Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Male Rhinoplasty

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 Asian Rhinoplasty

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…

The Middle Eastern–Mediterranean Nose

The Clinical Problem ( Fig. 18.1 ) The term Middle Eastern commonly refers to people of Turkish, Persian, Arabic, and North African descent. Although a large variety of nasal features can be seen, the population in Turkey usually presents with a mixture of Middle Eastern and Mediterranean nasal morphology. Synopsis Middle Eastern–Mediterranean patients possess a varied combination of nasal characteristics : 1. There is a significant…

Crooked Nose

The Clinical Problem ( Fig. 17.1 ) The deviated nose presents significant problems to the aesthetic surgeon and is one area in which revisions for residual deviation or asymmetry are common. Synonyms for the deviated nose include crooked, S -shaped, and twisted. Deviated noses can be defined when the nasal axis is displaced from the midline. Sometimes defining the midline can be a problem, because more…

Aesthetic Nasal Tip Surgery

The Clinical Problem ( Fig. 16.1 ) There is great variance within the accepted norm for nasal tip appearance. Fat bulbous noses or sharply projecting nose tips are very complex anatomic structures and require considerable surgical skill and experience when attempting tip rhinoplasty. Shaping and final positioning of the nasal tip complex is the most critical and sophisticated stage of rhinoplasty. Increased control and predictability are…

Prominent Nose

The Clinical Problem A prominent nose is regarded as abnormal if it is larger than average, but even within different cultures this is very subjective. Larger prevalence of the prominent nose in a total population is seen in the Mediterranean basin and in the Middle East. Patients look at their noses through a prism of internal reflection, which may also be the outlet for a psychological…

Platysma Bands

The Clinical Problem ( Fig. 14.1 ) Platysma bands are vertical, cordlike structures in the anterior neck that patients often describe as tendons and think detract from an appealing neck. Along with transverse cervical creases, submental skin, and/or fat excess and ptosis, they are key features of an aging neck. Bands may occur medially (paramedian or anterior) or laterally and start to make their appearance in…

The Turkey Neck: Surgical Management

The Clinical Problem Aging in white individuals is accompanied by jowls, submental laxity, or fullness and laxity, with banding of the platysma muscles. This combination is often referred to as a turkey neck. Along with these changes, which begin in the early 40s, are skin laxity and horizontal creasing. There is a progressive downward and forward cascade of skin, fat, and muscles, obliterating the cervicomental angle…

Management of the Neck

The Clinical Problem ( Fig. 12.1 ) Synopsis Neck shape is determined by the following: ▪ Mandible anatomy—chin hypoplasia ▪ Skin turgor, texture, tone ▪ Fat deposition location and volume ▪ Platysma anatomy and physiology ▪ Submandibular gland size and position ▪ Digastric muscle size ▪ Hyoid position ▪ Thyroid cartilage prominence The Aesthetic Problem Neck contours are determined by the interplay of multiple factors. Because…

High SMAS Face Lift

The Clinical Problem ( Fig. 11.1 ) The patient looks in the mirror and at recent photographs and thinks that he or she looks old and tired. She or he comments, “how I feel is much younger then how I look” and may state that the work environment is competitive and many cohorts look much younger. An associated loss of self-confidence may be claimed. Synopsis ■…

Nonsurgical Rejuvenation of the Periorbital Area

The Clinical Problem A variety of differing aesthetic treatments and procedures are presently available for nonsurgical periorbital rejuvenation. Although less invasive treatments will not replace surgery, a growing patient population is seeking results through low-risk procedures with associated minimal downtime. These techniques are largely based on wound healing and collagen generation and continue to improve as new technologies become available. Many devices target the injury deep…

Anatomic Relationship of SOOF and ROOF in Eyelid Rejuvenation

The Clinical Problem: Prominent Bulging Suborbicularis Oculi Fat Pad and Retro-Orbicularis Oculi Fat Pad ( Fig. 9.1 ) The aging lower eyelid can be a complex and difficult problem to improve aesthetically. There is considerable risk of over-resection of both fat and skin, with consequent pull-down ectropion and permanent hollowness. An anatomic understanding of the superficial and deep face fat compartments is crucial when attempting to…

Midface Descent and Malar Support

The Clinical Problem ( Fig. 8.1 ) Rejuvenation of the midface was formerly limited to a lower lid blepharoplasty in conjunction with some form of a face lift. Neither adequately addresses the nasojugal groove (also referred to as the tear trough) or the nasolabial fold. Furthermore, a traditional lower lid blepharoplasty would frequently include resection of herniated lower lid fat, which in turn could produce a…

Asian Blepharoplasty

The Clinical Problem Synopsis Upper eyelid blepharoplasty in Asians often refers to double-eyelid plasty and epicanthoplasty because about half of Asians lack an upper eyelid crease, so-called single eyelids. Many procedures for double-eyelid plasty have been reported since the suture technique was described by Mikamo in 1896. Although the surgical principles are similar to those for occidental eyelids, the surgical design and operative technique are different…

Upper Blepharoplasty

The Clinical Problem ( Fig. 6.1 ) Introduction The primary physical function of the upper eyelids is protection of the eyes but, together with the eyebrows and forehead, they form an expressive aesthetic unit, with significant social function. Anatomy and Aging Ideally, the upper eyelid resting position is 1 to 2 mm below the superior border of the corneal limbus and has 12 to 15 mm of lid…

Endoscopic Endotine Brow Lift Made Easy

The Clinical Problem The aging brow that requires an endo brow lift has to be considered within the aging face as a whole if a rejuvenation procedure is to be successful. A high frontal hairline, a brow ptosis causing visual field disturbance, a heavily wrinkled or creased forehead, a tendency to a poor scar, hair loss, or infection, associated medical conditions, and skin type are reasons…

Brow Lift

The Clinical Problem ( Fig. 4.1 ) Introduction Any patients requesting upper blepharoplasty must have an accurate assessment of the brow, and each portion must be treated according to its merits. Over-resection of the upper eyelid to compensate for brow ptosis will lead to a suboptimal result. The brow position must be checked for mobility; brow asymmetry might be a sign of upper eyelid ptosis on…

Aesthetic Applications for Fillers

The Clinical Problem—The Aging Face ( Fig. 3.1 ) How Does the Face Age? Each face ages in its own way according to genetics and external factors, such as sun, tobacco, diet, life stress, and illness. ▪ The main phenomena are the appearance of wrinkles, loss and shifting of facial volumes, and contraction of the muscles used in making facial expressions. ▪ The solution for the…

Aesthetic Medicine: Surgical Pearls

Introduction Aesthetic medicine comprises all medical procedures that are aimed at improving the physical appearance and satisfaction of the patient, using noninvasive to minimally invasive cosmetic procedures. These aesthetic procedures consist of: ▪ injections of neurotoxins ▪ dermal fillers/fat grafting ▪ chemical peels ▪ radiofrequency ▪ cryotherapy ▪ lasers and intense pulsed light (IPL) ▪ ultrasound treatment ▪ platelet-rich plasma (PRP) The author used a combination…

Informed Consent: Protecting the Patient and the Surgeon

The Process of Informed Consent Neal R. Reisman MD, JD, FACS The process of informed consent is very important to the practice of plastic surgery. Not only is it a requirement from a legal standpoint, but it should assist in clarifying goals and expectations. Understanding informed consent is a process and not specifically the document that becomes signed; the process should include not only the surgeon,…