Pearls and Pitfalls in Cosmetic Oculoplastic Surgery Pearls and Pitfalls in Cosmetic Oculoplastic Surgery

Edited by

Morris E. Hartstein, MD, FACS Clinical Associate Professor, Saint Louis University, Department of Ophthalmology and Division of Plastic and Reconstructive Surgery, St. Louis, Missouri John B. Holds, MD, FACS Clinical Professor, Saint Louis University, Departments of Ophthalmology and Otolaryngology-Head and Neck Surgery, St. Louis, Missouri Guy G. Massry, MD Director, Ophthalmic Plastic and Reconstructive Surgery. American Eye Institute, Cedars Sinai Medical Center, Los Angeles, CA, Spalding Dr. Cosmetic Surgery and Dermatology, Beverly Hills, California, Davidorf Eye Group, West Hills, California Morris E. Hartstein, MD, FACS John B. Holds, MD, FACS Clinical Associate Professor Clinical Professor Saint Louis University Saint Louis University Department of Ophthalmology Departments of Ophthalmology and Division of Plastic and Otolaryngology-Head and and Reconstructive Surgery Neck Surgery St. Louis, MO St. Louis, MO USA USA

Guy G. Massry, MD Director, Ophthalmic Pastic and Reconstructive Surgery American Eye Institute Cedars Sinai Medical Center Los Angeles, CA Spalding Dr. Cosmetic Surgery and Dermatology Beverly Hills, CA Davidorf Eye Group WestHills, CA USA

Library of Congress Control Number: 2007937487

ISBN: 978-0-387-25389-3 e-ISBN: 978-0-387-25389-3

Printed on acid-free paper.

© 2008 Springer Science+Business Media, LLC. All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodol- ogy now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identifified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.

9 8 7 6 5 4 3 2 1 springer.com Foreword

Learning oculofacial surgery is a lot like learning to dance. In the begin- ning, the dance student is consumed with where to put his or her feet. For these new students (or for the rhythmically challenged), dancing is characterized by the struggle to step their feet in imaginary numbered shoeprints, 1–2–3–4, and they barely hear the music. In surgery, the beginning surgeon is preoccupied with steps as well. Their focus is on the mechanical process. Proscribed steps create the paradigm for per- forming the surgery. With time, the dance student moves on to the next stage. He does not have to think as much about where he is putting his feet, and can start to listen to the music and feel the rhythm. The advanced surgeon begins to internalize the steps of surgery so that instead of a preoccupation with the next maneuver, she can start to individualize the surgery to the patient and employ flexibilty in the face of unique problems. The master dancer makes no conscious effort to move his feet; his feet move him. He does not concentrate on rhythm; the rhythm of the music becomes part of him. Freed from the intellectual exercise of dancing and from the technical requirements of keeping time, he is free to break from the restraints of the proscribed steps and invent a new dance as he goes along. The master surgeon enjoys a similar freedom. The focus is not on maneuvers and, in fact, the surgeon might be temporarily taken aback if asked to explain the mechanical details of what he is doing. Instead, the thought process is conceptual. The surgeon is visualizing a result, is sensitive to the nuances of the patient’s individual anatomy, and is always making adjustments to address the unique requirements presented by the case at hand. By approaching the operation conceptually, and having effortless command of anatomy and technique, the master surgeon is freed from the constraints of proscribed operations, and is able to invent new surgeries. In this book, a high octane collection of master surgeons provide a work that reflfl ects the scope of ophthalmic plastic surgery. There is mate- rial here for every type of student. The beginner will appreciate step-by- step instructions and clear anatomic diagrams. The advanced surgeon

v vi Foreword

will be drawn to the delightful tricks and peals that are sprinkled liberally throughout the text. The master surgeon (and the aspiring master) will recognize that they are seeking the same thing that the authors are seeking, and they will be stimulated to continue to search for better treatments and surgeries. The obvious hard work that went into the preparation of this book will pay off handsomely when its readers improve their ability to take care of their patients, and particularly when they are inspired to continue their own journey toward mastery of our discipline.

Robert Alan Goldberg, MD Karen and Frank Daby Professor of Ophthalmology David Geffen School of Medicine at UCLA Chief, Orbital and Ophthalmic Plastic Surgery Division Jules Stein Eye Institute Preface

The goal of this book is to help surgeons perform more effifi cient, produc- tive, and successful surgeries. By sharing our varied experiences, acquired through years of practice, we hope this book will provide insights that can enhance surgical outcomes. In compiling this text, we solicited con- tributions from experts in cosmetic oculoplastic surgery, as well as sur- geons from other related fi elds, such as facial plastic surgery, plastic surgery, and dermatology. The book is divided into 12 parts, which cover the spectrum of oculofacial procedures. Each section is divided into concise chapters focusing on just one aspect of a given procedure. Within these short chapters, each contributor offers tips on how to achieve optimal results. For example, the section on upper lid blepharoplasty is subdivided as follows: • Preoperative evaluation • Incision planning • Procedure pearls • Adjunctive procedures • Wound closure and postoperative care There are also multiple presentations on the same aspect of a procedure to provide different points of view and approaches. We greatly appreci- ate the various experts, who have shared their experiences.

Acknowledgments

Roberta D. Sengelmann and Brent R. Moody served as section chiefs for Part IX, Skin Rejuvenation.

Tamara R. Fountain served as section chief for Part XII, Functional Lid Malpositions, Sections 1–2, Ptosis.

We would like to thank Jan Heizer and Chris Kleber, Saint Louis Uni- versity Department of Ophthamology, for their assistance in preparing this book.

Morris E. Hartstein, MD, FACS John B. Holds, MD, FACS Guy G. Massry, MD

vii Contents

Foreword by Robert Alan Goldbergg ...... v Preface ...... vii Contributors ...... xxiii

Part I Preoperative Evaluation

1 Preoperative Evaluation of the Cosmetic Patient ...... 3 Jemshed A. Khan 2 Evaluation of the Cosmetic Patient ...... 6 Rona Z. Silkiss 3 Preoperative Patient Counseling for Cosmetic Blepharoplasty ...... 11 William P.D. Chen

Part II Anesthesia

4 Guide to Local Anesthetic Medications ...... 15 Vivian Schiedler and Bryan S. Sires 5 Motor Nerve Blocks in Oculofacial Surgery ...... 18 Vivian Schiedler and Bryan S. Sires 6 Regional Nerve Blocks in Oculofacial Surgery ...... 22 Vivian Schiedler and Bryan S. Sires 7 Procedural Sedation in Oculofacial Surgery ...... 27 Vivian Schiedler and Bryan S. Sires 8 Preoperative Preparation and Anesthesia ...... 30 William P.D. Chen 9 “Digital Diffusion” Technique for the Administration of Local Anesthetic in Eyelid Surgery ...... 32 Rona Z. Silkiss 10 Anesthesia for In-Offifi ce Oculoplastic Surgery: How We Do It ...... 33 Brent R. Moody and John B. Holds

ix x Contents

Part III Upper Lid Blepharoplasty

Section One Preoperative Evaluation 11 Upper Eyelid Blepharoplasty: The Evaluation ...... 41 Evan H. Black, John D. Siddens, Frank A. Nesi, Shoib Myint, and Geoffrey J. Gladstone 12 Preoperative Examination Checklist for Upper Blepharoplasty ...... 44 Philip L. Custer 13 Preoperative Evaluation and Documentation in Upper Blepharoplasty ...... 46 Cat Nguyen Burkat

Section Two Incision Planning 14 Marking Strategies for Upper Blepharoplasty ...... 51 Guy G. Massry 15 Orbit Size and Lid Marking in Upper Blepharoplasty . . . 53 Philip L. Custer 16 Incisional Guidelines When Marking the Skin in Upper Eyelid Blepharoplasty ...... 56 Sheri L. DeMartelaere, Todd R. Shepler, Sean M. Blaydon, Russell W. Neuhaus, and John W. Shore 17 Marking the Proposed Upper Eyelid Crease: Determining the Safe Amount of Skin Removal— The Pinch Technique ...... 58 Jemshed A. Khan 18 Preoperative Measurements in Upper Blepharoplasty: Patient Selection ...... 61 Jemshed A. Khan 19 Keys to Success When Marking the Skin in Upper Blepharoplasty ...... 62 John R. Burroughs and Richard L. Anderson 20 Skin Marking in Upper Blepharoplasty— Avoiding Pitfalls ...... 65 Cat Nguyen Burkat

Section Three Upper Blepharoplasty Procedure Pearls 21 Upper Blepharoplasty: Pearls for the Procedure ...... 71 Evan H. Black, John D. Siddens, Frank A. Nesi, Shoib Myint, and Geoffrey J. Gladstone 22 Fat Excision in Upper Blepharoplasty ...... 73 Sheri L. DeMartelaere, Todd R. Shepler, Sean M. Blaydon, Russell W. Neuhaus, and John W. Shore Contents xi

23 Mobilizing and Excising the Nasal Fat Pad in Upper Blepharoplasty ...... 74 Jemshed A. Khan 24 Tissue Removal Considerations in Blepharoplasty Surgery ...... 75 Rona Z. Silkiss 25 Fewer Hematomas in Upper Blepharoplasty ...... 76 Martin H. Devoto 26 Blepharoplasty Incisional Modalities: 4.0 Radiowave

Surgery vs. CO2 Laser ...... 81 Joseph Niamtu, III 27 Fat Preservation and Other Tips for Upper Blepharoplasty ...... 84 Cat Nguyen Burkat 28 Asian Blepharoplasty ...... 87 Samuel M. Lam

Section Four Adjunctive Procedures in Upper Blepharoplasty 29 Internal Brow Elevation with Corrugator Removal . . . . . 95 John R. Burroughs and Richard L. Anderson 30 Excision of ROOF During Upper Blepharoplasty ...... 99 Jemshed A. Khan 31 Addressing the Brow During Upper Blepharoplasty . . . . 100 Philip L. Custer 32 Transblepharoplasty Incision Lower Lid Canthopexy . . . . 102 John R. Burroughs and Richard L. Anderson 33 Lower Lid Canthopexy Through Upper Lid Incision . . . . 104 Guy Ben Simon and John D. McCann

Section Five Wound Closure and Postoperative Care 34 Avoiding Dog Ears During Upper Blepharoplasty Closure ...... 107 Peter S. Levin 35 Crease Formation in Upper Blepharoplasty ...... 109 Philip L. Custer 36 Use of Tissue Adhesive for Oculoplastic Incision Closure ...... 111 Charles B. Slonim 37 Avoiding or Minimizing Postoperative Swelling ...... 112 John R. Burroughs and Richard L. Anderson 38 Management of Postblepharoplasty Dry Eye ...... 114 Morris E. Hartstein xii Contents

Part IV Lower Lid Blepharoplasty

Section One Preoperative Considerations 39 Lower Eyelid Blepharoplasty: The Evaluation ...... 121 John D. Siddens 40 Lower Eyelid Blepharoplasty Evaluation: Avoid the Cookie Cutter Approach ...... 125 Sheri L. DeMartelaere, Todd R. Shepler, Sean M. Blaydon, Russell W. Neuhaus, and John W. Shore

Section Two Lower Blepharoplasty Procedure Pearls 41 Three-Step Technique for Lower Lid Blepharoplasty . . . . 129 Joseph A. Mauriello, Jr. 42 Lower Eyelid Blepharoplasty: Procedure Pearls and Pitfalls ...... 137 John D. Siddens 43 Lower Blepharoplasty: The Bilamelar Approach ...... 139 Guy G. Massry 44 The Skin in Lower Lid Blepharoplasty: General Principles ...... 140 Guy Ben Simon and John D. McCann 45 Incising the Septum over the Nasal, Central, and Lateral Fat Pads in Lower Blepharoplasty ...... 141 Jemshed A. Khan 46 Prolapsing the Inferior Fat Pads and Fornix in Lower Blepharoplasty ...... 143 Jemshed A. Khan 47 Identifying the Inferior Oblique in Transconjunctival Blepharoplasty ...... 145 Jemshed A. Khan 48 Achieving Symmetry in Lower Blepharoplasty Fat Removal ...... 147 Jemshed A. Khan 49 Hemostasis in Lower Blepharoplasty ...... 150 Erin L. Holloman and Sterling S. Baker 50 The Treatment of Festoons in Lower Blepharoplasty . . . . 151 Sheri L. DeMartelaere, Todd R. Shepler, Sean M. Blaydon, Russell W. Neuhaus, and John W. Shore

Section Three Fat Repositioning in Lower Blepharoplasty 51 Fat Repositioning in Lower Blepharoplasty: Less Is More ...... 157 Sheri L. DeMartelaere, Todd R. Shepler, Sean M. Blaydon, Russell W. Neuhaus, and John W. Shore Contents xiii

52 Fat Repositioning in Lower Lid Blepharoplasty: General Principles ...... 158 Guy Ben Simon and John D. McCann 53 Transconjunctival Lower Lid Blepharoplasty with and Without Fat Repositioning ...... 159 Guy G. Massry and Paul S. Nassif 54 Transconjunctival Lower Blepharoplasty with Intra-SOOF Fat Repositioning ...... 167 Yasaman Mohadjer and John B. Holds 55 Lower Lid Blepharoplasty with Fat Repositioning Using a Foam Bolster ...... 171 Eric A. Steele and Roger A. Dailey 56 Use of Tisseel in Lower Eyelid Blepharoplasty with Fat Repositioning ...... 173 Asa D. Morton 57 Lower Blepharoplasty with Fat Repositioning Without Sutures ...... 176 John R. Burroughs and Richard L. Anderson

Section Four Management of Postblepharoplasty Lid Retraction 58 Managing Postblepharoplasty Lower Eyelid Malposition ...... 183 Michael T. Yen 59 Retroauricular Dermal Spacer Graft for Lower Lid Retraction Repair ...... 187 Francesco P. Bernardini 60 Mid-Lower Eyelid Tarsoconjunctival Flap-Skin Graft: Treatment of Cicatricial Lower Lid Retraction ...... 190 John Pak 61 Treatment of Postblepharoplasty Lower Eyelid Retraction with Dermis Fat Spacer Grafting ...... 198 Bobby S. Korn and Don O. Kikkawa

Part V Forehead Rejuvenation

Section One Preoperative Considerations 62 Which Browlift to Do? ...... 205 Andrea N. Hass 63 Browlifting: Patient Evaluation ...... 206 Andrea N. Hass 64 Preoperative Botox for Endoscopic Browlifting ...... 208 Andrea N. Hass xiv Contents

Section Two Endoscopic Forehead Rejuvenation 65 Five Tips for Endoscopic Browlift ...... 211 Sheri L. DeMartelaere, Todd R. Shepler, Sean M. Blaydon, Russell W. Neuhaus, and John W. Shore 66 Anesthesia Options in Endoscopic Forehead Lifting . . . . 212 Andrew S. Eiseman 67 Endoscopic Forehead Rejuvenation: How to Set Up the Operating Room and Trouble Shooting ...... 215 Asa D. Morton 68 Endoscopic Forehead Rejuvenation: Equipment and Setup ...... 217 Asa D. Morton 69 Incision Technique for Endoscopic Forehead Elevation ...... 220 Andrew S. Eiseman 70 Endoscopic Forehead Elevation: Patient Marking and Preparation ...... 223 Geva Mannor 71 Endoscopic Midforehead Techniques: Improved Outcomes with Decreased Operative Time and Cost . . . . 224 Asa D. Morton 72 Fifteen Principles of Enhanced Success in Endoscopic Browlift ...... 228 Guy G. Massry 73 Dissection of Central Forehead and Temporal Pocket with Periosteal Release ...... 231 Don O. Kikkawa 74 Endoscopic Forehead Lifting: Dealing with the Central Brow Depressors ...... 234 Asa D. Morton 75 Elevation and Fixation of the Lateral Brow and Canthus ...... 236 Robert G. Fante 76 Fixation Methods in Endoscopic Browlifting ...... 237 Andrea N. Hass 77 Endosocopic Browlift with Deep Temporal Fixation Only ...... 238 Paul S. Nassif 78 Tridimensional Brow, Glabella, and Temple Enhancement with Micro Fat Injection During Endoscopic Forehead Rejuvenation ...... 247 Oscar M. Ramirez and Camilo O. Reyes Contents xv

79 Scalp Fixation in Endoscopic Browlift ...... 254 Robert G. Fante 80 Closing and Dressing the Wounds in Endoscopic Browlift ...... 257 Robert G. Fante 81 Endoscopic Forehead Rejuvenation: Avoiding and Managing Complications ...... 259 Asa D. Morton

Section Three Nonendoscopic Browlifting 82 The Direct Browlift: Focus on the Tail ...... 263 John B. Holds 83 Soft Tissue Augmentation of the Temporal Brow in Browlifting Surgery ...... 267 David E.E. Holck, Jill A. Foster, Manuel A. Lopez, and Kevin A. Kalwerisky

Part VI Mid-Face Lift

84 Mid-Face Lift: General Considerations and How I Do It ...... 275 Guy G. Massry 85 Ten Rules for Mid-Face Lifting for the Repair of Lid Retraction ...... 277 Morris E. Hartstein and Guy G. Massry 86 The Subperiosteal Mid-Face Lift Using Bioabsorbable Implants for Fixation ...... 278 David E.E. Holck, Jill A. Foster, Kevin A. Kalwerisky, and Manuel A. Lopez 87 Cheeklifting Pearls ...... 285 Clinton D. McCord, Jr. 88 Mid-Face Implants ...... 287 Joseph Niamtu, III

Part VII Botox

89 Introduction to Botox ...... 293 John R. Burroughs and Richard L. Anderson 90 Evaluating Potential Botox Patients ...... 294 Samuel M. Lam 91 Botox: General Principles of Treatment ...... 296 Samuel M. Lam xvi Contents

92 Botox: Where It Works Best ...... 298 Jemshed A. Khan 93 Preparation of Botox ...... 300 Jemshed A. Khan 94 Documentation of Treatment: Botox ...... 301 Jemshed A. Khan 95 Botox Injection Technique ...... 303 John R. Burroughs and Richard L. Anderson 96 Cosmetic Botox Applications: General Considerations and Dosing ...... 305 John R. Burroughs and Richard L. Anderson 97 Botox: Avoiding Pitfalls ...... 307 John R. Burroughs and Richard L. Anderson 98 Botox Injection Techniques: Minimizing Bruising and Discomfort ...... 309 Jemshed A. Khan 99 Botulinum Toxin Injections Pearls ...... 311 Rona Z. Silkiss 100 Botox Complications ...... 312 Jemshed A. Khan 101 Glabella Treatment with Botox ...... 314 Samuel M. Lam 102 Corrugator and Procerus Rhytid Treatment with Botox ...... 316 Jemshed A. Khan 103 Frontalis Injection with Botox ...... 318 Jemshed A. Khan 1 04 Frontalis Treatment with Botox ...... 320 Samuel M. Lam 105 Shaping of the Eyebrows with Botox ...... 322 David F. Horne and Thomas E. Rohrer 106 Botox Injection Techniques: Crow’s Feet ...... 326 Jemshed A. Khan 107 Orbicularis Oculi Treatment with Botox ...... 328 Samuel M. Lam 108 Perioral Botox Injections ...... 330 Jemshed A. Khan 109 Botox Injection to the Lacrimal Gland for the Treatment of Epiphora ...... 332 R. Jeffrey Hofmann Contents xvii

110 Botox Therapy for Hyperhydrosis: How I Do It ...... 335 Charles B. Slonim 111 Other Uses of Botox ...... 336 John R. Burroughs and Richard L. Anderson 112 Botox for Axillary Hyperhydrosis ...... 338 R. Jeffrey Hofmann

Part VIII Fillers

113 Optimizing Outcome from Facial Cosmetic Injections and Promoting Realistic Expectations ...... 341 Leslie Baumann 114 Filler Pearls: General Considerations ...... 344 John R. Burroughs and Richard L. Anderson 115 List of Fillers ...... 345 Bradley T. Kovach 116 Dermal Filler Pearls: the Hyaluronic Acids ...... 352 John R. Burroughs and Richard L. Anderson 117 Radiesse Pearls ...... 354 John R. Burroughs and Richard L. Anderson 118 Juvederm Pearls: Fine and Superfifi cial Lines ...... 356 John R. Burroughs and Richard L. Anderson 119 Achieving Beautiful Lip Augmentation ...... 357 Kimberly J. Butterwick 120 Restylane Injection for the Lower Eyelid Tear Trough ...... 362 R. Jeffrey Hofmann 121 Liquid Injectable Silicone for the Upper Third of the Face ...... 364 Derek H. Jones 122 Periocular Injectables with Hyaluronic Acid and Calcium Hydroxyapatite ...... 369 Robert A. Glasgold and Samuel M. Lam 123 Pearls and Pitfalls of Botox and Filler Substances in the Upper Third of the Face ...... 373 Seth L. Matarasso 124 Periorbital-Facial Volume Rejuvenation for Focal Defifi cits ...... 379 John R. Burroughs and Richard L. Anderson 125 Pearls for Periorbital Fat Transfer ...... 381 Lisa M. Donofrio xviii Contents

126 Complementary Fat Grafting in the Periorbital Region ...... 384 Samuel M. Lam, Mark J. Glasgold, and Robert A. Glasgold 127 Autogenous Orbicularis and Fat as a Filler ...... 386 John R. Burroughs, Michael T. Yen, and Richard L. Anderson

Part IX Skin Rejuvenation

Section One Skin Care 128 Skin Care 101: The Basics ...... 391 Diane S. Berson 129 Retinoids for the Cosmetic Patient ...... 393 Kenneth R. Beer 130 Evaluation of Skin Lesions in the Cosmetic Patient Made Simple: Actinic Keratosis ...... 396 Brent R. Moody

Section Two Nonablative Therapy 131 Chemical Peels for Facial Rejuvenation ...... 401 Andrew J. Kaufman 132 Nonablative Laser and Light Facial Rejuvenation ...... 404 Jeffrey S. Dover 133 Mesotherapy for Cosmetic Periocular Enhancement . . . . 409 Samuel M. Lam and Gustavo H. Leibaschoff

Section Three Ablative Therapy 134 Skin Rejuvenation Techniques: General Considerations ...... 413 Erin L. Holloman and Sterling S. Baker

135 CO2 Laser Skin Resurfacing Prophylaxis ...... 416 Jemshed A. Khan

136 CO2 Laser Resurfacing Immediate Postoperative Care Prior to Complete Epithelialization ...... 417 Jemshed A. Khan

137 Products Used in CO2 Laser Resurfacing Wound Care: Late Postoperative Care After Complete Epithelialization ...... 418 Jemshed A. Khan 138 Monopolar Radiofrequency Tissue Tightening ...... 419 Elizabeth F. Rostan Contents xix

139 Dual-Mode Erbium-YAG Laser Skin Resurfacing ...... 424 John B. Holds 140 Fraxel Treatment ...... 428 Howard Conn

Part X Thread Lift

141 Pros and Cons of Contour Threads for Upper Facial Rejuvenation ...... 433 Michael S. Kaminer 142 Periocular Suture Lifts: Brow and Malar Repositioning ...... 435 Samuel M. Lam 143 Contour Threads Technique Pearls ...... 438 Michael S. Kaminer 144 Combined Modalities for the Correction of Asymmetric Brow Position ...... 440 William P. Mack

Part XI Other Cosmetic Procedures

145 Repair of the Torn Earlobe ...... 445 Yoash R. Enzer 146 Upper Lip Lift as a Complementary Technique in Facial Rejuvenation ...... 452 Oscar M. Ramirez and Camilo O. Reyes 147 SMAS Malar Fat Pad Lift with Short Scar Face Lift . . . . . 457 Paul S. Nassif and Guy G. Massry 148 Ten Tips for a Reliable and Predictable Deep Plane Facial Rhytidectomy ...... 460 David E.E. Holck, Jill A. Foster, Kevin A. Kalwerisky, and O. Bailey Robertson

Part XII Functional Lid Malpositions

Section One Ptosis: Anterior Approach 149 Advantages of Sequential Versus Simultaneous Bilateral Levator Advancement Surgery ...... 475 Herbert J. Glatt 150 Considerations in Simultaneous vs. Sequential Bilateral Levator Repair ...... 476 Robert A. Mazzoli xx Contents

151 Unilateral Levator Resection for Jaw-Winking Ptosis ...... 478 Stuart R. Seiff 1 52 Ten Steps to Making Ptosis Surgery More Predictable . . . 479 Russell S. Gonnering 153 Adjustable Suture Technique for Levator Surgery ...... 481 Morris E. Hartstein and John J. Woog 154 Tarsal Switch Levator Resection for the Treatment of Myopathic Blepharoptosis ...... 484 Sheri L. DeMartelaere, Todd R. Shepler, Sean M. Blaydon, Russell W. Neuhaus, and John W. Shore 155 Modififi ed Levator Advancement Ptosis Technique ...... 490 Rona Z. Silkiss 1 56 Minimally Invasive Ptosis Repair ...... 491 Francesco P. Bernardini 157 Small Incision External Levator Repair ...... 494 Mark J. Lucarelli 158 Ptosis Repair by a Single-Stitch Levator Advancement ...... 497 Don Liu 159 Postoperative Care in Ptosis Surgery ...... 500 Edsel Ing

Section Two Ptosis: Posterior Approach 160 Pearls for Müller’s Muscle–Conjunctival Resection–Ptosis Procedure Combined with Upper Blepharoplasty ...... 503 Allen M. Putterman 1 61 Müller’s Muscle–Conjunctival Resection Pearls: Phenylephrine and Resection Considerations ...... 506 Melanie H. Erb and Steven C. Dresner 1 62 Avoiding Lid Contour Abnormalities in Müller’s Muscle–Conjunctival Resection: Recognizing the Lateral Shift ...... 508 Michael E. Migliori 1 63 Müller’s Muscle–Conjunctival Resection Procedure Tips ...... 509 Melanie H. Erb and Steven C. Dresner

Section Three Entropion 164 Minimally Invasive, Three-Step, Transconjunctival Entropion Repair ...... 513 Francesco P. Bernardini Contents xxi

165 Simple Entropion Repair Using the Orbicularis Strip . . . 515 Don Liu 166 Simple “Bedside” Cautery Entropion Repair ...... 517 David J. Singer

Section Four Ectropion 167 “Simple-Dimple” Lateral Tarsus Fixation ...... 521 William L. Walter 168 Lower Lid Retractor Dissection ...... 524 Jeffrey P. Edelstein 169 Simple Lower Lid Tightening Without Tarsal Strip ...... 525 Don Liu 170 Technique for Medical Canthal Flap to Correct Lid Retraction/Medial Ectropion ...... 526 Kathleen M. Duerksen 171 Medial Canthorraphy ...... 528 Francesco P. Bernardini 172 Myocutaneous Flaps and Canthopexy for Repair of Severe Cicatricial Ectropion ...... 531 James Leong and Raf Ghabrial

Index ...... 533 Contributors

Richard L. Anderson, MD, FACS Medical Director, Center for Facial Appearances, Salt Lake City, UT, USA

Sterling S. Baker, MD Assistant Clinical Professor, Department of Ophthalmology, Adjunct Clinical Professor, Department of Dermatology, University of Okla- homa College of Medicine, Oklahoma City, OK, USA

Leslie Baumann, MD Professor, University of Miami, Miami Heart Institute, Department of Dermatology, Miami Beach, FL, USA

Kenneth R. Beer, MD Director, The Palm Beach Esthetic Center, Voluntary Assistant Professor, University of Miami, West Palm Beach, FL, USA

Francesco P. Bernardini, MD Ospedale Evangelico Internazionale, Department of Ophthalmology, Genova, Italy

Diane S. Berson, MD Assistant Clinical Professor, Weill Medical College of Cornell Univer- sity, New York Presbyterian Hospital, Department of Ophthalmology, New York, NY, USA

Evan H. Black, MD Associate Professor, Wayne State University School of Medicine, Kresge Eye Institute, Department of Ophthalmology, Detroit, MI, USA

Sean M. Blaydon, MD Ophthalmic Plastic and Reconstructive Surgeon, Texas Oculoplastic Consultants, Austin, TX, USA

xxiii xxiv Contributors

Cat Nguyen Burkat, MD Assistant Professor, Ophthalmic Plastic and Reconstructive Surgery, University of Wisconsin, Madison, WI, USA

John R. Burroughs, MD Medical Director, Eye and Facial Appearances, Colorado Springs, CO, USA

Kimberly J. Butterwick, MD Scripps Memorial Hospital, La Jolla, CA, USA

William P.D. Chen, MD, FACS Clinical Professor, UCLA School of Medicine, Harbor-UCLA Medical Center, Department of Ophthalmology, Long Beach, CA, USA

Howard Conn, MD Private Practice, Irvine, CA, USA

Philip L. Custer, MD Professor, Washington University School of Medicine, Department of Ophthalmology and Visual Sciences, St. Louis, MO, USA

Roger A. Dailey, MD, FACS Lester Jones Chair, Oculofacial Plastic Surgery, Oregon Health and Sci- ences University, Division of Oculofacial Plastic & Reconstructive Surgery, Portland, OR, USA

Sheri L. DeMartelaere, MD, FACS Assistant Professor, Uniformed Services, University of the Health Sci- ences, Director, Ocular and Orbital Trauma Service, Brooke Army Medical Center, Department of Surgery, San Antonio, TX, USA

Martin H. Devoto, MD Director, Consultores Oftalmologicos, Division of Oculoplastic and Orbital Surgery, Buenos Aires, Argentina

Lisa M. Donofrio, MD Associate Clinical Professor, Yale University School of Medicine, Department of Dermatology, New Haven, CT, USA

Jeffrey S. Dover, MD SkinCare Physicians, Chestnut Hill, MA, USA

Steven C. Dresner, MD Associate Clinical Professor, University of Southern California, Depart- ment of Ophthalmology, Los Angeles, CA, Eyesthetica Inc., Santa Monica, CA, USA

Kathleen M. Duerksen, MD, FACS Private Practice, Tuscon, AZ, USA Contributors xxv

Jeffrey P. Edelstein, MD Private Practice, Chandler, AZ, USA

Andrew S. Eiseman, MD Assistant Professor, Uniformed Services University of the Health Sciences, Chief, Oculoplastics and Orbit Disease Center, Department of Surgery, Walter Reed Army Medical Center, Eye Clinic, Washington D.C., USA

Yoash R. Enzer, MD Assistant Clinical Professor, Warren Albert School of Medicine of Brown University, Rhode Island Hospital, Department of Surgery, Divi- sion of Ophthalmology, Providence, RI, USA

Melanie H. Erb, MD Assistant Clinical Professor, University of California at Irvine, Depart- ment of Ophthalmology, Irvine, CA, University of Southern California, Department of Ophthalmology, Los Angeles, CA, Eyesthetica Inc., Santa Monica, CA, USA

Robert G. Fante, MD Clinical Associate Professor, University of Colorado, Departments of Ophthalmology and Otolaryngology, Denver, CO, USA

Jill A. Foster, MD Associate Clinical Professor, The Ohio State University, The Eye Center of Columbus, Department of Ophthalmology, Columbus, OH, USA

Raf Ghabrial, MBBS, FRANZCO Senior Lecturer, University of Sydney, Sydney Oculoplastic Surgery, Sydney, Australia

Geoffrey J. Gladstone, MD Co-director of Oculofacial Surgery, William Beaumont Hospital, Depart- ment of Ophthalmology, Southfifield, MI, USA

Mark J. Glasgold, MD Clinical Assistant Profesor, Robert Wood Johnson Medical School, Department of Surgery, Highland Park, NJ, USA

Robert A. Glasgold, MD Clinical Assistant Professor, Robert Wood Johnson Medical School, Department of Surgery, Highland Park, NJ, USA

Herbert J. Glatt, MD University of Tennessee Medical Center, Department of Surgery, Knox- ville, TN, USA

Russell S. Gonnering, MD, FACS Clinical Professor, The Medical College of Wisconsin, Department of Ophthalmology, Brookfifield, WI, USA xxvi Contributors

Andrea N. Hass, MD Hass Plastic Surgery and Medispa, Palm Beach Gardens, FL, USA

Morris E. Hartstein, MD, FACS Clinical Associate Professor, Saint Louis University, Department of Ophthalmology and Division of Plastic and Reconstructive Surgery, St. Louis, MO, USA

R. Jeffrey Hofmann, MD Assistant Clinical Professor, Brown University, Rhode Island Eye Insti- tute, Department of Ophthalmology, Providence, RI, USA

David E.E. Holck, MD Chairman, Department of Ophthalmology, The University of Texas at San Antonio, Health Sciences Center, Director, Oculofacial Plastics and Orbital Service, Wilford Hall Medical Center, Department of Ophthal- mology, San Antonio, TX, USA

John B. Holds, MD, FACS Clinical Professor, Saint Louis University, Departments of Ophthalmol- ogy and Otolaryngology-Head and Neck Surgery, St. Louis, MO, USA

Erin L. Holloman, MD Private Practice, Oklahoma City, OK, USA

David F. Horne, MD Assistant Clinical Professor, Cornell University, New York Presbyterian Hospital, Department of Dermatology, New York, NY, USA

Edsel Ing, MD, FRCSC Assistant Professor, University of Toronto, Toronto East General Hos- pital, Toronto, Ontario, Canada

Derek H. Jones, MD Clinical Assistant Professor, David Geffen School of Medicine at UCLA, Department of Dermatology, Los Angeles, CA, USA

Kevin A. Kalwerisky, MD Fellow, Oculofacial Plastic Surgery, The University of Texas at San Antonio, Health Sciences Center, Wilford Hall Medical Center, Depart- ment of Ophthalmology, San Antonio, TX, USA

Michael S. Kaminer, MD Assistant Professor, Yale Medical School, New Haven, CT, Dartmouth Medical School, Hanover, NH, Department of Dermatology, SkinCare Physicians of Chestnut Hill, Chestnut Hill, MA, USA

Andrew J. Kaufman, MD, FACP Assistant Clinical Professor, David Geffen School of Medicine at UCLA, Center for Dermatology Care, Los Angeles, CA, USA Contributors xxvii

Jemshed A. Khan, MD Clinical Professor, Kansas University School of Medicine, Kansas Uni- versity Medical Center, Department of Ophthalmology, Kansas City, MO, USA

Don O. Kikkawa, MD Clinical Professor, Chief, Division of Oculofacial Plastic and Recon- structive Surgery, University of California, San Diego, Department of Ophthalmology, La Jolla, CA, USA

Bobby S. Korn, MD, PhD Assistant Professor, University of California, San Diego School of Medi- cine, Shiley Eye Center, Department of Ophthalmology, Division of Oculofacial Plastic & Reconstructive Surgery, La Jolla, CA, USA

Bradley T. Kovach, MD Florida Coastal Dermatology Associates, Naples, FL, USA

Samuel M. Lam, MD, FACS Facial Plastic Surgeon, Lam Facial Plastics, Plano, TX, USA

Gustavo H. Leibaschoff, MD President, ICAM USA, Inc., Director, International School of Meso- therapy, Dallas, TX, USA

James Leong, MBBS, MMed Clinical Associate Lecturer, University of Sydney, Sydney Eye Hospital, Sydney, Australia

Peter S. Levin, MD Clinical Adjuvant Professor, Stanford University School of Medicine, Department of Ophthalmology, Mountain View, CA, USA

Don Liu, MD Professor, University of Missouri, Department of Ophthalmology, Columbia, MO, USA

Manuel A. Lopez, MD Director, Facial Plastics Service, The University of Texas at San Antonio, Health Sciences Center, Wilford Hall Medical Center, Department of Otolaryngology, San Antonio, TX, USA

Mark J. Lucarelli, MD Associate Professor, University of Wisconsin, Director, Oculoplastics Service, Department of Ophthalmology and Visual Sciences, Madison, WI, USA

William P. Mack, MD Clinical Assistant Professor, University of South Florida, Department of Ophthalmology, Tampa, FL, USA xxviii Contributors

Geva Mannor, MD, MPH Head, Oculoplastic Surgery, SCRIPPS Clinic, Department of Ophthal- mology, La Jolla, CA, USA

Guy G. Massry, MD Director, Ophthalmic Plastic and Reconstructive Surgery, American Eye Institute, Cedars Sinai Medical Center, Los Angeles, CA, Spalding Dr. Cosmetic Surgery and Dermatology, Beverly Hills, CA, Davidorf Eye Group, West Hills, CA, USA

Seth L. Matarasso, MD Clinical Profesor, University of California, San Francisco, Department of Dermatology, San Francisco, CA, USA

Joseph A. Mauriello Jr., MD Ophthalmic Plastic and Reconstructive Surgeon, University of Medicine and Dentistry of New Jersey, Summit, NJ, USA

Robert A. Mazzoli, MD, FACS Consultant in Ophthalmology to the Surgeon General, Director, Ophthalmic Plastic, Reconstructive and Orbital Surgery, Associate Professor, Uniformed Services University of the Health Sciences, Bethesda, MD, Madigan Army Medical Center, Tacoma, WA, USA

John D. McCann, MD, PhD Medical Director, The Center for Facial Appearances, Salt Lake City, UT, USA

Clinton D. McCord, Jr., MD Associate Clinical Professor, Emory University School of Medicine, Paces Plastic Surgery and Recovery Center, Atlanta, GA, USA

Michael E. Migliori, MD, FACS Clinical Associate Professor, The Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Department of Ophthalmol- ogy, Providence, RI, USA

Yasaman Mohadjer, MD Washington University in St. Louis, Department of Ophthalmology and Visual Sciences, St. Louis, MO, USA

Brent R. Moody, MD Assistant Professor, Vanderbilt University, Department of Dermatol- ogy, Nashville, TN, USA

Asa D. Morton, III, MD Director, Ophthalmic and Facial Plastic Surgery, Eye Care Center of San Diego, San Diego, CA, USA Contributors xxix

Shoib Myint, DO, FAACS, FACO Ophthalmic and Facial Plastic Surgeon, Co-director, Beaumont Eye Institute, William Beaumont Hospital, Department of Ophthalmology, Southfifield, MI, USA

Paul S. Nassif, MD, FACS Spalding Drive Cosmetic Surgery & Dermatology, Beverly Hills, CA, USA

Frank A. Nesi, MD Associate Clinical Professor, Kresge Eye Institute, Wayne State University School of Medicine, William Beaumont Hospital, Department of Ophthalmology and Otolaryngology, Royal Oak, MI, USA

Russell W. Neuhaus, MD Ophthalmic Plastic and Reconstructive Surgeon, Texas Oculoplastic Consultants, Austin, TX, USA

Joseph Niamtu, III, DMD Private Practice, Cosmetic Facial Surgery, Richmond, VA, USA

John Pak, MD, PhD Oculoplastic Surgeon, Wheaton Eye Clinic, Department of Ophthalmol- ogy, Wheaton, IL, USA

Allen M. Putterman, MD Professor of Ophthalmology, Co-Director, Oculofacial Plastic Surgery, University of Illinois School of Medicine, Michael Reese Hospital and Medical Center, Chicago, IL, USA

Oscar M. Ramirez, MD, FACS Clinical Assistant Professor, The John’s Hopkins University School of Medicine, Baltimore, MD, Esthetique Internationale, Timonium, MD, USA

Camilo O. Reyes, MD Clinical Fellow, Esthetique Internationale, Timonium, MD, USA

O. Bailey Robertson, DDS Director, Facial Plastics Services, Wilford Hall Medical Center, Department of Oral and Maxillofacial Surgery, San Antonio, TX, USA

Thomas E. Rohrer, MD SkinCare Physicians of Chestnut Hill, Chestnut Hill, MA, USA

Elizabeth F. Rostan, MD Private Practice, Dermatology and Cosmetic Surgery Center of Char- lotte, Charlotte, NC, USA xxx Contributors

Vivian Schiedler, MD Oculoplastics and Orbital Consultants, Charlottesville, VA, USA

Stuart R. Seiff, MD Emeritus Professor, University of California, San Francisco, Chief, San Francisco General Hospital, Department of Ophthalmology, San Francisco, CA, USA

Todd R. Shepler, MD Ophthalmic Plastic and Reconstructive Surgeon, Texas Oculoplastic Consultants, Austin, TX, USA

John W. Shore, MD Ophthalmic Plastic and Reconstructive Surgeon, Texas Oculoplastic Consultants, Austin, TX, USA

John D. Siddens, DO Ophthalmic Plastic Surgery Clinical Instructor, University of South Car- olina School of Medicine, Department of Ophthalmology, Columbia, SC, USA

Rona Z. Silkiss, MD Chief, Division of Ophthalmic Plastic Reconstructive and Orbital Surgery, California Pacififi c Medical Center, Department of Ophthalmol- ogy, San Francisco, CA, USA

Guy Ben Simon, MD Tel Aviv University, Goldschleger Eye Institute, Department of Oph- thalmology, Ramat Gan, Israel

David J. Singer, MD, FACS Associate Clinical Professor, University of Miami School of Medicine, Anne Bates Leach Eye Hospital of Bascom Palmer Eye Institute, Department of Ophthalmology, Miami, FL, Aspen Valley Hospital, Aspen, CO, USA

Bryan S. Sires, MD, PhD Allure Laser Center and Medispa, Kirkland, WA, USA

Charles B. Slonim, MD, FACS Clinical Professor, University of South Florida College of Medicine, Department of Ophthalmology, Tampa, FL, USA

Eric A. Steele, MD Assistant Professor, Oregon Health & Sciences University, Department of Oculofacial Plastic and Reconstructive Surgery, Portland, OR, USA

William L. Walter, MD Emeritus Staff, Washington University Medical Department, Barnes Hospital, Private Practice, St. Louis Eye Clinic, St. Louis, MO, USA Contributors xxxi

John J. Woog, MD Professor, Mayo Clinic, Department of Ophthalmology, Rochester, MN, USA

Michael T. Yen, MD Associate Professor, Baylor College of Medicine, Department of Oph- thalmology, Houston, TX, USA