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Rotation advancement cheiloplasty

Access video content for this chapter online at Elsevier eBooks+ Introduction The integrated approach for unilateral cleft lip repair ( Video 19.2.1 ) is based on the senior author’s personal experience over a period of 33 years in a Taiwanese population. The surgical technique has been tested in other racially diverse populations. The approach is an ongoing process of refinements in presurgical management, surgical techniques, and…

Unilateral cleft lip: introduction

Access video lecture content for this chapter online at Elsevier eBooks+ History The social, cultural, and religious significance of the cleft lip has been documented throughout ancient history. Notable Peruvian pottery specimens dating back 3000 years have been linked to religious ceremonies and burial sites. A story originating from the Chin Dynasty of China (circa CE 390) recounts one of the earliest cleft lip repairs. The…

Embryology of the craniofacial complex

Introduction In 1657 the physician William Harvey wrote, “Nature is nowhere accustomed more openly to display her secret mysteries than in cases where she shows tracings of her workings apart from the beaten paths; nor is there any better way to advance the proper practice of medicine than to give our minds to the discovery of the usual law of nature, by careful investigation of cases…

Facial feminization

Access video content for this chapter online at Elsevier eBooks+ Introduction to facial feminization surgery Transgender patients typically do not identify with the gender assigned at birth. Both the genital sex, as well as the secondary sex characteristics that develop during puberty, produce ­clinically significant psychological distress, also known as ­gender dysphoria. A complex and extended transition period is ­usually required that involves numerous diagnostic ­processes,…

Surgical management of facial pain, including migraines

Synopsis ■ Facial pain affects an estimated 1.9% of the world’s population, with twice as many women affected compared to men. ■ Because of its complex nature, a team-based approach is preferred in the diagnosis and treatment of facial pain. ■ A subset of migraine headache patients suffers from compression of peripheral nerves of the head and neck. ■ These patients can be diagnosed through an…

Facial paralysis

Synopsis ■ Recapitulates relevant facial anatomy for proper clinical assessment and surgical planning. ■ Discusses the diverse etiology, the clinical presentation, and potential secondary complications associated with facial paralysis. ■ Emphasizes a thorough and focused assessment of the functional, psychosocial, and aesthetic consequences of facial paralysis. ■ Outlines treatment concepts, realistic therapeutic goals, and describes surgical key procedures in detail. Access video and video lecture content…

Aesthetic genital surgery

Synopsis ■ Male and female aesthetic genital surgery can greatly enhance confidence if a real or perceived deformity exists. ■ Many new genital surgeries have been developed. ■ In the male, penile enlargement surgery can result in severe deformities, which can often be reconstructed. ■ Hidden penis, penoscrotal web, and scrotum reduction surgeries are very successful with a low complication rate. ■ Labia minora and clitoral…

Energy devices in aesthetic surgery

Synopsis ■ Liposuction remains a staple of aesthetic body contouring. The introduction of new technology has allowed for improved outcomes with less invasive procedures. ■ While the introduction of energy-based skin tightening has improved patient outcomes, patient selection remains key to obtaining ideal results. In addition, managing expectations is important, as patients must be willing to accept a more modest result when compared to more aggressive…

Post-bariatric reconstruction

Synopsis ■ Obesity is a global epidemic with only rising rates. With the rise in bariatric surgical procedures, there has been a concomitant increase in the demand for plastic surgical reconstruction after massive weight loss (MWL). ■ Assessment of the MWL patient begins with a complete history and physical exam. Weight history, past surgical history, and nutritional status are key. ■ Preoperative identification of psychiatric comorbidities…

Medial thigh

Synopsis ■ Medial thighplasty has grown in popularity in the massive weight loss population, as they are often left with deformities of the inner and outer thigh. ■ Not every weight loss patient is a candidate for medial thighplasty. ■ Medial thighplasty is nuanced, and it is imperative for the plastic surgeon to respect anatomy, danger zones, and structures during this procedure. ■ Pre-thighplasty liposuction may…

Upper limb contouring

Synopsis ■ Upper limb contour is often of great concern to individuals following weight loss and some older women. ■ Correction of contour deformities of the axilla and forearm and in some instances the lateral thoracic region as well as the arm are critical to maximizing the aesthetics of the upper extremity. ■ Liposuction often plays an important role in brachioplasty. ■ Scar placement is an…

Buttock shaping with fat grafting and liposuction

Synopsis ■ Ideal candidates for augmentation by autologous fat grafting have sufficient liposuction donor sites to provide adequate fat for grafting. ■ Buttock augmentation by autologous fat grafting is extremely technique-dependent and requires meticulous attention to sterility and even distribution of grafted fat over hundreds of passes, from mid-muscle to skin. ■ The synergistic effect of augmentation combined with concomitant liposuction is the optimal method to…

Buttock augmentation with implants

Synopsis ■ Buttock augmentation is major surgery, with the potential for significant complications. ■ The overall goal of buttock augmentation is to achieve a more youthful appearance and contour and to create the ideal waist-to-hip ratio of 0.7. ■ There are three acceptable methods of buttock augmentation: (1) silicone implants placed in the subfascial plane; (2) silicone implants placed in the intramuscular plane; and (3) autologous…

Circumferential approaches to truncal contouring: Lower bodylift with autologous gluteal flaps for augmentation and preservation of gluteal contour

Synopsis ■ There has been a dramatic rise in popularity of aesthetic gluteal contouring in both weight loss and non-weight loss patients. ■ While most procedures performed today are autologous fat transfer and implant procedures, some gluteal deformities including skin excess or buttock ptosis demand alternative body contouring solutions. ■ Several techniques for autologous gluteal autoaugmentation with circumferential bodylift and excisional buttock lifts are used. ■…

Circumferential approaches to truncal contouring: autologous buttocks augmentation with purse-string gluteoplasty

Synopsis ■ Previous methods of buttock autoaugmentation have employed rotational flaps that are prone to complications due to poor vascularity. Purse-string gluteoplasty was developed as a unique method of buttock autoaugmentation that does not require any undermining or rotation of flaps, thus adding to its simplicity and safety. ■ Key elements of the procedure are buttock lifting combined with autoaugmentation, no undermining of autoaugmentation tissue, and…

Circumferential approaches to truncal contouring in massive weight loss patients: the lower lipo-bodylift

Synopsis ■ A two-position circumferential approach for body contouring of the lower trunk is presented as an alternative technique to the belt lipectomy described by Aly. ■ Mostly indicated in patients after massive weight loss, this procedure arose from the original lower bodylift from Ted Lockwood. ■ It allows the simultaneous skin resection and reshaping in the abdominal, flank, lateral thigh, back, and gluteal regions in…

Belt lipectomy

Synopsis ■ The skin/fat envelope is tethered to the underlying musculoskeletal anatomy in zones of adherence. These include the spine, the sternum, the linea alba of the abdomen, the inguinal area, the suprapubic area and the area between the hip and lateral thigh fat. ■ Massive weight loss patients make up the majority of patients who undergo lower bodylift/belt lipectomy surgery. Second are females with a…

Bra-line back lift

Synopsis ■ Comprehensive upper back deformity, which includes laxity of the skin, excess adiposity, and redundant lateral breast tissue, can be corrected using the bra-line back lift. ■ Candidates for the procedure have visible, graspable, and undesirable soft-tissue laxity in the mid and lateral upper backs. ■ The resection pattern extends anteriorly to the anterior axillary line at the level of the inframammary fold. ■ Preservation…