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Essentials
of
Aesthetic
A
Q
&
Companion
Surgery
MedOne
A
&
Q
Jeffrey
by
.
E
Janis
Sammy
(
§
Sinno
)
Thieme
Essentials of
Aesthetic Surgery
Q&A Companion
Essentials of
Aesthetic Surgery
Q&A Companion
JEFFREY E. JANIS, MD, FACS
Professor
Department of Plastic and Reconstructive Surgery;
Chief of Plastic Surgery (University Hospital);
Adjunct Professor
Departments of Neurosurgery, Neurology, and Surgery;
Co-Director
Center for Abdominal Core Health, The Ohio State University Wexner Medical Center;
Past President
American Society of Plastic Surgeons, American Council of Academic Plastic Surgeons,
American Her nia Society, and Migraine Surgery Society
Columbus, Ohio, USA
SAMMY SINNO,MD
Board-Certified Plastic Surgeon
TLKM Plastic Surgery;
Clinical Professor of Plastic Surgery
Northwestern Memorial Hospital
Division of Plastic Surgery;
Member of The Aesthetic Society
Chicago, Illinois, USA
200 illustrations
New York Stuttgart Delhi Rio de Janeiro
Library of Congress Cataloging-in-Publication Data is available with the publisher.
© 2025. Thieme. All rights reserved. Thieme Publishers New York 333 Seventh Avenue, 18th Floor New York, NY 10001, USA www.thieme.com +1 800 782 3488, customerservice@thieme.com
Important note: Medicine is an ever-changing science undergoing continual devel­opment. Research and clinical experience are continually expanding our knowledge, in particular our knowledge of proper treatment and drug therapy. Insofar as this book mentions any dosage or application, readers may rest assured that the authors, editors, and publishers have made every effort to ensure that such refer­ences are in accordance with the state of knowledge at the time of production of the book.
Nevertheless,this does not involve, imply, or express anyguarantee or responsibility on the part of the publishers in respect to any dosage instructions and forms of applications stated in the book. Every user is requested to examine carefully the manufacturersleaflets accompanying each drug and to check, if necessary, in con­sultation with a physician or specialist, whether the dosage schedules mentioned therein or the contraindications stated by the manufacturers differ from the state­ments made in the present book. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market. Every dosage schedule or every form of application used is entirely at the users own risk and responsibility. The authors and publishers request every user to report to the publishers any discrepancies or inaccuracies noticed. If errors in this work are found after publication, errata will be posted at www.thieme.com on the product descrip­tion page.
Some of the product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary names even though specific reference to this fact is not always made in the text. Therefore, the appearance of a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the public domain.
Thieme addresses people of all gender identities equally. We encourage our authors to use gender-neutral or gender-equal expressions wherever the context allows.
Cover design: © Thieme Cover image source: Cover photograph of the sculpture Surgical Aesthetic Art provided by the Ronadró Collection
Typesetting by Thomson Digital, India
Printed in India by Replika Press Pvt. Ltd. 5 4 3 2 1
DOI: 10.1055/b000000370 ISBN: 978-1-68420-135-8
Also available as an e-book: eISBN (PDF): 978-1-68420-136-5 eISBN (epub): 978-1-63853-669-7
This book, including all parts thereof, is legally protectedby copyright. Any use, exp­loitation, or commercialization outside the narrow limits set by copyright legislation, without the publishers consent, is illegal and liable to prosecution. This applies in particular to photostat reproduction, copying, mimeographing or preparation of microfilms, and electronic data processing and storage.
To the field of plastic surgery, filled with amazing talent and innovation, helping to transform lives, restore physical, mental, and emotional health, and serve patients.
And most of all to my wife, partner, and best friend, Emily, and our three absolutely
incredible children, Jackson, Brinkley, and Holdenfor everything and beyond.
Nothing is possible without you.
Jeffrey E. Janis, MD, FACS
To my Rosa, Genoa, and Giovanni: thank you always for your patience and support.
Sammy Sinno, MD

Contents

FOREWORD xi
Jamil Ahmad, MD, FRCSC
PREFACE xii ACKNOWLEDGMENTS xiii
Jeffrey E. Janis, MD, FACS
CONTRIBUTORS xiv
PART I ¤ BASIC CONSIDERATIONS
CHAPTER 1: THE AESTHETIC SURGERY PATIENT 3
Sammy Sinno, Jeremie Oliver Piña
CHAPTER 2: THE ARTISTRY OF PLASTIC SURGERY 8
Sammy Sinno, Jeremie Oliver Piña
CHAPTER 3: PHOTOGRAPHY FOR THE AESTHETIC SURGEON 13
Ara A. Salibian, Anmol Chattha
CHAPTER 4: MEDICOLEGAL CONSIDERATIONS IN AESTHETIC SURGERY 19
Sammy Sinno, Jeremie Oliver Piña
PART II ¤ ANESTHESIA
CHAPTER 5: BASICS OF ANESTHESIA FOR THE AESTHETIC SURGERY PATIENT 27
Aaron M. Kearney, Sammy Sinno, Anmol Chattha
CHAPTER 6: PERIOPERATIVE ANESTHESIA CONSIDERATIONS FOR THE AESTHETIC SURGERY PATIENT 32
Aaron M. Kearney, Sammy Sinno
CHAPTER 7: PROCEDURE-SPECIFIC ANESTHESIA GUIDELINES FOR THE AESTHETIC SURGERY PATIENT 37
Anmol Chattha, Sammy Sinno, Aaron M. Kearney
CHAPTER 8: MULTIMODAL ANALGESIA FOR THE AESTHETIC SURGERY PATIENT 42
Anmol Chattha, Sammy Sinno, Aaron M. Kearney
PART III ¤ SAFETY
CHAPTER 9: SAFETY CONSIDERATIONS IN AESTHETIC SURGERY 49
Adam Jacoby, Anmol Chattha
CHAPTER 10: DECREASING COMPLICATIONS IN AESTHETIC SURGERY 55
Sammy Sinno, Jeremie Oliver Piña
CHAPTER 11: VENOUS THROMBOEMBOLISM AND THE AESTHETIC SURGERY PATIENT 60
Ara A. Salibian, Anmol Chattha
PART IV ¤ SKIN CARE
CHAPTER 12: THE MEDI SPA AND OTHER PRACTICE CONSIDERATIONS 69
Sammy Sinno, Jeremie Oliver Piña
CHAPTER 13: ANATOMY,PHYSIOLOGY, AND DISORDERS OF THE SKIN 74
Sammy Sinno, Jeremie Oliver Piña
viii Contents
CHAPTER 14: COSMECEUTICALS AND OTHER OFFICE PRODUCTS 81
Sammy Sinno, Michael E. Nissan
CHAPTER 15: ETHNIC SKIN CARE 85
Sammy Sinno, Michael E. Nissan
PART V ¤ NONINVASIVE AND MINIMALLY INVASIVE THERAPY
CHAPTER 16: BASICS OF LASER THERAPY 93
Ara A. Salibian
CHAPTER 17: ABLATIVE LASER RESURFACING 98
Juan L. Rendon, Simon Moradian
CHAPTER 18: NONABLATIVE LASER RESURFACING 106
Ira L. Savetsky
CHAPTER 19: CHEMICAL PEELS 115
Juan L. Rendon, Simon Moradian
CHAPTER 20: DERMABRASION 126
Stelios C. Wilson
CHAPTER 21: BOTULINUM TOXIN 134
Sammy Sinno, Simon Moradian, Aaron M. Kearney
CHAPTER 22: SOFT TISSUE FILLERS 140
Nima Khosravani, Anup Patel, Simon Moradian
CHAPTER 23: FAT GRAFTING 154
Stelios C. Wilson
CHAPTER 24: TREATMENT OF PROMINENT VEINS 160
Sammy Sinno, Jeremie Oliver Piña
PART VI ¤ ADJUNCTS TO AESTHETIC SURGERY
CHAPTER 25: TISSUE GLUES 169
Sammy Sinno, Jeremie Oliver Piña
CHAPTER 26: FIXATION DEVICES 173
Sammy Sinno, Jeremie Oliver Piña
CHAPTER 27: IMPLANTS AND ALLOPLASTS (NONBREAST) 178
Nima Khosravani, Sammy Sinno, Jeremie Oliver Piña
CHAPTER 28: PROGRESSIVE TENSION SUTURES 183
Stelios C. Wilson, Simon Moradian
PART VII ¤ FACIAL SURGERY
CHAPTER 29: PERIORBITAL ANATOMY 193
Anmol Chattha, Elbert E. Vaca
CHAPTER 30: FACE AND NECK ANATOMY 199
Jacob Nathaniel Grow, Christopher C. Surek
CHAPTER 31: FACIAL ANALYSIS 211
Ira L. Savetsky, Anmol Chattha
CHAPTER 32: HAIR TRANSPLANTATION 226
Sammy Sinno, Jeremie Oliver Piña
CHAPTER 33: BROWLIFT 231
Cameron R. Erickson, Michael R. Lee
CHAPTER 34: UPPER BLEPHAROPLASTY 236
Elbert E. Vaca, Anmol Chattha
CHAPTER 35: LOWER BLEPHAROPLASTY 242
Joseph A. Kelling, Michael R. Lee
CHAPTER 36: ASIAN BLEPHAROPLASTY 249
Sammy Sinno, Michael E. Nissan
CHAPTER 37: CORRECTION OF THE TEAR TROUGH DEFORMITY 258
Elbert E. Vaca, Anmol Chattha
CHAPTER 38: LATERAL CANTHOPEXY 261
Elbert E. Vaca, Anmol Chattha
CHAPTER 39: BLEPHAROPTOSIS 265
Adam Jacoby, Anmol Chattha
CHAPTER 40: MIDFACE REJUVENATION 270
David A. Sterling, Christopher C. Surek
CHAPTER 41: PERIORAL REJUVENATION 280
Ira L. Savetsky, Anmol Chattha
CHAPTER 42: FACELIFT 289
Cameron R. Erickson, Michael R. Lee, Simon Moradian
CHAPTER 43: THE NASOLABIAL FOLD 297
Jacob Nathaniel Grow, Christopher C. Surek
CHAPTER 44: NECKLIFT 305
Ira L. Savetsky, Simon Moradian
CHAPTER 45: RHINOPLASTY 315
Elbert E. Vaca, Simon Moradian
CHAPTER 46: SECONDARY RHINOPLASTY 328
Sammy Sinno, Michael E. Nissan, Simon Moradian
CHAPTER 47: ETHNIC RHINOPLASTY 340
Anup Patel, Simon Moradian
CHAPTER 48: LIP AUGMENTATION 355
David A. Sterling, Christopher C. Surek
CHAPTER 49: GENIOPLASTY 362
Sammy Sinno, Michael E. Nissan
CHAPTER 50: OTOPLASTY 372
Stelios C. Wilson
Contents ix
PART VIII ¤ BREAST SURGERY
CHAPTER 51: BREAST ANATOMY 387
Ara A. Salibian, Anmol Chattha
CHAPTER 52: BREAST AUGMENTATION 392
Nima Khosravani, Anup Patel, Anmol Chattha
CHAPTER 53: MASTOPEXY 402
Shervin Etemad, Salam Kassis, Jacob G. Unger
CHAPTER 54: AUGMENTATION-MASTOPEXY 408
Shervin Etemad, Salam Kassis, Jacob G. Unger
x Contents
CHAPTER 55: BREAST REDUCTION 413
Juan L. Rendon, Anmol Chattha
CHAPTER 56: GYNECOMASTIA 421
Ira L. Savetsky
PART IX ¤ BODY CONTOURING
CHAPTER 57: LIPOSUCTION 431
Adam Jacoby, Simon Moradian
CHAPTER 58: BRACHIOPLASTY 436
Adam Jacoby
CHAPTER 59: BUTTOCK AUGMENTATION 442
Sammy Sinno, Michael E. Nissan
CHAPTER 60: ABDOMINOPLASTY 449
Juan L. Rendon, Simon Moradian
CHAPTER 61: MEDIAL THIGH LIFT 461
Ara A. Salibian
CHAPTER 62: BODY CONTOURING IN MASSIVE-WEIGHT-LOSS PATIENTS 466
Adam Jacoby
CHAPTER 63: FEMALE AESTHETIC GENITAL SURGERY 472
Sammy Sinno, Jeremie Oliver Piña
CHAPTER 64: NONINVASIVE BODY CONTOURING 477
Stelios C. Wilson
CHAPTER 65: AESTHETICS OF GENDER AFFIRMATION SURGERY 487
Juan L. Rendon
INDEX 502

Foreword

It is a great honor and privilege to be invited to write a foreword for Essentials of Aesthetic Surgery: Q&A Companion edited by my mentor and friend, Dr. Jeffrey E. Janis, and coedited by Dr. Sammy Sinno, a long-time
colleague and friend. I still vividly remember par ticipating in the Parkland Health and Hospital System preoper­ative rounds as a Chief Resident supervised by Dr. Janis. These were weekly educational sessions that gave the opportunity to the residents to review the treatment plans of patients who were scheduled for surgery. It was immediately clear that Dr. Janis demanded an organized, systematic, and thorough approach to the assessment and treatment planning for each patient. A variety of cases that spanned the whole spectrum of reconstructive and aesthetic plastic surgery were presented. What was most impressive was Dr. Janisability to draw from his wealth of knowledge and experience and distill it down to an organized and concise framework, to not only assess the problem and formulate an appropriate plan of care but also teach the fellows, residents, and medical students in attendance. One of the medical students I met during these rounds was Dr. Sinno, who coedited this Q&A Companion and who has already contributed to plastic surgery education in an impactful way.
Drs. Janis and Sinnos organized and thoughtful approach is illustrated in Essentials of Aesthetic Surgery and the Q&A Companion. Aesthetic surgery continues to be difficult to teach as it is the ultimate convergence of the art and science of plastic surgery. Decisions must be made based on the science and clinical evidence, but the out­come is often a subjective measurebeauty. However, Drs. Janis and Sinno have done an excellent job at curat­ing a text that provides a framework to approach aesthetic surgery.
Beyond reading the contents of Essentials of Aesthetic Surgery, one of the most useful ways to consolidate the information by the learner is to think through the information with the use of this Q&A Companion. The Q&A
Companion includes 65 chapters with questions and answers to parallel the content in Essentials of Aesthetic Surgery. The questions are high yield and accompanied by clear and concise explanations. The Q&A Companion
will be useful to learners from across the spectrum, from those trainees who are learning the information for the first time to those who are reviewing the information again at any timepoint in their plastic surgery careers. I would like to congratulate Drs. Janis and Sinno on another significant contribution to aesthetic sur­gery education.
Jamil Ahmad, MD, FRCSC
Director of Research and Education The Plastic Surgery Clinic; Assistant Professor Division of Plastic, Reconstructive, and Aesthetic Surgery University of Toronto Toronto, Ontario, Canada