Symposia

SYMPOSIUM ON PHARMACOLOGY FOR OUTPATIENTANESTHESIA: PART 1Presented on Thursday, September 22, 2005, 8:00 am—10:00 amModerator: Daniel S. Sarasin, DDS, Cedar Rapids, IA

Emergency Medications for OutpatientAnesthesiaO. Ross Beirne, DMD, PhD, Seattle, WA

No abstract provided.

Drug Interactions: New Wave ofHypertensive and Cardiac MedicationsKaren Baker, RPh, MS, Iowa City, IA

No abstract provided.

SYMPOSIUM ON COSMETIC SURGERY: THE FACE LIFTPresented on Thursday, September 22, 2005, 8:00 am—10:00 amModerator: Clarke O. Taylor, DDS, MD, Missoula, MT

History, Evolution, and AnatomyStephen W. Watson, DDS, MD, Plano, TX

Since its inception, the orthognathic surgeon has fol-lowed the mantra of the architect which states that “goodform follows good function.” This phrase was used in bothevaluation and treatment planning. So, esthetic consider-ations have long been an important part of the specialtyand it can be successfully argued that it has been a part oforal and maxillofacial surgery. This is especially true giventhe background and training received in dental school. Asorthognathic surgery became widespread in the 1970’s, thesliding genioplasty did provide for better position of theptotic lower lip. However, it was also an important part ofthe esthetic outcome and began to be modified to morecompletely achieve the cosmetic goal.

In the 1980’s the popularization of rigid internal fixa-tion reduced the immediate postoperative airway com-promise encountered with maxillomandibular fixation.This then brought about the debate of whether or notthe cosmetic rhinoplasty could be conveniently per-formed with maxillary osteotomies. Though initially con-troversial, many surgeons persevered. Once they realizethat the maxillary osteotomies they were performing hada predictably positive result in nasal esthetics, they sim-ply added the additional steps to complete the cosmeticrhinoplasty. Refinement of alloplastic implants in the1980’s combined with screw fixation made the electiveesthetic adjustments of the midface possible without thecomplicated osteotomies previously employed.

Three important advances occurred in the 1990’s lead-ing oral and maxillofacial surgeons further into the arenaof facial cosmetic surgery. These were the introductionof the endoscope and lasers and the ability to performorthognathic surgery as an outpatient. With a dental

background and residency training, the oral and maxil-lofacial surgeon was a natural with the endoscope andthe carbon dioxide and erbium YAG lasers allowed forprecise and predictable cosmetic alterations of the der-mal structures of the face. The ability to perform orthog-nathic surgery as an outpatient, or in many cases in theoffice, now made it more affordable for patients desiringconcomitant cosmetic procedures. With the oral andmaxillofacial surgeon’s training in general anesthesia andoffice surgery along with the introduction of short-termanesthetic agents, the specialty could provide the mostcost effective model for the delivery of cosmetic facialsurgery that had ever existed.

By the year 2000, oral and maxillofacial surgeons re-vealed the significance of combining the subperiostealanatomic plane with the facelift and browlift to achieveoptimum results.

Oral and maxillofacial surgeons are the most preparedto approach the subperiosteal plane via the intraoralapproach. This allows for relaxation of the soft tissues sothat results and stability of midlifts, facelifts, andbrowlifts are greatly enhanced. The focus of this presen-tation will be on the utilization of this technique.

Skin Incisions and Skin ClosureJon D. Perenack, DDS, MD, New Orleans, LA

The rhytidectomy procedure provides the surgeonwith a powerful tool to rejuvenate the neck line, jaw lineand midface of the aged patient. Ultimate satisfactionwith the surgical result depends not only upon a natural,youthful and esthetic result, but also upon the camou-flage of signs that would herald that surgery has beenperformed, namely, the incisions. Improperly designedand executed incisions, and their closure, result in many

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