Operative Technique in Plastic Surgery – Kevin C.Chung

Terri A. Zomerlei and Jeffrey E. Janis
30
Posterior Thigh and Hamstring Flaps for Ischial Ulcers
John Hulsen and Jeffrey E. Janis
31
Tensor Fascia Lata Flaps for Trochanteric Ulcers
Terri A. Zomerlei and Jeffrey E. Janis
32
Repair of Flank and Lumbar Defects
Sergey Y. Turin, Chad A. Purnell, and Gregory A.
Dumanian
SECTION VI POSTERIOR TRUNK RECONSTRUCTION
33
Erector Spinae (Paraspinous) Muscle Flap
Lauren M. Mioton and Gregory A. Dumanian
34
Trapezius Muscle Flap
Lauren M. Mioton and Gregory A. Dumanian
35
Superior Gluteal Artery Perforator Flap
Lauren M. Mioton and Gregory A. Dumanian
36
Tissue Expansion for Trunk Defects
Ibrahim Khansa and Jeffrey E. Janis
37
Keystone Flaps
Theodore A. Kung and Peter C. Neligan
38
Treatment of Axillary Hyperhidrosis
David L. Larson
PART 6 HAND SURGERY

SECTION I ANESTHESIA AND EMERGENCY PROCEDURES
1
Anesthesia and Emergency Procedures
John R. Lien and Kevin C. Chung
2
Fasciotomy for Compartment Syndrome of the Hand and
Forearm
John R. Lien and Kevin C. Chung
3
Revision Amputation and Shortening of the Digit
John R. Lien and Kevin C. Chung
4
Drainage of Septic Flexor Tenosynovitis
John R. Lien and Kevin C. Chung
SECTION II HAND FRACTURES AND DISLOCATIONS
5
Distal Phalanx Fractures
John R. Fowler and Thomas B. Hughes
6
Proximal Phalanx Fractures
John R. Fowler
7
Metacarpal Shaft Fractures
John R. Fowler and Thomas B. Hughes
8
Open Reduction for Carpometacarpal Joint Dislocation
John R. Fowler and Robert A. Kaufmann
9
Reconstruction of Acute and Chronic Ulnar Collateral
Ligament Injuries of the Thumb
John R. Fowler and Robert A. Kaufmann

10
Closed Reduction and Fixation of Bennett and Rolando
Fractures
John R. Fowler and Thomas B. Hughes
SECTION III JOINTS
11
Volar Plate Arthroplasty of the Proximal Interphalangeal
Joint
James T. W. Saunders and Amy M. Moore
12
Hemihamate Arthroplasty for the Proximal Interphalangeal
Joint Fracture Dislocation
David Wei, Mark A. Vitale, and Amy M. Moore
13
Thumb Carpometacarpal Joint Fusion With Locking Plates
John M. Felder and Amy M. Moore
SECTION IV WRIST FRACTURES AND CARPAL
INSTABILITY
14
Arthroscopic Examination of the Wrist
Emily Krauss and Amy M. Moore
15
Ligament Reconstruction for Chronic Scapholunate
Dissociation
Mark Morris and Kevin C. Chung
16
Lunotriquetral Ligament Reconstruction Using a Slip of the
Extensor Carpi Ulnaris Tendon
Mark Morris and Kevin C. Chung
17
Fixation of Acute Scaphoid Fractures

Ketan Sharma, James T. W. Saunders, and Amy M.
Moore
18
Scaphoid Nonunion: Nonvascularized Bone
Reconstruction
Matthew L. Iorio and Jason H. Ko
19
Scaphoid Fracture Nonunion: Vascularized Bone
Reconstruction
Matthew L. Iorio and Jason H. Ko
20
Open Reduction and Fixation of Acute Perilunate Fracture
Dislocation
Grant M. Kleiber and Amy M. Moore
21
Dorsal Capsulodesis for Scapholunate Stabilization with
Extensor Carpi Radialis Longus Tenodesis
Mark Morris and Kevin C. Chung
22
Proximal Row Carpectomy
Patrick Reavey and Amy M. Moore
SECTION V DISTAL RADIUS FRACTURES
23
Distal Radius Fractures
Shoshana W. Ambani and Kevin C. Chung
SECTION VI RHEUMATOID ARTHRITIS
24
Rheumatoid Arthritis of the Hand and Wrist
Shoshana W. Ambani and Kevin C. Chung
SECTION VII DEGENERATIVE DISEASE

25
Degenerative Disease of the Hand and Wrist
Shoshana W. Ambani and Kevin C. Chung
SECTION VIII NERVE CONDITIONS
26
Carpal Tunnel Release
Angelo B. Lipira and Jason H. Ko
27
Ulnar Tunnel Syndrome
Mary Claire Manske and Jason H. Ko
28
Cubital Tunnel Syndrome
Mary Claire Manske and Jason H. Ko
29
Radial Tunnel Decompression
Joseph Pirolo and Jason H. Ko
30
Primary Nerve Repair and Nerve Graft for Traumatic
Nerve Injuries
Sonya paisley Agnew and Jason H. Ko
31
Tendon Transfers for Median Nerve Injury
Rafael J. Diaz-Garcia and Kevin C. Chung
32
Tendon Transfers for Ulnar Nerve Injury
Rafael J. Diaz-Garcia and Kevin C. Chung
33
Tendon Transfers for Radial Nerve Injury
Rafael J. Diaz-Garcia and Kevin C. Chung
34
Tendon Transfers for Combined Median and Ulnar Nerve
Injury
Kate Elzinga and Kevin C. Chung

35
Distal Anterior Interosseous Nerve Transfer to Motor
Branch of Ulnar Nerve
Shelley S. Noland and Jason H. Ko
36
Nerve Transfers for High Radial Nerve Palsy
Shelley S. Noland and Jason H. Ko
SECTION IX TENDON CONDITIONS
37
Acute Repair of Flexor Tendon Injuries
Jacques A. Machol IV, Neal Chen, and Kyle R. Eberlin
38
Repair of Multiple Flexor Tendon Injury at Wrist Zone V
(Spaghetti Wrist)
Jacques A. Machol IV, Neal Chen, and Kyle R. Eberlin
39
Staged Flexor Tendon Grafting and Pulley Reconstruction
Richard Tosti, Jacques A. Machol IV, and Neal Chen
40
Tenolysis of Flexor Tendons
Richard Tosti, Jacques A. Machol IV, and Neal Chen
41
Acute Repair of Extensor Tendon Injuries in Zones I to VI
Michael Smith, Jacques A. Machol IV, and Neal Chen
42
Stabilization of Extensor Carpi Ulnaris Tendon Subluxation
With Extensor Retinaculum
Michael Smith, Jacques A. Machol IV, and Neal Chen
43
Trigger Finger Release
Donato Perretta, Jacques A. Machol IV, and Neal Chen
44
First Dorsal Compartment (de Quervain) Release

Donato Perretta, Jacques A. Machol IV, and Neal Chen
SECTION X FLAPS AND MICROSURGERY
45
Flap Coverage of Fingertip Injuries
Kate Elzinga and Kevin C. Chung
46
Flap Coverage of Thumb Defects
Kate Elzinga and Kevin C. Chung
47
Reverse Flow Radial Forearm Flap
Kate Elzinga and Kevin C. Chung
48
Ulnar Artery Perforator Flap
Kate Elzinga and Kevin C. Chung
49
Posterior Interosseous Artery Flap
Kate Elzinga and Kevin C. Chung
50
Free Lateral Arm Flap
John R. Lien and Kevin C. Chung
51
Pedicled and Free Groin Flap
Mark Morris and Kevin C. Chung
52
Free Anterolateral Thigh Flap
John R. Lien and Kevin C. Chung
53
Revascularization and Replantation of Digits
Mark Morris and Kevin C. Chung
54
Digital Artery Sympathectomy
John R. Lien and Kevin C. Chung

55
Ulnar Artery to Superficial Arch Bypass With a Vein Graft
for Ulnar Artery Thrombosis
Mark Morris and Kevin C. Chung
56
Second Toe to Thumb Transfer
John R. Lien and Kevin C. Chung
SECTION XI DUPUYTREN DISEASE
57
Dupuytren Contracture
John R. Lien and Kevin C. Chung
SECTION XII SPASTIC CONDITIONS
58
Elbow Extension Procedures
Paymon Rahgozar and Kevin C. Chung
59
Wrist Extension Procedures
Paymon Rahgozar and Kevin C. Chung
60
Finger Extension Procedures
Paymon Rahgozar and Kevin C. Chung
61
Lateral Key Pinch Reconstruction
Paymon Rahgozar and Kevin C. Chung
62
Grasp Improvement Procedures
Paymon Rahgozar and Kevin C. Chung
SECTION XIII CONGENITAL HAND DISORDERS
63
Release of Finger Syndactyly Using Dorsal Rectangular

Flap
Amir H. Taghinia
64
Hypoplastic Thumb Reconstruction
Amir H. Taghinia
65
Reconstruction of Radial Polydactyly
Amir H. Taghinia
66
Index Finger Pollicization for Hypoplastic Thumb
Amir H. Taghinia, Brian I. Labow, and Joseph Upton
67
Second Toe-to-Thumb Transfer for Hypoplastic Thumb
Amir H. Taghinia, Brian I. Labow, and Joseph Upton
68
Reconstruction of Amniotic Constriction Bands
Amir H. Taghinia
69
Centralization for Radial Longitudinal Deficiency
Amir H. Taghinia, Brian I. Labow, and Joseph Upton
70
Excision of Vascular Malformation of the Hand
Amir H. Taghinia
SECTION XIV TUMORS
71
Lumps and Bumps of the Hand and Wrist
Paymon Rahgozar and Kevin C. Chung
72
Excision of Glomus Tumors
Paymon Rahgozar and Kevin C. Chung
73
Excision of Hemangioma of the Hand
Paymon Rahgozar and Kevin C. Chung

74
Excision of Metacarpal Enchondroma
Paymon Rahgozar and Kevin C. Chung
75
Excision of Peripheral Nerve Schwannoma
Paymon Rahgozar and Kevin C. Chung
76
Excision of Malignant Skin Tumors
Paymon Rahgozar and Kevin C. Chung
Volume III
PART 7 LOWER LIMB RECONSTRUCTION AND
AMPUTATION
SECTION I ANESTHESIA AND EMERGENCY PROCEDURES
1
Femoral and Adductor Canal Blocks
Sarah Madison and Jean-Louis Horn
2
Popliteal Nerve Blocks
Ming Zhuo-Stine and Sarah Madison
3
Ankle Block
Andrew Lyons and Fred Mihm
4
Epidural Anesthesia
Rachel C. Steckelberg, Jean-Louis Horn, and Sarah
Madison
SECTION II FOOT, ANKLE, AND LOWER LEG

5
Fasciotomy of the Thigh, Lower Leg, and Foot
Graeme E. McFarland and Jason T. Lee
6
Drainage of Abscesses of Lower Leg and Foot
Michael Holland and Scott L. Hansen
7
Excision of Soft Tissue Tumors of the Foot and Ankle
Raffi S. Avedian, Robert J. Steffner, and Subhro K.
Sen
8
Ankle and Foot Bone Tumors
Robert J. Steffner, Raffi S. Avedian, and Sahitya K.
Denduluri
9
Debridement of Soft Tissue Infections of the Foot and
Ankle
Hunter S. Oliver-Allen, Michael Holland, and Scott L.
Hansen
10
Debridement of Infected Bone of the Foot and Ankle
Michael Holland and Scott L. Hansen
11
Bony Reconstruction of Foot and Ankle (Bone Grafts)
Kenneth J. Hunt and Loretta Chou
12
Reconstruction of the Forefoot
Rachel E. Hein and Scott T. Hollenbeck
13
The Medial Plantar Flap
Arash Momeni and Subhro K. Sen
14
Reconstruction of Heel and Plantar Defects: Free Flap
Goo-Hyun Mun and Kyong-Je Woo

15
The Reverse Sural Artery Flap for Lower Extremity
Reconstruction
Ashkaun Shaterian and Amber Leis
16
Ankle Reconstruction With Free Flap
Sean S. Li, Ahmed Suliman, and Deepak M. Gupta
17
Vascular Reconstruction of Lower Extremity, Foot, and
Ankle
Michael Sgroi and Jason T. Lee
18
Management of Diabetic Foot Ulcers
Rahim Nazerali
19
Nerve Repair and Reconstruction—Peroneal Nerve
Shawn Moshrefi and Catherine Curtin
20
Achilles Tendon Reconstruction
Hani Sbitany
21
Excision of Soft Tissue Tumors of the Lower Leg
Raffi S. Avedian and Robert J. Steffner
22
Excision of Bone Tumors of the Lower Leg
Raffi S. Avedian and Rohit K. Khosla
23
Debridement of Soft Tissue Infections of the Lower Leg
L. Scott Levin, Paul Magnuson, and Paulo Piccolo
24
Tibial Reconstruction
Vishwanath R. Chegireddy, Michael J. A. Klebuc, and
Anthony Echo
25
Soft Tissue Coverage of Lower Leg—Free Flap

Goo-Hyun Mun and Kyong-Je Woo
26
Soft Tissue Coverage of Lower Leg—Soleus Flap
Rahim Nazerali and Lee L. Q. Pu
SECTION III KNEE
27
Nerve Repair and Reconstruction—Tibial Nerve
Shawn Moshrefi and Catherine Curtin
28
Excision of Soft Tissue Tumors of the Knee
Raffi S. Avedian
29
Excision of Bone Tumors of the Knee
Raffi S. Avedian
30
Bony and Soft Tissue Debridement Around the Knee
Derek F. Amanatullah, Michael J. Chen, Sahitya K.
Denduluri, and James I. Huddleston
31
Bone Reconstruction of the Knee
Robert J. Steffner and Raffi S. Avedian
32
Soft Tissue Coverage of the Knee: Gastrocnemius Muscle
Flap
Hani Sbitany
33
Soft Tissue Coverage of the Knee: Free Flaps
Goo-Hyun Mun and So Young Kim
34
Repair of Patella Tendon
Patrick Horrigan, Michael Bellino, and Julius Bishop
SECTION IV THIGH

35
Excision of Soft Tissue Tumors of the Thigh
Raffi S. Avedian
36
Excision of Bone Tumors of the Femur
Raffi S. Avedian
37
Femoral Bone Debridement
Robert J. Steffner, David W. Lowenberg, and Sahitya
K. Denduluri
38
Reconstruction of Femur
Vishwanath R. Chegireddy, Michael J. A. Klebuc,
and Anthony Echo
39
Soft Tissue Coverage of the Thigh—Pedicled Rectus Flap
Brock Lanier and Alex Wong
40
Soft Tissue Coverage of Thigh-Free Flaps
Ulrich Kneser and Thomas Kremer
41
Nerve Repair and Reconstruction—Sciatic Nerve and
Femoral Nerve
Gabrielle B. Davis and Catherine Curtin
42
Keystone and Related Perforator Flaps
Michael W. Findlay
SECTION V AMPUTATION AND REPLANTATION
43
Amputation of the Lower Extremity: Toes, Foot, Ankle
Kedar S. Lavingia and Jason T. Lee
44
Amputation of the Lower Extremity: Above-Knee

Amputation, Below-Knee Amputation, Through-Knee
Amputation
Anahita Dua and Jason T. Lee
SECTION VI LYMPHEDEMA
45
Lymphaticovenous Anastomosis
Ann-Charlott Docherty Skogh and Martin Halle
46
Lymphedema: Lymph Node Transfer
Adrian S. H. Ooi and David W. Chang
47
Fasciocutaneous Debulking of Extremity Lymphedema:
The Charles Procedure
Clifford C. Sheckter and Peter Johannet
48
Liposuction for Treatment of Lymphedema
Dung Nguyen and Joseph Baylan
SECTION VII BURNS
49
Acute Management: Tangential Excision and Skin Grafting
Yvonne Karanas
50
Reconstruction of Contractures: Z-Plasty, Skin Grafting,
and Flaps
Xiangxia Liu
51
Soft Tissue Reconstruction with Propeller Flaps
Adam Jacoby, John T. Stranix, and Pierre Saadeh
PART 8 PEDIATRICS

SECTION I CLEFT LIP
1
Anatomical Subunit Repair of Unilateral Cleft Lip
David K. Chong and Kathryn V. Isaac
2
Unilateral Cleft Lip Repair: Millard/Mohler Modifications
Roberto L. Flores and Gerald J. Cho
3
Salyer Unilateral Cleft Lip/Nose Repair
Kenneth E. Salyer
SECTION II CLEFT PALATE REPAIR
4
Lip Adhesion
Catharine B. Garland, Jesse A. Goldstein, and Joseph
E. Losee
5
Bilateral Cleft Lip Repair
John A. van Aalst
6
Secondary Deformities
Catharine B. Garland, Jesse A. Goldstein, and Joseph
E. Losee
7
Delayed Hard Palate Repair in UCLP Patients
Jan Lilja
8
Furlow Palatoplasty
T. Guy Thorburn
9
von Langenbeck Palatoplasty
Kathryn V. Isaac and David K. Chong

10
Sommerlad Palatoplasty
T. Guy Thorburn
11
Two-Flap Palatoplasty
David K. Chong, Kathryn V. Isaac, and Kenneth E.
Salyer
12
Tongue-Lip Adhesion/Floor of Mouth Muscle Release for
Pierre Robin Sequence
Chad A. Purnell and Arun K. Gosain
13
Palatal Fistula
Gregory D. Pearson
14
Velopharyngeal Insufficiency
Jennifer L. McGrath and Arun K. Gosain
SECTION III CLEFT RHINOPLASTY
15
Secondary Cleft Rhinoplasty
Ali Totonchi and Ji H. Son
SECTION IV ATYPICAL CLEFTS-SOFT TISSUE
COMPONENT
16
Tessier 3 and 4 Clefts (Nasal-Cheek Region)
Philip Kuo-Ting Chen and Vikram S. Pandit
17
Tessier 7—Macrostomia Repair
Patrick A. Gerety and Scott P. Bartlett
SECTION V CUTANEOUS LESIONS

18
Tissue Expansion for Congenital Nevi
Lee W. T. Alkureishi and Bruce S. Bauer
19
Surgical Treatment of Congenital Midline Nasal Mass
Patrick A. Gerety and Scott P. Bartlett
SECTION VI SOFT TISSUE MASSES
20
Surgery of Neurofibromatosis in the Pediatric Patient
McKay McKinnon
21
Vascular Anomalies
Arin K. Greene and Jeremy A. Goss
SECTION VII PEDIATRIC BURNS AND WOUNDS
22
Functional Burn Reconstruction
David A. Billmire and Kim A. Bjorklund
23
Harvesting a Skin Graft
David A. Billmire and Kim A. Bjorklund
24
Burned Hand Reconstruction
David A. Billmire and Kim A. Bjorklund
25
Reconstruction of Burned Eyelids
David A. Billmire and Kim A. Bjorklund
26
Burn Neck Contracture Release
David A. Billmire and Kim A. Bjorklund
27
Adolescent Burned Breast Reconstruction
David A. Billmire and Kim A. Bjorklund

28
Pressure Injuries (Sacral and Pelvic Region, Columella—
From CPAP)
David A. Billmire and Kim A. Bjorklund
29
Pressure Injuries
Lawrence J. Gottlieb and Maureen Beederman
30
Vascular Lesions
Benjamin C. Garden and Jerome M. Garden
31
Laser Burn Scar Revision
C. Scott Hultman and Yuen-Jong Liu
32
Fat Grafting for Nerve Entrapment Within Burn Scars
C. Scott Hultman and Yuen-Jong Liu
SECTION VIII EAR RECONSTRUCTION
33
Auricular Reconstruction for Microtia and Post-Traumatic
Deformities
Charles H. Thorne
34
Stahl Ear
Akira Yamada and Arun K. Gosain
35
Constricted Ear
Akira Yamada and Julia Corcoran
36
Cryptotia
Akira Yamada and Arun K. Gosain
37
Prominent Ear
Akira Yamada and Arun K. Gosain

SECTION IX EYELID RECONSTRUCTION
38
Eyelid Coloboma
Adam R. Sweeney and Christopher B. Chambers
39
Congenital Ptosis
Adam R. Sweeney and Christopher B. Chambers
40
Epiblepharon
Adam R. Sweeney and Christopher B. Chambers
41
Canthopexy
Adam R. Sweeney and Christopher B. Chambers
42
Nasolacrimal Duct Obstruction
Emily M. Zepeda, Sarah M. Jacobs, and Christopher B.
Chambers
43
Management of the Microphthalmic or Anophthalmic Orbit
Sarah M. Jacobs and Christopher B. Chambers
SECTION X NASAL RECONSTRUCTION
44
Nasal Tip Hemangioma
T. Kwan-Wong and Jugpal S. Arneja
45
Nasal Septal Hematoma
Whitney L. Quong and Jugpal S. Arneja
SECTION XI PEDIATRIC NECK MASSES
46
Branchial Cleft Sinuses and Cysts
Mark Felton, Jugpal S. Arneja, and Neil K. Chadha

47
Thyroglossal Duct Cysts
Mark Felton, Jugpal S. Arneja, and Neil K. Chadha
SECTION XII FACIAL REANIMATION
48
Sural Nerve Harvest
Andre P. Marshall, Jeffrey R. Marcus, and Michael R.
Zenn
49
Cross Face Nerve Graft
Michael J. A. Klebuc
50
Motor Branch of Masseter for Innervation of Free Muscle
Flap
Michael J. A. Klebuc
51
Masseter-to-Facial Nerve Transfer
Michael J. A. Klebuc
52
Pediatric Facial Reanimation Using a Functional Gracilis
Muscle Transfer
Brad M. Gandolfi, Jeffrey R. Marcus, and Michael R.
Zenn
53
Corneal Neurotization
Joseph Catapano, Ronald Zuker, Asim Ali, and
Gregory H. Borschel
SECTION XIII BRACHIAL PLEXUS (OBSTETRICAL INJURY)
54
Primary Treatment of Neonatal Brachial Plexus Palsy
Bryce R. Bell, Ji-Geng Yan, and Hani Matloub

55
Secondary Neonatal Brachial Plexus Palsy Reconstruction
Joshua M. Adkinson
SECTION XIV LOWER EXTREMITY
56
Rotationplasty of the Lower Extremity
Samer Attar, Robert J. Steffner, and Terrance D.
Peabody
SECTION XV BREAST
57
Poland Syndrome
Patrick J. Buchanan and Paul S. Cederna
58
Gynecomastia
Dennis Hammond and Eric Yu Kit Li
59
Juvenile Hypertrophy
Dennis Hammond and Eric Yu Kit Li
60
Pectus Excavatum and Pectus Carinatum
Jamie C. Harris and Fizan Abdullah
SECTION XVI THORAX AND BACK
61
Myelomeningocele: Postnatal Repair
Gregory G. Heuer and Jesse A. Taylor
62
Myelomeningocele, Prenatal (Fetal) Repair
Gregory G. Heuer and Scott N. Adzick
63
Sacrococcygeal Teratoma

Nicholas J. Ahn and William H. Peranteau
SECTION XVII ABDOMEN
64
Prune Belly
Jamie C. Harris and Fizan Abdullah
65
Gastroschisis and Omphalocele
Jamie C. Harris and Fizan Abdullah
66
Management of the Open Abdomen
Alexander F. Mericli and Charles E. Butler
67
Umbilicoplasty
Sergey Y. Turin, Chad A. Purnell, and Gregory A.
Dumanian
SECTION XVIII PERINEUM
68
Hypospadias Repair
Christopher D. Morrison and Earl Y. Cheng
69
Vaginal and Vulvar Reconstruction
Elizabeth B. Yerkes and Julia Corcoran
70
Ambiguous Genitalia
Deborah L. Jacobson and Elizabeth B. Yerkes
SECTION XIX EMERGENCY DEPARTMENT LACERATIONS
71
Facial Laceration Emergency Room Closure Techniques
Christina Pasick and Peter J. Taub

SECTION XX CRANIOFACIAL PROSTHETICS
72
Craniofacial Anaplastology: Prosthetic Osseointegration
Chad A. Purnell, Rosemary Seelaus, and Pravin K.
Patel
SECTION XXI CONJOINED TWINS
73
Conjoined Twin Separation
Michael R. Bykowski, Joseph E. Losee, and Lorelei J.
Grunwaldt
Index I-1
_____________
†Deceased

Video Clips
PART 1
Chapter 1
Injection of Botulinum Toxin into the Glabellar
Region
Chapter 3
Injection of Botulinum Toxin into Crow’s Feet
Chapter 6
Injection of Botulinum Toxin into the DAO
Chapter 12 Nasolabial Fold Filler Injection
Chapter 14 Soft Tissue Injection 1
Soft Tissue Injection 2
Soft Tissue Injection 3
Soft Tissue Injection 4
Soft Tissue Injection 5
Chapter 31 Transconjuctival Approach to Resection and/or
Repositioning of Lower Eyelid Herniated Orbital Fat
Chapter 33 Transconjunctival Redraping
Chapter 70 Alar Contour Grafts
Chapter 76 Genioplasty 1
Genioplasty 2
PART 2
Chapter 2
Cranial Vault Expansion
Chapter 9
Monobloc Distraction
Chapter 23 Segmental Le Fort I Advancement: Two and Three

Piece
Chapter 29 Secondary Alveolar Bone Grafting of the Cleft
Alveolar Defect in Cleft Palate
Chapter 37 Right-Side Osteotomy
Splitting Right Side Nerve
Verifying Split
Left-Side Osteotomy and ST Dissection
Left-Side Osteotome and Split
Applying Wire Loops
Verification
Chapter 53 Correction of Orbital Flow Blowout Fractures:
Variation 1
Chapter 54 Correction of Orbital Floor Blowout Fractures:
Variation 2
Chapter 60 Open Reduction for Nasal Fracture
Chapter 73 Midface Exposure
Zygomaticofacial Repair, Part 1
Zygomaticofacial Repair, Part 2
Zygomaticofacial Repair, Part 3
PART 3
Chapter 1
Infraorbital Nerve Block
Chapter 6
Calvarial Graft Harvest
Chapter 7
Rib Graft Harvest
Chapter 12 Osteocutaneous Scapular Flap
Chapter 24 Tarsal Strip Canthoplasty
Chapter 43 Glossectomy
Chapter 46 Anterolateral Thigh Flap
Chapter 51 Labbé Procedure

PART 4
Chapter 5
Transgender Breast
Chapter 13 Delayed Tissue Expander
Chapter 17 Direct to Implant Breast Reconstruction
Chapter 20 Free TRAM Flap: Fascial and Intramuscular
Dissection
PART 5
Chapter 7
Minimally Invasive Anterior Components
Separation
Chapter 9
Anterior Components Release
Technique
Ventral Hernia Repair
Chapter 15 Buttock Lift, Part 1
Buttock Lift, Part 2
Chapter 17 VASERlipo Buttock Augmentation
Lipoabdominoplasty/Flankplasty/Lipoaugmentation
of the Buttocks
Silicone Elastomer Buttock Augmentation
Chapter 32 Flank Hernia Repair Technique
Chapter 33 Erector Spinae Muscle Flap
PART 7
Chapter 14 Reconstruction of Heel and Plantar
Defects: Free Flap
Chapter 25 Soft Tissue Coverage of Lower Leg
(Free-Flap)
Chapter 31 Bony Reconstruction of the Knee

Chapter 40 Soft Tissue Coverage of Thigh–
Free Flaps
Chapter 45 ICG Lymphography
Chapter 48 Liposuction for Lymphedema
Chapter 49 Tangential Excision, Part 1
Tangential Excision, Part 2
Tangential Excision, Part 3
PART 8
Chapter 12 Tongue-Lip Adhesion
Chapter 21 Vascular Anomalies
Chapter 31 Fractional Carbon Dioxide Laser
Pulsed Dye Laser
Chapter 32 Puregraft
Lipovage
Chapter 48 Sural Nerve Harvest
Chapter 51 Masseter-to-Facial Nerve Transfer
Chapter 52 Facial Reanimation
Chapter 55 PT Release
FCU to ERCB Tendon Transfer for Wrist Extension
Chapter 67 Umbilicoplasty

PART 1
Facial Aesthetic

(Trang không có chữ)

1
CHAPTER
Section I: Techniques for
Botulinum Toxins in the
Face
Injection of Botulinum Toxin
to the Glabellar Region
Jonathan Sykes, Peter Palhazi, and Amir Allak
DEFINITION
■ Hyperfunctioning of muscles in the periorbital region results in a tired, aged
appearance and increased rhytids.
■ Hyperdynamic glabellar musculature can create an angry appearance, whereas
overuse of the lateral eyelid muscles can narrow the eyelid aperture.
■ The position and orientation of the eyebrow is related to the relative strength
and contraction of the brow depressors vs the brow elevators.
■ The only elevators of the eyebrow are the paired frontalis muscles, whereas
depression of the eyebrow is accomplished by contraction of the midline
procerus muscles, the paired corrugator, and orbicularis oculi muscles.
■ Treatment with botulinum toxin can lessen the contraction of hyperdynamic
periorbital muscles and can improve the eyelid aperture, improve brow
position, and decrease periorbital rhytids.1
ANATOMY
■ The corrugator supercilii (CS) are paired, obliquely oriented muscles located
in the inferomedial brow deep to the inferior portion of the frontalis muscles.
■ The CS muscle originates from the bony superomedial orbital rim and passes
in a superior and lateral direction to insert onto the fascia of the frontalis
muscle and into the overlying skin (FIG 1).

■ In addition to coursing superiorly and laterally from its insertion, the CS
becomes more superficial as it travels laterally.
FIG 1 • Cadaveric dissection of the relationship of the
corrugator muscle to the nasal root and frontalis. CS,
corrugator supercilii.
■ The CS muscle body is pierced by the supraorbital and supratrochlear
neurovascular bundles carrying sensory input to the trigeminal nerve (V1). The
nerves then pierce the frontalis muscles approximately 2 to 3 cm above the
supraorbital rim to travel subcutaneously to the forehead and scalp (FIG 2).
■ The medial head of the CS has motor innervation from the zygomatic branch
of the facial nerve, whereas the lateral portion is supplied by the temporal
branch of the nerve.
■ Contraction of the muscle causes vertical grooves in the glabellar skin and
imparts an angry expression. Contraction also causes an inferomedial descent
of the medial clubhead of the brow.
■ The procerus is a midline flat and pyramidally shaped muscle located at the
root of the nose contributing to upper nasal contour.
■ The procerus originates from the periosteum and perichondrium of the nasal
bones and upper lateral cartilages and from the fascia of the nasal superficial
musculoaponeurotic system (SMAS) (see FIG 2).
■ Procerus inserts into the midline skin overlying the nasal root and

interdigitates superiorly with the frontalis muscle (see FIG 2).
■ The motor innervation to the procerus is supplied by the zygomatic branch of
the facial nerve.
■ Contraction of the midline muscle is responsible for horizontal glabellar
rhytids, transverse rhytids on the nasal dorsum, and descent of the medial
brow.
FIG 2 • Cadaveric dissection with coronal forehead flap
elevated viewed from the superior aspect of the head.
L, patient’s left; R, patient’s right; SO, supraorbital
neurovascular bundle; ST, supratrochlear neurovascular
bundle; NR, nasal root (indicating midline); PM,
procerus muscle.
PATIENT HISTORY AND PHYSICAL FINDINGS
■ It is important to evaluate the eyebrow and eyelid margin position prior to any
injection of botulinum toxin in the periorbital region.
■ The position of the eyebrow is related to the relative contraction of the brow
elevator (the frontalis muscle) vs the brow depressors (the CS and procerus
muscles medially and the orbicularis oculi muscle laterally).
■ In patients who are brow depressor dominant, the brow will assume a
relatively inferior position and appear ptotic; chemodenervation will elevate

the brow and enhance periorbital appearance.
■ The position of the upper eyelid margin in relation to the globe is also
important to evaluate prior to any botulinum toxin injection in the periorbital
region. The amount of ptosis is related to the amount of globe coverage by the
upper eyelid.
■ The distance from the superior to the inferior limbus of the globe is 11 mm in
most adults with the upper eyelid typically covering the superior limbus by 1
mm. If the upper eyelid position is inferior to this level, the lid is considered
ptotic.
■ It is important to diagnose any upper eyelid ptosis preinjection as any injection
into the periorbital musculature will affect brow position and injection into the
frontalis muscle in patients with eyelid ptosis may cause a decrease in the
visual field.
■ Any asymmetries in eyebrow and/or upper eyelid position should be noted,
documented, and discussed with the patient before injection of botulinum
toxin.
■ Hypercontraction of the corrugator muscles produces an angry, scowling
appearance. Muscular contraction depresses the medial clubhead of the brow
and causes a vertical fold that appears at right angles to the muscular axis.
■ The brow clubhead is moved both medially and inferiorly with contraction of
the corrugator. This is important in patients who have cosmetically removed
medial brow hairs, as injection of botulinum toxin will cause elevation and
lateralization of the brow clubhead.
■ Hypercontraction of the procerus muscle draws the medial brow inferiorly and
causes a horizontal furrow at the root of the nose.
■ Injection of botulinum toxin of the procerus causes elevation of the medial
brow and lessens the horizontal deep rhytid at the nasal root.
SURGICAL MANAGEMENT
Preoperative Planning
■ Patients should be screened for neuromuscular disorders including
amyotrophic lateral sclerosis, myasthenia gravis, and Eaton-Lambert syndrome
because these are contraindications for the use of the product.
■ Use in pregnant or nursing mothers is not advised, though no studies have
shown teratogenic damage to fetus or adverse effects to breast-feeding infants.
■ Patient medications should be screened for aminoglycoside antibiotics because

these affect the pharmacokinetics of the toxin and can potentiate the effects.
Positioning
■ The patient is examined in an upright position along with full facial analysis.
The treatment position is surgeon preference, upright, slightly recumbent, or
supine.
Approach
■ Delivery of the product is performed uniformly with percutaneous injection.
T E C H N I Q U E S
Video p1-c001
■ Injection of Botulinum Toxin Into the Glabellar
Region
■ Topical anesthetic cream, commonly containing lidocaine, is applied and left
in place for a minimum of 15 to 20 minutes and sometimes longer for
maximal anesthetic effect.
■ Botox is reconstituted into sterile injectable saline to the concentration of 2.5
to 4 units/0.1 mL. This is drawn up into a 1-cc syringe, and a 30-gauge short
Luer Lock needle is prepared for injection.
■ To avoid any spread of toxin into the extraocular muscles, or the upper
00:00 / 00:00

eyelid retractors (levator aponeurosis and Müller muscle), the needle is
usually directed away from the globe.
■ Injection of the glabellar muscles should be performed with a no. 30- to no.
32-gauge needle.
■ Approximately 20 to 25 units of botulinum toxin (or equivalent) are
typically sufficient to treat the glabellar musculature including both the CS
and procerus. This is usually distributed in a V-shaped pattern with the apex
at the nasal root.
■ The medial corrugator/depressor (clubhead) injection should be deep (just
superficial to bone), and the tail of the muscle should be injected closer to the
skin with the needle tangential to the skin.
■ Injection of toxin into the procerus should be at moderate depth over the
midline of the nasal root, with the needle being placed perpendicular to the
skin at the nasion.
PEARLS AND PITFALLS
Avoidance of
denervation and
ptosis of eyelid and
brow
■ To avoid diffusion of toxin into eyelid elevator muscles
and ptosis, injection should be directed superiorly and
obliquely.
■ If injection is performed too far superiorly above the
region of the corrugator, the medial inferior frontalis
muscle can be affected causing medial brow ptosis.
Dosing
■ A total of 20–25 units of Botox (or equivalent) is typically
used for treatment of the glabellar muscles.
■ A higher dosage may be necessary in males for optimal
results.
POSTOPERATIVE CARE
■ Ice packs should be provided to the patient and placed immediately after
injection.
■ Some patients may bruise post procedure, especially if anticoagulated. This
can be expected to resolve in several days.
■ Avoidance of topical massage for 24 hours postinjection is suggested.
Although some injectors suggest exercising injected facial muscles for 24

hours after a botulinum toxin injection, there is no evidence to prove that this
affects outcomes.
OUTCOMES
■ Onset of effect usually become apparent in 1 week.
■ The neuromodulation is commonly effective for 12 to 20 weeks wherein it
would need to be redosed for continued effect. This can vary from patient to
patient.
■ The outcome of botulinum toxin injection into the glabellar musculature is to
decrease or alleviate the glabellar frown lines and elevate the medial brow. The
cumulative effect is to eliminate the frowning or scowling appearance.2
■ Satisfaction after injection of glabellar botulinum toxin is usually high. The
procedure is simple, is fast, and causes no to very minimal downtime.
■ If all of the musculature is not denervated after an injection and the patient
requests additional toxin, it is simple to add toxin during a follow-up office
visit.
COMPLICATIONS
■ Inadvertent spread of the toxin into the upper eyelid retractor muscles can
cause ptosis of the upper eyelid via diminished contraction of the levator
aponeurosis/Müller muscle complex, allowing the eyelid protractors
(orbicularis oculi muscles) to dominate the eyelid position.3
■ If upper eyelid ptosis occurs, treatments exist to elevate the ptotic upper
eyelid. These treatments are designed to strengthen the eyelid retractors or to
slightly weaken the upper lid protractors. Either of these treatments changes
the protractor/retractor muscle balance, thereby elevating the ptotic eyelid.
■ Initial treatment in patients with toxin-induced ptosis is to instill topical
sympathomimetic eye drops. Topical drops, such as apraclonidine, stimulate
the sympathetic nervous system causing contraction of Müller muscle,
resulting in 1 to 3 mm of upper eyelid elevation. The drops are placed every 6
to 8 hours as needed to alleviate the ptosis.
■ The other means to treat inadvertent upper eyelid ptosis is to inject small
amounts of additional botulinum toxin into the pretarsal fibers of the
orbicularis oculi muscles. Diminishing the tone and contraction of the upper
eyelid protractor (orbicularis oculi muscle) also can result in upper eyelid
elevation and treatment of the ptotic eyelid.

ACKNOWLEDGMENT
The authors thank Sebastian Cotofana, MD, PhD, for his contribution to the
preparation of this chapter.
REFERENCES
1. Monheit G. Neurotoxins: current concepts in cosmetic use on the face and
neck—upper face (glabella, forehead, and crow’s feet). Plast Reconstr Surg.
2015;136(5 Suppl):72S-75S.
2. Prager W, Bee EK, Havermann I, Zschocke I. Onset, longevity, and patient
satisfaction with incobotulinumtoxinA for the treatment of glabellar frown
lines: a single-arm, prospective clinical study. Clin Interv Aging. 2013;8:449-
456.
3. Jia Z, Lu H, Yang X, et al. Adverse events of botulinum toxin type A in facial
rejuvenation: a systematic review and meta-analysis. Aesthetic Plast Surg.
2016;40(5):769-777.

2
CHAPTER
Injection of Botulinum Toxin
to the Forehead
David A. Sieber and Jeffrey M. Kenkel
DEFINITION
■ Static rhytids: wrinkles in the skin present at rest
■ Dynamic rhytids: wrinkles in the skin present with muscle
activation/animation
ANATOMY
■ Frontalis muscle: broad, fan-shaped muscle originating from the galea
aponeurotica below the coronal suture with insertions interdigitating into the
procerus, corrugator supercilii, depressor supercilii, and orbicularis oculi1,2
(FIG 1).
PATIENT HISTORY AND PHYSICAL FINDINGS
■ Patients will present complaining of static and/or dynamic rhytids on their
forehead.
■ Have the patients contract their frontalis muscles by asking them to raise their
brows and assess:
■ Muscle length and width
■ Strength of muscle (with stronger muscles having a few coarse rhytids and
weaker muscles with many fine rhytids)
■ Whether muscle has a decussation in the midline
■ Activity beyond temporal fusion line
■ Notice any superficial blood vessels, as injury of these during injection will
cause unnecessary post-treatment bruising.
■ Take note of brow position, depth, and strength of frontalis muscle as
weakening the frontalis muscle may worsen an already low brow or one that is

held in position with activation.
NONOPERATIVE MANAGEMENT
■ Nonoperative management using any form of the currently available
botulinum toxins (onabotulinumtoxinA, abobotulinumtoxinA, and
incobotulinumtoxinA) is able to successfully treat forehead rhytids.
Positioning
■ The patient should be comfortably seated in an upright position.
Approach
■ The forehead may be injected either from the side of the patient or behind the
patient’s head.
■ It is the author’s preferred approach to inject standing to the side of the patient.
■ When injecting from one side of the patient only, it is important to be
cognizant that the contralateral side is treated as desired and directed by
assessments done from the front of the patient.

FIG 1 • Shape of the frontalis muscle with insertions in
the orbicularis oculi, corrugator supercilii, depressor
supercilii, and procerus muscles.
T E C H N I Q U E S
■ Injection of Botulinum Toxin in the Forehead
■ The botulinum is mixed according to manufacturer recommendations or
physician preference.
■ Skin is prepped using alcohol and ice may be applied for anesthetic and as a
distractor.

■ The patient is asked to animate to demonstrate muscular boundaries (see
above).
■ Injections start medially and proceed across the patient’s forehead. The
neurotoxin is placed superficially beneath the dermis and raises a small skin
wheal. Additional rows of neurotoxin are placed above or below as needed.
■ Care should be taken when injecting around the brows as diffusion of the
product into the levator palpebrae superioris may cause the patient to have
temporary upper lid ptosis.
■ To prevent this, injections should not be performed beneath the lowest brow
crease or less than 2 cm above the orbital rim.
PEARLS AND PITFALLS
Technique
■ To avoid upper lid ptosis, neurotoxin should not be placed below the
lowest dynamic rhytid or less than 2 cm above the orbital rim.
Technique
■ Dosing and placement are determined by pretreatment assessment and
often may include a dose of toxin lateral to the temporal crest and in
the midline (in contrast to classic definitions of the frontalis).
Patient
selection
■ Patients with severe brow ptosis and strong dynamic lines may need to
be declined treatment with neurotoxins to avoid exacerbation of brow
ptosis.
POSTOPERATIVE CARE
■ Patients are sent home with small pack of ice and may apply as needed for
swelling and/or bruising.
OUTCOME
■ Excellent outcomes are achievable as demonstrated in FIG 2 with preservation
of natural brow position and shape (see FIG 2).

FIG 2 • A 44-year-old female before (A) and after (B)
having 38 units of onabotulinumtoxinA placed into her
forehead, glabella, and crow’s feet. Note the
preservation of brow shape and position after treatment
as well as slight opening of orbital aperture.
COMPLICATIONS
■ Patients should be counseled on possible risks of procedure including
bleeding, bruising, brow and upper eyelid ptosis, and facial asymmetry.
REFERENCES
1. Choi YJ, Won SY, Lee JG, et al. Characterizing the lateral border of the
frontalis for safe and effective injection of botulinum toxin. Aesthet Surg J.
2016;36:344-348.
2. Lorenc ZP, Smith S, Nestor M, et al. Understanding the functional anatomy of
the frontalis and glabellar complex for optimal aesthetic botulinum toxin type
A therapy. Aesthetic Plast Surg. 2013;37:975-983.

3
CHAPTER
Injection of Botulinum Toxin
to Soften Crow’s Feet
Sammy Sinno
DEFINITION
■ Lateral canthal lines, or “crow’s feet,” are one or more radial lines extending
laterally from the lateral canthus (FIG 1).
ANATOMY
■ The orbicularis oculi muscle is responsible for the appearance of crow’s feet.
Chronic contraction of this muscle (during squinting and smiling) as well as
thinning of the dermis with age accentuates these lines.
FIG 1 • Lateral canthal lines, or “crow’s feet.”
PATIENT HISTORY AND PHYSICAL FINDINGS

■ Patients with crow’s feet at rest commonly present initially in their 40s and
50s, though younger patients who desire softening of their crow’s feet during
animation may present earlier.
IMAGING
■ No imaging is required for this procedure.
MANAGEMENT
Preoperative Planning
■ The patient is asked to smile and squint repeatedly. The crow’s feet radiating
from the lateral canthus are noted.
Positioning
■ The patient is seated in an upright position.
T E C H N I Q U E S
■ After allowing 30 to 45 minutes for topical anesthetic to take effect, a
cooling device is used to further desensitize the area of injection.
■ 12 units of botulinum toxin are then injected on each side:
■ 4 units at 1 cm lateral to the lateral canthus
■ 4 units directly above
■ 4 units directly below (TECH FIG 1)
■ Care is taken on the inferior injection to avoid the zygomaticus major
muscle, which would cause unwanted smile abnormalities.
00:00 / 00:00

Video p1-c003
TECH FIG 1 • Target areas marked for injection into
the orbicularis oculi muscle.
PEARLS AND PITFALLS
Anesthesia
■ Allow adequate time for topical anesthesia to take effect.
Injection
■ Inject 1 cm lateral to the lateral canthus.
■ 12 units of botulinum toxin should be injected per side.
■ Avoid injection into the zygomaticus major muscle.
Postoperative care
■ Avoid strenuous exercise for 1–2 d.
■ No tight goggles for 3 d.
■ Sleep on back for 1–2 d postprocedure.
POSTOPERATIVE CARE
■ Cold compresses are given following injection to minimize postprocedure
bruising and edema.
■ Patients are instructed to sleep on their backs for 1 to 2 days postprocedure
and avoid wearing goggles for 3 days to avoid migration of toxin and unwanted

effects.
■ Strenuous exercise is permitted after 1 to 2 days.
OUTCOMES
■ See pre- and postprocedure photos.
COMPLICATIONS
■ Inadvertent injection into the zygomaticus major muscle can cause unwanted
smile deformity.
■ Migration of toxin postprocedure can also have unwanted effects including
brow ptosis.

4
CHAPTER
Injection of Botulinum Toxin
for Treatment of the Gummy
Smile
David A. Sieber and Jeffrey M. Kenkel
DEFINITION
■ Gummy smile is the hyperactivity of the levator labii superioris alaeque nasi
with animation causing excess upper lip elevation and exposure of the gums.
ANATOMY
■ The levator labii superioris alequae nasi originates on the medial wall of the
maxilla and then divides into two heads that insert into the nasal ala and medial
orbicularis oris (FIG 1).
PATIENT HISTORY AND PHYSICAL FINDINGS
■ Patients may present complaining of “too much teeth or gums showing while
smiling” or may also state that their “upper lip is too short” with animation.
NONOPERATIVE MANAGEMENT
■ Nonoperative management using any form of the currently available
botulinum toxins (onabotulinumtoxinA, abobotulinumtoxinA, and
incobotulinumtoxinA) can successfully treat a gummy smile. Typically, 2 to 4
units per side are selected as a starting dose, depending on degree of deformity
and prior patient injection history.
Positioning
■ The patient should be comfortably seated in an upright position.
Approach
■ It is the authors’ preferred approach to inject standing to the side of the patient.

■ When injecting from one side of the patient only, it is important to ensure that
both sides are treated in the same anatomical locations.
FIG 1 • Diagram illustrating orientation and length of
levator labii superioris alaeque nasi muscle.
T E C H N I Q U E S
■ Injection of Botulinum Toxin for Treatment of the
Gummy Smile
■ The botulinum is mixed according to manufacturer recommendations or
physician preference.
■ Skin is prepped using alcohol, and ice may be applied for anesthetic and as a
distractor.
■ The needle should be inserted 1 cm above the lateral extent of the ala down
to the supraperiosteal plane at the piriform aperture (TECH FIG 1).1