Facial plastics surgery

Question 1

what is it for?

Answer 1

aesthetic anxiety 
effect of ageing 
congenital 
trauma 
following tumour excision

Question 2

what is thought to create beauty in a face?

Answer 2

balance between the different components of the face

Question 3

what is the divine proportion?

Answer 3

1.618 
length v breadth of face 
width of nose compared to the mouth 
length of the nose to the nasal projection 
width of the eye to width of the face

Question 4

what are the different plastics procedures?

Answer 4

rhinoplasty
chin implants (mentoplasty)
face lift/ neck lift 
bleparoplasty 
brow lift 
skin rejuvenation 
otoplasty 
tumour surgery

Question 5

what needs to be done before a cosmetic procedure or a procedure which can have a cosmetic effect?

Answer 5

need to assess the face and the person - if big changes in mental health then shouldn’t be done
NHS Scotland has a strict cosmetic procedure document
rhinoplasty should never be offered at the first consultation

Question 6

what is an otoplasty?

Answer 6

a procedure for children with very sticky out ears
very simple procedure
should be considered from 6 onwards

Question 7

how is an otoplasty need assessed?

Answer 7

1cm from the most superior part of the pinna to the mastoid
2cm from Frankfort (top of tragus) posterior part of the pinna to mastoid
30 degrees mastoid and helix

Question 8

3 common problems causing need for otoplasty

Answer 8

underdeveloped anti-helical fold
prominent concha
protruding lobe

Question 9

What is blephroplasty?

Answer 9

for ageing eyelids
- accumulation of loose skin forms deepening creases in the lower lids
- slackening of the muscle beneath the skin allowing the fat, which cushions the eyes in their sockets, to protrude forward to give the appearance of bagginess
procedure reshapes the eyelids - extra fat and excess skin and sagging muscle is removed

Question 10

Reconstruction - order of closure

Answer 10

1. healing by secondary intention
2. primary closure
3. skin graft
4. skin flaps

Question 11

what are the determinants of healing by secondary intention?

Answer 11

use delayed when - infected tissue/wound or tumour unsure of margins
can give better cosmetic outcomes
less scarring/ movement of tissue

Question 12

what are the determinants of a skin graft?

Answer 12

quick and covers a large surface area 
can't go onto bone or tendon directly 
contracts and colour match isn't good with loss of volume 
retains tissue volume and pigmentation 
less contracture 
donor site morbidity and hair retained