Recent Publications by Dr. Fedok on Facial Plastic and Reconstructive Surgery

Dr. Fedok has written extensively and lectured internationally on all aspects of facial plastic and reconstructive surgery.  He is an editor of the textbook Minimally Invasive and Office-Based Procedures in Facial Plastic Surgery. He is a frequent guest editor and author for peer-reviewed journals.  His favorite topics to write and speak about are facelifts, rhinoplasty, revision rhinoplasty, mid-face and lower face rejuvenation, eyelid and brow surgery and laser procedures for facial rejuvenation.  He is an internationally-recognized expert in facial plastic and reconstructive surgery.

Original Article 121 The Rejuvenation of the Aged Central Lower Face: A Contemporary Perspective Fred G. Fedok, MD, FACS1 Department of Surgery, University of South Alabama, Mobile, Alabama Address for correspondence Fred G. Fedok, MD, FACS, Fedok Plastic Surgery, 113 East Fern Avenue, Foley, AL 36535 (e-mail: Facial Plast Surg 2019;35:121-128 Abstract Aging of the central face is typified by several common characteristics such as generalized volume loss, the appearance of a mental crease and marionette lines, thinning of the lips, and fixed and dynamic rhytids. These result from several processes such as atrophy of adipose and bone, changes in the support of the mandibular septum, and a loss of skin elasticity. There are many methods available for the improvement and rejuvenation of this facial anatomical area. Options include traditional surgical techniques, the application of volume and the use of laser, light, and energy-based devices. The recent application of biological interventions offers the possibility of cellular-based therapies to usher in a new era of true tissue regeneration. Optimal correction of the abnorn plished through an understanding and identification of the causes of the observed abnormalities and targeting with the best available intervention. There are a growing number of techniques and technologies to accomplish this. Keywords central lower face biologicals platelet-rich plasma alities may be accom- fat transfer marionette lines As the average age of the population continues to increase,12 there has been a growing demand for facial rejuvenation procedures. In response to this demand for facial rejuvena- tion, there has been an introduction of a widening array of techniques, methods, and technologies to accomplish this The past 50 years have seen a tremendous improvement in our understanding of the processes integral to facial aging. In the past, surgical attention appeared to be largely elasticity and sagging of facial skin, whereas now there is a greater appreciation of the role of involution-based changes in facial soft tissue suspensory elements, soft tissue volume, and skeletal mass.3 In turn, there has been a development of a spectrum of methods to reverse these age-related changes with the replenishment of volume, repositioning of facial soft tissue elements, and biological interventions Much has been written about the sagging of the eyebrows, arguably not as important as the upper face in social inter- actions, the lips and associated regional structures hold a similarly crucial role in facial discernment and social inter- face. An examination of the central lower facial areas of aging patients will suggest that this area, due to a relative dis- proportionate greater impact of volume loss compared with other facial regions, takes on an aged appearance in a more accelerated fashion than some of the other parts of the face. Many of the past approaches to the central lower face have been unsatisfactory, that is, the recommendation to deeply dermabrade the perioral rhytids, resulting in unsightly local hypopigmentation. The contemporary recognition of the need for volume and contemporary methods of skin tighten- ing has opened up a newer chapter in the rejuvenation of the central lower face י on the loss of the descent of midface structures, and the sagging of the neck tissues that come with aging. Relatively less has been written about the aging of the central lower face. This has been due in part, to the previous paucity of methods to effectively rejuvenate this anatomical area where aging is marked by deflation and fixed rhytids around the perioral area This important anatomical region includes the lips, the jawline, the chin, the subnasal, and the mandible. Although The Aesthetics of the Central Lower Face The central lower facial region includes the upper and lower lips, as well as the chin. The central lower facial region encompasses the inferior one-third of the horizontal facial proportions and can be further subdivided, with the upper lip accounting for one-third and the lower lip and chin accounting for two-thirds of the lower facial division.4,5 Copyright O 2019 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, DOI 10.1055/s-0039-1683857 ISSN 0736-6825 Issue Theme Aesthetic Treatment of the Jawline and Perioral Area; Guest Editor: S. Randolph Waldman, MD New York, NY 10001, USA. Tel: 1(212) 584-4662 Minimally Invasive and Office-Based Procedures in Facial Plastic Surgery Fred G. Fedok Paul J. Carniol Thieme incudes videos online Techniques in Facial Plastic Surgery Discussion and Debate ousDRO Fred Fedol, MD Robert Kellman, MD FACIAL PLASTIC SURGERY CLINICS OF NORTH AMERICA A 2 Clinics Review Articles FACIAL PLASTIC SURGERY CLINICS OF NORTH AMERICA Techniques in Facial Plastic Surgery: Discussion and Debate part 2 EDITORS Fred G. Fedck Robert M. Kelman CONSULTING EDITOR J. Regan Thomas FEBRUARY 2014 euiews
The Difficult Neck in Facelifting Corective Nasal Surgery in the Younger Patient Managing the Neck in the Era of the Short Scar Fаce-Lit Cutaneous Lasers
Revision Rhinoplasty Using the Endonasal Approach ACE The Treatment of Nasal Fractures Ach 24 Upper Eyelid Blepharoplasty Fred G. Fedok and Paul J. Carniol Background: Basic Science of Procedure Key Concepts The overall goal of surgery is to create a natural nonoperated appearance The term blepharoplasty was coined by Von Graefe in 1817 to describe a reconstructive technique. In the late 1920s, French surgeons, such as Bourget, advo- cated removal of herniated orbital fat for cosmetic reasons. In 1951, Castenares described the fat com partments of the upper and lower eyelids. Until re cently, fat removal had remained an integral part of blepharoplasty. During the last decade, the empha- ses in technique have shifted to skin removal with conservation of fat and the avoidance of eyelids with an overoperated appearance. Upper eyelid blepharoplasty is usually performed for cosmetic concerns, functional impairment of vision, or both. Each situation is frequently accom panied by an excess or prominence of eyelid skin, fat, or orbicularis muscle. This tissue redundancy is caused by the aging process or secondary to a famil- al propensity. Lid malposition and ptosis may also be concerns. In most situations, management of the excessive tissues of the upper eyelid includes some consideration of brow position; to ignore the close anatomical relationship between the brow and the upper eyelids in performing surgery of the region potentially jeopardizes the inal aesthetic and func- tional outcomes. The goal is to achieve facial harmo ny and optimal function while maintaining latitude for individual variation. For patients with visual field loss due to bleph- arochalasis and upper eyelid skin redundancy an additional goal is to alleviate visual field obstruction The emphases in technique have shifted to skin removal with conservation of fat and the avoidance of eyelids with an overoperated appearance If a browlift and upper eyelid blepharoplasty are performed together, care must be taken to avoid excessive excision of upper eyelid skin to avoid lagophthalmos. Introduction The eyes are the windows.... Most adults of the Western world can finish this common expression, and in many ways, the expression is true. Given their central location the eyelids contours and move- ments account for a large part of the expressiveness of the face and convey much of a person's nuances of communication. These factors have motivated Pertinent Anatomy both men and women to seek to maintain a healthy. youthful appearance and expressiveness through eyelid enhancement surgery That the face on frontal projection can be divided into vertically oriented thirds is a well-recognized concept (Fig. 24.1). In this model, the upper facial Advances in minimally invasive facial rejuvenation edG Fedk
The nineties beanty in style is back PEER-REVIEW FACIAL REJUVENATION |PRME THE MIDFACE FILLING,LIFTING, OR BLEPHAROPLASTY? Fred Fedok describes the treatment options available to address the changesbrought about by aging to the lower eyelid, lid-cheekjunctionand nasolabial folds of the aging processes are diferent in different age groups and among patients with characteristics. There is a role for the use of fillers, fat transfer, lifting procedures and placement of implants Patients ABSTRACT management of aging of the midface and lower eyelid. The dynamics of the most favorable outcomes are produced The optimal rejuvenation of the aging midface depends on an appreciation of the anatomic aspects of the undesirable characteristics as well as a facility in the several techniques useful in the when the proper diagnosis is coupled with the best combination of techniques for each individual patient. There are underlying inherited aging process in the facial area include skin laxity, loss of support of the lower eyelid and soft cheek tissues, volume loss, and bone loss. The manifestations variable several interventions available for the rejuvenation of the aging midface ANY PATIENTS SEEKING FACIAL with a contradictory repertoire of liposuction, excision and placement of early Tillers and implants rejuvenation begin their inquiry jowls platysma bands, and an unsightly neck. They describe sagging brows and upper eyelids, bags under their lower eyelids, excess skin in the lower eyelid region, and with concems about Catalyzedby thefurther knowledge and understanding of the descent of the midface structures that occurs with aging, there has been an expanding number af tools available to remedy various functional and cosmetic issues with the midface. These tools include surgical an undesirable shape to their lower eyelids. They rarely seek advice to directly address their midface except when the specific midface aging changes and remedies are pointed out to them. They do notice what they perceive as deepening nasolabial creases in part midface lifts of varying aggressiveness, advances in blepharoplasty to both correct eyelid position and to preserve a youthful eyelid shape, an ongoing spectrum of lower eyelid fat removal versus fat repositioning the use of various malar and orbital rim implants, and the FRED FEDOK, MD, FACS Fedok Plastic Surgery Foley, AL, US because of the media attention to the nasolabial folds in most recent adaptations of volume replacement using both autogenous fat and off-the-shelf fillers. The surface of the skin remainsa separate issue, with rhytids and skin laxity frequently requiring an intervention directed at the skin surface to cause collagen contraction and skin tightening such as lasers and radiofrequency devices regard to fillers. The patients also notice a flattening and laxity to their midface structures but frequently have difficulty describing exactly what is causing these changes. Patients usually do not understand why their nasolabial sulci appear to have become deeper and that email: they have a less attractive lower eyelid region than they did a decade previously. Until the late 80s and early 90s, there was a paucity of popular techniques used for the correction of midface aging It was already quite clear that a traditional facelift Anatomy and age related changes to the midface It is helpful to consider the lower eyelid, the lid-cheek junction, and the cheek as a functional unit The movement and the structural integrity of the area are interrelated Several simultaneous deleterious changes did very little for the lid-cheek junction or even the nasolabial folds. It was recognized that the maximum desirable impactof atraditional facelift was usually akong the jawline and in the neck. Although various cheek and submalar implants were available, they were not COVER STORY occur to this set of adjacent structures because of aging. The various dynamic factors that appear to be behind. midface aging include decreased skin elasticity and a relaxation of the cheek and orbital retaining ligaments KEYWORDS Midface, blepharoplasty, volume resoration, lifting techniques universally used. The nasolabial fold itself was attacked 32 May/June 2017 Management of the Middle Vault in Endonasal Rhinoplasty


  • Past President of the American Academy of Facial Plastic and Reconstructive Surgery
  • 30+ Years of Experience
  • Facial Plastic Surgery Specialist
  • High Expertise
  • Individualized Care