Ophthalmic Plastic Surgery of the Upper Face: Eyelid Ptosis, Dermatochalasis, and Eyebrow Ptosis

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Title Page
Copyright
Dedication
Contents
Foreword
Preface
Acknowledgements
Contributors
Section I Introduction
	1 Ptosis Classification
		1.1 Introduction
		1.2 Ptosis Classification
		1.3 Preoperative Assessment
			1.3.1 History of Present Illness
			1.3.2 Physical Examination
		1.4 Upper Eyelid Ptosis Classification
			1.4.1 Aponeurotic Ptosis
			1.4.2 Myogenic Ptosis
			1.4.3 Mechanical Ptosis
			1.4.4 Neurogenic Ptosis
			1.4.5 Pseudoptosis
		1.5 Eyebrow Ptosis Classification
		1.6 Clinical Decision-Making
		1.7 Photographing the Patient
		1.8 Informed Consent
		1.9 Principles of Surgical Correction
		1.10 When Not to Operate
		1.11 Postoperative Complications
		1.12 Aesthetic Concerns for Upper Eyelid and Eyebrow Rejuvenation
		References
	2 Aesthetic Anatomy of the Upper Face
		2.1 Introduction
		2.2 Skin
		2.3 Subcutaneous Tissue and Fat Compartments
		2.4 Superficial Musculoaponeurotic System
		2.5 Retaining Ligaments, Canthal Tendons, and Orbital Septum
		2.6 Mimetic Muscles and Eyelid Retractors
		2.7 Deep Fat Compartments
		2.8 Nervous Innervation to the Upper Eyelid and Forehead
			2.8.1 Sensory
			2.8.2 Motor
		2.9 Blood Supply
			2.9.1 Forehead
			2.9.2 Eyelid
		2.10 Lymphatic Drainage
			2.10.1 Forehead
			2.10.2 Eyelid
		2.11 Unique Considerations for the Upper Facial Surgeon: Facial Danger Zones
		2.12 Unique Anatomical Considerations for the Eyelid Surgeon
			2.12.1 Anterior Lamella
			2.12.2 Middle Lamella
			2.12.3 Posterior Lamella
			2.12.4 Eye Protective Mechanisms
		References
	3 Anatomic Considerations in the Aesthetic Surgery of the Upper Face
		3.1 Introduction
		3.2 Racial Differences
			3.2.1 Eyelid Skin
			3.2.2 Upper Eyelid Crease
			3.2.3 Epicanthal Fold
			3.2.4 Tarsal Plate
			3.2.5 Eyebrow Height and Contour
		3.3 Gender Differences
			3.3.1 Eyelid Skin
			3.3.2 Eyelid Dimensions
			3.3.3 Eyebrow Height and Contour
		3.4 Conclusions
		References
Section II Mechanical Ptosis
	4 Mechanical Ptosis: Etiology and Management
		4.1 Introduction
		4.2 Benign Eyelid Lesions
		4.3 Malignant Eyelid Lesions
		4.4 Orbital Lesions
		4.5 Periorbital Infections and Inflammation
		4.6 Other Considerations
		4.7 Summary
		References
	5 Upper Blepharoplasty
		5.1 Introduction
		5.2 Goals of Treatment
		5.3 Risks
		5.4 Benefits
		5.5 Informed Consent
		5.6 Indications
		5.7 Contraindications
		5.8 The Procedure
			5.8.1 Preoperative Checklist
			5.8.2 Instruments Needed
			5.8.3 Sutures Used
			5.8.4 Operative Technique: Step by Step
			5.8.5 Expert Tips/Pearls/Suggestions
			5.8.6 Postoperative Care Checklist
		5.9 Complications and Their Management
		References
	6 Double Eyelid Surgery
		6.1 Introduction
		6.2 Anatomical Considerations
			6.2.1 The Eyelid Crease and Fold
			6.2.2 The Medical Canthal Area
			6.2.3 The Lateral Canthal Area
		6.3 Goals of Intervention/Indications
		6.4 Risks of the Procedure
		6.5 Benefits of the Procedure
		6.6 Informed Consent
		6.7 Contraindications
		6.8 The Procedure
			6.8.1 Instruments Needed
			6.8.2 Preoperative Checklist
			6.8.3 The Operative Technique
			6.8.4 Expert Tips/Pearls/Suggestions
			6.8.5 Postoperative Care Checklist
		6.9 Complications and Their Management
		6.10 Alternative Approaches to Double Eyelid Surgery
		References
	7 A Guide to Eyebrow Contouring Options
		7.1 Introduction
		7.2 Evolving Trends in Brow Beauty
			7.2.1 History of Eyebrow Aesthetics
			7.2.2 Volume and Facial Aging
			7.2.3 Eyebrow Height and Proportions
		7.3 Patient Assessment
			7.3.1 History
			7.3.2 Physical Exam Checklist
		7.4 Risks of Surgery
		7.5 Choosing the Best Procedure/Physician Decision-Making
		7.6 Expert Tips/Pearls/Suggestions
			7.6.1 Upper Eyelid Considerations
			7.6.2 The Role of Nonsurgical Adjuncts
			7.6.3 Managing Asymmetry
			7.6.4 Minimizing Hair Loss
	8 Direct Eyebrow Elevation
		8.1 Introduction
		8.2 Relevant Anatomy
		8.3 Goals of Intervention, Indications, and Benefits of the Procedure
		8.4 Risks of the Procedure
		8.5 Preoperative Considerations and Patient Selection
		8.6 Informed Consent
		8.7 Relative Contraindications
		8.8 Procedure
			8.8.1 Instrumentation
			8.8.2 Preoperative Checklist
			8.8.3 Operative Technique
			8.8.4 Expert Tips/Pearls/Suggestions
			8.8.5 Postoperative Care
		8.9 Complications and Their Management
		References
	9 Internal Eyebrow Lift
		9.1 Introduction
		9.2 Anatomic Considerations of the Upper Facial Continuum
		9.3 Goals of Intervention
		9.4 Risks
		9.5 Benefits
		9.6 Informed Consent
		9.7 Indications
		9.8 Contraindications
		9.9 Patient Assessment
			9.9.1 Medical History
			9.9.2 Ophthalmic History
			9.9.3 Ophthalmic Examination
			9.9.4 Anatomic Evaluation: The Eyelid and Eyebrow Subunits
		9.10 Preoperative Checklist
		9.11 The Procedure
			9.11.1 Instrumentation Needed
			9.11.2 Sutures
			9.11.3 Operative Technique
		9.12 Expert Tips/Pearls/Suggestions
		9.13 Postoperative Care Checklist
		9.14 Complications and Their management
			9.14.1 Bleeding
			9.14.2 Infection
			9.14.3 Nerve Damage
			9.14.4 Postoperative Lagophthalmos and Dry Eye
			9.14.5 Residual Aesthetic Deformity
			9.14.6 Skin Dimpling
		9.15 Summary
		References
	10 Midforehead Browlift Technique
		10.1 Introduction
		10.2 Goals of Intervention/Indications
		10.3 Risks of the Procedure
		10.4 Benefits of the Procedure
		10.5 Informed Consent
		10.6 Contraindications
		10.7 Preoperative Assessment
		10.8 The Procedure
			10.8.1 Instruments Needed
			10.8.2 Operative Technique
		10.9 Expert Tips/Pearls/Suggestions
		10.10 Postoperative Care Checklist
		10.11 Complications and Their Management
		10.12 Conclusion
		References
	11 Open Coronal Pretrichial Browlift Surgery
		11.1 Introduction
		11.2 Unique Anatomical Considerations in Coronal Brow Lifting
			11.2.1 The Eyebrow
			11.2.2 The Anatomic Layers
			11.2.3 The Muscles of Elevation and Depression
			11.2.4 The Sensory Supply
			11.2.5 The Facial Nerve
			11.2.6 The Vascular Supply
		11.3 Patient Evaluation
			11.3.1 Forehead Length and Contour
			11.3.2 Eyebrow Shape and Contour
			11.3.3 Forehead Rhytids
			11.3.4 Nasal Root
		11.4 Goals of Intervention/Indications
		11.5 Risks of the Procedure
		11.6 Benefits of the Procedure
		11.7 Contraindications
		11.8 Informed Consent
		11.9 The Procedure
			11.9.1 Instruments Needed
			11.9.2 Sutures Used
			11.9.3 Preoperative Checklist
			11.9.4 The Operative Technique
		11.10 Expert Tips/Pearls/Suggestions
		11.11 Postoperative Care Checklist
		11.12 Complications and Their Management
			11.12.1 Expanding Hematoma
			11.12.2 Scarring
			11.12.3 Postoperative Brow Asymmetry
			11.12.4 Facial Nerve Damage
			11.12.5 Scalp and Forehead Numbness
			11.12.6 Alopecia
		11.13 Alternative Approaches to the Open Browlift
		References
		Bibliography
	12 Pretrichial Temporal Browlift
		12.1 Introduction
		12.2 Goals of Intervention/Indications
		12.3 Risks of Procedure
		12.4 Benefits of Procedure
		12.5 Contraindications
		12.6 Informed Consent
		12.7 Preoperative Evaluation
		12.8 The Procedure
			12.8.1 Instrumentation
			12.8.2 Preoperative Checklist
			12.8.3 Surgical Technique
		12.9 Expert Tips/Pearls/Suggestions
		12.10 Postoperative Care Checklist
		12.11 Complications
			12.11.1 Scarring
			12.11.2 Suture Granuloma
			12.11.3 Undercorrection
			12.11.4 Overcorrection
		12.12 Conclusion
		References
	13 Minimally Invasive Su-Por–Suture Temporal Brow Suspension: The Lift and Fill Technique
		13.1 Introduction
		13.2 Goals of Intervention/Indications
			13.2.1 Risks of the Procedure
			13.2.2 Benefits of the Procedure
			13.2.3 Informed Consent
		13.3 Contraindications
		13.4 The Procedure
			13.4.1 Instruments Needed
			13.4.2 Preoperative Checklist
			13.4.3 Operative Technique
		13.5 Expert Tips/Pearls/Suggestions
		13.6 Postoperative Care Checklist
		13.7 Complications and Their Management
		References
	14 Endoscopic Upper Face and Eyebrow Lifting
		14.1 Introduction
		14.2 Goals of Intervention
		14.3 Risks
		14.4 Informed Consent
		14.5 Indications
		14.6 Contraindications
		14.7 The Procedure
			14.7.1 Preoperative Checklist
			14.7.2 Instruments Needed
			14.7.3 Closure
			14.7.4 Local Anesthetic
			14.7.5 Fat Grafting
			14.7.6 Incision Placement
			14.7.7 Operative Technique
		14.8 Postoperative Care Checklist
		14.9 Expert Tips/Pearls/Suggestions
		14.10 Complications and Their Management
		14.11 Conclusions
		References
	15 Nonsurgical Management Techniques: Fillers and Neuromodulators
		15.1 Introduction
		15.2 Properties of Botulinum Toxins and Periocular Fillers
			15.2.1 Botulinum Toxin Properties
			15.2.2 Periocular Fillers Properties
		15.3 Single Therapy and Combination Treatments in the Upper Face
			15.3.1 Glabellar Frown Lines
			15.3.2 Crow’s-Feet
			15.3.3 Horizontal Forehead Lines
			15.3.4 Brow Lifting and Shaping
			15.3.5 Hypertrophic Orbicularis Oculi
			15.3.6 Midface
			15.3.7 Temple
		15.4 Conclusion
		References
	16 Fat Augmentation of the Brow
		16.1 Introduction
		16.2 Goals of Intervention
		16.3 Risks of Fat Grafting
		16.4 Benefits of Fat Grafting
		16.5 Informed Consent
		16.6 Indications
		16.7 Contraindications
		16.8 Preoperative Checklist
			16.8.1 Instrumentation
			16.8.2 Operative Technique: Step by Step
		16.9 Expert Tips/Pearls/Suggestions
		16.10 Postoperative Care Checklist
		16.11 Complications and Their Management
		16.12 Conclusion
		References
Section III Involutional Ptosis
	17 Involutional Ptosis: Etiology and Management
		17.1 Introduction
		17.2 Etiology
		17.3 Clinical Presentation
		17.4 Evaluation
			17.4.1 Evaluation of Eyelid
		17.5 Management
		References
	18 External Levator Advancement with Orbicularis-Sparing Technique
		18.1 Introduction/Goals of Intervention
		18.2 Risks
		18.3 Benefits
		18.4 Informed Consent
		18.5 Indications
		18.6 Relative Contraindications
		18.7 The Procedure
			18.7.1 Preoperative Checklist
			18.7.2 Instruments Needed
			18.7.3 Sutures Used
			18.7.4 The Operative Technique: Step by Step
		18.8 Postoperative Care Checklist
		18.9 Expert Tips/Pearls/Suggestions
		18.10 Complications and Their Management
			18.10.1 Undercorrection
			18.10.2 Overcorrection
			18.10.3 Lagophthalmos
			18.10.4 Unsatisfactory Eyelid Contour or Eyelid Crease Asymmetry
			18.10.5 Wound Infection
			18.10.6 Retrobulbar Hemorrhage
		18.11 Conclusion
		References
	19 Small Incision Anterior Levator Advancement
		19.1 Introduction
		19.2 Goals/Indications
		19.3 Risks of the Procedure
		19.4 Benefits of the Procedure
		19.5 Contraindications
			19.5.1 Absolute Contraindications
			19.5.2 Relative Contraindications
		19.6 Informed Consent
		19.7 The Procedure
			19.7.1 Instruments Needed
			19.7.2 Preoperative Checklist
			19.7.3 Operative Technique
		19.8 Expert Tips/Pearls/Suggestions
		19.9 Postoperative Care Checklist
		19.10 Complications and Their Management
		References
	20 Müller’s Muscle–Conjunctival Resection
		20.1 Introduction
		20.2 Special Preoperative Considerations
			20.2.1 Margin Reflex Distance 1
			20.2.2 Phenylephrine Test
			20.2.3 Determining the Amount of Müller’s Muscle–Conjunctival Resection
		20.3 Risks
		20.4 Benefits
		20.5 Informed Consent
		20.6 Contraindications
		20.7 Instrumentation
		20.8 Preoperative Checklist
		20.9 Operative Technique
		20.10 Expert Tips/Pearls/Suggestions
		20.11 Postoperative Management
		20.12 Complications and Their Management
		20.13 Acknowledgment
		References
	21 Dresner’s Modification of Müller’s Muscle–Conjunctival Resection
		21.1 Introduction
		21.2 Indications
		21.3 Risks
		21.4 Benefits
		21.5 Informed Consent
		21.6 Contraindications
		21.7 Instrumentation
		21.8 Preoperative Checklist
		21.9 Operative Technique
		21.10 Expert Tips/Pearls/Suggestions
		21.11 Results
		21.12 Complications and Their Management
		21.13 Conclusion
		References
	22 Posterior White Line Advancement
		22.1 Introduction
		22.2 Relevant Anatomy
		22.3 Indications
		22.4 Risks
		22.5 Benefits
		22.6 Informed Consent
		22.7 Contraindications
		22.8 Instrumentation
		22.9 Preoperative Checklist
		22.10 Operative Technique
			22.10.1 The White Line Advancement for Aponeurotic Ptosis
			22.10.2 Levatorpexy for Congenital Ptosis
		22.11 Expert Tips/Pearls/Suggestions
		22.12 Complications and Their Management
		22.13 Conclusions
		References
	23 The Fasanella–Servat Procedure
		23.1 Introduction
		23.2 Indications
		23.3 Risks
		23.4 Benefits
		23.5 Informed Consent
		23.6 Contraindications
		23.7 Instruments Needed
		23.8 Preoperative Checklist
		23.9 Operative Technique
		23.10 Expert Tips/Pearls/Suggestions
		23.11 Results
		23.12 Complications and Their Management
		23.13 Conclusion
		References
	24 Combined Upper Blepharoplasty and Ptosis Repair
		24.1 Introduction
		24.2 Clinical Evaluation and Indications for Surgery
		24.3 Combined Müller’s Muscle–Conjunctival Resection and Blepharoplasty
		24.4 Combined Fasanella–Servat and Blepharoplasty
		24.5 Combined Levator Aponeurotic Advancement and Blepharoplasty
			24.5.1 Indications
			24.5.2 Contraindications
			24.5.3 Instrumentation
			24.5.4 Preoperative Checklist
			24.5.5 Operative Technique
		24.6 Expert Tips/Pearls/Suggestions
		24.7 Postoperative Management
		24.8 Complications and Their Management
	25 Floppy Eyelid Syndrome Repair with Concomitant Ptosis Repair
		25.1 Introduction
		25.2 Goals of Intervention/Indications
			25.2.1 Risks of the Procedure
			25.2.2 Benefits of the Procedure
		25.3 Informed Consent
		25.4 Contraindications
		25.5 Preoperative Assessment
		25.6 Operative Technique
			25.6.1 Instruments Needed
			25.6.2 Surgical Technique
		25.7 Expert Tips/Pearls/Suggestions
		25.8 Postoperative Care Checklist
		25.9 Complications
		References
	26 Management of Lacrimal Gland Prolapse
		26.1 Introduction and Anatomy
		26.2 Goals of Intervention
		26.3 Risks
		26.4 Benefits
		26.5 Contraindications
			26.5.1 Surgical Procedure
			26.5.2 Instruments Needed
			26.5.3 Operative Technique: Step by Step
		26.6 Expert Tips/Pearls/Suggestions
		26.7 Postoperative Management and Complications
		References
Section IV Myogenic Ptosis
	27 Myogenic Ptosis: Etiology and Management
		27.1 Introduction
		27.2 Static Myogenic Ptosis
		27.3 Progressive Myogenic Ptosis
		References
	28 Static Myogenic Ptosis: Evaluation and Management
		28.1 Introduction
		28.2 Causes and Syndromic Associations of Static Myopathic Ptosis
			28.2.1 Isolated Congenital Ptosis
			28.2.2 Static Myopathic Ptosis with Associated Periocular Anomalies
			28.2.3 Congenital Ptosis with Aberrant Innervation
			28.2.4 Trauma
		28.3 History
			28.3.1 Personal History of Ptosis
			28.3.2 Family History of Ptosis
		28.4 The Physical Examination
			28.4.1 The Eyelid and Adnexal Examination
			28.4.2 The Eye Examination
		28.5 Management
			28.5.1 Observation
			28.5.2 Timing of Surgical Intervention
			28.5.3 The Surgical Approach
		28.6 Conclusions
		References
	29 Surgical Management of Levator Function Less Than 4 mm
		29.1 Introduction
		29.2 History of Frontalis Sling
			29.2.1 Patterns of Sling
			29.2.2 Sling Materials
			29.2.3 Fixation of Sling to Eyelid Tarsus
		29.3 Indications
		29.4 Consequences
		29.5 Unique Considerations in Frontalis Suspension
			29.5.1 Congenital Cases
			29.5.2 Acquired Cases
		29.6 Risks of the Procedure
		29.7 Benefits of the Procedure
		29.8 Relative Contraindications
		29.9 Informed Consent
		29.10 The Procedure
			29.10.1 Surgical Supplies and Equipment
			29.10.2 Preoperative Checklist
			29.10.3 Operative Technique
		29.11 Expert Tips/Pearls/Suggestions
		29.12 Postoperative Care Checklist
		29.13 Complications and Their Management
			29.13.1 Early Complications
			29.13.2 Late Complications
		References
	30 Surgical Management of Static Congenital Ptosis with Levator Function between 4 and 10 mm
		30.1 Introduction
		30.2 The Anatomy of the Eyelid Crease
		30.3 Preoperative Assessment
			30.3.1 Indications
			30.3.2 Consequences of Levator Resection
			30.3.3 Risks of the Procedure
			30.3.4 Benefits of the Procedure
			30.3.5 Relative Contraindications
			30.3.6 Alternatives
		30.4 Informed Consent
		30.5 Instrumentation
		30.6 The Levator Resection Procedure
		30.7 Expert Tips/Pearls/Suggestions
		30.8 Postoperative Care
		30.9 Complications and Their Management
		30.10 Conclusion
		References
	31 Progressive Myogenic Ptosis: Evaluation and Management
		31.1 Introduction
		31.2 Causes of Progressive Myopathic Ptosis
			31.2.1 Oculopharyngeal Muscular Dystrophy
			31.2.2 Chronic Progressive External Ophthalmoplegia
			31.2.3 Myotonic Dystrophies
			31.2.4 The Masquerader of Progressive Myopathic Ptosis
		31.3 History and Physical Examination
			31.3.1 The History
			31.3.2 Physical Examination
		31.4 Management of Progressive Myopathic Ptosis
			31.4.1 Timing of Repair
			31.4.2 Our Workhorse Procedure
		31.5 Conclusions
		References
	32 Syndromic Blepharoptoses
		32.1 Introduction
		32.2 Aberrant Innervation Syndromes
		32.3 Static Myopathic Ptoses Involving the Extraocular Muscles
		32.4 Progressive Myopathic Ptoses that Affect the Levator and Other Muscle Groups Presenting in Childhood
		32.5 Progressive Myopathic Ptoses Seen in Adulthood
		32.6 Management and Conclusions
		References
Section V Neurogenic Ptosis
	33 Neurogenic Ptosis: Diagnosis and Management
		33.1 Introduction
		33.2 Neuroanatomic Considerations
			33.2.1 Cortical and Supranuclear Pathways
			33.2.2 Oculomotor Nerve
			33.2.3 Oculosympathetic Pathway
			33.2.4 Neuromuscular Junction
		33.3 Localization
			33.3.1 Supranuclear/Cortical Localization
			33.3.2 Brainstem Localization
			33.3.3 Spinal Cord and Paravertebral Ganglia Localization
			33.3.4 Carotid Artery and Cavernous Sinus Localization
			33.3.5 Nuclear Localization
			33.3.6 Infranuclear Localization
		33.4 Aberrant Innervation Syndromes
			33.4.1 Compressive/Trauma
			33.4.2 Marin-Amat’s Syndrome
			33.4.3 Synkinesis
		33.5 Diseases of the Neuromuscular Junction
			33.5.1 Myasthenia Gravis
			33.5.2 Lambert–Eaton Syndrome
		33.6 Congenital Presentations
			33.6.1 Third Nerve Palsy
			33.6.2 Congenital Horner’s Syndrome
		33.7 Summary
		References
Section VI Pseudoptosis
	34 Pseudoptosis: Evaluation and Management
		34.1 Introduction
			34.1.1 Dermatochalasis
			34.1.2 Vertical Strabismus
			34.1.3 Contralateral Eyelid Retraction
			34.1.4 Enophthalmos
			34.1.5 Ocular Abnormalities
			34.1.6 Eyelid Protractor Overaction
		References
Section VII Additional Considerations in Upper Facial Surgery
	35 Eyelash Ptosis Management
		35.1 Introduction
		35.2 Anatomical Considerations
			35.2.1 Eyelash Cilia
			35.2.2 Levator Aponeurosis and Eyelid Crease
		35.3 Goals of Intervention/Indications
		35.4 Risks of the Procedure
		35.5 Benefits of the Procedure
		35.6 Informed Consent
		35.7 Contraindications
		35.8 Procedure
			35.8.1 Instruments Needed
			35.8.2 Preoperative Checklist
			35.8.3 Operative Technique
			35.8.4 Expert Tips/Pearls/Suggestions
			35.8.5 Postoperative Care Checklist
		35.9 Complications and Their Management
		References
	36 Blepharoptosis Reoperation
		36.1 Introduction
		36.2 Anatomical Considerations
		36.3 Goals of Intervention/Indications
		36.4 Risks of the Procedure
		36.5 Benefits of the Procedure
		36.6 Informed Consent
		36.7 Contraindications
		36.8 Procedure
			36.8.1 Instruments Needed
			36.8.2 Preoperative Checklist
			36.8.3 Operative Technique
			36.8.4 Expert Tips/Pearls/Suggestions
			36.8.5 Postoperative Care Checklist
		36.9 Complications and Their Management
		References
	37 Nonsurgical Management of Ptosis
		37.1 Introduction
		37.2 Mechanical Eyelid Elevation
			37.2.1 Eyelid Crutches
			37.2.2 Eyelid Taping
			37.2.3 Haptic Contact Lens
		37.3 Pharmacologic Eyelid Elevation
			37.3.1 Topical Therapy
			37.3.2 Neurotoxin Injections
		37.4 Management of Ptosis in the Anophthalmic Patient
		37.5 Management of Pseudoptosis with Filler Injection
		References
	38 Unique Considerations in Upper Facial Surgery
		38.1 Introduction
		38.2 Perioperative Medications
			38.2.1 Blood-Thinner Considerations
			38.2.2 Classes of Blood Thinners
			38.2.3 Balancing Thrombotic Risks and Bleeding Risks
			38.2.4 Time to Stop Blood Thinners Preoperatively
			38.2.5 Supplements and Other Considerations
		38.3 Perioperative Antibiotic Considerations
			38.3.1 Current Practice Patterns in Oculofacial Plastic Surgery
			38.3.2 Patterns and Rates of Surgical Site Infection
			38.3.3 Preoperative Recommendations
			38.3.4 Perioperative Recommendations
			38.3.5 Postoperative Recommendations
		38.4 Energy Devices
			38.4.1 Types of Devices
			38.4.2 Fire Risk and the Triad
			38.4.3 Effects of the Plume
		38.5 Conclusions
		References
	39 Staying Out of Trouble: Strategies Based on Recent OMIC Oculofacial Plastic Surgery Claims
		39.1 Introduction
		39.2 Particular Problem Areas in the Practice of Upper Facial Plastic Surgery
			39.2.1 Blepharoplasty and Ptosis Repair
			39.2.2 Brow Lifting
			39.2.3 Invasive Skin Treatments
		39.3 Fillers and Autologous Fat
		39.4 Goals for the Upper Facial Surgeon
			39.4.1 Establishing the Correct Diagnosis
			39.4.2 Knowing When to Say No to Treatment
			39.4.3 Effective Communication
			39.4.4 Surgical Plan and Execution
			39.4.5 Patient Follow-Up
			39.4.6 Actively Manage Complications
			39.4.7 Revisit Patient Expectations Frequently
		39.5 The Unhappy Patient: Cosmetic Dissatisfaction and Patient Expectations
			39.5.1 Refunds
			39.5.2 I’m Sorry Laws
		39.6 Expert Tips/Pearls/Suggestions
		39.7 Coping with the Process of a Malpractice Claim
		39.8 Conclusions
		References
		39.9 Appendix A
			39.9.1 Informed Consent for Ptosis Surgery (Droopy Eyelid Surgery)
		39.10 Appendix B
			39.10.1 Patient Cosmetic Surgical Agreement
Index
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