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More recently, nonablative energy devices have been designed to diffusely tighten the entire facial and neck area.6,7 These devices are potentially attractive to both patients and physicians. Patients may nd nonsurgical tightening less frightening, and they may view tightening devices as safer than face-lifts. From an anatomic standpoint, devices also offer the promise of results without visible scars, or the risk of focal neurovascular injury. Physicians may also nd tightening devices an attractive option. To the extent that tightening devices are unlikely to cause infection, dehiscence, injury, or asymmetry, they are safer. Postprocedure complications are rare, and additional corrective surgery or follow-up visits

Let s modify the system presented in Question 28-4 and graphed in Fig. 30-5. Suppose that we move the upward-opening parabola even further straight down, but leave the downwardopening parabola in the same place. What will happen to the solution points How will the equations in the system change

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as a whole before concentrating on the periocular (or any other individual) region, as the goal of any treatment is to create a harmonious facial appearance An observer s eye is actually drawn to asymmetry more so than rhytides or lines That is, creation of a smooth island in a sea of rhytides produces a less natural appearance than if the patient were not treated at all20,21 The patient is then evaluated from a frontal perspective Particular attention is paid to the presence of rhytides at rest, eyebrow contour and position, horizontal forehead rhytides that may be indicative of chronic brow elevation, extent of photoaging, presence of dermatochalasis in the upper eyelid, position of the upper eyelid margin relative to the pupil, and lower eyelid position If white sclera is visible above the superior limbus or below the inferior corneoscleral limbus, additional ophthalmic evaluation is warranted.

The presence of horizontal forehead rhytides may either indicate overactive use of the muscles or facial expression or a compensatory response to eyebrow ptosis One must make this distinction, as weakening the frontalis muscle in the latter setting will uncover a previously latent eyebrow ptosis That is, patients who have been elevating their eyebrows continuously in order to prevent impairment of their superior visual eld will no longer be able to do so if their frontalis muscle is weakened The examiner can identify the patient with latent brow ptosis by studying the patient when the frontalis muscle is completely relaxed (instruct the patient to relax their forehead) If the eyebrows assume a lower position when the frontalis muscle relaxes, BTX should not be injected into the forehead These patients need eyebrow and/or eyelid surgery to correct their underlying problem.

Next, the patient is asked to gently (not forcibly) close the eyes to ensure complete apposition of the upper and lower lids Some patients who have had prior surgery, trauma, or thyroid disease may be able to forcibly close their eyes but have an incomplete blink that leaves them highly vulnerable to symptomatic dry eyes if the orbicularis oculi muscle is weakened The patient is then instructed to forcibly close the eyes This permits evaluation of the pretarsal orbicularis oculi muscle in its dynamic state The appearance of a prominent bulge in the pretarsal region is suggestive of hypertrophic orbicularis oculi muscle Importantly, this condition must be differentiated from a bunched lower eyelid occurring as a result of cheek tissue recruitment with contraction of the zygomaticus major and minor muscles..

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TIP A detailed Server Data Sheet can be found at the companion web site: www.Reso-Net.com/PocketAdmin. Use this sheet as the basis of your server documentation and identify installed services.

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A small motorboat traveled downstream for 10 miles then turned around and traveled back upstream for 10 miles. The total trip took 3.5 hours. If the stream s rate is 3 mph, how fast would the motorboat have traveled in still water (a) 4 mph (b) 10 mph (c) 7 mph (d) 6 mph

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