The Clinical Problem ( Fig. 38.1 ) The medial thigh is a problematic zone for body contouring both in the aging patient, who has skin laxity and lipodystrophy, and in the massive weight loss patient, with critical skin flaccidity in the medial thigh. Patients with morbid obesity who have undergone massive weight loss (MWL) following a diet or bariatric surgery develop body dysmorphia due to skin…
The Clinical Problem ( Fig. 37.1 ) The hand is a major organ of the body. It is a sensory organ that has locomotor function and is used as a means of communication and assessing social status. The features of an aging face are in many ways similar to the features of an aging hand. Both show degenerative features in the skin as well as a…
The Clinical Problem ( Fig. 36.1 ) Synopsis Performing procedures to rejuvenate the arm requires an understanding of the aesthetic arm deformity and its pathophysiology. Excisional techniques (e.g., brachioplasty), liposuction, and nonsurgical treatment options may all be used for arm rejuvenation. There are a number of technical points that can make brachioplasty a reliable and rewarding procedure. The Aesthetic Problem This 67-year-old woman (see Fig. 36.1…
The Clinical Problem ( Figs. 35.1 and 35.2 ) Gluteal augmentation surgery has grown by 42%/year in Brazil. Patients who look for gluteoplasty augmentation with implants are about 36 years of age. This type of surgery does not have any relationship with occupation and socioeconomic status. The main clinical complaints that lead patients to seek this procedure are related to the following: 1. A lack of…
The Clinical Problem ( Fig. 34.1 ) Truncal body-contouring surgery aimed at excising large quantities of redundant skin and subcutaneous tissue, especially after massive weight loss, with or without bariatric surgery, is not without risk, but can be made safer and more rewarding for many patients. Liposuction-assisted pseudo-undermining technique helps preserve the lymphatics around intact Scarpa's fascia and reduces the problems with seroma formation, wound healing…
The Clinical Problem See Fig. 33.1 . The Aesthetic Problem A patient will present at surgery with a number of perceived concerns about their abdominal area. Often, this is a surplus of unwanted subcutaneous fat, visceral fat, loose skin, lack of definition, a so-called muffin top overhang in clothing, and a general dislike of the midsection. It is usual for more than one issue to present…
The Clinical Problem Contour deformities after post–bariatric surgery weight loss are varied and often complex. The Pittsburgh Rating Scale is a useful classification system that allows grading of 10 areas of the body following massive weight loss. Each area is scored on a scale of 0 to 3 and considered as part of the overall picture. Mild abdominal deformities call for standard measures, and increasing levels…
The Clinical Problem ( Fig. 31.1 ) Abdominoplasty is a surgical procedure designed to rejuvenate truncal aesthetics, in which flattening a protuberant abdomen, removing redundant tissue, and restoring normal waistline definition is a surgical challenge. Advancement in surgical techniques should reduce surgical risk and improve aesthetic outcomes. The term modified Brazilian abdominoplasty (MBA) originated after a presentation by the Brazilian plastic surgeon, Joao Erfon Ramos, at…
The Clinical Problem ( Fig. 30.1 ) Why is Gynecomastia Important? When my breasts developed as an adolescent male, I was winning medals for swimming, but I never swam in public again. The embarrassment felt by the patient may be very large and may cause unreasonable restrictions in lifestyle, in my opinion mainly because of joking by other males. I think gynecomastia should be termed andromastia,…
The Clinical Problem ( Fig. 29.1 ) A young woman's perception of normal body form is increasingly influenced by the media to match a somewhat stereotyped image of beauty. The Internet contains large volumes of graphic imagery available at the click of the mouse that can make any vulnerable young women, particularly those with asymmetric breasts, under even more pressure to conform. Minor asymmetry of any…
The Clinical Problem Hypoplasia and ptosis of the mammary are frequent occurrences, especially in multiparous women or in women after significant weight loss. Decreased breast volume may induce a negative body image and low self-esteem, affecting a patient's quality of life. A mastopexy survey of 487 members of the American Society for Aesthetic Plastic Surgery, published in 2006, concluded that the inverted T is the most…
The Clinical Problem ( Fig. 27.1 ) Synopsis ■ Different classifications of breast ptosis have been put forward by Regnault and Kirwan, depending on the extent of the nipple-areola complex (NAC) descent below the submammary fold. ■ The surgically corrected ptotic breast must be supported internally to prevent recurrence. ■ Implants can help in marginal ptosis. ■ An internal bra mesh system (Breform, Triangle Surgical, Buckinghamshire,…
The Clinical Problem Breast hypertrophy is a frequent condition in women. It may occur due to excessive development of glandular tissue during puberty, secondary to weight gain or as a result of naturally occurring fat deposition of breast tissue that takes place with aging. In this chapter, based on a case report, we will discuss clinical findings, expectations, surgical techniques, postoperative evolution, and possible complications. During…
The Clinical Problem ( Fig. 25.1 ) Hypomastia is usually a developmental issue but may also be seen after pregnancy, breastfeeding, or major weight loss. It is well known how negatively the size, shape, and symmetry of a woman's breast may affect her mental and physical well-being. Women with severe developmental hypomastia should not expect significant breast augmentation but aim to have more normal-looking breasts. This…
The Clinical Problem ( Figs. 24.1A, 24.2A, 24.3A, 24.4A, 24.5A, and 24.6A ) 1. Bleaching of discolored teeth 2. Improving tooth length to enhance the smile line 3. Surgical correction of hard and soft tissue to correct anatomic disparities and subsequent dental procedure 4. Restoring worn and missing spaces with crowns, veneers, and implants 5. Treating a single tooth space with an implant, eliminating the need…
The Clinical Problem ( Fig. 23.1 ) Synopsis ■ The patient, a 20-year-old woman, suffered an injury to the anterior maxilla in a motor vehicle accident. There were no injuries to her lips or other perioral structures. ■ Emergency care was provided immediately, and reconstruction commenced 3 months later. ■ Treatment, over a period of 18 months, included two surgical procedures and dental rehabilitation, including gingival…
The Clinical Problem Dentofacial (dentoskeletal) deformities are characterized by an abnormal position of the maxilla and/or mandible and associated teeth that affect jaw function and facial aesthetics. These deformities are as follows ( Fig. 22.1 ): Class I—normal skeletal pattern, maxilla and mandible in an orthognathic relationship Occlusal relationships are characterized by the mesiobuccal cusp of the maxillary first molar occluding with the mesiobuccal groove of…
The Clinical Problem ( Fig. 21.1 ) Increased nose self-awareness translates into increased patient concern and increased demand for relatively small changes in nasal contour. Medical rhinoplasty is especially well suited to many of these patients. The pretreatment consultation should include a psychological assessment. Patients with body dysmorphic disorder (BDD) need special consideration. Prior to treatment, it is helpful to demonstrate any asymmetries to the patient.…
The Clinical Problem ( Fig. 20.1 ) Rhinoplasty remains the most common aesthetic procedure in men, with 55,000 performed in 2014 alone. Male anatomic variation, frequent posttraumatic pathology, desired aesthetic differences, and the resultant technical nuances make a male rhinoplasty a different and unique challenge. Additionally, there is a negative connotation of the male rhinoplasty patient; it has been suggested they are difficult to satisfy and…
The Clinical Problem In recent years, young Asian women have often described their ideal nose as having a thin, gentle lateral curve and a slightly upward nasal tip. They also desire a narrower tip and ala than their present nose. Generally, the nasal tip is round and the skin is thick in Asians, especially in northeastern Asians. In addition to this, the most significant point is…