1. INTRODUCTION
Facial surgery interacts with a living, mechanically responsive structure. The face is a dynamic biomechanical network where muscles, fascia, ligaments, and bone continuously remodel under functional loads (Enlow & Hans, 1996; Pessa & Chen, 2002).
Morphodynamic Cosmetic Surgery (MDCS) emphasizes that “function determines form” and linear scars constitute negative dynamics that alter complex facial neuromuscolare network (Rizzo A., 2020).
Post-operative deformities such as eyelid retraction and pixie ear reflect pathological mechanical vectors and scar-driven contracture (Tomasek et al., 2002; Aarabi et al., 2007).
2. MECHANOBIOLOGY OF SOFT-TISSUE REMODELING
Fibroblasts sense tension through integrins and cytoskeletal deformation (Tomasek et al., 2002). Chronic loading drives myofibroblast differentiation, producing contractile α-SMA fibers. Excess tension reduces apoptosis, maintaining contracture (Aarabi et al., 2007).
Ocular tissues are highly sensitive to scars (Shu & Lovicu, 2017). Eyelid fibroblasts show high contractility (Li et al., 2015).
3. AGING AS A PREDISPOSING VECTOR SHIFT
Aging modifies facial mechanical geometry: maxillary retrusion (Pessa & Chen, 2002), orbital enlargement (Shaw et al., 2011), and mandibular resorption (Richardson, 2009). These changes weaken deep support and increase the impact of surgical vectors.
4. EYELID DEFORMATION AFTER BLEPHAROPLASTY
Deformities such as round eye, scleral show, and retraction arise from:
• Anterior lamella shortening (Oestreicher & Mehta, 2012; Mack & Hollenbeck, 2012)
• Middle lamella scarring (Shu & Lovicu, 2017)
• Lateral canthal insufficiency (Hurwitz, 1997)
• Age-related orbital and midface regression (Pessa & Chen, 2002; Shaw et al., 2011)
Morphodynamic Cosmetic Surgery interprets this as disruption of the neuromuscular–fascial continuum, blink forces reinforce pathological vectors (Rizzo A., 2020).
5. EARLOBE DISPLACEMENT AFTER FACELIFT (“PIXIE EAR”)
Skin-dominant lifts transmit caudal–anterior tension to the lobule (Sapountzis et al., 2013; Marlen, 2015). Periauricular scars contract via myofibroblasts (Tomasek et al., 2002).
Improper SMAS vector anchoring displaces the ear (Kaye et al., 2019; Dibbs et al., 2021).
MDCS sees the lobule as a floating mechanical unit easily deformed by misdirected vectors (Rizzo 2020).
6. FUNCTION → FORM IN MDCS
MDCS integrates:
• Scar mechanics (Tomasek et al., 2002)
• Habitual expressions shaping tissue (Rizzo A., 2024)
• Skeletal aging altering leverage (Shaw et al., 2011)
• Mechanical load influencing regeneration (Aarabi et al., 2007)
7. CONCLUSION
Postoperative deformities are mechanobiologic events determined by vectors, scar dynamics, disruption of the complex facial neuromuscular network and aging.
MDCS comprehends only mechanobiologically informed techniques preserving and correcting physiologic force distribution and mechanofascial continuity.
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