast for skeletal augmentation for various reformation. Volume maintenance over time is a key patient groups. advantage of commonly used alloplastic implants. In the past the goal of stable volume was believed to be due to utilization of an inert implant material and minimal tissue response over time. This view of Surgical goals implants has been found to be naive with respect to tissue–implant interface biology. Improved under- Clinical judgment always remains the most standing of interface biology has revealed the limi- important arbiter in selecting the appropriate implant tations of many implants and helped encourage the and surgical approach for an individual patient. development of bioactive implants [4]. Bioactive Patient implant requirements can be routinely clas- implants are biomaterials that allow for biologic sified as either onlay or inlay with regards to the type bonding of tissue to implant, which permits natural of skeletal augmentation. Purely cosmetic facial skel- tissue regeneration as opposed to chronic foreign body or inflammatory reaction. Bioactive interfaces theoretically reduce micro- motion and implant mobility over time. Secure $ This article is reprinted in an abridged format from: implant fixation allows for less opportunity of motion Friedman CD, Constantino PD, Sajjandian A. Alloplastic materials for facial skeletal augmentation. Facial Plast Surg at the interface to induce wound inflammation. Clin N Am 1999; 7(1):95–103. Chronic inflammation over the long term leads to * Corresponding author.. formation of avascular fibrous capsules. Although E-mail address: [email protected] such tissue reaction may by clinically quiesent, it (C.D. Friedman). can lead to gross implant mobility and secondary soft 1064-7406/02/$ – see front matter D 2002, Elsevier Science (USA). All rights reserved. PII: S1064-7406(02)00022-6 326 C.D. Friedman et al. / Facial Plast Surg Clin N Am 10 (2002) 325–333 tissue changes in the long term. Therefore, stable and acterized by various amount of fibrous and fibrovas- secure implant fixation becomes a very important cular ingrowth. Although polyethylene can support clinical goal that affects outcome. surface conduction of viable osteocytes, true inte- grative osteoconduction throughout an implant has not been documented by experimental results [8,9]. Implant materials Fibrovascular ingrowth makes porous polyethyl- ene an attractive implant for facial skeletal augmen- There are four commonly used implant materials tation for the following reasons. First, the ingrowth for facial skeletal augmentation: (1) silicone elasto- stabilizes fixation of the implant. Second, the implant mer, (2) porous polyethylene, (3) expanded polytetra- may be resistant to infection and therefore potentially fluoroethylene (ePTFE), and (4) hydroxyapatite– salvaged in the face of exposure if sufficient vas- calcium phosphate. Detailed implantology informa- cularity is present [10]. Fixation of implants is most tion on these materials can be found elsewhere in this commonly achieved with metal screws. issue. The tissue–implant interfaces exhibited by these materials are important to understand so that Expanded polytetrafluoroethylene clinical effectiveness is maximized. Expanded polytetrafluoroethylene (Gore-Tex, WL Silicone Gore, Flagstaff, AZ) has been used extensively as a soft tissue implant and vascular prosthesis. Various Silicone elastomer is a solid rubber–consistency formulations of fibrils are combined to create polymer of polymethyl siloxane. Due to its relative implants with pores of up to 30 lm. The tissue– inertness as an implant it has been developed for implant interface is usually that of limited fibrous many medical applications and specifically facial tissue ingrowth without significant capsule formation. skeletal augmentation [5]. Preformed shapes for Interesting recent experimental data have revealed nasal, malar, and chin augmentation have been in differential healing responses to ePTFE dependent use for many years. The tissue–implant interface is upon the anatomic site of implantation [11]. Such one of an avascular fibrous capsule. Capsular con- experiments shed light on potential uses in facial traction aides in securing the implant to a fixed implantation and the important questions that remain position over time. Initial fixation of silicone implants unanswered. Preformed chin and malar implants are should be attempted. Many surgeons prefer place- available, but the most common use is to augment the ment in a defined supraperiosteal pocket; others have nasal dorsum in reconstructive surgery. Extensive modified this by use of nonresorbable sutures or experience in this use has been reported with favor- metal screws. able outcomes [12]. Gore-Tex nasal augmentation The most commonly associated unfavorable result ultimately requires comparison with autogenous tis- with silicone implants has been underlying bone sue to make the final assessment of outcomes. resorption. This was identified by Robinson and Shuken [6] in 1969 and has been recounted in many Hydroxyapatite reports subsequently. Matarasso et al [7] have recently summarized these reports and provide findings that Currently, many forms of calcium phosphate and call for caution in advocating silicone chin implants hydroxyapatite biomaterials exist and have extensive for certain patient groups. Despite this well-known use in facial skeletal augmentation. These materials information, silicone implants remain popular and should be classified as bioactive in nature. The readily accepted by surgeons and patients. tissue–implant interface can be categorized as show- ing osteoconduction and osseointegration over time. Polyethylene Interested readers should consult previous reviews for comprehensive details on synthetic bone substitutes High-density porous polyethylene (MedPore, [13]. This discussion only highlights those materials Porex Industries, Fairburn, GA) has gained consid- in general use and emphasizes new information erable acceptance as an implant for facial skeletal relevant to clinical issues. augmentation. It is a particulate high-density polymer Hydroxyapatite biomaterials can be broadly cate- of ethylene that is then fused by a sintering process gorized into ceramic and nonceramic classes. Ceramic into a porous solid material. Pore size ranges from material of a porous nature has been used as an onlay 100 to 300 lm. The material is somewhat flexible and material for facial skeletal augmentation [14]. This readily carved. The tissue–implant interface is char- porous hard material (Interpore, Irvine, CA) has pore C.D. Friedman et al. / Facial Plast Surg Clin N Am 10 (2002) 325–333 327 sizes of up to 300 to 500 lm, which allows for fibro- surgery, to concealed incision surgery, and now mini- osseous conduction at the interface. The main clinical mally invasive endoscopically assisted approaches difficulties have been contouring the edges of the (Louis Morales, personal communication, 1997). Most implant for blending purposes and initial fixation with of the fronto-orbital and midfacial skeleton can be screws, which can lead to problematic implant frac- exposed via coronal scalp incisions and flap elevation. tures. Other surgeons have used granules of porous The midfacial and mandibular skeleton is most often hydroxyapatite for facial augmentation by limiting exposed via intraoral approaches. The nasal region is dissection and exposure to subperiosteal pockets for easily accessed with endonasal incisions. Fig. 1 illus- implant placement and awaiting initial soft tissue trates the authors’ preferred technique for the place- ingrowth healing to stabilize the implant [15]. ment of a chin implant. The
Load more

Recommended publications
  • Facial Implants
    Facial implants Information for patients Department of Maxillofacial Surgery, Sheffield Teaching Hospitals Figure 1. 3D skull showing implant reconstruction of the cheek This leaflet is designed to help you understand what is involved in having a facial implant. It explains some of the common side effects and complications associated with the procedure that you may need to be aware of. It is not meant to replace discussion between you and your surgical team, but it may help to answer some of your queries. If you have any further questions, please do not hesitate to ask. What are facial implants? Facial implants are custom made implants used to reconstruct the face. They are usually made from Medpor or from PEEK (Polyethetherketone) or titanium. All materials have been commonly and successfully used in surgery for many years. Custom made implants are made following a CT scan of the bony structures of your face and are bespoke and personal to you. PROUD TO MAKE A DIFFERENCE SHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST PD9803-PIL4179 v1 Issue Date: December 2019. Review Date: December 2022 Who will be treating me? Your treatment is carried out within Sheffield Teaching Hospitals and is led by a team of Consultants which might include a Maxillofacial Surgeon and an Ophthalmic Surgeon. Our Consultant Oral & Maxillofacial Surgeons have received full surgical training and all have dental expertise. All surgeons are under the General Medical Council Specialist for Oral & Maxillofacial Surgery. Sometimes other health professionals may need to be involved in your care. This might include dieticians, clinical psychologists and psychiatrists.
    [Show full text]
  • God Vård Av Barn Och Ungdomar Med Könsdysfori Metodbeskrivning Och Kunskapsunderlag
    God vård av barn och ungdomar med könsdysfori Metodbeskrivning och kunskapsunderlag Denna publikation skyddas av upphovsrättslagen. Vid citat ska källan uppges. För att återge bilder, fotografier och illustrationer krävs upphovsmannens tillstånd. Förord Detta dokument innehåller en beskrivning av de metoder som har använts för att ta fram God vård av barn och ungdomar med könsdysfori – Nationellt kunskapsstöd, och de kunskapsunderlag som ligger till grund för rekommen- dationer i kunskapsstödet. Kunskapsstödet finns på www.socialstyrelsen.se. För att göra kunskapsstödet mer lättläst har Socialstyrelsen valt att separat- publicera denna längre version av den arbetsprocess som ledde fram till kunskapsstödet, tillsammans med den vetenskapliga och kliniska bakgrunden till innehållet i kunskapsstödet. Lars-Erik Holm Generaldirektör Innehåll Förord ......................................................................................................................... 3 Framtagningen av kunskapsstödet ..................................................................... 9 Arbetsgruppens sammansättning ............................................................... 9 Faktaarbetet ................................................................................................. 10 Prioriteringsarbetet ....................................................................................... 13 Hälsoekonomiska bedömningar ............................................................... 15 Andra faktorer som har varit centrala i arbetet ....................................
    [Show full text]
  • Choosing the Best Procedure to Augment the Chin: Is Anything Better Than an Implant?
    507 Choosing the Best Procedure to Augment the Chin: Is Anything Better than an Implant? Jonathan M. Sykes, MD1 Rebecca Fitzgerald, MD2 1 Department of Otolaryngology/Facial Plastic Surgery, Address for correspondence Jonathan M. Sykes, MD, Department of University of California Davis Health System, Sacramento, California Otolaryngology/Facial Plastic Surgery, UC Davis Health System, 2 University of California Los Angeles, Los Angeles, California 2521 Stockton Blvd., #6206, Sacramento, CA 95817 (e-mail: [email protected]). Facial Plast Surg 2016;32:507–512. Abstract The chin plays a very important role in overall facial appearance, and aesthetic procedures to augment the chin in patients with microgenia can improve overall facial balance. Many procedures exist to enhance the appearance of a small chin. Procedures include surgeries such as placement of an alloplast implant and bony osteotomy of the mentum (sliding genioplasty). The advantages and disadvantages of each surgical technique are well documented. Although surgical augmentation of the chin has been the gold standard of therapy, recent development of injectable filler products with lifting capacity has changed the way that many practitioners alter chin shape and size. Filler agents allow augmentation of the chin in horizontal (projection), vertical, and Keywords transverse dimensions. Injectable fillers are a simple, noninvasive procedure that causes ► chin augmentation minimal to no downtime, incurs minimal risks, and allows the practitioner to shape the ► chin implant chin in three dimensions. This procedure allows patients to enhance their chin size ► genioplasty without requiring an operative visit. As more and varied filler products become FDA- ► volume approved, the versatility and application of these agents will increase.
    [Show full text]
  • Alloplastic Facial Implants: a Systematic Review and Meta- Analysis on Outcomes and Uses in Aesthetic and Reconstructive Plastic Surgery
    Aesth Plast Surg (2019) 43:625–636 https://doi.org/10.1007/s00266-019-01370-0 SYSTEMIC REVIEW FACIAL SURGERY Alloplastic Facial Implants: A Systematic Review and Meta- Analysis on Outcomes and Uses in Aesthetic and Reconstructive Plastic Surgery 1 2 1 5 Jeremie D. Oliver • Annica C. Eells • Elias S. Saba • Daniel Boczar • 5 5 5 3 David J. Restrepo • Maria T. Huayllani • Andrea Sisti • Michael S. Hu • 4 5 Daniel J. Gould • Antonio Jorge Forte Received: 1 February 2019 / Accepted: 24 March 2019 / Published online: 1 April 2019 Ó Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019 Abstract Results A total of 17 studies (n = 2100 patients, follow-up Background Alloplastic materials in facial surgery have range = 1 month–27 years) were included. Overall, mer- been used successfully for various applications in the silene mesh implants were associated with the highest risk reconstructive restoration or aesthetic augmentation of the of infection (3.38%). Methyl methacrylate implants were facial skeleton. The objective of this study was to conduct a associated with the highest rate of hematoma (5.98%). comprehensive systematic review of alloplastic implant Implants placed in the malar region (2.67%) and frontal materials utilized to augment the facial skeleton stratified bones (2.50%) were associated with the highest rates of by anatomical distribution, indication, specific material infection. Implants placed in the periorbital region were used, and respective outcomes. associated with the highest rate of inflammation (8.0%), Methods A comprehensive systematic review on alloplas- explantation (8.0%), and poor cosmetic outcome (17.0%).
    [Show full text]
  • God Vård Av Vuxna Med Könsdysfori Metodbeskrivning Och Kunskapsunderlag
    God vård av vuxna med könsdysfori Metodbeskrivning och kunskapsunderlag . Denna publikation skyddas av upphovsrättslagen. Vid citat ska källan uppges. För att återge bilder, fotografier och illustrationer krävs upphovsmannens till- stånd. Förord Detta dokument innehåller en beskrivning av de metoder som har använts för att ta fram God vård av vuxna med könsdysfori – Nationellt kunskapsstöd, och de kunskapsunderlag som ligger till grund för rekommendationer i kun- skapsstödet. Kunskapsstödet finns på www.socialstyrelsen.se. För att göra kunskapsstödet mer lättläst har Socialstyrelsen valt att se- paratpublicera denna längre version av den arbetsprocess som ledde fram till kunskapsstödet, tillsammans med den vetenskapliga och kliniska bakgrunden till innehållet i kunskapsstödet. Lars-Erik Holm Generaldirektör Innehåll Förord ......................................................................................................................... 3 Framtagningen av kunskapsstödet .................................................................. 13 Förstudie ......................................................................................................... 13 Arbetsgruppens sammansättning ............................................................ 15 Faktaarbetet ................................................................................................. 16 Prioriteringsarbetet ....................................................................................... 19 Hälsoekonomiska bedömningar ..............................................................
    [Show full text]
  • Product Catalog
    PRODUCT CATALOG SEPTEMBER 2019 Superior Facial & Body Aesthetics Designed by prominent surgeons, Implantech’s facial implants provide the youthful, cosmetic and reconstructive solutions desired by your patients. Count on our comprehensive line of silicone and expanded polytetrafluoroethylene (ePTFE) facial implants for industry-leading innovation and effective, pleasing outcomes. To enhance body areas, accept nothing less than our solid-silicone ContourFlex™ and PowerFlex™ products. Soft and supple, Implantech’s gluteal, pectoral and calf implants provide shaped volume and smoothed edges for the most natural look and feel. Our expanded lineup now includes more styles, with smooth and textured options for all three body- contouring areas and super-soft gluteal and pectoral selections. If no stock product is appropriate, tap into our patient-specific resources. We faithfully reproduce silicone implants either from CT scans with our 3D Accuscan® service or from a mold you make with one of our Moulage Kits. Or, carve your own from silicone blocks of different sizes, shapes and durometers. For scar management, our Cimeosil® products are specifically formulated for the topical management of keloids and hypertrophic scars. Our Cimeosil Scar and Laser Gel also helps with any scarring or redness associated with laser surgery, dermabrasion and chemical peels. Made of stretchable, fabric-covered silicone gel, our Gelzone® Wraps combine compression healing, musculoskeletal support and scar management. You can also depend on Implantech for sheeting and tubing. We offer sterile ePTFE and silicone sheeting for short term or long term applications and non-sterile, implant grade and health care grade silicone tubing. Get the service, quality, innovation and choices you and your patients deserve.
    [Show full text]
  • Facial Augmentation with Implants
    Chapter 24 Facial Augmentation with Implants Farzin Sarkarat, Behnam Bohluli and Roozbeh Kahali Additional information is available at the end of the chapter http://dx.doi.org/10.5772/59188 1. Introduction The public’s demand for facial beauty has increased over time. Different cosmetic procedures have been introduced to meet this demand. The essentials of facial cosmetic surgery are: 1- Volume replacement and 2- Facial augmentation. Better aesthetic results have been achieved by using less invasive surgical techniques including lifting procedures, injectable fillers, autologous fat transfer, and facial implants. The malar eminence and chin are the most common facial sites augmented via implants. Autologous tissues have been the gold standard for facial augmentation for years; but today alloplastic materials are more commonly used. Drawbacks of autogenous grafting include: donor site morbidity, limited availability, limited moldability, and unpredictable resorption [1].An ideal alloplastic implant must be made out of a material that has low bioactivity or toxicity. It must also be stable and biocompatible [2]. An understanding of these qualities is needed to prevent complications or to treat them should they occur. 2. The aging process One of the primary advancements in cosmetic facial surgery has been the realization of volume loss in aging and volume replacement via cosmetic surgery [3-6]. The abundance of midfacial volume is one of the main reasons that makes a person look young, which means having the right amount of fat in the right areas of the face. The loss or shift of this fat is a main contributor to facial aging [7]. Loss of volume and volume shift occur in all regions of the face and neck and are the reasons for aged appearance [5, 6].The youthful midface has voluminous and © 2015 The Author(s).
    [Show full text]
  • Injury in the Transgender Population: What the Trauma 3 – 1 in Fact, It Has Been Reported That More Than 40% of Gender
    REVIEW ARTICLE Injury in the transgender population: What the trauma surgeon needs to know Shane D. Morrison, MD, MS, Sarah M. Kolnik, MD, Jonathan P. Massie, MD, Christopher S. Crowe, MD, Daniel Dugi, III, MD, Jeffrey B. Friedrich, MD, Tam N. Pham, MD, Jens U. Berli, MD, 03/11/2021 on BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= by https://journals.lww.com/jtrauma from Downloaded Grant E. O’Keefe, MD, MPH, Eileen M. Bulger, MD, Downloaded Ronald V. Maier, MD, and Samuel P. Mandell, MD, MPH, Seattle, Washington from https://journals.lww.com/jtrauma ABSTRACT: Gender dysphoria, or the distress caused by the incongruence between a person’s assigned and experienced gender, can lead to significant psy- chosocial sequelae and increased risk of suicide (>40% of this population) and assault (>60% of this population). With an estimated 25 million transgender individuals worldwide and increased access to care for the transgender population, trauma surgeons are more likely to care for pa- tients who completed or are in the process of medical gender transition. As transgender health is rarely taught in medical education, knowledge of the unique health care needs and possible alterations in anatomy is critical to appropriately and optimally treat transgender trauma victims. Considerations of cross-gender hormones and alterations of the craniofacial, laryngeal, chest, and genital systems are offered in this review. by – BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= Further research on the optimal treatment mechanisms for transgender patients is needed. (J Trauma Acute Care Surg. 2018;85: 799 809. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.) KEY WORDS: Trauma; transgender; venous thromboembolism; surgical considerations.
    [Show full text]
  • Facial Feminization Surgery Procedures Facial Feminization Surgery Procedures
    Facial Feminization Surgery Procedures Facial Feminization Surgery Procedures By Trinity Rose www.facialfeminizationsurgery.net Facial Feminization Surgery (FFS) refers to surgical procedures, which will alter a masculine face to a feminine shape through the use of plastic surgery, reconstructive surgery, and maxillofacial surgery. Procedures range from the use of soft tissue procedures, facial fillers, implants, to more invasive procedures involving the buring (grinding) of facial bones, and the cutting (osteotomy) of facial bones. Due to the fact people differ in facial characteristics; a combination of serval procedures may need to be used to alter the face to the desired result to feminize the face. Most people refer to Facial Feminization Surgery as FFS when describing it. There are a number of surgical procedures that can be used to feminize the face when it comes to FFS. Depending on your facial structure and degree of masculine features, one or many of the following procedures can be used to feminize the transsexual face: Forehead contouring: Complated by a high speed bur Forehead reconstruction: Complated by cutting out a section or sections of the frontal skull Forehead compression/controlled facture: Research in progress Jaw tapering: Completed by a high speed bur or a bone saw Chin contouring/Mentoplasty: Completed by a high speed bur and or chin inplant Sliding genioplasty: Completed by cutting and removing the chin Cheekbone augmentation Through the use of implants Cheekbone reduction Complated by a high speed bur Lip contouring/Lip lift trachea shave blepharoplasty (Eyelid surgery to correct sagging or drooping of the eyelids) Rhinoplasty Facial Implants Facial Fillers Facelift FFS surgeon listings Further links about surgery can also be found at the bottom of this page.
    [Show full text]
  • Augmentation Mammoplasty
    INFORMED CONSENT FOR FACIAL IMPLANTS PLEASE REVIEW AND BRING WITH YOU ON THE DAY OF YOUR PROCEDURE PATIENT NAME ___________________________________________________ Based on my discussions with Dr Gutowski, I agree with, and choose to have the following facial implants: ___ Malar (cheek) implants ___ Chin implants ___ Jaw implants ___ Nose implants ___ Lip implants ___ Other _____________________ Patient Signature _________________________________ Date _____________ KAROL A. GUTOWSKI, MD, FACS AESTHETIC SURGERY CERTIFIED BY THE AMERICAN BOARD OF PLASTIC SURGERY MEMBER AMERICAN SOCIETY OF PLASTIC SURGEONS Patient Initials_________ INFORMED CONSENT FOR FACIAL IMPLANTS, Continued INSTRUCTIONS This is an informed-consent document that has been prepared to help inform you about facial implant surgery, its risks, and alternative treatments. It is important that you read this information carefully and completely. Please initial each page, indicating that you have read the page and sign the consent for surgery as proposed by your plastic surgeon. GENERAL INFORMATION. Facial implants are specially formed solid, biocompatible materials designed to enhance or augment the physical structure of your face. The precise type and size of implants best suited for you requires an evaluation of your goals, the features you wish to correct and your surgeon’s judgment. While any area of your face can be augmented with implants, the cheekbones, chin, lips, nose, and jaw are the most common sites for facial implants. Facial implants can bring balance and better proportion to the structural appearance of the face and they can help define the face by increasing projection and creating more distinct features. Facial implant surgery is best performed on people whose head and skull have reached physical maturity, which generally occurs in late adolescence.
    [Show full text]
  • Kallelse För HSN 2015-01-28.Pdf
    Kallelse Datum: 2015-01-20 HÄLSO- OCH SJUKVÅRDSNÄMNDEN Tid onsdag 28 januari 2015 09:00 Plats Oden Emil Lindells v 15 Växjö Kallade Ordinarie ledamöter Charlotta Svanberg (S), ordförande Tryggve Svensson (V), vice ordförande Roland Gustbée (M), 2:e vice ordförande Michael Sjöö (S) Christina Bertilfelt (S) Magnus Carlberg (S) Ann-Charlotte Kakoulidou (S) Ricardo Salsamendi (S) Annelise Hed (MP) Ove Löfqvist (M) Thomas Ragnarsson (M) Britt-Louise Berndtsson (C) Eva Johnsson (KD) Rolf Andersson (FP) Maria Sitomaniemi Stjernfelt (SD) Ersättare Stefan Marusic (S) Gert Andersson (S) Ulla-Britt Storck (S) Britt Bergström (V) Marianne Nilsson (M) Jennie Lundgren (M) Marianne Eckerbom (C) Thomas Haraldsson (C) Övriga kallade Ingrid Sivermo, Sekreterare Per-Henrik Nilsson Dan Petersson Utskriftsdatum: 2015-01-20 Kallelse Datum: 2015-01-20 1. Val av protokolljusterare samt justeringsdatum Förslag till beslut Föreslås att hälso-och sjukvårdsnämnden beslutar att jämte ordföranden justerarar andre vise ordförande Roland Gustbée protokollet samt att justering av protokollet sker den X 2. Godkännande av föredragningslista Förslag till beslut Föreslås att hälso- och sjukvårdsnämnden beslutar att godkänna föredragningslistan Centrumchefer 3. Informationsärende-centrumchefer Förslag till beslut Föreslås att hälso-och sjukvårdsnämnden beslutar att notera informationen till protokollet Sammanfattning Presentaion av centrumcheferna Utskriftsdatum: 2015-01-20 Kallelse Datum: 2015-01-20 Jens Karlsson 4. Informationsärende- ekonomi Förslag till beslut Föreslås
    [Show full text]
  • “Aesthetic Facial Implants”
    Facial Plastic and Reconstructive Surgery Fourth Edition Ira D. Papel John L. Frodel G. Richard Holt Wayne F. Larrabeejr. Nathan E. Nachlas Stephen S. Park Jonathan M. Sykes Dean M.Toriumi MediaCenter.thieme.com includes videos online Thieme Aesthetic Facial Implants William J. Binder, Babak Azizzadeh, Karan Dhir, and Geoffrey W. Tobias Introduction Implants and Biomaterials Over the last two decades, the marked improvement in bio- All implant materials induce the formation of fibroconnective material and the design of facial implants have expanded their tissue encapsulation, which creates a barrier between the host use in aesthetic and facial rejuvenation surgery.1-23 Alloplastic and the implant.78 Adverse reactions are a consequence of an implants offer a long-term solution to augment skeletal defi- unresolved inflammatory response to implant materials. The ciency, restore facial contour irregularity, and rejuvenate the behavior is also a function of the configuration characteristics of midface and mandible. Common implant procedures include: the site of implantation such as the thickness of overlying skin, cheek augmentation to balance the effects of malar hypopla- scarring of the tissue bed, and inherent underlying bone archi- sia; mandibular augmentation to create a stronger mandibular tecture that would tend to create a condition for implant insta- profile and a better nose-chin relationship; mandibular prejowl bility. For example, implants that are more deeply placed with and angle implants to augment traditional cervicofacial rhytid- thicker overlying soft tissue rarely become exposed or extrude. ectomy; submalar and midfacial implants to augment the hol- Other important factors such as prevention of perioperative he- lowness that occurs during the aging process; nasal implants matoma, seroma, and infection can significantly reduce host- for dorsal augmentation; and premaxillary implants to aug- implant interaction and thereby improve implant survivability.
    [Show full text]