Advanced Surgical Facial Rejuvenation Anthony Erian Melvin A. Shiffman (cid:120)(cid:3) (Editors) Advanced Surgical Facial Rejuvenation Art and Clinical Practice Editors Anthony Erian, MD Melvin A. Shiffman, MD Pear Tree Cottage 17501 Chatham Drive Cambridge Road Tustin, California 92780-2302 Wimpole 43 USA SG8 5QD Cambridge [email protected] United Kingdom [email protected] ISBN 978-3-642-17837-5 e-ISBN 978-3-642-17838-2 DOI 10.1007/978-3-642-17838-2 Springer Heidelberg Dordrecht London New York Library of Congress Control Number: 2011937179 © Springer-Verlag Berlin Heidelberg 2012 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. 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Cover design: eStudioCalamar, Figueres/Berlin Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Foreword The trend of this last century is undoubtedly to look young and youthful for the lon- gest time possible. I believe this is due to many factors. Certainly progress in medi- cine, precocious diagnosis of many diseases and new therapeutic protocols have contributed in increasing longevity but most of all never like in these last decades has the image of a person been so important. We have surely become a society of appearances. This book will certainly help the young cosmetic surgeon to choose the best tech- niques in order to achieve excellent results. Another important aspect that comes out of this well-described book is that invasive surgery is not necessary all the times as we once used to believe. Today, traditional lifting is usually proposed in fewer patients than before. It is possible to achieve ameliorations with other, less-invasive tech- niques such as fat transfer and others. In this way the patient can have short postop- erative recovery periods. We should learn to satisfy our patients with the less aggressive techniques possible. Theses combined techniques is the answer that this book can give to its readers. I think that we should really be grateful to Anthony Erian, Melvin Shiffman, and to the other authors for lending us their knowledge. I would like to add a simple thought of mine to the reader of this book. Besides the technique chosen, the cosmetic surgeon should always keep in mind that he or she is not infallible. In no way does he or she have divine power, so humbleness should be his or her main character trait. Personal hypertrophic ego can lead to major mistakes! We should make our patients happy and try to help them find a better way of living with themselves. My advice is always not to promise your patients what they will not receive. I would like to quote a beautiful thought of the author of the book The Face by Charles H. Willi, published in 1926: “The plastic surgeon is undoubtedly the greatest of all contemporary artists, he paints on living canvas and sculpts on human flesh contributing to the health and happiness and success of his patient.” Rome, Italy Giorgio Fischer, M.D. v Preface This book is the result of the hard work of many surgeons who wish to share with you their passion of facial aesthetic surgery. They are experts in their field and have agreed to share their knowledge and experience. The book covers comprehensive and “state- of-the-art” techniques in facial aesthetic surgery, and specific accounts and special techniques, both general and personal, are included. The aim of this book is to give an up-to-date account of the latest in cosmetic facial surgery, as the trends and techniques seems to change with the times. We sur- geons spend our lives learning and improving our techniques, honing and refining them. Both a beginner and an experienced surgeon will learn something from this text book. A new trend of nonsurgical solutions has been added, as now facial rejuvenation encompasses both surgical and nonsurgical. It is acknowledged that anatomy is 90% of surgery, hence the inclusion of a detailed account relevant to facial rejuvenation. This book has also stressed pre- and postoperative preparation to reduce complica- tions and avoid litigation which is essential to our society nowadays. Also, assessments and concepts of beauty have been added as it is difficult to have a basic parameter in this subjective industry. I am very grateful to all the doctors who contributed with their time, knowledge, and dedication to make this book a special one. I would like to refer to a facelift as surgical facial rejuvenation, as I feel the word “facelift” is confusing to both the patient and surgeon. It is also a misnomer. It is very difficult to divide the face into zones as all the anatomy is interlinked and interdependent. In modern surgery today, one tends to combine more than one procedure, both surgical and nonsurgical, so it is more appropriate to name it Surgical Facial Rejuvenation. I hope and believe that this book will be extremely useful to colleagues and stu- dents who want to know more about Facial Rejuvenation. Cambridge, UK Anthony Erian, M.D. vii Contents Part I Anatomy 1 Facial Anatomy ............................................ 3 Peter M. Prendergast 2 Facial Proportions .......................................... 15 Peter M. Prendergast 3 Danger Zones in Surgical Facial Rejuvenation................... 23 Peter M. Prendergast 4 Muscles Used in Facial Expression............................. 31 Melvin A. Shiffman 5 SMAFS (Superficial Musculoaponeurotic-Fatty System): A Changed SMAS Concept; Anatomic Variants, Modes of Handling, and Clinical Significance in Facelift Surgery ......... 35 Hassan Abbas Khawaja, Melvin A. Shiffman, and Enrique Hernández-Pérez Part II Anesthesia 6 Anesthesia for Minimally Invasive Cosmetic Surgery of the Head and Neck........................................ 49 Gary Dean Bennett 7 Personal Method of Anesthesia in the Office..................... 77 Stephen J. Gray Part III Preoperative and Postoperative 8 Preoperative and Postoperative Plan........................... 87 Anthony Erian and Ben Pocock 9 Facial Imaging ............................................. 95 John Flynn ix