Midface and Neck Aesthetic Plastic Surgery_Vol 1

Yet another book on face lifts
Acknowledgments
Surgical Anatomy Seminars
CHAPTER I - ANATOMY, PHYSIOLOGY, PATHOLOGY
	Starting with the rudiments: a guided dissection
		Cadaver dissection
		Subcutaneous tissues
		Muscles of Facial Expression (MFE
		Surgical SMAS
		The facial nerve
		The parotid
		Parotid, facial nerve and submandibular gland
		Subperiosteal malar dissection
		Subperiosteal dissection extended to the infraorbital area
		The infraorbital nerve
		Dissection of the forehead: the corrugator muscles
		Corrugator muscles and the supraorbital and supratrochlear nerves
	An outline of the anatomy and aesthetic pathophysiology of the face and neck
		The skin
		Common skin defects
		Subcutaneous tissues
		Superficial adipometry
		The most important fat deposits of surgical interest in the cheek
		SMAS (Superficial Muscular Aponeurotic System
		Neck bands
		Lateral view of the platysma
		Sub-SMAS
		Bichat’s fat pad
		The deep plane
		Ligaments and areas of adhesion
		Sensory innervation
		The trigeminal nerve
		The cervical plexus
		The motor innervation
		The facial nerve
		Motor nerves of the face and neck
		Arterial Blood Supply
		Venous drainage
	The orbital/periorbital midface areas
		The upper eyelid, and following pages
		Superficial anatomy of the lower eyelid (transcutaneous blepharoplasty
		Anatomy of the anterior lamella
		Fat compartments and lower oblique muscle
		Eyelid biodynamics
		The lateral canthal system
		Anatomy of the external canthal ligament (cadaveric dissection
		Obicularis muscle
		The eyelid septum
		The canthal ligament
		The canthal ligament and tendons
		Lacrimal gland
		The midface area, and following pages
	Important practical infraorbital and malar anatomy details
		Facial nerve and undermining planes
		Midface sensory nerve innervation
CHAPTER II - MIDFACE LIFT
	Midface and temporal lift
	Midface lift: we have finally made it
	The “surgery” look
	Aesthetic pathophysiology
		The most common defects in the midface area related to ageing
	Variables in the different techniques
		Approaches
	Undermining levels in the palpebral and malar/infraorbital areas, and following pages
		Superficial subcutaneous undermining
	The vectors (orientation of the flap), and following pages
	Flap anchorage, and following pages
	Correcting of defects in the malar and Infraorbital region
	The base technique
		Midface lift without incising the inferior portion of the orbicularis muscle
		Midface lift without a subciliary approach (Cornette de Saint Cyr’s technique
	Midface lift without subciliary incision in the orbicularis
	Midface lift without an orbicularis muscle subciliary incision, and following pages
	Deep undermining (subperiosteal
	Superficial undermining (suborbicularis
	Simple paracanthal flap, and following pages
	Bifid paracanthal flap
		Canthopexy
		Suspenders
	Endotine midace
		Skin resection
		Temporal approach
		Sutures
	Midface lift using barbed threads
	Barbed threads
		Anatomy of the orbital-periorbital area from a book published nearly 200 years ago
		Anatomy of the face back in history
	Questionnaire, and following pages
CHAPTER III - MIDFACE LIFT WITH TEMPORAL ANCHORING
	Indications
	Advantages
	Disadvantages
	Superolateral vector midface lift
	Pre-operative markings
	Anaesthesia
	The operation, and following pages
	Guidelines for the midface lift with “suspender” suturing
	Cases, and following pages
		Soft tissue ptosis with hollow palpebral/infraorbital areas
		Soft tissue ptosis with infraorbital/malar festoons
	The technique illustrated step by step, and following pages
		The lacrimal gland
		Excising eyelid fat
		Subcutaneous undermining
		Skin dissection and incision
		Assessing the amount of redundant skin in the lower eyelid
		Excising the redundant skin in the lower eyelid
CHAPTER IV - TRANSPALPEBRAL MIDFACE LIFT
	Indications
	Advantages
	Disadvantages
	Superior vector midface lift with subperiosteal undermining and transos. fixation
		Periorbital Anchoring
		Pre-operative markings
		Anaesthesia
		The operation
	Guidlines for the midface lift with “belt-like” anchoring
	Cases, and following pages
	The technique illustrated step by step, and following pages
CHAPTER V - UPPER EYELID COSMETIC SURGERY - UPDATES AND REVISIONS
	Indications
	Advantages
	Disadvantages
	Upper eyelid cosmetic surgery
	Notes on surgical anatomy
	Clinical examination and diagnosis
	Basic technique
		The Markings
		Anaesthesia
		The operation
	Analysing a few stages in detail
		Pre-operative photographs
		The pre-op markings of the skin to be removed
		Skin excision
		Sculpturing fat and the orbicularis muscle
		And if there’s not enough fat
		Other “filling” techniques for the upper eyelid
		Orbicularis flaps and grafts used to fill the upper eyelid
		Sutures
		What happens after the operation
	Let’s examine and discuss a few cases of upper blepharoplasty
	Complimentary techniques
		Transpalpebral stabilization of the eyebrows
		Repositioning the lacrimal gland
		Orbital bone rim abrasion
		Correcting eyelid ptosis
		Correcting Eyelid Retraction
		Canthopexy through an Upper Blepharoplasty Incision
	When and how eyebrows must be lifted
		The eyebrow’s position
		The eyebrow’s shape
		Techniques for lifting the eyebrows
		Direct eyebrow lift
	Temporal lift
		What do we want to lift
		The first incision and the dissection
		Releasing the fla p
		The second incision
		Anchoring the flap
		Sutures
	The temporal lift according to Fogli, and following pages
	Anchoring the central portion of the eyebrow
		Flap fixation with Mitek anchors
		Endotine anchoring
		Superolateral deep temporal lift
CHAPTER VI - LOWER EYELID COSMETIC SURGERY: Updates and Revisions
	Indications
	Advantages
	Disadvantages
	Lower eyelid cosmetic surgery
		An outline of surgical anatomy
		Clinical examination and diagnosis
		Eyelid tone
		Examination
		Photographs
	Basic technique: the transconjunctival approach
	Transconjunctival blepharoplasty
	Basic technique: the transcutaneous approach
	Modellig fat
	Loeb’s technique, and following pages
	Factors influencing the lower lid border position
		Factors involved in maintaining a correct lower lid position
		Factors leading to a lower lid displacement (before and/or after surgery
		What is a negative-positive vector
		Infrapalpebral depression: further considerations, and following pages
		Infrapalpebral depression: Eziopathogenesis, and following pages
		Correction of the infrapalpebral depression
		Filling grooves with fat grafts, and following pages
		Filling the crease with retroseptal fat (“Loeb
		Infrapalpebral grooves corrected using Loeb’s (Dike-Hamra) technique
		Transconjunctival fat transposition
		Transconjunctival fat transposition results
		Filling the naso-jugal groove with implants (Flowers,Yaremchuk, Bertossi and Nocini
		Filling the groove resorting to a midface lift
		Summarizing the essential points regarding the correction of the infrapalpebral groove
	The orbicularis muscle in a lower blepharoplasty
		Anatomy of the orbicularis
	The skin in a lower blepharoplasty
		Skin resection
			Skin resection at the end of an inferior blepharoplasty
		Suturing the lower eyelid
	Canthoplasty through the lower blepharoplasty incision
CHAPTER VII - CANTHOPLASTIES
	Indications
	Advantages
	Disadvantages
	Canthoplasties
		Further Anatomical Specifications
		Static canthopexy
		Plication of the canthal ligament (tarsal sling
		Beginner canthopexy
		Sectioning and respositioning the canthal ligament in a static canthopexy
		Tarsal strip, and following pages
		Further considerations on the tarsal strip technique
		Other static canthopexy techniques
		Anchoring the orbicularis with a flap or a direct suture (superficial canthopexy
	Dynamic canthopexy, and following pages
		Dynamic canthopexy techniques
		Dynamic canthopexy by sectioning/repositioning the canthal..., and following pages
		Where to position the lateral canthi and how to avoid asymmetries
		The post-operative period
		Dynamic canthopexy: late results
		Dynamic canthopexy in lower eyelid ptosis
		Dymanic canthopexy to correct sloping eyes
		The importance of the orbicularis muscle in dynamic canthopexies
		Cat woman
	Complex marginal retractions: when just a canthopexy is not sufficient
		Clinical tests for eyelid margin displacement
		Inferior eyelid ptosis
	Grafts and cutaneous flaps in the anterior lamella
		Integrating skin in the anterior lamella
		Integrating skin with a midface lift
	Grafts in the posterior lamella
		Scleral show and sloping eyes
		Skin graft in the posterior lamella
		Palatine mucosa graft in ther posterior lamella
		Cartilaginous grafts, and following pages
	Complications of canthopexy
CHAPTER VIII - ENDOCRINE ORBITOPATHY (Graves - Basedow’s Disease)
 - ENDOSCOPIC ENDONASAL TREATMENT OF BASEDOW’S
 OPHTHALMOPATHY
	Bilateral fat decompression according to Olivari
		Indications
		Advantages
		Disadvantages
	Bilateral bone decompression
		Indications
		Advantages
		Disadvantages
	Combined techniques of fat and bony decompression in one stage
		Indications
		Advantages
		Disadvantages
	ENDOCRINE ORBITOPATHY
		Patient affected by endocrine orbitopathy
		Epidemiology
		Clinical Aspects
		Diagnosis
		Differential diagnosis
	Treatment
		Steroid therapy
		Radiotherapy
		Surgical therapy
		Transpalpebral fat decompression, and following pages
		Levator muscle elongation, and following pages
		Palatine mucosa graft in the lower eyelid, and following pages
		Medical treatment of glabellar hypertone
		Surgical treatment of glabellar hypertone
	Clinical cases, and following pages
	ENDOSCOPIC ENDONASAL TREATMENT OF BASEDOW’S OPHTHALMOPATHY
CHAPTER IX - MIDFACE LIFT COMBINED WITH A NECK AND LOWER CHEEK LIFT
	Indications
	Advantages
	Disadvantages
	Combining midface and classic cervicofacial lifts, and following pages
		SMAS fixation
	Clinical cases, and following pages
	Technique illustrated step by step
CHAPTER X - THE “REVERSE MIDFACE LIFT”: the Le Fort I Osteotomy
	Le Fort I osteotomy
		Indications
		Advantages
		Drawbacks
	Introduction
		Our patients
		Maxillary retrusion
		Vertical maxillary excess
		Vertical maxillary defect
		Facial asymmetry
	Facial diagnosis and treatment planning
	Diagnosing the face
		Clinical evaluation
		Photograph
		Cephalometric analysis on lateral x-ray
	Treatment planning
	Case CR
	Le Fort I surgical technique
	Clinical case, and following pages
	Piezoeletric bone surgery
		Introduction
		Bone segments treated with piezosurgery
		Surgical sequence of orthognathic surgery
		Chin surgery
		Intrasurgical sequence of genioplasty
		Case report
		The mandibular angle surgery
		Mandibular angle osteotomy: intraoperative sequence
		Case report
		The malar surgery
		Case report
		Bimaxillary Transversal Distraction
		Case report
		Results
		The use of piezosurgery in pre-prosthetic and reconstructive surgery
		Le Fort I with bone grafts
		Surgical sequence
		Clinical case
		Conclusions
	Jawbone augmentation with fibula flap
		Clinical case
		Intraoperative sequence of the fibula flap
		Result
		Conclusions
Analytic index