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Surgical Lip Enhancement: Lip Lift and Lip Reduction

Lip Anatomy and Histology The lips serve many functions, such as eating, drinking, speaking, mimetic animation, kissing, and serving as a valve for the terminal oral airway. Lips are among the most vascular structures on the face and are supplied by the superior and inferior labial branches of the facial artery as it branches from the external carotid artery. The labial artery lies in the posterior…

Injectable Fillers and Surgical Lip Lift

The Differences Between Injectable Fillers Available in the United States: Pearls for Understanding and Achieving Optimum Outcomes Julie A. Woodward Author’s Note: The science of filler injection is complex and ever-changing. It seems pretty simple to uncap a needle and inject a gel filler into a wrinkle or fold to make it better or into the cheeks or lips to make them bigger. Although the process…

Neuromodulators

As I am editing the third edition of this textbook, some of the chapters have little changes in terms of their content. For instance, blepharoplasty, facelift, otoplasty, browlift , and surgical techniques like this simply have not experienced many major changes over a 5- or 6-year period. Neuromodulators, however, represent a science in its infancy. There are many new editions that mirror research and development and…

Cosmetic Otoplasty and Related Cosmetic Ear Surgery

Otoplasty is a very unique procedure for numerous reasons. For example, in many practices, it is frequently the only cosmetic procedure performed in the pediatric population. Also, patients of any age have an extremely high satisfaction rate as protruding ears is something that many patients feel is a disability. It is also a unique procedure. Much like rhinoplasty, it requires a unique mixture of science, anatomy,…

Facial Implants

Part 1: Midface Implants In the third edition of this chapter, a lot is the same and a lot has changed. Two of the most impactful factors are the popularity and expanding techniques of injectable fillers and the progress of digital technology for custom implants. Over the past 5 years, I have personally seen injectable fillers gain popularity and usage in areas previously treated by facial…

Rhinoplasty

Rhinoplasty , the quintessential “nose job,” is considered to be the most complex and challenging cosmetic procedure that exists in aesthetic surgery today. Nevertheless, it remains an extremely popular surgery for men and women. Its popularity has steadily increased over the years, even if not nearly as rapidly in rate as some procedures such as liposuction or aesthetic breast surgery. Rhinoplasty currently remains in the top…

Cosmetic Blepharoplasty

It is said that the eyes are “the window to the soul.” They are also the window to youth and human emotion and are thus one of the most important aspects of cosmetic facial surgery. The eyelid skin is the thinnest on the body, with aging changes such as fine lines beginning as early as the 20s. Younger patients notice mild skin excess and fat protrusion,…

Brow and Forehead Lift: Form, Function, and Evaluation

The brow and forehead complex is a unique structure in that it not only conveys the aesthetics of youth and aging but is also essential in communication. The mimetic upper facial muscles and periorbital region convey diverse nonverbal communication. We frequently “talk” with our brows and forehead. Raising the brow can signal a question or surprise; contracting and depressing the brow and forehead can signal aggression…

Face and Neck Lift (Cervicofacial Rhytidectomy)

This chapter represents my fourth comprehensive chapter on face and neck lift surgery. My original chapter was in the first edition of this text, the second chapter was in the second edition of this text, and the third chapter was an entire book entitled The Art and Science of Facelift Surgery , which was released by Elsevier in 2018. This chapter represents my fourth compilation. By…

The Aging Face

This chapter provides a comprehensive discussion of facial aging. It is important that the reader also note that specific anatomic aging changes are also discussed in individual chapters within this text. “Aging is a privilege denied to many,” Dr. Niamtu often tells patients who are unhappy with their aging. However, what is not denied to the cosmetic surgeon is dealing with this patient population daily. Perhaps…

Diagnosis of the Cosmetic Facial Surgery Patient: The Art of the Consult and the Office Patient Experience

Cosmetic surgery is a very unique specialty as it is totally elective. No one needs cosmetic facial surgery! Very few surgeons begin their journey as “strictly cosmetic surgeons.” Having a total cosmetic surgery practice is actually pretty rare as many “cosmetic surgeons” perform other procedures based on their background training. For instance, plastic surgeons may also deal with burns, trauma, and reconstruction; facial plastic surgeons may…

Extensor tendon injuries

Synopsis ▪ A thorough understanding of the complex anatomy is crucial for successful treatment of extensor tendon injuries. ▪ Injuries are classified into nine anatomic zones. Treatment strategies vary considerably according to the location of the lesion, ranging from splinting to tendon grafting. ▪ Minimal variations in tendon length may result in considerable alteration in range of motion. ▪ As in flexor tendon injuries, postoperative care…

Tendon transfers in the upper extremity

Synopsis ■ Tendon transfers in the upper limb are indicated to restore function to paralyzed muscle and tendon following nerve injury, direct muscle, or tendon injury, and to restore balance to hands affected by neurological disease. ■ In selecting donor tissue, the surgeon has to consider expendability of the muscle–tendon unit, the native strength of donor and paralyzed muscle, and the direction of transfer and integrity…

Nerve transfers

Synopsis ■ Nerve injuries are often devastating, with associated pain and impaired function. ■ Motor nerve injuries must be managed expeditiously, because regenerating axons must reach target muscle prior to degeneration and fibrosis – “time is muscle”. ■ Nerve transfers offer an advantageous method of reconstruction by delivering regenerating nerve fibers to the target end organ more quickly, thus converting a proximal injury to a more…

Flexor tendon injury and reconstruction

Synopsis ■ Tendons transmit forces generated by muscles to move joints or to create action power. Flexor tendon injuries are common, but recovery of satisfactory function, particularly after injuries within the digital sheath, is sometimes difficult. Lacerated flexor tendons should be treated by primary surgical repair whenever possible. ■ The current trend of end-to-end surgical tendon repairs is to use multistrand core sutures (four-strand repairs such…

Examination of the upper extremity

Synopsis ▪ Physical examination of the upper extremity starts with a detailed and accurate patient history. ▪ Physical examination of the upper extremity consists of inspection; palpation; measurement of length, girth, and ranges of motion; assessment of stability; and detailed assessment of the associated nerve and vascular systems. ▪ Thorough understanding of the anatomy, physiology, and biomechanics of the upper extremity is essential to perform a…

Essential anatomy of the upper extremity

Synopsis ▪ The hand is an incredibly designed structure with complex anatomy and precise biomechanics. The hand must be able to produce adequate force to allow performance of activities of daily living. Furthermore, it must ensure coordination of the fingers for precise prehension and fine motor tasks. ▪ In order to achieve an optimal functional and aesthetic outcome in patients requiring hand surgery, it is thus…

Autologous breast reconstruction using abdominal flaps

Synopsis Pedicled TRAM ▪ The pedicled transverse rectus abdominis (TRAM) flap is still the most popular way of transferring abdominal tissue to the breast. ▪ This technique, introduced by Dr. Carl Hartrampf, is consistently successful if it is performed properly. ▪ The muscle- and fascial-sparing technique ensures abundant vascularity to the TRAM flap while allowing secure and complication-free closure of the abdominal wall. ▪ The shaping…

Implant-based breast reconstruction

Synopsis Implant-based reconstruction ▪ Alloplastic breast reconstruction is the most common approach used today for postmastectomy breast reconstruction. ▪ Traditional breast implant reconstruction is performed as a planned two-stage procedure with the use of a tissue expander followed by exchange to a breast implant. ▪ Changing demographics of the mastectomy patient, improved devices and support matrices, as well as refinements in mastectomy techniques have allowed for…

Reduction mammaplasty and gynecomastia

Synopsis ▪ Macromastia, or mammary hypertrophy, is a disease process which can result in physical and psychological symptoms. ▪ Macromastia symptoms rarely improve without surgical intervention, which typically results in significant improvement in the patient's quality of life. ▪ Reduction mammaplasty techniques have evolved over millennia, with particularly great strides made in the last 100 years. ▪ Currently, there exist several well-designed techniques based on sound…