Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Forehead rejuvenation

Synopsis ■ Detailed knowledge of forehead anatomy is the basis for rejuvenation strategies of the forehead region. ■ Eyebrow position is the net result of forces that depress the brow, forces that raise the brow, and the structures that tether the eyebrow in place. ■ Brow depression is caused by glabellar frown muscles, the orbicularis, and gravity. Frontalis is the only effective brow elevator. ■ Attractiveness…

Facial feminization

Access video and video lecture content for this chapter online at Elsevier eBooks+ Introduction Facial gender confirmation surgery (FGCS), also popularly known as facial feminization surgery (FFS) or facial gender surgery (FGS), is one of the fastest-growing areas in plastic surgery. It is the surgical art of transforming a transgender person’s facial appearance from masculine to feminine or vice versa. More than other gender-affirming surgeries, FGS…

Perioral rejuvenation, including chin and genioplasty

Access video lecture content for this chapter online at Elsevier eBooks+ Despite the cardinal role played by perioral aesthetics in facial pulchritude or youthful appearance, minimal attention has been paid in the literature to correcting dysmorphologies of this region. There are two categories of patients who seek aesthetic improvement in the perioral area. In the younger patient, lip augmentation, lip shortening, or lip elongation can be…

Secondary facelift irregularities and the secondary facelift

Synopsis ■ Although many aspects of planning and performing secondary facelift surgery are similar to those of the primary procedure, one must identify and treat not only new problems that are the product of age, but those that have resulted from any prior procedure as well. Often it is these secondary irregularities that present the biggest challenge in terms of creativity, planning, preparation, and technique. ■…

Male facelift

Access video lecture content for this chapter online at Elsevier eBooks+ Introduction Over the past few decades increased numbers of men have sought facial rejuvenation as prevailing attitudes regarding aging and appearance have shifted. During this time plastic surgeons have recognized that a diminished margin for error arguably exists in male patients due to the fact that men have fewer options to conceal their scars or…

Neck rejuvenation

Synopsis ■ Aging is a global phenomenon affecting the entirety of the face. Therefore, the gold standard for neck rejuvenation is formal facelift surgery with both direct and ancillary techniques that address the neck concurrently. ■ Improvement in neck contour is predicated upon skin release from retaining ligaments, appropriate alteration of the soft tissue in the intermediate or subplatysmal plane including subplatysmal fat, digastric muscles and…

The lift-and-fill facelift

Synopsis ■ The science of facial aging as well as comprehensive knowledge of the anatomy of the facial fat compartments serve as the foundation of modern facial rejuvenation. Proper understanding of the fat compartments and danger zones in conjunction with contour-directed superficial musculo-aponeurotic system (SMAS) modifications is key to optimizing both safety and outcomes in facelifting procedures. ■ The primary processes involved in facial aging include…

High SMAS facelift: combined single flap lifting of the jawline, cheek, and midface

Access video lecture content for this chapter online at Elsevier eBooks+ Introduction Traditional facelift techniques have relied upon the tightening of thin flaps of aging skin to elevate and support sagging, deeper facial tissues. Although initial results from these procedures often appeared good, early recurrence of the original problems were common, and poor scars and healing problems were frequently seen due to obligatory wide flap undermining…

Facelift: The extended SMAS technique in facial rejuvenation

Synopsis ■ As the human face ages, many of the stigmata that are typically seen in aging relate to a change in the anatomic relationship that occurs between the superficial and deep facial fascia. ■ Improving technical control when contouring the superficial facial fascia and platysma provides for a more consistent, aesthetically pleasing result. ■ Performing a two-layer SMAS-type facelift requires commitment on the part of…

Facelift: Lateral SMASectomy facelift

Synopsis ■ Because the procedure does not require traditional SMAS flap elevation, there is less concern about tearing of the superficial fascia. ■ The potential for facial nerve injury is lower because most of the deep dissection is over the parotid gland. ■ Because SMAS flaps have not been elevated, they tend to hold suture fixation more strongly, and the potential for postoperative dehiscence and relapse…

Facelift: Platysma-SMAS plication

Synopsis ■ Predominantly oblique, but allows multivector traction to individualize the facelift. ■ Sutures placed closer to the point of lift have the best effect. ■ Delivers a good malar auto-augmentation. ■ Offers reduced downtime. ■ Safe and ideal for thin, attenuated SMAS layers or repeat facelifts. Access video content and video lecture content for this chapter online at Elsevier eBooks+ Introduction As summarized in Chapter…

Facelift: Facial rejuvenation with loop sutures: the MACS lift and its derivatives

Access video and video lecture content for this chapter online at Elsevier eBooks+ Introduction A facial rejuvenation procedure attempts to restore an aging face’s lost youth, by surgical or non-surgical means. Rhytidectomy is without any doubt the most established facial rejuvenation procedure today. This procedure has evolved substantially in the past five decades, since the superficial musculoaponeurotic system (SMAS) was introduced by Mitz and Peyronie in…

Principles and surgical approaches of facelift

Synopsis ■ Age-related changes occur in all layers of the face, including skin, superficial fat, superficial musculo-aponeurotic system (SMAS), deep fat, and bone. ■ Patients presenting for facial rejuvenation surgery are usually middle-aged or older, thus increasing the chance of comorbidities. Risk factors such as hypertension and smoking should be dealt with prior to facelift surgery. ■ Careful preoperative assessment will provide the surgeon with an…

Facial anatomy and aging

Access video lecture content for this chapter online at Elsevier eBooks+ Introduction The pathogenesis of facial aging is largely explained on an anatomical basis, particularly the variations in the onset and outcome of aging seen in different individuals. Surgical anatomy is a particular branch of anatomy that focuses on specific surgical objectives. In contrast, traditional anatomy deals with bodily structure from an evolutionary and comparative perspective.…

Minimally invasive multimodal facial rejuvenation

Synopsis We have been performing “refreshing” techniques for the past 35 years, offering an alternative to the classical facelift for facial rejuvenation. We can start treating some of our patients at an earlier age, and, as well, improve the aspect of faces that have been “over-stretched” by several rhytidoplasties. With these techniques we can improve the facial appearance of patients of all ages, using our technique…

Injectables and resurfacing techniques: Chemical peels

Access video lecture content for this chapter online at Elsevier eBooks+ The process of facial aging can be broken down into three major categories: (1) structural or gravitational changes; (2) correction of deflation or loss of volume; and (3) treatment of wrinkles, texture, and skin quality. The first two categories are very familiar to practitioners and the bulk of clinical and academic activities involve these areas.…

Injectables and resurfacing techniques: Lasers in aesthetic surgery

Synopsis ■ Non-surgical facial rejuvenation relies on matching the presenting skin pathology to an appropriate intervention. ■ Laser-based interventions rely on the creation of precise skin injuries, through selective photothermolysis. ■ Facial rejuvenation procedures that work at the skin surface can be complemented by neurotoxins and fillers as well as with autologous fat grafting. ■ Fractional lasers achieve their rejuvenating effects with decreased risks of infection,…

Correction of Tuberous Breast Deformity

Introduction Tuberous breast deformity is a congenital anomaly with widely variable morphologic presentation. The etiology remains uncertain, although it is postulated that the deformity has an embryologic origin with a possible genetic predisposition; however no clear link has yet been determined. The physical manifestations of tuberous breasts have been attributed to periareolar fibrous ring constriction and hypoplastic, elastic areolar fascial support, the combination of which predisposes…