Cosmetic Facial Surgery

Chapter 16  •  Cosmetic Removal of Nevi and Lesions With 4-MHz Radiowave Surgery
733
A
B
FIGURE 16-41.  Before (A) and after (B) radiowave ablation (biopsy
negative).
FIGURE 16-42.  A very light-skinned patient 12 weeks after removal of
several nevi with radiowave surgery. Persistent erythema of this duration
is rare, but can be seen in lighter-skinned patients. In my experience this
is rarely permanent and will fade over the ensuing several months.
pacemakers are safe, and even surgeons who have pacemakers
routinely use radiowave technology. Implanted cardiac defibril-
lators (ICDs) can be problematic; radiowave surgery should not
be performed without cardiology consult.
Although postablation erythema usually resolves by 8 weeks,
some patients (especially the lighter Fitzpatrick skin types) may
remain erythematous for much longer (Figure 16-42). Women
can cover this extended pinkness with makeup, but some
patients are put off by this, so it should be brought up during
the preoperative informed consent discussion.
Figure 16-42 shows a very light-skinned patient 12 weeks
after removal of several nevi with radiowave surgery. Persistent
erythema of this duration is rare, but can be seen in lighter
skinned patients. In my experience this is rarely permanent and
will fade over the ensuing several months.
Conclusion
Nevi are pigmented and nonpigmented tumors of the skin that
contain nevus cells; they are present on virtually all adults.13
They can be elevated, flat, pedunculated, smooth, papilloma-
tous, and even hairy. Common nevi are classified as junctional,
intradermal, or a combination of both, referred to as compound
nevi. The main challenge with benign pigmented lesions is
to differentiate them from malignant melanoma. Histologic
submission is necessary for suspicious lesions, although some
clinicians recommend biopsy for any pigmented lesion.
Cosmetic facial surgeons are frequently consulted for the
removal of benign lesions, and aesthetic results are extremely
important to patients and the surgeon’s reputation.
References
  1. Niamtu J: Radiowave surgery versus CO2 laser for upper blepharoplasty
incision: which modality produces the most aesthetic incision? Dermatol
Surg 34:912–921, 2008.
  2. Niamtu J: 4.0 MHz radiowave surgery in cosmetic facial surgery. In Bell
WH, Guerroro CA, editors: Distraction Osteogenesis of the Facial Skele-
ton, Ontario, Canada, 2007, BC Decker.
  3. Niamtu J: 4.0 MHz Radiowave surgery in cosmetic surgery. Australas J
Cosmet Surg 1:52–59, 2005.
  4. Niamtu J: 4.0 MHz radiowave surgery applications in cosmetic facial
surgery. J Cosmet Dermatol 16(11):33–46, 2003.
  5. Niamtu J: Radiofrequency applications in cosmetic facial surgery: making
waves. Plast Surg Products 11:52–58, 2001.
  6. Bridenstine JB: Use of ultra-high frequency electrosurgery (radiosurgery)
for cosmetic surgical procedures. Dermatol Surg 24:397–400, 1998.
  7. Olivar AC, Parouhar FA, Gillies CA, Servanski DR: Transmission electron
microscopy: evaluation of damage in human oviducts caused by different
surgical instruments. Ann Clin Lab Sci 29:281–285, 1999.
  8. Greenbaum SS, Krul EA, Watnick K: Comparison of CO2 laser and elec-
trosurgery in the treatment of rhinophyma. J Am Acad Dermatol 18363–
18368, 1988.
  9. Saidi MH, Alright BD, Setzler FD, et al: Diagnostic and therapeutic con-
ization using loop radiothermal cautery. J Reprod Med. 38(10):775–779,
1993 Oct.
10. Saidi MH, Setzler FD, Sadler KR, et al: Comparison of office loop elec­
trosurgical conization and cold knife conization. J Am Assoc Gynecol
Laparosc 1:135–139, 1994.
11. Turner RJ, Cohen RA, Voet RL, et al: Analysis of tissue margins of cone
biopsy specimens obtained with “cold knife,” CO2 and Nd:YAG lasers and
a radiofrequency surgical unit. J Reprod Med 37:607–610, 1992.
12. Cohen AF, Tiemstra JD: Diagnosis and treatment of rosacea. J Am Board
Fam Pract 15(3):214–217, 2002.
13. Soft Tissue Lesions. In Sauer GC, Hall JC, editors: Manual of Skin
Diseases, ed 7, Philadelphia, 1998, Lippincott-Raven, pp 338–342.

734
17 
Laser Treatment
of Vascular Lesions
T
oday’s patients are very sophisticated about any given
cosmetic surgery procedure or device. Thanks largely to
the Internet, patients have access to almost as much
information as clinicians. Well-informed patients know what
they want and often seek practitioners by technology level, espe-
cially for treatments with lasers and other light-based devices.
Minimally invasive procedures are in great demand; unfor-
tunately, many nonablative or minimally ablative procedures fail
to provide significant results.1-5 The treatment of red and brown
lesions with a combination device using 532-nm and 940-nm
wavelengths (VariLite vascular laser, Iridex Corp., Mountain
View, CA) is truly a lunchtime procedure that produces impres-
sive results on a wide variety of lesions (Figure 17-1).
Dealing with ectatic vessels, birthmarks (such as port-wine
stains), hemangiomas, tortuous veins, and related facial lesions
was a challenge in the past. They were treated with sclerosing
solutions, cryotherapy, radiofrequency needle ablation, surgical
excision, and other therapies. It was not until the advent of lasers
and the application of theories of selective thermolysis and
thermal relaxation time that the treatment of vascular lesions
advanced. Selective photothermolysis was introduced by Ander-
son and Parrish in 1983.6 The theory states that various target
chromophores could be selectively destroyed by specific wave-
lengths and pulse durations, with minimal damage to surround-
ing tissue.
The target for vascular lesions is oxyhemoglobin. Its primary
absorption peaks are at approximately 418, 542, and 577 nm
in the visible spectrum, and there is a secondary absorption peak
at 940 nm in the near-infrared spectrum (Figure 17-2).
Understanding thermal relaxation time (TRT)—defined as
the time required for an injured target to cool to half its peak
temperature immediately following laser irradiation—also
enabled more precise laser treatments. Having a pulse duration
that is shorter than the TRT of the treated vessel prevents the
energy from dissipating very far beyond the targeted vessel. This
means the heat generated by each pulse of the laser is confined
to the targeted blood vessels and is dissipated before it can
spread laterally to normal tissue.
Combining our understanding of selective photothermolysis
and TRT led to the development of laser technologies that
are safe and effective for treating vascular lesions. Some of
the earliest laser treatments for facial telangiectasias were per-
formed using continuous-wave carbon dioxide (10,600 nm)
and argon (488 and 514 nm) lasers7 (Figures 17-3 and 17-4).
Although successful outcomes were reported, these lasers
unselectively destroyed both ectatic vascular tissue and the over-
lying epidermis. These lasers were in effect sophisticated forms
of electrocautery.
The theory of selective photothermolysis spurred the devel-
opment of flashlamp-pumped, pulsed-dye, and copper-vapor
lasers. These lasers emit light at 577- to 585-nm wavelengths
that are selectively absorbed by oxyhemoglobin and can destroy
the ectatic vessel with minimal damage to the underlying tissue.
The pulsed-dye laser differs from older lasers in that it emits
light in pulses rather than a continuous beam. The 585-nm
flashlamp-pumped, pulsed-dye laser has become the gold stan-
dard by which other vascular lasers are judged. It has the sig-
nificant drawback of posttreatment purpura, which is difficult
to conceal and can persist for as much as 14 days (Figure 17-5).
Newer laser technology has led to the use of ultralong pulse,
585-nm lasers that eliminate postlaser purpura. Although the
pulsed-dye lasers are effective and versatile, they are heavy (more
than 136 kg), not portable, and expensive.
Treatment Wavelengths
Just as transistors made vacuum tubes obsolete, semiconductor
diode-pumped lasers are replacing vacuum tubes and flashlamp-
pumped lasers. The dual-wavelength (532- and 940-nm) laser
system is lightweight and portable, about the size of a videocas-
sette recorder. The laser weighs 8 kg and uses standard 120-V
alternating current. The 532-nm wavelength light is generated
by a high-powered diode laser at 808 nm. This is used to opti-
cally pump a neodymium-doped yttrium aluminum garnet
(Nd:YAG) crystal to produce 1064-nm light, which is then
focused on a potassium titanyl phosphate crystal to double its
FIGURE 17-1.  The Iridex VariLite dual-wavelength laser is a portable solid-
state laser that is extremely useful for treating vascular and pigmented
lesions. (Courtesy Iridex Corp., Mountain View, CA.)

Chapter 17  •  Laser Treatment of Vascular Lesions
735
frequency. This halves the wavelength, producing the final
532-nm radiation. Practitioners who are experienced with the
532-nm diode laser are familiar with the immediate disappear-
ance of the ectatic vessel after laser-light exposure. With the
longer 532-nm diode laser pulses, the blood is more gently
heated and damages the endothelial cells but does not burst the
vessel, as evidenced by the lack of purpura.
There are theories that laser energy creates a small steam
bubble that expands along the axis of the vessel, clearing the
lumen and pushing a column of hot blood along the vessel. As
the vessel cools during its TRT, the vapor bubble condenses
and collapses the vessel wall. Thermal coagulation of the blood,
now ejected well beyond the actual exposure site, creates an
Absorption (cm-1)
320 cm-1
20 cm-1
532 nm 585 nm
Oxyhemoglobin
755 nm 800 nm
940 nm
1064 nm
Melanin
1100
1000
900
800
700
600
500
400
FIGURE 17-2.  Absorption peaks for oxyhemoglobin and a secondary peak close to 940 nm in the near-infrared spectrum.
Smaller superficial veins are better treated at 532 nm; larger or deeper vessels are better treated at 940 nm. Hashed circles
show these wavelengths.
Visible light
Infrared
Pulsed dye
510 nm
Copper vapor
511 nm
Krypton
520-30 nm
KTP
532 nm
Freq. doubled
Nd: YAG
532 nm
Krypton
568-577 nm
Argon tunable
dye
577 nm
Copper vapor
578 nm
Pulsed dye
585 nm
Long-pulse dye
590 nm
Photoderm
550-900 nm
Ruby
694 nm
Alexandrite
755 nm
Nd: YAG
1064 nm
CO2
10,600 nm
500
600
700
800
1,000
Wavelength (nm)
FIGURE 17-3.  Electromagnetic spectrum with colors of the various wavelengths in the visible spectrum. Higher wavelengths are
not visible with the human eye.
intravascular plug, leaving an empty, thermally damaged lumen
at and around the site of the laser exposure7 (Figure 17-6).
When treating larger or deeper vessels containing both oxy-
genated and reduced hemoglobin, or when absorption by epi-
dermal melanin is a concern, there are significant benefits from
treating at 940 nm, which targets the secondary absorption
peak of oxyhemoglobin and reduced hemoglobin (see Figure
17-2). The 940-nm wavelength is emitted directly from a cus-
tomized indium gallium arsenide diode laser and is chosen for
larger and deeper vessels primarily because it is exactly at the
peak of the secondary absorption band of oxyhemoglobin in the
near-infrared region of the spectrum. Since the target is venous
blood, it is also important to consider the reduced hemoglobin

736
Chapter 17  •  Laser Treatment of Vascular Lesions
Depth of penetration by various lasers
Stratum
corneum
Epidermis
Dermis
Dermal vessels
Subcutaneous
fat
Excimer
193 nm
Nd:YAG
2940 nm
CO2
10600 nm
Argon
488-514 nm
KTP
532 nm
PDL
585-600 nm
Ruby
694 nm
Alexandrite
755 nm
Diode
800 nm
Nd:YAG
1064 nm
FIGURE 17-4.  Depth of penetration increases with increasing wavelength. This explains in part why the 532-nm wavelength is
used to treat superficial vessels, whereas the 940-nm wavelength is used for deeper vessels. (From Bolognia JL, Lorizzo JL:
Dermatology, ed 2, Edinburgh, UK, Mosby, 2008.)
FIGURE 17-5.  Purpura produced by early 585-nm lasers were a result of
blood extravasation from the vessels into the surrounding tissue. They are
difficult to cover with makeup and last for about 2 weeks, making this
treatment undesirable.
absorption spectrum. Less strongly absorbed wavelengths pen-
etrate more deeply and can uniformly heat through larger-
diameter vessels. Reduced hemoglobin absorption falls rapidly
above 950 nm; 940 nm is the longest wavelength for which
reduced hemoglobin has good absorption (see Figure 17-2). The
desired goal of 940-nm treatment is to use the longest effective
wavelength for both oxyhemoglobin and reduced hemoglobin
absorption while avoiding absorption by water.
Having a single laser with both 532-nm and 940-nm wave-
lengths is a significant clinical benefit. Both wavelengths can be
used without changing the handpiece. The operator simply
turns a switch to change from 532 nm to 940 nm. Dual-
wavelength lasers allow the selection of multiple handpieces
that can be used with both 532-nm and 940-nm treatment
wavelengths. Spot sizes are available in 0.7, 1, 1.4, 2, and
2.8 mm (see Figure 17-1).
Computer Pattern Generators
Computer pattern generators (CPGs) are available that produce
up to 50 pulses per second. The generator delivers 700-µm
treatment spots that are placed on 875 µm, 1 mm, or 1.17 mm
centers to center spacing over a 2-cm treatment area. This pre-
cisely controlled spacing leaves small untreated volumes sur-
rounding each treatment spot. These volumes act as thermal
dissipation zones during treatment, allowing the use of higher
energies in the treatment spots for greater clinical effect. After
treatment, the untreated zones become healing centers distri­
buted throughout the entire treatment area, allowing rapid
healing and giving maximum rejuvenation similar to that pre-
dicted by the fractional resurfacing theory. The CPG patterns
give 60%, 45%, or 30% skin coverage per treatment area. For
clinicians used to the mundane task of tracing individual telan-
giectasias, the CPG is a welcome implement that allows much
faster treatments, simplifies a boring procedure, and seems to
be less painful to the patient. The CPG has resurfacing capabi­
lities and can also be used for full-face treatments to improve
skin blemishes (producing a more uniform skin texture and
tone) and to treat large-area lesions, including poikiloderma,
port-wine stains, and matted telangiectasias. The CPG with
controllable spot size, configuration, and density facilitates the
treatment of large areas, including the full face.

Chapter 17  •  Laser Treatment of Vascular Lesions
737
Equipment Considerations
For the operator, modern magnified headlights with polarizing
filters are an all-in-one solution to eye safety, magnified vision,
and cross-polarization illumination during laser treatment for
vascular, pigmented, and cutaneous lesions (Figure 17-7). The
integrated eye-safety filters use narrow-band, color-balancing
coatings that provide clarity of view and give protection from
both the 532- and 940-nm laser wavelengths. Adjusting the
polarizing filter removes glare from the skin and creates the
illusion of seeing under the skin. This allows the operator to see
all vessels much better and some vessels that might not be appar-
ent to the naked eye. The most important innovation of this
headlight magnification system, however, is the fact that the
orange (or purple) protective eyewear usually required with
532- and 940-nm lasers is not needed. The built-in loupes
automatically filter out the respective wavelengths, and the
absence of colored lenses truly improves the visualization of
vessels and reduces eye fatigue. When not using the specialized
loupes, the operator, staff, and patient must wear protective
wavelength-specific eyewear (Figure 17-8).
The choice of handpieces is dictated by the patient’s anatomy
and type of lesion. For selected smaller telangiectasias, derma-
tosis papulosa nigra, lentigines, nevi, and macules, the straight
handpiece provides a controlled spot size of various diameters
Pathology
Telangiectasias are permanently dilated cutaneous blood vessels
visible to the naked eye. By definition, they do not exceed
1 mm in diameter. Millions of people, especially those with
Fitzpatrick skin types I and II, develop telangiectasias. The nasal
alae and medial cheeks are the most commonly involved areas.
On the basis of their appearance, telangiectasias can be simple
(linear), arborizing, spider-shaped, star-shaped, or punctate
(papular) lesions. Spider telangiectasias consist of red, radiating
arms stretching from a central pulsating arteriole. Histologi-
cally, they represent dilated or ectatic vessels in the superficial
papillary dermal plexus. Telangiectasias occur in up to 48% of
healthy children and 15% of normal adults. Telangiectasias of
the lower extremities occur in 29% to 41% of women and 6%
to 15% of men8 and arise from various factors. Intrinsic factors
include congenital causes, primary cutaneous disorders (such
as rosacea), systemic disease (e.g., collagen vascular disease),
Cushing disease, metastatic carcinoma, pregnancy, venous
incompetence, and inherited genetic disorders (e.g., hereditary
hemorrhagic telangiectasia). Extrinsic factors include drugs;
telangiectasias are induced by estrogens or chronic steroid use.
Other extrinsic factors are actinic and radiation dermatitis,
postsurgical rhinoplasty (wound closure under tension), radio-
therapy, and trauma.
A
B
FIGURE 17-7.  Illuminated cross-polarization loupes give the surgeon the ability to “see through the skin” by removing surface
glare. This gives the operator light, magnification, and eye protection for 532-nm and 940-nm wavelengths.
A
B
FIGURE 17-6.  A, Various-sized handpieces are
used to trace individual vessels. B, The 532-nm
or 940-nm laser beam is used to trace the
vessel at intervals, which ablates the ectatic  
or vascular lesion. (A, Courtesy Iridex Corp.,
Mountain View, CA.)

738
Chapter 17  •  Laser Treatment of Vascular Lesions
Pigmented Lesions
The absorption spectrum of melanin includes the ultraviolet,
visible, and near-infrared portions of the electromagnetic spec-
trum (see Figure 17-2). Virtually every wavelength along the
spectrum can theoretically be used to target melanin. Melano-
somes are much smaller than blood vessels, and a much shorter
pulse duration is required than for telangiectasias. Pigmented
lesions such as lentigines, keratoses, ephelides, and dermatosis
papulosa nigra are successfully treated with the 532-nm and
940-nm wavelength. Early hypertrophic scarring and keloids
that possess significant neovascularity are also successfully treated
(Figure 17-11). For most macular lesions, such as lentigines, the
endpoint is a uniform gray color and a popping sound that
occurs when a tissue becomes plasmoid (Figure 17-12). The
pigmented lesions exfoliate over 1 to 2 weeks. Larger or thicker
lesions may need retreatment until clinical clearing is achieved.
Anesthesia Concerns
Because the pain sensation is similar to a rubber-band snap or
an injection with a 32-gauge needle, the vast majority of patients
(Figure 17-9). For larger lesions, such as those of rosacea, poi-
kiloderma, melasma, and generalized facial-pigment resurfac-
ing, the CPG is superior and significantly reduces treatment
time by covering more ground.
With the single handpieces in the 532-nm mode, the vessels
are merely traced, and the operator watches as they disappear
(see Figure 17-6). It does not seem to make a difference whether
the laser is started proximally or distally to the ectatic vessel.
If a vessel is resistant to the 532-nm wavelength, a flip of
the switch brings in the “big gun”: the 940-nm wavelength.
This handpiece is used somewhat differently. Instead of tracing
along the entire vessel, as is done at 532 nm, the 940-nm
laser is used to strike the vessels at varying points along their
length.
When a given lesion is hit by a 940-nm pulse, this often
occludes the vessel several millimeters distally. This means that
the vessel can be treated with fewer pulses at this wavelength.
For small red lesions, a single pass is adequate. For larger red or
blue vessels, two passes may be required. I have treated larger
tortuous facial veins with multiple sessions at the 940-nm wave-
length (Figure 17-10).
A
B
FIGURE 17-8.  Eye safety must be continually practiced to protect the surgeon, patient, and staff.
A
B
FIGURE 17-9.  Smaller isolated lesions are most commonly treated by tracing individual vessels with the straight handpiece (A),
whereas larger areas can more easily and efficiently be treated with the scanner (B).

Chapter 17  •  Laser Treatment of Vascular Lesions
739
A
B
FIGURE 17-11.  The 532-nm or 940-nm wavelengths can
be effectively used to treat hypervascularity in healing
scars.
A
B
C
FIGURE 17-12.  A patient with dermatosis papulosa nigra before (A) and immediately after (B) laser treatment. Notice graying of
the lesions. C, 1 month post laser.
A
B
FIGURE 17-10.  The 940-nm handpiece enables the treatment of larger vessels.
seeking treatment for red or brown lesions do not require any
supplemental anesthesia. Refrigerated aloe gel provides a heat
sink, mitigates the discomfort, and is routinely used. Topical
anesthetic creams can also be used. Areas such as the nostrils,
alar bases, columellar area, lips, and perioral region can be very
sensitive, and supplemental local anesthetic blocks or infiltra-
tion can be used to obtund this discomfort (Figure 17-13). In
cases of many lesions or large treatment areas, IV sedation may
be preferable insofar as some patients do not tolerate the sting-
ing sensation as well for prolonged periods.
Figures 17-14 to 17-23 illustrate various vascular and pig-
mented lesions before and after treatment with the 532-nm and
940-nm wavelengths.
Text continued on page 744.

740
Chapter 17  •  Laser Treatment of Vascular Lesions
A
B
FIGURE 17-13.  Although most lesion treatments can be obtunded with cooling gel or topical anesthesia, more sensitive areas
may require local anesthesia augmentation.
A
B
C
D
FIGURE 17-14.  A–B, Male patient treated over two
sessions with the 532-nm laser. C–D, Other side
of the same patient.

Chapter 17  •  Laser Treatment of Vascular Lesions
741
A
B
FIGURE 17-15.  Patient treated over two sessions with the 532-nm laser.
A
B
FIGURE 17-16.  Patient treated for severe matted telangiectasias with the 532-nm laser. Today, treatment would be done with
the 940-nm wavelength, which was not available when this patient was treated.
A
B
FIGURE 17-17.  Patient treated over several sessions with the 532-nm laser for severe telangiectasias.

742
Chapter 17  •  Laser Treatment of Vascular Lesions
A
B
FIGURE 17-18.  Patient treated with a single session using the 940-nm wavelength for cherry angiomas.
A
B
FIGURE 17-19.  Patient treated with three sessions of the 532-nm laser for a birthmark on the cheek. If treated today, the 940-nm
wavelength would be used.
A
B
FIGURE 17-20.  Patient treated with a single session of the 940-nm wavelength for a lip hemangioma.

Chapter 17  •  Laser Treatment of Vascular Lesions
743
A
B
FIGURE 17-21.  Patient treated with three sessions using the 532-nm laser for dermatosis papulosa nigra.
A
B
FIGURE 17-22.  Patient treated with three sessions using the 940-nm laser for dermatosis papulosa nigra.
A
B
FIGURE 17-23.  Patient treated with three sessions using the 532-nm laser for multiple flat, pigmented lesions.

744
Chapter 17  •  Laser Treatment of Vascular Lesions
Complications
Any light-based treatment device can cause complications.9,10
Overtreatment that results in skin blistering and hypopigmenta-
tion is a potential but infrequent problem (Figure 17-24).
Because the 532-nm wavelength targets both, hemoglobin
and melanin (reds and browns) are affected. This can be pro­
blematic when treating darker skin types or individuals with
suntans. The 532-nm wavelength has the potential to destroy
melanocytes on the way to the hemoglobin. For this reason, care
must be used when treating larger suntanned areas or skin of
color. Postlaser crusting occasionally results and can be treated
with triple-antibiotic ointment (Figure 17-25). As with any
device, it is better to undertreat during multiple sessions than
to overtreat in a single session. Overtreatment with any laser
can result in permanent scarring (Figure 17-26). A safe setting
for one patient may overtreat another, so novice surgeons should
first perform test spots before attempting to treat large areas.
A
B
C
FIGURE 17-24.  Patient overtreated with the 532-nm wavelength, which resulted in an ulcerated wound that eventually healed,
but the patient was left with areas of hypopigmentation and texture changes.
A
B
FIGURE 17-25.  In larger cases, blistering and crusting can develop but generally heal uneventfully.
FIGURE 17-26.  Patient with several scars on the right perioral region from
overtreatment with the 532-nm laser. This area was successfully treated
with the CO2 laser and healed without a visible scar.

Chapter 17  •  Laser Treatment of Vascular Lesions
745
Conclusion
Today’s knowledgeable patients demand skin treatments with
big results and little downtime. The combination of 532-nm
and 940-nm wavelengths in solid-state lasers answers both of
these calls and makes the removal of telangiectasias and pig-
mented lesions truly a lunchtime procedure. Modern lasers
provide a wide array of treatment options and are portable,
predictable, and safe.
References
  1. Niamtu J: Non-ablative technologies. Lasers Surg Med 34:203–204, 2004.
  2. Niamtu J: Laser treatment of vascular and pig-mented lesions. Oral Maxil-
lofac Surg Clin North Am 16:239–245, 2004.
  3. Niamtu J: Clinical applications of the 532-nm diode laser for the treatment
of facial telangiectasias and pigmented lesions: literature review, history
and discussion of clinical expe-rience. Am J Cosmetic Surg 18:71–81,
2001.
  4. Niamtu J: The treatment of facial telangiectasias. Oral Maxillofac Surg Clin
North Am 12:771–780, 2000.
  5. Goldman MP, Bennett RG: Treatment of telangiectasia: a review. J Am
Acad Dermatol 17:167–182, 1987.
  6. Anderson RR, Parrish JA: Selective photothermolysis: precise microsurgery
by selective absorption of pulsed radiation. Science 220:524–527, 1983.
  7. Landthaler M, Hohenleutner U, Abd el Raheem TA: Therapy of vascular
lesions in the head and neck area by means of argon, Nd:YAG, CO2 and
flashlamp-pumped pulsed dye lasers. Adv Otorhinolaryngol 49:81–86,
1995.
  8. Alderson MR: Spider naevi: their incidence in healthy school children.
Arch Dis Child 38:286–288, 1963.
  9. West TB, Alster TB: Comparison of the long-pulsed dye (590–595 nm)
and KTP (532 nm) lasers in the treatment of facial and leg telangiectasias.
Dermatol Surg 24:221–226, 1999.
10. Niamtu J: Common complications of laser resurfacing and their treatment.
Oral Maxillofac Surg Clin North Am 12:579–593, 2000.

746
Index
A
Accreditation, for in-office operating facility,
257
Accutane (isotretinoin) therapy, skin
resurfacing and, 518–519
Acne flare, complicating laser skin
resurfacing, 592–596, 595f–596f
Acne scars, laser treatment of, 565–568,
565f–567f
Actinic damage, to eyelid skin, 132–133,
133f
Age
lip volume augmentation and, 646, 647f
otoplastic surgery and, 440–445
Aging
chin, 9, 9f
ear, 7–8
etiology of, 2b
facial, 1–12
brow in, 4, 5f, 131–132, 133f
cheeks in, 5–7, 6f
deflation in, 1, 1f
eyelids in, 131–134, 133f–134f
lower, 5
forehead in, 4
grading of, 253, 253f
lower, 8–9
midface, 5–7
nasolabial folds in, 7
regional, 2–3
skin in, 2–3, 3b, 4f
shape changes in, 1–2, 2f–4f
submental region, 9–10
upper, 3–5, 90
youthful face compared with, 1, 2f
jowls, 8, 9f
nasal, 7
neck, 9–10, 10f–11f
pathophysiology of, 1
perioral region, 8, 8f
periorbital areas, 131–134, 133f–134f
scalp, 3–4
Air emphysema, complicating midface
implants, 386
Airway management
intraoperative, in facelift surgery, 342
for rhinoplasty, sedation/anesthesia choice
and, 191
Alar base reduction, 212–218, 217f–220f
Alar base resection, 193, 195f
Alar flare, Botox treatment of, 616–617,
617f
Aloe gel, refrigerated, for laser treatment of
vascular lesions, 738–739
Alopecia, complicating endoscopic brow
and forehead lift, 125, 126f
Alpha hydroxy acid (AHA), for chemical
peel, 523, 523b
Amino-Plex medication, in post-laser care,
572–574, 574f
Amorphous nose, 175–176, 177f
Amphadase (hyaluronidase), for HA filler
reversal, 690, 691f
Anesthesia, 35–53
for cervicofacial rhytidectomy, 259–260
conscious sedation and, 49–51. See also
Conscious sedation.
for dual-wavelength laser treatment of
vascular lesions, 738–739
general, for rhinoplasty, 191
for injectable filler administration,
647–648
for lip reduction procedures, 703
local, 35. See also Local anesthesia.
for platysmaplasty, 264
tumescent, 48–49, 49b. See also
Tumescent anesthesia.
Anesthetized area
from inferior alveolar nerve block, 44–45
from infraorbital nerve block, 39–40, 41f
from infratrochlear nerve block, 40f
from maxillary nerve block, 41
from mental nerve block, 43, 45f
from supraorbital nerve block, 40f
from supratrochlear nerve block, 40f
from zygomaticofacial nerve block, 41,
43f
from zygomaticotemporal nerve block,
43f
Angiomas, cherry, laser treatment of,
before-and-after photographs of, 738
Anterior auricular muscle, 438–439, 439f
Antibiotics, for infection, complicating
rhinoplasty, 220–221
Antibody formation, to botulinum toxin
type A, 624–632
Antihelical fold
lack of, 440, 441f–442f
reconstruction of, Mustardé otoplasty for,
452–457. See also Mustardé
otoplasty, for antihelical fold
reconstruction.
Antihelix, reconstructed, postoperative
problems with, 472, 476f
Antiviral prophylaxis, before skin
resurfacing, 521–522
Aquaphor
in post-laser care, 570–571, 571f
for TCA peel, 529
Arnica montana, in postoperative
ecchymosis reduction, in facelift
surgery, 351
Arnold’s nerve, innervation of ear from,
436, 438f
Artefill
history of, 640, 640t
as permanent aesthetic injectable
implant, 641
Artery(ies)
auricular
anterior, supplying ear, 437, 439f
posterior, supplying ear, 437–438,
439f
carotid, external, branches of, supplying
ear, 437–438, 439f
temporal, superficial, supplying ear,
437–438, 439f
Ascher’s syndrome, 702
Asymmetry(ies)
complicating midface implants, 383–385,
385f–388f
complicating rhinoplasty, 222–223
facial
Botox treatment for, 622–623, 623f
normal, 371, 373f
Auricle
distance of, from cranium, 435, 436f
growth disturbances of, 439
Auricular artery
anterior, supplying ear, 437, 439f
posterior, supplying ear, 437–438, 439f
Auricular muscles, 438–439, 439f
Auriculocephalic angle, normal, 435,
437f
Auriculotemporal nerve, 48
innervation provided by, 37
sensory innervation of ear from, 436,
438f
B
Bell’s palsy, Botox treatment for, 622–623
Bell’s phenomenon, testing for, 136, 137f
BFL. See Brow and forehead lift (BFL).
biO2 Cosmeceuticals International
Oxy-Mist system, in post-laser skin
resurfacing care, 572–574, 574f–575f
Bioplate Push-In Tack, for endoscopic brow
and forehead lift fixation, 113, 115f
Page numbers followed by f indicate figures;
t, tables; b, boxes.

Index
747
Biopsy
shave, of lesion before ablation, 720,
721f
tissue, radiowave system for, 718, 720f
Biopsychosocial implications, of cosmetic
facial surgery, 13, 18–19, 19f
Birthmark, laser treatment of, before-and-
after photographs of, 738
Black lights, in making ultraviolet images,
31, 32f
Bleeding
complicating blepharoplasty, 163–165
complicating rhinoplasty, 219–220
during facelift surgery, control of, 269,
281f
intraoperative control of
in facelift surgery, 342–343
in lip reduction procedures, 705–706,
707f
periorbital, complicating blepharoplasty,
164
postoperative, in facelift surgery
management of, 276–279, 343–344,
344f–346f
prevention of, 343
serous, complicating blepharoplasty,
164–165
Blepharoplasty
anesthesia for, 141–142
before-and-after photographs of,
171f–174f
with brow and forehead lift, 93, 94f
complications of, 129
bleeding as, 163–165
eyelid, 163–164
periorbital, 164, 164f
dry, irritated eyes as, 166
ecchymosis as, 165, 165f
lagophthalmos as, 168–169, 169f
lower eyelid conjunctival granuloma
as, 168, 169f
lower eyelid malposition as, 166–167,
166b–167b, 167f
postoperative edema as, 165–166,
165f
postoperative upper eyelid ptosis as,
169, 170f
scarring as, 167–168, 168f
sequelae differentiated from, 161
wound dehiscence as, 166, 166f
cosmetic, 129–174
diagnosis for, 134–136
with endoscopic brow and forehead lift,
incision for, 97, 98f
eyelid crease problems from, 170
facelift with
before and after pictures of, 328f–
329f, 332f–333f
revision, before and after pictures of,
338f–341f
incisions for. See Incision(s),
blepharoplasty.
instrumentation for, 142–143, 143f–144f
postoperative bleeding and, 163
laser skin resurfacing with, incision
lasering in, 563
lower eyelid
postoperative stretching and massage
instructions for, 166b
skin-muscle approach for, 156–161,
159f–160f
anesthesia for, 142
preoperative markings for, 141, 141f
transconjunctival approach for,
149–154
anesthesia for, 142, 142f
fat pad resection in, 151–153,
152f–153f
incision in, 150–151, 151f
preoperative markings for, 141
skin pinch technique with, 155–156
orbital anatomy and, 129–131
patient selection for, 134–136
postoperative care for, 174
preoperative marking for, 138–141
revision, 169–170
sedation for, 142
surgical preparation for, 141–142
tests prior to, 134
with transfollicular subcutaneous brow
and forehead lift, 56, 57f–58f
treatment planning for, 136–138
upper eyelid
anesthesia for, 141–142, 142f
with brow lift, sequencing, 149, 150f
incision for, 143–149
postoperative stretching and massage
instructions for, 167b
preoperative marking for, 138–141
“weekend” facelift with, before and after
pictures of, 331f
Blood pressure control, intraoperative, in
facelift surgery, 342
Blood supply
to ears, 437–438, 439f
to nose, 176, 178f–179f
Body piercing
earlobe repair resulting from, 484, 488f
earlobe tears and, multiple, 492–493
Bone tunnels, for brow lift fixation, 113,
116f
Bones, nasal, 176–182
Botox. See Botulinum toxin type A (BTA).
Botulinum toxin type A (BTA), 604–639
action of, 605–606, 605f–606f
for “bunny” lines treatment, 611,
612f–613f
before-and-after photographs of, 626f
clinical usage of, 607–608
consent for, 607
complications of, 624–638
antibody formation as, 624–632
from “bargain” Botox, 633
ecchymosis as, 633–634, 634f
patient misunderstanding as, 624–633
perioral dysfunction as, 635–638, 637f
unnatural brow elevation as, 635, 636f
unwanted muscle paralysis as, 634,
635f
upper-lid ptosis as, 634–635, 635f
for depressor anguli oris treatment,
618–619
for facial asymmetry, 622–623, 623f
for facial pain, 623
FDA approval of, 604
for Frey syndrome, 612f
for frontalis treatment, 611–614
before-and-after photographs of,
626f–627f
brow-sparing injection pattern for,
614, 615f
injection pattern for, 611–612, 613f
subconscious brow elevation and,
612–614
units needed for, 612
for glabellar rhytids treatment, 609–611
before-and-after photographs of,
625f–626f, 683f
injection depth for, 609–610
injection pattern in, 609, 611f
injection sites in, 610–611, 611f
needle placement in, 609
units needed for, 611
for headache, 623
history of, 604–607, 605f
for hyperhidrosis, 623–624, 625f
for lateral canthal treatment, 614–616
before-and-after photographs of, 628f
ecchymosis prevention in, 615
injection pattern for, 615, 616f
for masseter treatment, 620–621
before-and-after photographs of, 631f
indications for, 620–621
injection pattern for, 621, 622f
units needed for, 621
for midfacial treatment, 616
for myofascial pain syndromes, 623, 624f
nasal indications for, 616–618
for nasal tip elevation, 617
for nasolabial fold treatment, 617–618,
617f–618f
before-and-after photographs of, 629f
needle selection for, 608, 609f
for nostril flare, 616–617, 617f
in oral commissure rejuvenation, 658,
659f
for perioral treatment, 618
before-and-after photographs of,
629f–630f, 683f
physiology of, 604–607, 605f–606f
for platysma band treatment, 621–622
before-and-after photographs of,
632f–633f
potency of, 605
reconstitution of, 607–608, 608f–609f
resistance to, 606
sequelae of
skin wheals as, 633, 634f
upper-lid pseudoptosis as, 634–635
storage of, countertop refrigerators for,
608, 610f
for temporomandibular dysfunction,
623
Botulism, 604–605
Bovine collagen
in Artefill, 641
as injectable filler, history of, 640–641,
640t
Breathing, compromised, complicating
rhinoplasty, revision surgery for, 223,
223f
Brow
aging changes in, 4, 5f, 131–132, 133f
depressors of, 607, 607f–608f
position of, 112f
Blepharoplasty (Continued)
Botulinum toxin type A (BTA) (Continued)

748
Index
problems with, complicating
endoscopic brow and forehead
lift, 126, 127f
transection of, in transfollicular
subcutaneous brow and forehead
lift, 64–65, 68f
treatment approaches to, in endoscopic
brow and forehead lift, 110–112,
111f–112f
elevation of, subconscious, frontalis
treatment and, 612–614
elevator of, 607, 607f–608f
ptosis of, from aging, 131–132, 133f
Brow and forehead lift (BFL), 90–128
blepharoplasty combined with, 93, 94f
endoscopic procedure for, 94–119. See
also Endoscopic brow and forehead
lift (EBFL).
with high hairline, 93–94
patient acceptance of, 92–94
prediction of, 91–92, 92f–93f
surgical approaches for, 90, 91f
upper facial diagnosis for, 90–92
Brow block, in scalp blocking, 46
Brow lift
Botox, controversy over, 614, 615f
Contour ThreadLift, 90
coronal, 90
direct, 90
endoscopic, with upper lid
blepharoplasty, sequencing, 149,
150f
facelift with
before and after pictures of, 328f, 333f
revision, before and after pictures of,
338f
fixation of, in endoscopic brow and
forehead lift, 113, 114f–117f
with forehead lift, 90–128. See also Brow
and forehead lift (BFL).
mini open, 54–89. See also Transfollicular
subcutaneous brow and forehead lift
(TFSBFL).
Bruising, complicating injectable fillers,
686, 687f
BTA. See Botulinum toxin type A (BTA).
Buccal nerve, innervation provided by, 37
Buccinator muscle atrophy, in aging face,
1–2
Buccinator muscles, location of, 251, 251f
“Bunny” lines, Botox treatment of, 611,
612f–613f
before-and-after photographs of, 626f
Burns, complicating laser skin resurfacing,
596–597
C
Calvarium, structure of, fixation locations
and, 112–113, 112f
Cameras, for clinical digital photography,
24, 24f
Candidal infections, complicating laser skin
resurfacing, 589, 590f
Cannulas, liposuction, 261–263, 262f
in pretunneling facelift flap, 274–276,
277f
Canthopexy, for lower-lid laxity, in
blepharoplasty, 153, 161, 162f
Captique, history of, 641
Carbon dioxide laser
for bleeding control in lip reduction
procedures, 705
for fat pad resection in blepharoplasty,
147–148, 147f–148f
for skin resurfacing. See Laser skin
resurfacing (LSR), carbon dioxide.
for upper lid blepharoplasty incision,
143, 144f
wavelength of, 547–548, 549f
Card Recovery, for data recovery, 33
Cardiac patients, facelift surgery in,
precautions for, 341
Carotid artery, external, branches of,
supplying ear, 437–438, 439f
Carruthers, Alastair, in development of
Botox, 604, 605f
Carruthers, Jean, in development of Botox,
604, 605f
Cartilage
ear, 439, 440f
hypertrophic, postoperative, 476, 477f
postoperative buckling of, 476, 477f
reactive postoperative conditions of,
472
weakening of, in Mustardé otoplasty,
453–454, 455f
nasal, 176–182, 179f
enlargement of, with age, 7
quadrangular, in nasal septum, 181–182,
184f
harvesting of, 204, 208f–209f
septal, harvesting of, for grafting in
rhinoplasty, 204–209, 208f–209f
Cervical plexus
block of, 47, 47f
in scalp blocking, 46
innervation of, 47
superficial branches of, 47
Cervicofacial rhytidectomy, 247–368
anatomy and, 249–251
ancillary procedures for, 327
anesthetic considerations for, 259–260
local and tumescent, 259–260
bleeding during, control of, 269, 281f
with blepharoplasty, before and after
pictures of, 328f–329f, 332f–333f
with brow lift, before and after pictures
of, 328f, 333f
with cheek implants, before and after
pictures of, 328f, 330f, 332f–334f
with chin implants, 263
before and after pictures of, 328f
with CO2 laser resurfacing, 563–564,
565f
before and after pictures of, 328f–330f
complications of, 341–363
affecting flap viability, 354–363
neurologic, 351–353
motor nerve injury as, 351,
351f–352f
sensory nerve injury as, 351–353,
353f–354f
postoperative, 343–344
edema and ecchymosis as, 349–351,
350f
external jugular vein injury as,
353–354, 355f
hematoma as, 343–344, 344f. See
also Hematoma, postoperative,
in facelift surgery.
prevention of
intraoperative considerations in,
342–343
preoperative considerations in,
341–342
customized, need for, 248
day of, 259
drape for, 260
facility for, 257, 258f
flap development in, 274–283. See also
Lipocutaneous flaps, in facelift
surgery.
history of, 248
incisions for. See Incision(s), facelift.
informed consent process for, 366–368,
368f
instrumentation for, 257–259, 258f
liposuction in, open, 279–283,
283f–284f
patient selection for, 252–253
anatomic considerations in, 253, 254f
platysmaplasty in, 263–264
before-and-after pictures of, 328f–334f
technique for, 264–269, 266f–268f
posterior platysma suspension in,
292–294, 294f–295f
postoperative care for, 311–319
day-after appointment in, 318–319,
318f
drains in, 311–316
dressings in, 316–317, 317f–318f
extended, 318–319, 319f
hair in, 311–316, 317f
medications in, 318
one-week follow-up appointment in,
319, 321f
potential, determining status for,
254–256
budget in, 256
health in, 254–255
psychological stability in, 255–256
recovery in, 256
predicting results of, 252–253, 252f–253f
preoperative consultation workup for,
256–257
preoperative marking for, 256–257, 259,
259f
prep for, 260
procedure for, 269–283
red flags for, 255–256
revision, 337–341
before-and-after photographs of,
337f–341f
challenges of, 337–338
discussion of, in preoperative
consultation, 257
postsurgical, 363–366, 365f–367f
procedure for, 334f–336f, 338–341
reasons for, 337–338
short-scar/“weekend”, 319–323, 322f
procedure for, 321–323, 323f–327f
with SMASectomy
and platysmaplasty and chin
implant, before and after
pictures of, 330f
Brow (Continued)
Cervicofacial rhytidectomy (Continued)

Index
749
and upper blepharoplasty, before
and after pictures of, 331f
simultaneous laser skin resurfacing in,
323–327, 327f
skin excess management in, 294–300
earlobe delivery in, 299–311,
302f–307f
key sutures in, pre- and postauricular,
296–298, 297f
in postauricular area, 310–311,
310f–314f
skin cutback in, 296–299, 298f–299f
skin suspension in, 295–296
vectors of tension for, 295–296,
296f–297f
in temporal tuft area, 305–307,
305f–306f
in tragal reconstruction, 307–310,
307f–310f
skin-only
limitations of, 279
revision, before and after pictures of,
338f
SMAS techniques for, 283–292
imbrication as, 286
plication as, 283–286
submental liposuction in, 260–263,
261f–264f
surgical procedure for, 260–269
Cervicomental region, tissue necrosis in,
after facelift, 358, 358f
Cetaphil Gentle Cleanser, in post-laser care,
570–571, 571f
Cetaphil moisturizer, in post-laser care,
571–572
Cheek implants. See Midface implants.
Cheekbones, deficient, 370f, 371
Cheeks, aging changes in, 5–7, 6f
Cheiloplasty, reduction, 701–717. See also
Lip reduction.
Chemical peel, 517. See also Resurfacing,
skin.
agents used for, 523–524, 523b
safe precautions for, 524
for aging skin in transconjunctival
blepharoplasty, 154, 155f
complications of, 536–546
hyperpigmentation as, 545, 547f
hypopigmentation as, 546, 547f–548f
involving transition zone, 536–545,
545f
in neck, 545, 546f
overtreatment as, 545, 546f
uneven treatment as, 536, 544f
depths of
classification of, 522, 522b
healing times for, 522, 523b
mechanism of action in, 523
medium depth, procedure for, 522–
523
Obagi Blue, 529–536. See also Obagi
Blue Peel (OBP).
procedure for, 524
skin conditioning prior to, 519–521
trichloroacetic acid. See Trichloroacetic
acid (TCA) peel.
Chemosis, complicating endoscopic brow
and forehead lift, 123, 125f
Cherry angiomas, laser treatment of,
before-and-after photographs of, 738
Chin
aging, 9, 9f
implants for. See Chin implant(s).
witch’s, 9, 9f
Chin implant(s), 386–419
before-and-after photographs of, 405,
407f–410f
in cervicofacial rhytidectomy, 263
complications of, 405–419
incision placement-related, 416–419,
419f
infection as, 411–416, 416f–418f
malposition as
inferior, 405–411, 411f
rotational, 411, 415f
superior, 405–411, 411f–414f
osteomyelitis as, 416, 418f
smoking-related, 411–416, 417f
custom, 419, 420f–421f
facelift with
before and after pictures of, 328f
revision, before and after pictures of,
340f–341f
lip reduction with, 709
before-and-after photographs of,
710f–711f
surgery for, 394–398
intraoral approach to, 394, 398–405
implant fixation in, 401, 402f
implant placement in, 401,
401f–402f
incision in
closure of, 401, 403f
horizontal, 398, 399f–400f
vertical, 401, 405f
subperiosteal dissection in, 398,
399f–401f
submental approach to, 394–398,
396f–397f
implant fixation in, 396f–397f, 398
implant placement in, 395–398,
396f–397f
incision closure in, 396f–397f, 398
incisions in, 394–395, 396f–397f
subperiosteal dissection in,
394–398, 396f–397f
“weekend” facelift with, before and after
pictures of, 330f
Clostridium botulinum, isolation of, 604
Cold compresses, in post-laser care,
570–571
Collagen, bovine
in Artefill, 641
as injectable filler, history of, 640–641,
640t
Columellar assessment, in nasal tip
evaluation, 187, 188f
Columellar struts, for nasal tip projection,
203–204
Computed tomography, in custom chin
implant fabrication, 419, 420f
Computer pattern generators, for laser
treatment of vascular lesions, 736
Computer simulation, in rhinoplasty
consultation, 185–186
Conchal wall/bowl hypertrophy, 440,
442f–443f
Davis procedure for, 445–452. See also
Davis procedure, for conchal bowl
excess.
Conchocephalic angle, normal, 435, 437f
Conchomastoid angle, normal, 435, 437f
Conjunctival granuloma, lower eyelid,
complicating blepharoplasty, 168,
169f
Conscious sedation, 49–51
intravenous, 51
monitored anesthetic care anesthetic
agents for, 51, 51f
procedure for, 51–53, 52f–53f
nitrous oxide/oxygen for, 49–51
oral, 50–51
Consent
for before-and-after photographs, 136
informed
for Botox therapy, 618–619
in consultation for cervicofacial
rhytidectomy, 256–257
for facelift, 366–368, 368f
for facial implants, 371–372
for filler injection, 644–645
complications/sequelae and, 686
for injecting silicone, 669
Consult
art of, 13–22
beginning, 13, 15f
for cervicofacial rhytidectomy,
preoperative, 256–257
diagnostic portion of, 13, 15, 15f–16f
educational aids for, 15
ending, 15–16
follow-up after, 16
preconsult and, 13, 14f
for reduction cheiloplasty, 701–702
for rhinoplasty, 182–186
for skin resurfacing, 522
Consultation room, 14f
Corneal shields, laser, 550–551, 551f
Corrugator supercilii muscles
Botox injections of, for glabellar rhytids,
610–611, 611f
as brow depressors, 607, 607f
transection of
in endoscopic brow and forehead lift,
112
in transfollicular subcutaneous brow
and forehead lift, 64–65, 68f
Cosmetic blepharoplasty, 129–174. See also
Blepharoplasty.
Cosmetic coordinator, role in preconsult,
13, 14f
Cosmetic otoplasty, 434–516
Cosmetic paradox, 702
CosmoDerm, in history of injectable fillers,
640–641, 640t
CosmoPlast, in history of injectable fillers,
640–641, 640t
Cottle test, for nasal valve collapse
diagnosis, 188
Cranial nerve V (trigeminal), facial
innervation by, 35–36, 35f–36f
Crow’s foot rhytids, 4–5
lateral canthal treatment for, 614–616
Crumley’s method, of nasal tip projection
assessment, 186–187, 187f
Cervicofacial rhytidectomy (Continued)
Conchal wall/bowl hypertrophy (Continued)

750
Index
Crus
intermediate, 181, 183f
lateral, 181, 183f
medial, 181, 183f
Cupid’s bow
defining, injectable fillers in, before-and-
after photographs of, 674f
in lip outlining, 648–650
augmenting, 651, 652f
Cutaneous cervical nerve, 47
Cutaneous ligaments
location of, 251, 252f
weakening of, in midfacial aging, 6–7, 6f
D
Davis procedure, for conchal bowl excess
bolster sutures in, 449f–452f, 452
dissection in, 447, 449f–452f
excess cartilage removal in, 447,
449f–452f
incisions in, 446–447, 449f–452f
closure of, 449f–453f, 452
local anesthesia for, 446
marking before, 445, 446f–448f
photographs before, 445
sedation for, 446
Débridement, during aggressive CO2 laser
resurfacing, 561–563, 562f–564f
Décolletage area, TCA peel of, 528–529,
530f
Deep FX laser, 555, 558f, 560f
Deep vein thrombosis (DVT), complicating
surgery, prevention of, 342
Deformation, earlobe repair resulting from,
484, 488f
Dehiscence, wound
complicating blepharoplasty, 166, 166f
complicating facelift surgery, 363,
363f–364f
complicating mandibular angle implants,
430, 432f
Dental disease, midface implants and, 371,
374f
Depressor anguli oris muscle
action of, 618–619, 619f
Botox treatment of, 618–619
controversy over, 618–619
injections for, 619, 620f
Dermatochalasis, 4–5, 5f, 132–133
after transconjunctival blepharoplasty,
chemical peel for, 154
Dermatosis papulosa nigra, dual-wavelength
laser treatment of, 738, 739f
before-and-after photographs of, 743f
Diagnosis, of cosmetic facial surgery
patient, 13–22. See also under specific
procedure, e.g. Blepharoplasty,
Transfollicular subcutaneous brow and
forehead lift (TFSBFL).
Digital photography, clinical, 23–34. See
also Photographs; Photography, digital,
clinical.
“Dog ear”, in postauricular skin
management
in facelift, 311, 314f
in weekend facelift, 322–323, 326f
Dorsal (external) nasal nerve
block of, 40, 42f
innervation provided by, 36
Dorsal hump, nasal, 181
assessment of, 185–186
reduction of
by osteotome, 201–202, 210
osteotomies and, 209–212
by rasping, 201–202, 209–210
by scissor resection, 201–202, 203f,
209–210
Dressings
post-facelift, 316–317, 317f–318f
extended, 318–319, 319f
post-laser skin resurfacing, 569–570,
570f
postoperative, for cosmetic otoplasty,
457–461, 460f–461f
Dry eyes, complicating blepharoplasty, 166
Dysport, 606–607. See also Botulinum
toxin type A (BTA).
E
Ear(s)
aging, 7–8
anatomy of
aberrant, 439–440
cartilaginous, 439, 440f
muscular, 438–439
neurologic, 436
normal, 434–435, 436f–437f
vascular, 437–438, 439f
antihelical fold of, lack of, 440, 441f–
442f, 461
block for, 48, 48f
combination deformities of, 440, 444f
conchal wall/bowl hypertrophy of, 440,
442f–443f
cosmetic surgery for, 434–516
deformities of, nonsurgical intervention
for, 445
embryology of, 434, 434f–435f
growth of, throughout lifespan, 8
protruding, heredity and, 440, 440f–441f
Earlobe(s)
adjunctive surgical procedures on,
476–484
delivery of, in facelift procedure,
299–311, 302f–307f
filler injection of, 667, 670f
before-and-after photographs of, 685f
hypertrophic, reduction of, 477–484
before-and-after photographs of,
484f–487f
incisions in, unfavorable scar from,
478, 483f
inferior lobe excision for, 478,
481f–482f, 486f–487f
wedge resection for, 477–478,
479f–481f
keloids of, 500–506
radiowave ablation of, 726, 728f
piercing of, simultaneous with repair,
493–497, 497f–498f
pixie
congenital, 300–305, 305f
from facelift, 300, 302f–303f
revision of, 337f
protruding, correction of, 457,
459f–460f
repair of
clinical results of, 500, 501f–505f
complications of
bleeding as, 497, 499f
hematoma as, 497
infection as, 500, 500f
inferior notching as, 497, 499f
pressure necrosis as, 500, 500f
wound dehiscence as, 497, 499f
torn
body piercing and, 492–493
classification of, 484, 488f
with multiple tears, simultaneous
repair of, 492–493, 495f–496f,
497
repair of, 484–493
anesthesia for, 484
complications of, 497–500
inferior border management in,
484–492, 493f–494f
simultaneous piercing and,
493–497, 497f–498f
sutures in, 492, 494f
Earlobe incision, for jowl liposuction, 263,
264f
EBFL. See Endoscopic brow and forehead
lift (EBFL).
Ecchymosis
complicating blepharoplasty, 165,
165f
complicating Botox therapy, 633–634,
634f
complicating endoscopic brow and
forehead lift, 123, 124f
complicating lateral canthal Botox
treatment, prevention of, 615
complicating midface implants, 381,
382f
complicating rhinoplasty, 220, 221f
complicating transfollicular subcutaneous
brow and forehead lift, 75, 83f
postoperative, in facelift surgery,
349–351, 350f
Edema
complicating endoscopic brow and
forehead lift, 123, 124f
complicating laser skin resurfacing, 587,
587f
complicating midface implants, 379–381,
382f
postoperative
complicating blepharoplasty, 165–166,
165f
complicating rhinoplasty, 222
in facelift surgery, 349–351, 350f
Editing software, digital, 24, 25f
Elastic gauze, in post-laser skin resurfacing
dressing, 569–570, 570f
Electrosurgery
history of, 718
machines for, lower-wavelength, 719f
radiowave surgery differentiated from,
718
Ellman radiofrequency microneedle
for bleeding control in facelift surgery,
343
for fat pad resection in blepharoplasty,
147–148, 147f–148f
for upper lid blepharoplasty incision,
143, 144f
Earlobe(s) (Continued)

Index
751
Ellman Surgitron Dual RF 4-MHz
radiowave surgical instrument, 718,
720f
Emergence delirium phenomenon, 52
Emotional issues, complicating facelift
surgery, 342
Emotions, after cosmetic facial surgery, 18
Emphysema
air, complicating midface implants, 386
patients with, facelift surgery in,
precautions for, 341–342
Endo Push Screw, for endoscopic brow and
forehead lift fixation, 113
Endonasal rhinoplasty, 197–199. See also
Rhinoplasty, closed.
Endoscopic brow and forehead lift (EBFL),
94–119
before-and-after results of, 119,
120f–123f
blepharoplasty with, incision for, 97, 98f
complications of, 119–126
alopecia as, 125, 126f
brow depressor problems as, 126, 127f
chemosis as, 123, 125f
edema/ecchymosis as, 123, 124f
hematoma/seroma as, 123, 124f
infection as, 125, 125f
inflammation from resorbable devices
as, 126, 127f
Prolene suture extrusion as, 125, 126f
relapse as, 119–123, 124f
supraorbital nerve paresthesia as, 123
unilateral frontalis palsy as, 123–125,
125f
fixation techniques in, 112–119
bone tunnels as, 113, 116f
Endotine fixation device as, 113, 117f
resorbable screws for, 113, 114f–116f
temporal, 113, 118f–119f
threadless retention posts as, 113, 116f
incisions for, 96–97, 98f
instrumentation for, 94–95, 95f–96f,
97–99, 100f
optical dissection pockets for, creation of,
99, 100f
periosteal release in
brow depressor management in,
110–112, 111f–112f
instrumentation for, 107–110, 109f
supraorbital, 106–110, 109f
postoperative course in, 119
preoperative planning for, 95–96, 96f
subperiosteal dissection in
connecting central and temporal
optical cavities, 105, 107f
frontal, 97, 98f, 99–103, 100f–103f
lateral orbital rim, 103, 103f–104f
adhesions transection in, 105–106,
108f–109f
malar, 104–105, 107f
temporal, 103–104, 105f–107f
surgical procedure for, 95–112
Endoscopic brow lift, with upper lid
blepharoplasty, sequencing, 149, 150f
Endotine fixation device, for brow lift
fixation, 113, 117f
Ephelides
dual-wavelength laser treatment of, 738
TCA peel for, 539f
Epiboly, 518
Epidermal sliding, in endpoint
determination for medium-depth TCA
peel, 527–528, 528f
Equipment. See also Instrumentation.
for clinical digital photography, 23–24
cameras as, 24, 24f
digital editing software as, 24, 25f
sliding photographic frames as, 23,
23f
Erbium:YAG laser, wavelength of, 547–548,
549f
Erythema
complicating laser skin resurfacing, 587,
588f
complicating radiowave ablation of nevi/
lesions, 727f, 733, 733f
Ethmoid bone, perpendicular plate of, in
nasal septum, 181–182, 184f
Ethmoidal artery, of nose, 176, 178f–179f
Ethmoidal nerve
innervation provided by, 36
interior, external nasal branch of, 182,
184f
Ethnic lips, 701. See also Lip reduction;
Macrocheilia.
Evolence
history of, 640t
properties of, 642–643
Expanded polytetrafluoroethylene (ePTFE)
implants, 369–370
External jugular vein
injury to, complicating facelift, 353–354,
355f
location of, 251, 251f
External nasal valve, collapse of, diagnosis
of, 188
External rhinoplasty, 199–202. See also
Rhinoplasty, open.
Eye(s)
dry, irritated, complicating
blepharoplasty, 166
protection of, for lasers, 550–551, 551f
Eyebrow, tattooed, asymmetrical,
complicating transfollicular
subcutaneous brow and forehead lift,
76, 83f
Eyelid(s). See also Blepharoplasty.
aging conditions of, 131–134, 133f–134f
bleeding in, complicating blepharoplasty,
163–164
evaluation of, for blepharoplasty, 134
innervation of, 132b
lamellae of, 129
laxity of, 134
tests for, 135, 135f–136f
lower
adhesion in, complicating laser skin
resurfacing, 597–600, 598f–600f
aging changes in, 5, 132–133
blepharoplasty for. See Blepharoplasty,
lower eyelid.
conjunctival granuloma of,
complicating blepharoplasty, 168,
169f
fat pads of, 131, 132f
malposition of, complicating
blepharoplasty, 166–167,
166b–167b, 167f
post-blepharoplasty stretching and
massage instructions for, 166b
preoperative marking of, for
blepharoplasty, 141
relation to globe, 138f
retraction of, complicating laser skin
resurfacing, 597, 597f
structures of, 129, 130f
upper
aging changes in, 4–5, 5f, 129,
132–133, 133f
blepharoplasty for. See Blepharoplasty,
upper eyelid.
crease of, 131, 132f
marking location of, for
blepharoplasty, 138–139, 139f
fat pads of, 131, 132f
post-blepharoplasty stretching and
massage instructions for, 167b
preoperative marking of, for
blepharoplasty, 138–141
“pinch test” after, 140, 140f
pseudoptosis of, as sequela of Botox
therapy, 634–635
ptosis of
complicating Botox therapy,
634–635, 635f
postoperative, in blepharoplasty,
169, 170f
structures of, 129, 129f
xanthelasma of, 133, 133f
F
Face
aging, 1–12. See also Aging, facial.
asymmetry of
Botox treatment for, 622–623, 623f
normal, 371, 373f
lower third of, deficiency of, management
of, 386–394, 394f–395f
pain in, Botox treatment for, 623, 624f
proportions of, rhinoplasty and, 175,
175f
Facelift surgery, 247–368. See also
Cervicofacial rhytidectomy.
Facial implants, 369–433. See also Implants.
Facial nerve
branches of, protection of, during facelift
surgery, 251
buccal branch of, facelift complications
involving, 351, 351f–352f
frontal branch of
protection of, during endoscopic
brow and forehead lift dissection,
105
unilateral palsy of, complicating
endoscopic brow and forehead
lift, 123–125, 125f
zygomatic branch of, facelift
complications involving, 351,
351f–352f
Factitious injury, to healing facelift tissues,
363, 364f–365f
Fat
autologous, injection of, 671–672,
673f–674f
inferior migration of, in jowl formation,
8
Eyelid(s) (Continued)

752
Index
subcutaneous
decrease in, in aging, 1
submental, 261, 262f
subplatysmal, overtreatment of, 261,
262f
superficial, in jowls and neck of normal
and obese patient, 260–261, 261f
transpositioning of, for lower eyelid fat
pseudoherniation, 154–155, 155f
Fat pads
lower eyelid
recontouring of, in blepharoplasty,
153
resection of, in blepharoplasty,
151–153, 152f–153f
periorbital
cushioning globe, 131, 132f
prolapse of, 133, 133f
upper eyelid, resection of, in
blepharoplasty, 147–148, 147f–148f
Fat pseudoherniation, eyelid, 133, 133f
lower, fat transpositioning for, 154–155,
155f
Fees, for postsurgical facelift revision,
364–365
Fentanyl, in monitored anesthetic care, 51,
51f
Festoons, periorbital, 134, 134f
Fillers, injectable, 640–700
amount needed, 645
anesthetic considerations for, 647–648
bovine collagen, history of, 640–641,
640t
common areas for, 643f
complications of, 672–691
bruising as, 686, 687f
consent process and, 686
filler migration as, 688, 690f
hematoma as, 686, 687f
herpetic outbreaks as, 686, 688f
overtreatment as, 686, 688f–689f
with HA fillers, reversal of, 685,
690, 691f
tissue necrosis as, 685–686, 686f
demonstrating anticipated results of, 645,
645f–646f
diagnostic decisions for, 645–646
for earlobes, 667, 670f
before-and-after photographs of, 685f
fat transfer as, 671–672, 673f–674f
historical overview of, 640–643, 640t
for horizontal forehead lines, 663, 663f
hyaluronic acid. See also Hyaluronic acid
(HA) filler(s).
history of, 640, 640t
ice application after augmentation with,
658, 660f, 662–663
informed consent process for, 644–645
for injection rhinoplasty, 665–666, 667f
injection techniques for, 645, 646f
for lateral canthal rhytids, 665, 666f
for lip-enhancement techniques,
648–653. See also Lip(s),
enhancement techniques for.
liquid silicone oil as, injection of,
667–671, 670f–673f
local anesthesia combined with, 641
longevity of, 644
malar augmentation with, 666–667,
668f–669f
marking patient for, 646
for midfacial augmentation, 666–667,
668f–669f
before-and-after photographs of,
684f
for nasojugal groove, 663–665,
664f–666f
before-and-after photographs of,
683f–684f
for nasolabial fold augmentation,
659–663. See also Nasolabial fold(s),
reducing, injectable fillers for.
patient expectations for
determining, 645–646
reasonable, encouraging, 644
for perioral filler techniques, 653–659.
See also Perioral region, filler
techniques for.
for periorbital rhytids, 663–665,
664f–666f
permanent, Artefill as, 641
for prejowl sulcus, 667, 670f
sculpting approach with, 644
selection of, 644
for tear trough. See Fillers, injectable, for
nasojugal groove.
tissue deposition of, 643–644
treatment considerations for, 644
Finger rest, for radiowave ablation of nevi/
lesions, 720–721, 722f
Fistula, parotid, complicating facelift
surgery, 359, 361f
Fitzpatrick skin classification system, 517,
518f
Fixation
brow lift, Vicryl sutures in, 113
screw
of cheek implants, 379, 381f–382f
of chin implants
in intraoral approach, 401, 402f
in submental approach, 396f–397f,
398
of mandibular angle implant, 428,
429f
Flap(s)
lipocutaneous, in facelift surgery. See
Lipocutaneous flap(s), in facelift
surgery.
SMAS, in facelift surgery, 286
subcutaneous
pretunneling of, 63, 63f
in transfollicular subcutaneous brow
and forehead lift, dissection of,
63–64, 64f–67f
skin redundancy after, 65–69, 69f
5 Fluorouracil (5 FU)
for chemical peel, 523, 523b
with triamcinolone, intralesional, for
earlobe keloids, 506, 506f
before-and-after photographs of,
513f
Forehead
aging changes in, 4
horizontal lines in, injectable fillers for,
663, 663f
lifting of
brow lift with, 90–128. See also Brow
and forehead lift (BFL).
transfollicular subcutaneous approach
to, 54–89. See also Transfollicular
subcutaneous brow and forehead
lift (TFSBFL).
local anesthetic techniques for, 38–39
Fractional CO2 laser skin resurfacing
superficial, 553, 554f–557f
ultralight, 552–553, 552f–554f
Fraxel Re:pair laser, 555, 559f–560f
Freckles
dual-wavelength laser treatment of, 738
TCA peel for, 539f
Frey syndrome, Botox treatment for,
623–624
Frontal nerve branches, 36
blocking of, 39
distribution of, 38–39, 39f
Frontalis muscle(s)
Botox injection of, 611–614. See also
Botulinum toxin type A (BTA), for
frontalis treatment.
as brow elevators, 607, 607f
FX treatment, active, 552
G
GAN. See Greater auricular nerve (GAN).
Gauze
elastic, in post-laser skin resurfacing
dressing, 569–570, 570f
saturated with hydrogen peroxide, in
post-laser care, 571, 571f
Genioplasty, sliding (horizontal), for short
lower facial third, 394, 394f–395f
Gingival display, excessive, Botox treatment
of, 617–618
Glabellar rhytids
Botox treatment of, 609–611. See also
Botulinum toxin type A (BTA), for
glabellar rhytids treatment.
HA filler treatment of, before-and-after
photographs of, 683f
Glands, sebaceous, of nose, hyperplasia of,
with aging, 7
Global skin, 517
Obagi Blue Peel for, 529–536. See also
Obagi Blue Peel (OBP).
Globe, fat pads cushioning, 131, 132f
Glossopharyngeal nerve, innervation of ear
from, 436
Goldman tip technique, classic, for nasal tip
projection, 203–204
Goode method, of nasal tip projection
assessment, 186–187, 187f
Graft(s)
exposure of, complicating rhinoplasty,
221–222
shield, for nasal tip projection, 203, 206f,
209f
Granuloma, conjunctival, lower eyelid,
complicating blepharoplasty, 168, 169f
Greater auricular nerve (GAN), 47–48
anterior branch of, innervation of ear
from, 436, 438f
facelift complications involving,
351–353, 353f–354f
location of, 251, 251f
Fat (Continued)
Fillers, injectable (Continued)
Forehead (Continued)

Index
753
posterior branch of, innervation of ear
from, 436, 438f
Greater occipital nerve block, technique of,
for posterior scalp anesthesia, 46, 46f
H
HA fillers. See Hyaluronic (HA) filler(s).
Hair
aging of, 3–4
loss of, complicating facelift surgery, 360,
362f
Hair-bearing skin, reepithelialization after
resurfacing and, 518, 519f
Hair follicles, in facelift flap, handling of,
279, 282f
Hair shock, following endoscopic brow and
forehead lift, 125, 126f
Hairline(s)
high, brow and forehead lift with,
93–94
natural, 57, 59f
Hand mirror, for consult, 13, 15f
“Handesthesia”, for injection procedures,
647
Handpieces, for dual-wavelength laser
treatment of vascular lesions, 721f,
737–738, 738f
Head
major sensory dermatomes of, 48, 48f
position of, after facelift surgery, 358
sensory anatomy of, 35–37
Headache, Botox treatment for, 623
Health, in patient selection for cervicofacial
rhytidectomy, 254–255
Hematoma
complicating earlobe repair, 497
complicating endoscopic brow and
forehead lift, 123
complicating injectable fillers, 686, 687f
complicating midface implants, 379–381,
383f
complicating otoplasty, 470–471, 473f
complicating rhinoplasty, 218–219
postoperative, in facelift surgery,
343–344, 344f
expanding, 343–344, 347f
management of, 276, 343–344,
345f–348f
minor, 343–349, 349f
management of, 343–349, 344f,
349f
retrobulbar, complicating blepharoplasty,
163–164
Hemitransfixion incision
for rhinoplasty, 193
for septoplasty, 193
Hemorrhage
intraoperative, in facelift surgery, control
of, 269, 281f
postoperative, in facelift surgery,
prevention of, 343
Hemostasis
in fat pad resection in blepharoplasty,
147–148
intraoperative
in facelift surgery, 342–343
in lip reduction procedures, 705–706,
707f
in midface implant pocket dissection,
376, 378f
Heredity, facial aging and, 1
Herpetic infection, complicating laser skin
resurfacing, 591–592, 594f
Home support, in consultation for
cervicofacial rhytidectomy, 256
Hooding, upper eyelid, 131–132
Horizontal forehead lines, injectable fillers
for, 663, 663f
Horizontal genioplasty, for short lower
facial third, 394, 394f–395f
Horizontal releasing incision, for facelift,
269
Horizontal sideburn incision, for facelift,
270
Hyaluronic acid (HA) filler(s). See also
Filler(s), injectable.
for depressions after rhinoplasty,
222–223, 222f
history of, 640–641, 640t
isovolumic degradation of, 640–641
longevity of, 640–641
reversal of, 690, 691f–692f
reversibility of, 644
Hyaluronidase, for HA filler reversal, 690,
691f
Hydrelle, introduction of, 641
Hydrogen peroxide, gauze saturated with,
in post-laser care, 571, 571f
Hydroquinone 4%, in prepeel skin
conditioning, 519
Hylaform, history of, 641
Hylaform Plus, history of, 641
Hyperhidrosis, Botox treatment for,
623–624, 625f
Hyperpigmentation
complicating chemical peel, 545, 547f
complicating laser skin resurfacing,
588f–589f
complicating otoplasty, 476, 478f
Hypertrophic scars
keloids differentiated from, 500–506
laser treatment of, 565–566
Hypopigmentation
complicating chemical peel, 546,
547f–548f
complicating laser skin resurfacing,
600–602, 601f–602f
of transfollicular subcutaneous brow and
forehead lift scar, 85, 85f
I
Imbrication, definition of, 283–284
Implant(s)
chin, 386–419. See also Chin implants.
facial, 369–433
materials for, 369
lip, 691–697. See also Lip implants.
mandibular angle, 419–430. See also
Mandibular angle implants.
midface, 370–386. See also Midface
implants.
prejowl, 401–405
submalar, 370–371, 371f
Incision(s)
blepharoplasty
“Bird beak”, indications for, 139, 140f
in endoscopic brow and forehead lift,
97, 98f
laser, 565, 565f
lower eyelid
marking of, 141, 141f
transconjunctival. See
Transconjunctival
blepharoplasty incision.
“Napoleon’s hat”, indications for, 139,
140f
upper eyelid
closure of, 148–149, 149f
upper extent of, marking, 139–141,
139f, 141f
for chin implant placement
intraoral approach
horizontal, 398, 399f–400f
closure of, 401, 403f
vertical, 401, 405f
submental approach, 394–395,
396f–397f
closure of, 396f–397f, 398
for Davis procedure for conchal bowl
excess, 446–447, 449f–452f
earlobe
for jowl liposuction, 263, 264f
unfavorable scars from, 478, 483f
endoscopic brow and forehead lift,
96–97, 98f
facelift
aesthetics of, 311, 315f–316f
design of, 269–274, 270f–276f
horizontal releasing, 269
horizontal sideburn, 270
postauricular, 269
posterior auricular
placement of, 271–274, 273f–277f
scar from, hairstyle and, 256
preauricular, 269
wound necrosis at, 354–358, 357f
pretragal versus. posttragal, 271,
272f–273f
revision, planning, 338–339
short scar/weekend, 321, 323f
in temporal tuft area
closure of, 305–307, 305f–306f
wound breakdown at, 354, 357f
vertical superior temporal extension,
269, 270f
vertical temporal release, 269, 270f
for lip implant placement, 694,
695f–696f
for lip lift, 709, 713f–714f
for mandibular angle implant placement,
423, 426f
closure of, 429, 430f
for midface implant placement, 373–375,
375f
closure of, 379, 381f–382f
platysmaplasty, 264–265
rhinoplasty
hemitransfixion, 193
intercartilaginous, 193, 194f–195f,
198
Killian, 193, 195f, 198
marginal
for closed technique, 192–193,
198
Greater auricular nerve (GAN) (Continued)
Hemostasis (Continued)
Incision(s) (Continued)

754
Index
for open technique, 191–192, 192f,
199–200, 200f
rim, 194f, 198
transcartilaginous (intracartilaginous),
192–193, 194f, 198
transcolumellar, 191–192, 193f
transfixion, 193, 195f–196f, 198
for skin pinch technique, 156, 157f–158f
for SMAS imbrication, 286
subciliary, for skin-muscle approach for
lower blepharoplasty, 156,
159f–160f
for torn earlobe repair, 484, 489f
closure of, inadvertent lobe elongation
and, 484, 490f
prevention of, 484, 490f–491f
transfollicular, 57–75. See also
Transfollicular incision.
trichophytic, 57–59. See also
Transfollicular incision.
Infection(s)
complicating chin implants, 411–416,
416f–418f
complicating endoscopic brow and
forehead lift, 125, 125f
complicating facelift surgery, 262f,
360–363
complicating laser skin resurfacing,
588–591, 589b, 589f–590f
candidal, 589, 590f
herpetic, 591–592, 594f
methicillin-resistant Staphylococcus
aureus, 591, 592f–593f
Pityrosporum, 589, 589f
staphylococcal, 589–591, 590f
complicating midface implants, 381–383,
384f
complicating otoplasty, 476, 477f–478f
complicating rhinoplasty, 220–221
Inferior alveolar nerve
block of, 44–45, 45f
innervation provided by, 37
Inferior lobe notching, complicating earlobe
repair, 497, 499f
prevention of, 484–492, 493f
Inferior oblique muscle, in lower eyelid,
131, 132f
Inferior palpebral branches, course of, 37
Infiltrative peripheral anesthesia, regional
nerve block anesthesia versus, 37
Inflammation, from resorbable devices,
complicating endoscopic brow and
forehead lift, 126, 127f
Informed consent. See Consent, informed.
Infraorbital nerve
block of, 39–41
area of anesthesia from, 39–40, 41f
facial approach to, 39–40, 41f
intraoral approach to, 39, 40f
supplying nose, 175, 184f
Infraorbital neurovascular bundle,
protection of, in midface implant
placement, 375–376, 376f
Infratrochlear nerve
blocking of, 39, 40f
branches of, supplying nose, 182, 184f
distribution of, 38–39, 39f
innervation provided by, 36
protection of, during endoscopic brow
and forehead lift dissection, 99
Inhalants, from laser therapy, protection
from, 551
Injection rhinoplasty, 665–666, 667f
Innervation
of eyelids and associated structures,
132b
sensory, of head and neck, 35–37
Instrumentation
for blepharoplasty, 142–143, 143f–144f
postoperative bleeding and, 163
for brow and forehead lift
endoscopic
periosteal release, 107–110, 109f
subperiosteal dissection, 94–95,
95f–96f, 97–99, 100f
transfollicular subcutaneous, 56
for cervicofacial rhytidectomy, 257–259,
258f
for midface implant placement, 372–373,
374f
Intercartilaginous incision, for rhinoplasty,
193, 194f–195f, 198, 211f
Intermediate reticular dermis, in medium-
depth TCA peel, 527
Internal nasal valve, 181, 182f
collapse of, diagnosis of, 188
Intracartilaginous incision, for rhinoplasty,
192–193, 194f, 198
Intracellular volatilization, in radiowave
surgery, 718, 719f
Intradermal placement, of injectable fillers,
643–644, 643f
Intravenous sedation, 51
monitored anesthetic care anesthetic
agents for, 51, 51f
procedure for, 51–53, 52f–53f
Iridex VariLite dual-wavelength laser, for
vascular and pigmented lesions, 734,
742f
Isotretinoin (Accutane) therapy, skin
resurfacing and, 518–519
J
Jowls
formation of, 8, 9f
liposuction of, 263, 264f
Jugular vein, external, injury to,
complicating facelift, 353–354, 355f
Juvederm, history of, 640, 640t
Juvederm XC, introduction of, 641
K
Keloids
earlobe, 500–506
intralesional triamcinolone for, 506,
506f
before-and-after photographs of,
513f–514f
surgical excision and radiation for,
506–512, 507f–512f
before-and-after photographs of,
514f–515f
surgical excision with intralesional
steroid injections for, before-
and-after photographs of, 515f
treatment options for, 506–512
hypertrophic scars differentiated from,
500–506
Keratolytic agents, for chemical peel,
mechanism of action of, 523
Keratoses
dual-wavelength laser treatment of, 738
multiple, radiowave removal of,
before-and-after photographs of,
729f
Kerner, Justinius, in study of botulism, 604
Ketamine, in monitored anesthetic care, 51,
51f
Kiesselbach plexus, 176, 178f
Killian incision
for rhinoplasty, 193, 195f, 198
for septal harvesting, 204
for septoplasties, 193, 195f
L
Lacrimal gland, 131, 132f
avoiding injury to, from osteotomes,
223, 223f
Lacrimal nerve, innervation provided by, 36
Lagophthalmos
complicating blepharoplasty, 168–169,
169f
permanent, from blepharoplasty,
prevention of, 139
Laryngeal mask airway (LMA), for
monitored anesthetic care, 52, 53f
Laser(s)
585-nm flashlamp-pumped pulsed-dye,
for vascular lesions, 734, 736f
carbon dioxide. See Carbon dioxide
laser.
wavelength of, 547–548, 549f
definition of, 547–548
dual-wavelength (532- and 940-nm), for
vascular lesions, 734–735
clinical benefit of, 736
mechanism of action of, 734–736
erbium:YAG, 548
wavelength of, 548, 549f
eye protection for, 550–551, 551f
Iridex VariLite dual-wavelength, for
vascular and pigmented lesions,
734, 734f
for vascular lesions, 734–745. See also
Vascular lesions, laser treatment of.
Laser skin resurfacing (LSR), 546–548
carbon dioxide
aggressive, of perioral region, before-
and-after photographs of, 550,
667
aggressive high-energy multipass,
555–564
débridement pros and cons in,
561–563, 562f–564f
documentation of, 560
mandibular border management in,
561, 561f
patient selection for, 555, 559
procedure for, 555–564
sedation for, 560
settings for, 560
subunit treatment in, 560
of aging skin in transconjunctival
blepharoplasty, 153–154, 155f
Incision(s) (Continued)
Infratrochlear nerve (Continued)
Keloids (Continued)

Index
755
background on, 547–548
blepharoplasty with, incision lasering
in, 563
case presentations on, 574, 575f–587f
complications of, 518f, 574–602
acne flare as, 592–596, 595f–596f
burns as, 596–597
edema as, 587, 587f
erythema as, 587, 588f
hyperpigmentation as, 588,
588f–589f
hypopigmentation as, 600–602,
601f–602f
infections as, 588–591, 589b,
589f–590f. See also
Infection(s), complicating laser
skin resurfacing.
lower-eyelid retraction as, 597,
597f
milia formation as, 592, 594f
scars as, 596–597, 596f–597f
synechiae as, 597–600, 598f–600f
for facelift scars, 365, 366f–367f
facelift with, 563–564, 565f
before-and-after pictures of,
328f–330f, 334f
simultaneous, 323–327, 327f
fires from, prevention of, 551–552
fractional
deep, 550, 555, 558f–560f
superficial, 553, 554f–557f
ultralight, 550, 552–553, 552f–554f
light, 550
lite, 553–554, 557f–558f
medium, 550, 554–555, 558f
options for, 552–564
precision of, 547–548
in revision facelift, before and after
pictures of, 337f, 339f–340f
in scar treatment, 565–568, 565f–568f
with transfollicular subcutaneous brow
and forehead lift, 73, 74f
in transfollicular subcutaneous brow
and forehead lift scar revision,
85–86, 86f–88f
for unfavorable earlobe scars, 478,
483f
care after, 569–574
contraindications to, 549
misinformation on, 550
patient selection for, 549–550
safety with, 550–552
of surgical and traumatic scars, 568–569,
568f–569f
Lateral canthal region, Botox treatment of,
614–616
before-and-after photographs of, 628f
Lateral canthal rhytids, injectable fillers for,
665, 666f
Lateral cartilages, of nose
lower
anatomy of, 181, 182f–183f
tripod concept of, 203, 205f
upper, anatomy of, 180–181, 181f–182f
Lateral crural steal procedure, for nasal tip
projection, 203–204, 207f
Lateral nasal artery, 176, 178f–179f
Lateral nasal branches, course of, 37
Lateral orbicularis muscles, contributing to
“crow’s feet” wrinkles, 607
Lentigines, dual-wavelength laser treatment
of, 738
Lesser occipital nerve, 47–48
innervation of ear from, 436, 438f
Levator anguli oris muscle, location of, 251,
251f
Levator labii superioris alaeque nasi, Botox
injection of, for excessive gingival
display, 617–618
Levator palpebrae superioris muscle, 130,
131f
Lifestyle
facial aging and, 1
in patient selection for cervicofacial
rhytidectomy, 255
Ligament(s)
cutaneous
location of, 251, 252f
weakening of, in midfacial aging, 6–7,
6f
mandibular, laxity of, in jowl formation,
8
masseteric cutaneous
laxity of, in jowl formation, 8
weakening of, in aging cheek, 6–7
orbicularis retaining, laxity in, in aging
upper eyelid, 4–5
osteocutaneous, location of, 251, 252f
osteocutaneous retaining, weakening of,
in midfacial aging, 6–7, 6f
parotid cutaneous, weakening of, in
aging cheek, 6–7
Lighting, for photographs, 26, 27f–28f
Linear threading technique
for lip enhancement, 648, 649f
for nasolabial fold augmentation,
660–662, 661f
Lip(s)
anatomy of, 702–703
enhancement techniques for, 648–653
creating vermilion outline as, 651,
652f
increasing deep lip volume as,
651–652, 653f–654f
before-and-after photographs of,
665–666, 677f–678f
fat injection cannula technique for,
652–653, 654f–656f
massing filler after injection in, 652,
654f
linear threading as, 648, 649f
lip outline as, before-and-after
photographs of, 648–651,
650f–651f, 678f
serial puncture as, 648, 649f
ethnic, 701. See also Lip reduction;
Macrocheilia.
histology of, 702–703, 703f
lower
aging changes in, 8
local anesthesia technique for, 38, 38f
reduction of, 701–717. See also Lip
reduction.
shortening procedure for, 709,
713f–716f
size of, excessive, 701. See also
Macrocheilia.
upper
aging changes in, 8, 8f
local anesthesia technique for, 38, 38f
volume augmentation of, before-and-
after photographs of, 675f
volume augmentation of
age and, 646, 647f
before-and-after photographs of,
675f–678f
demonstrating anticipated results of,
645, 646f
Lip implants
case presentations of, 697f–700f
materials for, 691–692, 693f
placement technique for, 694–697,
695f–697f
pros and cons of, 692–694
Lip reduction
before-and-after photographs of,
710f–712f
chin implant augmentation with, 709
complications of, 707–709
edema as, 708, 709f
infection as, 708
overresection as, 707
underresection as, 707
postoperative care for, 707, 709f
preoperative marking for, 704, 704f
procedures for, 703–709
anesthesia for, 703
preoperative preparations of, 703
sedation for, 704
subtotal, 707, 708f
Lipocutaneous flap(s), in facelift surgery
development of, 252
pretunneling in, 274–277, 277f
scissor dissection in, 278–279,
279f–280f
handling of, 249
“long-flap” dissection for, 277–278, 278f
postauricular dissection of, 279,
282f–283f
protection of, from thermal insult from
electrosurgery, 343
“short-flap” dissection for, 277–278,
278f
viability of, complications affecting,
354–363
Liposuction
cannulas for, 261–263, 262f
in pretunneling facelift flap, 274–276,
277f
jowl, 263, 264f
open, in facelift surgery, 257, 279–283,
283f–284f
submental, in cervicofacial rhytidectomy,
260–263, 261f–264f
tumescent, 49, 49b, 50f
“Lipstick lines.” See Vertical lip rhytids.
Local anesthesia, 35
for blepharoplasty, 141–142, 142f
for cervicofacial rhytidectomy, 259–260
combined with injectable fillers, 641
for Davis procedure for conchal bowl
excess, 446
hemimidfacial, 41–43
infiltrative peripheral versus regional
nerve block for, 37
Laser skin resurfacing (LSR) (Continued)
Lip(s) (Continued)

756
Index
for laser treatment of vascular/pigmented
lesions, 738–739, 740f
for lip implant placement, 694
mechanism of action of, 35
for midface implant placement, 373–375
“miniblock” technique with, for
injectable filler administration, 648,
648f–649f
for nasolabial fold augmentation, 660,
661f
of neck, 47–48
for radiowave ablation of nevi/lesions,
720–721
for rhinoplasty, 193–197, 196f–197f
for skin-muscle approach for lower
blepharoplasty, 156, 157f–158f
for skin pinch technique, 156
for tear trough filling, 664
techniques for, 37–48
for blocking main sensory nerves of
head and neck, 38–45
for nasolabial fold anesthesia, 38, 38f
for upper and lower lip anesthesia, 38,
38f
topical preanesthesia for, 37
for torn earlobe repair, 484
Loupes, illuminated cross-polarization, for
laser treatment of vascular/pigmented
lesions, 734–735, 737f
Lower lateral cartilages, of nose, anatomy
of, 181, 182f–183f
LSR. See Laser skin resurfacing (LSR).
Lumenis Encore CO2 laser, 548, 549f
Lumenis UltraPulse Encore CO2 laser, 548,
549f, 552
M
MAC. See Monitored anesthetic care
(MAC).
Macrocheilia. See also Lip reduction.
definition of, 701
dentofacial deformities contributing to,
701, 702f
differential diagnosis of, 702
medical causes of, 702
Malar augmentation, with injectable fillers,
666–667, 668f–669f
Malocclusions, chin augmentation and,
386
Mandibular angle implants, 419–430
complications of, 430
wound dehiscence as, 430, 432f
configurations for, 423
custom, 429–430, 430f–431f
diagnosis for, 419–423, 424f
placement of, 423–429
incision closure after, 429, 430f
incisions for, 423, 426f
in pocket, 427–428, 428f
subperiosteal dissection in, 423, 427f
screw fixation of, 428, 429f
Taylor, 419, 423
Mandibular ligaments, laxity of, in jowl
formation, 8
Mandibular nerve (V3)
block of, facial approach to, 45, 46f
branches of, 37
facial innervation by, 35–37, 36f
marginal
course of, 263, 263f
facelift complications involving, 351,
353f
Mandibulolabial folds, prominent, in aging
perioral region, 8
Marginal incision
for closed rhinoplasty, 192–193, 198
for open rhinoplasty, 191–192, 192f,
199–200, 200f
“Marionette lines”, in aging perioral region,
8
Masseter muscle(s)
atrophy of, in aging face, 1–2
Botox treatment of, 620–621. See also
Botulinum toxin type A (BTA), for
masseter treatment.
volume of, in mandibular aesthetics, 419,
422f
Masseteric cutaneous ligaments
laxity of, in jowl formation, 8
weakening of, in aging cheek, 6–7
Mastoid dressing, for cosmetic otoplasty,
458, 461, 461f
Maxillary branches, of trigeminal nerve
supplying nose, 182, 184f
Maxillary nerve (V2)
block of, 41–43, 44f
facial innervation by, 35–37, 36f
terminal branches of, 36–37
McGregor’s patch, 249
Medial orbicularis muscles, as brow
depressors, 607, 607f
Medial orbicularis oculi muscle, Botox
injections of, for glabellar rhytids,
610–611, 611f
Medications, postrhytidectomy, 318
Melanoma, malignant, warning signs of,
719–720, 721f
Melanosomes, dual-wavelength laser
treatment of, 738
Melasma
OBP peel for, 543f
TCA peel for, 540f
Melkersson-Rosenthal syndrome, 702
Menopause, facial aging and, 1
Mental nerve
block of, 43, 44f–45f
branches of, 37
protection of, in submental chin implant
surgery, 398, 400f
Mentalis muscle(s)
location of, 251, 251f
in submental chin implant surgery, 398,
399f–400f
Mentolabial fold, filler augmentation of,
658–659, 660f
before-and-after photographs of,
679f–680f
Mersilene sutures, for Mustardé otoplasty,
456, 456f–457f
Methicillin-resistant Staphylococcus aureus
(MRSA)
complicating laser skin resurfacing, 591,
592f–593f
complicating rhinoplasty, 220–221
Microneedle, radiofrequency. See
Radiofrequency microneedle.
Midazolam, in monitored anesthetic care,
51, 51f
Midface
aging of, 5–7
augmentation of, with injectable fillers,
666–667, 668f–669f
before-and-after photographs of, 684f
Botox treatment of, 616
Midface implants, 370–386
early, problems with, 370
facelift with, before and after pictures of,
328f, 330f, 332f–334f
oral health and, 371, 374f
placement of
case presentations of, 386, 388f–392f
incision for, 373–375, 375f
instrumentation for, 372–373, 374f
in pocket, 376, 378f–379f, 379
postoperative care for, 379
preoperative planning of, 371,
373f–374f
sequelae and complications of,
379–386, 382f
air emphysema as, 386
asymmetries as, 383–385,
385f–388f
ecchymosis as, 381, 383f
edema as, 379–381, 382f
hematoma as, 379–381, 383f
infection as, 381–383, 384f
pain as, 386
subperiosteal dissection for, 373–376,
375f–378f
surgical, 372–379
preoperative planning for, 371–372
in revision facelift, before and after
pictures of, 337f, 339f, 348f
screw fixation of, 379, 381f–382f
selection of, 370–371, 370f–372f
Migraine, Botox treatment for, 623
Milia formation, complicating laser skin
resurfacing, 543f, 594f
Mini open brow lift, 54–89. See also
Transfollicular subcutaneous brow and
forehead lift (TFSBFL).
Mirror, hand, for consult, 13, 15f
Modiolus, in nasolabial fold formation, 7
Moles, cosmetic removal of, 718–733. See
also Radiowave surgery, 4-MHz, for
cosmetic nevi/lesion removal.
Monitored anesthetic care (MAC), 51
anesthetic agents for, 51, 51f
procedure for, 51–53, 52f–53f
Müller’s muscle, 130
Muscle(s)
atrophy of, in aging face, 1–2
auricular, 438–439, 439f
buccinator, location of, 251, 251f
corrugator supercilii, transection of
in endoscopic brow and forehead lift,
112
in transfollicular subcutaneous brow
and forehead lift, 64–65, 68f
depressor anguli oris
action of, 618–619, 619f
Botox treatment of, 618–619
of ear, 438–439
levator anguli oris, location of, 251,
251f
Local anesthesia (Continued)
Mandibular nerve (V3) (Continued)

Index
757
masseter. See Masseter muscle(s).
mentalis
location of, 251, 251f
in submental chin implant surgery,
398, 399f–400f
nasalis
Botox injection of, for “bunny” lines,
611, 613f
location of, 611, 612f
of nose, 176, 178f
orbicularis oculi, 129–130, 129f–130f.
See also Orbicularis oculi muscle(s).
orbicularis oris, in submental chin
implant surgery, 398, 399f–400f
paralysis of, unwanted, complicating
Botox therapy, 634, 635f
platysma. See Platysma.
procerus. See Procerus muscle(s).
Mustardé otoplasty, for antihelical fold
reconstruction, 452–457
cartilage weakening in, 453–454, 455f
dissection in, 453, 455f
horizontal mattress suture placement in,
456–457, 456f–458f
marking before, 452–453, 454f
postoperative problems with, 472, 476f
sequencing of, with other procedures,
452–453
Myofascial pain dysfunction
Botox treatment for, 623, 624f
masseter treatment for, 620–621
N
Nasal septum, anatomy of, 181–182,
184f
Nasal tip
age-related changes in, 202–203, 204f
bulbous, cephalic strip excision of
cartilage for, 203, 206f
clinical evaluation of, 186–188
columella in, 187, 188f
projection in, 186–187, 187f
shape in, 186
elevation of, Botox in, 617
procedures on, 202–218
support of, verification and strengthening
of, 202–203, 205f
Nasal valve, collapse of, diagnosis of, 188
Nasalis muscle
Botox injection of, for “bunny” lines,
611, 613f
location of, 611, 612f
Nasion, 176–179
Nasociliary nerve, branches of, 36
Nasofrontal angle, 176–179, 179f
ideal, 185–186
Nasojugal groove, injectable fillers for,
663–665, 664f–666f
before-and-after photographs of,
683f–684f
complications of, 690–691, 691f–692f
Nasolabial angle, 179f
Nasolabial fold(s)
Botox treatment of, 617–618, 617f–618f
before-and-after photographs of,
629f
deepening of, in facial aging, 37
local anesthesia technique for, 38, 38f
reducing
injectable fillers for, 659–663
amount needed for, 660
anesthetic technique for, 660, 661f
before-and-after photographs of,
680f–682f
common mistakes in, 661
demonstrating anticipated results of,
645, 645f
linear threading technique for,
660–662, 661f
postinjection instructions for,
662–663
viewing results after first fold
treated, 662, 662f
SMASectomy in, 286–287
Neck
aging, 9–10, 10f–11f
local anesthesia of, 47–48
major sensory dermatomes of, 48, 48f
sensory anatomy of, 35–37
skin resurfacing for, 518
laser, fractional CO2, 552, 554f
Obagi Blue Peel in, 531
TCA peel in, 528–529, 529f
overtreatment from, 545, 546f
Necrosis, tissue, complicating otoplasty,
470, 471f–472f
Neivert osteotome, in dorsal hump
reduction, 210
Nerve(s)
Arnold’s, innervation of ear from, 436,
438f
auriculotemporal, sensory innervation of
ear from, 436, 438f
buccal, innervation provided by, 37
cutaneous cervical, 47
dorsal (external) nasal, innervation
provided by, 36
ethmoidal, innervation provided by, 36
facelift complications involving, 351–353
facial, frontal branch of, protection of,
during endoscopic brow and
forehead lift dissection, 105
frontal. See also Frontal nerve.
branches of, 36
glossopharyngeal, innervation of ear
from, 436
greater auricular, 47–48. See also Greater
auricular nerve (GAN).
greater occipital, block of, technique of,
for posterior scalp anesthesia, 46, 46f
inferior alveolar, innervation provided by,
37
infratrochlear
innervation provided by, 36
protection of, during endoscopic brow
and forehead lift dissection, 99
lacrimal, innervation provided by, 36
lesser occipital, 47–48
innervation of ear from, 436, 438f
mandibular
branches of, 37
facial innervation by, 35–37, 36f
marginal, course of, 263, 263f
maxillary
facial innervation by, 35–37, 36f
terminal branches of, 35, 37
mental
branches of, 37
protection of, in submental chin
implant surgery, 398, 400f
motor, facelift complications involving,
351, 351f–352f
nasociliary, branches of, 36
ophthalmic, facial innervation by, 35–36,
36f
phrenic, in cervical plexus block, 47
sensory, facelift complications involving,
351–353, 353f–354f
spinal accessory, facelift complications
involving, 353, 354f
supraorbital
innervation provided by, 36
marking location of, for endoscopic
brow and forehead lift, 95–96,
97f
supratrochlear
innervation provided by, 36
marking location of, for endoscopic
brow and forehead lift, 95–96,
97f
transverse cervical, facelift complications
involving, 353
trigeminal, facial innervation by, 35–36,
35f–36f
zygomatic, course and branches of,
36–37
zygomaticofacial, course of, 37
zygomaticotemporal. See also
Zygomaticotemporal nerve.
course of, 36
Nerve block
greater occipital, technique of, for
posterior scalp anesthesia, 46, 46f
inferior alveolar nerve, 44–45, 45f
mandibular nerve, facial approach to, 45,
46f
maxillary, 37, 41–43
mental nerve, 43, 44f–45f
total second division, 41–43, 44f
Nerve pressure points, protection of,
intraoperative, in facelift surgery,
342
Neurotoxins, 604–639
botulinum toxin type A as, 604–607.
See also Botulinum toxin type A
(BTA).
Nevus, cosmetic removal of, 718–733. See
also Radiowave surgery, 4-MHz, for
cosmetic nevi/lesion removal.
Nitrous oxide/oxygen, for conscious
sedation, 49–51
Noncompliance, with post-laser care, 571,
571f–572f
Nose. See also Rhinoplasty.
aging of, 7
amorphous, 175–176, 177f
anatomy of, 175–176, 177f
blood supply to, 176, 178f–179f
bone and cartilage of, 176–182, 179f
functional assessment of, 187–188
musculature of, 176, 178f
nerves supplying, 182, 184f
nostril flare in, Botox treatment of,
616–617, 617f
Muscle(s) (Continued)
Nasolabial fold(s) (Continued)
Nerve(s) (Continued)

758
Index
relation of, to face, proportional
evaluation of, 185–186
skin of, thickness of, 176
Nostril flare, Botox treatment of, 616–617,
617f
O
Obagi Blue Peel (OBP), 529–536
acid application for, 530–531
before-and-after photographs of, 543f
care after, 536
complications of, hypopigmentation as,
546, 547f
degreasing for, 530
frost after, 531–536
second/third, coat in, 531, 535f
skin type for, 530, 534f
trichloroacetic acid in, 530, 535f
OBP. See Obagi Blue Peel (OBP).
Occlusion, chin augmentation and, 386
Office
features of, 13, 13f–14f
staff of, importance of, 13
treatment rooms of, 14f
countertop refrigerators in, 608, 610f
Operating rooms, in-office, 14f, 247, 247f,
257, 258f
Ophthalmic branches, of trigeminal nerve
supplying nose, 182, 184f
Ophthalmic nerve (V1), facial innervation
by, 35–36, 36f
Oral commissure, injectable fillers in
rejuvenation of, 658, 659f
Oral health, midface implants and, 371,
374f
Orbicularis oculi muscle(s), 129–130,
129f–130f
in lower eyelid
hypertrophied, 133, 133f
Botox treatment of, before-and-after
photographs of, 629f
excision/shrinking of, in skin pinch
technique, 156
skin-muscle approach for lower
blepharoplasty for, 156–161
trimming of, in skin-muscle approach
for lower blepharoplasty,
156–161
medial, Botox injections of, for glabellar
rhytids, 610–611, 611f
pretarsal, subciliary bulge from
contraction of, treatment of, 616,
616f–617f
in upper eyelid, excision of, in
blepharoplasty, 144, 145f
Orbicularis oris muscle
Botox injections of, for “lipstick lines”,
618, 619f
dysfunction of, macrocheilia from,
702
location of, 703, 703f
protection of, in lip reduction
procedures, 705
in submental chin implant surgery, 398,
399f–400f
Orbicularis retaining ligaments, laxity in, in
aging upper eyelid, 4–5
Orbit, anatomy of, 129–131
Orbital septum, 129–130, 130f–131f
incision of, in upper lid blepharoplasty,
144, 146f
Orthognathic surgery, need for, in
rhinoplasty evaluation, 187, 189f–190f
Osteocutaneous ligaments, location of, 251,
252f
Osteocutaneous retaining ligaments,
weakening of, in midfacial aging, 6–7,
6f
Osteomyelitis, complicating chin implants,
416, 418f
Osteoporosis, facial aging and, 1
Osteotomy(ies), after dorsal hump
reduction, 201–202
lateral, 210–211, 211f–212f, 214f
medial, 210, 212f
micropuncture, 210, 213f
sliding, 210, 212f
Otoplasty, cosmetic, 434–516
adjunctive earlobe surgical procedures
with, 476–484
case presentations of, 461, 462f–470f
complications of, 461–471
hematoma as, 470–471, 473f
necrosis and tissue loss as, 470,
471f–472f
perforation as, 471, 475f
suture dehiscence as, 471, 474f
suture-related, 471, 474f
for correction of protruding earlobe, 457,
459f–460f
Davis procedure for, 445–452. See also
Davis procedure, for conchal bowl
excess.
goals of, 445
Mustardé otoplasty for antihelical fold
reconstruction as, 452–457. See also
Mustardé otoplasty, for antihelical
fold reconstruction.
postoperative dressing for, 457–461,
460f–461f
postoperative problems with, 471–476
antihelix curvature problems as, 472,
476f
asymmetry as, 472, 475f
cartilage buckling as, 476, 477f
cartilage hypertrophy as, 476, 477f
cartilage reactivity as, 472
hyperpigmentation as, 476, 478f
infections as, 476, 477f–478f
overcorrection as, 471–472
undercorrection as, 471–472
procedural timing for, 440–445
Oxyhemoglobin
absorption peaks of, 734, 735f
as target in vascular lesion treatment,
736f
P
Pacemakers, radiowave surgery and,
727–733
Pain, complicating midface implants, 386
Paralysis, muscle, unwanted, complicating
Botox therapy, 634, 635f
Parotid cutaneous ligaments, weakening of,
in aging cheek, 6–7
Parotid fistula, complicating facelift surgery,
359, 361f
Parotideomasseteric fascia, in facelift
surgery, 250, 250f
Patient education, as part of consult, 15
Patient representative, importance of, 13
Patient screening, 16, 16b
Pedunculated scalp lesion, radiowave
ablation of, before-and-after
photographs of, 729f
Peel, chemical, 517. See also Chemical peel;
Resurfacing, skin.
Perforation, complicating otoplasty, 471,
475f
Periodontal disease, midface implants and,
371, 374f
Perioral region
aging of, 8, 8f
dysfunction of, complicating Botox
therapy, 635–638, 637f
filler techniques for, 653–659
mentolabial fold augmentation as,
658–659, 660f
before-and-after photographs of,
679f–680f
oral commissure injection as, 658,
659f–660f
philtral column enhancement as,
653–654, 656f
before-and-after photographs of,
674f
vertical lip rhytids treatment as,
654–658, 657f
Periorbital areas
aging of, 131–134, 133f–134f
bleeding in, complicating blepharoplasty,
164, 164f
festoons of, 134, 134f
pigmentation of, 133
Periorbital rhytids, injectable fillers for,
663–665, 664f–666f
Perlane, history of, 640t
PermaLip, 692
Petroleum jelly
after TCA peel, 529
in post-laser care, 531–536, 570–571,
570f
Pevelle Silk, history of, 641
Phenol, for chemical peel, 523, 523b
mechanism of action of, 523
Philtral column enhancement, 653–654,
656f
before-and-after photographs of, 674f
Photoaging, skin, 2
histologic effects of, 2, 3b
Photodamage, to skin, 2, 4f
TCA peel for, 537f–538f, 541f
Photographic frame, sliding, of treatment
room doors, 23, 23f
Photographs
archiving of, 31–33, 34f
background canvas for, 25–26, 26f
before-and-after. See also under specific
procedure, e.g. Blepharoplasty,
before-and-after photographs of.
as marketing tools, consent for, 136
clinical, high-quality, importance of, 23
for consult, 13, 15, 15f
data recovery for, 33
deceptive images in, 28, 30f–31f
patient cooperation for, 25
Nose (Continued)

Index
759
preoperative, for Davis procedure for
conchal bowl excess, 445
preoperative series of, 136, 137f
standardization of, 25, 26f
taking and making, 25–28
for treatment planning, for rhinoplasty,
183, 185f
ultraviolet light, making, 29–31, 32f–33f
view box for, bulb type in, 28–29, 32f
views for, standard, 25, 25f
Photography, digital, clinical, 23–34
data recovery for, 33
deceptive images and, 28, 30f–31f
equipment for, 23–24. See also
Equipment, for clinical digital
photography.
flash use in, 28, 30f
focal length in, 26–27, 28f–29f
focus for, 26–27
framing in, 27, 28f
image archiving in, 31–33, 34f
image-editing and, 25, 27–28
of images or texts from journals or
books, 29, 32f
lens for, 26–27
lighting for, 26, 27f–28f
for making ultraviolet images, 29–31,
32f–33f
patient manipulation in, 28, 31f
of radiographs, 28–29, 32f
shadow prevention in, 26, 27f–28f
with zoom lens, 27, 29f
PhotoImpact, 24, 25f
Photothermolysis, selective
introduction of, 734
in laser technology development, 734
in laser therapy, 547–548
Phrenic nerve, in cervical plexus block, 47
Piercing, earlobe, simultaneous with repair,
493–497, 497f–498f
Piercing studs
for delayed ear piercing, 493–497,
497f–498f
for simultaneous earlobe repair and
piercing, 493, 497f, 500
Pigmentation, periorbital, 133
Pigmented lesion(s)
dual-wavelength laser treatment of, 738
before-and-after photographs of, 743f
radiowave ablation of, before-and-after
photographs of, 730f–733f
Pilosebaceous units, reepithelialization after
resurfacing and, 518–519, 519f
Pityrosporum infection, complicating laser
skin resurfacing, 589, 589f
Pixie earlobe
congenital, 300–305, 305f
from facelift, 300, 302f–303f
revision of, 337f
Platysma
description of, 264
flexing of, 264, 265f
suspension of, posterior (lateral),
292–294, 294f–295f
with SMAS flap, 286
Platysmal banding, in aging neck, 9–10,
10f, 621, 622f
Botox treatment for, 621–622, 622f
before-and-after photographs of,
632f–633f
Platysmaplasty
in cervicofacial rhytidectomy, 263–264
anesthesia for, 264
before-and-after pictures of, 328f–
334f
technique for, 264–269, 266f–268f
corset, midline, 265, 266f–267f
Plication, definition of, 283–284
Poisoning, sausage, 604
Polyethylene implants, porous, drawbacks
of, 369–370, 369f
Polymethylmethacrylate (PMMA),
microspheres of, in Artefill, 641
Polytetrafluoroethylene implants, expanded
(ePTFE), 369–370
cords/strands of, for lip augmentation,
691
new formulation of, for lip
augmentation, 691, 693f
Porous polyethylene implants, drawbacks
of, 369–370, 369f
Posterior auricular incision, for facelift,
269
placement of, 271–274, 273f–275f
horizontal, 273–274, 275f–277f
scar from, hairstyle and, 274
Posterior auricular muscle, 438–439, 439f
Posterior auricular region, flap breakdown
in, 354, 356f
Posterior auricular skin, management of, in
weekend facelift, 322–323, 326f
Posttragal incision, in facelift, pretragal
incision vs., 271, 272f–273f
Preanesthesia, topical, for local anesthesia,
37
Preauricular incision
for facelift, 269
wound necrosis at, 354–358, 357f
Preconsult, purpose of, 13, 14f
Prejowl implant, 401–405
Prejowl sulcus, injectable fillers for, 667,
670f
Preoperative appointment, 16–17, 17f
Pretragal incision, in facelift, posttragal
incision vs., 271, 272f–273f
Pretunneling, in facelift flap development,
274–277, 277f
Procerus muscle(s)
Botox injections of, for glabellar rhytids,
610–611, 611f–612f
as brow depressors, 607, 607f
transection of, in transfollicular
subcutaneous brow and forehead
lift, 64–65, 68f
Prolapse, of periorbital fat pads, 133, 133f
Propofol, in monitored anesthetic care, 51,
51f
Proportion, facial, rhinoplasty and, 175,
175f
Pseudoherniation, fat
of eyelids, 133, 133f
lower eyelid, fat transpositioning for,
154–155, 155f
Pseudoptosis, upper eyelid, as sequela of
Botox therapy, 634–635
Psychological stability, in patient selection
for cervicofacial rhytidectomy,
255–256
Ptosis
brow, from aging, 131–132, 133f
upper eyelid
complicating Botox therapy, 634–635,
635f
postoperative, in blepharoplasty, 169,
170f
Pull test, for lid laxity, 135, 136f
Purpura, posttreatment, with 585-nm
flashlamp-pumped, pulsed-dye laser,
734, 736f
Q
Quadrangular cartilage, in nasal septum,
181–182, 184f
harvesting of, 204, 208f–209f
R
Radiation, with excision for earlobe keloids,
506–512, 507f–512f
before-and-after photographs of,
514f–515f
Radiesse
dental x-rays and, 688, 689f
history of, 640t
migration of, 688, 690f
properties of, 641, 642f
Radiofrequency bipolar forceps, for
hemostasis, in lip reduction
procedures, 706, 707f
Radiofrequency microneedle
for bleeding control
in facelift surgery, 343
in lip reduction procedures, 705
for fat pad resection in blepharoplasty,
147–148, 147f–148f
for upper lid blepharoplasty incision,
143, 144f
Radiowave surgery
4-MHz
complications of, 727–733
erythema as, 733, 733f
for cosmetic nevi/lesion removal,
718–733
before-and-after photographs of,
728f–733f
technique for, 719–722, 721f–726f
for keloids/hypertrophic conditions,
726, 728f
pacemakers and, 727–733
postoperative care for, 726–727
for rhinophyma, 722–726
for tissue biopsy, 718, 720f
wavelength of, on electromagnetic
spectrum, 719f
Reception room, 13f
Recovery, 13, 18–19, 18f, 20f
from cervicofacial rhytidectomy, realistic
expectations for, 256
Recovery suite, 14f, 247, 247f
Reduction cheiloplasty, 701–717. See also
Lip reduction.
consultation for, 701–702
diagnosis for, 701–702
Reepithelialization, after skin resurfacing,
mechanism of, 518, 519f
Photographs (Continued)
Platysmal banding, in aging neck
(Continued)

760
Index
Regional nerve block anesthesia, infiltrative
peripheral anesthesia versus, 37
Restylane, history of, 640–641, 640t
Resurfacing, skin, 517–603
by chemical peel, 517. See also Chemical
peel.
consultation before, 522
contraindications to, 518–519
laser, 546–548. See also Laser skin
resurfacing (LSR).
patient selection for, 517
pharmacologic concerns before, 521–522
reepithelialization after, mechanism of,
518, 519f
skin conditioning prior to, 519–521
Retin-A (retinoic acid, tretinoin)
for chemical peel, 523, 523b
in prepeel skin conditioning, 519
Retinoic acid (Retin-A)
for chemical peel, 523, 523b
for prepeel skin conditioning, 519
Retraction suture, in lower lid
blepharoplasty, 150–151, 151f
Retrobulbar hematoma, complicating
blepharoplasty, 163–164
Retropulsion, to evaluate fat pad prolapse,
133
“Reverse telephone deformity” complicating
otoplasty, 472, 475f
Rhinophyma, 7, 722–726
causes of, 722
external skin treatment of, 183–185,
186f
radiowave treatment of, 726, 727f–728f
Rhinoplasty, 175–246
alar base reduction in, 212–218,
217f–220f
anesthesia for
general, 191
local, 193–197, 196f–197f
before-and-after photographs of, 223,
224f–244f
case presentations for, 223
closed, 197–199
before-and-after photographs of, 224f,
226f
incisions for, 192–193, 194f–195f,
198
sequencing in, 198
typical sequence for, 198–199
complications and treatment of, 218–223
bleeding as, 219–220
ecchymosis as, 220, 221f
graft exposure as, 221–222
hematoma as, 218–219
infection as, 220–221
prolonged postoperative edema as,
222, 222f–223f, 236f–237f
wound breakdown as, 221–222
consultation for, 182–186
endonasal, 197–199. See also Rhinoplasty,
closed.
examination for, 182–186
external, 199–202. See also Rhinoplasty,
open.
external nasal splint for, 218, 221f
external versus endonasal technique for,
189–191
incisions for, options for, 191–193
injection, 665–666, 667f
intravenous sedation for, 191
nasal dressing in, 218
nasal tip procedures in, 202–218
major tip support categories and,
204–209
minor tip support categories and,
209
septal harvesting and support for,
204–209, 208f–209f
open, 199–202
before-and-after photographs of, 225f,
227f–231f, 233f, 236f–241f
benefit of, 199
flap elevation in, 200–202, 201f–202f
incisions for, 191–192, 192f–193f,
199–200
sequence for, 176, 199
skeletonization in, 200–202,
201f–202f
technique for, 199–202
postoperative care for, 218
reconstructive, after cancer treatment,
before-and-after photographs of,
242f
with silicone “Capriotti” implant,
before-and-after photographs of,
199–200, 235f
terminology for, 175–176, 176f
treatment planning for, 188–189
wound closure in, 218
Rhytidectomy, cervicofacial, 247–368. See
also Cervicofacial rhytidectomy.
Rim incision, for rhinoplasty, 194f, 198
Rubin osteotome, in dorsal hump
reduction, 201–202, 210, 210f
Rusch tube, for monitored anesthetic care,
52, 52f
S
Saddle nose deformity, assessment of,
185–186
Safety, of laser skin resurfacing, 550–552
Sausage poisoning, 604
Scalp
aging in, 3–4
blocking of, 46
innervation of, 46, 46f
local anesthetic techniques for, 38–39
posterior, anesthesia for, greater occipital
nerve block technique for, 46, 46f
Scar(s)
blepharoplasty, 167–168, 168f
incisional modality and, 167
complicating laser skin resurfacing,
596–597, 596f–597f
complicating laser treatment of vascular
lesions, 744, 744f
earlobe incision, unfavorable, 478, 483f
facelift, unfavorable, management of,
365, 365f–367f
hypertrophic, keloids differentiated from,
500–506
laser treatment of, 565–568, 565f–568f
subcutaneous, previous, revision facelift
and, 335f–336f, 339–340
surgical, laser skin resurfacing of,
568–569, 569f
traumatic, laser skin resurfacing of,
568–569, 568f–569f
Scissor dissection, in facelift flap
development, 278–279, 279f–280f
Scott, Allen, in development of Botox, 604,
605f
Screening, patient, 16, 16b
Screw fixation
of cheek implants, 379, 381f–382f
of chin implants
in intraoral approach, 401, 402f
in submental approach, 396f–397f,
398
of mandibular angle implant, 428, 429f
Scroll region, of nose, 181, 182f
Sculptra, properties of, 641–642
Sebaceous glands of nose, hyperplasia of,
with aging, 7
Sedation, intravenous
for aggressive CO2 laser skin resurfacing,
560
for blepharoplasty, 142
conscious, 49–51. See also Conscious
sedation.
for Davis procedure for conchal bowl
excess, 446
for laser treatment of vascular/pigmented
lesions, 738–739
for lip reduction procedures, 704
for medium-depth TCA peel, 525
for rhinoplasty, 191
Selective photothermolysis, in laser therapy,
547–548
Sensory anatomy, of head and neck, 35–37
Sentinel vein, protection of, during
endoscopic brow and forehead lift
dissection, 105, 107f
Septal cartilage, harvesting of, for grafting
in rhinoplasty, 204–209, 208f–209f
Septal reset procedure, for lower eyelid fat
pseudoherniation, 155
Septoplasty
in closed rhinoplasty, 198
Killian incision for, 193, 195f
transfixion incisions for, 193, 195f–196f
Septorhinoplasty, before-and-after
photographs of, 232f, 243f–244f
Septum
incision of, in skin-muscle approach for
lower blepharoplasty, 156,
159f–160f
retraction of, relation of lower eyelid to
globe and, 138f
Serial puncture technique, for lip
enhancement, 648, 649f
Seroma(s)
after facelift surgery, 344, 349f, 359
complicating endoscopic brow and
forehead lift, 123, 124f
complicating midface implants, 384f
Shadows, in photographs, prevention of,
26, 27f–28f
Shield graft, for nasal tip projection, 203,
206f, 209f
Short face syndrome, 386–394
Short-scar facelift, 319–323, 322f
procedure for, 321–323, 323f–327f
with SMASectomy
Rhinoplasty (Continued)
Scar(s) (Continued)

Index
761
and platysmaplasty and chin implant,
before and after pictures of,
330f
and upper blepharoplasty, before and
after pictures of, 331f
Silastic transparent membrane, post-laser
skin resurfacing, 569–570, 570f
Silicone, injectable, as filler, 642
Silicone implants, 369–370
Silicone oil, injectable
advantages of, 667
for depressed scar after transfollicular
subcutaneous brow and forehead
lift, 86–87, 88f–89f
injection of, 667–671, 670f–673f
microdroplet injection of, 670, 671f
migration of, 688, 690f
“rice grain” injection technique for, 670,
671f
Silicone rubber, for lip implants, 692
Silikon 1000, FDA approval of, 667–669
Skeletonization, in open rhinoplasty,
200–202, 201f–202f
Skin
classification of, Fitzpatrick system for,
517, 518t
conditioning of, pre-resurfacing,
519–521
dimpling of, after SMAS tightening, 255,
293f
eyelid, 129–130
facial, aging of, 2–3, 3b, 4f
global, 517
Obagi Blue Peel for, 529–536. See also
Obagi Blue Peel (OBP).
nasal, thickness of, 176
assessment of, 183–185
pigmentation of, skin resurfacing and,
517, 518f
redundant
after facelift surgery, 261f, 359
after liposuction and platysmaplasty,
265–269, 268f
resurfacing of, 517–603. See also
Resurfacing, skin.
trimming of, in skin-muscle approach for
lower blepharoplasty, 156–161,
159f–160f
Skin-muscle approach, for lower
blepharoplasty, 156–161, 159f–160f.
See also Blepharoplasty, lower eyelid,
skin-muscle approach for.
Skin pinch technique, with
transconjunctival blepharoplasty,
155–156
Sliding genioplasty, for short lower facial
third, 394, 394f–395f
SMAS. See Superficial musculoaponeurotic
system (SMAS).
SMASectomy, facelift with, 286–292,
289f–293f
before-and-after pictures of, 328f–334f
in nasolabial fold reduction, 286–287
revision, before and after pictures of,
338f–341f
in weekend facelift procedure, 321–322,
324f–325f
before and after pictures of, 330f–331f
Smoke plume
from laser therapy, evacuation of, 551,
552f
from radiowave ablation, evacuation of,
721, 723f
Smoking
cervicofacial rhytidectomy and, risks
associated with, 342
chin implant complications related to,
411–416, 417f
in patient selection for cervicofacial
rhytidectomy, 255
Snap test, for lid laxity, 135, 135f
Soft-tissue fillers, for depressions after
rhinoplasty, 222–223, 222f
Software, digital editing, 24, 25f
Spider telangiectasias, 737
Spinal accessory nerve, facelift
complications involving, 353, 354f
Staff, office, importance of, 13
Staphylococcal infections, complicating laser
skin resurfacing, 589–591, 590f
Staphylococcus aureus, methicillin-resistant,
complicating laser skin resurfacing,
591, 592f–593f
Steatoblepharon, 133
Sternocleidomastoid muscle, vulnerable
structures related to, 251, 251f
Steroids
injected, for hypertrophic or keloid
facelift scars, 365, 365f
oral, for postoperative edema, in facelift
surgery, 349–350
Subcision, of depressed scars, 568
Subcutaneous fat
decrease in, in aging, 1
submental, 261, 262f
Subcutaneous flap, in transfollicular
subcutaneous brow and forehead lift
dissection of, 63–64, 64f–67f
skin redundancy after, 65–69, 69f
pretunneling of, 63, 63f
Subcutaneous layer, in facelift surgery, 249,
249f
Submalar region
deficiency in, 370–371, 370f
implants for, 370–371, 371f–372f
and need for zygomaticomalar
augmentation, 370f, 371
volume loss in, 370
fill for, 370
Submental incision, for platysmaplasty,
264–265
Submental liposuction, in cervicofacial
rhytidectomy, 260–263, 261f–264f
Submental region, aging of, 9–10
Subnasal lift, 709, 713f–716f
Subnasal region, volume augmentation
of, before-and-after photographs of,
675f
Sulcus, prejowl, injectable fillers for, 667,
670f
Sunlight, avoidance of, post-laser skin
resurfacing, 572, 574f
Sunscreen use, in prepeel priming, 520
Superficial musculoaponeurotic system
(SMAS)
controversy over, 249–250
description of, 249, 249f
excised, for facial augmentation,
290–292, 293f
in facelift history, 248
facelift techniques involving, 283–292
imbrication of, in facelift surgery, 286,
287f–288f
management of
deep-plane techniques of, 292
SMASectomy technique in, 286–292,
289f–293f
in weekend facelift procedure,
321–322, 324f–325f
muscular. See also Modiolus.
in nasiolabial fold formation, 7
physiologic function of, 250
plication of, in facelift surgery, 283–286
suspension of
closed, 284–285, 286f
definition of, 283–284
open, 283–286
definition of, 283–284
purse-string sutures in, 285, 287f
tenting of, in SMASectomy procedure,
288, 289f
Superior auricular muscle, 438–439, 439f
Superior labial artery, of nose, 176, 179f
Superior labial branches, course of, 37
Superior oblique muscle, in upper eyelid,
131, 132f
Supraorbital nerve
blocking of, 39, 40f
deep division of, protection of, during
endoscopic brow and forehead lift
periosteal release, 106–107
distribution of, 38–39, 39f
innervation provided by, 36
marking location of, for endoscopic brow
and forehead lift, 95–96, 97f
paresthesia of, complicating endoscopic
brow and forehead lift, 123
protection of, during endoscopic brow
and forehead lift dissection, 99,
101f–102f
Supratrochlear nerve(s)
blocking of, 39, 40f
branches of, supplying nose, 182, 184f
distribution of, 38–39, 39f
innervation provided by, 36
marking location of, for endoscopic brow
and forehead lift, 95–96, 97f
protection of, during endoscopic brow
and forehead lift dissection, 99, 101f
Surgery
day of, 17, 17f
post, 17, 17f
Surgical scars, laser skin resurfacing of,
568–569, 569f
Suture(s)
dehiscence of, complicating otoplasty,
471, 474f
exfoliation of, complicating otoplasty,
471, 474f
gut
for incision closure
in platysmaplasty, 265
in submental chin implant
placement, 396f–397f, 398
Short-scar facelift (Continued)
Superficial musculoaponeurotic system
(SMAS) (Continued)

762
Index
in upper lid blepharoplasty,
148–149, 149f
for incision tacking, in upper lid
blepharoplasty, 148–149
for transfollicular subcutaneous brow
and forehead lift
inflammatory reaction to, 76, 83f
interrupted subcutaneous, 72–73,
73f–74f
key, 69–71, 70f–71f
for incision closure
in endoscopic brow and forehead lift,
113, 118f–119f
in facelift, 311, 314f
for lip reduction closure
final, 706–707, 707f
key, 704, 706–707
mattress, horizontal, placement of, in
Mustardé otoplasty, 456–457,
456f–458f
nylon
in closed SMAS suspension, 284–285,
286f
for incision closure
in platysmaplasty, 265, 267f
in upper lid blepharoplasty,
148–149
in SMAS fixation in SMASectomy,
254, 290f–291f
perforating skin complicating otoplasty,
471, 474f
from previous surgery, in revision facelift,
336f, 339–340
Prolene
in brow lift fixation, 113, 115f–116f
extrusion of, complicating endoscopic
brow and forehead lift, 125, 126f
purse-string, in closed SMAS suspension,
285–286, 287f
reactions or infections from, complicating
facelift surgery, 359–360, 362f
retraction, in lower lid blepharoplasty,
150–151, 151f
suspension
for lateral platysma suspension,
292–294, 294f–295f
for lower eyelid canthopexy, 161, 162f
platysma, in platysmaplasty, 265, 268f
in torn earlobe repair, 492, 494f
Vicryl
in brow lift fixation, 113
in cheek implant fixation, 379
Suture lines, irregularities of, after facelift
surgery, 359, 360f–361f
Swelling
after cosmetic facial surgery, 20f
complicating injectable fillers, 686, 688f
Synechiae, complicating laser skin
resurfacing, 597–600, 598f–600f
T
“Talkesthesia”, for injection procedures, 647
Tarsus, 129f–130f, 130
Tattoos
eyebrow, asymmetrical, complicating
transfollicular subcutaneous brow
and forehead lift, 76, 83f
for facelift scars, 365–366, 367f
TCA. See Trichloroacetic acid (TCA).
Tear trough deformity, 5
injectable fillers for, 663–665, 664f–666f
before-and-after photographs of,
683f–684f
complications of, 690–691, 691f–692f
Telangiectasias, 737
dual-wavelength laser treatment of, 737
before-and-after photographs of, 738,
740f–741f
“Telephone deformity”
complicating otoplasty, 472, 475f
reverse, complicating otoplasty, 472, 475f
Temporal artery, superficial, supplying ear,
437–438, 439f
Temporal fixation, in endoscopic brow and
forehead lift, 113, 118f–119f
Temporal nerve, frontal branch of, facelift
complications involving, 351
Temporomandibular dysfunction
Botox treatment for, 623
masseter treatment for, 620–621
TFSBFL. See Transfollicular subcutaneous
brow and forehead lift (TFSBFL).
Thermal injury, to healing facelift tissues,
363, 364f
Thermal relaxation time
definition of, 734
in laser technology development, 734
Threadless retention posts, for brow lift
fixation, 113, 116f
Tissue(s)
lateral damage to, from incisional
modalities, 718, 719f
loss/necrosis of
complicating injectable fillers,
685–686, 686f
complicating otoplasty, 470,
471f–472f
Topical anesthesia
for injectable filler administration, 647,
647f–648f
for nasolabial fold augmentation, 660
for tear trough filling, 664, 664f
Topical preanesthesia, for local anesthesia,
37
Tragus, in facelift
reconstruction of, 307–310, 307f–310f
tissue breakdown in, 358, 358f
weekend, sculpting of, 322, 324f–325f
Transcartilaginous incision, for rhinoplasty,
192–193, 194f, 198
Transcolumellar incision, for rhinoplasty,
191–192, 193f
Transconjunctival approach, for lower eyelid
blepharoplasty, 149–154. See also
Blepharoplasty, lower eyelid,
transconjunctival approach for.
Transconjunctival blepharoplasty incision,
150–151, 151f
closure of, 153, 154f
Transdomal incision, for septal harvesting,
204, 208f
Transfixion incisions
for rhinoplasty, 193, 195f–196f, 198
for septoplasties, 193, 195f–196f
Transfollicular incision
crafting, 57–59, 58f–61f
extent of, 62, 63f
geometry of, 60–75
irregular, random, undulating
configuration of, 62, 62f
large triangular configuration of, 60, 62f
pattern of, 57
placement of, 57–59, 60f–61f
position of, 59, 61f
small triangular configuration of, 60–62,
62f
Transfollicular subcutaneous brow and
forehead lift (TFSBFL), 54–89
anatomic structures encountered during,
64, 66f
anesthesia for, 56–57, 58f
before-and-after results of, 80f–82f
blepharoplasty with, 56, 57f–58f
brow depressor transection in, 64–65,
68f
CO2 laser resurfacing with, 73, 74f
complications for, 75–76
ecchymosis as, 75, 83f
eyebrow tattoo asymmetry as, 76, 83f
inflammatory reaction to gut sutures
as, 76, 83f
undertreatment as, 76, 84f
wound breakdown as, 75, 82f
diagnosis for, 56
disadvantages of, 55–56
endoscopic brow and forehead lift
compared with, 54t
fixation in
interrupted subcutaneous gut sutures
for, 72–73, 73f–74f
key sutures for, 69–71, 70f–71f
follow-up of, 73
hair washing after, 73, 74f
hairline scar considerations in, 76–87
hypopigmentation as, 85, 85f
problematic incision as, 85–87
with widow’s peak, 76, 85f
healing after, 75, 75f–78f
hemostasis during, 64–69, 67f
incision for, 57–75. See also
Transfollicular incision.
indications for, 54–55, 55f
instrumentation for, 56
postoperative appearance of, 73, 76
preoperative marking for, 56, 56f
scar revision in, CO2 laser resurfacing for,
85–86, 86f–88f
skin excision in
decision on, 69–71, 69f–70f
technique of, 71–72, 71f–73f
subcutaneous flap in
dissection of, 63–64, 64f–67f
skin redundancy after, 65–69, 69f
pretunneling of, 63, 63f
surgical technique of, 56–75, 56f–58f
Transillumination, in facelift flap
development, 277, 278f
Transverse cervical nerve, facelift
complications involving, 353
Trauma, earlobe repair resulting from, 484
Traumatic scars, laser skin resurfacing of,
568–569, 568f–569f
Tretinoin (Retin-A)
for chemical peel, 523, 523b
in prepeel skin conditioning, 519
Suture(s) (Continued)
Transfollicular incision (Continued)

Index
763
Triamcinolone, intralesional, for earlobe
keloids, 506, 506f
before-and-after photographs of,
513f–514f
Trichloroacetic acid (TCA) peel
of aging skin in transconjunctival
blepharoplasty, 154, 155f
before-and-after photographs of,
537f–542f, 544f
complications of
hypopigmentation as, 546, 548f
overtreatment as, 545, 546f
uneven treatment as, 536, 544f
with laser resurfacing, 536, 537f
mechanism of action of, 523
multiple-coat, medium-depth, 525–529
acid application for, 525–526
care after, 529, 530f–534f
degreasing for, 525, 525f
endpoint determination in, 527,
527f–528f
of eyelids, 528, 528f–529f
goal of, 527
instrumentation for, 525, 526f
IV sedation for, 525
in neck/décolletage area, 528–529,
529f–530f
second coat in, 526–527, 526f
third coat in, 528
safety precautions for, 524
strengths of, skin type and, 520
ultralight, 523f–524f
Trichophyllic, trichophytic differentiated
from, 54
Trichophytic, trichophyllic differentiated
from, 54
Trichophytic approach, to brow and
forehead lift, 54. See also
Transfollicular subcutaneous brow and
forehead lift (TFSBFL).
Tricophytic incision, 57–59. See also
Transfollicular incision.
Trigeminal nerve (V)
branches of, supplying nose, 182, 184f
facial innervation by, 35–36, 35f–36f
Triluma, in prepeel skin conditioning, 520
Tripod concept, of lower lateral cartilages,
203, 205f
Tumescent anesthesia, 48–49, 49b
for cervicofacial rhytidectomy, 259–260
for endoscopic brow and forehead lift,
96–97, 97f
for facelift, 269, 269f
for fat extraction, 671
in lipocutaneous flap dissection in
facelift, 274–276
for transfollicular subcutaneous brow and
forehead lift, 56–57, 58f
Tumescent liposuction, 49, 49b, 50f
Tyndall effect, 665, 692f
complicating tear trough filler treatment,
690–691, 692f
U
Ultralight TCA peel, 524–525, 524f
Ultraviolet images, making, 29–31,
32f–33f
Ultraviolet light/skin scanners
in documenting resurfacing effects,
520–521, 521f–522f
in predicting response to peel, 520–521,
520f–521f
Upper lateral cartilages, of nose, anatomy
of, 180–181, 181f–182f
V
Vagus nerve, auricular branches of, 436
Van Ermengem, Emile, in study of
botulism, 604
Vascular lesions, laser treatment of,
734–745
anesthetic considerations for, 738–739
before-and-after photographs of,
740f–742f
complications of, 744
blistering/crusting as, 744, 744f
overtreatment as, 744, 744f
scarring as, 744, 744f
computer pattern generators for, 736
equipment considerations for, 737–738
pathology and, 737
treatment wavelengths for, 734–736,
735f, 737f
Vein(s)
auricular, posterior, draining ear, 438,
439f
jugular, external, injury to, complicating
facelift, 353–354, 355f
sentinel, protection of, during endoscopic
brow and forehead lift dissection,
105, 107f
temporal, superficial, draining ear, 438,
439f
VeraFil Inflatable Lip Implant, 692, 693f
Vermilion outline of lip
creating, 651, 652f
definition of, injectable fillers in,
before-and-after photographs of,
676f, 678f
Vertical lip rhytids
Botox treatment for, 618, 619f
before-and-after photographs of,
630f
with filler and CO2 laser resurfacing,
657, 657f
injectable filler for, 657, 657f
Vertical superior temporal extension
incision, for facelift, 269, 270f
Vertical temporal release incision, for
facelift, 269, 270f
Vicryl sutures
in brow lift fixation, 113
in cheek implant fixation, 379
Visual acuity testing, 134–135
Vomer, in nasal septum, 181–182, 184f
W
Wavelengths, for laser treatment of vascular
lesions, 734–736, 735f, 737f
“Weekend” facelift, 319–323, 322f
procedure for, 321–323, 323f–327f
with SMASectomy
and platysmaplasty and chin implant,
before and after pictures of, 330f
and upper blepharoplasty, before and
after pictures of, 331f
Weir-type resection, 193, 195f
Widow’s peak, transfollicular subcutaneous
brow and forehead lift scar with, 76,
85f
Windows, for archiving images, 31–33,
34f
Witch’s chin, 9, 9f
Wood’s light, in making ultraviolet images,
31, 32f
Wound breakdown
complicating rhinoplasty, 221–222
complicating transfollicular subcutaneous
brow and forehead lift, 75, 82f
Wound dehiscence
complicating blepharoplasty, 166, 166f
complicating facelift surgery, 363,
363f–364f
complicating mandibular angle implants,
430, 432f
X
Xanthelasma, of eyelids, 133, 133f
Z
Zygomatic nerve, course and branches of,
36–37
Zygomaticofacial nerve
block of, 40, 43f
course of, 37
Zygomaticomalar augmentation, need for,
with submalar deficiency, 370f, 371
Zygomaticotemporal nerve
block of, 40, 42f–43f
in scalp blocking, 46
course of, 36
medial, protection of, during endoscopic
brow and forehead lift dissection,
105

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