Geoffrey 3 C. Gurtner, Peter C. Neligan, Daniel Z. Liu – Plastic Surgery-Craniofacial, Head and Neck Surgery-Pediatric Plastic Surgery. 3-Elsevier (2018)

Plastic
Surgery
Fourth Edition
Craniofacial, Head and Neck Surgery
Pediatric Plastic Surgery
Volume Three

Content Strategist: Belinda Kuhn
Content Development Specialists: Louise Cook, Sam Crowe, Alexandra Mortimer
e-products, Content Development Specialist: Kim Benson
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Video Liaison: Will Schmitt

Fourth Edition
Editor-in-Chief
Peter C. Neligan
MB, FRCS(I), FRCSC, FACS
Professor of Surgery
Department of Surgery, Division of Plastic Surgery
University of Washington
Seattle, WA, USA
Part 2 Volume Editor
Joseph E. Losee
MD
Ross H. Musgrave Professor of Pediatric
Plastic Surgery
Department of Plastic Surgery
University of Pittsburgh Medical Center;
Chief Division of Pediatric Plastic Surgery
Children’s Hospital of Pittsburgh
Pittsburgh, PA, USA
Multimedia Editor
Daniel Z. Liu
MD
Plastic and Reconstructive Surgeon
Cancer Treatment Centers of America at
Midwestern Regional Medical Center
Zion, IL, USA
For additional online figures, videos and video lectures visit Expertconsult.com
London, New York, Oxford, Philadelphia, St Louis, Sydney 2018
Craniofacial, Head and Neck Surgery
Pediatric Plastic Surgery
Volume Three
Plastic
Surgery
Part 1 Volume Editor
Eduardo D. Rodriguez
MD, DDS
Helen L. Kimmel Professor of Reconstructive
Plastic Surgery
Chair, Hansjörg Wyss Department of Plastic
Surgery
NYU School of Medicine
NYU Langone Medical Center
New York, NY, USA

© 2018, Elsevier Inc. All rights reserved.
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Second edition 2006
Third edition 2013
Fourth edition 2018
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Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
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Video Contents
Chapter 11: Asian facial cosmetic surgery
1.1: Medial epicanthoplasty
11.2: Eyelidplasty: Non-incisional method
11.3: Rhinoplasty
11.4: Subclinical ptosis correction (total)
11.5: Secondary rhinoplasty: Septal extension graft and costal
cartilage strut fixed with K-wire
Kyung S. Koh, Jong Woo Choi, and Clyde H. Ishii
Chapter 12: Neck rejuvenation
12.1: Anterior lipectomy
James E. Zins, Colin M. Morrison, and C. J. Langevin
Chapter 13: Structural fat grafting
13.1: Structural fat grafting of the face
Sydney R. Coleman and Alesia P. Saboeiro
Chapter 14: Skeletal augmentation
14.1: Chin implant
Michael J. Yarumchuk
© Mesa J, Havlik R, Mackay D, Buchman S, Losee J, eds. Atlas of
Operative Craniofacial Surgery, CRC Press, 2019.
14.2: Mandibular angle implant
14.3: Midface skeletal augmentation and rejuvenation
Michael J. Yarumchuk
© Michael J. Yaremchuk
Chapter 16: Open technique rhinoplasty
16.1: Open technique rhinoplasty
Allen L. Van Beek
Chapter 20: Otoplasty and ear reduction
20.1: Setback otoplasty
Leila Kasrai
Chapter 23: Abdominoplasty procedures
23.1: Abdominoplasty
Dirk F. Richter and Alexander Stoff
Chapter 24: Lipoabdominoplasty
24.1: Lipoabdominoplasty (including secondary lipo)
Osvaldo Saldanha, Sérgio Fernando Dantas de Azevedo,
Osvaldo Ribeiro Saldanha Filho, Cristianna Bonnetto Saldanha, and
Luis Humberto Uribe Morelli
Chapter 26.2: Buttock augmentation: Buttock
augmentation with implants
26.2.1: Buttock augmentation
Terrence W. Bruner, Jose Abel De la Peña Salcedo,
Constantino G. Mendieta, and Thomas L. Roberts III
Chapter 27: Upper limb contouring
27.1: Brachioplasty
27.2: Upper limb contouring
Joseph F. Capella, Matthew J. Trovato, and Scott Woehrle
Volume One:
Chapter 15: Skin graft
15.1: Harvesting a split-thickness skin graft
Dennis P. Orgill
Chapter 34: Robotics in plastic surgery
34.1: Robotic microsurgery
34.2: Robotic rectus abdominis muscle flap harvest
34.3: Trans-oral robotic surgery
34.4: Robotic latissimus dorsi muscle harvest
34.5: Robotic lymphovenous bypass
Jesse C. Selber
Volume Two:
Chapter 6.2: Facelift: Principles of and surgical
approaches to facelift
6.2.1: Parotid masseteric fascia
6.2.2: Anterior incision
6.2.3: Posterior incision
6.2.4: Facelift skin flap
6.2.5: Facial fat injection
Richard J. Warren
6.2.6: Anthropometry, cephalometry, and orthognathic surgery
Jonathon S. Jacobs, Jordan M. S. Jacobs, and Daniel I. Taub
Chapter 6.3: Facelift: Platysma-SMAS plication
6.3.1: Platysma-SMAS plication
Dai M. Davies and Miles G. Berry
Chapter 6.4: Facelift: Facial rejuvenation with loop
sutures – the MACS lift and its derivatives
6.4.1: Loop sutures MACS facelift
Patrick L. Tonnard
From Aston SJ, Steinbrech DS, Walden JL, eds. Aesthetic Plastic
Surgery, Saunders Elsevier; 2009; with permission from Elsevier
Chapter 6.7: Facelift: SMAS with skin attached – the
“high SMAS” technique
6.7.1: The high SMAS technique with septal reset
Fritz E. Barton Jr.
© Fritz E. Barton Jr.
Chapter 6.8: Facelift: Subperiosteal midface lift
6.8.1: Subperiosteal midface lift: Endoscopic temporo-midface
Oscar M. Ramirez
Chapter 9: Blepharoplasty
9.1: Periorbital rejuvenation
Julius Few Jr. and Marco Ellis
© Julius Few Jr.

xiii
Video Contents
Chapter 26: Velopharyngeal dysfunction
26.1: Velopharyngeal incompetence – 1
26.2: Velopharyngeal incompetence – 2
26.3: Velopharyngeal incompetence – 3
Richard E. Kirschner and Adriane L. Baylis
Chapter 27: Secondary deformities of the cleft lip,
nose, and palate
27.1: Abbé flap
27.2: Alveolar bone grafting
27.3: Complete takedown
27.4: Definitive rhinoplasty
Evan M. Feldman, John C. Koshy, Larry H. Hollier Jr., and
Samuel Stal
27.5: Thick lip and buccal sulcus deformities
Evan M. Feldman and John C. Koshy
Chapter 36: Pierre Robin Sequence
36.1: Mandibular distraction
Arun K. Gosain and Chad A. Purnell
Chapter 39: Vascular anomalies
39.1: Lip hemangioma
Arin K. Greene
Chapter 43: Reconstruction of urogenital defects:
Congenital
43.1: First-stage hypospadias repair with free inner preputial
graft
43.2: Second-stage hypospadias repair with tunica vaginalis
flap
Mohan S. Gundeti and Michael C. Large
Volume Four:
Chapter 2: Management of lower extremity trauma
2.1: Anterolateral thigh flap harvest
Michel Saint-Cyr
Chapter 3: Lymphatic reconstruction of the
extremities
3.1: End-to-side lymphovenous bypass technique
© Cheng M-H, Chang D, Patel K. Principles and Practice of
Lymphedema Surgery, Elsevier; 2015.
3.2: Recipient site preparation for vascularized lymph node
transfer – axilla
© Cheng M-H, Chang D, Patel K. Principles and Practice of
Lymphedema Surgery, Elsevier; 2015.
3.3: Indocyanine green lymphography
David W. Chang
3.4: Charles procedure
Peter C. Neligan
Chapter 6: Diagnosis and treatment of painful
neuroma and nerve compression in the lower
extremity
6.1: Diagnosis and treatment of painful neuroma and of nerve
compression in the lower extremity 1
6.2: Diagnosis and treatment of painful neuroma and of nerve
compression in the lower extremity 2
Chapter 28: Post-bariatric reconstruction
28.1: Post-bariatric reconstruction – bodylift procedure
J. Peter Rubin and Jonathan W. Toy
© J. Peter Rubin
Volume Three:
Chapter 6: Aesthetic nasal reconstruction
6.1: The three-stage folded forehead flap for cover and lining
6.2: First-stage transfer and intermediate operation
Frederick J. Menick
Chapter 7: Auricular construction
7.1: Total auricular construction
Akira Yamada
Chapter 8: Acquired cranial and facial bone
deformities
8.1: Removal of venous malformation enveloping intraconal
optic nerve
Renee M. Burke, Robert J. Morin, and S. Anthony Wolfe
Chapter 13: Facial paralysis
13.1: Facial paralysis
Eyal Gur
13.2: Facial paralysis
13.3: Cross facial nerve graft
13.4: Gracilis harvest
Peter C. Neligan
Chapter 14: Pharyngeal and esophageal
reconstruction
14.1: Reconstruction of pharyngoesophageal defects with the
anterolateral thigh flap
Peirong Yu
Chapter 15: Tumors of the facial skeleton: Fibrous
dysplasia
15.1: Surgical approaches to the facial skeleton
Yu-Ray Chen, You-Wei Cheong, and Alberto Córdova-Aguilar
Chapter 17: Local flaps for facial coverage
17.1: Facial artery perforator flap
17.2: Local flaps for facial coverage
Peter C. Neligan
Chapter 21.2: Rotation advancement cheiloplasty
21.2.1: Repair of unilateral cleft lip
Philip Kuo-Ting Chen, M. Samuel Noordhoff, Frank Chun-Shin,
Chang, and Fuan Chiang Chan
21.2.2: Unilateral cleft lip repair – anatomic subunit
approximation technique
David M. Fisher
Chapter 24: Alveolar clefts
24.1: Unilateral cleft alveolar bone graft
24.2: Mobilized premaxilla after vomer osteotomy prior to
setback and splint application
Richard A. Hopper and Gerhard S. Mundinger

xiv
Video Contents
6.3: Diagnosis and treatment of painful neuroma and of nerve
compression in the lower extremity 3
A. Lee Dellon
Chapter 7: Skeletal reconstruction
7.1: Medial femoral condyle/medial geniculate artery
osteocutaneous free flap dissection for scaphoid nonunion
Stephen J. Kovach III and L. Scott Levin
Chapter 10: Reconstruction of the chest
10.1: Sternal rigid fixation
David H. Song and Michelle C. Roughton
Chapter 12: Abdominal wall reconstruction
12.1: Component separation innovation
Peter C. Neligan
Chapter 13: Reconstruction of male genital defects
13.1: Complete and partial penile reconstruction
Stan Monstrey, Peter Ceulemans, Nathalie Roche,
Philippe Houtmeyers, Nicolas Lumen, and Piet Hoebeke
Volume Five:
Chapter 6: Mastopexy options and techniques
6.1: Circumareolar mastopexy
Kenneth C. Shestak
Chapter 7: One- and two-stage considerations for
augmentation mastopexy
7.1: Preoperative markings for a single-stage augmentation
mastopexy
W. Grant Stevens
Chapter 10: Reduction mammaplasty with short scar
techniques
10.1: SPAIR technique
Dennis C. Hammond
Chapter 11: Gynecomastia surgery
11.1: Ultrasound-assisted liposuction
Charles M. Malata
Chapter 15: One- and two-stage prosthetic
reconstruction in nipple-sparing mastectomy
15.1: Pectoralis muscle elevation
15.2: Acellular dermal matrix
15.3: Sizer
Amy S. Colwell
Chapter 16: Skin-sparing mastectomy: Planned
two-stage and direct-to-implant breast
reconstruction
16.1: Mastectomy and expander insertion: First stage
16.2: Mastectomy and expander insertion: Second stage
Maurizio B. Nava, Giuseppe Catanuto, Angela Pennati,
Valentina Visintini Cividin, and Andrea Spano
Chapter 19: Latissimus dorsi flap breast
reconstruction
19.1: Latissimus dorsi flap technique
Scott L. Spear†
19.2: Markings
19.3: Intraoperative skin paddles
19.4: Tendon division
19.5: Transposition and skin paddles
19.6: Inset and better skin paddle explanation
Neil A. Fine and Michael S. Gart
Chapter 20.2: The deep inferior epigastric artery
perforator (DIEAP) flap
20.2.1: The Deep Inferior Epigastric Artery Perforator (DIEAP)
flap breast reconstruction
Phillip N. Blondeel and Robert J. Allen, Sr
Chapter 21.2: Gluteal free flaps for breast
reconstruction
21.2.1: Superior Gluteal Artery Perforator (SGAP) flap
21.2.2: Inferior Gluteal Artery Perforator (IGAP) flap
Peter C. Neligan
Chapter 21.3: Medial thigh flaps for breast
reconstruction
21.3.1: Transverse Upper Gracilis (TUG) flap 1
Peter C. Neligan
21.3.2: Transverse Upper Gracilis (TUG) flap 2
Venkat V. Ramakrishnan
Chapter 23.2: Partial breast reconstruction using
reduction and mastopexy techniques
23.2.1: Partial breast reconstruction using reduction
mammoplasty
Maurice Y. Nahabedian
23.2.2: Partial breast reconstruction with a latissimus dorsi flap
Neil A. Fine
23.2.3: Partial breast reconstruction with a pedicle TRAM
Maurice Y. Nahabedian
Volume Six:
Chapter 1: Anatomy and biomechanics of the hand
1.1: The extensor tendon compartments
1.2: The contribution of the interosseous and lumbrical
muscles to the lateral bands
1.3: Extrinsic flexors and surrounding vasculonervous
elements, from superficial to deep
1.4: The lumbrical plus deformity
1.5: The sensory and motor branches of the median nerve in
the hand
James Chang, Vincent R. Hentz, Robert A. Chase, and
Anais Legrand
Chapter 2: Examination of the upper extremity
2.1: Flexor profundus test in a normal long finger
2.2: Flexor sublimis test in a normal long finger
2.3: Extensor pollicis longus test in a normal person
2.4: Test for the Extensor Digitorum Communis (EDC) muscle
in a normal hand
2.5: Test for assessing thenar muscle function
2.6: The “cross fingers” sign
2.7: Static Two-Point Discrimination Test (s-2PD Test)
2.8: Moving 2PD Test (m-2PD Test) performed on the radial or
ulnar aspect of the finger

xv
Video Contents
2.9: Semmes–Weinstein monofilament test: The patient should
sense the pressure produced by bending the filament
2.10: Allen’s test in a normal person
2.11: Digital Allen’s test
2.12: Scaphoid shift test
2.13: Dynamic tenodesis effect in a normal hand
2.14: The milking test of the fingers and thumb in a normal
hand
2.15: Eichhoff test
2.16: Adson test
2.17: Roos test
Ryosuke Kakinoki
Chapter 3: Diagnostic imaging of the hand and
wrist
3.1: Scaphoid lunate dislocation
Alphonsus K. Chong and David M. K. Tan
3.2: Right wrist positive midcarpal catch up clunk
Alphonsus K. Chong
Chapter 4: Anesthesia for upper extremity surgery
4.1: Supraclavicular block
Subhro K. Sen
Chapter 5: Principles of internal fixation as applied
to the hand and wrist
5.1: Dynamic compression plating and lag screw technique
Christopher Cox
5.2: Headless compression screw
5.3: Locking vs. non-locking plates
Jeffrey Yao and Jason R. Kang
Chapter 7: Hand fractures and joint injuries
7.1: Bennett reduction
7.2: Hemi-Hamate arthroplasty
Warren C. Hammert
Chapter 9: Flexor tendon injury and reconstruction
9.1: Zone II flexor tendon repair
9.2: Incision and feed tendon forward
9.3: Distal tendon exposure
9.4: Six-strand M-tang repair
9.5: Extension–flexion test – wide awake
Jin Bo Tang
Chapter 10: Extensor tendon injuries
10.1: Sagittal band reconstruction
10.2: Setting the tension in extensor indicis transfer
Kai Megerle
Chapter 11: Replantation and revascularization
11.1: Hand replantation
James Chang
Chapter 12: Reconstructive surgery of the mutilated
hand
12.1: Debridement technique
James Chang
Chapter 13: Thumb reconstruction: Non-
microsurgical techniques
13.1: Osteoplastic thumb reconstruction
13.2: First Dorsal Metacarpal Artery (FDMA) flap
Jeffrey B. Friedrich
Chapter 14: Thumb reconstruction: Microsurgical
techniques
14.1: Trimmed great toe
14.2: Second toe for index finger
14.3: Combined second and third toe for metacarpal hand
Nidal F. Al Deek
Chapter 19: Rheumatologic conditions of the hand
and wrist
19.1: Extensor tendon rupture and end–side tendon transfer
James Chang
19.2: Silicone metacarpophalangeal arthroplasty
Kevin C. Chung and Evan Kowalski
Chapter 20: Osteoarthritis in the hand and wrist
20.1: Ligament reconstruction tendon interposition arthroplasty
of the thumb carpometacarpal joint
James W. Fletcher
Chapter 21: The stiff hand and the spastic hand
21.1: Flexor pronator slide
David T. Netscher
Chapter 22: Ischemia of the hand
22.1: Radial artery sympathectomy
Hee Chang Ahn and Neil F. Jones
22.2: Interposition arterial graft and sympathectomy
Hee Chang Ahn
Chapter 24: Nerve entrapment syndromes
24.1: The manual muscle testing algorithm
24.2: Scratch collapse test – carpal tunnel
Elisabet Hagert
24.3: Injection technique for carpal tunnel surgery
24.4: Wide awake carpal tunnel surgery
Donald Lalonde
24.5: Clinical exam and surgical technique – lacertus
syndrome
Elisabet Hagert
24.6: Injection technique for cubital tunnel surgery
24.7: Wide awake cubital tunnel surgery
Donald Lalonde
24.8: Clinical exam and surgical technique – radial tunnel
syndrome
24.9: Clinical exam and surgical technique – lateral
intermuscular syndrome
24.10: Clinical exam and surgical technique – axillary nerve
entrapment
Elisabet Hagert
24.11: Carpal tunnel and cubital tunnel releases in the same
patient in one procedure with field sterility: Part 1 – local
anesthetic injection for carpal tunnel
24.12: Carpal tunnel and cubital tunnel releases in the same
patient in one procedure with field sterility: Part 2 – local
anesthetic injection for cubital tunnel
Donald Lalonde and Michael Bezuhly
Chapter 25: Congenital hand I: Embryology,
classification, and principles
25.1: Pediatric trigger thumb release
James Chang

xvi
Video Contents
Chapter 27: Congenital hand III: Thumb hypoplasia
27.1: Thumb hypoplasia
Joseph Upton III and Amir Taghinia
Chapter 30: Growth considerations in pediatric
upper extremity trauma and reconstruction
30.1: Epiphyseal transplant harvesting technique
Marco Innocenti and Carla Baldrighi
Chapter 31: Vascular anomalies of the upper
extremity
31.1: Excision of venous malformation
Joseph Upton III and Amir Taghinia
Chapter 32: Peripheral nerve injuries of the upper
extremity
32.1: Suture repair of the cut digital nerve
32.2: Suture repair of the median nerve
Simon Farnebo and Johan Thorfinn
Chapter 35: Free-functioning muscle transfer in the
upper extremity
35.1: Gracilis functional muscle harvest
Gregory H. Borschel
Chapter 36: Brachial plexus injuries: Adult and
pediatric
36.1: Pediatric: shoulder correct and biceps-to-triceps transfer
with preserving intact brachialis
36.2: Adult: results of one-stage surgery for C5 rupture, C6–T1
root avulsion 10 years after
36.3: Nerve transfer results 1
36.4: Nerve transfer results 2
36.5: Nerve transfer results 3
36.6: Nerve transfer results 4
36.7: Nerve transfer results 5
David Chwei-Chin Chuang
Chapter 37: Restoration of upper extremity function
in tetraplegia
37.1: The single-stage grip and release procedure
37.2: Postoperative results after single-stage grip release
procedure in OCu3–5 patients
Carina Reinholdt and Catherine Curtin
Chapter 38: Upper extremity vascularized composite
allotransplantation
38.1: Upper extremity composite tissue allotransplantation
W. P. Andrew Lee and Vijay S. Gorantla
Chapter 39: Hand therapy
39.1: Goniometric measurement
39.2: Threshold testing
Christine B. Novak and Rebecca L. Neiduski

Lecture Video Contents
Volume One:
Chapter 1: Plastic surgery and innovation in medicine
Plastic surgery and innovation in medicine
Peter C. Neligan
Chapter 7: Digital imaging in plastic surgery
Digital imaging in plastic surgery
Daniel Z. Liu
Chapter 15: Skin graft
Skin graft
Peter C. Neligan
Chapter 19: Repair and grafting of peripheral nerve
Nerve injury and repair
Kirsty Usher Boyd, Andrew Yee, and Susan E. Mackinnon
Chapter 20: Reconstructive fat grafting
Reconstructive fat grafting
J. Peter Rubin
Chapter 21: Vascular territories
Vascular territories
Steven F. Morris
Chapter 22: Flap classification and applications
Flap classification and applications
Joon Pio Hong
Chapter 23: Flap pathophysiology and pharmacology
Flap pathophysiology and pharmacology
Cho Y. Pang and Peter C. Neligan
Chapter 24: Principles and techniques of
microvascular surgery
Principles and techniques of microvascular surgery
Fu-Chan Wei, Nidal F. Al Deek, and
Sherilyn Keng Lin Tay
Chapter 25: Principles and applications of tissue
expansion
Principles and applications of tissue expansion
Ivo Alexander Pestana, Louis C. Argenta, and
Malcolm W. Marks
Chapter 26: Principles of radiation
Therapeutic radiation: principles, effects, and complications
Gabrielle M. Kane
Chapter 28: Benign and malignant nonmelanocytic
tumors of the skin and soft tissue
Benign and malignant nonmelanocytic tumors of the skin and soft
tissue
Rei Ogawa
Chapter 31: Facial prosthetics in plastic surgery
Facial prosthetics in plastic surgery
Gordon H. Wilkes
Volume Two:
Chapter 4: Skincare and nonsurgical skin
rejuvenation
Skincare and nonsurgical skin rejuvenation
Leslie Baumann and Edmund Weisberg
Chapter 5.2: Injectables and resurfacing techniques:
Soft-tissue fillers
Soft-tissue fillers
Trevor M. Born, Lisa E. Airan, and Daniel Suissa
Chapter 5.3: Injectables and resurfacing techniques:
Botulinum toxin (BoNT-A)
Botulinum toxin
Michael A. C. Kane
Chapter 5.4: Injectables and resurfacing techniques:
Laser resurfacing
Laser resurfacing
Steven R. Cohen, Ahmad N. Saad, Tracy Leong,
and E. Victor Ross
Chapter 5.5: Injectables and resurfacing techniques:
Chemical peels
Chemical peels
Suzan Obagi
Chapter 6.1: Facelift: Facial anatomy and aging
Anatomy of the aging face
Bryan Mendelson and Chin-Ho Wong
Chapter 6.2: Facelift: Principles of and surgical
approaches to facelift
Principles of and surgical approaches to facelift
Richard J. Warren
Chapter 6.3: Facelift: Platysma-SMAS plication
Platysma-SMAS plication
Miles G. Berry

xviii
Lecture Video Contents
Chapter 6.4: Facelift: Facial rejuvenation with loop
sutures – the MACS lift and its derivatives
Facial rejuvenation with loop sutures – the MACS lift and its
derivatives
Mark Laurence Jewell
Chapter 6.5: Facelift: Lateral SMASectomy facelift
Lateral SMASectomy facelift
Daniel C. Baker and Steven M. Levine
Chapter 6.6: Facelift: The extended SMAS technique
in facial rejuvenation
The extended SMAS technique in facelift
James M. Stuzin
Chapter 6.7: Facelift: SMAS with skin attached – the
“high SMAS” technique
SMAS with skin attached – the high SMAS technique
Fritz E. Barton Jr.
Chapter 6.8: Facelift: Subperiosteal midface lift
Subperiosteal midface lift
Alan Yan and Michael J. Yaremchuk
Chapter 6.9: Facelift: Male facelift
Male facelift
Timothy J. Marten and Dino Elyassnia
Chapter 6.10: Facelift: Secondary deformities and
the secondary facelift
Secondary deformities and the secondary facelift
Timothy J. Marten and Dino Elyassnia
Chapter 7: Forehead rejuvenation
Forehead rejuvenation
Richard J. Warren
Chapter 8: Endoscopic brow lifting
Endoscopic brow lift
Renato Saltz and Alyssa Lolofie
Chapter 9: Blepharoplasty
Blepharoplasty
Julius Few Jr. and Marco Ellis
Chapter 11: Asian facial cosmetic surgery
Asian facial cosmetic surgery
Clyde H. Ishii
Chapter 12: Neck rejuvenation
Neck rejuvenation
James E. Zins, Joshua T. Waltzman, and Rafael A. Couto
Chapter 13: Structural fat grafting
Structural fat grafting
Sydney R. Coleman and Alesia P. Saboeiro
Chapter 15: Nasal analysis and anatomy
Nasal analysis and anatomy
Rod J. Rohrich
Chapter 19: Secondary rhinoplasty
Secondary rhinoplasty
Ronald P. Gruber, Simeon H. Wall Jr., David L. Kaufman,
and David M. Kahn
Chapter 21: Hair restoration
Hair restoration
Jack Fisher
Chapter 22.1: Liposuction: A comprehensive review
of techniques and safety
Liposuction
Phillip J. Stephan, Phillip Dauwe, and Jeffrey Kenkel
Chapter 22.2: Correction of liposuction deformities
with the SAFE liposuction technique
SAFE liposuction technique
Simeon H. Wall Jr. and Paul N. Afrooz
Chapter 23: Abdominoplasty procedures
Abdominoplasty
Dirk F. Richter and Nina Schwaiger
Chapter 25.2: Circumferential approaches to truncal
contouring: Belt lipectomy
Belt lipectomy
Al S. Aly, Khalid Al-Zahrani, and Albert Cram
Chapter 25.3: Circumferential approaches to truncal
contouring: The lower lipo-bodylift
Circumferential lower bodylift
Dirk F. Richter and Nina Schwaiger
Chapter 25.4: Circumferential approaches to truncal
contouring: Autologous buttocks augmentation with
purse string gluteoplasty
Purse string gluteoplasty
Joseph P. Hunstad and Nicholas A. Flugstad
Chapter 25.5: Circumferential approaches to truncal
contouring: Lower bodylift with autologous gluteal
flaps for augmentation and preservation of gluteal
contour
Lower bodylift with gluteal flaps
Robert F. Centeno and Jazmina M. Gonzalez
Chapter 26.3: Buttock augmentation: Buttock
shaping with fat grafting and liposuction
Buttock shaping with fat grafting and liposuction
Constantino G. Mendieta, Thomas L. Roberts III,
and Terrence W. Bruner
Chapter 27: Upper limb contouring
Upper limb contouring
Joseph F. Capella, Matthew J. Trovato, and Scott Woehrle
Chapter 30: Aesthetic genital surgery
Aesthetic genital surgery
Gary J. Alter

xix
Lecture Video Contents
Volume Three:
Chapter 10.3: Midface reconstruction: The M. D.
Anderson approach
Midfacial reconstruction: The M. D. Anderson approach
Matthew M. Hanasono and Roman Skoracki
Chapter 12: Lip reconstruction
Lip reconstruction
Peter C. Neligan and Lawrence J. Gottlieb
Chapter 14: Pharyngeal and esophageal
reconstruction
Pharyngoesophageal reconstruction
Peirong Yu
Chapter 15: Tumors of the facial skeleton: Fibrous
dysplasia
Fibrous dysplasia
Alberto Córdova-Aguilar and Yu-Ray Chen
Chapter 17: Local flaps for facial coverage
Local flaps for facial coverage
David W. Mathes
Chapter 19: Facial transplant
Facial transplant
Michael Sosin and Eduardo D. Rodriguez
Chapter 32: Nonsyndromic craniosynostosis
Nonsyndromic craniosynostosis
Patrick A. Gerety, Jesse A. Taylor, and Scott P. Bartlett
Chapter 36: Pierre Robin Sequence
Pierre Robin sequence
Chad A. Purnell and Arun K. Gosain
Chapter 39: Vascular anomalies
Vascular anomalies
Arin K. Greene and John B. Mulliken
Volume Four:
Chapter 2: Management of lower extremity trauma
Management of lower extremity trauma
Yoo Joon Sur, Shannon M. Colohan, and Michel Saint-Cyr
Chapter 15: Surgery for gender identity disorder
Surgery for gender identity disorder
Loren S. Schechter
Chapter 16: Pressure sores
Pressure sores
Robert Kwon, Juan L. Rendon, and Jeffrey E. Janis
Chapter 17: Perineal reconstruction
Perineal reconstruction
Hakim K. Said and Otway Louie
Volume Five:
Chapter 5: Breast augmentation with autologous fat
grafting
Breast augmentation with autologous fat grafting
E. Delay
Chapter 6: Mastopexy options and techniques
Mastopexy
Robert Cohen
Chapter 9: Reduction mammaplasty with inverted-T
techniques
Reduction mammaplasty with inverted-T techniques
Maurice Y. Nahabedian
Chapter 15: One- and two-stage prosthetic
reconstruction in nipple-sparing mastectomy
Prosthetic reconstruction in nipple-sparing mastectomy
Amy S. Colwell
Chapter 20.1: Abdominally based free flaps:
Introduction
Abdominally-based autologous breast reconstruction
Maurice Y. Nahabedian, Phillip N. Blondeel, and David H. Song
Chapter 20.2: The deep inferior epigastric artery
perforator (DIEAP) flap
Abdominally-based autologous breast reconstruction
Maurice Y. Nahabedian, Phillip N. Blondeel, and David H. Song
Chapter 20.3: The superficial inferior epigastric
artery (SIEA) flap
Abdominally-based autologous breast reconstruction
Maurice Y. Nahabedian, Phillip N. Blondeel, and David H. Song
Chapter 20.4: The free TRAM flap
Abdominally-based autologous breast reconstruction
Maurice Y. Nahabedian, Phillip N. Blondeel, and David H. Song
Chapter 25: Radiation therapy considerations in the
setting of breast reconstruction
Radiation therapy in breast reconstruction
Steven Kronowitz
Volume Six:
Chapter 7: Hand fractures and joint injuries
Hand fractures and joint injuries
Joseph S. Khouri and Warren C. Hammert
Chapter 13: Thumb reconstruction: Non-
microsurgical techniques
Thumb reconstruction
Nicholas B. Vedder and Jeffrey B. Friedrich
Chapter 21: The stiff hand and the spastic hand
The stiff hand
David T. Netscher, Kenneth W. Donohue, and Dang T. Pham

xx
Lecture Video Contents
Chapter 24: Nerve entrapment syndromes
Tips and pearls on common nerve compressions
Elisabet Hagert and Donald Lalonde
Chapter 30: Growth considerations in pediatric
upper extremity trauma and reconstruction
Growth considerations in pediatric upper extremity trauma and
reconstruction
Marco Innocenti and Carla Baldrighi
Chapter 33: Nerve transfers
Nerve injury and repair
Kirsty Usher Boyd, Andrew Yee, and Susan E. Mackinnon
Chapter 37: Restoration of upper extremity function
in tetraplegia
Restoration of upper extremity function in tetraplegia
Carina Reinholdt and Catherine Curtin

Preface to the Fourth Edition
When I wrote the preface to the 3rd edition of this book, I
remarked how honored and unexpectedly surprised I was to
be the Editor of this great series. This time ‘round, I’m equally
grateful to carry this series forward. When Elsevier called me
and suggested it was time to prepare the 4th edition, my
initial reaction was that this was way too soon. What could
possibly have changed in Plastic Surgery since the 3rd edition
was launched in 2012? As it transpires, there have been many
developments and I hope we have captured them in this
edition.
We have an extraordinary specialty. A recent article by
Chadra, Agarwal and Agarwal entitled “Redefining Plastic
Surgery” appeared in Plastic and Reconstructive Surgery—Global
Open. In it they gave the following definition: “Plastic surgery
is a specialized branch of surgery, which deals with deformi-
ties, defects and abnormalities of the organs of perception,
organs of action and the organs guarding the external pas-
sages, besides innovation, implantation, replantation and
transplantation of tissues, and aims at restoring and improv-
ing their form, function and the esthetic appearances.” This is
an all-encompassing but very apt definition and captures the
enormous scope of the specialty.1
In the 3rd edition, I introduced volume editors for each of
the areas of the specialty because the truth is that one person
can no longer be an expert in all areas of this diverse specialty,
and I’m certainly not. I think this worked well because the
volume editors not only had the expertise to present their area
of subspecialty in the best light, but they were tuned in to
what was new and who was doing it. We have continued this
model in this new edition. Four of the seven volume editors
from the previous edition have again helped to bring the latest
and the best to this edition: Drs Gurtner, Song, Rodriguez,
Losee, and Chang have revised and updated their respective
volumes with some chapters remaining, some extensively
revised, some added, and some deleted. Dr. Peter Rubin has
replaced Dr. Rick Warren to compile the Aesthetic volume
(Vol. 2). Dr. Warren did a wonderful job in corralling this
somewhat disparate, yet vitally important, part of our spe-
cialty into the Aesthetic volume in the 3rd edition but felt that
the task of doing it again, though a labor of love, was more
than he wanted to take on. Similarly, Dr. Jim Grotting who did
a masterful job in the last edition on the Breast volume,
decided that doing a major revision should be undertaken by
someone with a fresh perspective and Dr. Maurice Nahabe-
dian stepped into that breach. I hope you will like the changes
you see in both of these volumes.
Dr. Allen Van Beek was the video editor for the last edition
and he compiled an impressive array of movies to comple-
ment the text. This time around, we wanted to go a step
further and though we’ve considerably expanded the list of
videos accompanying the text (there are over 170), we also
added the idea of lectures accompanying selected chapters.
What we’ve done here is to take selected key chapters and
include the images from that chapter, photos and artwork,
and create a narrated presentation that is available online;
there are annotations in the text to alert the reader that this is
available. Dr. Daniel Liu, who has taken over from Dr. Van
Beek as multimedia editor (rather than video editor) has done
an amazing job in making all of this happen. There are over
70 presentations of various key chapters online, making it as
easy as possible for you, the reader, to get as much knowledge
as you can, in the easiest way possible from this edition. Many
of these presentations have been done by the authors of the
chapters; the rest have been compiled by Dr. Liu and myself
from the content of the individual chapters. I hope you find
them useful.
The reader may wonder how this all works. To plan this
edition, the Elsevier team, headed by Belinda Kuhn, and I,
convened a face-to-face meeting in San Francisco. The volume
editors, as well as the London based editorial team, were
present. We went through the 3rd edition, volume by volume,
chapter by chapter, over an entire weekend. We decided what
needed to stay, what needed to be added, what needed to be
revised, and what needed to be changed. We also decided
who should write the various chapters, keeping many exist-
ing authors, replacing others, and adding some new ones; we
did this so as to really reflect the changes occurring within the
specialty. We also decided on practical changes that needed to
be made. As an example, you will notice that we have omitted
the complete index for the 6 Volume set from Volumes 2-6
and highlighted only the table of contents for that particular
volume. The complete index is of course available in Volume
1 and fully searchable online. This allowed us to save several
hundred pages per volume, reducing production costs and
diverting those dollars to the production of the enhanced online
content.
In my travels around the world since the 3rd edition was
published, I’ve been struck by what an impact this publication
has had on the specialty and, more particularly, on training.
Everywhere I go, I’m told how the text is an important part
of didactic teaching and a font of knowledge. It is gratifying
to see that the 3rd edition has been translated into Portuguese,
Spanish, and Chinese. This is enormously encouraging. I
hope this 4th edition continues to contribute to the specialty,
remains a resource for practicing surgeons, and continues to
prepare our trainees for their future careers in Plastic Surgery.
Peter C. Neligan
Seattle, WA
September, 2017
1 Chandra R, Agarwal R, Agarwal D. Redefining Plastic Surgery. Plast
Reconstr Surg Glob Open. 2016;4(5):e706.

List of Editors
Editor-in-Chief
Peter C. Neligan, MB, FRCS(I), FRCSC, FACS
Professor of Surgery
Department of Surgery, Division of Plastic Surgery
University of Washington
Seattle, WA, USA
Volume 1: Principles
Geoffrey C. Gurtner, MD, FACS
Johnson and Johnson Distinguished Professor of
Surgery and Vice Chairman,
Department of Surgery (Plastic Surgery)
Stanford University
Stanford, CA, USA
Volume 2: Aesthetic
J. Peter Rubin, MD, FACS
UPMC Professor of Plastic Surgery
Chair, Department of Plastic Surgery
Professor of Bioengineering
University of Pittsburgh
Pittsburgh, PA, USA
Volume 3: Craniofacial, Head and Neck Surgery
Eduardo D. Rodriguez, MD, DDS
Helen L. Kimmel Professor of Reconstructive
Plastic Surgery
Chair, Hansjörg Wyss Department of Plastic
Surgery
NYU School of Medicine
NYU Langone Medical Center
New York, NY, USA
Volume 3: Pediatric Plastic Surgery
Joseph E. Losee, MD
Ross H. Musgrave Professor of Pediatric Plastic
Surgery
Department of Plastic Surgery
University of Pittsburgh Medical Center;
Chief Division of Pediatric Plastic Surgery
Children’s Hospital of Pittsburgh
Pittsburgh, PA, USA
Volume 4: Lower Extremity, Trunk, and Burns
David H. Song, MD, MBA, FACS
Regional Chief, MedStar Health
Plastic and Reconstructive Surgery
Professor and Chairman
Department of Plastic Surgery
Georgetown University School of Medicine
Washington, DC, USA
Volume 5: Breast
Maurice Y. Nahabedian, MD, FACS
Professor and Chief
Section of Plastic Surgery
MedStar Washington Hospital Center
Washington, DC, USA;
Vice Chairman
Department of Plastic Surgery
MedStar Georgetown University Hospital
Washington, DC, USA
Volume 6: Hand and Upper Extremity
James Chang, MD
Johnson & Johnson Distinguished
Professor and Chief
Division of Plastic and Reconstructive Surgery
Stanford University Medical Center
Stanford, CA, USA
Multimedia editor
Daniel Z. Liu, MD
Plastic and Reconstructive Surgeon
Cancer Treatment Centers of America at Midwest-
ern Regional Medical Center
Zion, IL, USA

List of Contributors
VOLUME ONE
Hatem Abou-Sayed, MD, MBA
Vice President
Physician Engagement
Interpreta, Inc.
San Diego, CA, USA
Paul N. Afrooz, MD
Resident
Plastic and Reconstructive Surgery
University of Pittsburgh Medical Center
Pittsburgh, PA, USA
Claudia R. Albornoz, MD, MSc
Research Fellow
Plastic and Reconstructive Surgery
Memorial Sloan Kettering Cancer Center
New York, NY, USA
Nidal F. Al Deek, MD
Doctor of Plastic and Reconstructive Surgery
Chang Gung Memorial Hospital
Taipei, Taiwan
Amy K. Alderman, MD, MPH
Private Practice
Atlanta, GA, USA
Louis C. Argenta, MD
Professor of Plastic and Reconstructive Surgery
Department of Plastic Surgery
Wake Forest Medical Center
Winston Salem, NC, USA
Stephan Ariyan, MD, MBA
Emeritus Frank F. Kanthak Professor of Surgery,
Plastic Surgery, Surgical Oncology,
Otolaryngology
Yale University School of Medicine;
Associate Chief
Department of Surgery;
Founding Director, Melanoma Program
Smilow Cancer Hospital, Yale Cancer Center
New Haven, CT, USA
Tomer Avraham, MD
Attending Plastic Surgeon
Mount Sinai Health System
Tufts University School of Medicine
New York, NY, USA
Aaron Berger, MD, PhD
Clinical Assistant Professor
Division of Plastic Surgery
Florida International University School of
Medicine
Miami, FL, USA
Kirsty Usher Boyd, MD, FRCSC
Assistant Professor Surgery (Plastics)
Division of Plastic and Reconstructive Surgery
University of Ottawa
Ottawa, Ontario, Canada
Charles E. Butler, MD, FACS
Professor and Chairman
Department of Plastic Surgery
Charles B. Barker Endowed Chair in Surgery
The University of Texas MD Anderson Cancer
Center
Houston, TX, USA
Peter E. M. Butler, MD, FRCSI, FRCS,
FRCS(Plast)
Professor
Plastic and Reconstructive Surgery
University College and Royal Free London
London, UK
Yilin Cao, MD, PhD
Professor
Shanghai Ninth People’s Hospital
Shanghai Jiao Tong University School of
Medicine
Shanghai, China
Franklyn P. Cladis, MD, FAAP
Associate Professor of Anesthesiology
Department of Anesthesiology
The Children’s Hospital of Pittsburgh of UPMC
Pittsburgh, PA, USA
Mark B. Constantian, MD
Private Practice
Surgery (Plastic Surgery)
St. Joseph Hospital
Nashua, NH, USA
Daniel A. Cuzzone, MD
Plastic Surgery Fellow
Hanjörg Wyss Department of Plastic Surgery
New York University Medical Center
New York, NY, USA
Gurleen Dhami, MD
Chief Resident
Department of Radiation Oncology
University of Washington
Seattle, WA, USA
Gayle Gordillo, MD
Associate Professor
Plastic Surgery
The Ohio State University
Columbus, OH, USA
Geoffrey C. Gurtner, MD, FACS
Johnson and Johnson Distinguished Professor
of Surgery and Vice Chairman,
Department of Surgery (Plastic Surgery)
Stanford University
Stanford, CA, USA
Phillip C. Haeck, MD
Surgeon
Plastic Surgery
The Polyclinic
Seattle, WA, USA
The late Bruce Halperin†, MD
Formerly Adjunct Associate Professor of
Anesthesia
Department of Anesthesia
Stanford University
Stanford, CA, USA
Daniel E. Heath
Lecturer
School of Chemical and Biomedical Engineering
University of Melbourne
Parkville, Victoria, Australia
Joon Pio Hong, MD, PhD, MMM
Professor
Plastic Surgery
Asan Medical Center, University of Ulsan
Seoul, South Korea
Michael S. Hu, MD, MPH, MS
Postdoctoral Fellow
Division of Plastic Surgery
Department of Surgery
Stanford University School of Medicine
Stanford, CA, USA
C. Scott Hultman, MD, MBA
Professor and Chief
Division of Plastic and Reconstructive Surgery
University of North Carolina
Chapel Hill, NC, USA
Amir E. Ibrahim
Division of Plastic Surgery
Department of Surgery
American University of Beirut Medical Center
Beirut, Lebanon
Leila Jazayeri, MD
Microsurgery Fellow
Plastic and Reconstructive Surgery
Memorial Sloan Kettering Cancer Center
New York, NY, USA
The editors would like to acknowledge and offer grateful thanks for the input of all previous editions’ contributors, without whom this new edition would
not have been possible.

xxiv
List of Contributors
Brian Jeffers
Student
Bioengineering
University of California Berkeley
Berkeley, CA USA
Lynn Jeffers, MD, FACS
Private Practice
Oxnard, CA, USA
Mohammed M. Al Kahtani, MD, FRCSC
Clinical Fellow
Division of Plastic Surgery
Department of Surgery
University of Alberta
Edmonton, Alberta, Canada
Gabrielle M. Kane, MB, BCh, EdD, FRCPC
Associate Professor
Radiation Oncology
University of Washington
Seattle, WA, USA
Raghu P. Kataru, PhD
Senior Research Scientist
Memorial Sloan-Kettering Cancer Center
New York, NY, USA
Carolyn L. Kerrigan, MD, MSc, MHCDS
Professor of Surgery
Surgery
Dartmouth–Hitchcock Medical Center
Lebanon, NH, USA
Timothy W. King, MD, PhD, FAAP, FACS
Associate Professor with Tenure
Departments of Surgery and Biomedical
Engineering;
Director of Research, Division of Plastic Surgery
University of Alabama at Birmingham (UAB)
Craniofacial and Pediatric Plastic Surgery
Children’s of Alabama – Plastic Surgery;
Chief, Plastic Surgery Section
Birmingham VA Hospital
Birmingham, AL, USA
Brian M. Kinney, MD, FACS, MSME
Clinical Assistant Professor of Plastic Surgery
University of Southern California
School of Medicine
Los Angeles, CA, USA
W. P. Andrew Lee, MD
The Milton T. Edgerton MD, Professor and
Chairman
Department of Plastic and Reconstructive
Surgery
Johns Hopkins University School of Medicine
Baltimore, MD, USA
Sherilyn Keng Lin Tay, MBChB, MSc,
FRCS(Plast)
Consultant Plastic Surgeon
Canniesburn Plastic Surgery Unit
Glasgow Royal Infirmary
Glasgow, UK
Daniel Z. Liu, MD
Plastic and Reconstructive Surgeon
Cancer Treatment Centers of America at
Midwestern Regional Medical Center
Zion, IL, USA
Wei Liu, MD, PhD
Professor
Plastic and Reconstructive Surgery
Shanghai Ninth People’s Hospital
Shanghai Jiao Tong University School of
Medicine
Shanghai, China
Michael T. Longaker, MD, MBA, FACS
Deane P. and Louise Mitchell Professor and Vice
Chair
Department of Surgery
Stanford University
Stanford, CA, USA
H. Peter Lorenz, MD
Service Chief and Professor, Plastic Surgery
Lucile Packard Children’s Hospital
Stanford University School of Medicine
Stanford, CA, USA
Susan E. Mackinnon, MD
Sydney M. Shoenberg Jr. and Robert H.
Shoenberg Professor
Department of Surgery, Division of Plastic and
Reconstructive Surgery
Washington University School of Medicine
St. Louis, MO, USA
Malcolm W. Marks, MD
Professor and Chairman
Department of Plastic Surgery
Wake Forest University School of Medicine
Winston-Salem, NC, USA
Diego Marre, MD
Fellow
O’Brien Institute
Department of Plastic and Reconstructive
Surgery
St. Vincent’s Hospital
Melbourne, Australia
David W. Mathes, MD
Professor and Chief of the Division of Plastic
and Reconstructive Surgery
University of Colorado
Aurora, CO, USA
Evan Matros MD, MMSc
Plastic Surgeon
Memorial Sloan-Kettering Cancer Center
New York, NY, USA
Isabella C. Mazzola, MD
Attending Plastic Surgeon
Klinik für Plastische und Ästhetische Chirurgie
Klinikum Landkreis Erding
Erding, Germany
Riccardo F. Mazzola, MD
Plastic Surgeon
Department of Specialistic Surgical Sciences
Fondazione Ospedale Maggiore Policlinico, Ca’
Granda IRCCS
Milano, Italy
Lindsay D. McHutchion, MS, BSc
Anaplastologist
Institute for Reconstructive Sciences in Medicine
Edmonton, Alberta, Canada
Babak J. Mehrara, MD, FACS
Associate Member, Associate Professor of
Surgery (Plastic)
Memorial Sloan Kettering Cancer Center
Weil Cornell University Medical Center
New York, NY, USA
Steven F. Morris, MD, MSc, FRCSC
Professor of Surgery
Department of Surgery
Dalhousie University
Halifax, Nova Scotia, Canada
Wayne A. Morrison, MBBS, MD, FRACS
Professorial Fellow
O’Brien Institute
Department of Surgery, University of Melbourne
Department of Plastic and Reconstructive
Surgery, St. Vincent’s Hospital
Melbourne, Australia
Peter C. Neligan, MB, FRCS(I), FRCSC,
FACS
Professor of Surgery
Department of Surgery, Division of Plastic
Surgery
University of Washington
Seattle, WA, USA
Andrea J. O’Connor, BE(Hons), PhD
Associate Professor
Department of Chemical and Biomolecular
Engineering
University of Melbourne
Parkville, Victoria, Australia
Rei Ogawa, MD, PhD, FACS
Professor and Chief
Department of Plastic
Reconstructive and Aesthetic Surgery
Nippon Medical School
Tokyo, Japan
Dennis P. Orgill, MD, PhD
Professor of Surgery
Harvard Medical School
Medical Director, Wound Care Center;
Vice Chairman for Quality Improvement
Department of Surgery
Brigham and Women’s Hospital
Boston, MA, USA

xxv
List of Contributors
Cho Y. Pang, PhD
Senior Scientist
Research Institute
The Hospital for Sick Children;
Professor
Departments of Surgery/Physiology
University of Toronto
Toronto, Ontario, Canada
Ivo Alexander Pestana, MD, FACS
Associate Professor
Plastic and Reconstructive Surgery
Wake Forest University
Winston Salem, NC, USA
Giorgio Pietramaggior, MD, PhD
Swiss Nerve Institute
Clinique de La Source
Lausanne, Switzerland
Andrea L. Pusic, MD, MHS, FACS
Associate Professor
Plastic and Reconstructive Surgery
Memorial Sloan Kettering Cancer Center
New York, NY, USA
Russell R. Reid, MD, PhD
Associate Professor
Surgery/Section of Plastic and Reconstructive
Surgery
University of Chicago Medicine
Chicago, IL, USA
Neal R. Reisman, MD, JD
Chief
Plastic Surgery
Baylor St. Luke’s Medical Center
Houston, TX, USA
Joseph M. Rosen, MD
Professor of Surgery
Plastic Surgery
Dartmouth–Hitchcock Medical Center
Lebanon, NH, USA
Sashwati Roy, MS, PhD
Associate Professor
Surgery, Center for Regenerative Medicine and
Cell based Therapies
The Ohio State University
Columbus, OH, USA
J. Peter Rubin, MD, FACS
UPMC Professor of Plastic Surgery
Chair, Department of Plastic Surgery
Professor of Bioengineering
University of Pittsburgh
Pittsburgh, PA, USA
Karim A. Sarhane, MD
Department of Surgery
University of Toledo Medical Center
Toledo, OH, USA
David B. Sarwer, PhD
Associate Professor of Psychology
Departments of Psychiatry and Surgery
University of Pennsylvania School of Medicine
Philadelphia, PA, USA
Saja S. Scherer-Pietramaggiori, MD
Plastic and Reconstructive Surgeon
Plastic Surgery
University Hospital Lausanne
Lausanne, Vaud, Switzerland
Iris A. Seitz, MD, PhD
Director of Research and International
Collaboration
University Plastic Surgery
Rosalind Franklin University;
Clinical Instructor of Surgery
Chicago Medical School
Chicago, IL, USA
Jesse C. Selber, MD, MPH, FACS
Associate Professor, Director of Clinical
Research
Department of Plastic Surgery
MD Anderson Cancer Center
Houston, TX, USA
Chandan K. Sen, PhD
Professor and Director
Center for Regenerative Medicine and Cell-
Based Therapies
The Ohio State University Wexner Medical
Center
Columbus, OH, USA
Wesley N. Sivak, MD, PhD
Resident in Plastic Surgery
Department of Plastic Surgery
University of Pittsburgh
Pittsburgh, PA, USA
M. Lucy Sudekum
Research Assistant
Thayer School of Engineering at Dartmouth
College
Hanover, NH, USA
G. Ian Taylor, AO, MBBS, MD, MD(Hon
Bordeaux), FRACS, FRCS(Eng), FRCS(Hon
Edinburgh), FRCSI(Hon), FRSC(Hon
Canada), FACS(Hon)
Professor
Department of Plastic Surgery
Royal Melbourne Hospital;
Professor
Department of Anatomy
University of Melbourne
Melbourne, Victoria, Australia
Chad M. Teven, MD
Resident
Section of Plastic and Reconstructive Surgery
University of Chicago
Chicago, IL, USA
Ruth Tevlin, MB BAO BCh, MRCSI, MD
Resident in Surgery
Department of Plastic and Reconstructive
Surgery
Stanford University School of Medicine
Stanford, CA, USA
E. Dale Collins Vidal, MD, MS
Chief
Section of Plastic Surgery
Dartmouth–Hitchcock Medical Center
Lebanon, NH, USA
Derrick C. Wan, MD
Associate Professor
Division of Plastic Surgery
Department of Surgery
Director of Maxillofacial Surgery
Lucile Packard Children’s Hospital
Stanford University School of Medicine
Stanford, CA, USA
Renata V. Weber, MD
Assistant Professor Surgery (Plastics)
Division of Plastic and Reconstructive Surgery
Albert Einstein College of Medicine
Bronx, NY, USA
Fu-Chan Wei, MD
Professor
Department of Plastic Surgery
Chang Gung Memorial Hospital
Taoyuan, Taiwan
Gordon H. Wilkes, BScMed, MD
Clinical Professor of Surgery
Department of Surgery University of Alberta
Institute for Reconstructive Sciences in Medicine
Misericordia Hospital
Edmonton, Alberta, Canada
Johan F. Wolfaardt, BDS,
MDent(Prosthodontics), PhD
Professor
Division of Otolaryngology – Head and Neck
Surgery
Department of Surgery
Faculty of Medicine and Dentistry;
Director of Clinics and International Relations
Institute for Reconstructive Sciences in Medicine
University of Alberta
Covenant Health Group
Alberta Health Services
Alberta, Canada
Kiryu K. Yap, MBBS, BMedSc
Junior Surgical Trainee & PhD Candidate
O’Brien Institute
Department of Surgery, University of Melbourne
Department of Plastic and Reconstructive
Surgery, St. Vincent’s Hospital
Melbourne, Australia
Andrew Yee
Research Assistant
Division of Plastic and Reconstructive Surgery
Washington University School of Medicine
St. Louis, MO, USA
Elizabeth R. Zielins, MD
Postdoctoral Research Fellow
Surgery
Stanford University School of Medicine
Stanford, CA, USA

xxvi
List of Contributors
VOLUME TWO
Paul N. Afrooz, MD
Resident
Plastic and Reconstructive Surgery
University of Pittsburgh Medical Center
Pittsburgh, PA, USA
Jamil Ahmad, MD, FRCSC
Director of Research and Education
The Plastic Surgery Clinic
Mississauga;
Assistant Professor
Surgery
University of Toronto
Toronto, Ontario, Canada
Lisa E. Airan, MD
Aesthetic Dermatologist NYC
Private Practice;
Associate Clinical Professor Department of
Dermatology
Mount Sinai School of Medicine
New York, NY, USA
Gary J. Alter, MD
Assistant Clinical Professor
Division of Plastic Surgery
University of California
Los Angeles, CA, USA
Al S. Aly, MD
Professor of Plastic Surgery
Aesthetic and Plastic Surgery Institute University
of California Irvine
Orange, CA, USA
Khalid Al-Zahrani, MD, SSC-PLAST
Assistant Professor
Consultant Plastic Surgeon
King Khalid University Hospital
King Saud University
Riyadh, Saudi Arabia
Bryan Armijo, MD
Plastic Surgery Chief Resident
Department of Plastic and Reconstructive
Surgery
Case Western Reserve/University Hospitals
Cleveland, OH, USA
Daniel C. Baker, MD
Professor of Surgery
Institute of Reconstructive Plastic Surgery
New York University Medical Center
Department of Plastic Surgery
New York, NY, USA
Fritz E. Barton Jr., MD
Clinical Professor
Department of Plastic Surgery
UT Southwestern Medical Center
Dallas, TX, USA
Leslie Baumann, MD
CEO
Baumann Cosmetic and Research Institute
Miami, FL, USA
Miles G. Berry, MS, FRCS(Plast)
Consultant Plastic and Aesthetic Surgeon
Institute of Cosmetic and Reconstructive
Surgery
London, UK
Trevor M. Born, MD
Division of Plastic Surgery
Lenox Hill/Manhattan Eye Ear and Throat
Hospital North Shore-LIJ Hospital
New York, NY, USA;
Clinical Lecturer
Division of Plastic Surgery
University of Toronto Western Division
Toronto, Ontario, Canada
Terrence W. Bruner, MD, MBA
Private Practice
Greenville, SC, USA
Andrés F. Cánchica, MD
Chief Resident of Plastic Surgery
Plastic Surgery Service Dr. Osvaldo Saldanha
São Paulo, Brazil
Joseph F. Capella, MD
Chief Post-bariatric Body Contouring
Division of Plastic Surgery
Hackensack University Medical Center
Hackensack, NJ, USA
Robert F. Centeno, MD, MBA
Medical Director
St. Croix Plastic Surgery and MediSpa;
Chief Medical Quality Officer
Governor Juan F. Luis Hospital and Medical
Center
Christiansted, Saint Croix, United States Virgin
Islands
Ernest S. Chiu, MD, FACS
Associate Professor of Plastic Surgery
Department of Plastic Surgery
New York University
New York, NY, USA
Jong Woo Choi, MD, PhD, MMM
Associate Professor
Department of Plastic and Reconstructive
Surgery
Seoul Asan Medical Center
Seoul, South Korea
Steven R. Cohen, MD
Senior Clinical Research Fellow, Clinical
Professor
Plastic Surgery
University of California
San Diego, CA;
Director
Craniofacial Surgery
Rady Children’s Hospital, Private Practice,
FACES+ Plastic Surgery, Skin and Laser Center
La Jolla, CA, USA
Sydney R. Coleman, MD
Assistant Clinical Professor
Plastic Surgery
New York University Medical Center
New York;
Assistant Clinical Professor
Plastic Surgery
University of Pittsburgh Medical Center
Pittsburgh, PA, USA
Mark B. Constantian, MD
Private Practice
Surgery (Plastic Surgery)
St. Joseph Hospital
Nashua, NH, USA;
Adjunct Clinical Professor
Surgery (Plastic Surgery)
University of Wisconsin School of Medicine
Madison, WI, USA;
Visiting Professor
Plastic Surgery
University of Virginia Health System
Charlottesville, VA, USA
Rafael A. Couto, MD
Plastic Surgery Resident
Department of Plastic Surgery
Cleveland Clinic
Cleveland, OH, USA
Albert Cram, MD
Professor Emeritus
University of Iowa
Iowa City Plastic Surgery
Coralville, IO, USA
Phillip Dauwe, MD
Department of Plastic Surgery
University of Texas Southwestern Medical
School
Dallas, TX, USA
Dai M. Davies, FRCS
Consultant and Institute Director
Institute of Cosmetic and Reconstructive
Surgery
London, UK
Jose Abel De la Peña Salcedo, MD, FACS
Plastic Surgeon
Director
Instituto de Cirugia Plastica S.C.
Huixquilucan
Estado de Mexico, Mexico
Barry DiBernardo, MD, FACS
Clinical Associate Professor, Plastic Surgery
Rutgers, New Jersey Medical School
Director New Jersey Plastic Surgery
Montclair, NJ, USA
Felmont F. Eaves III, MD, FACS
Professor of Surgery, Emory University
Medical Director, Emory Aesthetic Center
Medical Director, EAC Ambulatory Surgery
Center
Atlanta, GA, USA

xxvii
List of Contributors
Marco Ellis, MD
Director of Craniofacial Surgery
Northwestern Specialists in Plastic Surgery;
Adjunct Assistant Professor
University of Illinois Chicago Medical Center
Chicago, IL, USA
Dino Elyassnia, MD
Associate Plastic Surgeon
Marten Clinic of Plastic Surgery
San Francisco, CA, USA
Julius Few Jr., MD
Director
The Few Institute for Aesthetic Plastic Surgery;
Clinical Professor
Plastic Surgery
University of Chicago Pritzker School of
Medicine
Chicago, IL, USA
Osvaldo Ribeiro Saldanha Filho, MD
Professor of Plastic Surgery
Plastic Surgery Service Dr. Osvaldo Saldanha
São Paulo, Brazil
Jack Fisher, MD
Associate Clinical Professor
Plastic Surgery
Vanderbilt University
Nashville, TN, USA
Nicholas A. Flugstad, MD
Flugstad Plastic Surgery
Bellevue, WA, USA
James D. Frame, MBBS, FRCS, FRCSEd,
FRCS(Plast)
Professor of Aesthetic Plastic Surgery
Anglia Ruskin University
Chelmsford, UK
Jazmina M. Gonzalez, MD
Bitar Cosmetic Surgery Institute
Fairfax, VA, USA
Richard J. Greco, MD
CEO
The Georgia Institute For Plastic Surgery
Savannah, GA, USA
Ronald P. Gruber, MD
Adjunct Associate Clinical Professor
Division of Plastic and Reconstructive Surgery
Stanford University
Stanford, CA
Clinical Association Professor
Division of Plastic and Reconstructive Surgery
University of California San Francisco
San Francisco, CA, USA
Bahman Guyuron, MD, FCVS
Editor in Chief, Aesthetic Plastic Surgery Journal
Emeritus Professor of Plastic Surgery
Case School of Medicine
Cleveland, OH, USA
Joseph P. Hunstad, MD, FACS
Associate Consulting Professor
Division of Plastic Surgery
The University of North Carolina at Chapel Hill;
Private Practice
Huntersville/Charlotte, NC, USA
Clyde H. Ishii, MD, FACS
Assistant Clinical Professor of Surgery
John A. Burns School of Medicine;
Chief, Department of Plastic Surgery
Shriners Hospital
Honolulu Unit
Honolulu, HI, USA
Nicole J. Jarrett, MD
Department of Plastic Surgery
University of Pittsburgh
Pittsburgh, PA, USA
Elizabeth B. Jelks, MD
Private Practice
Jelks Medical
New York, NY, USA
Glenn W. Jelks, MD
Associate Professor
Department of Ophthalmology
Department of Plastic Surgery
New York University School of Medicine
New York, NY, USA
Mark Laurence Jewell, MD
Assistant Clinical Professor Plastic Surgery
Oregon Health Science University
Portland, OR, USA
David M. Kahn, MD
Clinical Associate Professor of Plastic Surgery
Department of Surgery
Stanford University School of Medicine
Stanford, CA, USA
Michael A. C. Kane, BS, MD
Attending Surgeon
Plastic Surgery
Manhattan Eye, Ear, and Throat Hospital
New York, NY, USA
David L. Kaufman, MD, FACS
Private Practice Plastic Surgery
Aesthetic Artistry Surgical and Medical Center
Folsom, CA, USA
Jeffrey Kenkel, MD
Professor and Chairman
Department of Plastic Surgery
UT Southwestern Medical Center
Dallas, TX, USA
Kyung S. Koh, MD, PhD
Professor of Plastic Surgery
Asan Medical Center, University of Ulsan School
of Medicine
Seoul, South Korea
Tracy Leong, MD
Dermatology
Rady Children’s Hospital - San Diego;
Sharp Memorial Hospital;
University California San Diego Medical Center
San Diego;
Private Practice, FACES+ Plastic Surgery, Skin
and Laser Center
La Jolla, CA, USA
Steven M. Levine, MD
Assistant Professor of Surgery (Plastic)
Hofstra Medical School, Northwell Health,
New York, NY, USA
Michelle B. Locke, MBChB, MD
Senior Lecturer in Surgery
Department of Surgery
University of Auckland Faculty of Medicine and
Health Sciences;
South Auckland Clinical Campus
Middlemore Hospital
Auckland, New Zealand
Alyssa Lolofie
University of Utah
Salt Lake City, UT, USA
Timothy J. Marten, MD, FACS
Founder and Director
Marten Clinic of Plastic Surgery
San Francisco, CA, USA
Bryan Mendelson, FRCSE, FRACS, FACS
The Centre for Facial Plastic Surgery
Toorak, Victoria, Australia
Constantino G. Mendieta, MD, FACS
Private Practice
Miami, FL, USA
Drew B. Metcalfe, MD
Division of Plastic and Reconstructive Surgery
Emory University
Atlanta, GA, USA
Gabriele C. Miotto, MD
Emory School of Medicine
Atlanta, GA, USA
Foad Nahai, MD
Professor of Surgery
Division of Plastic and Reconstructive Surgery
Department of Surgery
Emory University School of Medicine
Emory Aesthetic Center at Paces
Atlanta, Georgia, USA
Suzan Obagi, MD
Associate Professor of Dermatology
Dermatology
University of Pittsburgh;
Associate Professor of Plastic Surgery
Plastic Surgery
University of Pittsburgh
Pittsburgh, PA, USA

xxviii
List of Contributors
Sabina Aparecida Alvarez de Paiva, MD
Resident of Plastic Surgery
Plastic Surgery Service Dr. Ewaldo Bolivar de
Souza Pinto
São Paulo, Brazil
Galen Perdikis, MD
Assistant Professor of Surgery
Division of Plastic Surgery
Emory University School of Medicine
Atlanta, GA, USA
Jason Posner, MD, FACS
Private Practice
Boca Raton, FL, USA
Dirk F. Richter, MD, PhD
Clinical Professor of Plastic Surgery
University of Bonn
Director and Chief
Dreifaltigkeits-Hospital
Wesseling, Germany
Thomas L. Roberts III, FACS
Plastic Surgery Center of the Carolinas
Spartanburg, SC, USA
Jocelyn Celeste Ledezma Rodriguez, MD
Private Practice
Guadalajara, Jalisco, Mexico
Rod J. Rohrich, MD
Clinical Professor and Founding Chair
Department of Plastic Surgery
Distinguished Teaching Professor
University of Texas Southwestern Medical Center
Founding Partner
Dallas Plastic Surgery Institute
Dallas, TX, USA
E. Victor Ross, MD
Director of Laser and Cosmetic Dermatology
Scripps Clinic
San Diego, CA, USA
J. Peter Rubin, MD, FACS
Chief
Plastic and Reconstructive Surgery
University of Pittsburgh Medical Center;
Associate Professor
Department of Surgery
University of Pittsburgh
Pittsburgh, PA, USA
Ahmad N. Saad, MD
Private Practice
FACES+ Plastic Surgery
Skin and Laser Center
La Jolla, CA, USA
Alesia P. Saboeiro, MD
Attending Physician
Private Practice
New York, NY, USA
Cristianna Bonnetto Saldanha, MD
Plastic Surgery Service Dr. Osvaldo Saldanha
São Paulo, Brazil
Osvaldo Saldanha, MD, PhD
Director of Plastic Surgery Service Dr. Osvaldo
Saldanha;
Professor of Plastic Surgery Department
Universidade Metropolitana de Santos
- UNIMES
São Paulo, Brazil
Renato Saltz, MD, FACS
Saltz Plastic Surgery
President
International Society of Aesthetic Plastic Surgery
Adjunct Professor of Surgery
University of Utah
Past-President, American Society for Aesthetic
Plastic Surgery
Salt Lake City and Park City, UT, USA
Paulo Rodamilans Sanjuan MD
Chief Resident of Plastic Surgery
Plastic Surgery Service Dr. Ewaldo Boliar de
Souza Pinto
São Paulo, Brazil
Nina Schwaiger, MD
Senior Specialist in Plastic and Aesthetic
Surgery
Department of Plastic Surgery
Dreifaltigkeits-Hospital Wesseling
Wesseling, Germany
Douglas S. Steinbrech, MD, FACS
Gotham Plastic Surgery
New York, NY, USA
Phillip J. Stephan, MD
Clinical Faculty
Plastic Surgery
UT Southwestern Medical School;
Plastic Surgeon
Texoma Plastic Surgery
Wichita Falls, TX, USA
David Gonzalez Sosa, MD
Plastic and Reconstructive Surgery
Hospital Quirónsalud Torrevieja
Alicante, Spain
James M. Stuzin, MD
Associate Professor of Surgery
(Plastic) Voluntary
University of Miami Leonard M. Miller School of
Medicine
Miami, FL, USA
Daniel Suissa, MD, MSc
Clinical Instructor
Section of Plastic and Reconstructive Surgery
Yale University
New Haven, CT, USA
Charles H. Thorne, MD
Associate Professor of Plastic Surgery
Department of Plastic Surgery
NYU School of Medicine
New York, NY, USA
Ali Totonchi, MD
Assistant Professor
Plastic Surgery
Case Western Reserve University;
Medical Director Craniofacial Deformity Clinic
Plastic Surgery
MetroHealth Medical center
Cleveland, OH, USA
Jonathan W. Toy, MD, FRCSC
Program Director, Plastic Surgery Residency
Program Assistant Clinical Professor
University of Alberta
Edmonton, Alberta, Canada
Matthew J. Trovato, MD
Dallas Plastic Surgery Institute
Dallas, TX, USA
Simeon H. Wall Jr., MD, FACS
Director
The Wall Center for Plastic Surgery;
Assistant Clinical Professor
Plastic Surgery
LSU Health Sciences Center at Shreveport
Shreveport, LA, USA
Joshua T. Waltzman, MD, MBA
Private Practice
Waltzman Plastic and Reconstructive Surgery
Long Beach, CA, USA
Richard J. Warren, MD, FRCSC
Clinical Professor
Division of Plastic Surgery
University of British Columbia
Vancouver, British Columbia, Canada
Edmund Weisberg, MS, MBE
University of Pennsylvania
Philadelphia, PA, USA
Scott Woehrle, MS BS
Physician Assistant
Department of Plastic Surgery
Jospeh Capella Plastic Surgery
Ramsey, NJ, USA
Chin-Ho Wong, MBBS, MRCS, MMed(Surg),
FAMS(Plast Surg)
W Aesthetic Plastic Surgery
Mt Elizabeth Novena Specialist Center
Singapore
Alan Yan, MD
Former Fellow
Adult Reconstructive and Aesthetic
Craniomaxillofacial Surgery
Division of Plastic and Reconstructive Surgery
Massachusetts General Hospital
Boston, MA, USA

xxix
List of Contributors
Michael J. Yaremchuk, MD
Chief of Craniofacial Surgery
Massachusetts General Hospital;
Clinical Professor of Surgery
Harvard Medical School;
Program Director
Harvard Plastic Surgery Residency Program
Boston, MA, USA
James E. Zins, MD
Chairman
Department of Plastic Surgery
Dermatology and Plastic Surgery Institute
Cleveland Clinic
Cleveland, OH, USA
VOLUME THREE
Neta Adler, MD
Senior Surgeon
Department of Plastic and Reconstructive
Surgery
Hadassah University Hospital
Jerusalem, Israel
Ahmed M. Afifi, MD
Assistant Professor of Plastic Surgery
Department of Surgery
University of Wisconsin
Madison, WI, USA;
Associate Professor
Department of Plastic Surgery
Cairo University
Cairo, Egypt
Marta Alvarado, DDS, MS
Department of Orthodontics
Facultad de Odontología
Universidad de San Carlos de Guatemala
Guatemala
Eric Arnaud, MD
Pediatric Neurosurgeon and Co-Director
Unité de Chirurgie Craniofaciale
Hôpital Necker Enfants Malades
Paris, France
Stephen B. Baker, MD, DDS
Associate Professor and Program Director
Co-Director Inova Hospital for Children
Craniofacial Clinic
Department of Plastic Surgery
Georgetown University Hospital
Georgetown, WA, USA
Scott P. Bartlett, MD
Professor of Surgery
Surgery
University of Pennsylvania;
Chief Division of Plastic Surgery
Surgery
Children’s Hospital of Philadelphia
Philadelphia, PA, USA
Bruce S. Bauer, MD
Chief
Division of Plastic Surgery
NorthShore University HealthSystem
Highland Park;
Clinical Professor of Surgery
Department of Surgery
University of Chicago Pritzker School of
Medicine
Chicago, IL, USA
Adriane L. Baylis, PhD
Speech Scientist
Section of Plastic and Reconstructive Surgery
Nationwide Children’s Hospital
Columbus, OH, USA
Mike Bentz, MD, FAAP, FACS
Interim Chairman
Department of Surgery
University of Wisconsin;
Chairman Division of Plastic Surgery
Department of Surgery
University of Wisconsin
Madison, WI, USA
Craig Birgfeld, MD, FACS
Associate Professor, Pediatric Plastic and
Craniofacial Surgery
Seattle Children’s Hospital
Seattle, WA, USA
William R. Boysen, MD
Resident Physician, Urology
University of Chicago Medicine
Chicago, IL, USA
James P. Bradley, MD
Professor and Chief
Section of Plastic and Reconstructive Surgery
Temple University
Philadelphia, PA, USA
Edward P. Buchanan, MD
Division of Plastic Surgery
Baylor College of Medicine
Houston, TX, USA
Michael R. Bykowski, MD, MS
Plastic Surgery Resident
Plastic Surgery
University of Pittsburgh Medical Center
Pittsburgh, PA, USA
Edward J. Caterson, MD, PhD
Director of Craniofacial Surgery
Division of Plastic Surgery
Brigham and Women’s Hospital
Boston, MA, USA
Rodney K. Chan, MD
Chief Plastic and Reconstructive Surgery
Clinical Division and Burn Center
United States Army Institute of Surgical
Research
Joint Base San Antonio, TX, USA
Edward I. Chang, MD
Assistant Professor
Department of Plastic Surgery
The University of Texas M. D. Anderson Cancer
Center
Houston, TX, USA
Constance M. Chen, MD, MPH
Director of Microsurgery
Plastic and Reconstructive Surgery
New York Eye and Ear Infirmary of Mt Sinai;
Clinical Assistant Professor
Plastic and Reconstructive Surgery
Weil Medical College of Cornell University;
Clinical Assistant Professor
Plastic and Reconstructive Surgery
Tulane University School of Medicine
New York, NY, USA
Yu-Ray Chen, MD
Professor of Surgery
Plastic and Reconstructive Surgery
Chang Gung Memorial Hospital
Taoyuan City, Taiwan
Philip Kuo-Ting Chen, MD
Professor
Craniofacial Center
Chang Gung Memorial Hospital
Taoyuan City, Taiwan
Ming-Huei Cheng, MD, MBA
Professor
Division of Reconstructive Microsurgery
Department of Plastic and Reconstructive
Surgery
Chang Gung Memorial Hospital
Taoyuan City, Taiwan
Gerson R. Chinchilla, DDS MS
Director
Department of Orthodontics
Facultad de Odontología
Universidad de San Carlos de Guatemala
Guatemala
Peter G. Cordeiro, MD
Chief
Plastic and Reconstructive Surgery
Memorial Sloan Kettering Cancer Center;
Professor of Surgery
Surgery
Weil Medical College of Cornell University
New York, NY, USA
Alberto Córdova-Aguilar, MD, MPH
Attending Plastic Surgeon
Surgery
Faculty of Medicine Ricardo Palma University
Lima, Peru
Edward H. Davidson, MA(Cantab), MBBS
Resident Plastic Surgeon
Department of Plastic Surgery
University of Pittsburgh
Pittsburgh, PA, USA

xxx
List of Contributors
Sara R. Dickie, MD
Clinician Educator
Surgery
University of Chicago Hospital Pritzker School of
Medicine;
Attending Surgeon
Section of Plastic and Reconstructive Surgery
NorthShore University HealthSystem
Northbrook, IL, USA
Risal S. Djohan, MD
Microsurgery Fellowship Program Director
Plastic Surgery
Cleveland Clinic;
Surgery ASC Quality Improvement Officer
Plastic Surgery
Cleveland Clinic
Cleveland, OH, USA
Amir H. Dorafshar, MBChB, FACS, FAAP
Associate Professor
Plastic and Reconstructive Surgery
Johns Hopkins Medical Institute;
Assistant Professor
Plastic Surgery
R Adams Cowley Shock Trauma Center
Baltimore, MD, USA
Jeffrey A. Fearon, MD
Director
The Craniofacial Center
Dallas, TX, USA
Alexander L. Figueroa, DMD
Craniofacial Orthodontist
Rush Craniofacial Center
Rush University Medical Center
Chicago, IL, USA
Alvaro A. Figueroa, DDS, MS
Co-Director
Rush Craniofacial Center
Rush University Medical Center
Chicago, IL, USA
David M. Fisher, MB, BCh, FRCSC, FACS
Medical Director Cleft Lip and Palate Program
Plastic Surgery
Hospital for Sick Children;
Associate Professor
Surgery
University of Toronto
Toronto, Ontario, Canada
Roberto L. Flores, MD
Associate Professor of Plastic Surgery
Director of Cleft Lip and Palate
Hansjörg Wyss Department of Plastic Surgery
NYU Langone Medical Center
New York, NY, USA
Andrew Foreman, B. Physio, BMBS(Hons),
PhD, FRACS
Consultant Surgeon, Department of
Otolaryngology - Head and Neck Surgery
University of Adelaide,
Royal Adelaide Hospital,
Adelaide, SA, Australia
Patrick A. Gerety, MD
Assistant Professor of Surgery
Division of Plastic and Reconstructive Surgery
Indiana University and Riley Hospital for
Children
Philadelphia, PA, USA
Jesse A. Goldstein, MD
Chief Resident
Department of Plastic Surgery
Georgetown University Hospital
Washington, DC, USA
Arun K. Gosain, MD
Chief
Division of Plastic Surgery
Ann and Robert H. Lurie Children’s Hospital of
Chicago
Chicago, IL, USA
Lawrence J. Gottlieb, MD
Professor of Surgery
Department of Surgery
Section of Plastic and Reconstructive Surgery
University of Chicago
Chicago, IL, USA
Arin K. Greene, MD, MMSc
Department of Plastic and Oral Surgery
Boston Children’s Hospital;
Associate Professor of Surgery
Harvard Medical School
Boston, MA, USA
Patrick J. Gullane, MD, FRCS
Wharton Chair in Head and Neck Surgery
Professor of Surgery, Department of
Otolaryngology - Head and Neck Surgery
University of Toronto
Toronto, Ontario, Canada
Mohan S. Gundeti, MB, MCh, FEBU,
FRCS(Urol), FEAPU
Associate Professor of Urology in Surgery and
Pediatrics, Director Pediatric Urology, Director
Centre for Pediatric Robotics and Minimal
Invasive Surgery
University of Chicago and Pritzker Medical
School Comer Children’s Hospital
Chicago, IL, USA
Eyal Gur, MD
Professor of Surgery, Chief
Department of Plastic and Reconstructive
Surgery
The Tel Aviv Sourasky Medical Center
Tel Aviv, Israel
Bahman Guyuron, MD, FCVS
Editor in Chief, Aesthetic Plastic Surgery
Journal;
Emeritus Professor of Plastic Surgery
Case School of Medicine
Cleveland, OH, USA
Matthew M. Hanasono, MD
Associate Professor
Department of Plastic Surgery
The University of Texas MD Anderson Cancer
Center
Houston, TX, USA
Toshinobu Harada, PhD
Professor in Engineering
Department of Systems Engineering
Faculty of Systems Engineering
Wakayama University
Wakayama, Japan
Jill A. Helms, DDS, PhD
Professor
Surgery
Stanford University
Stanford, CA, USA
David L. Hirsch, MD, DDS
Director of Oral Oncology and Reconstruction
Lenox Hill Hospital/Northwell Health
New York, NY, USA
Jung-Ju Huang, MD
Associate Professor
Division of Microsurgery
Plastic and Reconstructive Surgery
Chang Gung Memorial Hospital
Taoyuan, Taiwan
William Y. Hoffman, MD
Professor and Chief
Division of Plastic and Reconstructive Surgery
UCSF
San Francisco, CA, USA
Larry H. Hollier Jr., MD
Division of Plastic Surgery
Baylor College of Medicine
Houston, TX, USA
Richard A. Hopper, MD, MS
Chief
Division of Craniofacial Plastic Surgery
Seattle Children’s Hospital;
Surgical Director
Craniofacial Center
Seattle Children’s Hospital;
Associate Professor
Department of Surgery
University of Washington
Seattle, WA, USA
Gazi Hussain, MBBS, FRACS
Clinical Senior Lecturer
Macquarie University
Sydney, Australia
Oksana Jackson, MD
Assistant Professor
Plastic Surgery
Perelman School of Medicine at the University
of Pennsylvania;
Assistant Professor
Plastic Surgery
The Children’s Hospital of Philadelphia
Philadelphia, PA, USA

xxxi
List of Contributors
Syril James, MD
Clinic Marcel Sembat
Boulogne-Billancourt
Paris, France
Leila Jazayeri, MD
Microsurgery Fellow
Plastic and Reconstructive Surgery
Memorial Sloan Kettering Cancer Center
New York, NY, USA
Sahil Kapur, MD
Assistant Professor
Department of Plastic Surgery
University of Texas - MD Anderson Cancer
Center
Houston, TX, USA
Henry K. Kawamoto Jr., MD, DDS
Clinical Professor
Surgery Division of Plastic Surgery
UCLA
Los Angeles, CA, USA
David Y. Khechoyan, MD
Division of Plastic Surgery
Baylor College of Medicine
Houston, TX, USA
Richard E. Kirschner, MD
Section Chief
Plastic and Reconstructive Surgery
Nationwide Children’s Hospital;
Senior Vice Chair
Plastic Surgery
The Ohio State University Medical College
Columbus, OH, USA
John C. Koshy, MD
Division of Plastic Surgery
Baylor College of Medicine
Houston, TX, USA
Michael C. Large, MD
Urologic Oncologist
Urology of Indiana
Greenwood, IN, USA
Edward I. Lee, MD
Division of Plastic Surgery
Baylor College of Medicine
Houston, TX, USA
Jamie P. Levine, MD
Chief of Microsurgery
Associate Professor
Plastic Surgery
NYU Langone Medical Center
New York, NY, USA
Jingtao Li, DDS, PhD
Consultant Surgeon
Oral and Maxillofacial Surgery
West China Hospital of Stomatology
Chengdu, Sichuan, People’s Republic of China
Lawrence Lin, MD
Division of Plastic Surgery
Baylor College of Medicine
Houston, TX, USA
Joseph E. Losee, MD
Ross H. Musgrave Professor of Pediatric Plastic
Surgery
Department of Plastic Surgery
University of Pittsburgh Medical Center;
Chief, Division of Pediatric Plastic Surgery
Children’s Hospital of Pittsburgh
Pittsburgh, PA, USA
David W. Low, MD
Professor of Surgery
Division of Plastic Surgery
Perelman School of Medicine at the University
of Pennsylvania;
Clinical Associate
Department of Surgery
Children’s Hospital of Philadelphia
Philadelphia, PA, USA
Ralph T. Manktelow, MD, FRCSC
Professor of Surgery,
The University of Toronto,
Toronto, Ontario, Canada
Paul N. Manson, MD
Distinguished Service Professor
Plastic Surgery
Johns Hopkins University
Baltimore, MD, USA
David W. Mathes, MD
Professor and Chief of the Division of Plastic
and Reconstructive Surgery
Surgery Division of Plastic and Reconstructive
Surgery
University of Colorado
Aurora, CO, USA
Frederick J. Menick, MD
Private Practitioner
Tucson, AZ, USA
Fernando Molina, MD
Director
Craniofacial Anomalies Foundation A.C.
Mexico City;
Professor of Plastic Reconstructive and
Aesthetic Surgery
Medical School
Universidad La Salle
Mexico City, Distrito Federal, Mexico
Laura A. Monson, MD
Division of Plastic Surgery
Baylor College of Medicine
Houston, TX, USA
Reid V. Mueller, MD
Associate Professor
Plastic Surgery
Oregon Health and Science University
Portland, OR, USA
John B. Mulliken, MD
Professor
Department of Plastic and Oral Surgery
Boston Children’s Hospital
Harvard Medical School
Boston, MA, USA
Gerhard S. Mundinger, MD
Assistant Professor
Craniofacial, Plastic, and Reconstructive Surgery
Louisiana State University Health Sciences
Center
Children’s Hospital of New Orleans
New Orleans, LA, USA
Blake D. Murphy, BSc, PhD, MD
Craniofacial Fellow
Plastic Surgery
Nicklaus Children’s Hospital
Miami, FL, USA
Peter C. Neligan, MB, FRCS(I), FRCSC,
FACS
Professor of Surgery
Department of Surgery, Division of Plastic
Surgery
University of Washington
Seattle, WA, USA
M. Samuel Noordhoff, MD, FACS
Emeritus Professor in Surgery
Chang Gung University
Taoyuan City, Taiwan
Giovanna Paternoster, MD
Unité de chirurgie crânio-faciale du departement
de neurochirurgie
Hôpital Necker Enfants Malades
Paris, France
Jason Pomerantz, MD
Assistant Professor
Surgery
University of California San Francisco;
Surgical Director
Craniofacial Center
University of California San Francisco
San Francisco, CA, USA
Julian J. Pribaz, MD
Professor of Surgery
University of South Florida, Morsani College of
Medicine
Tampa General Hospital
Tampa, FL, USA
Chad A. Purnell, MD
Division of Plastic Surgery
Lurie Children’s Hospital of Northwestern
Feinberg School of Medicine
Chicago, IL, USA
Russell R. Reid, MD, PhD
Associate Professor
Surgery/Section of Plastic and Reconstructive
Surgery
University of Chicago Medicine
Chicago, IL, USA
Eduardo D. Rodriguez, MD, DDS
Helen L. Kimmel Professor of Reconstructive
Plastic Surgery
Chair, Hansjörg Wyss Department of Plastic
Surgery
NYU School of Medicine
NYU Langone Medical Center
New York, NY, USA

xxxii
List of Contributors
Craig Rowin, MD
Craniofacial Fellow
Plastic Surgery
Nicklaus Children’s Hospital
Miami, FL, USA
Ruston J. Sanchez, MD
Plastic and Reconstructive Surgery Resident
University of Wisconsin
Madison, WI, USA
Lindsay A. Schuster, DMD, MS
Director Cleft-Craniofacial Orthodontics
Pediatric Plastic Surgery
Children’s Hospital of Pittsburgh of UMPC;
Clinical Assistant Professor of Plastic Surgery
Department of Plastic Surgery
University of Pittsburgh School of Medicine
Pittsburgh, PA, USA
Jeremiah Un Chang See, MD
Plastic Surgeon
Department of Plastic and Reconstructive
Surgery
Penang General Hospital
Georgetown, Penang, Malaysia
Pradip R. Shetye, DDS, BDS, MDS
Assistant Professor (Orthodontics)
Hansjörg Wyss Department of Plastic Surgery
NYU Langone Medical Center
New York, NY, USA
Roman Skoracki, MD
Plastic Surgery
The Ohio State University
Columbus, OH, USA
Mark B. Slidell, MD, MPH
Assistant Professor of Surgery
Department of Surgery
Section of Pediatric Surgery
University of Chicago Medicine Biological
Sciences
Chicago, IL, USA
Michael Sosin, MD
Research Fellow
Department of Plastic Surgery Institute of
Reconstructive Plastic Surgery
NYU Langone Medical Center
New York, NY, USA;
Research Fellow
Division of Plastic Reconstructive and
Maxillofacial Surgery
R Adams Cowley Shock Trauma Center
University of Maryland Medical Center
Baltimore, MD, USA;
Resident
Department of Surgery
Medstar Georgetown University Hospital
Washington, DC, USA
Youssef Tahiri, MD, MSc, FRCSC, FAAP,
FACS
Associate Professor
Pediatric Plastic & Craniofacial Surgery
Cedars Sinai Medical Center
Los Angeles, CA, USA
Peter J. Taub, MD
Professor
Surgery Pediatrics Dentistry and Medical
Education
Surgery Division of Plastic and Reconstructive
Surgery
Icahn School of Medicine at Mount Sinai
New York, NY, USA
Jesse A. Taylor, MD
Mary Downs Endowed Chair of Pediatric
Craniofacial Treatment and Research;
Director, Penn Craniofacial Fellowship;
Co-Director, CHOP Cleft Team
Plastic, Reconstructive, and Craniofacial Surgery
The University of Pennsylvania and
Children’s Hospital of Philadelphia
Philadelphia, PA, USA
Kathryn S. Torok, MD
Assistant Professor
Pediatric Rheumatology
University of Pittsburgh
Pittsburgh, PA, USA
Ali Totonchi, MD
Assistant Professor
Plastic Surgery
Case Western Reserve University;
Medical Director Craniofacial Deformity Clinic
Plastic Surgery
MetroHealth Medical Center
Cleveland, OH, USA
Kris Wilson, MD
Division of Plastic Surgery
Baylor College of Medicine
Houston, TX, USA
S. Anthony Wolfe, MD
Plastic Surgery
Miami Children’s Hospital
Miami, FL, USA
Akira Yamada, MD, PhD
Professor of Plastic Surgery
World Craniofacial Foundation
Dallas, TX, USA;
Clinical Assistant Professor
Plastic Surgery
Case Western Reserve University
Cleveland, OH, USA
Peirong Yu, MD
Professor
Plastic Surgery
M. D. Anderson Cancer Center;
Adjunct Professor
Plastic Surgery
Baylor College of Medicine
Houston, TX, USA
Ronald M. Zuker, MD, FRCSC, FACS,
FRCSEd(Hon)
Professor of Surgery
Department of Surgery
University of Toronto;
Staff Plastic and Reconstructive Surgeon
Department of Surgery
SickKids Hospital
Toronto, Ontario, Canada
VOLUME FOUR
Christopher E. Attinger, MD
Professor, Interim Chairman
Department of Plastic Surgery
Center for Wound Healing
Medstar Georgetown University Hospital
Washington, DC, USA
Lorenzo Borghese, MD
Plastic Surgeon
Chief of International Missions
Ospedale Pediatrico Bambino Gesù
Rome, Italy
Charles E. Butler, MD, FACS
Professor and Chairman
Department of Plastic Surgery
Charles B. Barker Endowed Chair in Surgery
The University of Texas M. D. Anderson Cancer
Center
Houston, TX, USA
David W. Chang, MD
Professor of Surgery
University of Chicago
Chicago, IL, USA
Karel Claes, MD
Department of Plastic and Reconstructive
Surgery
Ghent University Hospital
Ghent, Belgium
Mark W. Clemens II, MD, FACS
Associate Professor
Plastic Surgery
MD Anderson Cancer Center,
Houston, TX, USA
Shannon M. Colohan, MD, MSc
Assistant Professor of Surgery
University of Washington
Seattle, WA, USA
Peter G. Cordeiro, MD
Chief
Plastic and Reconstructive Surgery
Memorial Sloan Kettering Cancer Center
New York, NY, USA
Salvatore D’Arpa, MD, PhD
Department of Plastic and Reconstructive
Surgery
Ghent University Hospital
Ghent, Belgium

xxxiii
List of Contributors
Michael V. DeFazio, MD
Department Plastic Surgery
MedStar Georgetown University Hospital
Washington, DC, USA
A. Lee Dellon, MD, PhD
Professor of Plastic Surgery
Professor of Neurosurgery
Johns Hopkins University
Baltimore, MD, USA
Sara R. Dickie, MD
Clinical Associate of Surgery
University of Chicago Hospitals
Pritzker School of Medicine
Chicago, IL, USA
Ivica Ducic, MD, PhD
Clinical Professor of Surgery
GWU Washington Nerve Institute
McLean, VA, USA
Gregory A. Dumanian, MD
Stuteville Professor of Surgery
Division of Plastic Surgery
Northwestern Feinberg School of Medicine
Chicago, IL, USA
John M. Felder III, MD
Fellow in Hand Surgery
Plastic Surgery
Washington University in Saint Louis
St. Louis, MO, USA
Goetz A. Giessler, MD, PhD
Professor Director
Plastic-Reconstructive, Aesthetic and Hand
Surgery
Gesundheit Nordhessen
Kassel, Germany
Kevin D. Han, MD
Department of Plastic Surgery
MedStar Georgetown University Hospital
Washington, DC, USA
Piet Hoebeke
Department of Urology
Ghent University Hospital
Ghent, Belgium
Joon Pio Hong, MD, PhD, MMM
Professor of Plastic Surgery
Asan Medical Center, University of Ulsan
Seoul, South Korea
Michael A. Howard, MD
Clinical Assistant Professor of Surgery
Plastic Surgery
NorthShore University HealthSystem/University
of Chicago
Chicago, IL, USA
Jeffrey E. Janis, MD, FACS
Professor of Plastic Surgery, Neurosurgery,
Neurology, and Surgery;
Executive Vice Chairman, Department of Plastic
Surgery;
Chief of Plastic Surgery, University Hospitals
Ohio State University Wexner Medical Center
Columbus, OH, USA
Leila Jazayeri, MD
Microsurgery Fellow
Plastic and Reconstructive Surgery
Memorial Sloan Kettering Cancer Center
New York, NY, USA
Grant M. Kleiber, MD
Assistant Professor of Surgery
Division of Plastic and Reconstructive Surgery
Washington University School of Medicine
St. Louis, MO, USA
Stephen J. Kovach III, MD
Assistant Professor
Division of Plastic Surgery
University of Pennsylvania
Philadelphia, PA, USA
Robert Kwon, MD
Southwest Hand and Microsurgery
3108 Midway Road, Suite 103
Plano, TX, USA
Raphael C. Lee, MS, MD, ScD, FACS,
FAIMBE
Paul and Allene Russell Professor
Plastic Surgery, Dermatology, Anatomy and
Organismal Biology, Molecular Medicine
University of Chicago
Chicago, IL, USA
L. Scott Levin, MD, FACS
Chairman of Orthopedic Surgery
Department of Orthopaedic Surgery
University of Pennsylvania School of Medicine
Philadelphia, PA, USA
Otway Louie, MD
Associate Professor
Surgery
University of Washington Medical Center
Seattle, WA, USA
Nicolas Lumen, MD, PhD
Head of Clinic
Urology
Ghent University Hospital
Ghent, Belgium
Alessandro Masellis, MD
Plastic Surgeon
Euro-Mediterranean Council for Burns and Fire
Disasters
Palermo, Italy
Michele Masellis, MD
Former Chief of Department of Plastic and
Reconstructive Surgery and Burn Therapy
Department of Plastic and Reconstructive
Surgery and Burn Therapy - ARNAS Ospedale
Civico e Benfratelli
Palermo, Italy
Stephen M. Milner, MB BS, BDS
Professor of Plastic Surgery
Surgery
Johns Hopkins School of Medicine
Baltimore, MD, USA
Arash Momeni, MD
Fellow, Reconstructive Microsurgery
Division of Plastic Surgery
University of Pennsylvania Health System
Philadelphia, PA, USA
Stan Monstrey, MD, PhD
Department of Plastic and Reconstructive
Surgery
Ghent University Hospital
Ghent, Belgium
Venkateshwaran N, MBBS, MS, DNB, MCh,
MRCS(Intercollegiate)
Consultant Plastic Surgeon
Jupiter Hospital
Thane, India
Rajiv P. Parikh, MD, MPHS
Resident Physician
Department of Surgery, Division of Plastic and
Reconstructive Surgery
Washington University School of Medicine
St. Louis, MO, USA
Mônica Sarto Piccolo, MD, MSc, PhD
Director
Pronto Socorro para Queimaduras
Goiânia, Goiás, Brazil
Nelson Sarto Piccolo, MD
Chief
Division of Plastic Surgery
Pronto Socorro para Queimaduras
Goiânia, Goiás, Brazil
Maria Thereza Sarto Piccolo, MD, PhD
Scientific Director
Pronto Socorro para Queimaduras
Goiânia, Goiás, Brazil
Vinita Puri, MS, MCh
Professor and Head
Department of Plastic, Reconstructive Surgery
and Burns
Seth G S Medical College and KEM Hospital
Mumbai, Maharashtra, India
Andrea L. Pusic, MD, MHS, FACS
Associate Professor
Plastic and Reconstructive Surgery
Memorial Sloan Kettering Cancer Center
New York, NY, USA

xxxiv
List of Contributors
Vinay Rawlani, MD
Division of Plastic Surgery
Northwestern Feinberg School of Medicine
Chicago, IL, USA
Juan L. Rendon, MD, PhD
Clinical Instructor Housestaff
Department of Plastic Surgery
The Ohio State University Wexner Medical
Center
Columbus, OH, USA
Michelle C. Roughton, MD
Assistant Professor
Division of Plastic and Reconstructive Surgery
University of North Carolina at Chapel Hill
Chapel Hill, NC, USA
Hakim K. Said, MD, FACS
Associate Professor
Division of Plastic surgery
University of Washington
Seattle, WA, USA
Michel Saint-Cyr, MD, FRSC(C)
Professor
Plastic Surgery
Mayo Clinic
Rochester, MN, USA
Michael Sauerbier, MD, PhD
Professor, Chair
Department for Plastic, Hand, and
Reconstructive Surgery
Academic Hospital Goethe University Frankfurt
am Main
Frankfurt am Main, Germany
Loren S. Schechter, MD
Associate Professor and Chief
Division of Plastic Surgery
Chicago Medical School
Morton Grove, IL, USA
David H. Song, MD, MBA, FACS
Regional Chief, MedStar Health
Plastic and Reconstructive Surgery
Professor and Chairman
Department of Plastic Surgery
Georgetown University School of Medicine
Washington, DC, USA
Yoo Joon Sur, MD, PhD
Associate Professor
Department of Orthopedic Surgery
The Catholic University of Korea, College of
Medicine
Seoul, Korea
Chad M. Teven, MD
Resident
Section of Plastic and Reconstructive Surgery
University of Chicago
Chicago, IL, USA
VOLUME FIVE
Jamil Ahmad, MD, FRCSC
Director of Research and Education
The Plastic Surgery Clinic
Mississauga, Ontario, Canada;
Assistant Professor of Surgery
University of Toronto
Toronto, Ontario, Canada
Robert J. Allen Sr., MD
Clinical Professor of Plastic Surgery
Department of Plastic Surgery
New York University Medical Center
Charleston, NC, USA
Ryan E. Austin, MD, FRCSC
Plastic Surgeon
The Plastic Surgery Clinic
Mississauga, ON, Canada
Brett Beber, BA, MD, FRCSC
Plastic and Reconstructive Surgeon
Lecturer, Department of Surgery
University of Toronto
Toronto, Ontario, Canada
Philip N. Blondeel, MD
Professor of Plastic Surgery
Department of Plastic Surgery
University Hospital Ghent
Ghent, Belgium
Benjamin J. Brown, MD
Gulf Coast Plastic Surgery
Pensacola, FL, USA
Mitchell H. Brown, MD, MEd, FRCSC
Plastic and Reconstructive Surgeon
Associate Professor, Department of Surgery
University of Toronto
Toronto, Ontario, Canada
M. Bradley Calobrace, MD, FACS
Plastic Surgeon
Calobrace and Mizuguchi Plastic Surgery Center
Departments of Surgery, Divisions of Plastic
Surgery
Clinical Faculty, University of Louisville and
University of Kentucky
Louisville, KY, USA
Grant W. Carlson, MD
Wadley R. Glenn Professor of Surgery
Emory University
Atlanta, GA, USA
Bernard W. Chang, MD
Chief of Plastic and Reconstructive Surgery
Mercy Medical Center
Baltimore, MD, USA
Mark W. Clemens II, MD, FACS
Assistant Professor Plastic Surgery
M. D. Anderson Cancer Center
Houston, TX, USA
Robert Cohen MD, FACS
Medical Director
Plastic Surgery
Scottsdale Center for Plastic Surgery
Paradise Valley, AZ and;
Santa Monica, CA, USA
Amy S. Colwell, MD
Associate Professor
Harvard Medical School
Massachusetts General Hospital
Boston, MA, USA
Edward H. Davidson, MA(Cantab), MB, BS
Resident Plastic Surgeon
Department of Plastic Surgery
University of Pittsburgh Medical Center
Pittsburgh, PA, USA
Emmanuel Delay, MD, PhD
Unité de Chirurgie Plastique et Reconstructrice
Centre Léon Bérard
Lyon, France
Francesco M. Egro, MB ChB, MSc, MRCS
Department of Plastic Surgery
University of Pittsburgh Medical Center
Pittsburgh, PA, USA
Neil A. Fine, MD
President
Northwestern Specialists in Plastic Surgery;
Associate Professor (Clinical) Surgery/Plastics
Northwestern University Fienberg School of
Medicine
Chicago, IL, USA
Jaime Flores, MD
Plastic and Reconstructive Microvascular
Surgeon
Miami, FL, USA
Joshua Fosnot, MD
Assistant Professor of Surgery
Division of Plastic Surgery
The Perelman School of Medicine
University of Pennsylvania Health System
Philadelphia, PA, USA
Allen Gabriel, MD
Clinical Associate Professor
Department of Plastic Surgery
Loma Linda University Medical Center
Loma Linda, CA, USA
Michael S. Gart, MD
Resident Physician
Division of Plastic Surgery
Northwestern University Feinberg School of
Medicine
Chicago, IL, USA
Matthew D. Goodwin, MD
Plastic Surgeon
Plastic Reconstructive and Cosmetic Surgery
Boca Raton Regional Hospital
Boca Raton, FL, USA

xxxv
List of Contributors
Samia Guerid, MD
Cabinet
50 rue de la République
Lyon, France
Moustapha Hamdi, MD, PhD
Professor of Plastic and Reconstructive Surgery
Brussels University Hospital
Vrij Universitaire Brussels
Brussels, Belgium
Alexandra M. Hart, MD
Emory Division of Plastic and Reconstructive
Surgery
Emory University School of Medicine
Atlanta, GA, USA
Emily C. Hartmann, MD, MS
Aesthetic Surgery Fellow
Plastic and Reconstructive Surgery
University of Southern California
Los Angeles, CA, USA
Nima Khavanin, MD
Resident Physician
Department of Plastic and Reconstructive
Surgery
Johns Hopkins Hospital
Baltimore, MD, USA
John Y. S. Kim, MD
Professor and Clinical Director
Department of Surgery
Division of Plastic Surgery
Northwestern University Feinberg School of
Medicine
Chicago, IL, USA
Steven Kronowitz, MD
Owner, Kronowitz Plastics
PLLC;
University of Texas, M. D. Anderson Medical
Center
Houston, TX, USA
John V. Larson, MD
Resident Physician
Division of Plastic and Reconstructive Surgery
Keck School of Medicine of USC
University of Southern California
Los Angeles, CA, USA
Z-Hye Lee, MD
Resident
Department of Plastic Surgery
New York University Medical Center
New York, NY, USA
Frank Lista, MD, FRCSC
Medical Director
The Plastic Surgery Clinic
Mississauga, Ontario, Canada;
Assistant Professor Surgery
University of Toronto
Toronto, Ontario, Canada
Albert Losken, MD, FACS
Professor of plastic surgery and Program
Director
Emory Division of Plastic and Reconstructive
Surgery
Emory University School of Medicine
Atlanta, GA, USA
Charles M. Malata, BSc(HB), MB ChB,
LRCP, MRCS, FRCS(Glasg), FRCS(Plast)
Professor of Academic Plastic Surgery
Postgraduate Medical Institute
Faculty of Health Sciences
Anglia Ruskin University
Cambridge and Chelmsford, UK;
Consultant Plastic and Reconstructive Surgeon
Department of Plastic and Reconstructive
Surgery
Cambridge Breast Unit at Addenbrooke’s
Hospital
Cambridge University Hospitals NHS
Foundation Trust
Cambridge, UK
Jaume Masià, MD, PhD
Chief and Professor of Plastic Surgery
Sant Pau University Hospital
Barcelona, Spain
G. Patrick Maxwell, MD, FACS
Clinical Professor of Surgery
Department of Plastic Surgery
Loma Linda University Medical Center
Loma Linda, CA, USA
James L. Mayo, MD
Microsurgery Fellow
Plastic Surgery
New York University
New York, NY, USA
Roberto N. Miranda, MD
Professor
Department of Hematopathology
Division of Pathology and Laboratory Medicine
MD Anderson Cancer Center
Houston, TX, USA
Colin M. Morrison, MSc (Hons) FRCSI
(Plast)
Consultant Plastic Surgeon
St. Vincent’s University Hospital
Dublin, Ireland
Maurice Y. Nahabedian, MD, FACS
Professor and Chief
Section of Plastic Surgery
MedStar Washington Hospital Center
Washington DC, USA;
Vice Chairman
Department of Plastic Surgery
MedStar Georgetown University Hospital
Washington DC, USA
James D. Namnoum, MD
Clinical Professor of Plastic Surgery
Atlanta Plastic Surgery
Emory University School of Medicine
Atlanta, GA, USA
Maria E. Nelson, MD
Assistant Professor of Clinical Surgery
Department of Surgery, Division of Upper GI/
General Surgery, Section of Surgical Oncology
Keck School of Medicine
University of Southern California
Los Angeles, CA, USA
Julie Park, MD
Associate Professor of Surgery
Section of Plastic Surgery
University of Chicago
Chicago, IL, USA
Ketan M. Patel, MD
Assistant Professor of Surgery
Division of Plastic and Reconstructive Surgery
Keck Medical Center of USC
University of Southern California
Los Angeles, CA, USA
Nakul Gamanlal Patel, BSc(Hons),
MBBS(Lond), FRCS(Plast)
Senior Microsurgery Fellow
St. Andrew’s Centre for Plastic Surgery
Broomfield Hospital
Chelmsford, UK
Gemma Pons, MD, PhD
Head
Microsurgery Unit
Plastic Surgery
Hospital de Sant Pau
Barcelona, Spain
Julian J. Pribaz, MD
Professor of Surgery
Brigham and Women’s Hospital
Harvard Medical School
Boston, MA, USA
Venkat V. Ramakrishnan, MS, FRCS,
FRACS(Plast Surg)
Consultant Plastic Surgeon
St. Andrew’s Centre for Plastic Surgery
Broomfield Hospital
Chelmsford, UK
Elena Rodríguez-Bauzà, MD
Plastic Surgery Department
Hospital Santa Creu i Sant Pau
Barcelona, Spain
Michael R. Schwartz, MD
Board Certified Plastic Surgeon
Private Practice
Westlake Village, CA, USA
Stephen F. Sener, MD
Professor of Surgery, Clinical Scholar
Chief of Breast, Endocrine, and Soft Tissue
Surgery
Department of Surgery, Keck School of
Medicine of USC
Chief of Surgery and Associate Medical Director
Perioperative Services
LAC+USC (LA County) Hospital
Los Angeles, CA, USA

xxxvi
List of Contributors
Joseph M. Serletti, MD, FACS
The Henry Royster–William Maul Measey
Professor of Surgery and Chief
Division of Plastic Surgery
University of Pennsylvania Health System
Philadelphia, PA, USA
Deana S. Shenaq, MD
Chief Resident
Department of Surgery - Plastic Surgery
The University of Chicago Hospitals
Chicago, IL, USA
Kenneth C. Shestak, MD
Professor, Department of Plastic Surgery
University of Pittsburgh Medical Center
Pittsburgh, PA, USA
Ron B. Somogyi, MD MSc FRCSC
Plastic and Reconstructive Surgeon
Assistant Professor, Department of Surgery
University of Toronto
Toronto, ON, Canada
David H. Song, MD, MBA, FACS
Regional Chief, MedStar Health
Plastic and Reconstructive Surgery
Professor and Chairman
Department of Plastic Surgery
Georgetown University School of Medicine
Washington, DC, USA
The late Scott L. Spear†, MD
Formerly Professor of Plastic Surgery
Division of Plastic Surgery
Georgetown University
Washington, MD, USA
Michelle A. Spring, MD, FACS
Program Director
Glacier View Plastic Surgery
Kalispell Regional Medical Center
Kalispell, MT, USA
W. Grant Stevens, MD, FACS
Clinical Professor of Surgery
Marina Plastic Surgery Associates;
Keck School of Medicine of USC
Los Angeles, CA, USA
Elizabeth Stirling Craig, MD
Plastic Surgeon and Assistant Professor
Department of Plastic Surgery
University of Texas
MD Anderson Cancer Center
Houston, TX, USA
Simon G. Talbot, MD
Assistant Professor of Surgery
Brigham and Women’s Hospital
Harvard Medical School
Boston, MA, USA
Jana Van Thielen, MD
Plastic Surgery Department
Brussels University Hospital
Vrij Universitaire Brussel (VUB)
Brussels, Belgium
Henry Wilson, MD, FACS
Attending Plastic Surgeon
Private Practice
Plastic Surgery Associates
Lynchburg, VA, USA
Kai Yuen Wong, MA, MB BChir, MRCS,
FHEA, FRSPH
Specialist Registrar in Plastic Surgery
Department of Plastic and Reconstructive
Surgery
Cambridge University Hospitals NHS
Foundation Trust
Cambridge, UK
VOLUME SIX
Hee Chang Ahn, MD, PhD
Professor
Department of Plastic and Reconstructive
Surgery
Hanyang University Hospital School of Medicine
Seoul, South Korea
Nidal F. Al Deek, MD
Surgeon
Plastic and Reconstructive Surgery
Chang Gung Memorial Hospital
Taipei, Taiwan
Kodi K. Azari, MD, FACS
Reconstructive Transplantation Section Chief
Professor
Department of Orthopedic Surgery
UCLA Medical Center
Santa Monica, CA, USA
Carla Baldrighi, MD
Staff Surgeon
Pediatric Surgery Meyer Children’s Hospital
Pediatric Hand and Reconstructive Microsurgery
Unit
Azienda Ospedaliera Universitaria Careggi
Florence, Italy
Gregory H. Borschel, MD, FAAP, FACS
Assistant Professor
University of Toronto Division of Plastic and
Reconstructive Surgery;
Assistant Professor
Institute of Biomaterials and Biomedical
Engineering;
Associate Scientist
The SickKids Research Institute
The Hospital for Sick Children
Toronto, Ontario, Canada
Kirsty Usher Boyd, MD, FRCSC
Assistant Professor
Division of Plastic Surgery, University of Ottawa
Ottawa, Ontario, Canada
Gerald Brandacher, MD
Scientific Director
Department of Plastic and Reconstructive
Surgery
Johns Hopkins University School of Medicine
Baltimore, MD, USA
Lesley Butler, MPH
Clinical Research Coordinator
Charles E. Seay, Jr. Hand Center
Texas Scottish Rite Hospital for Children
Dallas, TX, USA
Ryan P. Calfee, MD
Associate Professor
Department of Orthopedic Surgery
Washington University School of Medicine
St. Louis, MO, USA
Brian T. Carlsen, MD
Associate Professor
Departments of Plastic Surgery and Orthopedic
Surgery
Mayo Clinic
Rochester, MN, USA
David W. Chang, MD
Professor
Division of Plastic and Reconstructive Surgery
The University of Chicago Medicine
Chicago, IL, USA
James Chang, MD
Johnson & Johnson Distinguished Professor
and Chief
Division of Plastic and Reconstructive Surgery
Stanford University Medical Center
Stanford, CA, USA
Robert A. Chase, MD
Holman Professor of Surgery – Emeritus
Stanford University Medical Center
Stanford, CA, USA
Alphonsus K. S. Chong, MBBS, MRCS,
MMed(Orth), FAMS (Hand Surg)
Senior Consultant
Department of Hand and Reconstructive
Microsurgery
National University Health System
Singapore;
Assistant Professor
Department of Orthopedic Surgery
Yong Loo Lin School of Medicine
National University of Singapore
Singapore
David Chwei-Chin Chuang, MD
Senior Consultant, Ex-President, Professor
Department of Plastic Surgery
Chang Gung University Hospital
Tao-Yuan, Taiwan
Kevin C. Chung, MD, MS
Chief of Hand Surgery
Michigan Medicine
Charles B G De Nancrede Professor, Assistant
Dean for Faculty Affairs
University of Michigan Medical School
Ann Arbor, Michigan, USA
Christopher Cox, MD
Attending Surgeon
Kaiser Permanente
Walnut Creek, CA, USA

xxxvii
List of Contributors
Catherine Curtin, MD
Associate Professor
Department of Surgery Division of Plastic
Surgery
Stanford University
Stanford, CA, USA
Lars B. Dahlin, MD, PhD
Professor and Consultant
Department of Clinical Sciences, Malmö – Hand
Surgery
University of Lund
Malmö, Sweden
Kenneth W. Donohue, MD
Hand Surgery Fellow
Division of Plastic Surgery
Department of Orthopedic Surgery
Baylor College of Medicine
Houston, TX, USA
Gregory A. Dumanian, MD, FACS
Stuteville Professor of Surgery
Division of Plastic Surgery
Northwestern Feinberg School of Medicine
Chicago, IL, USA
William W. Dzwierzynski, MD
Professor and Program Director
Department of Plastic Surgery
Medical College of Wisconsin
Milwaukee, WI, USA
Simon Farnebo, MD, PhD
Associate Professor and Consultant Hand
Surgeon
Department of Plastic Surgery, Hand Surgery
and Burns
Institution of Clinical and Experimental
Medicine, University of Linköping
Linköping, Sweden
Ida K. Fox, MD
Assistant Professor of Plastic Surgery
Department of Surgery
Division of Plastic and Reconstructive Surgery
Washington University School of Medicine
St. Louis, MO, USA
Paige M. Fox, MD, PhD
Assistant Professor
Department of Surgery, Division of Plastic and
Reconstructive Surgery
Stanford University Medical Center
Stanford, CA, USA
Jeffrey B. Friedrich, MD
Professor of Surgery and Orthopedics
Department of Surgery, Division of Plastic
Surgery
University of Washington
Seattle, WA, USA
Steven C. Haase, MD, FACS
Associate Professor
Department of Surgery, Section of Plastic
Surgery
University of Michigan Health
Ann Arbor, MI, USA
Elisabet Hagert, MD, PhD
Associate Professor
Department of Clinical Science and Education
Karolinska Institute;
Chief Hand Surgeon
Hand Foot Surgery Center
Stockholm, Sweden
Warren C. Hammert, MD
Professor of Orthopedic and Plastic Surgery
Chief, Division of Hand Surgery
Department of Orthopedics and Rehabilitation
University of Rochester
Rochester, NY, USA
Isaac Harvey, MD
Clinical Fellow
Department of Pediatric Plastic and
Reconstructive Surgery
Hospital for SickKids
Toronto, Ontario, Canada
Vincent R. Hentz, MD
Emeritus Professor of Surgery and Orthopedic
Surgery (by courtesy)
Stanford University
Stanford, CA, USA
Jonay Hill, MD
Clinical Assistant Professor
Anesthesiology, Perioperative and Pain Medicine
Stanford University School of Medicine
Stanford, CA, USA
Steven E. R. Hovius, MD, PhD
Former Head, Department of Plastic,
Reconstructive and Hand Surgery
Erasmus MC
University Medical Center
Rotterdam, the Netherlands;
Xpert Clinic, Hand and Wrist Center
The Netherlands
Jerry I. Huang, MD
Associate Professor
Department of Orthopedics and Sports
Medicine
University of Washington;
Program Director
University of Washington Hand Fellowship
University of Washington
Seattle, WA, USA
Marco Innocenti, MD
Associate Professor of Plastic Surgery,
University of Florence;
Director, Reconstructive Microsurgery
Department of Oncology
Careggi University Hospital
Florence, Italy
Neil F. Jones, MD, FRCS
Professor and Chief of Hand Surgery
University of California Medical Center;
Professor of Orthopedic Surgery;
Professor of Plastic and Reconstructive Surgery
University of California Irvine
Irvine, CA, USA
Ryosuke Kakinoki, MD, PhD
Professor of Hand Surgery and Microsurgery,
Reconstructive, and Orthopedic Surgery
Department of Orthopedic Surgery
Faculty of Medicine
Kindai University
Osakasayama, Osaka, Japan
Jason R. Kang, MD
Chief Resident
Department of Orthopedic Surgery
Stanford Hospital & Clinics
Redwood City, CA, USA
Joseph S. Khouri, MD
Resident
Division of Plastic Surgery, Department of
Surgery
University of Rochester
Rochester, NY, USA
Todd Kuiken, MD, PhD
Professor
Departments of PM&R, BME, and Surgery
Northwestern University;
Director, Neural Engineering Center for Artificial
Limbs
Rehabilitation Institute of Chicago
Chicago, IL, USA
Donald Lalonde, BSC, MD, MSc, FRCSC
Professor of Surgery
Division of Plastic and Reconstructive Surgery
Saint John Campus of Dalhousie University
Saint John, New Brunswick, Canada
W. P. Andrew Lee, MD
The Milton T. Edgerton MD, Professor and
Chairman
Department of Plastic and Reconstructive
Surgery
Johns Hopkins University School of Medicine
Baltimore, MD, USA
Anais Legrand, MD
Postdoctoral Research Fellow
Plastic and Reconstructive Surgery
Stanford University Medical Center
Stanford, CA, USA
Terry Light, MD
Professor
Department of Orthopedic Surgery
Loyola University Medical Center
Maywood, IL, USA
Jin Xi Lim, MBBS, MRCS
Senior Resident
Department of Hand and Reconstructive
Microsurgery
National University Health System
Singapore
Joseph Lopez, MD, MBA
Resident, Plastic and Reconstructive Surgery
Department of Plastic and Reconstructive
Surgery
Johns Hopkins University School of Medicine
Baltimore, MD, USA

xxxviii
List of Contributors
Susan E. Mackinnon, MD
Sydney M. Shoenberg, Jr. and Robert H.
Shoenberg Professor
Department of Surgery, Division of Plastic and
Reconstructive Surgery
Washington University School of Medicine
St. Louis, MO, USA
Brian Mailey, MD
Assistant Professor of Surgery
Institute for Plastic Surgery
Southern Illinois University
Springfield, IL, USA
Steven J. McCabe, MD, MSc, FRCS(C)
Director of Hand and Upper Extremity Program
University of Toronto
Toronto Western Hospital
Toronto, Ontario, Canada
Kai Megerle, MD, PhD
Assistant Professor
Clinic for Plastic Surgery and Hand Surgery
Technical University of Munich
Munich, Germany
Amy M. Moore, MD
Assistant Professor of Surgery
Division of Plastic and Reconstructive Surgery
Department of Surgery
Washington University School of Medicine
St. Louis, MO, USA
Steven L. Moran, MD
Professor and Chair of Plastic Surgery
Division of Plastic Surgery, Division of Hand and
Microsurgery;
Professor of Orthopedics
Rochester, MN, USA
Rebecca L. Neiduski, PhD, OTR/L, CHT
Dean of the School of Health Sciences
Professor of Health Sciences
Elon University
Elon, NC, USA
David T. Netscher, MD
Program Director, Hand Surgery Fellowship;
Clinical Professor, Division of Plastic Surgery
and Department of Orthopedic Surgery
Baylor College of Medicine;
Adjunct Professor of Clinical Surgery (Plastic
Surgery)
Weill Medical College
Cornell University
Houston, TX, USA
Michael W. Neumeister, MD
Professor and Chairman
Division of Plastic Surgery
Springfield Illinois University School of Medicine
Springfield, IL, USA
Shelley Noland, MD
Assistant Professor
Division of Plastic Surgery
Mayo Clinic Arizona
Phoenix, AZ, USA
Christine B. Novak, PT, PhD
Associate Professor
Department of Surgery, Division of Plastic and
Reconstructive Surgery
University of Toronto
Toronto, Ontario, Canada
Scott Oates, MD
Deputy Department Chair;
Professor
Department of Plastic Surgery, Division of
Surgery
The University of Texas MD Anderson Cancer
Center
Houston, TX, USA
Kerby Oberg, MD, PhD
Associate Professor
Department of Pathology and Human Anatomy
Loma Linda University School of Medicine
Loma Linda, CA, USA
Scott Oishi, MD
Director, Charles E. Seay, Jr. Hand Center
Texas Scottish Rite Hospital for Children;
Professor, Department of Plastic Surgery and
Department of Orthopedic Surgery
University of Texas Southwestern Medical Center
Dallas, TX, USA
William C. Pederson, MD, FACS
President and Fellowship Director
The Hand Center of San Antonio;
Adjunct Professor of Surgery
The University of Texas Health Science Center at
San Antonio
San Antonio, TX, USA
Dang T. Pham, MD
General Surgery Resident
Department of Surgery
Houston Methodist Hospital
Houston, TX, USA
Karl-Josef Prommersberger, MD, PhD
Chair, Professor of Orthopedic Surgery
Clinic for Hand Surgery
Bad Neustadt/Saale, Germany
Carina Reinholdt, MD, PhD
Senior Consultant in Hand Surgery
Center for Advanced Reconstruction of
Extremities
Sahlgrenska University Hospital/ Mölndal
Mölndal, Sweden;
Assistant Professor
Department of Orthopedics
Institute for Clinical Sciences
Sahlgrenska Academy
Goteborg, Sweden
Justin M. Sacks, MD, MBA, FACS
Director, Oncological Reconstruction;
Assistant Professor
Department of Plastic and Reconstructive
Surgery
Johns Hopkins School of Medicine
Baltimore, MD, USA
Douglas M. Sammer, MD
Associate Professor of Plastic and Orthopedic
Surgery
Chief of Plastic Surgery at Parkland Memorial
Hospital
Program Director Hand Surgery Fellowship
University of Texas Southwestern Medical Center
Dallas, TX, USA
Subhro K. Sen, MD
Clinical Associate Professor
Plastic and Reconstructive Surgery
Robert A. Chase Hand and Upper Limb Center
Stanford University School of Medicine
Stanford, CA, USA
Pundrique R. Sharma, MBBS, PhD and
FRCS (Plast)
Consultant Plastic Surgeon
Department for Plastic and Reconstructive
Surgery
Alder Hey Children’s Hospital
Liverpool, UK
Randolph Sherman, MD, FACS
Vice Chair
Department of Surgery
Cedars-Sinai Medical Center
Los Angeles, CA, USA
Jaimie T. Shores, MD
Clinical Director, Hand/Arm Transplant Program
Department of Plastic and Reconstructive
Surgery
Johns Hopkins University School of Medicine
Baltimore, MD, USA
Vanila M. Singh, MD, MACM
Clinical Associate Professor
Anesthesiology, Perioperative and Pain Medicine
Stanford University School of Medicine
Stanford, CA, USA
Jason M. Souza, MD, LCDR, MC, USN
Staff Plastic Surgeon, United States Navy
Walter Reed National Military Medical Center
Bethesda, MD, USA
Amir Taghinia, MD, MPH
Attending Surgeon
Department of Plastic and Oral Surgery
Boston Children’s Hospital;
Assistant Professor of Surgery
Harvard Medical School
Boston, MA, USA
David M. K. Tan, MBBS
Senior Consultant
Department of Hand and Reconstructive
Microsurgery
National University Health System
Singapore;
Assistant Professor
Department of Orthopedic Surgery
Yong Loo Lin School of Medicine
National University Singapore
Singapore

xxxix
List of Contributors
Jin Bo Tang, MD
Professor and Chair
Department of Hand Surgery;
Chair, The Hand Surgery Research Center
Affiliated Hospital of Nantong University
Nantong, The People’s Republic of China
Johan Thorfinn, MD, PhD
Senior Consultant of Plastic Surgery, Burn Unit;
Co-Director
Department of Plastic Surgery, Hand Surgery
and Burns
Linköping University Hospital
Linköping, Sweden
Michael Tonkin, MBBS, MD, FRACS(Orth),
FRCS(Ed Orth)
Professor of Hand Surgery
Department of Hand Surgery and Peripheral
Nerve Surgery
Royal North Shore Hospital
The Children’s Hospital at Westmead
University of Sydney Medical School
Sydney, New South Wales, Australia
Joseph Upton III, MD
Staff Surgeon
Department of Plastic and Oral Surgery
Boston Children’s Hospital;
Professor of Surgery
Harvard Medical School
Boston, MA, USA
Francisco Valero-Cuevas, PhD
Director
Brain-Body Dynamics Laboratory;
Professor of Biomedical Engineering;
Professor of Biokinesiology and Physical
Therapy;
(By courtesy) Professor of Computer Science
and Aerospace and Mechanical Engineering
The University of Southern California
Los Angeles, CA, USA
Christianne A. van Nieuwenhoven, MD, PhD
Plastic Surgeon/Hand Surgeon
Plastic and Reconstructive Surgery
Erasmus Medical Centre
Rotterdam, the Netherlands
Nicholas B. Vedder, MD
Professor of Surgery and Orthopedics
Chief of Plastic Surgery Vice Chair
Department of Surgery
University of Washington
Seattle, WA, USA
Andrew J. Watt, MD
Attending Hand and Microvascular Surgeon;
Associate Program Director, Buncke Clinic Hand
and Microsurgery Fellowship;
Adjunct Clinical Faculty, Stanford University
Division of Plastic and Reconstructive Surgery
The Buncke Clinic
San Francisco, CA, USA
Fu-Chan Wei, MD
Professor
Department of Plastic Surgery
Chang Gung Memorial Hospital
Taoyuan, Taiwan
Julie Colantoni Woodside, MD
Orthopedic Surgeon
OrthoCarolina
Gastonia, NC, USA
Jeffrey Yao, MD
Associate Professor
Department of Orthopedic Surgery
Stanford Hospital & Clinics
Redwood City, CA, USA

My wife, Gabrielle Kane, has always been my rock. She not
only encourages me in my work but gives constructive criti-
cism bolstered by her medical expertise as well as by her
knowledge and training in education. I can never repay her.
The editorial team at Elsevier have made this series possible.
Belinda Kuhn leads the group of Alexandra Mortimer, Louise
Cook, and the newest addition to the team, Sam Crowe. The
Elsevier production team has also been vital in moving this
project along. The volume editors, Geoff Gurtner, Peter Rubin,
Ed Rodriguez, Joe Losee, David Song, Mo Nahabedian, Jim
Chang, and Dan Liu have shaped and refined this edition,
making vital changes to keep the series relevant and up-to-
date. My colleagues in the University of Washington, headed
by Nick Vedder, have provided continued encouragement
and support. Finally, and most importantly, the residents and
fellows who pass through our program keep us on our toes
and ensure that we give them the best possible solutions to
their questions.
Peter C. Neligan, MB, FRCS(I), FRCSC, FACS
Driven by constant innovation, the field of head, neck, and
craniofacial surgery has truly evolved and made notewor-
thy advances over the last several decades. The diverse
expertise of the renowned contributors has provided the
latest clinical evidence and surgical techniques to facilitate
the decision-making process, which ultimately impacts the
outcomes of patients with conditions involving congenital,
oncologic, traumatic, and acquired deformities. This volume
is a comprehensive resource for specialists of all levels. It
has been a true privilege to work with such a distinguished
faculty willing to share their vast experience and insights
in their respective fields. It is with great admiration that I
sincerely thank the contributors for their generous donation
of time, commitment to excellence, dedication to education,
and advancement of the field.
Eduardo D. Rodriguez, MD, DDS
This volume represents the expertise of the current leaders
within pediatric plastic surgery; and I am grateful for their
dedication and efforts in making this “labor of love” a reality
and the standard within the field. This work is dedicated to
my families – at work and at home – and serves as a living
example of work–life integration for me. “Thank you” to my
work family – my colleagues, staff, patients and their families;
and, to my home family – Franklyn P. Cladis, MD and our son
Hudson. You all have and continue to provide significant
meaning to my life.
Joseph E. Losee, MD, FACS, FAAP
Acknowledgments

Dedicated to future plastic surgeons. Take up the torch
and lead us forward!

1 
Anatomy of the head and neck
Ahmed M. Afifi, Ruston J. Sanchez and Risal S. Djohan
SYNOPSIS
■ The superficial fascial layer of the face and neck is formed by the
superficial cervical fascia (enclosing the platysma), the superficial
facial fascia (synonymous with the superficial musculo-aponeurotic
system (SMAS)), the superficial temporal fascia (often called the
temporoparietal fascia), and the galea.
■ The deep fascial layer of the face and neck is formed by the deep
cervical fascia (or the general investing fascia of the neck), the deep
facial fascia (also known as the parotideomasseteric fascia), and the
deep temporal fascia. The deep temporal fascia is continuous with the
periosteum of the skull.
■ The deep temporal fascia splits into two layers at the level of the
superior orbital rim. The two layers insert into the superficial and deep
surfaces of the zygomatic arch.
■ The facial nerve is initially deep to the deep fascia, eventually
penetrating it towards the superficial fascia. The fat and connective
tissue filling the space between the superficial temporal fascia and the
superficial layer of the deep temporal fascia is a subject of significant
debate. Its importance stems from the temporal branch of the facial
nerve crossing from deep to superficial in this layer.
■ Most surgeons believe that it is the superficial temporal fat pad that
fills this space. Others believe there is a distinct fascial layer in this
region, named the parotideomasseteric fascia.
■ The facial nerve is at significant risk of injury in the area right above
the zygomatic arch.
■ Pitanguy’s line describes the course of the largest branch of the
temporal division of the facial nerve.
■ The marginal mandibular nerve can be located above or below the
level of the mandible. It is usually located between the platysma and
the deep cervical fascia and is always superficial to the facial vessels.
■ There are multiple fat pads in the face. They can be superficial to the
SMAS, between the SMAS and the deep fascia, or deep to the deep fascia.
■ Knowledge of the sensory nerves is important, especially within the
context of evaluating and treating migraine headaches.
Aesthetic and reconstructive surgery of the head and neck
depends on appreciating the three-dimensional anatomy and
the functional and cosmetic methods of rearranging the dif-
ferent structures. This chapter is not intended to be a detailed
description of the head and neck anatomy, which is beyond
such a limited space. It rather offers a different perspective on
the anatomy that is more relevant to the plastic surgeon and
highlights certain anatomical regions that have fundamental
importance or are more controversial.
The fascial planes of the head and
neck and the facial nerve
A peculiar feature of the anatomy of the head and neck is the
concentric arrangement of the facial soft tissues in layers.
These layers have different names and characteristics from
one area of the head and neck to the other, but they maintain
their continuity across boundaries (Fig. 1.1). Unfortunately,
inconsistent nomenclature has been used to describe these
layers leading to significant confusion among readers. The
facial nerve usually passes in defined planes in between these
layers, crossing from one layer to the other only in specific
well-described zones. Knowledge of these planes and their
relation to the facial nerve is vital if plastic surgeons are to
safely access the soft tissues and bony structures of the head
and neck.1,2 In the following discussion, we will not only
describe the anatomy and nomenclature of these layers as
mostly agreed upon, but also try to elucidate the sources of
deliberation and confusion in describing this crucial anatomy.3
The bordering regions of neck, cheek (lower face), temple,
and the scalp are arbitrarily divided by the lower border of
the mandible, the zygomatic arch, and the temporal line,
respectively. Topographically, there are two layers of fascia
covering the face, a superficial and deep, which cover these
regions and extend over other structures, such as the eyelid
and the nose (see Fig. 1.1).
The superficial layer of fascia is formed by the superficial
cervical fascia (platysma), the superficial facial fascia (SMAS),
the superficial temporal fascia (temporoparietal fascia), and

3
The fascial planes of the head and neck and the facial nerve
The deep layer of fascia is formed by the deep cervical fascia,
the deep facial fascia (parotideomasseteric fascia), the deep
temporal fascia, and the periosteum. This layer is superficial
to the muscles of mastication, the salivary glands and the
main neurovascular structures (see Figs. 1.1 & 1.2). Over bony
areas, such as the skull and the zygomatic arch, this deep
fascia is inseparable from the periosteum.
The facial fat pads are localized collections of fat present
deep to the superficial layer of fascia. These are anatomically
the galea aponeurotica (Figs. 1.1 & 1.2). To be more precise,
this superficial fascia splits to enclose many of the facial
muscles. This is a consistent pattern seen all over the head and
neck region; e.g., the superficial cervical fascia splits into a
deep and superficial layer to enclose the platysma, the super-
ficial facial fascia splits to enclose the midfacial muscles, and
the galea splits to enclose the frontalis. The two layers of the
superficial fascia then rejoin at the other end of the muscle,
before splitting again to enclose the next muscle and so on.
Fig. 1.1  The facial layers of the scalp, face, and neck.
Deep temporal fascia
Deep facial fascia
Deep
cervical fascia
Zygomatic
arch
Coronoid
process
Parotid gland
Mandible
Temporalis
Temporal bone
Periosteum
Skin
Galea
Superficial facial fascia,
enclosing mimetic
muscles of face (SMAS)
Superficial cervical fascia
(enclosing platysma)
Subcutaneous
fat
Superficial temporal
(temporoparietal) fascia

4
CHAPTER 1 • Anatomy of the head and neck
orbicularis oculi, oris, zygomaticus major and minor, frontalis,
and platysma, are enclosed by (or form part of) the SMAS.
The SMAS is often referred to as the superficial facial fascia.
In reality, the superficial facial fascia covers the superficial
and deep surfaces of the muscles. However, these layers are
hard to separate intraoperatively (except in certain areas such
as the neck). Dissection superficial to the superficial facial
fascia (just under the skin) will generally avoid injury to
the underlying facial nerve. However, such dissection can
compromise the blood supply of the overlying skin flaps.
Often, the surgeon can safely maintain this superficial fascia
in the lower face and neck (whether it is the platysma or
the SMAS) with the skin, allowing a secure double layer
closure and maintaining skin vascularity (e.g. during a neck
dissection). In the anterior (medial) face, the facial nerve
branches become more superficial just under or within the
SMAS layer.
and histologically distinct structures from the subcutaneous
fat present between the skin and the superficial fascia (which
will be discussed later). These fat pads include the superficial
temporal fat pad, the galeal fat pad, suborbicularis oculi fat
pad (SOOF), the retro-orbicularis oculi fat pad (ROOF), and
the preseptal fat of the eyelids. Deep to the deep fascia are
several other fat pads: the deep temporal fat pads, the buccal
fat pads, and the postseptal fat pads of the eyelids.4
The fascia in the face
The first layer the surgeon encounters in the face deep to
the skin and its associated subcutaneous fat is the SMAS
(superficial musculo-aponeurotic system) (see Figs. 1.1 &
1.2).5 The SMAS varies in thickness and composition between
individuals and from one area to another, and it can be fatty,
fibrous, or muscular.6 The muscles of facial expression, e.g.,
Fig. 1.2  The different fascial layers of the face and neck.
(A) Dissection in the superficial plane, between the skin and the
superficial fascia. (B) Elevation of the superficial fascial layer,
formed of the superficial cervical fascia (platysma), the superficial
facial fascia (SMAS), and the superficial temporal fascia
(temporoparietal fascia). (C) Note the proximity of the nerve (on
the blue background) to the zygomatic and mandibular ligaments
(at the tips of the left and right surgical instruments, respectively).
A
STF
SMAS
Platysma
STF
SMAS
Platysma
B
Superficial layer reflected
The nerves penetrate the deep fascia towards their
innervation of the SMAS and platysma
Zygomatic
ligament
and nerve
Mandibular
ligament
and
buccal
nerve
C

5
The fascial planes of the head and neck and the facial nerve
fascia (see Fig. 1.4A).5 Therefore, dissection in this plane
should be strictly on the deep temporal fascia, which can be
identified by its bright white color and sturdy texture. To
ensure that the surgeon is in the right plane, he or she can
attempt to grasp the areolar tissues over the deep temporal
fascia using an Adson forceps; if in the right plane, one will
not catch any tissue. Once deep enough and right on the deep
temporal fascia, dissection can proceed quickly using a peri-
osteal elevator hugging the tough deep temporal fascia
(Fig. 1.5).
In the region right above the zygomatic arch the space
between the superficial TPF and the deep temporal fascia
(sometimes referred to as the subaponeurotic space) and the
fat/fascia it contains is both a debatable and an important
subject (see Fig. 1.4). Its importance stems from the facial
nerve crossing this space from deep to superficial right above
the zygomatic arch. A third layer of fascia has been described
in this space (between the superficial and deep temporal
fascia) and is referred to as the parotidotemporal fascia, the
subgaleal fascia, or the innominate fascia.10,11 The term “fascial
layer” is used loosely, as there is no general consensus as to
how thick connective tissue must be before it can be consid-
ered a “fascial layer”. What some authors refer to as “loose
connective tissue” may be called a “fascial layer” or a “fat
pad” by others. Our own cadaver dissection showed that this
third fascial layer could often be identified. It extends for a
short distance above and below the arch. Directly superficial
to the arch, the facial nerve is deep to this layer, piercing it to
become more superficial 1–2 cm cephalad to the arch (see
below).
Above the zygomatic arch and at the same horizontal level
as the superior orbital rim, the deep temporal fascia splits into
two layers: the superficial layer of the deep temporal fascia
(sometimes referred to as the middle temporal fascia, inter-
mediate fascia, or the innominate fascia) and the deep layer
of the deep temporal fascia (see Fig. 1.3).7 The deep and
superficial layers of the deep temporal fascia attach to the
superficial and deep surfaces of the zygomatic arch. There are
three fat pads in this region.7,12 The superficial fat pad is
located between the superficial temporal fascia and superficial
layer of the deep temporal fascia and, as described above, is
analogous with the parotidotemporal fascia, subgaleal fascia,
and/or the loose connective tissue between the superficial
and deep temporal fascia. The middle fat pad is located
directly above the zygomatic arch between the superficial and
deep layers of the deep temporal fascia. Finally, the deep fat
pad (also known as the buccal fat pad) is deep to the deep
layer of the deep temporal fascia, superficial to the temporalis
muscles and extends deep to the zygomatic arch. It is consid-
ered an extension of the buccal fat pad.
Most of the controversy in describing the fascial layers in
the temporal region arises from confusing the superficial tem-
poral fascia with the superficial layer of the deep temporal fascia.
This is very significant since the facial nerve is deep to or
within the former and superficial to the latter. The second
point is the location of the deep temporal fascia superficial to
the temporalis muscle. There is another fascial layer on the
deep surface of the muscle; this is not the deep temporal fascia
and is of little significance from a surgical standpoint. The
final controversy is what exactly is the innominate fascia? This
term is often used to describe the superficial layer of the deep
temporal fascia above the arch. Other surgeons reserve the
The next layer in the face is the deep facial fascia, which is
also known as the parotideomasseteric fascia (see Figs. 1.1 &
1.2). Over the parotid gland, this layer is adherent to the
capsule of the gland. The facial nerve is initially (i.e., right
after it exits the parotid gland) deep to the deep facial fascia.
Most of the muscles of facial expression are superficial to the
planes of the nerve. The nerve branches pierce the deep fascia
to innervate the muscles from their deep surface, with the
exception of the mentalis, levator anguli oris, and the buccina-
tors (see Fig. 1.2). These three muscles are deep to the facial
nerve and are thus innervated on their superficial surface.
The fascia in the temporal region
The cheek and lower face are separated from the temporal
region by the zygomatic arch. There are two layers of fascia
in the temporal region (below the skull temporal lines): the
superficial temporal fascia (also known as the temporoparietal
fascia (TPF)) and the deep temporal fascia (Figs. 1.3 & 1.4A).7–9
The deep temporal fascia lies on the superficial surface of the
temporalis muscle. Between the superficial and deep temporal
fascia is a loose areolar plane that is relatively avascular and
easily dissected. However, the frontal branch of the facial
nerve is within or directly beneath the superficial temporal
Fig. 1.3  The facial layers of the temporal region. The fat/fascia in the
subaponeurotic plane (arrow; between the temporal fascia and deep temporal
fascia) is intimately related to the facial nerve. Some authors believe that there is a
separate fascial layer in this space, referred to as the parotideomasseteric fascia.
Deep temporal fascia
Zygomatic
arch
Coronoid process
of mandible
Masseter
Temporalis
Middle temporal fat pad
Sentinel vein
Temporal bone
Hair
Skin
Ear
SMAS
Facial nerve
Parotidomasseter
fascia
Frontal branch
of facial nerve
Subcutaneous fat
Superficial
temporal
fascia

6
CHAPTER 1 • Anatomy of the head and neck
While the fascial layers in the temporal region are well
described, there is more debate and variability of the anatomy
of the fascial layers and the facial nerve directly superficial to
the arch.12,14,15 The superficial facial fascia (SMAS) is continu-
ous with the TPF, but it is not clear if the deep facial and deep
temporal fasciae are continuous to each other or attach and
arise from the periosteum of the arch separately. In addition,
the thickness of the soft tissues from the periosteum to skin is
minimal and the tissues are tightly adherent, making identi-
fication of the fascial planes and the facial nerve hazardous in
this region.16 The frontal branch of the facial nerve pierces the
deep temporal fascia to become more superficial near the
vicinity of the upper border of the arch, and this area consti-
tutes one of the danger zones of the face (see below).
The fascia in the neck
The nomenclature used to describe the different fascial layers
in the neck also creates significant confusion. There are two
different fascias in the neck: the superficial and the deep (Figs.
1.3 & 1.6). The latter is composed of three different layers: (1)
the superficial layer of the deep cervical fascia, also known as
term to the areolar tissue between the superficial layer of the
deep temporal fascia and the superficial temporal fascia (i.e.,
the innominate fascia can be synonymous with the paroti-
dotemporal fascia or subgaleal fascia or the superficial tem-
poral fat pad).13
The plane of dissection in the temporal region depends on
the goal of the surgery (see Fig. 1.4). In general, the surgeon
should avoid the superficial temporal fascia as it harbors the
frontal branch of the facial nerve. During surgery to expose
the orbital rims and the forehead musculature, the dissection
plane is between the superficial temporal fascia and deep
temporal fascia (see Fig. 1.4A). To expose the arch, the super-
ficial layer of the deep temporal fascia is divided and dissec-
tion proceeds between it and the middle fat pad (the superficial
layer of the deep temporal fascia will act as an extra layer
protecting the nerve) (see Fig. 1.4B). Finally, when a coronal
approach is used, but the arch does not need to be exposed,
dissection can proceed deep to the temporalis muscles, elevat-
ing them with the coronal flap (see Fig. 1.4B). Using this
avascular plane avoids potential traction or injury to the
frontal nerve and ensures good aesthetic results as it prevents
possible fat atrophy or retraction of the temporalis muscle.
Fig. 1.4  The different planes of dissection in the temporal region. (A) Dissection
between the superficial temporal fascia (temporoparietal fascia) and the deep
temporal fascia. In this plane, the surgeon should try to stay right on the deep
temporal fascia. (B) Dissection deep to the deep temporal fascia. This is a safe plan
that will lead to the zygomatic arch. The facial nerve will be protected by the
superficial layer of the deep temporal fascia. (C) Dissection deep to the temporalis
muscle. The muscle can be left as part of the skin flap. This is a safe and easy plan
if no exposure of the arch is needed.
A
Superficial
temporal
fascia
Galea
Facial nerve
B
Superficial layer of deep
temporal fascia
Middle temporal fat pad
Periosteum
Deep
temporal
fascia
C
Temporalis muscle
Superficial
layer
Deep layer

7
Retaining ligaments and adhesions of the face
cervical fascia represent the continuation of the SMAS into the
neck. In general, when skin flaps are raised in the neck, the
platysma muscle is maintained with the skin to enhance its
blood supply (e.g. during neck dissections). However, in
necklifts the skin is raised off the platysma to allow platysmal
shaping and skin redraping. Tissue expanders placed in the
neck could be placed either deep or superficial to the platysma.
Placing them superficially will create thinner flaps that are
more suitable for facial resurfacing, while placing them deeper
allows a more secure coverage of the expander.19,20
The superficial layer of deep cervical fascia, or the general
investing layer of deep cervical fascia, is what plastic surgeons
commonly refer to simply as the “deep cervical fascia”. It
encircles the whole neck and has attachments to the spinous
processes of the vertebrae and the ligamentum nuchae poste-
riorly. It splits to enclose the sternocleidomastoid and the
trapezius muscles. It also splits to enclose the parotid and the
submandibular glands. The deep facial fascia, or parotideo-
masseteric fascia, is therefore considered the continuation of
the deep cervical fascia into the face.
Retaining ligaments and adhesions
of the face
The ligaments of the face maintain the skin and soft tissues of
the face in their normal positions, resisting gravitational
changes. Knowledge of their anatomy is important for both
the craniofacial and the aesthetic surgeon for several reasons.
For the aesthetic surgeon, these ligaments play an important
role in maintaining facial fat in its proper positions. For ideal
aesthetic repositioning of the skin and soft tissues of the face,
numerous surgeons recommend releasing the ligaments. For
the craniofacial surgeon, the zones of adherence represent
coalescence between different fascial layers, possibly luring
the surgeon into an erroneous plane of dissection. In facial
reconstruction or face transplants, reconstructing or maintain-
ing these ligaments is important to prevent sagging of the soft
tissues with its functional and aesthetic consequences.
Various terms have been used to describe these ligamen-
tous attachments. Moss et al. classified them into ligaments
(connecting deep fascia/periosteum to the dermis), adhesions
(fibrous attachments between the deep and the superficial
fascia), and septi (fibrous wall between layers).21
In the periorbital and temporal region, various ligaments
and adhesions have been described with numerous names
given to each (Fig. 1.7). Along the skull temporal line lies the
temporal line of fusion, also known as the superior temporal
septum, which represents the coalition of the temporal fascia
with the skull periosteum. These adhesions end as the tem-
poral ligamentous adhesions (TLA) at the lateral third of the
eyebrow.21 The TLA measure approximately 20 mm in height
and 15 mm in width and begin 10 mm cephalad to the supe-
rior orbital rim. Both the temporal line of fusion and the TLA
are sometimes referred to collectively as temporal adhesions.
The inferior temporal septum extends posteriorly and inferi-
orly from the TLA on the surface of the deep temporal fascia
towards the upper border of the zygoma. It separates the
upper temporal region superiorly from the lower temporal
region inferiorly and represents the upper boundary of the
parotideomasseteric fascia (the fascial layer between the
superficial and the deep temporal fascia in the region just
the general investing layer of deep cervical fascia; (2) the
middle layer, commonly named the pretracheal fascia; and (3)
the deep layer, or the prevertebral fascia (see Figs. 1.3 & 1.6).
The pretracheal fascia encircles the trachea, thyroid, and the
esophagus, while the prevertebral fascia encloses the prever-
tebral muscles and forms the floor of the posterior triangle of
the neck. For practical purposes, it is the superficial cervical
fascia and the superficial layer of the deep cervical fascia that
the plastic surgeon encounters.17,18
The superficial cervical fascia encloses the platysma muscle
and is closely associated with the subcutaneous adipose
tissue. The platysma muscle and its surrounding superficial
Fig. 1.5  Dissection in the temporal layer.
Superficial temporal fascia
(temporoparietal fascia)
Deep temporal fascia
Temporalis
Loose areolar tissue
Fig. 1.6  Fascial layers of the neck. 1, Investing layer of deep cervical fascia; 2,
pretracheal fascia; 3, carotid sheath; 4, superficial fascia; 5, prevertebral fascia.
(Reprinted with permission from © Elsevier Inc. All rights
reserved.)
Cross section
1
2
3
4
5

8
CHAPTER 1 • Anatomy of the head and neck
oculi muscle at the junction of its pretarsal and orbital
components.
In the midface, the retaining ligaments have been divided
into direct, or osteocutaneous, ligaments and indirect liga-
ments. Direct ligaments run directly from the periosteum to
the dermis, and include the zygomatic and mandibular liga-
ments. Indirect ligaments represent a coalescence between the
superficial and deep fascia and include the parotid and
the masseteric cutaneous ligaments (Fig. 1.9; see Fig. 1.2C).
The retaining ligaments indirectly fix the mobile skin and its
intimately related superficial fascia (SMAS) to the relatively
immobile deep fascia and underlying structures (masseter
and parotid).
The zygomatic and the masseteric ligaments together form
an inverted L, with the angle of the L formed by the major
zygomatic ligaments (Fig. 1.9; see Fig. 1.2C). These ligaments
are typically around 5–15 mm wide and are located 4.5 cm in
front of the tragus and 5–9 mm behind the zygomaticus minor
muscle.26–30 Anterior to this main ligament are multiple other
bundles that form the horizontal limb of the inverted L. There
have been different descriptions of the anatomy of these
above the zygomatic arch).22 The supraorbital ligamentous
adhesions extend from the TLA medially along the eyebrow.
The orbicularis retaining ligament (ORL) lies along the
superior, lateral, and inferior rims of the orbit, extending from
the periosteum just outside the orbital rim to the deep surface
of the orbicularis oculi muscle (Fig. 1.8).23,24 This ligament
serves to anchor the orbicularis oculi muscle to the orbital
rims. The orbicularis oculi muscle attaches directly to the bone
from the anterior lacrimal crest to the level of the medial
limbus. At this level the ORL replaces the bony origin of the
muscle, continuing laterally around the orbit. Initially short,
it reaches its maximum length centrally near the lateral
limbus.25 It then begins to diminish in length laterally, until it
finally blends with the lateral orbital thickening (LOT). The
LOT is a condensation of the superficial and deep fascia on
the frontal process of the zygoma and the adjacent deep
temporal fascia. The ORL and the orbital septum both attach
to the arcus marginalis, a thickening of the periosteum of the
orbital rims.24 The ORL is also referred to as the periorbital
septum and, in its inferior portion, as the orbitomalar liga-
ment. The ORL attaches to the undersurface of the orbicularis
Fig. 1.7  The ligaments of the periorbital region.
Superior temporal septum
Temporalis
Corrugator supercilii
Inferior temporal septum
Attachment of orbicularis retaining ligament
Temporal ligamentous adhesion
Supraorbital ligamentous adhesion
Frontal branch of facial nerve
Zygomaticotemporal nerve
Zygomaticofacial nerve
Lateral orbital thickening
Lateral brow thickening
Sentinel vein

9
The buccal fat pad
boundary of the prezygomatic space is the orbicularis retain-
ing ligament, which separates it from the preseptal space.
The more rigid inferior boundary is formed by the reflection
of the fascia covering the floor as it curves superficially to
blend with the fascia on the undersurface of the orbicularis
oculi. This inferior boundary is further reinforced by the
zygomatic retaining ligaments. Medially, the space is closed
by the origins of the levator labii and the orbicularis oculi
muscle from the medial orbital rim. Finally, the lateral
boundary is formed superiorly by the LOT over the frontal
process of the zygoma and more inferiorly by the zygomatic
ligaments.34 The facial nerve branches cross in the roof of
(i.e., superficial to) this space. The only structure traversing
the prezygomatic space is the zygomatic branch of the facial
nerve, emerging from its foramen located just caudal to
the ORL.
The malar fat pad and the
subcutaneous fat compartments
of the face
Rohrich and Pessa, in an extensive study of the facial subcu-
taneous fat, found the cheek to be partitioned into multiple,
independent anatomical compartments superficial to the
superficial fascia.35 These subcutaneous fat compartments
(also referred to as fat pads) are separated by distinct facial
condensations that arise from the superficial fascia and insert
into the dermis of the skin.36–38 These superficial fat pads
include the nasolabial, jowl, malar, or cheek (subdivided into
medial, middle, and lateral-temporal compartments); perior-
bital (subdivided into inferior, superior, and lateral compart-
ments); and forehead (subdivided into central and medial
compartments).36 This anatomy is important because elements
of facial aging may be characterized by how these compart-
ments change relatively in both position and volume with
time.38 Elevation of the malar fat pad, which is triangular in
shape with its base at the nasolabial crease and its apex more
laterally towards the body of the zygoma, is important for
facial rejuvenation and in facial palsy.39 During facelift dissec-
tion, septal transition zones between these superficial fat
compartments are regions of potential injury to deeper struc-
tures, including branches of the facial nerve as well as the
greater auricular nerve.38
The buccal fat pad
The buccal fat pad is an underappreciated factor in post-
traumatic facial deformities and senile aging and is frequently
overlooked as a flap or graft donor site.40,41 Senile laxity of the
fascia allows the fat to prolapse laterally, contributing to the
square appearance of the face.42 With many traumatic injuries
the fat herniates, either superficially, towards the oral mucosa,
or even into the maxillary sinus.25,43–45 This fat is anatomically
and histologically distinct from the subcutaneous fat. It is
voluminous in infants to prevent indrawing of the cheek
during suckling, and gradually decreases in size with age.46 It
functions to fill the glide planes between the muscles of
mastication.
zygomatic ligaments, likely related to the variability in their
thickness and location, as well as the different criteria used by
different authors to define what is truly a “ligament”. Often
the surgeon will encounter these ligaments along the whole
length of the zygomatic arch.30 The vertical limb of the L is
formed by the masseteric ligaments, which are stronger near
their upper end (at the zygomatic ligaments), and extend
along the entire anterior border of the masseter as far as the
mandibular border.5,31 The parotid ligaments, also referred to
as preauricular ligaments, represent another area of firm
adherence between the superficial and deep fascia.26,28,29 The
mandibular ligaments originate from the parasymphyseal
region of the mandible around 1 cm above the lower man-
dibular border.28,29 There are several descriptions of other
retaining ligaments in the face, most notably the mandibular
septum and the orbital retaining septum.32,24
The prezygomatic space
The prezygomatic space is a glide plane space overlying the
body of the zygoma, deep to the orbicularis oculi and the
suborbicularis fat (see Fig. 1.8).33 Its floor is formed by a fascial
layer covering the body of the zygoma and the lip elevator
muscle (namely the zygomaticus major, zygomaticus minor,
and the levator labii superioris). This fascial layer extends
caudally over the muscles, gradually becoming thinner and
allowing the muscle to be more discernible. The superior
Fig. 1.8  The orbicularis retaining ligaments.
Skin
Orbicularis oculi
Orbicularis oculi
Lower tarsus
Upper tarsus
Orbicularis retaining
ligaments
Orbicularis retaining
ligaments
Orbital septum
Orbital septum
Orbital rim

10
CHAPTER 1 • Anatomy of the head and neck
The facial nerve
During most facial plastic surgeries, whether congenital,
reconstructive, or aesthetic, there are one or more branches
of the facial nerve that are at risk for injury. Although
there is abundant literature on the anatomy of the facial
nerve branches, the majority of publications describe two-
dimensional anatomy, depicting the trajectory of the nerve
and its surface anatomy in relation to anatomic landpoints
(see Fig. 1.3).9,16,48–55 However, it is the third dimension, the
depth of the facial nerve in relation to the layers of the face,
that is most relevant to the practicing surgeon. In spite of
the significant variability in the branching patterns, the facial
nerve consistently passes in defined planes, crossing from one
plane to another in certain zones.1 It is in these “danger zones”
that dissection should be avoided or done carefully. In the rest
of the face, the dissection can proceed relatively quickly by
adhering to a certain plane, either superficial or deep to the
plane of the nerve.
It is usually described as being formed of a central body
and four extensions, the buccal, pterygoid, and superficial and
deep temporal. The body is located on the periosteum of the
posterior maxilla (surrounding the branches of the internal
maxillary artery) overlying the buccinator muscle and extends
forwards in the vestibule of the mouth to the level of the
maxillary second molar. The buccal extension is the most su-
perficial, extending along the anterior border of the masseter
around the parotid duct. Both the body and the buccal exten-
sion are superficial to the buccinator and deep to the deep
facial fascia (parotideomasseteric fascia) and are intimately
related to the facial nerve branches and the parotid duct. The
buccal extension is in the same plane as the facial artery, which
marks its anterior boundary. The pterygoid extension passes
backwards and downwards deep to the mandibular ramus to
surround the pterygoid muscles. The deep temporal extension
passes superiorly between the temporalis and the zygomatic
arch. The superficial temporal extension is actually totally
separate from the main body and lies between the two layers
of the temporal fascia above the zygomatic arch.47
Fig. 1.9  The retaining ligaments of the face. (Reproduced with permission from Gray’s Anatomy 40e, Standring S (ed), Churchill Livingstone, London, 2008.)
A
B
Zygomatic cutaneous ligament
Preauricular parotid cutaneous ligament
parotideomasseteric cutaneous ligament
Platysma cutaneous ligament
Mandibular ligament

11
The facial nerve
5. By following the terminal branches of the nerve
proximally.
The nerve passes forwards and downwards to pierce the
parotid gland. In the parotid gland the nerve divides into the
zygomaticotemporal and the cervicofacial divisions, which in
turn divide into the five terminal branches of the facial nerve:
frontal, zygomatic, buccal, marginal mandibular, and cervical
(Fig. 1.10). However, the zygomatic and buccal branches show
significant variability in their location and branching patterns,
as well as a significant overlap in the muscles they innervate
– they are sometimes grouped together and referred to as
“zygomaticobuccal”. The temporal and the mandibular
branches are perhaps at the highest risk for iatrogenic injury,
especially as the muscles they innervate show little if any
cross-innervation, making injury to these branches much
more noticeable.
Frontal (temporal) branch
This consists of 3–4 branches that innervate the orbicularis
oculi muscle, the corrugators and the frontalis muscle. Several
anatomic landmarks are used to describe their surface
anatomy. The most common description is Pitanguy’s line,
extending from 0.5 cm below the tragus to a point 1 cm above
the lateral edge of the eyebrow (or 1 cm lateral to the lateral
canthus).9,56 Ramirez described the nerve as crossing the
zygomatic arch 4 cm behind the lateral canthus.57 However,
other surgeons describe the area spanning the middle two-
thirds of the arch as the territory of the nerve. Gosain et al.
found frontal nerve branches are found at the lower border of
the zygomatic arch between 10 mm anterior to the external
The facial nerve nucleus lies in the lower pons and is
responsible for motor innervation to all the muscles derived
from the second branchial arch. A few sensory fibers originat-
ing in the tractus solitarius join the facial nerve to supply the
skin of the external acoustic meatus. The nerve emerges from
the lower border of the pons, passes laterally in the cerebel-
lopontine angle, and enters the internal acoustic meatus. The
facial nerve then traverses the temporal bone (being liable to
injury in temporal bone fractures) to exit the skull through the
stylomastoid foramen. Just after its exit it is enveloped by a
thick layer of fascia that is continuous with the skull perios-
teum and is surrounded by a small aggregation of fat and
usually crossed by a small blood vessel. This makes its iden-
tification in this area a challenging task. Several methods for
identification of the facial nerve trunk have been described:
1. If the tragal cartilage is followed to its deep end, it
terminates in a point. The nerve is 1 cm deep and
inferior to this “tragal pointer”. There is an avascular
plane anterior to the surface of the tragus that allows a
safe and quick dissection to this tragal pointer.
2. By following the posterior belly of the digastric
posteriorly, the nerve is found passing laterally
immediately deep to the upper border of the posterior
end of the muscle.
3. If the anterior border of the mastoid process is traced
superiorly, it forms an angle with the tympanic bone.
The nerve bisects the angle formed between these two
bones (at the tympanomastoid suture).
4. By feeling the styloid process in between the mastoid
bone and the posterior border of the mandible. The
nerve is just lateral to this process.
Fig. 1.10  The facial nerve.
Parotid gland
Posterior
auricular nerve
Zygomaticotemporal division
Cervicofacial division
Marginal mandibular
branches
Cervical branch
Buccal branches
Zygomatic branches
Temporal branches

12
CHAPTER 1 • Anatomy of the head and neck
retaining ligaments can aid in identification of these nerve
branches. As mentioned previously, the major zygomatic liga-
ment is located around 45 mm in front of the tragus (it might
be helpful to mark this location on the skin prior to facelift
surgery). Medial to this ligament is the zygomaticus major
muscle and the overlying prezygomatic space, and just infe-
rior to this ligament are the upper zygomatic branches of the
facial nerve. These branches are deep to the deep facial fascia
at this level. The lower zygomatic branches of the facial nerve
pass inferior to the upper masseteric ligaments and are closer
to the SMAS. Therefore, both the zygomatic and upper mas-
seteric ligaments should be divided close to the SMAS to
protect the facial nerve branches.30 The buccal branches
emerge from the parotid in the same plane as the parotid duct
(deep to the parotideomasseteric fascia). They pierce the deep
fascia at the anterior edge of the masseter, close to the mas-
seteric cutaneous ligaments (see Fig. 1.2C). Together, the
zygomatic and buccal branches supply the orbicularis oculi,
midfacial muscle, orbicularis oris, and the buccinator. Unlike
the marginal mandibular and the frontal divisions, there are
a number of communicating branches between the buccal and
zygomatic divisions, and injury to a single branch of these
nerves is usually unnoticeable. Facial lacerations medial to the
level of the lateral canthus are usually not amenable to explo-
ration or repair of the facial nerve.
Marginal mandibular
The marginal mandibular nerve is one of the most commonly
encountered branches of the facial nerve and is in jeopardy in
multiple operations, including neck dissections, submandibu-
lar sialadenectomy, and exposure of the mandible.65 There are
numerous descriptions and variations of both the trajectory
of the nerve and its plane (i.e. depth), necessitating care in a
wide area of dissection in the lower face and the submandibu-
lar triangle.2,50,66–70 In addition, the nerve can vary between a
single branch and up to 3 or 4 branches.2,67,71,72
After exiting the parotid gland near its lower border, the
nerve loops downward, often below the mandibular border.
Whether the nerve crosses the mandibular border into the
submandibular triangle in all individuals is a matter of
debate.2,66,73 Although several cadaver studies found the nerve
to be more commonly above the mandibular border, clinical
experience has shown that it is frequently located in the
submandibular triangle, up to 3 or even 4 cm below the
mandible.2,50,66,74–76 This might also vary with the position of
the neck, and the surgeon must consider the wide variability
of the nerve location in his dissection.2 The nerve then passes
upwards back into the face midway between the angle and
mental protuberance. Once the nerve crosses the facial vessels,
its major trunk is usually above the border of the mandible,
although smaller branches may continue in the neck to supply
the platysma.2
After exiting the parotid gland, the nerve is initially deep to
the parotideomasseteric fascia. In the submandibular triangle,
the nerve is usually described as lying between the platysma
and the deep cervical fascia. However, it might occasionally
be found deep to the deep fascia near the superficial surface of
the submandibular gland. The nerve is deep to the platysma
and superficial to the facial vessels throughout its course. As
the nerve crosses into the lower face, the platysma thins and
the nerve can be injured during a subcutaneous dissection.
auditory meatus and 19 mm posterior to the lateral orbital
rim.16 Finally, Zani et al. in 300 cadaver dissections reported
that the nerve is in a region limited by two straight diverging
lines; the first line from the upper tragus border to the most
cephalic wrinkle of the frontal region, and the second line
from the lower tragus border to the most caudal wrinkle of
the frontal region.51 Although there is no connection between
the frontal nerve and other branches of the facial nerve, there
are connections within the frontal branches themselves.16 In
addition, the more posterior divisions of the frontal nerve
may be less clinically significant than the anterior branches,
the injury of which will lead to noticeable brow deformities.16
A line from the tragus to 1 cm above the lateral eyebrow or
1.5 cm lateral to the lateral canthus seems to be a fairly accu-
rate marking of the largest branch of the frontal nerve.
With this great variation in surface anatomy, it is the plane
of the nerve (the depth) that is most important (see Fig. 1.4).
After emerging from the parotid gland, the nerve is protected
by the deep facial fascia (parotideomasseteric fascia) lying on
the masseter muscle. In midfacial procedures (e.g. facelift),
dissection is usually superficial to the deep facial fascia (which
protects the nerve deep to it). In the temporal area, the nerve
is on the undersurface of the superficial temporal fascia (see
Fig. 1.5). Here dissection is usually deep to the nerve, either
directly superficial or deep to the deep temporal fascia (or the
superficial layer of the deep temporal fascia). However, the
crossing of the nerve from deep to superficial in the vicinity
of the zygomatic arch is a matter of debate. This is largely
because of the confusion regarding the anatomy of the fascia
in relation to the arch. Directly over the arch, the facial layers
are tightly adherent (with little thickness of tissues from the
bone to the skin). While the SMAS is continuous with the
temporoparietal fascia across the arch, it is not clear if the
deep facial fascia is continuous with the deep temporal fascia
or they are separate layers that adhere to the periosteum of
the zygomatic arch.7,8,58,59 At the lower border of the arch, the
nerve is very close to the periosteum.60–63 The nerve is still
deep to the SMAS/TPF and deep to the areolar tissue between
the TPF and the deep temporal fascia (which, as described
above, is sometimes considered as a separate layer of fascia
called the parotidotemporal fascia). This deep location of the
nerve allows safe transection of the SMAS at the level of the
zygomatic arch in facelift surgeries.13,63,64 The nerve passes
from its deep location to the superficial temporal fascia in the
region right above the zygomatic arch.13 In this area, the fascia
layers are more tightly adherent, which is a warning sign that
the facial nerve is in close proximity. Dissection in this transi-
tion zone, extending over the arch and the 2–3 cm above it,
should be done carefully (see Fig. 1.3).
Zygomatic and buccal branches
These branches emerge from the parotid and diverge forwards
lying over the masseter muscle under the parotideomasseteric
(deep facial) fascia. The exact point where they pierce the deep
fascia is variable but is in the vicinity of the anterior border
of the masseter. The upper branches to the midfacial muscle
(zygomatic branches) pierce the deep fascia approximately
4 cm in front of the tragus in close proximity (around 1 cm
inferior) to the zygomatic ligaments (see Fig. 1.2C). These
branches soon innervate the zygomaticus major muscle
through its deep surface. The zygomatic and masseteric

13
The musculature
ing of the brow depressor muscles allows the epicranial
aponeurosis to move backwards leading to elevation of the
brow.
The loose areolar tissue between the galea and the perios-
teum is also referred to as the subgaleal fascia. This fascia is
loose especially over the vertex of the scalp, allowing a quick
dissection with minimal bleeding. It becomes more dense
closer to the supra orbital rims. Most surgeons consider this
layer as a potential dissection “plane” rather than a discrete
“layer”.8,89 However, it has been shown to be a distinct layer
that can be elevated independently as a vascularized flap.90
This is especially possible closer to the zygomatic arch and
the supraorbital rims where this layer is more substantial. It
is formed histologically of multiple lamina, with most of the
vasculature along the superficial and the deep lamina.33,91,92
The pericranium is simply the periosteum of the skull
bones and is tightly adherent to normal sutures but easily
dissected over the flat skull bones. It can be elevated as a
separate flap for various uses, although once separated from
the skull bones it significantly retracts.93,94
Five arteries supply the scalp. From the front, there is the
supraorbital artery and the supratrochlear artery (branches of
the ophthalmic artery from the internal carotid artery), the
superficial temporal artery from the side, and the posterior
auricular and the occipital arteries form the back (the latter
three arteries arise from the external carotid artery). In general,
these vessels run along the galea as they enter the periphery
of the scalp. At this level, they give multiple perforating
branches to the deeper subgaleal fascia. Closer to the vertex,
most of the vessels become more superficial, anastomosing
with the contralateral vessels. This explains why scalp flaps
(formed of skin and galea with an intact subdermal plexus)
can be safely extended across the midline, while pure galeal
flaps cannot.95
The nerve supply of the anterior part of the scalp is by four
branches of the trigeminal nerve: supratrochlear nerve (STN),
supraorbital nerve (SON), zygomaticotemporal nerve (ZTN),
and the auriculotemporal nerve. The posterior part of the
scalp (roughly behind the level of the auricle) is supplied by
four branches of the cervical nerves (C2 and C3): the great
auricular nerve, the lesser occipital nerve, the greater occipital
nerve, and the third occipital nerve.
The musculature
In general, the muscles of the forehead and eyebrow are
arranged in three planes: the superficial plane right under the
skin formed by the frontalis, procerus, and the orbicularis
oculi; the deep plane formed by the corrugators; and an
intermediate plane formed by the depressor supercilii
(Fig. 1.11).
Frontalis, galeal fat pad, and the glide plane
The frontalis muscle originates from the galea aponeurosis
and inserts distally (inferiorly) into the eyebrow skin inter-
digitating with the procerus, corrugator, and the orbicularis
oculi. Just above the nasion, both frontalis muscles are con-
tiguous with each other. At a variable point (1.5–6 cm) above
the level of the superior orbital rim, the muscles diverge, with
the medial borders becoming connected by an extension of
The marginal mandibular nerve supplies the lower lip
muscles, depressor anguli oris, mentalis, and the upper part
of the platysma.67,71 Injury to the marginal mandibular branch
usually causes a recognizable deformity,77–79 and several surgi-
cal maneuvers have been advocated to protect the nerve.80,81
When exposing the mandible, the surgeon can identify the
nerve in the usual subplatysmal location. However, it might
be safer and faster to go to a deeper plane, elevating the deep
fascia and/or the facial vessels and using them to protect the
nerve. Dissection above the platysma laterally will also avoid
nerve injury.
Cervical branch
The cervical branch of the facial nerve primarily supplies the
platysma. It has received little attention in the literature, as
injury of this nerve may pass unnoticed. However, such injury
may cause weakness of the lower lip depressors, which is
often confused with injury to the mandibular nerve (marginal
mandibular nerve pseudoparalysis).82,83 However, mentalis
function differentiates the two conditions, as it is preserved
in cases of cervical branch injury.
The cervical nerve exits the parotid gland and passes
1–15 mm behind the angle of the mandible. It then passes
forwards, in the subplatysmal plane 1–4.5 cm below the
border of the mandible.84 The cervical nerve is often composed
of more than one branch. It may communicate with the mar-
ginal mandibular nerve (which might explain the lower lip
asymmetry after its injury), and consistently communicates
with the transverse cervical nerve, although this latter com-
munication is currently of little significance.66,85
Connection with sensory nerves
Several authors have noticed connections between the
branches of the facial nerve with sensory nerves, including
the infraorbital, mental nerves, and transverse cervical
nerves.72,84,86–88 The exact clinical importance of this finding is
yet to be seen.
The scalp
The five layers of the scalp are well known by the mnemonic
SCALP:
■ Skin
■ Connective tissue
■ Galea Aponeurotica
■ Loose areolar tissue
■ Pericranium.
The galea aponeurotica is also known as the epicranial apo-
neurosis and corresponds to the SMAS in the face. Peculiar to
the scalp is the tight connection of the skin to the galea by a
dense network of connective tissue fibers. This makes separa-
tion of the skin from the galea difficult (similar to the palm)
and bloody. In addition, this lattice of connective tissue stents
the vessels open which, combined with the scalp’s rich vas-
cularity, leads to profuse bleeding.
The galea is a dynamic structure, being controlled by the
frontalis muscle anteriorly and the occipitalis posteriorly. The
skin moves together with the galea due to their tight attach-
ment. This is important in brow rejuvenation where weaken-

14
CHAPTER 1 • Anatomy of the head and neck
and described the muscle as being formed of three or four
parallel muscle groups with loose areolar tissue in between.100
Janis et al. similarly found that both heads are indistinguish-
able shortly after their origin.102 In all cases, the muscle fibers
blend together laterally and become more superficial. Medial
to the SON, the corrugator is clearly separated from the
overlying frontalis/orbicularis oculi muscle. However, it
becomes more superficial laterally near its insertion blending
with the frontalis. This close interdigitation with the orbicu-
laris explains the difference in description of the anatomy in
this region between the different authors. Intraoperatively, the
corrugator can be recognized by its parallel oblique fibers,
darker color, and deeper location, as opposed to the orbicu-
laris oculi which is more superficial and inferior, is lighter in
color, and has a circular orientation of the fibers.
The muscle origin is approximately 2.5 cm in width and
1 cm in height, starting a few millimeters lateral to the midline
and reaching almost to the level of the SON.100 The muscle
then passes laterally to insert in the skin of the eyebrow,
reaching as far as the lateral third of the eyebrow. Janis et al.
found that the most lateral extension of the muscle is 43 mm
from the midline and 7 mm medial to the lateral orbital rim,
while the most superior extension is 33 mm cephalad to the
level of the nasion.
The nerve supply of the corrugator is probably from both
the frontal (temporal) and the zygomatic divisions of the
facial nerve.72,76,102,103 The branch(es) from the frontal nerve
enter the muscle from its lateral end, and hence the importance
of complete muscle excision lateral to the SON so as not to
leave intact innervated muscle. The zygomatic (or upper
the galea aponeurotica.96 This divergence point is higher in
females. This is important when injecting botulinum toxin for
treatment of forehead rhytides.
Deep to the frontalis at the level of the eyebrows is the
galeal fat pad, a band of fibroadipose tissue that is frequently
encountered in brow lift procedures.97 This fat pad extends for
2–2.5 cm above the supraorbital rims being intimately related
to the corrugator muscles. Between the galeal fat pad and the
periosteum is the glide plane space, which allows mobility of
the brow over the underlying bone. Similar to the SMAS in
the face, the galea aponeurotica in the scalp seems to split to
cover both deep and the superficial surfaces of the frontalis.
At the level of the supraorbital rim, the fascia covering the
deep surface of the frontalis becomes more adherent to the
periosteum, sealing the galeal fat pad and the glide plane
space above it from the eyelids. It is possible that the weak-
ness of these attachments may be predisposed to brow ptosis,
especially laterally.98,99
Corrugators
The anatomy of the corrugators has gained significance
recently, with the realization of its role in browlift, migraine
surgery and treatment of forehead rhytides. This renewed
interest has led to multiple anatomical studies reporting that
the muscle is larger than originally described.100,101 The muscle
originates from the supraorbital ridge and passes obliquely
upwards and laterally to insert into the skin of the eyebrow.
Usually described as being comprised of a transverse and an
oblique head, Park et al. found that this distinction is not clear
Fig. 1.11  Muscles of facial expression.
Layer 1
1. Depressor anguli oris
2. Zygomaticus minor
3. Orbicularis oculi
Layer 2
4. Depressor labii inferioris
5. Risorius
6. Platysma
7. Zygomaticus major
8. Levator labii superioris
alaeque nasi
Layer 3
9. Orbicularis oris
10. Levator labii superioris
Layer 4
11. Mentalis
12. Levator anguli oris
13. Buccinator
1
2
3
4
5
6
7
8
9
10
11
12
13

15
Muscles of mastication
of the first pharyngeal arch, they are all supplied by the
mandibular division of the trigeminal nerve.
The temporalis muscle
The temporalis arises from the bony floor of the temporal
fossa, with attachments to the deep surface of the deep tem-
poral fascia. It passes deep to the zygomatic arch to insert into
the coronoid process of the mandible and the anterior border
of the ramus of the mandible almost down to the third molar
tooth. It receives its blood supply from the anterior and pos-
terior deep temporal arteries, arising from the maxillary artery
and supplying the muscle through its deep surface.108 It
receives secondary blood supply from the middle temporal
artery, which arises from the superficial temporal artery near
the zygomatic arch and travels along the deep temporal fascia.
Based on its dominant deep pedicle, the muscle’s arc of rota-
tion is at the zygomatic arch, and can be rotated as a flap for
coverage of the orbit, upper cheek, and ear.109,110 The muscle
is also frequently used for facial reanimation.
The masseter muscle
This strong muscle arises from the lower border and inner
surface of the zygomatic arch by two heads: a superficial head
from the anterior two-thirds of the arch and a deep head
forms the posterior third. The superficial head descends
downwards and backwards, while the deep head descends
vertically downwards. Both heads then insert together at the
lateral and inferior surfaces of the mandible.
The medial pterygoid muscle
The medial pterygoid muscle arises by two heads: a small
superficial head from the maxillary tubercle behind the last
molar and a deep large head from the medial surface of the
medial pterygoid. Both heads run downwards and backwards
to insert on the inner surface of the angle of the mandible. In
mandibular fractures the action of this muscle is responsible
for the upwards and forwards movement of the posterior
segment.
The lateral pterygoid muscle
This muscle also has two heads, a smaller upper head from
the infratemporal surface and ridge of the greater wing of the
sphenoid, and a lower larger head from the lateral surface of
the lateral pterygoid plate. The fibers pass backwards to insert
into the anterior surface of the neck of the mandible and the
capsule of the temporomandibular joint. Some of the fibers
pierce the capsule to attach to the intra-articular disc. In
condylar fractures, this muscle is responsible for the displace-
ment of the mandibular condyle, while in Le Fort fractures,
the muscle pulls the maxillary segment downwards and
backwards resulting in premature contact of the molar and
resulting in an anterior open bite.
Actions of muscle of mastication
Together, these muscles control most of the movements of the
mandible. Elevation of the mandible is achieved by the tem-
poralis and the masseter, while the pterygoids protract the
mandible and move it to the contralateral side.
buccal) division sends a nerve that travels cranially along the
side of the nose to innervate the nasalis followed by the
procerus and the corrugator.72,103
Procerus
This small muscle arises from the nasal bone and the upper
lateral cartilages and ascends superiorly to insert into the
glabellar skin between the eyebrows, blending with frontalis
along the medial ends of the eyebrow.104 Contraction of the
procerus produces transverse glabellar rhytides.
Depressor supercilii
This small muscle lies between the orbicularis oculi and the
corrugators, although some authors consider it part of either
muscle.99,105–107 It arises from the frontal process of the maxilla
2–5 mm below the frontomaxillary suture, slightly posterior
and superior to the posterior lacrimal crest.105 Daniel and
Landon described it as running vertically between the pale
circular orbicularis oculi more superficially and the brownish
transverse corrugator lying in a deeper plane.106 It finally
inserts into the dermis of the medial eyebrow.
Midfacial muscles
From lateral to medial, the zygomaticus major, zygomaticus
minor, and the levator labii superioris originate from the
anterior surface of the maxilla (see Fig. 1.11). Their line of
origin is a curved line, convex downwards, with the medial
limit higher than the lateral end. These muscles form the floor
of the prezygomatic space and are covered by a fascial mem-
brane that is more stout superiorly, being around 2–3 mm
thick. This fascial membrane is identified by its pale color and
coarse lobulation. The levator labii superioris origin reaches
the inferior orbital rim while the zygomaticus major origin is
separated from the inferior orbital rim by the front of the body
of the zygoma. The three muscles insert into the substance of
the upper lip.
The levator labii superioris alaeque nasi originates from the
frontal process of the maxilla. Its fibers pass downwards and
laterally to insert into the lower lateral cartilage of the nose
and the upper lip.
The levator anguli oris arises from the maxilla below the
orbital foramen lying deep to the lip elevators. It is one of the
few facial muscles innervated on their superficial surface.
The depressor labii inferioris and the depressor anguli oris
are continuous with the platysma and draw the lip down-
wards and laterally.
The mentalis is a thick small muscle that is important in
exposure of the mandible and in chin surgery. It arises from
the buccal surface of the mandible over the roots of the inci-
sors and inserts into the chin. Repair of the mentalis is vital
after buccal incisions to prevent chin ptosis.
Muscles of mastication
The four muscles of mastication, the temporalis, masseter, and
lateral and medial pterygoids, are mostly present in the
temporal and infratemporal fossae and control mandibular
movement during speech and mastication. Being derivatives

16
CHAPTER 1 • Anatomy of the head and neck
the recognition of their role in the aetiology of migraine
headaches.113,114 Knowledge of the anatomy of these nerves
is also important both to avoid iatrogenic injury and for
local anesthetic blocks.115,116 In general, the face is supplied
by the three divisions of the trigeminal nerve (through three
branches from each division), with the scalp receiving addi-
tional supply from the cervical superficial spinal nerves (Fig.
1.12; see Fig. 1.9).
The frontal division of the trigeminal nerve supplies the
upper eyelid, forehead, and a large portion of the scalp
through three branches: the supraorbital, supratrochlear, and
the infratrochlear nerves (Fig. 1.13A; see Fig. 1.12). The first
two are particularly important due to their role in triggering
frontal migraine and the possibility of their injury during
forehead and eyebrow rejuvenation.114 In addition, successful
anesthetic blocks of the SON can effectively anesthetize large
areas of the scalp.
The SON exits the orbit through either a notch or foramen
located at the level of the medial limbus.117 There is significant
variation in its exit point,114,117–123 which can be a notch, a
foramen, or a canal. This point of emergence is approximately
25–30 mm from the midline. It is usually a few millimeters
above the orbital rim but can be up to 19 mm above it.118–121
The nerve then divides into a superficial (medial) and a deep
(lateral) branch. The superficial division passes superficial to
the frontalis to supply the forehead skin.114 The larger deep
division, which is more prone to iatrogenic injury, passes
cephalad in a more lateral location. As its name suggests, it is
in a deeper plane lying between the galea and the perios-
teum.122,123 It passes upwards 1 cm medial to the temporal
fusion line, and supplies sensation to the frontoparietal scalp.
Forehead dissection is safer in the subperiosteal plane as
opposed to a subgaleal (subfrontalis) plane which places the
deep branch of the SON in risk.124
The pterygomasseteric sling
The masseter and the medial pterygoid insert respectively
into the lateral and medial surfaces of the lower edge of the
mandible near the mandibular angle. These insertions are
connected to each other by the pterygomasseteric sling, a
fibrous raphe extending around the mandibular border and
connecting both insertions.111 Disruption of this raphe will
lead to an unaesthetic upward retraction of the masseter, most
visible on clinching the jaws.112
The aesthetic importance of the masseter
and the temporalis muscle
Atrophy, hypertrophy, or displacement of either the masseter
or the temporalis can be aesthetically bothersome. Masseter
hypertrophy leads to an increased bigonial angle, although
most cases of benign masseteric hypertrophy (BMH) are actu-
ally caused by a laterally positioned mandibular ramus and
not by a true hypertrophy of the muscle. Deformities of the
temporalis muscle are more common, and are usually iatro-
genic due to improper resuspension of the origin of the muscle
during a coronal incision leading to retraction of the muscle
inferiorly. This leads to a visible bulge above the zygoma and
a depression near the origin of the muscle. Repair of the
atrophy or displacement of the masseter and the temporalis
often involves the use of alloplastic implants, as the muscles
cannot usually be stretched to their original lengths.
The sensory innervation
The anatomy of the sensory nerves and their relation to the
surrounding muscles has gained significant importance with
Fig. 1.12  The sensory supply of the face.
A1
A1 - external nasal
B1
B1 - infraorbital
C1
C1 - mental
A3
A3 - supratrochlear
B3
B3 - zygomaticotemporal
C3
C3 - auriculotemporal
A2
A2 - infratrochlear
B2
B2 - zygomaticofacial
C2
C2 - buccal
GAN
GON - greater occipital nerve
LON
LON - lesser occipital nerve
GON
GAN - greater auricular nerve
A4
A4 - supraorbital