Contributors
Richard L. Anderson, MD, FACS
Medical Director, Center for Facial Appearances, Salt Lake City, UT, USA
Sterling S. Baker, MD
Assistant Clinical Professor, Department of Ophthalmology, Adjunct Clinical Professor, Department of Dermatology, University of Oklahoma College of Medicine, Oklahoma City, OK, USA
Leslie Baumann, MD
Professor, University of Miami, Miami Heart Institute, Department of Dermatology, Miami Beach, FL, USA
Kenneth R. Beer, MD
Director, The Palm Beach Esthetic Center, Voluntary Assistant Professor, University of Miami, West Palm Beach, FL, USA
Francesco P. Bernardini, MD
Ospedale Evangelico Internazionale, Department of Ophthalmology,
Genova, Italy
Diane S. Berson, MD
Assistant Clinical Professor, Weill Medical College of Cornell University, New York Presbyterian Hospital, Department of Ophthalmology, New York, NY, USA
Evan H. Black, MD
Associate Professor, Wayne State University School of Medicine, Kresge
Eye Institute, Department of Ophthalmology, Detroit, MI, USA
Sean M. Blaydon, MD
Ophthalmic Plastic and Reconstructive Surgeon, Texas Oculoplastic
Consultants, Austin, TX, USA
xxiii
xxiv Contributors
Cat Nguyen Burkat, MD
Assistant Professor, Ophthalmic Plastic and Reconstructive Surgery,
University of Wisconsin, Madison, WI, USA
John R. Burroughs, MD
Medical Director, Eye and Facial Appearances, Colorado Springs,
CO, USA
Kimberly J. Butterwick, MD
Scripps Memorial Hospital, La Jolla, CA, USA
William P.D. Chen, MD, FACS
Clinical Professor, UCLA School of Medicine, Harbor-UCLA Medical Center, Department of Ophthalmology, Long Beach, CA, USA
Howard Conn, MD
Private Practice, Irvine, CA, USA
Philip L. Custer, MD
Professor, Washington University School of Medicine, Department of
Ophthalmology and Visual Sciences, St. Louis, MO, USA
Roger A. Dailey, MD, FACS
Lester Jones Chair, Oculofacial Plastic Surgery, Oregon Health and Sciences University, Division of Oculofacial Plastic & Reconstructive Surgery, Portland, OR, USA
Sheri L. DeMartelaere, MD, FACS
Assistant Professor, Uniformed Services, University of the Health Sciences, Director, Ocular and Orbital Trauma Service, Brooke Army Medical Center, Department of Surgery, San Antonio, TX, USA
Martin H. Devoto, MD
Director, Consultores Oftalmologicos, Division of Oculoplastic and
Orbital Surgery, Buenos Aires, Argentina
Lisa M. Donofrio, MD
Associate Clinical Professor, Yale University School of Medicine, Department of Dermatology, New Haven, CT, USA
Jeffrey S. Dover, MD
SkinCare Physicians, Chestnut Hill, MA, USA
Steven C. Dresner, MD
Associate Clinical Professor, University of Southern California, Department of Ophthalmology, Los Angeles, CA, Eyesthetica Inc., Santa Monica, CA, USA
Kathleen M. Duerksen, MD, FACS
Private Practice, Tuscon, AZ, USA
Contributors xxv
Jeffrey P. Edelstein, MD
Private Practice, Chandler, AZ, USA
Andrew S. Eiseman, MD
Assistant Professor, Uniformed Services University of the Health Sciences, Chief, Oculoplastics and Orbit Disease Center, Department of Surgery, Walter Reed Army Medical Center, Eye Clinic, Washington D.C., USA
Yoash R. Enzer, MD
Assistant Clinical Professor, Warren Albert School of Medicine of Brown University, Rhode Island Hospital, Department of Surgery, Division of Ophthalmology, Providence, RI, USA
Melanie H. Erb, MD
Assistant Clinical Professor, University of California at Irvine, Department of Ophthalmology, Irvine, CA, University of Southern California, Department of Ophthalmology, Los Angeles, CA, Eyesthetica Inc., Santa Monica, CA, USA
Robert G. Fante, MD
Clinical Associate Professor, University of Colorado, Departments of Ophthalmology and Otolaryngology, Denver, CO, USA
Jill A. Foster, MD
Associate Clinical Professor, The Ohio State University, The Eye Center of Columbus, Department of Ophthalmology, Columbus, OH, USA
Raf Ghabrial, MBBS, FRANZCO
Senior Lecturer, University of Sydney, Sydney Oculoplastic Surgery,
Sydney, Australia
Geoffrey J. Gladstone, MD
Co-director of Oculofacial Surgery, William Beaumont Hospital, Department of Ophthalmology, Southfield, MI, USA
Mark J. Glasgold, MD
Clinical Assistant Profesor, Robert Wood Johnson Medical School, Department of Surgery, Highland Park, NJ, USA
Robert A. Glasgold, MD
Clinical Assistant Professor, Robert Wood Johnson Medical School, Department of Surgery, Highland Park, NJ, USA
Herbert J. Glatt, MD
University of Tennessee Medical Center, Department of Surgery, Knoxville, TN, USA
Russell S. Gonnering, MD, FACS
Clinical Professor, The Medical College of Wisconsin, Department of Ophthalmology, Brookfield, WI, USA
xxvi Contributors
Andrea N. Hass, MD
Hass Plastic Surgery and Medispa, Palm Beach Gardens, FL, USA
Morris E. Hartstein, MD, FACS
Clinical Associate Professor, Saint Louis University, Department of Ophthalmology and Division of Plastic and Reconstructive Surgery, St. Louis, MO, USA
R. Jeffrey Hofmann, MD
Assistant Clinical Professor, Brown University, Rhode Island Eye Institute, Department of Ophthalmology, Providence, RI, USA
David E.E. Holck, MD
Chairman, Department of Ophthalmology, The University of Texas at San Antonio, Health Sciences Center, Director, Oculofacial Plastics and
Orbital Service, Wilford Hall Medical Center, Department of Ophthalmology, San Antonio, TX, USA
John B. Holds, MD, FACS
Clinical Professor, Saint Louis University, Departments of Ophthalmology and Otolaryngology-Head and Neck Surgery, St. Louis, MO, USA
Erin L. Holloman, MD
Private Practice, Oklahoma City, OK, USA
David F. Horne, MD
Assistant Clinical Professor, Cornell University, New York Presbyterian Hospital, Department of Dermatology, New York, NY, USA
Edsel Ing, MD, FRCSC
Assistant Professor, University of Toronto, Toronto East General Hospital, Toronto, Ontario, Canada
Derek H. Jones, MD
Clinical Assistant Professor, David Geffen School of Medicine at UCLA,
Department of Dermatology, Los Angeles, CA, USA
Kevin A. Kalwerisky, MD
Fellow, Oculofacial Plastic Surgery, The University of Texas at San Antonio, Health Sciences Center, Wilford Hall Medical Center, Department of Ophthalmology, San Antonio, TX, USA
Michael S. Kaminer, MD
Assistant Professor, Yale Medical School, New Haven, CT, Dartmouth Medical School, Hanover, NH, Department of Dermatology, SkinCare
Physicians of Chestnut Hill, Chestnut Hill, MA, USA
Andrew J. Kaufman, MD, FACP
Assistant Clinical Professor, David Geffen School of Medicine at UCLA, Center for Dermatology Care, Los Angeles, CA, USA
Contributors xxvii
Jemshed A. Khan, MD
Clinical Professor, Kansas University School of Medicine, Kansas University Medical Center, Department of Ophthalmology, Kansas City, MO, USA
Don O. Kikkawa, MD
Clinical Professor, Chief, Division of Oculofacial Plastic and Reconstructive Surgery, University of California, San Diego, Department of
Ophthalmology, La Jolla, CA, USA
Bobby S. Korn, MD, PhD
Assistant Professor, University of California, San Diego School of Medicine, Shiley Eye Center, Department of Ophthalmology, Division of Oculofacial Plastic & Reconstructive Surgery, La Jolla, CA, USA
Bradley T. Kovach, MD
Florida Coastal Dermatology Associates, Naples, FL, USA
Samuel M. Lam, MD, FACS
Facial Plastic Surgeon, Lam Facial Plastics, Plano, TX, USA
Gustavo H. Leibaschoff, MD
President, ICAM USA, Inc., Director, International School of Mesotherapy, Dallas, TX, USA
James Leong, MBBS, MMed
Clinical Associate Lecturer, University of Sydney, Sydney Eye Hospital,
Sydney, Australia
Peter S. Levin, MD
Clinical Adjuvant Professor, Stanford University School of Medicine, Department of Ophthalmology, Mountain View, CA, USA
Don Liu, MD
Professor, University of Missouri, Department of Ophthalmology,
Columbia, MO, USA
Manuel A. Lopez, MD
Director, Facial Plastics Service, The University of Texas at San Antonio, Health Sciences Center, Wilford Hall Medical Center, Department of
Otolaryngology, San Antonio, TX, USA
Mark J. Lucarelli, MD
Associate Professor, University of Wisconsin, Director, Oculoplastics
Service, Department of Ophthalmology and Visual Sciences, Madison,
WI, USA
William P. Mack, MD
Clinical Assistant Professor, University of South Florida, Department of Ophthalmology, Tampa, FL, USA
xxviii Contributors
Geva Mannor, MD, MPH
Head, Oculoplastic Surgery, SCRIPPS Clinic, Department of Ophthalmology, La Jolla, CA, USA
Guy G. Massry, MD
Director, Ophthalmic Plastic and Reconstructive Surgery, American Eye Institute, Cedars Sinai Medical Center, Los Angeles, CA, Spalding Dr. Cosmetic Surgery and Dermatology, Beverly Hills, CA, Davidorf
Eye Group, West Hills, CA, USA
Seth L. Matarasso, MD
Clinical Profesor, University of California, San Francisco, Department of Dermatology, San Francisco, CA, USA
Joseph A. Mauriello Jr., MD
Ophthalmic Plastic and Reconstructive Surgeon, University of Medicine and Dentistry of New Jersey, Summit, NJ, USA
Robert A. Mazzoli, MD, FACS
Consultant in Ophthalmology to the Surgeon General, Director,
Ophthalmic Plastic, Reconstructive and Orbital Surgery, Associate Professor, Uniformed Services University of the Health Sciences, Bethesda, MD, Madigan Army Medical Center, Tacoma, WA,
USA
John D. McCann, MD, PhD
Medical Director, The Center for Facial Appearances, Salt Lake City, UT, USA
Clinton D. McCord, Jr., MD
Associate Clinical Professor, Emory University School of Medicine, Paces Plastic Surgery and Recovery Center, Atlanta, GA,
USA
Michael E. Migliori, MD, FACS
Clinical Associate Professor, The Warren Alpert School of Medicine at
Brown University, Rhode Island Hospital, Department of Ophthalmology, Providence, RI, USA
Yasaman Mohadjer, MD
Washington University in St. Louis, Department of Ophthalmology and Visual Sciences, St. Louis, MO, USA
Brent R. Moody, MD
Assistant Professor, Vanderbilt University, Department of Dermatology, Nashville, TN, USA
Asa D. Morton, III, MD
Director, Ophthalmic and Facial Plastic Surgery, Eye Care Center of San Diego, San Diego, CA, USA
Contributors xxix
Shoib Myint, DO, FAACS, FACO
Ophthalmic and Facial Plastic Surgeon, Co-director, Beaumont Eye
Institute, William Beaumont Hospital, Department of Ophthalmology, Southfield, MI, USA
Paul S. Nassif, MD, FACS
Spalding Drive Cosmetic Surgery & Dermatology, Beverly Hills, CA,
USA
Frank A. Nesi, MD
Associate Clinical Professor, Kresge Eye Institute, Wayne State University School of Medicine, William Beaumont Hospital, Department of Ophthalmology and Otolaryngology, Royal Oak, MI, USA
Russell W. Neuhaus, MD
Ophthalmic Plastic and Reconstructive Surgeon, Texas Oculoplastic
Consultants, Austin, TX, USA
Joseph Niamtu, III, DMD
Private Practice, Cosmetic Facial Surgery, Richmond, VA, USA
John Pak, MD, PhD
Oculoplastic Surgeon, Wheaton Eye Clinic, Department of Ophthalmology, Wheaton, IL, USA
Allen M. Putterman, MD
Professor of Ophthalmology, Co-Director, Oculofacial Plastic Surgery, University of Illinois School of Medicine, Michael Reese Hospital and Medical Center, Chicago, IL, USA
Oscar M. Ramirez, MD, FACS
Clinical Assistant Professor, The John’s Hopkins University School of Medicine, Baltimore, MD, Esthetique Internationale, Timonium, MD,
USA
Camilo O. Reyes, MD
Clinical Fellow, Esthetique Internationale, Timonium, MD, USA
O. Bailey Robertson, DDS
Director, Facial Plastics Services, Wilford Hall Medical Center, Department of Oral and Maxillofacial Surgery, San Antonio, TX, USA
Thomas E. Rohrer, MD
SkinCare Physicians of Chestnut Hill, Chestnut Hill, MA, USA
Elizabeth F. Rostan, MD
Private Practice, Dermatology and Cosmetic Surgery Center of Charlotte, Charlotte, NC, USA
xxx Contributors
Vivian Schiedler, MD
Oculoplastics and Orbital Consultants, Charlottesville, VA, USA
Stuart R. Seiff, MD
Emeritus Professor, University of California, San Francisco, Chief, San Francisco General Hospital, Department of Ophthalmology, San Francisco, CA, USA
Todd R. Shepler, MD
Ophthalmic Plastic and Reconstructive Surgeon, Texas Oculoplastic
Consultants, Austin, TX, USA
John W. Shore, MD
Ophthalmic Plastic and Reconstructive Surgeon, Texas Oculoplastic
Consultants, Austin, TX, USA
John D. Siddens, DO
Ophthalmic Plastic Surgery Clinical Instructor, University of South Carolina School of Medicine, Department of Ophthalmology, Columbia,
SC, USA
Rona Z. Silkiss, MD
Chief, Division of Ophthalmic Plastic Reconstructive and Orbital Surgery, California Pacific Medical Center, Department of Ophthalmology, San Francisco, CA, USA
Guy Ben Simon, MD
Tel Aviv University, Goldschleger Eye Institute, Department of Ophthalmology, Ramat Gan, Israel
David J. Singer, MD, FACS
Associate Clinical Professor, University of Miami School of Medicine,
Anne Bates Leach Eye Hospital of Bascom Palmer Eye Institute, Department of Ophthalmology, Miami, FL, Aspen Valley Hospital,
Aspen, CO, USA
Bryan S. Sires, MD, PhD
Allure Laser Center and Medispa, Kirkland, WA, USA
Charles B. Slonim, MD, FACS
Clinical Professor, University of South Florida College of Medicine, Department of Ophthalmology, Tampa, FL, USA
Eric A. Steele, MD
Assistant Professor, Oregon Health & Sciences University, Department of
Oculofacial Plastic and Reconstructive Surgery, Portland, OR, USA
William L. Walter, MD
Emeritus Staff, Washington University Medical Department, Barnes Hospital, Private Practice, St. Louis Eye Clinic, St. Louis, MO, USA
Contributors xxxi
John J. Woog, MD
Professor, Mayo Clinic, Department of Ophthalmology, Rochester, MN,
USA
Michael T. Yen, MD
Associate Professor, Baylor College of Medicine, Department of Ophthalmology, Houston, TX, USA
Part I
Preoperative Evaluation
1
Preoperative Evaluation of
the Cosmetic Patient
Jemshed A. Khan
First and foremost, the surgeon should elicit from the patient those specific topographic facial features that the patient wants to have improved. Patients often express concern that their periocular facial features are communicating unintended signals such as disapproval (glabellar frown lines), tiredness (lower eyelid fat pad herniation or upper eyelid ptosis), worry, or ageing (crow’s feet). The face, as an organ of communication, is malfunctioning. 1
After eliciting and documenting the patient’s concerns and taking photographs, the surgeon can evaluate the facial features for the anatomic basis of the patient’s concerns. Patient’s concerns are often related to familial, gravitational, or age-related facial changes.
Patients who cannot accept a “marked definite and noticeable improvement” as opposed to a “perfect result” may be considered poor candidates for aesthetic surgery. Informed consent includes discussing with the patient the risks, consequences, benefits, and alternatives of surgery as well as a signed document.
Finally, keep in mind that properly informed patients will not and should not always choose the surgical option that most effectively addresses their physical concerns. Other considerations factor in, including cost, invasiveness, surgical risk, location and visibility of surgical incisions, recovery times, postoperative morbidity, and procedure length.
The goal is not to invariably create the best aesthetic improvement, but rather to educate the patient to the point where the patient can select the procedures which best meet their aesthetic goals while at the same time considering financial and psychological constraints, tolerance for surgical risk, and desires regarding rapidity of recovery.
3
4J.A. Khan
Figure 1.1. Preoperative appearance of upper eyelid dermatochalasis communicates unintended facial signals of anger, skepticism, or disapproval.
Figure 1.2. Postoperative appearance communicates a more neutral and friendly
appearance