Follicular Unit Excision (FUE) Basics.

Follicular unit excision (FUE) has risen to the forefront as the world's most popular hair transplant procedure. However, most writing on this subject has catered to the advanced practitioner. The goal of this article will be to focus on safe planning and decision making along with key technical steps that will guide the beginner surgeon to harvest a graft safely and to harvest the donor area in a uniform way to avoid overharvesting. Topics covered in this article also include instrumentation and decision making between FUE versus linear strip excision.

The Best Business Moves You Can Use To Enhance Your Practice.

This article offers a practical approach for cosmetic surgeons to develop and enhance their clinical practice by offering pearls that have worked for the author. Leadership of staff is the cornerstone of developing a successful business practice by hiring, retaining, and inspiring key talent. It is important to develop a clear vision for a practice and to articulate a unique selling proposition that can attract patients and be effectively communicated by authentic videos. Peers can be a source of accountability and feedback and can help provide support and structure to a business owner.

Hair Loss and Hair Restoration in Women.

Hair restoration in women involves mastering both the medical and the surgical treatment. Preoperatively, women should be thoroughly evaluated for biochemical causes of hair loss along with a complete history and physical examination taken. The physician must recognize the clinical presentation of scarring alopecias and maintain a low threshold for biopsy to rule out this condition. Postoperative hair shock loss is a common feature following hair transplant in women, and the surgeon should understand the preoperative counseling and preventative measures needed, the intraoperative methods to reduce the incidence, and the postoperative strategies to handle the situation.

Fat Grafting for Facial Contouring.

Fat grafting is a safe, effective method for facial rejuvenation if used to restore lost facial volume, but it is not as a method to correct cutaneous deformities and rhytids, or to counteract gravitational effects. The most significant postoperative complication is weight gain that can make a face look overinflated. Accordingly, it is important to select a safe and appropriate candidate. This article outlines who is a suitable prospect for fat grafting and juxtaposes the two methods of facial volume restoration: fat grafting versus injectable fillers. Then a detailed exposition of the operative technique is outlined, including anesthesia, harvesting, processing, and injection. Finally, this article concludes with a description of the postoperative course and the management of potential complications.

Halos and Asymmetric Triangles: Designing the Eyelids with Volume Using Fillers and/or Fat.

Periorbital aging is mainly a product of volume loss, which can be addressed with fillers and/or fat grafting. This stands in contrast to the lower face where a lifting procedure can be the principal method to improve moderate-to-significant aging. New models to explain these concepts of periorbital rejuvenation to both the surgeon and the prospective patient are outlined herein, namely, three facial halos (around the eyes, around the perimeter of the face, and around the mouth) and asymmetric triangles around the eyes. Specific techniques for fillers and fat grafting are also covered separately in detail in this article.

Analysis of Facial Aesthetics as Applied to Injectables.

Understanding the role of volume loss in the aging face has resulted in a paradigm shift in facial rejuvenation techniques. Injectable materials for volume restoration are among the most widespread cosmetic procedures performed. A new approach to the aesthetics of facial aging is necessary to allow the greatest improvement from volumetric techniques while maintaining natural appearing results. Examining the face in terms of facial frames and facial shadows provides the fundamental basis for our injectable analysis.

Midface sculpting with autologous fat.

There is currently a major paradigm shift from excision-based surgery to strictly volume enhancement. Because there is still no perfect facial filler, development of synthetic facial injectables continue to advance at a remarkable pace. Each type of filler carries a specific characteristic that makes it more suitable for a certain clinical application. The continuing change in facial fillers offers the possibility for volume augmentation procedures with less downtime and without the need for harvesting fat. We predict that volume enhancement will continue to play an increasing role as both a complementary and as a stand-alone procedure in facial rejuvenation.

Volumetric rejuvenation: general concepts.

Volume restoration has become a cornerstone in facial rejuvenation. This article focuses on the aesthetic concepts of volume loss and how to restore volume to mimic nature. The concept of evolving facial shape from a circle, to an upright triangle, to a square, to an inverted triangle is covered. Little model of the inverted egg shape is also proposed. The benefit of restoring an outer facial frame, periorbital frame, and perioral frame is elaborated. Lip volumization is also briefly covered. Finally, understanding the role of highlights and shadows on the impact of aging is addressed.

Integrating injectable fillers and fat in facial rejuvenation.

This article focuses on the discussion of the risks, benefits, and limitations of the three principal methods for facial volumization: fat grafting, injectable fillers, and alloplastic implants. By understanding these issues, a surgeon can better discuss what would be ideal for a particular patient. Fat grafting offers, the most cost-effective solution to a patient with sufficient volume loss. Injectable fillers provide an easy, predictable, and accurate nonsurgical alternative that is scalable in cost. Alloplastic implants are more ideally used in individuals with skeletal rather than soft-tissue deficiencies or in younger patients where the soft-tissue envelope is sufficient to mask the implant.

Volume rejuvenation of the facial upper third.

The next three articles in this issue take a unique approach to discussing volumetric restoration. Robert Glasgold has provided an assessment for each facial region and five different renowned authors (TK, SPS, RF, SML, and EFW) have been asked to speak on a particular volumetric product, of which they are considered an expert, as it applies to the different regions of the face. The articles are broken into the following: (1) upper third which corresponds to the upper eyelid, brow, temple, and forehead; (2) middle third which will cover lower eyelid, cheek, and perioral area; and (3) lower third which discusses the marionette, prejowl, and jawline. Our hope is that by placing differing opinions of experienced authors, organized by facial region together, the reader will have the opportunity to more readily compare the options. The contributing authors and their product area are as follows: Theda Kontis, MD-hyaluronic acid; Steve Smith, MD-calcium hydroxyl appetite; Rebecca Fitzgerald, MD-poly-L lactic acid; Sam Lam, MD-polymethyl methacrylate; and Edwin Williams, MD-Autologous Fat Transfer. If the author included general comments on the product, they are included in the article on the upper face only and are not repeated. Please note that other individuals may also have significantly assisted in the production of these articles, but those listed above are the senior authors.

Volume management of the middle third-lower orbit/midface.

This is the second of the three articles discussing volumetric rejuvenation of the face. The previous article, Volume Rejuvenation of the Facial Upper Third, focused on the upper one-third of the face while this article focuses on the middle one-third, primarily the lower eyelid, cheek, and perioral area. Again, the authors (RG, TK, SPS, RF, SL, and EFW) from the upper face article have provided a summary of rejuvenation utilizing a product of which they are considered an expert. Robert Glasgold has provided volumetric analysis of the region as an introduction.

Volume rejuvenation of the lower third, perioral, and jawline.

This is the third and final article discussing volumetric rejuvenation of the face. The previous two articles, Rejuvenation of the Upper Third and Management of the Middle Third, focused on the upper two-thirds of the face while this article focuses on the lower face, including the marionette area, jawline, and neck. Again, the authors of the previous two articles have provided a summary of rejuvenation utilizing a product of which they are considered an expert. Robert Glasgold has provided volumetric analysis of the region as an introduction.

Asian blepharoplasty.

This article discusses in detail the cultural aesthetic issues that confront the surgeon interested in performing Asian blepharoplasty in terms of defining an aesthetic Asian ideal and the subject of natural and ethnic preservation of identity. The surgical methodology of how to perform a full-incision-based Asian blepharoplasty is outlined in a stepwise fashion along with the perioperative concerns (preoperative planning and counseling, nature of recovery, and complications and revision surgery).

Complications in hair restoration.

Hair restoration requires a high level of specialized skill on the part of both the surgeon and the assistant team. Recipient-site problems can manifest from either surgeon or assistant error. The surgeon can create an unnatural hairline due to lack of knowledge of natural hair-loss patterns or badly executed recipient sites. He must also be cognizant of how hairs naturally are angled on the scalp to re-create a pattern that appears natural when making recipient sites. Assistants can also greatly contribute to the success or failure of surgery in their task of graft dissection and graft placement.