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This article discusses different dermatologic diseases which have the impact to the process of fingerprint acquirement. There are many people, who suffer under such skin diseases and are therefore excluded from the set of users of a biometric system. The classification of skin diseases is made from the medical point of view. [ABSTRACT FROM AUTHOR]

The classification of drugs included in the database of this book was performed according to the ATC/DDD system (Table 2.6.1). This system was developed by modifying and extending the European Pharmaceutical Market Research Association (EPhMRA) classification system by Norwegian researchers and was called the Anatomical Therapeutic Chemical (ATC) classification. In 1982, the WHO Collaborating Centre for Drug Statistics Methodology was established in Oslo and is funded by the Norwegian government. In 1996, WHO started to develop use of the ATC/DDD system as an international standard for drug utilization studies. [ABSTRACT FROM AUTHOR]

Diabetes mellitus and the treatments used do not appear to be a risk factor for premature ejaculation. There was no increase in the odds ratio in a large study. [ABSTRACT FROM AUTHOR]

Cimetidine is effective on Ca2+ influx into sperm cells in vitro. In vivo, it exerts an antiandrogenic effect. During treatment of peptic ulcer and in healthy men, testosterone levels decreased, gonadotropin levels increased and sperm count decreased in a considerable number of men. In contrast, ranitidine, famotidine, pantoprazole and lansoprazole did not demonstrate this effect. [ABSTRACT FROM AUTHOR]

Ejaculation is "the emission of semen to the exterior, resulting from the contraction of muscles surrounding the male internal urogenital ducts" (Medline's definition). It is closely connected to the male orgasm. Sexual behaviour has components of rewarding behaviour, and ejaculation appears to be the most reinforcing component. Little is known about the neurochemical basis of this rewarding experience. Some relations to opioids and their receptors have been shown (Coolen et al. 2004). [ABSTRACT FROM AUTHOR]

The testis is a paired organ located in the scrotum. It consists of two different functional compartments: (a) the seminiferous tubules; and (b) the interstitial tissue. The tubules contain the spermatogenetic tissue, the volume of which amounts to up to 90% of the testicular volume. The interstitial tissue contains the blood and lymph vessels, the nerves, the connective tissue and the immune cells, and the Leydig cells, in which the testosterone biosynthesis takes place. [ABSTRACT FROM AUTHOR]

In this chapter we discuss allergic skin disorders other than atopic dermatitis (AD): the urticaria-angioedema syndrome, allergic contact dermatitis (ACD), protein contact dermatitis (PCD), phytodermatitis, allergic photodermatitis and allergic vasculitis. [ABSTRACT FROM AUTHOR]

In this chapter we analyze the unending worldwide increase of pediatric allergic diseases and their natural history. Of concern is the early age at which atopy starts its march in these defenseless children. [ABSTRACT FROM AUTHOR]

A heredity component in the pathogenesis of atopic disease has been shown in Chap. 4, and an increased prevalence of atopic disease in Chap. 5, so such diseases represent a very contemporary problem: even a cursory glance at the literature clearly demonstrates the growing prevalence of atopic disorders. In the past two decades, a number of factors have contributed to this increase: urbanization that has brought in pollen-carrying ornamental plants and has generated extensive pollution, excessive smoking that seems to have made inroads everywhere, increased exposure to allergens, and poor ventilation of modern homes, which are outfitted with everything that favors Der p proliferation. These figures alone demonstrate that atopic diseases must not be underestimated, regardless of their manifestations. This is not only because a mild clinical picture can quickly become complicated, but also because in cases that are serious from the outset, only an accurate and timely diagnosis -and a rapid therapeutic conclusion — can effectively resolve this contingency. [ABSTRACT FROM AUTHOR]

Never before in the history of medicine have the nosology and etiology of a new disease been defined as quickly as in the case of AIDS (acquired immune deficiency syndrome). The worldwide dissemination of human immunodeficiency virus (HIV) over the past 47 years is one of the most catastrophic examples of the emergence, transmission, and propagation of a virus [248]. AIDS was first observed in the USA in 1981 through the study of young homosexual males demonstrating a high rate of Pneumocystis carinii pneumonia (PCP) associated with Kaposi's sarcoma (KS), also at a visceral level [222]. At the time, KS was considered a rare form of cancer that mainly affected subjects over the age of 60. Reports of cases of pneumocystosis and/or KS, often associated with other severe opportunistic infections, rose to such an extent that 159 cases were reported between June and November 1981 [222]. It was soon discovered that HIV infection had spread above all among young adults from already identified risk categories: homosexuals, drug addicts, hemophiliacs, recipients of transfusions of blood or blood products, or natives of Haiti and Zaire, Rwanda and Burundi [61, 87, 182, 455, 555]. [ABSTRACT FROM AUTHOR]

Primary immunodeficiencies (PIDs), once considered to be very rare, are now increasingly recognized because of growing knowledge in the immunological field and the availability of more sophisticated diagnostic techniques and therapeutic modalities [161]. However in a database of >120,000 inpatients of a general hospital for conditions suggestive of ID 59 patients were tested, and an undiagnosed PID was found in 17 (29%) of the subjects tested [107]. The publication of the first case of agammaglobulinemia by Bruton in 1952 [60] demonstrated that the PID diagnosis is first done in the laboratory. However, PIDs require specialized immunological centers for diagnosis and management [33]. A large body of epidemiological evidence supports the hypothesis of the existence of a close etiopathogenetic relation between PID and atopy [73]. In particular, an elevated frequency of asthma, food allergy (FA), atopic dermatitis and enteric pathologies can be found in various PIDs. In addition we will discuss another subject that is certainly of interest: the pseudo-immunodepressed child with recurrent respiratory infections (RRIs), an event that often requires medical intervention and that very often leads to the suspicion that it involves antibody deficiencies [149]. [ABSTRACT FROM AUTHOR]

Although it has long been known that malnutrition, immunity and infection are intricately linked to one another, the study of malnutrition and immunology has been progressing only relatively recently [97]. However, malnutrition and infections in children is a destructive interplay with global dimensions. Human studies and laboratory experiments have confirmed that the alterations of nutritional thymectomy, correlated with kwashiorkor, correspond to deep immune deficiencies [52]. The pioneering studies by Suskind [108] and Chandra [22, 23] have established the relationships between immunity and malnutrition, stemming from a profound knowledge of the endangered functions and the employment of more reliable technologies [52]. It is now common understanding that nutritional deficiencies, either quantitative or qualitative, also during pregnancy, may alter to different degrees humoral and/or cell-mediated immune (CMI) responses [28], thereby representing the most common cause of secondary immunodeficiency (ID) [9] after AIDS [23]. [ABSTRACT FROM AUTHOR]

The first description of an event similar to anaphylaxis was made at least 4,600 years ago [179]; however, only in 1765 was a fatal case reported in Europe (Chap. 17). In 1905, the first cases (one lethal) of food anaphylaxis were reported [72, 174], the subject of a book appeared in 1919 [111], and since 1926 [214] such cases have continued with an impressive frequency. The term "anaphylaxis" (from the Greek "αναϕυλαξις", away from protection) was coined by Portier and Richet in 1902 during a Mediterranean voyage [156] to define the paradoxical effect of an experimental protocol. While attempting to immunize dogs to the venom of the sea anemone, after the first nonlethal tolerated dose, they unwillingly sensitized the animals with the second dose injected after 2 weeks, either equal to or less than the previous dose, and noted that the dogs exhibited severe manifestations, even lethal. Therefore the first injection sensitizes the animal, provoking synthesis of IgE antibodies; after a latent period for sensitization, re-exposure to the inciting allergen triggers within a few minutes the very severe clinical manifestations called anaphylactic shock, the reverse result of the prophylaxis envisaged by the scientists [156]. [ABSTRACT FROM AUTHOR]

It is difficult to fulfill Koch's postulates when considering the etiology of autoimmune diseases (AIDs), which are multifactorial diseases where a primary role is played by genetic factors associated with environmental factors responsible for their clinical expressions [359]. Direct evidence is restricted to transplacental transmission of IgG pathogenic autoantibodies (Aab) from the affected mother to her fetus, such as in neonatal myasthenia gravis, polychondritis and Graves' disease. Indirect evidence comes mainly from AID reproduction in animal models and/or development of genetically determined AID models, and from the isolation of Aab or reactive T cells [359]. In this chapter, a multiplicity of abnormalities associated with systemic AIDs in different organs and systems will be examined. [ABSTRACT FROM AUTHOR]

The rapid development of new drugs to cure or control human illness corresponds to an expanding spectrum of adverse reactions to such agents. Before the introduction of sulfonamides in the late 1930s, the incidence of adverse drug reaction (ADR) approximated 0.5%-1.5% of all patients. Currently, 15%-30% of hospitalized patients experience an ADR [120]. The zenith is found in nurslings and toddlers. Drugs cause allergic and pseudoallergic reactions (PAR), even though other researchers, especially the Anglo-Americans, seem to consider it more suitable to call them ADRs, obviously shaped on the definition of adverse reactions to food, thus foregoing a pathogenic classification [2]. [ABSTRACT FROM AUTHOR]

Hymenoptera, an order of bees and wasps, were known and written about by the early Latin and Greek scholars: Aristotle (384/383-322 B.C.) accurately reported on the bees, Aristophanes (445-385 B.C.) titled one of his comedies "The Wasps" and Virgil (70-19 B.C.) described them in the "Georgics," although they first appeared in a hieroglyphic of 2641 B.C., attributing the death of Pharaoh Menes to a wasp sting, and a note in the "Babylonian Talmud" reports an analogous fatality [15]. In France in 1765, the first reported case of mortal anaphylaxis in a 30-year-old who had twice suffered near fatal episodes was published [19]. In 1914, the anaphylactic shock induced by insects was identified with the anaphylaxis described by Portier and Richet [134]. From the scientific point of view in 1978, during a prospective study of the disease, the venom was recognized to be the causative agent responsible for Hymenoptera sting hypersensitivity [53]. As a result of a deeper understanding of the mechanisms of this illness, a radical change in both the identification of venom and allergen components and in the diagnosis and treatment has been reflected in a positive sense towards the practice of SIT (specific immunotherapy). [ABSTRACT FROM AUTHOR]

In this chapter we provide noncomprehensive review of miscellaneous conditions associated with pediatric allergy. There are other phenomena that can rightly enter within the symptom patterns attributed to both gastroenteric and genitourinary systems. [ABSTRACT FROM AUTHOR]

The eye and the ocular membranes are frequently prone to allergic reactions in sensitized patients, because of the common ectodermal origins of the skin and several ocular structures, easy access for aeroallergens, and because of potential conjunctival immune reactivity. In this chapter we examine the various forms that involve the eye from an allergic-immunological view-point. [ABSTRACT FROM AUTHOR]

The palatine and lingual tonsils, adenoids or pharyngeal tonsils and lymphoid pharyngeal tissue constitute the von Waldeyer ring [213] (Fig. 15.1) or NALT (nasal-associated lymphoid tissue) [51]. The tubal tonsils and lateral pharyngeal bands are less prominent components [85]. [ABSTRACT FROM AUTHOR]

Although specific immunotherapy (SIT) or specific desensitization therapy was first introduced into allergy practice in 1911, only during the last 50 years have controlled trials been conducted [200]. Noon [166] and then Freeman [82] treated some patients affected with hay fever, which was the name of allergic rhinitis (AR), a term that still survives in the Anglo-American literature, by immunizing patients to a so-called toxin existing in certain pollens; whence the term "vaccine", which remained in current use. Before beginning any treatment, Noon [166] took notes about the dilutions of allergen extracts, which when instilled into his conjunctiva, produced an immediate local reaction, thus showing that the conjunctival reaction could be provoked only by instilling ever more concentrated allergen solutions. The treated patients manifested a marked reduction in symptoms and Noon consequently stated that they had acquired a growing immunity to such a toxin [166]. [ABSTRACT FROM AUTHOR]

Allergic rhinitis (AR) is a very common disease. This condition, which predominates during the childhood years [48], is found most often in boys up to 10 years of age, and at equal rates with girls from the ages of 10-20 years. Studies conducted in many countries in recent years, thanks chiefly to the ISAAC study (Table 5.21), have revealed a significant increase in its prevalence, especially among 13- to 14-year-olds, reaching a rate of 80% in Paraguay. There is an increase in prevalence from the age of 15-17years, of 18% in girls vs 14% in boys [184]. As for the minimum age of onset, Table 5.5 shows that children as young as 1-3 months are sensi-tized to pollens. At this age children may be sensitized to HDM (house dust mite), pets and pollens [78]. While 50% of cases were diagnosed within the 1st year in the United States, this took place in an area with a dry climate and thus lacked the most well-known allergens [149]; however, the case of a little girl shown in Fig. 5.23 is eloquent. A recent study from Denmark [174] during a 6-year follow-up in a population of 7- to 17-year-old subjects reported a significant association between the SPT (skin prick tests) sensitization to grass (RR=2.6) and HDM (RR=2.7) or a positive IgE screening test (RR=2.4) and the development of AR. [ABSTRACT FROM AUTHOR]

Several reports have pointed out that there is notable confusion between allergy and pseudoallergy (PA), to the point that epidemiological studies carried out in the United States have shown extremely elevated prevalence values for food allergy (FA), justified solely by a wide confusion with PA. According to the Asthma and Allergy Foundation, 5%-10% of Americans affected by allergy (35-40 million) present symptoms of FA, whereas according to the Federal Register of the Department of Agriculture.it is about 15%, while the American College of Allergists reports rates of up to 25 %-50%. According to a group of consultants of the American Food Industry [2], in 14% of 3,700 families there was at least one subject affected by FA or who followed a special diet because they thought they were affected, most often by cow's milk (CM) (30%), fish and crustaceans (16.7%), vegetables (20%), fruit (20%), chocolate (9.7%), egg (7%), meat in general (5.7%), nuts (4%), wheat (3.3%), with an unexpectedly low percentage for peanuts (6.4%) [2]. [ABSTRACT FROM AUTHOR]

Food allergy (FA) was born as cow's milk (CM) allergy (CMA). Only humans began and continue to use milk of other animals to nurse offspring, although Hippocrates recorded gastric upset and hives due to CM and proposed dietetic measures. The use of animal milk to feed children began spreading around the mid-eighteenth century, with a preference for ass or goat's milk rather than for CM [249]. In parallel, the consequent decline in breast feeding became evident from the fifteenth to nineteenth centuries: perhaps "nine months of blood, nine months of milk" [95] were too heavy. Subsequent discoveries in the fields of microbiology and medicine provided a more thorough basis for development of substitutes for breast milk (BM). Comparisons against the advisers of bottle feeding were requested, with unhappy results [95] and also differences in mortality among the BM-fed infants compared to non-BM-fed infants were worthlessly pointed out [249]. Even if at the start of the 20th century the first cases of anaphylaxis [436], one of which was fatal [161], and of CMA [196] were documented in the German literature, artificial feeding increased like an avalanche in the 20th century [249]. [ABSTRACT FROM AUTHOR]

The diagnosis of atopic disease has particular characteristics, since pediatric allergy is significantly different from adult allergy. It is essentially based on a detailed family and personal history. The purpose of the history is not only to confirm or exclude a clinical pattern of suspected allergic disease, but also to identify and demonstrate the pertinent etiological factors. Diagnostic tests can help the physician if they are considered in connection to symptoms, but not if evaluated individually: infants and boys are too often labeled as atopic only because skin prick tests (SPTs) or RAST (radioallergosorbent tests) are positive. We cannot continue without underlining the special prudence that must be reserved for the possible inappropriateness of parent declarations, mainly when symptoms are not reported in a simple and objective way. However, to facilitate information exchange, it is necessary to take advantage of what parents report, listen to them, encouraging them to talk: a keen and accurate patiently gathered history concretely helps the pediatrician to individuate the direct causal relationship. [ABSTRACT FROM AUTHOR]

The atopic state is an individual's augmented and persistent genetic predisposition to produce allergen-specific IgE antibodies after exposure to common allergens, with a significant correlation between IgE-producing B cells and relative total serum IgE levels in the systemic circulation, significantly more elevated than the levels of nonatopic children [201]. We best understand the pathogenesis of the atopic diathesis by analyzing the regulatory mechanisms of IgE synthesis, based on genetic and environmental factors that are not always well known [48]. Genetic control appears to be exercised not only on atopic disease as such and the type of sensitization, but mainly on a predisposition not specifically directed to elicit the onset of atopic disease. Fundamentally, a growing body of evidence emphasizes the role of environmental factors [409, 504] in determining the type of sensitization and form of atopic disease precipitated in genetically at-risk babies in relation to the allergens encountered and the conditions regulating this event [182]. [ABSTRACT FROM AUTHOR]

Immunodeficiency and immaturity are two distinct concepts, both characterizing the neonatal period: it is a transitory period for the immune system, opening exquisitely new problems [86]. Immunodeficiency depends on the immaturity at the molecular and functional level of immunocompetent cells, and to accomplish diverse and sophisticated roles such cells should complete their differentiation. The neonatal incapacity to respond to sudden exposures to antigens and microrganisms is not exclusively a consequence of immune immaturity, but also of a missed immune experience. Neonates should leave a situation of immunological dependence, dictated by the necessity of avoiding maternofetal reactions during pregnancy, to adapt to the new requirements of extrauterine life. During intrauterine life, the fetal immune system (FIS) is modulated in a suppressive direction so that the reactions directed against the maternal HLA antigens do not occur, in concert with mechanisms of maternal tolerance correlated with fetal genetic and antigenic heterogeneity, to avoid a graft-versus-host disease (GvHD). [ABSTRACT FROM AUTHOR]

Since it is not possible to act on the genotype, the scientists' research and the clinicians' experience are directed at eliminating or at least reducing exogenous predisposing factors. It is consequently necessary to combat the potential danger of such factors at birth and, if permitted, even before (Table 3.1) [122]. As a result of the incomplete maturation of the mucosal barrier, the risk of an allergic sensitization is higher [84, 117, 122, 127], because of the resulting immaturity of the local immune defense system [11], including Th1 cells, IFN-γ, B cells, sIgA and sIgM (secretory) antibodies, neutrophils, macrophages, and complement. Thus the neonate is vulnerable to penetration of harmful luminal macromolecules or their antigenic fragments and, if deprived of the unique immune factors of breast milk (Tables 2.12, 2.13, 2.20-2.22), the condition may become even more critical, and the impact of a retarded gut closure can be striking. [ABSTRACT FROM AUTHOR]

The concept of forbidden foods that should not be eaten goes back to the Garden of Eden and apart from its religious meanings it may also have foreshadowed the concept of foods that can provoke adverse reactions. Thus we could say that allergic diseases have plagued mankind since the beginning of life on earth. The prophet Job was affected by a condition that following the rare symptoms described by the Holy Bible might be identified as a severe form of atopic dermatitis (AD). The earliest record of an apparently allergic reaction is 2621 B.C., when death from stinging insects was first described by hieroglyphics carved into the walls of the tomb of Pharaoh Menes depicting his death following the sting of a wasp. In 79 A.D., the death of the Roman admiral Pliny the Elder was ascribed to the SO2-rich gases emanating from the eruption of Mount Vesuvius. Hippocrates (460-377 B.C.) was probably the first to describe how cow's milk (CM) could cause gastric upset and hives, proposing dietetic measures including both treatment and prevention for CM allergy. [ABSTRACT FROM AUTHOR]

Autologous fat transfer has become an increasingly important method of facial rejuvenation both as a standalone procedure as well as in combination with traditional rejuvenative methods, like facelifting, browlifting, and blepharoplasty. In certain respects, fat grafting stands in contradistinction to previous efforts at rejuvenation in that the face is augmented with tissue rather than subtracted by lifting, pulling, and excising. A simple analogy to understand the benefits of fat grafting is looking at a full and ripe grape that becomes prunelike (wrinkled, puckered) over time like a convex, youthful face that undergoes contraction and involution with aging. Rather than remove what appears to be redundant tissue and transform that raisin into a pea, perhaps it would be better to reinflate that tiny raisin back into a grape. [ABSTRACT FROM AUTHOR]

It would be helpful to have a safe and effective method to reverse the early signs of facial laxity. This early sagging of the jowls, eyebrows, and neck does not require a full facelift. The curl lift provides a good alternative for lifting the face and returning to work in 1 week [1]. This procedure can also be combined with chemical peels [2] or laser resurfacing [3], treatment of the anterior neck [4], augmentation with adipose tissue [5], a browlift, or blepharoplasty [6]. [ABSTRACT FROM AUTHOR]

This chapter is dedicated to my dear friend Franco Antognini M.D. (1945-2006) who was the anesthesiologist in my clinic for over 13 years. His great talent and humanity should be remembered as an example for young physicians. He will be missed by all, especially his wife, daughter, and son (who is just starting his medical career). [ABSTRACT FROM AUTHOR]

The medical legal implications of facial cosmetic proce­dures are related to:1. Failure to maintain patient rapport2. Breach of the standard of care3. Failure to obtain informed consent 4. Failure to obtain information on significant past medical history 5. Failure to diagnose and/or treat complications in a timely manner6. Performing procedures not requested [ABSTRACT FROM AUTHOR]

There are several techniques and procedures proposed for neck rejuvenation that have less than optimal results for correcting the submental and jowl areas. The prob­lem with the submental area is that the point of the pull is angled and too far away. That is to say behind the ear and the back hairline is distant from the submental area. Therefore, if the surgeon wants to have a natural look to a facelift there will always be some laxity and loose­ness in the submental area and if the surgeon pulls it too tight to compensate for the distance there will be an unnatural result with a windblown appearance. Patients wish to have a natural appearance. [ABSTRACT FROM AUTHOR]

Despite the periorbital and nasolabial areas being the structures that are most visible during social engage­ments and showing the signs of aging at an earlier stage, aging of the neck with or without fat accumulation seems to be the most troublesome to most patients. For this reason, patients request neck rejuvenation as an isolated procedure or as a component of a more com­prehensive facial rejuvenation. [ABSTRACT FROM AUTHOR]

"I want to look better, but I don't want a full facelift". That is a statement a plastic surgeon hears frequently from a patient. What can a plastic surgeon offer a patient who wants a significant facial rejuvenation but does not want a full facelift? In a world where there is a new technique being advertised everyday on TV, or in high­end maga­zines, about looking younger with minimal downtime, it is more important than ever to get educated as plastic surgeons and to educate the public on what to realisti­cally expect. No one procedure is perfect for every pa­tient. The neck and the jaw line show the early signs of facial aging, so achieving a youthful neck line is a very critical step in facial rejuvenation. [ABSTRACT FROM AUTHOR]

"I have baggy eyelids," and "I don't like my neck" are, ar­guably, the commonest complaints one hears from pa­tients seeking facial aesthetic improvements. The latter complaint may be presented as "I am beginning to look like my mother," "I have a fat neck," "I have loose skin in my neck," "I hate my jowls" and other such specific or nonspecific complaints. When pressed to identify the exact changes needing improvement, patients may point to the obtuse cervicomental angle, loose skin, neckbands, presence of jowls and submental fat. [ABSTRACT FROM AUTHOR]

For the most part, the preceding chapters have focused on a spectrum of soft­tissue procedures that can have a profound effect on altering facial form and ultimately improving aesthetics. The vast number of procedures which have been presented make it clear that today's cosmetic surgeon has an extensive armamentarium of techniques available to achieve facial rejuvenation. While patients seeking advice about facial cosmetic sur­gery often focus on structures such as the nose, the eyes, and the laxity of their skin, the facial cosmetic surgeon's assessment frequently identifies the lower third of the face as an area that can be surgically modified to im­prove overall facial appearance and harmony. [ABSTRACT FROM AUTHOR]

Chin augmentation with alloplastic implants has been established for over 40 years. The popularity of this pro­cedure has grown owing to a better understanding of the anatomy and aging process of the mandible and an increase in diversity of alloplastic implants which have been more artistically designed for fit, form, and func­tion. [ABSTRACT FROM AUTHOR]

Within the last three decades, as the demand for aes­thetic facial surgery has increased, surgeons have been challenged to discover effective methods that are safe, ethical, and scientifically sound. This experimentation is yielding new knowledge and vastly improved tech­niques. The author has used the techniques to augment alloplastically the malar midface and premandible re­gions over the past 15 years. [ABSTRACT FROM AUTHOR]

Normally, in the function of the smile, the lips are re­tracted and elevated to expose a portion of the upper incisor teeth. In some cases, the lip retraction is too ex­treme and it exposes all of the incisors plus a large por­tion of gum above. This produces the so­called horse smile or gummy smile (Fig. 73.1), the correction of which was described by Rubinstein and Kostianovsky [1]. The operation is a relatively simple one that can be performed on an outpatient basis or in a well­equipped office. The results obtained are good. [ABSTRACT FROM AUTHOR]

The tissue alterations that appear as a consequence of the aging face affect not only the lids, cheek, and the forehead but also the upper lip [1, 2]. The lengthening and the shape deformities of the upper lip are not only the most important senile alterations but are also the most evident aesthetic senile changes [3]. [ABSTRACT FROM AUTHOR]

Knowledge of the anatomic layers of the face, their contents, and their relationship with each other is of paramount importance to perform effective midface lifting and to minimize the complications. According to Stuzin et. al. [1] the facial soft tissue is composed of skin, subcutaneous fat, the superficial musculoaponeu­rotic system (SMAS), mimetic muscle, deep facial fascia (parotid masseteric fascia), and the plane containing the facial nerve, the parotid duct, and the buccal fat pad. [ABSTRACT FROM AUTHOR]

The oval shape of the face may be lost on its lower por­tion, on both sides of the face in young, mature, or old people. This aesthetic defect is named "jowls." Jowls may be of different kinds: 1. They may be due to a pure buccal fat ptosis without subcutaneous fat accumulation and this is treated by buccal fat extraction only.2. Buccal fat ptosis may be associated with a localized fatty subcutaneous accumulation and buccal fat ex­traction has to be associated with liposuction of this fatty accumulation also responsible for these jowls. 3. Another kind of jowls may be due only to a localized subcutaneous accumulation of fat and this aesthetic anomaly is treated by localized liposuction. 4. Finally jowls may be due to a simple localized or generalized skin excess on the lower face without lo­calized subcutaneous fat accumulation or buccal fat ptosis (pseudojowls or false jowls). [ABSTRACT FROM AUTHOR]

Ear prominence is the most common congenital de­formity. Correcting the prominent ear is usually a very gratifying procedure for both the patient and the surgeon (Fig. 65.1). The goal of otoplasty therefore is to reposition the ear so that the ear occupies a closer angle to the skull while maintaining a natural appear­ance. A natural appearance is one with smooth curves without sharp angles, step­offs or irregularities, with a sufficiently deep postauricular sulcus. [ABSTRACT FROM AUTHOR]

Blepharoplasty surgery is not without risks. The sur­geon should be aware of the possible complications and understand how to prevent, diagnosis in a timely fash­ion, and treat these problems. [ABSTRACT FROM AUTHOR]