The use of Piezosurgery® in facial bone surgery is a safe and predictable technique with low morbidity. With Piezosurgery®, it is possible to make very precise cuts into the mineralized tissue (bone) without affecting neighbor structures, thus preventing damage to the mucosa, muscle, nerves or blood vessels. We recommend it´s use in areas that are difficult to access, for osteotomies that require curves and continuity on the mandibular base and angle.
In nasal osteotomies, it minimizes trauma to the soft tissues and increases precision when eliminating the bony cap and performing the osteotomy under direct view, using and external approach with an extended subperiosteal dissection. This reduces post-surgical edema and ecchymosis and provides better control of the osteotomy line when narrowing the nasal pyramid and reducing the bony hump, either via osteotomy or osteoplasty.
A detailed preoperative analysis of facial features is an essential part of an individualized and exhaustive surgical plan that takes into consideration factors like the patient’s aesthetic preferences, anthropometric characteristics, age, ethnicity, gender and the harmonic relationship between facial thirds. At this time, diagnostic tools are also available that make it possible to do a comprehensive facial analysis, including 3D stereophotogrammetry -3D camera technology- (VECTRA H1 3D Imaging System, Canfield Scientific, NJ, USA), which has provided a valuable tool that complements the surgeon’s experience.
The introduction of 3D camera technology provides a practical method for objectively comparing surgical results. Stereophotogrammetry involves estimating the 3D coordinates of points on an object (the face, in our case), employing measurements made in two or more photographic images taken from different positions. In addition to rendering a 3D image, the data is easily obtained and, thanks to the included software, it can be used to perform anthropometric analyses of facial soft tissue landmarks with a reliability of 1 mm, and to simulate the proposed before and after results of facial feminization surgery.
This technology offers a unique tool in the field of FGCS for visual communication with the patient and makes it possible to enhance the process of clinical documentation. Thanks to 3D simulation and evaluation tools, the patient’s own image can be used to explore possible outcomes, educate them about their options, explain limitations, and establish appropriate expectations.
In some cases, we recommend the use of stereolithographic 3D models to improve preoperative planning. In this respect, the standardized incorporation of 3D printing (Form 2 3D Printer, Formlabs GmbH, Berlin Germany) is an important advance in diagnosis. The 3D printing of CT scans of skulls allows for model surgery to be practiced, which enables Facialteam surgeons to refine the precise procedures that should be performed on the patient on the day of surgery.
3D CT scan
Imaging tests are an essential part of a correct diagnosis and proper surgical planning. Today, the combination of CT scan (Computed Tomography) and 3D reconstruction makes it possible to obtain detailed and accurate anatomical information. This is essential when it comes to detecting the facial features that can be modified, providing the patient with precise information and assisting surgical planning. Moreover, being able to compare these images with postoperative CT results is extremely useful when assessing and explaining the changes made to the bone structure.