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The periorbita, cheeks, and midface are an area of complex facial form and function. There is a particular pleasing visual harmony of these regions in the youthful face. With time, the robust glow and fullness of youth fades and diminishes. The skin is the first component to show the passage of time as it dulls, wrinkles, and blemishes. This is followed by a slow loosening and sagging of soft tissues as they descend from their once-fixed points of the skeletal foundation. The smooth transitions between regions are separated and hollows and ridges appear. These processes continue throughout life and eventually are accompanied by the visible consequences of bone resorption. The faces age, and as the countenance of the human spring turns through summer into autumn, function follows form, and symptoms accompany signs. A thorough understanding of both youthful and elder anatomy as well as the stigmata of aging is prerequisite to perform rejuvenating procedures. This article discusses these changes and how the older anatomy becomes the new norm.

To illustrate problems observed with lowporosity expanded polytetrafluoroethylene soft tissue implants and to describe a new dual-porosity implant, the technique for insertion, and this author's preliminary experience.Method: A review of 175 pieces of SoftForm (Collagen Corporation, Palo Alto, Calif) placed in 69 patients over 3 years was performed. Between October 1, 1997, and September 30, 2000, 106 Advanta implants (Atrium Medical Corporation, Hudson, NH) in 42 patients have been carried out. A new instrument for implant insertion and the procedure used is described herein. Results:The low-porosity expanded polytetrafluoroethylene implants demonstrated a significant amount of problems with shrinkage and migration.Conclusions: Preliminarily, the dual-porosity implants would appear to offer a lower incidence of these complications. They are subjectively softer to feel once in place. Insertion is quick and easy using the method described herein.

ugmentation of the chin is a long-standing and effective technique for facial enhancement. We have used preformed expanded polytetrafluoroethylene (Gore-Tex) implants for chin augmentation for several years. For this study, we collectively pooled data detailing our experiences with this material. From January 1, 1998, to March 30, 2001, a total of 324 Gore-Tex chin implants were placed. No resorption or visible movement of any implant occurred. Two (0.62%) of the 324 implants became infected and were ultimately removed. No other complications occurred. This complication rate compares favorably to other reports. Five implants (1.5%) were removed or changed in size due to patient requests. All remaining patients (97.8%) were satisfied with their result. We also describe technical points and procedure modifications that have helped us achieve beneficial results for our patients. Gore-Tex is a reliable implant material that helps the surgeon to achieve a high degree of patient satisfaction in chin augmentation.

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The history of tattooing dates back to a time as ancient as civilization itself, when this highly symbolic method of expression afforded more than a mere touch of individuality. The iceman Ötzi, the 5,200-year-old European Bronze-Age mummy discovered in northern Italy, was covered in punctate tattoos dispersed throughout the skin over his arthritic joints, incurred from multiple ritualistic, therapeutic interventions. In ancient Egypt, dermal tattoos branded criminals, stigmatized prostitutes, and marked social rank. In the 17th century, as European explorers settled into overseas colonies, the practice of tattooing was gradually assimilated into Western culture, with the word tattoo itself deriving from ta-tau, Tahitian for "the results of tapping." With the Industrial Revolution, the mechanization of conventional tattooing tools allowed for more precise and varied patterns, while the incorporation of multiple pigments provided for multicolored designs. The embrace by popular culture, the military community, and private groups and gangs eventually culminated in the widespread cultural phenomenon that has become evident today. Removal of Tattoos and Permanent Makeup