Essentials of Aesthetic Surgery

972
Index
preoperative evaluation for, 259-260
preparation for, 262-263
preprocedure details, 263-264
technique for, 263-265
Dermal suspension autoaugmentation-
mastopexy, 881


Dermis anatomy, 182
Dermis, homologous, 338
Dexamethasone, and pain control, 112
Diabetes, perioperative anesthesia consid-
erations, 89
Diet

surgical complication and, 148-149
wound healing and, 184

Dilution, of chemical peel agents, 242-243
Dimethicone, 192-193
Dimorphism, sexual, and relationship to at-
tractiveness, 18
Diode laser, 223
Direct liplift, 670-671
Distances for photography, 22-23
Diver’s test, 842, 843
Documentation, medicolegal considerations
and, 47-51
defensive documentation, 50-51
informed consent, 51
legal defenses, 48-49
legibility, 49
Donor site dominance for hair transplanta-
tion, 404
Dorsal augmentation, 602-604
Dorsal hump reduction, 599-600
Double-bubble deformity, 742
Dry-eye syndrome, 459
Dual plane pocket dissection, 732-734
Dyschromia
chemical peels for, 232
erbium-doped fractionated laser for, 223
nonablative laser resurfacing for, 226
Dyspigmentation, laser therapy for, 209
Dysplastic nevi, 188
E
Ear
anatomy and development of, 691-693
causes of abnormal morphology of, 69
normal aesthetic proportions of, 399, 693
Creases, evaluation of, 284
Cross-hatching, technique for, 288
Cross-radial, technique for, 288
Croton oil peel
general features, 237-238
postpeel care, 251-252
Crow’s-feet
chemodenervation for, 282


Cryolipolysis, 927-929
Cryosurgery, 187
Cutis laxa, 184
Cyanoacrylates, 325-326
D
da Vinci, Leonardo, 16, 17
Dantroline as treatment for malignant hy-
perthermia, 80
Davison-Caprini risk assessment model,
130
De Architectura, 16
De Devina Proportione (The Divine
Proportion)
Debulking of preaponeurotic tissues, 471-
474
Decision-making for patient selection for
ambulatory surgery, 88-90
Decolonization, staphylococcus and, 137,
149
Deep venous thrombosis


in hospitalized patients, 127
incidence of, 127, 129

Demographics of aesthetic surgery
patients, 3
Depression
description of patients with, 6
recognizing signs of, 3
Dermabrasion
complications of, 267-268
contraindications for, 261
equipment for, 262-263
indications for, 261
informed consent for, 262
manual spot dermabrasion, 263
microdermabrasion technique, 265-267
for perioral rejuvenation, 535
physical examination for, 262

973
Index
chemical peels for, 239-240
dyschromia, 198-199
evaluation for hydration, 198
Fitzpatrick skin types, 197-198
general characteristics of, 197
hair removers for, 200

sunscreen for, 200
Euclid, 14
Excitation mechanism of lasers, 205
Exogenous sources of wound contamina-
tion, 134

658
External carotid system, 364, 365, 381
External jugular vein, 382
External lower blepaharoplasty and orbicu-
laris suspension, 455-456
External lower blepaharoplasty with orbicu-
laris suspension and septal reset,
456-457
Eye protection, 97
Eyelashes, 369
Eyelid
aesthetic evaluation of, 438-440
anatomy of
blood supply, 364-365
deformities of, 435-436, 491-492
fat, 370
glands, 369
margin, 369
muscles, 357-364, 430-431
nerves, 366-367
skin, 356, 357-364
upper eyelid, 429-435
Asian
comparison of Asian and white, 462-
466
assessment of, 394-395, 542
normal versus ptotic, 498
pathology of, 435-436
photography of, 27-28
F
Face and neck
anatomy of
anterior triangle of neck, 387
bones, 383
danger zones, 380, 549
facial bones, 383

Ear, anatomy of, 399, 691-693

295
Ectropion
after CO2 laser therapy, 219

Edema curve, 11
Efudex, 187, 189
Ehlers-Danlos syndrome, 184
Elastoderma, 184
Electrodessication and curettage (ED&C), 187
Elements, 14
Embrace, for scar management, 156
Embryology
of breast, 711-712
of ear, 691
Emetic zone, role in postoperative nausea
and vomiting, 77
Endoscopic necklift, 573
Endotine ribbon, 330, 332
Endotine tack, 329, 332

Epicanthoplasty, 468, 478-479
Epicanthus, types of, 464-465
Epidermal peels, 234
Epidermis, anatomy of, 181
ePTFE; see -
ylene
Erbium-doped fractional laser, 223
Erbium-yttrium aluminum garnet laser
equipment, 213
for perioral rejuvenation, 536
and postoperative care, 217-218
Ethnic rhinoplasty
anatomic variations of, 635-636
complications of, 643
grafting materials for, 636-637
informed consent for, 635
postoperative care after, 643
preoperative evaluation for, 634-635
technique for
base reductions, 643
closure, 642
dorsal grafting, 640
managing the bony vault, 638
managing the middle third, 638
managing the nasal base, 639
opening the nose, 637-638
tip contouring, 640-642
Ethnic skin, 197-200
acne and, 199

974
Index
Fascia
of face, 374, 375
lyophilized, 337
of neck, 375-376
parotidomasseteric, 375
SMAS, 374
Fasciocutaneous retaining ligaments,
385
Fasting guidelines, preoperative, 66
Fat
of abdominal wall, 837
of midface, 483-484
periorbital compartments of, 370
subcutaneous layers of, 799-800
zones of adherence and, 800
Fat grafting
complications of, 310-312
equipment for, 298
for facelift, 546
informed consent for, 297
for male-to-female top surgery, 940
postoperative care after, 303
preoperative evaluation for, 297
preparation for
harvest site selection, 297-298
incisions for harvest, 297-298
of selected areas
cheek, 307-310
lips, 305-307
marionette grooves, 303-306
nasolabial folds, 303-304
tear trough, 307-310
of tear trough deformities, 486
technique for
component separation, 300-301
fat placement, 301-302
harvest, 299
Federal regulations for ambulatory surgery
centers, 175
Feet, positioning for photographing body
series, 32-34
Female genital aesthetic surgery
complications of, 922-923
for functional problems, 924
general considerations for, 887-888
goals of, 891-892
informed consent for, 897
labia minora enlargement, 888-889
outcomes, 923-924
postoperative care after, 922
preoperative evaluation for, 896-897
relevant anatomy for, 892-895
Face and neck—cont’d
anatomy of—cont’d
motor nerves, 378-379
nerves, 376-379
retaining ligaments, 384-387
sensory nerves, 376-378
soft tissue layers, 372-376
vessels, 381-382
photography of, 23-27
treatment after massive weight loss,
882-883
Facelift
anesthesia for, 547
and bleeding risk, 165
common malpractice claims and, 52
complications of, 548-549
intraoperative care during, 547
postoperative care after, 547-548
postoperative skin maintenance, 549
preoperative evaluation for 540-543
and progressive tension sutures, 345
techniques for, 544-546
Facial analysis
of cheek, 399
of chin, 400
for classifying rhytids, 390
of divine proportion, using neoclassical
canons, 391-392
of ears, 399
for Fitzpatrick skin type, 390
of forehead, 394
on frontal view, 392, 393
of globe, 395
on lateral view, 392, 393
of lower eyelid, 395
of mouth, 400
of neck, 400
of nose, 395-399
for photoaging, 390
for skin texture and thickness, 390
of upper eyelid, 394-395
Facial expression for photography, 40
Facial feminization surgery, 934-939
Facial nerve, 367, 378-379
Facial plastic surgery
anesthesia guidelines for, 95-97
Facial vein, 382
Factor Xa inhibitors for chemoprophylaxis,
165
Fanning technique, 288
Farkas, 18, 19
Fasanella-Servat procedure, 503-504

975
Index
hyperpigmentation and, 185
laser therapy and, 208-209

Fixation devices
advantages of, 332
background of, 329
complications of, 333
direct needle sutures, 329
disadvantages of, 332
Endotine ribbon, 330
Endotine tack, 329
Mitek anchor, 330-331
outcomes, 332-333
quill suture, 331-332
Ultratine tack, 330
V-Loc barbed suture, 331
Flaps
for epicanthoplasty, 478-479
forehead, dissection planes, 422-423
Flash sterilization, 152
Flavonoids, 194
Fleur-de-lis abdominoplasty, 850, 874
FlexHD, 338
Fluence, and lasers, 206
Fluid management, for liposuction, 125
Flumazenil for benzodiazepine reversal,
71
Focal lengths, 22-23
Follicles, 182
Follicular unit extraction, 408
Forehead
anatomy of
blood supply, 364
bones, 412-413
fat compartment, 373
galea aponeurosis, 412
muscles, 413-415
nerves, 415-416
retaining structures, 412-413
soft tissue layers, 412
surface, 355

assessment of, 394, 416, 541
ideal aesthetics of, 411
injection with botulinum toxin, 274-
275

treatment algorithm for, 417
Fork-in-the-road legal defense, 48
Fractional lasers
complications of, 220
equipment, 207, 213-214
techniques for
clitoris and clitoral hood, 912-914
labia majora, 915-918
labia minora reduction, 898-912
mons and mons pubis, 918-922
Female pattern baldness, 404
Femoral triangle, 856
Festoon, 453, 484
Feverfew, 195
FFS; see Facial feminization surgery
Fibrin glue, 323-325, 333
Fibonacci, 15
Fibonacci sequence, 15
Fibrous papules, 187
Fillers, soft tissue
aesthetic evaluation for
lines/furrows/creases, 284
lips, 283
lower lid/tear trough, 284
midface/malar region, 284
calcium hydroxyapatite, 288-291

for chin dimpling, 282
complications of, 294-295
contraindications for, 282-283
for crow’s-feet, 282
equipment for, 285-286
for ethnic skin, 200
for forehead, 280
hyaluronic acid, 286-288
FDA approved, 287
indications for, 287
injection techniques, 287-288
nonanimal stabilized, 286-287
ideal characteristics of, 286
indications for, 282-283
informed consent for, 284-285
for labiomental groove, 282
for lips, 281, 648-657
for lower face, 281
for midface, 280-281
for nasal contouring, 282
for perimental hollows, 282
for perioral rejuvenation, 280, 530-533
Fire, and laser therapy, 220
First impression, 4

Fitzpatrick skin types
chemical peels and, 233
dermabrasion and, 259
ethnic skin evaluation and, 197-198
facial analysis and, 390

976
Index
Glide plane space, 412
Globe, assessment of, 395
Glogau photoaging scale, 233, 260, 390
Glycolic acid
for chemical peels, general features,
235-236
combined with trichloroacetic acid, 248-
249
as moisturizing agent, 193, 194
perioral peeling technique, 244-245
Golden mean; see Golden ratio
Golden proportion; see Golden ratio
Golden ratio

and Fibonacci numbers, 15
and golden rectangle, 15
and Vitruvian explanation of proportion,
16
Golden rectangle, 14-15
-
ties, 119
Grafts
for lip augmentation, 660-664
for nasal tip, 608-609

295
Great auricular nerve, 377, 378, 549
Greater occipital nerve, 377
Gull-wing liplift, 670-671
Gynecomastia
complications of treating, 794
contraindications for treating, 789
demographics of, 789
etiologic factors for, 789
indications for treating, 789
informed consent for treating, 791
outcomes of treating, 794-795
postoperative care after treating, 793-
794
preoperative evaluation of, 790
staging of, 790
techniques for treating
combined/staged approach, 793
nonoperative, 791
operative, 791
suction-assisted liposuction, 793
surgical excision, 792
ultrasound-assisted liposuction, 792-
793
Gynoid lipodystrophy, 800-801
Frankfort plane, as reference for head posi-
tioning, 23
Fraxel, 223
Free-nipple grafting, 782-783
Frontal bone, 383
Frontal branch of facial nerve, course of,
379
Frontalis muscle, 357, 359, 414, 425
Frontalis suspension, 507
Full-scar facelift and necklift, 574
Functional capacity for anesthesia, 67-68
Functional status for anesthesia, 67-68
Furnas otoplasty, 696, 698-700
Furrows, evaluation of, 284
G
Gabapentin/pregabalin,
for pain control, 112
Gabapentinoids, and pain control, 114
Galea aponeurosis, 412
Gastric emptying, comorbidities that af-
fect, 67


facial feminization, 934-939
female-to-male bottom surgery, 951-
955
male-to female bottom surgery, 947-951
top surgery, 939-947
Genetic skin disorders, 184
Genioplasty
complications of, 689-690
contraindications for, 677
equipment for
alloplastic augmentation, 683-684
biologic augmentation, 684
osseous genioplasty, 684
indications for, 677
informed consent for, 682
postoperative care after, 688
preoperative evaluation for, 678-682
relevant anatomy for, 676-677
techniques for
implant genioplasty, 687-688
osseous genioplasty, 684-686
Genital aesthetic surgery; see Female genital
aesthetic surgery
Giant congenital nevi, 188
Ginseng, 195
Glabellar complex, injection of, 273-274

977
Index
peribulbar, 458
retrobulbar, 458
statistics from ambulatory surgery cen-
ters, 178
Herbal supplements

after upper blepharoplasty, 446
discontinuation before laser therapy,
210

perioperative anesthesia considerations
for, 91-92
High-density porous polyethylene, 339
High-intensity focused ultrasound, 929-
930
High-lateral-tension abdominoplasty, 849-
850
Histrionic patients, 6
HIV infection, and poly-L-lactic acid, 291
Horizontal lower lid shortening, 495
Huger vascular zones, 838
Humectant, 193


for correction of tear trough deformity,
485-486
indications for, 287
for lip augmentation, 648-649
technique for, 287-288
Hyaluronidase, 294
Hydroquinone
for ethnic skin, 240
laser therapy and, 209-210
mechanism of action, 189, 199
treatment for pigmented skin, 195
Hydroxyapatite, 339-340
Hyperpigmentation
after chemical peels, 255
after dermabrasion, 267
after erbium-yttrium aluminum garnet
therapy, 220
after sclerotherapy, 316

laser therapy, 219
prevention after laser resurfacing,
218
Hypersensitivity reaction
to botulinum toxin, 278

H
Hair color, considerations for transplanta-
tion, 404
Hair density, normal, 404
Hair growth, phases of, 182, 402
Hair reduction, and nonablative laser resur-
facing, 226-227
Hair transplantation
complications of, 409-410
contraindications for, 403
equipment for, 405
for facial feminization, 937
for facial feminization surgery, 937
goals of, 402
indications for, 403
informed consent for, 404
postoperative care after, 408-409
preoperative care for, 404
preoperative considerations for, 404
donor site dominance, 404
preoperative evaluation for
-
tern baldness, 404
-
tern bladness, 403
reasons for, 402
technique for
anesthesia, 405
combined follicular unit extraction and
transplantation, 408
donor site harvesting, 405-406
follicular unit extraction, 408
graft dissection, 406
graft insertion, 406-408
Hairline, 416-417, 935-936
Handpiece, control of
for dermabrasion, 264
for microdermabrasion, 266-267
Hatch suture, 705
Hatef risk assessment model, 131
Healing curve, 10
Health history, as component of patient
consultation, 4
Health Insurance Portability and
Accountability Act guidelines for
photography, 40-41
Hematoma
after facelift, 548

978
Index
Intense pulsed light, 207, 224, 226
Intermittent pneumatic compression, 164,
165
Interpositional bone grafts, for genioplasty,
685
Intralipid 20%, for treatment of local anes-
thetic system toxicity, 105
J
Jessner solution
combined with trichloroacetic acid, 248
general features, 236
perioral peeling technique, 245-246
postpeel care, 250
Jowling, and retaining ligaments, 387
Jumping genioplasty, 685
Juvéderm products, 287
K
Keratinolytic agents, 189
Keratoacanthoma, 186
Ketamine, and pain control, 112
Kohl, 14
Kojic acid, 195, 199
Kybella, 570
L
L-ascorbic acid, 193
Labia majora reduction
direct excision, 915-917
liposuction, 918
Labia minora volume reduction
bilateral deepithelialization, 911-912
edge resection, 900-901
wedge resection, 901-911
Labiaplasty; see Female genital aesthetic
surgery

Laboratory tests, preoperative, 64
Lacrimal apparatus, 434-435
Lacrimal function test, 438
Lacrimal glands, anatomy of, 369

Lactic acid, 193, 199
Lagophthalmos, 460
Landmarks
for genioplasty, 676

series, 41
of perioral region, 528
of periorbital skeleton, 355
Hypertension
and hematoma after facial rejuvenation, 4
perioperative anesthesia considerations
for, 85
Hypervascularity, laser therapy for, 209, 226
Hypopigmentation
after carbon-dioxide laser therapy, 218
after chemical peels, 255
after dermabrasion, 267
after erbium-yttrium aluminum garnet
therapy, 220

Hypothermia
causes of, 122
complications of, 75, 123
contributing factors, 75

incidence of, 122
PACU recovery, 76
patient-associated risk factors for, 75
perioperative, 74-76
prevention of, 76, 123
warming maneuvers for, 75-76
wound healing and, 152
I
Imiquimod, as treatment for skin cancer, 187
Implant genioplasty, 687-688
Implants
for breast augmentation, 727-730
for buttock augmentation, 830, 832-833
for female-to-male bottom surgery, 955
nonbreast, 335-342
In situ squamous cell cancer, 186
In-line canthopexy, 493
Incision options, for browlift
anterior hairline, 420
coronal, 419-420
direct forehead skin excision, 418-419
endoscopic-assisted, 422
limited incision, 420-421
transblepharoplasty, 419
Incisional blepharoplasty, 467, 468-474
Inferior ligament of Schwalbe, 363
Inferior tarsal muscle, 361
Informed consent, 726-727
Inframammary fold, considerations for
treating, 739
Inframammary incision, 735, 736
Infrared A, 199
Injection sites for facial nerve block, 241

979
Index
Lentigo, 188
Leonardo of Pisa; see Fibonacci
Lesions, of skin, 185-189
Levator reinsertion, 507
Liber Abaci, 15
Licorice, 195, 199
Lid invagination, 444
Lidocaine
liposuction and, 103-104, 805-806
toxicity of, 104, 214, 806
Liedl, Charles, 18
Lifestyle, and surgical complications, 147-149
Lighting for photography, 21
Linear threading, 288
Lines, evaluation of, 284
Lip augmentation
goals of, 645
preoperative evaluation for, 646-648
techniques for
anguloplasty, 672-673
bullhorn liplift, 667-669
corner mouthlift, 672-673
direct liplift, 670-671
grafts, 660-664
gull-wing liplift, 670-671
implants, 657-660
indirect liplift, 667-669

lip suspension, 669-670
subnasal lift, 667-669
V-Y advancement, 664-666
vermilion liplift, 670-671
Lip suspension, 669-670
Lipectomy, suction-assisted, 53-54
Liplift, 536
Lipoabdominoplasty, 848
Liposuction
anesthesia guidelines for, 102-104
techniques for
laser-assisted, 808
power-assisted, 807
radiofrequency-assisted, 809
suction-assisted, 806
ultrasound-assisted, 806-807
water-assisted, 808
Lips
ideal dimensions of, 646-647
rejuvenation with implants, 537-538
aesthetic evaluation of, 283, 400, 528-
529
augmentation with fat, 305-306
Laparoscopic adjustable gastric band, 870
Laser peel, photographic series for, 28-29
Laser resurfacing
ablative, 212-220
nonablative, 223-228
Laser therapy, 205-211
anesthesia guidelines for, 97-98
contraindications for, 208
indications for, 207-208
informed consent for, 210-211
physics of, 205-206
preoperative evaluation and preparation
for, 208-210
for prominent veins, 316-318
types of lasers
ablative, 206
fractional, 207
nonablative, 206-207
Lasers
diode, 223
erbium-doped fractional, 223-224
intense pulsed light, 224
midinfrared, 223
ND:YAG, 223
Q-switched ND:YAG, 223
radiofrequency, 224-225
visible light, 224
LAST; see Local anesthetic system toxicity
Lateral canthopexy
complications of, 497

indications for, 491
postoperative care, 497
preoperative evaluation for, 491
special anatomic considerations for
deep-set eyes, 495-496
prominent eyes, 496
techniques for
horizontal lower lid shortening, 495
in-line canthopexy, 493
orbicularis suspension, 493-494
-
pexy, 492
tarsal strip release, 495
transcantho-canthopexy, 493
transosseous canthopexy, 494-495
Lateral orbital thickening, 363, 385
Lathyrogens, wound healing and, 185
Lawsuits; see Malpractice
Legibility of documentation, 49
Length of surgical procedure, safety and, 123

980
Index
patient communication and, 45-47
patient selection and, 44-45
Marionette grooves
fat grafting of, 303-304

533
Masseter muscle, injection with botulinum
toxin, 277
Massive weight loss
photography after, 35-37
techniques for body contouring after,
862-863, 874-883
tissue characteristics after, 874, 876, 877,
878, 882
Mastopexy
after explantation, 759
after massive weight loss, 880, 881
and augmentation, 759
complications of, 758-759
contraindications for, 752
indications for, 752
informed consent for, 753
outcomes, 760-761
photographic series for, 39
postoperative care after, 758
preoperative evaluation for, 752-753
techniques for
periareolar, 753-755
vertical and horizontal scar, 757-758
vertical scar, 755-757
for tuberous breast deformity, 760
Mastopexy, photographic series for, 39
Medi spa
ambulatory surgery center (ASC) and,
171, 174-175


marketing and advertising for, 173
postoperative complications, 177-178
practice settings for, 172


Medi-speak, medicolegal considerations
and, 46
Medial thigh lift
after massive weight loss, 878-879

massive-weight-loss patients, 858
non-massive-weight-loss patients,
858
Pittsburgh rating scale, 858
contraindications for, 857
Lips—cont’d
rejuvenation with implants—cont’d
enhancement of, 283
fat grafting of, 305-307
photograph series of, 29-30

youthful characteristics of, 281


Local anesthetic system toxicity
EMS and transfer protocols for, 105
intralipid administration for, 105
management of, 104-105, 816
Low-level laser therapy, 931
Lower lid-cheek junction, and soft tissue

Lower lid/tear trough, evaluation of, 284

baldness, 404

294
Lunchtime peel, 193-194
Lux 1540 fractional laser, 224
Lymphatics
of breast, 718-719
function of, 182
massage of, 155
of periorbita, 365
M
MAC; see Monitored anesthesia care
Maintenance counseling, 11
Malar bag, 453

Male pattern baldness, 404
Malignant hyperthermia
basic considerations for, 79
Malignant Hyperthermia Association of
the United States (MHAUS), 81
management of, 80-81
North American Malignant Hyperthermia

signs of, 80
and total intravenous anesthesia, 60
Malignant Hyperthermia Association of the
United States, 81

Malposition of lower lid, postoperative, 460
Malpractice
common claims, 52-54
documentation and, 47-51
frequency of claims by specialty, 43

981
Index
Morbid obesity

comorbidities of, 869
Motivation for aesthetic surgery, 6
Mouth, assessment of, 400
Moving needle technique, 112, 113
Müller muscle-conjunctival resection, 504

Multimodal analgesia; see also Opioids
addiction after surgery, 108-109
local anesthetics and, 112-113
medications for, 111-112
and opioid use, 107-111
recommendations for surgeons, 109-110
regimen for, 113-115
surgeon’s role in, 108
Muscle necrosis, patient positioning and,
73
Mushroom extract, 195
Mustardé otoplasty, 696, 698-700
N

557
Naloxone for reversal of narcotics, 71
Narcissistic patients, 6

Nasal deviation, correction of, 613
Nasal obstruction, correction of, 587-588,
614
Nasal region, botulinum toxin injection of,
274

Nasolabial fold
algorithm for treatment options, 558-
559
anatomy of, 551
causes of deepening, 554-555

complications of treating, 563
dynamics of, 553
smiling, 553-554
fat grafting of, 303-304
histologic observations, 552
informed consent for treating, 558
observations after dissection, 551-552
postoperative care after, 562

relationship to SMAS, 552-553

techniques for
dermal fat grafting, 560
equipment for, 859-860
indications for, 857
informed consent for, 859
postoperative care after, 865-866
preoperative evaluation for, 857-859
relevant anatomy for, 856
techniques for
after massive weight loss, 862-863
classic technique with transverse skin
excision/upper thigh crescent ex-
cision, 860-862
fasciofascial suspension technique,
864
spiral lift, 864-865
Medical clearance, 9
Medication storage and disposal, 108, 109
Medicolegal considerations
common claims, 52-54
documentation, 47-51
patient communication, 45-47
patient selection, 44-45
Meibomian glands, 369
Melanoma, 186-187


Metabolic equivalents, assessment for func-
tional status, 67-68
Methicillin-resistant Staphylococcus aureus,
antibiotic prophylaxis for, 149
Microdermabrasion, 263, 265-267

Microthermal zones of ablation, 213


Midface-malar region, evaluation of, 284

Midinfrared laser, 223
Mimetic muscles, 374-375
Miniabdominoplasty, 848-849

Mitek anchor, 330-331, 333-334
Modiolus, 552
Mohs micrographic surgery, 187
Moisturizers, 192-195
Monitored anesthesia care
agent reversal, 71
goals of, 68
medications for, 68-69
sedation continuum, 70
tools of airway continuum, 70
Monopolar radiofrequency, 207
Mons and mons pubis techniques, 918-922

982
Index
Nipple-areola complex, vascular compro-
mise of, 783

295
Nonablative laser resurfacing
anesthesia for, 225
applications for, 226-227
complications of, 227
equipment for, 223-225
postoperative care after, 227
safety considerations for, 225

techniques for, 225-226
Nonablative lasers
mechanism of action, 206-207
risks of, 210-211
Nonanimal stabilized hyaluronic acid prod-
ucts, 286-287
Nonendothermal endovenous ablation, for
prominent veins, 319
Nonincisional blepharoplasty, 474-478
Normothermia, 152
North American Malignant Hyperthermia


baldness, 403
Nose
anatomy of, 581-586
assessment of, 395-399
ethnic variations of, 398-399, 636
NSAIDs, 111-112, 114
Nutrition, and wound healing, 184
O
Obesity
body mass index and, 90-91
and clinical correlations, 90
obstructive sleep apnea and, 87
Obstructive sleep apnea
background information, 87
perioperative anesthesia considerations
for, 87-88
physiologic derangement with, 87
preoperative assessment for, 87-88

Occlusives, 192-193
Ocular damage and blindness, 220
Ocular examination, 437

administrative issues and, 119-120
anesthesia evaluation for, 121
Nasolabial fold—cont’d
techniques for—cont’d
facelift, 561-562
injections, 559
nasolabial lipectomy, 561
primary excision, 562
ND:YAG laser, 223
Neck
assessment of, 400, 543
injection with botulinum toxin, 276-277
qualities of aging, 565
qualities of youthful appearance, 400, 565
Necklift
anesthesia guidelines for, 95-97
complications of, 578-579
component evaluation of
chin, 568
digastric muscles, 568
fat, 566-567
mandibulocutaneous ligament, 568
platysma, 567
skin, 566
submandibular gland, 568

informed consent for, 568
nonsurgical options for rejuvenation,
569-570
botulinum toxin, 569
medication, 570
ultrasonography, 569
postoperative care of, 577-578
surgical options for rejuvenation, 570-571
endoscopic necklift, 573
full-scar facelift and necklift, 574
liposuction, 570-571
platysmal procedures, 575-577
short-scar facelift and necklift, 573-574

submental anterior necklift, 571-573
Nefertiti, 13-14
Negative psychological indicators (red

Neodermal matrix, bilaminate, 338

Nerves, facial danger zones for, 380, 549
Neurotic patients, 7
Nevi, 187
Nicotine metabolites, 148
Nipple sensation
after breast augmentation, 740
after breast reduction, 784

983
Index
P
P6-accupressure, as antiemetic therapy, 79
Pacemakers, 85, 86
Pacioli, Luca, 15
Pain management; see also multimodal anal-
gesia; opioids
complication reduction with, 153

nonopioid options for, 110

Paranoid patients, 7
Parotidomasseteric fascia, 375
Patient communication
listening behaviors to avoid, 45-46
listening skills, 46
speaking habits, 46-47
Patient consultation
health history, 4

motivation, 5-6
physical evaluation, 7-8
preparing for surgery, 9
psychology, 5, 6-7
rejection, 8
Patient positioning
for anesthesia, 73-74
complications of, 74
and venous thromboembolism preven-
tion, 153-154
Patient safety in medi spas, 177-178
Patient selection
and medi spa procedures, 177
and medicolegal considerations, 44-45
PDT; see Photodynamic therapy
Pedicles, for breast reduction, 772-774
Peels; see Chemical peels
Periareolar incision, 736-737


Perioral region
anatomy of, 528
assessment of, 543
injection with botulinum toxin, 275-276
Perioral rejuvenation
complications of, 538
techniques for
ablative laser resurfacing, 535-536
chemical peels, 534
chemodenervation, 530
dermabrasion, 535
fat grafting, 533-534
contraindications for, 147
core principles of, 120-121
liposuction and, 124-125
postoperative pain and nausea and, 123-
124
preoperative evaluation for, 121

safety considerations for, 119
Oils, 192
Operative and follow-up care
day of surgery, 9-10
maintenance counseling, 11
postoperative care, 10
recovery after cosmetic surgery, 10-11
revisions, 12
Opioids; see also Multimodal analgesia
addiction to, 108-109

diversion and, 108
epidemic of, 107-108
and Medicaid patients, 108
prescribing patterns for, 107
risk factors for abuse of, 109
statistics, 107-108
storage and disposal of, 108
surgeon’s role, 108
Orbera weight loss balloon, 870
Orbicularis suspension, 493-494
Orbit, fat compartment of, 373
Orbital anesthesia for ablative laser resur-
facing, 215
Osteotomies, 601-602
Otoplasty
contraindications for, 695
preoperative evaluation for, 694-695
relevant anatomy for, 691, 692-693
equipment for, 696
goals of, 694
indications for, 695
informed consent for, 695
techniques for
Converse-Wood-Smith, 701-703
for Darwin tubercle, 705
Furnas, 698-700
for mastoid prominence, 705
Mustardé, 696-698
prominent helical root correction, 705
prominent lobule correction, 704
for Stahl ear, 705

294

984
Index
for genioplasty, 679
informed consent for, 40-41
lighting, 40
preoperative planning and, 9
preparation of patient for, 40
series
body, 32-34
breast, 35-37
brow and eyelids, 27-28, 418
face and neck, 23-27
laser/chemical peel, 28-29
lip, 29-30
male body, 34-35
rhinoplasty, 30-32
Physical evaluation, 7-8

Society of Anesthesiologists, 122
Physics of lasers, 205
Pigmentation
in ethnic skin, 198-199
inhibitors, 199
treatment with cosmeceuticals, 195
Pinch blepharoplasty, 454
Pitanguy line, 379



Platonic solids, 15
Platysmal banding
botulinum treatment for, 276-277
photography of, 27
Platysmal procedures, for necklift
corset platysmaplasty, 576-577

platysmal muscle sling, 576
Plutarch, 14
Poly-L-lactic acid, 291-292, 341, 649
Polydioxanone, 342
Polyglactin 910, 342
Polylactide derivatives, 341
Polymethylmethacrylate, 292
indications for using, 292
lip augmentation with, 649-650
technical considerations for, 292
Polyphenols, 194
Polysomnography, and obstructive sleep
apnea, 87
PONV; see Postoperative nausea and vomit-
ing

293
Perioral rejuvenation—cont’d
techniques for—cont’d
lip implants, 537-538

subnasal liplift, 536-537
Periorbital region
anatomy of
blood supply, 364-365
conjunctiva, 369
eyebrow, 355
eyelashes, 369
eyelid surface, 356-357, 369
fat, 370
glands, 369
ligamentous framework, 361-364
lymphatic, 367
muscles, 357-364
nerves, 366-367
orbital septum, 367-368
skeletal, 355
skin, 357
soft tissue, 355-370, 413
tarsus, 368-369
botulinum toxin injection of, 275
characteristics of aging, 452
measurements of, 357

Peripheral neuropathy, patient positioning
and, 73, 74
Peripheral vascular disease, perioperative
anesthetic considerations for, 86
Perlane products, 287
Personality disorders
histrionic patients, 6
narcissistic patients, 6
neurotic patients, 7
paranoid personality, 7
schizoid patients, 6
Petrolatum, 192
Phenol-croton oil and TCA peels, 238
Phi, 15
Phidias, 15
Photoaging, 194
Photodynamic therapy, 187, 224
Photography
background, 40
for botulinum toxin injection, 271
elements of standardization overview, 21
focal lengths and distances, 21, 22-23

sensors, 22

985
Index
Pseudofolliculitis barbae, 200
Pseudoptosis, 499
Pseudoxanthoma elasticum, 184
Psychological factors in patient evaluation,
5, 6-7
Ptosis
acquired, 500
congenital, 499-500
degrees of, 501
of eyelids, 278
glandular, 763-764
involutional, algorithm for treatment, 505

true, 499

Pull-away test, 453
Pulmonary aspiration prevention, 66, 67
Pulmonary hypertension, perioperative an-
esthesia considerations for, 86
Pulse duration, and lasers, 206
Pulse width, and lasers, 206
Pulsed dye laser, 224, 226
Putterman procedure; see Müller muscle-
conjunctival resection
Pythagoras, 14
Q
Q-switched ND:YAG laser
general characteristics, 223
for tattoo removal, 226


surgical facilities, 119
Quality assessment and safety, 119
Quill suture, 331-332
R




veins, 318


see

for, 27

edema curve, 11
emotional response, 11
healing curve, 10-11
Postanesthesia recovery unit care, 81
Postanesthetic shivering, 76
Postbariatric body contouring
consensus guidelines for, 134
preoperative laboratory testing, 133
safety issues for, 132-134
solo versus team approach for, 133
surgical staging, 133
Postbariatric surgery
involving liposuction, 131, 132
and venous thromboembolism, 131-132
Postdischarge nausea and vomiting
incidence, 76
PACU rescue therapy for, 79
risk factors and management, 77-78
Postoperative nausea and vomiting
ambulatory surgery and, 90
incidence of, 123-124
in medi spa patients, 177
multimodal management of, 124
neurotransmitters and, 77

PACU rescue therapy for, 79
risk factors and management, 77-78
Pregnancy

preoperative testing for, 63-64

Premature peeling, 254
Preparing for surgery, 9
Preseptal fat, 433
Pressure ulcers, as complication of patient
positioning for anesthesia, 73
Priming, before chemical peels, 239-240
Progeria, 184
Progressive tension sutures
for abdominoplasty, 847
complications of, 351
contraindications for, 345

equipment for, 346
indications for, 344-345
informed consent for, 345-346
outcomes, 350-351
postoperative care, 349-350
preoperative elevation for, 345
technique, 346-349
Proportion of man; see Vitruvian Man
Proportion, facial, 391-393
Protected Health Information, 41

986
Index
open approach, 597-598
septoplasty, 604

95-97

after dermabrasion, 267


erbium-doped fractionated laser for, 224
nonablative laser resurfacing for, 226






heat and, 200
and intense pulsed light, 224


S
SAFElipo; see Separation, aspiration, and fat
equalization liposuction
Safety
chemical peels and, 240-241
laser therapy and, 214, 225

administrative issues, 119-120
clinical issues, 121-122
combination surgical procedures and,
126-127
core principles, 120-121
liposuction, 124-125
physiologic stresses, 122-123
postoperative pain and nausea, 123-
124
postbariatric body contouring and, 132-
134
risk assessment and, 129-131
supplements and, 146-147
surgical site infections and, 134-137
venous thromboembolism and
postbariatric procedures, 131-132
Saline, for lip augmentation, 658
Scarring
after chemical peels, 255
after CO2 laser therapy, 219
after dermabrasion, 268
as common malpractice claim, 52
laser therapy for, 209, 226

see Breast reduc-
tion

common malpractice claims and, 52
photographic series for, 39



763



747



of anterior triangle, 387
of cheek and mandible, 385, 386

of neck, 386-387
of periorbital area, 384, 385
of temporal area, 384



370




aesthetic indications for, 589
anesthesia guidelines for, 98
complications of
aesthetic, 616-617
functional-medical, 615-616
corticosteroids and, 155
equipment for, 596-597
functional indications for, 589-590
informed consent for, 596
photographic series for, 30-32
postoperative care after, 615
preoperative evaluation for, 590-595
relevant anatomy for, 581-586
techniques for
alar base and nostrils, 610-612
closed (endonasal) approach, 598-599
nasal airway obstruction, 614
nasal deviation, 613
nasal dorsum, 599-604
nasal tip, 604-610

987
Index
Silicone

for lip augmentation, 649, 658
for nonbreast applications, 340-341
for scar management, 155-156
Skin
analysis of
for aging, 185, 540
for Fitzpatrick skin type, 185, 197-198,
208-209, 233, 259, 390
for quality, 185, 390, 540
anatomy of
and chemical peel depth, 235
normal, 181-182, 372
benign lesions of, 187-188
cancer, 186-187
basal cell cancer, 186
melanoma, 186-187
squamous cell cancer, 186
treatment, 187
common therapies for, 189
ethnic skin care, 197-200
genetic disorders of, 184
physiology of, 182-184
premalignant lesions of
actinic keratosis, 187
redundancy, 869
wound healing of, 183-185
Skin antisepsis protocol, 149

Skin resurfacing
and facelift, 546
for lower blepharoplasty, 454
Skin tag; see Acrocordon
Skin-only blepharoplasty, 454
Sliding genioplasty, 685
SMAS; see
system
Smiling, stages of, 553
Smoking
patient history, 4
surgical complications of, 148
Smoking, perioperative anesthesia consid-
erations for, 86
Snap test, 209
Snap-back test, 453
Soemmering ligaments, 364
Soft tissues of face and neck
Solar lentigo, 188
Spider angioma, 188
Spider veins; see Telangiectasias
postoperative management of, 155-156

Scatter, lasers and, 205
SCC; see Squamous cell cancer
Schirmer test, 438
Schizoid patients, 6
Scleral show, 453
Sclerosing agents, 314
Sclerotherapy, for prominent veins, 313-
316
Screening duplex ultrasound, and venous
thromboembolism, 165
Sculptra, 291-292
Seal of American Society of Plastic
Surgeons, 18
Sebaceous hyperplasia, 187
Seborrheic keratosis, 188
Secondary breast reduction, 777-778
Secondary rhinoplasty
complications of, 632
endonasal/closed approach for, 621
external/open approach for, 621
grafts for, 630-631
indications for, 620
postoperative care after, 631
preoperative evaluation for, 621-625
surgical obstacles, 621
technique
for contour irregularities, 630
for displaced/deviated structures,
625-626
for overresection, 628-629
for prosthetic complications, 630
for underresection, 626-628
treatment planning for, 625
Selective thermolysis, 206
Selenium, 195
Self-image versus true image, 5
Separation, aspiration, and fat equalization
liposuction, 809-810
Septoplasty, 604
Septorhinoplasty, common malpractice
claims and, 52-53
Serial puncture technique, 288
Seroma, and progressive tension sutures,
350-351

Short-scar facelift and necklift, 573-574
Sign in, 150
Sign out, 150

988
Index
Surgical site infections, 134-137
Surgiholic patients, medicolegal consider-
ations for, 45
Sutures
barbed, 153
continuous, for abdominoplasty, 349
interrupted, for abdominoplasty, 346-
348
for umbilicus inset, 348
Symbolism of beauty, 14
Synmastia, 740

Syringomas, 187
T

Taping, after chemical peels, 243, 249
Tarsal strip release, 495
Tarsoligamentous complex, 431-432
Tarsus, anatomy of, 368-369
Tattoos, laser therapy and, 208, 226
TCA; see Trichloroacetic acid
Tear trough

grafts, 488
and lower blepharoplasty, 453, 487-488

Tear trough deformity
anatomic considerations for
central fat pad, 484
festoons, 484
contraindications for correction of, 484-
485
grading system for, 482-483
indications for correction of, 484-485
informed consent for, 485
nonsurgical treatment of

nonvascularized fat grafting for, 486
preoperative evaluation for, 485
surgical treatment of
blepharoplasty midface lift, 488
lower blepharoplasty and orbicularis
suspension, 487
lower blepharoplasty with orbicularis
suspension and septal reset, 487-
488
tear trough grafts, 488

Tears, 435, 438
Telangiectasias, 188, 313
Spot size, and lasers, 206
Squamous cell cancer, 186
Squinch test, 453
Squint test, 453
Standard of care legal defense, 48
Staphylococcus colonization, general con-
siderations for, 137
State regulations for ambulatory surgery
centers, 175-176
Statistics of aesthetic surgery patients, 3

Sterile technique, 134
Steroids, 184, 293
Stick and place technique for graft insertion,
406-407
STOP-BANG questionnaire, 87-88

Sub-SMAS facelift, 545
Subcutaneous facelift, 545
Subcutaneous mastectomy, for female-to-
male top surgery, 941-946
Subglandular/subfascial pocket dissection,
731
Submandibular triangle, 387
Submental anterior necklift
indications, 571
technical considerations, 571-573
Submental triangle, 387
Subnasal liplift, 536-537
Suborbicularis oculi fat pads, anatomy of,
370
Subpectoral pocket dissection, 731-732
Subperiosteal facelift, 545
Suction lipectomy, for breast reduction,
771-772
Sunscreen, 189, 194

374, 552-553

492
Supraorbital ligamentous adhesion, 384
Supraperiosteal facelift, 545
Surface cooling, and lasers, 206
Surfactants, 191, 192

outcomes, 147
Surgical Care Improvement Project, 845
Surgical drains, management of, 137
Surgical eligibility, 8
Surgical safety checklist from World Health
Organization, 150-151

989
Index
Tumescent anesthesia for ablative laser re-
surfacing, 215
Turmeric, 195

U
Ulceration, after sclerotherapy, 315
Ultrasonography, for necklift, 569
Ultratine tack, 330, 332
Umbilicus
anatomy of, 840
suture technique for insetting, 348

Urine cotinine test, 148
V
V-Loc barbed suture, 331, 333
V-Y advancement for lip augmentation,
664-666
Varicose veins, 188, 313-319
Veins
prominent
conservative management of, 313, 319
endovenous laser ablation (EVLA) for,
318
goals of treating, 313
laser therapy for, 316-318
nonendothermal endovenous ablation
for, 319
risk factors for, 313
sclerotherapy for, 313-316
surgery for, 319
varicose

surgery for, 319
sentinel, 381, 382
of skin, 182
Venous lake, 188
Venous thromboembolism
abdominoplasty and, 162
algorithm for preventing, 129
Caprini risk assessment model, 160-161,
161-162
guidelines for prevention of, 160-161
intraoperative risk reduction for, 164-165
patients at risk for, 162
and postbariatric surgery, 131-132
postoperative risk reduction for, 165

164

Telangiectatic matting, after sclerotherapy,
315
Telogen, 182, 402
Temporal ligamentous adhesion, 384
Tessari method, of sclerotherapy, 315
ThermaCool, 224
Thermal injuries resulting from suboptimal
patient positioning for anesthe-
sia, 73
Thermal injuries, and suboptimal patient
positioning, 73
Thermal relaxation time, and lasers, 206
Time out, 150
Tip projection, correction of, 604-610
Tissue adhesives; see Tissue glues
Tissue glues
cyanoacrylates, 325-326

principles of, 323

293
Top surgery
complications of, 947
female-to-male surgery, 940-946
indications for, 939
male-to-female surgery, 939-940
Topical therapy for skin cancer, 187
Total intravenous anesthesia, 60
Transaxillary incision, 737
Transblepharoplasty midface lift, 488
Transcantho-canthopexy, 493
Transconjunctival fat removal, 454-455
Transepidermal water loss, 198
Transgender surgery; see
surgery
Transmission, lasers and, 205
Transosseous canthopexy, 494-495
Transpalpebral corrugator supercilii resec-
tion, 445
Transumbilical incision, for breast augmen-
tation, 738
Tretinoin, 193
Trichloroacetic acid
application technique, 246-247
combined with glycolic acid, 248-249
combined with Jessner solution, 248
general characteristics, 237
postpeel care, 250-251
True osteocutaneous retaining ligaments,
385
Tuberous breast deformity, 760

990
Index
W
Wavelength, and lasers, 206
Wicking, of fat, 300
Witch’s-chin deformity, 681
Wood lamp
for determining depth of dyschromia,
232
World Health Organization surgical safety
checklist, 150
Wound healing

stages of, 183-184
X

Z
Zones of adherence, 800

556
Venous thromboembolism—cont’d
prophylaxis, 153-154
statistics, 160, 178
Venus de Milo, 17-18
Vermilion liplift, 670-671
Vertical banded gastroplasty, 870
Vessels
of abdominal wall, 838
of face and neck, 381-382
of periorbital region, 365
Visible light laser, 224
Vision loss, patient positioning and, 74
Vitamin A, 147, 193
Vitamin B, 147
Vitamin C, 147, 193
Vitamin E, 193
Vitruvian Man, 16-17
Vitruvian Triad, 16
Vitruvius Polio, Marcus, 16