Facial Plastics

Question 1

What is the name of the area where the septum articulates with the nasal bones?

Answer 1

“Keystone”

Question 2

At what vertebrae is the hyoid bone located?

Answer 2

C3-C4

Question 3

Difference in nasofrontal angle between men and women?

Answer 3

Men tend to have a more acute NFA than do women.

Question 4

A reconstructive surgeon plans on using a tissue expander for the scalp. What is the ideal layer of placement of the tissue expander?

Answer 4

Calvarium

This is because tissue expanders work best in locations with solid bony support under the expander balloon (ex. scalp, forehead)

Question 5

What is an absolute contraindication to performing chemical peels?

Answer 5

Isotetinoin use within the last 6 months

Postpeel reepithelialization relies upon the epidermis within hair follicles and sebaceous glands. Isotetinoin prevents reepithelialization from these locations

Question 6

What is the first stage of auricular reconstruction for microtia?

Answer 6

Harvest costal cartilage at age 6 or later.

Question 7

Pogonian

Answer 7

Anterior most portion of the chin

Question 8

Which three facial muscles are the exception and run deep to the course of the facial nerve?

Answer 8

1. Levator anguli oris
2. Buccinator
3. Mentalis

These muscles are innervated on their superior surface

Question 9

What forms the nasofacial angle?

Answer 9

Intersection of the line from the glabella and pogonion with the nasion to nasal tip.

Ideally 35 degrees

Question 10

Name two areas that heal well by secondary intention?

Answer 10

• Temple
• Medial canthus

Heal better if wound is superficial and in a concave area

Question 11

Frankfort horizontal plane

Answer 11

line from the superior aspect of the external auditory canal to the inferior aspect of the infraorbital rim on a lateral view.

For standardization for patient positioning for facial analysis

Question 12

Menton (definition)

Answer 12

Lowest point of the chin

Question 13

Nasofrontal angle

Answer 13

115-135 degrees

Question 14

Nasofacial angle

Answer 14

36-40 degrees

Question 15

Nasolabial angle

Answer 15

90-95 degrees

Question 16

Nasomental angle

Answer 16

120-132 degrees

Question 17

Mentocervical angle

Answer 17

80-95 degrees

Question 18

What are the subunits of the face?

Answer 18

• Forehead
• Periorbital region
• Cheeks
• Nose
• Perioral region and chin
• Neck

Question 19

Fitzpatrick Skin Classification System

Answer 19

Classifies degrees of skin pigmentation and ability to tan. Graded I - VI
-Forecasts sun sensitivity and susceptibility to photodamage

Question 20

What is the significance of the Fitzpatrick Skin Classification System?

Answer 20

Provides important information related to the risk factors for skin resurfacing procedures

Question 21

Which Fitpatrick Skin Classes are at higher risk for pigmentary dyschromia (hyper or hypo-pigmentation) after skin resurfacing procedures?

Answer 21

III and up

Question 22

What are the main indications for skin resurfacing?

Answer 22

1. Photo-damage
2. Fine Wrinkles
3. Pigmentary dyschomia
4. Acne scars

Question 23

Describe the 6 skin types in Fitzpatrick Skin Classification System

Answer 23

I - White or freckled, Always burns
II - White, Usually burns
III - White to olive, Sometimes burns *
IV - Brown, Rarely burns * 
V - Dark Brown, Very barely burns *
VI - Black, Never burns *

Question 24

What are contraindications of skin resurfacing with chemical peels, dermabrasion, and lasers?

Answer 24

1. Facelift surgery in last 6 months
2. Isotretinoin (Accutane) in past 1 year
3. Active HSV infection
4. Active skin disorder (ex. psoriasis)

Question 25

Describe the difference in pigmentary changes after skin resurfacing

Answer 25

Hyperpigmentation tends to occur sooner and can be successfully treated with topical therapy

Hypopigmenation tends to be a delayed phenomenon and is often permanent

Question 26

Glogau Classification system

Answer 26

-Describes the amount of surface facial aging
Grades the severity of wrinkles
Grades the severity of photodamage

Question 27

Glogau Scale: Group I

Answer 27

• Mild
• Typical age: 28-35
• Description: No wrinkles
• Early photo aging, mild pigment changes, no keratosis, minimal wrinkles, minimal or no make up

Question 28

Glogau Scale: Group II

Answer 28

• Moderate
• Typical age: 35-50
• Description: Wrinkles in Motion
• Skin Characteristics: Early to moderate photo aging, early brown spots visible, keratosis palpable but not visible, parallel smile lines begin to appear, wears some foundation

Question 29

Glogau Scale: Group III

Answer 29

• Advanced
• Typical age: 50-65
• Wrinkles at rest
• Skin characteristics: Advanced photo aging: obvious discoloration, visible capillaries, visible keratosis, wears heavier foundation

Question 30

Glogau Scale: Group IV

Answer 30

• Severe
• Typical Age: 60+
• Description: Only wrinkles
• Skin Characteristics: Severe photo aging: yellow/grey skin color, prior skin malignancies, wrinkles throughout, no normal skin, cannot wear make-up because it cracks and cakes

Question 31

Dedo Classification of the Neck

Answer 31

Class I - VI for characterizing the submental and anterior neck region

Question 32

Dedo: Class I

Answer 32

Youthful neck

Question 33

Dedo Class II

Answer 33

Only skin laxity

Question 34

Dedo: Class III

Answer 34

excessive submandibular and submental adipose`

Question 35

Dedo: Class IV

Answer 35

Anterior platysma banding

Question 36

Dedo: Class V

Answer 36

Microgenia or retrognathia

Question 37

Dedo: Class VI

Answer 37

Low positioned hyoid bone