Color Atlas of Cosmetic Oculofacial Surgery

358
Index
D
deaths, botulinum toxin injection, 227
debulking in upper blepharoplasty, 40, 45, 49
Asians, 86, 87
advanced concepts, 104–6, 308, 311
depressor anguli oris, botulinum toxin injection, 214, 224
depressor labii inferioris muscle, botulinum toxin injection, 214
avoidance in depressor anguli oris injection, 224
depressor supercilii, botulinum toxin injection, 214
depth of crease in Asian blepharoplasty, differences between two
lids, 257, 259
dermatochalasis
Asian blepharoplasty in, 84, 98
± fatty prolapse or ptosis, 98
decision tree for management, 59
dermis (face)
eyelid, 10
fillers, 327–54
complications, 324, 325–6, 349–51
periorbital, 324–6
thickness, 237
dermis–fat graft, hollow supratarsal sulcus, 266
diet, postoperative, 2
digital photographs, 2, 3
discoloration, hyaluronic acid, 324, 325, 349
dissection pocket in transconjunctival laser lower blepharoplasty
see supraperiostal pocket
distichiasis, Asians, 7
documentation and records, medical, 1, 3
botulinum toxin injection, 228
hyaluronic acid filler injection, 352
double anchoring in cheeklift, 126, 143
downgaze (looking downwards), examination after upper
blepharoplasty, 307
downward clotheslining effect in cheeklift, 121, 199
drill hole for inadequate periosteum in reanchoring of muscle
flap (in cheeklift), 154
drug-like effects, cosmetic agents with (=cosmeceuticals),
periorbital use, 321–6
E
ecchymosis with botulinum toxin injection, 218
ectropion, lower lid, 2
edema see swelling
education, patient, 3
Asian blepharoplasty, confusing terminology, 75
elderly Asian patients, upper blepharoplasty, 98
endoscopic-assisted eyebrow forehead lift, 31–41, 61
closure (skin/wound), 40
supplemented by other procedures, 25, 43, 61
technique and instrumentation, 31–2
enophthalmos (deep-set eye), cheeklift with, 119, 120
epiblepharon, Asians, 7
epicanthal fold, 7
excision, 7
use of term, 76
epicranial aponeurosis (galea aponeurotica), 27, 28, 29
epidermis (face)
eyelid, 10
thickness, 237
epithelialization in laser skin resurfacing, 247, 248
erbium:YAG laser skin resurfacing, 231, 246
compared with other systems, 233–4
procedure/technique, 246
safety and anesthesia, 241–2
tissue response, 235
wound healing, 237
erythema following laser skin resurfacing, 249, 250
ethnic origin and laser skin resurfacing, 238
Eurasian crease, 9, 44
evaluation/assessment (incl. examination)
post-upper blepharoplasty, 307–8
preoperative, 1–3
blepharoptosis, 198
laser skin resurfacing, 238–9
examination see evaluation
exophthalmos (eye prominence), cheeklift with, 118, 119, 121,
123, 124, 128, 139, 143
eye (eyeball; globe)
compressing, in transconjunctival laser lower blepharoplasty,
186
deep-set, cheeklift with, 119, 120
prominence, cheeklift with, 118, 119, 121, 123, 124, 128,
139, 143
in tear trough injection with filler, avoiding injury to, 347–8
see also vision
eyebrows
raised, margin reflex distance with, laser blepharoplasty of
upper lid, 159
tenting with botulinum toxin injection, 227
see also brow
eyelash see distichiasis; lash ptosis
eyelids (in general)
cellulitis, 2
folds, glide zone concept and, 305, 306, 307
phimosis see blepharophimosis
skin see skin
eyelids, lower
anatomy, 16–18
blepharoplasty see blepharoplasty
complications see complications
ectropion, 2
laxity, 122
repositioning in transconjunctival laser blepharoplasty, 186
retraction see retraction
eyelids, upper
anatomy, 5–15
Asians see Asian
anatomy Western (Caucasian/non-Asian), 10–15
blepharoplasty see blepharoplasty
crease see crease
‘outer double’ and ‘inner-double’, 75
ptosis see blepharoptosis (lid ptosis)

359
Index
F
facelift, traditional, 115
see also cheeklift
facial anatomy
age effects see age-related changes
bony, 116
facial dystrophy and severe eye prominence, cheeklift, 139
facial expression/animation, muscles (mimetic muscles), 12, 116
botulinum toxin injection and, 124
deep, 17
forehead/brow, 29
facial nerve, frontal branch, 29
facial skin see skin
fanning technique with hyaluronic acid filler, 335, 337
nasolabial folds, 338
Fasanella–Servat correction, 199, 204
fascia
capsulo-palpebral, release, 123, 143
submuscular see submuscular fascia
temporal see temporal fascia
fascia lata, autogenous, frontalis suspension using, 209
fascia sling, canthoplasty with, for poor anchoring at canthus, 144
fat/fat pads, 17
in Asian blepharoplasty, 82, 82–3, 98
case commentaries, 271, 273, 274, 278, 280, 281, 282, 283,
284, 285, 287, 288, 289, 290, 292, 293, 294, 295,
296, 297, 299, 300
excessive/overzealous removal, 251, 255, 257, 265, 266
central see central fat pads
lateral see lateral fat pads
in lower eyelid, prolapse/herniation, in traditional
blepharoplasty, excision, 110
in lower eyelid, prolapse/herniation, in transconjunctival laser
blepharoplasty, 173, 182–6, 188–91
assessment, 174
excision, 184–5
looking for residual bulging fat, 186
mobilization, 182–3
prolapsing the inferior fat pads, 178
repositioning, 174, 188–91
septal incisions over, 181
malar, 18, 116
nasal see nasal fat pads
preaponeurotic see preaponeurotic fat
retro-orbicularis oculi see retro-orbicularis oculi fat
suborbicularis oculi, 17, 116
in upper eyelid
Asians without crease, 6
prolapses, Asian blepharoplasty, 98
in upper eyelid blepharoplasty, 46, 51, 52, 53
Asians see Asian blepharoplasty (subheading above)
see also interpad septum
female vs male, upper lid crease requirements, 45
fillers, dermal see dermis
Fitzpatrick skin type classification system, 238
fixation
brow and forehead in endoscopic-assisted brow lift, 39–40
in cheeklift see anchoring
crease (upper lid), 57
skin–muscle flap in lower blepharoplasty, 113
forehead see brow
fractionated laser skin resurfacing (CO2 laser), 231,
232, 245
antibiotic coverage, 240
compared with other systems, 233–4
relative risks, 239
safety and anesthesia, 242
tissue response, 237
wound healing, 237
frontal branch of facial nerve, 29
frontal nerve, 29
block, Asian blepharoplasty, 17
frontalis muscle
anatomy, 29
botulinum toxin injection, 214, 222, 323
complications, 323
technique, 218, 222
suspension, 191, 208–9
frown lines see glabellar rhytides
full-thickness suturing method of Asian
blepharoplasty, 101
G
gaze upwards/downwards see downgaze; upgaze
general anesthesia
Dr Chen’s viewpoint, 19
Dr Khan’s viewpoint, 20
Dr McCord’s viewpoint, 21
frontalis suspension, 208
laser skin resurfacing, 242
levator resection, 207
glabellar rhytides (frown lines), 321
botulinum toxin injection, 220, 221, 321, 345
complications, 323
dose, 216
dermal fillers, 325, 332, 345
glide zone, 303–10
revisional surgery and, 308, 311–13, 315
globe see eye
Glogau wrinkle classification scale, 216
glues, temporary crease creation, 8, 251
graft see dermis–fat graft; skin graft
Grenz zone and CO2 laser skin resurfacing, 235
H
half-moon crease see semi-lunar crease
head-back positions, Asians, 8
healing (wound), laser skin resurfacing, 237
height of crease, 253
suboptimal results, 255
case commentaries, 280, 283, 297
revision and correction, 258, 261–2
see also high crease; low crease
hemostasis see bleeding

360
Index
high crease, excessively, 252, 255, 258, 259, 261, 264, 268
beveled approach to revisional blepharoplasty, 313, 316, 318
data, 317, 318
case commentaries, 272, 275, 276, 279, 290
hooding, lid, case commentaries, 272, 284, 285, 293, 294,
296, 299
Horner’s syndrome, 197
hyaluronic acid (HA) incl. non-animal stabilized HA (NASHA),
327–54
complications, 324, 325, 349
contraindications, 322
documentation of treatment, 352
indications and patient selection, 332
informed consent, 353–4
injection techniques, 334–48
advanced, 345–51
basic, 335–6
general principles, 333
periorbital augmentation with, 324
brow, 324
glabellar furrows, 325, 345
tear trough, 324, 346–7
physician experience, 332
hydrocortisone see steroid cream
hydroxyapatite see calcium hydroxyapatite
hyperpigmentation following laser skin resurfacing, 249
hypodermis, thickness on face, 237
I
incisions
for Asian (upper) blepharoplasty, 76, 78, 79, 80, 81, 82,
83, 88
in revisional surgery, 313, 315
for browlift
direct browlift, 62, 64
endoscopic-assisted brow lift, 33
mid-forehead brow lift, 66
for browplasty, 70
closing of see closure
for levator muscle resection, 205
for lower blepharoplasty, 109
in transconjunctival laser blepharoplasty, 179, 180, 181
for tarso-aponeurectomy (of McCord), 199
in Chen’s modification, 200
for upper blepharoplasty, 47–8
Asians, see subheading above
in laser blepharoplasty, 161, 163, 165
infection risk
hyaluronic acid filler injection, 344, 350
laser skin resurfacing and its prevention, 240, 247, 248
inferior oblique muscle in transconjunctival laser
blepharoplasty, 177, 182
informed consent see consent
infraorbital nerve block, hyaluronic acid filler injection, 341
‘inner double’ eyelid, 75
innervation see nerve supply
insurance claims, 23
interpad septum, 53
lysis, 56
involutional ptosis, 193, 194, 203
isotretinoin (Accutane) and laser skin resurfacing, 237, 238
J
jaw-winking ptosis see Marcus Gunn jaw-winking ptosis
jowl augmentation with hyaluronic acid filler, 332, 348
junctional fat in upper blepharoplasty, 53
Juvéderm™ Ultra, 329, 333
glabella, 345
lips, 341
nasolabial folds, 338
tear trough, 346
Juvéderm™ Ultra Plus, 329, 333, 334
nasolabial folds, 338
K
Keith needle, threading of silastic rod using, 208
keloids and laser skin resurfacing, 237, 238
Khan, Dr
examination, 3
preoperative regimen, 19–20
Khan–Jaeger plate, titanium, 178
Krause’s glands, 15
L
lacrimal glands, 15
accessory, 15
prolapsed, repair in upper blepharoplasty, 44, 54
lagophthalmos
in laser blepharoplasty of upper lid, search for, 159
in levator muscle resection, postoperative occurrence, 207
lamellar scar, middle, in revisional Asian blepharoplasty, 312,
313, 315
laser blepharoplasty (CO2), 157–91
lower lid, transconjunctival, 173–91
anatomic landmarks and surgical tips, 177
limitations/contraindications, 174
patient selection, 173–4
safety, 176
selection and parameters, 175
surgical steps, 178–91
upper lid, 157–72
instruments/safety/selection/parameters, 160
patient selection, 157–9
surgical steps, 161–72
laser skin resurfacing, 231–50
comparison of various methods, 233–4
complications
cheeklift and management of burns, 153
cheeklift and management of laser burns, 153
contraindications, 239
risk factors for, 238–9
infection risk and its prevention, 240, 247, 248
postoperative wound care, 247–50

361
Index
preoperative evaluation, 238–9
safety and anesthesia, 241–2
tissue response, 235
wound healing, 237
lash ptosis, Asians, 7
see also distichiasis
lateral canthus see canthoplasty; canthus
lateral fat pads in lower blepharoplasty
in standard blepharoplasty, excision, 112
in transconjunctival laser blepharoplasty
excision, 185
mobilization, 183
septal incisions over, 181
length of crease, 253
levator aponeurosis
anatomy, 14
Asians (± crease), 303–4
in Asian blepharoplasty, 86, 89
in beveled approach to revisional surgery, adhesions
between orbicularis and, 315
crease presence and significance of, 74
dehiscence or rarefaction causing ptosis, 193
repair/tuck/advancement/resection, 204
resection of tarsus plus, 199–203
in upper blepharoplasty, 48, 50, 51, 53
Asians see subheading above
with lasers, 164
levator palpebrae superioris (levator muscle), 14
function
0-5mm, surgical options, 198, 208–9
6-10mm, surgical options, 198, 205–7
11mm and above, surgical options, 198, 199–204
evaluation, 198
in laser blepharoplasty, 166
resection, 205–7
lid see eyelid
lidocaine (Xylocaine), 19, 20
blepharoplasty of upper lid
Asian, 76, 77
laser, 163
ligamentous support of face, 300
ligation approach to Asian blepharoplasty (conjunctival
suturing method), 100–3
permanency problems, 256
line(s) see wrinkles
linear threading technique with hyaluronic acid filler, 335
lips, 342
nasolabial folds, 338
lips
botulinum toxin injection, 216
lateral commissure, 24, 216
for vertical lines, 223
hyaluronic acid filler, 332, 341–4
swelling after, 349
local anesthesia
Asian blepharoplasty of upper lid, 76–7
Dr Chen’s viewpoint, 19
Dr Khan’s viewpoint, 20
Dr McCord’s viewpoint, 21
hyaluronic acid filler injection, 341
laser blepharoplasty of upper lid, 163
laser skin resurfacing, 242
looking upwards/downwards see downgaze; upgaze
low crease, excessively, 255, 262
lubrication (eye), postoperative, 21–2
M
McCord, Dr
postoperative considerations, 20–2
tarso-aponeurectomy, 199, 202
Chen’s modification, 200–1
malar fat pads, 18, 116
malar ligament, orbital, 18, 116
male vs female, upper lid crease requirements, 45
Marcus Gunn jaw-winking ptosis, 196, 208
frontalis suspension, 208
levator muscle resection contraindicated, 207
margin reflex distance, laser blepharoplasty of upper lid, 159
marionette lines (melolabial folds), hyaluronic acid filler,
332, 340
mechanical ptosis, 193, 197
medial canthus see canthus
medical records see documentation and records
melolabial folds, hyaluronic acid filler, 332, 340
men vs women, upper lid crease requirements, 45
mental nerve block, hyaluronic acid filler injection
lips, 341
melolabial fold, 340
mentalis area, botulinum toxin injection, 223
micro thermal zones for fractionated CO2 skin
resurfacing, 232
midface
ageing effects, 115
anatomy, 116
lift see cheeklift
mid-forehead, brow lift, 66–7
mimetic muscles see facial expression, muscles
mortalities/deaths, botulinum toxin injection, 227
mouth depressors, botulinum toxin injection, 214
technique, 218
see also perioral botulinum toxin injection
Müller’s muscle, 15
in levator muscle resection, 205
resection, 204
in tarso-aponeurectomy, inclusion, 202
multiple creases, 251, 255
surgery, 265
case commentary, 296
multiple-pass ablative CO2 laser skin resurfacing, 244
muscles
of animation/facial expression see facial expression
for botulinum toxin targeting, 214
see also specific muscles
musculo-aponeurotic system, superficial see superficial
musculo-aponeurotic system

362
Index
myasthenia gravis, 197
myocutaneous (skin–muscle) flap
cheekflap (in cheeklift), 117
lower blepharoplasty, 109, 112
resection and periosteal fixation, 113
upper blepharoplasty, 51, 54, 55
Asians, 83, 85
laser blepharoplasty, 164
myogenic ptosis, 193, 195
N
nasal fat pads
in lower transconjunctival laser blepharoplasty, 174
developing pedicles for repositioning, 189
excision, 184
mobilization, 182
repositioning, 190
septal incisions over, 181
in upper blepharoplasty, 46, 51, 52
laser blepharoplasty, 167
see also interpad septum
nasally-tapered crease, 7, 9
Asians, 75, 266
case commentaries, 291, 292
creation, 79, 80, 258, 266, 267
nasolabial folds, 18
hyaluronic acid filler, 332, 338
neck
lift, traditional facelift as, 115
platysma see platysma
necrosis with dermal fillers, 326, 351
nerve block
Asian blepharoplasty, 17
hyaluronic acid filler injection, 341
nerve supply to eyebrow area, 29
in endoscopic-assisted brow lift, 37–8
neurogenic ptosis, 193, 197
neuromuscular junction, botulinum toxin
actions, 211, 212
neurovascular bundle, supraorbital, in laser upper
blepharoplasty, 166
nodules with dermal fillers, 324, 325–6, 350
oblique muscle, inferior, in transconjunctival laser
blepharoplasty, 177, 182
oculomotor (3rd) nerve palsy, 197
ophthalmic division of trigeminal nerve, 29
ophthalmoplegia, chronic progressive external, 197
optical space, subperiosteal, creation for endoscopic-assisted
brow lift, 31, 34–5
oral region see mouth depressors; perioral botulinum toxin
injection
orbicularis fascia see submuscular fascia
orbicularis oculi muscle, 12, 17
in Asian blepharoplasty, 81, 82, 83, 85, 87, 104, 105, 106
in beveled approach to revisional surgery, adhesions
involving, 313–14
botulinum toxin injection, 214
avoiding direct injection, 218
for brow lift, 323
for crow’s feet, 219, 322–3
for glabellar furrows, 322
in cheeklift, anchoring of inferior rim/arch, 117,
125–32, 141
problems/failure, 141, 150–3
double anchoring, 126, 143
in lower blepharoplasty, trimming of fibers, 113
in upper blepharoplasty, 50–6
Asians, see subheading above
with lasers, 163, 164, 168, 171
see also myocutaneous flap
O
orbicularis oris muscle, botulinum toxin injection, 214
orbit
cosmeceutical use in areas around, 321–6
rim
in cheeklift, anchoring of flap at, 126, 129
in laser lower transconjunctival blepharoplasty, 184
in laser upper blepharoplasty, 166
orbital malar ligament, 18, 116
orbital septum (septum orbitale)
anatomy, 14
Asians (± crease), 305
Asian blepharoplasty, 82–3
revisional surgery, 311, 313
laser blepharoplasty
lower lid, 180, 181
upper lid, 163
‘outer double’ eyelid, 75
P
parallel crease, 7, 9, 75
case commentaries, 275, 276, 277, 279, 282, 283, 284, 285,
287, 288, 293, 297, 299
in upper blepharoplasty, 45, 47
for Asians, 75, 76, 78, 80, 266
patient
education see education
evaluation see evaluation
pediatric ptosis, management, 198
perioral botulinum toxin injection, 223
risks, 215
periorbital areas, cosmeceuticals, 321–3
periosteal flap canthoplasty (for poor anchoring at
canthus), 144
periosteum
in cheeklift, anchoring of skin–muscle flap to, 129
problems, 154
in endoscopic-assisted brow lift, release, 36
in lower blepharoplasty, fixation of skin–muscle
flap to, 113
in upper laser blepharoplasty, avoiding exposure, 168
see also subperiosteal dissection; supraperiostal pocket
Perlane®, 329, 333, 334

363
Index
jowl augmentation, 348
nasolabial folds, 338
permanency of crease, 253
suboptimal results, 256
revision and correction, 257, 263–4
pharmaceuticals, cosmetic, periorbital use, 321–5
phimosis see blepharophimosis
photographic records, 2
physical activity, postoperative, 22
pigmentation problems following laser skin resurfacing, 249
pinch sign after upper blepharoplasty, 308
pinch technique
in botulinum toxin injection, 218
in laser blepharoplasty, determining safe amount of lid skin
removal by, 162
platysma, botulinum toxin injection, 214, 224, 226
dose, 216
poly-L-lactic acid periorbital augmentation, 324
postinflammatory hyperpigmentation following laser skin
resurfacing, 249
postoperative considerations, 1, 2, 3
blepharoplasty, 20–2
laser, upper lid, 172
laser skin resurfacing, 247–50
see also complications
postorbicularis fascia see submuscular fascia
preaponeurotic fat pad in upper lid blepharoplasty, 305–6
Asians, 82, 82–3, 305–6
excessive removal, 265, 266
laser blepharoplasty, 165
preaponeurotic space/platform (and upper blepharoplasty),
311–13
in Asians, 311–13
in beveled approach to revisional surgery, 315–17
debulking, 86, 104–6, 311
premedications, Asian blepharoplasty, 76
preoperative considerations, 19, 19–20
evaluation see evaluation
preorbital foramina, 17
preseptal region, Asians
with absent crease, 305
blepharoplasty and, 81
fat, 6
pretarsal region/zone
Asians without crease, 305
skin graft with excessively low crease, 262
procerus muscle, 29
botulinum toxin injection, 214, 220–1, 322
technique, 218
resection for endoscopic-assisted eyebrow forehead lift,
37–8
Prolene sutures
browpexy (internal), 68
laser blepharoplasty
lower lid, 189
upper lid, 170
lateral canthoplasty, 111
prominence
eye, cheeklift with, 118, 119, 121, 123, 124, 128, 139, 143
supratarsal sulcus, in Asian blepharoplasty, 259
proparacaine see topical anesthesia
protractor muscles of brow/eyelid area, 29
ptosis
eyebrow, management algorithm, 59
eyelid see blepharoptosis
lash, Asians, 7
push-ahead technique with hyaluronic acid filler, 335
lips, 342
tear trough, 346
R
racial origin and laser skin resurfacing, 238
records see documentation and records
rectangular debulking of eyelid tissues, 104–6
re-epithelialization with laser skin resurfacing, 247, 248
Reloxin®, 211
Restylane®, 328–9, 333, 334
glabella, 345
injection techniques
cross-hatching, 336
fanning, 337
linear threading, 335
serial puncture, 334
lips, 341
smoker’s lines, 343
nasolabial folds, 338
tear trough, 346
resurfacing see laser skin resurfacing
retinal vascular occlusion complicating hyaluronic acid
injection, 351
retraction (lower lid)
cicatricial, following upper blepharoplasty, 262
spacer insertion, 155
retro-orbicularis fascia see submuscular fascia
retro-orbicularis oculi fat (ROOF), 116
in browplasty, 70
in laser blepharoplasty of upper lid, 168
revision surgery see secondary surgery
rhytides see wrinkles
Riolan’s muscle, 12
‘round-eye’ look, 266
rudimentary crease, 251, 255, 265
case commentary, 278, 282, 287, 288, 292, 295
S
safety
blepharoplasty, 22
laser see laser blepharoplasty (CO2)
laser skin resurfacing, 241–2
scalp incision for endoscopic-assisted brow lift, 33
scars, 20–1
in revisional Asian blepharoplasty, excision, 270
midlamellar scar, 312, 313, 315
screw fixation, brow and forehead in endoscopic-assisted brow
lift, 39–40

364
Index
secondary (correction/‘touch-up’/revision) surgery, 22, 308–9
Asian blepharoplasty, 90, 256, 257–301, 311–19
beveled approach, 309, 311–19
commentary on case studies, 271–301
glide zone and, 308–9, 311–13, 315
cheeklift, 144–56
semi-lunar (half-moon) crease, 258
dissatisfaction with, 251, 266–9
case commentary, 276
surgery, 266–9
septum orbitale, 14
serial puncture technique with hyaluronic acid filler, 334, 335
shape of crease, 253
suboptimal results, 253
revision and correction, 258
silastic rod, frontalis suspension using, 191, 208–9
skin
closure see closure
eyelid
Caucasians/non-Asians, 10, 11
in laser blepharoplasty of upper lid, determining safe
amount of removal, 162
revision Asian blepharoplasty for patients with shortage of,
268
revision Asian blepharoplasty for patients with some
redundancy of, 267, 271, 282, 298
vertical recruitment (in skin deficiency) for secondary
cheeklift, 144, 150–3
facial (in general)
resurfacing see laser skin resurfacing
thickness, 237
type, classification system, 238
incisions see incisions
see also dermatochalasis and entries under transcutaneous
skin graft (Asian blepharoplasty revision)
with excessively low crease, 262
with semi-lunar crease, 268, 269
see also dermis–fat graft
skin–muscle flap see myocutaneous flap
skin-to-orbicularis adhesions in beveled approach to revisional
Asian blepharoplasty, 313
slip knot, closure of laser upper blepharoplasty, 171
smoker’s lines, filling, 343, 344
SNAP-25 and botulinum toxin, 212, 213
solar radiation (sun) exposure in Fitzpatrick skin type
classification system, 238
spacer insertion in cheeklift, 123, 143
in lower lid retraction, 156
stab incisions in Asian blepharoplasty, full-thickness suturing
method with, 101
staples in endoscopic-assisted brow lift, 40
steroid (hydrocortisone) cream in laser skin resurfacing
postoperative, 247, 248, 249, 250
preoperative, 240
stimulator fillers, 327
stitches see sutures
subcutaneous (subdermal) eyelid tissue, 12
in Asian blepharoplasty, removal, 80
subcutaneous flap, mid-forehead brow lift, 67
subgaleal flap, mid-forehead brow lift, 67
submuscular fascia (posterior to orbicularis oculi; retro-
orbicularis fascia; post-orbicularis fascia; orbicularis
fascia), 13
in laser blepharoplasty, 164
suborbicularis oculi fat, 17, 116
in cheeklift, 143
subperiosteal dissection
in cheeklift, 117–18
in endoscopic-assisted brow lift, 31, 34–5
in transconjunctival laser lower blepharoplasty, 188
sulcus, hollow superior, dermal filler, 325
see also supratarsal area
sun exposure in Fitzpatrick skin type classification system, 238
sunscreen SPF 30 following laser skin resurfacing, 249, 250
superficial (submuscular) musculo-aponeurotic system (SMAS),
18, 26, 27, 124, 330
botulinum toxin injection into, 124, 211
in cheeklift, 143
anchoring of inferior rim of orbicularis muscle, 125, 130
supraorbital nerve, 29
in endoscopic-assisted brow lift, 38
supraorbital neurovascular bundle in laser upper blepharoplasty,
166
supraperiostal (dissection) pocket in transconjunctival laser
lower blepharoplasty
developing, 188
securing of fat pads in, 191
supratarsal area/sulcus in Asian blepharoplasty, 81
prominent, 259
skin grafts with excessively low crease, 262
sunken/hollowed, 255, 257, 258, 266
case commentary, 291
see also sulcus
supratrochlear nerve, 29
in endoscopic-assisted brow lift, 37
sutures (stitches), 21
browlift
direct brow lift, 62, 64
mid-forehead brow lift, 67
browpexy (internal), 68
cheeklift, in anchoring of orbicularis flap, 129, 130, 132
Fasanella–Servat correction of ptosis, 204
frontalis suspension, 208, 209
lateral canthoplasty, 111
levator aponeurosis repair/tuck/advancement/resection, 204
levator muscle resection, 205, 206
lower blepharoplasty, 114
tarso-aponeurectomy (of McCord), 199
in Chen’s modification, 201
upper blepharoplasty, 58
crease fixation in Caucasians, 57
laser blepharoplasty, 170, 171
old stitches found after four years (case commentary), 288
upper blepharoplasty in Asians
crease fixation, 57, 88, 89
laser blepharoplasty, 190

365
Index
in revision surgery, 262, 264, 267, 270
suture ligation method see ligation approach
swelling (edema)
lips, after dermal filler injection, 349
postoperative, 21
symmetry regarding lid creases, 253, 256
lack see asymmetry
T
tapes (adhesive eyelid), 8, 251
case commentary, 278
tarso-aponeurectomy, 199–203
tarsoligamentous sling, 122
tarsus (tarsal plates), 15
in Asian blepharoplasty, 78
tarsal height technique in revision surgery, 267, 268
lateral shifting, 194
tear function anomaly in ptotic patient, 198
tear trough fillers, 324, 346–8
temporal fascia, 26
deep, 26, 28
fixing of flap (in cheeklift) to, 131, 132
superficial, 26, 28, 29
temporal forehead lift (lateral brow lift), 61, 65
in conjunction with upper blepharoplasty, 43
technique, 65
temporal orbital orbicularis oculi, botulinum toxin injection, 323
titanium Khan–Jaeger plate, 178
topical anesthesia (with proparacaine), 10
Asian blepharoplasty, 76, 77
botulinum toxin injection, 218
hyaluronic acid filler injection, 341
laser skin resurfacing, 241–2
‘touch-up’ surgery see secondary surgery
transconjunctival intramuscular suturing technique (Asian
blepharoplasty), 101
transconjunctival laser blepharoplasty see laser blepharoplasty
transcutaneous intradermal and intratarsal suturing technique
(Asian blepharoplasty), 103
transcutaneous intramuscular suturing technique (Asian
blepharoplasty), 101
transcutaneous intratarsal suturing, twisted needle and
compression technique with, 102
transitional fat in upper blepharoplasty, 53
trans-lid lift see cheeklift
transorbicularis vector in debulking for Asian
blepharoplasty, 105
trapezoidal debulking of eyelid tissues, 104–6, 308, 311
triangular debulking of eyelid tissues, 104–6
trigeminal nerve, ophthalmic division, 29
twisted needle and compression technique with transcutaneous
intratarsal suturing, 102
U
undermining
in optical space creation for endoscopic-assisted Eyebrow
Surgery, 34
in revision Asian blepharoplasty, 267
skin–muscle flap in lower blepharoplasty, 112
upgaze (looking upwards)
Asians, 8
examination after upper blepharoplasty, 308
upward clotheslining effect in cheeklift, 119, 120
V
VAMP and botulinum toxin, 213
vertical skin recruitment, 144, 150
vesicle-associated membrane protein and botulinum toxin, 213
vision
blurring see blurred vision
loss complicating hyaluronic acid injection, 351
volumizer fillers, 327
W
Watzke sleeve, silastic, 208, 209
Westcott spring scissors, upper blepharoplasty, 50, 51
Asians, 82, 83
in revision surgery, 263, 313
‘Western’ upper eyelid anatomy see Caucasians
Westernizing blepharoplasty see Asian blepharoplasty
wetfield (bipolar) cautery, Asian blepharoplasty, 81, 83, 84
Whitnall’s ligament in laser upper blepharoplasty, 164
Wolfring’s glands, 15
women vs men, upper lid crease requirements, 45
wound
closure see closure
laser skin resurfacing
healing, 237
postoperative care, 247–50
wrinkles (rhytides/lines)
classification scale, 216
produced by specific muscles, 214
see also specific muscles
X
X-ray treatment (facial) and laser skin resurfacing, 237, 238
Xylocaine see lidocaine