Cosmetics Flashcards
A patient with Dedo class III skin should be accessed by which incision?
A. Submental access only
B. CFR to to redrape skin without submental incision or liposuction
C. Submental incision with or without pre auricular access for fat removal
D. CFR to redrape the skin, submental incision, and platysmal plication
C. submental incision with or without pre auricular access for fat removal
Type I (relatively normal
Minimal neck deformity
Submental access only
Type II (skin laxity)
Little cervical fat or attenuated platysma
CFR to redrape skin without submental incision or liposuction
Type III (fat accumulation)
Good skin and platysma tone
Submental +/- periauricular access for fat removal only
Type IV (platysmal banding)
Laxity of all soft tissue layers
CFR to redrape the skin + submental incision + platysmal plication
Type V (retrognathic/microgenic)
Mandibular deficiency
Genial implant vs genioplasty vs orthognathic surgery
Type VI (low hyoid)
“Problem neck”
Hyoid rarely repositioned; limits esthetic outcome of CFR.
A patient that rarely burns and tans with ease would have which skin type on the Fitzpatrick scale?
A. 1
B. 2
C. 3
D. 4
D. 4
Type I - White; very fair, red or blond hair, blue eyes; freckles. Always burns, never tans
Type II - White, fair, red or blond hair, blue, hazel, or green eyes. Usually burns, tans with difficulty
Type III - Cream white, fair with any eye or hair color. Sometimes mild burn, gradually tans
Type IV - Brown, typical Mediterranean caucasian skin. Rarely burns, tans with ease
Type V - Dark brown; mid-eastern skin types. Very rarely burns, tans easily
Type VI - Black skin and hair, brown eyes. Never burns, tans very easily
A patient with wrinkles at rest, some skin discoloration, visible capillaries and keratosis, and needs to wear heavier foundation may be what age based on their glasgau photoaging characteristics?
A. 28-35
B. 35-50
C. 50-65
D. 65 and up
C. 50-65
Group I - mild classification
28-35
No wrinkles. Early photo aging, mild pigment changes, no keratosis, minimal wrinkles, minimal or no makeup
Group II - moderate classification
35-50
Wrinkles in motion. Early to moderate photo aging; early brown spots visible, keratosis palpable but not visible, parallel smile lines begin to appear, wears some foundation
Group III - advanced classification
50-65
Wrinkles at rest. Advanced photo aging; obvious discoloration, visible capillaries, visible keratosis, wears heavier foundation
Group IV - severe classification
65 and up
Only wrinkles. Severe photo aging; yellow/grey skin color, prior skin malignancies, wrinkles throughout - no normal skin, cannot wear make-up because it cracks and cakes
The zygomatic prominence lies:
A. 1 cm inferior and 1 cm lateral to the lateral canthus
B. Above the frankfurt horizontal line
C. 2 cm inferior and 1.5-2 cm lateral to the lateral canthus
D. 2 cm inferior and directly below the lateral canthus
C. 2 cm inferior and 1.5-2 cm lateral to the lateral canthus
The zygomatic prominence is located 2 cm inferior and 1.5-2 cm lateral to the lateral canthus and below the Frankfort Horizontal line
Hinderer’s Point is the intersection of which two lines?
A. ala-tragal and lateral canthus-commissure
B. ala-tragal and lateral limbus-commissure
C. ala-canthus and lateral canthus-commissure
D. ala-canthus and lateral limbus-commissure
A. ala-tragal and lateral canthus-commissure
Hinderer’s point is the intersection between the alar-tragal line and lateral canthal-commissure line. It’s used for assessment of malar projection
This point of intersection represents the area where the temporal branch of the facial nerve is most vulnerable, as it courses superficially in this region.
When injecting the frontalis muscle with botox, where should your injection be?
A. Midway between the superior orbital rim and trichion
B. Midway between the apex of the brow and trichion
C. At the apex of the brow
D. 1 cm above the superior orbital rim
When injecting the frontalis muscle, botox should be injected 1cm above the supraorbital rim, otherwise the diffusion of the toxin can lead to levator paresis.
What is the mechanism of action of botulinum toxin?
A. Competitively inhibit ACh binding at the post synaptic receptor
B. Prevent ACh release from the presynaptic neuron
C. Prevent ACh packaging into presynaptic vesicles
D. Hyperpolarize post synaptic neurons to prevent signal propagation
B. Prevent ACh release from the presynaptic neuron
Botox inhibits the release of acetylcholine into the presynaptic cleft.
Botox prevents the release of acetylcholine by cleaving SNARE proteins (e.g., SNAP-25), which are essential for acetylcholine vesicles to fuse with the nerve membrane and release their contents.
Which patient is the most appropriate for a pretrichial brow lift?
A. woman with a 7 cm forehead
B. male with a 4 cm forehead
C. gentleman with male pattern baldness
D. woman with thin hair
A. Woman with a 7 cm forehead
A pretrichial or trichophytic incision for a brow lift would be appropriate for shortening of long foreheads or excision of thinning hair-bearing areas temporally. The best candidate would be someone with a high forehead and low brow position, so someone with a 7cm forehead would be the best candidate.
Men don’t lose hair in the temporal regions usually, so this probably would not be helpful.
Thin hair would not hide the scarring well.
Average forehead length is ~5cm measured from trichion to soft tissue glabella.
How many incisions are made for an endoscopic brow lift?
A. 3
B. 4
C. 5
D. 6
C. 5
1 midline, 2 paramedian, and 2 temporal
The incisions are made 2 cm posterior to the hairline
How many incisions are used for a blepharoplasty and where are they?
2 Incisions are made for a blepharolplasty.
External incisions are created in the natural eye skin creases, so there is a superior and an inferior incision. The superior incision is determined by pinching the excess upper lid skin with fine, blunt forceps until the eyelashes evert. The inferior incision is usually the supratarsal crease, because it’s usually in a normal position. It’s just above the superior punctum and extends laterally, fading into one of the crow’s feet. If there’s no supratarsal crease, raise a skin-muscle flap. This will allow you to attach the levator aponeurosis to the inferior edge of the incision, creating a new supratarsal fold.
Describe an upper blepharoplasty technique.
The upper eyelid is elevated, and the inferior incision line is marked in the natural supratarsal lid crease, approximately 1 cm above the lid margin. Medially, the marking ends above the lacrimal punctum. Laterally, it is extended approximately 1 cm beyond the lateral canthus with a general upward slope (at the level of the lateral canthus, the incision should be approximately 5 mm above the level of the canthus). The superior incision line is marked as the excess skin is pinched with smooth forceps and the forehead/eyebrow is stabilized. A minimum of 20 mm of skin must remain between the upper eyelid margin and the lower eyebrow margin to prevent postoperative lagophthalmos. The superior incision is marked with the skin held by the forceps and curves into the inferior incision medially and laterally in an elliptical fashion
Skin and orbicularis oculi is excised. After excision of muscle, the orbital septum is exposed and the yellowish fat pads are visible through the septum. The orbital septum is incised, and the fat is allowed to herniate through, and they are gently excised as needed.
Where are the skin incisions in a lower blepharoplasty?
Lower eyelid blepharoplasty is conducted using a subciliary incision with a lateral extension within a natural skin crease, allowing for a minimum of 5 mm between the upper and lower eyelid incisions. A skin muscle flap is elevated, the orbital septum is incised and excess periorbital fat is gently removed. Usually a lateral canthopexy is also performed if necessary.
A transconjunctival approach for a blepharoplasty can be accomplished when there is no excision of skin or muscle (the goal is fat removal).
A bulbous, rounded nasal tip is due to:
A. Long lateral crus
B. Hyperplastic lateral crus
C. Hypoplastic medial crus
D. Long medial crus
B. Hyperplastic lateral crus
A bulbous, round nasal tip is a direct result of the shape of the lower lateral cartilages. The two lower lateral cartilages merge in the midline to help form the support of the nasal tip. A bulbous nasal tip results when the domal cartilage is excessively wide and rounded.
A. Long lateral crus: A long lateral crus may contribute to a wide nasal base but is less likely to cause a bulbous tip specifically.
C. Hypoplastic medial crus: This might lead to inadequate tip support but does not typically result in a bulbous tip.
D. Long medial crus: This could contribute to projection issues or a more pointed nasal tip, not a rounded or bulbous appearance.
What is the normal internal nasal valve angle?
A. 5-10 degrees
B. 10-15 degrees
C. 15-20 degrees
D. 20-25 degrees
B. 10-15 degrees
The internal nasal valve is created by the junction of the septum and upper lateral cartilage and is usually 10-15 degrees. A spreader graft can maintain the patency of the internal nasal valve. It is placed between the septum and the upper lateral cartilages.
The cottle maneuver is used to determine if a nasal obstruction is due to internal or external valve obliteration.
What is the significance of Webster’s triangle when performing nasal osteotomies?
A. Violation of Webster’s triangle can lead to internal nasal valve collapse
B. Violation of Webster’s triangle can lead to an open roof deformity
C. Violation of Webster’s triangle can lead to external nasal valve collapse
D. Violation of Webster’s triangle can lead to a nasal tip deformity
A. Violation of Webster’s triangle can lead to internal nasal valve collapse
Preservation of Webster’s triangle is paramount when performing lateral osteotomies to prevent internal nasal valve collapse.
Violation of Webster’s triangle with lateral nasal osteotomies can cause decreased airflow.
It refers to a specific triangle-shaped region of bone that is formed by the lateral nasal wall, the medial edge of the maxillary bone, and the medial maxillary border.
