Upper Eyelid Gold Weight Implantation in the Asian Patient with Facial Paralysis

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Upper Eyelid Gold Weight Implantation in the Asian Patient with Facial Paralysis"

Transcription

1 Upper Eyelid Gold Weight Implantation in the Asian Patient with Facial Paralysis Phillip H. Choo, M.D., Susan R. Carter, M.D., and Stuart R. Seiff, M.D. Sacramento and San Francisco, Calif. Patients with facial paralysis may develop ophthalmic complications. Poor eyelid closure and lagophthalmos place the patient at increased risk for the development of corneal problems such as epithelial defects, stromal thinning, bacterial infection, and even perforation. Initial treatment should be conservative and include the use of ocular lubricants, moisture chambers, and taping of the lower eyelid into proper position. Surgical intervention may be required in patients who have failed medical therapy or in whom the facial paralysis is not expected to improve. Gold weight implantation in the upper eyelid has become a popular procedure to correct upper eyelid retraction and to improve corneal coverage. Previous descriptions of gold weight placement in the upper eyelid have focused on Caucasian eyelid anatomy. However, there are distinct anatomic differences between the Caucasian and Asian eyelids, which dictate the overlying aesthetic differences. We describe our technique for placement of a gold weight in the Asian upper lid, with attention to the maintenance of symmetric eyelid creases. We reviewed the charts of six Asian patients with facial paralysis who underwent gold weight placement in the upper eyelid for the correction of lid retraction. All patients did well functionally and aesthetically, and none developed an extrusion of the implant with this approach. (Plast. Reconstr. Surg. 105: 855, 2000.) Patients with facial paralysis can have numerous ophthalmic manifestations including upper eyelid retraction, lower eyelid ectropion, poor eyelid closure or lagophthalmos, and decreased tear production. Patients with these findings are at increased risk for developing complications secondary to corneal exposure, such as epithelial defects, stromal thinning, bacterial infection, and perforation. Initial treatment includes the use of ocular lubricants, moisture chambers, and taping of the lower eyelid into proper position. 1,2 However, some patients continue to have signs of corneal exposure even on maximal medical therapy. Others are stable on maximal medical therapy, but the facial paralysis fails to improve, and they are subsequently faced with the tedious work of continually lubricating the exposed cornea. These two categories of patients are candidates for surgical correction of lagophthalmos. 2 Gold weight implantation in the upper eyelid is an effective procedure to correct upper eyelid retraction in patients with facial paralysis and corneal compromise. 3 5 Previous descriptions of gold weight placement in the upper eyelid have focused on Caucasian eyelid anatomy. 6 However, there are distinct anatomic differences between the Caucasian and Asian eyelids, which are responsible for the overlying aesthetic differences. 7 9 Inferior descent of the brow fat pad or submuscular fibroadipose layer in the Asian eyelid, in combination with a low insertion point for the orbital septum, results in a low or indistinct eyelid crease and a fullappearing eyelid To maintain symmetry and the natural Asian appearance, these anatomic differences must be considered when a gold weight is implanted into an Asian upper eyelid. We describe our technique and review the results of Asian patients who have undergone this procedure. METHODS Preoperative Assessment The presence or absence of a crease is noted in both upper eyelids, and the height of the crease from the eyelid margin is measured. From the Ophthalmic Plastic and Reconstructive Surgery Service, Department of Ophthalmology at the University of California Davis, and the Division of Ophthalmic Plastic and Reconstructive Surgery at the Beckman Vision Center and Department of Ophthalmology, University of California San Francisco. Received for publication April 26, 1999; revised July 22, None of the above authors has any commercial association with the MedDev Corporation. 855

2 856 PLASTIC AND RECONSTRUCTIVE SURGERY, March 2000 The proper size gold weight is then selected for implantation by taping a progressively larger weight onto the skin of the retracted upper eyelid until lagophthalmos resolves. However, the weight should not be so heavy that it creates a significant ptosis. If further corneal coverage is necessary, a lower eyelid tightening procedure may be necessary at the same time as the gold weight placement. Surgical Procedure A preexisting eyelid crease is marked with a fine-tip marking pen just slightly wider than the width of the gold weight chosen for implantation. If no crease is present in either of the upper eyelids, an incision approximately 3 to 4 mm from the upper eyelid margin is marked. The medial extent of the incision should not extend past the superior punctum or into an epicanthal fold because of the risk for medial canthal webbing. An additional mark is placed at the margin in line with the center of the pupil in primary gaze. The upper eyelid is then injected with anesthetic solution, and the surgical field is prepared and draped under sterile conditions. A 4-0 silk traction suture is placed through the upper eyelid margin to retract the lid inferiorly. An incision through skin and pretarsal orbicularis oculi muscle is made. Dissection is carried down to the anterior surface of the tarsal plate. If either the submuscular fibroadipose layer or the preaponeurotic fat pads are encountered, care should be taken not to excise these structures. Instead, they should be retracted away from the field with a Desmarres retractor to increase visualization. Once dissection has been made to the anterior surface of the tarsal plate, a pocket to house the gold weight is made anterior to both the levator fibers and the tarsal plate. The pocket should be somewhat larger than the actual size of the gold weight and displaced slightly medial to the center of the pupil in primary position (Fig. 1, above). During the dissection and creation of the pocket, the attachments of the levator aponeurosis to the anterior surface of the tarsal plate should not be disinserted. Although a limited levator recession may be helpful in correcting the upper eyelid retraction, one may cause an iatrogenic ptosis. In addition, if facial nerve function improves and the weight is removed, the patient may be left with a residual ptosis. Instead, the gold weight should be placed anterior to the FIG. 1.(Above) Dissection has been made to the anterior surface of the tarsal plate, and a pocket for the gold weight has been created. Note the low crease incision and the preservation of the submuscular fibroadipose layer. (Center) Gold weight is secured in place with sutures placed through the positioning holes and into partial-thickness tarsal plate. The fibroadipose layer is then brought over the implant before closure. (Below) Immediate postoperative appearance of the right upper eyelid. fibers of the levator aponeurosis as well as the tarsal plate (see Fig. 3). Interrupted sutures are then placed through each of the three positioning holes of the gold weight and attached to the tarsal plate with partial-thickness bites. The eyelid must be everted and checked for full-thickness suture

3 Vol. 105, No. 3 / UPPER EYELID GOLD WEIGHT IMPLANTATION 857 passes. Full-thickness passes may lead to corneal abrasions or ulcers, which are extremely difficult to treat in facial palsy patients. The three sutures are then tied sequentially, applying only light pressure. This prevents buckling of the tarsal plate if there is uneven placement of the sutures in relation to the positioning holes. Once the gold weight is secured in place, the preaponeurotic fat pads and the submuscular fibroadipose layer are brought over the gold weight (Fig. 1, center). The orbicularis muscle layer and skin are then closed as separate layers (Fig. 1, below). RESULTS The charts of six Asian patients with facial paralysis who underwent placement of a gold upper eyelid weight (MedDev, Palo Alto, Calif.) were reviewed (Fig. 2). Four women and two men, ranging in age from 38 to 82, had unilateral facial palsies and corneal exposure. Etiology of the facial palsy was idiopathic in two patients and occurred following intracranial FIG. 2.(Above) Same patient 3 months after gold weight implantation in the right upper eyelid. Note the preservation of the single upper eyelid crease and the epicanthal fold to maintain the Asian appearance of this patient. (Below) Same patient on attempted eyelid closure. tumor resection in four patients. The range of gold weights used was 1.2 to 1.6 g. Follow-up ranged from 12 to 60 months, with a mean of 26.5 months. All patients experienced an improvement in corneal epithelial defects and lagophthalmos after placement of the gold weight. Infection, inflammation, migration, and extrusion were not observed in any of the patients. DISCUSSION The Asian upper eyelid crease has received much attention in the plastic surgery literature This interest has been promoted by the popularity of the Asian blepharoplasty or double eyelid surgery. In the past, some authors have focused on achieving a westernized or Caucasian appearance. 26,27 In our experience, most of the Asian patients whom we have consulted for an upper blepharoplasty have wanted to maintain their Asian appearance. The difference between the Asian and the Caucasian upper eyelid crease is dictated by the difference in the underlying anatomy. The upper eyelid crease forms at the highest point of attachment of the levator aponeurosis to the subcutaneous tissue. In Caucasians, the orbital septum inserts onto the anterior surface of the levator aponeurosis above the superior border of the tarsal plate and holds the preaponeurotic fat pads in place. This allows the anterior fibers of the levator aponeurosis to extend to the subcutaneous tissue at or above the superior border of the tarsal plate and to create a high upper eyelid crease. In Asians, the brow fat often descends inferiorly as the submuscular fibroadipose layer (Fig. 3). This layer provides fullness to the upper eyelid, acts as a barrier between the anterior fibers of the levator aponeurosis and the subcutaneous tissue, and prevents the formation of a high eyelid crease. Furthermore, in Asians the insertion site of the orbital septum onto the anterior surface of the levator aponeurosis is variable. In this area, the septum becomes diffuse and less prominent, allowing for the inferior descent of the preaponeurotic fat pads. It is this combination of a prominent submuscular fibroadipose layer, weak inferior septum, and the inferior descent of the preaponeurotic fat pads that can either prevent the formation of an eyelid crease (single eyelid) or create a low crease (double eyelid). These anatomic differences need to be con-

4 858 PLASTIC AND RECONSTRUCTIVE SURGERY, March 2000 FIG. 3. This diagram illustrates some of the differences between the Caucasian and Asian upper eyelids. Both the preaponeurotic fat pads (P) and the fibroadipose layer (F) descend more inferiorly in the Asian upper eyelid. The white arrows point to recommended incision sites for gold weight implantation. Notice that the incision should be made lower in the Asian eyelid. In addition, the gold weight (white rectangle) may be placed slightly lower on the tarsal plate in the Asian eyelid. In both cases, however, the gold weight is placed anterior to both the tarsal plate and the inferior fibers of the levator aponeurosis, which insert onto the surface of the tarsal plate. sidered when planning gold weight placement in the Asian patient. One should focus on maintaining symmetry with the unaffected side and take special steps during the procedure to maintain a low or single eyelid crease. First, one should avoid a high incision (generally 8 to 10 mm from the lash margin in the Caucasian eyelid), which may promote a bifid or a westernized crease. Instead, the incision should be kept low (3 to 4 mm from the lash margin) or at a preexisting crease if present (Fig. 3). Furthermore, one may encounter brow fat (submuscular fibroadipose layer) as well as the preaponeurotic fat pads during dissection toward the anterior surface of the tarsal plate. If this occurs, the brow fat and the preaponeurotic fat pads should be preserved. These layers act as a barrier between the anterior fibers of the levator aponeurosis and the overlying dermis and prevent the formation of an unwanted eyelid crease above the incision. In addition, these layers help to prevent an anterior extrusion of the gold weight implant and counteract upper eyelid retraction by providing an extra weight load. Another difference in technique between the Asian and Caucasian eyelids is the location of the gold weight implantation. In Caucasian eyelids, some surgeons prefer to place the gold weight high in the lid to reduce visibility of the weight. However, the weight in the Asian eyelid can be placed lower because it is camouflaged by both the preaponeurotic fat pads and the fibroadipose layer (Fig. 3). One criticism of the above technique may be the low incision. Catalano et al. 28 stated the importance of not overlapping any portion of the implant to prevent an extrusion. In our series, none of the patients has developed an extrusion. However, this is a serious concern, and we try to prevent this by covering part if not all of the implant with the submuscular fibroadipose layer and the preaponeurotic fat pads. Next, we advocate meticulous closure of

5 Vol. 105, No. 3 / UPPER EYELID GOLD WEIGHT IMPLANTATION 859 the orbicularis muscle and the overlying skin in two separate layers. In conclusion, with careful attention to the anatomic differences between Asian and Caucasian eyelid anatomy, one can implant a gold weight in the Asian upper eyelid to improve function while preserving the natural appearance of the Asian patient. Phillip H. Choo, M.D. University of California Davis Medical Center Department of Ophthalmology 4860 Y. Street, Suite 2400 Sacramento, Calif ACKNOWLEDGMENT This work was funded in part by the Research to Prevent Blindness Foundation. REFERENCES 1. Seiff, S. R., and Carter, S. R. Reanimation of the paretic eyelid complex. Facial Plast. Surg. Clin. North Am. 6: 21, Seiff, S. R., and Chang, J. S., Jr. The staged management of ophthalmic complications of facial nerve palsy. Ophthalmic Plast. Reconstr. Surg. 9: 241, Chapman, P., and Lamberty, B. G. H. Results of upper lid loading in the treatment of lagophthalmos caused by facial palsy. Br. J. Plast. Surg. 41: 369, Pickford, M. A., Scamp, T., and Harrison, D. H. Morbidity after gold weight insertion into the upper eyelid in facial palsy. Br. J. Plast. Surg. 45: 460, O Connell, J. E., and Robin, P. E. Eyelid gold weights in the management of facial palsy. J. Laryngol. Otol. 105: 471, Seiff, S. R., Sullivan, J. H., Freeman, L. N., and Ahn, J. Pretarsal fixation of gold weights in facial nerve palsy. Ophthalmic Plast. Reconstr. Surg. 5: 104, Seiff, S. R. Anatomy of the Asian eyelid. Facial Plast. Surg. Clin. North Am. 4: 1, Liu, D., and Hsu, W. M. Oriental eyelids: Anatomic difference and surgical consideration. Ophthalmic Plast. Reconstr. Surg. 2: 59, Carter, S. R., Seiff, S. R., Grant, P. E., et al. The Asian lower eyelid: A comparative anatomic study using high-resolution magnetic resonance imaging. Ophthalmic Plast. Reconstr. Surg. 14: 227, Hisatomi, C., and Fujin, T. Anatomic considerations concerning blepharoplasty in the Oriental patient. Adv. Ophthalmic Plast. Reconstr. Surg. 2: 151, Doxanas, M. T., and Anderson, R. L. Oriental eyelids: An anatomic study. Arch. Ophthalmol. 102: 1232, Kim, M. K., Rathbun, J. E., Aguilar, G. L., and Seiff, S. R. Ptosis surgery in the Asian eyelid. Ophthalmic Plast. Reconstr. Surg. 5: 118, Sayoc, B. T. Plastic construction of the superior palpebral fold. Am. J. Ophthalmol. 38: 556, Pang, H. G. Surgical formation of upper lid fold. Arch. Ophthalmol. 65: 783, Boo-Chai, K. Plastic construction of the superior palpebral fold. Plast. Reconstr. Surg. 31: 74, Sayoc, B. T. Anatomic consideration in the plastic reconstruction of a palpebral fold in the full upper eyelid. Am. J. Ophthalmol. 63: 155, Rubenzik, R. Surgical revision of the Oriental lid. Ann. Ophthalmol. 9: 1189, Zubiri, J. S. Correction of the Oriental eyelid. Clin. Plast. Surg. 8: 725, Doxanas, M. T., and Serra, F. Surgical revision of Oriental eyelids. Ophthalmic Surg. 16: 657, Chen, W. P. Asian blepharoplasty: Update on anatomy and techniques. Ophthalmic Plast. Reconstr. Surg. 3: 135, Weng, C. J., and Noordhoff, M. S. Complications of Oriental blepharoplasty. Plast. Reconstr. Surg. 83: 622, Fernandez, L. R. The East Asian eyelid: Open technique. Clin. Plast. Surg. 20: 247, Choi, A. K. Oriental blepharoplasty: Nonincisional suture technique versus conventional incisional technique. Facial Plast. Surg. 10: 67, Chen, W. P. Concept of triangular, trapezoidal, and rectangular debulking of eyelid tissues: Application in Asian blepharoplasty. Plast. Reconstr. Surg. 97: 212, Sergile, S. L., and Obata, K. Mikamo s double-eyelid operation: The advance of Japanese aesthetic surgery. Plast. Reconstr. Surg. 99: 662, McCurdy, J. A., Jr. Westernization of the Oriental eyelid. Otolaryngol. Head Neck Surg. 90: 142, Matsunaga, R. S. Westernization of the Asian eyelid. Arch. Otolaryngol. 111: 149, Catalano, P. J., Bergstein, M. J., and Biller, H. F. Comprehensive management of the eye in facial paralysis. Arch. Otolaryngol. Head Neck Surg. 121: 81, 1995.

Facial Nerve Paralysis: Management of the Eye

Facial Nerve Paralysis: Management of the Eye Facial Nerve Paralysis: Management of the Eye Facial Nerve Paralysis: Management of the Eye Introduction Anatomy Options Discussion of Literature Introduction-Facial Nerve Paralysis Functional and cosmetic

More information

Pretarsal Fixation of Gold Weights in Facial Nerve Palsy

Pretarsal Fixation of Gold Weights in Facial Nerve Palsy Ophthalmic Plastic and Reconstructive Surgery 5(2): 104-109. 1989. 104 1989 Raven Press, Ltd., New York Pretarsal Fixation of Gold Weights in Facial Nerve Palsy Stuart R. Seiff, M.D., John H. Sullivan,

More information

5 Upper eyelid blepharoplasty

5 Upper eyelid blepharoplasty 5 Upper eyelid blepharoplasty INSTRUMENTS Marking pen No. 15 scalpel blade Blade handle Castroviejo needle holder Castroviejo calipers 0.5 fixation forceps Westcott scissors 6-0 prolene suture Bovie cautery

More information

A clinical algorithm for the management of facial nerve palsy from an oculoplastic perspective

A clinical algorithm for the management of facial nerve palsy from an oculoplastic perspective A clinical algorithm for the management of facial nerve palsy from an oculoplastic perspective S.A. SADIQ, R.N. DOWNES Abstract Background/Aims Facial nerve palsy can be a sight-threatening complication.

More information

STANILA A.(1), BOTEZAN A.(1), COSTACHE I.(2), STANILA D.M.(1)

STANILA A.(1), BOTEZAN A.(1), COSTACHE I.(2), STANILA D.M.(1) STANILA A.(1), BOTEZAN A.(1), COSTACHE I.(2), STANILA D.M.(1) (1) The Faculty of Medicine "Victor Papilian, SIBIU, ROMANIA ; (2) Ocular Surface Research Center CCSO, SIBIU, ROMANIA The facial nerve is

More information

Lid Surgery (Blepharoplasty)

Lid Surgery (Blepharoplasty) Lid Surgery (Blepharoplasty) Blepharoplasty Blepharoplasty surgery involves the removal or redistribution of eyelid tissue. These tissues include skin, muscle and fat, all of which undergo changes with

More information

Ophthalmic Management of the Facial Palsy Patient

Ophthalmic Management of the Facial Palsy Patient Ophthalmic Management of the Facial Palsy Patient Philip L. Custer, M.D. 1 ABSTRACT The management of the ocular sequelae of facial palsy should be individualized for each patient. The patient s age, ocular

More information

Lateral Canthoplasty by the Micro-Mitek Anchor System: 10-Year Review of 96 Patients

Lateral Canthoplasty by the Micro-Mitek Anchor System: 10-Year Review of 96 Patients CRANIOMAXILLOFACIAL DEFORMITIES/COSMETIC SURGERY J Oral Maxillofac Surg 69:1745-1749, 2011 Lateral Canthoplasty by the Micro-Mitek Anchor System: 10-Year Review of 96 Patients Carmine Alfano, MD,* Stefano

More information

Management of the Eye in Facial Paralysis

Management of the Eye in Facial Paralysis 140 Mahsa Sohrab, MD 1 Usiwoma Abugo, MD 2 Michael Grant, MD, PhD 1 Shannath Merbs, MD, PhD 1 1 Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland 2 Department of Ophthalmology,

More information

Eyelid Reconstruction

Eyelid Reconstruction Eyelid Reconstruction Michael Underbrink, M.D. Faculty Advisor: Karen Calhoun, M.D. The University of Texas Medical Branch Department of Otolaryngology Grand Rounds Presentation December 18, 2002 Introduction

More information

Lower eyelid retraction, secondary to middle lamellar cicatrix,

Lower eyelid retraction, secondary to middle lamellar cicatrix, SURGICAL TECHNIQUE En-Glove Lysis of Lower Eyelid Retractors With AlloDerm and Dermis-Fat Grafts in Lower Eyelid Retraction Surgery Heather S. Chang, M.D.*, Diana Lee, B.S.*, Mehryar Taban, M.D.*, Raymond

More information

Corporate Medical Policy Reconstructive Eyelid Surgery and Brow Lift

Corporate Medical Policy Reconstructive Eyelid Surgery and Brow Lift Corporate Medical Policy Reconstructive Eyelid Surgery and Brow Lift File Name: Origination: Last CAP Review: Next CAP Review: Last Review: reconstructive_eyelid_surgery_and_brow_lift 1/2000 9/2015 9/2016

More information

Integumentary System Individual Exercises

Integumentary System Individual Exercises Integumentary System Individual Exercises 1. A physician performs an incision and drainage of a subcutaneous abscess in his office for a particularly uncooperative established patient. How should this

More information

Raising the suborbicularis oculi fat (SOOF): its role in chronic facial palsy

Raising the suborbicularis oculi fat (SOOF): its role in chronic facial palsy Br J Ophthalmol 2;84:141 146 141 Raising the suborbicularis oculi fat (SOOF): its role in chronic facial palsy Jane M Olver Western Eye Hospital, Marylebone Road, London NW1 5YE and Eye Department, Charing

More information

Blepharoplasty & Cosmetic eyelid surgery

Blepharoplasty & Cosmetic eyelid surgery Our cosmetic surgery team at The USF Eye Institute offers a wide variety of cosmetic procedures of the eyelids and face with the goal of obtaining a natural and rejuvenated appearance. Dr.Leyngold has

More information

Harvesting Fat from the Infratemporal Fossa

Harvesting Fat from the Infratemporal Fossa Techniques in Cosmetic Surgery Harvesting Fat from the Infratemporal Fossa Bahman Guyuron, M.D., and Kevin Rose, M.D. Cleveland, Ohio As part of forehead rejuvenation and surgical treatment of migraine

More information

Thyroid Eye Disease. Anatomy: There are 6 muscles that move your eye.

Thyroid Eye Disease. Anatomy: There are 6 muscles that move your eye. Thyroid Eye Disease Your doctor thinks you have thyroid orbitopathy. This is an autoimmune condition where your body's immune system is producing factors that stimulate enlargement of the muscles that

More information

Outcomes of Levator Resection at Tertiary Eye Care Center in Iran: A 10-Year Experience

Outcomes of Levator Resection at Tertiary Eye Care Center in Iran: A 10-Year Experience pissn: 1011-8942 eissn: 2092-9382 Korean J Ophthalmol 2012;26(1):1-5 http://dx.doi.org/10.3341/kjo.2012.26.1.1 Original rticle Outcomes of Levator Resection at Tertiary Eye Care Center in Iran: 10-Year

More information

The Modified Fasanella-Servat Procedure: Description and Quantified Analysis

The Modified Fasanella-Servat Procedure: Description and Quantified Analysis Original Investigation The Modified Fasanella-Servat Procedure: Description and Quantified Analysis David B. Samimi, M.D.*, Melanie H. Erb, M.D.*, Christianne J. Lane, Ph.D., and Steven C. Dresner, M.D.*

More information

Oculoplastic, Orbital and Lacrimal Fellowship Programme.

Oculoplastic, Orbital and Lacrimal Fellowship Programme. Oculoplastic, Orbital and Lacrimal Fellowship Programme. Faculty: Mr Raman Malhotra Mr Konal Saha (Oct 2012-Sept 2013) A. Definition and scope of the subspecialty The goal of fellowship training in oculoplastic

More information

Cosmetic Eyelid Surgery & Blepharoplasty (Eye Bag Removal)

Cosmetic Eyelid Surgery & Blepharoplasty (Eye Bag Removal) MR DAVID CHEUNG Consultant Ophthalmic and Oculoplastic Surgeon Contact Info NHS: Sandwell General Hospital, Birmingham PA: Denise Kaur 0121 507 3165 Russells Hall Hospital, Dudley : PA Jo Gough: 01384

More information

Complications of Strabismus Surgery

Complications of Strabismus Surgery Complications of Strabismus Surgery Tjeerd de Faber, Martha Tjon Rutger van Ruyven Alexis Damanakis Ondercorrectie Overcorrectie Wat vind je erger? 1 DELLEN Corneal dellen are small areas of thinning associated

More information

Tissue Reinforcement with Strattice Reconstructive Tissue Matrix following Correction of Severe Breast Deformity

Tissue Reinforcement with Strattice Reconstructive Tissue Matrix following Correction of Severe Breast Deformity Tissue Reinforcement with Strattice Reconstructive Tissue Matrix following Correction of Severe Breast Deformity Robert Cohen, MD, FACS* Paradise Valley, AZ Case summary A 41-year old woman with a history

More information

Traumatic Primary Eyelid and Facial Laceration Repair. Riva Lee Asbell Philadelphia, PA

Traumatic Primary Eyelid and Facial Laceration Repair. Riva Lee Asbell Philadelphia, PA Traumatic Primary Eyelid and Facial Laceration Repair Riva Lee Asbell Philadelphia, PA I INTRODUCTION I always have to work a little harder when coding for traumatic eyelid and facial repairs. There is

More information

OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY

OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY NASOLABIAL FLAP FOR ORAL CAVITY RECONSTRUCTION Harry Wright, Scott Stephan, James Netterville Designed as a true myocutaneous flap pedicled

More information

Examination of the Nerves. Assessment of nerve Function

Examination of the Nerves. Assessment of nerve Function Examination of the Nerves Assessment of nerve Function 1 Bacterial invasion and granuloma formation Nerve thickening Tenderness Nerve Damage (Loss of function) Reactions Visibly thickened or Palpable Nerves

More information

Institute of Ophthalmology. Thyroid Eye Disease. aka Thyroid Associated Ophthalmopathy

Institute of Ophthalmology. Thyroid Eye Disease. aka Thyroid Associated Ophthalmopathy Institute of Ophthalmology Thyroid Eye Disease aka Thyroid Associated Ophthalmopathy Causes TED/TAO is an eye disease associated with disease of the thyroid gland Most commonly, it occurs with an overactive

More information

ORIGINAL ARTICLE. Transconjunctival Lower Blepharoplasty. A Retrospective Comparison of Transposing Fat to the Subperiosteal vs Supraperiosteal Planes

ORIGINAL ARTICLE. Transconjunctival Lower Blepharoplasty. A Retrospective Comparison of Transposing Fat to the Subperiosteal vs Supraperiosteal Planes ORIGINAL ARTICLE Transconjunctival Lower Blepharoplasty With Fat Repositioning A Retrospective Comparison of Transposing Fat to the Subperiosteal vs Supraperiosteal Planes Donald B. Yoo, MD; Grace Lee

More information

ELECTROMYOLYSIS OF THE EYELID ORBICULARIS MUSCLE FOR THE TREATMENT OF EXTERNAL PERIORBITAL WRINKLES OR CROW S FEET

ELECTROMYOLYSIS OF THE EYELID ORBICULARIS MUSCLE FOR THE TREATMENT OF EXTERNAL PERIORBITAL WRINKLES OR CROW S FEET ELECTROMYOLYSIS OF THE EYELID ORBICULARIS MUSCLE FOR THE TREATMENT OF EXTERNAL PERIORBITAL WRINKLES OR CROW S FEET INTRODUCTION: External periorbital wrinkles are one of the most evident facial signs of

More information

Cosmetic blepharoplasty

Cosmetic blepharoplasty Atlas Oral Maxillofacial Surg Clin N Am 12 (2004) 91 130 Cosmetic blepharoplasty Joseph Niamtu, III, DDS Oral/Maxillofacial and Cosmetic Facial Surgery, 10230 Cherokee Road, Richmond, VA 23235, USA It

More information

SURGERY OF THE EYELIDS

SURGERY OF THE EYELIDS CHAPTER 7 SURGERY OF THE EYELIDS Eyelid disorders are common and their treatment is often surgical. Most eyelid diseases will produce three possible effects: 1. Cosmetic deformity. This may vary from being

More information

Ptosis. Patient Information - Adnexal

Ptosis. Patient Information - Adnexal Patient Information - Adnexal Ptosis What is ptosis? Ptosis is the medical name for the drooping of the upper eyelid, which can happen in one or both eyes. A low upper lid can interfere with vision by

More information

Bascom Palmer Eye Institute. Aesthetic Center

Bascom Palmer Eye Institute. Aesthetic Center Bascom Palmer Eye Institute Aesthetic Center Ophthalmic Plastic Surgery Complete eye health includes having healthy eyes and healthy eyelids. Common eyelid problems include excess skin and droopy eyes.

More information

Evaluation of the Cosmetic Patient

Evaluation of the Cosmetic Patient APC Ophthalmology Conference Evaluation of the Cosmetic Patient David K. Isaacs, M.D. Clinical instructor Loma Linda University Clinial Staff Attending UCLA/Jules Stein Eye Institute Lecture Agenda Review

More information

Upper blepharoplasty is one of the most common cosmetic. The Sigmoid Upper Eyelid Blepharoplasty: Redefining Beauty. John P. Fezza, M.D.

Upper blepharoplasty is one of the most common cosmetic. The Sigmoid Upper Eyelid Blepharoplasty: Redefining Beauty. John P. Fezza, M.D. SURGICAL TECHNIQUE The Sigmoid Upper Eyelid Blepharoplasty: Redefining Beauty John P. Fezza, M.D. * *Center for Sight, Sarasota; and Department of Ophthalmology, University of South Florida, Tampa, Florida,

More information

Lesions, and Masses, and Tumors Oh My!!

Lesions, and Masses, and Tumors Oh My!! Lesions, and Masses, and Tumors Oh My!! Presented by: Susan Ward, CPC, CPC-H, CPC-I, CPCD, CEMC, CPRC 1 1 CPT GUIDELINES Agenda CPT DEFINITIONS OP REPORT CASES 2 Definitions Cyst - a closed sac having

More information

To our knowledge, a long-term follow-up study COSMETIC

To our knowledge, a long-term follow-up study COSMETIC COSMETIC Outcomes Article The Measure of Face-Lift Patient Satisfaction: The Owsley Facelift Satisfaction Survey with a Long-Term Follow-Up Study Michael T. Friel, M.D. Richard E. Shaw, Ph.D. Matthew J.

More information

INVOLUTIONAL BLEPHAROPTOSIS OCCURS IN THE ELderly

INVOLUTIONAL BLEPHAROPTOSIS OCCURS IN THE ELderly External Levator Advancement vs Müller s Muscle Conjunctival Resection for Correction of Upper Eyelid Involutional Ptosis GUY J. BEN SIMON, MD, SEONGMU LEE, BS, ROBERT M. SCHWARCZ, MD, JOHN D. McCANN,

More information

Scapula Plating System

Scapula Plating System Scapula Plating System Scapula Plating System Acumed is a global leader of innovative orthopaedic and medical solutions. We are dedicated to developing products, service methods and approaches that improve

More information

Dermatochalasis is the crepey, wrinkled, Surgical Treatment Options for Lower Eyelid Aging. Cosmetic Technique. Joe Niamtu III, DMD

Dermatochalasis is the crepey, wrinkled, Surgical Treatment Options for Lower Eyelid Aging. Cosmetic Technique. Joe Niamtu III, DMD Cosmetic Technique Surgical Treatment Options for Lower Eyelid Aging Joe Niamtu III, DMD The lower eyelid and associated anatomy represent a complex structure that is key in facial aging and rejuvenation.

More information

Descemet s Stripping Endothelial Keratoplasty (DSEK)

Descemet s Stripping Endothelial Keratoplasty (DSEK) Descemet s Stripping Endothelial Keratoplasty (DSEK) Your doctor has decided that you will benefit from a corneal transplant operation. This handout will explain your options to you. It explains the differences

More information

Open and Endoscopic Forehead Lift. Plastic Surgery. For All Brow and Forehead Lift Procedures. Revolutionizing. Soft-Tissue Fixation

Open and Endoscopic Forehead Lift. Plastic Surgery. For All Brow and Forehead Lift Procedures. Revolutionizing. Soft-Tissue Fixation Plastic Surgery Open and Endoscopic Forehead Lift For All Brow and Forehead Lift Procedures Revolutionizing Soft-Tissue Fixation DESIGNED FOR SIMPLICITY AND PREDICTABILITY The versatile design can be applied

More information

ANTERIOR CERVICAL DISCECTOMY AND FUSION. Basic Anatomical Landmarks: Anterior Cervical Spine

ANTERIOR CERVICAL DISCECTOMY AND FUSION. Basic Anatomical Landmarks: Anterior Cervical Spine Anterior In the human anatomy, referring to the front surface of the body or position of one structure relative to another Cervical Relating to the neck, in the spine relating to the first seven vertebrae

More information

Open and Endoscopic Forehead Lift. Plastic Surgery. For All Brow and Forehead Lift Procedures. Revolutionizing. Soft-Tissue Fixation

Open and Endoscopic Forehead Lift. Plastic Surgery. For All Brow and Forehead Lift Procedures. Revolutionizing. Soft-Tissue Fixation Plastic Surgery Open and Endoscopic Forehead Lift For All Brow and Forehead Lift Procedures Revolutionizing Soft-Tissue Fixation DESIGNED FOR SIMPLICITY AND PREDICTABILITY The versatile design can be applied

More information

Surgical Coding Errors & English 101. Riva Lee Asbell. Fort Lauderdale, FL

Surgical Coding Errors & English 101. Riva Lee Asbell. Fort Lauderdale, FL Surgical Coding Errors & English 101 Riva Lee Asbell Fort Lauderdale, FL INTRODUCTION Many surgical coding mistakes result from misinterpretation of CPT (Current Procedural Terminology) wording. When the

More information

Blepharoplasty - Eyelid Surgery

Blepharoplasty - Eyelid Surgery Blepharoplasty - Eyelid Surgery Introduction Eyelid surgery repairs sagging or drooping eyelids. The surgery is also known as blepharoplasty, or an eyelid lift. Sagging or drooping eyelids happen naturally

More information

Lip Cancer: Treatment & Reconstruction

Lip Cancer: Treatment & Reconstruction Lip Cancer: Treatment & Reconstruction GBMC - Head & Neck Cancer Grand Rounds Elizabeth E. Redd, M.D. With the assistance of Ira Papel, M.D. Patrick Byrne, M.D. Lip Cancer: Treatment & Reconstruction Anatomic

More information

Outcome of Surgery for Bilateral Third Nerve Palsy

Outcome of Surgery for Bilateral Third Nerve Palsy CLINICAL INVESTIGATIONS Outcome of Surgery for Bilateral Third Nerve Palsy Kazuhiro Aoki, Tatsushi Sakaue, Nobue Kubota and Toshio Maruo Department of Ophthalmology, Teikyo University School of Medicine,

More information

Outcome Assessment of Breast Distortion Following Submuscular Breast Augmentation

Outcome Assessment of Breast Distortion Following Submuscular Breast Augmentation Aesth Plast Surg (2009) 33:44 48 DOI 10.1007/s00266-008-9275-y ORIGINAL ARTICLE Outcome Assessment of Breast Distortion Following Submuscular Breast Augmentation Scott L. Spear Æ Jaime Schwartz Æ Joseph

More information

Ophthalmic Plastic Surgery and Orbitofacial Aesthetic Surgery

Ophthalmic Plastic Surgery and Orbitofacial Aesthetic Surgery Ophthalmic Plastic Surgery and Orbitofacial Aesthetic Surgery Dr. Savari Desai Ophthalmic plastic surgery is a branch of ophthalmology that deals with disorders and diseases of the eyelid, socket, lacrimal

More information

Integra. Subtalar MBA and bioblock Implant SURGICAL TECHNIQUE

Integra. Subtalar MBA and bioblock Implant SURGICAL TECHNIQUE Integra Subtalar MBA and bioblock Implant SURGICAL TECHNIQUE Table of contents Introduction Description... 2 Indications... 2 Contraindications... 2 Surgical Technique Step 1: Incision and Dissection...3

More information

INSTRUCTIONS FOR EYELID SURGERY (BLEPHAROPLASTY)

INSTRUCTIONS FOR EYELID SURGERY (BLEPHAROPLASTY) INSTRUCTIONS FOR EYELID SURGERY (BLEPHAROPLASTY) The following instructions pertain specifically to blepharoplasty or eyelid surgery. ------------------------------------------------------- WHAT TO EXPECT

More information

11/11/2015. Glaucoma: Diagnosis and Treatment. Financial disclosures. Glaucoma: the problem. Joshua J. Ney, M.D. No disclosures to report

11/11/2015. Glaucoma: Diagnosis and Treatment. Financial disclosures. Glaucoma: the problem. Joshua J. Ney, M.D. No disclosures to report Glaucoma: Diagnosis and Treatment Joshua J. Ney, M.D. No disclosures to report Financial disclosures Glaucoma: the problem Glaucoma is second most common cause of blindness worldwide 7 million people are

More information

Hydrogel Competence in Eye Surgery

Hydrogel Competence in Eye Surgery Hydrogel Competence in Eye Surgery Self-inflating tissue expander osmed self-inflating tissue expanders are made of a specially developed hydrogel that uses the osmotic principle to gain volume. These

More information

Facial Plastic and Reconstructive Surgery Service Educational Goals

Facial Plastic and Reconstructive Surgery Service Educational Goals Facial Plastic and Reconstructive Surgery Service Educational Goals 1. First-Year Resident (PGY-2) I. Knowledge Goals. Upon completion of this rotation the PGY-2 resident will have basic knowledge of the

More information

Eyelid Surgery - Lower

Eyelid Surgery - Lower Eyelid Surgery - Lower Are your eyes still one of the most striking features on your face? Do they convey your actual emotions and inner vitality, or do they make you appear fatigued, sad, or older than

More information

Some of the ophthalmic surgeries performed at the DMV Center.

Some of the ophthalmic surgeries performed at the DMV Center. Some of the ophthalmic surgeries performed at the DMV Center. This document presents some types of the surgeries performed by the ophthalmology service at the DMV veterinary center as well as the equipment

More information

La décompression orbitaire dans la maladie de Basedow

La décompression orbitaire dans la maladie de Basedow La décompression orbitaire dans la maladie de Basedow P. Mahy 1, C. Daumerie 2, A. Boschi 3 Services de stomatologie et chirurgie maxillo-faciale 1 d endocrinologie et de nutrition 2 et d ophtalmologie

More information

Minimally Invasive Spine Surgery

Minimally Invasive Spine Surgery Chapter 1 Minimally Invasive Spine Surgery 1 H.M. Mayer Primum non nocere First do no harm In the long history of surgery it always has been a basic principle to restrict the iatrogenic trauma done to

More information

X-Plain Trigeminal Neuralgia Reference Summary

X-Plain Trigeminal Neuralgia Reference Summary X-Plain Trigeminal Neuralgia Reference Summary Introduction Trigeminal neuralgia is a condition that affects about 40,000 patients in the US every year. Its treatment mostly involves the usage of oral

More information

Guideline for the Management of Acute Peripheral Facial nerve palsy. Bells Palsy in Children

Guideline for the Management of Acute Peripheral Facial nerve palsy. Bells Palsy in Children Guideline for the Management of Acute Peripheral Facial nerve palsy Definition Bells Palsy in Children Bell palsy is an acute, idiopathic unilateral lower motor neurone facial nerve palsy that is not associated

More information

NASAL TIP surgery is considered

NASAL TIP surgery is considered ORIGINAL ARTICLE A 20-Year Review of the "New Domes" Technique for Refining the Drooping Nasal Tip Fernando Pedroza, MD Objective: To describe in detail a technique to achieve cephalic rotation, projection,

More information

For non-superficial eye injuries an individual may be considered an incident case only once per lifetime.

For non-superficial eye injuries an individual may be considered an incident case only once per lifetime. 1 OPHTH_15 EYE INJURIES Background This case definition was developed by the Armed Forces Health Surveillance Branch (AFHSB) and the Tri-Service Vision Conservation and Readiness Program (TSVCRP) at the

More information

Apt Workshop Handout. Apt Lecture Workshop: Cutting No Slack For The Sagging Eye Syndrome. Age-Related Degeneration! of LR-SR Band!

Apt Workshop Handout. Apt Lecture Workshop: Cutting No Slack For The Sagging Eye Syndrome. Age-Related Degeneration! of LR-SR Band! Apt Lecture Workshop: Cutting No Slack For The Sagging Eye Syndrome Age-Related Degeneration of LR-SR Band Joseph L Demer MD, PhD Zia Chaudhuri MS, FRCS (Glasg) Robert A Clark MD Jules Stein Eye Institute

More information

Cosmetic Eyelid Surgery

Cosmetic Eyelid Surgery Cosmetic Eyelid Surgery An introduction to the procedures available, patient results, expectations, and recovery This whitepaper is presented by M. Azhar Ali, M.D. F.A.C.S., of Amae Plastic Surgery in

More information

SCOPE OF PRACTICE PGY-6 PGY-7 PGY-8

SCOPE OF PRACTICE PGY-6 PGY-7 PGY-8 PGY-6 Round on all plastic surgery inpatients every day. Assess progress of patients and identify real or potential problems. Review patients progress with attending physicians daily and participate in

More information

Ptosis Evaluation and Management

Ptosis Evaluation and Management Otolaryngol Clin N Am 38 (2005) 921 946 Ptosis Evaluation and Management Brenda C. Edmonson, MD*, Allan E. Wulc, MD 847 Easton Road, Suite 1500, Warrington, PA 18976 Drooping of the upper eyelids is one

More information

3D Analysis of Breast Augmentation Defines Operative Changes and Their Relationship to Implant Dimensions

3D Analysis of Breast Augmentation Defines Operative Changes and Their Relationship to Implant Dimensions NORTHEASTERN SOCIETY OF PLASTIC SURGEONS 3D Analysis of Breast Augmentation Defines Operative Changes and Their Relationship to Implant Dimensions Oren M. Tepper, MD, Kevin H. Small, MD, Jacob G. Unger,

More information

The Anatomy of the Greater Occipital Nerve: Implications for the Etiology of Migraine Headaches

The Anatomy of the Greater Occipital Nerve: Implications for the Etiology of Migraine Headaches Cosmetic The Anatomy of the Greater Occipital Nerve: Implications for the Etiology of Migraine Headaches Scott W. Mosser, M.D., Bahman Guyuron, M.D., Jeffrey E. Janis, M.D., and Rod J. Rohrich, M.D. Cleveland,

More information

Anatomical Approach to Rhinoplasty

Anatomical Approach to Rhinoplasty Anatomical Approach to Rhinoplasty Herve LeBoeuf, MD Faculty Advisor: Karen Calhoun, MD The University of Texas Medical Branch Department of Otolaryngology Grand Rounds Presentation January 2001 Which

More information

Thyroid eye disease (TED)

Thyroid eye disease (TED) Thyroid eye disease (TED) Mr David H Verity, MD MA FRCOphth Consultant Ophthalmic Surgeon Synonyms: Graves ophthalmopathy, thyroid ophthalmopathy, thyroid associated ophthalmopathy This information leaflet

More information

PROPERTY OF ELSEVIER SAMPLE CONTENT - NOT FINAL

PROPERTY OF ELSEVIER SAMPLE CONTENT - NOT FINAL Oncoplastic breast conservation surgery Melvin J Silverstein C H A P T E R 5 Introduction Oncoplastic breast conservation surgery combines oncologic principles with plastic surgical techniques. But it

More information

a guide to understanding facial palsy a publication of children s craniofacial association

a guide to understanding facial palsy a publication of children s craniofacial association a guide to understanding facial palsy a publication of children s craniofacial association a guide to understanding facial palsy this parent s guide to facial palsy is designed to answer questions that

More information

Ophthalmology ROUNDS. The Complications of Blepharoplasty Surgery Part 2. Department of Ophthalmology and Vision Sciences

Ophthalmology ROUNDS. The Complications of Blepharoplasty Surgery Part 2. Department of Ophthalmology and Vision Sciences MARCH/APRIL 2005 Volume 3, Issue 2 Ophthalmology ROUNDS AS PRESENTED IN THE ROUNDS OF THE DEPARTMENT OF OPHTHALMOLOGY AND VISION SCIENCES, FACULTY OF MEDICINE, UNIVERSITY OF TORONTO The Complications of

More information

Ophthalmology ROUNDS. The Complications of Blepharoplasty Surgery Part 1. Department of Ophthalmology and Vision Sciences

Ophthalmology ROUNDS. The Complications of Blepharoplasty Surgery Part 1. Department of Ophthalmology and Vision Sciences JANUARY/FEBRUARY 2005 Volume 3, Issue 1 Ophthalmology ROUNDS AS PRESENTED IN THE ROUNDS OF THE DEPARTMENT OF OPHTHALMOLOGY AND VISION SCIENCES, FACULTY OF MEDICINE, UNIVERSITY OF TORONTO The Complications

More information

Heel Pain Syndromes DELLON INSTITUTES FOR PERIPHERAL NERVE SURGERY

Heel Pain Syndromes DELLON INSTITUTES FOR PERIPHERAL NERVE SURGERY Heel Pain s 5 3333 N CALVERT ST, SUITE 370, BALTIMORE, MD 21218 T410 467 5400 F410 366 9826 delloninstitutes.com your complaints are Pain, numbness or burning in your heel. The timing of this pain and

More information

Head and Neck Procedure Guide

Head and Neck Procedure Guide Head and Neck Procedure Guide Mr. Rodney Mountain MBChB FRCS (ORL)Ed Consultant Otolaryngologist Head and Neck Surgeon Department of Otolaryngology University of Dundee Scotland Mr. Peter Steele MBChB

More information

The Aesthetic Earlobe: Classification of Lobule Ptosis on the Basis of a Survey of North American Caucasians

The Aesthetic Earlobe: Classification of Lobule Ptosis on the Basis of a Survey of North American Caucasians Cosmetic The Aesthetic Earlobe: Classification of Lobule Ptosis on the Basis of a Survey of North American Caucasians Arian Mowlavi, M.D., D. Garth Meldrum, M.D., Bradon J. Wilhelmi, M.D., Ashkan Ghavami,

More information

Intracapsular Allogenic Dermal Grafts for Breast Implant Related Problems

Intracapsular Allogenic Dermal Grafts for Breast Implant Related Problems Cosmetic Intracapsular Allogenic Dermal Grafts for Breast Implant Related Problems Richard A. Baxter, M.D. Mountlake Terrace, Wash. Despite advances in surgical techniques and breast implant design, certain

More information

Facial Paralysis and Reanimation Smile Surgery Jeffrey R. Marcus MD. Introduction:

Facial Paralysis and Reanimation Smile Surgery Jeffrey R. Marcus MD. Introduction: Facial Paralysis and Reanimation Smile Surgery Jeffrey R. Marcus MD 2007 Jeffrey R. Marcus MD Introduction: Facial paralysis can result from a variety of causes, and it can affect people at nearly any

More information

Division of Surgery Plastic and Reconstructive Surgery. Botox Cosmetic Injection: Consent Form INSTRUCTIONS

Division of Surgery Plastic and Reconstructive Surgery. Botox Cosmetic Injection: Consent Form INSTRUCTIONS Division of Surgery Plastic and Reconstructive Surgery Botox Cosmetic Injection: Consent Form INSTRUCTIONS This is an informed-consent document that has been prepared to help inform you about BOTOX (Botulina

More information

MODIFIED STRAYER GASTROCNEMIUS RECESSION: A Technique Guide for the Supine Positioned Patient

MODIFIED STRAYER GASTROCNEMIUS RECESSION: A Technique Guide for the Supine Positioned Patient C H A P T E R 4 5 MODIFIED STRAYER GASTROCNEMIUS RECESSION: A Technique Guide for the Supine Positioned Patient M. Jay Groves, IV, DPM Gastrosoleal equinus is a common deforming force on the foot and ankle.

More information

Surgical Privileges Form: Ophthalmology CLINICAL PRIVILEGES REQUEST Applicant s Name:. Scope of Practice:... License. No. (If Any):.. Facility:..

Surgical Privileges Form: Ophthalmology CLINICAL PRIVILEGES REQUEST Applicant s Name:. Scope of Practice:... License. No. (If Any):.. Facility:.. Surgical Privileges Form: Ophthalmology CLINICAL PRIVILEGES REQUEST Applicant s Name:. Scope of Practice:... License. No. (If Any):.. Facility:.. CATEGORY I: CORE PRIVILEGES 1. Admitting privileges 2.

More information

Facial Re-Contouring Using Autologous Fat Transfer

Facial Re-Contouring Using Autologous Fat Transfer Egypt, J. Plast. Reconstr. Surg., Vol. 34, No. 1, January: 65-69, 2010 Facial Re-Contouring Using Autologous Fat Transfer AMGAD HENDY, M.D. The Department of Plastic & Reconstructive Surgery, Faculty of

More information

Breast Augmentation. If you are dissatisfied with your breast size, augmentation surgery is a choice to consider. Breast augmentation can:

Breast Augmentation. If you are dissatisfied with your breast size, augmentation surgery is a choice to consider. Breast augmentation can: Breast Augmentation What is Breast Augmentation? Also known as augmentation mammaplasty, breast augmentation involves using implants to fulfill your desire for fuller breasts or to restore breast volume

More information

1 of 6 2/10/12 10:15 AM

1 of 6 2/10/12 10:15 AM Home Dr. Bitar About Us Events Media Specialties Non Surgical Gallery Fees Contact Us Plastic Surgery Products Magazine, October 2007 Issue Breast Augmentation: The Axillary Approach by George John Bitar,

More information

The Ahmed Glaucoma Valve Leading the Way in Advanced Glaucoma Drainage Technology

The Ahmed Glaucoma Valve Leading the Way in Advanced Glaucoma Drainage Technology The Ahmed Glaucoma Valve Leading the Way in Advanced Glaucoma Drainage Technology Dr. A. Mateen Ahmed President & CEO - New World Medical, Inc. New World Medical, Inc. (NWMI) is a high tech medical device

More information

Eyelid Retraction, Lid Lag, Lagophthalmos, and von Graefe s Sign

Eyelid Retraction, Lid Lag, Lagophthalmos, and von Graefe s Sign Eyelid Retraction, Lid Lag, Lagophthalmos, and von Graefe s Sign Quantifying the Eyelid Features of Graves Ophthalmopathy Ramakrishna V. Gaddipati, MD, Dale R. Meyer, MD, FACS Purpose: To report the frequency

More information

of endoscopic versus external repair of orbital

of endoscopic versus external repair of orbital Otolaryngology Head and Neck Surgery (2007) 136, 38-44 ORIGINAL RESEARCH Endoscopic versus external repair of orbital blowout fractures Hong-Ryul Jin, MD, Je-Yeob Yeon, MD, See-Ok Shin, MD, Young-Seok

More information

Laparoscopic Inguinal Hernia Repair Surgery Patient Information from SAGES

Laparoscopic Inguinal Hernia Repair Surgery Patient Information from SAGES Laparoscopic Inguinal Hernia Repair Surgery Patient Information from SAGES About Your Inguinal Hernia and Laparoscopic Repair: Approximately 600,000 inguinal or groin hernia repair operations are performed

More information

Botox & Fillers. Edward S. Kwak MD

Botox & Fillers. Edward S. Kwak MD Botox & Fillers Edward S. Kwak MD Have you started doing that thing in the mirror? That private ritual where you pull the skin of your forehead or by your mouth and eyes with your fingertips so your face

More information

Administering Depo-Medrol injection. Administering dexamethasone injections + the ANTI-VEGF medication

Administering Depo-Medrol injection. Administering dexamethasone injections + the ANTI-VEGF medication Aberrometer Administering Depo-Medrol injection Administering dexamethasone injections + the ANTI-VEGF medication Administering subconjunctival dexamethasone injection Amniotic membrane transplantation

More information

BREAST IMPLANTS (enlargement, augmentation) Dr. Benjamin Van Raalte TYPES OF IMPLANTS saline round implants high profiles low profile shaped

BREAST IMPLANTS (enlargement, augmentation) Dr. Benjamin Van Raalte TYPES OF IMPLANTS saline round implants high profiles low profile shaped BREAST IMPLANTS (enlargement, augmentation) Dr. Benjamin Van Raalte has 20 years of experience with breast enlargement including axillary incisions and gel implants. Dr. Van Raalte is the first Quad City

More information

Chapter 10. Extended Healing Period. Wound Location

Chapter 10. Extended Healing Period. Wound Location Chapter 10 SECONDARY WOUND CLOSURE KEY FIGURE: Dead space under skin closure Secondary wound closure is also referred to as closure by secondary intention. The skin edges of the wound are not sutured together;

More information

F ORUM. Special Topic. Facial Reshaping Using Minimally Invasive Methods

F ORUM. Special Topic. Facial Reshaping Using Minimally Invasive Methods Special Topic Facial Reshaping Using Minimally Invasive Methods Q1 Richard Ellenbogen, MD; Gary Motykie, MD; nthony Youn, MD; Steven Svehlak, MD; and Dan Yamini, MD Dr. Ellenbogen, Dr. Motykie, Dr. Yamini,

More information

Scout Vessel Guard. A cover for vessels during anterior lumbar spine surgery.

Scout Vessel Guard. A cover for vessels during anterior lumbar spine surgery. Scout Vessel Guard. A cover for vessels during anterior lumbar spine surgery. Technique Guide Instruments and implants approved by the AO Foundation Table of Contents Introduction Scout Vessel Guard 2

More information

INFORMED CONSENT BLEPHAROPLASTY SURGERY

INFORMED CONSENT BLEPHAROPLASTY SURGERY INFORMED CONSENT BLEPHAROPLASTY SURGERY INSTRUCTIONS This is informed-consent document which had been prepared to help your plastic surgeon inform you about blepharoplasty surgery, its risks, and alternative

More information

Chapter 24. Evolution of Procedures

Chapter 24. Evolution of Procedures Chapter 24 BREAST SURGERY KEY FIGURES: Saline implant reconstruction Latissimus dorsi reconstruction Free TRAM reconstruction In the developed world, breast reconstruction after mastectomy and breast reduction

More information

Call today at 1 877 702 2020

Call today at 1 877 702 2020 Call today at 1 877 702 2020 VISIAN ICL LASIK is a well known, successful, and accurate laser vision correction procedure which has been FDA approved in the U.S. for 15 years. The majority of patients

More information

Kensington Eye Center 4701 Randolph Road, #G-2 Rockville, MD 20852 (301) 881-5701 www.keceyes.com

Kensington Eye Center 4701 Randolph Road, #G-2 Rockville, MD 20852 (301) 881-5701 www.keceyes.com Kensington Eye Center 4701 Randolph Road, #G-2 Rockville, MD 20852 (301) 881-5701 www.keceyes.com Natasha L. Herz, MD INFORMED CONSENT FOR DESCEMET S STRIPPING and AUTOMATED ENDOTHELIAL KERATOPLASTY (DSAEK)

More information