Aesthetic Flashcards
What branches of the external carotid artery supply the lid?
Facial internal maxillary and superficial temporal
Discuss the innervation to the eyelid
V2 supplies, the lower eyelid, cheek, and upper lip
Lateral palpebral branch of the lacrimal nerve, which is a branch of the infraorbital nerve supplies, the lateral superior portion of the upper eyelid
The lacrimal nerve, a branch of the ophthalmic division of V1 provide sensation to the upper eyelid
Infratrochlear nerve provide sensation to the medial aspect of the upper and lower eyelid
Zygomatico facial nerve provides sensation to the lateral fat pad of the lower eyelid
Discuss the composition of tears
Goblet cells produce mucin on the inner layer
Lacrimal gland secretes the aqueous middle layer
Meibomian glands produce the outer lipid layer
Lymphatic drainage of the eyelid
Medial goes to sub maxillary lymph nodes
Lateral goes to parotid lymph nodes
What patients require lateral canthotomy and canthoplasty
Patient with lid distraction, greater than 6 mm
What is an abnormal schirmers test?
Less than 10 mm
What is the only extraocular muscle to directly insert into bone?
Inferior oblique
Third, most common eyelid cancer
Sebaceous cell carcinoma
Most common complication after lower eyelid, bleph
Lower eyelid malposition
What is the preferred treatment of lower eyelid atrophy on once passed the six weeks
Canthoplasty with spacer graft
What is responsible for bunny lines?
Levator labii superioris alequae and nasalis
What is the origin and insertion of the corrugator muscle?
Origin from the frontal bone near the superior medial orbital rim lateral to the origin of the procerus muscle
Inserts into the dermis of the forehead skin above the middle third of the eye eyebrow
What nerve is encountered and preserved during resection of the medial aspect of the corrugator muscles?
Supratrochlear
What is the innervation of the corrugators
The media head, which is responsible for horizontal movement and vertical global lines is innovated by the frontal branch
The oblique head which is responsible for horizontal movement and medial brow. Depression is innovated by the buccal branch.
Normal forehead height for women
Ranges between four and five cm
During the aging process, the forehead lengthens due to receding hairline and brow descent
What is the plan of dissection in an endoscopic brow lift?
Subperiosteal over the forehead
Deep to the temporoparietalfascia over the temple
Superior temporal septum must be released to achieve continuity between these dissections
UV light
UVA is the most damaging with a longer wavelength
UVB is responsible for most of the DNA damage of the skin and has a wavelength of 280 to 315
Meretoja syndrome
Systemic form of amyloidosis
Excessively lack skin in person’s 20 years older
Facial polyneuropathy
Amyloid deposits in perineum and endoneurium of peripheral nerves
Surgery is contraindicated
Idiopathic skin laxity disorders MDE
Patchy areas of mid dermal elastic lysis
Localized fine wrinkling
No systemic abnormalities
Pathogenesis poorly understood
Surgery contraindicated
What is the endpoint of each of the describe dissection layers in the cheeks?
Skin elevation is at the nasolabial fold
SMAS is at upturning of the modiolus
Describe the continuity at the tissue plane of the deep temporal fascia
Cranial periosteum
Deep temporal fascia
Parotid masseteric fascia
Deep cervical fascia
The deep temporal fascia splits into two layers that surround the superficial temporal fat pad as they extend inferiorly
The superficial layer then becomes the parotid masseteric fascia
Describe the superficial muscular aponeurotic system
Galea
Frontalis
Superficial temporal fascia
SMAS
Platysma
Superficial cervical fascia
What is responsible for the development of festoons?
Orbicularis Oculi cutaneous ligaments are stretched with herniation of orbital fat pad and loss of malar fat pad support following its descent
What is responsible for jowling
Soft tissue cutaneous ligaments include the masseteric cutaneous ligaments that stretch from the anterior border of the masseter to the skin
What is responsible for Marinette lines?
Osteo cutaneous ligaments include the zygomatic and mandibular ligaments
Zygomatic ligaments are responsible for male, fat, descent, and nasolabial full deepening
Volume deflation in the setting of an intact, mandibular ligament can lead to the presence of Marinette lines
Minimal access cranial suspension
The SMAS is purse string sutured to the DTF with two sutures to correct the neck and the lower third of the face and sometimes an additional suture to address the mailer fat pad
What is the risk of facial nerve injury in a primary versus secondary facelift?
Risk of nerve injury is the same
Describe the course of the spinal accessory nerve
Exit the jugular foramen
Travels deep to the styloid process
Courses underneath the SCM
Exits from the posterior border of the SCM fascia within 2 cm superior to the GAN
Susceptible to injury after it exits the muscle in the posterior triangle of the neck
Posterior triangle of the neck
SCM anterior border
Trapezius posterior border
Middle one third clavicle inferior
Contain spinal accessory nerve
The trunks of the brachial plexus
Scapular and transverse cervical branches of the thyrocervical trunk
External jugular vein
Anterior triangle of the neck
Posterior border is the SCM
Anterior border is midline of the neck
Superior border is the mandible
Contains the vagus nerve
Hypoglossal nerve
Part of sympathetic trunk
Mylohyoid nerve
Anterior jugular veins internal jugular, common facial lingual, superior, thyroid, middle thyroid veins facial vein, submental vein
When is the ear It’s adult size.
80% of the adult size by age 6
90% above age 10
Ear width is reached by seven for boys and six for girls
Length reaches by 13 for boys and 12 for girls
Average width is 3 to 4 centimeters
Height is 5.5 to 7 cm
Describe ear anatomy
Lies one ear length posterior and lateral from the lateral orbital rim
Highest point of the ear coincides with the brow and the lowest point with the columella
Angles approximately 15° posteriorly
Upper third protrude 10 to 12 mm from the scalp
Middle is 16 to 18 mm from the scalp
Lower is 20 to 22 mm from the scalp
Furnas sutures
Placed in the concha and mastoid
These are the last sutures placed after completion of all other steps
The conchal angle is ideally less than 90°
Most common complication of otoplasty
Residual deformity
Where can the nose be injected with fillers?
The sub, SMAS plane above the plane of the periosteum in the nasal dorsum and side walls
What is a tension nose
Combination of thin, constricted, nasal skin envelope with strong, lower lateral cartilage, leading to a potentially twisted or deviated appearance
Also defined as excessive growth of the quadrangular cartilage, resulting in a high dorsum and displaced lower lateral cartilages
Sensory to the nose
External anterior ethmoidal nerve supplies, the distal, nasal dorsum and nasal tip. It is at increased injury risk when endonasal approaches used.
Internal anterior ethmoidal nerve supplies, the septum and the internal nasal walls
Nasal palatine nerve
Normal internal nasal valve angle
10 to 15°
What is the septum made of?
Septal cartilage the nasal crest of the Maxilla, the perpendicular plate of the ethmoid and the vomer
What muscle assist in maintaining the patency of the external nasal valve
Levator labii superioris alaeque nasi
What is the normal relationship between the bony base with and the alar base with of the nose?
Bony base with should be 80% of the alar base with
Nasofrontal angle
134° in females and 130° in males
Angle of divergence
Between the left and right middle crura of the lower lateral cartilages and should be between 30 and 60°
Nasolabial angle
Assesses tip rotation
Should be 95 to 100° in females and 90 to 95° in males
Inverted V deformity
When the middle vault is not preserved, and there is over resection of the upper lateral cartilage during dorsal reduction
Visible separation between the bone vault and the middle vault
Poly beak deformity
High septal angle, combined with decreased tip projection
Grenz zone
Sub epidermal region of dermis where neo collagen formation by fibrous occurs after wounding or damage
This is the area that is responsible for the regenerative changes in the skin after treatments
What is the most predictable peeling agent?
Phenol
Jessners peel
Made of Salicylic acid lactic acid and resorcinol mixed in ethanol
Baker Gordon phenol peel
Phenol
Water
Liquid soap
Croton oil
Most common long, lasting side effect of phenol peels
Hypo pigmentation, which can be permanent
How do you increase the penetration of a laser?
Increase the pulse energy or increase the number of passes
Most common type of laser used for hair removal
Nd YAG
Another name for phenol
Carbolic acid
What is the long-term effect of Retin-A treatment of sun damaged skin?
Pre-malignant lesions regress
Mechanism of action of retinoids
Decreased activation of Metalloproteinases through inhibition of AP one transcription
What bio material is designed to be replaced by bone
Bioactive glass is both Osteo conductive and Osteo inductive
At what age is skeletal growth essentially complete
Cranial vault is complete at three years
Facial skeleton is complete at 14
What kind of material should you use in a loadbearing cranial facial reconstruction?
Autologous
What are the three unique properties of lasers?
Coherent
Monochromatic
Intense
585 nm pulse died laser is absorbed by what chromophores
Oxyhemoglobin
What laser is best for tattoo and hair removal in patient with darker skin
ND yaG
Should target hair in the anagen phase
