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ENT Board Study > Facial Plastics > Flashcards

Facial Plastics Flashcards

1
Q

What is the Frankfort horizontal line?

A

Imaginary line drawn from the top of the tragus to the infraorbital rim

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2
Q

What is the trichion?

A

Hairline in the midsagittal plane

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3
Q

What is the glabella?

A

The most prominent portion of the forehead in the midsagittal plane

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4
Q

What is the nasion?

A

The deepest point in the nasofrontal angle and the beginning of the nasal dorsum

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5
Q

What is the radix?

A

The root of the nose; the uppermost segment of the nasal pyramid

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6
Q

What is the rhinion?

A

The junction of the bony and cartilaginous dorsum

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7
Q

Where is the nasal skin the thinnest?

A

The rhinion

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8
Q

What is the nasal tip?

A

The anterior most point of the nose

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9
Q

What is the pogonion?

A

The anterior most point of the chin

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10
Q

What is the menton?

A

The inferior most point of the chin

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11
Q

What is the nasofacial angle?

A

The angle between the plane of the face and the nasal dorsum; usually 36 degrees

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12
Q

What is the nasolabial angle?

A

The angle between the upper lip and the nasal tip

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13
Q

What is the ideal nasolabial angle in men?

A

90 to 95 degrees

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14
Q

What is the ideal nasolabial angle in women?

A

95 to 105 degrees

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15
Q

What is nasal projection?

A

The degree to which the nasal tip extends out from the plane of the face

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16
Q

What is nasal rotation?

A

The plane of the nostril openings with respect to the plane of the face

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17
Q

How far should ears ideally project from the mastoid?

A

20 degrees

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18
Q

Collagen synthesis in the dermis declines by what percentage per year in adult life?

A

3 percent

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19
Q

Where is the incision placed for a coronal forehead lift?

A

4 to 6 cm behind the anterior hairline, through the galea

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20
Q

What are the advantages of the coronal forehead lift?

A
  1. No visible scar
  2. Excellent exposure
  3. Ability to address different muscles for rhytid control
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21
Q

What are the disadvantages of the coronal forehead lift?

A
  1. Most extensive of the forehead lifts
  2. Elevates the hairline
  3. Cannot use in males with alopecia
  4. Scalp hypoesthesia
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22
Q

Where is the incision placed for a high forehead lift?

A

Just inferior to the hairline for a pretrichial lift or 2 mm posterior to the hairline for a trichophytic lift

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23
Q

What are the advantages of the high forehead lift?

A
  1. Excellent exposure
  2. Height of the hairline is not altered
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24
Q

What are the disadvantages of the high forehead lift?

A
  1. Potentially visible scar
  2. Scalp hypoesthesia
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25
Q

What is the ideal position of the male brow?

A

The supraorbital rim

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26
Q

What is the ideal position of the female brow?

A

On the supraorbital rim with a lateral arch above the rim

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27
Q

Where should the highest point of the brow be located?

A

Vertically up from the lateral limbus

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28
Q

What are the advantages of the midforehead lift?

A
  1. Less extensive
  2. Does not alter the hairline
  3. Allows precise brow elevation
  4. Avoids scalp hypoesthesia
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29
Q

What are the disadvantages of the midforehead lift?

A
  1. Visible scar
  2. Difficult to achieve lateral brow elevation
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30
Q

What are the advantages to the direct brow lift?

A
  1. Simple procedure
  2. Able to tightly control brow position and shape
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31
Q

What are the disadvantages to the direct brow lift?

A
  1. Visible scar
  2. Unable to address crow’s feet
  3. Unable to address other musculature
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32
Q

What nerves are most at risk from a coronal or high forehead lift?

A
  1. Frontal branch of CN VII
  2. Supraobital nerves
  3. Supratrochlear nerves
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33
Q

What is the term for excessive upper eyelid skin laxity?

A

Dermatochalasis

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34
Q

What are the primary indications for upper lid blepharoplasty?

A
  1. Dermatochalasis with impairment of visual fields
  2. Fat pseudoherniation into the central and medial fat compartments
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35
Q

When performing blepharoplasty, where is the inferior aspect of the incision placed?

A

The superior border of the tarsal plate in the naturally formed skin crease, 7 to 10 mm from the lash line

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36
Q

When creating the superior incision for upper lid blepharoplasty, how many mm superior is the line placed?

A
  1. 8 to 10 mm at the midpupillary line
  2. 5 mm at the lateral canthus
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37
Q

What is the most concerning complication of blepharoplasty?

A

Orbital hematoma

38
Q

What occurs if too much skin is resected during upper lid blepharoplasty?

A

Lagophthalmos

39
Q

When evaluating for lower lid blepharoplasty, what history is critical?

A
  1. Presence of xerophthalmia (primary or secondary to LASIK)
  2. Medical conditions leading to eyelid problems (Grave’s disease)
  3. Lid distraction test to allow for less than 10 mm of play
  4. Snap test to assure the tissue snaps firmly back onto the globe (avoids post-operative ectropion)
40
Q

How does one distinguish between fat pseudoherniation and fluid retention in the lower lid?

A

Pseudoherniation occurs above the infraorbital rim, fluid retention occurs along and beneath the rim

41
Q

When is the skin-muscle flap lower lid blepharoplasty indicated?

A

To address skin excess and fat pseudoherniation

42
Q

When is the skin flap lower lid blepharoplasty indicated?

A

For patients with excess skin only

43
Q

When is the transconjunctival lower lid blepharoplasty indicated?

A

To adderss excess fat; no skin excess

44
Q

Where is the skin-muscle flap incision placed when peforming lower lid blepharoplasty?

A

2 to 3 mm below the lash line (subciliary)

45
Q

What is an advantage to the transconjunctival approach to lower lid blepharoplasty?

A
  1. Avoids a visible scar
  2. Avoids potential postoperative ectropion
46
Q

Describe the classes of mid/lower face aging.

A
  1. Class I-minimal laxity; not good surgical candidate
  2. Class II-Skin laxity alone
  3. Class III-Skin laxity with submental jowling and excess fat
  4. Class IV-anterior platysmal banding
  5. Class V-congenital or acquired micrognathia which may need augmentation
  6. Class VI-low-lying hyoid bone
47
Q

Why is a low-lying hyoid bone problematic in patients undergoing rhytidectomy?

A

Inability of the surgeon to address the cervicomental contour

48
Q

When performing a SMAS plication, at what level is the flap raised?

A

Just deep to the hair follicles in the hair-bearing portions and more superficially just deep to the subdermal plexus in the other portions

49
Q

What is the incidence of hematoma after rhytidectomy?

A

3 to 15 percent

50
Q

What nerves are at risk when performing rhytidectomy?

A
  1. Great auricular nerve
  2. CN VII-particularly frontal, buccal, and marginal mandibular
51
Q

What is a Class I Fitzpatrick?

A

very white, always burns, never tans

52
Q

What is a Class II Fitzpatrick?

A

white, usually burns, tans minimally

53
Q

What is a Class III Fitzpatrick?

A

white to olive, sometimes burns, tans

54
Q

What is a Class IV Fitzpatrick?

A

brown, rarely burns, always tans

55
Q

What is a Class V Fitzpatrick?

A

dark brown, very rarely burns, tans profusely

56
Q

What is a Class VI Fitzpatrick?

A

black, never burns, tans profusely

57
Q

What must be done to prevent scarring from dermabrasion?

A

Do not damage the reticular dermis

58
Q

What are the major indications for dermabrasion?

A
  • Surgical scars
  • Acne scarring
  • Tattoo removal
  • Telangiectasias
  • Melasma
  • Wrinkles
  • Milia
59
Q

Who are ideal candidates for chemical peels?

A

Fitzpatrick Class I-III non-oily skin

60
Q

What is the depth of a superficial peel?

A

Papillary dermis, partial epidermolysis

61
Q

What are the effects of a superifical peel?

A

Rejuvenate skin, address very fine rhytids, treat pigment changes, actinic damage

62
Q

What solutions are used for a superficial peel?

A
  • Glycolic acid
  • Tretinoin
  • TCA 10-25%
  • Jessner solution
63
Q

What is the penetration level of a medium depth peel?

A

Supeficial reticular dermis

64
Q

What are the effects of a medium depth peel?

A

Remove actinic keratoses, pigment changes, and flattens depressed scars

65
Q

What solutions are used in a medium depth peel?

A
  • TCA 35 to 50%
  • Full strength phenol (88%)
66
Q

What are the advantages to using TCA for a peel?

A
  • Less bleaching effects (can be used on darker-skinned)
  • Not systemically toxic
67
Q

What is the penetration level of a deep peel?

A

Midreticula dermis

68
Q

What are the effects of a deep peel?

A

Corrects most severe actinic damage, rhytids, acne scarring

69
Q

What solution is used for a deep peel?

A
  • Baker’s phenol
    • Phenol 88%
    • 2 mL tap water
    • 3 drops croton oil
    • 8 drops soap solution
70
Q

Why should one avoid the neck when doing a deep peel?

A

There are no adnexal structures to promote re-epithelialization

71
Q

Does more phenol lead to a deeper peel?

A

No, because the concentration is inversely propotional to the depth

72
Q

What is “frosting” in a peel?

A

Protein coagulation, which inhibits further penetration of the peeling compound

73
Q

What is the ideal nasofrontal angle?

A

120 degrees

74
Q

What are the advantages to closed septorhinoplasty?

A
  • Minimize tip edema
  • No external incision
  • Short operative time
75
Q

What are the disadvantages to closed septorhinoplasty?

A
  • Limited tip modification possible
  • Distortion of normal anatomy can lead to surgical error
76
Q

What are the advantages to open septorhinoplasty?

A
  • Excellent exposure
  • Ability to make manipulations of the nasal tip
77
Q

What are the disadvantages to open septorhinoplasty?

A
  • Visible scar
  • Prolonged tip edema
  • Longer operative time
78
Q

What are the major sources of nasal tip support?

A
  • Medial crura
  • Lateral crura
  • Medial crural attachments to the septal cartilage
  • The scroll area
79
Q

What are the minor sources of nasal tip support?

A
  • Interdomal ligament
  • Cartilaginous septal dorsum
  • Sesamoid complex
  • Attachments of the alar cartilage to the overlying skin
  • Nasal spine
80
Q

How much alar width must be preserved when doing a cephalic trim to avoid nasal valve collapse?

81
Q

How can one deproject the nose?

A

Shortening all three limbs of the nasal tip at once

82
Q

How do you decrease columellar show?

A

Trim the caudal border of the septum and/or medial crura

83
Q

How can one narrow a wide nasal base?

A

Weir excisions

84
Q

What is a Norwood Type I?

A

Minimal or no recession of the hair line

85
Q

What is a Norwood Type II?

A

Areas of recession at the frontotemporal hair line

86
Q

What is a Norwood Type III?

A

Deep symmetrical recession at the temples that are bare or only sparsely covered

87
Q

What is a Norwood Type IV?

A

Hair loss is primarily from the vertex, limited recession of the frontotemporal hair line

88
Q

What is a Norwood Type V?

A

Vertex hair loss region is separated from the frontotemporal region but is less distinct; the band of hair across the Crown is narrow

89
Q

What is a Norwood Type VI?

A

Frontotemporal and vertex regions are joined together

90
Q

What is a Norwood Type VII?

A

Most severe form A narrow band of hair remains in horseshoe shape

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