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8802A Reduction Mammaplasty: Inferior versus Posterior Pedicle. Author: Y. Levet. 12 min 8901A Malar Augmentation. Authors: U.T. Hinderer, J. del Rio. 17 rain 8902A Mammaplasty with Periareolar Scar (in Spanish)• Author: R.A. Bustos. 37 min 8903A Sub-Platysmal Lifting. Author: G. Jost. 17 rain 8904A An Improved Technique for Immediate Retropectoral Reconstruction after Subcutaneous Mastectomy. Author: G. Maillard. 10 min 8905A Z-Mammaplasty with Minimal Scarring. Author: G. Maillard. 27 min 9001A Rhinoplasty with Hinderer's Lower Nasal Base Implant. Author: U.T. Hinderer, J. del Rio. 12 rain 9002A Upper Face Rhytidectomy (Sub-Periosteal/Sub-SMAS). Authors: U.T. Hinderer, J. del Rio, F. Urriolagoitia. 15 min 9004A Axillary Breast Augmentation. Author: R. Riu. 15 rain 9005C3 Classification of the "Regard•" Author: Y. Levet. 15 min 9101B Buttocks Augmentation. Author: R. Baroudi**. 20 min 9102B Nasal Anatomy and Aesthetics. Author: R. Daniel. 50 min 9103B Open Rhinoplasty. Author: R. Gruber**. 53 min 9104B Sub-SMAS Rhytidectomy of the Upper Two Thirds of the Face. Author: U.T. Hinderer**. 56 rain 9105B Fat Compartments of the Face and Neck. Author: Y.G. Illouz. 12 min 9106B Subplatysmal Face Lift. Author: G• Jost. 52 rain 9107B Subperiosteal Face Lift. Author: F. Ortiz-Monasterio. 32 min 9108B Malar Midface and Premandible Alloplastic Augmentation. Author: E. Terino. 52 rain ~A = surgical techniques ZB = anatomical dissections 3C = others * Clinica Planas, VIII International Course ** San Diego Anatomical Dissections. The price for the complete set of 8 videos for ISAPS members is $800; for nonmembers, $1200. All videos in NTSC from countries using this system (USA, Japan, etc.) should be ordered through the Liposuction Society of North America (LSNA), 444 E. Algonquin Rd., Arlington Heights, IL 60005-4664, USA.

Book Review Male Aesthetic Surgery, e d i t e d b y E u g e n e H. C o u r tiss. 2nd edition. M o s b y - Y e a r B o o k I n c . , St. L o u i s , 1991.

N o b e t t e r r e c o m m e n d a t i o n c a n be g i v e n to the s e c o n d e d i t i o n o f this e x c e l l e n t v o l u m e t h a n the t r i b u t e s to be f o u n d in the t w o f o r e w o r d s of the b o o k . I n o n e M i c h a e l J u r k i e w i c z writes The first edition of Male Aesthetic Surgery has been a good reference volume for me not only as someone involved in post-graduate education and training in plastic surgery but also as an active practitioner. If the first edition has been good, then the second edition gives every

Announcements and Book Review

promise of being better• Almost all of the chapters have been re-written and brought up to "current state of the art." . . . I have found this volume provides sound up-to-date advice from acknowledged experts and authorities in the field to those of us in the daily practice of plastic surg e r y - o n e practitioner to another• The total spectrum of aesthetic surgery in men is covered. Nothing of importance is left out. T h o m a s D. R e e s , o n e of the a c k n o w l e d g e d masters in the field o f a e s t h e t i c plastic surgery, writes in his f o r e w o r d Twenty years ago the very concept of writing a special article, to say nothing of a book, on the subject of aesthetic surgery in the male would have evoked disbelief and drawn cynical smiles within most quarters of plastic surgery. This book is addressing that very subject once again, as a second edition as well, which speaks clearly for the success of the first . . . . In my own practice, I have been fascinated by the changing demographics of the male aesthetic patient. There is no lucid profile of the "typical male aesthetic patient." It is clear now that in the male, as in the female, there are a number of genuine reasons for the male to seek changes in his physical appearance, and that he need not be suspect of harboring a significant underlying neurotic disturbance in doing so. • . . Today, we as plastic surgeons are seeing men from every walk of life: doctors, lawyers, financiers, and even clergymen. Men seeking plastic surgery no longer needs to be a closet secret. However, the subject is not as openly discussed as it is amongst women. A n d n o w , f r o m the s t a n d p o i n t of this r e v i e w e r , let us h e a r in g r e a t e r detail f r o m the editor, E u g e n e (Gene) C o u r t i s s . O n e of the delightful a n d e d u c a tional a s p e c t s o f this b o o k is the f r a n k , c o m m o n s e n s e editorial c o m m e n t w h i c h a p p e a r s at the e n d of e a c h of the s e v e n s e c t i o n s o f the b o o k . C o u r t i s s ' c o m m e n t s are d o w n - t o - e a r t h a n d practical, a n d are e s p e c i a l l y p r o f o u n d d e s p i t e the simplicity with w h i c h t h e y a p p e a r o n the p r i n t e d page. A s a n e x a m ple, in c o m m e n t i n g o n two v e r y good c h a p t e r s writt e n b y J a m e s M a y , Jr. with his colleague, M. S h a r o n W e b b , a n d a n o t h e r b y D. R a l p h Millard, Jr. in the s e c t i o n o f the b o o k d e a l i n g with the interface b e t w e e n a e s t h e t i c a n d r e c o n s t r u c t i v e s u r g e r y , he writes: Plastic surgery has gone beyond the business of filling holes. The aesthetic result has become important. However, in our desire to obtain the best appearing result, we should not compromise our treatment. That means tumors should be properly excised and facial fractures approached as appropriate for the problem. Also, we should consider the function and appearance of the donor site, whether it be for a free flap, a local flap, or a skin graft. • . . Often in our zeal to employ the newest method of treatment, we reject the tried and true. Case in point: the use of split-thickness skin grafts, the workhorse of the past, is often forgotten. Instead, new methods, such as tissue expanders and free flaps, are employed when a skin

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graft would serve better and be safer and possibly more aesthetic. Because the use of cosmetics is not socially acceptable for men, the end result of scar revision in men becomes more important than in women . . . . Ache scars remain one of the many challenges to plastic surgeons. Although dermabrasion, which lowers elevated scars, and subcutaneous fillers, which raise them, have been successful in some patients, the results are generally unpredictable and often disappointing. In commenting on the papers dealing with aesthetic surgery of Asians and African-Americans, Courtiss writes • . . Obviously, one ethnic group cannot, and should not, be made into another . . . . Just as in Caucasians, the nose is the most important structure that provides ethnic characteristics in the Asian and African-American. Whereas the objective in Caucasian nasal surgery is usually to reduce the nasal profile in both Asians and African-Americans, the objective is to augment the profile. Although some surgeons decry the use of any alloplastic material in any rhinoplasty, others believe that the materials are satisfactory in primary rhinoplasty, particularly in Asians and African-Americans. In such circumstances, the implant should not be excessively large. In commenting on the various techniques to correct baldness, Courtiss states • . . The more a given surgeon performs a procedure, the better he is able to perform it. The little innuendos and tricks that make fair results into good ones and good results into excellent ones require time to learn. Although this concept applies to all surgery, its significance in the surgical treatment of male-pattern baldness is incontrovertible. As a result, surgery for male-pattern baldness should not be for the occasioiaal surgeon. In commenting upon surgery of the submental and neck region in males, Courtiss wisely advises that • . . Although most men are best treated by a facelift, on rare occasions, direct excision of neck skin and fat may be the best treatment [by use of a vertical elliptical excision of the redundant tissues broken up by a primary Zplasty or several Z-plasties at the point of maximum tightening of the angle of the neck] . . . . However, this method should be reserved for those who do not wish a face-neck lift, or for those who are bothered only by their neck . . . . By not going beyond the thyroid cartilage and keeping the scar under the chin, the scar can be minimized•

Demonstration of this technique in the chapter by Thomas Biggs is accompanied by an excellent case with good pre- and post-operative photographs as well as the operative illustration of the Z-plasty technique in the submental and anterior neck region.

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As far as this reviewer is concerned, this is a fascinating book to read from one cover to the other. Among the plastic surgeons who have contributed to the thirty-one chapters of the book are names familiar to us all including Anderson, Argenta, Baker, Biggs, Cohen, Cole, Davis, Falces, Fisher, Friedenthal, Furnas, Goldwyn, Gradinger, Graham, Grazer, Gunter, Jackson, Kauffman, Kaye, Klatsky, Matory, May, Millard, Miller, Noe, Pitman, Polayes, Ristow, Robson, David Smith, Spira, Vallis, Van der Koch, and Zook. The ten sections of the volume are divided up into the following subjects: aesthetic objectives; general considerations including patient selection, limiting risk of medical liability--a surgeon's view, limiting risk of medical liability--a lawyer's view, and physiology of maleness; wound healing, scars, and the skin including scar revision and acne scars, vascular lesions and tattoos, chemical peel and dermabrasion, and injectable soft tissue substitutes; ambulatory surgery; interface between aesthetic and reconstructive surgery; special considerations in Asians and in African-Americans; male-pattern baldness; facial and cervical contouring; aging including blepharoplasty, e y e b r o w and forehead, facelift, and direct anterior neck contouring; and finally, body contouring. In general, throughout the entire contents of this book, the illustrative anatomic and surgical material as well as the pre- and post-operative photographs are very commendable. The narrative writing style of the majority of the authors is simple, direct, not too verbose, and very well chosen as a complement to the illustrations and the photographs. Among those individual cases which this reviewer found admirable in their post-operative results, are those of patients requiring tattoo removal including the use of the argon laser; shaving and dermatome excision of rhinophyma; chemical peel of the lower eyelids without the use of tape; aesthetically fine results in the correction of a massive defect of the nose and maxilla following the Mohs treatment for squamous cell carcinoma; postoperative results in nasal surgery in African-Americans; defatting and sculpting of the wide nasal tip of Asians; good aesthetic correction of marked retrusion of the maxilla in an acromegalic patient; use of hydroxyapatite or proplast implants in the malar and chin regions; admirable post-operative results in various forms of protruding ears requiring otoplasty; one good case demonstrating the use of pure liposuction for the submental fat deposits without excision; very good " n a t u r a l " appearing results in forehead and e y e b r o w lifting; excellent natural post-operative results in facelifting by a " m a s t e r " in this field of surgery; and a fascinating long-term post-operative result of reconstructive and aesthetic plastic surgery in contouring the body of a

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morbidly obese man following a massive weight loss. There are, of course, a few distractions and inadvisable procedures especially in the chapter dealing with chemical peel in which the tape to create a deep peel extends over from the facial and cheek region onto the lateral neck region (was the neck also peeled?) which according to Tom Baker and Clyde Litton is an absolute " N o - N o . " It is refreshing, after several papers dealing with the use of injectable materials, to listen to Gene Courtiss: Although the FDA has approved the use of two forms of collagen, such injections are controversial. Some physicians debate their safety and others their efficacy; all agree that their benefit is temporary. This appears to be also true with autologous fat injections. How much, if any, injected fat lives? At present three unanswered essential questions about fat injections preclude its widespread use: How should the fat be removed? How should it be treated once it is removed? And how should it be

Announcements and Book Review

injected? Until these issues are clarified, the value of fat injections will be as controversial as the other methods of subcutaneous substitutes. By this time, the reader of this review should have a clear impression as to the excellence of this volume of Male Aesthetic Surgery. For any plastic surgeon w h o - - r e g a r d l e s s of his training, age and e x p e r i e n c e - - d e a l s with the male patient, especially from an aesthetic standpoint, this book should be a part of his most frequently used reading matter, and it should sit in a prominent place on his consultation room bookshelf. Congratulations are extended to Gene, and indeed to all of the 45 contributors to this very readable volume. Blair O. Rogers, M.D. Professor of Clinical Surgery (Plastic Surgery) N e w York University Medical Center