Hartstein / Holds / MD Pearls and Pitfalls in Cosmetic Oculoplastic Surgery

2009
ISBN: 978-0-387-69007-0
Verlag: Springer US
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 552 Seiten, eBook

This superbly practical quick-reference guide features high-yield snapshots of more than 200 cosmetic procedures. The editors and authors are all expert in their fields and offer "here’s how I do it" advice on the most commonly performed procedures. The authors address pre-operative evaluation, procedural pearls, wound healing, complications, and common anesthesia issues. Nearly every case has full color illustrations that bring it to life. Each chapter serves as the voice of an expert and experienced colleague, reminding readers of the pearls and pitfalls of each procedure. These pearls will lead to quicker cases, fewer complications, and more satisfactory outcomes for physicians and patients.

Zielgruppe

Professional/practitioner

Autoren/Hrsg.

Hartstein, Morris E.

Holds, John

MD,

Massry, MD, Guy G.

Massry, Md

FACS,

Inhaltsverzeichnis

Part I. Preoperative evaluation.- 1. Preoperative evaluation of the cosmetic patient.- 2. Evaluation of the Difficult Cosmetic Patient.- 3. Preoperative patient counseling for cosmetic blepharoplasty.- Part II. Anesthesia.- 4. Guide to Local Anesthetic Medications.- 5. Motor nerve blocks in oculofacial surgery.-6. Regional nerve blocks in oculofacial surgery.- 7. Procedural Sedation in oculofacial surgery.- 8. Pre-operative preparation and Anesthesia.- 9. Maximizing patient comfort for blepharoplasty with straight local anesthesia.- 10. How to minimize discomfort to the patient when injecting the lids.- 11. Achieving patient comfort in blepharoplasty surgery.- 12. Enhancing patient comfort with local anesthetic.- 13. 'Digital Diffusion' Technique for the Administration of Local Anesthetic.- 14. Oculofacial Anesthesia.- 15. Anesthesia for in-office oculoplastic surgery.- Part III: Upper Lid Blepharoplasty.- Section One: Preoperative evaluation.- 16. Upper Eyelid Blepharoplasty: The Evaluation.- 17. Preoperative examination checklist for upper blepharoplasty.- 18. Preoperative measurements in upper blepharoplasty.- 19. Patient evaluation for upper blepharoplasty.- 20. Preoperative Evaluation and documentation in upper blepharoplasty.- Section Two: Incision planning.- 21. Marking strategies for upper blepharoplasty.- 22. Orbit size and lid marking in upper blepharoplasty.- 23. Incisional guidelines when marking the skin in Upper Eyelid Blepharoplasty.- 24. Marking the Proposed Upper Eyelid Crease: Determining the Safe Amount of Skin Removal:The Pinch Technique.- 25. Keys to success when Marking the skin in Upper Blepharoplasty.- 26. Skin marking adjustments in upper lid blepharoplasty.- 27. Preventing web formation during skin marking in upper blepharoplasty.- 28. Skin marking in upper blepharoplasty—avoiding pitfalls.- Section Three: Upper blepharoplasty procedurepearls.- 29. Upper blepharoplasty: Pearls for the Procedure.- .30. Fat excision in upper blepharoplasty.- 31. Mobilizing and Excising the Nasal Fat Pad in upper blepharoplasty.- 32. Tissue removal considerations in Blepharoplasty surgery.- 33. Less hematomas in upper blepharoplasty.- 34. Ellman vs. CO2: which Is better?.- 35. Fat preservation and other tips for Upper blepharoplasty.- Section four: Adjunctive procedures in upper blepharoplasty.- 36. Internal brow lift with corrugator removal.- 37. Trans-blepharoplasty incision browpexy.- 38. Addressing the brow during upper blepharoplasty.- 39. The ROOF in upper blepharoplasty.- 40. Excision of ROOF Fat during upper blepharoplasty.- 41. Transblepharoplasty incision lower lid canthopexy.- 42. Lower lid canthopexy through Upper lid incision.- Section five: Wound closure and post-op care.- 43. Avoiding Dog Ears during Upper Blepharoplasty Closure.- 44. Crease formation in upper blepharoplasty.- 45. Use of Tissue adhesive for blepharoplasty incision closure.- 46. Postoperative care following upper blepharoplasty.- 47. Avoiding or minimizing Postoperative Swelling.- Section six: Special Topics.- 48. Management of post-blepharoplasty dry eye.- 49. Asian Blepharoplasty.- PART IV: Lower Lid Blepharoplasty.- Section One: Preoperative considerations.- 50. Lower Eyelid Blepharoplasty: The Evaluation.- 51. Lower Eyelid Blepharoplasty evaluation—avoid the cookie cutter approach.- 52. The skin in lower lid blepharoplasty—general principles.- Section Two: Procedure pearls.- 53. The treatment of festoons in lower blepharoplasty.- 54. Achieving symmetry in lower blepharoplasty fat removal.- 55. Lower Eyelid Blepharoplasty: Procedure Pearls and Pitfalls.- 56. Incising the septum over the nasal, central, and lateral fat pads in lower blepharoplasty.- 57. Hemostasis in Lower blepharoplasty.- 58. Prolapsing the inferior fat pads

Leseproben

"90 Evaluating Potential Botox Patients (p. 294-295)

Samuel M. Lam

Understanding the clinical bene? ts and limitations of Botox (BTX) therapy is important; these must be effectively communicated to every patient in order to ensure uniform satisfaction. As almost every practitioner of cosmetic enhancement, surgeon and physician alike, use Botox in his or her clinical practice, it is important to differentiate the quality of one’s Botox therapy from competitors. This chapter will recount how to attain consistently excellent results and to minimize patient discomfort so as to increase patient loyalty and repeat visits. Botox injection is easy to perform but must be undertaken with care and attention for optimal results.

Evaluation of the Potential Botox Patient

Botox therapy provides excellent and safe periocular cosmetic enhancement when applied in a deliberate and conscientious method. During the initial consultation, the physician should ask what experiences the patient may have had with Botox in the past and what expectations he or she should hold. Review of the patient’s prior experiences is informative as to what pitfalls the physician can avoid in the current session. For example, if the patient says that the brow position descended excessively with prior usage, the physician should pay particular attention to how to treat the frontalis.

Excessive ecchymosis from a previous treatment may re? ect careless or inadvertent venopuncture or a patient’s excessive usage of a nonsteroidal antiin? ammatory medication. Counseling a patient during the initial phone encounter to avoid aspirin, herbal therapies, or other blood-thinning medications is important as is avoiding treatment 1–2 weeks before an important professional or social engagement in case ecchymosis arises and cannot be entirely camou? aged.

It is helpful during the discussion to study the patient’s habits of animation and particular anatomic features before injection is undertaken. During discussion with a patient, the physician may glean clues that can be very informative. For example, the patient may constantly raise or hold the eyebrows skyward to compensate for brow ptosis. Treatment of these frontalis rhytids with Botox will compromise the patient’s ability to lift the brows and be quite devastating for the patient.

Having the patient close the eyes tightly and then slowly open them, concentrating all the while on not using the brow muscles, will prove conclusively to the patient that the frontalis is being used to alleviate brow ptosis and therefore should not be injected. Also, the surgeon may observe that the patient constantly frowns during pensive moments. Therefore, the surgeon can advise that therapy of the glabellar musculature may prove bene? cial to break this undesirable habit. In fact, treatment of this unin- tended habitual action over a period of a year may actually break the habit, as the patient unconsciously unlearns this behavior over time. These clinical clues can only be effectively discerned when the patient is unwittingly observed, so the initial cosmetic consultation can be invaluable in many respects for the physician."