Complications in Minimally Invasive Facial Rejuvenation : Prevention and Management

**__Expert guidance on minimizing and managing risks for a wide array of facial procedures__** The demand for minimally invasive facial procedures has increased exponentially over the past 20 years. In fact, an AAFPRS survey estimated that 80% of cosmetic facial procedures performed by their surgeons in 2019 were minimally invasive. Given the vast number of patients and underqualified practitioners administering facial surgery treatments, complications and poor outcomes are a significant issue. Complications in Minimally Invasive Facial Rejuvenation: Prevention and Management by internationally prominent facial plastic surgeon Paul J. Carniol, renowned dermatologists Mathew M. Avram and Jeremy A. Brauer, and esteemed colleagues fills a gap in the literature. Organized in five sections and 19 chapters, the book starts with discussions of appropriate patient selection, anesthesia considerations, relevant anatomy, and potentially toxic smoke plumes generated by laser treatments and electrocautery. Section two details fillers and fat transfers for volume restoration, neuromodulators to reduce the appearance of wrinkles, and deoxycholic acid to treat submental fat. Section three covers high-energy devices and procedures such as laser resurfacing, chemical peels, vascular and pigment laser and light sources, radiofrequency, and microneedling. The final two sections feature discussion of liposuction and cryolipolysis, followed by the minimally invasive procedures threadlifting, face and neck lifts, hair transplantation, and blepharoplasty. **Key Highlights** * Important insights on avoidance and management of adverse complications such as diplopia, ptosis, deformities, and asymmetry, as well as potentially life-threatening cerebrovascular accidents, visual loss, skin loss, and infection * Extensive detailed illustrations and surgical photographs improve visual understanding of anatomical topography * High-quality videos enhance knowledge of surgical nuances, potential pitfalls, and preventive measures to avoid problems This is an essential reference for dermatology, plastic surgery, and otolaryngology residents and fellows. Practitioners who specialize in cosmetic dermatology and facial plastic surgery will also find this an invaluable surgical companion. This book includes complimentary access to a digital copy on https://medone.thieme.com. Complications in Minimally Invasive Facial Rejuvenation: Prevention and Management MedOne Information Title Page Copyright Dedication Contents Videos Foreword Preface Contributors Section I: Complications Prevention Essentials 1 General Approach: The Consultation—Patient Evaluation 1.1 Introduction 1.2 Assessment of Expectations 1.3 Assessment for Body Dysmorphic Disorder 1.4 Accurate History Taking 1.5 Preoperative Counseling 1.6 Conclusion 2 Anesthesia for Minimally Invasive Facial Aesthetic Surgery 2.1 The Office-Based Surgery Setting 2.2 Preprocedure Preparation 2.3 Local Anesthesia 2.3.1 Topical Local Anesthesia 2.3.2 Subcutaneous or Tissue Infiltration 2.3.3 Regional Nerve Blocks 2.3.4 Tumescent Anesthesia 2.3.5 Cryoanesthesia 2.3.6 Oral Sedation 2.3.7 Monitored Anesthesia Care 2.4 Laser-Anesthesia Complications 2.4.1 Fire 2.5 Recovery and Discharge 2.6 Conclusion 3 Anatomy 3.1 Introduction 3.2 Skin Anatomy 3.2.1 Epidermis 3.2.2 Dermis 3.3 Forehead Anatomy 3.3.1 Central Forehead and Glabella 3.3.2 Temporal Fossa 3.4 Periorbital Anatomy 3.4.1 Upper and Lower Eyelids 3.4.2 Eyebrows 3.5 Midface 3.5.1 Lid/Cheek Junction 3.5.2 Cheek 3.6 Nasal Anatomy 3.6.1 Skin–Soft Tissue Envelope 3.6.2 Deep 3.7 Facial Nerve Branches 3.7.1 Frontal Branch 3.7.2 Zygomatic Branch 3.7.3 Buccal Branch 3.7.4 Marginal Branch 3.7.5 Cervical Branch 4 Plumes, Laser/Cautery 4.1 Introduction 4.2 Inorganic Contents of the Plume 4.3 Organic Contents of the Plume 4.4 Protective Strategies Section II: Injectables: Avoiding and Managing Complications 5 Fillers 5.1 Introduction 5.2 General Principles 5.2.1 Patient-Related Factors 5.2.2 Product-Related Factors 5.2.3 Technique-Related Factors 5.2.4 Pretreatment Prophylaxis 5.3 Adverse Reactions and Complications 5.4 Early Adverse Reactions and Management of Complications 5.4.1 Bruising 5.4.2 Edema 5.4.3 Placement Related: Inappropriate Placement and Depth, Overcorrection 5.4.4 A Tool for Management of Early Adverse Events: Use of Blunt-Tip Cannula 5.5 Inflammatory Reactions 5.5.1 Allergic Reactions and HA Hypersensitivity 5.5.2 Acute Infection 5.6 Vascular Events 5.6.1 Anatomic Considerations and Mechanisms 5.6.2 Technique 5.6.3 Identification 5.6.4 Treatment and Management of Vascular Compromise 5.7 Specific Considerations 5.7.1 Blindness 5.8 Delayed Adverse Reactions and Management of Complications 5.8.1 Noninflammatory Nodules 5.8.2 Inflammatory Reactions Including Infection and Granuloma Formation 6 Fat Transfers 6.1 Introduction 6.2 Risks and Complications 6.3 Vascular Occlusion 6.4 Atypical Infections 6.5 Fat Necrosis 6.6 Treatment of Facial Fat Necrosis 6.7 Conclusion 7 Neuromodulators for Muscle Induced Wrinkles 7.1 Introduction 7.2 Upper Face 7.3 Midface 7.4 Lower Face 7.5 Neck 8 Deoxycholic Acid 8.1 Description of Technology/Procedures 8.1.1 Introduction 8.1.2 Mechanism of Action 8.2 Optimizing Use and Avoiding Complications 8.2.1 Clinical Trials 8.2.2 Determination of Ideal Patient 8.2.3 Assessing Preplatysmal Fat 8.2.4 Proper Injection Technique 8.2.5 Common Complications 8.2.6 Complications: Nerve Injury 8.2.7 Complications: Skin Ulceration and Necrosis 8.2.8 Complications: Dysphagia 8.2.9 Complications: Alopecia 8.3 Early Identification of Complications 8.4 Managing Complications 8.5 Conclusion Section III: High Energy Devices: Avoiding and Managing Complications 9 Laser Resurfacing 9.1 Introduction 9.2 Key Points for Maximizing Safety with Lasers and Other Energy Devices 9.3 Key Points for Maximizing Safety with Shallower-Penetrating Lasers and Energy Devices 9.4 Fractional Laser Systems 9.4.1 Nonablative Fractional Laser Systems 9.4.2 Microneedling and RF Pins/Needles 9.5 Nonfractional Ablative Treatment 9.6 Key Points for Maximizing Safety in the Eye Area 9.7 Key Points for Maximizing Safety in the Perioral/Cheek Area 9.8 Key Points for Maximizing Safety in Different Skin Types 9.9 Ethnic Skin 9.10 Tanned/Solar-Damaged Skin 9.11 X-Irradiated Skin 10 Chemical Peels 10.1 Background 10.2 Patient Selection 10.3 Preoperative Guidelines 10.4 Complication Prevention 10.5 Infection Prophylaxis 10.6 Complication Management 10.6.1 Delayed Reepithelialization 10.7 Scarring 10.7.1 Infection 10.7.2 Erythema and Hyperpigmentation 10.7.3 Hypopigmentation 10.7.4 Cardiac Arrhythmia 10.8 Conclusion 11 Vascular and Pigment Laser and Light Sources 11.1 Vascular and Pigment Laser and Light Sources 11.1.1 Laser Treatment of Vascular Lesions 11.1.2 Choice of Device—Wavelength and Pulse Duration 11.1.3 Enhancing Outcomes in the Treatment of Vascular Lesions 11.2 Laser Treatment of Pigmented Lesions 11.2.1 Nanosecond and Picosecond Lasers (1,064 nm, 755 nm, 532 nm) 11.2.2 Long-Pulsed Lasers (532 nm, 595 nm, 755 nm, 800–890 nm, 1,064 nm) 11.2.3 Light Sources 11.2.4 Pigment Nonspecific Lasers 11.2.5 Combination of Lasers 11.3 Managing Complications from Laser Treatment of Vascular and Pigmented Lesions 11.4 Conclusion 12 Radiofrequency and Microneedle Radiofrequency 12.1 Introduction 12.2 Science of RF 12.3 Neocollagenesis 12.4 Methods of RF Delivery 12.5 Safety Measures 12.6 Patient Selection 12.7 Complications 12.7.1 Prolonged Swelling, Erythema, Discomfort 12.7.2 Postinflammatory Hyperpigmentation (PIH) 12.7.3 Second-Degree Burn 12.7.4 Fat Loss 12.7.5 Textural Abnormalities 12.7.6 Acne Flair/Infection 12.7.7 Dysesthesia/Neuropraxia 12.7.8 Seroma/Cyst 12.8 Conclusion 13 Complications of Platelet-Rich Plasma and Microneedling 13.1 Platelet-Rich Plasma—An Introduction 13.2 Platelet-Rich Plasma—Avoiding, Identifying, and Managing Complications 13.3 Microneedling—An Introduction 13.4 Microneedling—Avoiding, Identifying, and Managing Complications Section IV: Lipo Reduction: Avoiding and Managing Complications 14 Liposuction 14.1 Background 14.2 Preoperative Evaluation 14.2.1 Physical Examination and Laboratory Evaluation 14.2.2 Anesthetic Planning 14.2.3 Selecting the Right Tools to Optimize Aesthetic Results 14.3 Procedure 14.3.1 Cannulas 14.3.2 General Principles of Surgical Technique 14.3.3 Malar Fat Pad and Cheek Contouring 14.3.4 Treatment of the Nasolabial Fold and Pretragal Sulcus 14.3.5 Treatment of the Jowl 14.3.6 Submental Liposuction 14.3.7 Facial and Periorbital Autologous Fat Transfer 14.3.8 Liposuction of Other Body Sites 14.4 Postoperative Considerations 14.5 Minimizing Risks 14.6 Management of Complications 14.6.1 Pain and Edema 14.6.2 Vascular Complications 14.6.3 Suboptimal Aesthetic Outcomes 14.6.4 Perforation Injury 14.6.5 Intravascular Volume Redistribution 14.6.6 Nerve Injury 14.6.7 Infection 14.6.8 Seroma 14.6.9 Delayed Improvement 14.6.10 Lidocaine Toxicity 14.7 Conclusions 15 Cryolipolysis 15.1 Introduction 15.2 Cryolipolysis Mechanism of Action 15.3 Safety Profile of Cryolipolysis 15.4 Paradoxical Adipose Hyperplasia in Cryolipolysis 15.5 Delayed Post-treatment Pain in Cryolipolysis 15.6 Miscellaneous Complications in Cryolipolysis 15.7 Introduction to ATX-101 15.8 Safety Profile of ATX-101 15.9 Marginal Mandibular Nerve Injury with ATX-101 15.10 Vascular Complications in ATX-101 15.11 Conclusion Section V: Minimally Invasive Surgery: Avoiding and Managing Complications 16 Thread Lift 16.1 Introduction 16.2 Complications 16.3 PDO Threads 16.4 Prevention of Complications Utilizing PDO Threads 16.4.1 Patient Selection 16.4.2 Patient Informed Consent 16.4.3 Treatment Protocols 16.4.4 Posttreatment Instructions and Protocols 16.5 Management of Complications 16.5.1 Bruising 16.5.2 Mild-to-Moderate Puckering/Irregularity 16.5.3 Severe Puckering/Irregularity of Superficial Placement of Threads 16.5.4 Infection 16.6 Conclusion 17 SMAS Lift 17.1 Introduction 17.2 Indications and Patient Selection 17.3 Surgical Technique 17.3.1 Procedure Details 17.3.2 Optimizing Results 17.4 Complications 17.4.1 Minimizing Risk and Complications 17.4.2 Early Identification of Complications 17.4.3 Management of Complications 18 Hair Transplantation 18.1 Introduction 18.2 Current Hair Transplantation Technique 18.3 Unfavorable Results in Hair Transplantation 18.3.1 Hairline that is Too Low and/or Too Straight. 18.3.2 Grafts Too Large (Too Many Hairs Per Graft) Giving a Clumpy (Pluggy) Appearance 18.3.3 Scarring Alopecia of the Donor Site 18.3.4 Poor Hair Growth After Hair Transplantation 18.4 Conclusion 19 Blepharoplasty 19.1 Introduction 19.2 Patient Evaluation 19.3 Common Postoperative Problems: Their Avoidance and Correction 19.3.1 Upper Eyelid Blepharoplasty Complications 19.3.2 Lower Eyelid Blepharoplasty Complications 19.3.3 Uncommon/Catastrophic Blepharoplasty Complications 19.4 Conclusion Index Additional MedOne Information Expert guidance on minimizing and managing risks for a wide array of facial procedures The demand for minimally invasive facial procedures has increased exponentially over the past 20 years. In fact, an AAFPRS survey estimated that 80% of cosmetic facial procedures performed by their surgeons in 2019 were minimally invasive. Given the vast number of patients and underqualified practitioners administering facial surgery treatments, complications and poor outcomes are a significant issue. Complications in Minimally Invasive Facial Rejuvenation: Prevention and Management by internationally prominent facial plastic surgeon Paul J. Carniol, renowned dermatologists Mathew M. Avram and Jeremy A. Brauer, and esteemed colleagues fills a gap in the literature. Organized in five sections and 19 chapters, the book starts with discussions of appropriate patient selection, anesthesia considerations, relevant anatomy, and potentially toxic smoke plumes generated by laser treatments and electrocautery. Section two details fillers and fat transfers for volume restoration, neuromodulators to reduce the appearance of wrinkles, and deoxycholic acid to treat submental fat. Section three covers high-energy devices and procedures such as laser resurfacing, chemical peels, vascular and pigment laser and light sources, radiofrequency, and microneedling. The final two sections feature discussion of liposuction and cryolipolysis, followed by the minimally invasive procedures threadlifting, face and neck lifts, hair transplantation, and blepharoplasty. Key Highlights Important insights on avoidance and management of adverse complications such as diplopia, ptosis, deformities, and asymmetry, as well as potentially life-threatening cerebrovascular accidents, visual loss, skin loss, and infection Extensive detailed illustrations and surgical photographs improve visual understanding of anatomical topography High-quality videos enhance knowledge of surgical nuances, potential pitfalls, and preventive measures to avoid problems This is an essential reference for dermatology, plastic surgery, and otolaryngology residents and fellows. Practitioners who specialize in cosmetic dermatology and facial plastic surgery will also find this an invaluable surgical companion. This book includes complimentary access to a digital copy on https://medone.thieme.com . "The demand for minimally invasive facial procedures has increased exponentially over the past 20 years. In fact, an AAFPRS survey estimated that 80% of cosmetic facial procedures performed by their surgeons in 2019 were minimally invasive. Given the vast number of patients and underqualified practitioners administering facial surgery treatments, complications and poor outcomes are a significant issue. Complications in Minimally Invasive Facial Rejuvenation: Prevention and Management by internationally prominent facial plastic surgeon Paul J. Carniol, renowned dermatologists Matthew M. Avram and Jeremy A. Brauer, and esteemed colleagues fills a gap in the literature. Organized in five sections and 19 chapters, the book starts with discussions of appropriate patient selection, anesthesia considerations, relevant anatomy, and potentially toxic smoke plumes generated by laser treatments and electrocautery. Section two details fillers and fat transfers for volume restoration, neuromodulators to reduce the appearance of wrinkles, and deoxycholic acid to treat submental fat. Section three covers high-energy devices and procedures such as laser resurfacing, chemical peels, vascular and pigment laser and light sources, radiofrequency, and microneedling. The final two sections feature discussion of liposuction and cryolipolysis, followed by the minimally invasive procedures threadlifting, face and neck lifts, hair transplantation, and blepharoplasty. Key Highlights Important insights on avoidance and management of adverse complications such as diplopia, ptosis, deformities, and asymmetry, as well as potentially life-threatening cerebrovascular accidents, visual loss, skin loss, and infection Extensive detailed illustrations and surgical photographs improve visual understanding of anatomical topography High-quality videos enhance knowledge of surgical nuances, potential pitfalls, and preventive measures to avoid problems This is an essential reference for dermatology, plastic surgery, and otolaryngology residents and fellows. Practitioners who specialize in cosmetic dermatology and facial plastic surgery will also find this an invaluable surgical companion"-- Provided by publisher