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Rhinoplasty

For videos accompanying this chapter see ExpertConsult.com . See inside cover for access details. Introduction The nose is a multifarious structure with critical mechanical and functional roles, which by virtue of its position, serves as the central and salient component of the face. Its relationship to surrounding structures is in part responsible for a harmonious, pleasing form as a whole. Functionally, the nose provides an airway…

Neck Lift

Acknowledgment All photographs, illustrations, descriptions, and text contained in this chapter are property of the Marten Clinic of Plastic Surgery, San Francisco, CA, and are used with permission. For video accompanying this chapter see ExpertConsult.com . See inside cover for access details. Introduction Why Perform a Neck Lift? Why perform a neck lift? Why not just lift the cheeks and jawline or perform other procedures that…

Facelift

For video accompanying this chapter see ExpertConsult.com . See inside cover for access details. Introduction Our face is our most inextricable sense of self. A person’s self-image and self-esteem are powerfully influenced by their appearance. People requesting a facelift are aware of loss of confidence as a result of their altered “look.” The way people are “judged” and treated by others, whether supportive or discriminatory, is…

Lower Eyelid and Midcheek Rejuvenation

For videos accompanying this chapter see ExpertConsult.com . See inside cover for access details. Introduction The lower eyelid and midcheek are areas that patients commonly present with, usually with the complaint of eye bags or just “looking tired.” Intuitively, it should be appreciated that these patients are actually looking for rejuvenation of the midcheek and to look more youthful, not merely for the elimination of the…

Upper Eyelid Rejuvenation

For videos accompanying this chapter see ExpertConsult.com . See inside cover for access details. Introduction The human mind instinctively examines another’s eyes before any other facial feature. Trustworthiness, aggression, and even fertility are conveyed by the appearance of the eyes. The periorbital region influences facial harmony and is the most powerful tool for nonverbal communication and expression. For these reasons, esthetic enhancement of the upper eyelid…

Forehead Lift

Introduction The first forehead lift procedures were performed using an “open” technique in which long incisions on the scalp or along the frontal hairline were made, a forehead flap was turned inferiorly, and modifications were made to corrugator supercilii and other muscles under direct vision. These breakthrough procedures served several generations of patients well and, while still performed by many surgeons today, they have been rejected…

Facial Aging and Anatomy of the Facial Nerve

Introduction The pathogenesis of facial aging may be explained on an anatomical basis. An anatomical approach to surgical rejuvenation of the face provides the way to obtaining a “natural” result that is lasting and with minimal morbidity. Fundamental to safety when operating in the face is a firm grounding in the principles on which the facial soft tissue layers are constructed. Understanding the relations of the…

Nonoperative Facial Rejuvenation

Introduction Over the past decades, significant advances in our understanding of the mechanisms underpinning the aging process have coincided with immense advances in the tools and technologies available to address these changes. No longer is the face seen as a monolithic entity that needs to be pulled or lifted. Changes in the bone structure, fat compartments, myofascial layers, and skin all contribute to restoring esthetic beauty…

Lesions of the Hand

Introduction Masses of the upper extremity are among the most common reasons for referral to a hand surgeon, with ganglions alone representing the second most frequent cause of referral. The vast majority of these lesions are benign, however the average hand surgeon will encounter a few malignant sarcomas during their career. For this reason, when evaluating any mass of the upper extremity it is imperative that…

Rheumatoid Arthritis of the Hand and Wrist

Definition Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by symmetrical polyarticular arthritis, typically affecting the wrist and small joints of the hands and feet. Inflammation progresses to joint destruction with pain, deformity, and disability. Nonarticular manifestations include rheumatoid nodules, pulmonary fibrosis, renal amyloidosis, pericarditis, endocarditis, atherosclerosis, Felty’s syndrome, keratoconjunctivis sicca, hemolytic anemia and generalized systemic symptoms such as malaise, anorexia, anemia, and weight loss.…

Wrist Pathology

Acknowledgments The authors would like to thank the previous authors of this chapter, Owen L. Ala, MD and T. Shane Johnson, MD, for their contributions. Physical Examination of the Wrist When performing a physical examination of the wrist, it is helpful to approach the wrist in a systematic fashion based on anatomical regions. Knowledge of anatomical landmarks will help the practitioner develop a differential diagnosis, while…

Osteoarthritis and Prosthetic Joints in the Hand

Introduction Osteoarthritis (OA) is the most common debilitating joint disorder worldwide, and its prevalence is likely to increase as life expectancy increases, creating a substantial economic burden. Risk factors such as sex, radiographic features, and scintigraphy have not been specifically associated with the condition. Commonly, patients will report pain, decreased function, deformity, and challenges undertaking simple tasks such as activities of daily living as well as…

Fractures and Dislocations in the Hand

Introduction “Many handis make light warke ” John Heywood (1497–1580) Hand surgery is always teamwork between the surgeon, the patient, and the therapist. One cannot get a successful outcome without the cooperation of the other two. Interestingly there are exceedingly few randomized controlled trials in the management of hand fractures despite this being a common injury. Hand fractures are often considered to be a soft tissue…

Dupuytren Disease

Introduction Definition Dupuytren disease (DD) is a benign fibromatosis of the palmar fascias in which nodules and skin pits in the distal palm are usually the first signs. As it progresses, cords are formed which in time may contract limiting extension of the fingers and causing webspace contractures. The disease usually starts in the ring finger and little finger ray, but may affect any ray in…

Nerve Compression

For videos accompanying this chapter see ExpertConsult.com . See inside cover for access details. Nerve compression syndromes are a common clinical presentation in plastic surgery practice. The upper extremity is most commonly affected, with carpal tunnel syndrome being most frequent followed by cubital tunnel syndrome. The etiology of these disorders is usually multifactorial, with systemic disorders, prolonged postural changes, and repetitive activities contributing to their development.…

Brachial Plexus Injuries and Reanimation

For videos accompanying this chapter see ExpertConsult.com . See inside cover for access details. The brachial plexus comprises a complex grouping of nerve fascicles, giving function and sensation to the upper extremity. Progressing from proximally to distally, the plexus is divided into regions termed roots, trunks, divisions, cords, and branches. Within these nerves, there is a clearly defined internal topography that will guide future reconstructive efforts…

Nerve Injury, Repair, and Reconstruction

For videos accompanying this chapter see ExpertConsult.com . See inside cover for access details. Nerve injury, repair, and reconstruction describes the traditional classification of nerve injuries as well as a clinical grouping of nerve injuries according to the mechanism of injury. A clinical grouping of open versus closed and crush versus traction/avulsion or penetrating injuries has implications on the severity of associated soft tissue and bony…

Compartment Syndrome in the Extremities

Introduction Compartment syndrome in either upper or lower extremity is often underestimated and may have detrimental consequences for functioning of the involved extremity. Muscle groups in the extremities are separated by fascial sheaths to ensure that muscles move in the right vector and achieve maximal efficiency during contraction. Fascial sheaths also provide additional surface area for muscle origins because bone alone does not offer enough surface…

Digital Replantation and Thumb Reconstruction

For videos accompanying this chapter see ExpertConsult.com . See inside cover for access details. Introduction Vascular surgeons Jacobson and Suarez introduced the microscope to perfect microvascular small vessel anastomosis in 1960, which rapidly led to its application in revascularizing digits and replantation. , It was promptly adopted in Taiwan, the USA, Australia and, later, Europe. China independently and unbeknown to the West had been achieving remarkable…

Tendon Transfers

Acknowledgments The authors would like to acknowledge the generous assistance of Mr Donald Sammut in the preparation of this chapter. For video accompanying this chapter see ExpertConsult.com . See inside cover for access details. Introduction Tendon transfer is the surgical transplantation of a normal muscle–tendon unit (MTU) into a new location to restore function of a nonfunctioning MTU. This may be distinguished from a tendon graft,…