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Biomedical subjects

Steven Fagien

Publications and source records attributed to Steven Fagien.

13 recordsLinked to original sources
PubMed2004

Current concepts in aesthetic upper blepharoplasty.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Discuss nomenclature and anatomy associated with upper blepharoplasty. 2. Perform preoperative assessment, decision-making, and counseling of patients. 3. Describe current surgical planning, eyelid marking, and various techniques used in upper blepharoplasty, including lasers. 4. Recognize and treat postoperative complications from blepharoplasty. Traditional blepharoplasty has often involved the excision of both lax skin and muscle and excessive removal of fat, leaving patients long term with a hollow orbit and a harsh, operated appearance that accelerates the aging process. Current methods of periorbital rejuvenation are more conservative, are based on concise preoperative evaluation, and involve the limited resection of the coveted soft tissue from the eye to restore a youthful appearance. The authors describe anatomy, preoperative assessment, decision-making and counseling of patients, surgical planning, eyelid marking, and various techniques, including lasers, along with postoperative complications associated with current concepts in aesthetic upper blepharoplasty.

Algorithms↗
PubMed2004

Temporary management of upper lid ptosis, lid malposition, and eyelid fissure asymmetry with botulinum toxin type A.

During the past 10 years the primary focus for the aesthetic use of botulinum toxin has been directed to the treatment of dynamic facial lines. This agent has been shown to be very effective for the improvement of facial shape. The use of botulinum toxin type A for the correction of a variety of presentations of facial asymmetry has also been well established. The general principles regarding the counter-effects of facial muscle protagonists and antagonists and their potential effects on the position of facial soft-tissue regions apply here as well. Twenty-two patients received botulinum toxin type A for the temporary treatment of mild to moderate unilateral upper eyelid ptosis and aesthetic improvement of lower eyelid position, with favorable results. Although commonly related to a rare yet feared adverse consequence from the inappropriate application of botulinum toxin, its application for the treatment of upper eyelid ptosis, eyelid position, and other lid fissure asymmetries for aesthetic improvement is presented.

Adult↗
PubMed2004

Consensus recommendations on the use of botulinum toxin type a in facial aesthetics.

The use of botulinum toxin type A for facial enhancement is the most common cosmetic procedure currently undertaken in the United States. Overall clinical and study experience with botulinum toxin type A treatment for facial enhancement has confirmed that it is effective and safe in both the short and long term. Nevertheless, consistent guidelines representing the consensus of experts for aesthetic treatments of areas other than glabellar lines have not been published. Therefore, a panel of experts on the aesthetic uses of Botox Cosmetic (botulinum toxin type A; Allergan, Inc., Irvine, Calif.) was convened to develop consensus guidelines. This publication comprises the recommendations of this panel and provides guidelines on general issues, such as the importance of the aesthetic evaluation and individualization of treatment, reconstitution and handling of the botulinum toxin type A, procedural considerations, dosing and injection-site variables, and patient selection and counseling. In addition, specific considerations and recommendations are provided by treatment area, including glabellar lines, horizontal forehead lines, "crow's feet," "bunny lines" (downward radiating lines on the sides of nose), the perioral area, the dimpled chin, and platysmal bands. The review of each area encompasses the relevant anatomy, specifics on injection locations and techniques, starting doses (total and per injection point), the influence of other variables, such as gender, and assessment and retreatment issues. Factors unique to each area are presented, and the discussion of each treatment area concludes with a review of key elements that can increase the likelihood of a successful outcome. Summary tables are provided throughout.

Botulinum Toxins, Type A↗
PubMed2003

The horizontal dynamic of the medial and lateral canthus.

PURPOSE: To identify and quantify the horizontal dynamic movement of the medial and lateral canthus in subjects without previous eyelid surgery. METHODS: Prospective, experimental study. RESULTS: Seventy-two eyes in 36 normal subjects were studied. Frontal view lateral canthal movement with abduction of the globe averaged -0.4 mm (negative numbers mean the canthus moves in the opposite direction of the globe), with a range of -3.8 to 2.1. Profile view lateral canthal movement with abduction of the globe averaged 1.6 mm, with a range of -2.2 to 4.7 mm. Frontal view lateral canthal movement with adduction of the globe averaged -0.3 mm, with a range of -3.7 to 3.9 mm. Profile view lateral canthal movement with adduction of the globe averaged 0.5 mm, with a range of -2.4 to 3.9 mm. Frontal view medial canthal movement with abduction of the globe averaged -0.4 mm, with a range of -3.9 to 1.5 mm. Frontal view medial canthal movement with adduction of the globe averaged 0.1 mm, with a range of -5.2 to 4.6 mm. Intrasubject variation was observed for all measurements. CONCLUSIONS: The medial canthus and the lateral canthus are dynamic structures that move with horizontal eye movements in patients who have not undergone canthoplasty. The measured movement of the lateral canthus differed, based on the position from which the measurements were made, and was not always in the direction of the globe. The movement of the lateral canthus and the medial canthus differed on the right and left sides of the same subject.

Adolescent↗
PubMed2003

Botulinum toxin type A for facial aesthetic enhancement: role in facial shaping.

The application of injectable chemodenervation with botulinum toxin type A has become a useful and significant tool for facial rejuvenation. Since its original discovery and descriptions of its use for improvement of dynamic facial lines and furrows, botulinum toxin type A has been shown to be effective in a host of other applications. Because of its synergistic effects, it is used as an adjunctive agent for a variety of procedures, from injectable facial soft-tissue augmentation to brow lifts. The art of using botulinum toxin type A, or Botox (Allergan, Irvine, Calif.), has evolved from a technical procedure to one that is influenced by aesthetic judgment and applications that extend beyond line eradication to improve facial form and shape.

Botulinum Toxins, Type A↗
PubMed2003

The cosmetic use of botulinum toxin.

The approach to facial rejuvenation continues to evolve. For decades, the primary focus on rejuvenation has centered on modalities such as skin care, skin resurfacing, soft-tissue augmentation, and surgical intervention. A better understanding of the physiologic changes that occur with facial aging lends itself to new approaches and techniques that are mindful of the causes. As animation has shown to be a significant contributor to both the appearance of facial lines and soft-tissue malposition, there has been recent interest in chemodenervating agents and their applications in the field of facial rejuvenation. These agents, by and large, efface rhytides by selective and precise focal paralysis of the underlying facial musculature and, therefore, reduce or eliminate the prominence of the overlying rhytides. In addition, chemodenervation can serve as an adjunct for facial rejuvenation because of its influence on facial soft-tissue position and shape. Botulinum toxin, derived from Clostridium botulinum, is the most widely used agent; therefore, this new modality, its applications in cosmetic plastic surgery, and its applications to other areas will be discussed.

Botulinum Toxins↗
PubMed2002

Advanced rejuvenative upper blepharoplasty: enhancing aesthetics of the upper periorbita.

The surgical approach to rejuvenation of the periorbita continues to evolve with the application of procedures that are safe and effective with a greater sensitivity of aesthetics. Most of the topics in the recent literature discuss improvements with techniques relating to the lower eyelid and midface. Improved surgical techniques of the upper periorbita have been mostly limited to advances in brow lifting. The most common and traditional approach to upper blepharoplasty has remained essentially unchanged and has not considered, to the same degree as in the lower periorbita, the actual changes that occur with age or more accurate surgical approaches toward rejuvenation. The author presents an overview of his personal view of the concepts relating to the aging upper periorbita and discusses his experiences with this procedure.

Adolescent↗