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Файл:Ординатура / Офтальмология / Английские материалы / Pearls and Pitfalls in Cosmetic Oculoplastic Surgery_Hartstein, Holds, Massry_2009.pdf
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- •Foreword
- •Preface
- •Contributors
- •Reference
- •2 Evaluation of the Cosmetic Patient
- •The Eightfold Path to Patient Happiness
- •Listen to Your Patient Before Surgery (or you will surely have to listen to them after)
- •Document and Demonstrate
- •Ensure Appropriate Patient Motivation
- •Determine Realistic Surgical Goals
- •Conduct a Thorough Informed Consent
- •Create an Aesthetic Environment
- •Topical Ocular Anesthetics
- •Lidocaine
- •Bupivacaine
- •Epinephrine
- •EMLA
- •Other Topical Anesthetics
- •Bicarbonate
- •Benzyl Alcohol
- •References
- •Facial Nerve Blocks
- •Retrobulbar and Peribulbar Blocks
- •References
- •Sensory Nerve Blocks
- •Lacrimal Nerve Block
- •Frontal Nerve Block
- •Nasociliary Nerve Block
- •Infraorbital Nerve Block
- •Zygomaticofacial Nerve Block
- •Staff
- •Monitoring
- •Minimal Sedation
- •Moderate Sedation
- •Antagonists/Reversal Agents
- •References
- •Selection of Local Anesthesia
- •Selection of Oral Sedative Agent
- •Procedure
- •References
- •19 Keys to Success When Marking the Skin in Upper Blepharoplasty
- •26 Blepharoplasty Incisional Modalities: 4.0 Radiowave Surgery vs. CO2 Laser
- •Study
- •Results
- •References
- •27 Fat Preservation and Other Tips for Upper Blepharoplasty
- •28 Asian Blepharoplasty
- •29 Internal Brow Elevation with Corrugator Removal
- •41 Three-Step Technique for Lower Lid Blepharoplasty
- •Step 1: Transconjunctival Fat Removal
- •Step 3: Resuspension of the Anterior Lamella and Adjacent Malar Fat Pad to the Lateral Orbital Periosteum
- •Rationale for the Three-Step Procedure
- •Pearls
- •References
- •Divide Each Fat Pad Flush with the Orbital Rim—Nasal and Central Fat Pads
- •Divide Each Fat Pad Flush with the Orbital Rim—Lateral Fat Pad
- •Surgical Technique
- •Postoperative Care
- •Complications
- •Comments
- •References
- •54 Transconjunctival Lower Blepharoplasty with Intra-SOOF Fat Repositioning
- •Patient Selection
- •Procedure
- •Postoperative
- •Conclusion
- •References
- •56 Use of Tisseel in Lower Eyelid Blepharoplasty with Fat Repositioning
- •57 Lower Blepharoplasty with Fat Repositioning Without Sutures
- •Fat-Repositioning Procedure
- •References
- •Indications
- •Complications
- •Procedure
- •Stage 1
- •Stage 2
- •Conclusions
- •References
- •61 Treatment of Postblepharoplasty Lower Eyelid Retraction with Dermis Fat Spacer Grafting
- •Surgical Technique
- •References
- •Tumescent Technique
- •Avoiding Anesthetic Toxicity
- •Tumescent Technique
- •References
- •69 Incision Technique for Endoscopic Forehead Elevation
- •Central Incision
- •Paracentral Incisions
- •Temporal Incisions
- •Prevention of Alopecia
- •71 Endoscopic Midforehead Techniques: Improved Outcomes with Decreased Operative Time and Cost
- •Suggested Reading
- •Dissection of Central Forehead Space and Scalp
- •Dissection of Temporal Space
- •Release of Periosteum
- •77 Endosocopic Browlift with Deep Temporal Fixation Only*
- •Endoscopic Browlift with Deep Temporal Fixation Only
- •Temporal Lift
- •Surgical Technique
- •Incisions
- •Release of the Brow Depressor Muscles
- •Brow Elevation and Fixation
- •Results (Before and After Photographs)
- •Introduction
- •Surgical Technique
- •Conclusions
- •References
- •79 Scalp Fixation in Endoscopic Browlift
- •Suggested Reading
- •82 The Direct Browlift: Focus on the Tail
- •Patient Selection
- •Procedure
- •Postoperative
- •Complications
- •Conclusion
- •Introduction
- •Procedure
- •Conclusions
- •References
- •86 The Subperiosteal Mid-Face Lift Using Bioabsorbable Implants for Fixation*
- •References
- •88 Mid-Face Implants
- •105 Shaping of the Eyebrows with Botox
- •Modifying the Position of the Medial Eyebrows
- •Modifying the Position of the Lateral Eyebrows
- •Arching and Lifting the Eyebrows
- •Lowering and Flattening the Eyebrows
- •Treating Eyebrow Asymmetry
- •Pitfalls
- •Conclusion
- •References
- •109 Botox Injection to the Lacrimal Gland for the Treatment of Epiphora
- •113 Optimizing Outcome from Facial Cosmetic Injections and Promoting Realistic Expectations
- •Preparations
- •Posttreatment
- •Expectations
- •115 List of Fillers
- •Consultation
- •Anesthesia
- •Choice of Filler
- •Anatomic Guidelines
- •Technique
- •Summary
- •References
- •121 Liquid Injectable Silicone for the Upper Third of the Face
- •References
- •122 Periocular Injectables with Hyaluronic Acid and Calcium Hydroxyapatite
- •General Principles
- •Hyaluronic Acid (HA)
- •Calcium Hydroxyapatite
- •References
- •125 Pearls for Periorbital Fat Transfer
- •129 Retinoids for the Cosmetic Patient
- •Background
- •Suggested Reading
- •Patient Selection
- •Infrared vs. Pulsed Dye
- •Postoperative Care
- •Choosing a Device
- •KTP or Frequency-Doubled Nd:YAG laser (532 nm)
- •Pulsed-Dye Laser (585 nm, 595 nm)
- •Intense-Pulsed Light Device (500–1200 nm)
- •Long-Pulsed Nd:YAG laser (1064 nm)
- •Fractional Resurfacing Lasers
- •Low Intensity Sources
- •Laser and Light Sources for Skin Rejuvenation
- •Patient Evaluation
- •Surgical Planning
- •Anesthetic Techniques
- •Surgical Procedure
- •Postoperative Care
- •Background
- •Technology
- •Patient Selection
- •Treatment
- •Conclusion
- •Key Elements of Procedure
- •Patient Selection and Preparation
- •Procedure
- •Postoperative
- •Conclusion
- •References
- •145 Repair of the Torn Earlobe
- •Questions to Ask the Patient
- •Basic Principles
- •Surgical Technique for Complete Earlobe Tears
- •Surgical Repair for Partial Torn Earlobes
- •References
- •Introduction
- •Preoperative Markings
- •Technique
- •Discussion
- •Conclusion
- •Reference
- •147 SMAS Malar Fat Pad Lift with Short Scar Face Lift
- •148 Ten Tips for a Reliable and Predictable Deep Plane Facial Rhytidectomy
- •Introduction
- •Tip 1. Marking (Figure 148.1)
- •Tip 2. Skin Flap Dissection (Figure 148.2)
- •Tip 3. Marking the Zygomatic Arch (Figure 148.3)
- •Tip 4. SMAS Flap Creation (Figure 148.4)
- •Tip 5. Creating the SMAS Flap (Figure 148.5 and 148.6)
- •Tip 6. SMAS Flap Fixation (Figure 148.7)
- •Tip 7. Skin Flap Fixation (Figure 148.8)
- •Tip 8. Addressing the Earlobe (Figure 148.9)
- •Tip 9. Skin Excision Tips (Figure 148.10)
- •Tip 10. Addressing the Neck (Figure 148.11)
- •References
- •153 Adjustable Suture Technique for Levator Surgery
- •Surgical Technique
- •Reference
- •154 Tarsal Switch Levator Resection for the Treatment of Myopathic Blepharoptosis
- •Surgical Technique
- •Suggested Reading
- •156 Minimally Invasive Ptosis Repair
- •Mini-invasive Ptosis Surgery
- •Suggested Reading
- •Further Reading
- •158 Ptosis Repair by a Single-Stitch Levator Advancement
- •Reference
- •References
- •171 Medial Canthorraphy
- •Index
192 J. Pak
Stage 2
1.Sever the conjunctival fl ap at 5–6 weeks after the first stage of the procedure (Figures 60.9 [preop] and 60.10 [postop]).
2.If any mild ectropion exists, instruct the patient to massage the lower lid upward multiple times.
Conclusions
The mid-lower eyelid tarsonconjunctival flap–skin graft is a powerful technique in the surgical armentarium for severe cicatricial lower eyelid retraction.10 The procedure can result in excellent esthetic and functional outcomes, particularly in those situations where previous reconstructive efforts have failed.
Figure 60.1. Bilateral lower eyelid cicatricial retraction.
Chapter 60 Mid-Lower Eyelid Tarsoconjunctival Flap-Skin Graft 193
Figure 60.2. Incision of anterior lamellae.
Figure 60.3. Incision of conjunctiva 4 mm below lid margin.
194 J. Pak
Figure 60.4. Unification of cutaneous and conjunctival incisions.
Figure 60.5. Position the transconjunctival graft.
Chapter 60 Mid-Lower Eyelid Tarsoconjunctival Flap-Skin Graft 195
Figure 60.6. Suture for a conjunctival graft to conjunctiva and inferior retractors.
Figure 60.7. Placement of full-thickness skin graft to anterior defect.
196 J. Pak
Figure 60.8. Secure skin graft adhesion with recipient bed using Telfa bolster.
Figure 60.9. Preoperative photo of left lower eyelid.
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