Cosmetics Flashcards
1
Q
Purpose of columellar strut graft
A
tip support
2
Q
what does cephalic trim do
A
refines boxy/bulbous tip
3
Q
True/False: peri-op steroids decrease edema and ecchymoses in rhinoplasty
A
True
4
Q
what is the sub epidermal region of dermis where neocollagen forms after wounding or actinic damage
A
grenz zone
5
Q
medication to stop 1 year prior to any skin resurfacing
A
isotretinoin (Accutane) - causes atrophy of pilosebacous glands which impairs wound healing and re-epithelialization
6
Q
pre-treatment regimen prior to chemical peel
A
hydroquinone, tretinoin, glycolic acid, sunscreen
7
Q
what does tretinoin do to the skin
A
epidermis - thins stratum corner, suppresses melanocytes
dermis - increased type 3 collagen synthesis, increased elasticity, increased angiogenesis
8
Q
Class of mildest chemical peels
A
alpha hydroxy acid (glycolic acid, lactic acid, citric acid, magic acid, tartaric acid)
9
Q
what is a Jesner peel?
A
medium depth peel, consists of salicylic acid, lactic acid, resorcinol and ethanol
10
Q
Name an example of a deep chemical peel
A
phenol peel (reliable penetration into upper reticular dermis)
11
Q
what does croton oil do in a chemical peel?
A
acts as a skin irritant to deepen the peel
12
Q
what is the most common long-lasting side effect of a phenol peel?
A
hypopigmentation
13
Q
what is the most serious potential side effect of a phenol peel?
A
cardiotoxicity
14
Q
most common problem after laser skin resurfacing
A
hyperpigmentation
15
Q
what effect does a chemical peel have on the dermis?
A
decrease of nonlamellar collagen
16
Q
medication that inhibits tyrosinase to cause skin lightening
A
hydroquinone
17
Q
time between treatment for salicylic acid peels
A
4 weeks
18
Q
histologic changes of photoaged akin
A
thickening of epidermis, flattening of epidermal-dermal junction, decreased melanocyte concentration, dermal inflammation
19
Q
what is melasma
A
irregular brown patches on sun-exposed skin, treat with hydroquinone +/- tretinoin
20
Q
what medication causes long term increase in dermal collagen
A
tretinoin
21
Q
treatment protocol for acyclovir before and after chemical peel for patient with history of HSV
A
24 hours prior to peel and 5 days after
22
Q
mechanism of action of retinoids
A
decreased activation of metalloproteinases through the inhibition of AP-1 transcription
23
Q
Process by which a material acts as a scaffold for ingrowth of osteoblasts and gradual formation of osseous tissue
A
osteoconduction
24
Q
Process by which undifferentiated pluripotent cells are stimulated to develop into bone
A
osteoinduction
25
In which plane should facial implants be placed in adults?
subperiosteal
26
Location of infraorbital nerve
1 cm inferior to orbital rim in the mid pupillary line
27
Pulse duration of a laser should be MORE OR LESS than the thermal relaxation time of the target tissue?
Less
28
pulsed dye lasers are absorbed by what chromophore?
oxyhemoglobin - targets redness in skin or cutaneous vascular lesions
29
which is laser is effective for selecting purple and black tattoo pigment?
Q-switched ruby laser
30
which laser is contraindicated for use with red, white and skin colored tattoo pigment?
Q-switched ruby laser - can darken the pigment irreversibly
31
which laser is idea for removing blue-green tattoo pigment?
Q-switched alexandrite laser
32
which laser is good for removing red, orange or brown tattoos?
Q-switched Nd:YAG/KTP (versatile and commonly used for tattoos in general)
33
In what hair growth phase are lasers most effective for hair removal?
anagen
34
CO2 laser is absorbed by which chromophore
water
35
most common complication of ablative lasers
hyperpigmentation
36
advantages of erbium laser over CO2 for skin resurfacing
1) less thermal damage to surrounding tissues
2) more rapid re-epithelialization
3) decreased risk of hypopigmentation
37
which filler requires pre-test of the skin prior to placement?
bovine collagen (allergic reaction in 5%) - Zyderm and Zyplast
38
What is Radiesse?
calcium hydroxyapatite beads in an aqueous gel, lasts up to 2 years, **do not use in lips**
39
What is Sculptra?
poly-L-lactic acid polymer filler, lasts up to 2 years, FDA approved for treatment of HIV-associated lipodystrophy of the face
40
What is Artefill?
polymethymethacrylate/collage/lidocaine mix, only permanent filler approved by FDA for nasolabial folds **do not use in lips**
41
In what areas is androgenic alopecia most evident?
frontal and crown
42
Hair growth cycle: active growth phase
anagen (lasts 3-10 years)
43
Hair growth cycle: hair loss phase
catagen (lasts 2-3 weeks)
44
Hair growth cycle: resting phase
telogen (lasts 3-12 weeks)
45
What enzyme is associated with male alopecia?
genetically susceptible follicles have increased 5-alpha-reductase activity
46
most common cause of hair loss in women
androgenic alopecia
47
Name for hair loss that occurs when the body goes through something traumatic (childbirth, malnutrition, major surgery)
Telogen effluvium
48
Name for hair loss when an insult occurs to the hair follicle during mitosis or metabolic activity (ie chemotherapy)
Anagen effluvium
49
Best donor site for hair transplantation
occiput (hairs here have the longest life span and transplant maintains characteristics of the donor area)
50
Size of a micro graft for hair transplantation
1-2 follicles
51
Size of a mini graft for hair transplantation
3-4 follicles
52
size of a standard graft for hair transplantation (punch graft)
8-30 follicles
53
pattern of hair loss/growth after hair transplantation
- hair growth for 1 month then
- hair loss then
- normal hair growth after 3 months
54
most common complication of hair transplantation
donor scar widening
55
What are the blood supply zones of the abdomen?
- Zone I: midabdomen - supplied by deep superior and inferior epigastric arteries
- Zone II: lower abdomen - supplied by superficial and deep circumflex arteries
- Zone III - lateral abdomen/flanks - suppled by intercostals, subcostal and lumbar arteries
56
What is the major blood supply to an abdominoplasty flap?
lateral intercostal arteries (zone III)
57
What is the most common nerve injury after abdominoplasty?
lateral femoral cutaneous nerve
58
Most common complication of combined abdominoplasty and liposuction
seroma
59
Initial step in management of a massive weight loss patient who is increasingly disoriented and obtunded on POD#1 s/p belt lipectomy
thiamine
60
Most common metabolic deficiency in patient s/p gastric bypass
iron deficiency
61
Which procedure is associated most frequently with post-op mortality in an ambulatory surgery center?
abdominoplasty (from PE)
62
Most common long-term complication of brachioplasty
widen or hypertrophic scar
63
Most common nerve injury in brachioplasty
MABC (travels with basilic vein just superficial to deep fascia - leave 1cm of fat on the deep fascia to avoid this)
64
What technique in thigh lift decreases the incidence of scar widening?
suspend superficial Scarpas fascia to Colles fascia
65
To decrease risk of seroma after medial thigh lift, preserve deep tissue in what area?
femoral triangle - bounded by inguinal ligament, adductor longus and sartorius (lots of lymphatics in this area)
66
how much tumescent is used in wet liposuction?
200-300cc/area
67
how much tumescent is used in superwet liposuction?
1:1
68
Most common complication of liposuction
contour irregularities
69
Initial symptoms of lidocaine toxicity
dizziness, tinnitus, lethargy
70
Amount of fluid infiltrate that is left in the body at the end of liposuction procedure
70%
71
Symptoms of fat embolism syndrome
respiratory distress, altered mental status, petechial rash (usually occurs within 48 hrs post-op)
72
which fat layer changes with weight gain - SUPERFICIAL or DEEP?
DEEP
73
What are the 5 zones of adherence that should be avoided during liposuction?
1) lateral gluteal depression
2) gluteal crease
3) distal posterior thigh
4) mid medial thigh
5) inferolateral iliotibial tract
74
Max safe dose of lidocaine in liposuction infiltrate
35mg/kg
75
when do lidocaine levels peak after infiltration into subcutaneous fat?
10-14 hrs after infiltration
76
treatment of lidocaine toxicity
intralipid
77
advantage of power-assisted liposuction over manual liposuction
reduced surgeon fatigue
78
recommended fluid replacement when performing large volume liposuction (>5L)
maintenance IVF then 0.25cc IV for every 1cc of liposuction aspirate over 5L (when superwet technique is used)
79
What are the major predisposing conditions for fat embolism syndrome?
traumatic long bone fractures, ortho surgery, soft tissue injury, liposuction
80
What is the congenital syndrome with repetitive episodes of eyelid edema with subsequent elevator dehiscence and ptosis?
blepharochalasis
81
What is senile ptosis?
levator dehiscence
82
Signs of senile ptosis
- elevated tarsal crease (>7mm)
- thinned upper eyelid
- lid droop with downward gaze
83
Best test for evaluating senile ptosis
marginal reflex distance (MRD) 1
84
treatment of senile ptosis
levator advancement or plication
85
what findings make up Horners syndrome
lid ptosis, pupil miosis, facial anhidrosis
86
where should the apex of the brow lie?
at the lateral limbus of the eye in forward gaze
87
what is the distance from the orbital rim to the orbital apex?
4-4.5cm
88
where does the nasolacrimal duct drain?
beneath the inferior turbinate
89
what is analogous to the levator in the the lower lid?
capsulopalpebral fascia
90
what muscles are responsible for medial brow depression?
corrugated, depressor supercilii, orbicularis oculi
91
What are the fat compartments of the upper lid?
2 fat compartments: central and nasal
92
What are the fat compartments of the lower lid?
3 fat compartments: medial, central, lateral
93
what separates the medial and central fat pads of the lower lid?
inferior oblique muscle
94
what is the arcus marginalis?
periosteal thickening at the orbital rim where the orbital septum attaches
95
What is the inner layer of the tear film made of, where is it made and what does it do?
- made of mucin
- made in goblet cells in the conjunctiva
- promotes dispersion of the overlying aqueous layer
96
What is the middle layer of the tear film made of, where is it made and what does it do?
- made of water and proteins
- made in lacrimal gland
- controls against infection
97
What is the outer layer of the tear film made of, where is it made and what does it do?
- made of lipids
- made in meibomian glands
- prevents tear film evaporation
98
what is the anatomic basis for the tear trough deformity
- tear trough ligament extends from medial canthus inferolaterally to the mid pupillary line where it connects with orbiculares retaining ligament
99
how do you measure levator function?
measure upper lid excursion with brow and frontalis held in neutral (normal >10mm, moderate function 5-10mm, poor function <5mm)
100
differences in Asian eyelid compared to Caucasian eyelid
- lack of supra tarsal fold (no dermal insertion of levator aponeurosis)
- shorter tarsus
- increase incidence of epicanthal folds
101
what separates the lower lid from the mid face?
orbitomalar ligament
102
who needs canthopexy vs canthoplasty?
lower lid distraction <6mm - canthopexy
| lower lid distraction >6mm - canthoplasty
103
what is the most appropriate procedure for congenital lid ptosis?
frontalis sling with TFL fascia
104
what is the most commonly injured muscle in an orbital blowout fracture?
inferior oblique muscle (only extra ocular muscle to insert into bone directly)
105
Treatment for lid resection 25% or less?
primary closure with wedge resection
106
Reconstruction of central upper lid 50% defect?
Tenzel semicircular flap
107
Reconstruction of 100% lower lid defect?
Mustarde flap
108
Reconstruction of central upper lid >50% defect
- Hughes tarsoconjunctival flap for middle and posterior lamella
- skin graft or local flap for anterior lamella
109
what is the test for myasthenia graves?
Tensilon test (edrophonium injection leading to short term improvement of ptosis)
110
Most common complication after lower lid blepharoplast
lower lid malposition
111
what is the surgical treatment of lower lid ectropion
canthoplasty with capsulopalpebral spacer graft
112
What will correction of ptosis in one eye do in a bilateral case?
make the ptosis worse on the non corrected side - Herings law
113
What is the mechanisms of action of Botox?
inhibits acetylcholine release at the neuromuscular junction - blocks nerve stimulation of muscle activity
114
what does a unit of Botox correspond to?
1 unit = median intraperitoneal lethal dose (LD50) in mice
115
What muscles elevate the brow?
frontalis
116
What muscles elevate the upper lid?
levator palpeerde and Mueller's muscle
117
How do you manage brow ptosis after Botox?
alpha-adrenergic agonist ophthalmic drops (phenylephrine or iopidine)
118
Why do men require a higher dose of Botox?
greater muscle mass
119
What are the FDA approved cosmetic indications for Botox ?
Glabellar lines, crows feet and transverse forehead lines
120
Contraindications for Botox use
Absolute:
1) infection at injection site
2) known hypersensitivity to Botox or its formulation
3) pregnancy
4) patients with peripheral motor neuron disorders or neuromuscular junction disorders
Relative:
1) Coagulopathy
2) Breastfeeding
121
What muscles are innervated by the frontal branch of the facial nerve?
frontalis, corrugator, procerus, depressor supercilii
