POSTOPERATIVE COURSE AND COMPLICATIONS
419
antibiotics are given. The hair is carefully shampooed the
morning after surgery. Patients can shampoo their own
hair on the second postoperative day. Soaking the hair
for 15 minutes before shampooing is very useful in
accelerating the shedding of crusts.
Postoperative Course
and Complications
Edema occurs in most, although not all, patients and
begins usually 1 to 2 days after surgery and lasts for 3 to
5 days. Hypoesthesia results from the severing of nerves
in the donor site. This is normally temporary; in most
patients, it resolves after 3 to 6 months. Hypertrophic
scarring may occur in predisposed individuals.
References
1. Lee SJ, Kim DW, Jun JB, et al: Observations on the grouping
pattern of scalp hairs and compound hair in a normal healthy
population, Korean J Dermatol 32(6):998, 1994.
2. Bernstein RM, Rassman WR: The logic of follicular unit
transplantation, Dermatol Clin 17(2):277, 1999.
3. Finasteride Male Pattern Hair Loss Study Group: Long-term
(5-year) multinational experience with finasteride 1 mg in the
treatment of men with androgenetic alopecia, Eur J Dermatol
12(1):38, 2002.
4. Stough DB, Haber RS: The donor area. In Stough DB, Haber
RS, eds: Hair replacement, ed 1, St Louis, 1996, Mosby, p 131.
5. Limmer BL: Elliptical donor harvesting. In Stough DB, Haber
RS, eds: Hair replacement, ed 1, St Louis, 1996, Mosby, p 142.
6. Hitzig GS: Pulley suture utilization in scalp reconstruction
surgery, J Dermatol Surg Oncol 18(3):220, 1992.
7. Hwang SJ, Lee JJ, Oh BM, et al: The effects of dehydration,
preservation temperature, and time on the hair grafts, Ann
Dermatol 14(3):149, 2002.
Figure 44-13
Implantation of the follicular units between existing hairs.
Figure 44-15
A patient who underwent one replacement procedure.
Figure 44-14
Preoperative and postoperative views of a patient who underwent one session.
HAIR TRANSPLANTATION IN ASIANS
420
8. Kim JC, Choi YC: Hair follicle regeneration after horizontal
resecting: implications for hair transplantation. In Stough
DB, Haber RS, eds: Hair replacement, ed 1, St Louis, 1996,
p 358.
9. Lee SJ, Lee HJ, Hwang SJ, et al: Evaluation of survival rate
after follicular unit transplantation using the KNU implanter,
Dermatol Surg 27:716, 2001.
421
Page number followed by b indicates a box; f, a figure; and
t, a table.
A
ABNOM (acquired bilateral nevus of Ota–like macules),
403–404
before laser surgery, 406f
measures for improving clinical outcomes for patients
with, 408t
with QS lasers, 409
suggested treatment parameters for, 406t
Acellular dermis, 212
Acne vulgaris, temporary aggravation of, 397
Acquired bilateral nevus of Ota–like macules. See
ABNOM
Acute nasolabial angle, 235
AdvantaTM implant insertion, 290–291
Aesthetic facial skeletal surgery, introduction to, 307
Alar base
drastic thinning of, 276f
postoperative view showing narrowed, 168f
preoperative view showing broad, 168f
reduction procedures, 150
resection, 273f
simple pressure across, 321
sutured, 272f
Alar margin, 269
Alar rim, 271f, 274f–276f
Alcaine®, 118
Alexandrite and Ruby, 402
Allergy and cardiac toxicity, 398
Alloderm? graft, 83f, 212, 290–291, 293, 313
Alloderm? implant, 294f
Alloplastic materials, for nasal augmentation, 229
Alpha hydroxy acids (AHAs), 387
Anatomic chin implant with mandibular extension, 343
Angle-molar tooth line, 355–356
Angle ostectomy, 360f, 364f
illustration of intraoperative view of, 366f
using an offset oscillating saw, 365
Angle-splitting ostectomy, 371, 372f–373f, 374f, 375
Angle tooth line, 359f
Anterior malar osteotomy line, 331f
Anterior nasal spine, 153
Anterior sliding genioplasty, 373f
Arbitrary line, on forehead skin/lateral aspect of eyebrow,
124
Areolar tissue and levator aponeurosis, 52
Arlt method, 87, 88f
Asian beauty, traditional concept of, 363
Asian eyelid, cross-section view of, 4f
Asian facial bone structure, 363
Asian males with upper eyelid redundancy, 65–67
Asian nose, anatomy of, 229
Asians and Caucasians
eyelid, anatomic differences between, 2
hair transplantation, differences between, 413
Aspirin, 49, 327
Asymmetry, 21, 78, 82f
nostrils, 198
correction of, 281
as potential side effects, 33
and relapsed double eyelids, 69f
and unfavorable results, 69
Augmentation rhinoplasty, 193
ancillary procedures, 150
anesthesia for, 202
auricular cartilage harvesting, 231
with autograft/alloplasty combination, 201–209
autologous grafting material, 230
Index
INDEX
422
Augmentation rhinoplasty (cont’d)
with bone graft, 253–256
anesthesia, 253
complications, 256
consultation of, 253
postoperative care, 256
preoperative preparation, 253
recovery after, 256
with cartilage graft, 229–251
anesthesia, 230
complications, 251–252
consultation, 230
instruments and supplies, 230
patient selection for, 229–230
postoperative care, 243–246
recovery after, 246
costal cartilage harvesting, 231, 233–234
dressing, 150
with endonasal/external rhinoplasty approach, 234
instruments used for, 146f
introduction to, 137–144
postoperative evaluation of, 150, 151f
potential complications of, 251–252
preoperative evaluation of, 141, 151f
with silicone implant, 193–194
surgical approach to, 141, 204
using autograft and alloplast combination, 143
Auricular cartilage, 143
LLCs with, 264f
to prevent graft visibility, 242
Autograft, 172
and alloplast, combination of, 202
augmentation rhinoplasty, 143
Autoimmune diseases, 394
Autologous cartilage, options for, 143
Autologous collagen, 289
B
Bacitracin, topical antibiotic ointment, 47
Baek method, 28, 28f
Bard-Parker surgical blade, 44, 52, 108
Bard-Parker knife handle, 12
Beta hydroxy acid (BHA), 387
Bilateral vestibular flaps, 216f
Biomatrix, 290
Biplanar forehead lift, 129, 132f
BK method, 29, 29f
Black nylon suture, 298
Blair method, 89, 94f, 100f
Blaskovics method, 91, 102f
Blepharoptosis, 33
Bloodstaining, of adipose tissue, 415
Blue peeling, 393
Boo-Chai method, 3f, 27, 27f
BotoxTM injections, 363, 379, 380
Botulinum Toxin A, 379
Bowman lacrimal double-ended probes, 10, 12f
Brow fat, 134f
Buried single suture technique, 20f
Buried suture technique, 8, 24–32, 33
Buttress graft, 237
C
Calavarial bone, 211
Calipers
to measure central width of tarsal plate, 43
measuring inner and outer points with, 11f
Calvatrial graft harvest, 310f
Canoe-shaped graft, 241
Cap graft, 261f
intraoperative placement of multilayered, 264, 265f
placement of, 262f
postoperative view, 262f
preoperative view, 262f
and shield graft, 264
Cartilage graft, 230
augmented dome with, 221f
in dorsal segment, 200
sutured with columellar cartilages, 174f
Catgut, suture materials, 24
Caucasian eyelid, 4f, 55f
Caudal extension graft, 235–237, 237f
back margin of, 236
shape and attitude of, 236
Cavum and cymba cartilage, 232f
Cefazolin
and clindamycin, 319
prophylactic antibiotic, 349
Cefuroxime, 405
Cephalexin, prophylactic antibiotics, 145
Cephalic rotation, 198
excessive, 198f
Cheek depression, 379
Chemical peel
characteristics of, 388–389
classification of, 387–388, 388t
consultation for, 394
preparation and pretreatment for, 394
INDEX
423
Chemical peel (cont’d)
procedure for, 395
skin-reaction response to, 395
Chemical skin rejuvenation, in Asians, 387–399
Chin augmentation with silicone implant, 343
anesthesia for, 343
complications of, 346
consultation for, 343–347
postoperative care of, 344–346
procedure for, 343
recovery after, 346
Chin fragment, with miniplate and screws, 351f
Chin implant, anticipated location of, 344f
Chin retrusion, treatment of advanced, 349
Chisel, 319
carving bone graft, 254f
Cicatrical columellar deformity, 216f
Cicatrization, 398
Circumvestibular mucosal incision, intraoral finding
before, 350f
Clindamycin, prophylactic antibiotic, 349
CO2 laser, 52
Coal acid, 389
Collagen injection, 289
Columella-labial angle, 183, 269
retrusive columella and, 269
Columellar deviation
asymmetric strut fixation causes, 258f
result of an excessively long L-shaped silicone implant,
214
Columellar implant
inside deep sublabial pocket, 186f
long, supratip lobular redness caused by, 197f
to provide tip projection, 139
Columellar incision, skin closure of, 173
Columellar strut implant, 147–148, 183, 257–262
with cartilage graft-enhanced tips, 214
closure, dressing, postoperative care, and recovery, 186
consultation with patients for, 183–184
from dorsocolumellar implant, 184
intraoperative view, 257f
and L-shaped implant, 269
placement of, 257f
preoperative care, medications, anesthesia, and
instrument for, 184–185
shortening, 163
Composite auricular graft, use of, 284f
Conjunctival irritation, 72
Conjunctival suffusion, 71
Contact dermatitis, 9
Contagious impetigo, 394
Convex face, in Asians, 335
Cool Glide Xeo, 393
Cool Touch laser, 393
Corrugator supercilli muscle bundles, 126, 128
Cortex anterior, 374
Costal cartilage, 220, 268f, 279
absorption rate of, 211
to augment and lengthen nose, 282f
carved for the septal repair, 225f
for dorsal augmentation, 231–234
dorsal grafts, 233f, 234f, 246f
extended spreader grafts from, 281f
for nasal augmentation, 225f
harvesting, complications during, 220
nasal graft, warping of, 200f
septal and dorsal reconstruction with, 225f–226f
shield and cap graft, 264
Crease construction, 46f
Crepe wrinkled pretarsal skin, an unfavorable results, 70
Crow’s feet area
for lateral orbital rim, 62f
skin redundancy over, 63
Cutaneous suture technique, 23
D
Darvocet N-100TM, 50, 297, 303
Deep dermal sutures, at dermis muscle junction, 300
Deficient maxilla, advancement of, 319
Depressed scar, scar revision of, 76f
Depth problems, 76
deep crease, ectropion, or both, 76
shallow crease or loss of fold, 76
Dermal plane, needle travels on, 27
Dermis, 212
and muscle, suture thread on, 35, 36f–39f
and tarsal plate, 24
Dermofat/Fascial graft
consultation on, 294
graft harvesting, 294
postoperative care, 296
procedure, 295
recovery, 296
Diazepam (Valium), 414
Dish face, correction of, 319–325
anesthesia, 319
complications, 321–324
instruments, 319
INDEX
424
Dish face, correction of (cont’d)
preoperative care, 319
procedure, 319–321
recovery, 321
Dissection
columellar, 147, 156
dorsal pocket, 146
lower dorsal, 156
periosteal, 147
sublabial, 153–155
tip, 156
Distinctive double eyelid fold, 135f
Distortion, local anesthetic to avoid, 107
Dome-binding sutures, 215
Dome cartilages, 172, 177f
Dome skin, 172
Donor harvesting technique, 414
Dorsal augmentation, 204, 241–242
tip projection and supratip break after, 209f
Dorsal component, 147
Dorsal hump, masking of, 188f
Dorsal implant
dimensions of, 140f
for shallow dorsum, 138
Dorsal irregularity, result of inadequate implant carving,
214
Dorsal pocket, 236f
Dorsocolumellar implant
to assist tip projection, 138
dimensions of, 140f
as solid stabilizer, 138
Dorsum
postoperative view showing balanced, 165f
postoperative view showing straight, well-defined, 166f
preoperative view showing a sharp, deviated, 166f
preoperative view showing shallow, 165f
Dot and lacrimal lake, relationship between, 108f
Double ball retractor, 146
Double break, exaggerated, 198, 198f
Double eyelid crease accentuates, creation of, 5f
Double eyelid fold, 34f
creation with cotton-tipped applicator, 50f
as narrower, 17f
postoperative view of, 5f, 58f
relapsed, 70f
size of, 51
Double eyelid lines, loss of, 21
Double eyelid operation, 1, 3
for aging patient, 61–68
complain of unfavorable results after, 75
consultation with patients for, 62
postoperative care and recovery of, 67, 108f, 115f
preoperative care, premedication, and anesthesia for,
62–67, 108f
surgical microscopes for, 35
thick fold after, 71
Double or multiple Z-plasty methods, 89
“Downtime”, 401
Droopy lateral folds, an unfavorable results, 70
Durometers, to define hardness of implant, 139
Dysport, 378, 383f
E
E-PTFE, 202
and auricular cartilage, 202
between cartilages, 203f
dermis and, 202
Jung’s forceps for placement of soft, 205f
layers of soft, 204f
wrapped in dermofat graft, 222f
Ecchymosis, 165
as potential side effects, 33
Ectropion, 63
from excessive pulling on skin, 37
Edema, of nasal root and nasal tip, 164f
Elastic net dressing, 331
En bloc skin-muscle excision, 66f
Endonasal approach
to augmentation rhinoplasty, 145
incisions for, 206f
and IV antibiotics, 211
Epicanthal fold
anomaly of reversed, 105
covering lacrimal lake, 105
Epicanthoplasty, 51, 105
classification of, 87
double eyelid surgery without, 115f
enhance aesthetic result of double eyelid surgery, 105
minor scar of, 73
scar formation with, 112
Epidermal flap, 129
hair shaft under, 128
lower incision of, 128
Epiphora, 71
Erbium YAG laser, 393
Erythema, 395
Eversion suture, 85f
Expanded fibrillated polytetrafluoroethylene, 290
INDEX
425
Expanded polytetrafluoroethylene (e-PTFE) nasal
implants, 198
deviated nose result of, 200f
Extrusion, 196
Eye drops, anesthetic, 9, 14f
Eyebrow position
as asymmetric, 64
postoperative view shows low, 59f
preoperative view shows high, 59f
as symmetric, 33, 64
Eyelid fold, removal of, 83–86
postoperative view of, 86f
preoperative view of, 86f
Eyelids
anatomic detail of, 35
covered with gauze, 32
ice pack, to lessen pain and edema of, 32
with less tarsal elevation, 72
marking of, 43f
measurements and markings with stretched, 50f
multiple film layers of, 35
parallel type, 34
postoperative view of puffy, 71f
ptotic change of, 52
single or poorly defined supratarsal creases, 62
skin excised on, 52f
tapered type, 34
on upgaze, 46
without epicanthal fold, 105
Eyes, gluelike discharge from, 21
F
Facial expression, disturbance in, 379
Famciclovir, 405
Fat
exposure of inner and outer orbital, 19f
extraction of
anesthetic solution on fat compartment to, 18f
inner and outer by lateral incision, 11f
by massage and compression of upper eyelids, 18f
grafting, in preseptal space, 79
injection, 290
pushing eyeball to observe bulging, 54f
removal in multiple redundant folds, 44
removal of orbital, 19f
Fat pad, opening for patients with low preaponeurotic fat,
52
Fernandez method, 3f
Finasteride with/without minoxidil, 414
Fixation
on medial, central, and lateral points, 35, 38f
orbicularis oculi-levator aponeurosis, 66f
plication of levator muscle during, 72
pretarsal orbicularis oculi muscle cuff for, 55f
skin-levator aponeurosis, 65
tarsodermal, 35
turnover septodermal, 35–37
Flowers method, 89
postoperative view, 99f
preoperative view, 99f
Flowers split V-W advancement flap, 99f
Foman/Metzenbaum type, 146
Forehead
guideline for advancement of, 125f
hairline incision for patients with high, 127
skin excision, excess, 133f
Forehead flap fixation, 130f
Forehead lifts, beneficial effect of, 123
Fox method, 91
for lateral canthal lengthening, 101f
modification of, 102f
Free fat or dermofat graft, 79
Freehand technique, 113f
Frenulum
clipping, 153
cut with scissors, 157f
Frontalis muscle plication with multiple horizontal
mattress sutures, 133f
Fuente del Campo method, 89, 97f
Full dorsocolumellar implant, 139
G
Galea with interrupted 3-0 VicrylTM sutures, 331
Gauze roll/elastic bandage, for hemostasis, 129
Geneva pattern, 12, 150
Genioplasty, 340, 349–353, 372
anesthesia, 349
complications, 351
instruments, 349
postoperative facial views after, 352f–353f
preoperative care, 349
procedure, 349
recovery, 350–351
Gingivobuccal incision, 364f
Gingivolabial frenulum, as infiltrated, 155f
Glue and adhesive tape, nonsurgical alternatives, 33
Glycolic acid, 388, 397
pKa value of, 388
INDEX
426
Glycolic acid (cont’d)
preparation, 388
storage, 389
Gore-Tex TM, 137, 202, 204, 211–212, 213f, 214, 216, 229,
290–291, 314
fixation of, 315f
incision for, 315f
for nasal augmentation, 146
for paranasal augmentation, 315f
Grafts
drying of, 416
on Petri dish, 416
planning of peripyriform sinus placement of, 310f
preparation, 416
H
Hair transplantation
in Asians, 413–420
implantation, 417
postoperative course and complications, 418–419
preoperative instructions and anesthesia, 414
Hammering, to separate cortical bone from cancellous
bone, 375
Harado and Komato method, 25, 25f
Hata method, 24, 24f
problem with, 24
Hayashi method, 2f
Hemostasis
with bipolar cautery, 303, 367
reduces hematoma formation/wound breakdown,
350
Henderson-Hasselback equation, 388t
Hering’s law, 33
Herpes labialis, 394
Herptic, bacterial, and mycotic infections, 398
Hibiclens, appropriate antiseptic solution, 327
High fold
correction of, 78f–79f
and deep creases, 75
mechanism of failure in, 76, 80f
and moderately deep creases, 75
postoperative, 78f
preoperative, 79f
and shallow creases, 75
Hiraga method, 87–88
postoperative view, 89f
preoperative view, 89f
refinements of, 88, 91f
Hori’s macules, 403
Horizontal/oblique injection method, 383
Horizontal osteotomy, 350f
Hughes simple Y-V advancement flap, 89, 97f
Human immunodeficiency virus (HIV), 414
Hydroxyacetic acid, 388
Hydroxyapatite granules, use of porous, 313
Hylaform, 290
Hyperpigmentation
after treatment with glycolic acid peel, 397f
and depigmentation, 395
host factors for, 397
Hypertrophic epicanthoplasty scar, 73f
Hypertrophic scar, 73, 103f
I
Ideal Asian eyelid, properties of, 87
Iliac bone graft, 143, 254f
Implant
augmentation rhinoplasty, 141
calcified silicone, 199f
capsule formation around, 141f
columellar strut, 138f
dorsal, 138f
dorsal augmentation using, 201
dorsocolumellar, 138f
handling of, 156–157
hardness of, 139
insertion of, 157
malposiion, 193
materials, use of, 290
modification of, 163
partial columellar, 138f
partial dorsal, 138f
placement and modification of, 149
positioning of, 157
silicone, 147
size and shape of, 138–140
suture fixation of, 183
Imre method, 89, 92f
Incision line, 34f, 329
cause triangle-shaped double eyelids, 34
double eyelids with, 34
drawn with medial and lateral point of bougie, 34
parallel to ciliary margin, 51f
upper
parallel to ciliary margin, 63f
with primary gaze position, 63f
Incision technique, 1
advantage of, 33, 49
INDEX
427
Incision technique (cont’d)
disadvantages of, 33
limitations of, 33
using microscope, 33
Incisions
bilateral marginal, 171
external rhinoplasty, 142
lower line of, to determine shape and height of
surgically created crease, 44
paramedian and lateral, 125f
precolumellar and marginal, 142
pretrichial, 127–129
sublabial, 142
transcolumellar, 171
vestibular, 141
Incomplete folds, an unfavorable results, 70
Incrustation, 398
Infraorbital nerve, regional block of, 153
Infratip lobular area, depressed scar of, 195f
Integrated columellar strut dorsal graft, 246f
Intermaxillary fixation, 337, 339
Intoxication, 398
Intraoral incision, 373
Intubation
nasotracheal, 363
orotracheal, 363
Inverted V transcolumellar incision, 171f
IPL devices, suggested parameters for, 404t
J
Jessner’s solution, 387
preparation, 389
and salicylic acid, 393
storage, 389
Joseph periosteal elevator, 153, 160f, 171
for periosteal dissection, 204
Jung method, 31, 31f
Jung’s forceps, 208f
K
Kenalog, 245
Ketamine hydrochloride and propofol, 202
KLS Martin hexa-headTM, 126
KLSTM screw, 130f
KLSTM titanium screw, 185
KNU implanters
graft implantation using, 417f
types of, 417f
L
L-shaped dorsocolumellar implants, 229
L-shaped silicone implant, design of, 147t
Labial frenulum, to identify midline, 320
Lacrimal probe, under suture, 17f
Lactic acid
preparation, 389
storage, 389
Lagophthalmos, 72
Laser and intense pulsed light source
advantages and disadvantages of, 401–402, 401t
for treatment of pigmentation problems in Asians,
402–404
Lateral canthoplasty, 89–103
anesthesia for, 118
in Asian eyelids, 117
with the double-eyelid operation, 117
indication of, 117
markings for, 117, 118
operative procedure for, 118–119
postoperative view of, 119, 121f
preoperative marking for, 118-119
with skin-conjunctival flap elevation, 119
Lateral canthus, anatomy of, 117
Lateral cartilage and septum, 156
Lateral crural grafts, 240
Lateral donor harvesting, 415f
Lateral ligation method, 8
immediate postoperative views of, 20f
making for, 9
patient selection for, 8
preoperative view of, 20f
procedure for, 19
Le Fort I osteotomy, 313, 340, 322f
Lentigine, 402
before laser surgery, 403f
Lesolucynol, a component of Jessner’s solution, 398
Levator aponeurosis, 33, 39f
identification of, 52
needle passing, 56f
with orbicularis oculi muscle, 50f
tarsal plate and, 75
Levator-orbicularis fixation, 57f
Lid crease, formation of, 46
Lidocaine hydrochloride with epinephrine, 329
Lidocaine/marcaine with epinephrine, 124
Lidocaine with epinephrine, 35, 51, 64, 118, 153, 230–231,
314, 320, 343, 373, 417
LifeCell, 212, 290
INDEX
428
Ligation
transconjunctival, 7
transcutaneous, 7
Ligature
as loose, 16
as tight, 16
Light-emitting diode (LED) laser, photomodulation using,
409
Lim’s lateral canthoplasty, pre- and postoperative view of,
121f
Lim’s method, 119
Line of fixation, supratarsal crease as, 57f
Lip
advancement
anesthesia for, 297
consultation, 297
dissection, 297
marking for, 297
postoperative care, 300
premedication, 297
preoperative care, 297
recovery, 301
augmentation, 289–296
consultation with patients for, 290
implant insertion, 291
injectable fillers, 289–290
pocket dissection, 291
postoperative view after upper and lower, 293f
procedure, 290
and cheek swelling, 368
marking on white, 299f
reduction, 305f–306f
anesthesia for, 303
consultation, 303
dissection, 303
postoperative care, 303
preoperative care, 303
recovery, 303
tattooing procedure, 297
thick and protruding, 289
vermilion, 293f
Lipophilic Jessner’s solution, for skin care of acne and oily
skin, 389
ListerineTM antiseptic solution, 153
Lobular component, 147
Local anesthetic infiltration, 154f
Local anesthetic solution, preparation of, 145
Long columellar implant, for an adequate tip projection,
176f
Long-pulsed Alexandrite laser, 403
Loss of fold
postoperative view, 81f
preoperative view, 81f
Low double eyelid, methods of raising, 77f
Low fold
postoperative, 79f
preoperative, 78f
Lower face-contouring surgery, 371
Lower incision, lateral extension of, 62f
Lower lateral cartilages (LLCs), 202, 264
Lumenis, 403
M
M3 plate system, 321
MAC, 124
Magnetic resonance imaging (MRI), 184
Malar complex
cephalic view of, 331f
mobilization of, 331f
Malar osteotomy
anterior and posterior, 329
operative procedure, 328–331
patient selection and preparation, 327–328
potential merits of, 327
Mandibular angle ostectomy, 340, 355, 363–369
anesthesia, 363
complications, 368
consultation, 363
instruments, 364, 364f
lifted by periosteal elevator, 366f
mandibular angle resection in correcting, 371
periosteal elevation over, 364
postoperative care, 368
precise extraction of, 361f
preoperative care, 363
procedure, 364
recovery, 368
softening of, 385f
Mandibular angle resection, to soften square jaw, 355
Mandibular angle splitting ostectomy, 371–375
anesthesia, 373
complications, 375
consultation, 372
instruments, 373
postoperative care, 375
preoperative care, 372
procedure, 373
recovery, 375
INDEX
429
Mandibular angle surgery, magnitude of, 379
Mandibular anterior segmental osteotomy, operative
procedure, 337–338
Mandibular bone, illustration of, 358f
Mandibular canal, 355f, 364f
anatomy of, 355
orientation of, 358f
traced on radiograph, 355
Mandibulogram, 355–361
construction, 355–356
illustration of, 358f
reconstruction, 356
Marcine with epinephrine solution, 124
Markings, 290
by fine felt-tip marker, 50, 106
Maruo method, 1f, 24, 24f
Masseter muscle
as quadrangular muscle, 377
volume, changes in, 379t
Masseteric aponeurosis, 374
Masseteric muscle hypertrophy, botulinum toxin type A
injection for, 377–386
indications, 377
injection technique, 377–379
Mastoid bone graft, 143, 254f
harvesting, 253–255
Maxilla with miniplates and screws, 322f
Maxillary and mandibular anterior segmental osteotomy,
335–341
anesthesia, 335
complications, 339
postoperative course, 339
preoperative evaluation, 335
Maxillary anterior segmental osteotomy, operative
procedure, 336–337
Maxillary retroposition, hallmark of, 313
Maxillary sinus, during medial malar osteotomy, 332
Mayo stand
for intraoral surgery, 335
for supporting nasotracheal tube, 335f
Med-Pore, 229
Medial and lateral points, marking, 11f
Medial canthal anatomy, 106f
Medial canthus, placement of an ophthalmic measure on,
11f
Medial crural cartilages, 177f
Medial epicanthoplasty, 87–104
Medial muscle cuff, 56f
Medpor®, 314
fixation of, 315f
for paranasal augmentation, 315f
MicroAirTM, 364f, 365
Mikamo method, 1f, 23, 23f
Milia, 73
Mitsui method, 2f
Mobilized malar complex
medial repositioning of, 331f
posterior repositioning of, 332f
superior repositioning of, 331f
Modified Mustarde method, 96f
Modified Park Z-epicanthoplasty, 89
Modified Z-epicanthoplasty, 57f, 113f
marking for, 110f
Moisturizing agents and ultraviolet-shield cream,
application of, 395
Mometasone furoate and fusidic acid, 403
Monacryl sutures, 237, 240
Monopolar bovie cautery
for cutting and dissection purposes, 45
to excise preaponeurotic fat pad, 44
Mosquito hemostat, 19f
Mueller’s muscle retract, 81
Mulliken-Hoopes method, 89, 97f
Multiple grafts, 263–264
Multiple Z-plasty, 216f
Muscle, as fixating medium, 49
Muscle cuff laterally, 56f
Mustarde method, 89, 95f
postoperative view, 96f
preoperative view, 96f
Mutou method, 26, 26f
N
Nanosecond, 401
Nasal augmentation
autologous grafting materials for, 229
graft choice, 279
postoperative care, 281
with short nose, 279
surgical technique, 279
Nasal base
freed from premaxillary bone, 184f
postoperative narrowed, 141f
preoperative wide, 141f
Nasal base-lifting procedure, 297
Nasal base reduction, 269–277
complications, 269–277
procedure, 269
INDEX
430
Nasal bone
dissection over, 156
grafting, 255
Nasal bridge, 201
and tip, postoperative view showing, 164f
Nasal dome skin flap development, 171
Nasal hump
postoperative view, 168f
preoperative view, 168f
Nasal lobule and dorsum, 145
Nasal septal cartilage, 143
Nasal tip, 201
as anesthetized, 153
augmentation
for Asians, 257–267
postoperative care, 264–268
cartilage modification, 183
deprojection, 263
as infiltrated, 153
lobule management, 237
major refinement in, 172
overrotation of, 279
partial dorsal to support and enhance, 139
support, 142
NASHA gel, 290
Nasotracheal intubation, 335, 373
Needle, to block supraorbital, supratrochlear, and
zygomaticotemporal nerves, 124
Neutral color, 149
Nonablative lasers, 393
Nonablative rejuvenation, 406
Nonablative skin rejuvenation, parameters and technique
for, 408t
Nonalloplastic augmentation rhinoplasty, in Asian patient,
229
Nonincisional technique
advantages of, 23
disadvantages of, 23
for double eyelid operation, 23
primary indication for, 23
Nose
closing, 242–243
contracted, 280–281, 285f–286f
corrected with extended spreader grafts, 215f
ideal shape of, 201
lengthening of short, 279
lengthening with bilateral and unilateral spreader
grafts, 284f
shortening of, 189f
Nostrils
columellar deviation and asymmetry of, 214
vertical orientation of, 168f
Nylon
with buried knots, 110
on P-3 needle, 54
suture materials, 24
O
Obagi peel, 393
Obwegeser inferior border retractor, 365f
Obwegeser retractor, 319
Obwegeser vertical osteotomy retractor, 365f
Ocular injury, 73
Ogawa method, 89, 92f
Oh method, 30, 30f
Oil, removal of, 395
Onlay graft, 261
Onlay/shield grafts, 183
Open/close test, 8f
Open rhinoplasty, 171–181, 185–186
implant fixation, 172
implant insertion, 171
marginal and transcolumellar incisions in, 206f
for nasal tip surgery, 204
postoperative care, 178
recovery, 178–181
Opthalmic antibiotic ointment, 32
Oral and topical medications, 394
Orbicularis and orbital septum, 45f
Orbicularis-levator fixation technique, 49–59
advantage of, 49
anesthesia for, 51–52
consultation with patients for, 49
dissection of, 52–53
instruments for, 52
marking of, 50
postoperative care for, 55
premedication for, 50
preoperative care for, 49, 58f
recovery from, 55–57
Orbicularis oculi-levator aponeurosis fixation technique,
conservative placement with, 62f
Orbicularis oculi muscle, 28, 35, 52
aponeurosis penetration on, 2
excising strip of, 1
forceps grasping, 55f
Orbital fat, 35
and levator aponeurosis, view of, 66f
INDEX
431
Orbital septum, 45
in Asian eye, 44
cutting levator aponeurosis for, 54f
laterally divided, 54f
with levator aponeurosis, 4f
medially divided, 54f
opening of, 44
penetrated with tip of scissors or needle cautery, 53f
Oropharyngeal cavity, 364
Osteotomy line, lateral view of, 331f
P
Palatal mucosa, use of digital pressure on, 320
Palpabral fissure, size of, 51
Paraffin
and liquid silicone, 215
perforated skin during removal of, 223f–224f
and silicone, injection of, 193
use of, 137
Paraffinoma, 138f, 193f
Paranasal augmentation with implant, 313
anesthesia, 314
complications, 314–317
instruments, 314
preoperative care, 313–314
procedure, 314
recovery, 314
Park dorsal implant, 140t
Park dorsocolumellar implant, 140t
Park epicanthoplasty scar, 115f
Park method, 4f, 89
Park Z-epicanthoplasty, 105–115
anesthesia, 107
consultation with patients for, 105
design of, 109f
dissection, 107
postoperative care, 112
postoperative view (both eyes), 93f
postoperative view (one eye), 93f
preoperative view (both eyes), 93f
preoperative view (one eye), 93f
recovery, 112
Park Z-plasty, 93f
Partial columellar pocket, 183f
Partial-incision double eyelidplasty, 33
anesthesia for, 35
clinical cases of, 40
consultation of patient for, 33
dissection for, 35
marking of, 33–34
postoperative care of, 37
preoperative care of, 33
recovery from, 37–40
Peeling agents
application of, 395
pharmacologic agent of, 389
removal of, 395
Peeling, pretreatment for, 395
Perichondrium, careful dissection of, 231
Periocular arterial anatomy, 117f
Periorbital area, 135f
Periorbital ecchymosis and swelling, 131
Periosteal elevation, 127f
Periosteal/galeal sutures, 128
Periosteum, 374
elevated from nasal tip, 160f
elevation of, 366
with Obwegeser inferior border stripper, 365f
with periosteal elevator, 343
and upper lateral cartilage, 154f
Persistent redness, 196, 196f
Petroleum jelly, applied for scar, 394
Phenol, preparation, 389
Phenylephrine, 321
Philtral advancement, 300f
Phisohex antiseptic solution, 327
prepping, 295
soap, 64
Pig nose, 183
Pinch technique, 64f
“Pinocchio-type” nose, 214, 263
Plaster tape, to prevent multiple creases, 76
Plumping graft, 261
postoperative view, 262f
preoperative view, 262f
Pneumothorax and excessive scarring, 220
Pollybeak deformity, 196, 197f
Polydiaoxane suture (PDS suture), 257
Polymixin, topical antibiotic ointment, 47
Polytetrafluoroethylene, 290, 313
Popping, 418
“Popping-up” phenomenon, 418
Porous polyethylene Medpor, 313
Post molar gum area, 359f
Postauricular incision, 232f
Posterior malar osteotomy, 331f
Postinflammatory hyperpigmentation (PIH), 402, 402f
Povidone-iodine solution, 145
INDEX
432
Preaponeurotic fat
displacement, 85f
formation of multiple creases after removal of, 71f
removal of, 62
unnamed transparent capsule, 71f
Preaponeurotic fat pad, 44
confirming preaponeurotic space, 45f
removed from fatty and full upper eyelid, 30
Premaxilla, periosteum of, 153
Premaxillary augmentation with bone graft, 309
anesthesia, 309
complications, 311
consultation, 309
perinasal bone graft fixation, 310
postoperative care, 310–311
preoperative care, 309
recovery, 311
skull bone graft harvesting, 309
Premaxillary bone, exposure of, 310f
Premaxillary bony erosion, 218f
Preseptal graft, 82f
Preseptal orbicularis, 45
Preseptal tissues, 39f
Pressure
infratip lobular, 196
supratip lobular, 196
Pretarsal and orbital soft tissue technique, 2
Pretarsal area, preaponeurotic fat penetration on, 2
Pretarsal fullness, 76–78
postoperative view, 81f
preoperative view, 81f
Pretarsal orbicularis, excision of, 45
Pretarsal show, 57f
Pretarsal tissue, 35, 38f
with tarsal plate, 80f
Pretrichial forehead flap, suture fixation of, 131f
Pretrichial forehead lift, alternative to four-hole
endoscopic forehead lift, 131f
Pretrichial incision, modified, 131f
Priming, skin care regimen, 395
Prominent and asymmetric malar complexes, 333f
Proparacaine hydrochloride, 118
Propofol drip, 204
Propofol/midazolam, 204
Prosthesis
columellar portion of, 149f
dorsal component of, 149f
effect of, 149
Ptosis, 79–83
due to postsurgical edema, 72f
on left eye
operative view, 84f
postoperative view, 84f
preoperative view, 84f
by levator muscle, 72
Ptotic eyebrow fat, removing, 66f
Puffy double eyelid folds, persistent postoperative,
123f
Pulse oximetry, to determine appropriate level of
sedation, 145
Punch-out acne scars, 405
Pushing and spreading motion technique, 156
Q
Q-med, 290
Q-switched lasers, 402
R
Radiofrequency
advantage of, 409
bipolar, 409
and light-emitting diode, 409
unipolar, 409
Radix, 201
RAE nasotracheal intubation, 335
Ramus
Obwegeser vertical osteotomy retractor on posterior
border of, 363, 365f
view of the posterior border of, 365f
Reduction malarplasty, 327–334
with anterior and posterior malar osteotomies, 327
cautions, 331–332
complications, 331
coronal incision for, 328f
postoperative course, 331
Relapse, and unfavorable results, 69
Retruded chin, preoperative facial views of, 351f–352f
Revision augmentation rhinoplasty, 211–227
Revision double eyelid operation, 75–86
high fold, 75
low fold, 75
Revision rhinoplasty
after wound healing and scar maturation, 211
in Asian patient, 211
Revisional Asian blepharoplasty
postoperative photograph of, 47f
preoperative photograph of, 47f
Rhinoplasty approach, external, 235f
INDEX
433
Rib, 143f
calcified, 231
Rib cartilage graft, method of augmentation rhinoplasty,
143
Rib cartilage harvesting, 143
Rigid fixation, using miniplates, screws, and interdental
wires, 341
Rogman method, 89, 92f
Ropivacaine, 35
Rotated implant, intraoperative view of, 199f
Rubin and the Harold classification, 388
Rudimentary supratarsal crease, illustration of, 51f
S
Saddle nose deformity, 220–226
Salicylic acid, 387, 389
preparation, 389
for producing crust formation, 398
for skin care of acne and oily skin, 389
storage, 389
Salicylism, 398
Sam Facial implantTM, 291
SamTM, 290–291
Sayoc method, 2f
Scar
formation, 114f
keloid or hypertrophic, 343
submental, 343
wide and depressed, 75
Screw fixation, 184f
use of, 183
Seborrhoeic keratosis, 402
Sellion, posterior point of nose, 201
Sensory innervations of the forehead skin, 126f
Septal/auricular cartilages, 211
Septal cartilage
bilateral spreader grafts from, 281f
for mild to moderate degree of dorsal augmentation,
230
Septal incision line, 39f
Septal window, creating, 66f
Septum
with levator aponeurosis, 37
orbital and aponeurosis, lower fusion point
between, 2
Sheehan method, 89
case presentation, 92f
postoperative view, 92f
preoperative view, 92f
Shield graft, 258
with cap graft, 266f
to lengthen nose, 281f
multilayered, 264
postoperative view, 260f
preoperative view, 260f
support, 264
Short pulse width, 401
Sigmoid notch/condyle, 374
Silastic, 229
Silicone, augmented tip with, 221f
Silicone columellar strut, 176f
Silicone dorsal implant, 177f
Silicone implant
beneath skin, 213f
induces capsule formation, 212
redness and swelling due to infected, 212f
removal of, 217f
strengths, 137–138
weakness, 138
Silicone/polytetrafluoroethylene, for nasal dorsal
augmentation, 137
Silicone rubber implant
for nasal augmentation, 137
and PTFE, 143
Silk, suture materials, 24
Single-bladed knife , to obtain strip, 415f
Single eyelid
acceptable Type II epicanthal fold in, 107f
cross-section view of, 36f
Single knot continuous buried method, 29
Single-stitch threading procedure, 15f
Single suture technique
advantages of, 8
anesthesia for, 9–10
complications of, 21
immediate postoperative view, 18f
instruments for, 10–12
marking for, 9
marking instruments for, 14f
operative instruments for, 15f
with orbital fat removal
marking for, 9
patient selection for, 8
procedure for, 18–19
patient selection for, 8
postoperative care for, 19–21
preoperative care for, 9, 18f
procedure for, 12–18
INDEX
434
Single Z-plasty methods, 89
Size dissatisfaction, an unfavorable results, 69
Skin
with 8-0 nylon, 38f–39f
color change, 212
conservative excision of, 65f
ellipse of, 83
excision of, 45
as fixating medium, 49
nasal tip, 212
preoperative view of thick eyelid, 65f
Skin-conjunctival flaps, view of, 118f
Skin excision conservative
postoperative view of, 68f
preoperative view of, 68f
Skin incision, 44
over marked crease, 44f
Skin-levator muscle ligation method, 7
and skin-tarsus ligation method, comparison
of, 7f
Skin-levator-skin fixation technique, 43–48
postoperative care for, 47
Skin muscle excision, at orbital rim, 63f
Skin-muscle island, 64
Skin peeling, 387
Skin redundancy
among same age group, 51
in upper eyelid, 67
Skin-tarsus ligation method, 7
drawbacks of, 7
Skull bone graft harvesting, 255, 255f
Skull bone/rib cartilage grafts, harvesting of, 143
“Sleepy eye” appearance, 9
Sodium bicarbonate, 51
Soft-diet formula, 339
Soft form implant insertion, 291
Soft lobular component, 148
Soft prosthesis, flexibility of, 148f
Spaeth method, 89
design, 96f
postoperative view, 96f
Spreader graft, on one side, 282f
Static crease, 46
Steroids, 394
Strenuous restrictions, for alloplastic lip augmentation,
296
Structural grafting, principles of, 229
Subcutaneous tissue and orbicularis oculi muscle, 52
Subdermal plane, 52
Sublabial approach, 153
anesthesia for, 153
instruments, 156f
instruments for, 153
postoperative care, 165
premedication, 153
preoperative care, 153
recovery, 165
Subperiosteal dissection, 329, 374
Subperiosteal tunnel, created from lingual surface, 337
Subtle tip elevation, pre- and postoperative view showing,
188f
Sunken eyelid, 71
dermofat graft, 83f
fat injection in
postoperative view, 84f
preoperative view, 84f
and multiple creases, 79
postoperative view, 83f
preoperative view, 83f
Sunken groove, 61
Superior tarsal border, myocutaneous flap along, 45f
Supralobular and infralobular tip pressure points, 157
Supraorbital and supratrochlear nerve branches, 129
Supratip depression, preoperative view of, 213f
Surgical lip augmentation, 290
SurgidekTM suture, 128, 270f
Suture fixation, between orbicularis and septum, 52
Suture granuloma, 73
Suture technique
multiple, 23–32
single, 7–21
Suture thread, cysts or exposure of, 21
Swelling
as potential side effects, 33
use of steroids for, 368
Symmetric pocket, goal of, 255
T
Taping with benzoin/steristrips, 178
Tarsal eversion
and ectropion, 71
and extra crease, 72f
Tarsal plate, fixated at lower level, 79f
Tarsodermal fixation technique, 35, 36f, 40
five-day postoperative view (eyes closed) of, 40f
five-day postoperative view (eyes open) of, 40f
four-month postoperative view (eyes closed) of, 40f
four-month postoperative view (eyes open) of, 40f
INDEX
435
Tarsodermal fixation technique (cont’d)
immediate postoperative view (eyes closed) of, 40f
immediate postoperative view (eyes open) of, 40f
preoperative view of, 40f
Tarsus
with anesthetic, distend, 14f
anterior surface of, 35
blood vessel plexus along, 35
height of, 44
during levator muscle stretched, 15f
measuring, 44
suture thread on, 36f, 38f
Tattoos and nevus of Ota, 401
TCA. See Trichloroacetic acid
Telfa pads, 417
Temporalis muscle fascia, 294
Temporomandibular joint (TMJ) function, 377
Tension
and poor design, scar formation closure with, 112
against supralobular tip, 162f
“Tent-pole” effect, 148
Tessier maxilla mobilizer, 320
Timer, to measure peeling time, 396f
Tip-defining points (TDPs), 201, 257
rhomboid-shaped, 202f
Tip deprojection, 196
preoperative view showing, 175f
Tip deviation, 217f
Tip graft
with buttress graft, 243f
with lateral crural grafts, 243f
Tip projection and columellolabial angle
postoperative view, 176f
preoperative view, 176f
Tissue, approximation versus strangulation of, 70f
Topical and oral medications, 394
Toxin with syringe, 378
Tragal cartilage, 211
Transdomal suture, 257
intraoperative views, 258f
postoperative views, 258f
preoperative views, 258f
Transfusion, 339
Transparency, 198
Trapezoidal debulking, of preaponeurotic platform, 43
Triamcinolone acetonide injections, use of, 112
Trichloroacetic acid
peels, 393
preparation, 389
primary agent for medium-depth chemical peels, 393
for spot application on senile pigments, freckles, and
acne, 387
storage, 389
Triple dome, 198
Trismus, 379
Turnover septodermal fixation technique, 37f
immediate postoperative view (eyes closed) of, 41f
immediate postoperative view (eyes open) of, 41f
one-year postoperative view (eyes closed) of, 41f
one-year postoperative view (eyes open) of, 41f
preoperative view, 41f
for thin eyelids patients, 35
Tweed and Begg, extraction philosophies of, 340
2-point stitch procedure, 10f
U
Uchida method, 89, 91, 103f
modification of, 99f
postoperative view, 98f
preoperative view, 98f
UltrasoftTM, 290
Umezawa method, 25, 25f
Upper eyelid
after conjunctival flap, 121f
dynamic crease of, 46
lacrimal bougie on, 34f
mark margin of, 11f
preoperative view shows heaviness of, 134f
skin and brow ptosis, redundancy of, 61
Upper incision, determination of, 62f
Upper lateral cartilages (ULCs), 159f, 204
Upper lid blepharoplasty
postoperative view of, 61f
preoperative view of, 61f
Upper lip
reduction, 304f
wedge resection of, 304f
V
V-Y advancement technique, 3
V-Y closure, to avoid alar base broadening, 320
Vermilion border, 297
Vermilion lip flap, 298
advancement, 298f
Vermilion mucosal flap
development of, 297
postoperative view of, 298f
Vermilion skin, 299f
INDEX
436
Versapulse, 403
Vestibular approach, 145–151
anesthesia for, 145
instruments for, 146
operative technique, 146–147
preoperative care, 145
preoperative medication, 145
Vestibular dome with chromic catgut suture, 173
Vestibular incision, impending implant extrusion by, 196f
Vestibular skin with dome cartilage, 158f
Vicodin ESTM, 153
Vicryl TM with interrupted sutures, 316f
VicrylTM dermal sutures, 298, 300, 350
Vitamin E, 327
Volume distribution, 3-cc syringe for accurate control of,
380
Von Ammon method, 87, 89, 100f
W
W-plasty technique, 3, 89
Watanabe method, 87–88
postoperative view, 90f
preoperative view, 90f
Wetfield cautery, 44
Woodland, 290
Wound, closure of, 46
Wound dehiscence, 282
X
XanaxTM, 50, 153, 297, 303
Xylometazoline nasal spray, a nasal topical medication,
321
Xyloxaine with epinephrine, 43
Y
Y-V advancement flap, 89
Yankauer suction tip, evacuating saliva with, 368
Z
Z-epicanthoplasty, 105
with double eyelid procedure, 106
incision for, 107
original and modified, 110f
Z-plasty method, 3, 88–89
Zealous taping, 163
Zigzag hairline pattern, 128
Zygomatic arch
for anatomic orientation, 381
with incised periosteum, 329f
schematic cross-sectional diagram of dissection toward,
329f