Morphodynamic Cosmetic Surgery - the holistic beauty

In the Treccani encyclopedia the world holism is explained like this:
“General biological theory according to which the vital manifestations of organisms must be interpreted on the basis of the functional interrelations and interdependencies between the parts that make up the system, which as a whole has its own characteristics not attributable to the sum of its parts.”

Applied to numerous research fields, the holistic scientific approach includes:
1) The multidisciplinary,
2) The in-depth study of complex systems,
3) The recognition of the feedback mechanism within a system and between various systems.

According to holistic science, the division into modules can lead to errors!
And I think that this is also true in Aesthetic Surgery.

You cannot think in compartments, you cannot work on a nose as if it were a thing, disconnected from the other parts of the body.

The same applies for the lips, eyes, neck, etc. I also used to think like that before, but I did not like the results.

Cranio-facial growth

Over the years many theories have followed one another to explain the cranio-facial growth, from the exquisitely genetic ones (see “Genome Project”), in which everything is explained with the genetic heritage, to the markedly functional ones (Moss), in which the shape is justified almost exclusively by function.

Purely genetic theory can be safely dismissed along with all the enormous expectations that genetic research nourished in the eighties.

The fundamental dogma of biology was:

life is controlled by DNA!

The body of a man of medium height, weighing 70 kg, is made up of about 100.000 billion cells!

Our DNA was formed in three billion years of evolution!

With all this immensity of cells and functions, after so many years of evolution, human DNA was expected to be of enormous complexity.

At the basis of the ambitious Genome Project there was the belief that we could find, and therefore modify, the gene responsible for each physical characteristic, for each protein of the human body, for each disease, and we even began to think that the genes also controlled our emotions, our behaviors, character and so on.

But the shocking conclusion that scientists have come to is that the total number of genes in a human being is around 25,000 and, considering that the fruit fly has a slightly smaller genetic heritage than the human, that is, around 15,000 genes, it has been concluded that: the enormous complexity of the human body is not due to a richer genetic heritage, but to something else.

Which means that the “genetic control” of our destiny has been replaced by the primacy of the regulation of gene expression. These are mediated by signals (for example proteins) from other cells and by signals from the environment, so from factors external to the genetic heritage that modulate gene expression and therefore morphology.

The continuous shape changes of proteins due to variations in the electromagnetic charge, even thousands of times per second, are the real architects of life: and so, the modern epigenetics is born.

As a reaction to a purely genetic vision, “Moss’ Functional Matrix Theory“ was born, according to which craniofacial development is not due to cartilage or bones, but to the influence of adjacent soft tissues.

In Moss’ functional matrix theory, face growth occurs as a response to functional need and is mediated by the soft tissues in which the skeleton is embedded. Therefore the origin, growth and maintenance of skeletal tissue are always secondary, compensatory and mechanically forced responses to events and processes that occur in non-skeletal tissues, organs and functional spaces in relation to the bone tissue (periosteal or capsular functional matrices).

Subsequently, the “Multifactorial theory of Von Limborgh” included the previous theories enriching them with new concepts, claiming that cranio-facial growth is the result of various factors, which are divided into:

intrinsic factors (genetic heritage as properly said),

epigenetic factors both local (matrices of soft tissues, such as eyes, brain, tongue…) and general (hormones such as insulin for example),

environmental factors, both local (actions of muscle forces) and general (availability of oxygen in the tissues)

Therefore, both the ability of soft tissues and environmental factors to modify the growth of skeletal tissues is definitely recognized.

All of this applies to cranio-facial growth.

But once the skeleton is formed, in an adult, do genetic or environmental influences prevail in subsequent changes?

“I had a tiny nose and it grew!”

The face of each of us over the years undergoes many changes.

It is a widespread belief that in the old age the nose and ears grow.

It is true, this can happen, a small nose can double or triple its size, it can become much wider, longer, potato-shaped, the nostrils widen and thicken and so on.

But it does not always happen, not for everyone.

Some people age without the nose growing, others in a few years undergo major changes.

Is everything predetermined by genetics? I think not, so let us try to understand why it happens.

The nose is in the center of the face.

Everything that happens to the face passes through the nasal region, all the expressions, emotions, grimaces, contractions of the facial mimic muscles, case greater or lesser stresses of the tissues of the nasal region, causing changes in the shape of the nose, even with growth occurred.

A solid law of biology says that: the functional stresses of the tissues determine their growth, hypertrophy, and hyperplasia.

By hypertrophy we mean an increase in the volume of an organ, consequent to an abnormal increase in the volume of the cellular elements that constitute it.

By hyperplasia we mean a progressive biological process, which leads to the growth of an organ or tissue due to the increase in the number of cells that constitute it.

As an example, think of the formidable changes that take place in the body of a young man who constantly devotes himself to bodybuilding, not only the muscles, but the whole skeletal structure increases.

Or some diseases of bone metabolism such as acromegaly, in which there is an acquired deformation of the facial skeleton.

There are even some tribes that give themselves skeletal deformations as a sign of beauty and distinction.

So, is it the shape of the nose genetically determined?

Yes, but there is no gene dedicated to the shape of the nose; there are a number of factors that most likely determine a particular inherited nose shape.

During adolescence it takes place the most evident shape transformation of the face and nose.

As for every part of the body, even for the nose there is a set of information contained in the genetic code, which has the potential to express in the course of growth and determine own shape.

But we have seen that other factors also intervene in determining the morphology and, among these, the function is predominant. So respiratory functions, parafunctions, expressions, habits, but also emotions play an important role in the shape of the body, especially for the face.

In traditional surgical rhinoplasty, all these other factors are almost never taken into consideration, often only the otolaryngologist colleagues are attentive to the functional aspects, but above all to the respiratory ones.

Almost always, with a reductive rhinoplasty, the size of the upper respiratory tract is reduced. This will have consequences in the pharyngeal area and therefore on the posture of the tongue and therefore on the lower third of the face and so on. Almost always, otolaryngologists integrate rhinoseptoplasty with surgical reduction of turbinates to promote nasal respiratory patency.

In my experience, despite the adequate patency of the respiratory tract, wrong habits often prevail, such as breathing with your mouth open, or others, either way damage can occur.

So even after the traditional rhinoplasty operations it is appropriate to consider how the changes made will be processed and compensated by the complex facial network and by the patient.

In Morphodynamic Cosmetic Surgery, any relationship between the shape of the nose and other zones of the face should be sought, the dynamics may have contributed to that shape.

Often, before tackling the nasal region, the surrounding areas are prepared and subsequently the focus goes on the nose. In other cases, the reverse process is applied – the nasal region must be started first with and then the others, for example the chin region, or frontal region.

Treatment priorities are established based on individual situations and behaviors.