Introduction Breast reconstruction using the deep inferior epigastric perforator (DIEP) flap has become the gold standard for autologous breast reconstruction for most plastic surgeons. The principle benefit of the DIEP flap compared to other flaps is that the abdomen is…
Introduction Abdominally based reconstructions have been utilized for the last 40 years. In 1979, Holstrom used tissue normally discarded from abdominoplasty as a free flap for breast reconstruction. In 1982, Hartrampf described and popularized the pedicled TRAM (transverse rectus abdominis…
In his article “Anatomy and pathophysiology of facial aging”, Zimbler states, “Facial aesthetics begin with the marriage of hard and soft tissue integration; however, it is the changing balance of these elements that is the hallmark of the aging process…
Introduction Pedicled transverse rectus abdominis musculocutaneous (TRAM) breast reconstruction has been performed in patients for nearly four decades now. Many technical modifications have developed since Dr. Hartrampf's first operation, and these strategies have improved our ability to offer this operation…
Indications Three groups of patients benefit from implant augmentation of the mandibular body, angle, and ramus. These include patients with normal, deficient, or surgically altered anatomy. Normal dimensions Most patients who desire mandible augmentation have lower face horizontal dimensions that…
Chin augmentation with implants is the most frequently performed facial implant surgery. It has long been considered a simple procedure, often done in the office setting, and one that always gives gratifying results. Unfortunately, outcomes after chin augmentation are often…
A relative deficiency in lower midface projection may be congenital or acquired, particularly after cleft surgery and maxillary fractures. Since the majority of white faces are convex, midface concavity is often considered less attractive. Fig. 10.1 shows the average midface…
Prominent malar bones are considered attractive. Hence, the malar area is frequently augmented with implants. Although not documented in the literature, personal experience with primary and secondary malar implant surgery has shown that there is a significant incidence of patient…
The upper midface skeleton has direct and indirect influences on the appearance of the face and, particularly, the eyes. The relationship between the globe and the orbital rims will determine if the eyes appear prominent or deep set. Because the…
The size and shape of the internal orbit determines orbital volume and the position of the eye. An increase in orbital volume results in enophthalmos – the recession of the ocular globe within the bony orbit. The principal mechanism in…