Ophthalmic Plastic Surgery of the Upper Face: Eyelid Ptosis, Dermatochalasis, and Eyebrow Ptosis

Review by G Ullas
Newcastle upon Tyne, UK

At initial glance, our readers may wonder as to why this book is reviewed here. It does not immediately appear to be something within the realms of ENT as we traditionally think of it in the UK. However, one must consider the evolving subspecialty of facial plastic surgery. Facial plastic surgery is very much in its infancy in the UK, and largely exists as the practice of rhinoplasty and skin cancer surgery. As the name suggests, facial plastic surgery does involve the whole face, indicating the relevance of this text.

The upper face is an often-neglected aspect of the face, but can significantly affect patients when injured or diseased. ENT pathology and surgery can have long-term effects on this region, whether it is facial nerve palsy, large cancer resections, open frontal sinus work or even the results of radiotherapy. Unfortunately, we are not often very good at assessing the upper third region. The adage applies that one cannot see what one does not look for. Beyond the findings of periorbital cellulitis, we do not routinely assess the eyelids. This text is an accessible and practical book that covers this topic.

As an ENT trainee who is focused on a career in facial plastic surgery, this book makes for an interesting and useful read. It is intended as a practical guide for surgeons starting to oper- ate on the upper face region. There are excellent step-by-step illustrations and intra-operative photographs that really help you understand how each procedure works. For more advanced practitioners, there are highly useful tips, from experts who have been at those barriers we all encounter when learning new procedures. The book is divided into an overview of various pathologies, followed by sections on each pathology, with descriptions of a variety of ways to address them.

Some may feel that the subject matter is too concerned with aesthetics to be of use in the National Health Service; however, the functional effects of ptosis, brow weakness and dermatochalasis are frequently underestimated. These conditions often leave patients with recurrent headaches, visual disturbances or disfigurement.

A particularly interesting chapter is that on open coronal pretrichial brow lift surgery. It describes a procedure useful to ENT surgeons, and provides insights into other procedures conducted in a similar manner. Personally, it gave me some ideas for improving the reconstruction following open frontal sinus surgery, particularly in terms of restoring the natural contours following the drilling, which is not something I had considered before. The chapter on endoscopic brow lift is also of interest. It conveys the application of endoscopic surgery principles, well known to ENT surgeons, but simply applied to a different area.

Overall, I recommended this book for trainees with an interest in facial plastic surgery as well as consultants interested in expanding their practice. It comes in a convenient, easy-to-digest format that will be welcome at all levels.

Amazon Link: Ophthalmic Plastic Surgery of the Upper Face: Eyelid Ptosis, Dermatochalasis, and Eyebrow Ptosis
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