Cosmetic Surgery Art and Techniques

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Melvin A. Shiffman • Alberto Di Giuseppe
Editors

Cosmetic Surgery
Art and Techniques
Editors
Melvin A. Shiffman, M.D., J.D., FCLM Alberto Di Giuseppe, M.D.
Chair, Section of Surgery Institute of Plastic and Reconstructive
Newport Specialty Hospital Surgery, School of Medicine
Tustin, CA University of Ancona
USA Ancona
Italy

ISBN 978-3-642-21836-1 ISBN 978-3-642-21837-8 (eBook)

DOI 10.1007/978-3-642-21837-8
Springer Heidelberg New York Dordrecht London

Library of Congress Control Number: 2011941191

© Springer-Verlag Berlin Heidelberg 2013

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This book is dedicated to the memory of my parents, Albert and Eva
Shiffman, who made me what I am today with encouragement and
sacrifices to send me to college and medical school.
The book is dedicated to my sister, Vivian Sadin (now deceased),
and my brother-in-law, Stan Sadin, who have been my very dearest
friends. Also to my loving daughter-in-law, Kim Shiffman, R.N., who
is the epitome of excellence in nursing, being both caring and efficient
in her work with newborn infants and who, at one time, was my
Recovery Room nurse. My wife, Pearl, has withstood constant
clattering on my computer and travels with me internationally while
I teach cosmetic surgery through lectures and workshops. She is my
constant companion. And to my compatriot and colleague,
Sid Mirrafati, M.D., with whom friendship is more like family.
My students, nationally and internationally, have been an
inspiration to me by their dedication to learning and enthusiasm to be
better physicians. But, most of all, their friendship.
I have to include those international surgeons who I have worked
with in lecturing at meetings who have become my dear friends and
who are colleagues of exceptional talent. To name a few, these include
Alberto Di Giuseppe, Anthony Erian, Afshin Fatemi, Julio Ferreira,
Giorgio Fischer, Pierre Fournier, Justin Hao, Enrique Hernandez-
Perez, Toma Mugea, Angelo Rebelo, Lina Valero, Fernando Pedrosa,
and Tetsuo Shu (now deceased). There are more but the list would be
endless. Books that I have edited, in Cosmetic Surgery, have resulted
in e-mail friendships with many surgeons who almost never say no to
my request for a chapter. These names run in the hundreds.
What more can I wish for in my 55 years as a physician and
36 years as a medical legal consultant?

Melvin A. Shiffman
Foreword

With this book, Cosmetic Surgery: Art and Techniques, published by Melvin A.
Shiffman M.D., J.D. and Alberto Di Giuseppe M.D., Cosmetic Surgeons now have a
complete encyclopedia in our field: Human Beauty Surgery
Mel should be especially congratulated as he has accomplished what he decided
years ago: to give recognition to our specialty of pure Cosmetic Surgery thanks to the
publication of a large series of books about our daily work that is ours for many years.
In the numerous already published volumes, he gives the groundwork where our prac-
titioners, experienced or beginners, can find teaching resulting from many years of
practice by experienced Cosmetic Surgeons coming from all around the world. This
book is very special among all the other ones already published as it is all encompassing
and is the first one in the literature about General Cosmetic Surgery. In the present time
teaching is audiovisual. Words of course are indispensable but a visible representation
of what has been said is crucial. We all know how important a diagram or a slide is.
As Napoleon the First used to say when he had to summarize his tactic before a
battle to make his mind up: “a little drawing is better than a long talk”. An image
focuses, zooms our attention, and stimulates our mind. We know that it enhances our
understanding on the strategy of a future procedure. It is acting as an impact.
This book will satisfy the readers as in its 68 chapters they can find carefully
described all the conventional reliable techniques as well as the most recent advances
offered today to our patients. The different procedures described are on the head and
neck, breasts, abdomen, limbs, liposuction, lipofilling, peeling, and hair grafting.
Many other chapters are dedicated to the different lasers, radio frequency, facial
implants, fillers, threads, and the use of stem cells and growth factors. Also included
are chapters on buttocks lift and implants, intimate surgery in women and men, anat-
omy, and the History of Cosmetic Surgery.
This important iconography explaining fully all the procedures will allow Cosmetic
Surgeons to obtain the best possible results, to avoid or decrease the number of com-
plications, major or minor, and to have a satisfied patient. Today, like before, one
should be conscious of the responsibilities that we have when modifying the face or
body of human beings and should be reminded always of the old surgical saying,
“Better prepare and prevent than repair and repent.” This underlines how important is
visual teaching.
As written by the highly talented and respected Richard Aronsohn, Founder of the
American Board of Cosmetic Surgery, “Psychiatry works from the inside out.
Cosmetic Surgery works from the outside in.” Both help people to enhance their self-
esteem and to feel good about themselves. As a matter of fact, Cosmetic Surgeons are
Surgical Psychiatrists. A good result makes patient and Surgeon happy. A complica-
tion or a poor result makes patient and Surgeon unhappy.

vii
viii Foreword

It is not possible to comment about all that is offered in this book, but the publishers
should feel happy to have included all the procedures or trends presently offered or
requested by our patients of the present time. It summarizes for the Surgeon in a very
short time the necessary different steps of an operation.
This book is an indispensable up-to-date tool needed by Cosmetic Surgeons as it
visualizes the present advances in our specialty allowing us to maintain and/or
enhance Human Beauty or to fight against the Aging process.

Paris, France Pierre F. Fournier, M.D.

Preface

Cosmetic (or aesthetic) surgery is a specialty of medical practice that has attracted
physicians from most countries around the world interested in improving the “beauty”
of the patient. Patients are flocking to cosmetic surgeons to improve their appearance
to meet the expectations of their own body image. Although cosmetic surgery is an
elective procedure, the medical indication for these procedures is to improve the
patient’s psychological needs. Since health care has improved and life span has been
prolonged, individuals are trying to preserve or return to their youthful appearance.
Technology and techniques have improved to make cosmetic surgery safer for the
patient and less invasive in some aspects so that patients can return to their normal
activities sooner and with shorter periods of discomfort.
This book on Cosmetic Surgery contains step-by-step descriptions of the proce-
dures (old, new, and modifications) with illustrations and/or color photos. The con-
tents include a history of cosmetic surgery, anatomy, anesthesia, head and neck
surgery, breast surgery, abdominal and thoracic surgery, and extremities and buttocks
procedures. Also described are labioplasty, total body lift following massive weight
loss, and penile enhancement. Dermatologic procedures are described including laser
rejuvenation, radiofrequency rejuvenation, and chemical peeling.
The international contributors are experts in their fields and have published exten-
sively in the medical literature. Some contributors are professors and many lecture at
international meetings and workshops on a regular basis. This book is comprehensive
and is an attempt to expose the student training in cosmetic surgery, the physician
starting in cosmetic surgery, and the experienced practitioner in cosmetic surgery to
the many aspects of aesthetic procedures that may improve their results and improve
patient safety.
The editors, in this book, are interested in producing a means of exposing all
surgeons to procedures commonly used to improve a patient’s appearance and satis-
faction. The learning mechanism used is step-by-step descriptions with illustrations
and color photos of the procedures. We hope that cosmetic surgeons will thus be able
to better understand a variety of the techniques.

Tustin, CA, USA Melvin A. Shiffman, M.D., J.D., FCLM

ix
Contents

Part I History and Anatomy

1. History of Cosmetic Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Melvin A. Shiffman
2. Anatomy of the Face and Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Peter M. Prendergast
3. Anatomy of the Breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Peter M. Prendergast
4. Anatomy of the Anterior Abdominal Wall . . . . . . . . . . . . . . . . . . . . . . . 57
Peter M. Prendergast
5. Anatomy of the Eyelid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Oren G. Benyamini and Morris E. Hartstein

Part II Anesthesia

6. Regional Anesthesia for Cosmetic Surgery

of the Face and Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Arnaud Deleuze, Marc Gentili, and Francis Bonnet
7. Liposuction with Local Tumescent Anesthesia
and Microcannula Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Bernard I. Raskin and Shilesh Iyer
8. Tumescent Technique. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Melvin A. Shiffman
9. Anesthesia for Aesthetic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Gary Dean Bennett

Part III Head and Neck

10. Facial Peels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147

Niti Khunger
11. Facial Resurfacing with the Ultrapulse Laser. . . . . . . . . . . . . . . . . . . . . 167
Bernard I. Raskin

xi
xii Contents

12. Capacitive Radiofrequency Skin Rejuvenation. . . . . . . . . . . . . . . . . . . . 195

Manoj T. Abraham and Joseph J. Rousso
13. Mesotherapy in Aesthetic Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Maya Vedamurthy
14. Upper Blepharoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
Morris E. Hartstein
15. Lower Blepharoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
Morris E. Hartstein
16. Blepharoptosis: The Check Ligament Technique . . . . . . . . . . . . . . . . . . 235
Antonio Stanizzi
17. Aesthetic Rhinoplasty Utilizing Various Techniques Depending
on the Abnormality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
Fernando D. Burstein
18. Otoplasty. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
Cristina Isac, Aurelia Isac, Tiberiu I. Bratu, and Nicolae Antohi
19. Brow Lift. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
Shoib Allan Myint
20. Mid-Forehead Buttonhole Eyebrow Elevation . . . . . . . . . . . . . . . . . . . . 299
Harry Mittelman, Gregory J. Vipond, and Joshua D. Rosenberg
21. Facelift... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311
Phillip R. Langsdon and Courtney Shires
22. Short-Scar Purse-String Facelift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323
Amir M. Karam, L. Mike Nayak, and Samuel M. Lam
23. Modified Facelift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
Phillip R. Langsdon and Courtney Shires
24. Subperiosteal Face-Lift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337
Lucas G. Patrocinio, Tomas G. Patrocinio, Jose A. Patrocinio,
and Marcell M. Naves
25. Suture Facelift Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 355
Peter M. Prendergast
26. Facial Implants. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393
Bruce B. Chisholm
27. Fat Transfer to the Face . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405
Melvin A. Shiffman
28. Facial Fillers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415
Peter M. Prendergast
29. Ultrasound-Assisted Lipoplasty: Basic Physics,
Tissue Interactions, and Related Results/Complications . . . . . . . . . . . . 451
William W. Cimino
30. Facial Recontouring with Liposuction . . . . . . . . . . . . . . . . . . . . . . . . . . . 461
Alberto Di Giuseppe and George Commons
Contents xiii

31. Chin, Cheek, and Neck Vaser Liposculpture. . . . . . . . . . . . . . . . . . . . . . 467

Alberto Di Giuseppe, George Commons, and Alessandro Scalise
32. An Integrated Technique for Facial Rejuvenation:
Adaptation to a Changing Clinical Environment . . . . . . . . . . . . . . . . . . 485
Moshe S. Fayman
33. Hair Restoration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 517
Samuel M. Lam
34. Jowl and Neck Remodeling with Ultrasound-Assisted
Lipoplasty (VASER). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 539
Alberto Di Giuseppe and George Commons

Part IV Breast

35. Breast Augmentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 555

Lina Valero De Pedroza
36. The Inverted Dual Plane Mastoplasty Technique . . . . . . . . . . . . . . . . . . 571
Giovanni Di Benedetto, Luca Grassetti, Davide Talevi,
Daniele Bordoni, Manuela Bottoni, and Alessandro Scalise
37. Remodeling Breast and Torso with Combined Fat
Liposuction and Grafts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 585
Alfredo Hoyos
38. Breast Augmentation and Reconstruction with Fat Transfer . . . . . . . . 595
Todd K. Malan
39. The Staple-First Technique for Simultaneous Augmentation
Mastopexy for Moderately to Severely Ptotic Breasts . . . . . . . . . . . . . . 605
Ted S. Eisenberg
40. Circumareolar Nipple-Areola Complex Mastopexy
and Areolar Shifting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 621
Robert A. Shumway
41. Mastopexy/Breast Reduction with Short Inverted T Scar . . . . . . . . . . . 633
Toma T. Mugea
42. The Medial and Superior Pedicle Mastopexy
with Dual Plane Inverted-T Augmentation . . . . . . . . . . . . . . . . . . . . . . . 705
Tiberiu I. Bratu, Cristina Isac, Olariu Daniela, Grujic Daciana,
Dorina Mihaijlovic, and Nicolae Antohi
43. Breast Augmentation and Mastopexy . . . . . . . . . . . . . . . . . . . . . . . . . . . 715
Toma T. Mugea
44. Periareolar Mammaplasty for the Treatment
of Massive Gynecomastia with Breast Ptosis. . . . . . . . . . . . . . . . . . . . . . 747
Marco Túlio Rodrigues da Cunha
45. Reduction Mammoplasty: “The Piece of Art” . . . . . . . . . . . . . . . . . . . . 755
Fahmy S. Fahmy and Mohamed Ahmed Amin Saleh
xiv Contents

46. The Moufarrege Total Posterior Pedicle Mammaplasty . . . . . . . . . . . . 775

Richard Moufarrege and Elia Botros
47. Mastopexy with Chest-Wall-Based Flap
and Pectoralis Muscle Loop . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 791
Ruth Maria Graf, André Ricardo Dall’Oglio Tolazzi,
and Maria Cecília Closs Ono
48. Hypertrophic Tubular Breast Reduction:
Surgical Technique with New Inframammary Fold Level . . . . . . . . . . . 805
Toma T. Mugea
49. Breast Reduction with Vaser. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 857
Alberto Di Giuseppe, Michael Nagy, Mario Scaglioni,
and Elisabetta Petrucci
50. Gynecomastia: Scarless Male Breast Reduction with Vaser . . . . . . . . . 871
Alberto Di Giuseppe, Antonella Belligolli, Marina Pierangeli,
Davide Talevi, and Luca Grassetti

Part V Abdomen

51. Abdominoplasty: Aesthetics of the Anterior

Abdominal Wall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 887
Fahmy S. Fahmy and Mohamed Ahmed Amin Saleh
52. Circular Lipectomy with Lateral Thigh–Buttock Lift . . . . . . . . . . . . . . 907
Héctor J. Morales Gracia
53. The Horseshoe Abdominoplasty. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 925
Richard Moufarrege and Elia Botros
54. Mini-Abdominoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 939
Bruce A. Mast
55. Ultrasound-Assisted Abdominal Liposuction . . . . . . . . . . . . . . . . . . . . . 949
Peter M. Prendergast

Part VI Extremities and Buttocks

56. Brachioplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 973

Sumeet N. Makhijani, Alain Polynice, Jerome D. Chao,
and James G. Hoehn
57. Circumferential Para-Axillary Superficial
Tumescent (CAST) Liposuction for Upper Arm Contouring . . . . . . . . 981
Andrew T. Lyos
58. Thigh Lift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 993
Sadri Ozan Sozer and Francisco J. Agullo
59. Buttock Lift. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1001
Sadri Ozan Sozer and Francisco J. Agullo
Contents xv

60. Liposuction of Lower Extremities and Buttocks. . . . . . . . . . . . . . . . . 1011

Alberto Di Giuseppe, Guido Zannetti, and Daniele Bordoni
61. Buttock and Hip Enhancement with Implants . . . . . . . . . . . . . . . . . . . 1043
Jesus Benito-Ruiz
62. Liposculpture and Buttock Augmentation with Fat Grafting . . . . . . . 1063
Arturo Grau
63. Large Volume Fat Transplant to Buttocks and Legs
for Enhancement and Reconstruction . . . . . . . . . . . . . . . . . . . . . . . . . . 1087
Lina Valero De Pedroza
64. Treatment of Venous Insufficiency with Sclerotherapy . . . . . . . . . . . . 1093
Alessandro Frullini

Part VII Miscellaneous

65. Labioplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1101

Cristina Isac, Aurelia Isac, Nicolae Antohi, and Tiberiu I. Bratu
66. Total Body Lift After Extreme Weight Loss . . . . . . . . . . . . . . . . . . . . . 1111
Dennis J. Hurwitz
67. Penile Enhancement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1127
Hassan Abbas Khawaja and Melvin A. Shiffman
68. Complications of Cosmetic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1135
Melvin A. Shiffman

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1185
 Part I
History and Anatomy