Day 1 :
Heumarkt Clinic, Germany
Thomas Haffner (MD) is a board certified reconstructive, vascular and cosmetic surgeon in Germany. He was trained in the reconstructive-plastic surgery and senology section of the Semmelweis University (Szabolcs Str.) in Budapest. He is specialized also in vascular surgery and worked there many years as department leader in German clinics. Attending educational courses by Prof. E. Biemer had certified in the endoscopic plastic surgery and micro-surgery. He completed cadaver and live Op. courses in the universities of Erlangen, Ulm, Regensburg and resident assistance by Prof. Rettinger in Ulm. In 2000 he established his private clinic for vascular-reconstructive & aesthetic surgery in Cologne, Germany. His primary focus is the breast and facial surgery using minimal invasive and endoscopic methods. He invented the innovative vertical scar free reconstructive 3D mastopexy. He presented a new facelift method the "Temporal Endoscopic Face and Midface Lifting" without facial scars.
Background: Oculoplastic operations are in the top most performed plastic operations worldwide. However, the common way of blepharoplasty doesn’t address hollowing eyes, depletions and skeletonisation around the orbital following natural aging. Neither the blepharoplasty nor periorbital procedures are focused on longevity and aging prevention. Iatrogenic worsening of skeletonisation and hollowing exist by all day routine working. Moreover the aesthetic unit of eyelids, brows, temple, forehead and midface are mostly ignored and not plastic surgically addressed.
Objective: The objective of the study is to demonstrate new trends of extended oculoplastic surgery according to 19 years cosmetic-plastic surgery experience of the author; the meticulous orbicular and endoscopic minimal invasive peri-orbicular procedures being as new standards in the oculoplastic surgery. Aging addresses the whole face; oculoplastic surgeries should be made therefore nor isolated, but considering of the aging of neighboring regions around the eyes.
Methods: New methods such as the fat and muscle augmentation were already presented from many years at conferences through papers such as the muscle and fat augmentation blepharoplasty, the endoscopic minimal invasive brow-temple and midface rejuvenations such as tarsus securing canthopexies. By all these methods disfiguring complications can be prevented and the results be enhanced. These new methods are already new standards today in the oculoplastic surgery and should be known even by dermato-surgeons. The time of common easy blepharoplasty exists no more. The new standards in the oculoplastic surgery such as the muscle and fat augmented upper lid blepharoplasty, the tissue sparing lower lid blepharoplasty, canthoplasty and canthopexy, endoscopic facial rejuvenation are presented and strongly recommended for all actively working oculoplastic surgeons.
Results: Using the new kind of standard procedures in the oculoplastic surgery much better results had been achieved during the past 10 years. An operated look, skeletonisation and disfiguring dimples could be always prevented. All operated patients looks natural, without operated look. The canthopexy with tarsal strip procedure counts as the best way but also the most difficult way in treating scleral show and ectropion. Periorbicular orbicularis shifting and lifting promote much lower lid and cheek position by upper lid blepharoplasty incision. There was no postoperative upper eyelid ptosis and also retreating prolapse of the upper lid doesn´t happen, when an adjuvant direct brow lift or a temple-forehead lift made, when the patients gets botulinum-toxin brow lift regularly. The canthopexy was also used as a preventive procedure against scleral show and ectropion. The scars are very fine and inconspicuous after muscle augmented blepharoplasty.
Conclusions: There are new standards in the oculoplastic and periorbicular and endoscopic facial surgery, which should be known by all operative active orbicular surgeon. The usually performed common ways of upper and even lower lid blepharoplasty are out. Every surgeon must critical proof, whether to perform a skin resection at all by lower lid blepharoplasty, than in any case of lowering of the tarsus, scleral show a iatrogenic damage exist, which had been avoided by no skin excision lower lid blepharoplasty.