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Файл:Ординатура / Офтальмология / Английские материалы / Advanced Surgical Facial Rejuvenation_Erian, Shiffman_2011.pdf
X
- •Foreword
- •Preface
- •Contents
- •1: Facial Anatomy
- •1.1 Introduction
- •1.2 Facial Skeleton
- •1.5 Retaining Ligaments
- •1.6 Mimetic Muscles
- •1.7 Deep Plane Including the Deep Fat Compartments
- •1.8 Facial Nerve
- •1.9 Sensory Nerves
- •1.10 Arteries of the Face
- •References
- •2: Facial Proportions
- •2.1 Introduction
- •2.2 Surface Markings
- •2.3 Proportions
- •2.4 The Golden Ratio
- •2.5 Planes and Angles
- •2.6 Conclusions
- •References
- •3.1 Introduction
- •3.2 Details of Zones
- •3.2.1 Zone 1
- •3.2.2 Zone 2
- •3.2.3 Zone 3
- •3.2.4 Zone 4
- •3.2.5 Zone 5
- •3.2.6 Zone 6
- •3.2.7 Zone 7
- •3.3 Conclusions
- •References
- •4: Muscles Used in Facial Expression
- •4.1 Introduction
- •4.2 Discussion
- •References
- •5.1 Introduction
- •5.2 Studies and Technique
- •5.3 Results
- •5.4 Discussion
- •5.4.1 SMAS and SMAFS: Concept and Variations
- •5.4.1.1 Sleep Lines
- •5.4.1.2 Membranous SMAFS
- •5.4.1.3 Fatty SMAFS
- •5.4.1.4 Flaccid SMAFS
- •5.4.1.5 Mixed SMAFS
- •5.4.1.7 Fleshy SMAFS
- •5.4.1.8 Fibrous SMAFS
- •5.4.1.9 SMAFS Sleep Lines Correction
- •5.5 Conclusions
- •References
- •6.1 Introduction
- •6.2 Surgical Facility
- •6.3 Ancillary Personnel
- •6.4 Preoperative Evaluation
- •6.4.1 Preoperative Risk Assessment
- •6.4.3 Cardiac Disease
- •6.4.4 Obesity
- •6.4.5 Hypertension
- •6.4.6 Diabetes Mellitus
- •6.4.7 Pulmonary Disease
- •6.4.8 Obstructive Sleep Apnea
- •6.4.9 Malignant Hyperthermia Susceptibility
- •6.5 Selections and Delivery of Anesthesia
- •6.5.1 Local Anesthesia
- •6.5.3 Regional Anesthesia
- •6.5.4 General Anesthesia
- •6.5.5 Preoperative Preparation
- •6.5.6 Perioperative Monitoring
- •6.5.7 Fluid Replacement
- •6.5.8 Recovery and Discharge
- •References
- •Recommended Reading
- •7.1 Introduction
- •7.3 Other Considerations
- •7.4 Assessing Level of Sedation
- •7.5 Agents Used in Sedation
- •7.5.1 Propofol
- •7.5.2 Benzodiazepines
- •7.5.3 Clonidine and Dexmedetomidine
- •7.5.4 Ketamine
- •7.5.5 Opioids
- •7.5.6 Acetaminophen
- •7.5.8 Other Agents
- •7.6 Devices Used in the Delivery of Sedation
- •7.7 Postoperative Nausea and Vomiting (PONV)
- •7.7.1 Risk Factors
- •7.8 Techniques of Sedation
- •7.9 Conclusions
- •References
- •8: Preoperative and Postoperative Plan
- •8.1 Plan for Facelift Surgery
- •8.2 Facelift Preoperative Instructions
- •References
- •9: Facial Imaging
- •9.1 Introduction
- •9.2 The Camera
- •Practical Tips
- •9.3 Resolution
- •Practical Tips on Resolution
- •9.4 Lighting
- •Practical Tips
- •9.5 Background
- •Practical Tips
- •9.6 Advertising and Ethics
- •9.7 Before and After Photos
- •9.8 Consent
- •Practical Tips for Consent for Photography
- •9.9 Special Problems with Consent
- •9.10 Radiology
- •9.10.1 Computed Tomography (CT)
- •9.10.2 Magnetic Resonance Imaging (MRI)
- •10.1 Introduction
- •10.2 Skin Aging
- •10.3 Techniques
- •10.3.1 Skin Care Program
- •10.3.1.1 Tretinoin
- •10.3.1.2 Skin Cleansers
- •10.3.1.3 Sun Protection
- •10.3.1.4 Light Chemical Peel or “Friendly Peel”
- •10.3.1.5 Microdermabrasion
- •10.3.1.6 Carboxytherapy
- •10.4 Complications
- •10.5 Discussion
- •10.6 Conclusions
- •References
- •11: What Is Human Beauty?
- •11.1 Introduction
- •11.2 Beauty
- •11.2.1 What Is Human Beauty? What Do the Books Say? Dictionaries? Philosophers?
- •11.2.2 Konrad Lorenz’s Theory
- •11.3 Conclusion
- •11.4 Summary
- •12: Body Dysmorphic Disorder
- •12.2 Symptoms
- •12.3 Consequences of BDD
- •12.4 Associated Disorders
- •12.5 Treatment
- •12.6 Discussion
- •12.7 Conclusions
- •References
- •13: Hair Transplantation
- •13.1 Introduction
- •13.3 Modern Hair Transplantation and Terminology
- •13.4 Nonsurgical Treatment Options
- •13.4.1 Medications
- •13.5 Nonmedical Treatments
- •13.6 Preoperative Consultation
- •13.7 Female Considerations
- •13.8 Preoperative Instructions
- •13.9 Surgical Planning
- •13.9.1 Men with MPB
- •13.9.2 The Crown
- •13.9.3 Females
- •13.9.4 Selection of Donor Area Site and Size
- •13.9.5 Estimating Size of Donor Strip
- •13.10 Anesthesia
- •13.11 Removal of Donor Strip
- •13.12 Follicular Unit Extraction
- •13.12.1 Indications for FUE
- •13.12.2 Advantages of FUE
- •13.12.3 Disadvantages of FUE
- •13.13 Graft Preparation
- •13.14 Recipient Site Creation
- •13.15 Graft Orientation: CAG or SAG
- •13.16 Instruments (Table 13.3)
- •13.17 Re-creating a Natural Hairline
- •13.18 Planting Recipient Grafts
- •13.19 The Vertex Region
- •13.20 Postoperative Care
- •13.21 Complications
- •13.21.1 Surgical Complications/Side Effects
- •13.21.2 Cosmetic/Esthetic Complications
- •13.22 Examples of Applications for Hair Transplants
- •13.22.1 Male Pattern Baldness
- •13.22.2 Female Pattern Hair Loss
- •13.22.3 Transplants After Rhytidectomy
- •13.22.4 Transplants After Burns
- •13.23 Non-scalp Areas
- •13.24 Transgendered Patients
- •13.25 Conclusions
- •References
- •14: Ablative Laser Facial Resurfacing
- •14.1 Introduction
- •14.2 Technique
- •14.2.1 Preoperative Preparation
- •14.2.2 Carbon Dioxide Laser
- •14.2.3 Erbium Laser
- •14.2.4 Postoperative Care
- •14.3 Complications
- •14.4 Discussion
- •14.5 Conclusions
- •References
- •15: Photorejuvenation
- •15.1 Introduction
- •15.2 Technique
- •15.3 Complications
- •15.4 Discussion
- •15.5 Conclusions
- •References
- •16.1 Introduction
- •16.2 Skin Anatomy
- •16.3 Technique
- •16.3.1 Patient Selection
- •16.3.2 Pretreatment
- •16.3.3 Technique
- •16.4 Alpha Hydroxy Acids
- •16.5 Salicylic Acid
- •16.6 Jessner’s Peel
- •16.6.1 Medium Depth Peels
- •16.7 Trichloroacetic Acid
- •16.8 Adjunctive Measures
- •16.9 Postoperative Care
- •16.10 Complications
- •16.11 Discussion
- •16.12 Conclusions
- •References
- •17: Deep Phenol Chemical Peels
- •17.1 Introduction
- •17.2 Patient Selection
- •17.3 Technique
- •17.4 Complications
- •17.5 Conclusions
- •References
- •18: Chemical Blepharoplasty
- •18.1 Introduction
- •18.2 Skin Preparation
- •18.3 Skin Evaluation and Chemical Agent Selection
- •18.4 Anesthesia and Sedation
- •18.5 Details of the Procedure
- •18.6 The Postoperative Period
- •18.7 Complications
- •18.7.1 Ectropion
- •18.7.4 Web Formation
- •18.7.5 Eyelid Skin Infection
- •18.8 Discussion
- •18.9 Conclusion
- •References
- •19: Facial Implants
- •19.1 Introduction
- •19.2 Technique
- •19.2.1 Midface Implants
- •19.2.2 Mandibular Implants
- •19.3 Complications
- •19.4 Discussion
- •19.5 Conclusions
- •References
- •20: Injectable Facial Fillers
- •20.1 Introduction
- •20.2 Historical Background
- •20.3 Available Facial Fillers
- •20.3.1 Autologous Fat
- •20.3.2 Collagen
- •20.3.3 Hyaluronic Acids (HAs)
- •20.3.4 Synthetic Polymers
- •20.4 Technical Considerations
- •20.5 Injection Techniques
- •20.6 Post-procedural Considerations
- •20.7 Facial Filler Complications
- •20.8 Conclusions
- •References
- •Recommended Reading
- •21: Botulinum Toxin for Facial Rejuvenation
- •21.1 Introduction
- •21.2 History
- •21.3 Chemical Overview
- •21.5 Onset and Duration of Paralysis
- •21.10 Locations of Treatment
- •21.10.1 Upper Face
- •21.10.2 Midface
- •21.10.3 Lower Face
- •21.11 New Frontiers for Botulinum Toxin in Facial Rejuvenation
- •21.12 Contraindications
- •21.13 Avoidance of Potential Pitfalls
- •21.15 Conclusions
- •References
- •22: History of Fat Transfer
- •22.1 Introduction
- •22.2 History
- •References
- •23.1 Introduction
- •23.2 Relevant Anatomy and Pathophysiology
- •23.3 Clinical Applications
- •23.3.1 Harvesting the Fat
- •23.3.2 Preparation
- •23.4 Applications and Injection Techniques
- •23.4.1 Injection Methods
- •23.5 Complications
- •References
- •24.1 Introduction
- •24.2 Patient Assessment
- •24.4 Anatomy
- •24.5 Liposuction
- •24.6 Tumescent Anesthesia
- •24.7 Liposuction Technique
- •24.8 Summary of Critical Points for Successful Liposuction
- •24.9 Chin Implantation
- •24.10 Submentoplasty
- •24.10.1 Submentoplasty Technique
- •24.11 Dealing with the Visible Submandibular Gland
- •24.12 Complications
- •24.12.1 Over-resection of Fat
- •24.12.2 Sialocele
- •24.12.3 Nerve Injury
- •24.12.4 Seroma
- •24.12.5 Skin Redundancy
- •24.12.6 Chronic Pain
- •24.12.8 Infection
- •24.12.9 Bleeding and Hematomas
- •24.12.10 Skin Slough
- •24.13 Conclusions
- •References
- •Submental Liposuction
- •26: Vaser UAL for the Heavy Face
- •26.1 Introduction
- •26.2 Technologies
- •26.3 Technique
- •26.4 Complications
- •27: Suture Facelift Techniques
- •27.1 Introduction
- •27.2 Concept
- •27.3 Patient Selection
- •27.4 Suture Types and Materials
- •27.4.1 Barbed Sutures
- •27.4.1.2 Anchored Bidirectional Barbed Sutures
- •27.4.1.3 Unidirectional Barbed Sutures
- •27.4.2 Non-barbed Sutures
- •27.4.2.1 Nonabsorbable Non-barbed Sutures
- •27.4.2.2 Absorbable Non-barbed Sutures
- •Upper Face
- •Midface
- •Lower Face
- •Neck
- •27.4.3 Coned Sutures
- •27.4.3.1 Midface
- •27.4.3.2 Neck
- •27.5 Postoperative Care
- •27.6 Complications
- •27.7 Conclusions
- •References
- •28: Bio-Lifting and Bio-Resurfacing
- •28.1 Introduction
- •28.2 Patient Desires
- •28.3 Aging of the Face
- •28.4 T3 Bioresurfacing
- •28.4.2 Young-Peel Method
- •28.4.2.2 Transdermal Introduction of Substances (Trans Peel)
- •28.4.3 Photodynamic Treatment
- •28.6 Biolifting
- •28.6.1 Method
- •28.6.1.2 Middle Layer
- •28.6.1.3 Deep Layer
- •28.6.1.4 Threads of Support
- •28.7 Endo Light Lift
- •28.8 Biodermogenesi™
- •28.9 Bio-Lifting: Protocol of Treatment
- •28.10 Conclusions
- •References
- •29: Standard Facelifting
- •29.1 Introduction
- •29.2 Technique
- •29.3 Postoperative Care
- •29.4 Complications
- •29.4.1 Hematoma
- •29.4.2 Nerve Injury
- •29.4.3 Infection
- •29.4.4 Skin Flap Necrosis
- •29.4.5 Hypertrophic Scarring
- •29.4.7 Parotid Gland Pseudocyst
- •29.5 Discussion
- •29.6 Conclusions
- •References
- •30.1 Introduction
- •30.4 Role of the Retaining Ligaments in Aging Face
- •30.5 Role of the Retaining Ligaments on Facelift
- •30.7 Presurgical Planning of Facelift
- •30.8 Facelift Procedure with Release and Suspension of the Retaining Ligaments and SMAS
- •30.8.1 Design of Skin Incision
- •30.8.2 Dissection
- •30.8.3 Liposuction
- •30.8.4 Treatment of Crow’s Feet and Sagging Lower Eyelid
- •30.8.5 Suspension
- •30.9 Clinical Cases
- •30.9.1 Case 1
- •30.9.2 Case 2
- •References
- •31.1 Introduction
- •31.2 Consultation
- •31.3.2 Photography
- •31.3.4 Preoperative Preparation on the Operating Table
- •31.3.5 Anesthesia: Intravenous Sedation
- •31.3.6 Nerve Mapping
- •31.3.8 Instrumentation
- •31.4 Procedure
- •31.5 The SMAS
- •31.6 Dressings
- •31.7 Results
- •References
- •32.1 Introduction
- •32.2 Technique
- •32.3 Complications
- •32.4 Discussion
- •32.5 Conclusions
- •References
- •33.1 Introduction
- •33.3.1 Marking
- •33.3.2 Anesthesia
- •33.4.1 Dressings
- •33.6 Disadvantages
- •References
- •34.1 Introduction
- •34.2 Strategy and Selection of SMAS Flap
- •34.3 SMAS Flap Study
- •34.4 Discussion
- •34.5 Conclusions
- •References
- •35.1 Introduction
- •35.2 Anatomic Considerations
- •35.2.1 The Facial Nerve
- •35.2.2 The SMAS Layer
- •35.3 Indications
- •35.4 Technique
- •35.5 Discussion
- •35.6 Complications
- •35.6.1 Hematoma
- •35.6.2 Nerve Injury
- •35.7 Conclusions
- •References
- •Recommended Reading
- •36.1 Introduction
- •36.2 Surgical and Functional Anatomy of the Face
- •36.2.1 Parotidomasseteric Fascia
- •36.2.2 Temporal Fascia
- •36.2.3 Deep Cervical Fascia
- •36.2.4 Malar: Buccal Fat Pad
- •36.2.5 Facial Mimetic Muscles
- •36.2.6 Facial Nerve
- •36.2.7 Retaining Ligaments
- •36.3 Anatomicohistologic Study of the Retaining Ligaments of the Face
- •36.3.1 Zygomatic Cutaneous Ligament (McGregor’s Patch)
- •36.3.2 Preauricular Parotid Cutaneous Ligament
- •36.3.3 Parotidomasseteric Cutaneous Ligament
- •36.3.4 Platysma Cutaneous Ligament
- •36.3.5 Mandibular Ligament
- •36.4 Aging Changes in the Face
- •36.5 Facelift and Historical Development of Retaining Ligaments of the Face
- •36.6 Retaining Ligament Correction and SMAS Plication in Facelift
- •36.6.1 Preparations for Surgery and Skin Marking
- •36.6.2 Surgical Technique
- •36.7 Postoperative Care and Complications
- •References
- •37.1 Introduction
- •37.2 Technique
- •37.3 Conclusions
- •References
- •38.1 Introduction
- •38.2 Preoperative Evaluation
- •38.3 Preoperative Markings
- •38.4 Anesthesia
- •38.5 Deep Plane Technique
- •38.6 Postoperative Care
- •38.7 Complications
- •38.8 Discussion
- •Recommended Reading
- •39: Subperiosteal Face-Lift
- •39.1 Introduction
- •39.2 Technique
- •39.2.1 Preoperative Evaluation
- •39.2.2 Surgical Technique
- •39.3 Complications
- •39.4 Discussion
- •39.5 Conclusions
- •References
- •40.1 Introduction
- •40.2 Limited Flap Rhytidectomy Procedures
- •40.3 Extended Flap Rhytidectomy Procedures
- •40.4 Deep-Plane Rhytidectomy
- •40.5 Adjuvant Procedures
- •References
- •41.1 Introduction
- •41.2 Pathomechanics
- •41.3 Preoperative Evaluation
- •41.3.1 Rhytidectomy in the Postbariatric Patient
- •41.4 Postoperative Care and Complications
- •41.5 Conclusions
- •References
- •42: Complications of Facelift Surgery
- •42.1 Introduction
- •42.2 Complications
- •42.2.1 Asymmetry
- •42.2.2 Bleeding
- •42.2.3 Dehiscence
- •42.2.5 Ear Deformities
- •42.2.6 Edema
- •42.2.7 Hair Loss
- •42.2.8 Hematoma
- •42.2.9 Infection
- •42.2.10 Irregularities
- •42.2.11 Necrosis
- •42.2.12 Neurological
- •42.2.13 Pain
- •42.2.14 Pigmentation Changes
- •42.2.15 Salivary Fistula
- •42.2.16 Scar
- •42.2.17 Seroma
- •References
- •43.1 Introduction
- •43.2 Historical Review
- •43.3 Anatomic Guidelines
- •43.4 The Eyebrow and Forehead as an Aesthetic Unit
- •43.5 Position of the Eyebrows
- •43.6 General Indications
- •43.7.1 Frontal Ptosis Degree
- •43.7.2 Depth of the Skin Furrows
- •43.7.3 Asymmetries
- •43.7.4 Frontal Redundant Skin
- •43.8 What Fixing Approaches and Techniques Do We Use?
- •43.8.1 Coronal
- •43.8.2 Pretrichial/Trichial
- •43.8.3 “Half Frontal”
- •43.8.4 Direct Eyebrow Lift
- •43.8.5 Endoscopic
- •43.9 Complications
- •43.10 Discussion
- •43.11 Conclusions
- •References
- •44: Endoscopic Forehead Lift
- •44.1 Forehead Aging Process
- •44.2 Indications
- •44.3 Alternative Methods
- •44.4 Anatomy
- •44.5 Endoscopic Forehead Lift Surgery: Rationale
- •44.6 Technique
- •44.6.1 Instruments
- •44.6.2 Anesthesia
- •44.6.3 Delimitation of the Working Areas
- •44.6.4 Skin Incisions
- •44.6.5 Subaponeurotic Supraperiosteal Dissection
- •44.6.6 Subperiosteal Dissection
- •44.6.7 Interfascial Dissection
- •44.6.8 Communication Between the Two Pockets
- •44.6.9 Endoscope Placement and Use
- •44.6.10 Periosteal and Muscular Sectioning
- •44.6.11 Fixation Suture Placement
- •44.6.12 Closure
- •44.6.13 Postoperative Follow-Up
- •44.7 Complications
- •44.8 Discussion
- •References
- •45.1 Introduction
- •45.2 History
- •45.3 Forehead Anatomy
- •45.5 Nonsurgical Techniques in Forehead Rejuvenation
- •45.6.1 Autogenous Fat Injection
- •45.6.2 Moisturizing Graft
- •45.6.3 Open Frontal Lift
- •45.6.4 Periorbital Approach
- •45.6.6 Forehead Endoscopic Rejuvenation
- •45.7 Complications
- •45.8 Conclusions
- •References
- •46.1 Introduction
- •46.2 Patient Marking
- •46.3 Surgical Procedure
- •46.4 Complications
- •46.5 Discussion
- •46.6 Conclusions
- •References
- •47: Endobrow Lift
- •47.1 Introduction
- •47.2 Anatomy
- •47.3 Endobrow Lift
- •47.3.1 Objectives of a Brow Lift
- •47.3.2 Preoperative Counseling
- •47.3.3 Learning Curve
- •47.3.5 Surgical and Nonsurgical Treatments of Forehead Rejuvenation
- •47.3.6 Direct Operations to the Brow
- •47.3.7 Endoscopic Brow Lift
- •47.3.8 Risks
- •47.4 Variations of Forehead and Brow Lift
- •47.5 Transpalpebral Corrugator Resection
- •47.6 Coronal Incision
- •47.7 Fat Grafting
- •47.8 Suspension and Suture Techniques
- •47.8.1 Thread Lift Guide
- •47.8.2 Thread Lift Risks
- •47.9 Botox (Chemodenervation with Botulinum Toxin)
- •47.10 Endobrow
- •47.10.1 Screw Placement
- •47.10.2 Possible Complications
- •References
- •48: Minimally Invasive Midface Lift
- •48.1 Introduction
- •48.2 Surgical Goals
- •48.3 Indications and Contraindications
- •48.4 Surgical Technique
- •48.4.1 Preoperative Markings
- •48.4.2 Anesthesia
- •48.4.5 Anchoring the Suture to the Deep Temporalis Fascia
- •48.5 Complications
- •48.6 Conclusions
- •Recommended Reading
- •49: Upper Eyelid Blepharoplasty
- •49.1 Introduction
- •49.2 Periorbital Aging
- •49.3 Anatomic Considerations
- •49.4 Musculature
- •49.5 Orbital Septum
- •49.6 Levator Palpebrae Superioris
- •49.7 Orbital Fat
- •49.8 Preoperative Evaluation
- •49.9 Ocular Assessment
- •49.10 Operative Procedure
- •49.11 Upper Eyelid Blepharoplasty Approach
- •49.12 Preparation
- •49.13 Postoperative Care
- •49.14 Complementary Treatments
- •49.14.1 Restoration of Infrabrow and Lateral Brow Volume
- •49.14.2 Injectable Fillers
- •49.14.3 Structural Fat Grafting of the Infrabrow Region
- •49.15 Complications
- •49.15.1 Hematomas
- •49.15.2 Blindness
- •49.15.3 Epiphora
- •49.15.4 Suture Line Complications
- •49.15.5 Wound Healing Complications
- •49.15.6 Ocular Injury
- •49.15.7 Contour Irregularities
- •References
- •50: Lower Eyelid Blepharoplasty
- •50.1 Introduction
- •50.2 Periorbital Aging
- •50.3 Anatomic Considerations
- •50.3.1 Lamellae
- •50.3.2 Musculature
- •50.3.3 Orbital Fat
- •50.3.4 Infraorbital and Midface Anatomy
- •50.4 Preoperative Evaluation
- •50.4.1 Ocular Assessment
- •50.4.3 Assessment of Tear Trough or Nasojugal Deformity
- •50.5 Operative Procedure
- •50.5.1 Technique
- •50.5.1.1 Transconjunctival Approach
- •Preparation
- •Postoperative Care
- •50.5.1.2 Skin–Muscle Flap Approach
- •Preparation
- •Incision
- •Fat Removal
- •Closure
- •Postoperative Care
- •50.6 Complementary Treatments with Restoration of Infraorbital Volume
- •50.6.1 Injectable Fillers
- •50.6.2 Orbital Fat Repositioning
- •50.6.3 Suborbicularis Oculi Fat Lift
- •50.7 Structural Fat Grafting of the Infraorbital Region
- •50.8 Complications
- •50.8.1 Ectropion
- •50.8.2 Hematomas
- •50.8.3 Blindness
- •50.8.4 Epiphora
- •50.8.5 Suture Line Complications
- •50.8.6 Wound Healing Complications
- •50.8.7 Skin Discoloration
- •50.8.8 Ocular Injury
- •50.8.9 Contour Irregularities
- •References
- •51: Upper Blepharoplasty of the Asian Eyelid
- •51.1 Introduction
- •51.2 Instrument List
- •51.3 Operative Technique
- •51.4 Postoperative Care
- •Reference
- •52: Medial and Lateral Epicanthoplasty
- •52.1 Introduction
- •52.3 Technique
- •52.3.1 Medial Epicanthoplasty
- •52.3.1.1 Elliptical excision: Von Ammon, Arlt, Hiraga, and Watanabe methods
- •52.3.1.2 Z-Plasty Method
- •52.3.2 Lateral Epicanthoplasty
- •52.4 Complications
- •52.5 Conclusions
- •References
- •53.1 Introduction
- •53.2 Hyaluronic Acid Gel Filler
- •53.3 Patient Marking and Preparation
- •53.4 The Injection
- •53.5 Complications
- •53.6 Discussion
- •53.7 Conclusions
- •References
- •54: Combined Technique in Otoplasty
- •54.1 Introduction
- •54.2 Technique
- •54.3 Complications
- •54.4 Discussion
- •54.5 Conclusions
- •References
- •55: Rhinoplasty
- •55.1 Introduction
- •55.2 Types of Nasal Deformity
- •55.3 Preoperative Analysis
- •55.4 Surgical Techniques
- •55.4.1 Incisions in Rhinoplasty
- •55.4.2 Osteotomies in Rhinoplasty
- •55.5 Complications
- •55.5.1 Intrasurgical Complications
- •55.5.2 Immediate Postoperative Complications
- •55.5.3 Early Postoperative Complications
- •55.5.4 Late Postoperative Complications
- •55.6 Conclusions
- •References
- •56.1 Introduction
- •56.2 Biochemistry
- •56.3 Storage
- •56.4 Mechanism of Action
- •56.5 Duration of Action
- •56.6 Clinical Uses
- •56.6.1 FDA-Approved Uses
- •56.6.2 Aesthetic Off-Label Uses
- •56.8 Nonsurgical Rhinoplasty
- •56.8.1 Initial Consult
- •56.8.2 Physical Examination
- •56.8.3 Nasal Anatomy
- •56.8.4 Anesthesia and Prophylaxis
- •56.8.5 Needles
- •56.8.6 Injection Technique
- •56.8.7 Dosage
- •56.8.8 Postinjection Care
- •56.8.9 Patient Satisfaction
- •56.9.1 Asian
- •56.9.2 African-American
- •56.9.3 Hispanic
- •56.9.4 Arabic (Middle Eastern)
- •56.9.5 Aging
- •56.9.6 Revision Rhinoplasty
- •56.10 Discussion
- •56.11 Conclusions
- •References
- •57: Lip Enhancement: Personal Technique
- •57.1 Introduction
- •57.2 Anatomical Basics of the Human Lip
- •57.3 Injectable Materials
- •57.4 Technique
- •57.5 Postoperative Instructions
- •57.6 Complications
- •57.7 Discussion
- •References
- •58.1 Introduction
- •58.2 Advantages
- •58.3 Mechanism of Action
- •58.4 The Tumescent Technique
- •58.5 Indications
- •58.6 Contraindications
- •58.7 Technique
- •58.8 Complications
- •58.9 Special Considerations
- •58.9.1 Submandibular Gland Exposure
- •58.9.2 Platysmal Band Exposure
- •58.9.3 Thyroid Thickness or Band
- •58.9.4 Receding Chin
- •References
- •59: Neck Lifting Variations
- •59.1 Introduction
- •59.2 Pathophysiology of the Aging Neck
- •59.2.1 Aging Skin
- •59.2.2 Aging Soft Tissue
- •59.2.3 Aging Facial Skeleton
- •59.3 Other Factors
- •59.4 Evaluation of the Aging Neck
- •59.4.2 Physical Findings
- •59.5 Jowl/Mandibular Evaluation
- •59.6 Submental/Neck Evaluation
- •59.7 Surgical Technique Selection
- •59.7.1 Nonsurgical Intervention
- •59.7.2 Botulinum Toxin A
- •59.7.3 Skin Tightening Procedures
- •59.7.4 Intradermal Fillers
- •59.7.5 Laser Resurfacing
- •59.8 Surgical Treatment
- •59.8.1 Liposculpting
- •59.8.2 Platysmaplasty
- •59.8.3 Rhytidoplasty
- •59.9 Special Neck Lifting
- •59.9.1 Vertical Neck Lift
- •59.9.2 Horizontal Neck Lift
- •59.10 Clinical Pearls and Pitfalls
- •References
- •60.1 Introduction
- •60.2 Technique
- •60.3 Instructions
- •60.3.1 Day of Treatment
- •60.3.2 Second Day: Micropore Tape Mask Removal and Application of Subgalatic Mask
- •60.3.3 Eighth Day: Bismuth Subgalatic Mask Removal
- •60.4 Patient Instructions
- •60.4.1 Shopping List
- •60.4.2 Night Before Procedure
- •60.4.3 The Procedure (Day 1)
- •60.4.6 Days Four (4) to Seven (7)
- •60.4.7 Mask Removal on Day Eight (8)
- •60.5 Remember
- •60.6 Complications
- •60.7 Discussion
- •60.8 Conclusions
- •61.1 Applications of Permanent Cosmetics
- •61.2 Preprocedure Preparation
- •61.3 Pigment Blends
- •61.4 Eyebrows
- •61.5 Lips
- •61.6 Postprocedure Considerations
- •61.6.1 Longevity
- •61.6.2 Risks
- •61.7 Conclusions
- •Recommended Reading
- •62.1 Introduction
- •62.4 Mechanism of Action/Histology
- •62.5 Technique
- •62.6 Longevity
- •62.7 Complications
- •62.8 Conclusions
- •References
- •63.2 Prevalence
- •63.3 Clinical Features
- •63.3.1 Morphological Changes
- •63.3.2 Metabolic Changes
- •63.3.3 Pathogenesis
- •63.3.4 Protease Inhibitors
- •63.4 HIV Infection
- •63.5 Nutritional Status, Age, and Adiposity
- •63.6 Female Sex
- •63.7 Cytokines
- •63.8 Management
- •63.8.1 Nonsurgical Treatment of HIV Facial Lipoatrophy
- •63.9 Autologous Fat Transfer
- •63.9.1 History of Autologous Fat Transfer
- •63.10 Theories of Fat Graft Survival
- •63.11 Histological Evaluation of Transplanted Fat
- •63.12 Technique
- •63.13 Surgical Technique
- •63.13.1 Anaesthesia of the Donor Site
- •63.13.2 Choice of Donor Site
- •63.13.3 Harvesting Method
- •63.15 Placement
- •63.16 Post-operative Care
- •63.17 Complications
- •63.18 Discussion
- •63.19 Conclusions
- •References
- •64.1 Introduction
- •64.2 Comparative Studies
- •References
- •65.1 Introduction
- •65.2.1 Duty
- •65.2.2 Breach of Duty (Negligence)
- •65.2.3 Causation
- •65.2.4 Damages
- •65.3 Avoiding Lawsuits
- •65.4 What to Do When a Lawsuit Is Threatened or Filed
- •Index
144 |
P.C. Cotterill |
a |
b |
c
Fig. 13.15 (a) Donor strip is incised using a single blade being careful to keep blade parallel to the hair follicles. Notice that the end of the strip is tapered. (b) The strip is being dissected out ensuring that the blade is 1–2 mm below level of the follicle bulb
leaving some fat surrounding the bulb and avoiding deeper blood vessels and nerves. The assistant applies strong counter traction with the use of the tissue clamp. (c) Strip is removed and any stray hairs or hair spicules are removed from the wound
accordingly. When patients return after many years, having had the original punch graft excision technique performed, previous circular punch scars that leave intact hairs between excised rows, and between grafts on the same rows, can be excised. The current strip excision techniques can benefit this type of patient twofold: (1) By re-excising and minimizing old punch scars and (2) making available more reusable donor hair.
After the wound has been sutured closed, any trapped hairs under the suture are carefully freed. The area is then cleansed with a dilute hydrogen peroxide mixture applied from a spray bottle. At this juncture, if a second strip is to be taken from a temporal site, the patient’s
head is taken out of the prone pillow and turned to one side for the next excision. Otherwise, if donor excision is complete, then the patient is turned over on to their back to wait while the strip is being dissected until such time as the recipient site is anesthetized.
13.12 Follicular Unit Extraction
Follicular unit extraction (FUE) is a relatively new technique that uses small circular punches to core out donor grafts one at a time. Unlike the original punch
13 Hair Transplantation |
145 |
a |
b |
c
Fig. 13.16 (a) Trichophytic closure technique showing the inferior border of the wound being trimmed at a 45° angle to create a triangular strip 1 × 1 mm. (b) The strip is being trimmed to de-epithelialize one to two follicular units. (c) Following single-layer closure
grafts that were 3.5 –4.0 mm in diameter, FUE employs a 0.7 –1.0 mm punch. Because the site created is so small, sutures are not required and the wound is allowed to heal by secondary intention.
13.12.1 Indications for FUE
1.Wanting to avoid linear scalp donor site scar
2.Limited recipient area dictating the need for fewer grafts: eyebrow, eyelash, and moustache
3.Due to excessive scarring in donor area, further linear scars are not appropriate
4.Use of non-scalp hair, that is, chest, back, and beard
5.To thicken widened scars in donor area from traditional excisions that cannot be re-excised
13.12.2 Advantages of FUE
1.Tiny 0.7–1.0 mm incision
2.No sutures required
3.No linear scar in donor area
4.No or minimal tension in donor area
5.Possibility of wearing hair in donor area very short
13.12.3 Disadvantages of FUE
1.Higher percentage of follicular transection and ingrown hairs compared to FUT
2.Time consuming and more costly to patient
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