Cosmetic Medicine and Surgery, An Issue of Clinics in Plastic Surgery - E- Book

Adam Rotunda, Raffi Hovsepian, Malcolm D. Paul

Description

More and more plastic surgeons are turning to cosmetic medicine and minimally invasive surgery as a way to supplement their practices. This multidisciplinary issue, which includes dermatologists as well as plastic surgeons, gives detailed information on how to perform several procedures, including dermabrasion, botox injection, laser therapy, and thermage.

Sujets

• Reconstructive
• Medical
• Médecine
• Cosmetic
• Surgery

Informations

• Publié par: Saunders
• Date de parution: 28 avril 2011
• Nombre de lectures: 0
• EAN13: 9781455709489
• Langue: English
• Poids de l'ouvrage: 10 Mo

Extrait

Clinics in Plastic Surgery , Vol. 38, No. 3, July 2011
ISSN: 0094-1298
doi: 10.1016/S0094-1298(11)00079-4

Contributors
Clinics in Plastic Surgery
Cosmetic Medicine and Minimally Invasive Surgery
Malcolm D. Paul
Raffi V. Hovsepian
Adam M. Rotunda
ISSN  0094-1298
Volume 38 • Number 3 • July 2011

Contents
Cover
Contributors
Forthcoming Issues
Cosmetic Medicine and Surgery: A Shift in Perspective
An Overview of Cosmetic Medicine and Surgery: Past, Present, and Future
The Interface of Cosmetic Medicine and Surgery: Working from the Inside and the Outside
BeautiPHIcation™: A Global Approach to Facial Beauty
Volumizing the Face With Soft Tissue Fillers
Dermabrasion
The Art and Science of New Advances in Cosmeceuticals
An Overview of Botulinum Toxins: Past, Present, and Future
Principles and Practice of Cutaneous Laser and Light Therapy
Radio Frequency Energy for Non-invasive and Minimally Invasive Skin Tightening
Fractionation: A New Era in Laser Resurfacing
Laser, Light, and Energy Devices for Cellulite and Lipodystrophy
Sclerotherapy: It Is Back and Better
Injectable Therapies for Localized Fat Loss: State of the Art
Noninvasive Body Contouring with Radiofrequency, Ultrasound, Cryolipolysis, and Low-Level Laser Therapy
Lifting and Wound Closure with Barbed Sutures
Index
Clinics in Plastic Surgery , Vol. 38, No. 3, July 2011
ISSN: 0094-1298
doi: 10.1016/S0094-1298(11)00081-2

Forthcoming Issues
Clinics in Plastic Surgery , Vol. 38, No. 3, July 2011
ISSN: 0094-1298
doi: 10.1016/j.cps.2011.06.001

Cosmetic Medicine and Surgery: A Shift in Perspective

Malcolm D. Paul, MD
Aesthetic and Plastic Surgery Institute, University of California, Irvine, 1401 Avocado Avenue, Suite 810, Orange, CA 92660, USA
E-mail address: [e-mail]
E-mail address: [e-mail]
E-mail address: [e-mail]

Raffi V. Hovsepian, MD
Aesthetic and Plastic Surgery Institute, University of California, Irvine, 1401 Avocado Avenue, Suite 810, Orange, CA 92660, USA
E-mail address: [e-mail]
E-mail address: [e-mail]
E-mail address: [e-mail]

Adam M. Rotunda, MD
http://www.newportskincancer.com , 1100 Quail Street, Suite 102, Newport Beach, CA 92660, USA
E-mail address: [e-mail]
E-mail address: [e-mail]
E-mail address: [e-mail]

Malcolm D. Paul, MD, Guest Editor
Adam M. Rotunda, MD, Guest Editor
Raffi V. Hovsepian, MD, Guest Editor
In the articles in this publication, the technologies that provide medical and surgical solutions for cosmetic indications are explored, including barbed sutures, neurotoxins, cosmeceuticals, sclerotherapy, dermabrasion, fillers, lasers, and other energy sources, including face and body contouring devices, that provide solutions that respond to a consumer demand for less aggressive solutions to the aging face and body contour deformities.
The introductory article sets the stage in depth for the content in this issue, describing the outcome of revelations of vector and volume effect on the aging face, the demand for less aggressive procedures, effects of the most recent economic downturn on industry developments and patient requests, addressing “outside-in” technologies such as peels, collagen, silicone, and topical treatments. The adoption of Botox and hyaluronic acid for use in unanticipated ways exceeding their original intended use is discussed along with laser technology and its indications for hair removal, removal of vascular lesions, tattoo removal, and, more recently, laser-based lipolysis.
Clinics in Plastic Surgery , Vol. 38, No. 3, July 2011
ISSN: 0094-1298
doi: 10.1016/j.cps.2011.02.004

An Overview of Cosmetic Medicine and Surgery: Past, Present, and Future

Malcolm D. Paul, MD
Aesthetic and Plastic Surgery Institute, University of California, Irvine, CA, USA
E-mail address: [e-mail]

Abstract
The evolution of thought and process in cosmetic medicine and surgery has united specialists from various backgrounds with the goal of providing safe, reproducible techniques to improve the various elements of the aging face from within and without. The realization that the aging face is both vector and volume based has dramatically altered the approach to reversing the signs of aging. Ultimately, it was the joining of forces from multiple specialties that provided a blueprint for impressive improvement in the return of a youthful, natural look.

Keywords
• Aging face • Cosmetic surgery • Cosmetic medicine • Soft tissue fillers


The more things change, the more they stay the same
In many disciplines including those outside medicine, the thought that there really is no change, only a realization that new things do not cause a change, has been held to be true for decades. This idea does not apply to the thought and process in reversing the signs of an aging face. Although the aging face has been treated for centuries, only recently it was recognized that the process occurred at multiple levels, from the bony structural support of the facial soft tissues and included the muscle, fat, and skin. It has been known for decades that environmental factors such as smoking, climate, and sun exposure have profound influence on the appearance of the face, and considerable energy has been devoted to informing the patient that there are ways to minimize the effect of environmental factors that accelerate facial aging and may lead to skin cancers. There are, of course, genetic influences on how and when the face ages visibly, but, at this time, the genetic forces that determine how and when the face ages cannot be modulated. A sentinel article on the “senility of the aging face” by Gonzalez-Ulloa and Flores 1 was an important attempt to understand the cause and effect of facial aging. They understood that the changes that were observed occurred at both bony and soft tissue levels. This monumental publication makes one wonder why more intellectual energy was not devoted to reversing the signs of the aging face at multiple anatomic levels rather than working solely on the skin. The early facelifting procedures had been used for decades before there was a shift in thought with regard to how and why the face ages and the understanding that merely pulling on the ptotic skin was not enough to reestablish a youthful, harmonious shape to the rejuvenated face.

Architecture and volume: master teachings
The number of available options for both medical and surgical reversal of the aging face has dramatically increased because it is now understood how and why these changes occur, and this understanding has fueled commercial interest in providing what is needed to accomplish these goals. Over the centuries, there was an understanding of what constituted a beautiful face, not only with Cleopatra but also with others (the imprint in the ruins of Persepolis in Shiraz shows all of the desired facial contours that were visible in the ancient Iranian queen). The “universal symbols of beauty” have been captured in the minds and hands of notable artists (Bill Little has repeatedly shown us how the renaissance artists knew what Ralph Millard called the “ideal normal”). Bill also taught that a beautiful face had to include an Ogee curve, architecturally understood, and once we saw it, we knew that Bill was correct in applying this form to the goals in facial rejuvenation. 2, 3 When I looked back at the history of brow and midface lifting, 4, 5 I did not appreciate that, despite the understanding of facial aging as described by Gonzalez-Ulloa and Flores in 1965, at least 75 years of facial aesthetic surgical techniques before and after this publication failed to address volume-based deficiencies. The early surgical procedures directed at repositioning ptotic facial soft tissue failed to address the volumetric loss including bone and soft tissue. These techniques were well intentioned but principally involved undermining skin and repositioning it under tension. The stretched, unnatural look was often justified by trying to convince the viewer that “my patients are happy.” It was the work of Ed Terino, who, although not the first to use autologous or alloplastic implants, was the first to logically approach skeletal deficiencies with specific alloplastic implants based on his 3-dimensional understanding of facial shape. 6 His zonal analysis clearly provided an easily understandable way to address regional volume-based deficiencies. Those surgeons who understood the profound effect that volume restoration had on facial shaping clearly showed that some techniques worked better than others. The work of Hester and colleagues 7 in the 1990s directed attention at shifting the midface soft tissues vertically to augment this anatomic area and blend the lid-cheek junction. Other major contributors 8 - 18 also recognized the profound effect that mobilizing the ptotic midface had on facial rejuvenation. However, some of these more aggressive techniques, including the subperiosteal and extended superficial musculo-aponeurotic system approaches, carried the added risks of prolonged edema, possible neurapraxias, eyelid malposition, and, in some cases, a new look that required weeks to “look natural.” As is always true in aesthetic plastic surgery, selecting the right technique for a given patient largely determines the success achieved. So, some patients do well with a given technique, others do not (understanding the negative-vector orbit taught us why vertical lifting techniques could be associated with higher morbidity, including, but limited to, lid malposition). 19 The longevity of these results was impressive, but less-aggressive means of facial rejuvenation also showed impressive longevity. 20 Vector-based correction as a sole means of reversing the signs of aging is, although well intentioned, wrong minded in light of the profound influence of the works of