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Access video content for this chapter online at Elsevier eBooks+ Introduction Acquired cranio-orbital deformities comprise a vast array of etiological entities which result in defects, disproportions, or asymmetries in the upper face and skull, and they are commonly associated with functional visual and neurological disturbances. Reconstruction poses a unique set of challenges. Restoration of the complex surface topography and structural integrity of the skull and orbits,…
Access video and video lecture content for this chapter online at Elsevier eBooks+ Introduction Auricular defects can cause psychosocial morbidity to the affected patient that may be improved with surgical correction. Congenital abnormalities of the external ear are common and are comprised of a wide spectrum of presentations from complete absence to minor irregularities. Congenital external ear anomalies are classified by etiology and may arise from…
Synopsis ■ The field of plastic surgery originated with the first early attempts to reconstruct the face, especially the nose. ■ The face tells the world who we are and materially influences what we can become. ■ The restoration of a normal appearance and an open airway to allow comfortable breathing remains the goal. ■ Treatment choices will depend on an understanding of the deformity and…
Synopsis ■ The forehead heals particularly well by secondary intention when local flaps are inadequate. ■ When additional skin is necessary in the context of radiation, a thin, non-hair-bearing fasciocutaneous free flap is optimal. ■ Regional or free flaps are usually required for scalp defects that include the pericranium. ■ Unlike other head and neck sites, tissue expansion may play a role in reconstruction of the…
Access video lecture content for this chapter online at Elsevier eBooks+ Craniomaxillofacial fractures are commonly encountered in plastic surgical practice. Fracture patterns vary widely ( Fig. 1.1 ) and may involve isolated facial bones, multiple contiguous bones, or multiple levels of the face with comminution or segmental bone loss. Open full size image Figure 1.1 The different anatomic regions involved in craniomaxillofacial fractures are shown here.…
Access video and video lecture content for this chapter online at Elsevier eBooks+ Botulinum toxin types Botulinum toxin is produced by Clostridium botulinum , an anaerobic, gram-positive, spore-forming rod. The bacterium produces eight distinguishable neurotoxins. Although both types A and B are currently US Food and Drug Administration (FDA) approved, only type A toxin has indications for cosmetic use ( Table 8.3.1 ). The toxin is…
Synopsis ■ Soft-tissue fillers provide versatile tools in the correction of facial wrinkles and facial contouring, as well as in the restoration of the volumetric loss associated with aging. ■ Reversibility is an advantageous property of fillers, allowing adjustments that may be needed due to technical errors or changes in the tissues that occur with aging. ■ Inexperienced injectors should always opt for rapidly resorbable fillers…
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Access video lecture content for this chapter online at Elsevier eBooks+ Introduction Skin care involves several basic hygiene activities that include cleansing and moisturizing. With advancements in the understanding of skin physiology, more effective moisturizers have been developed that contain ingredients designed to improve the appearance and functioning of the skin. These products are known as cosmeceuticals; however, from a regulatory standpoint, there is no such…
Introduction The first local anesthetic agent was cocaine, discovered and utilized in the nineteenth century. In 1885 Halsted at Johns Hopkins University first introduced cocaine for nerve blocks. He later became addicted to cocaine through self-experimentation. Either by blocking conduction in peripheral nerves or by preventing excitation of nerve endings, local anesthetics effectively block the receptors for pain. This is achieved by anesthetics reversibly binding to,…
Access video lecture content for this chapter online at Elsevier eBooks+ Introduction Surgeons who understand the anatomy of nerve blockade will be able to effectively anesthetize large areas of the face safely in a comfortable, reproducible, and expeditious manner. These blocks allow the surgeons to choose noninvasive modalities, office-based treatments, and dermatologic reconstructions without hospital involvement. This is especially important given the increasing trends in the…
Introduction Postoperative pain management in plastic surgery remains a topic of increasing interest amidst heightened awareness of the opioid epidemic. Pain is defined as the sensory and emotional reaction to actual or perceived tissue injury. Nociceptive pain is due to stimulation of peripheral pain receptors at suprathreshold levels from damage to non-neural tissue. Inflammatory pain is due to peripheral pain sensitization from activation of the immune…
Synopsis ■ The importance of patient safety has been acknowledged for centuries. However, medical errors still happen and are usually explained by the “Swiss cheese model” of sentinel events. ■ Aesthetic surgery is generally elective, and patient safety is of paramount importance. ■ The three pillars of safety – tools and evidence (evidence-based medicine), systems and processes , and culture and communication – can help us…
Identifying your brand: a roadmap to your entire practice A successful practice begins before a business plan is created, before the doors are open, and long before the first patient is even seen. As plastic surgeons, while we have an extremely specific and unique skill set, we must not only set ourselves apart from our colleagues but also from other specialties, in order to be truly…
Synopsis ■ Societal interest in plastic surgery is increasing: ■ The number of plastic surgery procedures as reported by The Aesthetic Society (American Society for Aesthetic Plastic Surgery [ASAPS]) has increased 82% since 1997 ■ Women between the ages of 35 and 50 consistently comprise the largest group of patients for both surgical and non-surgical procedures. ■ Understanding the patients' motivations for surgery and their expectations…
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Access video and video lecture content for this chapter online at Elsevier eBooks+ Introduction With increasing societal acceptance and insurance coverage of gender affirmation surgery (GAS), plastic surgeons are caring for more transgender and gender diverse (TGD) people. This chapter will provide a succinct overview of the TGD population along with the assessment, perioperative management, and basic technical aspects of the most performed GAS procedures. Due…
Introduction An astounding 5 billion people lack access to safe, affordable, and timely surgical care worldwide. Only one-fifth of the world’s surgeons serve the poorest half of the world’s population. Truche et al . estimated that the number of plastic surgeons in low- to middle-income countries (LMICs) ranged between 0.0073 to 0.0093 plastic surgeons per 100,000 people, in contrast to the 2.18 plastic surgeons per 100,000…
Introduction The American Association of Oral Surgeons was founded in 1921. It subsequently became the American Association of Oral and Plastic Surgeons, and the American Association of Plastic Surgeons in 1942. Both the field of plastic and reconstructive surgery as well as the training of plastic and reconstructive surgeons have been constantly evolving over the past 100 years. The specialty has evolved over a similar period…