Index

A

Ablative lasers CO2 lasers

aesthetic benefit, 275 airborne debris, 275

crow’s feet outcome, 275, 276 Hibiclens, 275

Jaeger lid plate, 275 nerve block, 275 protective goggles, 275 “spot” fashion, 275 white char, 275

complications, 274 contraindications, 274 erbium lasers and CO2

posttreatment, 276 pretreatment, 275

Fitzpatrick skin classification, 274 hyperpigmentation, 275

Adams, W.P. Jr., 211, 315

Aesthetic. See Periorbital aesthetic evaluation Aesthetic eyelid and periorbital surgery

anti-metabolites, 307 corticosteroids

description, 310 management, 310 mechanism, 310 safety, 311

fillers

hyaluronic acid gel, 311 post-injection contour, 311 safety, 311

soft tissue augmentation, 311 5-fluorouracil

management, 308–310 mechanism, 308 safety, 310

structure, 307, 308

meticulous preoperative evaluation, 307 scar formation, 307

Aging face, aesthetics bone remodeling, 72 facial harmony, 72

internal and external factors, 72 Ahn, M.S., 7

Anderson, R.L., 5, 101, 199 Appearance, 25–28 Arroyo, J.M., 7

Asian blepharoplasty aesthetic rejuvenation, 147

anatomic considerations, upper eyelid apparent palpebral fissure, 148 levator aponeurosi, 148

levator palpebrae superioris, 149 musculature, 148

orbital fat, 149

orbital septum, 148–149 eyelid crease formation, 151–156 modern management, upper eyelid

dermatochalasis, 149 subtractive eyelid surgery, 149

periorbital aging changes, 156 strategies, aging eyelid

Asians without crease, 150 cultural sensitivity, 150 natural crease, 150

supratarsal crease formation, 150–151 youthful upper eyelid, 149

Assessment

brow and upper eyelid continuum, 34–38 lower eyelid and cheek continuum, 39–42 orbitoskeletal and globe, 33–34

Aufricht, G., 313, 318

Averageness, 25–26 Aviv, J.E., 6 Azizzadeh, B., 3, 313

B

Baker, S.S., 211, 279

Baylis, H.I., 5, 173 Beauty

anatomic subunits, eyelid eyebrow, 27, 28

intercanthal and palpebral fissure distance, 28 lower lid to midface transition, 27

pretarsal skin and canthal angle, 26, 27 skin tone and clarity, 26

upper, 26 “averageness”, 25 feature size, 25–26 oculofacial surgeon, 25

perception and symmetry, 25 Beckman, H., 279

Beer, G.J., 3 Belsare, G., 101, 199

Beman, R., 279

Ben Simon, G.J., 212

Bettman, A., 4, 313 Bichat’s fat pad (BFP)

described, 233 excision, 234 placement, 233

Binder, W.F., 6

Blanch, A., 7

Blepharoplasty. See also Asian blepharoplasty; Transconjunctical lower blepharoplasty; Transcutaneous blepharoplasty; Upper eyelid blepharoplasty

aesthetic eyelid surgery, 4 canthal suspension surgery, 5 cosmetic surgery, 4

eyelid crease formation, 4

fat preservation and reposition, 5 lower lid, 5

suture reposition, 5 “Tarsal Strip” procedure, 5 transconjunctival lower, 5 treatments, aging face, 3 upper lid skin excisions, 4 VKH, 3

Blepharoplasty complications medical management

brow position, 121

canthal webbing and scarring, 118–119 corneal abrasion, 113

diplopia, 117

dry eye syndrome, 115 eyelid hematoma, 110 fat and skin, 121

globe rupture/perforation, 112–113 infection, 114

lacrimal gland injury, 115–116 lagophthalmos, 114

lid crease and fold, 120–121 ptosis, 116

retrobulbar/intraorbital hemorrhage, 110–112 sulcus deformity, 118

suture milia, 120 undercorrection/overcorrection, 121–122

surgical management brow position, 121 canthal webbing, 119 corneal abrasion, 116 diplopia, 117

dry eye syndrome, 115 eyelid hematoma, 110 fat and skin, 121

globe rupture/perforation, 113 infection, 114

lacrimal gland injury, 115–116 lagophthalmos, 115

lid crease and fold, 120–121 ptosis, 116–117

retrobulbar/intraorbital hemorrhage, 112 sulcus deformity, 118

suture milia and scarring, 120 undercorrection/overcorrection, 122

Blitzer, A., 6

BoNTA treatment, 295 Boo-Chai, K., 4 Botoxr cosmetic, 290

Botulinum toxin-A (BTX), 7 Bourget, J., 313

Bourguet, J., 4, 173

Brennan, G.H., 6

Brow and upper eyelid continuum. See Periorbital aesthetic evaluation Brow lift. See Endoscopic brow lift

Browlift

arcus marginalis, 6 “Browpexy”, 6 BTX, 7

coronal technique, 5 endoscopic technique, 6 nerve damage, 66 rejuvenation techniques, 66 upper lid blepharoplasty, 59

Browpexy, 105

Browplasty, 289

BTX. See Botulinum toxin-A Buchanan, A.G., 25

Burnett, C.D., 7

Butler, C.E., 212

C

Camargos, A., 7 Canthal webbing

lateral, 118, 119 medial, 118, 119 Y-V and Z-plasty, 119

Canthopexy

canthal incision, 193 infracilliary incision, 193 orbicularis, 192

Canthoplasty

conjunctiva and retractors, 188 f lid shortening, 188 procedure, 188

Carbon dioxide (CO2) chromophore, 281

fat sculpting and shrinkage, 280 high frequency pulsed beams, 280 laser

application, 212 class 4, 281

photothermolysis, 212 upper lid blepharoplasty, 279

Carniol, P.J., 260 Catten, M., 7

Certified registered nurse anesthetist (CRNA), 48

Cheek and lower eyelid continuum. See Periorbital aesthetic evaluation Cheek implants

candidates, 252 incision, 248

large submalar, 254 local anesthesia, 247–248 medium submalar

combined shell implants, 255

facelift, blepharoplasty and CO2 laser resurfacing, 254, 256 placement, 253

upper blepharoplasty and facelift, 253 screw fixation, 249, 250

silicone, 245 Cicatricial ectropion, 214 CO2. See Carbon dioxide Codner, M.A., 7

Cohen, M.S., 208

Coleman, S.R., 5, 7 Corneal exposure, 122, 169 Coronal brow lift, 61, 62 Corticosteroids

description, 310 management

adjunctive agents, 310 intradermal injection, 310

mechanism, 310 safety, 311

Cosmetic

complaints and goals, 31 surgery, 4

treatments

periocular area, 297

tear trough in prominent eye, 301–303 Cosmetic eyelid surgery

preoperative photograph, 91 upper lid blepharoplasty, 87

Costaneres, S., 4, 5 Crow’s feet, 291 Czyz, C.N., 109

D

Davidson, T.M., 5

Deep temporal fascia (DTF), 71 Defocused

coagulation, 283 energy dispersion, 280 fat resection, 284 laser mode, 285

modes, lens incisions, 281 skin/subcutaneous flap, 287

De la Plaza, R., 7 De los Rios, E., 8 Direct eyebrow lift

aesthetic contour, 79 descent and deflation, 79

involutional brow ptosis/facial nerve palsy, 80 limited lateral supraciliary procedure

antibiotic ointment, 80 frontalis muscle, 80 natural rhytids, 80 preoperative markings, 80 structure, 80

suturing technique, 80, 81 mid-forehead lift

division, incision, 82 procedure, 82 significance, 82 structure, 82

non-surgical and surgical options, 80 position, 79

risk, hairs damage, 80 scar management

significant drawback, 82

surgical and non-surgical treatment, 82–83 scarring, 80

signficance, 80

youthful eyebrow complex, 79 Dortzbach, R.K., 211

Douglas, R.S., 307 Doxanas, M.T., 6, 103

Dryden, R., 4

Dry eye syndrome, 115 Dupuytren, G., 4 DysportT

abobotulinumtoxinA, 290 aliquots, belly, 293 clinical trial, 295 cosmetic treatments, 290 dose units, 291

frontalis muscle, 293 glabeller complex, 292

E

Edgerton, M., 5 Endomidface lift, 229, 234 Endoscopic

Guyuron’s access device, 229–230 minimal incision, 227–228 Peruvian fisherman’s knot, 231 technique, 225–226

views, midface dissection, 230, 231 Endoscopic brow and forehead rejuvenation

aesthetics and aging, 71–72 complications

alopecia, 76

endoscopic approach, 76 hematoma formation, 76 lagophthalmos, 76

development, 69 endoscopic techniques, 69 instrumentation, 73–76 lid redundancy, 69 patient selection

blepharoplasty, 72

dynamic and static asymmetries, 72 minimal skin redundancy, 73

technique

Arcus elevation, 75

dental elastic rubber bands, 73 direct visualization, 74

DTF, 74

30° endoscope, 75 ROOF, 75

standard sterile fashion, 73 STPF, 71

suspension force vector, 75 temporo-parietal incision, 74 topographical line, 73 Vicryl suture, 76

temporal anatomy

brow musculature, 70 corrugators, 70

DTF, 71

external and internal carotid systems, 71 facial nerve function, 69–70

minor depressor mechanism, 70 SMAS, 71

TPF, 70

venous drainage, 71 Endoscopic brow lift

frontal and oblique views, 78 instruments, 73

Endoscopic forehead lift. See Endoscopic brow and forehead rejuvenation

5-Fluorouracil management

autologous facial fat injections, 309 cicatricial left lower eyelid retraction, 309 eyelid scarring and contracture, 308

frost suture, 309 intradermal injection, 308 placement, 308

tissue matrix graft, 309, 310 wound healing, cicatricial, 309

mechanism description, 308

glaucoma surgery, 308 TGF-b, 308

thymidylate deficiency, 308 safety, 310

structure, 307, 308 Focused

anodized instrument, 281 modes, lens incisions, 281 skin incision, 286

Forehead. See Endoscopic brow and forehead rejuvenation Forehead anatomy

corrugator supercilii muscle, 12 depressor supercilli, 12, 13 frown lines, 12

muscle functions, orbicularis, 13 orbicularis oculi, division, 12–13 primary depressors, 12 procerus, 12

transverse furrows, 12 Forehead lifting

alopecia rate, 58 anatomy

depressor muscles, 58 frontalis muscles, 58 orbital fibers, 58 sensory innervation, 59

complications

medial brow complex, 66 re-exploration, 66

coronal and trichophytic approaches, 58 coronal incision, 58

endoscopic techniques, 57 meticulous technique, 58 planning and execution, 58 preoperative assessment

characteristics, 59

dorsal aesthetic lines, nose, 59 hydrogen peroxide, 65 strenuous activity, 66

rhytidectomy, 57 technique

bilateral supraorbital and supratrochlear nerve blocks, 61 bipolar cautery, 62

blade transitions, 62 Botox, 63

brow lift, 59 coronal approach, 59

coronal markings mimic, 59–60 corrugator excision, 63

Dexon and Maxon suture, 64, 65 frontalis, 64

graphic depicts, 61 hair follicles, 61

inflammatory response, 65

lateral aspect, 61, 62

lateral portions, tricophytic incision, 65 monopolar cautery, 63–64 non-penetrating retractor, 63

skin level, 64

subgaleal dissection, 62, 63 trichophytic incision, 60 tricophytic lift markings, 60 vertical myotomy, 64 wound closure, 65

Foster, J.A., 7, 109 Fractionated lasers ablative, 276

dyschromia and photodamage, 276 nonablative

posttreatment, 277

technical considerations, 276–277 Freund, R.M., 13

5-FU. See 5-Fluorouracil Fuchs, E., 4

Fuente del Campo, A., 7 Fuller, T.A., 279

G

Geist, C., 120 General anesthesia

muscle relaxation, 48 nonpotent inhaled anesthetic, 49 procedural constraints, 48 respiratory disorders, 48

Georgescu, D., 101, 199

Glabellar myectomy. See Upper eyelid blepharoplasty Glasgold, M.J., 259, 261, 267–269

Glasgold, R.A., 259, 261, 267–269

Goldberg, R.A., 5, 8, 117, 212, 307 Goldspink, N., 83

Gordy, D.D., 5

Grady, J.M., 25 Graf, D., 4 Graham, H.D., 71

Griepentrog, G.J., 79

Groth, M.J., 5, 173

H

Hamilton, D.G., 273 Hamra, S.T., 5, 7 Hamra, T., 7 Hartstein, M.E., 125 Harvey, J.T., 300 Hass, A.N., 110 Hemostasis

bipolar cautery, 287

intraoperative and postoperative hemorrhage risk, 279 scalpel/scissor incision, 280

thermo-coagulation zone, 281 Hester, T.R., 7

Hicok, K.C., 16

Hoenig, J.A., 307

Holden, P.K., 159

Holds, J.B., 25, 297 Huang, W., 7

Human immunodeficiency virus (HIV), 8 Husain, A., 279

Hyaluronic acid (HA) fillers, 290–291

I

Illouz, Y.G., 7

J

Janjanin, S., 120

Johnson, C.M., 58

Joshi, A.S., 120

K

Kakizaki, H., 15

Kamer, F.M., 5, 7

Kantzen, L.B., 5

Karam, A.M., 147

Kazim, M., 299

Kersten, R.C., 208

Kikkawa, D.O., 11, 16, 211

Klein, J.A., 47

Kolle, F., 4

Korn, B.S., 11, 16

Krastinova-Lolov, D., 7

Kulbersh, J.S., 3

Kulwin, D.R., 208

L

Lacrimal gland prolapse re-suspension technique, 107 surgical technique, 107 temporal upper lid fullness, 106

Lacrimal gland repositioning. See Upper eyelid blepharoplasty Lagophthalmos

bilateral, 114, 115 FTSG, 115

laser in situ keratomileusis (LASIK), 114 levator muscle complex, 115

Lam, S.M., 147, 259, 261, 267–269 Lam, V.B., 109

Langlois, J.H., 25

LASER. See Light amplification by stimulated emission of radiation Laser incisional eyelid surgery

absorption curve, 281 chromophore, CO2 laser, 281 CO2, upper lid blepharoplasty, 279 direct brow lift

endoscopic/pre-trichial, 286 laser skin incision, brow, 287

Mueller’s and levator aponeurosis visualization, 287 skin/subcutaneous tissue flap excision, 287

vicryl suture, levator aponeurosis, 287 disadvantages, 279

history

CO2 lasers, 280 hemorrhage, 280

nonpigmented tissue ablation, 279

RF and monopolar cautery device, 280 laser-assisted tarsal strip and SOOF lift

Desmarres retractor, 287–288 Jaeger plate, 287

lateral eyelid, tarsus, 288

skin resurfacing/transcutaneous lower blepharoplasty, 287 wedge resection, 288

laser skin resurfacing, 280

lower lid transconjunctival blepharoplasty anesthetic mixture, 284

care, patient, 285

cotton tip applicator, 286 fat pads exposure, 285

incision, conjuctiva and retractors, 285 inferior arcade visualization, 285 injection, fatal pads, 285

laser finger elevation, 286 sub-ciliary incision, 286

modes, lens, 281 ptosis repair, 286 safety, 281

upper blepharoplasty

beam test, tongue blade, 283 David-Baker lid clamp, 283

flap excision, to-and-fro manner, 284 injection, anesthetic, 282

lid crease measurement, 281 pinch technique, 282

ptosis repair, 282

skin flap elevation and dissection, 284 skin incision completion, 283

sterile aluminum foil, 282

Laser skin resurfacing. See Periorbital laser resurfacing Laser treatment of festoons

aging, 212 allergies, 212 complications

herpes simplex infection, 217 herpes simplex virus, 217 hypopigmentation, 219

laser skin resurfacing, 219 pigmentary changes, 219

preliminary microbiologic cultures, 217 scarring and ectropion, 219

transconjunctival lower lid blepharo-plasty, 217–219 description, 211

lower eyelid and cheek, 211 medical treatment, 212

preoperative evaluation and patient selection medical and dermatologic histories, 213 medications, 213

photography, 213

sun damaged skin, 213 treatments options, 213

skin folds, 211 tissue interaction

ablative pulse, 213 CO2 laser, 213

residual thermal energy, 213 thermal damage, 213

Yag lasers, 213 treatment protocols anesthesia, 214

bio-occlusive topical wound dressings, 214 debridement, 214

inferior orbital rim, 214 malar eminence, 214 residual reticular dermis, 214

upper lid blepharoplasty, 214–217 wound healing problems, 215

zygomatico-cutaneous ligaments, 211

Lateral canthal tendon (LCT), 13, 17, 105, 185, 203, 206, 207, 233

Lateral canthus canthal anatomy

anterior and posterior lamella, 186 lower eyelid anatomy, 185 preseptal and pretarsal segment, 186

complications canthal webs, 196

canthus/lower lid, 196 pain and tenderness, 196 surgical healing, 196

suture abscesses and granulomas, 196 cosmetic surgeon, 185

description, 185

lower blepharoplasty, 185 patient evaluation

globe prominence, 187 position and appearance, 186

preoperative examination modalities, 186 scleral show, 187

tendons and orbicularis tone, 186 post-operative care, 196

surgical techniques

aesthetic blepharoplasty patients, 188 aesthetic procedure, 187 canthopexy, 188, 191

canthoplasty, 188–189

classic canthoplasty procedure, 188 modified canthoplasty, 191–192 prominent glob, 192–194

Lateral orbital thickening (LOT), 206 Lateral palpebral ligament (LPL), 185, 186 Lee, K.J., 147, 313

Lee, S., 307 Leibovitch, I., 15 Leibsohn, J., 4 Lemke, B.N., 211 Levartovsky, S., 208 Levator aponeurosis

attenuated/disinserted, involutional ptosis, 126 eyelid crease, 128

identification, 128 separation, tarsal plate, 131

Levator muscle function, 138

Levator palpebrae superioris (LPS), 16, 149 Levator ptosis repair, blepharoplasty

anatomy

aponeurosis, 128–129 orbicularis oculi muscle, 128

orbital septum and eyelid crease, 128 tarsal plate and upper eyelid, 129

complications, 134

Muller’s muscle/conjunctival, 125–126 patient evaluation

Bell’s phenomenon and orbicularis strength, 127 Horner syndrome, 126

levator excursion, 126 MRD1, 126–127 Schirmer testing, 127

vertical palpebral fissure, 126–127 Zone-Quick, 127–128

preoperative examination, 134 procedure

aponeurosis separation, 131 cold compresses, 134 eyelid skin incision, 130

injury, Muller’s muscle, 131–132 lacrimal gland, dislocated, 130–131 lid crease marking, 129

local anesthetic infiltration, 129 nasal and temporal sutures, 132–133 preaponeurotic fat, 130

pretarsal orbicularis, exised, 131, 132

reformation, lid crease, 133 rigid corneal shield, 129–130 temporary slip-knot, 131, 133 vcryl suture, 131, 132

Lexer, E., 5, 6 Lid laxity

ectropion, 203

vertical shortening, 206

Light amplification by stimulated emission of radiation (LASER)

absorption curve, 281 beam test, 283

blunt dissection, 280

CO2 incisional surgery, 279 cotton tip applicator, 286 Desmarres retractor, 285 disadvantages, 279

fat resection, 284

fat sculpting and shrinkage, 280 finger elevation, 286 identification, 285

incisional devices, 280

RF and monopolar cautery devices, 280 safe material, 282

safety, 281 skin/subcutaneous flap, 287 sub-/pre-periosteal plane, 288

tarsal strip and SOOF Lift, 287–288 Lindsey, C., 120

Lisman, R., 5 Lockwood, C.B., 18 Long, J.A., 5, 173

LPS. See Levator palpebrae superioris Lucarelli, M.J., 79

M

Maas, C.S., 7, 289

MAC. See Monitored anesthesia care Mackenzie, W., 4

Mancini, R., 307

Mandell, G., 279

Margin reflex distance-2 (MRD2), 40, 161, 202

Margin reflex distance (MRD)

lower upper lid vs. Caucasian patients, 14 measurement, 90

phenylephrine, 138

upper eyelid position, 137–138 Margin-to-reflex distance one (MRD1), 37 Maruo, M., 151

Massry, G.G., 3, 26–28, 45, 116, 131, 173, 185, 303

Matarasso, A., 233 McCann, J.D., 101, 199, 212 McCord, C.D., 6, 103 McCord, D., 7

Mendelson, B.C., 211, 315 Midface

analysis, inferior, 38 augmentation, 243 hypoplasia, 33 implants

configurations, 249

recumbent positioning, 243, 244 laugh lines, 42

and lower eyelid continuum, 40 volume restoration, 243, 244

Midface anatomy malar region

OML and SOOF, 19–20 triangular region, 19

nasojugal groove “eyelid bags”, 19 tear trough, 19

nasolabial region, 20–21 soft tissue lamellae

concentric layers, 18 SMAS, 19

topography, 18

Midface and lower eyelid rejuvenation aesthetic considerations

double ogee-line, 228

male vs. female, convexity, 229 blepharoplasty, 234–235

drains, closure, taping and dressing, 235 endoscopic technique, 225

fat grafting, 235 indications, 227–228

intraoral dissection, periorbita, 231 patient selection, 227

periorbital region, 225 pre-operative preparation, 228 subperiosteal face lift

biplanar technique, 227 central oval, 227 suspension sutures, 226

technique

anatomical nomenclature, 229 BFP, 233

endomidface and endotemporo-midface lift, 229 infraorbital SOOF, 231

Ramirez periosteal elevator and TLF, 230 sequential endoscopic view, 230, 231 suture placement, 233–234

temporal incision, 229 zygomatic arch, 230

Midface elevation

arcus marginalis, 205 LOT, 206

orbicularis oculi muscle, 205 preperiosteal midface elevation, 206 upper eyelid blepharoplasty, 205

Midface lift

anterior lamella, 208 autologous fat grafting, 7

endoscopic minimal incision, 227 endotemporo, 229

open and endoscopic subperiosteal method, 7 post-operative edema and fast recovery, 7 preparation, 205

procedure, 206

Mid-forehead lift. See Direct eyebrow lift Mikaelian, A.J., 5

Mikamo, K., 151 Miller, C.C., 4 Mitz, V., 7, 313

Monitored anesthesia care (MAC) benzodiazepines, 48

CRNA, 48 opioid, 48 propofol, 48

Moore, S., 299

Morton, A.D., 87

MRD. See Margin Reflex Distance; Margin reflex distance MRD1. See Margin-to-reflex distance one

MRD2. See Margin reflex distance-2 Mullers’s muscle-conjunctival resection

blepharoplasty, 137 phenylephrine test, 138–139 ptosis procedure, 139

Murphy, M.R., 57, 58 Muzaffar, A.R., 211, 315

N

Nassif, P.S., 173

Nathan, L.E., 279

Negative vector eyelid, 187, 192, 298 Nettar, K.D., 289

Neuromodulators and fillers, periorbital rejuvenation complications, 294–295

meaning, 295 nonsurgical adjuncts, 289 region, 289

review, products beneficial action, 290 BotoxCosmeticT, 290

Botulinum toxin type A (BoNTA), 289–290

bovine collagen, 290

hyaluronic acid (HA) fillers, 290–291 SculptraT and RadiesseT, 291 serotypes, 290

treatment

crow’s feet, 291 frontalis muscle, 293

Glabellar complex, 292–293 nasojugal groove/tear trough, 293–294

Niamtu, J. III., 243, 244, 246, 247, 249–256 Nolan, W.B. III., 13

Non-ablative lasers

cool touch and N-lite, 273–274, 276 fractionated laser

posttreatment care, 277

technical considerations, 276–277

O

O’Brien, C.S., 50, 51

Occelston, N.L., 83 Oculofacial anesthesia

aesthetic eyelid, 45 consideration issues

allergic reactions, 46

malignant hyperthermia (MH), 49 general anesthesia, 48–49

local injectable absorption rate, 47 hyaluronidase, 47 local anesthetics, 47 systemic toxicity, 46

MAC, 47–48 oral sedation, 47 post-operative

NSAID agents, 49 pain control, 49

regional nerve blocks injection patterns, 50, 51 ophthalmology, 49

sensation loss, 49 supero-temporal orbital rim, 50

sensory blocks

frontal nerve block, 50, 52 infraorbital nerve block, 51

zygomaticofacial and zygomaticotemporal nerve, 51 technical aspects, 52

topical, 45–46 tumescent, 47 Oculoplastic surgery, 8

Oh, S., 11 O’Kan, S., 83 Olivari N., 299

OML. See Orbitomalar Ligament Open brow lift

mid-forehead wrinkles, 58 minimal side effects, 59 risks and benefits, 58

Ophthalmic anesthesia, 49 Oral sedation

anxiety, 47 properties, 47, 48

systemic anxiolytics, 47

Orbital compartment syndrome, 112 Orbitomalar ligament (OML), 19, 20, 164, 205 Ortiz-Monasterio, F., 7

Owsley, J.Q., 315

P

Pang, H.G., 151 Pang, R.G., 4 Passot, R., 57 Patel, C.K.N., 279 Paul, M.D., 7 Penne, R.B., 110

Periorbita. See Periorbital fat grafting Periorbital aesthetic evaluation

brow and upper eyelid continuum Asian and non-Asian, 36 asymmetry, facial nerve palsy, 35 dermatochalasis, 36

dynamic rhytids and furrows, 34 eyebrow position, 35

eyelid crease, 36, 38

eyelid retraction, MRD1, 37, 39 frontalis muscle compensation, 35, 36

levator aponeurosis, stretching/dehiscence, 37, 38 macroscopic assessment, 34–35

preoperative and postoperative appearance, 37 ptosis, 35

reparative and regenerative mechanisms, 34 tired/unhappy appearance, 35, 36

vertical palpebral fissure and MRD1, 37 complaints, oculofacial cosmetic patient, 31 lower eyelid and cheek continuum

concomitant brow ptosis and dermatochalasis, 38, 39 convexity-concavity-convexity, 41

floppy eyelid syndrome, 40 laugh lines, 42

laxity and scleral show, 40, 41 malar mounds and festoons, 42 MRD2, 40

orbital fat herniation, 38, 39 palpation and laxity, 40 scleral show, 39–40

snap-test and distraction tests, 40 tear trough deformity, 41–42

volume depletion and weakened midfacial soft tissue, 41 medical and psychological assessment, 31

orbitoskeletal and globe assessment anterior globe prominence, 33 Bell’s phenomenon, 33

components, ophthalmic examination, 33 conjunctival findings, 33 enophthalmos/sunken eye, 33, 34 exophthalmometry, 33 exophthalmos/prominent eye, 33, 34 facial, midfacial/cheek bones, 32–33 flourescein/rose bengal dye use, 33 hertel exophthalmometer, 33 identification, eyelids, 33

prominent malar eminences and cheekbones, 33 radiographic imaging, 33

photo documentation, 31–32 units, 32

Periorbital aesthetic surgery appropriate techniques in, 3 blepharoplasty, 3–5 forehead lift

brow lift, 5–6 neuromodulators use, 6–7 subcutaneous dissection, 5

midface

aging changes, 7 alloplastic facial implants, 8 endoscopic rejuvenation, 7 HIV, 8

SMAS, 7

subperiosteal rejuvenation, 7 synthetic fillers, 8

volume restoration, 7, 8 Periorbital fat grafting

age, volume loss, 259 characteristics, 260 complications

contour irregularities, 271 fat infiltration entry sites, 271 infections, 271

intravascular injections, 271 planning and technique, 271 tissue roll and kenalog fails, 271

facial and eyelid rejuvenation, 259, 260 fat vs. filler, 266

goal and objectives, 259 harvesting

anesthesia, 266 cannula, 267

determining amount, 267 donor determination, 266 instruments, 267

stab incision, 266–267 hyaluronic acids, 271 implementation, 259 injection

adding volume, 269 below rim filling, 269 blunt cannulas, 268, 269

bony inferior orbital rim, 268 concavity, 270

midcheek, 268 nerve block, 268

Periorbital fat grafting (cont.) preoperative markings, 268 superficial, “tear trough”, 268–269 techniques, 269

Type 1 lids, 269

Type 2 lids, volume augmentation, 270 lower eyelid

characteristics, youthful lid, 261 cheek formation, 260

fat reduction, 261

inferior orbital rim, 261, 262 lid–cheek junction, 260 malar mounds, 261 management, 261 nasolabial fold, 260

oral/intralesional steroids, 261

orbital rim and midfacial volume loss, 261 pseudoherniated fat, 261

role, 260

traditional surgery, 260 volume restoration, 260–261

postoperative recovery applying ice, 270 strenuous activity, 270 swelling and bruising, 270 touch-up procedure, 271

procedures, 259 processing

completion of centrifugation, 267 Luer-Lok syringes, 268

traditional blepharoplasty, 260 upper eyelid

“A-frame” deformity, 262 age-related volume loss, 262

architecture and rejuvenation plan, 262 bony definition, 265

brow and temple, 261–262 caution, 263

concavity and shadowing, 262 deflation, 264

fat pocket, 263 “flap of skin”, 264

goal, lid rejuvenation, 264 lateral fold, 263

lid hooding, 264, 266 “pseudo-pseudo herniated fat”, 263 skeletonization, SOR, 265

soft tissue cushioning, 265 structure, type 1, 263

superior orbital rim (SOR), 262 traditional brow lifts, 264

Type 1, lid fold and lash line, 262–263 Type 2, natural concavity, 264

volume augmentation, 259 volume replacement, 259

Periorbital laser resurfacing

ablative laser (see Ablative lasers) challenging, cosmetic surgery, 273 CO2 laser, 275–276

Fitzpatrick skin classification, 274 fractionated lasers

posttreatment, 277 technology, 276–277

history erbium, 273

fractionated ablative lasers, 274 fractionated nonablative lasers, 274

mid-1990, ultrapulsated CO2, 273 technology and development, 273 traditional nonablative lasers, 273–274

laser skin resurfacing, uses, 274 lower lid

laxity, 273 rhytids, 277

posttreatment, CO2 and Erbium, 276 pseudoherniation, orbital fat, 273 resurfacing lasers

anatomic changes, 274 cutaneous laxity, 274

surgical management, 273 “tightening” lower lid, 277

Periorbital rejuvenation, 3, 6, 41, 139, 289, 316 Perkins, S.W., 159

Peyronie, M., 7, 313

PFP. See Preaponeurotic fat pad Phenylephrine test

left upper eyelid ptosis, 138 Müller’s muscle, 138

patient’s clinical history, 138–139 steps, 138

Plastic surgery

blepharoplasty incisions and excision, 4 cosmetic, 4

Posterior approach ptosis repair anesthesia, 139 complications, 145 periorbital rejuvenation, 137

postoperative management, 144–145 preoperative evaluation

eyelid ptosis, 137–138 levator muscle function, 138 phenylephrine test, 138–139

surgical approaches, 137 surgical technique

conjunctiva and Müller’s muscle, 142–143 conjunctival wound, 143

eyelid marking, upper blepharoplast, 139–140

frontal block, 140

instilling local anesthetic, 143–144

preventing inappropriate ptosis clamp placemen, 141 ptosis clam placement, 141

resection, 141 suture knot, 143

sutur passage, 141–142 traction suture, 140–141 upper blepharoplasty, 696

Post-lower eyelid blepharoplasty description, 200

eyelid and cheek anatomy anterior lamella, 200 cheek fat pad, 201

circular sphincter muscle, 201 horizontal palpebral aperture, 200 medial canthus, 200

orbital orbicularis oculi, 201 skin and muscle flap, 200 SOOF, 201

muscle flap, 200 pathophysiology

edema and chemosis, 202 inferior orbital rim, 201 lateral canthus, 201 vertical inadequacy, 201

preoperative evaluation

hertel exophthalmometer, 203 lagophthalmos, 202

lateral canthal position, 202 presentation, 202 retroauricular skin grafting, 200 surgical procedures

canthal resuspension technique, 203 canthopexy, 203

collagen fibers, 204 DermaMatrix allograft, 204 hard palate graft, 204

lateral canthal resuspension, 203 lateral tarsal strip (LTS), 203 orbital orbicularis oculi muscle, 203 posterior lamellar contraction, 203 reconstruction process, 204

scleral grafts, 204 vascularization, 204 vertical inadequacy, 203

surgical technique

eyelid splinting and casting, 206 graft placement, 206

lateral canthal resuspension, 206 midface elevation, 205–206

Preaponeurotic fat pad (PFP), 15 Priel, A., 11

Prieto, V.G., 212 Profitt, F., 25

Prominent eye. See Prominent eye management Prominent eye management

anatomic associations bowstringing, 298

hypoplastic malar eminence, 298 negative vector eyelid, 298 physical findings, 298

armentarium, surgical corrective techniques, 305 blepharoplasty, prominent globe

agophthalmos and exposure keratitis, 304 bowstringing, 304, 305

canthoplasty, 304

conventional surgical approach, 304 corneal protective mechanisms, 304 fat removal and medial fat pad, 304 malar implants placement, 304

cheek/orbital rim implants augmentation and osteotomy, 299 decompression, onlay silicone, 299

onlay silicone/porous polyethylene, 299, 300 eyelid retraction repair, 299–300

globe, prominent description, 297

diagnosed and managed, aesthetic enhancement, 297 TED, 297

treatment, 297 lower lid retraction

full-thickness skin grafting, 301 hard palate mucosa, 301

lateral canthoplasty and canthotomy, 301 spacer grafts, 301

orbital decompression surgery description, 298

optic neuropathy/uncontrollable ocular exposure, 298–299

technique, transantral and fat, 299 ‘‘rescue’’ techniques

midface lifting, 303

post-blepharoplasty complications, 303 surgical correction, 303

tear trough, cosmetic treatment autogenous fat grafting, 302–303

blepharoplasty, intra-SOOF technique, 302 blepharoplasty/midface lift procedures, fat repositioning, 302–303 fat repositioning techniques, 301

injectable and hyaluronic acid fillers, 302 midface lifting and trans-lid techniques, 302

upper lid retraction anterior technique, 300

Mueller’s muscle/levator aponeurosis, 300

Prominent globe, 192, 203, 297–299, 304. See also Prominent eye management

Proptosis

eyelid retraction, 297 and TED, 298

Psillakis, J.M., 7

Ptosis, 116–117. See also Levator ptosis repair, blepharoplasty Ptosis repair. See Levator ptosis repair, blepharoplasty; Posterior

approach ptosis repair Putterman, A.M., 137

Q

Quatela, V.C., 71

R

Rabinowitz, S., 7

Ramey, N.A., 45 Ramirez, O.M., 6, 7, 225 Rauscher, G.E., 7 Reardon, E.J., 5

Reddy, U.P., 45 Retrobulbar hemorrhage

CT, 110, 111

medical and surgical management, 112 subconjunctival and orbital, 110, 112 Retroorbicularis oculi fat pad (ROOF), 19–20

Rhodes, G., 25

Rhytidectomy. See Short-flap SMAS rhytidectomy Rogachefsky, A.S., 7

Roggman, L.A., 25 Rosenbaum, A.L., 117 Rumley, T.O., 7

S

Sabini, P., 71 Sadick, N.S., 260 Sajja, K., 137 Sayoc, B.T., 4

Scar management. See Corticosteroids; Direct eyebrow lift; 5-Fluorouracil Scheiner, A.J., 211

Selva, D., 15

Sheen, J.H., 4

Shorr, M., 5

Shorr, N., 208

Short-flap SMAS rhytidectomy advantages, 314

aging process, 314 anatomic features

bony framework, face and neck, 316 facial nerve, 315–316

neck banding, 315

neurosensory and neuromotor branches, 315

Short-flap SMAS rhytidectomy (cont.) deep plane facelifts, 315

deep tissue plication, 313 long-skin flaps, 314–315 postoperative care, 324–326 potential complications, 325 preoperative

assessment, 316–317 care, 317

skin undermining, 313

surgical preparation and technique AP1, AP2, AP3 and AP4, 322 autoclave tape, 317

excision, intraoperative, 320–322

facial subcutaneous dissection, 319, 320 frontal branch, facial nerve, 319, 320 general anesthesia/IV sedation., 317 imbrication, 320–322

intraoperative markings, incisions, 318, 319 mandible angle elevation, 320, 321 platysmaplasty, 318

postauricular skin flap elevation, 319–321 sequential order, procedures, 317

skin tailoring, 321–324

submental suction-assisted lipectomy, 318 wound tension, 313–314

Sichel, J., 4

Siegel, R.J., 5 Skin graft

eyelid, 201 thickness, 208

Skin-muscle flap tacking suture, 165

transcutaneous technique, 164 Skin pinch, 139, 140, 160 Skoog, T., 7, 313

SMAS. See Superficial musculoaponeurotic system Smith, B., 5

Smith, R.C., 5 Soft tissue fillers agents, 293

BoNTA treatment, 295

corrugator supercilii originates, 292 fibroblastic ingrowth, 290 manufacture, syringe, 290

role, 293 Spadafora, A., 8 Stallworth, C.L., 69 Stefanyszyn, M.A., 110

Sub-orbicularis oculi fat (SOOF) elevation, infraorbital, 231, 232 suspension, 234

suture placement, 233 Sulcus deformity

dermis fat grafting, 118

hollow bilateral superior sulci, 117

Superficial musculoaponeurotic system (SMAS), 7, 19 Surgical anatomy

eyebrows, 13–14 eyelid

lamellae, 15–16 lower eyelid, 17–18 tarsus, 17 topography, 14–15

upper retractors, 16–17 facial proportions, 11–12

facial vasculature, innervation and lymphatic drainage carotid and temporal arteries, 21

facial motor, function, 22 ophthalmic artery, 21 supraorbital neurovascular, 21

forehead, 12–13 midface

malar region, 19–20 nasojugal groove, 19 nasolabial region, 20–21 soft tissue lamellae, 18–19 topography, 18

Symmetry

degree of asymmetry, 25 facial beauty, 25

Syniuta, L.A., 117

T

Taban, M., 307

Tan, K.S., 11

Tanna, N., 120 Tao, J.P., 31 Tapia, A., 7

Tear trough deformity effects, 294

esthetic creams and ice, 294 HA fillers, 294

injection techniques, 294

periorbital rejuvenation techniques, 293 volume replacement, 293–294

Temporal line of fusion (TLF), 230 Temporoparietal fascia (TPF), 70 Tenzel, R.R., 5

Terrino, E.O., 8 Tessier, P., 7 Thacker, N.M., 117 Toledo Rios, R., 8 Topical anesthesia

eye drops

examination techniques, 46 surgical preparation solutions, 45

topically applied ophthalmic drops, 46 skin creams

compounding pharmacy, 47 diffusion, local infiltration, 46 EMLA, 46

Transconjunctical lower blepharoplasty complications

diplopia, 184

eyelid malposition, 184 fat reduction, 183 granulomas, 184

subconjunctival edema, 183 description, 173

eyelid analysis/preoperative evaluation adjunctive procedures, 176

lower lid factors, 176 lower lid retractors, 176

preoperative assessment, 177 lower eyelid anatomy

anatomic orientation, 174

central and temporal fat pads, 176 fat pads, 174

inferior fornix, 174 inferior tarsal boarder, 174

layers, 174 orbital floor, 175

postseptal/retroseptal dissection, 175 lower eyelid rejuvenation, 173 postoperative care, 183

procedure, 173 surgical technique

conjunctiva and retractors, 178 Desmarres retractor, 178 eyelid anatomy, 177

fat pads, 178

hemostasis and anesthesia, 177 local anesthetic, 177

postoperative bruising and swelling, 180 Prolene suture, 180

suborbital rim space, 179 subperisoteal pockets, 180 traction suture, 180

Transcutaneous blepharoplasty complications and management

dry eye/chemosis, 169

eyelid malposition/ectropion, 169 hematoma, 169

milia, 168–169 dermatochalasis, 159 eyelid position and laxity

frost suture, 161–162 globe protrusion, 160

margin-reflex distance 2 (MRD-2), 161 snap and lid distraction test, 161

fat transposition

bipolar cautery, 166–167 malar extension, 172 transcutaneous approach, 166

festoons and malar edema ectropion, 163

preoperative examination, 163 lower eyelid tightening, 168 operative technique

blunt elevation, 165

excess skin-muscle excision, 165 lateral orbicularis oculi muscle, 164 lower eyelid skin marking, 164 meticulous cauterization, 165 presence, pseudoherniation, 164 skin-muscle flap, 165

patient examination

eyelid skin redundancy, 160 fat pseudoherniation, 160 hyperpigmentation, 160 ocular lubrication, 161 optimal rejuvenation, 160 skin quality, 160

patient expectations and psychology, 163–164

patient selection

Fitzpatrick skin types V-VI, 160 medications, 159

symptoms, 159 postoperative care

antibiotic/steroid ophthalmic, 168 hematoma formation, 168

revision patients

lid rotational techniques, 162 proper suspension techniques, 162 treatment, eyelid malposition, 162

skin resurfacing, 168 surgical anatomy

capsulopalpebral fascia, 164 orbicularis oculi muscle, 164 orbital fat, 164

Tricophytic brow lift, 60 Trokel, S., 299

U

Uchida, K, 151

Uppal, R.S., 308

Upper blepharoplast eyelid marking curvilinear manner, 139 patient/surgeon preference, 139 skin “pinch” technique, 140

Upper eyelid asymmetry aponeurosis, 120

bilateral involutional brow ptosis, 121, 122 lid creases and folds, 120

punctual occlusion, 122 Upper eyelid blepharoplasty

anatomical and preoperative evaluation orbital ligament release, 103 ROOF, 103

superior orbital rim, 103 anesthesia

dissection and vasoconstriction, injection, 94 excess medial skin, 94

markin symmetry, 94

monitored intravenous sedation, 93 4-0 silk traction suture, 94 surgical incision, 95

asymmetry

brow position, 121 fat, 121

lid crease and fold, 120–121 skin, 121 undercorrection/overcorrection,

121–122

“bread and butter” procedure, 87 brow ptosis, 102

complications, 99

corrugator muscle contraction, 102 cosmetic references, 87

factors, 101 glabellar myectomy

blepharoplasty incision, 105

corrugators and depressor supercilii muscles, 105–106

en block resection, 105

excision, supercilii muscle, 105–106 procerus muscle, 106

surgical technique, 105–106 gravity effects, 102

heavy lids, 107 hemorrhage

anticoagulant therapy, 109, 112 CT, 110, 111

eyelid hematoma, 109–110 natural clotting process, 110, 111 retrobulbar/intraorbital, 110–112

incision irregularities

canthal webbing, 118–119 scarring, 119–120

suture milia, 120

Upper eyelid blepharoplasty (cont.) infection

preseptal cellulitis, 113 proptosis and chemosis, 110, 114 suture abscess, 113

internal brow fat sculpting

lateral canthal resuspension, 104 postoperative scarring, 104 surgical technique, 104–105 upward traction, 104

vertical spreading technique, 104–105 lacrimal gland prolapse

re-suspension technique, 107 surgical technique, 107 temporal upper lid fullness, 106

management approaches, 109 pathophysiological mechanisms, 102 patient examination

normal aging brow, 91 “pseudo MRD”, 90 risks, dry eye, 91

standardized measurement, 90 visual field testing, 91

patient history, 90

patients’ concerns assessment digital morphing programs, 89 initial consultation, 89

pre-and postoperative image representation, 90 periorbital consideration

anatomic components, 87, 88

blepharoptosis and dermatochalasia, patient, 89 eyelid crease, 88

levator aponeurosis attachment, 88 position, brow, 88–89 preaponeurotic fat, 88

pretarsal skin, 87 septum fusion, 88 postoperative management

antibiotic ophthalmic ointment, 97 commercial gel mask, 97

pre-and postoperative photographs, 99 pseudoptosis, patient, 98

sound intraoperative technique, 122 surgery

globe pressure and spreading, 96 incisional options, 95

lid crease fixation, defined, 97 orbicularis muscle, 95–96 steri-strips, Mastisol, 96, 97 wound separation, 95

surgery preparation alcohol wipes, 91

calipers four reference point, 91 compass calipers, 92

crease symmetry, 93 excess medial skin, 93, 94 Graffe fixation forceps, 93 prior to marking, 91, 94 surgical markers, 92

surgical complications diplopia, 117

dry eye syndrome, 115 lacrimal gland injury, 115–116 lagophthalmos, 114–115 ptosis, 116–117

sulcus deformity, 117–118 surgical prep, 95

tired facial appearance, 102 unrealized patient expectations, 122 vision loss

corneal abrasion, 113 globe rupture/perforation,

112–113

orbital compartment syndrome, 112

V

Valiente, E., 7

Van Lint, A., 50, 51 Viterbo, A., 235

Vogt–Koyanagi–Harada (VKH) syndrome, 3 Volume augmentation

periorbital fat grafting benefit, skin removal, 263 filling concavity, 264 “flap of skin”, 264 implementation, 271

lower lid and midface region, 259 pan facial, 266

plastic surgery, 259

pre-and post-augmentation, 269 pseudoherniated fat, 261 skeletonization, 270

unfold upper lid skin, 270 upper eyelid, skin removal, 263

Type 2, superior orbital rim and lash line, 265

Volume depletion, 5, 37, 41, 262

Volume preservation. See Periorbital Fat Grafting Von Graefe, C.F., 3, 4

W

Wachter, B., 31

Wang, T.D., 69

Webster, R.C., 5, 313, 314 Westmore, M.G., 79 Woodward, D.J., 45 Woodward, J.A., 45, 279

Wound modulation. See Aesthetic eyelid and periorbital surgery

Y

Yoon, S., 31

Yu, K.C.Y, 289

Z

Zweifler, M., 315