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The chin is a crucial landmark and mandates careful consideration for facial appearance. Optimal chin appearance requires evaluation and treatment in three dimensions: anteroposterior, transverse, and vertical planes. The optimization of chin deficiencies requires understanding of bony anatomy as well as the relationship of the adjacent facial structures including the lip, teeth, and nose. The practitioner should be familiar with techniques in injection, placement of alloplastic implants, as well bony genioplasty., Competing Interests: None declared., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

As the use of fillers becomes increasingly more common and the skill level of those injecting is so varied, adverse events can be expected to increase as well. Avoiding complications is always the best measure, and with appropriate training and injection techniques, many complications can be avoided. However, adverse events can occur in the best of hands, and early detection and treatment may eliminate or minimize sequelae. This article is an effort to help in that endeavor., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

The chin plays a very important role in overall facial appearance, and aesthetic procedures to augment the chin in patients with microgenia can improve overall facial balance. Many procedures exist to enhance the appearance of a small chin. Procedures include surgeries such as placement of an alloplast implant and bony osteotomy of the mentum (sliding genioplasty). The advantages and disadvantages of each surgical technique are well documented. Although surgical augmentation of the chin has been the gold standard of therapy, recent development of injectable filler products with lifting capacity has changed the way that many practitioners alter chin shape and size. Filler agents allow augmentation of the chin in horizontal (projection), vertical, and transverse dimensions. Injectable fillers are a simple, noninvasive procedure that causes minimal to no downtime, incurs minimal risks, and allows the practitioner to shape the chin in three dimensions. This procedure allows patients to enhance their chin size without requiring an operative visit. As more and varied filler products become FDA-approved, the versatility and application of these agents will increase., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

The evaluation and treatment of patients with congenital orofacial clefting is a challenging task. Successful treatment requires a concerted effort by the cleft surgeon and cleft team to maximize the appearance and function of the cleft patient. To become a competent cleft surgeon, a facial plastic surgeon must be dedicated to a lifelong pursuit of technical excellence through continual evaluation, self-criticism, and improvement of surgical techniques and approaches. The contemporary cleft surgeon must integrate the knowledge gained by mentors that have years of expert experience and evidence-based information demonstrated by careful study. This information should help guide the young cleft surgeon as experience is gained and expertise developed through years of careful observation and evaluation of patients. This article is a discussion of the art and science of cleft surgery. It outlines the timetable associated with cleft repairs, the resources necessary to provide superior cleft care, and exposes the weaknesses and frailties of all cleft surgeons. It is designed to aid cleft surgeons in their pursuit of perfection., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Complications resulting from cleft lip and cleft rhinoplasty surgery are usually due to errors in surgical planning and technique. The various secondary deformities resulting from cleft lip and cleft rhinoplasty surgeries are reviewed and management options discussed., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Hyaluronic acid (HA) fillers have many favorable characteristics that make it a popular injectable filler device. Its minimal immunogenicity and relative ease of use has helped HA become the most commonly used injectable filler today. A brief history of injectable fillers, the various injection techniques, and legal ramifications are discussed. A review of the most recent literature compares the efficacy and safety of HA to other injectable filler substances., (© Thieme Medical Publishers.)

The nasal septum plays an important role in both the appearance and function of the nose. Deviation of the nose is common and correction requires a focused, anatomically based treatment. Reconstruction and support of the septum is a necessary component to a straight nose. The "four R's" of nasal septal repair--resection, reposition, reconstruction, and replacement--can be used to straighten the septum and maximize nasal appearance and function., (© Thieme Medical Publishers.)

Profile alignment, including nasal dorsal reduction, is one of the most common maneuvers in aesthetic rhinoplasty. Techniques often include cartilaginous excision and bony hump reduction with a chisel or a rasp. Cartilaginous nasal vault excision can result in separation of the junction between the upper lateral cartilages and the dorsal septum. This separation can cause an inferior-medial repositioning of the upper lateral cartilages and overall weakening of middle vault infrastructure. Furthermore, surgical interruption of this key region can also damage the internal nasal valve configuration and function and create static and dynamic airway obstruction. This article outlines the anatomy and function of the middle nasal vault and internal nasal valve. In addition, it provides an overview of aesthetic complications of dorsal hump removal including inverted-V deformity, saddle nose deformity, hourglass deformity, and their functional consequences. Preoperative individual risk factors for middle-third deformities are mentioned. Preventive and corrective surgical techniques including cartilage grafting and reconstructive sutures are also detailed., (© Thieme Medical Publishers.)

Many face-lift variations have been described including short skin flap, long skin flap, superficial musculoaponeurotic system flap, deep plane, composite flap, and subperiosteal face-lifts. Each technique offers its set of advantages and disadvantages. Theoretical benefits include a more optimal treatment of the midface, nasolabial fold, and periorbital area. A review of the literature highlights some of the potential advantages of the deep plane face-lift and the difficulty in objectively comparing the various techniques., (© Thieme Medical Publishers.)

The process of aging is the result of subcutaneous loss of volume, in addition to vertical tissue descent. Surgeons are therefore emphasizing soft tissue augmentation to achieve a natural, rejuvenated appearance in patients. Autologous fat grafting is now a commonly performed aesthetic procedure. Autologous fat grafting is a challenging procedure, due to the fragile characteristic of adipose tissue. Viability of transplanted fat is a main consideration when fat grafting is performed. Poor fat viability produces an inadequate result and thus can be considered as a complication of this procedure. Many studies have demonstrated that fat longevity is dependent upon handling and preparation of fat. This article outlines the history of autologous fat grafting. The technique of fat grafting is described, along with review of the evidence of fat viability according to the technique used. The specific technique for autologous fat grafting in the lower third of the face is described including augmentation of the labiomandibular fold, lips, chin, and the jaw., (© Thieme Medical Publishers.)

The middle nasal third is often the source of both aesthetic and functional problems with primary rhinoplasty. Weakness of the middle nasal vault can occur from overresection of the upper lateral cartilages or cartilaginous nasal septum, malposition of the upper lateral cartilages, or from secondary scarring from the primary rhinoplasty. These functional and aesthetic problems can be avoided by maintaining an adequate infrastructure to the middle nasal vault. If secondary problems occur in the middle nasal third, precise anatomic reconstruction can be performed in the form of cartilage grafting and/or suture reconstitution. This reconstruction requires an in-depth knowledge of the functional nasal anatomy and the ability to re-create the infrastructure so that it withstands the forces of scarring and wound contraction. This article outlines the anatomy of the middle third of the nose, the conditions that cause secondary middle-third problems, and the surgical management of these deformities.

The bilateral cleft lip is a complex deformity involving discontinuity of the soft tissue layers of the lip and, frequently, the underlying bony structure. Satisfactory repair requires a thorough understanding of the anatomic deformity. The authors' philosophy and timing of the bilateral cleft lip repair are discussed. Details of the surgical technique are outlined.

Cleft and craniofacial healthcare is complex, warranting a specialized, multidisciplinary approach. The modern cleft team is best suited to deliver appropriate care to both affected individuals and their families.

Correction of the cleft-lip nasal deformity is a difficult task that requires a clear understanding of the associated complex anatomic abnormalities. These deformities tend to accentuate as nasal growth continues. Primary tip rhinoplasty in the unilateral deformity improves nasal tip symmetry and decreases the need for intermediate surgery. Intermediate rhinoplasty in the bilateral deformity is performed when nasal tip projection is markedly diminished. In both the unilateral and bilateral deformity, definitive rhinoplasty utilizing the open-structure rhinoplasty approach allows maximum exposure for placement of structural grafts to improve tip projection, definition, support, and function. In this article, the pathologic anatomy of the unilateral and bilateral cleft nasal deformity is described. The philosophy and timing of repair are discussed. Finally, the techniques used by the authors to address both the aesthetic and functional problems are outlined.