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In service > Cosmetics > Flashcards

Cosmetics Flashcards

1
Q

Purpose of columellar strut graft

A

tip support

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2
Q

what does cephalic trim do

A

refines boxy/bulbous tip

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3
Q

True/False: peri-op steroids decrease edema and ecchymoses in rhinoplasty

A

True

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4
Q

what is the sub epidermal region of dermis where neocollagen forms after wounding or actinic damage

A

grenz zone

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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

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6
Q

pre-treatment regimen prior to chemical peel

A

hydroquinone, tretinoin, glycolic acid, sunscreen

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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

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8
Q

Class of mildest chemical peels

A

alpha hydroxy acid (glycolic acid, lactic acid, citric acid, magic acid, tartaric acid)

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9
Q

what is a Jesner peel?

A

medium depth peel, consists of salicylic acid, lactic acid, resorcinol and ethanol

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10
Q

Name an example of a deep chemical peel

A

phenol peel (reliable penetration into upper reticular dermis)

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11
Q

what does croton oil do in a chemical peel?

A

acts as a skin irritant to deepen the peel

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12
Q

what is the most common long-lasting side effect of a phenol peel?

A

hypopigmentation

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13
Q

what is the most serious potential side effect of a phenol peel?

A

cardiotoxicity

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14
Q

most common problem after laser skin resurfacing

A

hyperpigmentation

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15
Q

what effect does a chemical peel have on the dermis?

A

decrease of nonlamellar collagen

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16
Q

medication that inhibits tyrosinase to cause skin lightening

A

hydroquinone

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17
Q

time between treatment for salicylic acid peels

A

4 weeks

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18
Q

histologic changes of photoaged akin

A

thickening of epidermis, flattening of epidermal-dermal junction, decreased melanocyte concentration, dermal inflammation

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19
Q

what is melasma

A

irregular brown patches on sun-exposed skin, treat with hydroquinone +/- tretinoin

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20
Q

what medication causes long term increase in dermal collagen

A

tretinoin

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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

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22
Q

mechanism of action of retinoids

A

decreased activation of metalloproteinases through the inhibition of AP-1 transcription

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23
Q

Process by which a material acts as a scaffold for ingrowth of osteoblasts and gradual formation of osseous tissue

A

osteoconduction

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24
Q

Process by which undifferentiated pluripotent cells are stimulated to develop into bone

A

osteoinduction

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25
Q

In which plane should facial implants be placed in adults?

A

subperiosteal

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26
Q

Location of infraorbital nerve

A

1 cm inferior to orbital rim in the mid pupillary line

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27
Q

Pulse duration of a laser should be MORE OR LESS than the thermal relaxation time of the target tissue?

A

Less

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28
Q

pulsed dye lasers are absorbed by what chromophore?

A

oxyhemoglobin - targets redness in skin or cutaneous vascular lesions

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29
Q

which is laser is effective for selecting purple and black tattoo pigment?

A

Q-switched ruby laser

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30
Q

which laser is contraindicated for use with red, white and skin colored tattoo pigment?

A

Q-switched ruby laser - can darken the pigment irreversibly

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31
Q

which laser is idea for removing blue-green tattoo pigment?

A

Q-switched alexandrite laser

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32
Q

which laser is good for removing red, orange or brown tattoos?

A

Q-switched Nd:YAG/KTP (versatile and commonly used for tattoos in general)

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33
Q

In what hair growth phase are lasers most effective for hair removal?

A

anagen

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34
Q

CO2 laser is absorbed by which chromophore

A

water

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35
Q

most common complication of ablative lasers

A

hyperpigmentation

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36
Q

advantages of erbium laser over CO2 for skin resurfacing

A

1) less thermal damage to surrounding tissues
2) more rapid re-epithelialization
3) decreased risk of hypopigmentation

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37
Q

which filler requires pre-test of the skin prior to placement?

A

bovine collagen (allergic reaction in 5%) - Zyderm and Zyplast

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38
Q

What is Radiesse?

A

calcium hydroxyapatite beads in an aqueous gel, lasts up to 2 years, do not use in lips

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39
Q

What is Sculptra?

A

poly-L-lactic acid polymer filler, lasts up to 2 years, FDA approved for treatment of HIV-associated lipodystrophy of the face

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40
Q

What is Artefill?

A

polymethymethacrylate/collage/lidocaine mix, only permanent filler approved by FDA for nasolabial folds do not use in lips

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41
Q

In what areas is androgenic alopecia most evident?

A

frontal and crown

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42
Q

Hair growth cycle: active growth phase

A

anagen (lasts 3-10 years)

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43
Q

Hair growth cycle: hair loss phase

A

catagen (lasts 2-3 weeks)

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44
Q

Hair growth cycle: resting phase

A

telogen (lasts 3-12 weeks)

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45
Q

What enzyme is associated with male alopecia?

A

genetically susceptible follicles have increased 5-alpha-reductase activity

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46
Q

most common cause of hair loss in women

A

androgenic alopecia

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47
Q

Name for hair loss that occurs when the body goes through something traumatic (childbirth, malnutrition, major surgery)

A

Telogen effluvium

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48
Q

Name for hair loss when an insult occurs to the hair follicle during mitosis or metabolic activity (ie chemotherapy)

A

Anagen effluvium

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49
Q

Best donor site for hair transplantation

A

occiput (hairs here have the longest life span and transplant maintains characteristics of the donor area)

50
Q

Size of a micro graft for hair transplantation

A

1-2 follicles

51
Q

Size of a mini graft for hair transplantation

A

3-4 follicles

52
Q

size of a standard graft for hair transplantation (punch graft)

A

8-30 follicles

53
Q

pattern of hair loss/growth after hair transplantation

A
  • hair growth for 1 month then
  • hair loss then
  • normal hair growth after 3 months
54
Q

most common complication of hair transplantation

A

donor scar widening

55
Q

What are the blood supply zones of the abdomen?

A
  • 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
Q

What is the major blood supply to an abdominoplasty flap?

A

lateral intercostal arteries (zone III)

57
Q

What is the most common nerve injury after abdominoplasty?

A

lateral femoral cutaneous nerve

58
Q

Most common complication of combined abdominoplasty and liposuction

A

seroma

59
Q

Initial step in management of a massive weight loss patient who is increasingly disoriented and obtunded on POD#1 s/p belt lipectomy

A

thiamine

60
Q

Most common metabolic deficiency in patient s/p gastric bypass

A

iron deficiency

61
Q

Which procedure is associated most frequently with post-op mortality in an ambulatory surgery center?

A

abdominoplasty (from PE)

62
Q

Most common long-term complication of brachioplasty

A

widen or hypertrophic scar

63
Q

Most common nerve injury in brachioplasty

A

MABC (travels with basilic vein just superficial to deep fascia - leave 1cm of fat on the deep fascia to avoid this)

64
Q

What technique in thigh lift decreases the incidence of scar widening?

A

suspend superficial Scarpas fascia to Colles fascia

65
Q

To decrease risk of seroma after medial thigh lift, preserve deep tissue in what area?

A

femoral triangle - bounded by inguinal ligament, adductor longus and sartorius (lots of lymphatics in this area)

66
Q

how much tumescent is used in wet liposuction?

A

200-300cc/area

67
Q

how much tumescent is used in superwet liposuction?

A

1:1

68
Q

Most common complication of liposuction

A

contour irregularities

69
Q

Initial symptoms of lidocaine toxicity

A

dizziness, tinnitus, lethargy

70
Q

Amount of fluid infiltrate that is left in the body at the end of liposuction procedure

A

70%

71
Q

Symptoms of fat embolism syndrome

A

respiratory distress, altered mental status, petechial rash (usually occurs within 48 hrs post-op)

72
Q

which fat layer changes with weight gain - SUPERFICIAL or DEEP?

A

DEEP

73
Q

What are the 5 zones of adherence that should be avoided during liposuction?

A

1) lateral gluteal depression
2) gluteal crease
3) distal posterior thigh
4) mid medial thigh
5) inferolateral iliotibial tract

74
Q

Max safe dose of lidocaine in liposuction infiltrate

A

35mg/kg

75
Q

when do lidocaine levels peak after infiltration into subcutaneous fat?

A

10-14 hrs after infiltration

76
Q

treatment of lidocaine toxicity

A

intralipid

77
Q

advantage of power-assisted liposuction over manual liposuction

A

reduced surgeon fatigue

78
Q

recommended fluid replacement when performing large volume liposuction (>5L)

A

maintenance IVF then 0.25cc IV for every 1cc of liposuction aspirate over 5L (when superwet technique is used)

79
Q

What are the major predisposing conditions for fat embolism syndrome?

A

traumatic long bone fractures, ortho surgery, soft tissue injury, liposuction

80
Q

What is the congenital syndrome with repetitive episodes of eyelid edema with subsequent elevator dehiscence and ptosis?

A

blepharochalasis

81
Q

What is senile ptosis?

A

levator dehiscence

82
Q

Signs of senile ptosis

A
  • elevated tarsal crease (>7mm)
  • thinned upper eyelid
  • lid droop with downward gaze
83
Q

Best test for evaluating senile ptosis

A

marginal reflex distance (MRD) 1

84
Q

treatment of senile ptosis

A

levator advancement or plication

85
Q

what findings make up Horners syndrome

A

lid ptosis, pupil miosis, facial anhidrosis

86
Q

where should the apex of the brow lie?

A

at the lateral limbus of the eye in forward gaze

87
Q

what is the distance from the orbital rim to the orbital apex?

A

4-4.5cm

88
Q

where does the nasolacrimal duct drain?

A

beneath the inferior turbinate

89
Q

what is analogous to the levator in the the lower lid?

A

capsulopalpebral fascia

90
Q

what muscles are responsible for medial brow depression?

A

corrugated, depressor supercilii, orbicularis oculi

91
Q

What are the fat compartments of the upper lid?

A

2 fat compartments: central and nasal

92
Q

What are the fat compartments of the lower lid?

A

3 fat compartments: medial, central, lateral

93
Q

what separates the medial and central fat pads of the lower lid?

A

inferior oblique muscle

94
Q

what is the arcus marginalis?

A

periosteal thickening at the orbital rim where the orbital septum attaches

95
Q

What is the inner layer of the tear film made of, where is it made and what does it do?

A
  • made of mucin
  • made in goblet cells in the conjunctiva
  • promotes dispersion of the overlying aqueous layer
96
Q

What is the middle layer of the tear film made of, where is it made and what does it do?

A
  • made of water and proteins
  • made in lacrimal gland
  • controls against infection
97
Q

What is the outer layer of the tear film made of, where is it made and what does it do?

A
  • made of lipids
  • made in meibomian glands
  • prevents tear film evaporation
98
Q

what is the anatomic basis for the tear trough deformity

A
  • tear trough ligament extends from medial canthus inferolaterally to the mid pupillary line where it connects with orbiculares retaining ligament
99
Q

how do you measure levator function?

A

measure upper lid excursion with brow and frontalis held in neutral (normal >10mm, moderate function 5-10mm, poor function <5mm)

100
Q

differences in Asian eyelid compared to Caucasian eyelid

A
  • lack of supra tarsal fold (no dermal insertion of levator aponeurosis)
  • shorter tarsus
  • increase incidence of epicanthal folds
101
Q

what separates the lower lid from the mid face?

A

orbitomalar ligament

102
Q

who needs canthopexy vs canthoplasty?

A

lower lid distraction <6mm - canthopexy

lower lid distraction >6mm - canthoplasty

103
Q

what is the most appropriate procedure for congenital lid ptosis?

A

frontalis sling with TFL fascia

104
Q

what is the most commonly injured muscle in an orbital blowout fracture?

A

inferior oblique muscle (only extra ocular muscle to insert into bone directly)

105
Q

Treatment for lid resection 25% or less?

A

primary closure with wedge resection

106
Q

Reconstruction of central upper lid 50% defect?

A

Tenzel semicircular flap

107
Q

Reconstruction of 100% lower lid defect?

A

Mustarde flap

108
Q

Reconstruction of central upper lid >50% defect

A
  • Hughes tarsoconjunctival flap for middle and posterior lamella
  • skin graft or local flap for anterior lamella
109
Q

what is the test for myasthenia graves?

A

Tensilon test (edrophonium injection leading to short term improvement of ptosis)

110
Q

Most common complication after lower lid blepharoplast

A

lower lid malposition

111
Q

what is the surgical treatment of lower lid ectropion

A

canthoplasty with capsulopalpebral spacer graft

112
Q

What will correction of ptosis in one eye do in a bilateral case?

A

make the ptosis worse on the non corrected side - Herings law

113
Q

What is the mechanisms of action of Botox?

A

inhibits acetylcholine release at the neuromuscular junction - blocks nerve stimulation of muscle activity

114
Q

what does a unit of Botox correspond to?

A

1 unit = median intraperitoneal lethal dose (LD50) in mice

115
Q

What muscles elevate the brow?

A

frontalis

116
Q

What muscles elevate the upper lid?

A

levator palpeerde and Mueller’s muscle

117
Q

How do you manage brow ptosis after Botox?

A

alpha-adrenergic agonist ophthalmic drops (phenylephrine or iopidine)

118
Q

Why do men require a higher dose of Botox?

A

greater muscle mass

119
Q

What are the FDA approved cosmetic indications for Botox ?

A

Glabellar lines, crows feet and transverse forehead lines

120
Q

Contraindications for Botox use

A

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
Q

What muscles are innervated by the frontal branch of the facial nerve?

A

frontalis, corrugator, procerus, depressor supercilii

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