Werner L.Mang · Manual ofAesthetic Surgery 2 Professor Dr.med.Dr.habil.Werner L.Mang was born in Ulm,Germany, on 9 April 1949.Following his basic surgical training in the 1970s, he became a specialist in ENT (1980) and plastic operations (1984). He is the Medical Director ofthe Bodenseeklinik,Europe’s largest clinic for aesthetic surgery.Professor Mang is Chairman ofthe Board of Directors ofMang-Medical AG,founding President ofthe German Society for Aesthetic Surgery,President ofthe International Society of Aesthetic Surgery,and an honorary member ofnumerous specialist societies. He is also the author ofthe successful Manual ofAesthetic Surgery, Volume 1 (Mang School),which has been translated into English, Portuguese,Russian,and Chinese. He is the author ofmore than 200 specialist publications;he has been a pioneer in his field in Germany and has personally carried out more than 30,000 cosmetic operations over the last 20 years.Thus,Professor Mang has significantly influenced the evolution ofaesthetic surgery,as did Professor Pitanguy before him. Werner L. Mang MANUAL OF AESTHETIC 2 SURGERY ■ Breast Augmentation ■ Liposuction ■ Brachioplasty ■ Hair Transplantation ■ Abdominoplasty ■ Adjuvant Therapies ■ Thigh and Buttock Lift Including Spacelift Coauthors Klaus Lang · Frank Neidel · Marian Stefan Mackowski Nico Roßmann · Manuel Stock 120 Medical Illustrations by Hans Jörg Schütze 20 Plates ofSurgical Instruments and 66 Photographs 123 ISBN 3-540-66553-6 Springer Berlin Heidelberg NewYork Library ofCongress Control Number:00061916 This work is subject to copyright.All rights are reserved,whether the whole or part ofthe material is concerned,specifically the rights oftranslation,reprinting,reuse ofillustrations, recitation,broadcasting,reproduction on microfilm or in any other way,and storage in data banks.Duplication ofthis publication or parts thereofis permitted only under the provisions ofthe German Copyright Law ofSeptember 9,1965,in its current version,and permission for use must always be obtained from Springer-Verlag.Violations are liable for prosecution under the German Copyright Law. Springer is a part ofSpringer Science+Business Media springeronline.com © Springer-Verlag Berlin Heidelberg 2005 Printed in Germany The use ofgeneral descriptive names,registered names,trademarks,etc.in this publication does not imply,even in the absence ofa specific statement,that such names are exempt from the relevant protective laws and regulations and therefore free for general use.Product liability: The publishers cannot guarantee the accuracy ofany information about dosage and applica- tion contained in this book.In every individual case the user must check such information by consulting the relevant literature. Editor:Gabriele M.Schröder,Heidelberg Desk editor:Irmela Bohn,Heidelberg Production editor:Ute Pfaff,Heidelberg Medical Illustrations:Hans Jörg Schütze,Köln Cover-Design:Erich Kirchner,Heidelberg Typesetting and Reproduction ofPlates and Photos: AM-productions GmbH,Wiesloch Printing and bookbinding:Stürtz AG,Würzburg DVD-Video:Video Transfer,Groß-Umstadt Printed on acid-free paper 24/3150 – 5 4 3 2 1 0 Addresses Professor Dr.med.Dr.habil.Werner L.Mang Ärztlicher Direktor der Bodenseeklinik Lindau Klinik für Plastische und Ästhetische Chirurgie Graf-Lennart-Bernadotte-Straße 1 88131 Lindau / Germany Tel.+49 (0) 83 82 – 26 01 80; Fax +49 (0) 83 82 – 26 01 87 0 email:[email protected] Internet:www.Bodenseeklinik.de APL-Professor,Klinikum rechts der Isar Technische Universität München Ismaninger Straße 22 81675 München / Germany Dr.med.Klaus Lang Bodenseeklinik Lindau Graf-Lennart-Bernadotte-Straße 1 88131 Lindau / Germany Dr.med.Marian Stefan Mackowski Bodenseeklinik Lindau Graf-Lennart-Bernadotte-Straße 1 88131 Lindau / Germany Dr.med.Frank Neidel Bodenseeklinik Lindau Graf-Lennart-Bernadotte-Straße 1 88131 Lindau / Germany Dr.med.Nico Roßmann Bodenseeklinik Lindau Graf-Lennart-Bernadotte-Straße 1 88131 Lindau / Germany Dr.med.Manuel Stock Bodenseeklinik Lindau Graf-Lennart-Bernadotte-Straße 1 88131 Lindau / Germany In memory of Dr.Karl Mang Dominic Blake Manual ofAesthetic Surgeryis dedicated to my wife,Sybille, and my children,Gloria-Victoria and Thomas-Werner. Without my wife Sybille I would have been unable to find the energy to build the new clinic at Lake Constance or to write this manual.Over the last few years,there has been no time for holidays or free weekends with my family, and it thus pleases me even more that,despite this stress, both my children are interested in the field ofmedicine. Naturally,it would be wonderful ifmy children could one day continue my life’s work and become capable surgeons. Introduction My idea ofwriting an audiovisual work about aesthetic surgery has been crowned by success,for which I am extremely grateful.In Volume 1 ofthe Manual ofAesthetic Surgery,for the first time treatments were described simply,clearly,and concisely using text,pictures,and videos,so that young doctors who want to learn about this area,either as interested students and doctors or as young specialists in aesthetic/plastic surgery, could acquire the basic knowledge and surgical expertise they need with- out making treatment mistakes. The manual is intended to be a basic tool and is not for professionals and doctors who have been practicing in this specialty for a long time. It is intended to be a textbook for doctors who are starting out in this field and want to learn about it. Naturally,it was not possible to mention all the tricks,subtleties, and latest operation methods,suture materials,implants,etc.in these volumes.Every aesthetic surgeon must learn these through further training and conferences.However,for every surgical technique in trauma or abdominal surgery,the basics ofthe operation must be standardized.This was achieved well with Volume I ofthe manual. It has been the most successful book ofits kind for Springer-Verlag, Heidelberg,and has been published in Spanish,Russian,and Chinese because ofthe enormous interest in it. I had never thought that this book would be so well accepted.It has become an interdisciplinary textbook for surgeons,ENT and dental surgeons,plastic surgeons,dermatologists,gynecologists,orthopedists, and urologists and has a place in many hospital libraries throughout the world. After the first volume was published,I received invitations to give lectures and surgical courses and take up chairmanships from almost everywhere in the world.I have been accredited as an honorary professor at foreign universities and see my life’s task in plastic/aesthetic surgery as being to bring together all specialties that teach and research the field ofaesthetic surgery in order to ensure excellent quality assurance in relation to patient care. IX As a result ofmy lectures to the most varied specialist societies on every continent,I have discovered again and again that there is competition between ENT surgeons,dental surgeons,and plastic surgeons in almost every country,even though all three specialties perform extremely valuable work in the field ofaesthetic surgery. The leading plastic surgeons ofthe past,Diefenbach,von Gräfe,Joseph, and Lexer,were either ENT surgeons or general surgeons.We must never forget our history and the disciplines from which the specialty of aesthetic/plastic surgery has developed. Anyone who has had sound surgical training and has an interest in the field ofaesthetic surgery will value this book as a benchmark.It can help in allowing the specialty ofaesthetic surgery to be taught in an interdis- ciplinary way,so that the specialties concerned can mutually exchange knowledge and thus contribute to further progress in this field. Aesthetic surgery can only achieve a serious basis in the long-term through constant training,the exchange ofideas,attendance at confer- ences,and the opening up ofall specialties that perform valuable work in this field.Neither plastic surgery nor ENT and dental surgery can claim this specialty for themselves alone,as there is too much overlap both historically and in the specialist further-training guidelines. For this reason,work is carried out in an interdisciplinary way at the clinic at Lake Constance with the departments ENT and plastic surgery,plastic and reconstructive surgery,maxillofacial surgery, aesthetic dental surgery,dermatology,and venous,hair and laser surgery.This is the only way a large clinic can cover the entire spectrum. The same applies to a well-trained aesthetic surgeon.He will always have main areas within his field ofwork and will be unable to cover all operations professionally alone.This is why the model ofthe clinic at Lake Constance will be successful in the long term,as in this clinic different groups ofspecialists are unified and offer interdisciplinary aesthetic surgery.This is the clinic ofthe future. Every year approximately 3,000 operations are carried out at the clinic at Lake Constance,which has five operating theaters and 50 beds. The Manual ofAesthetic Surgeryshould be seen as the symbiosis of my lifetime work with the Bodenseeklinik.It has been published to coincide with the building ofthe new clinic (completion 2003).In view ofthe great success and enormous demand for Volume 1,Volume 2 has now been published.The building ofthe new clinic has resulted in a delay but Volume 2 uses the same principles as Volume 1 and describes X