REVIEWS
A s a service to our readers, Plastic and Recon-
structive Surgery® reviews books, DVDs, prac-
tice management software, and electronic media
items of educational interest to reconstructive and
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Reviewers are selected on the basis of relevant
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view so published. Send books, DVDs, and any other
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75390-8820.
Ronald P. Gruber, M.D.
Review Editor
Anatomy and Botulinum Toxin
Injections
By Fabio M. Ingallina, M.D., and Patrick Trévidic, M.D. Pp.
130. E2e Medical Publishing, Paris, France, 2010. Price:
$286.
A natomy and Botulinum
Toxin Injections is a
handy, detailed, soft-cover
atlas/text that is divided into
10 chapters based on the
muscles of the face and neck
that might benefit from bot-
ulinum injections. It is ac-
companied by a DVD. As the
authors state in the Preface,
each chapter represents a
muscle, and each muscle is
reviewed from a similar perspective, beginning
with a description of the muscle and ending with
injection technique and dosage. Sections 3
through 5 of each chapter contain beautiful ca-
daver dissections that are valuable for any physi-
cian operating on or treating facial structures. In-
deed, the artwork and accompanying cadaver
dissections are the most valuable aspects of this
book and are unlike any other botulinum injec-
tion reprints that we know of. The book fills a
void in appreciating facial anatomy as it relates to
botulinum toxins.
Copyright ©2011 by the American Society of Plastic Surgeons
www.PRSJournal.com
Although we enjoyed and highly recommend
this atlas on a global scale, we have some concerns.
There are no references and no index, which may
not always be a requirement for this type of format
but would have helped confirm the anatomical
findings and locate for the reader additional re-
sources. Conversely, the inclusions of muscle in-
nervations and the location of motor end plates
are too detailed and, although anatomically inter-
esting, clinically somewhat irrelevant. To their
credit, the authors do include both commercially
available neurotoxins and the corresponding
units that they prefer. However, they omitted their
reconstitution, their recommended conversion ra-
tio between Botox and Dysport (which appears to
be 1:2.5), and their technique of injecting small
and precise amounts. Furthermore, there is little
rationalization in their dosing guidelines and if
they believe, as is implied in the book, that dif-
ferent toxins have the same injection sites, that
should be stated. Also, they frequently recom-
mend inserting the needle to the bone and with-
drawing “1-2 mm” back into the belly of the muscle.
Although that maneuver may assist proper place-
ment for a novice injector, it tends to be more pain-
ful to the patient and moreover is worrisome when
treating small muscles or those that overlie adjacent
muscles.
On a regional level, the authors state “never
inject the inferior portion of the frontalis muscle.”
Few dogmas in medicine are absolute, and in the-
ory this may have some validity, but in reality, the
inferior fibers of this muscle interdigitate with the
lateral fibers of the corrugator supercilii, and it
would be futile to truly isolate them. They also
initially state that these inferior injections should
be “1 to 2 cm above the orbital superior border to
reduce the risk of ptosis”; five pages later, that
margin of safety is changed to “2 to 3 cm.” It should
be acknowledged that some patients accept a low-
ered brow if all rhytides are ameliorated (this is
one of the most important discussions we have
with any patient considering frontalis muscle
treatment). In this discussion, they mention the
levator palpebrae muscle, a muscle that many as-
sociate with eyelid ptosis, but it cannot be found
on any of their very nice dissections or illustra-
tions. The authors devote three separate chapters
to the anatomy of the glabellar complex with a
total of 10 injection sites (approximately double
the number that is generally suggested) to treat
this aesthetic unit. A considerable amount of
space is devoted to these individual muscles, in-
clusive of a chapter on the somewhat obscure de-
pressor supercilii, a muscle that is often consid-
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 Plastic and Reconstructive Surgery • November 2011
ered to be the medial fibers of the orbicularis
oculi. However, it is frustrating that they do so to
the complete exclusion of all nasal musculature.
When treating the orbicularis oculi muscle, it
is unclear why this is the sole area where there is
a disparity in the number of injection sites for the
two toxins. As this text is also designed to help even
the novice injector, the brow depressor activity of
the lateral superior fibers of the orbicularis oculi
and the consequent brow elevation with their in-
activation should have been emphasized. In addi-
tion, the authors state that treating the inferior
fibers of the orbicularis oculi often “treats the tear
trough depression.” What would have been more
informative and more accurate is if they had stated
that a preinjection snap test is warranted to ensure
adequate skin recoil and that weakening these
fibers may widen the ocular aperture and reduce
some of the dynamic fine infraocular rhytides.
Weakening the muscles in the lower two-thirds
of the face (i.e., “extended” use of botulinum
toxin) is usually not considered alone or what is
referred to as monotherapy and is often used in
combined therapy with adjunctive soft-tissue aug-
mentation and/or lasers. This concept is also not
mentioned. Imprecision or excessive toxin admin-
istration particularly in this area can result not
only in an aesthetic deformity but also in func-
tional impairment, and this should have been re-
inforced. The location, function, and resultant
rhytides of the levator labii superioris alaeque nasi
muscle seem to coincide exactly with what would
be expected of the nasalis muscle. Nevertheless,
the authors do correctly state that inactivation of
this small muscle (levator labii superioris alaeque
nasi) blunts the upper third of the nasolabial fold
but, importantly, they do not mention that as a
consequence it can also blunt the cupid’s bow.
It is also surprising that they did not mention
that treating this small muscle can help to improve
a “gummy smile.” No mention is made of the role
of botulinum toxin for the plunging nasal tip or
postrhinoplasty transverse upper lip rhytide.
Moreover, not much is discussed about facial re-
shaping with botulinum toxin.
Locating and treating the depressor anguli
oris can be difficult and, although they do cau-
tion assiduous avoidance of the depressor labii
inferioris, the three injection sites that they
show seem to be in the general vicinity of
both the platysma and the masseter muscles.
The latter masseter muscle, although not routinely
treated, should have been included in the diagrams
and the corresponding injection pattern, as masse-
1150
ter hypertrophy treatment is a frequent concern in
certain populations.
Despite the aforementioned critiques, Drs. Fa-
bio Ingallina and Patrick Trévidic have provided
wonderful facial muscle dissections and illustra-
tions accompanied by live models depicting the
majority of the important facial muscles that are
essential to properly injecting botulinum toxin.
They are to be commended for taking this pro-
cedure to a new three-dimensional level and, al-
though the injection sites and technique may not
be universally adopted, the text is an excellent
asset to those injectors, novice and experienced,
interested in learning about facial musculature as
it relates to the aesthetic surgeon. Finally, it will
serve as a handy reference when “brushing up” on
muscular facial anatomy or as a teaching tool for
educating patients.
DOI: 10.1097/PRS.0b013e3182311baa
Alan Matarasso, M.D.
Seth Matarasso, M.D.
Decision Making in Plastic Surgery
Edited by Jeffrey L. Marsh and
Chad A. Perlyn. Pp. 340. Quality
Medical Publishing, Inc., St.
Louis, Mo., 2010. Price: $225.
D ecision Making in Plastic
Surgery, edited by Jeffrey
L. Marsh and Chad A. Per-
lyn, is a welcome update to
the original textbook, and it
retains the algorithm format
in the management of plas-
tic surgery patients. The al-
gorithms present clinical
scenarios in a clean and linear layout with acceptable
management options. The decision trees are orga-
nized by problem, interventions (surgical and non-
surgical arranged hierarchically when appropriate),
and endpoints. The preceding page contains text
that highlights critical decision-making points that
detail key aspects of the physical examination, pre-
operative evaluation, surgical considerations, post-
operative management, and complications. The
chapters are written by experts in their respective
fields, and each chapter has a list of selected refer-
ences for further reading. There are no figures, il-
lustrations, or accompanying DVD.
The book is organized into three sections:
Fundamentals, Reconstructive Surgery, and Aes-
thetic Surgery. The Fundamentals section con-
tains 12 chapters on wound management, from
facial lacerations and acute soft-tissue trauma to
Volume 128, Number 5 • Reviews
chronic pressure sores and scars. In this section,
there is a comprehensive and well-thought-out algo-
rithm for keloid management that incorporates all
the facets of care, including debulking, radiation,
chemotherapy, and pressure treatments. The ma-
jority of the book focuses on reconstructive surgery,
with 97 chapters devoted to skin, head and neck,
breast and trunk, upper extremity, and lower ex-
tremity. The chapters dedicated to congenital anom-
alies—specifically, cleft lip and palate—were among
the best in the book and presented the best man-
agement schemes based on anatomy, age, and prior
interventions. At the end of each broad topic, there
are chapters dedicated to the management of com-
plications. This section also contains excellent chap-
ters on the management of hand-related problems.
By organizing topics into separate algorithms, this
book presents perhaps the easiest and most orga-
nized format that I have seen in the management of
congenital hand anomalies.
The aesthetic surgery section has 28 chapters
organized into the following topics: skin, brow and
periorbital, face, nose, breast, body contouring,
and massive weight loss. This format emphasizes
the importance of the examination and diagnosis
in aesthetic surgery, as each algorithm branched
from different components of the physical exam-
ination. This is best demonstrated in the chapters
dedicated to the correction of the different com-
ponents of nasal deformity. Although the recon-
structive surgery section contains chapters on the
management of complications, this is missing in
the aesthetic surgery section and would be a real
benefit if included. Overall, the book is compre-
hensive and provides updates to decision-making
algorithms based on current literature.
By design, the text and outline of the algorithms
are concise and at times appear generalized. How-
ever, the purpose of this book is to provide a frame-
work for the management of plastic surgical patients.
To fully use this book, readers should make notes on
sections as they come across them. Also, readers
should keep in mind that the algorithms are rec-
ommendations and reflect the authors’ opinions on
the subject. This is an ideal book for plastic surgical
residents, as it will help them develop a strategy for
the management of the entire breadth of plastic
surgery. Moreover, I would recommend this book to
anyone preparing for the boards and for established
practitioners, as it will help to organize and focus
their study.
DOI: 10.1097/PRS.0b013e3182311bc2
Tae Chong, M.D.
Correction: Redefining the Vascular Anatomy
and Clinical Applications of the Sartorius
Muscle and Myocutaneous Flap
I n the Reconstructive article by Mojallal et al. entitled
“Redefining the Vascular Anatomy and Clinical Ap-
plications of the Sartorius Muscle and Myocutaneous
Flap,” published in the May 2011 issue of the Journal
(Plast Reconstr Surg. 2011;127:1946 –1957), the last
name of the fourth author is incorrect. The author’s
name should read “Christophe Ho Quoc, M.D.” (cor-
rection in italics).
DOI: 10.1097/PRS.0b013e318238ca93
REFERENCE
Mojallal A, Wong C, Shipkov C, Hocuoq C, Recchiuto J, Brown
S, Rohrich RJ, Saint-Cyr M. Redefining the vascular anatomy and
clinical applications of the sartorius muscle and myocutaneous
flap. Plast Reconstr Surg. 2011;127:1946–1957.
Correction: Brow Lift in Facial Rejuvenation:
A Systematic Literature Review of Open versus
Endoscopic Techniques
I n the Cosmetic Evidence-Based Medicine Special
Topic by Graham et al. entitled “Brow Lift in Facial
Rejuvenation: A Systematic Literature Review of
Open versus Endoscopic Techniques,” published in
the October 2011 issue of the Journal (Plast Reconstr
Surg. 2011;128:335e–341e), the last name of the third
author is incorrect. The author’s name should read
“T. Jonathan Kurkjian, M.D.” (correction in italics).
DOI: 10.1097/PRS.0b013e318238cb66
REFERENCE
Graham DW, Heller J, Kirkjian TJ, Schaub TS, Rohrich RJ.
Brow lift in facial rejuvenation: A systematic literature review
of open versus endoscopic techniques. Plast Reconstr Surg.
2011;128:335e–341e.
Correction: Introducing the New PRS iPad
App: The New World of Plastic Surgery
Education
I n the editorial by Rohrich et al. entitled “Introducing
the New PRS iPad App: The New World of Plastic
Surgery Education,” published in the September 2011
issue of the Journal (Plast Reconstr Surg. 2011;128:799 –
802), the disclosure for Karen Abramson is incorrect.
It should read “Disclosure: Karen Abramson is the President
and CEO of Wolters Kluwer Health/Lippincott Williams &
Wilkins, publisher of Plastic and Reconstructive Surgery
and the PRS iPad app.”
DOI: 10.1097/PRS.0b013e318238cd02
REFERENCE
Rohrich RJ, Sullivan D, Tynan E, Abramson K. Introducing the
new PRS iPad app: The new world of plastic surgery education.
Plast Reconstr Surg. 2011;128:799–802.
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