Aesthetic Plastic Surgery of the East Asian Face Hon g Ryu l Jin , MD, Ph D Professor an d Ch air Depar t m en t of Otorh in olar yngology–Head an d Neck Su rger y Boram ae Medical Cen ter Seoul Nat ion al Un iversit y College of Medicin e Seoul, Repu blic of Korea 956 illu st rat ion s Th iem e New York • St u t tgar t • Delh i • Rio de Jan eiro Execut ive Editor: Tim othy Y Hiscock Man aging Editor: J Ow en Zurh ellen IV Editorial Assist an t: Naam ah Sch w art z Director, Editorial Ser vices: Mar y Jo Casey Product ion Editor: Ken n eth L Ch u m bley International Production Director: An dreas Schabert Vice President, Editorial and E-Product Developm en t: Vera Spilln er In tern at ion al Market ing Director: Fion a Hen derson In tern at ion al Sales Director: Louisa Turrell Director of Sales, North Am erica: Mike Rosem an Sen ior Vice President and Chief Operating Of cer: Sarah Vanderbilt Presiden t: Brian D Scan lan Medical Illu st rators: Hyu n -Hang Lee Librar y of Con gress Cat alogin g-in -Pu blicat ion Dat a Nam es: Jin, Hong Ryul, editor Title: Aesth et ic plast ic surger y of th e East Asian face / [edited by] Hong Ryul Jin Descript ion : New York : Th iem e, [2016] | In clu d es bibliograp h ical referen ces an d in dex Iden t ifiers: LCCN 2015048817| ISBN 9781626231436 (h ardcover : alk pap er) | ISBN 9781626231443 (eISBN) Su bject s: | MESH: Recon st ru ct ive Surgical Procedu res | Cosm et ic Tech n iques | Surger y, Plast ic m eth ods | Face surger y | Asian Con t in en t al An cest r y Group Classificat ion : LCC RD119 | NLM WO 600 | DDC 617.9/52—d c23 LC record available at h t t p://lccn loc.gov/2015048817 Im p or t an t n ot e: Medicin e is an ever-ch anging scien ce u n dergoing t in u al develop m en t Research an d clin ical exp erien ce are t in u ally expan ding ou r kn ow ledge, in p ar t icu lar ou r kn ow ledge of prop er t reat m en t an d drug th erapy In sofar as th is book m en t ion s any dosage or applicat ion , readers m ay rest 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app licat ion u sed is en t irely at th e u ser’s ow n risk an d resp on sibilit y Th e au th ors an d pu b lish ers requ est ever y u ser to report to th e p u blish ers any discrep an cies or in accu racies n ot iced If errors in th is w ork are foun d after publicat ion , errat a w ill be posted at w w w.th iem e.com on th e p rod u ct descript ion p age Som e of th e produ ct n am es, p aten t s, an d registered design s referred to in th is book are in fact registered t radem arks or p ropriet ar y n am es even th ough speci c referen ce to th is fact is n ot alw ays m ade in th e text Th erefore, th e app earan ce of a n am e w ith out d esign at ion as proprietar y is n ot to be st rued as a represen t at ion by th e pu blish er th at it is in th e pu blic dom ain © 2016 Th iem e Medical Pu blish ers, In c Th iem e Publish ers New York 333 Seven th Aven ue, New York, NY 10001 USA +1 800 782 3488, custom erser vice@th iem e.com Th iem e Publish ers St u t tgart Rü digerst rasse 14, 70469 St ut tgart , Germ any +49 [0]711 8931 421, custom erser vice@th iem e.de Th iem e Publish ers Delh i A-12, Secon d Floor, Sector-2, Noida-201301 Ut t ar Pradesh , In dia +91 120 45 566 00, cu stom erser vice@th iem e.in Th iem e Publish ers Rio d e Jan eiro, Th iem e Pu blicaỗừes Ltda Edifớcio Rodolph o de Paoli, 25 an dar Av Nilo Peỗan h a, 50 – Sala 2508 Rio de Jan eiro 20020-906, Brasil +55 21 3172 2297 Cover design : Th iem e Publish ing Grou p Typ eset t ing by Prairie Papers Prin ted in Ch in a by Asia Pacific Offset ISBN 978-1-62623-143-6 Also available as an e-book: eISBN 978-1-62623-144-3 54321 Th is book, in cluding all par t s th ereof, is legally protected by copyrigh t Any use, exploit at ion , or com m ercializat ion outside th e n arrow lim it s set by copyrigh t legislat ion w ith ou t th e p u blish er’s sen t is illegal an d liable to prosecut ion Th is applies in part icular to ph otost at reproduct ion, copying, m im eograph ing or duplicat ion of any kin d, t ran slat ing, preparat ion of m icro lm s, an d elect ron ic dat a processing an d storage Dedicated to th ose p hysician s w h o believe th at a p h ilosophy is requ ired to ch ange even a sm all par t of th e face v Contents Forew ord ix Dean M Torium i Forew ord x Stephen S Park Preface xi Ack n ow ledgm en t s xii Con t r ib u tor s xiii I Intro ductio n Th e Ch an gin g Face of Aest h et ic Facial Plast ic Su r ger y am on g East Asian s Keng Lu Tan and Hong Ryul Jin II Rhino plasty Au gm en t at ion Rh in op last y Usin g Silicon e Im p lan t s 13 In-Sang Kim Th e Use of Cost al Car t ilage for Dor sal Au gm en t at ion an d Tip Graft in g .26 Victor Chung and Dean M Torium i Nasal Tip Mod if cat ion in Asian s: Au gm en t at ion an d Rot at ion Con t rol 47 Hong Ryul Jin and Jong Sook Yi Hu m p Resect ion 60 Tae-Bin W on and Hong Ryul Jin Cor rect ion of t h e Deviated , Tw isted Nose .72 Hun-Jong Dhong Cor rect ion of t h e Sad d le Nose 87 Keng Lu Tan and Chae-Seo Rhee Alar Base Mod if cat ion .99 Ian Loh Chi Yuan and Hong Ryul Jin Aest h et ic Rh in op last y for Sou t h east Asian s .108 Eduardo C Yap 10 Cor rect ion of t h e Sh or t , Con t racted Nose 122 Hong Ryul Jin 11 Man agem en t of Allop last -Related Com p licat ion s 135 Eunsang Dhong III Blepharo plasty 12 Dou b le-Eyelid Su r ger y: Non in cision al Su t u re Tech n iqu es 151 Jin Joo Hong and Hae W on Yang 13 Dou b le-Eyelid Su r ger y: In cision al Tech n iqu es 162 Jae W oo Jang 14 Agin g-Related Up p er Blep h arop last y 173 Hok yung Choung and Nam ju Kim 15 Ep ican t h op last y an d Aest h et ic Lateral Can t h op la st y 184 Yongho Shin 16 Low er Blep h arop last y 196 Yoon-Duck Kim and Kyung In W oo 17 Cor rect ion of Ptosis 210 W oong Chul Choi and Juw an Park 18 Man agem en t of Dou b le-Eyelid Su r ger y Com p licat ion s 225 In-chang Cho and Aram Harijan vii viii Content s IV Facial Bo ne Surge ry 19 Zygom a Red u ct ion 243 Sanghoon Park and Jihyuck Lee 20 Man d ible Red u ct ion 254 Sanghoon Park and Seungil Chung 21 Aest h et ic Or t h ogn at h ic Su r ger y 268 Seong Yik Han and Kar Su Tan 22 Gen iop last y 286 Seong Yik Han and Kar Su Tan V Facial Skin and Hair Rejuvenatio n 23 Man agem en t St rategies for t h e Agin g Asian Face: Ph ilosop h y an d Evolu t ion 303 Sam uel M Lam 24 Facial Fat Graft in g 311 Kyoung-Jin (Saf ) Kang 25 En d oscop ic Foreh ead an d Brow Lift .324 Tee Sin Lee and Stephen S Park 26 Facial Reju ven at ion Usin g En er gy Devices 339 Un-Cheol Yeo 27 Hair Tran sp lan t at ion in East Asian s .349 Sungjoo (Tom m y) Hw ang 28 Aest h et ic Laser Hair Rem oval for t h e Asian Face 364 W ooseok Koh VI Minim ally Invasive Facial Plastic Surgery 29 Aest h et ic Facial Use of Bot u lin u m Toxin in East Asian s 377 Kyle Seo 30 Facial Con tou r in g Usin g Filler s 392 Jongseo Kim 31 Man agem en t of Facial Filler In ject ion Com p licat ion s .405 Hyoung Jin Moon and Jong Sook Yi In d ex .415 414 VI Minim ally Invasive Facial Plastic Surgery 11 Algh oul M, Codn er MA Ret ain ing ligam en t s of th e face: review of an atom y an d clin ical ap p licat ion s Aesth et Su rg J 2013;33(6):769–782 19 Lam bros V Th e u se of hyalu ron idase to reverse th e e ect s of hyaluron ic acid ller Plast Recon st r Surg 2004;114(1): 277 12 Tan sat it T, Moon HJ, Apin u n t rum P, Ph et udom T Veri cat ion of em bolic channel causing blin dness follow ing ller inject ion Aesthet ic Plast Surg 2015;39(1):154–161 20 Klein KC, Gu h a SC Cu t an eou s w ou n d h ealing: cu rren t cept s an d advan ces in w ou n d care In dian J Plast Su rg 2014;47(3):303–317 13 Carruth ers JD, Fagien S, Roh rich RJ, Wein kle S, Carruth ers A Blin dn ess cau sed by cosm et ic ller inject ion : a review of cause and th erapy Plast Recon st r Surg 2014;134(6): 1197–1201 21 Sh a r R, Am ir A, Gu r E Long-term com p licat ion s of facial inject ion s w ith Rest ylan e (inject able hyalu ron ic acid) Plast Recon st r Su rg 2000;106(5):1215–1216 14 Fagien S Paper presen ted at: 2013 Allergan ALFA execut ive su lt an t s m eet ing; Novem ber 23, 2013; New York, NY 15 Lazzeri D, Agost in i T, Figus M, Nardi M, Pan t alon i M, Lazzeri S Blin dn ess follow ing cosm et ic inject ion s of th e face Plast Recon st r Su rg 2012;129(4):995–1012 16 Sung MS, Kim HG, Woo KI, Kim YD Ocu lar isch em ia an d isch em ic ocu lom otor n er ve p alsy after vascu lar em bolizat ion of inject able calciu m hydroxylapat ite ller Op h th al Plast Recon st r Su rg 2010;26(4):289–291 22 Hirsch RJ, Naru rkar V, Carru th ers J Man agem en t of in jected hyalu ron ic acid in duced Tyn dall e ect s Lasers Su rg Med 2006;38(3):202–204 23 Fern án dez-Aceñ ero MJ, Zam ora E, Borbujo J Gran u lom atous foreign body react ion again st hyalu ron ic acid: report of a case after lip augm en t at ion Derm atol Surg 2003;29(12):1225–1226 24 Rau lin C, Greve B, Hart sch u h W, Soegding K Exu dat ive gran ulom atous react ion to hyaluron ic acid (Hylaform ) Con t act Derm at 2000;43(3):178–179 17 Coh en JL, Biesm an BS, Dayan SH, et al Treat m en t of Hyaluron ic acid ller-in duced im pen ding n ecrosis w ith hyalu ron idase: Con sen su s recom m en dat ion s Aesth et Su rg J 2015;35(7):844–849 25 Sidw ell RU, Dh illon AP, Bu tler PE, Ru st in MH Localized gran ulom atous react ion to a sem i-perm an ent hyaluron ic acid an d acr ylic hydrogel cosm et ic ller Clin Exp Derm atol 2004;29(6):630–632 18 Kim DW, Yoon ES, Ji YH, Park SH, Lee BI, Dh ong ES Vascular com plicat ion s of hyalu ron ic acid llers an d th e role of hyalu ron idase in m an agem en t J Plast Recon st r Aesth et Su rg 2011;64(12):1590–1595 26 Plau s W J, Herm an n G Th e su rgical m an agem en t of su percial infect ion s caused by at ypical m ycobacteria Su rger y 1991;110(1):99–103 27 Jordan DR, Stoica B Filler m igrat ion : a n u m ber of m ech an ism s to sid er Oph th al Plast Recon st r Surg 2015;31(4):257–262 Index Note: Page nu m bers follow ed by f an d t in dicate gures an d tables, respect ively A ablat ive rejuvenat ion , 339 – lasers for, 340, 343, 344f – principles of, 340 abscess, facial fat graft ing an d, 320, 320f ACell See Mat riStem acn e, facial, im provem ent , laser hair rem oval an d, 369, 369f acn eiform erupt ion, facial fat graft ing an d, 320 aden osin e t riph osph ate (ATP), in hair t ran splant procedures, 306 adipose-derived stem cells, in fat graft ing, 318 ADSC See adipose-derived stem cells aesth et ic facial plast ic surger y, in East Asian s – pearls, – t ren ds in , 3–10 aging See also bleph aroplast y, aging-related – of Asian face, m an agem en t of, 303–310 –– pearls, 303 – low er eyelid, 196–197, 197f – periocular, 196–197, 197f – periorbit al ch anges related to, 174 – skin , solar exposure an d, 303–304 ala (pl., alae) – asym m et ric, 14, 15 – East Asian , ideal sh ap e of, 100, 100f – aring of, 99, 101, 101f – h anging, 100, 101, 103 –– sail excision for, 109–110, 110f–111f – h ooding, 101 – physical exam in at ion of, 99–100, 100f – resect ion, 9, 15 – w ide, alar base – de n ition of, 99 – of East asian n ose, 99 – eth n ic variat ions in , 99 – illu sions an d, 100 – m odi cat ion –– in dication s for, 99 –– patient evaluat ion for, 99–101 –– pearls, 99 – poor h arm ony w ith n asal dorsum and t ip, after alar base surger y, 105 – skin of, 101 – skin qu alit y an d, 100 – surger y –– in aesth et ic rh in oplast y for South east Asians, 116 –– case st u dies, 105–106, 106f, 107f –– for cleft n ose, 103, 104f –– com plicat ion s of, 104–105, 105f –– excision design , 102, 102f –– key techn ical poin ts in, 103–104 –– n asal obst ruct ion after, 105 –– pearls, 99 –– poor h arm ony of alar base w ith nasal dorsum an d t ip after, 105 –– scarring after, 104–105, 105f –– tech niques for, 101–103 –– t ypes of, 102, 102f – su rgical an atom y of, 101, 101f – w idth of, 99, 100 alar bat ten grafts, 39 alar-colum ellar disproport ion, correct ion of, 53–54, 54f alar facial groove, 101 alar lift , sail excision for, 109–110, 110f–111f alar rim – excessively th ick, 99 – hanging, 99 alar rim graft(s), 39, 54–55 – in correct ive rh in oplast y for sh or t t racted n ose, 128, 128f alar w edge resect ion , 102, 102f – large, V-Y advan cem en t for, 103 – and sill excision , com bin ed, 102, 102f, 103f, 105–106, 106f, 107f AlloDerm , in rh in oplast y, 135 – com plicat ion s of, 138, 138f, 140 allograft , in genioplast y, com plicat ion s of, 294–295, 295f alloplast ic im plan t s See also Gore-Tex; Medpor; silicone im plan ts – advant ages of, 13 – in Asian aesth et ic surger y, 14 – calci cat ion of, 22 – capsule form at ion w ith, 22 – for chin –– com plicat ion s of, 294–295, 295f –– in facial rejuven at ion , 309 – com plicat ion s of, 13, 14, 22–23, 28, 28f – in fect ion w ith , 23, 24, 25f – in h eren t physical characterist ics of, problem s cau sed by, 22–23 – in rh in oplast y –– calci cat ion , secon dar y rhin oplast y for, 139, 140f –– com plicat ion s of, 135–148 –– deviated, secon dar y rhin oplast y for, 138–139 –– infectious com plications of, 141 –– in am m at ion caused by, 140 –– m obile, secon dar y rhin oplast y for, 139 –– pat ien t evaluat ion, 136–138 –– pearls, 135 –– prot rusion , secondar y rhin oplast y for, 139 –– visible, secon dar y rh in oplast y for, 139 – in septorhin oplast y, 135–136, 143 –– pearls, 135 – an d sh ort n ose deform it y, 122 – skin an d m ucosal dam age caused by, 22 alopecia See also h air loss – en doscopic forehead an d brow lift an d, 337 – tem porar y, after h air t ran splant at ion , 359 an atom y – of alar base, 101, 101f – of Asian eyelid, 6, 211 – of Asian face, 6, 7f, 8f – of Asian n ose, 6, 26, 27f, 61–62 – of East Asian eyelid, 162–163, 163f – of facial arter y, 407, 407f – of facial bon es, – of forehead, 324–326, 325f–327f, 331–332, 332f – of glabella, 324–326, 325f–327f, 331–332, 332f – of intern al n asal valve, 87 – of lateral n asal ar ter y, 404f – n egat ive vector, 197f, 198, 207, 207f – posit ive vector, 198 – of tem poral region , 324–326, 325f–327f – of upper eyelid, 152–153, 153f, 162 an esthesia – for augm en tat ion rhin oplast y, 16, 28 – for blepharoplast y, 178 – for double-eyelid surger y, 166 – for en doscopic forehead an d brow lift , 330 – for facial fat graft ing, 312, 313 – for ller inject ion in facial touring, 394 – for gen ioplast y, 290 – for ptosis surger y, 216, 216f – for zygom a reduct ion , 247 Angle classi cat ion , of m alocclusion , 269, 270f an terior segm ent al osteotom y, for bim a xillar y prot rusion , 274t, 277–279, 279f – an d gen ioplast y, 286, 295, 296f–297f, 298, 299f Aqu am id See polyacr ylam ide gel arcus m argin alis, 326, 331 arteriovenous st u la, h air t ransplan tat ion an d, 360 Artesense See polym ethyl m ethacr ylate Asian (s) – de n it ion of, – facial aesthet ic procedures u sed in , 3, 4f ASO See an terior segm en t al osteotom y ATP See aden osin e triph osph ate (ATP) augm en tat ion rhin oplast y See also n asal dorsal augm en tat ion – alar bat ten graft s in , 39 – alar rim graft s in , 39 – an esth esia for, 16, 28 – an d base reduct ion , 39 – brow lift w ith , 15 – case st udies, 40–43, 40f–45f – cau dal septal extension graft in, 34, 34f, 40, 41f – closure for, 21, 39 – com plicat ion s of, 22–23 – defat t ing for, 18, 18f – an d glabellar augm en tat ion , 39 – incision s for, 17, 21 – key techn ical point s, 21–22, 40 – an d low n asal bridge, 21 – open , in cision s for, 17 – open ing nose for, 28 – osteotom y in , 19 – pat ien t evaluat ion for, 14–15, 14f, 15f – pearls, 13 – posit ion ing for, 16 – postoperat ive care, 39–40 – principles of, 13 – release of ligam en tous at tachm en ts in , 18 – septal cart ilage h ar vest in , 18–19, 19f – silicon e im plant s for, 13–25 –– case st udies, 23–24, 24f, 25f –– closu re tech n ique for, 21 –– com plicat ions of, 22–23 –– derm al fat graft w ith , 22, 23f –– displacem en t an d m ovem en t of, 23 415 416 Index augm en tat ion rhin oplast y (cont inued) – silicon e im plant s for (cont inued) –– ext rusion of, 23 –– in fect ion w ith , 23, 24, 25f –– in sert ion of, 19, 19f –– key tech nical poin ts in , 21–22 –– pearls, 13 –– periosteal pocket for, 17–18, 18f –– p rep arat ion of, 16–17, 16f, 17f –– splin t ing, 21 – skin ap elevat ion, 17, 17f – skin m arking for, 15–16, 16f – spreader graft placem en t in , 32–33, 33f, 40, 41f – stacked on lay graft for, 19–20, 20f – surgical tech niques for, 28–39 – t ip contouring in , 37–39, 38f – an d t ip -to-sept um h eigh t di erence w ith lateral crural in clin at ion , varian t techn ique for, 21, 21f – un i ed graft an d im plan t hybrid in sert ion in , 20 – varian t techn iques for, 20–21 – vert ical lin e for, 16, 16f – w ing graft placem en t in , 20, 20f autoim m un e disease, an d saddle n ose, 89 autologous grafts, 8–9 B backstop graft , in aesth et ic rh inoplast y for South east Asian s, 113 beaut y – Asian ideal of, – cult ural beliefs about , – Eurocen t ric, – Korean de nit ion of, in uence of, Bell’s ph enom enon , preoperat ive evaluat ion, 177, 181, 214, 329 Belotero See hyaluronic acid bigonial dist an ce, 254, 270, 271f – increased, 255–256 – reduct ion of, 255 bilateral vert ical sagit t al ram us osteotom y, m an dibular, 274t bim axillar y advan cem ent/ reduct ion, 9, 295, 296f–297f, 298, 299f bim axillar y prot rusion , an terior segm en tal osteotom y for, 274t, 277–279, 279f – an d gen ioplast y, 286, 295, 296f–297f, 298, 299f bim axillar y surger y See anterior segm en tal osteotom y; double jaw surger y bitem poral w idth, 270, 271f bizygom at ic w idth, 244–246 Blaskovics’ m eth od, for aesthet ic lateral can th oplast y, 190–191, 191f bleph aroplast y, 7f, 307, 307f See also double-eyelid su rger y – aging-related (upper), 173–183, 328 –– an esth esia for, 178 –– asym m et r y after, 181 –– bleph aroptosis an d, 175, 176f –– brow posit ion an d, 175–176 –– case st udies, 182–183, 182f–183f –– com plicat ions of, 180–181 –– corneal protect ion m ech an ism an d, 177 –– deep superior sulcus an d, 175, 175f –– derm atoch alasis an d, 175, 176f –– eyelid crease design in , 178 –– eyelid crease form at ion in , 179, 180f –– eyelid w rin kles an d, 177 –– fat rem oval in , 179, 179f, 181 –– goals of, 173–174 –– key tech n ical poin ts in , 180 –– lacrim al gland injur y in , 181 –– lacrim al gland posit ion an d, 177 –– lagoph th alm os after, 181 –– levator fu nct ion an d, 175, 175f, 176f –– an d nat ural eyelid crease creat ion , 182, 182f –– an d not iceable eyelid crease creat ion , 183, 183f –– orbit al fat prolapse an d, 177 –– an d orbit al h em orrhage, 181 –– pat ien t dissat isfact ion w ith , 180 –– pat ien t evaluat ion for, 175–178 –– pearls, 173 –– postoperat ive care, 180 –– skin closure, 179, 180f –– skin excision in , 178, 178f, 181 –– skin text ure and thickn ess an d, 178 –– an d su perior sulcus, 181 –– tear secret ion and, 177 –– tech n iques for, 178–179 –– too-h igh double-lid fold after, 181 –– t ren ds in , 173–174 –– under-correct ion in, 180 –– unn at ural eyelid tou r after, 181 –– upper eyelid crease an d, 177 –– w ith out eyelid crease creat ion, 182, 182f – Asian , 162 See also doubleeyelid su rger y – com plicat ion s of, 225–239 – dem an d for, am ong East asian s, 196 – an d epicanth oplast y, com bin ed, – fat preser vat ion m eth od, 197–198, 202–203 –– in dicat ion s for, 198 – fat t ran sposit ion , 199, 202–203 –– com plicat ions of, 206 –– subperiosteal, 202–203 –– supraperiosteal, 203, 203f – goals of, 173–174 – low er, 196–209 –– in Asian pat ien ts, surgical siderat ion s, 199 –– asym m et r y after, 205 –– case st udies, 206–207, 207f –– com plicat ions of, 205–206 –– conjun ct ival ch em osis after, 206 –– diplopia after, 206 –– ect ropion after, 205, 205f –– eyelid ret ract ion after, 205 –– globe posit ion an d, 198 –– h orizont al laxit y correct ion procedures, 204 –– in ferior orbital rim an d, 197f, 198 –– key tech n ical poin ts in , 204 –– an d lateral tarsal st rip procedure, 204 –– low er eyelid laxit y an d, 198–199 –– an d m in im ally invasive lateral can th oplast y, 204 –– n egat ive vector anatom y an d, 197f, 198, 207, 207f –– an d orbicu laris oculi suspension, 204, 206, 207f –– orbicularis-retain ing ligam ent release and orbitom alar suspension in , 203 –– an d orbit al h em orrh age, 206 –– pat ien t evaluat ion for, 197–199 –– pearls, 196 –– w ith pin ch skin excision , 199, 201, 201f –– posit ive vector an atom y an d, 198 –– postoperat ive care, 201 –– an d prom in en t lateral fat pad, 205 –– an d SOOF lift , 198, 199, 203, 207, 207f –– surgical tech n iques for, 199–204 –– t ransconju nct ival approach, 197, 199 –– t ransconju nct ival fat excision procedure, 199–201, 199f, 200f –– t ranscu tan eous approach , 197, 199, 201, 202f – upper –– an d en doscopic foreh ead an d brow lift , 336 –– skin -on ly, 304f blepharoptosis, 162, 174, 174f – cau ses of, 210 – correct ion , 153, 154 – versu s derm atoch alasis, 175, 176f – after double-eyelid surger y, 236–237, 237f – evalu at ion , 175, 176f – involut ion al –– clin ical presen tat ion of, 175, 175f –– an d deep superior sulcus, 175, 175f – pat ien t evaluat ion , 211–214 – versu s ptosis, 174, 175f – upper eyelid fu nct ion in, 153 blindn ess – fat graft em bolizat ion an d, 320 – after ller inject ion , 10, 403 –– preven t ion of, 407–408, 408f blood, as ller, propert ies of, 393t bot ulinum toxin – as adjun ct to en doscopic foreh ead an d brow lift , 336 – aesth et ic facial use of, 377–391 –– inject ion levels, 379 –– landm arks for, 379 –– pat ien t evaluat ion for, 378 –– pearls, 377 – for brow lift ing an d shaping, 336, 381–382 – for bu nny lin es, 384, 384f – for cobbleston e ch in , 385, 386f – com m ercial form ulat ion s, 378 – com plicat ion s of, 389 – for crow ’s-feet , 380–381, 381f, 382f – dilut ion of, 378–379 – dosage of, 378 – for forehead an d glabellar rhyt idosis, 328 – for forehead h orizon t al lin es, 379, 379f, 380f – for glabellar frow n lin es, 379–380, 380f – for gum m y sm ile, 384, 384f – for infraorbital eye open ing, 382–383, 383f – for infraorbital w rin kles, 382, 382f – int raderm al inject ion, 388–389, 389f – for m arion et te lines, 385, 386f – for m asseter m uscle hypert rophy, 386–388, 387f, 388f – for m outh corn er elevat ion , 385, 386f – for n asal t ip lift ing, 383, 383f – for parot id glan d reduct ion, 388, 389f – for perioral rhyt ids, 384–385, 385f – for plat ysm al ban ds, 386, 386f – for squ are jaw, 386–388, 387f, 388f – storage of, 378–379 breast augm en tat ion , an d cost al cart ilage h ar vest , 28–29, 29f brow lift See also en doscopic foreh ead an d brow lift – w ith augm en tat ion rh in oplast y, 15 – an d blepharoplast y, 176 – botulinum toxin for, 336, 381–382 Index – incision s for, 329, 330f – indicat ion s for, 15 brow t ip aesthet ic line, 72–73, 73f bruising – facial fat graft ing an d, 319 – ller inject ion an d, 407 bun ny lin es, bot ulin um toxin for, 384, 384f BVSRO See bilateral vert ical sagit t al ram us osteotom y C calci cat ion, of alloplast ic im plan ts, 22 calcium hydroxylapat ite, 394, 405 – propert ies of, 393t cart ilage – auricular, advan tages of, 24 – autologous, for nasal t ip augm en tat ion , 13 – ch al –– in corrective rhinoplast y for short contracted nose, 124f, 125 –– har vest of, 17, 109 – costal See cost al cart ilage – as dorsal im plan t , 114 – septal, har vest of, 18–19, 19f, 62 cart ilage grafts, – in rhinoplast y, caruncle See lacrim al carun cle Caucasians, as beau t y ideal, historical perspect ive on , Caucasoids, ceph alom et r y – eth n ic di erences and, 270–272, 272f, 290f – for gen ioplast y, 287, 288t, 289, 290f, 295, 297f, 298 – param et ric values, disparit y am ong Asians an d Caucasians, 270–272, 272f – preoperat ive, in orth ogn athic surger y, 282f–284f – referen ce poin t s in , 270, 271f, 272f, 273t ch arm ing roll, 378, 383 ch eek – ller inject ion in, 397–399, 398f – four crescen t aging lin es, 397–399, 398f ch eekbones – Asian , 6, 7f – prom in en t (high ), 243, 244 ch em ical peeling, in facial rejuvenat ion , 340 ch em osis, conjun ct ival, after low er bleph aroplast y, 206 ch in – aesth et ics of, 286 – alloplast ic im plan t for, 309 – asym m et r y, and low er facial touring, 257 – augm ent at ion , 40–43, 42f –– in facial rejuvenat ion , 309 –– ller inject ion for, 400–401, 401f – cobblestone, bot ulin um toxin for, 385, 386f – de n it ion of, 257 – drooping/distor t ion , after gen ioplast y, 294 – ideal, ch aracterist ics of, 286 – on lay augm en tat ion, h istorical perspect ive on , 287 – peau d’orange on , after gen ioplast y, 294–295 – in plann ing for low er facial contouring, 257 – posit ion , ceph alom et ric an alysis of, 287, 288t, 289, 290f, 295, 297f – psychosocial sign i can ce of, 286 – ptosis, after gen ioplast y, 294 – resect ion, in low er facial touring, 257 ch in im plan t , cobbleston e ch in , bot ulinu m toxin for, 385, 386f cocain e abuse, and saddle n ose, 89–90 collagen , inject ion, depth of, 405 colum ella – Asian , 26, 27f – lengthen ing aps for, – ret ract ion of, 100 – ret rusion of, 99 – sh or t , – w ide base of, 99 colum ellar base, too-w ide, correct ion of (n arrow ing of), 103, 104f Com fort Pulse Tech n ology (Th erm age), 344 com pu ted tom ography – e beam , 272 – preoperat ive –– for gen ioplast y, 289 –– for m an dibular reduct ion , 256 –– for secon dar y rh inoplast y, 136 conjoin t fascia, 326, 327f, 331 conjoin t ten don , 331 conjunct ival ch em osis, after low er blepharoplast y, 206 conjunct ival prolapse, after ptosis correct ion , 221 conjunct ival tarsal Mü llerectom y, 211 conjunct ivo-Mü llerectom y See Mü ller m u scle conjun ct iva resect ion (MMCR) t act len s–in du ced ptosis, 214, 214f t ract ion , nasal, postoperat ive, 24, 25f corneal protect ion m ech an ism , preoperat ive evaluat ion , 177 corneal ulcer, 177 correct ive rh in oplast y, 72–86 – approach for, select ion of, 75 – bleeding/hem atom a after, 81 – case st udies, 81–83, 82f–85f – closure, 80 – com plicat ion s of, 81 – dorsal irregularit y/deviat ion after, 81 – dressing, 80 – edem a after –– late (persisten t), 81 –– m anagem en t of, 81 – en don asal approach for, 75 – extern al approach for, 75 – key tech n ical poin ts in , 80–81 – n asal sept al st raighten ing in, 77–78, 78f – osteotom y in , 76–77 – pat ien t select ion , 74–75 – pearls, 72 – postoperat ive m an agem en t, 80 – preoperat ive pat ien t in ter view for, 74 – for saddle n ose, 87–98 –– pearls, 87 – sept al exten sion graft in , 79–80, 80f – for sh ort t racted nose, 122–134, 141–142, 142f –– case st udies, 131–133, 132f–133f –– closure, 129 –– com plicat ion s of, 130–131 –– com posite graft for, 124f, 125, 129, 130f –– dorsal augm en tat ion in , 129, 129f –– elongat ion of fram ew ork in , 127, 128f –– graft car ving for, 126, 126f, 127f –– graft m aterial h ar vest ing for, 125–126, 125f –– key tech n ical point s in , 130 –– m ovabilit y of costal cart ilage graft after, 130–131 –– n asal obst ru ct ion after, 131 –– pat ien t evaluat ion , 122–123, 123f –– pearls, 122 –– pneum oth orax du e to, 130 –– skin dam age in, 130 –– skin un derm in ing, 127 –– st rategies for, 123–125, 124f –– techn iques for, 123–129 –– t ip graft s in , 127–128, 128f –– t ip problem s after, 131 –– t ip reposit ion ing in , 127–128, 128f –– w arping of costal cart ilage graft after, 130, 131f – spreader graft in , 78–79, 79f – surgical plann ing, 74 – tech n iques for, 75–80 corrugator supercilii m uscle, 326–327 costal cart ilage – advant ages of, 27–28 – age and, 28 – car ving –– for augm ent at ion rh in oplast y, 31, 43, 44f –– for dorsal on lay graft , 126, 126f, 127f –– for at st raigh t piece, 126, 127f – disadvan tages of, 13 – graft splint ing techn ique, 31, 32f – h ar vest of, 125–126, 125f –– an atom ical siderat ion s in , 29, 29f –– in cision for, 28–29, 29f –– an d pn eum oth orax, 130 –– an d scar, 28, 29f, 31 –– tech niqu e for, 28–31, 30f, 40, 41f, 43, 44f – for n asal dorsal augm en tat ion , 8, 26–46, 30f, 41f, 43, 44f –– pearls, 26 – n asal dorsal onlay graft –– m ovabilit y of, 130–131 –– w arping of, 130, 131f – for n asal t ip graft ing, 26–46, 30f, 41f –– pearls, 26 – problem s w ith , 13 coun seling, preoperat ive, for rh in oplast y, 27–28 CPT See Com fort Pulse Tech n ology Crohn’s disease, an d saddle n ose, 89 crow ’s-feet – bot ulin um toxin for, 380–381, 381f, 382f – preoperat ive evaluat ion , 177 cu cum ber face, 246 D deep tem poralis fascia, 325, 325f, 326f den t al m odel, 272 depigm en tat ion , after laser facial h air rem oval, 370 derm al hydrat ion , u sing hyaluron ic acid, 402 derm atoch alasis, 174, 174f, 210, 328 – versu s blep h aroptosis, 175, 176f – brow ptosis w ith , 176 – evaluat ion , 175 digital im aging – m orphing w ith , 27 – in rh inoplast y plan n ing, 27, 40, 40f, 43, 43f diplopia, after low er blepharoplast y, 206 dist ract ion test (for w ard t ract ion test), for eyelid laxit y, 198–199 dorsal nasal arter y, ller inject ion in , prevent ion of, 403, 408–409, 409f double eyelid, 151–152, 152f, 162, 163, 174 – form at ion –– extern al-in cision techn ique, 153 –– n on in cision sut ure ligat ion for, 153 – h eigh t for, 165, 166f – open ing ph ase, 153f – rest ing ph ase, 153f – too-high , after aging-related (upper) bleph aroplast y, 181 417 418 Index double-eyelid surger y, 162 – asym m et r y after, 233 – bleph aroptosis after, 236–237, 237f – com plicat ion s of, 158–160, 170, 225–239 –– case st udies, 238, 238f –– key tech nical poin ts for, 237 –– pat ient evaluat ion , 225 –– pearls, 225 –– surgical tech n iques for, 226–237 – deep fold after, 228 – ect ropion after, 228, 230f – an d epicanth oplast y, 185–186, 186f – an d exoph th alm os, 154 – incision al, 162–172 –– an esth esia for, 166 –– asym m et r y after, 170 –– case st udies, 170–171, 171f –– closu re, 169, 169f –– com plicat ions of, 170 –– for correct ion of h igh crease to low crease, 171, 171f –– for correct ion of sh ort in side crease to out side crease, 170, 171f –– crease design , 165–166, 166f –– crease disappearance after, 170 –– disadvan tages of, 163 –– xat ion sut ure of eyelid crease in , 168, 168f –– in dicat ion s for, 163, 163f –– key tech nical poin ts in , 169 –– an d levator advan cem en t , 169, 169f –– m ult iple folds caused by, 166, 167, 168f –– orbicularis m uscle rem oval in , 166–167, 167f –– orbit al fat rem oval in, 167, 167f –– pat ient evaluat ion for, 163–164 –– pearls, 162 –– postoperat ive care, 170 –– ROOF rem oval in , 167, 167f –– skin bulging after, 168, 169f –– skin excision in , 165, 166–167, 166f, 167f –– skin in cision in , 166, 167f –– skin su t ure in, 169, 169f –– tech n iques for, 165–169 – inclusion cyst after, 226, 227f – m ult iple folds caused by, 166, 167, 168f, 233–236, 234f, 235 – n onin cision al sut u re tech n iques –– case st udies, 161, 161f –– com plicat ions of, 158–160 –– an d irregular fold, 159 –– key tech nical poin ts in , 158 –– an d knot exposu re, 160 –– an d lid m argin tension eversion, 160, 160f –– n eedle ch oice, 156 –– pearls, 151 –– procedu res for, 156–157, 156f–158f –– an d relapse, 158–159 –– an d scar, 159, 160f –– an d st itch abscess, 160 –– an d st rangulat ion , 160 –– sut u re m aterial, 155–156 – part ial in cision al tech nique, 163 – pat ien t evaluat ion for, 154 – pret arsal fullness after, 232–233, 233f – ptosis after, 238, 238f – an d pu y eyelid, 154 – rem oval of surgically created eyelid fold after, 237 – revision case, 154–155 – scar after, 226, 226f, 227f – shallow fold after, 227–228, 228f – sim ple sut ure tech n ique, 163 – su nken eyelid after, 236, 236f – t ran sconjunct ival Mü ller t ucking in, 158, 159f, 161, 161f – t riple fold caused by, 166, 167, 168f, 232, 233–236, 234f, 235f, 238, 238f – an d w eak levator fun ct ion, 154 double jaw surger y, 274t, 279 dr y eye syn drom e, 177, 181, 214 E East Asian s, – facial aesth et ic procedures used in, 3, 4f – ph en ot ypic feat ures of, ecchym osis, after en doscopic forehead an d brow lift , 337 ect ropion , 8, 198 – after dou ble-eyelid surger y, 228, 230f – after low er bleph aroplast y, 205, 205f – after ptosis correct ion , 221 eczem a, lateral can th al, 174 edem a – after en doscopic foreh ead an d brow lift , 337 – facial fat graft ing an d, 319 – after ller inject ion , 403, 412 EFBL See en doscopic foreh ead an d brow lift E-lin e See esth et ic lin e (E-lin e) en doscopic foreh ead and brow lift , 324–338 – advant ages an d disadvan tages of, 324, 330 – alopecia caused by, 337 – an atom ical siderat ion s in, 324–326, 325f–327f, 331–332, 332f – an esthesia for, 330 – an d bot ulin um toxin , 336 – closure, 336 – com bin ed approach , sequen ce of, 336 – com plicat ion s of, 337 – dissect ion , 331 – dressing, 336 – ecchym osis after, 337 – edem a after, 337 – exam in at ion for, 328–329 – xat ion m eth od, 332–336 –– w ith cort ical bone t un nels, 334, 335f –– w ith En dot in e Forehead device, 334–336, 336f –– w ith brin glue, 333 –– w ith m onocort ical screw s, 333–334, 334f – forehead an d brow xat ion in , 332–333 – gran ulom a form at ion after, 337 – h airlin e elevat ion after, 337 – h em atom a caused by, 337 – h istorical perspect ive on , 324 – h istor y-taking for, 328–329 – an d im plan t problem s, 337 – incision s for, 330–331, 331f – indicat ion s for, 328 – an d infect ion, 337 – inst rum en t s for, 330, 330f – an d int racran ial inju r y, 337 – key tech n ical poin t s in , 336–337 – n er ve injur y in, 337 – n o xat ion in , 333 – an d open tech n iques, com parison of, 324, 329 – over- and un der-correct ion in , 337 – pat ien t evaluat ion for, 328–330 – pearls, 324 – plan e of dissect ion for, 325, 325f, 326f, 331 – postoperat ive care, 336 – preparat ion for, 330 – relaps after, 337 – release of m uscular an d ligam en tous at tach m en t in, 331–332, 332f – serom a after, 337 – sut u re ext rusion after, 337 – techn iques for, 330–336 – tem poral xat ion in, 332, 333f – an d w oun d problem s, 337 En dot ine Foreh ead device, 334–336, 336f en t ropion , 162 – correct ion of, 168 – after ptosis correct ion , 221 epican th al fold(s), 164–165, 173, 184 – recon st ruct ion , 194, 194f – thirds of, 185 – t ypes of, 184–185, 185f – un der-corrected, 188–189 epican th oplast y, 184–189 – an atom ical considerat ion s in , – com plicat ion s of, 187–189 – an d dog-ear, 185–186 – double-fold operat ion an d, 185–186, 186f, 187f – Fuen te’s t ran sposit ion ap for, 187, 188f – Jordan’s deep t issue approach m ethod, 188f – Mat sun aga’s m odi ed M-plast y m ethod, 188f – m edial, 8, 165 – m odi cat ion an d re nem ent for Asian s, – m odi ed Uch ida m ethod, 187, 188f – palpebral m argin in cision m eth od, – Park’s Z-plast y m eth od, 187, 188f – pat ien t evaluat ion for, 185 – pearls, 184 – reconst ruct ive, 189, 189f, 190f –– back-cut design in, 189, 189f –– rotat ion ap in , 189, 190f –– V-Y advancem en t ap for, 189, 189f, 190f – reverse Fuente’s design , 186f, 187 – Roveda m ethod, 186 – scar after, 187–189 – sim ple skin excision m ethod, 186 – skin excision in, 185 – skin redraping m ethod, 187, 188f – surgical techn iques for, 186–187 – V-Y advan cem en t m ethods, 186–187, 187f – W-plast y m eth od, 186 – Wu’s square- ap m eth od, 188f – Yoon’s on e-arm ed ju m ping m an m eth od, 188f – Z-plast y ap m ethod, 186–187, 188f epicanth us inversus, 184, 185f – iat rogen ic, 187–189 – preven t ion of, 189, 189f, 190f epicanth us palpebralis, 184, 185f epicanth us supraciliaris, 184, 185f epicanth us tarsalis, 184, 185, 185f E-plan e See esth et ic plan e (E-plane) ePTFE See Gore-Tex er yth m a – after ller inject ion, 407 – after laser facial h air rem oval, 370 esthet ic line (E-line), 272, 272f, 288, 289f esthet ic plane (E-plane), 392 exoph th alm os, dou ble-eyelid surger y and, 154 expan ded polytet uoroethylen e See Gore-Tex exposure kerat it is, 177, 181 external n asal valve – collapse, 100–101 – sten osis, after alar base surger y, 100 eyebrow (s) See also brow lift; en doscopic foreh ead an d brow lift; ptosis – aesth et ics of, 327, 327f – age-related ch anges in , 174, 175–176, 327 – asym m et r y of, 328 – depressor m uscles, 326, 332 Index – elevat ion, in com pen sat ion for bleph aroptosis, 174, 174f, 175, 175f, 210, 211, 212f, 221, 222f – elevator m uscles, 326 – h air t ran splant for, 305, 305f – ideal posit ion of, 327, 327f – posit ion of, evaluat ion , 175–176, 329 – rejuvenat ion of, 307–308, 307f, 308f – sh ape, evaluat ion , 329 – sh aping, bot ulin um toxin for, 336, 381–382 – sym m et r y, evaluat ion , 329 – t at tooing, 328 – volum izat ion of, 308, 308f eyelash (es) – direct ion of, 215, 215f – upp er, dow nw ard angulat ion , 164 eyelash ptosis, 162, 215, 215f – correct ion of, 168, 218–219 – evaluat ion of, 164 eyelid(s) See also lid lag; lid m argin – age-related ch anges in , 174, 328 –– m an agem ent of, 307–309, 307f – Asian –– an atom y of, 6, 162–163, 163f, 211 –– characterist ics of, 173, 196 – asym m et r y –– after dou ble-eyelid surger y, 233 –– preoperat ive, 233 – Caucasian , an atom y of, 163f – East Asian , an atom y of, 162–163, 163f – low er –– age-related changes in, 196–197, 197f –– Asian, characterist ics of, 196 –– asym m et r y, after low er bleph aroplast y, 205 –– fat graft ing for, 322, 322f –– u id accu m u lat ion in , 198 –– horizon tal laxit y correct ion procedures for, 204 –– laxit y, 198–199 –– loss of skin elast icit y, 198 –– ret ract ion, after low er bleph aroplast y, 205 – ptosis, 328 –– evaluat ion , 329 – redu ndan t skin of, evaluat ion , 329 – rejuvenat ion of, 307–308, 307f, 308f – skin of, 164 – sun ken, 236, 236f – upp er See also double eyelid; single eyelid –– an atom y of, 152–153, 153f, 162 –– anterior lam ella, 152–153 –– eth n ic variat ions, 152 –– fat pockets in, 177 –– low er-posit ioned t ran sverse ligam en t in , 167, 168f –– m iddle lam ella, 152 –– opening process of, 152–153, 153f –– orbital fat of, 164 –– posterior lam ella, 152–153 –– pu y, 177 dou ble-eyelid surger y an d, 154 –– ret ractors, 210 –– st ruct ure-fun ct ion relat ion ships, 151 – w rin kles –– correct ion , 177 –– preoperat ive evaluat ion , 177 eyelid crease See also eyelid fold(s) – aging an d, 307–308, 307f, 308f – deep, after double-eyelid surger y, 228 – design –– in aging-related (upper) bleph aroplast y, 178 –– in double-eyelid surger y, 165–166, 166f – duplicated, 177 – evaluat ion , 177 – xat ion sut ure of, in doubleeyelid surger y, 168, 168f – form at ion , in aging-related (u pper) blepharoplast y, 179, 180f, 182, 182f, 183, 183f – heigh t , 165, 166f, 177, 213 –– ideal, 163 –– preoperat ive sim ulat ion , 163 – high –– correct ion of, 229–232, 231f–233f –– after double-eyelid surger y, 170, 229–232, 230f – in side, 164, 164f – low , after dou ble-eyelid su rger y, 170, 228–229, 228f, 229f – nasally t apered, 164 – outside, 164, 164f –– fan -parallel t ype, 164 –– fan t ype, 164, 164f –– h igh er, 164, 165f –– parallel t ype, 164, 164f – parallel, 164 – part ially high , after doubleeyelid surger y, 232 – postoperat ive disappearan ce, after double-eyelid surger y, 170, 226–227 – sem ilun ar, 164 – sh allow, after double-eyelid surger y, 227–228, 228f – sh ape of, 164 – su rgically created, 308 –– age-related ch anges an d, 177 –– aging an d, 309 – too-h igh, after aging-related (upper) blepharoplast y, 181 – w ebbing of, 165, 165f eyelid fold(s) See also eyelid crease – deep, after double-eyelid surger y, 228, 238, 238f – in /out (n eut ral), 154, 155f, 156 – in side, 154, 155f, 156 – irregular, n onin cision al dou bleeyelid surger y an d, 159 – m ult iple, caused by doubleeyelid surger y, 166, 167, 168f, 233–236, 234f, 235 – out side, 154, 155f, 156 – sh allow, after double-eyelid surger y, 227–228, 228f – surgically created, rem oval of, 237 – t riple –– after double-eyelid su rger y, 166, 167, 168f, 232, 233–236, 234f, 235f, 238, 238f –– p r im ar y, cor re ct ion , 236, 236f eye surger y, aesth et ic See also bleph aroplast y – an atom ical siderat ion s in , F face(s) – Asian , 243, 244f –– aesth et ic ideals an d, 378, 392–393 –– aging, m an agem en t of, 303–310, 311 –– anatom ical siderat ions, 6, 7f, 8f, 378 –– ch aracterist ics of, 272, 272f – brachyceph alic, 243, 244f, 254 – Caucasian, 243, 244f – cult ural beliefs about , – dolich oceph alic, 243, 244f – fem ale, at t ract ive com posites, 3, 4f – at , adding dim en sion to, 255, 255f, 311 – fron tal plane, ver t ical division s ( fth s), 270, 271f, 324 – fron tal view, aesthet ic divisions in , 270, 271f – ideally sh aped, creat ion of, 255, 255f, 256f – low er –– aging of, 309 –– rejuven at ion of, 309 –– sh ape, classi cat ion of, 256, 256f –– w idth classi cat ion of, 256, 256f narrow ing, 255 – m esocephalic, 254 – sh ape –– cult ural factors a ect ing, 257 –– eth nicit y an d, 257 –– an d fat graft ing, 311 – th irds of (rule of th irds), 270, 271f, 288, 289f, 324 – volum e loss in , 304–305, 304f, 311 – volum e restorat ion in , 304–305, 304f, 311–312 facelift , 309 – h igh -frequen cy focused ult rasoun d in , 10 – laser in , 10 facial an alysis, 14, 14f, 74, 75f, 244–246, 255–256, 270 – for en doscopic forehead an d brow lift , 329 – for fat graft ing, 311–312 – for gen ioplast y, 288–290 facial arter y, an atom y of, 407, 407f facial asym m et r y – causes of, 73 – an d fat graft ing, 311–312 – after ller inject ion , 412 – after genioplast y, 294 – an d low er facial touring, 257 – preoperat ive, 14, 73 – t ransverse correct ion genioplast y for, 290, 291f facial bones – age-related ch anges in , 174, 178 – Asian , an atom y of, facial bone surger y See also m an dible; m axilla; orth ognath ic surger y – com plicat ions of, 280–281 facial touring – llers for, 392–404 –– pearls, 392 – surger y for, 243 See also m an dible, reduct ion (con touring) –– plann ing for, 256–257, 256f facial tour lin e(s) – an terior, 244f – posterior, 244f facial h air – in m en, 364–365 – in w om en, 364–365 facial h arm ony, evaluat ion , 246, 246f facial m idlin e, 72–73, 73f facial n er ve – fron tal bran ch of, 325, 325f, 326, 331 –– inju r y in en doscopic foreh ead and brow lift , 337 – palsy, an d un ilateral ptosis, 174, 175f, 176 – zygom at ic bran ch , 326 facial rejuvenat ion , See also endoscopic foreh ead an d brow lift – hyaluron ic acid for, 393 – ligh t devices for, 340–344 – n on surgical, 10 – u sing en ergy devices, 339–348 –– devices com m on ly used in , 340 –– pearls, 339 – volum e restorat ion in , 304–305, 304f facial sw elling, after hair t ran splant at ion , 359 facial sym m et r y, an alysis of, 270 Fasan ella-Ser vat procedure, 211 419 420 Index fat graft ing, – facial, 304–305, 304f, 311–323 –– an d abscess form at ion , 320, 320f –– an d acn eiform eru pt ion , 320 –– addit ion al procedures, 318 –– an esth esia for, 312, 313 –– areas, 313–317, 313f, 314t–315t –– asym m et r y after, 319 –– baton grip tech nique, 317, 318f –– bruising after, 319 –– can nulas for, 312, 312f –– case st udies, 321–322, 321f, 322f –– com plicat ions of, 319–321 –– direct ion of inject ion , 314, 316f –– donor-site com plicat ions, 321 –– edem a after, 319 –– en t r y sites for, 314, 316f –– fat preparat ion for, 312–313, 313f –– fat resorpt ion in , 319 –– in foreh ead region , 315–317, 317f, 317t, 322, 322f –– graft gravitat ional descen t in , 319 –– graft h ar vest for, 312–313 –– graft m igrat ion in , 319 –– h em atom a caused by, 319 –– h istor y-t aking for, 312 –– hyperpigm en tat ion after, 319 –– hypo- an d hyper-correct ion in , 319 –– an d in am m at ion , 320 –– inject ion tech n iques, 313–317 –– in st rum en ts for, 312, 312f –– irregularit y after, 319 –– key tech nical poin ts in , 318–319 –– in low er face, 313–315, 313f, 314t –– for low er lid rejuvenat ion , 322, 322f –– lum p/bum p cau sed by, 319 –– in m idface, 313–315, 313f, 314t –– pat ien t evaluat ion for, 311–312 –– pearls, 311 –– placem en t , 313–317, 314t–315t –– postoperat ive care, 318 –– preparation for, 312 –– scar after, 319–320 –– sequen t ial autologous fat inject ion (SAFI) techn ique for, 313, 313f, 314t–315t, 316f, 317t –– sequen t ial depth of inject ion , 314, 316f –– sequen t ial inject ion in abut t ing areas, 314–315, 316f –– an d skin n ecrosis, 320, 320f –– tech n iques for, 312–318 –– in tem poral region , 313–315, 313f, 314t –– vascu lar em bolizat ion of fat after, 320–321, 320f –– volum e used, 313–317, 314t–315t –– w h ole face, 321, 321f – for su nken eyelid, 236, 236f – in upper-eyelid/brow com plex, 308, 308f ller inject ion , 10 – aesthet ic uses of, 392 – bruising after, 407 – bum ps caused by, 413 – in ch in , 400–401, 401f – com plicat ion s of, 10 –– delayed onset , 412–413 –– early on set , 407–411 –– pat ien t evaluat ion , 406 – danger zon es, 407 – depth of, 405 – edem a after, 412 – er ythm a after, 407 – facial tou ring using, 392–404 –– an esth esia for, 394 –– can n ulas for, 407, 407f –– in ch eek, 397–399, 398f –– com plicat ion s of, 403–404, 403f, 405–414 –– in foreh ead, 396, 397f –– key techn ical point s in , 402–403 –– m aterials for, 393–394, 393t –– n eedles for, 394, 394f, 407, 407f –– pat ien t assessm ent for, 393 –– pat ien t su ltat ion for, 393 –– pearls, 392 –– Reteen age m eth od, 397–399, 398f –– techn iques for, 394–402 –– in tem ple, 396–397, 397f – in facial volu m e restorat ion , 304–305, 393t, 405 – fan n ing tech n ique, 395, 396f, 406 – ller m igrat ion after, 413 – llers for, 10, 393t – for foreh ead and glabellar rhyt idosis, 328 – gran ulom a after, 413 – high -risk areas, 405–406 – hypersen sit ivit y react ion to, 407 – in fect ion after, 413 – in am m at ion after, 412 – in t ra-arterial, 403, 409, 410f –– m anagem en t of, 409 –– prevent ion of, 407–408, 408f – for jaw line resh aping, 401, 402f – for jow l touring, 401, 402f – linear threading (t un n eling) techn ique, 395, 395f, 406 – in lips, 400 – for low er face contouring, 400–401, 401f, 402f – lum piness after, 412, 413 – for m arion et te lin es, 401–402 – for nasal augm ent at ion , 395, 395f, 399–400, 399f – – – – in nasolabial folds, 400, 400f pain after, 407 self-pistol tech niqu e, 395 serial pun ct ure (“kisses”) tech niqu e, 395, 395f, 406 – skin n ecrosis after, 403, 403f, 406, 406f, 409, 410f, 411, 412f – skin th ickn ess an d, 405 – for sun ken eyelid, 236, 236f – super cial, ller visibilit y after, 412, 413f – in tear t rough, 399 – for tear t rough depression, 197 – techn iques for, 395 – in upper-eyelid/brow com plex, 308, 308f – ven ous congest ion cau sed by, 411, 412f nasteride, 351 follicular un it ext ract ion , for h air restorat ion , 306, 354–355, 355f follicular un it t ransplan t , for h air restorat ion , 306, 350, 354, 355 folliculit is – facial, im provem en t , laser h air rem oval and, 369, 369f – in hair t ran splan tat ion , 355, 356f, 359–360 – after laser facial h air rem oval, 370 foreh ead See also en doscopic foreh ead an d brow lift – age-related ch anges in , 327 – an atom y of, 324–326, 325f–327f, 331–332, 332f – augm en tat ion, 15 – ller inject ion in , 396, 397f – h air rem oval from , 9, 365, 369, 369f, 371–372, 371f, 372f – h eigh t , evaluat ion, 329 – h orizon t al lin es in , bot ulin um toxin for, 379, 379f, 380f – layers of, 325, 396, 396f – preoperat ive exam in at ion of, 14–15, 14f – resh aping, by h air reduct ion , 9, 365, 369, 369f, 371–372, 371f, 372f – rhyt idosis, 328 –– evaluat ion, 329 – sh ape, evalu at ion , 329 – size, cu lt u ral beliefs about , 365 – w iden ing, laser hair rem oval for, 365, 369, 369f, 371–372, 371f, 372f four crescent aging lines, 397–399, 398f Fox’s m eth od, for aesthet ic lateral can th oplast y, 191, 191f Frankfort h orizon tal line, 288–289, 289f fron t alis m uscle, 210, 326 – in t raderm al bot ulin um toxin inject ion and, 388–389, 389f – overact ivit y of, 328 –– un ilateral, 328 – ptosis surger y an d, 210, 211, 215, 219–220, 220f – sling, 211, 215, 219–220, 220f FUE See follicular un it ext ract ion FUT See follicular unit t ran splant G galeal fat pad, 332, 332f gen ioplast y, 274, 274t, 282–283, 282f–284f, 286–300 – advan cem en t sliding via int raoral approach , historical perspect ive on , 287, 287f – anesthesia for, 290 – anterior sliding advan cem en t , h istorical perspect ive on , 287, 287f – asym m et r y after, 294 – bleeding and, 293 – and bony m alun ion /n onu nion, 293 – bony m arking for, 290, 291f – case st udies, 295, 296f–297f, 298, 299f – cephalom et r y for, 287, 288t, 289, 290f, 295, 297f, 298 – chin ptosis after, 294 – closure, 292 – com plicat ion s of, 293–295 –– allograft-related, 294–295, 295f – dressing for, 292 – xat ion in, 292, 292f – historical perspect ive on, 287, 287f – histor y-taking for, 287 – in cision for, 290, 291f – in dicat ion s for, 286 – in fect ion after, 293 – in t raoral approach for, 290, 291f – key tech n ical poin t s in , 293 – labial m ucosal in cision for, 290, 291f – lip drooping after, 294 – m an dibular bony irregu larit y after, 294, 294f – m arginal gingival in cision for, 290, 291f – m en t al n er ve injur y in , 293 – narrow ing, 255, 255f, 256f –– com bin ed w ith m an dible reduct ion (con touring), 260, 260f – pain after, 293 – pat ien t evaluat ion for, 287–288 – pearls, 286 – preoperat ive assessm en t for, 288–290 – sagit tal augm en tat ion (an terior advan cem ent) tech nique, 290, 291f – sagit tal reduct ion (posterior reduction) technique, 290, 291f – skin dim pling after, 294 – tech n iques for, 290–292, 291f – t ran sverse correct ion tech n ique, 290, 291f – ult rason ic bone cu t ter for, 292, 292f, 293 – vert ical augm en tat ion techn ique, 290, 291f Index – vert ical reduct ion tech n ique, 290, 291f glabella – an atom y of, 324–326, 325f–327f, 331–332, 332f – augm en tat ion , 39 – preoperat ive evaluat ion , 15 glabellar frow n lin es, bot ulin um toxin for, 379–380, 380f, 381f glabellar rhyt idosis, 328 – evaluat ion , 329 glycopyrrolate, 16 gon ial angle, ideal, 256 Gore-Tex, 13, 113 – advant ages of, 14 – chin im plan t , com plicat ion s of, 294, 295f – disadvan tages of, 14 – dorsal n asal graft , 43, 43f – preform ed n asal dorsal im plan t , 114, 114f, 115f – rem oval rate for, 135 – in rh in oplast y, 8, 135 –– com plicat ion s of, 135 – sh eet , n asal dorsal im plant , 116 gran ulom a – after en doscopic foreh ead an d brow lift , 337 – after ller inject ion , 413 gran ulom atous disease(s), an d saddle n ose, 89 gum m y sm ile, bot ulin um toxin for, 384, 384f H h air, Asian , 6, 9, 350 h air densit y, in Asian s, 350 h airline – Asian , 349–350, 350f – correct ion , laser h air rem oval for, 365 – design – – in h a ir t n sp la n t at ion , – , f, – , 361f –– laser h air rem oval an d, 369, 369f – elevat ion , after en doscopic foreh ead an d brow lift , 337 – evaluat ion of, 329 – unn at ural, after hair t ran splant at ion, 359 h air loss, 305–307, 305f, 306f See also alopecia – m ale pat tern , 349 – preven t ion , m edicat ion s for, 351 – tem porar y, after h air t ran splant at ion, 359 h air rem oval/reduct ion, – facial, using laser, 364–374 See also laser h air rem oval h air restorat ion , 9, 305–307, 305f, 306f See also hair t ran splant at ion – follicu lar un it ext ract ion for, 306, 354–355, 355f – follicu lar un it t ransplan t for, 306, 354, 355 h air t ran splan t at ion , 349–363 See also h air restorat ion – an d arterioven ous st ula, 360 – in Asian s, 349 – case st udies, 360–361, 361f – com plicat ion s of, 358–360 – and deh iscen ce, 358 – den sit y gradien t an d layering e ect in , 357, 357f, 358 – depth -con t rolled tech n ique for, 355–356, 356f, 358 – don or h ar vest ing for, 353–355 See also follicular un it ext ract ion –– st rip su rger y m eth od, 353–354, 354f – facial sw elling after, 359 – folliculit is w ith , 355, 356f, 359–360 – graft dissect ion , 355–356, 355f, 356f – graft preser vat ion, 356 – gray hair follicles an d, 355, 355f, 358 – h airline design in, 352–353, 353f – and h iccups, 360 – hyperesthesia after, 359 – hypoesth esia after, 358–359 – im planters for, 356, 356f – key tech n ical point s in , 358 – and loss of t ransplan t , 360 – and n ecrosis, 358 – n eu ralgia after, 359 – n um bn ess after, 358–359 – opt im al densit y for, 358 – pain after, 358 – pat ien t evaluat ion for, 351–352 – pearls, 349 – pit t ing after, 360 – poor graft su r vival after, 360 – postoperat ive care, 358 – preparat ion for, on day of surger y, 352 – recipien t site, 356–358, 357f – scalp prurit us after, 359 – and scars, 351, 352, 358, 359 – and syn cope, 360 – tech n iques for, 352–358 – tem porar y hair loss after, 359 – un n at ural h airlin e due to, 359 – and W-plast y for scar revision, 358, 359, 359f Han Ryu , h em atom a – after en doscopic forehead an d brow lift , 337 – facial fat graft ing an d, 319 – after ller inject ion , 403 – w ith m an dible reduct ion (contouring), 261 – preseptal, low er bleph aroplast y an d, 206 – ret robulbar, low er blepharoplast y an d, 206 h em orrhage See also orbit al h em orrhage – gen ioplast y an d, 293 – in Le Fort I osteotom y, 280 – w ith m an dible reduct ion (con touring), 261 – in m andibular sagit t al split ram us osteotom y, 280 Hering’s law, 214–215 h iccu ps, h air t ran splan t at ion and, 360 HIFU See ult rasoun d, h igh in tensit y focused high-frequency focused ultrasound (HIFU), in face lift, 10 h igh sagit t al supraforam in al osteotom y, m an dibu lar, 274, 276, 276f, 281 Hinderer an alysis, of m axim al m alar project ion , 245, 245f horizontal line, in lower eyelid, 198 HSSO See h igh sagit t al supraforam in al osteotom y h um pectom y See n asal h um p surger y h um p n ose(s) See also nasal h um p – Asian , 60–71 –– ch aracterist ics of, 60–61, 87, 88f – p reoperat ive exam inat ion of, 60–61 hyaluron ic acid, 10, 393–394, 405 – biph asic, 393–394 – d erm al hydrat ion using, 402 – em bolizat ion , treat m en t of, 409–410, 411f – for facial rejuven at ion, 393 – m on ophasic, 394 – p ropert ies of, 393t hyaluron idase, t reat m en t of ller em bolizat ion, 409–410, 411f hyperbaric oxygen t reat m en t , for ller em bolizat ion, 410f, 411 hyperesth esia, after h air t ran splant at ion , 359 hyperpigm en t at ion – facial, reduct ion , laser hair rem oval an d, 368, 368f – facial fat graft ing and, 319 – after laser facial hair rem oval, 370 – p ost-in am m ator y, 100, 196 hypoch lorous acid, 16–17 hypoesthesia, after hair t ran splant at ion , 358–359 I in clusion cyst , after eyelid surger y, 226, 227f in fect ion – alloplast ic im plant s and, 23, 24, 25f, 141 – augm en tat ion rhin oplast y and, 13 – en doscopic forehead an d brow lift an d, 337 – ller inject ion an d, 413 – gen ioplast y an d, 293 – m an dible reduct ion (con touring) an d, 261 – n asal alloplast ic im plan ts an d, 141 – orth ogn ath ic surger y and, 280 – rh inoplast y an d, 143 – an d saddle n ose, 89 – septoplast y and, 143 – septorh inoplast y an d, 141, 143 in ferior alveolar ner ve inju r y, in m an dible redu ct ion (con touring), 261 in am m at ion – facial fat graft ing and, 320 – ller inject ion an d, 412 – w ith m an dible reduct ion (con touring), 261 – w ith n asal alloplast ic im plan ts, 140 infraorbital eye opening, botulinum toxin for, 382–383, 383f in fraorbital n er ve, injur y – in orth ognath ic surger y, 281 – in zygom a reduct ion , 249 in fraorbital w rinkles, bot ulin um toxin for, 382, 382f in tense pulsed ligh t – in facial rejuvenat ion , 340, 341–342, 341f, 342f –– com plicat ion s of, 342, 342f – for n on ablat ive rejuven at ion , 339–340 in tercanth al dist ance, 185f in terepican th al dist an ce, 184, 185, 185f, 189 in tern al n asal valve – an atom y of, 87 – collapse of, 87–88 in terpalpebral ssure, 212, 213f in t racran ial injur y, in endoscopic foreh ead and brow lift , 337 intraoral vertical ram us osteotom y, m andibular, 276, 277f IPL See inten se pulsed light IVRO See in t raoral vert ical ram us osteotom y J jaw line, resh aping, ller inject ion for, 401, 402f jow l touring, ller inject ion for, 401, 402f Juvederm See hyaluronic acid K keloids, 9, 100 – h air t ran splant at ion an d, 351, 359 keratitis, after ptosis correction, 221 Korea, plast ic surger y in, L lacrim al carun cle – bilateral size discrepan cy, 185 – exposu re –– epican thal fold an d, 184, 185 –– excessive, 189 – h ook-sh aped, 184, 185f – rou nd, 184, 185f – sh ape of, 184, 185f – t riangular, 184, 185f – visible size of, after epican thoplast y, 184 421 422 Index lacrim al glan d – injur y, in bleph aroplast y, 181 – posit ion , preoperat ive evaluat ion, 177 lagoph th alm os – w ith congen it al ptosis, 214 – evalu at ion , 177, 329 – iat rogenic postoperat ive, 176, 181 – after ptosis correct ion , 214, 221 laser(s) – for ablat ive rejuven at ion, 340, 343, 344f – Accusculpt , 344 – Aram is, in facial rejuven at ion, 342–343, 343f – carbon dioxide (CO2), in facial rejuven at ion , 340, 343 – ch rom oph ores for, 339–340, 342, 342f – CoolTou ch , in facial rejuvenat ion , 342–343 – dye, in facial rejuven at ion, 339, 340 – Edge, in facial rejuven at ion, 344f – in face lift , 10 – for facial hair rem oval, 364–374 –– pearls, 364 – in facial rejuven at ion, 340–344 – fract ion al, in facial rejuven at ion, 340, 343–344, 344f –– ablat ive, 343, 344f –– n on ablat ive, 343 – Fraxel, in facial rejuven at ion, 343 – interst it ial, in facial rejuvenat ion , 344, 344f, 345f – m idin frared, in facial rejuvenat ion , 339, 342–343, 342f, 343f – Nd:YAG, in facial rejuvenat ion , 339, 340, 342 – for n onablat ive rejuvenat ion , 339–340 – Q-sw itch ed, in facial rejuvenat ion , 340 – Sm ar tlipo, 344 – Sm ooth beam , in facial rejuvenat ion , 342–343 – thu liu m , in facial rejuven at ion , 343–344 laser hair rem oval, 9, 364–374 – case st udies, 370–372, 371f, 372f – com plicat ion s of, 370, 370f – e cacy of, factors a ect ing, 365–366 – for fem ale East Asian s, 366–367, 367f – h airlin e design for, 369, 369f – h istorical perspect ive on , 364 – key techn ical point s in , 370 – lasers used for, 364 – for m ale East Asian s, 367–369 –– aesth et ic e ect s of, 368, 368f –– goals of, 367 –– m ot ivat ions for, 364–365 –– techn ique for, 368 – m ech anism s of, 365, 365f – pat ien t evaluat ion for, 366 – pearls, 364 – targets for, 365, 365f – tech n iques for, 366–369 lateral canth al rhyt ids See crow ’s-feet lateral canth oplast y, – aesthet ic, 189–192 –– Blaskovics’ m ethod for, 190–191, 191f –– can didates for, 190 –– case st udies, 194, 194f –– Fox’s m ethod for, 191, 191f –– patient evaluation for, 189–190 –– pearls, 184 –– principles of, 189 –– Sh in’s m eth od for, 191, 192f –– surgical tech niques for, 190–192 –– Von Am m on’s m ethod for, 190, 190f – clin ical applicat ion s of, 189 – com bin ed w ith Mongolian slan t low ering, 191–192, 193f, 194, 194f – cont rain dicat ion s to, 190 – m in im ally invasive, 204 – m odi cat ion an d re n em ent for Asian s, – postoperat ive care, 192 lateral crural graft – in correct ive rh in oplast y for sh or t t racted n ose, 123–125, 124f – for nasal t ip contouring, 53–54, 53f, 54f – onlay, 53–54, 53f – st rut , 53–54, 54f lateral n asal arter y – an atom y of, 404f – ller inject ion in , preven t ion of, 404, 406 lateral t arsal st rip procedure, 204 Le Fort I osteotom y See also double jaw surger y – m axillar y, 274t, 276–277, 278f –– bleeding in, 280 leprosy, an d saddle n ose, 89 levator palpebralis, 210 – age-related changes in, 174 – apon eurosis –– advan cem ent , 169, 169f, 177 –– deh iscen ce, 175, 212–213, 328 –– plicat ion , in double-eyelid surger y, 169 –– ptosis surger y an d, 210, 211 –– st retch ing or disin sert ion , 177, 212–213, 213f – an d congenital ptosis, 211, 212f – fun ct ion, evaluat ion , 175, 176f, 212, 213f – m alfun ct ion, in aponeurot ic ptosis, 213, 213f – ptosis surger y an d, 210, 211 – resection, in ptosis correction, 219 lid lag, after ptosis correct ion , 221 lid m argin – closed, 154, 155f – de n it ion of, 154 – dou ble-eyelid su rger y an d, 154, 155f – in/out (neut ral) fold, 154, 155f, 156 – inside fold, 154, 155f, 156 – open, 154, 155f – out side fold, 154, 155f, 156 – sh apes of, 154, 155f – ten sion eversion, 160, 160f lip(s) – Asian , ch aracterist ics of, 270 – drooping, after gen ioplast y, 294 – ller inject ion in , 400 – posit ion of, evaluat ion , 272, 272f, 288, 289f – project ion of, 270 liposuct ion , for fat graft h ar vest , 312–313 – com plicat ion s of, 321 low er eyelid, sagging, low er-posit ion ed t ran sverse ligam ent (LPTL), in upper eyelid, 167, 168f M m alarplast y, an d gen ioplast y, 286 m alar prom in ence, m alar reduct ion , m ale pat tern h air loss, 349 m align ancy, an d saddle n ose, 89 m alocclusion , – classi cat ion of, 269, 270f – in ter-arch problem s an d, 269 – in t ra-arch problem s an d, 269 – after orth ognath ic surger y, 281 m an dible See also or th ogn ath ic su rger y – asym m et r y, an d low er facial contouring, 257 – bilateral ver t ical sagit tal ram us osteotom y, 274t – fract ure, int raoperat ive, 261 – h igh sagit tal supraforam in al osteotom y, 274, 276, 276f, 281 – hypoplasia, psych osocial e ects of, 286 – in st abilit y, after orth ogn ath ic su rger y, 281 – in t raoral vert ical ram u s osteotom y, 276, 277f – an d m axilla, abn orm al skeletal relat ionsh ip bet w een , 257 – orth ogn athic surger y of, 274–275, 274t –– case st udies, 282–283, 282f–284f –– com plicat ion s of, 281, 282f –– fract ure in , 281 –– in com plete osteotom y in , 281 – ostectom y –– cur ved, w ith oscillat ing saw, 258, 258f, 259, 259f –– tangent ial, w ith reciprocat ing saw (lateral cortex ostectom y), 258, 258f –– t ypes of, 258, 258f – prot rusion , orthogn ath ic surger y for, 274t – reduct ion (con tou ring), 254–267 –– asym m et r y and, 257 –– case st u dies, 261, 262f, 263, 263f–264f, 265, 265f–267f –– ch in an d, 257 –– com plicat ion s of, 261 –– dylar fract ure in, 261 –– eth n icit y an d, 257 –– fract ure in, 261 –– fron tal plan e an alysis for, 256, 256f –– gen eral procedure for, 258–260, 259f –– h em orrh age w ith , 261 –– infect ion w ith , 261 –– in am m at ion w ith , 261 –– int raoral versus extern al approach for, 258 –– key techn ical poin ts in, 260 –– m an dible-m axilla relat ion ship an d, 257 –– an d n arrow ing gen ioplast y, com bin ed, 260, 260f –– n er ve injur y in, 261 –– patien t evaluat ion for, 255–256 –– pearls, 254 –– postoperat ive care, 260 –– preoperat ive im aging for, 256, 256f –– sagit t al plan e an alysis for, 256 –– soft t issue and, 257 –– surgical plan n ing, 256 –– surgical tech niqu es for, 258–260, 259f –– t ran sverse plan e analysis for, 256, 256f –– an d un favorable aesth et ic outcom e, 261 –– an d zygom a reduct ion , com bin ed, 246, 252, 252f, 253f, 263–265, 263f–267f – ret rusion, orth ogn ath ic surger y for, 274t – sagit tal split ram us osteotom y, 274–275, 274t –– bleeding during, 280 –– case st u dies, 282–283, 282f–284f –– an d gen ioplast y, 286 –– infect ion after, 280 – vert ical de cien cy, or th ogn ath ic surger y for, 274t – vert ical excess, orthogn ath ic surger y for, 274t m an dibular angle – Asian, 6, 7f, 254 – prom in ent , 254 – reduct ion , –– an d gen ioplast y, 286 – resect ion of, 255 – secon dar y (postoperat ive), 259, 260 m an dibular plan e–sellar nasion (MP-SN) angle, 256 Index m andibular prognath ism , w ith long face, case st udies, 282–283, 282f–284f m andibular ram u s osteotom y, tech n ique for, developm ent of, 269f m andibular redu ct ion / advan cem en t , m argin -re ex distan ce – clin ical signi can ce of, 175, 176f, 212 – m easurem en t of, 175, 175f, 212, 213f m argin -re ex distan ce 1, 164, 210, 212, 213f m argin -re ex distan ce 2, 198, 212, 213f m arion et te lin es – bot ulinum toxin for, 385, 386f – ller inject ion for, 401–402 m asseter m uscle, hypert rophy – bot ulinum toxin for, 386–388, 387f, 388f – an d low er facial contouring, 257 Mat riStem , in h air t ran splant procedures, 306 m axilla See also bim axillar y prot rusion ; orthogn ath ic surger y – dow n -fract ure, in orthogn ath ic surger y, 281 – in st abilit y, after orthognath ic surger y, 281 – Le Fort I osteotom y, 274t, 276–277, 278f –– bleeding in , 280 – an d m an dible, abn orm al skelet al relat ion ship bet w een, 257 – or th ogn ath ic surger y for, 274t, 276–277 –– com plicat ion s of, 281, 282f –– in com plete osteotom y in , 281 – preoperat ive evaluat ion, 15 – prot ru sion, orth ognath ic surger y for, 274t – vert ical excess, orth ognath ic surger y for, 274t m axillar y ret rusion , m axim al m alar project ion , 245, 245f m edial epican th oplast y, 8, 165, 194, 194f – w ith ptosis su rger y, 212 m edical skin care, in facial rejuven at ion, 340 Medpor, 13, 113 – advant ages of, 14 – rem oval rate for, 135 – in rh in oplast y, 135 –– com plicat ion s of, 135 m elan in index, 366, 367f m ent al n er ve injur y, in genioplast y, 293 m icrognath ia, psych osocial e ect s of, 286 m icrojet inject ion , in skin rejuven at ion, 340, 347, 347f m idface – age-related ch anges in , 174 – four crescen t aging lin es, 397–399, 398f m idpupillar y h orizon tal lin e, 27f, 60, 61f m inoxidil, 351 MMCR See Mü ller m uscle conju nct iva resect ion (MMCR) Mongolian slant , low ering, 191–192, 193f, 194, 194f Mongoloids, – phen ot ypic feat ures of, m outh corn er elevat ion , bot ulin um toxin for, 385, 386f MP-SN angle See m an dibu lar plan e–sellar n asion (MP-SN) angle MRD See m argin -re ex dist ance m ucocele, w ith n asal alloplast ic im plan t , 138, 139f, 140, 141f Mü ller m uscle, 210 – ptosis su rger y an d, 210, 211, 214 Mü ller m uscle conjunct iva resect ion (MMCR), 211, 214, 215, 219 m yasth en ia gravis, 164 N NAR See n on ablat ive rejuven at ion n asal ala (pl., alae) See ala (pl., alae) n asal base, reduct ion, 39 n asal bon es, n asal bridge, low, 6, 7f, 8f n asal dorsal augm en tat ion, 8–9, 21, 135, 136f – w ith alloplast ic im plant , and sh ort n ose deform it y, 122 – alloplast ic im plan ts for, 135 See also alloplast ic im plant s –– pearls, 135 – an d base reduct ion , 39 – case st udies, 40–43, 40f–45f – closure for, 39 – in correct ive rh in oplast y for sh ort t racted nose, 129, 129f – costal cart ilage for, 8, 26–46, 30f, 41f, 43, 44f –– pearls, 26 – dorsal graft placem en t an d xat ion in , 35–37, 35f, 36f, 37f – ller inject ion for, 395, 395f, 399–400, 399f –– com plicat ion s of, 408–409, 410f – and glabellar augm en tat ion , 39 – graft , w ithout osteotom y, 31–32, 32f – w ith h um p resect ion , 65–67, 66f – key tech n ical point s, 40 – m anagem en t of bony vault in, 31–32, 32f – m anagem en t of m iddle th ird in, 32–33, 33f – m an agem en t of n asal base in , 34, 34f – osteotom y in, 32 – p at ient evaluat ion for, 26–28, 27f – p ostoperat ive care, 39–40 – p reoperat ive cou nseling for, 27–28 – silicone im plan ts for, 13–25 – spreader graft placem en t in, 32–33, 33f, 40, 41f – surgical tech n iques for, 28–37 n asal dorsu m – an d appearan ce of n asal base, 100, 105 – Asian , 26, 27f – bony an d cart ilaginous, relat ion sh ip of, 61–62, 62f – p reoperat ive evaluat ion, 15 n asal h um p – ch aracterist ics of, 60–61, 87, 88f – gen eralized, 61 – localized, 61 – versus pseudo hu m p, 61, 61f n asal h um p surger y, 60–71 – an atom ical siderat ion s in , 61–62, 62f – case st udies, 68, 68f–69f, 70, 70f–71f – com plicat ions of, 67, 138, 139f, 140, 141f – com pon en t h um p reduct ion , 63, 64f – ser vat ive h um pectom y, 65, 66f – d issect ion an d septal cart ilage h ar vest in , 62 – d orsal augm en t at ion an d t ip re nem ent w ith, 65–67, 66f – funct ion al problem s after, 67 – an d in ternal valve collapse, 67 – inverted-V deform it y after, 67 – key tech nical poin ts in , 67 – in large-h um p n ose, 63, 64f – n asal dorsal irregularit y after, 67 – open versus closed approach for, 62 – pearls, 60 – an d residu al convexit y, 67 – sequ en ce of surger y and t ip plast y in, 62–63, 63f – in sm all-h um p n ose, 65, 66f – spreader grafts in , 65, 65f – tech niqu es for, 61–67 n asal obst ruct ion – after alar base surger y, 105 – assessm en t for, 73–74 – after correct ive rhin oplast y for short t racted n ose, 131 – after n asal t ip surger y, 55 n asal pro le, 6, 7f n asal pyram id, n asal root , preoperat ive evaluat ion , 15 n asal sept um , – d eviated, st raigh ten ing, 77–78, 78f – dissect ion , in aesth et ic rhin oplast y for South east Asians, 111, 112f – ischem ia, an d saddle n ose, 89–90 – L-st rut , fabricat ion of, 92–93, 93f – perforat ion –– Medpor im plant an d, 137, 138f –– and saddle n ose, 89–90 – subtot al recon st ruct ion , for class saddling, 92–93, 93f n asal skin , 6, 15, 26, 27f, 61, 62f, 100 – exam inat ion of, 74 n asal t ip, 6, 7f, 8f, 26, 27f – an d appearan ce of n asal base, 100, 105 – asym m et r y, 55 – augm en tat ion , 13 –– case st udies, 56–57, 56f–58f –– w ith en don asal on lay graft , 56, 56f–57f – boxy, ceph alic resect ion of low er lateral cart ilage lateral cru s for, 52–53, 53f – bulbous, ceph alic resect ion of low er lateral cart ilage lateral cru s for, 52–53, 53f – cap graft via en don asal approach , 48–49, 49f – colum ellar st rut , in terdom al sut ure, an d on lay graft via endonasal approach , 49, 50f – touring, 37–39, 38f –– case st udies, 40–43, 40f–45f, 56–57, 56f–58f –– graft sh ow ing after, 55 –– key tech n ical poin t s, 40, 55 –– lateral crural st rut grafts for, 37–38, 38f –– and n asal obst ru ct ion , 55 –– pain /discom for t after, 55 –– pat ien t evaluat ion for, 48, 48f –– shield graft versus h orizon tal onlay graft for, 38, 38f, 40, 41f, 43, 44f – cost al cart ilage graft for, 26–46, 30f, 41f –– pearls, 26 – deviat ion , 55 – evaluat ion of, 48, 48f – lateral crural graft for, 53–54, 53f, 54f – lift ing, bot ulin um toxin for, 383, 383f – m odi cat ion –– in correct ive rh in oplast y for short t racted n ose, 123–125, 124f, 127–128, 128f, 131 –– using open approach , 57, 57f–58f – over-rot at ion, 55 – pain in , after correct ive rhin oplast y for short t racted nose, 131 – preoperat ive evaluat ion, 15 423 424 Index n asal t ip (cont inued) – projection and counter-rotation, in aesthetic rhinoplast y for Southeast Asians, 112–113, 113f – project ion of, 47–48, 48f, 60 –– augm en tat ion via en don asal approach, 48–49, 49f, 50f –– loss of, 55 –– sept al exten sion graft for, 49–51, 51f – re n em en t –– w ith h um p resect ion , 65–67, 66f –– preoperat ive cou nseling for, 27–28 –– surgical tech n iques for, 37–39 – revision surger y, 136, 138, 138f – rigid, w ith AlloDerm im plan t , secon dar y rh inoplast y for, 140 – rot at ion , 9, 60 –– septal exten sion graft for, 49–51, 51f – rot at ion of, 47–48, 48f – septal exten sion graft for, 49–51, 51f –– en d-to-en d, 50, 52f –– overlapping, 50, 51f –– tech n ique for, 50–51, 51f, 52f –– t ypes of, 50, 51f – sh ape, evaluat ion of, 48, 48f – sh ield graft for, 51, 53f – silicon e im plant an d, 13–25 – skin thin ning on, augm ent at ion rh inoplast y w ith silicon e im plan t an d, 23 – stacked on lay graft for, 13 – support , evaluat ion of, 48, 48f – surger y –– in Asian s, 47 –– com plicat ions of, 55 –– in h um p resect ion, 62–63, 63f –– key tech nical poin ts, 55 –– m odi cat ion an d re n em en t for Asian s, 8–9 –– pearls, 47 –– prin ciples of, 47 –– tech n iques for, 47, 48–55 – volum e of, 47 –– reduct ion , ceph alic resect ion of low er lateral cart ilage lateral crus for, 52–53, 53f – w idth of, 47 – w ing graft for, 13 n asion , level of, in Asian s, 60, 61f n asion (N)–an terior nasal sp in e (ANS)/an terior n asal spin e (ANS)–m en ton (Me) rat io, 272, 272f, 287, 288t, 289, 290f n asofron t al angle, 60 n asofron t al t ran sit ion , 14f, 15 n asolabial angle, 60, 272, 272f – acute, 15 – in Asian s, 15 – obt use, 122, 123f n asolabial fold(s), ller inject ion in , 400, 400f n eck See also plat ysm al ban ds – adiposit y, m an agem ent of, 309 n euralgia, after hair t ran splan tat ion, 359 n eurotoxin inject ion See also bot ulin um toxin – for brow depressors, 332 – for plat ysm al bands, 309 n onablat ive rejuvenat ion – physiologic e ect s of, 340 – prin ciples of, 339–340 n onsurgical in ter ven t ion , 10 n ose See also nasal ent ries; saddle n ose – alar base, 99 –– m odi cat ion of, 99–107 – ar terial su pply to, an d ller inject ion , 403, 404, 406, 408–409, 409f – Asian, anatom y of, 6, 26, 27f, 61–62 – basal view of, 100, 100f – bird’s-eye view of, 73, 73f, 82f, 84f – bony asym m et r y, 14 – bony pyram id –– late deviat ion after correct ive rh in oplast y, 81 –– an d saddle nose, 87, 88f – cleft , 103, 104f – cont racted, postsurgical, 122 – crooked –– physical exam in at ion of, 72–73, 73f, 74f –– surgical correct ion of, 72–86 See also correct ive rhin oplast y – deform it y See also saddle n ose –– oblique ligh t ing of, 74f –– surgical correct ion of, 72–86 See also correct ive rhin oplast y – deviat ion –– low er th ird, 79–80, 80f –– m iddle th ird, 78–79, 79f –– m idvault , 77 –– physical exam in at ion of, 72–73, 73f, 74f –– surgical correct ion of, 72–86 See also correct ive rhin oplast y –– t ip, 77 –– upper-th ird, 75–77 – extern al, physical exam in at ion of, 72–73, 73f, 74f – in tern al, exam in at ion of, 73–74 – inverted-V deform it y, 67, 87, 88f – keyston e area, 87, 88f – lateral cru ra, m alposit ion ed, 54 – low er lateral car t ilages, 88 –– dest ruct ion , w ith alloplast ic im plant com plicat ion s, 136 – physical exam inat ion of, 72–74 – preoperat ive exam in at ion of, 14–15, 14f, 26–28, 27f, 60–61 – preoperat ive X-ray of, 15, 15f – quadrangular cart ilage, and saddle nose, 87, 88f – short See also correct ive rh in oplast y, for sh ort t racted n ose –– congen ital, 122 –– correct ion , 122–134 –– path ogen esis of, 122 –– postoperat ive, 122, 123f – skin -soft t issue envelope, exam in at ion of, 74 – South east Asian, characterist ics of, 108 – start ing point of, in Asian s, 60, 61f – t w isted –– physical exam in at ion of, 72–73, 73f, 74f –– surgical correct ion of, 72–86 See also correct ive rh in oplast y – upper lateral cart ilages, 87–88 –– dest ruct ion, w ith alloplast ic im plan t com plicat ion s, 136 nost ril(s) – asym m et r y of, 99 –– after alar base surgery, 105, 105f –– after correct ive rhin oplast y for sh ort t racted nose, 131 – large, 99 – teardrop, after alar base surger y, 105, 105f num bness, after h air t ran splan t at ion , 358 O oblique lin e, in low er eyelid, 197f, 198 Obw egeser-Dal Pon t m ethod See sagit tal split ram us osteotom y (SSRO) occlusion – ideal, 269 – n orm al, 268–269 – preoperat ive evaluat ion , in gen ioplast y, 288 ocular m ot ilit y, preoperat ive evaluat ion , 177 open bite, orth ogn ath ic surger y for, 274t orbicu laris oculi, 326–327 – prom inen ce of, 197f, 198 – suspension procedure, 198, 199, 204, 206, 207f – t igh ten ing procedure, 199 orbicu lus oculi m uscle, orbit , – age-related ch anges in , 174 orbit al fat – age-related ch anges in , 198 – cen t ral, 164, 177, 198 – h ern iat ion , 164 – lateral, 198 – m edial, 164, 177, 198 – prolapse, 177, 197f, 198 – prot rusion , an d low er eyelid appearan ce, 196 – pseudoh erniat ion of, 197f – rem oval –– aesthet ic e ects of, 197 –– in aging-related (upper) bleph aroplast y, 179, 179f –– in dou ble-eyelid surger y, 167, 167f –– in dicat ion s for, 198 orbital hem orrh age – aging-related (upper) bleph aroplast y an d, 181 – low er bleph aroplast y an d, 206 orbital ret ain ing ligam en t , 326, 327f, 331 orth ogn athic surger y, – aesth et ic, 268–285 –– pat ien t evaluat ion for, 269–272 –– pearls, 268 –– psych ological siderat ion s in, 269–270 – case st udies, 282–283, 282f–284f – classi cat ion of, by diagn osis, 274, 274t – com plicat ion s of, 280–281 – dylar resorpt ion after, 281 – de n it ion of, 268 – developm en t of, 268, 269f – fun ct ional relapse after, 281 – and fun ct ion al restorat ion , 268 – in com plete osteotom ies in , 281 – in fect ion after, 280 – key tech n ical poin t s in , 280 – m an dibu lar, 274–275, 274t –– case st u dies, 282–283, 282f–284f –– com plicat ion s of, 281, 282f – m axillar y, 274t, 276–277 –– com plicat ion s of, 281, 282f – n er ve injur y in , 281 – pain after, 280 – part ial necrosis of bon e segm en t an d m ucosa after, 281, 282f – postoperat ive care, 279–280 – psych osocial ben e t s of, 268 – tech n iques for, 274–279 – tech n ological advan ces an d, 268 – un favorable osteotom ies in , 281 osteotom y – in aesth et ic rh inoplast y for South east Asians, 113 – anterior segm en tal, for bim axillar y prot rusion , 274t, 277–279, 279f –– an d gen ioplast y, 286, 295, 296f–297f, 298, 299f – in augm en tat ion rhin oplast y, 19 – bilateral vert ical sagit t al ram u s, m an dibular, 274t – in correct ive rh in oplast y, 76–77 – h igh sagit t al supraforam in al, m an dibular, 274, 276, 276f, 281 – in t raoral vert ical ram us, m an dibular, 276, 277f – Le Fort I See also double jaw surger y –– m axillar y, 274t, 276–277, 278f ––– bleeding in , 280 – m an dibu lar ram us, tech nique for, developm ent of, 269f – in n asal dorsal augm ent at ion , 32 – in rh in oplast y, 76–77 Index –– lateral, 76–77, 76f, 77f –– m edial, 76f, 77 –– t ips for perform ing, 77 –– t ypes of, 76, 76f – sagit tal split ram us, m andibular, 274–275, 274t –– bleeding du ring, 280 –– case st udies, 282–283, 282f–284f –– an d gen ioplast y, 286 –– infect ion after, 280 – in zygom a reduct ion –– an terior, 247, 247f –– I-sh aped, 248 –– L-sh aped, 246–247, 247f, 248 –– ostectom y versus, 248 –– posterior, 247, 247f P p ain – after ller inject ion , 403, 407 – after gen ioplast y, 293 – after h air t ran splan t at ion , 358 – after n asal t ip surger y, 55 – after orthogn ath ic su rger y, 280 Pain ter, Neil, p alpebral apert ure, w idening of, 378 p alpebrom alar groove, 197f, 198, 199 p aranasal augm ent at ion , 15 p aranasal im plant , p aresth esia, after zygom a reduct ion , 249 p arot id glan d, reduct ion, bot ulin um toxin for, 388, 389f p eau d’orange, on ch in , after genioplast y, 294–295 p eriorbital fat , 164 p henyleph rin e test , 214, 215 p hotodocu m en tat ion – for facial fat graft ing, 312 – postoperat ive, w ith ptosis correct ion , 212 – preoperat ive, 27, 74, 101 –– for bleph aroplast y, 164 –– for endoscopic foreh ead and brow lift , 330 –– for h air t ransplan tat ion , 352 –– for low er blepharoplast y, 199 –– for m andibular redu ct ion, 256 –– for ptosis correct ion, 212 – during ptosis correct ion , 218, 219f p iriform ligam ent s, release of, in augm ent at ion rh in oplast y, 18 Pit anguy line, 325, 325f p latelet-rich plasm a – in fat graft ing, 318 – in hair transplant procedures, 306 p lat ysm al ban ds – bot u linum toxin for, 386, 386f – neurotoxin inject ion for, 309 PLLA See poly-L-lact ic acid p neum at ic com pression , in skin rejuven at ion, 340, 347, 347f p neum oth orax, cost al car t ilage h ar vest and, 130 polyacr ylam ide gel, proper t ies of, 393t poly-caprolacton e, 394 poly-L-lact ic acid, 394, 405 – proper t ies of, 393t polym ethyl m eth acr ylate, propert ies of, 393t pore size, int raderm al bot ulin um toxin inject ion an d, 388–389, 389f porous h igh -den sit y polyethylen e See Medpor prem axilla, preoperat ive evaluat ion, 14f, 15 prem axillar y augm en tat ion , 15 prem axillar y graft , 54 pretarsal area – fulln ess, after double-eyelid surger y, 232–233, 233f – h eigh t-volum e relat ionsh ip in , 232–233, 233f pretarsal bulge, 378, 383 pretarsal sh ow, 165, 166f procerus m uscle, 326–327 pro loplast y, 60–71 – pearls, 60 PRP See platelet-rich plasm a pseudo h um p, 61, 61f pseudolift , in t raderm al bot u lin um toxin inject ion an d, 388–389, 389f pseudoptosis, 162 – cau ses of, 210 ptosis, 162, 176, 307, 307f See also ch in, ptosis; eyelash ptosis – aesth et ic e ects of, 174, 327 – aging-related, 212–213, 327, 328 – apon eurot ic, 211, 212–213, 212f, 213f – asym m et ric, 214–215 – versus blepharoptosis, 174, 175f – congenital, 211, 212f, 213–214, 222, 222f – tact lens–in duced, 214– 214f – correct ion of, 169, 169f, 210–224 –– an esth esia for, 216, 216f –– case st udies, 221–222, 222f –– com plicat ions of, 220–221 –– conjunct ival prolapse after, 221 –– tour deform it y after, 221 –– dissect ion in, 216–217, 217f, 218f –– an d early postoperat ive revision, 221, 221f –– ect ropion after, 221 –– en t ropion after, 221 –– eyelid crease design for, 215–216, 216f –– and eye protective function, 214 –– xat ion of levator-Mü ller m uscle ap in , 217–218, 218f, 219f –– fron talis sling for, 210, 211, 215, 219–220, 220f –– h istorical perspect ive on, 210–211 –– in cision for, 216, 217f –– in st ru m en ts for, 215, 216f –– kerat it is after, 221 –– key tech n ical poin t s in , 220 –– lagoph th alm os after, 221 –– and levator resect ion , 219 –– levator su rger y for, 215 –– lid lag after, 221 –– m eth od, select ion of, 215 –– Mü ller m uscle conjun ct iva resect ion (MMCR) for, 211, 214, 215, 219 –– pat ien t evaluat ion for, 211–214 –– pearls, 210 –– photographs in sit t ing posit ion during, 218, 219f –– postoperat ive care, 220 –– preoperat ive siderat ion s, 214–215 –– preparat ion for, 215–216, 216f –– tech n iques for, 215–220 –– un ilateral versu s bilateral, 215 –– visual eld test before, 214 – d iagnosis of, 212–214 – after double-eyelid surger y, 238, 238f – evaluat ion of, 164, 210 – funct ion al e ect s of, 174 – Hering’s test and, 214–215 – h istor y-t aking for, 211–212 – latent , 214–215 – m asked, 211 – over-correct ion of, 220 – physical exam ination for, 211–212 – u nder-correct ion of, 220, 221f – u nilateral, 174, 175f, 176, 210, 215 pug n ose, 87 pulm on ar y em bolism , fat graft and, 321 R Radiesse See calcium hydroxylapat ite radiofrequency devices, in facial rejuven at ion , 340, 344–346 – bipolar, 344, 345 –– w ith ligh t , 345 – in lt rat ive fract ional, 345–346, 346f – m on opolar, 344, 345 reduct ion rh in oplast y, 60 – pearls, 60 relapsing polych on drit is, and saddle n ose, 89 Rest ylan e See hyaluron ic acid ret rogn athia, ret ro-orbicularis orbit al fat (ROOF), 164 – rem oval, in double-eyelid surger y, 167, 167f revision rhin oplast y, 24, 25f rhin oplast y, 7f – adjun ct ive surgeries and procedures w ith, – aesth et ic, for South east Asians, 108–121 –– alar lift via sail excision in , 109–110, 110f–111f –– case st udies, 117, 118f, 119, 119f–121f –– closure, 116 –– com plicat ion s of, 117 –– ch al cart ilage h ar vest for, 109 –– dorsal im plan t for, 113–116 –– key tech n ical poin t s in , 116 –– m em bran ous sept um dissect ion in , 111, 112f –– osteotom y in , 113 –– pat ien t coun seling before, 109 –– pat ien t evaluat ion for, 108–109 –– pearls, 108 –– sept al extension graft in, 112, 112f, 113f –– tech n iques for, 109–116 –– t ip project ion an d coun terrot at ion in, 112–113, 113f – alloplast ic im plant s in See also alloplast ic im plan ts –– com plicat ion s of, 135–148 –– pearls, 135 – augm en tat ion See augm en t at ion rh in oplast y – correct ive See correct ive rhin oplast y – for deviated/t w isted n ose, 72–86 See also correct ive rhin oplast y –– pearls, 72 – edem a after –– late (persisten t), 81 –– m an agem en t of, 81, 140 – in fect ion s in , 143 – inject ion, asym m et r y caused by, 412 – m odi cat ion an d re n em en t for Asians, – osteotom y in, 76–77 –– lateral, 76–77, 76f, 77f –– m edial, 76f, 77 –– t ips for perform ing, 77 –– t ypes of, 76, 76f – pat ient evaluat ion for, 14–15, 14f, 15f, 72–75 – plan n ing for, 27 – preoperat ive cou nseling for, 27–28 – preoperat ive evaluat ion for, 27, 60–61 – secon dar y –– for alloplast-related com plicat ion s, 135–148 –– case st udies, 143, 144f, 145, 145f–147f –– and capsule aroun d silicone im plan t , 136, 137f –– for deviated im plant , 138–139 –– for dorsal skin redn ess, 139 –– and Gore-Tex im plan t com plicat ion s, 137 –– for h ard n asal t ip, 140 425 426 Index rh in oplast y (cont inued) – secon dar y (cont inued) –– for im plan t calci cat ion , 139, 140f –– for im plan t prot ru sion, 139 –– for in fect ious dit ion s, 140–141 –– key tech nical poin ts in, 142–143, 142f –– an d Medpor im plan t com plicat ion s, 137, 138f –– for m obile im plan t , 139 –– for n on in fect ious dit ion s, 138–140 –– pat ient evalu at ion for, 136–138 –– for sh ort nose deform it y, 141–142, 142f –– tech niqu es for, 138–142 –– for visible im plan t , 139 rhyt idectom y, 309 rhyt ids – foreh ead, 327 – glabellar, 327 – lateral can th al See crow ’s-feet – perioral, bot ulin um toxin for, 384–385, 385f Ricket t s line See esthet ic line (E-line) ROOF See ret ro-orbicularis orbital fat (ROOF) rule of fth s, 270, 271f, 324 rule of th irds, 270, 271f, 288, 289f, 324 S saddle n ose (deform it y) – aesth et ic e ects of, 87, 88f, 89f – an atom ic siderat ion s, 87–88, 88f, 89f – case st udies, 94, 95f, 96, 96f–98f – ch aracterist ics of, 87, 88f – class 1, 90–91, 91f – class 2, 90, 91–92, 91f, 92f – class 3, 90, 91f, 92–93, 93f – class 4, 90, 91f, 93, 94f – classi cat ion of, 90, 91f – correct ion of, 87–98 –– pearls, 87 – disease an d, 89 – et iology of, 88–90 – exten ded spreader graft for, 92, 92f – fun ct ion al e ects of, 87 – iat rogenic cau ses, 89 – m alignan cy an d, 89 – pat ien t evaluat ion , 90 – versus pseudo saddle, 87, 88f – septal exten sion graft for, 92, 92f – spreader graft for, 92, 92f, 93 – surgical tech niqu es for, 90–93, 91f–94f –– key tech nical poin ts, 93 – system ic disease an d, 89 – total dorsal recon st ruct ion for, 93, 94f – t raum a-related, 89 SAFI See sequen t ial autologous fat inject ion (SAFI) tech n ique sagit tal split ram us osteotom y (SSRO), m an dibular, 274–275, 274t – bleeding during, 280 – case st udies, 282–283, 282f–284f – an d genioplast y, 286 – in fect ion after, 280 Sam urai eyebrow, 382 sarcoidosis, an d saddle n ose, 89 sausage eyelid, 232 scalp, prurit us, after h air t ran splan tat ion, 359 SCALP m n em onic, 396, 396f scar(s), See also keloids – after alar base surger y, 104–105, 105f – w ith epican th oplast y, 187–189 – after eyelid surger y, 226, 226f, 227f – facial fat graft ing an d, 319–320 – after ller inject ion , 411 – hair t ran splan tat ion and, 351, 352, 358, 359 – hypert roph ic, 100, 185, 196 –– w ith epican th oplast y, 189 –– after eyelid surger y, 226 –– h air t ran splan t at ion an d, 351, 359 –– t reat m en t of, 189 – w ith n onin cision al sut u re techn ique for dou ble-eyelid surger y, 159, 160f – resurfacing, 10 Sculpt See poly-L-lact ic acid seborrh eic derm at it is, after laser facial hair rem oval, 370, 370f sent inel vein, in forehead, 325, 326f, 331–332 Sephyl See blood, as ller septal extension graft , 135, 136f – in aesth et ic rh inoplast y for Sou th east Asian s, 112, 112f, 113f – in correct ive rh in oplast y for sh or t t racted n ose, 123–125, 124f septoplast y, in fect ion s in , 143 septorh in oplast y, 135 – com plicated, 135, 143 –– alloplast ic im plan ts for, 135 –– pearls, 135 – in fect ion s in , 143 sequen t ial autologous fat inject ion (SAFI) tech n ique, 313, 313f, 314t–315t, 316f, 317t serom a, after en doscopic foreh ead an d brow lift , 337 shield graft , in aesthet ic rh in oplast y for South east Asian s, 113 Sh in’s m eth od, for aesth et ic lateral can th oplast y, 191, 192f silicon e, liquid, propert ies of, 393t silicon e im plan t s, 8, 113 – advan tages of, 13–14 – for augm en tat ion rh inoplast y, 13–25 –– capsu le aroun d, 136, 137f –– pearls, 13 – ch in , com plicat ions of, 294 – com plicat ion s of, 22–23, 28, 28f, 135 – derm al fat graft w ith, 22, 23f – popularit y of, 13–14 – rem oval rate for, 135 – in rhin oplast y, 135 –– com plicat ions of, 135, 136, 137f –– an d m ucocele form at ion, 138, 139f, 140, 141f –– pearls, 135 Silskin See silicon e, liquid single eyelid, 152, 152f, 162–163, 173 – an atom y of, 153 – opening ph ase, 153f – rest ing ph ase, 153f skeletal reduct ion surger y, skin, Asian, – age-related ch anges in , 174, 178, 310 –– sun exposu re an d, 303–304 – of alar base, 101 – ch aracterist ics of, 196 – ch in –– dim pling, after genioplast y, 294 –– peau d’orange appearance, after gen ioplast y, 294–295 – in epican th al area, 185 – of eyelid, 164 – facial, laser h air rem oval and, 368, 368f – lift ing, in low er facial contouring, 257 – low er eyelid, loss of elast icit y, 198 – n asal, 15, 26, 27f, 61, 62f, 100 –– dam age in correct ive rh inoplast y for sh ort cont racted n ose, 130 –– dorsal redn ess, secondar y rh inoplast y for, 139 –– exam in at ion of, 74 –– m obilit y, evalu at ion , 123, 123f – n ecrosis –– w ith fat graft em bolizat ion , 320, 320f –– after ller inject ion , 403, 403f, 406, 406f, 409, 410f, 411, 412f –– after h air t ran splan t at ion , 358 – palpebral, – rejuvenat ion , 310 – resist ance to aging, 303–304, 378 – resurfacing, 310 – topical therapy for, 310 skin color – cu lt u ral beliefs about , 5, 303–304 – an d h air t ran splant at ion, 350 skin rejuvenat ion – ablat ive, 339–340 See also ablat ive rejuven at ion – n on ablat ive, 339 See also n on ablat ive rejuven at ion – t ype I, 339, 340 –– w ith in ten se pulsed ligh t , 341–342, 341f – t ype II, 339, 340 –– w ith in ten se pulsed ligh t , 342 skull, Asian, ch aracterist ics of, 349–350, 350f sn ap -back test , for eyelid laxit y, 198–199 sn ub n ose, postoperat ive, 122, 123f soft t issue, lift ing, in low er facial tou ring, 257 SOOF See suborbicularis orbit al fat (SOOF) South east Asians, 3, 8f – aesth et ic rh in oplast y for, 108–121 –– pearls, 108 squ are jaw, bot ulin um toxin for, 386–388, 387f, 388f SSRO See sagit t al split ram u s osteotom y (SSRO) stereoph otogram m et r y, preoperat ive, 27 steroid inject ion , after correct ive rh in oplast y, 81 st im ulator(s) ( ller), propert ies of, 393t subn asale–labialis in ferior:labialis inferior–soft t issue m en ton (Sn –Li:Li–Me´) rat io, 272f, 288, 289f subn asale–stom ion :stom ion –soft t issue m en ton (Sn–St:St–Me´) rat io, 272f, 288, 289f suborbicularis orbital fat (SOOF) – elevat ion (lift), 198, 199, 203, 207, 207f – in fat reposit ion ing bleph aroplast y, 203, 203f sun exposure – avoidan ce, after laser facial h air rem oval, 370 – and skin aging, 303–304 superior palpebral fold, 6, 7f superior su lcus – deepen ing –– age-related, 175, 175f –– w ith ptosis, 211, 212f – m an agem en t in aging-related (u pper) blepharoplast y, 181 supraorbital ner ve, injur y, in ller inject ion , 403 supraorbital neurovascular bundle, 325, 326f suprat roch lear n eurovascular bundle, 325–326, 326f supt rat rochlear arter y, ller inject ion in , prevent ion of, 404, 406 surgical tech niqu es, m odi cat ion an d re n em en t for Asians, 8–9 Index syn cope, hair t ran splan tat ion an d, 360 syph ilis, and saddle n ose, 89 T tear breakup t im e, 177, 181 tear secret ion , preoperat ive evaluat ion , 177, 181 tear t rough , ller inject ion in , 399 tear t rough depression, 197–198, 197f, 199 – fat graft ing for, 322, 322f teeth , exposure, an d facial aesth et ics, 270 tem p le, ller inject ion in, 396–397, 397f tem p oral fossa – ller inject ion in , 396–397, 397f – layers of, 396, 397f tem p oral region , an atom y of, 324–326, 325f–327f tem p orom an dibular join t (TMJ) – dysfunct ion , preoperat ive docum en tat ion of, 270 – in st abilit y, after orthognath ic surger y, 281 – pain, after orth ogn athic surger y, 280 tem p oropariet al fascia, 325, 325f, 326f Th erm age, 344 thread lift ing, 10 th um bprint sign , 32 TMJ See tem porom an dibular join t (TMJ) Tran ilast , 188 t ransconjun ct ival Mü ller t ucking, 158, 159f, 161, 161f t raum a, an d saddle n ose deform it y, 89 t riam cinolon e acetate, inject ion – after correct ive rh in oplast y, 81 – for hyper t roph ic scar, 189 t riangular m alar m oun d, 198 t rism us, after zygom a reduct ion , 249 t w o-jaw su rger y, 268 See also double jaw surger y vit am in c ion toph oresis, in facial rejuven at ion , 340 V-lin e surger y, 255, 255f volum izer(s), propert ies of, 393t, 405 Von Am m on’s m eth od, for aesthet ic lateral can thoplast y, 190, 190f W Wegen er’s gran ulom atosis, an d saddle n ose, 89 West Asians, W h it nall’s ligam en t , 167 Wilkin son an alysis, of m axim al m alar project ion , 245, 245f U X u lt rasoun d – in facial rejuven at ion, 340 – h igh -in ten sit y focused, in facial rejuvenat ion , 340, 346, 346t u pper eyelid crease, 6, 7f, 162 – low, 163 X-ray, preoperat ive – for gen ioplast y, 287, 289 – for m an dibular reduct ion , 256 – of n ose, 15, 15f – for secon dar y rh inoplast y, 136 V visual eld(s) – im provem ent, after aging-related (upper) blepharoplast y, 180 – ptosis and, 174 – test ing, w ith ptosis correct ion , 214 Z zero-m eridian, 288–289, 289f zygom a reduct ion , 243–253 – an esth esia for, 247 – an terior osteotom y in , 247, 247f – approach for, 246–247 – asym m et r y after, 249 – case st udy, 250, 250f, 251f – – – – com plicat ions of, 249–250 xat ion in , 247, 248f, 249 goals of, 243–244 in fraorbit al n er ve injur y an d paresth esia after, 249 – in t raoral approach for, 246–247 – I-sh aped osteotom y in, 248 – key tech n ical poin ts in , 248–249 – L-sh aped osteotom y in , 246–247, 247f, 248 – an d m an dible reduct ion (con touring), com bin ed, 246, 252, 252f, 253f, 263–265, 263f–267f – n on un ion after, 249 – ostectom y versus osteotom y in , 248 – pat ient evalu at ion for, 244–246 – pearls, 243 – posterior osteotom y in, 247, 247f – soft t issue sagging after, 249 – surgical tech n iques for, 246–247 – t rism us after, 249 – an d u nder-correct ion , 250 – vector of t ran sposition in , 248 zygom at ic arch, zygom at ic body, – posit ion of, 244–245 – volum e of, 244 zygom at ico-tem poral vein , m edial, 325, 326f 427 ... facial aesthetic appearance in East Asians These various techniques will be addressed throughout this textbook, with speci c modi cations for Asians 1 The Changing Face of Aesthetic Facial Plastic. .. expect that this book w ill guide the new surgeons venturing into aesthetic plastic surgery of the Asian face, as well as provide valuable inform ation to the others Hong Ryul Jin xi Acknow ledgments... Yap, MD xv I Introduction The Changing Face of Aesthetic Facial Plastic Surgery among East Asians Keng Lu Tan and Hong Ryul Jin Pearls • Asian s, part icularly th ose in East Asia, h ave seen •