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

1. Auflage 2010
ISBN: 978-0-387-69007-0
Verlag: Springer US
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 552 Seiten, Web PDF

Reihe: Medicine

A “Clinical Pearl” is shorthand for that critical nugget of information that makes a procedure or a treatment option or therapeutic agent more effective, more efficient, and produces the best possible outcome. A pearl is essentially “off-label”. In surgical specialties, these pearls are even more important because knowing how to avoid complications is better for the patient and the physician. With this book, ophthalmologists and cosmetic surgeons can become more skilled and increase their numbers of successful outcomes.

Zielgruppe

Professional/practitioner

Autoren/Hrsg.

Hartstein, Morris E.

Holds, John

Massry, MD

Inhaltsverzeichnis

Preoperative Evaluation.- Anesthesia.- Upper Lid Blepharoplasty.- Lower Lid Blepharoplasty.- Forehead Rejuvenation.- Mid-Face Lift.- Botox.- Fillers.- Skin Rejuvenation.- Thread Lift.- Other Cosmetic Procedures.- Functional Lid Malpositions.

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."