Cosmetic questions OMSITE Flashcards
When performing a z-plasty to remove a prominent labial frenum the secondary incisions are made at an angle approximately 60 degrees to allow the main limb to be rotated: A. 33 degrees B. 45 degrees C. 60 degrees D. 90 degrees
D. 90 degrees
A z-plasty is designed to rotate the frenum or scar 90 degrees. Secondary incisions made at other angles may not allow as great a rotation of the main limb (in this case, the main frenum incision) as those made at 60 degrees to the main limb
The superior tarsal crease is important in upper lid blepharoplasty as it usually coincides with the:
A. Inferior aspect of the blepharoplasty skin incision
B. Superior aspect of the blepharoplasty skin incision
C. Fusion of tarsus to the skin
D. Fusion of the orbital septum to the skin
ANSWER: A
RATIONALE:
The inferior aspect of the blepharoplasty incision is placed at the superior eyelid crease. This eyelid crease is formed due to the fusion of the levator superioris with the orbicularis oculi and skin. Although, usually seen to be within 8-12 mm of the lid margin in Caucasians, the position varies with age and racial characteristics. The superior aspect of the skin incision is dictated by the amount of skin removal needed. The “pinch test” gives a good idea for placement of the superior incision. The orbicularis oculi is a sphincter-like muscle beneath the skin and it extends throughout the upper eyelid. Its position does not directly correlate with the upper eyelid skin fold/crease. The orbital septum lies beneath the orbicularis oculi and is an extension of the periosteum of the orbit. It fuses to the levator muscle and not directly to the skin.
When planning blepharoplasty procedures, the surgeon must realize that the inferior oblique muscle lies between: A. lacrimal gland and middle fat pad B. middle and lateral fat pads C. nasal and middle fat pads D. nasal fat pad and medial canthus
ANSWER: C
RATIONALE:
The Lacrimal gland is found in the upper eyelid and not in the lower eyelid. The middle and lateral fat pads are close to each other and are not separated by a muscle. The inferior oblique muscle lies in between the nasal and middle fat pads and must be protected during fat excision in this area. It is especially prone to damage in transconjuctival lower eyelid blepharoplasty procedures. The inferior oblique muscle lies lateral to the middle fat pad and not medial to it.
The “nasal tripod” concept in rhinoplasty procedures refers to:
A. Upper lateral and lower lateral cartilages and nasal septum
B. Fusion of the upper lateral and lower lateral cartilages
C. Medial and lateral crura of the lower lateral cartilages
D. Nasal septum and medial crura of the lower lateral cartilages
ANSWER: C
RATIONALE:
The two upper lateral cartilages fuse with the nasal septum to form the
Internal nasal valve area. The lower lateral cartilages and septum provide support for the nasal tip. The upper and lower lateral cartilages do not directly fuse with each other. The close relationship through a fibrous attachment contributes to tip support and an intercartilagenous incision will interrupt this attachment. The medial crura are taken together to form one leg of the tripod and the lateral crurae form one leg each of the tripod. Changes in tip rotation and position may be visualized in terms of modification of this tripod during rhinoplasty. The nasal septum and medial crura are closely associated to form a primary tip support mechanism. Full transfixion incisions interrupt this attachment and may cause tip drooping.
Which of the following surgical incisions are made during external rhinoplasty procedures?
A. Marginal and transcollumellar incisions
B. Ttranscollumellar and intercartilagenous incisions
C. Intercartilagenous and transfixion incisions
D. Hemi-transfixion and marginal incisions
ANSWER: A
RATIONALE:
The marginal rim incision is made along the caudal margin of the lower lateral cartilage. The transcollumellar incision is a skin incision across the mid-columella. Bilateral marginal and the transcollumellar incisions help complete external skeletonization of the nasal skeleton. The intercartilagenous incision is used in endonasal rhinoplasty techniques. The blade passes deep to the lateral crura and superficial to the upper lateral cartilage. The transfixion incision is generally used in endonasal rhinoplasty procedures for exposure of caudal septum. A complete transfixion incision transects the attachment of both medical crura to the septum, and thus some loss of tip support results. The hemitransfixion incision is also used in endonasal rhinoplasty procedures for exposure of caudal septum. As it is only made on one side and usually stops short of the anterior nasal spine, it preserves some tip support as compared to a complete transfixion incision.
A medium depth chemical peel using 35 to 40% Tricholoracetic acid (TCA) is expected to penetrate:
A. epidermis and papillary dermis
B. epidermis, papillary dermis and upper reticular dermis
C. epidermis, papillary dermis, upper and mid-reticular dermis
D. epidermis, papillary dermis, upper, mid and lower reticular dermis
ANSWER: B
RATIONALE:
Chemical peels are classified according their depth of penetration into superficial, medium, and deep depth peels. Superficial peels penetrate into the epidermis and papillary dermis. Examples of superficial peel agents include TCA (up to 30%), Jessner’s solution, and Glycolic acid (10-30 %). Medium depth peels penetrate into epidermis, papillary dermis and upper reticular dermis. Examples of medium peel agents include TCA (35-50 %), phenol (88%), and Jessner’s solution plus TCA (35%). Deep depth peels penetrate into epidermis, papillary dermis, upper and mid reticular dermis. Examples of deep peel agents include Bakers phenol and Litton’s phenol. Extension of chemical peeling agents into the lower reticular dermis produces scarring and is not indicated.
A 40 year-old female requesting cosmetic facial laser resurfacing is classified as a Fitzpatrick skin type II patient. She is likely to have which of the following characteristics:
A. Red hair, light skin, blue-green eyes, never tans
B. Black hair, dark skin, black eyes, easily tans
C. Brown-black hair, medium-dark skin, brown-black eyes, easily tans
D. Blond hair, light skin, blue eyes, tans with difficulty
ANSWER: D
RATIONALE:
Fitzpatrick type 1 patients give a history of always having a skin burn with sun exposure. Fitzpatrick type V patients give a history of very rarely burning on sun exposure. Fitzpatrick type IV patients rarely if ever, burn on sun exposure. Fitzpatrick type II patients give a history of usually burning on sun exposure. Fitzpatrick divided skin types into six categories based on the skin color and their reactivity to the sun exposure
Skin type
I white always burns never tans
II white usually burns, tans with difficulty
III white sometimes mild burn, tan very easily.
IV brown rarely burn, tan with ease
V dark brown very rarely burn, tan very easily
VI black no burn, tan very easily
A 65 year old female with cervicofacial rhytidosis has completed a cervicofacial rhytidectomy within the past 15 hours. Her facial bandage is in place and she is having extreme pressure and pain under the bandage on the right side. The most likely cause of this pain is? A. Cervical Nerve injury B. Infection C. Muscle Injury D. Hematoma
ANSWER: D
RATIONALE:
A hematoma is the most common and significant cause of pain after a cervicofacial rhytidectomy. Most hematomas occur within 1 to 15 hours after surgery, but can occur up to 48 hours after the procedure. The incidence has been reported to be 10 to 15 % of all patients undergoing this procedure. Prevention with good surgical technique and hemostasis is important. Some surgeons place drains to assist with prevention of a hematoma. Infections following cervicofacial rhytidectomies are rare, and are usually occur 3 to 4 days out if they occur at all. Muscle injury while quite rare could cause pain in the neck region, however it is usually not associated with pressure sensations. Cervical nerves are less likely to be injured , but the great auricular nerve is the most commonly injured of the cervical chain with an incidence reported from 0.53% to 2.6%. Most nerve injuries during this procedure do not cause pain, but anesthesia.
Botulinum Toxin A prevents wrinkles of the skin by what neuroactivity at the neuromuscular junction? A. Blocks the release of acetylcholine B. Blocks the release of norepinephrine C. Prevents binding of acetylcholine D. Prevents binding of norepinephrine
ANSWER: A
RATIONALE:
Botulinum Toxin A is being used frequently in cosmetic surgical practices to inhibit the function of the muscles of facial expression. Botulinum Toxin is an endotoxin produced by the bacterium Clostridium botulinum. Botulism (caused by consumption of C. botulinum- contaminated food) is not an infection per se but is a side affect caused by the ingestion of the endotoxins that are produced by this bacteria. This toxin can be lethal when consumed in excess dosages. The FDA has approved the use of a preparation of botulinum toxin Type A (Botox) for muscular disorders, but not for cosmetic use. The mechanism of action is that the Botox molecule binds to the neuromuscular endplate and blocks the release of acetylcholine. Botulinum toxin does not effect the binding of acetylcholine, and has no effect on norepinephrine release or binding.
What is the normal nasolabial angle in Caucasian females? A. 60-74 B. 75-90 C. 95 to 110 D. 115-130
ANSWER: C
RATIONALE:
The nasolabial angle is the defining element of nasal tip elevation as the nose relates to the upper lip. The average Caucasian female nasolabial angle is 95-110.
Four weeks following a malar augmentation utilizing a Silastic prosthesis the patient complains of severe pain and paresthesia in the infraorbital region on the right side only. What clinical decision protocol would be advised?
A. Place patient on narcotics for 4 weeks until the pain is controlled
B. Ignore the problem, this is common and should improve with time
C. Surgically explore the region and check the position of the implant
D. Place the patient on a muscle relaxant to relieve the pain
ANSWER: C
RATIONALE:
Malar augmentation with an alloplastic implant is generally a mildly painful procedure. The infraorbital nerve is in close proximity of the malar implant position, and could cause pressure on the nerve if malpositioned. Ignoring the problem long term could cause permanent paraesthesia. During surgical placement is important to place the implant in a pocket that is free from interference with the infraorbital nerve. Placing a patient on narcotics will assist with pain management, but will not eliminate the source of the problem. Ignoring ongoing pain for a prolonged period may create a chronic pain state, and the source of the pain may not improve. Early impingement management is important to avoid permanent nerve damage. Muscle relaxants will not improve nerve damage pain.
Following upper lid blepharoplasty, the most common cause of post-operative lagophthalmus of the upper eye lid is due to:
A. wound dehiscence.
B. debulking of orbicularis muscle. C. excessive amount of skin removal. D. pre-op ptosis condition.
ANSWER: C
RATIONALE:
Excess skin removal can lead to lagopthalmus. Assessment of visual status, including acuity and EOM, lacrimation, and pain is necessary. Management is directed by degree of lagopthalmus. Mild conditions may be managed by massage, time and proper ocular lubricants while the tightness may relax avoiding further surgery. If the corneal surface is compromised, a skin graft may be necessary. The posterior auricular area is usually best match for color and skin thickness. Ptosis is a frequent complication with this repair. Wound dehiscence usually leads to aesthetic compromise. Debulking of the orbicularis is to excessive skin removal, and minimizes the occurences of lagopthalmus. Pre-op ptosis would be addressed in your surgical treatment plan, and combine a Muller- conjuctival resection or levator aponeurosis procedure combined with blepharoplasty.
A peri-operative open roof deformity created during a rhinoplasty to remove a bony or cartilaginous hump is most commonly corrected with?
A. Onlay bone graft.
B. Septoplasty.
C. Suturing of the upper lateral cartilage.
D. Lateral nasal osteotomies.
ANSWER: D
RATIONALE:
Lateral nasal osteotomies are necessary events in rhinoplasty surgery to symmetrically narrow the lateral nasal sidewalls medially and create a more natural appearance. Onlay cartilage and bone grafts can be a treatment option during revision rhinoplasty to correct an open roof deformity, with soft tissue prolapse. Lateral osteotomies are performed after the dorsal reduction to give a stable bony platform to safely remove a nasal hump. Performing the lateral nasal osteotomies last in the surgical sequence, immediately preceeding the application of pressure splints, diminishes inta-operative swelling, oozing, post-operative swelling and ecchymosis.
Defects in the upper and lower lip that are greater than 1/3 but less than 2/3 of the length of the lip are best treated by which flap? A. Gillies FAN Flap. B. Abbe’ Flap. C. V-Y Advancement Flap. D. Nasolabial flap.
ANSWER: B
RATIONALE:
The Abbe’ flap is an excellent choice. This is a well vascularized flap based on the labial vessels. It allows reconstruction of the defect with lip tissue from the opposing lip. Disadvantages of this flap are that it is 2-stage repair and may cause relative microstomia. The flap does not provide a sensate reconstruction. The Gillies FAN flap is designed for defects greater than 75% of the upper or lower lip. Sensate reconstruction is achieved. The Abbe flap is not indicated in defects greater than 2/3 of the upper and lower lip. V-Y advancement flap is used to bring oral cavity mucosa to the vermillion. Close proximity of the donor site to the recipient site is needed. The nasolabial flap is indicated for the upper lip only.
In performing facial scar revisions or new facial incisions, knowledge of resting skin tension lines (RSTLs) is relevant in aesthetic scar outcomes because?
A. Facial nerves run parallel to RSTLs.
B. The likelihood of developing a thickened or hypertrophic scar is inversely related to the
degree to which the injury or incision parallels RSTLs.
C. The likelihood of developing a thickened or hypertrophic scar is inversely related to the
degree to which the injury or incision runs perpendicular to RSTLs.
D. RSTLs have minimal effects on scar developments.
ANSWER: B
RATIONALE:
The facial nerve and its brances run both parallel and perpendicular to RSTLs.
Scar revisions or planned scars should be oriented with respect to RSTLs. These well documented, natural tissue planes display the least amount of tension and are ideal for scar placement. RSTLs very often correspond to nature’s wrinkles, running perpendicular to underlying muscle movement.
The neurosensory innervation and vascular supply to the nose are derived from?
A. maxillary division of trigeminal nerve, internal and external carotid system
B. opthalmic division of trigeminal nerve, internal and external carotid system
C. maxillary and opthalmic division of trigeminal nerve, internal and external carotid system
D. maxillary and opthalmic division of trigeminal nerve, internal carotid only.
ANSWER: C
RATIONALE:
Virtually all of the sensory innervation to the nasal area is derived from either the opthalmic (V1) or maxillary (V2) division of the trigeminal nerve. The nose is highly vascular, possesing arterial contributions from both the internal and external carotid system. The outer nose and anterior septum are supplied from the external carotid system via the facial artery and its branches. The superior septum and orbital area are supplied through the internal carotid system via the ethmoidal branches of the opthalmic artery
When considering blepharoplasty, brow lift, or botox injections, the major muscles of the forehead and eyebrow which must be considered include:
A. procerus, corrugator supercillii, occipitofrontalis and orbicularis oculi
B. temporalis, occipitofrontalis, and corrugator supercillii
C. procerus, corrugator supercillii, and temporalis.
D. temporalis, corrugator supercillii, occipitofrontalis and orbicularis oculi
ANSWER: A
RATIONALE:
The occipitofrontalis allows the scalp to move anteriorly and posteriorly, elevating the eyebrows. The orbicularis oculi close the eyelid, in doing so it also pulls down the skin of the forehead, temple and cheek. The corrugator lowers and moves the brows medially, producing vertical wrinkles of the forehead. The procerus lowers the medial brow and produces horizontal wrinkles over the nose. In the forehead region, all muscles are innervated by the temporal branch of the facial nerve, except for the procerus, which is innervated by the buccal branch of the facial nerve.
Botulinum toxin A, when used for cosmetic purposes, can be expected to last: A. permanently B. 1-2 months C. 4-6 months D. 8-10 months
ANSWER: C
RATIONALE:
The effects of botulinum toxin are temporary, typically lasting for four to six months depending on the muscle injected and the amount of toxin used. Studies submitted to the FDA by the manufacturer report an average of four months therapeutic effect for cosmetic indications
The generally accepted initial total dose for treatment of glabellar lines with botulinum type A toxin is: A. 4 units B. 20 units C. 50 units D. 100 units
ANSWER: B
RATIONALE:
For initial treatment of glabellar lines, the starting dose is recommended to be 20 units divided into five injection sites of 4 units each: two sites in each corrugator muscle and one site in the procerus muscle
The most common complication that occurs when injecting botulinum toxin type A in the periocular region is: A. blepharoptosis B. ophthalmoplegia C. Horner’s syndrome D. loss of lateral gaze
ANSWER: A
RATIONALE:
The most common complication of injecting botulinum toxin type in the periocular region is blepharoptosis, due to diffusion of the toxin into the levator palpebrae superioris muscle. This can be minimized by injecting at least one cm above the bony supraorbital rim.
Common medications prescribed preoperatively for facial skin resurfacing include all of the following except: A. oral steroid B. anti-viral agent C. tretinoin cream D. oral antibiotic
ANSWER: A
RATIONALE:
The use of antibiotics and antiviral agents pre and post-operatively has been well established as protocol in skin resurfacing to prevent bacterial infection and post surgical herpetic outbreaks. Tretinoin cream allows for removal of superficial cells to enhance the penetration of the CO2 laser. Steroids are contraindicated.
The percentage of soft tissue to bony advancement associated with an anterior horizontal sliding osteotomy (genioplasty) of the mandible typically is: A. 20-30 B. 40-50 C. 60-70 D. 80-90
ANSWER: D
RATIONALE:
While results of soft tissue advancement can vary depending on technique, a true horizontal genioplasy with a broad based soft tissue pedicle (standard technique) will result in an 80-90% soft tissue advancement.
Which of the following describes the effects of intrinsic aging of the skin that are noted histologically? A. dermal collagen production increases B. the epidermis thickens C. dermal elastin production decreases D. rete pegs are promoted and enhanced
ANSWER: C
RATIONALE:
Dermal elastin production decreases with age. Generalized age-related dermal atrophy incledues decreased rete peg, epidermal thinning, and decreased dermal collagen production.
The normal distance in Caucasians from the upper eyelid margin to the superior tarsal crease is usually: A. 3 millimeters B. 5 millimeters C. 10 millimeters D. 15 millimeters
ANSWER: C
RATIONALE:
The supratarsal crease is generally 9-10 millimeters above the lash line of the upper eyelid in Caucasians. The crease represents an area where fibers from the levator aponeurosis attach to the posterior surface of the skin.
During closed rhinoplasty, delivery of the lower lateral cartilages requires the surgeon to perform a marginal incision and which other incision? A. intercartilaginous B. transfixion C. Killian D. transcolumellar
ANSWER: A
RATIONALE:
During closed rhinoplasty, delivery of the lower lateral cartilages requires the use of a marginal incision and an intercartilaginous incision. The transfixion incision connects the right and left nares through the columnella and is near the caudal edge of the cartilaginous septum, not the lower lateral cartilage. The Killian incision is used to approach the septum. The transcolumnellar incision is used in open rhinoplasty.
In cosmetic facial surgery, dilute solution of local anesthesia and epinephrine is used to facilitate anesthesia, hemostasis and fat removal. This anesthetic technique is called: A. hypotensive anesthesia B. tumescent anesthesia C. disassociative anesthesia D. neuroleptic anesthesia
ANSWER: B
RATIONALE:
Tumescent anesthesia most commonly involves Lidocaine 0.1% and epinephrine 1: 1 million. This solution is injected into the tissues under pressure to cause a tumescent effect, hence the name. This mixture provides local anesthesia, hemostasis and facilitates fat removal.
Hair follicles and sebaceous glands are in which skin layer? A. Superficial epidermis B. Deep epidermis C. Superficial dermis D. Deep dermis
ANSWER: D
RATIONALE:
The hair follicles and sebaceous glands reside in the deep dermis and this area is never intentionally invaded in cosmetic resurfacing as a full thickness burn would ensue with serious scarring.
In cosmetic blepharoplasty of the upper eyelid, the following tissue layer is not routinely incised, reduced or recontoured: A. Eyelid skin B. Orbicularis oculi muscle C. Orbital septum D. Mueller’s Muscle
ANSWER: D
RATIONALE:
In routine cosmetic upper eyelid blepharoplasty, excess skin, muscle and fat are removed. The fat is retroseptal, lying immediately beneath the orbital septum. The levator aponeurosis is the next visible layer and deep to that lies Mueller’s muscle which is assists with upper eyelid elevation. This muscle is not incised or recountoured in routine bepharoplasty of the upper eyelid.
In submental liposuction, problems with skin dimpling, waviness, and depressions can be prevented with the following:
A. leaving an adequate layer of subcutaneous fat
B. allowing the skin to adhere to platysma
C. removing all subcutaneous fat
D. keeping the plane of fat removal deep to the platysma layer
ANSWER: A
RATIONALE:
A layer of subcutaneous fat is necessary to prevent adherence of the skin to the mylohyoid and the platysma muscles. Waviness and dimpling can occur if fat removal is uneven or when areas of skin are devoid of subcutaneous fat. Keeping the fat removal deep to the platysma layer will lead to minimal esthetic improvement and the possibility of facial nerve injury.
A 40 year old woman consults with you regarding her microgenia. Her occlusion was corrected years ago with orthodontics, and she suffers from mild obstructive sleep apnea. Her condition would best be corrected with: A. an alloplastic chin augmentation B. an autogenous bone graft to the chin C. a mandibular sagittal split osteotomy D. an advancement genioplasty
ANSWER: D
RATIONALE:
Advancement of the genial tubercles and genioglossus muscle will help this patients cosmesis, and positively influence her obstructive sleep apnea. A sagittal split osteotomy alone will create a malocclusion. Neither a chin implant nor an onlay bone graft to the chin will advance her genial tubercles or suprahyoid musculature.
Which agent is best used to treat hyperpigmentation following skin resurfacing? A. Glycolic acid B. Phenol C. Hydroquinone D. Isotretinoin
ANSWER: C
RATIONALE:
Hydroquinone inhibits melanin formation and increases melanocyte degradation. This causes a reversible hypopigmentation and melanocyte inhibition. Glycolic acid, phenol, and isotretinoin are all skin resurfacing agents and are not used for the treatment of hyperpigmentation.
The most common complication following otoplasty is: A. infection B. perichondritis C. hematoma formation D. hypertrophic scar formation
ANSWER: C
RATIONALE:
Hematoma formation is generally seen in the retroauricular space. It is treated by evacuation and pressure dressings, while antibiotics should be considered.
Which of the following statements regarding esthetic evaluation of the midface is true?:
A. The zygomatic prominence should be located 2 cm inferior and 1.5 to 2 cm lateral to the lateral canthus of the eye.
B. The infraorbital rim should be 0 to 2 mm behind the cornea
C. Greater than 3-4 mm of sclera should be exposed inferiorly between the limbus and the
lower eyelid.
D. The zygomatic prominence should be located several mm superior to the Frankfort
horizontal plane.
ANSWER: A
RATIONALE:
The midface region is best evaluated in four basic views - frontal in repose and smiling, profile, three-quarter oblique, and basal. The zygomatic prominence is located 2 cm inferior and 1.5-2 cm lateral to the lateral canthus, and below the Frankfort Horizontal plane. The infraorbital rim should be 0-2 mm anterior to the cornea. Normal scleral show is less than 4 mm.
When narrowing the nose at the end of a rhinoplasty procedure, the lateral nasal bone osteotomies are made superiorly to which soft tissue landmark? A. Nasion B. Radix C. Medial canthus D. Superior septal angle
ANSWER: C
RATIONALE:
The glabella and radix of the nose are incorrect and will result in carrying the osteotomy too far superiorly into thick bone, preventing infracturing and causing a surperior hinging. The correct answer is to carry the lateral ostetomies superiorally to the level of the medial canthus which corresponds to thinner bone allowing for backfracture of the nasal bones. The superior septal angle is a nonsensical distractor in this question.
When performing lower lid blepharoplasty, how many fat pads are normally excised or reduced? A. one B. two C. three D. four
ANSWER: C
RATIONALE:
Lower lid blepharoplasty normally involves removal of fat from all three fat compartments. In the upper lid, there are two fat compartments and the lacrimal gland is located superior and lateral. Failure to identify and remove fat from all three fat pads in lower lid surgery can result in insufficient fat removal and/or asymmetry. Of course, exceptions exist and fat removal should be guided by clinical judgement. Care must be taken to identify and avoid injury to the inferior oblique muscle.
When performing carbon dioxide laser skin resurfacing, the deep landmark of the ablation is the: A. basement membrane B. epidermis C. papillary dermis D. reticular dermis
ANSWER: D
RATIONALE:
Each patient is unique and requires tailoring of technique to adapt to individual skin morphology. However, the anatomic depth of laser resurfacing is the reticular dermis. If this anatomic plane is not known or recognized, significant complications may result. This is determined by a chamois (light tan) color occuring in the resurfaced area during the second pass with the carbon dioxide laser.
Which of the following periorbital tissues represent an extension of the periosteum? A. Tarsal plate B. Whitnall’s Tubercle C. Orbital septum D. Lockwoods ligament
ANSWER: C
RATIONALE:
The orbital septum is a direct extension from the periosteum of the orbit and separates the preseptal and postseptal orbital components. Whitnall’s tubercle is a slightly raised prominence in the lateral orbital rim on the zygoma which serves as an attachment for the lateral canthal ligament. The tarsal plates are comprised of dense connective tissue and are located in both the upper and lower eyelids. The tarsal plates help form and support the shape of the eyelids. Lockwood’s ligament is a fascial suspensory ligament which helps maintain the vertical position of the globe within the orbit.
In a standard facelift operation, which of the deeper tissues is commonly altered? A. Parotidomasseteric fascia B. Dermis C. Erb’s point D. Superficial musculoaponeurotic system
ANSWER: D
RATIONALE:
The SMAS is the anatomic plane for a standard facelift procedure and lies superficial to the major nerves and blood vessels, but deep to the subdermal plexus. It is normally imbricated or excised and repositioned during a face-lift surgery. Incisions are normally made through the dermis but the dermal layer itself is not altered during surgery. The parotidomasseteric fascisa covers the lateral masseter muscle and splits to envelop the parotid gland, but is not altered in a
standard facelift operation. Erb’s point in located on the side of the neck in the area of the 5th and 6th cervical nerves.
Retrobulbar hematoma occurring after cosmetic blepharoplasty is best treated by:
A. warm compresses
B. atropine drops
C. emergent evacuation
D. intravenous antihypertensive medication
ANSWER: C
RATIONALE:
Retrobulbar hematoma is reported to occur in 0.04% of all blepharoplasty procedures. Blindness can result from a retrobulbar hematoma and immediate evacuation for decompression is the treatment of choice.
Intradomal sutures are placed during rhinoplasty to:
A. narrow the alar bases
B. maintain the position of the upper lateral cartilages
C. narrow and/or elevate the nasal tip
D. close an open-roof deformity
ANSWER: C
RATIONALE:
The nasal tip or intradomal region is located at the junction of the medial and lateral crura. Intradomal sutures can control and position the nasal tip. The nasal cinch suture or alar reduction can narrow the alar base width. Lateral osteotomies are used to close an open-roof deformity. Suturing can be used to maintain upper lateral cartilage position in some cases.
