Additional Information
Book Details
Abstract
Take your practice to the next level! Cosmetic Facial Surgery provides a highly illustrated, case-based approach to common face and neck procedures. In this full-color reference, internationally renowned surgeon Joe Niamtu III, DMD, covers techniques including brow, face, and neck lifts; nose, eye, and ear surgery; cosmetic surgery practice with discussions of the process of facial aging, diagnosing and consulting with patients, clinical digital facial implants; skin resurfacing; the use of neurotoxins; and the removal of skin lesions. The book also prepares you for photography, and anesthesia considerations.
- Comprehensive coverage includes the full range of surgical procedures from the upper face to the lower face/neck area.
- Over 3,000 full-color photos show surgical techniques and before-and-after shots of actual cases done by Dr. Niamtu.
- A DVD includes videos of procedures performed by the author, bringing complicated procedures to life.
- Accessible, easy-to-grasp descriptions, written in an engaging, first-person narrative, explain concepts based on real cases and on Dr. Niamtu's experience.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Cosmetic Facial Surgery | i | ||
| Copyright page | iv | ||
| Contributor | v | ||
| Dedication | vii | ||
| Foreword | ix | ||
| Preface | xi | ||
| Features and Organization | xiii | ||
| Key Features | xiii | ||
| Organization | xiii | ||
| DVD Features | xiv | ||
| Chapter 5 | xiv | ||
| Table of Contents | xv | ||
| 1 The Aging Face | 1 | ||
| Regional Facial Aging | 2 | ||
| Skin | 2 | ||
| Upper Facial Aging | 3 | ||
| Hair | 3 | ||
| The Forehead and Brow | 4 | ||
| Upper Eyelids | 4 | ||
| Midfacial Aging | 5 | ||
| Lower Eyelids | 5 | ||
| Cheeks | 5 | ||
| Nasolabial Folds | 7 | ||
| Nasal Aging | 7 | ||
| Ears | 7 | ||
| Lower Face | 8 | ||
| Perioral Region | 8 | ||
| Jowls | 8 | ||
| Chin | 9 | ||
| Submental Region | 9 | ||
| Neck | 9 | ||
| Conclusion | 10 | ||
| References | 11 | ||
| 2 Diagnosis of the Cosmetic Facial Surgery Patient | 13 | ||
| Meeting the Doc | 13 | ||
| Patient Screening | 16 | ||
| Preoperative Appointment | 16 | ||
| Day of Surgery | 17 | ||
| Post Surgery | 17 | ||
| Patient Recovery and Biopsychosocial Implications | 18 | ||
| Conclusion | 22 | ||
| Reference | 22 | ||
| 3 Clinical Digital Photography | 23 | ||
| Equipment | 23 | ||
| Cameras | 24 | ||
| Digital Editing Software | 24 | ||
| Taking and Making Pictures | 25 | ||
| Background Canvas | 25 | ||
| Light and Shadows | 26 | ||
| Lens and Focus | 26 | ||
| Image-Editing Pearls and Pitfalls | 27 | ||
| Deceptive Images | 28 | ||
| Specialized Photographic Indications | 28 | ||
| Radiographs | 28 | ||
| Copying Images or Text From Journals or Books | 29 | ||
| Making Ultraviolet Images | 29 | ||
| Image Archiving | 31 | ||
| Data Recovery | 33 | ||
| Conclusion | 34 | ||
| References | 34 | ||
| 4 Anesthesia Considerations for Cosmetic Facial Surgery | 35 | ||
| Local Anesthesia for Cosmetic Facial Surgery | 35 | ||
| Mechanism of Action of Local Anesthetics | 35 | ||
| Sensory Anatomy of the Head and Neck | 35 | ||
| Trigeminal Nerve | 35 | ||
| Ophthalmic Nerve (V1) | 36 | ||
| Maxillary Nerve (V2) | 36 | ||
| Mandibular Nerve (V3) | 37 | ||
| Local Anesthetic Techniques | 37 | ||
| Infiltrative Peripheral Anesthesia Versus Regional Nerve Block Anesthesia | 37 | ||
| Use of Topical Preanesthesia | 37 | ||
| Technique for Upper and Lower Lip Anesthesia | 38 | ||
| Technique for Nasolabial Fold Anesthesia | 38 | ||
| Local Anesthetic Techniques for Blocking the Main Sensory Nerves of the Head and Neck | 38 | ||
| Scalp and Forehead | 38 | ||
| Infraorbital Nerve Block | 39 | ||
| Total Second Division Nerve Block | 41 | ||
| Mental Nerve Block | 43 | ||
| Inferior Alveolar Nerve Block (Intraoral) | 44 | ||
| Mandibular Nerve (V3) Block (Facial Approach) | 45 | ||
| Blocking the Scalp | 46 | ||
| Greater Occipital Nerve Block Technique for Posterior Scalp Anesthesia | 46 | ||
| Local Anesthesia of the Neck | 47 | ||
| Innervation of the Cervical Plexus | 47 | ||
| Superficial Branches of the Cervical Plexus | 47 | ||
| Cervical Plexus Block | 47 | ||
| Ear Block | 48 | ||
| Major Sensory Dermatomes of the Head and Neck | 48 | ||
| Tumescent Anesthesia | 48 | ||
| Conscious Sedation | 49 | ||
| Nitrous Oxide/Oxygen | 49 | ||
| Oral Sedation | 50 | ||
| Intravenous Sedation | 51 | ||
| Monitored Anesthetic Care Anesthetic Agents | 51 | ||
| The Procedure | 51 | ||
| Conclusion | 53 | ||
| References | 53 | ||
| 5 Mini Open Brow Lift | 54 | ||
| Diagnosis | 56 | ||
| Surgical Technique | 56 | ||
| Crafting the Incision | 57 | ||
| Incision Position | 59 | ||
| Incision Geometry | 60 | ||
| Complications | 75 | ||
| Hairline Scar Considerations | 76 | ||
| Conclusion | 87 | ||
| References | 89 | ||
| 6 Brow and Forehead Lifting | 90 | ||
| Upper Facial Diagnosis | 90 | ||
| Patients Either Like the Look of Elevated Brows or They Don’t | 92 | ||
| Endoscopic Brow and Forehead Surgical Procedure | 94 | ||
| Instrumentation | 94 | ||
| Surgical Procedure | 95 | ||
| Fixation Techniques | 112 | ||
| Postoperative Course | 119 | ||
| Case Presentations | 119 | ||
| Complications | 119 | ||
| Conclusion | 126 | ||
| References | 128 | ||
| 7 Cosmetic Blepharoplasty | 129 | ||
| Orbital Anatomy | 129 | ||
| Aging Conditions of the Eyelids and Periorbital Areas | 131 | ||
| Diagnosis and Patient Selection | 134 | ||
| Treatment Planning | 136 | ||
| Preoperative Marking | 138 | ||
| Upper Eyelid | 138 | ||
| Lower Eyelid Markings | 141 | ||
| Surgical Preparation and Anesthesia | 141 | ||
| Lower Eyelid Anesthesia | 142 | ||
| Blepharoplasty Instrumentation | 142 | ||
| Upper Lid Incision | 143 | ||
| Lower Eyelid Blepharoplasty | 149 | ||
| Transconjunctival Technique | 149 | ||
| Alternative Treatment of the Lower Eyelid | 154 | ||
| Skin Pinch Technique | 155 | ||
| Skin-Muscle Approach for Lower Blepharoplasty | 156 | ||
| Lower Eyelid Canthopexy | 161 | ||
| Blepharoplasty Complications | 161 | ||
| Bleeding | 163 | ||
| Ecchymosis | 165 | ||
| Postoperative Edema | 165 | ||
| Wound Dehiscence | 166 | ||
| Dry, Irritated Eyes | 166 | ||
| Lower Lid Malposition | 166 | ||
| Blepharoplasty Scars | 167 | ||
| Lower Eyelid Conjunctival Granuloma | 168 | ||
| Lagophthalmos | 168 | ||
| Postoperative Upper Eyelid Ptosis | 169 | ||
| Revision Blepharoplasty | 169 | ||
| Eyelid Crease Problems | 170 | ||
| Clinical Cases | 170 | ||
| Postoperative Blepharoplasty Care | 174 | ||
| Conclusion | 174 | ||
| References | 174 | ||
| Suggested Readings | 174 | ||
| 8 RHINOPLASTY | 175 | ||
| Anatomy | 175 | ||
| Nasal Musculature | 176 | ||
| Nasal Blood Supply | 176 | ||
| Nasal Bone and Cartilage Anatomy | 176 | ||
| Examination and Consultation | 182 | ||
| Nasal Tip Clinical Evaluation | 186 | ||
| Treatment Planning | 188 | ||
| External Versus Endonasal Technique | 189 | ||
| General Anesthesia or Intravenous Sedation | 191 | ||
| Incision Options | 191 | ||
| Local Anesthesia | 193 | ||
| Closed Rhinoplasty | 197 | ||
| Sequencing in Closed Rhinoplasty | 198 | ||
| Typical Sequence for Closed Rhinoplasty | 198 | ||
| Open Rhinoplasty | 199 | ||
| Open Rhinoplasty Technique | 199 | ||
| Incisions | 199 | ||
| Flap Elevation (Skeletonization) | 200 | ||
| Nasal Tip Procedures | 202 | ||
| Septal Harvesting and Support | 204 | ||
| Major Tip Support Categories | 204 | ||
| Minor Nasal Tip Support Categories | 209 | ||
| Dorsal Hump Reduction and Osteotomies | 209 | ||
| Alar Base Reduction | 212 | ||
| Wound Closure and Nasal Dressing | 218 | ||
| Postoperative Care | 218 | ||
| Complications and Treatment | 218 | ||
| Hematoma | 218 | ||
| Bleeding | 219 | ||
| Infection | 220 | ||
| Graft Exposure or Wound Breakdown | 221 | ||
| Prolonged Postoperative Edema | 222 | ||
| Irregularities, Asymmetries, and Depressions | 222 | ||
| Case Presentations | 223 | ||
| Case 1 | 224 | ||
| Case 2 | 225 | ||
| Case 3 | 226 | ||
| Case 4 | 227 | ||
| Case 5 | 228 | ||
| Case 6 | 229 | ||
| Case 7 | 230 | ||
| Case 8 | 231 | ||
| Case 9 | 232 | ||
| Case 10 | 233 | ||
| Case 11 | 234 | ||
| Case 12 | 236 | ||
| Case 13 | 237 | ||
| Case 14 | 238 | ||
| Case 15 | 239 | ||
| Case 16 | 240 | ||
| Case 17 | 241 | ||
| Case 18 | 242 | ||
| Case 19 | 243 | ||
| Case 20 | 244 | ||
| Conclusion | 245 | ||
| References | 245 | ||
| 9 Cervicofacial Rhytidectomy | 247 | ||
| Facelift History | 248 | ||
| Facelift Anatomy | 249 | ||
| Patient Selection | 252 | ||
| Determining Status for Potential Cosmetic Facial Surgery | 254 | ||
| Health | 254 | ||
| Psychological Stability | 255 | ||
| Recovery | 256 | ||
| Budget | 256 | ||
| Preoperative Consultation Workup | 256 | ||
| Facility | 257 | ||
| Instrumentation | 257 | ||
| The Day of Surgery | 259 | ||
| Anesthetic Considerations | 259 | ||
| Local and Tumescent Anesthesia | 259 | ||
| Prep and Drape | 260 | ||
| The Surgical Procedure | 260 | ||
| Submental Liposuction | 260 | ||
| Chin Implants | 263 | ||
| Platysmaplasty | 263 | ||
| Platysmaplasty Technique | 264 | ||
| Facelift Procedure | 269 | ||
| Incision Design | 269 | ||
| Flap Development | 274 | ||
| SMAS Techniques | 283 | ||
| SMAS Plication (Open Suspension) | 283 | ||
| Purse-String Sutures | 286 | ||
| SMAS Imbrication (Open Suspension) | 286 | ||
| SMAS Flap | 286 | ||
| SMASectomy | 286 | ||
| Posterior Platysma Suspension | 292 | ||
| Addressing Excess Skin | 294 | ||
| Delivering the Earlobe | 300 | ||
| Postoperative Care | 311 | ||
| Short-Scar/“Weekend” Facelift | 319 | ||
| Weekend Facelift Procedure | 321 | ||
| Simultaneous Laser Skin Resurfacing | 323 | ||
| Concomitant or Ancillary Procedures | 327 | ||
| Revision Facelift Surgery | 337 | ||
| Revision Surgical Procedure | 338 | ||
| Complications in Facelift Surgery and Their Prevention | 341 | ||
| Preoperative Considerations | 341 | ||
| Intraoperative Considerations | 342 | ||
| Intraoperative Surgical Complications | 342 | ||
| Postoperative Surgical Complications | 343 | ||
| Minor Hematoma | 344 | ||
| Postoperative Edema and Ecchymosis | 349 | ||
| Neurologic Complications | 351 | ||
| Motor Nerve Injury | 351 | ||
| Sensory Nerve Complications | 351 | ||
| External Jugular Vein | 353 | ||
| Complications Affecting Flap Viability | 354 | ||
| Postsurgical Revision | 363 | ||
| The Informed Consent Process | 366 | ||
| References | 368 | ||
| 10 Facial Implants | 369 | ||
| Midface Implants | 370 | ||
| Implant Selection | 370 | ||
| Preoperative Planning | 371 | ||
| Surgical Placement | 372 | ||
| Postoperative Care | 379 | ||
| Sequelae and Complications | 379 | ||
| Case Presentations | 386 | ||
| Chin Implants | 386 | ||
| Chin Implant Surgery | 394 | ||
| Intraoral Placement of Chin Implants | 398 | ||
| Chin Implant Complications | 405 | ||
| Custom Chin Implants | 419 | ||
| Mandibular Angle Implants | 419 | ||
| Surgical Placement | 423 | ||
| Custom Implants | 429 | ||
| Complications With Mandibular Angle Implants | 430 | ||
| Conclusion | 430 | ||
| References | 433 | ||
| 11 Cosmetic Otoplasty and Related Ear Conditions | 434 | ||
| Embryology | 434 | ||
| Normal Anatomy | 434 | ||
| Neurologic Anatomy | 436 | ||
| Vascular Anatomy | 437 | ||
| Muscular Anatomy | 438 | ||
| Cartilaginous Anatomy | 439 | ||
| Aberrant Anatomy | 439 | ||
| Lack of Antihelical Fold | 440 | ||
| Conchal Wall or Bowl Hypertrophy | 440 | ||
| Combination Deformities | 440 | ||
| Cosmetic Otoplasty Procedural Timing | 440 | ||
| Surgical Procedures | 445 | ||
| Nonsurgical Intervention | 445 | ||
| The Davis Procedure | 445 | ||
| Mustardé Otoplasty for Antihelical Fold Reconstruction | 452 | ||
| Cartilage Weakening | 453 | ||
| Horizontal Mattress Suture Placement | 456 | ||
| Correction of the Protruding Earlobe | 457 | ||
| Postoperative Dressing | 457 | ||
| Case Presentations | 461 | ||
| Otoplasty Complications | 461 | ||
| Postoperative Otoplasty Problems | 471 | ||
| Adjunctive Earlobe Surgical Procedures | 476 | ||
| Earlobe Reduction | 477 | ||
| Repair of Torn Earlobes | 484 | ||
| Simultaneous Earlobe Repair and Piercing | 493 | ||
| Complications | 497 | ||
| Clinical Results | 500 | ||
| Treatment of Earlobe Keloids | 500 | ||
| Treatment Options | 506 | ||
| Conclusion | 512 | ||
| References | 516 | ||
| 12 Skin Resurfacing | 517 | ||
| The Art of the Peel | 517 | ||
| Patient Selection | 517 | ||
| Resurfacing Contraindications | 518 | ||
| Preresurfacing Skin Conditioning | 519 | ||
| Prepeel Pharmacologic Concerns | 521 | ||
| Preoperative Consultation | 522 | ||
| Medium-Depth Chemical Peel Procedure | 522 | ||
| Peeling Agents | 523 | ||
| Mechanism of Action | 523 | ||
| Safety Precautions | 524 | ||
| Chemical Peel Procedure | 524 | ||
| Ultralight Tca Peel | 524 | ||
| Multiple-Coat, Medium-Depth TCA Peels | 525 | ||
| Postpeel Care | 529 | ||
| Obagi Blue Peel | 529 | ||
| Case Presentations | 536 | ||
| Chemical Peel Complications | 536 | ||
| Hyperpigmentation | 545 | ||
| Hypopigmentation | 546 | ||
| Laser Skin Resurfacing | 546 | ||
| Patient Selection | 549 | ||
| Laser Safety | 550 | ||
| CO2 Laser Treatment Options | 552 | ||
| Ultralight Fractional CO2 Laser Skin Resurfacing | 552 | ||
| Superficial Fractional CO2 Laser Procedure | 553 | ||
| CO2 Lite Laser Skin Resurfacing | 553 | ||
| Medium CO2 Laser Skin Resurfacing | 554 | ||
| Deep Fractional Laser Skin Resurfacing | 555 | ||
| Aggressive High-Energy Multipass CO2 Laser Skin Resurfacing | 555 | ||
| Aggressive CO2 Procedure | 555 | ||
| Blepharoplasty Incisions | 565 | ||
| Laser Treatment of Scars | 565 | ||
| Laser Skin Resurfacing of Surgical and Traumatic Scars | 568 | ||
| Postlaser Care | 569 | ||
| Case Presentations | 574 | ||
| Complications of Facial CO2 Laser Resurfacing | 574 | ||
| Post–Laser Skin Resurfacing Edema | 587 | ||
| Extended Post-Laser Erythema | 587 | ||
| Post-Resurfacing Hyperpigmentation | 588 | ||
| Post–Laser Skin Resurfacing Infections | 588 | ||
| Methicillin-Resistant Staphylococcus aureus (MRSA) Post-LSR Infection | 591 | ||
| Herpetic Infection | 591 | ||
| Milia Formation | 592 | ||
| Acne Flare | 592 | ||
| Post–Laser Skin Resurfacing Burns and Scars | 596 | ||
| Synechiae | 597 | ||
| Hypopigmentation | 600 | ||
| References | 602 | ||
| 13 Neurotoxins in Cosmetic Facial Surgery | 604 | ||
| Botulinum Toxin Type A: History and Physiology | 604 | ||
| Clinical Usage of Botulinum Toxin A | 607 | ||
| Treatment of Glabellar Rhytids | 609 | ||
| Treating “Bunny” Lines | 611 | ||
| Frontalis Treatment | 611 | ||
| Lateral Canthal Treatment | 614 | ||
| Midfacial Treatment | 616 | ||
| Nasal Indications | 616 | ||
| Nostril Flare | 616 | ||
| Nasal Tip Elevation | 617 | ||
| Nasolabial Fold Treatment | 617 | ||
| Perioral Treatment | 618 | ||
| Treating the Depressor Anguli Oris | 618 | ||
| Mentalis Treatment | 619 | ||
| Masseter Treatment | 620 | ||
| Platysma Band Treatment | 621 | ||
| Facial Asymmetry | 622 | ||
| Neurotoxins for Facial Pain/TMD Treatment/Headache | 623 | ||
| Hyperhidrosis/Frey Syndrome | 623 | ||
| Case Presentations | 624 | ||
| Complications of Neurotoxin Treatment | 624 | ||
| Conclusion | 638 | ||
| References | 638 | ||
| 14 Use of Injectable Fillers in Cosmetic Facial Surgery | 640 | ||
| Recent Historical Overview of Facial Fillers Available in the United States | 640 | ||
| Tissue Deposition of Injectable Fillers | 643 | ||
| Injectable Fillers: Treatment Considerations | 644 | ||
| Informed Consent Process | 644 | ||
| Injection Techniques | 645 | ||
| Diagnostic Decisions and Patient Expectations | 645 | ||
| Marking the Patient | 646 | ||
| Anesthetic Considerations | 647 | ||
| Lip-Enhancement Techniques | 648 | ||
| Lip Outline | 648 | ||
| Creating the Vermilion Outline | 651 | ||
| Increasing Deep Lip Volume | 651 | ||
| Fat Injection Cannula Technique | 652 | ||
| Perioral Filler Techniques | 653 | ||
| Philtral Columns | 653 | ||
| Vertical Lip Rhytids | 654 | ||
| Oral Commissure Injection | 658 | ||
| Augmenting the Mentolabial Fold | 658 | ||
| Filler Augmentation of Nasolabial Folds | 659 | ||
| Alternate Injection Sites | 663 | ||
| Horizontal Forehead Lines | 663 | ||
| Periorbital Rhytids | 663 | ||
| Tear Trough (Nasojugal Groove) | 663 | ||
| Lateral Canthal Rhytids | 665 | ||
| Injection Rhinoplasty | 665 | ||
| Malar Augmentation With Injectable Fillers | 666 | ||
| Filler Injection of the Earlobes | 667 | ||
| Injecting the Prejowl Sulcus | 667 | ||
| Alternate Filler Techniques | 667 | ||
| Liquid Silicone Oil Injection | 667 | ||
| Fat Transfer | 671 | ||
| Case Presentations | 672 | ||
| Complications of Injectable Fillers | 672 | ||
| Lip Implants | 691 | ||
| Lip Implant Technique | 694 | ||
| Lip Implant Case Presentations | 697 | ||
| References | 700 | ||
| 15 Lip Reduction (Reduction Cheiloplasty) | 701 | ||
| Diagnosis and Consultation | 701 | ||
| Differential Diagnosis | 702 | ||
| Lip Anatomy and Histology | 702 | ||
| Lip-Reduction Procedure | 703 | ||
| Preoperative Preparation | 703 | ||
| Anesthesia | 703 | ||
| Procedure | 703 | ||
| Subtotal Lip Reduction | 707 | ||
| Postoperative Care | 707 | ||
| Complications | 707 | ||
| Lip Shortening Procedure (Subnasal Lift) | 709 | ||
| Procedure | 709 | ||
| References | 717 | ||
| 16 Cosmetic Removal of Nevi and Lesions With 4-MHz Radiowave Surgery | 718 | ||
| Technique | 719 | ||
| Rhinophyma | 722 | ||
| Postoperative Care After Radiowave Excision | 726 | ||
| Complications | 727 | ||
| Conclusion | 733 | ||
| References | 733 | ||
| 17 Laser Treatment of Vascular Lesions | 734 | ||
| Treatment Wavelengths | 734 | ||
| Computer Pattern Generators | 736 | ||
| Pathology | 737 | ||
| Equipment Considerations | 737 | ||
| Pigmented Lesions | 738 | ||
| Anesthesia Concerns | 738 | ||
| Complications | 744 | ||
| Conclusion | 745 | ||
| References | 745 | ||
| Index | 746 | ||
| A | 746 | ||
| B | 746 | ||
| C | 748 | ||
| D | 750 | ||
| E | 750 | ||
| F | 751 | ||
| G | 752 | ||
| H | 753 | ||
| I | 753 | ||
| J | 754 | ||
| K | 754 | ||
| L | 754 | ||
| M | 756 | ||
| N | 757 | ||
| O | 758 | ||
| P | 758 | ||
| Q | 759 | ||
| R | 759 | ||
| S | 760 | ||
| T | 762 | ||
| U | 763 | ||
| V | 763 | ||
| W | 763 | ||
| X | 763 | ||
| Z | 763 |