| Table of Contents |
| Section A | Surgical Anatomy | |
| Figure 1.1 | Anterior view of the skull | 1 |
| Figure 1.2 | Lateral view of the skull | 2 |
| Figure 1.3 | Lateral view: muscles of the head and neck | 3 |
| Figure 1.4 | Left: branches of cranial nerve VII (facial nerve), Right: sensory nerves of the face | 4 |
| Table 1.1 | Branches of cranial nerve V (trigeminal nerve) | 5 |
| Figure 1.5 | Branches of the facial nerve (circles indicate areas at greatest risk for injury) | 5 |
| Figure 1.6 | Vascular supply to the face | 6 |
| Figure 1.7 | Anatomy of the nose | 7 |
| Figure 1.8 | Subunits of the face | 8 |
| Figure 1.9 | Anatomy of the external ear | 9 |
| Figure 1.10 | Anatomy of the eye | 10 |
| Figure 1.11 | Anatomy of the nail unit | 11 |
| Figure 1.12 | Skin tension lines (face): for planning optimal incisions to minimize scarring | 12 |
| Figure 1.13 | Skin tension lines (anterior) | 13 |
| Figure 1.14 | Skin tension lines (posterior) | 14 |
| Figure 1.15 | Great saphenous vein (GSV) and its tributaries | 15 |
| Figure 1.16 | Small saphenous vein (SSV) and its tributaries | 16 |
| Section B | Excisional and Non-excisional Surgery | |
| | Preoperative History | 17 |
| Figure 2.1 | Guidelines for prophylactic and empiric antibiotics | 20 |
| Table 2.1 | Commonly used prophylactic antibiotic agents for cutaneous surgery | 21 |
| Table 2.2 | Antiseptic scrubs | 22 |
| Table 2.3 | Local anesthetics | 23 |
| | Anesthetics: Key Facts | 25 |
| Table 2.4 | Tumescent anesthesia solution | 27 |
| Table 2.5 | Electrosurgery | 28 |
| | Cryosurgery | 30 |
| Table 2.6 | Recommended surgical margins | 32 |
| Table 2.7 | Melanoma staging | 34 |
| | Main Indications for Mohs Micrographic Surgery | 38 |
| | Mohs Micrographic Surgery Procedure | 39 |
| Figure 2.2 | Mohs micrographic surgery | 40 |
| | Elliptical Fusiform Excision | 41 |
| Figure 2.3 | Elliptical fusiform excision | 41 |
| | Placement of Incisions and Excisions on the Face | 42 |
| Figure 2.4 | Placement of incisions and excisions on the face | 42 |
| | Simple Interrupted Stitch | 43 |
| Figure 2.5 | Simple interrupted stitch | 43 |
| | Buried Vertical Mattress Stitch | 44 |
| Figure 2.6 | Buried vertical mattress stitch for deep dermal tissue approximation and eversion | 44 |
| | Cutaneous Vertical Mattress Stitch | 45 |
| Figure 2.7 | Vertical mattress stitch | 45 |
| | Horizontal Mattress Stitch | 46 |
| Figure 2.8 | (a, b) Horizontal mattress stitch | 46 |
| | Running Subcuticular Stitch | 47 |
| Figure 2.9 | Running subcuticular/intradermal stitch | 47 |
| | Pulley Stitch | 48 |
| Figure 2.10 | Pulley stitch (epidermal): for closure of wounds under tension | 48 |
| | Three Point Suture (aka Tip stitch) | 49 |
| Figure 2.11 | Three-point stitch (AKA tip stitch) | 49 |
| | "Dog Ear" Repair | 50 |
| Figure 2.12 | Repair of dog ears | 50 |
| | "Leashing" of Dog Ears | 51 |
| Figure 2.13 | "Leashing" the dog ear | 52 |
| Table 2.8 | Absorbable sutures | 53 |
| Table 2.9 | Nonabsorbable sutures | 55 |
| Table 2.10 | Topical antimicrobial agents | 56 |
| Table 2.11 | Wound dressing | 58 |
| Table 2.12 | Surgical complications | 59 |
| Table 2.13 | Suture removal timetable | 63 |
| | Commonly Used Surgical Instruments in Dermatologic Surgery | 64 |
| Figure 2.14 | Scalpel handles | 64 |
| Figure 2.15 | Scalpel blades | 65 |
| Figure 2.16 | Curettes | 66 |
| Figure 2.17 | Needle holders | 67 |
| Figure 2.18 | Adson Forceps | 68 |
| Figure 2.19 | Bishop Harmon forceps | 69 |
| Figure 2.20 | Jacobson hemostat forceps | 70 |
| Figure 2.21 | Scissors: general operating scissors for suture cutting | 71 |
| Figure 2.22 | Scissors: the curved Mayo scissor (left), and the straight Metzenbaum scissor with blunted tips (right) | 72 |
| Figure 2.23 | Castroviejo needle driver | 73 |
| Figure 2.24 | Chalazion clamp | 74 |
| Figure 2.25 | Skin hook | 75 |
| Figure 2.26 | English nail splitter | 76 |
| Figure 2.27 | Nail elevator | 77 |
| Section C | Advanced Repairs | |
| | Flap Overview | 79 |
| | Single Advancement Flap | 80 |
| Figure 3.1 | Single advancement flap | 80 |
| | Bilateral Advancement Flap (H-Plasty) | 81 |
| Figure 3.2 | Bilateral advancement flap | 81 |
| | Z-Plasty | 82 |
| Figure 3.3 | Z-plasty | 82 |
| | M-Plasty | 83 |
| Figure 3.4 | M-plasty | 83 |
| Figure 3.5 | M-plasty | 84 |
| | S-Plasty | 85 |
| Figure 3.6 | S-plasty | 85 |
| | Rotation Flap | 86 |
| Figure 3.7 | Rotation flap | 86 |
| | Double Advancement Rotation Flap (O-Z Plasty) | 87 |
| Figure 3.8 | Double advancement rotation flap or O-Z plasty | 87 |
| | Rhomboid Flap | 88 |
| Figure 3.9 | Standard rhomboid transposition flap, modified rhomboid flap | 88 |
| | Bilobed Transposition Flap | 89 |
| Figure 3.10 | (a): Traditional bilobed transposition flap, (b): Zitelli modified bilobed transposition flap | 89 |
| | Skin Grafts Overview | 90 |
| | Stages of Graft Survival | 90 |
| Table 3.1 | Skin graft types | 91 |
| Section D | Cosmetic Dermatology: Fillers, Neurotoxins, and Chemical Peels | |
| Table 4.1 | Botulinum toxin dilutions | 93 |
| Table 4.2 | Injectable fillers | 94 |
| Table 4.3 | Chemical peels | 98 |
| Section E | Lasers and Other Technology | |
| | Laser Overview: Light Amplification by Stimulated Emission of Radiation | 99 |
| Table 5.1 | Lasers used in dermatology | 100 |
| Table 5.2 | Fractionated laser devices | 104 |
| Table 5.3 | Home use and low-energy devices | 106 |
| Table 5.4 | Tattoo removal by laser | 108 |
| Table 5.5 | Photo-induced eye injury | 110 |
| | Novel Devices: Skin Tightening and Body Sculpting | 111 |
| Section F | Leg Veins | |
| | Leg Vein Treatment Overview | 113 |
| | Leg Vein Treatment Algorithm | 115 |
| Table 6.1 | Laser for leg veins | 116 |
| Table 6.2 | Sclerotherapy agents | 117 |
| | Index | 121 |
