WP Chung O T in Plastic Surgery

Operative Techniques in Plastic Surgery , 1e Published May 2019

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Operative Techniques in Plastic Surgery, 1e ISBN 978-1-4963-3950-8 Price £195.00/ €220.00

A new addition to the best-selling Operative Techniques series, Operative Techniques in Plastic Surgery provides superbly illustrated, authoritative guidance on operative techniques along with a thorough understanding of how to select the best procedure, how to avoid complications, and what outcomes to expect. Easy to follow, up to date, and highly visual, this step- by-step reference covers nearly all operations in current use in plastic surgery, and is ideal for residents and physicians in daily practice.

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Editors and contributors are globally renowned authorities in their respective subspecialties and are known for their surgical expertise. Perfect for a quick preoperative review of the steps of a procedure.

Hundreds of full-color intraoperative photographs and illustrations, as well as numerous high- quality videos, capture procedures step by step and help you immediately apply your knowledge.

Comprehensively covers all areas of plastic surgery including facial aesthetic, breast, hand, trunk reconstruction and body contouring, head and neck reconstruction, craniofacial trauma and reconstruction, lower limb reconstruction, and pediatric plastic surgery.

Published May 2019 Sample Chapter Preview

When you have to be right

C H A P T E R 20

Section VII: Brow Lifting

Indications and Techniques for Coronal Brow Lifting

Richard J. Warren

DEFINITION

■■ The surgical significance of the temporal crest line is that overlying fascial layers are tethered to bone in a band imme- diately medial to the palpable ridge. This has been called the zone of fixation or the zone of adhesion. 2,3 Inferiorly, where the ridge approaches the orbital rim, the fixation becomes broader and denser, forming the orbital ligament, also known as the temporal ligamentous adhesion. Regardless of the surgical technique used, when a full-thickness forehead flap is mobilized, all fascial attachments to bone must be released, including the zone of adhesion and the orbital liga- ment, plus attachments to the supraorbital rim and lateral orbital rim. 4 ■■ The temporal crest also marks a change in nomenclature as tissue planes transition from lateral to medial. The deep temporal fascia covers the temporalis muscle and is attached to bone along the temporal crest. It then continues medially as the periosteum of the frontal bone. Similarly, the super- ficial temporal fascia (also known as the temporal-parietal fascia) continues medially as the galea aponeurotica. ■■ The galea aponeurotica splits into a superficial and a deep layer to encompass the frontalis muscle. Inferiorly, the deep galea layer separates further into three separate layers: two layers encompass the galeal fat pad, and a third layer is adherent to periosteum. 2 Superficial to the deepest galeal

■■ Brow ptosis describes an abnormally low position of the eyebrow complex, either in whole or in part. ■■ Low lying or malpositioned eyebrows may be congenital or acquired through aging. ■■ Brow position and shape convey an impression of emotion. When the entire brow is low, the patient looks tired. When only the medial brow is low, the patient appears to be angry, and when only the lateral brow is low, the patient appears to be sad. 1 ■■ Brow ptosis encroaches on the upper lid sulcus, changing the dynamics of the upper lid/brow junction. Thus, brow ptosis will affect the assessment of patients presenting for blepharoplasty, periorbital fat grafting, or senile eyelid pto- sis repair. ANATOMY ■■ Underlying the forehead is the frontal bone. Laterally, the frontal bone is crossed by a curved ridge called the temporal crest (temporal ridge or temporal fusion line). This palpable landmark separates the forehead from the temporal fossa laterally ( FIG 1 ). The temporalis muscle takes its origin from the temporal fossa.

Temporal crest line (superior temporal septum) Temporal ligamentous adhesion (orbital ligament)

Sentinel vein

Supraorbital ligamentous adhesion

Inferior temporal septum

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Temporal branches of the facial nerve

FIG 1  • Galeal attachments must be completely released to allow a forehead flap to move superiorly. The firmest attachment is at the temporal ligamen- tous adhesion (orbital ligament) but is also present along the supraorbital rim (supraorbital ligamentous adhesion), down the lateral orbital rim (lateral orbital thickening) and along the temporal crest line. In rais- ing the flap, the temporal branches of the facial nerve will be in the roof of the dissection immediately above the medial zygomatic vein (sentinel vein).

Lateral orbital thickening of periorbital septum

Orbicularis retaining ligament

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Part 1 Facial Aesthetic

deep branch that runs between the periosteum and the deep- est layer of galea and then pierces the frontalis near the hair- line to innervate scalp skin. 5 Motor Nerves ■■ The temporal branch of the facial nerve is the only motor nerve of surgical concern in this area. The tempo- ral branch enters the temporal fossa as several (2–4) fine branches that lie on the periosteum of the zygomatic arch in its middle third. Between 1.5 and 3.0 cm above the arch, these branches become more superficial, traveling within the superficial temporal fascia (temporoparietal fascia) to innervate the frontalis, superior orbicularis, and glabellar muscles. 6 A number of different landmarks can be used to predict the course of the temporal branches. These include ■■ The middle third of the palpable zygomatic arch ■■ 1.5 cm lateral to the tail of the eyebrow ■■ Parallel and adjacent to the inferior temporal septum ■■ Immediately superior to the medial zygomaticotemporal vein (sentinel vein) ■■ In the coronal brow lift procedure, the dissection should be entirely deep to the temporal branches of the facial nerve. ■■ The periorbital region is the most expressive part of the human face. Subtle changes in eyebrow shape can pro- foundly affect facial appearance. 1 ■■ Because of the importance of periorbital expression, humans have historically resorted to any means at their disposal to alter their eyebrows. These have included eyebrow plucking and shaving, makeup, and tattoos. ■■ Aesthetically, the eyebrow is only one part of the puzzle in the periorbital zone. Other variables include the presence of senile eyelid ptosis, the loss of upper sulcus orbital fat, and the accumulation excess of upper eyelid soft tissue (skin, orbicularis muscle, and orbital fat). ■■ The preferred forehead will be devoid of vertical of trans- verse lines. It will be framed superiorly by a well-positioned aesthetically shaped hairline and inferiorly by well-posi- tioned, attractively shaped eyebrows. ■■ The “ideal” eyebrow shape is affected by ethnicity, gender, and the era in which we live ( FIG 2 ). There are certain themes that define aesthetically pleasing eyebrow in the 21st century: 7 ■■ The medial eyebrow level should lie over the medial orbital rim. ■■ The medial border of the eyebrow should be vertically in line with the medial canthus. ■■ The eyebrow should rise gently, peaking slightly at least two-thirds of the way to its lateral end; typically, this peak lies vertically above or lateral to the lateral limbus. ■■ The lateral tail of the brow should be higher than the medial end. ■■ The male brow should be lower and less peaked. ■■ Abnormally low eyebrows can be congenital or acquired over time through aging. ■■ Age-related brow ptosis causes the forehead/eyebrow com- plex to encroach on the upper orbit, resulting in a pseudoex- cess of upper eyelid skin. In response, patients subconsciously contract the frontalis to raise the eyebrows, leading to trans- verse forehead lines. This is accentuated with the presence of mild senile eyelid ptosis. Such patients will often present with a request for upper lid blepharoplasty. PATHOGENESIS

layer is the so-called glide plane space, which allows the scalp flap to shift superiorly. ■■ The galeal fat pad extends across the entire width of the lower 2 cm of the forehead; medially it encompasses the supratroch- lear nerves and much of the corrugator musculature. The galeal fat pad is separated from the preseptal fat (retro-orbi- cularis oculi fat or ROOF) by one of the layers of galea (see above). Laterally, this galeal layer is thought to be inconsistent, with some individuals having continuity between the galeal fat pad and the preseptal fat (ROOF). Within the eyelid, the sep- tum orbitale divides the preseptal fat (ROOF) from orbital fat. ■■ Muscle anatomy plays a significant role in determining eyebrow shape and position. In addition to the soft tissue attachments, the level of the eyebrow is the result of a bal- ance between the muscular forces that elevate the brow, the muscular forces that depress the brow, and gravity. ■■ Brow depressors in the glabella originate from bone and insert into soft tissue. The procerus runs vertically near themidline, the depressor supercilii and supramedial orbicularis run obliquely, and the corrugator supercilii runs mostly transversely. ■■ The transverse corrugator supercilii is the largest and most significant of these muscles. Useful landmarks to locate the corrugator are as follows: the corrugator originates from the orbital rim at its most superomedial corner, right at the entrance to the orbit. The transverse head passes through galeal fat becoming more superficial until it interdigitates with the orbicularis and frontalis under a skin dimple that is visible when the patient frowns. ■■ The orbicularis encircles the orbit acting like a sphincter. Medially and laterally, the orbicularis fibers run vertically and act to depress brow level. Laterally, orbicularis is the only muscle that depresses brow position. ■■ The frontalis is the only elevator of the brow. It originates from the galea aponeurotica superiorly and interdigitates inferiorly with the orbicularis. Contraction raises this muscle mass and the overlying eyebrow, which is a cutaneous struc- ture. The muscle is deficient laterally, so its primary lifting effect is on the medial and central portions of the eyebrow. Sensory Nerves ■■ Innervation to the upper periorbita is supplied by the supra- orbita and supratrochlear nerves, as well as two lesser nerves, the infratrochlear and zygomaticotemporal. ■■ The zygomaticotemporal nerve exits posterior to the lateral orbital rim piercing the deep temporal fascia just inferior to the sentinel vein. In coronal brow lifting, with com- plete release of the lateral orbital rim, it is often avulsed. Consequences of this are minimal and temporary. ■■ The supratrochlear nerve usually exits the orbit superomedi- ally, although the exact location is variable. It immediately divides into four to six branches that usually pass through the substance of the corrugator. These branches then travel superiorly, on the superficial surface of the frontalis, innervat- ing the central forehead and first few centimeters of the scalp. ■■ The supraorbital nerve exits the superior orbit through a notch in the rim, or about 10% of the time, through a fora- men that is superior to the rim. ■■ The supraorbital nerve divides into two segments: super- ficial and deep. The superficial branch pierces orbicularis and frontalis, traveling as several small branches on the superficial surface of the frontalis to innervate the central forehead as far posteriorly as the first 2 cm of hair. The rest of the scalp, as far back as the vertex, is innervated by the

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Chapter 20 Indications and Techniques for Coronal Brow Lifting

■■ A patient may be a candidate to have the entire brow com- plex lifted or more commonly to have only part of the eye- brow raised, thus improving eyebrow shape. Occasionally, in a patient who chronically looks angry, this may involve raising the medial brow only, but most commonly, it is the lateral third to one-half of the eyebrow that requires reposi- tioning with little or no lift of the medial portion. ■■ Weakening or eliminating the glabellar frown musculature is a useful parallel objective. ■■ If brow lifting is contemplated, the effect on the upper eyelid complex must be considered. Previous upper lid blepharo- plasty may have left a patient tissue deficient, so that brow lifting could impair eyelid closure. Also, brow lifting may reveal the previously unappreciated hollowing of the upper lid sulcus. NONOPERATIVE MANAGEMENT ■■ Numerous nonoperative strategies are available to change eyebrow shape and/or position. ■■ Nonmedical: eyebrow plucking, cosmetic makeup, tattooing ■■ Medical, nonsurgical: botulinum toxin injection, synthetic filler injection, thread lifting ■■ Surgical, non-brow lift: transpalpebral frown muscle ablation SURGICAL MANAGEMENT Preoperative Planning ■■ There are many surgical techniques available to elevate or to reshape the eyebrow. The coronal approach is a traditional method with a long track record of proven results. 11,12 ■■ The preoperative discussion is an excellent time for the sur- geon to teach the patient about periorbital aging. To achieve the patient’s objectives, some concepts that are new to the patient may be introduced. A patient requesting brow reju- venation surgery may also be a candidate for blepharoplasty, upper sulcus fat grafting, or eyelid ptosis repair. ■■ This procedure provides maximum visibility and flexibility. Therefore, during the planning process, the surgeon should develop a mental image of what portion of the eyebrows are to be lifted, how much lift is required, and if there is any brow asymmetry to be corrected. ■■ With the patient awake and in the upright position, with the forehead in repose, the desired amount and direction of eyebrow elevation are assessed by manually elevating the brow complex ( FIG 3 ). Specific vectors have been described, but more artistic decision-making is preferred.

■■ Other lines in the forehead are caused by the glabellar frown muscles. Vertical lines are caused by the transversely oriented corrugator, horizontal lines are caused the verti- cally running procerus, and oblique lines are caused by the depressor supercilii and orbicularis. ■■ Age-related brow ptosis is not universal. Up to 40% of peo- ple have relatively stable eyebrow position throughout life and are generally not candidates for brow lift surgery. 8 ■■ Frontalis is the only lifting force to counter balance the various muscles and gravity that depress the brow level. The lateral portion of the eyebrow is particularly sensitive to this inter- play because frontalis action is attenuated laterally and also because the security of lateral brow fixation to bone is incon- sistent. 9,10 Poor soft tissue attachment with no muscular lift will inevitably lead to ptosis of the lateral third of the eyebrow. PATIENT HISTORY AND PHYSICAL FINDINGS ■■ Most patients will not be aware of the many factors involved in periorbital aging, and they may not want the multiple pro- cedures required to treat all of these components. For that reason, identifying the main component of every patient’s periorbital aging is important. Old photographs are very helpful in helping the surgeon determine which age-related changes predominate. ■■ Assessment is done with the patient awake and upright in the sitting or standing position. The following issues are evalu- ated: visual acuity, eyebrow and orbital symmetry, position of anterior hairline, thickness of scalp hair, transverse fore- head lines, glabellar frown lines, thickness of eyebrow hair, eyebrow height, axis of the eyebrow (downward or upward lateral tilt), shape of the eyebrow (flat or peaked), passive and active eyebrow mobility, and the presence of old scars or tattoos. The upper eyelids should also be assessed for soft tissue redundancy, for upper sulcus hollowing, and for eyelid level (ptosis or lid retraction). ■■ To identify patients with chronic frontalis contraction, examination should be done with eyes open and eyes closed. When the eyes are closed, the frontalis can be made to relax, revealing the true position and shape of the eyebrows. If the eyebrows are forcibly held in this position when the patient opens their eyes, the eyebrow-eyelid relationship without frontalis effect will be revealed. FIG 2  • The attractive eye exhibits a modest amount of visible upper lid (“tarsal show”); this dimension is about one-third of the distance from the lash line to the lower border of the eyebrow. The brow itself starts medially over the supraorbital rim and vertically in line with the medial canthus. It angles gently upward, peaking about two-thirds of the way along the brow toward its lateral extent. In females, this peak is at or lateral to the lateral limbus of the eye. In men, this peak is minimal or absent. Laterally, the “tail” of the brow should end at a higher point than the medial end of the brow.

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FIG 3  • With the frontalis muscle in repose, the desired amount and direction of eyebrow elevation are estimated by manually elevating the brow complex. The desired vector of lift can also be determined using this method.

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Part 1 Facial Aesthetic

■■ Essential preoperative markings include the incision and the vectors for flap mobilization. ■■ Ancillary markings that are useful include the expected course of the temporal branch of the facial nerve, the expected location of the supraorbital and supratrochlear nerves, and the location of the frown muscles (determined with the patient awake and frowning). Positioning ■■ The patient is placed on the operating table in the supine position with the head on a small pillow or soft donut. ■■ The head of the bead is raised slightly to help reduce venous engorgement in the surgical area. ■■ Intermittent compression devices are applied to the legs, and a heating device covers the patient. Approach ■■ Possible approaches for an open brow lift are ■■ Coronal incision ■■ Anterior hairline incision ■■ Combination of these two (modified coronal) ( FIG 4 ) ■■ Possible planes of dissection are ■■ Subcutaneous ■■ Subgaleal ■■ Subperiosteal ■■ The coronal incision is well hidden in the hair of the scalp. There are two options for the dissection plane: subgaleal or subperiosteal. Of the two, the subgaleal approach is most often used because it provides a rapid bloodless plane of dis- section with excellent exposure of the frown musculature. ■■ The anterior hairline incision puts the surgeon closer to the eyebrows and also provides excellent visibility. The main disadvantage of the anterior hairline incision is a potentially visible scar along the anterior hairline. Thoughtful incision techniques and careful suture techniques will mitigate this problem. There are three potential planes of dissection: sub- cutaneous, subgaleal, and subperiosteal. The subcutaneous plane offers some unique advantages: no transection of sen- sory nerves, the separation of skin from underlying frontalis,

Coronal incision

Modified coronal incision

Anterior hairline incision

thus effacing transverse forehead lines and the direct shift- ing of the eyebrow, which is a cutaneous structure. 13 ■■ The modified coronal approach (anterior hairline approach with lateral incision placement like a coronal incision) is much like a coronal procedure but with a hairline incision used to avoid elevating the anterior hairline in patients with a high forehead. Like the coronal, this approach lends itself to the subgaleal plane, although it is technically straightfor- ward to change planes at the anterior hairline, creating a subcutaneous plane deep to the forehead skin and a subga- leal plane laterally. FIG 4  • Approaches for an open brow lift include the classic coronal incision, made about 6 cm behind the hairline, the anterior hairline inci- sion, and a combination of the two—a modified version with an anterior hairline incision combined with a coronal-type approach laterally. will be partially transected, utilizing the Camirand prin- ciple 14 ( TECH FIG 1A ). ■■ The standard coronal incision is designed to be about 6 cm behind the hairline although this is variable, depending on the height of the forehead. Laterally, the marking extends to the ear and, in some cases, may be made in continuity with a facelift incision. The incision can be taken across the top of the head in a gentle curve, or it can peak slightly in the midline to allow for some flap rotation. ■■ With all coronal brow lift approaches, the superficial and deep branches of the supraorbital nerve will be tran- sected, as will the anterior branch of the temporal artery, which will require hemostasis. ■■ The flap is easily raised in the subgaleal plane. This can be done with blunt dissection or with a scalpel blade bev- eled away from the periosteum ( TECH FIG 1B ). Lateral to the temporal crest, the superficial temporal fascia (tem- poroparietal fascia) is separated from the deep temporal

T E C H N I Q U E S

■■ Coronal Brow Lift (Subgaleal Plane) ■■ Preoperative surgical marking will have been done (see above). ■■ The procedure is done under general anesthetic or local anesthetic with sedation. ■■ The head and neck area is prepped and draped with exposure of the entire face. ■■ A local anesthetic mixture composed of 1% lidocaine with 1:100 000 epinephrine and 0.25% bupivacaine with 1:200 000 epinephrine is infiltrated into the incision line, along the supra- and lateral orbital rims plus some injection under the scalp flap. ■■ After waiting for the epinephrine effect, the incision is made full thickness through the scalp down to perios- teum over the skull centrally and laterally down to the deep temporal fascia. The scalpel is beveled parallel to the hair follicles. If an anterior hairline incision is planned, the scalpel is beveled in such a way that the hair follicles

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Contributors

Mithat Akan, MD Professor

Oluwaseun A. Adetayo, MD, FAAP, FACS Assistant Professor of Plastic Surgery Section Chief of Pediatric Plastic Surgery Bernard & Millie Duker Children’s Hospital Director, Cleft-Craniofacial Center at Albany Medical Center Albany Medical Center Albany, New York Joshua M. Adkinson, MD Chief of Hand Surgery Assistant Professor of Surgery Division of Plastic Surgery Indiana University School of Medicine Children’s Hospital of Philadelphia C. Everett Koop Endowed Chair of Pediatric Surgery Perelman School of Medicine at the University of Pennsylvania Philadelphia, Pennsylvania Mouchammed Agko, MD Assistant Professor Section of Plastic Surgery Department of Surgery Medical College of Georgia at Augusta University Augusta, Georgia Sonya Paisley Agnew, MD Assistant Professor Loyola University Medical Center Chicago, Illinois Jamil Ahmad, MD Director of Research and Education The Plastic Surgery Clinic Mississauga, Ontario, Canada Assistant Professor Department of Surgery University of Toronto Toronto, Ontario, Canada Nicholas J. Ahn, MD Research Fellow Children’s Hospital of Philadelphia Indianapolis, Indiana N. Scott Adzick, MD Surgeon-in-Chief

Fizan Abdullah, MD, PhD Vice-Chair, Department of Surgery Head, Division of Pediatric Surgery Program Director, Fellowship in Pediatric Surgery Orvar Swenson Founders’ Board Chair in Pediatric Surgery Ann & Robert H. Lurie Children’s Hospital of Chicago Professor of Surgery Northwestern University Chicago, Illinois Samer Abouzeid, MD, DDS Lecturer Plastic, Reconstructive and Craniofacial Surgery Department Faculty of Medicine of the Saint Joseph University Lecturer Faculty of Dental Medicine of the Saint Joseph University Attending Plastic, Reconstructive and Craniofacial Surgery Department Hotel Dieu de France the Saint Joseph University Hospital Beirut, Lebanon Ghassan S. Abu-Sittah, MBchB, FRCS(Plast) Assistant Professor of Surgery Head of Division of Plastic & Reconstructive Surgery American University of Beirut Medical Center Beirut, Lebanon Co-Director, Conflict Medicine Program, Global Health Institute Honorary Senior Clinical Lecturer, Queen Mary University of London

Department of Plastic Surgery Istanbul Medipol University Istanbul, Turkey Asim Ali, MD, FRCSC Ophthalmologist-in-Chief and Mira Godard Chair in Vision Research Department of Ophthalmology The Hospital for Sick Children University of Toronto Toronto, Ontario, Canada Lee W. T. Alkureishi, MBChB Clinical Assistant Professor Plastic and Reconstructive Surgery University of Illinois Health Pediatric Plastic and Craniofacial Surgeon Plastic Surgery Shriners Hospitals for Children Chicago, Illinois Amir Allak, MD, MBA Facial Plastic/Reconstructive Surgery Fellow Division of Facial Plastic Surgery Department of Otolaryngology— Head and Neck Surgery University of California, Davis Sacramento, California Michael Alperovich, MD, MSc Assistant Professor of Plastic Surgery Department of Surgery Yale University School of Medicine New Haven, Connecticut Derek F. Amanatullah, MD, PhD Redwood City, California Shoshana W. Ambani, MD Plastic Surgeon Medical Director of Plastic Surgery Henry Ford Allegiance Hospital Jackson, Michigan Assistant Professor Orthopedic Surgery Stanford Hospital and Clinics

London, United Kingdom Nicholas S. Adams, MD Clinical Instructor

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Division of Plastic Surgery College of Human Medicine Spectrum Health/Michigan State University Grand Rapids, Michigan

Center for Fetal Research Philadelphia, Pennsylvania Surgical Resident Albany Medical Center Department of Surgery Albany, New York

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Contributors

Daniel A. Belkin, MD Clinical Assistant Professor Ronald O. Perelman Department of Dermatology NYU Langone Medical Center Associate Laser & Skin Surgery Center of New York New York, New York Bryce R. Bell, MD Hand and Upper Extremity Surgery Department of Orthopaedic Surgery Texas Children’s Hospital Conroe, Texas Michael Bellino, MD Assistant Professor Department of Orthopaedic Surgery Stanford University School of Medicine Palo Alto, California Mihir K. Bhayani, MD, FACS Head and Neck Surgical Oncology NorthShore University HealthSystem

Daniel C. Baker, MD Clinical Professor Department of Plastic Surgery New York University Langone Medical Center New York, New York Reena Bakshi, MD Research Fellow Department of Surgery University of California, Los Angeles Craniofacial Treatment and Research The Children’s Hospital of Philadelphia Professor of Surgery The Perelman School of Medicine University of Pennsylvania Philadelphia, Pennsylvania Lawrence S. Bass, MD, FACS Clinical Assistant Professor of Plastic Surgery Zucker School of Medicine at Hofstra Northwell New York, New York Bruce S. Bauer, MD, FACS, FAAP Director of Pediatric Plastic Surgery NorthShore University HealthSystem Clinical Professor of Surgery University of Chicago Pritzker School of Medicine Highland Park Hospital Northbrook, Illinois Joseph Baylan, MD Resident Physician School of Medicine Stanford University Palo Alto, California Devra B. Becker, MD, FACS Associate Professor, Department of Plastic Surgery Chief of Plastic Surgery, UPMC Passavant Director of Wound Healing Services, UPMC Passavant Department of Plastic Surgery University of Pittsburgh Medical Center Pittsburgh, Pennsylvania Maureen Beederman, MD Resident Section of Plastic and Reconstructive Surgery Department of Surgery The University of Chicago Medicine Chicago, Illinois Robert Beinrauh, MD Head of Craniofacial Surgery Plastic and Reconstructive Surgery Department Kaiser-Permanente Hospital Downey, California Los Angeles, California Scott P. Bartlett, MD Mary Downs Endowed Chair in

Jugpal S. Arneja, MD, MBA, FAAP, FACS, FRCSC Professor (Clinical), Surgery Division of Plastic Surgery University of British Columbia Associate Member Sauder School of Business University of British Columbia Associate Chief, Surgery British Columbia Children’s Hospital Attending Plastic Surgeon British Columbia Children’s Hospital Vancouver, British Columbia, Canada Jeffrey A. Ascherman, MD Thomas S. Zimmer Professor of Reconstructive Surgery at CUMC Site Chief, Division of Plastic Surgery Columbia University Medical New York, New York Samer Attar, MD Associate Professor of Orthopaedic Surgery Northwestern Medicine Chicago, Illinois Raffi S. Avedian, MD Assistant Professor of Orthopaedic Surgery Stanford University Medical Center Department of Orthopaedic Surgery Charlotte and George Schultz Orthopaedic Tumor Center Palo Alto, California Haithem M. Elhadi Babiker, MD, DMD, FAAP, FACS Assistant Professor, University of Cincinnati Medical Center Division of Pediatric Plastic & Craniofacial Surgery Cincinnati Children’s Hospital Medical Center Plastic Surgery Department Brussels University Hospital Vrije Universiteit Brussel Brussels, Belgium Stephen B. Baker, MD, DDS Professor and Program Director Director, Center for Facial Restoration Department of Plastic Surgery MedStar Georgetown University Hospital Washington, District of Columbia Medical Director, Craniofacial Program Inova Children’s Hospital Falls Church, Virginia Cincinnati, Ohio Fadi Bakal, MD

Clinical Assistant Professor Pritzker School of Medicine University of Chicago Evanston, Illinois David A. Billmire, MD Chief of Plastic Surgery Cincinnati Shriners Hospital Cincinnati, Ohio Craig Birgfeld, MD Associate Professor Division of Plastic Surgery Department of Surgery University of Washington Seattle Children’s Hospital Harborview Medical Center

Seattle, Washington Julius Bishop, MD Assistant Professor and Associate Residency Director Department of Orthopaedic Surgery Stanford University School of Medicine Palo Alto, California Nataliya Biskup, MD Cosmetic and Reconstructive Plastic Surgeon Plastic Surgery Center Wichita, Kansas Kim A. Bjorklund, MD, MEd Director of Brachial Plexus Program Department of Plastic, Reconstructive & Hand Surgery Nationwide Children’s Hospital Assistant Professor The Ohio State University College of Medicine Columbus, Ohio

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Contributors

Neil K. Chadha, MBChB(Hons), MPHe BSc(Hons), FRCS Associate Clinical Professor Division of Otolaryngology-Head and Neck Surgery University of British Columbia Vancouver, British Columbia, Canada Pediatric Otolaryngology Surgeon Division of Pediatric Otolaryngology- Head and Neck Surgery British Columbia Children’s Hospital Vancouver, British Columbia, Canada Rawad S. Chalhoub, MD Post Graduate Year 1 Plastic and Reconstructive Surgery American University of Beirut Medical Center Beirut, Lebanon Christopher B. Chambers, MD Associate Professor of Ophthalmology Associate Professor of Plastic Surgery, Department of Surgery Oculoplastic and Orbital Surgery Fellowship Director Associate Residency Program Director University of Washington School of Medicine Seattle, Washington Chief of Plastic and Reconstructive Surgery Director of Microsurgery Fellowship Professor of Surgery The University of Chicago Medicine & Biological Sciences Chicago, Illinois Edward I. Chang, MD, FACS Associate Professor Department of Plastic Reconstructive Surgery University of Texas MD Anderson Cancer Center Houston, Texas Vincent A. Chavanon, MD Chief Resident Division of Plastic Surgery Bernard W. Chang, MD Chief of Plastic Surgery Mercy Medical Center Baltimore, Maryland David W. Chang, MD, FACS

Richard H. Caesar, MA, MB BChir, FRCOphth Consultant Surgeon Ock Street Clinic Abingdon, England Barı ş Çakir, MD Plastic Reconstructive and Aesthetic Surgery Specialist Visiting Staff of American Hospital (Sisli/ İ stanbul) Istanbul, Turkey Bradley Calobrace, MD CaloAesthetics Plastic Surgery Center CaloSpa Louisville, Kentucky Ashley A. Campbell, MD Assistant Professor of Ophthalmology Wilmer Eye Institute Johns Hopkins University School of Medicine Baltimore, Maryland Chris A. Campbell, MD, FACS Associate Professor Department of Plastic Surgery University of Virginia Charlottesville, Virginia Northwell—Lenox Hill Hospital Department of Plastic Surgery New York, New York Joseph Catapano, BHSc, MD Department of Surgery, Division of Plastic and Reconstructive Surgery University of Toronto Toronto, Ontario, Canada Paul S. Cederna, MD Chief Section of Plastic Surgery Michigan Medicine Robert Oneal Professor of Plastic Surgery Professor, Department of Biomedical Engineering Jennifer Capla, MD Plastic Surgeon Private Practice

Gregory H. Borschel, MD, FAAP, FACS Associate Professor and Research Director Division of Plastic and Reconstructive Surgery University of Toronto Associate Professor Institute of Biomaterials and Biomedical Engineering Associate Scientist, SickKids Research Institute The Hospital for Sick Children Toronto, Ontario, Canada James P. Bradley, MD Vice Chairman, Professor, Northwell Plastic Surgery Zucker School of Medicine Hofstra/Northwell Lake Success, New York Colin M. Brady, MD Pediatric Plastic and Craniofacial Surgeon Children’s Healthcare of Atlanta Atlanta, Georgia Francisco G. Bravo, MD, PhD Clinica Gomez Bravo Madrid, Spain Lawrence E. Brecht, DDS NYC Prosthodontics New York, New York Derek A. Bruce, MB, ChB, FAANS, FACS, FAPP Professor of Neurosurgery & Pediatrics Center for Neuroscience & Behavioral Medicine Children’s National Medical Center Washington, District of Columbia Plastic and Reconstructive Surgeon Georgia Institute for Plastic Surgery Savannah, Georgia Charles E. Butler, MD, FACS Professor and Chairman Department of Plastic Surgery The University of Texas MD Anderson Cancer Center Houston, Texas Michael R. Bykowski, MD, MS Chief Resident Department of Plastic Surgery Patrick J. Buchanan, MD Director of Hand Surgery

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Department of Surgery Mount Sinai Hospital New York, New York Vishwanath R. Chegireddy, MD General Surgery Resident Department of Surgery Houston Methodist Hospital Houston, Texas

University of Pittsburgh Pittsburgh, Pennsylvania

University of Michigan Ann Arbor, Michigan

Nicole C. Cabbad, MD, MBA Craniofacial Plastic Surgeon Department of Plastic and Reconstructive Surgery Nicklaus Children’s Hospital Miami, Florida

Nuri A. Celik, MD Private Practice Istanbul, Turkey

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Contributors

Kevin C. Chung, MD, MS Chief of Hand Surgery, Michigan Medicine Director, University of Michigan Comprehensive Hand Center Charles B. G. de Nancrede Professor of Surgery Professor of Plastic Surgery and Orthopaedic Surgery Assistant Dean for Faculty Affairs Associate Director of Global REACH University of Michigan Medical School Ann Arbor, Michigan Jeffrey R. Claiborne, MD Private Practice Plastic Surgeon Sieveking and Claiborne Plastic Surgery Nashville, Tennessee Mark W. Clemens, MD, FACS Associate Professor Department of Plastic Surgery MD Anderson Cancer Center University of Texas Houston, Texas C. Spencer Cochran, MD Dallas Rhinoplasty Center Assistant Professor Department of Plastic Surgery Clinical Assistant Professor Department of Otolaryngology UT Southwestern Medical Center Dallas, Texas Eric Lowry Cole, MD Director, Craniofacial and Pediatric Plastic Surgery Assistant Professor Plastic Surgery University of Texas Medical Branch League City, Texas Patrick Colley, MD Assistant Professor Otolaryngology—Head and Neck Surgery Icahn School of Medicine—Mount Sinai Hospital New York, New York Zachary J. Collier, MD Division of Plastic & Reconstructive Surgery Department of Surgery USC Keck School of Medicine Los Angeles, California Brendan Collins, MD Attending Physician and Microsurgical Fellowship Director

Jessica A. Ching, MD Co-Director, Craniofacial Clinic Assistant Professor of Plastic Surgery Associate Program Director of Plastic Surgery Department of Surgery Michael V. Chiodo, MD Plastic Surgery Resident Hansjörg Wyss Department of Plastic Surgery New York University Langone Medical Center New York, New York University of Florida Gainesville, Florida

Hung-Chi Chen, MD, PhD, FACS Professor of Plastic Surgery Department of Plastic and Reconstructive Surgery China Medical University China Medical University Hospital International Medical Service Center Taichung, Taiwan Michael J. Chen, MD Current Orthopaedic Resident Department of Orthopaedic Surgery

School of Medicine Stanford University Stanford, California Neal C. Chen, MD Assistant Professor Harvard Medical School Interim Chief

Ernest S. Chiu, MD, FACS Associate Professor of Plastic Surgery

Department of Orthopaedic Surgery Hand and Upper Extremity Service Massachusetts General Hospital Boston, Massachusetts Philip Kuo-Ting Chen, MD Director, Craniofacial Center Taipei Medical University Hospital Professor of Surgery Taipei Medical University Taipei, Taiwan Earl Y. Cheng, MD Division Head of Pediatric Urology Founder’s Board Chair of Pediatric Urology Ann and Robert H. Lurie Children’s Hospital of Chicago Professor of Urology Feinberg School of Medicine Northwestern University Chicago, Illinois Ming-Huei Cheng, MD, MBA, FACS Professor Division of Plastic Reconstructive Microsurgery Department of Plastic & Reconstructive Surgery Chang Gung Memorial Hospital Taoyuan City, Taiwan Pierre M. Chevray, MD, PhD Houston Methodist, Institute for Reconstructive Surgery Associate Professor, Weill Cornell Medical College Adjunct Associate Professor, Baylor College of Medicine Program Director, Houston Methodist Plastic Surgery Residency Houston, Texas

Director, Kimmel Hyperbaric and Advanced Wound Healing Center

NYU Langone Health New York, New York

Gerald J. Cho, MD Assistant Professor, Plastic Surgery Washington University in St. Louis Saint Louis, Missouri Jong-Woo Choi, MD, PhD, MMM Professor Department of Plastic Surgery Asian Medical Center Seoul, South Korea David K. Chong, MBBS, FRACS Cleft/Craniofacial Surgeon Department of Plastic and Maxillofacial Surgery Royal Children’s Hospital Melbourne, Australia Loretta Chou, MD Professor of Orthopaedic Surgery Stanford University Redwood City, California Carrie K. Chu, MD, MS Assistant Professor Department of Plastic Surgery The University of Texas MD Anderson Cancer Center Houston, Texas Michael W. Chu, MD Kaiser Permanente Medical Group Department of Plastic & Reconstructive Surgery Los Angeles, California

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Mercy Medical Center Baltimore, Maryland

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Contributors

Arlen Denny, MD, FACS, FAAP Professor Plastic Surgery Neurosurgery Pediatrics Medical College of Wisconsin Director Craniofacial Surgery Fellowship Retired Children’s Hospital of Wisconsin Milwaukee, Wisconsin

Gehaan D’Souza, MD Editor-in-Chief CEO Iconic Plastic Surgery Carlsbad, California Rollin K. Daniel, MD Clinical Professor Department of Plastic Surgery University of California Irvine Medical Center Orange, California Private Practice Newport Beach, California

Amy S. Colwell, MD, FACS Associate Professor Harvard Medical School Division of Plastic Surgery Massachusetts General Hospital Boston, Massachusetts J. Alejandro Conejero, MD, FACS Assistant Professor of Surgery Division of Plastic Surgery Albert Einstein College of Medicine Montefiore Medical Center Bronx, New York Mark B. Constantian, MD, FACS Traveling Professor, American Society for Aesthetic Plastic Surgery Clinical Adjunct Professor of Surgery (Plastic Surgery) University of Wisconsin Madison, Wisconsin Visiting Professor Department of Plastic Surgery University of Virginia Charlottesville, Virginia Julia Corcoran, MD, FACS, FAAP Associate (Adjunct) Professor of Surgery & Medical Education Feinberg School of Medicine Northwestern University Attending Surgeon Shriners Hospital for Children Chicago, Illinois Sebastian Cotofana, MD, PhD Associate Professor Albany Medical College Albany, New York Clayton Crantford, MD Private Practice Charleston, South Carolina Eric J. Culbertson, MD Body and Breast Cosmetic Surgeon The Jacobs Center for Cosmetic Surgery Healdsburg, California

Rafael J. Diaz-Garcia, MD Attending Surgeon Medical Operations Officer Department of Surgery Allegheny Health Network Clinical Assistant Professor Department of Plastic Surgery University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania

Lisa R. David, MD, MBA, FACS Chairman Department of Plastic and Reconstructive Surgery Professor of Plastic and Reconstructive Surgery and Pediatrics Residency Program Director Wake Forest University Baptist Medical Center Winston-Salem, North Carolina Gabrielle B. Davis, MD, MS Resident Physician Division of Plastic & Reconstructive Surgery Department of Surgery Stanford, California Erez Dayan, MD Plastic & Reconstructive Surgery Massachusetts General Hospital/ Harvard Medical School Boston, Massachusetts Joseph H. Dayan, MD Division of Plastic & Reconstructive Surgery Memorial Sloan Kettering Cancer Center New York, New York Alessandro de Alarcon, MD, MPH Associate Professor Director, Center for Pediatric Voice Disorders Medical Director, Complex Airway Cincinnati Children’s Hospital Medical Center University of Cincinnati Cincinnati, Ohio Sahitya K. Denduluri, MD Resident Physician Department of Orthopaedic Surgery

J. Rodrigo Diaz-Siso, MD Postdoctoral Research Fellow Hansjörg Wyss Department of Plastic Surgery New York University Langone Health New York, New York Claire Sanger Dillingham, DO Associate Professor Department of Plastic and Reconstructive Surgery Wake Forest Baptist Medical Center Winston-Salem, North Carolina Cone Health Department of Plastic and Reconstructive Surgery Greensboro, North Carolina Robert C. Dinsmore, MD, FACS Staff Surgeon Medical College of Georgia at Augusta University Chief of Plastic Surgery at Charlie Norwood VA Associate Professor of Surgery Section of Plastic and Reconstructive Surgery Department of Surgery Augusta, Georgia Joseph J. Disa, MD, FACS Vice Chair of Clinical Activities Department of Surgery Attending Surgeon Memorial Sloan Kettering Cancer Center Professor of Surgery Weill Medical College of Cornell University New York, New York

Catherine Curtin, MD Associate Professor Division of Plastic Surgery

Stanford University Palo Alto, California Copyright © 2019 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.

Daniel A. Cuzzone, MD Craniofacial Fellow Children’s Healthcare of Atlanta Atlanta, Georgia Kasandra Dassoulas, MD Richmond Aesthetic Surgery Midlothian, Virginia

Stanford University Stanford, California

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Contributors

Adel Y. Fattah, PhD, FRCS(plast) Consultant Plastic Surgeon Director, Facial Nerve Programme Clinical Director Regional Paediatric Burns and Plastic Surgery Service Alder Hey Children’s NHS Foundation Trust Liverpool, United Kingdom John M. Felder, MD Assistant Professor of Surgery Division of Plastic Surgery Washington University in St. Louis St. Louis, Missouri Mark Felton, BSc, MBChB, MSc, MD, FRCS(Eng) Consultant Paediatric Otolaryngologist Evelina London Children’s Hospital Guy’s and St. Thomas’ NHS Foundation Trust London, United Kingdom John G. Fernandez, MD, FACS Director of Plastic and Reconstructive Surgery Cancer Treatment Centers of America Philadelphia, Pennsylvania Julius W. Few, MD Director, The Few Institute for Aesthetic Plastic Surgery Clinical Professor, Division of Plastic Surgery University of Chicago Pritzker School of Medicine Health Science Clinician Feinberg School of Medicine Northwestern University Chicago, Illinois Program Director—Plastic Surgery The Peter MacCallum Cancer Centre Plastic, Reconstructive and Hand Surgeon The Canberra Hospital Surgical Lead Plastic, Reconstructive and Hand Surgery Australasian Clinical Trials Network Director Program for Molecular and Cellular Innovation in Surgery Senior Lecturer The University of Melbourne Department of Surgery Royal Melbourne Hospital Melbourne, Australia Michael W. Findlay, MBBS, PhD, FRACS, FACS

Ahmed Elsherbiny, MSc, MD Associate Professor of Plastic Surgery Director of Sohag Cleft Clinic Sohag University Hospital Sohag, Egypt Dino Elyassnia, MD, FACS Marten Clinic of Plastic Surgery San Francisco, California

Amir H. Dorafshar, MD, FACS, FAAP Professor (PAR), Chief and Program Director Division of Plastic and Reconstructive Surgery Rush University Medical Center Chicago, Illinois Gaby Doumit, MD, MSc, FRCSC, FACS Assistant Professor of Surgery Department of Plastic and Craniofacial Surgery University of Montreal Montreal, Canada Anahita Dua, MD, MS, MBA Vascular Surgery Fellow Division of Vascular Surgery Department of Surgery Stanford Hospital and Clinics Palo Alto, California Gregory A. Dumanian, MD Lucille and Orion Stuteville Professor of Surgery Chief of Plastic Surgery Feinberg School of Medicine Northwestern University Chicago, Illinois David J. Dunaway, CBE, FDSRCS, FRCS(plast) Professor Craniofacial Unit Great Ormond Street Hospital for Children London, United Kingdom Nguyen Phan Tu Dung, MD, PhD Chief of Rhinoplasty and Maxillofacial Department Director of Vietnam JW Anesthetic Hospital Ho Chi Minh City, Vietnam Kyle R. Eberlin, MD Assistant Professor of Surgery Associate Director, MGH Hand Surgery Fellowship Division of Plastic and Reconstructive Surgery Massachusetts General Hospital Anthony Echo, MD Assistant Professor of Plastic Surgery, Houston Methodist Hospital Research Institute Assistant Professor of Plastic Surgery, Weill Cornell Medicine Assistant Clinical Professor of Surgery, Texas A&M University Houston, Texas Harvard Medical School Boston, Massachusetts

Kate Elzinga, MD, FRCSC Plastic Surgeon Department of Surgery University of Calgary Calgary, Alberta, Canada

Omri Emodi, DMD Vice Chair Department of Oral and Maxillofacial Surgery Rambam Health Care Campus Clinical lecture in Oral and Maxillofacial Surgery Ruth & Bruce Rappaport Faculty of Medicine Technion—Israel Institute of Technology Haifa, Israel Barry L. Eppley, MD, DMD Clinical Professor of Plastic Surgery Indiana University School of Medicine Maxillofacial and Oral Surgery Duke University Medical Center Chief, Section of Plastic Surgery Durham VA Medical Center Section Chief, Plastic & Reconstructive Surgery Durham Veterans Administration Medical Center Durham, North Carolina Cherry L. Estilo, DMD Attending Dentist Dental Service Department of Surgery Memorial Sloan Kettering Cancer Center Clinical Member Memorial Sloan Kettering Cancer Center Associate Professor of Surgery Weill Cornell Medical College Associate Attending Dentist New York Presbyterian Weill Cornell Medical Center New York, New York IU Health Hospitals Indianapolis, Indiana Detlev Erdmann, MD, PhD, MHSc Professor of Surgery Division of Plastic, Reconstructive,

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Contributors

Roy G. Geronemus, MD Director, Laser & Skin Surgery Center of New York Clinical Professor of Dermatology New York University Medical Center Attending Surgeon Department of Plastic Surgery New York Eye and Ear Infirmary Mt Sinai School of Medicine New York, New York David Gerth, MD Miami Beach, Florida Paul A. Ghareeb, MD Fellow Division of Plastic and Reconstructive Surgery Emory University School of Medicine Atlanta, Georgia Ashkan Ghavami, MD Assistant Clinical Professor David Geffen School of Medicine UCLA Private Practice Beverly Hills, California Amir M. Ghaznavi, MD Staff, Department of Plastic & Reconstructive Surgery Cleveland Clinic Florida Weston, Florida Cerrene N. Giordano, MD Instructor, Micrographic Surgery and Dermatologic Oncology Mount Sinai Icahn School of Medicine New York, New York Jesse Goldstein, MD, FAAP, FACS Assistant Professor Department of Plastic Surgery Children’s Hospital of Pittsburgh University of Pittsburgh Medical Center Pittsburgh, Pennsylvania Christopher B. Gordon, MD, FACS, FAAP Professor Division of Plastic Surgery Department of Surgery Cincinnati Children’s Hospital Medical Center Cincinnati, Ohio Arun K. Gosain, MD Children’s Service Board Professor and Chief, Pediatric Plastic Surgery Anne and Robert Lurie Children’s Hospital Feinberg School of Medicine Northwestern University Chicago, Illinois Plastic Surgery MOSA Surgery

Benjamin C. Garden, MD Department of Dermatology University of Illinois at Chicago Chicago, Illinois Jerome M. Garden, MD Professor of Clinical Dermatology Northwestern University Feinberg School of Medicine Chicago, Illinois Evan S. Garfein, MD, FACS Associate Professor of Surgery Departments of Surgery and Otorhinolaryngology Albert Einstein College of Medicine Chief Ravi Garg, MD Chief Resident Plastic and Reconstructive Surgery University of Wisconsin Madison, Wisconsin Catharine B. Garland, MD Director, Cleft and Craniofacial Anomalies Clinic American Family Children’s Hospital Assistant Professor of Surgery Division of Plastic and Reconstructive Surgery University of Wisconsin School of Medicine and Public Health Madison, Wisconsin Plastic and Reconstructive Surgery Medical Director, Comprehensive Gender Services Program University of Wisconsin Madison, Wisconsin Brian R. Gastman, MD Professor Cleveland Clinic Lerner College of Medicine Staff in Plastic Surgery/Taussig Cancer Center Melanoma-Soft Tissue Cancer-Head and Neck Cancer Cleveland Clinic Cleveland, Ohio Finny George, MD Long Island Plastic Surgical Group Garden City, New York Patrick A. Gerety, MD Assistant Professor of Surgery Division of Plastic Surgery Indiana University and Riley Hospital for Children Indianapolis, Indiana Division of Plastic Surgery Montefiore Medical Center Bronx, New York Katherine M. Gast, MD, MS Assistant Professor of Surgery

David Charles A. Fisher, MD Clinical Assistant Professor of Surgery University of North Carolina School of Medicine Assistant Professor of Surgery Division of Plastic Surgery Department of Surgery Sean M. Fisher, MD Plastic and Reconstructive Surgery Resident University of Washington Seattle, Washington Roberto L. Flores, MD Joseph G. McCarthy Associate Professor of Reconstructive Plastic Surgery Director of Cleft Lip and Palate Hansjorg Wyss Department of Plastic Surgery Department of Surgery University of Toronto Chief, Division of Plastic and Reconstructive Surgery Medical Director, The Centre for Craniofacial Care and Research The Hospital for Sick Children Chair, Division of Plastic and Reconstructive Surgery Department of Surgery Toronto, Ontario, Canada Jordan D. Frey, MD Resident Hansjörg Wyss Department of Plastic Surgery NYU Langone Health New York, New York John R. Fowler, MD Assistant Dean for Medical Student Research Assistant Professor, Department of Orthopaedics University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania Brad M. Gandolfi, MD Craniofacial Plastic and Reconstructive Surgeon Paramus, New Jersey Carolinas Medical Center Charlotte, North Carolina NYU Langone Health New York, New York Christopher R. Forrest, MD, MSc, FRCSC, FACS Professor and Chair Division of Plastic and Reconstructive Surgery

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