Pearls and Pitfalls in Cosmetic Oculoplastic Surgery

Morris E. Hartstein, MD, FACS Department of Ophthalmology and Division of Plastic Surgery, Saint Louis University School of Medicine, , Director, Eye Plastics, Assaf Harofeh Medical Center, Zerifin, Israel Guy G. Massry, MD, Spaulding Cosmetic Surgery, 120 South Spaulding Drive,Suite 315Beverly Hills, Ca 90212 John B Holds, MD,FACS, Professor, Department of Ophthalmology and Otolaryngology, Saint Louis University School of Medicine 12990 Manchester Road, Suite 102, St. Louis, MO 63131

Part 1: Preoperative Evaluation;Ch. 1: Preoperative Evaluation of the Cosmetic Patient;Ch. 2: Evaluation of the Cosmetic Patient; Ch. 3: Preoperative Patient Counseling for Cosmetic Blepharoplasty; Part 2: Anesthesia; Ch. 4: Cosmetic Oculofacial Pearls to Live By; Ch. 5: Guide to Local Anesthetic Medications; Ch. 6: Motor Nerve Blocks in Oculofacial Surgery; Ch. 7: Regional Nerve Blocks in Oculofacial Surgery; Oculofacial Surgery; Ch. 9: Preoperative Preparation and Anesthesia in Blepharoplasty; Ch. 10: “Digital Diffusion” Technique for the Administration of Local Anesthetic in Eyelid Surgery; Ch. 11: Anesthesia for In-Office Oculoplastic Surgery: How We Do It; Ch. 12: Pain Reduction Using Vibration in Aesthetic injections and in eye and facial plastic surgery; Ch. 13: Tips for Safer, More Effective, and More Comfortable Periocular Anesthetic Injections and Sedation; Part 3: Upper Lid Blepharoplasty; Section 1: Preoperative Evaluation; Ch. 14: Upper Eyelid Blepharoplasty: The Evaluation; Ch. 15: Preoperative Examination Checklist for Upper BlepharoplastyCh. 16: Preoperative Evaluation and Documentation in Upper Blepharoplasty; Ch. 17: Ten Tips to Avoid the Perils, Pitfalls and Complications of Cosmetic Blepharoplasty; Section 2: Incision Planning; Ch. 18: Marking Strategies for Upper Blepharoplasty; Ch. 19: Orbit Size and Lid Marking in Upper Blepharoplasty; Ch. 20: Incisional Guidelines When Marking the Skin in Upper Eyelid Blepharoplasty; Ch. 21: Marking the Proposed Upper Eyelid Crease: Determining the Safe Amount of Skin Removal—The Pinch Technique; Ch. 22: Preoperative Measurements in Upper Blepharoplasty: Patient Selection; Ch. 23: Keys to Success When Marking the Skin in Upper Blepharoplasty; Ch. 24: Skin Marking in Upper Blepharoplasty—Avoiding Pitfalls; Section 3: Upper Blepharoplasty Procedure Pearls; Ch. 25: A simple method for more efficient blepharoplasty surgery; Ch. 26: Upper Blepharoplasty: Pearls for the Procedure; Ch. 27: Blepharoplasty Pearls:  General Tips; Ch. 28: Fat Excision in Upper Blepharoplasty; Ch. 29: Mobilizing and Excising the Nasal Fat Pad in Upper Blepharoplasty; Ch. 30: The Sigmoid Upper Lid Blepharoplasty; Ch. 31: Tissue Removal Considerations in Blepharoplasty Surgery; Ch. 32: Fewer Hematomas in Upper Blepharoplasty; Ch. 33: Blepharoplasty Incisional Modalities: 4.0 Radiowave Surgery vs. CO2 Laser; Ch. 34: Doing Safe Upper Blepharoplasty Surgery:  When Less is Better; Ch. 35: Upper Blepharoplasty Pearls; Ch. 36: Fat Preservation and Other Tips for Upper Blepharoplasty; Ch. 37: Upper Eyelid Fat Repositioning; Ch. 38: Asian Blepharoplasty; Ch. 39: Upper Lid Blepharoplasty in the Asian Patient; Ch. 40: Recognizing the Differences in Asian Eyelid Anatomy; Section 4: Adjunctive Procedures in Upper Blepharoplasty; Ch. 41: Transblepharoplasty Internal Brow Elevation with Corrugator Removal; Ch. 42: Transblepharoplasty Incision LowerEyelid Canthoplasty; Section 5: Wound Closure and Postoperative Care; Ch. 43: Avoiding Dog Ears During Upper Blepharoplasty Closure; Ch. 44: Crease Formation in Upper Blepharoplasty; Ch. 45: Use of Dermabond Tissue Adhesive for Oculoplastic Incision Closure; Ch. 46: Reducing Postoperative Swelling; Ch. 47: Management of Postblepharoplasty Dry Eye; Ch. 48: Bump Thermoplasty for Small Benign Eyelid Lesions and Wound Artifacts; Ch. 49: Scar Management; Part 4: Lower Lid Blepharoplasty; Section 1: Preoperative Considerations; Ch. 50: Lower Eyelid Blepharoplasty: The Evaluation; Ch. 51: Lower Eyelid Blepharoplasty Evaluation: Avoid the Cookie Cutter Approach; Section 2: Lower Blepharoplasty Procedure Pearls; Ch. 52: Lower Eyelid Blepharoplasty: Procedure Pearls and Pitfalls; Ch. 53: Lower Lid Blepharoplasty: Transcutaneous verses transconjunctival approach; Ch. 54: Incising the Septum over the Nasal, Central, and Lateral Fat Pads in Lower Blepharoplasty; Ch. 55: Prolapsing the Inferior Fat Pads and Fornix in Lower Blepharoplasty; Ch. 56: Identifying the Inferior Oblique in Transconjunctival Blepharoplasty; Ch. 57: The ”GRED (Globe Retropulsion and Eyelid Depression)” Maneuver to Access Post-septal Fat in Transconjunctival Lower Blepharoplasty; Ch. 58: Achieving Symmetry in Lower Blepharoplasty Fat Removal; Ch. 59: The Treatment of Festoons in Lower Blepharoplasty; Ch. 60: Step by step treatment of post blepharoplasty chemosis; Ch. 61: Chemosis:  Avoidance and Management Tips; Ch. 62: Making Lower Eyelid Transconjunctival Blepharoplasty Easier, Safer, and More Comfortable; Ch. 63: Management of Severe Postoperative Bleeding with Hemostatic Matrix; Section 3: Repositioning in Lower Blepharoplasty; Ch. 64: Fat Repositioning in Lower Blepharoplasty: Less Is More; Ch. 65: Fat Repositioning in Lower Blepharoplasty: Does the Plane of Fat Transposition Affect The Outcome?; Ch. 66: Transconjunctival Lower Lid Blepharoplasty with and Without Fat Repositioning; Ch. 67: Fat Pedicle Isolation During Transconjucntival Lower Blepharoplasty With Fat Repositioning: “The Inverse Shoe Shine Sign”; Ch. 68: Transconjunctival Pre-periosteal Fat Repositioning Blepharoplasty; Ch. 69: Lower Lid Blepharoplasty with Fat Repositioning Using a Foam Bolster; Ch. 70: Use of Tisseel in Lower Eyelid Blepharoplasty with Fat Repositioning; Ch. 71: Lower Blepharoplasty with Non-Suture Fat Repositioning; Ch. 72: The Bustier Lower Lid Blepharoplasty; Ch. 73: Lower blepharoplasty: Lift and Fill; Section 4: Management of Postblepharoplasty Lid Retraction; Ch. 74: Managing Postblepharoplasty Lower Eyelid Malposition; Ch. 75: Retroauricular Dermal Spacer Graft for Lower Lid Retraction Repair; Ch. 76: Mid-Lower Eyelid Tarsoconjunctival Flap-Skin Graft: Treatment of Cicatricial Lower Lid Retraction; Ch. 77: Treatment of Postblepharoplasty Lower Eyelid Retraction with Dermis Fat Spacer Grafting; Ch. 78: Lateral CanthalWebs; Ch. 79: True Lower Eyelid Retractor Recession as an Adjunct to Lower Lid Recession Surgery; Part 5: Forehead Rejuvenation; Section 1: Preoperative Considerations; Ch. 80: Which Browlift to Do?; Ch. 81: Browlifting: Patient Evaluation; Ch. 82: Preoperative Botox for Endoscopic Browlifting; Ch. 83: Forehead and Eyebrow Anatomy and its Continuity with the Eyelid; Section 2: Endoscopic Forehead Rejuvenation; Ch. 84: Five Tips for Endoscopic Browlift; Ch. 85: Anesthesia Options in Endoscopic Forehead Lifting; Ch. 86: Endoscopic Forehead Rejuvenation: How to Set Up the Operating Room and Trouble Shooting; Ch. 87: Endoscopic Forehead Rejuvenation: Equipment and Setup; Ch. 88: Incision Technique for Endoscopic Forehead Elevation; Ch. 89: Endoscopic Forehead Elevation: Patient Marking and Preparation; Ch. 90: Endoscopic Midforehead Techniques: Improved Outcomes with Decreased Operative Time and Cost; Ch. 91: Fifteen Principles of Enhanced Successin Endoscopic Browlift; Ch. 92: Dissection of Central Forehead and Temporal Pocket with Periosteal Release; Ch. 93: Endoscopic Forehead Lifting: Dealing with the Central Brow Depressors; Ch. 94: Elevation and Fixation of the Lateral Brow and Canthus; Ch. 95: Fixation Methods in Endoscopic Browlifting; Ch. 96: Endoscopic Browlift with Deep Temporal Fixation Only; Ch. 97: Tridimensional Brow, Glabella, and Temple Enhancement with Micro Fat Injection During Endoscopic Forehead Rejuvenation; Ch. 98: Scalp Fixation in Endoscopic Browlift; Ch. 99: Closing and Dressing the Wounds in Endoscopic Browlift; Ch. 100: Endoscopic Forehead Rejuvenation: Avoiding and Managing Complications; Section 3: Nonendoscopic Browlifting; Ch. 101: The Direct Browlift: Focus on the Tail; Ch. 102: Soft Tissue Augmentation of the Temporal Brow in Browlifting Surgery; Ch. 103: In-Office Brow and Forehead Lifting By A Quick Multi-Incision Trichophytic Approach; Ch. 105: The external browpexy: A minimally invasive brow lifting or stabilization procedure; Part 6: Mid-Face Lift; Ch. 106: Mid-Face Lift: General Considerations and How I Do It; Ch. 107: Ten Rules for Mid-Face Lifting for the Repair of Lid Retraction; Ch. 108: The Subperiosteal Mid-Face Lift Using Bioabsorbable Implants for Fixation; Ch. 109: Cheeklifting Pearls; Ch. 110: Preperiosteal Midface Lift Through Transtemporal Approach; Ch. 111: Maintaining Lateral Wound and Canthal Regularity in External Midface Lifts; Ch. 112: Cheek Implants; Part 7: Botox; Ch. 113: Introduction to Botulinum Toxin; Ch. 114: Evaluating Potential Patients for Neurotoxin; Ch. 115: Neurotoxin: General Principles of Treatment; Ch. 116: Botox: Where It Works Best; Ch. 117: Preparation of Botox; Ch. 118: Documentation of Treatment: Botox; Ch. 119: Botulinum Toxin Injection Technique; Ch. 120: Cosmetic Botulinum Toxin Applications:  General Considerations and Dosing; Ch. 121: Botulinum Toxin: Avoiding Pitfalls; Ch. 122: Botox Injection Techniques: Minimizing Bruising and Discomfort; Ch. 123: Botulinum Toxin Injections Pearls; Ch. 124: Botox Complications; Ch. 125: Glabella Treatment with Neurotoxin; Ch. 126: Corrugator and Procerus Rhytid Treatment with Botox; Ch. 127: Frontalis Injection with Botox; Ch. 128: Frontalis Treatment with Neurotoxin; Ch. 129: Shaping of the Eyebrows with Botulinum Toxin Type A (BoNT-A; Ch. 130: Botox Injection Techniques: Crow’s Feet; Ch. 131: Orbicularis Oculi Treatment with Neurotoxin; Ch. 132: Perioral Botox Injectionsh. 133: Botulinum Toxin Type A Cosmetic:  How to Achieve Precise and Predictable Results;  Ch. 134: Botox Injection to the Lacrimal Gland for the Treatment of Epiphora; Ch. 135: Botox Therapy for Hyperhydrosis: How I Do It; Ch. 136: Other Uses of Botulinum Toxins; Ch. 137: Botox for Axillary Hyperhydrosis; Ch. 138: Use of Incobotulinum toxin A (Xeomin) for cosmetic facial rejuvenation; Ch. 139: Management of Benign Essential Blepharospasm; Part 8: Fillers; Ch. 140: Optimizing Outcome from Facial Cosmetic Injections and Promoting Realistic Expectations; Ch. 141: Pearls and Pitfalls of Injectable Facial Fillers; Ch. 142: Table of Fillers; Ch. 143: Dermal Filler Pearls:  The Hyaluronic Acids; Ch. 144: Radiesse® Pearls:  General Tips for Safer, More Comfortable, and Better Results; Ch. 145: Belotero Pearls; Ch. 146: Hyaluronic Acid Pearls:  Fine and Superficial Lines; Ch. 147: Achieving Beautiful Lip Augmentation; Ch. 148: Restylane Injection for the Lower Eyelid Tear Trough; Ch. 149: Liquid Injectable Silicone for the Upper Third of the Face; Ch. 150: Periocular Injectables with Hyaluronic Acid and Polymethyl Methacrylate using  microcannulas; Ch. 151: Novel Uses for Hydroxylapatite (Radiesse®) Filler:  Beyond the Facial Folds; Ch. 152: Pearls and Pitfalls of Botox and Filler Substances in the Upper Third of the Face; Ch. 153: Lower Eyelid Rejuvenation:  A Pictorial Management Guide; Ch. 154: Upper Eyelid Volumization with Hyaluronic Acid; Ch. 155: Correcting the upper eyelid hollow with filler; Ch. 156: Pearls for Periorbital Fat Transfer; Ch. 157: Volumetric Rejuvenation of the Tear Trough with fat transfer to Ristow’s space; Ch. 158: Complementary Fat Grafting in the Periorbital Region; Ch. 159: Autogenous Orbicularis and Fat as a Filler; Part 9: Skin Rejuvenation; Section 1: Skin Care; Ch. 160: Skin Care 101: The Basics; Ch. 161: Retinoids for the Cosmetic Patient; Ch. 162: Evaluation of Skin Lesions in the Cosmetic Patient Made Simple: Actinic Keratosis; Section 2: Nonablative Therapy; Ch. 163: Chemical Peels for Facial Rejuvenation; Ch. 164: Nonablative Laser and Light Facial Rejuvenation; Section 3: Ablative Therapy; Ch. 165: Ablative resurfacing-general considerations; Ch. 166: CO2 Laser Skin Resurfacing Prophylaxis; Ch. 167: CO2 Laser Resurfacing Immediate Postoperative Care Prior to Complete Epithelialization; Ch. 168: Products Used in CO2 Laser Resurfacing Wound Care: Late Postoperative Care After Complete Epithelialization; Ch. 169: Ablative Fractional Laser Skin Resurfacing; Ch. 170: Fractionated CO2 Laser Skin Resurfacing; Ch. 171: Monopolar Radiofrequency Tissue Tightening; Ch. 172: Dual-Mode Erbium-YAG Laser Skin Resurfacing; Ch. 173: Fraxel Treatment; Part 10: Other Cosmetic Procedures; Ch. 174: Repair of the Torn Earlobe; Ch. 175: Upper Lip Lift: a Powerful Rejuvenative Procedure; Ch. 176: Ten Tips for a Reliable and Predictable Deep Plane Facial Rhytidectomy; Ch. 177: Facelifting in the Full Neck; Ch. 178: Assessment and Treatment of the Aging Jaw Line; Ch. 179: Masseteric Facial Anastomosis for Dynamic Lower Eyelid Reanimation in Facial Paralysis; Part 11: Functional Lid Malpositions; Section 1: Ptosis- Anterior Approach; Ch. 180: Advantages of Sequential Versus Simultaneous Bilateral Levator Advancement Surgery; Ch. 181: Considerations in Simultaneous vs. Sequential Bilateral Levator Repair; Ch. 182: Ten Steps to Making External Levator Ptosis Surgery More Predictable; Ch. 183: Adjustable Suture Technique for Levator Surgery; Ch. 184: Tarsal Switch Levator Resection for the Treatment of Myopathic Blepharoptosis; Ch. 185: Modified Levator Advancement Ptosis Technique; Ch. 186: Minimally Invasive Ptosis Repair; Ch. 187: Small Incision External Levator Repair; Ch. 188: Levator Aponeurotic Dehiscence: A Pictorial Review; Ch. 189: Ptosis Repair by a Single-Stitch Levator Advancement; Ch. 190: Postoperative Care for Dry Eye Prevention in Ptosis Surgery; Section 2: Ptosis- Posterior Approach; Ch. 191: Pearls for Müller’s Muscle–Conjunctival Resection–Ptosis Procedure Combined with Upper Blepharoplasty; Ch. 192: Müller’s Muscle-Conjunctival Resection Pearls: Phenylephrine and Resection Considerations; Ch. 193: Avoiding Lid Contour Abnormalities in Müller’s Muscle-Conjunctival Resection: Recognizing the Lateral Shift; Ch. 194: Müller’s Muscle–Conjunctival Resection Procedure Tips; Section 3: Entropion; Ch. 195: Minimally Invasive, Three-Step, Transconjunctival Entropion Repair; Ch. 196: Entropion Repair by Pre-tarsal Orbicularis Transposition; Ch. 197: Simple “Bedside” Cautery Entropion Repair; Section 4: Ectropion; Ch. 198: “Simple-Dimple” Lateral Tarsus Fixation; Ch. 199: Simplified Lower Lid Tightening Without a Tarsal Strip; Ch. 200: Technique for Medical Canthal Flap to Correct Lid Retraction/Medial Ectropion; Ch. 201: Medial Canthorraphy; Ch. 202: Myocutaneous Flaps and Canthopexy for Repair of Severe Cicatricial Ectropion; Ch. 203: Internal Vertical Mattress Eyelid Reconstruction