Plastic Surgery: Volume 2: Aesthetic Surgery (Plastic Surgery, 2)

✍ Scribed by J. Peter Rubin, Peter C. Neligan MB FRCS(I) FRCSC FACS

• Publisher: Elsevier
• Year: 2023
• Tongue: English
• Leaves: 1181
• Edition: 5
• Category: Library

✦ Synopsis

Comprehensive and fully up to date, the six-volume Plastic Surgery remains the gold standard text in this complex area of surgery. Completely revised to meet the demands of both the trainee and experienced surgeon, Aesthetic Surgery, Volume 2 of Plastic Surgery, 5th Edition, features new, full-color clinical photos, procedural videos, lectures, and authoritative coverage of hot topics in the field. Editor-narrated video presentations offer a step-by-step audio-visual walkthrough of techniques and procedures.

• New chapters cover local anesthesia, anatomic blocks of the face and neck, facelifts,  neck rejuvenation, energy devices in aesthetic surgery, and aesthetic genital surgery; coverage throughout includes new, pioneering translational work shaping the future of aesthetic surgery. 

• New digital video preface by Dr. Peter C. Neligan addresses the changes across all six volumes. 

• New treatment and decision-making algorithms added to chapters where applicable. 

• New video lectures and editor-narrated slide presentations offer a step-by-step audiovisual walkthrough of techniques and procedures.  

• Evidence-based advice from an expanded roster of international experts allows you to apply the very latest advances in aesthetic surgery and ensure optimal outcomes. 

• Purchase this volume individually or own the entire set, with the ability to search across all six volumes online! 

• An eBook version is included with purchase. The eBook allows you to access all of the text, figures and references, with the ability to search, customize your content, make notes and highlights, and have content read aloud. 

✦ Table of Contents

Any screen. Any time. Anywhere.
Plastic
Surgery
Copyright
Contents
Video Contents
Lecture Video Contents
Preface to the Fifth Edition
List of Editors
List of Contributors
Acknowledgments
Dedication
1
1 Managing the aesthetic surgery patient
Societal interest in cosmetic surgery
The concept of beauty
Increasing societal acceptance of cosmetic surgery
The role of social media
The role of video conferencing
The Aesthetic Society statistics
Surgeon advertising
Patient motivation for cosmetic surgery
The ideal patient
Special patient groups
The male cosmetic surgery patient
The young aesthetic surgery patient
Friends or family as your aesthetic surgery patient
The initial consultation
First contact with the office
Nurse assessment
Surgeon's assessment
Photography
Patient coordinator
After the appointment
Second and subsequent consultations
Saying “no” to a potential patient
When to say “no”
How to say “no”
Saying “yes”: what is involved?
Managing surgical expectations
Managing financial expectations
Informed consent
Preoperative regime for the patient
Anesthesia consultation
Postoperative follow-up
Follow-up consultations
The unsatisfactory outcome
The patient is happy
Both the patient and the surgeon are unhappy
The patient is unhappy but the surgeon is happy
Managing the unhappy patient
Managing a colleague's unhappy patient
Managing your own unhappy patient
Conclusion
References
2
2 Principles of practice management and social media for cosmetic surgery
Identifying your brand: a roadmap to your entire practice
Staffing
Physical space
Digital marketing and website
Design and ease of use
Content
Media: photographs and video
Search engine optimization (SEO)
Reputation management
How to solicit positive reviews
How to handle negative reviews
Social media
Conclusion
References
3
3 Essential elements of patient safety in aesthetic plastic surgery
Introduction
Why do medical errors happen?
The three pillars of patient safety
Pillar 1 Tools and resources: evidence-based medicine/best practices
Pillar 2 Systems and processes
Pillar 3 Culture and communication
Specific patient safety considerations
Cardiovascular and venous thromboembolic considerations
Pulmonary considerations
Hypothermia
Other important patient factors
Telemedicine
Conclusions
References
4
4 Pain management in plastic surgery
Introduction
Opioid epidemic
Opioids
Acetaminophen, nonsteroidal anti-inflammatory drugs, and selective COX-2 inhibitors
Acetaminophen
NSAIDs
COX-2 inhibitors
Adjuvant multimodal medications
Gabapentin
Muscle relaxants
Steroids
Topical anesthetics
Local anesthetics
Tumescent analgesia
Regional anesthesia
Epidural anesthesia
Putting it all together: multimodal analgesia (MMA) regimen
References
5
5 Anatomic blocks of the face and neck
Introduction
Anatomic blocks of the face
Section 1: Infraorbital nerve block
Anatomy
Technique
Area of anesthesia
Section 2: mental and mental plus nerve blocks
Anatomy
Technique
Area of anesthesia
Section 3: Supraorbital/supratrochlear, infratrochlear nerve blocks
Anatomy
Technique
Area of anesthesia
Section 4: zygomaticotemporal nerve, zygomaticofacial nerve, and lacrimal nerve
Anatomy
Technique
Area of anesthesia
Section 5: dorsal nasal nerve
Anatomy
Technique
Area of anesthesia
Section 6: great auricular nerve and lobular nerve
Anatomy
Technique
Area of anesthesia
Section 7: transverse cervical nerves and lesser occipital nerve
Anatomy
Technique
Area of anesthesia
Section 7: V3 and buccal nerve
Anatomy
Technique
Area of anesthesia
Conclusion
References
6
6 Local anesthesia
Introduction
Combining local anesthetic agents with oral analgesics and anxiolytic agents (benzodiazepines)
Current practice
Summary
References
7
7 Non-surgical skin care and rejuvenation
Introduction
Cleansers
Cold cream cleansers
Cleansing milks
Cleansing oils
Micellar water cleansers
Cleansing scrubs
Moisturizers
Improved skin smoothness and softness
Increased skin hydration
Improved optical appearance
Moisturizer ingredients
Petrolatum
Silicone
Ceramides
Natural moisturizing factor
Sodium PCA
Urea and lactic acid
Retinoids
Sunscreens
Summary
References
8-1
8.1 Editors’ perspective: injectables and non-surgical resurfacing techniques
8-2
8.2 Injectables and resurfacing techniques: Soft-tissue fillers
Introduction
The pathophysiology of wrinkles
Historical perspective
Classification of fillers
Autologous fillers
Biologic fillers
Synthetic fillers
Injection technique
Indications and applications
Glabellar lines
Forehead lines
Eyebrows
Tear troughs
Nasolabial folds
Malar augmentation
Marionette lines
Jawline augmentation
Panfacial volumetric augmentation
Facial lipoatrophy
Lips
Perioral and mandibular filling
Chin
Nasal reshaping (off-label)
Scars and deformities
Hand rejuvenation
Use and dosage of hyaluronidase
Contraindications and considerations
Complications and their treatment
Special considerations for energy-based devices and facelift procedures
Conclusion
References
8-3
8.3 Injectables and resurfacing techniques: Botulinum toxin/neurotoxins
Botulinum toxin types
Upper face
Forehead
Anatomy
Treatment goals
Dosing and injection technique
Glabella
Anatomy
Treatment goal
Dosing and injection technique
Periocular region
Anatomy
Treatment goals
Injection technique
Midface
Nose
Anatomy
Treatment goals
Dosing and injection technique
Gingival show
Anatomy
Treatment goals
Dosing and injection technique
Lower face
Masseter muscle prominence
Anatomy
Treatment goal
Dosing and technique
Perioral lines
Anatomy
Treatment goals
Dosing and technique
Chin
Anatomy
Treatment goals
Dosing and injection technique
Depressor anguli oris (DAO)
Anatomy
Treatment goal
Dosing and injection technique
Platysmal bands
Anatomy
Treatment goals
Dosing and injection technique
References
8-4
8.4 Injectables and resurfacing techniques: Lasers in aesthetic surgery
Introduction
Historical perspective
Basic science of resurfacing procedures
Biology of wound healing
Inflammation
Proliferation
Remodeling
Laser–tissue interactions and properties of lasers
Molecular basis of light–tissue interaction
Selective photothermolysis (SPT)
Reaction types
Photothermal
Biostimulation
Cooling
Ablative skin rejuvenation
Non-ablative skin rejuvenation
Fractional resurfacing
Diagnosis and clinical evaluation
Patient selection and treatment
Facial rejuvenation
Full-field ablative lasers
Fractional ablative lasers
Fractional non-ablative lasers
Intense pulsed light
Combination treatments
Improving vessels
Improving pigment
Contraindications
Post-procedure care
Complications
Pigmentary change
Scarring
Infection
Prolonged erythema
Acne
Milia
Disclosures
References
8-5
8.5 Injectables and resurfacing techniques: Chemical peels
Medium-depth trichloroacetic acid (TCA) peels
Pre-peel skin preparation
Jessner’s solution/TCA 35%
Dry ice/TCA 35%
Obagi Blue Peel/Z.O. CDP
Deep chemical peels
Patient evaluation
Preoperative planning
Preparation of the solution
Intraoperative routine
Factors determining the depth of the peel
Judging the depth of the peel
Full-face peel
Aftercare
Variation of peels
Results
Complications
Conclusion
References
8-6
8.6 Minimally invasive multimodal facial rejuvenation
Introduction
Rejuvenation: changing attitudes and new procedures
Techniques
Botox
Fillers
Facial liposculpture
Fat suction
Fat injection
Other procedures
Conclusion
References
9-1
9.1 Editors’ perspective: surgical facial rejuvenation
9-2
9.2 Facial anatomy and aging
Introduction
Regions of the face
Surgical anatomy of the face, layered anatomy, SMAS, facial spaces and retaining ligaments
Layer 1: skin
Layer 2: subcutaneous tissue
Layer 3: musculo-aponeurotic layer
Layer 4
Layer 5
Anatomy over the cavities in the skeleton
Facial spaces
Upper temporal space
Prezygomatic space
Premaxillary space
Premasseter spaces
Middle premasseter space
Buccal space
Retaining ligaments of the face
Facial nerve branches
Aging changes of the face
Skin
Subcutaneous tissue
Muscle aging
Facial spaces and retaining ligaments
Bone changes
Regional changes observed with the aging face temple and forehead
The midcheek
Lower face
Considerations for correcting aging changes of the face based on facial anatomy
Dissection planes
SubSMAS dissection (layer 4)
Level 5
Placement of sutures
Summary
Acknowledgments
References
9-3
9.3 Principles and surgical approaches of facelift
Introduction
Historical perspective
Anatomy and patient presentation
Skin
Facial fat: ptosis, volume loss, and volume gain
Change in facial shape
Superficial musculo-aponeurotic system
Facial muscles
Retaining ligaments
Deep fascia
Bone
Facial nerve
Sensory nerves
Neck anatomy
Patient selection
Anatomic assessment
Surgery
Anesthesia
Local anesthetic infiltration
Surgical technique
Subcutaneous facelift
Facelift incisions
Facelift skin flap dissection
Deep tissue surgery
SMAS plication
Loop sutures (MACS lift)
Supraplatysmal plane facelift
SMASectomy
SMAS flap with skin attached (deep-plane facelift)
Subcutaneous facelift with separate SMAS flap (dual plane facelift)
Subperiosteal facelift
Skin flap closure (Video 9.3.4)
Neck surgery
Choice of procedure
Ancillary techniques
Browlift surgery and blepharoplasty
Volume removal
Volume augmentation
Midface lift
Lip procedures
Dressings and drains
Postoperative care
Early complications
Hematoma
Sensory nerve injury
Motor nerve injury
Skin necrosis
Infection
Sialocele or fistula (submandibular or parotid glands)
Venous thromboembolism
Late complications
Unsatisfactory scars
Alopecia
Ear deformities
Facial distortion and irregularities
Facial analysis, anthropometrics and concepts of facial shape
References
9-4
9.4 Facelift: Facial rejuvenation with loop sutures: the MACS lift and its derivatives
Introduction
Considerations of the facial aging process
Considerations on the centrofacial aging process
Anterior midface
Periorbital area
Perioral area
Skin aging
Patient evaluation
Matching the correct procedure to each deformity
Surgical strategy and technique
The minimal access cranial suspension (MACS) facelift
Preoperative markings
Infiltration
Incision and flap elevation
Suspension sutures
Skin redraping and resection
The Auersvald hemostatic net
Ancillary lifting procedures
Neck lift
Temporal lift/gliding brow lift
Periorbital rejuvenation
Augmentation blepharoplasty
Augmentation upper blepharoplasty
Internal browpexy and temporal lift
Temporal lift
Lower augmentation blepharoplasty
The lower lid augmentation procedure
Resurfacing procedures of the periocular area
Laser resurfacing
Croton oil peel
Dark circles
Perioral rejuvenation
Lip lift
Surgical technique
Volume restoration of the lips
Lip volume loss
Loss of lip definition
Vertical rhytids
Nasolabial fold and marionette grooves
Lip resurfacing procedures
Laser resurfacing
Croton oil peel
Facial volume restoration and skin rejuvenation
Microfat graft lipofilling
Surgical technique
Sharp needle intradermal fat grafting (SNIF)
Surgical technique
Complications of SNIF
Nanofat injection and needling
Clinical indications for nanofat delivery
Surgical technique
Nanofat delivery methods
Fine needle injection
Microneedling
Nanofat mixture
Nanofat cream
Postoperative care and complications
MACS lift/neck lift
Perioral rejuvenation
Microfat grafting
Periorbital rejuvenation
Skin resurfacing
Nanofat delivery
References
9-5
9.5 Facelift: Platysma-SMAS plication
Introduction
Technique (Video 9.5.1 and Video lecture 9.5.1)
Evaluation
Patients and methods
Results
Complications
Discussion
The neck
Conclusion
References
9-6
9.6 Facelift: Lateral SMASectomy facelift
Historical perspective
Senior author’s personal philosophy
Surgical technique
Anesthesia
Incisions
Skin flap elevation
Defatting the neck and jowls
Open submental incision with medial platysma approximation
Lateral SMASectomy including platysma resection
Vectors
Skin closure, temporal and earlobe dog-ears
Postoperative care
Complications
Further reading
9-7
9.7 Facelift: The extended SMAS technique in facial rejuvenation
Introduction
Anatomic considerations
Retaining ligaments
Aesthetic analysis and treatment planning
Descent of facial fat
Volume loss and facial deflation
Radial expansion
Role of skeletal support in formulating a surgical treatment plan
Facial width, bizygomatic diameter and malar volume
Facial length and the relative vertical heights of the lower and middle third of the face
Convexity of the malar region juxtaposed to the concavity of the submalar region
Vertical height of the mandibular ramus and horizontal length of the mandibular body
Aesthetic advantages of formal SMAS elevation in a two-layer dual plane SMAS facelift
Surgical technique: extended SMAS dissection
SMAS elevation
SMAS fixation
Variations in extended SMAS technique to affect a restoration in facial shape
Release
Vectors of fat elevation: facial asymmetry
SMAS fixation
Correction of platysma bands and cervical obliquity
Sequence of SMAS fixation versus platysmaplasty
Incisions
Summary
References
9-8
9.8 High SMAS facelift: combined single flap lifting of the jawline, cheek, and midface
Introduction
Fundamental concepts in rejuvenation of the face
Why use the SMAS?
SMAS and the midface
The “high SMAS” concept
The extended SMAS concept
Lamellar dissection and bidirectional tissue shifts
“Lateral sweep” and the SMAS
Recognizing the components of the aging change of the face and employing logical solutions to improve them
Preoperative planning
Planning the temple incision
Planning the pre-auricular incision
Planning the postauricular incision
Planning the conchomastoid portion of the postauricular incision
Planning the transmastoid portion of the postauricular incision
Planning the occipital portion of the postauricular incision
Preoperative preparations
General
Smoking
Radiofrequency and ultrasonic “skin-shrinking” treatments
Hair color and chemical treatment of hair
Infection prophylaxis
Allocating operating room time
Anesthesia
Preoperative anesthesia medications
Patient monitoring during anesthesia
Method of intra-operative sedation
Surgical technique
Patient positioning, urinary catheter insertion, and patient marking
Patient prepping and draping
Administering local anesthesia
Making incisions
Skin flap elevation
Temple dissection
SMAS dissection
Assessing completeness of SMAS flap dissection
Neck lift
SMAS suspension and proper SMAS vector
SMAS suspension in the narrow face
SMAS suspension when the temporal incision is along the temporal hairline
SMAS suspension with a trifurcated SMAS flap
SMAS suspension when interzygomatic widening is not desired
Trimming and management of the posterior margin of the SMAS flap
Suspension of the lateral SMAS border
Drain placement
Skin flap repositioning and suspension suture placement
Exteriorizing the lobule
Skin flap trimming and closure
Trimming and closure along the conchomastoid/auriculomastoid sulcus
Trimming and closure of the occipital incision
Microgathering of occipital wound-length discrepancy and dog-ear management
Trimming and closure of the temporal incision
Trimming and closure of the pre-auricular incision
Earlobe reconfiguration and reduction
Insetting the lobule
Closure of the submental incision
Dressings
Postoperative care
Summary
Declaration
Acknowledgment and retention of rights
References
9-9
9.9 The lift-and-fill facelift
Introduction
Basic science/disease process
Anatomy
Retaining ligaments of the face
Superficial fat compartments
Deep fat compartments
Blood supply
Chronology of compartmental fat deflation
Danger zones
Patient selection, evaluation and planning
Midface width and facial length evaluation
Facial fullness evaluation
Treatment/surgical technique
Preoperative marking
Filling of fat compartments
Fat grafting sequence
Fat harvesting, preparation and injection technique
Donor site selection
Fat harvesting technique
Fat refinement and purification
Fat injection
Facelift classifications
Skin incisions
Local anesthetic infiltration technique
Selective skin undermining
SMAS and platysma manipulation
Postoperative bruising and swelling reduction
Superficial versus deep-plane dissection
Postoperative care
Outcome, prognosis, complications
Minor complications
Infection
Fat embolism
Hematoma
Seroma
Ischemia
Sensory nerve injury
Motor nerve injury
References
9-10
9.10 Neck rejuvenation
Introduction
Historical perspective
Anatomy and the effect of aging
Effects of aging/disease process
Preoperative assessment
Non-surgical options
Surgical options
Liposuction
Technique for liposuction of the neck
Anterior (submental) incision
Technique for anterior lipectomy and platysmaplasty (Video 9.10.4 )
Direct excision of neck skin and Z-plasty
Management of the submandibular glands
Postoperative care
Complications
References
9-11
9.11 Male facelift
Introduction
Aging of the male face and male facial aesthetics
Recognizing the components of the aging deformity of the face
Treatment strategies in the male patient
The bald man and the man with short hair
Man with shaved head
The “facelift” phobic man
Short scar facelifts in men
Preoperative planning in the male facelift patient
Planning incisions in the male facelift patient
Planning the temple incision
Planning the pre-auricular incision
Planning the perilobular incision
Planning the postauricular incision
Planning the transmastoid portion of the postauricular incision
Planning the occipital incision
Planning the submental incision
Treating the forehead in the male facelift patient
Treating the neck in the male facelift patient
Treating the chin in the male facelift patient
Eyelid surgery in the male facelift patient
Fat grafting in the male facelift patient
Preoperative preparations in the male patient
Anesthesia in the male facelift patient
Surgical technique
SMAS suspension
Drain placement
Pre-auricular beard follicle epilation
Ancillary procedures and alternative strategies in the male patient
Earlobe reduction
Upper lip lift
Nasolabial fold excision
Postoperative care of the male facelift patient
Summary
Case examples
Declaration
Acknowledgment and retention of rights
References
9-12
9.12 Secondary facelift irregularities and the secondary facelift
Introduction
Strategy in treating the secondary facelift patient
Identification and analysis of secondary aging change
Identification and analysis of secondary surgical irregularities
Hairline displacement and disruption
Hair loss
Poorly sited scars
Pre-helical portion of the preauricular incision
Tragal portion of the preauricular incision
Perilobular portion of the facelift incision
Postauricular portion of the facelift incision
Submental incision
Wide scars
Cross-hatched scars
Distortion of tragal anatomy
Distortion of earlobe anatomy
Over-excision of subcutaneous fat
Over-excision of subplatysmal fat
Over-excision of buccal fat
Under-rejuvenated neck
Prominent submandibular glands
Protruding digastric muscles
Residual platysma bands
Treatment of “radiofrequency neck” and “ultrasound neck”
Undertreatment of the SMAS
Uncorrected and undercorrected midface irregularities
Residual jowl
Distortion and abnormal appearances due to inappropriate skin shifts
Compression of the temporal face
Skin deficiencies and “tight look”
Skin slough
Distortion and abnormal appearances due to inappropriate SMAS shifts or SMAS injury
“Smile block”
Unaesthetic facial implants
The unrejuvenated forehead
Unrejuvenated perioral region
Uncorrected facial atrophy
Eyelid skin deficiencies and eyelid malposition
Over-reliance on laser resurfacing
Patient considerations
Technical considerations in secondary facelift
Conclusion
Case studies
Declaration
Acknowledgment
References
9-13
9.13 Perioral rejuvenation, including chin and genioplasty
Perioral anatomy and aesthetics
Chin aesthetics and analysis
Perioral imperfections
Chin deformities and procedure selection
Lip surgical corrections
Direct lip lift (DLL)
Indirect lip lift (ILL)
Resurfacing
Lip augmentation
Autogenous materials
Nonautogenous injectables
Conclusions
References
9-14
9.14 Facial feminization
Introduction
Historical perspective
Anatomy
Diagnosis, indications, pre- and postoperative management
Patient selection criteria
Hormone therapy
Timeline for FGS
General postoperative management
Outcomes, complications and future directions
Outcomes and complications
Medical necessity of FGS
Future directions
Virtual surgical planning in FGS
Upper third and hair
Frontonasal-orbital contouring, hairline restoration and brow lift
Introduction
Anatomic considerations
Preoperative considerations, diagnosis, indications
Surgical techniques, treatments
Approach
Frontal sinus setback and burring
Postoperative care
Outcomes, prognosis, and complications
Middle third
Malar augmentation and zygomatic osteotomies
Introduction
Preoperative considerations, diagnosis, indications
Surgical techniques, treatments
Approach
Malar implants
Zygomatic osteotomies
Autologous fat grafting
Postoperative care
Outcomes, prognosis, and complications
Feminizing rhinoplasty and lip augmentation
Introduction
Preoperative considerations, diagnosis, indications
Surgical techniques
Approach
Dorsal hump reduction
Nasal bone osteotomies
Tip reduction, rotation and deprojection
Lip lift
Postoperative care
Outcomes, prognosis, and complications
Lower third and neck
Mandibular reduction and genioplasty
Introduction
Surgical techniques, treatments
Angle reduction, mandibular body ostectomy and genioplasty
Postoperative care
Outcomes, prognosis, and complications
Chondrolaryngoplasty
Introduction
Anatomic considerations
Surgical techniques, treatments
Chondrolaryngoplasty
Postoperative care
Outcomes, prognosis, and complications
Vocal cord surgery
References
10
10 Editors’ perspective: brow and eye
11
11 Forehead rejuvenation
Introduction
Historical perspective
Anatomy
Galea
Muscle
Sensory nerves
Motor nerves
Patient presentation
Forehead aging
Aesthetics
Patient selection
Surgical techniques
Open coronal approach
Anterior hairline approach
Endoscopic approach
Temple approach
Transpalpebral approach – muscle modification
Lateral brow approach
Cutaneous approaches
Transpalpebral browpexy
Suture suspension browpexy
Postoperative care
Outcomes
Complications
Secondary procedures
References
12
12 Endoscopic brow lift
Introduction
Anatomic considerations
Brow considerations
Patient selection
Surgical technique
Postoperative care
Outcomes, prognosis and complications
Final considerations
Further reading
13
13 Blepharoplasty
Introduction
Historical perspective
Basic science/disease process
Essential and dynamic anatomy
Osteology and periorbita
Lateral retinaculum
Medial orbital vault
Forehead and temporal region
Eyelids
Upper eyelid
Septal extension
Lower eyelid
Retaining ligaments
Blood supply
Innervation: trigeminal nerve and facial nerve
Youthful, beautiful eyes
Etiology of aging
Diagnosis/patient presentation
Evaluation basics
Medical and ophthalmic history
Ocular examination
Visual acuity
External examination
Orbits and malar eminence
Pupils
Extraocular muscles
Globe
Tear film
Photographic documentation
Unintentional deception in eye appearance
Patient selection
Operative planning
Anatomic-directed therapy
Upper eyelid position
Lower eyelid tonicity
Eyelid ptosis or retraction
Globe position and malar prominence
Tear trough deformities
Optimal brow positioning
Treatment/technique (Video 13.1 & Video Lecture 13.1 )
Continuum of aesthetic enhancement
Upper eyelid surgery
Simple skin blepharoplasty
Anchor (or invagination) blepharoplasty
Orbital fat excision
Blepharoptosis
Surgical technique
Lower lid blepharoplasty
Transconjunctival blepharoplasty
Transcutaneous blepharoplasty
Orbital fat
Orbital fat transposition
Plication techniques
Orbital septum plication
Capsulopalpebral fascia plication
Orbicularis suspension
Canthopexy
Midfacelifting
Postoperative care
Complications
Special considerations
Non-surgical enhancement
Male blepharoplasty
Blepharoplasty in people of color
References
14
14 Secondary blepharoplasty
Introduction
Anatomy
Corneal protection
Pathophysiology and anatomical changes of the aging eyelid
Patient evaluation
Medical history
Physical examination
Procedures/techniques
Upper eyelid blepharoplasty
Eyelid malposition
Ptosis
Upper lid retraction
Lower eyelid blepharoplasty
Transcutaneous lower lid blepharoplasty
Transconjunctival lower lid blepharoplasty
Lateral canthal tendon anchoring procedures
Secondary lower lid procedures
Complications in blepharoplasty
Visual loss secondary to hemorrhage
Globe perforation during anesthesia
Damage to the extraocular muscles
Damage to the cornea
Wound dehiscence
Lower eyelid malposition
Upper eyelid malposition
Loss of lashes
Dry eyes
Infection
Incisional scarring
Excessive fat resection
Inappropriate lower lid fat resection
Conclusion
References
15
15 Asian facial cosmetic surgery
Introduction
Asian blepharoplasty
Introduction
Historical perspective
Preoperative consideration and diagnosis
Double-eyelidplasty
Non-incisional method
Incisional method
Ptosis correction
Non-incisional method
Incisional method
Secondary double-eyelidplasty
Height problem
Depth problem
Adhesion problem
Power problem
Volume problem
Four-directional extension
Medial epicanthoplasty
Lateral canthal lengthening
Lower lid lowering
Asian lower blepharoplasty
Aging upper blepharoplasty
Infrabrow lift
Asian rhinoplasty
Introduction
Historical perspective
Recent trends
Diagnosis
Nasal dorsum
Nasal tip
Surgical techniques and treatment
Prerequisites for Asian rhinoplasty (Figs. 15.34 & 15.35)
How to control the nasal tip projection
How to control nasal tip rotation
How to augment the nasal dorsum
Principles in nasal dorsum augmentation
Procedures
Outcomes, prognosis, and complications
Implant deviation
Exposure and infection of alloplastic implant
Capsular contracture
Secondary procedures
Forehead augmentation
Paranasal augmentation
Alar base surgery
Genioplasty
Asian facial bone surgery
Introduction
New perspective for aesthetic facial bone surgeries
Three planes on the face
Coronal plane with facial depth
Axial plane with facial depth
Sagittal plane with facial depth
Historical perspective
Malarplasty
Mandibuloplasty
Orthognathic surgery and anterior segmental ostectomy
Diagnosis and patient indication
Total facial profiles
Prominent mandible
Prominent zygoma
Chin
Dentoalveolar protrusion
Surgical techniques and treatments
Mandibuloplasty (Fig. 15.49)
Malarplasty (Fig. 15.52)
Intraoral infracture technique with incomplete osteotomy
Bicoronal approach
Narrowing genioplasty (Fig. 15.54)
Aesthetic orthognathic surgery
Surgery-first orthognathic approach (Fig. 15.58)
Occlusal plane-altering orthognathic surgery (Fig. 15.60)
Bimaxillary protrusion: anterior segmental setback ostectomy
Combined ASO, orthognathic surgery with facial contouring surgery
Outcomes, prognosis, and complications
Malarplasty
Mandibuloplasty
Asian facelift
Introduction
Historical perspective
Anatomic considerations in Asian facelifts
Preoperative considerations and diagnosis
Surgical techniques and treatment
Extended SMAS facelift (Fig. 15.63)
Incision and skin flap elevation (Fig. 15.64A,B)
SMAS flap elevation (Fig. 15.64C)
SMAS fixation and skin closure (Fig. 15.64D)
Neck lift
Asian male facelift
Outcomes, prognosis, and complications
Conclusion
Acknowledgment
R­ef­er­en­ces
16
16 Facial fat grafting
Introduction
Diagnosis/patient presentation
Patient selection
Surgical technique
Preoperative markings
Patient positioning
Harvesting
Refinement
Infiltration
Postoperative care
Outcomes, prognosis, and complications
Nanofat, platelet-rich plasma, platelet-rich fibrin, and concentrated growth factors
Conclusion
References
17
17 Editors’ perspective: nose
18
18 Nasal analysis and anatomy
Introduction
Nerve supply
Intrinsic and extrinsic nasal musculature
Nasal ligaments
Nasal bones, cartilages, and septum
References
19
19 Open technique rhinoplasty
Introduction
Historical perspective
Basic science/disease process
Diagnosis/patient presentation
Consultation
Nasal history
Nasal examination
Imaging
Expectations
Informed consent
Patient selection
Treatment surgical technique
Anesthesia and preoperative management (Video 19.1 )
Incisions and approach
Component dorsal hump reduction and dorsal reconstitution
The nasal airway
Septal reconstruction
Inferior outfracture/limited submucous resection
Harvesting autologous grafting material
Septal cartilage
Ear cartilage
Costal cartilage
Temporal fascia
The nasal tip
Cephalic trim
Columellar strut graft
Septal extension grafts
Nasal tip suturing techniques
Nasal tip grafting techniques
The alar rims
Alar contour and extended alar contour grafts
Lateral crural strut grafts
The alar–columellar relationship
Percutaneous lateral nasal osteotomies
Closure
Depressor septi nasi muscle release
Shaping the columella
Alar base surgery
Alar flaring
Alar flaring with modification of nostril shape
Correction of specific deformities
Deviated nose with dorsal hump
Systematic analysis
Operative goals
Surgical plan
Outcome
Long, wide nose with a drooping tip and nasal airway obstruction
Systematic analysis
Operative goals
Surgical plan
Outcome
Postoperative care
Dressings and wound care
Medications
Activity restrictions
General instructions
Follow-up
Outcomes, prognosis, complications
Outcomes
Prognosis
Complications
Bleeding
Infection
Prolonged edema
Deformities and deviation
Nasal airway obstruction
Secondary procedures
References
20
20 Closed technique rhinoplasty
Introduction
The anatomy and science necessary for surgical success
Why is rhinoplasty difficult?
Rhinoplasty as a right-brain operation
Equilibrium and balance
The structural nasal layers
Upper cartilaginous vaults
Middle and lower cartilaginous vaults
Dorsum and tip
Patterns of secondary deformity
Four common anatomic traps that predispose to unfavorable results (Table 20.1)
Low radix or low dorsum
Narrow middle vault
Inadequate tip projection
Alar cartilage malposition
The traps in surgical practice
The effect of rhinoplasty on the airway
Traditional concepts and clinical observations
Results of an airway outcome study in 600 patients
Patient selection
Fallacies of planning: two false assumptions that lead to unsatisfactory results
The interview
Differences in primary and secondary candidates
The preoperative examination
Valves
Septum
Turbinates
External nose
Basic nasal aesthetics
Preoperative photographs
Setting goals with the patient
Discussion of potential complications and revisions
Parameters of rhinoplasty planning
Skin thickness and distribution
Tip lobular contour
The balance between nasal base size and bridge height
Why this author still prefers endonasal rhinoplasty
The decision to operate
How to teach yourself rhinoplasty
Surgical technique
Routine order of surgical steps
Skeletonization
Technical details
Dorsal resection
Technical details
Nasal spine–caudal septum
Technical details
Alar cartilage resection
Technical details
Upper lateral cartilages and shortening the nose
Technical details
Septoplasty, spreader graft tunnels
Technical details
Turbinectomy
Graft placement and wound closure
Osteotomy
Technical details
Alar wedge resection
Technical details
Prioritizing the septal graft specimen for augmentation
Augmentation strategy: radix, spreader, and tip grafts
Dorsum and radix
Spreader grafts
Lateral wall and columellar grafts
Tip grafting (Fig. 20.18)
Technical details
Routine postoperative care
Dressings
Selection and use of additional graft donor sites and other augmentation materials
Conchal cartilage
Calvarial bone
Costal cartilage
Alloplastics
Maxillary augmentation
The postoperative course
Variations on the standard
Nasal deviation (Fig. 20.21)
Rhinoplasty in men
Ethnic rhinoplasty
Cleft lip nasal deformity
Older patients
Rhinophyma
The donor site-depleted patient
Problems in the postoperative course
Iatrogenic airway obstruction
Skeletal problems
Soft-tissue problems
Graft problems
Intraoperative and postoperative hemorrhage
Septal perforation
Rhinitis
Circulatory problems
Infection
Septal collapse
Red nose
Obscure complications
The unhappy patient
Identity of the previous surgeon
The decision to re-operate
Secondary rhinoplasty
Why primary and secondary rhinoplasty are the same operation
Deformities caused by prior open rhinoplasty
How to understand our most unhappy patients
References
21
21 Airway issues and the deviated nose
Introduction
Anatomy
Physiology
Temperature regulation and humidification
Particulate filtration
Olfaction
Phonation
Secondary sex organ
Historical perspective
Basic science/disease process
Rhinitis
The septum
The internal nasal valve
The external nasal valve
The turbinates
Diagnosis/patient presentation
History
Physical examination
Rhinomanometry
Radiology
Patient selection
Treatment/surgical technique
Treatment of rhinitis based on sub-type
Infectious rhinitis
Allergic rhinitis
Vasomotor rhinitis
Atrophic rhinitis
Rhinitis medicamentosa
Hypertrophic rhinitis
Correction of deviated nasal bones
Treatment of the deviated septum
Septal tilt
C-shaped anteroposterior deviation
C-shaped cephalocaudal deviation
S-shaped anteroposterior deviation
S-shaped cephalocaudal deviation
Localized deviation
Treatment of the incompetent internal nasal valve
Treatment of the incompetent external nasal valve
Treatment of turbinate disorders
Mechanical procedures
Destructive procedures
Turbinate resection procedures
Postoperative care
Outcomes/prognosis/complications
Secondary procedures
References
22
22 Secondary rhinoplasty
Introduction
Definitions
Why secondaries are difficult
Analysis
Operative techniques
Preparing to be a biological sculptor
The open versus closed approach in secondary rhinoplasty
Anesthesia
Opening the nose and tip deconstruction
Suture techniques and grafts (reconstruction)
Suture techniques: general principles
Grafts: general principles
Common secondary problems
Broad, bulbous, round tip
Collapsed middle third of nose
Collapsed or concave rims (external valves)
Isolated collapse of the lateral external valve
Short nose
Broad nasal base
Nasal dorsum irregularities
Saddle nose deformity
Pollybeak deformity
Airway problems (septoplasty)
Postoperative care
Early bad result
Tape
Fillers
Corticosteroids
Complications and untoward results
Columellar scar
Post-rhinoplasty fibrotic syndrome
The difficult patient
References
23
23 Otoplasty and ear reduction
Introduction
Historical perspective
Basic science/disease process
Diagnosis/patient presentation
Overall size and shape
Upper third
Middle third
Lower third
Asymmetry
Patient selection
Treatment/surgical technique
Standard otoplasty for prominent ears of normal size
Incision (Video 23.1 )
Dissection
Correction (Fig. 23.3)
Endpoint
Closure
Otoplasty for large ears or ears with inadequate helical rim definition
Incision
Dissection
Correction
Closure
Otoplasty for constricted ears
Otoplasty for cryptotia
Otoplasty for Stahl’s ears
Correction of aging, elongated earlobes
Incision
Closure
Correction of earring-related complications
Correction of facelift deformities around the ear
Earlobe deformities
Tragal deformities
Retroauricular deformities
Scars
Postoperative care
Outcomes, prognosis, and complications
Secondary procedures
References
24
24 Hair restoration
Introduction
Historical perspective
Patient selection
Preoperative marking (Fig. 24.1)
Technique4–8
Postoperative care
Case examples
Conclusion and key summary points
References
25-1
25.1 Editors’ perspective: liposuction
25-2
25.2 Liposuction: a comprehensive review of techniques and safety
Introduction
Basic science and anatomic considerations
Classification
Diagnosis, operative indications, and patient selection
Preoperative assessment
Initial evaluation
Physical exam
Patient education and informed consent
Operative considerations
Preoperative marking
Anesthesia and location of operation
Maintaining core body temperature and immediate preoperative care
Patient positioning
Prone/supine
Lateral decubitus positioning
Lidocaine
Epinephrine
Wetting solutions and perioperative fluid management
Tranexamic acid
Current recommendations for perioperative fluid management
Fluid resuscitation
Treatment options
Surgical endpoints
Cannulas and probes
Tip configuration
Cannula diameter
Cannula length
Cannulas utilized in traditional SAL
Cannulas utilized in PAL
VAL
Treatment areas
Arms
Back
Abdomen
Hips/flanks
Buttocks
Thighs
Lateral and posterior thighs
Medial thigh
Anterior thigh
Knees/ankles
Neck
Postoperative care
Complications
Emerging technology
Injection lipolysis
Non-invasive devices
Conclusion
References
25-3
25.3 Correction of liposuction deformities with the SAFE liposuction technique
Introduction
Challenges of repeat liposuction
The dose–response curve
Adjunctive energy modalities
Paradigms for the treatment of fat
Indications and contraindications
Patient evaluation
Preoperative planning and preparation
Surgical technique
Anesthesia
Markings
Patient positioning
Technique
Step 1: Separation
Step 2: Aspiration
Step 3: Fat equalization
Preventing contour deformities
Ancillary procedures
Postoperative care
Results and outcomes
Problems and complications
26
26 Editors’ perspective: abdominal contouring
27
27 Abdominoplasty
Introduction
Historical perspective
Patient selection and screening
Anatomy
Preoperative planning and preparation
Informed consent
Perioperative management
Contraindications to abdominoplasty
Patient positioning and superwet local anesthesia
Nuisances, untoward sequelae, and complications
Infections
Fluid collections
Blood loss and fluid replacement
Hematoma
Venous thromboembolism (VTE)
Nerve entrapment syndromes
Wound ischemia and necrosis
Scars
Pain
Combined procedures: abdominoplasty and breast surgery or intra-abdominal pelvic surgery with concomitant abdominal contour ...
Combining abdominoplasty with anatomically distant procedures, including breast surgery
Significance of operative procedure length
Related considerations in abdominoplasty
Downstaging
Limited abdominoplasties (types II and III in the abdominolipoplasty system of classification and treatment)181–184
Mini-abdominoplasty (type II)
The modified or lower abdominoplasty (type III)
Panniculectomy without umbilical circumscription
Scarring
Umbilicus
Scarred abdomen
Flanks
Reverse abdominoplasty
Secondary abdominoplasty
Bariatric plastic surgery
Males
Fleur-de-lis abdominoplasty
A note on scarring and the umbilicus
The waistline
Mons pubis
High definition
Visceral fat
Functional outcomes of abdominoplasty
Energy devices and non-surgical techniques in relation to an abdominoplasty
360° liposuction and abdominoplasty
Abdominoplasty surgical markings
Abdominoplasty surgical technique
Summary
References
28
28 Lipoabdominoplasty with anatomical definition: a new concept in abdominal aesthetic surgery
Introduction
Principles of the lipoabdominoplasty with anatomical definition
Patient selection
Marking
Upper abdomen
Lower abdomen and pubis
Point A
Surgical technique
Anatomical definition liposuction
Negative areas
Positive areas
Horizontal incision and preservation of Scarpa's fascia
Tunnel construction and diastasis plication
Omphaloplasty
Suture, drainage, therapeutics, and postoperative care
Special cases
Results
Comments
Conclusion
References
29
29 Editors’ perspective: truncal contouring
30
30 Bra-line back lift
Introduction/overview
Treatment goals and planned outcomes
Preoperative planning and preparation
Patient evaluation
Preoperative markings
Patient positioning
Procedural approach
Potential complications and management
Postprocedural care
Outcomes and evidence
Summary
References
31
31 Belt lipectomy
Introduction
Historical perspective
Basic science and disease process
Anatomy
Massive weight loss patients
The 20–30 pounds overweight group
Normal weight patients group
Diagnosis and patient presentation
BMI level at presentation
Fat deposition pattern
The skin/fat envelope
Commonalities of presentation
Patient selection
Lower bodylift type II (Lockwood technique)
Belt lipectomy/central bodylift
Selection criteria
Preoperative evaluation
Treatment/surgical techniques
Rationale for circumferential excisional procedures
Belt lipectomy
Goals
Marking the vertical midline
Horizontal mons pubis marking
Mark from lateral mons to ASIS
Superior horizontal abdominal marks
The posterior vertical midline is marked
The posterior midline extent of resection is marked
The inferior back marks
The superior back marks
Vertical alignment marks
Positioning sequence
Anesthesia and deep vein thrombosis/pulmonary embolism prophylaxis
Surgical technique
Postoperative care
Outcomes/prognosis/complications
Complications
Wound separation
Seromas
Dehiscence
Infection
Tissue necrosis
Deep vein thrombosis and pulmonary embolism
Psychological difficulties
References
32
32 Circumferential approaches to truncal contouring in massive weight loss patients: the lower lipo-bodylift
Introduction
Patient selection and screening
Treatment goals and planned outcomes
Preoperative planning and preparation
Markings
Patient positioning
Procedural approach
Type 1
Types 2 and 3
Anterior preparation
Mons pubis reconstruction
Adjuvant liposuction
Male “love handles”
Potential complications and management
Postoperative care
Outcomes
Maximal point of gluteal projection
Scar appearance
Transition vectors
Conclusions
References
33
33 Circumferential approaches to truncal contouring: autologous buttocks augmentation with purse-string gluteoplasty
Introduction
Patient selection
Surgical technique
Postoperative care
Outcomes and complications
References
34
34 Circumferential approaches to truncal contouring: Lower bodylift with autologous gluteal flaps for augmentation and pre ...
Introduction
Gluteal hypoplasia in the massive weight loss and aesthetic patient
Development of techniques
Aesthetic analysis
BMI and procedural indications
Gluteal flap selection
Clinical anatomy
Operative markings
Operative technique
Complications
Perioperative care and safety
Summary
References
35-1
35.1 Editors’ perspective: buttock augmentations
35-2
35.2 Buttock augmentation with implants
Gluteal aesthetic ideals
Topographical anatomy
Aesthetic analysis
Upper inner gluteal/sacral junction: ideal presacral space shape
Lower inner gluteal fold/leg junction
Lateral mid-buttock/hip contour
Lateral view aesthetics
Diagnosis/patient presentation
Ethnic considerations
Caucasian
Hispanic
African American
Asian
Patient selection
Aesthetic goals
Buttock implants (Video 35.2.1 )
Implant placement and selection
Anatomic planes of dissection for implant placement
Submuscular plane
Intramuscular plane
Subfascial plane
Implant shape selection
Muscle height-to-width ratio
Implant selection
The lateral view
Implant size selection
Intramuscular implant surgical technique
Markings
Preparation
Anesthesia/positioning
Incision design/selection
Skin flap dissection
Muscle dissection
Sizers/implant size
Drains
Implant placement/closure
Subfascial implant surgical technique
Markings
Technique
Drains
Closure
Postoperative care
Activity
Garments
Postoperative pain management
Complications
Wound dehiscence
Implant exposure
Infection
Seroma
Capsular contracture
Neuropraxia
Implant rotation
Implant malposition
Hyperpigmentation/skin discoloration
Skin ulceration
Chronic pain
Secondary procedures
Scar revision
Conclusion
References
Further reading
35-3
35.3 Buttock shaping with fat grafting and liposuction
Expert commentary on gluteal fat grafting
Introduction
Historical perspective
Gluteal aesthetic ideals
Diagnosis/patient presentation
Patient selection
Who is a good candidate for autologous fat grafting of the buttocks?
Aesthetic goals
Fat grafting surgical technique
Pre-surgical markings
Surgical technique
Postoperative care
Activity and follow-up
Outcomes, prognosis, and complications
Complications of grafting
Infection
Seromas
Neuropraxia
Hematologic and metabolic disturbances
Fat embolism
Secondary procedures
Additional augmentation
Expert commentary on gluteal fat grafting* Daniel A. Del Vecchio * Dedicated to D. Ralph Millard, MD
Commentary on patient selection, technique, and safety
What’s in a name?
GFG patient subtypes and preoperative considerations
Bimodal age distribution
The relative result and the absolute result
GFG subtypes
“Skinny” GFG (100% GFG, 0% liposuction)
Obese GFG (80% liposuction, 20% GFG)
The dense, fibrous fat GFG patient
The male GFG patient
Transgender male to female GFG
The staged versus the revision GFG patient
Comorbidities
Author’s current technique
Simultaneous separation and tumescence (SST)
Concluding comments
References
36
36 Upper limb contouring
Introduction
Historical perspective
Basic science/disease process
Diagnosis/patient presentation
Patient selection
Plan formulation
Laboratory work-up
Preoperative visit
Thromboembolic disease prophylaxis
Treatment/surgical technique
Anatomy
Marking
Operative technique (Videos 36.1 & 36.2 , Video Lecture 36.1 )
Postoperative care
Outcomes, prognosis, and complications
Secondary procedures
References
37
37 Medial thigh
Introduction
Anatomy
Patient selection and pre-surgical assessment
Pre-thighplasty liposuction
Surgical considerations
The upper third
The middle third
The lower third
Preoperative markings
Horizontal resection
Vertical resection
Intra-operative approach
Complications
Conclusions
References
38
38 Post-bariatric reconstruction
Obesity
Definition and epidemiology
Methods of weight reduction
Diet and exercise
Pharmacotherapy
Bariatric surgery
Incidence and decision-making for body contouring post-bariatric surgery
Diagnosis/presentation/evaluation
History
Physical examination
Assessment
Patient preoperative counseling and education
Patient selection/timing of surgery
Psychological considerations in post-bariatric body contouring
Patient safety and intraoperative considerations
Surgical techniques by anatomic region
Abdominal contouring
Deformity/patient evaluation
Operative planning and techniques
Variations in abdominal contouring and reconstruction
Complications
Lower bodylift/buttock contouring
Deformity/patient evaluation
Patient selection
Markings
Operative technique (Video 38.1)
Postoperative care
Vertical thigh-lift
Deformity/patient evaluation
Patient selection
Markings
Operative technique (Fig. 38.13)
Postoperative care
Complications
Contouring of the arms, breast, upper trunk, and male chest in the MWL patient
Staging and combination procedures
Complications/secondary procedures
Body contouring centers of excellence
References
39
39 Energy devices in aesthetic surgery
Introduction
Historical perspective
Background
Ultrasound-assisted liposuction
Preoperative preparation
Surgical technique
Optimizing outcomes
Postoperative care
Complications and management
Laser-assisted liposuction
Preoperative preparation
Surgical technique
Postoperative care
Complications and management
Energy-based skin tightening
Historical perspective
Radiofrequency-based skin tightening
Helium plasma-based skin tightening
Patient selection
Summary
References
40
40 Aesthetic genital surgery
Introduction
Male genital aesthetic surgery
Introduction
Measurements
Patient selection/examination
Anatomy
Penile enlargement
Penile lengthening
Outcomes
Girth increase treatment
Fat injections
Foreign body injections
Dermal and dermal fat grafts
Allograft dermal matrix grafts
Reconstruction of penile enlargements
Reversal of V–Y advancement flap
Fat removal
Diffuse foreign body removal
Dermal fat graft and AlloDerm removal
Postoperative care
Outcomes
Penoscrotal web
Scrotum enlargement
Hidden penis
Surgical technique
Outcomes
Female genital aesthetic surgery
Introduction
Anatomy
Labia minora reduction
Surgical technique
Outcomes
Labia majora modeling and reduction
Surgical technique
Mons pubis descent and lipodystrophy
Conclusion
References
Confidence is ClinicalKey