E-Book, Englisch, 627 Seiten, ePub
Nahai / Saltz Endoscopic Plastic Surgery
2. Auflage 2008
ISBN: 978-1-63853-610-9
Verlag: Thieme
Format: EPUB
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)
E-Book, Englisch, 627 Seiten, ePub
ISBN: 978-1-63853-610-9
Verlag: Thieme
Format: EPUB
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)
The landmark first edition of had a profound influence on the practice of plastic surgery and set the stage for the current trend toward minimally invasive plastic surgery procedures. The second edition continues that tradition with 13 additional chapters and numerous cases demonstrating results. With the guidance provided in this edition, surgeons will be able to master the necessary skills for the latest endoscopic techniques in aesthetic surgery and offer their patients the minimally invasive procedures they have been requesting.
The book is divided into four sections: Basics, Face, Breast, and Abdomen. Each clinical section begins with a chapter on applied anatomy followed by several chapters by different authors discussing their individual approaches to a specific anatomic area. Additionally, the book explores ancillary procedures such as lymphatic massage, radiofrequency treatments, microdermabrasion, fillers, and lasers. These chapters discuss the use of nonsurgical cosmetic treatments for a complete facial rejuvenation package.
The book provides expert commentary on the latest minimally invasive procedures, including summary boxes listing clinical caveats. It features color illustrations, as well as preoperative, intraoperative, and postoperative photographs, and a supplemental DVD with operative videos.
Autoren/Hrsg.
Fachgebiete
Weitere Infos & Material
Part I Basics
1 Fundamentals of Endoscopic Plastic Surgery
Part II Face
2 Applied Anatomy of the Face and Midface
3 Evaluation and Treatment Options in Brow Rejuvenation
4 Endoscopic Brow Lift: Three-Portal Approach
5 Endoscopic Brow Lift: Five-Portal Approach
6 Lateral and Transpalpebral Approach to Brow Lift
7 Rejuvenation of the Midface
8 Midface Lift With Barbed Sutures
9 Closed Lower Eyelid Midface Lift
10 Ancillary Treatments for Enhanced Facial Rejuvenation
11 Lasers in Aesthetic Surgery
12 Soft Tissue Fillers in Aesthetic Facial Surgery
Part III Breast
13 Axillary Approach for Endoscopically Assisted Breast Augmentation
14 Submuscular Breast Augmentation
15 Subfascial Transaxillary Breast Augmentation
Part IV Abdomen
16 Videoendoscopic Subcutaneous Abdominoplasty
Chapter 2
Applied Anatomy of the Face and Midface
Foad Nahai
Precision in aesthetic surgery depends not only on the technical skills of the surgeon, but almost equally on the surgeon’s detailed knowledge of anatomy. This is particularly pertinent in aesthetic surgery of the face performed with and without the endoscope. The endoscope offers a different perspective to the anatomy compared with the open approach. Structures such as nerves and vessels are visualized from different angles and magnified. A detailed knowledge of the anatomic layers of the forehead and face is a prerequisite for successful and safe aesthetic surgery. This includes a comprehensive understanding of the anatomy in three dimensions so that at any time a surgeon who has only a two-dimensional image on the monitor can gauge the exact location of the endoscope and instrument tips. Anatomic structures and relationships are not consistent, and the surgeon must be aware of possible variations. The anatomy may vary from individual to individual as well as from one side of the face and body to the other in the same person. Previous surgical procedures may also alter the anatomy and should be considered in all secondary aesthetic procedures of the face and body. Endoscopic identification of a nerve on one side of the forehead does not necessarily mean that the contralateral nerve will be in exactly the same location.
MUSCLES OF THE SCALP AND BROW
The muscles of the scalp, brow, and periorbital region are major contributors to facial animation and appearance. Emotional expressions and overall facial appearance depend on the actions of these muscles. With age and repeated contractions, these muscles produce lines or rhytids reflecting the insertion of the muscles into the overlying skin. These characteristic changes cause the familiar patterns of expression and aging on the face. The muscles of the scalp and brow include the epicranius, procerus, corrugator supercilii, and orbicularis oculi. These muscles are responsible for movements of the scalp, forehead, and eyebrows and the rhytids that mark the forehead, glabella, and periorbital areas. The modification of these muscles and the interactive balance between them are responsible for repositioning of the brow after endoscopic or open procedures.
EPICRANIUS
Pertinent Anatomy
The epicranius or scalp muscle is made up of the occipitofrontalis, the major portion, and a variably developed temporoparietalis. The occipitofrontalis is a wide fibromuscular layer that covers the entire scalp from the nuchal line to the eyebrows. It is composed of two paired muscle bellies—the occipital bellies (occipitalis muscles) and the frontal bellies (frontalis muscles); these are connected by the galea aponeurotica. The clinically significant frontal bellies or frontalis muscles are thin rectangular muscles with no bony attachments. These muscles are connected posteriorly to the galea aponeurotica at or in front of the coronal suture and insert anteriorly into the glabellar musculature where the medial fibers of the frontal belly intermingle with the procerus; the intermediate fibers mingle with the corrugator supercilii and the orbicularis oculi. The medial fibers of the frontal bellies may be joined for a variable length above the root of the nose. Supratrochlear and supraorbital branches of the ophthalmic artery supply the frontalis, and it is innervated by multiple branches of the frontal branch of the facial nerve.
Clinical Correlation
The frontal bellies, acting from above, elevate the eyebrows and forehead. Acting from below, they pull the scalp forward. The frontal bellies are responsible for the transverse forehead wrinkles, reflecting attachments or insertions of the muscle into the overlying forehead skin. Although transverse forehead wrinkles are produced by either action of the frontal bellies, increased tone in the brow depressors, corrugator, procerus, and orbicularis leads to an increase in frontalis tone. This muscle imbalance and increase in tone deepens the forehead lines. The occipital bellies draw the scalp backward, acting in opposition to the downward action of the frontalis. Improvement in brow position after a forehead lift may be attributable to reduced tone in the frontalis after modification of the brow depressors, allowing unopposed action of the occipitalis to elevate the brow. This relationship is the basis of the “functional brow lift” in which no brow fixation is performed.
GALEA APONEUROTICA
Pertinent Anatomy
The galea aponeurotica is an integral part of the occipitofrontalis and epicranius muscles. It is a thick, fibrous layer with fibers that run sagittally between the occipital and frontal bellies. Posteriorly between the separate bellies of the occipitalis, the galea is attached to the external protuberance and highest nuchal line of the occipital bone. Anteriorly the galea splits to enclose the frontal bellies and continues as a narrowing triangular portion between the two frontal bellies as they converge at the root of the nose. Laterally on each side, fibers that run coronally encompass the temporoparietalis and the external ear muscles. The galea is firmly attached to the overlying skin by the firm superficial fascia, which continues as the temporoparietal fascia and eventually attaches to the zygoma. On its deep surface the galea is connected to the epicranium by loose connective tissue and allows movement of the galea and scalp. There are no nerves or vessels deep to or within this loose connective tissue in the forehead above the level of the supraorbital ridge. The absence of these structures allows rapid, safe brow elevation in the subgaleal or subperiosteal plane. The endoscope, however, is essential for visualization of the area between the supraorbital rim and the supraorbital ridge, where the supraorbital nerve may emerge through a foramen.
The temporoparietalis is a very thin sheet of muscle lying between the frontal bellies of the occipitofrontalis and the auricular muscles. It is variably developed and may be absent.
PROCERUS
Pertinent Anatomy
The procerus is a small, thin, pyramid-shaped muscle extending from the nasal dorsum to the central forehead. It is considered one of the nasal muscles and may be as large as 2 by 8 cm. It originates from the fascia overlying the distal portion of the nasal bones and upper lateral nasal cartilage and inserts into the skin of the lower forehead between the eyebrows, intermingling with the medial fibers of the frontalis. Branches of the facial artery supply the procerus. It is innervated by the upper buccal branches of the facial nerve.
Clinical Correlation
The procerus muscle pulls downward on the medial eyebrows. This action augments the glabellar prominence, producing transverse glabellar wrinkles that are improved with procerus muscle excision. When viewed through the endoscope, the fibers of the procerus are oriented vertically, whereas the corrugator fibers course diagonally and differ slightly in color.
CORRUGATOR SUPERCILII
Pertinent Anatomy
The corrugator supercilii is a long, narrow muscle measuring approximately 1 by 5 cm; it is wider at its origin and narrows toward its insertion. It lies deep to the frontalis and orbicularis oculi at the medial end of the eyebrow. Originating from the medial end of the supraciliary arch, its transverse and oblique heads with fibers run laterally and slightly upward toward their insertion into the central part of the hair-bearing brow. The corrugator supercilii is supplied by the supratrochlear and supraorbital vessels. Although classically it was thought that the muscle is innervated by the frontal branch of the facial nerve, Boyd (personal communication, 2005) demonstrated additional innervation of the muscle medially through the buccal branches of the facial nerve.
Clinical Correlation
The corrugator supercilii pulls the eyebrows medially and downward, producing vertical glabellar wrinkles. The depth of these frown lines is related to the thickness of the muscles, their constant contractions, and the thickness of the overlying skin. At times the transverse head may act as an elevator of the medial brow. Much attention has been directed to the role of corrugator excision during endoscopic brow lift because it is considered the prime depressor of the medial brow, a role that it shares with the medial orbicularis.
ORBICULARIS OCULI
Pertinent Anatomy
The orbicularis oculi, the most superficial muscle, is a relatively large, flat, broad, elliptical muscle that occupies not only the upper and lower lids and covers the orbit but also extends beyond the orbit onto the cheek and temporal regions. Its fibers form an uninterrupted ellipse. It comprises the orbital, palpebral, and lacrimal portions. The orbital portion is thicker and darker than the palpebral portion. Many of its fibers insert into the skin and subcutaneous tissues of the eyebrow and constitute the depressor supercilii. Its origin is the nasal portion of the frontal bone and the frontal process of the maxilla. The fibers of insertion intermingle with the frontalis and corrugator muscles, inserting into the skin and subcutaneous tissues of the eyebrow. The palpebral portion is thinner and lies within the eyelids. The lacrimal portion of the muscle lies behind the lacrimal sac. The transverse facial, supratrochlear, and supraorbital vessels supply this muscle. The orbicularis is innervated by the temporal, zygomatic, and buccal branches of the facial nerve.
Clinical Correlation
The orbicularis oculi is a...
