Index
186
management of, 32, 33f
after rhinoplasty, 88
skin fl ap, after facelift, 91–92, 92f, 95
Necrotizing fasciitis, after upper eyelid blepharoplasty,
54
Negative vector, maxillary hypoplasia and, 127, 127f
Nerve graft(s), in facial reanimation, 127, 128, 130
Nerve injury
in bilateral sagittal-split mandibular osteotomy,
153–154
in facial implantation, 99
in genioplasty, 157–158
in intraoral vertical ramus mandibular osteotomy,
156
in LeFort I osteotomy, 160
Neurapraxia, after facial implantation, 99
Nodule(s), with dermal fi llers, 15
NOE. See Naso-orbital-ethmoid region
Nonsteroidal anti-infl ammatory drugs (NSAIDs),
perioperative management of, 34–35, 91,
91t, 99
Nose. See also Cleft lip nasal deformity; Nasal entries
alar base reduction, 80–81, 81f
alar batten grafts, 80, 81f
bony vault, deviation of, 80
cartilaginous structures, deviation of, 80
crooked, correction of, 80
middle vault collapse, 80, 80f
supra-alar collapse, after rhinoplasty, 80, 81f
tip-supratip relationship, 82
NSQIP. See National Surgical Quality Improvement
Program
O
Obstructive sleep apnea
perioperative management of patients with, 23
with syndromic craniofacial synostosis, 132
Oculomotor nerve injury, LeFort I osteotomy and, 160
Open bite deformity, 156, 156f
Ophthalmoplegia, transient, after blepharoplasty, 53
Optic atrophy, in child with craniofacial dysostoses,
137
Optic nerve, injury to, LeFort I osteotomy and, 160
Oral commissure, management of, in facial
reanimation, 130–131, 130f
Orbicularis oculi muscle
paralysis, 60–61, 61f, 62, 64f
physiology of, 60
weakness of, 60–61, 61f
Orbit
surgical approaches to, 115
tumors of, 52
Orbital fractures, 110–114
chronic, repair of, 115–116
late considerations, 114–116
volume enlargement caused by, correction of, 115
Oroantral fi stulas, LeFort I osteotomy and, 160
Myasthenia gravis
diagnosis of, 52
upper eyelid ptosis in, 52
Mycobacteria, and granulomata, 60, 60f
Mydriasis, transient, after blepharoplasty, 53
Myobloc. See Botulinum toxin, serotype B
N
Narcotics, 20–21
Nasal airway obstruction
with cleft lip nasal deformity, 140
persistent, after rhinoplasty, 87, 87f
Nasal dorsum
augmentation, complications of, 86–87, 87f
collapse, trauma-related, 116–117
graft, 86–87, 87f
implant for, complications of, 103, 103f
inverted-V deformity, 86
irregularities, after rhinoplasty, 86
problems, after rhinoplasty, 86–87. See also Saddle
nose deformity
scooped appearance, after rhinoplasty, 86
Nasal implants, 103, 103f
complication rates, 101t
infection, 103
Nasal septum
deviation, LeFort I osteotomy and, 160
intraoperative damage to, 80
perforation, after rhinoplasty, 88
Nasal tip
bossae, 83
bulbosity, correction of, 83–84
grafts
camoufl aging, 82–83, 83f
with lateral crural grafts, 82–83, 83f
problems, after rhinoplasty, 82–83, 83f
problems, after rhinoplasty, 82–86, 82f–85f
NASHAs. See Hyaluronic acid, nonanimal stabilized
Nasociliary nerve, injury to, LeFort I osteotomy and,
160
Nasofrontal duct injury, 118
Nasolabial fl ap reconstruction, preoperative planning
for, 30–31
Nasolacrimal injury(ies)
LeFort I osteotomy and, 160
with naso-orbital-ethmoid fractures, 117
Naso-orbital-ethmoid region, 116
fractures of, 116, 116f
complications of, 117
National Surgical Quality Improvement Program,
surgical risk factor database, 22
Naugle exophthalmometer, 113
Nausea and vomiting, postoperative care, prevention
of, 18
Necrosis
frontal central, in hair transplant recipient site, 171,
171f
Index 187
with poor self-image, 7
predisposed to unhappiness/dissatisfaction,
characteristics of, 6, 6t
psychological profi le of, preoperative assessment of, 5
selection of, 6, 9
surgeon’s relationship with, 7–8
Patient expectations, 5
and blepharoplasty, 49
and brow rejuvenation, 70
for hair restoration, 166–167
inappropriate, 2
avoidance of, 2–3, 3t
preoperative computer imaging and, 78
with skin resurfacing, 40
Peabody, Francis Weld, 1, 1f
Penicillin, indications for, 33
Periodontal defect(s)
LeFort I osteotomy and, 159–160
mandibular body and symphysis osteotomy and, 157
Perlane, 12–13
PGA. See Polyglycolic acid
Phenol peels, complications of, 42
Phimosis, 62, 64f
Photograph(s)
before brow rejuvenation, 71
preoperative
for facial implants, 97–98
for upper eyelid blepharoplasty, 51
Photosensitizing agents, 41–42, 41t
Physical examination, preoperative, 50
Pigmentation, alterations in, after skin resurfacing,
40–42
PIH. See Postinfl ammatory hyperpigmentation
Pincushioning, 36
Plate(s), resorbable, for cranial fi xation, 135–136, 136f
PLLA. See Poly-L-lactic acid
PMMA. See Polymethylmethacrylate
Pneumocephalus, in surgical treatment of
craniosynostosis, 133
Pneumothorax, 81
Pollybeak deformity, 82, 82f
Polydimethylsiloxane, characteristics of, 97, 98t
Polyester fi ber, characteristics of, 97, 98t
Polyethylene
facial implant, complication rates, 101t
high-density, characteristics of, 97, 98t
Polyglycolic acid, in craniofacial implants, 135–136
Poly-L-lactic acid, 13
in craniofacial implants, 135–136
Polymethylmethacrylate
characteristics of, 97, 98t
injectable, complications of, 13, 13f
Polytetrafl uoroethylene, expanded
characteristics of, 97, 98t
facial implant, complication rates, 101t
tubular form of, 100
Postanesthesia care unit, 26
Oronasal fi stula
LeFort I osteotomy and, 160
after palatoplasty, 142, 142f
Orthognathic surgery
complications of, 151–162, 151t
infection after, 151–152
pearls, 162
principles of, 151
relapse after, 152
OSA. See Obstructive sleep apnea
Osteogenesis. See also Distraction osteogenesis
in fracture healing, 107–108
Osteomyelitis
frontal bone, 118
posttraumatic, 107
Osteosynthesis, 106
Otoplasty, 145–146
pearls, 146
Oxygen
and fi re risk, 25
hyperbaric, 32–33
supplemental, pitfalls of, 25
P
PABA. See para-Aminobenzoic acid
PACU. See Postanesthesia care unit
Palatal fi stula, after palatoplasty, 142, 142f
Palatoplasty
in cleft repair, 141–142
pearls, 146
Papilledema, in child with craniofacial dysostoses, 137
Para-Aminobenzoic acid, 19–20
Parotidectomy, in facial reanimation, 130
Parotid fi stula, after facelift, 94
Parotid gland
lacerations, 119–120, 119f
complications of, 120
repair of, 119–120, 119f
management of, in facial reanimation, 130
Parotitis, chronic, posttraumatic, 120
Past medical history, preoperative review of, 49,
90–91
Patient(s)
criticism of previous surgeons, and potential for
further dissatisfaction, 6
demanding, 6
depressed, 6
dissatisfaction
causes of, 8–9
risk factors for, 6–8
dissatisfi ed, management of, 8–9
pearls, 9
education of, 8
goals for plastic surgery, 5
perfectionist, 6
personality characteristics of, preoperative
assessment of, 5
Index
188
scars, minimization/prevention of, 81
secondary, preoperative evaluation for, 78, 79f
septal perforation after, 88
supra-alar collapse after, 80, 81f
Rhytidectomy. See Facelift
Rhytides
botulinum toxin for, complications of, 10–12
collagen for, 12
Ropivacaine
cardiovascular safety of, 19
duration of action of, 19t
maximum dose of, 19t
pharmacology of, 20t
RSTL. See Relaxed skin tension lines
S
Saddle nose deformity, 86, 117
Salivary fi stula, with parotid duct injury, 120
Scalp reduction, for alopecia, 172, 173f
Scar(s)
after browlift, 74
contracture of, 35
depressed, 36
dyspigmented, after upper eyelid blepharoplasty, 55,
56f
facial, minimization of, 30–31
in hair transplantation, in donor area, 168, 168f, 169
in hair transplant donor site, 170–171, 170f
hypertrophic, 35, 35f
after facelift, 95
in hair transplant donor site, 169
after upper eyelid blepharoplasty, 55, 55f
after rhinoplasty, 81
scalp, widening of, after surgical treatment of
craniosynostosis, 134, 134f
after skin resurfacing, 40, 42–44
atrophic/hypopigmented, 43
contractile, 43
factors associated with, 42–43, 43t
textural, 43, 44f
Schirmer testing, 50
Scleral shield(s), 39
Scleral show, 36
after upper eyelid blepharoplasty, 55
Screw(s), titanium, exposure, after browlift, 75, 75f
Sculptra, 13
Sedation
guidelines for, 21, 24
in hair transplantation, 167–168
intravenous, 20–21
pearls, 26
practitioner providing, qualifi cations of, 24
Seizure(s), local anesthetic-induced, 19
Self-image
cosmetic surgery and, 7
and dissatisfi ed patient, 8–9
poor, patients with, 7
Postinfl ammatory hyperpigmentation, after skin
resurfacing, 42, 42f, 42t
Postoperative care, in immediate recovery period, 26
Posttraumatic osteomyelitis, 107
Povidone iodine, and cornea, 52
Prednisone, indications for, after skin resurfacing, 44
Premedication, 18–19
Prevelle Silk, 12–13
Prilocaine, pharmacology of, 20t
Procaine, pharmacology of, 20t
Propofol, 20–21
Proptosis, in child with craniofacial dysostoses, 137
Proton pump inhibitors, preoperative indications for,
18
Pruritus
in normal wound healing, 43
in scar formation, 43
Pseudomonas aeruginosa, 34
Psychiatric assessment, preoperative, 6–7, 49, 90
PTOM. See Posttraumatic osteomyelitis
Pulmonary complications, risk factors for, 23
Pulsatile ophthalmopathy, in child with craniofacial
dysostoses, 137
Pyogenic granuloma, in hair transplant donor site, 169,
170f
R
Radiation therapy, previous
and facial fl ap survival, 32
and facial implant extrusion, 127, 127f
and facial paralysis, special considerations for, 127,
127f
Radiesse, 13
Reactive dyschromia, after skin resurfacing, 42
Recovery, inappropriate, 2
avoidance of, 3, 3t
Relaxed skin tension lines, 30–31
Remifentanil, 20
Respiratory system adverse events. See Ventilatory
depression
Restylane, 12–13
Rhinoplasty
alloplastic implants in, complications of, 78, 79f
bleeding/hemorrhage after, 88
complications of
intraoperative, 79–81
involving nasal dorsum, 86–87, 87f
involving nasal tip, 82–86, 82f–85f
postoperative, 82–88
healing after, 78–79
infection after, 87–88
loss of nasal tip projection after, 82, 82f
with nasal implant, complications of, 103, 103f
necrosis after, 88
pearls, 88
persistent nasal airway obstruction after, 87, 87f
preoperative evaluation for, 78–79
Index 189
microbiology of, 44, 44t
risk factors for, 44
laser
complications of, 41, 42, 42f, 47
erythema after, 47
medium, 39
patient expectations associated with, 40
pearls, 47
postinfl ammatory hyperpigmentation after, 42, 42f,
42t
postprocedure care, 42, 43
procedures for, 39
scarring after, 40, 42–44
atrophic/hypopigmented, 43
contractile, 43
factors associated with, 42–43, 43t
textural, 43, 44f
skin breakdown after, 43
superfi cial, 39
toxic shock syndrome after, 46
wound healing after, delayed, 47
Skin/soft tissue envelope, nasal
damage to, 78, 79f
intraoperative, 79–80
preoperative evaluation, for rhinoplasty, 78
Skin tension, and facial wound healing, 31
Skin test(s), for hypersensitivity to bovine collagen, 14
Skull, persistent defects, after craniofacial
reconstruction, 136–137
Skull base
anomalies, with craniofacial dysostoses, 134
fractures of, 118
Slot defect, after alopecia reduction, 172, 173f
SMAS. See Superfi cial musculoaponeurotic system
Smoking
and facelift, 91, 95
and skin fl ap survival, 95
Smoking cessation, 91, 95
perioperative, 32
Sodium citrate, preoperative indications for, 18
Sodium thiopental, 21
Softform, 100
SSTE. See Skin/soft tissue envelope
Staphylococcus aureus, 33
Stereolithography, craniofacial, 114–115
Steroids, indications for
after facelift, 95
with facial implant, 99
after skin resurfacing, 43–44
Streptococcus viridans, 33
Succinylcholine, 21–22
Superfi cial musculoaponeurotic system, 90
fl ap, elevation of, 94
Superior sulcus deformity, 113, 113f
Supraorbital foramen, 73, 73f
Supraorbital nerve, injury to, in browlift, 72–73
Supraorbital notch, 73, 73f
Sensory nerve(s), injury to
in bilateral sagittal-split mandibular osteotomy,
153–154
in browlift, 72–73
in facelift, 94
in intraoral vertical ramus mandibular osteotomy,
156
in LeFort I osteotomy, 160
with mandibular fracture, 108
orbitozygomatic fractures and, 114
Seroma
after facelift, 95
with locoregional facial fl ap, 34
persistent, with facial implantation, 99
Sevofl urane, 21
Sialocele
management of, in facial reanimation, 130
with parotid duct injury, 120
Sialoendoscopy, in trauma patient, 120
Sialogram, in trauma patient, 120
Silastic
characteristics of, 97, 98t
facial implant
complications of, 100
seroma with, 99
malar implant, 102–103
Silicone
and cancer risk, 100
facial implant
characteristics of, 97, 98t
complication rates, 101t
seroma with, 99
injections, complications of, 13, 13f
Silikon 1000, 13
Skin breakdown, after skin resurfacing, 43
Skin fl ap(s). See Flap(s)
Skin incision(s)
pretrichial, 74, 74f
trichophytic, 74, 74f
Skin necrosis
after facelift, 91–92, 92f, 95
after rhinoplasty, 88
Skin resurfacing
complications of, 39, 39f
intraoperative, 39
timing of, 39–40
wound depth and, 39
deep, 39
dyspigmentation after, 40–42
ectropion after, 43, 44, 44f
erythema after
normal, 47
persistent, 47
and scar formation, 47
expected side eff ects of, 40
herpes simplex virus infection after, 45–46, 46f
infection after, 44–46, 44t, 45f, 46f
Index
190
Tumor(s), orbital, 52
Tyndall eff ect, 14–15
U
Ultrasoft, 100
Upper eyelid blepharoplasty
complications of
immediate postoperative, 53–54
incisional, 55
intraoperative, 52–53
late postoperative, 54–55
preoperative, 49–52
patient expectations and, 49
pearls, 56
preoperative assessment for, 49–52
preoperative photographs, 51
surgical planning for, 51
V
Valcyclovir, indications for, 45–46
Vasodilation, anesthesia-related, 21
Vasovagal syncope, 167
Velopharyngeal dysfunction
causes of, 142
after cleft repair, 142–143
treatment of, 142–143
Ventilatory depression, 21
monitored anesthesia care and, 25
monitoring for, 18
Ventilatory insuffi ciency. See Hypoventilation;
Ventilatory depression
Ventroperitoneal shunt, in child with craniosynostosis,
134
Vigilon, 47
Vision
loss of
after blepharoplasty, 53, 59
with orbitozygomatic fractures, 113
monitoring
after facial fracture repair, 114
after upper eyelid blepharoplasty, 53–54
problems
in child with craniofacial dysostoses, 137
LeFort I osteotomy and, 160
after upper eyelid blepharoplasty, 54–55
Visual acuity
decreased, LeFort I osteotomy and, 160
examination, in blepharoplasty patient, 52
Vitamin E, perioperative management of, 79, 91, 91t, 99
Volatile anesthetics, 21, 22
Vomer fl ap, in palatoplasty, 141–142
von Willebrand’s disease, 79
W
Whistle deformity, after cleft lip repair, 139, 139f
Wound dehiscence. See Dehiscence
Supratrochlear nerve, injury to, in browlift, 72–73
Surgeon(s)
patient’s preoperative assessment of, 5
relationship with cosmetic surgery patient, 7–8
Surgery, duration of, 24–25
Surgical judgment, inappropriate, 2
avoidance of, 3, 3t
Surgical mesh, facial implant, complication rates, 101t
Surgical technique, inappropriate, 2
avoidance of, 3, 3t
Suture(s)
and infection prevention, 34
and prevention of dehiscence, 35
resorbable, for cranial fi xation, 135–136
Suture tracks, visible, after upper eyelid blepharoplasty,
55, 56f
T
Tarsorrhaphy, in child with craniofacial dysostoses, 137
TCA. See Trichloroacetic acid peel
Tear fi lm, physiology of, 50
Teeth, devitalization of, mandibular body and
symphysis osteotomy and, 157
Telangiectasias, postoperative care, 36
Telecanthus, with naso-orbital-ethmoid fractures,
116–117
Telephone ear deformity, 145, 146f
Temporomandibular joint
ankylosis, 110, 110f
dysfunction, after bilateral sagittal-split mandibular
osteotomy, 154
function, after mandibular fracture, 108
Temporoparietal fl ap, for hair restoration, 172
Tensilon test, 52
Tetracaine
duration of action of, 19t
maximum dose of, 19t
Therapeutic index, 20
Titanium, for facial implant, 97
TMJ. See Temporomandibular joint
Toxic shock syndrome
after rhinoplasty, 87
after skin resurfacing, 46
Tracheostomy, in children with craniofacial dysostoses,
132
Trap door deformity, 36, 36f
Triamcinolone acetonide
indications for
after facelift, 95
in hair transplantation, 169
intramuscular, after skin resurfacing, 44
Trichiasis, facial reanimation and, 129
Trichloroacetic acid peel, 40
complications of, 40, 41
Trigeminal nerve, paresthesia, orbitozygomatic
fractures and, 114
Index 191
Z
ZMC. See Zygomatico-maxillary complex
Zyderm, hypersensitivity to, 14
Zyderm I, 12
Zyderm II, 12
Zygoma, surgical approaches to, 115
Zygomatic fractures, 110–114
late considerations, 114–116
Zygomatico-maxillary complex
fractures, chronic, 115–116
fractures of, 111, 112f
Zygomatic osteotomy(ies), 115–116, 116f
Zyplast, 12
Wound healing
delayed, after skin resurfacing, 47
disorders aff ecting, 49
factors aff ecting, 95
by secondary intention. See Closure, by secondary
intention
after skin resurfacing, normal, 40
X
Xeomin. See Botulinum toxin
Y
Yeast. See Candida infection; Malassezia