- •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
24 Cosmetic Surgical Rejuvenation of the Neck |
263 |
24.13 Conclusions
With our rapidly aging population the number of patients seeking rejuvenation of age-related changes of the neck will undoubtedly increase. While rhytidectomy has traditionally been the cornerstone technique that has been used to achieve this goal, there are many cases where submentoplasty or liposuction is appropriate as
stand-alone procedures (Fig. 24.31). When used in the appropriate patient they are truly minimally invasive and yet can provide spectacular results with minimal downtime (Fig. 24.32). Clearly, many patients will benefit from a combination of techniques (Fig. 24.33). To provide an optimal outcome for patients seeking this kind of care, one must be versatile and have “all of the tools in the tool box.”
Fig. 24.31 (a) Preoperative |
a |
b |
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40-year-old female. (b) One |
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month following an |
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aggressive submentoplasty |
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with subplatysmal fat |
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excision, platysmal |
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resection, and simultaneous |
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facelift. This is a good |
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example of an obtuse chin |
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neck angle grade 4AB |
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Fig. 24.32 (Left) Preoperative 45-year-old Hispanic female. (Right) Six months following submentoplasty with back-cutting and anterior platysmal plication along with chin implant placement. She is an example of a type II A neck deformity pre-op. No skin was excised
264 |
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L.A. Cuzalina and C.E. Bailey |
Fig. 24.33 (a) Preoperative |
a |
b |
52-year-old female. (b) Six |
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months following a facelift |
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with aggressive submento- |
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plasty including partial |
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digastric reduction to |
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compensate for a low hyoid. |
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This good example of a Type |
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IV C neck, which is the most |
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challenging diagnostic |
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situation to treat |
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References
1.Bourguet J. La chirugie esthetique de la face: Les rides. Monde Med, 15 Jan 1928.
2.Aufricht G. Surgery for excess skin of the face. In: Transactions of the second international congress of plastic surgery. Edinburgh: E & S Livingston; 1960. pp. 495–502.
3.Connell BF. Neck contour deformities: the art, engineering, anatomic diagnosis, architectural planning, and aesthetics of surgical correction. Clin Plast Surg. 1987;14(4):683–92.
4.Feldman JJ. Corset platysmaplasty. Plast Reconstr Surg. 1990;85(3):333–43.
5.Klein JA. The tumescent technique for liposuction surgery. Am J Cosmet Surg. 1987;4:263–7.
6.Courtiss E. Suction lipectomy of the neck. Plast Reconstr Surg. 1985;76(6):882–9.
7.Hodgkinson DJ. Clinical applications of radiofrequency: nonsurgical skin tightening (thermage). Clin Plast Surg. 2009;36(2):261–8.
8.Goldman A. Laser-assisted liposuction. Clin Plast Surg. 2009;36(2):241–53.
9.Sposito MM. New indications for botulinum toxin type A in cosmetics: mouth and neck. Plast Reconstr Surg. 2002; 110:601–11.
10.Park SH, Kim DW, Lee MA, Yoo SC, Rhee SC, Koo SH, et al. Effectiveness of mesotherapy on body contouring. Plast Reconstr Surg. 2008;121(4):179e–85e.
11.Prado A, Andrades P, Danilla S, Leniz P, Castillo P, Gaete F. A prospective, randomized, double blind, controlled clinical trial comparing laser-assisted lipoplasty with suction-assisted lipoplasty. Plast Reconstr Surg. 2006;118(4):1032–45.
12.Matarasso A, Pfeifer TM. Mesotherapy and injection lipolysis. Clin Plast Surg. 2009;36(2):181–92.
13.Gryskiewicz J. Submental suction-assisted lipectomy without platysmaplasty: pushing the skin envelope to avoid a face lift for unsuitable candidates. Plast Reconstr Surg. 2003;112(5):1393–405.
14.Little JW. Treatment of the full obtuse neck (panel discussion). Aesthetic Surg J. 2005;25(4):397.
15.Ellenbogen R, Karlin JV. Visual criteria for success in restoring the youthful neck. Plast Reconstr Surg. 1980;66(6):826–37.
16.Dedo DD. “How I do it” plastic surgery. Practical suggestion on facial plastic surgery. A preoperative classification of the neck for cervicofacial rhytidectomy. Laryngoscope. 1980;90(11 Pt 1):1894–6.
17.de Castro CC. The anatomy of the platysma muscle. Plast Reconstr Surg. 1980;66(5):680–3.
18.Baker DC, Conley J. Avoiding facial nerve injuries in rhytidectomy: anatomical variations and pitfalls. Plast Reconstr Surg. 1979;64(6):781–95.
19.Dingman RO, Grabb WC. Surgical anatomy of the mandibular ramus of the facial nerve based on the dissection of 100 facial halves. Plast Reconstr Surg. 1962;29:266–72.
20.Liebman EP, Webster RC, Gaul JR, Griffin T. The marginal mandibular nerve in rhytidectomy and liposuction surgery. Arch Otolaryngol Head Neck Surg. 1988;104(2):179–81.
21.Larrabee WF, Makielski KH, Henderson JL. Surgical anatomy of the face. Philadelphia: Lippincott Williams & Wilkins; 2004. p. 81–4.
22.Klein JA. Tumescent technique, tumescent anesthesia and microcannular liposuction. St. Louis: Mosby; 2000. p. 4–5.
23.Klein JA. Tumescent technique for regional anesthesia permits lidocaine doses of 35 mg/kg for liposuction. J Dermatol Surg Oncol. 1990;16(3):248–63.
24.Klein JA. Tumescent technique, tumescent anesthesia and microcannular liposuction. St. Louis: Mosby; 2000. p. 30.
25.Klein JA. Tumescent technique, tumescent anesthesia and microcannular liposuction. St. Louis: Mosby; 2000. p. 131–40.
26.Rubin JP, Bierman C, Roscow CE, Arthur GR, Chang Y, Courtiss EH, et al. The tumescent technique: the effect of high tissue pressure and dilute epinephrine on absorption of lidocaine. Plast Reconstr Surg. 1999;103(3):990–6.
27.Hayashi Y, Sumikawa K, Maze M, Yamatodani A, Kamibayashi T, Kuro M, et al. Dexmedetomidine prevents epinephrine – induced arrhythmias through stimulation of central alpha-2 adrenoreceptors in halothane anesthetized dogs. Anesthesiology. 1991;75(1):113–17.
28.Klein JA. Tumescent technique, tumescent anesthesia and microcannular liposuction. St. Louis: Mosby; 2000. p. 126.
24 Cosmetic Surgical Rejuvenation of the Neck |
265 |
29.Bitner JB, Friedman O, Farrior RT, Cook TA. Direct submentoplasty for neck rejuvenation. Arch Facial Plast Surg. 2007;9(3):194–200.
30.Conrad K, Chapkik JS, Reifen E. e-PTFE (Gore-Tex) suspension cervical facial Rhytidectomy. Arch Otolaryngol Head Neck Surg. 1993;119(6):694–8.
31.Ramirez OM. Cervicoplasty: nonexcisional anterior approach. A 10-year follow-up. Plast Reconstr Surg. 2003;111(3): 1342–5.
32.Giampapa VC. Suture suspension technique offers predictable, long lasting neck rejuvenation. Aesthetic Surg J. 2000;20:253.
33.Guyuron B, Jackowe D, Lamphongsai S. Basket submandibular gland suspension. Plast Reconstr Surg. 2008;122(3): 938–43.
34.de Pompe Pina D, Castro Quinta W. Aesthetic resection of the submandibular gland. Plast Reconstr Surg. 1991;88(5): 779–87.
35.Singer DP, Sullivan PK. Submandibular gland I: an anatomic evaluation and surgical approach to submandibular gland resection for facial rejuvenation. Plast Reconstr Surg. 2003;112(4):1150–4.
36.Barron R, Margulis A, Iceksen M, Zeltser R, Eldad A, Nahlieli O. Iatrogenic parotid sialocele following rhytidectomy: diagnosis and treatment. Plast Reconstr Surg. 2001; 108(6):1782–4.
37.Department of Health and Human Services Centers for Disease Control and Prevention. Strategies for clinical management of MRSA in the community: summary of an Experts’ Meeting convened by the Centers for Disease Control and Prevention, 2006.
38.Baker DC, Stefani WA, Chiu ES. Reducing the incidence of hematoma requiring surgical evaluation following male rhytidectomy: a 30 year review of 985 cases. Plast Reconstr Surg. 2005;116(7):1973.