Even though I wrote a new concept in the topic title, this practice, which was put forward by plastic surgeons in the 1960s, has come to the fore again in recent years.
Profiloplasty, to be briefly described, is all of the procedures aimed at correcting the side view of the person. Of course, the main determining factor in the side view is the nose, and therefore rhinoplasty, which is the corrective procedure for the nose. Unfortunately, many doctors have only recommended rhinoplasty for patients who apply for facial complaints, due to the simplicity of the procedure and the low cost of the procedure. This has led to an increase in the number of patients who do not feel that they are more beautiful or more handsome despite having a nose surgery, and an increase in artificial-looking noses that are not suitable for the face. As a matter of fact, patients who want to have nose surgery have given up having this operation they want to have, seeing these bad examples around them.
Profiloplasty not only evaluates the lateral and oblique view of the patient’s face, but also the angle and proportions of the units that have an effect on this appearance. Although profiloplasty evaluates the face as a whole, if we classify the units of the face:
1. Get it
2. Eyebrows
3. Nose
4. Cheeks
5. Lips
6. Chin
7. Tickle region
8. Neck
9. Ears
In addition, double and triple evaluations are also important. Namely
1. Forehead-nose angle
2. Nose-lip angle
3. Nose-chin angle
4. Chin-to-chin ratio
5. Jaw-neck angle
6. Ear-nose size ratio
7. Forehead-nose-chin ratios
8. Nasolabial sulcus-nose relationship
Profiloplasty can be explained with simple examples. For example, if a patient with a large nose applying for nose surgery also has a large chin, an operation performed only on the patient’s nose will result in two ways:
· The patient’s nose is left large in proportion to the chin, and as a result, even if the nose is beautiful in shape, the patient’s nose and chin will remain in their former size, so the facial features will be coarse. After such a procedure, the patient and his surroundings think that the operation does not work at all, because a large nose is still a large nose.
The patient’s nose is reduced, not adjusted according to the size of the chin, and as a result, a disproportionate nose appears, which is not compatible with the face, but looks very artificial, but does not make the patient happy at all.
The procedure to be done in such a patient should perhaps be a slight filing of the bone at the tip of the chin in the same operation and the adjustment of the nose to the new chin so that the patient will have a harmonious and pleasant nose as a result.
What can be done with Profiloplasty:
1. Forehead: It can be filed, especially if the frontal processes are protruding in men. Or, if the forehead is very flat, the forehead can be brought into a convex shape with fat injections. The narrow forehead can be made wider by removing the hair by epilation in both men and women, whose hairline is located far below, or in cases where the hair is lost and the hairline regresses, hair transplantation can be performed. All these processes are decisive on the side view of the person.
2. Eyebrows: Eyes can be revealed by increasing the distance of the eyebrow tip to the lateral canthus by hanging eyebrows on low eyebrows.
3. Nose: With the Rhinoplasty procedure, the nose can be reduced, enlarged, raised and lowered, or lengthened and shortened.
4. Cheeks: Sagging cheeks on the old face can be lifted by hanging or fat-looking cheeks can be made weaker. Cheekbones can be clarified and nasolabial sulci can be blurred. A more rested expression can be given to the face by filling the cheeks.
5. Lips: Anatomically, the upper lip is slightly in front of the lower lip (1-2 mm) and the lower lip is thicker than the upper lip. Sometimes, one of the most important points of the procedure in rhinoplasty candidates is the thickening of the lip with fillers or the patient’s own fat. Thinning of thick lips is also possible, but this is not very common.
6. Chin: After the nose, the most important factor in profiloplasty is the evaluation of the chin. Jaw tip problems are very diverse:
The mentum is behind, the chin height is normal
The mentum is back and the chin height is short
The mentum is back and the chin height is long
The mentum is forward and the chin height is short
The mentum is forward and the chin height is normal
· The mentum is back and the chin height is long. Although any of these problems can be seen, the most common deformity in our country is the posterior mentum and short chin height. While this causes a round face in women, it also causes weak facial features in men. Therefore, the most frequently applied chin correction method in profiloplasty is augmentation mentoplasty. Augmentation mentoplasty can be done in the following ways:
I. Fat injection: The fat taken from the patient’s waist or abdomen or under the jowl is given to the chin after some procedures
ii. Administering external injection substances: Many foreign substances such as collagen, hyaluronic acid, etc. can be injected into the chin.
iii. Cartilage placement.
iv. Placing jaw tip prostheses: silicon etc…
vv Moving the jaw bones forward by cutting them surgically.
7. Jowl region: Excess fat in the submental region causes the patient’s chin to appear shorter than it is. A simple liposuction or submental fat excision to this area will smooth the chin contour.
8. Wrinkled skin in the neck area can be corrected with a neck lift operation. This procedure should be applied mostly in middle-aged and older patients. In younger patients, it may be necessary to inject fat into the entire mandible contour (not just the chin tip) to correct the cervicomental angle.
9. Ears: Although the ears are organs with more deformities when viewed from the front or from the back, the folds of the entire auricle should be fully visible in normal anatomy from the profile. Correction of this in patients with prominent ear deformities contributes greatly to the side view.
So how will the patient understand what is right for him? While some of the patients who apply see only one aspect of the problem, some of them misjudge the problem. The main role here falls on the plastic surgeon. After taking the front, side and oblique pictures of the patient, these are studied. These studies, which are done with computer programs, are not done, for example, to say to a rhinoplasty candidate “we will make you this nose, you will be beautiful like that, you will be wonderful”. These programs are designed to reveal the patient’s problems, not to deceive the patient.
With the help of the computer, the relationship between the units mentioned above is revealed and the angles and ratios are measured. Then, possible results are presented to the patient by making appropriate corrections. While profiloplasty is a very mathematical procedure until now, it is an art when it is put into reality. A simple filling procedure can be done by a medical esthetician. An otolaryngologist can perform a nose surgery. Cheeks can be shaped by a dermatologist with external filling materials. Even an ophthalmologist can perform cosmetic surgery on your eyelids and eyebrows. However, only a plastic surgeon can evaluate all of these and more and recommend and apply the most appropriate operation or series of operations for you.
