• The Technical Use of Croton Oil Peels
on darker-skinned individuals and is usually the result of sun exposure. Sun
avoidance and protection are important in prevention, as is the pretreatment to
suppress melanocytes. If hyperpigmentation occurs, it is treated with tretinoin
and hydroquinone 4%. Although it can linger a few weeks, permanent problems
have not been seen.
-
tically with valacyclovir, 500 mg twice a day for 3 days before the peel and con-
tinued for 7 days after. An outbreak is suspected if intense itching and dysesthe-
sias occur. With altered epithelium , the outbreak can resem ble erythem atous
lesions as opposed to vesicles. The treatm ent consists of doubling the dose of
the oral antiviral and application of a topical antiviral such as penciclovir. The
topical medication should be applied with a cotton-tipped applicator to prevent
heals without scars.
Genital herpes infections that are transferred to the face are more virulent and
of the virus, so all patients need to be warned to wash their hands thoroughly
before applying any ointment or touching the face.
The possibility of ectropion should always be considered when peeling the lower
lid if laxity is present. Sequential lighter peeling and a tarsorrhaphy stitch are
helpful in preventing problems; a formal canthopexy is another consideration.
Mild tension in the lower lid may occur after peeling and responds well to mas-
Milia can be seen early in the healing process and m ay be related to the use of
occlusive ointm ents. Milia usually respond to tretinoin or gentle excision with
Prolonged erythema (persisting longer than 12 weeks) may be related to the use
of occlusive petrolatum ointments containing antibiotics. It has also been seen
when the skin preparation was shortened or om itted. It always subsides com -
pletely and does not require treatment. Erythema has notably decreased using
the postpeel treatment with taping and bismuth subgallate paste.
CONCLUSION
Stone of deep chem ical peeling.2
caustic agent, and the croton oil concentration can be manipulated to bring about
a desirable clinical result without causing hypopigm entation. By lowering the
croton oil concentration, the “all-or-none” action attributed to the Baker peel
• The Art and Science of Croton Oil Peeling
disappears, and along with it the prim ary source of intim idation for surgeons.
of the anesthetic nature of phenol, and this is what allowed them to function.
Ironically, peeling has come full circle, and the peels of the 21st century are much
m ore like those of the lay peelers in the 1920s. By em bracing the past, we are
able to advance into the future. As m ore practitioners are involved and m ore
research is undertaken, croton oil peels will evolve and improve, and their true
potential will be realized.
When comparing croton oil peels with lasers, it is important to note that in ex-
perienced hands, laser resurfacing is a viable alternative, but som e important
not regenerated, possibly because of the thermal component, and the longevity
of the results is not comparable. The appearance of lasered skin can be thinner,
and there is a degradation of results after several years. The stability of peeled
skin is rem arkable and in older patients can be considered perm anent. When
peels, lasers would have to be proportionately better to justify recom m ending
them . I hope that this chapter gives the reader adequate guidance and encour-
agement to try these peels before investing large sums of money on a laser.
Peeling older patients to improve aging changes is a reality, and peeling younger
patients increm entally to keep up w ith aging is an am bitious but attainable
rejuvenation can be realized.
Technical Pearls
• Double-gloving prevents burns to the hand. Sterile gloves are m ore pro-
tective.
• Carefully drying the applying hand prevents inadvertent application where
not desired.
• The application material should not be wet enough to drip.
• The hand holding the application material should never cross over the eyes.
• Lubricant should not be applied to the eyes, and corneal protectors should
not be used.
• Elevating the head of the bed helps prevent the solution from rolling into
the eye.
• The surgeon must be vigilant for pooling at the inner canthus.
• A piece of gauze should always be available to absorb solution if needed.
• A handheld fan can be used to dissipate fumes.
• A full-face peel should not be rushed (at least 45 to 60 minutes).
• The Technical Use of Croton Oil Peels
REFERENCES
1. Baker TJ. Chemical face peeling and rhytidectomy: a combined approach for facial reju-
venation. Plast Reconstr Surg 29:199-207, 1962.
Plast Reconstr Surg 105:227-239, 2000.
3. Niam tu J III. Local anesthetic blocks of the head and neck for cosmetic facial surgery, I: a
review of basic sensory anatomy. Cosmet Dermatology 17:515-522, 2004.
4. Niamtu J III. Local anesthetic blocks of the head and neck for cosm etic facial surgery, II:
techniques for upper and mid face. Cosmet Dermatology 17:583-587, 2004.
5. Niamtu J III. Local anesthetic blocks of the head and neck for cosmetic facial surgery, III:
techniques for maxillary nerve. Cosmet Dermatology 17:645-647, 2004.
6. Niamtu J III. Local anesthetic blocks of the head and neck for cosmetic facial surgery, IV:
techniques for the lower face. Cosmet Dermatology 17:714-720, 2004.
their croton oil formulas. Plast Reconstr Surg 105:240-248, 2000.
peels. Plast Reconstr Surg 75:652-659, 1985.
formulae) and extreme pulsed laser CO2 resurfacing. Dermatol Peru 15:181-184, 2005.
-
cer prophylaxis. Arch Dermatol 142:976-982, 2006.
Baker TJ. The ablation of rhitides by chemical m eans: a preliminary report. J Fla Med Assoc
48:451-454, 1961.
Edison RB. Lighter phenol peels allow faster recovery and less discomfort. Aesthetic Surg J
16:239-240, 1996.
Plast Reconstr Surg 105:752-763, 2000.
-
ferent concentrations of phenol and croton oil. Plast Reconstr Surg 105:1061-1083, 2000.
Kaminaka C, Yamamoto Y, Furukawa F. Nevoid basal cell carcinoma syndrome successfully
treated with trichloroacetic acid and phenol peeling. J Dermatol 34:841-843, 2007.
Kaminaka C, Yamamoto Y, Yonei N, et al. Phenol peels as a novel therapeutic approach for ac-
tinic keratosis and Bowen disease: prospective pilot trial with assessment of clinical his-
tological and immunohistochemical correlations. J Am Acad Dermatol 60:615-625, 2009.
Landau M. Chemical peels. Clin Dermatol 26:200-208, 2008.
-
-
adelphia: Elsevier Saunders, 2013.
York: Springer-Verlag, 2000.
Stagnone JJ, Stagnone GJ. A second look at chemabrasion. J Dermatol Surg Oncol 8:701-705, 1982.
-
abrasion on normal and sun-damaged skin. Aesthetic Plast Surg 6:123-135, 1982.
Truppman ES, Ellenby JD. Major electrocardiographic changes during chemical face peeling.
Plast Reconstr Surg 63:44-48, 1979.
(Trang không có chữ)
Acid peels, 320–321
Acne scarring
derm abrasion for, 318
Microbotox for, 301–302
sharp needle intraderm al fat grafting
and subcision for, 101–102
Acyclovir, 69
Adipocytes
description of, 111–112
viability of, for nanofat grafting, 116–117
Adipose-derived stem cells, 111
A-frame deform ity, 36, 38, 156, 284
Aging; see Facial aging; Periorbital aging;
Skin aging
Alar artery, 270
Alpha-hydroxy acids, 5
Anesthesia
for augmentation blepharoplasty, 41
for m icrofat grafting, 24–25
for m idface volum ization, 227
for m inimal access cranial suspension
facelift, 24
for nanofat grafting, 119
for perioral rejuvenation, 64
for sharp needle intradermal fat grafting,
90
Angular artery, 220
Angular vein, 218
Antiviral prophylaxis, 330
Asian patients
forehead contouring in, 282
nose contouring in, 271–272, 275–277
supraorbital brow contouring in, 277–
278
upper eyelid contouring in, 286
Aspirin, 246
Atrophic craquelé, 88
Augmentation blepharoplasty
anesthesia for, 41
artistic considerations in, 56–58
concept of, 35–37
contraindications for, 38–39
description of, 18
indications for, 38–39
lower eyelid
indications for, 42
m arkings for, 42–43
m icrofat graft placement, 43
nanofat grafting w ith, 122–123
overcorrection in, 57
patient evaluation and selection for, 38
results and outcomes of, 46, 48, 50,
52–53
sausagelike fat deposit in tear trough,
57
technique for, 42–44
volume of fat injected, 44
in men, 201–203
m icrofat blending in, 55
morphologic considerations in, 56–58
overcorrection in, 56
overgrafting in, 54
patient evaluation and selection for,
37–38
postoperative care, 44
problem s and complications of, 54–55
resection blepharoplasty versus, 37–39
results and outcomes of, 45–53
temporal lift and, 171
upper eyelid
anesthesia for, 41
croton oil peel w ith, 365–366
markings for, 40–41
nanofat grafting w ith, 122–123
orbicularis muscle resection in, 42
patient evaluation and selection for, 38
results and outcomes of, 45–49, 51
technique for, 41–42
volume of fat injected, 42
Augmentation mastopexy, 37
Autologous fat grafting, 111
Baker, Thom as, 319, 337
Baker peel
“all-or-none” phenomenon of, 319, 321,
375
croton oil concentration in, 339
description of, 319–321, 336–337, 375
Basement membrane, 339
Index
Index
Beut techniques, for m idface volum ization
type 1, 229–232, 244–245, 247
type 2, 234, 244
type 3, 235–238, 244, 247
type 4, 239–242, 244, 247
Bilamellar approach, 365
Blepharoplasty
augmentation; see Augmentation bleph-
aroplasty
lower eyelid, 37
resection, 35
Blindness, 246
Botox; see also Microbotox
facial slim m ing technique using, 307
historical background on, 291–292
injection technique for, 294
mechanism of action, 293
Microbotox versus, 294–295, 308
objective of, 294
problem s associated w ith, 292–293
Bruce Connell view, 144
Bunny lines, 292, 300
Bupivacaine, 337
CAL; see Cell-assisted lipotransfer
Carbolic acid, 333
CD34+ cells, 117
Celecoxib, 331
Cell-assisted lipotransfer, 111
Centrofacial aging
case study of, 141–142
causes of, 326
croton oil peel for, 370
of, 16, 139
Centrofacial rejuvenation
case studies of, 143–208
description of, 16–18
m inimal access cranial suspension lift
w ith, 128–129
Cervicomental angle, 144–145
Cervicomental lift procedure, 154
Cervicomental sagging, 170, 174, 188,
204
Cervicoplasty, 16
Chem ical peels
Baker formula for, 319–321
croton oil; see Croton oil peel
deep, 342–343
history of, 318–320
hypopigmentation concerns w ith, 319,
322
preoperative planning and preparation,
328–330
skin preparation before, 328–329
Collagenase, 316, 329
Columellar artery, 270
Croton oil
caustic properties of, 333
chem ical peel using; see Croton oil peels
properties of, 333
Croton oil peels
ancillary procedures, 363–366
antiviral prophylaxis for, 330, 375
cardiac toxicity concerns, 337
case studies of, 159–160, 354–356,
367–374
contraindications for, 325–328
croton oil concentration in, 321
deep, 342–343, 374
defrosting, 342–343
depth of, 339–343, 345
description of, 317
discom fort after, 331
ectropion concerns, 375
epiderm al sliding, 343
erythema after, 329, 354–355, 358–359,
360, 362–364, 375
ethnic factors, 325–326
forehead assessments before, 327
history of, 319, 321
hyperpigmentation caused by, 375
hypopigmentation caused by, 374
indications for, 325–328
laser resurfacing versus, 376
light peels, 365–366
lower eyelid assessments before, 326
medical history-taking before, 329
medication prophylaxis, 330
m ilia after, 375
neck assessments before, 327
nose assessments before, 328
papillary derm is depth of, 342, 346–348
partial peels, 363–366
patient evaluation and selection for, 325
perioral skin, 339
postoperative care and recovery for
antibiotic-anesthetic cream , 353
bismuth subgallate application, 361-363
phases of, 353–359
Index
second phase of, 355, 358–359
zinc-oxide tape m ask, 359–361, 363
preauricular area assessments before,
327–328
preoperative planning and preparation,
328–330
problem s and complications of, 374–375
results and outcomes of, 354–356,
367–374
reticular derm is depth of, 342–343, 347
segmental peels, 363–366
skin preparation before, 328–329
skin thickening caused by, 374
skin thickness assessments, 327
sum mary of, 375–376
technical pearls for, 376
technique for
anesthesia, 336–337
anesthesia-free, 330–332
application process, 345–352
applying m aterials used in, 338
croton oil concentrations, 334–335
deep rhytids, 351
depth determ inations, 339–343, 345
description of, 343–352
in forehead, 346–347, 356
frosting appearance, 338, 342, 345–
346
intraoperative routine, 336–338
in lower eyelids, 349, 364, 371
in neck, 350
in nose, 350
olive oil, 336
operating room environment, 331
oral sedation, 331
patient positioning, 344
in perioral region, 345–346, 356
phenol, 330–331, 333–336
in preauricular area, 348
safety measures, 338
sensory nerve blocks, 337
solution preparation, 332–336, 344
in upper eyelids, 350
zone-based, 352–353
upper eyelid assessments before, 326
upper face assessments before, 326
Croton tiglium , 333
Crow’s-feet area, 8, 15, 192, 241–242, 244,
292, 296, 298, 300, 326, 328, 351–
353, 364
Cupid’s bow, 68–69, 73
Cytoskeleton, 339
Dark circles under eyelids, nanofat grafting
for, 123–125, 133
Décolleté area, nanofat grafting in, 125–
127
Deep medial cheek compartment, 218–220
Deep m icrofat grafting, sharp needle intra-
derm al fat grafting w ith, 94
Deep piriform space, 218–220
see
Depressor anguli oris, 308
Derm abrasion, 318
Derm al appendages, 341
see also
sharp needle intradermal fat grafting as,
88
Derm al papillae, 339
Derm is, 340–341
Desmosomes, 340
Ectropion, 37, 365, 375
Epiderm al sliding, 343
Epiderm is, 339, 341
Erbium -YAG laser resurfacing
description of, 320
lips, 75, 77
sharp needle intradermal fat grafting
w ith, 99–100
Estrogen, 316
European descent, patients of
forehead contouring in, 282
nose contouring in, 271, 273
supraorbital brow contouring in, 279–
281
Extrinsic aging, 87, 315–316
Eyebrow
in men, 281
tail of
temporal hooding of, 36–37, 48, 178
in women, 281
Eyelid(s)
assessment of, before croton oil peel, 328
hollow, 35–36, 57
laxity of, 38
lower; see Lower eyelid(s)
upper; see Upper eyelid(s)
Eyelid-cheek junction, 37–38, 42, 46,
48–53, 149, 167, 188, 190, 194, 198,
200–201, 204
Index
Face
center of, 17
emotional expressions from , 140–141
eye-tracking movements on, 140
weight changes in, 253
Facelift; see Surgical facelift
Facial aging; see also Skin aging
causes of, 315–317
estrogen decreases associated w ith, 316
extrinsic, 87, 315–316
38
factors involved in, 139, 196
gravitational changes associated w ith,
317
historical views on, 139
hormonal declines associated w ith, 316
intrinsic, 87, 315
lips, 67–69
mechanism s of, 5, 18, 37
modalities of, 7
periorbital region, 63–64, 77
process of, 317–318, 326
skin changes associated w ith, 5
structural changes associated w ith, 317
sun exposure and, 316–317
Facial anim ation, 8–9
Facial artery, 270
case studies of, 188, 196
centrofacial aging caused by, 16, 139
descent and, 17
facial sagging versus, 7, 14, 16
illustration of, 7
in periorbital area, 35, 56
treatment of, 87, 317
in upper eyelid area, 174
Facial expressions, 140
Facial fat atrophy, hinge hypothesis of, 8–9,
37, 88
Facial grooves, 8–9
Facial rejuvenation
case studies of, 143–208
fat grafting in; see Fat grafting
goal of, 14
history of, 6
volume distribution in, 15
Facial resurfacing
acid peels for, 320–321
chem ical peels for, 318–320
croton oil peel for; see Croton oil peel
dermabrasion for, 318
laser for, 320, 376
nonablation for, 320
Facial rhytids
perioral; see Perioral rhytids
sharp needle intraderm al fat grafting
for; see Sharp needle intradermal fat
grafting
Facial sagging
illustration of, 7, 17, 196
surgical facelift for, 5
in upper lip, 63
Fat cells, 8
Fat centrifugation, 26
Fat grafting
case studies of, 11–12
history of, 6–7
importance of, 7
surgical facelift and, 14
Fat particles, in m icrofat grafting, 21–22
Fat transfer, 6
Fibroblasts, 340
5–Fluorouracil, 374
Forehead
assessment of, before croton oil peel, 327
croton oil peel of, 346–347, 356
Microbotox of, 298–299, 307
volumetric contouring of, using soft tis-
Free radicals, 316
Geniom andibular groove, 348
Glabellar region
croton oil peel of, 346
Microbotox of, 298–299
Glycosam inoglycans, 316, 340
Grater-type cannulas, 22, 55
m icrofat grafting, 25–27, 113
sharp needle intraderm al fat grafting,
92
88
Index
see also
dilution for, 255
injection technique, 255–256
overview of, 253–254
patient evaluation and selection for,
254
postoperative care for, 256
problem s and complications of, 260
results and outcomes of, 257–260
technique for, 254–256
vascular complications of, 260
Infraorbital fat compartment, 215, 217
Intradermal fat injections, 88, 91; see also
Sharp needle intradermal fat grafting
Intravascular injection
prevention of, 133
safety considerations for, 30
Intrinsic aging, 87, 315
“inverted cone of youth,” 15
Jawline, Microbotox indications for, 302–
308
Jowling, 303–304, 306
Keloids, Microbotox for, 308
Keratinocytes, 339–340
Ketorolac trometham ine, 337
Lamellar bodies, 340
Laser resurfacing
croton oil peels versus, 376
Erbium-YAG
description of, 320
lips, 75, 77
sharp needle intraderm al fat grafting
w ith, 99–100
intraderm al fat injections and, 89
Lateral canthus rounding, 365
Lateral vertical reference, 222, 224
Levator labii superioris alaeque nasi, 219
Light therapy, 5
Lip(s)
aesthetics of, 67–69
case studies of, 77–80
female, 67–69
in frontal view, 68
liplift, 71–74, 81
lower lip to upper lip proportions, 67–68
m icrofat grafting of, 69–71, 76–80
problem s and complications of, 80–81
rejuvenation of, 66–67
results and outcomes of, 77–80
resurfacing of, 74–77, 81
upper
liplift of, 71–74, 77, 81
lower lip and, proportions between,
67–68
m icrofat grafting of, 77
rejuvenation of, 77
sagging of, 63, 71
vertical height of, 17
verm iliocutaneous border of, 68–69
volume enhancements of, 66–70
Liplift, 71–74, 81
cell-assisted lipotransfer versus, 111
description of, 6, 111
indications for, 16
Liposuction, cannulas for, 23
Lower eyelid(s)
aging deform ity of, 37
assessment of, before croton oil peel, 326
atrophic craquelé of skin of, 88
“bags” in, 38, 123–125
bilamellar approach to, 365
croton oil peel of, 349, 364, 371
dark circles under, nanofat grafting for,
123–125, 133
Microbotox application to, 292, 300
Lower eyelid augmentation blepharoplasty
indications for, 42
m arkings for, 42–43
m icrofat graft placement, 43
nanofat grafting w ith, 122–123
overcorrection in, 57
patient evaluation and selection for, 38
results and outcomes of, 46, 48, 50, 52–53
sausagelike fat deposit in tear trough, 57
technique for, 42–44
volume of fat injected, 44
Index
Lower eyelid blepharoplasty
augmentation; see Lower eyelid augmen-
tation blepharoplasty
description of, 37
traditional, 38
Lower malar partition, 223–224
Luer-Lok cannula, 23
Luer-to-Luer connectors, 114, 116
MACS lift; see Minimal access cranial sus-
pension lift
Malar area
fat grafting in
for acne scarring, 102
for lower eyelid augmentation blepha-
roplasty, 42–43
loss of volume in, 38
overcorrection of, 58
Malar equator, 222, 224
Marionette grooves, 8, 11–13, 27, 49, 76,
79–80, 88, 99–100, 188, 204
Matrix metalloproteinases, 316
grafting, 26
Medial m idface viaduct, for m idface volu-
m ization
Beut type 1, 229–232, 244–245, 247
Beut type 2, 234
Medial vertical reference, 222, 224
Mercedes cannula, 116
Microbotox
acne scarring applications of, 301–302
Botox versus, 294–295, 308
complications of, 307–308
description of, 291
dilutions for, 296
droplet distribution, 297
forehead applications of, 298–299, 307
historical background on, 291–293
indications for, 291
infraorbital complications of, 307
injection technique for, 295–307
jawline indications for, 302–308
keloids treated w ith, 308
lower eyelid application of, 292
neck indications for, 302–307
nomenclature associated w ith, 293
oily facial skin applications of, 301–302
origin of, 293
physiologic basis for action, 293
rosacea applications of, 301–302
sum m ary of, 308
undereye applications of, 300
Microfat grafting
anesthesia for, 24–25
cannulas for, 22–23, 112
complications of, 30
contraindications for, 23
description of, 112
dow ntime after, 23–24
fat particles in, 21–22
harvesting technique for, 25–27, 113
indications for, 23
injection of, 26–27
markings for, 25
m inimal access cranial suspension
facelift and, 12–14, 128–129
outcomes of, 29–30
overcorrection w ith, 30
patient evaluation and selection for, 23
patient positioning for, 25
patient preparation for, 23–24
in periorbital region, 15
postoperative care for, 28
preoperative planning for, 23–24
principle of, 21–23
problem s associated w ith, 30
results of, 29–30
safety considerations for, 30
survival of, 22
technical pearls for, 31
volumes of fat grafted per area, 27
Microlaser resurfacing, of upper lip, 75
Midazolam , 25
Midface
aging of, 213–214
analysis of, 222–223
anatomy of, 214–221, 326
deep medial cheek compartment of,
218–220
deep piriform space of, 218–220
fat grafting of, 154
infraorbital fat compartment of, 215, 217
nasolabial fat compartment of, 221
prem axillary space of, 218–220
prezygom atic space of, 214–216, 218
suborbicularis oculi fat of, 214, 216, 219
-
partments of, 221
Midface volum ization
anatomy of, 214–221
Index
ancillary procedures, 240
anesthesia for, 227
blindness concerns, 246
contraindications for, 213
indications for, 213
injection adverse-event zones, 225–227
injection target areas for, 222–225
insertion ports used in, 228
lateral vertical reference for, 222, 224
lower injection adverse-event zone,
225–227
lower malar partition, 223–224
m alar equator, 222, 224
m arkings for, 227
medial vertical reference for, 222, 224
m idface analysis for, 222–223
nasolabial insertion port, 228, 231, 238
patient positioning for, 227
postoperative care for, 240
preoperative planning and preparation
for, 222–228
problem s and complications of, 246–247
results and outcomes of, 241–246
setup for, 228
target areas for, 222–225
technical pearls for, 248
techniques for, 229–240
lateral m idface viaduct (Beut type 3),
235–238, 244, 247
medial m idface viaduct (Beut type 1),
229–232, 244–245, 247
medial m idface viaduct (Beut type 2),
234, 244
239–242, 244, 247
upper injection adverse-event zone,
226–227
upper malar partition, 223–224
Midfacelift, 153–154
Minimal access cranial suspension lift
anesthesia for, 24
case studies of, 10–11, 14
centrofacial rejuvenation w ith, 128–129
long-term results of, 9
m arkings for, 129
m icrofat grafting w ith, 12–14, 128–129
perioral rejuvenation and, 76, 79
sharp needle intraderm al fat grafting
w ith, 97, 103
Mouth
aging changes around, 63
facial expressions from , 140
Muscle hypertony, 5
Muscle hypertrophy, 5
Nanofat grafting
adipocyte viability analysis, 116–117
ancillary procedures for, 120
anesthesia for, 119
cell culture for, 117–118
clinical implications of, 118
clinical results w ith, 112
contraindications for, 113
dark circles under eyelids treated w ith,
123–125, 133
décolleté area applications of, 125–127
description of, 112
full-face applications of, 122–123
indications for, 113
injection technique used in, 119
m arkings for, 119
neck applications of, 128–131
patient evaluation and selection for, 113
patient positioning for, 119
perioral applications of, 120–121
periorbital aging applications of, 124–125
postoperative care, 120
preoperative planning and preparation
for, 113–115
problem s and complications of, 133
reconstruction applications of, 132
results and outcomes of, 120–133
stem cells, 117–118
technique for, 119–120
tools for, 114
Nasolabial fat compartment, 221
Nasolabial fold
anatomy of, 326–327
m icrofat grafting of, 64–66, 76, 88,
94–95
rhytids of, 103
sharp needle intradermal fat grafting of,
94–95, 98
subcision of, 95
Natural aging, 315
Neck
aging of, 327
anterior rhytids of, sharp needle intra-
derm al fat grafting for, 104–105
closed approach to, 16
croton oil peel of, 350
jowling of, 303–304, 306
Index
laxity of, 144–145, 149–151, 184, 192
Microbotox indications for, 302–307
nanofat grafting of, 128–131
open approach to, 16
sharp needle intraderm al fat grafting of,
130–131
Niamtu, Joseph III, 337
Nose
anatomy of, 268–270
arteries of, 270
assessment of, before croton oil peel, 328
croton oil peel of, 350
volumetric contouring of, using soft tis-
anesthesia, 274
in Asian patients, 271–272, 275–277
injection technique, 274–277
in patients of European descent, 271, 273
in women, 266
Obagi, Zein, 320
Oily facial skin, Microbotox for, 301–302
Olive oil, 336
Ophthalm ic artery, 268–269
Oral com m issures, 327
Orbicularis muscle, 42
Orbicularis oculi muscle
anatomy of, 214–215, 220
pinch and pull technique of, 235–236
Orbitomalar groove, 175
Orbitom alar ligament, 217
Overcorrection
in augmentation blepharoplasty, 56
in lip resurfacing, 81
in lower eyelid augmentation blepharo-
plasty, 57
in m alar area, 58
w ith m icrofat grafting, 30
in sharp needle intraderm al fat grafting,
107
Panniculus adiposus, 305
Panniculus carnosus, 305
Papillary derm is, 340
Peels; see Chem ical peels; Croton oil peel
Perioral region
croton oil peel of, 339, 345–346, 356
nanofat grafting in, 120–121
skin thickness in, 327
Perioral rejuvenation
anesthesia for, 64
lips
aesthetics of, 67–69
case studies of, 77–80
female, 67–69
in frontal view, 68
liplift, 71–74, 81
m icrofat grafting of, 69–71, 76–80
problem s and complications of, 80–81
rejuvenation of, 66–67
results and outcomes of, 77–80
resurfacing of, 74–77, 81
upper to lower lip proportions, 67–68
verm iliocutaneous border of, 68–69
volume enhancements of, 66–70
m inimal access cranial suspension lift
and, 76, 79
nanofat grafting for, 120–121
nasolabial fold correction, 64–66, 76, 88,
94–95
patient evaluation and selection for,
63–64
results and outcomes of, 76–80
technical pearls for, 82
Perioral rhytids
croton oil peel for, 369
description of, 15, 63, 75, 327
sharp needle intradermal fat grafting for,
96–98, 121
Periorbital aging
case study of, 77
mechanism s involved in, 18
nanofat grafting for, 124–125
traditional treatment of, 18
Periorbital region
aging of, 63–64
emotional expression in, 63
m icrofat grafting in, 15, 81
Phenol peels, 319, 330–331, 333–337, 375
Philtral colum ns
description of, 68–69
sharp needle intradermal fat grafting for
enhancement of, 106
Photoaging, 316
Pinch and pull technique, 235–236
Index
“Polar bear deform ity,” 53
Postorbicularis oris fat, 220
Preauricular area
croton oil peel of, 348
description of, 327–328
Prem axillary space, 218–220
Prezygom atic space, 214–216, 218
Procerus, 273
Reconstruction, nanofat grafting for, 132
Resection blepharoplasty
augmentation blepharoplasty versus,
37–39
description of, 35
lim itations of, 39
Reticular derm is, 340, 342
Retinoic acid, 5
Rhytids; see also Wrinkles
croton oil peel for, 351, 372–373
in décolleté area, 125–127
perioral; see Perioral rhytids
treatment of, 317
Risorius, 308
Rosacea, Microbotox for, 301–302
Safety
m icrofat grafting, 30
sharp needle intraderm al fat grafting, 91
Sagging; see Facial sagging
Sausagelike fat deposits in tear troughs, 57,
237
Scleral show, 37
Seborrheic keratoses, 315
Sharp needle intradermal fat grafting
acne scarring corrected w ith, 101–102
ancillary procedures w ith, 93
anesthesia for, 90
anterior neck rhytids corrected w ith,
104–105
case studies of, 76–77, 79–80
contraindications for, 88–89
deep m icrofat grafting w ith, 94
Erbium -YAG laser resurfacing w ith,
99–100
fat harvesting for, 92
fat resorption after, 93
of glabellar frow n lines, 93
indications for, 88–89
injection technique for, 92–93
m arkings for, 90
m inimal access cranial suspension lift
w ith, 97, 103
nasolabial fold, 94–95, 98
of neck, 130–131
overcorrection in, 107
patient evaluation and selection for,
87–88
patient positioning for, 90
perioral rhytids treated w ith, 96–98, 121
philtral colum n enhancement w ith, 106
postoperative care for, 93
preoperative planning and preparation
for, 89
problem s and complications of, 107
results and outcomes of, 93–106
safety during, 91
subcision m aneuver, 92
technical pearls for, 108
white roll enhancement w ith, 106
Skin
anatomy of, 339–342
hyperpigmentation of, 375
hypopigmentation of, 319, 322, 374
layers of, 339–341
resurfacing of; see Facial resurfacing
Skin aging; see also Facial aging
case study of, 196
changes caused by, 5
extrinsic factor that causes, 87, 315–316
factors involved in, 87, 315
intrinsic factor that causes, 87, 315
Skin care products, 5
“Sleep lines,” 326
SNIF; see Sharp needle intraderm al fat
grafting
see
also
anatom ic considerations for, 268–269
contraindications for, 267
description of, 265
forehead, 280, 282
historical context of, 266–267
indications for, 267
of nose; see Nose, volumetric contouring
of
preoperative planning and preparation,
267–271
results and outcomes of, 286
safety considerations for, 268–271
supraorbital brow, 277–280, 286
technical pearls for, 287
Index
see
also
temples, 283–284; see also
upper eyelids, 284–286
upper facial contouring, 265–267
vascular occlusion concerns w ith, 268
Solar elastosis, 316, 367–368
Stem cells
adipose-derived, 111
keratinocytes as, 339–340
m acrofat, 117–118
m icrofat, 117–118
nanofat, 117–118
Stratum basale, 339
Stratum corneum , 340
Stratum granulosum , 340
Stratum spinosum , 340
Strom al vascular fraction, 111–112
Suborbicularis oculi fat, 214, 216, 219, 236
Substance P, 293
Sun exposure, 87, 316–317
218
12–13
Supraorbital brow
description of, 266
volumetric contouring of, using soft tis-
Supraorbital nerve blocks, 284
Supraorbital ridge, 285
Surgical facelift
facial sagging corrected w ith, 5
fat grafting w ith, 14
options for, 5
stability of, 9–13
Sweat glands, 291, 295, 341
Synergy, 6
Tail of eyebrow
temporal hooding of, 36–37, 48, 178
in women, 281
TCA peels; see Trichloroacetic acid peels
Tear troughs
description of, 50, 52, 57
medial m idface viaduct (Beut type 1)
technique for, 229–232, 244–245
sausagelike fat deposit in, 57, 237
Telomeres, 316
-
dilution for, 255
injection technique, 255–256, 283–284
overview of, 253–254
patient evaluation and selection for, 254
postoperative care for, 256
problem s and complications of, 260
results and outcomes of, 257–260
technique for, 254–256
vascular complications of, 260
Temple wasting, 253
Temporal hooding, 36–37, 48, 178
“Tonnard” cannula, 22
Tretinoin, 329
Triazolam , 331
Trichloroacetic acid peels, 320–321, 374
Undercorrection, in lip resurfacing, 81
Upper eyelid(s)
assessment of, before croton oil peel, 326
augmentation blepharoplasty of
anesthesia for, 41
croton oil peel w ith, 365–366
m arkings for, 40–41
nanofat grafting w ith, 122–123
orbicularis muscle resection in, 42
patient evaluation and selection for, 38
results and outcomes of, 45–49, 51
technique for, 41–42
volume of fat injected, 42
croton oil peel of, 350
volumetric contouring of, using soft tis-
Upper facial contouring
aesthetic considerations of, 265–267
forehead, 280, 282
nose; see Nose, volumetric contouring of
supraorbital brow, 277–280
Index
temples, 283–284
upper eyelids, 284–285
Upper lip
liplift of, 71–74, 77, 81
m icrofat grafting of, 77
nanofat grafting of, 121
rejuvenation of, 77
sagging of, 63, 71
vertical height of, 17
Upper malar partition, 223–224
Valacyclovir hydrochloride, 330, 375
Verm iliocutaneous border
sharp needle intraderm al fat grafting en-
hancement of, 106
Vodder method, 28
Volume depletion, 6
Volume distribution, 15
White roll
121, 199
sharp needle intradermal fat grafting en-
hancement of, 106
Wrinkles; see also Rhytids
décolleté area, 125–127
perioral, 15, 63, 75
treatment of, 87
Xanthelasma, 124
(Trang không có chữ)