FPRS facelift and facial implants

Question 1

With what layer in the neck is the SMAS layer contiguous?

Answer 1

The platysma

Question 2

What leads to jowl formation?

Answer 2

Relaxation of the masseteric cutaneous ligament and the parotid cutaneous ligament (Lore fascia) allows for inferomedial migration of the buccal fat pad. The descent of the fat pad is halted when it reaches the mandibular cutaneous ligament, leading to formation of the jowl and deepening of
the prejowl sulcus (Marionette line).

Question 3

What structures are responsible for creating the

nasolabial fold?

Answer 3

The distal portions of the zygomaticus major and zygomaticus minor muscles insert into the dermis at the lateral aspect of the upper lip, creating the nasolabial fold.

Question 4

What is the process of aging that leads to the

nasojugal/tear trough deformity?

Answer 4

Atrophy and descent of the suborbicularis oculi fat and
malar fat pad collecting at the nasolabial fold, leaving the
infraorbital region exposed and the infraorbital rim more
prominent

Question 5

What surgical approach is most common for malar

implant placement?

Answer 5

Intraoral (canine fossa)

Question 6

Anterior to the parotid gland, what layer separates

the branches of the facial nerve from the SMAS?

Answer 6

The parotidomasseteric fascia

Question 7

What is the vector of pull for the soft tissues of the

face during rhytidectomy?

Answer 7

Posterior and superior

Question 8

During rhytidectomy, what determines whether the preauricular incision curves into the hairline or
stays below the inferior edge of the preauricular
tuft?

Answer 8

The level of the hairline. If the preauricular tuft is 1 to 2 cm
below the superior portion of the helical insertion, the
incision can curve into the hairline. If there is a high
preauricular tuft, the incision should be immediately below
this.

Question 9

Review some risk factors associated with skin

necrosis following rhytidectomy.

Answer 9

Tobacco use, superficial dissection, excessive wound tension, untreated hematoma, systemic conditions associated with microvascular disease

Question 10

Smoking increases the risk of flap necrosis following rhytidectomy by what factor?

Answer 10

Thirteen times

Question 11

Which facelift technique is most prone to hyper-

trophic scarring?

Answer 11

Skin-only facelift

Question 12

What is the most commonly injured nerve during

rhytidectomy?

Answer 12

Greater auricular nerve (1 to 7%)

Question 13

When elevating the cervical skin flap during rhytidectomy, the great auricular nerve is inadvertently transected. How should this complication be managed?

Answer 13

Direct suture anastomosis

Question 14

During rhytidectomy, an uninterrupted bridge of tissue should be maintained between the temporal and preauricular elevations to protect what structure?

Answer 14

Frontal branch of the facial nerve

Question 15

The temporal branch of the facial nerve lies within or immediately deep to what structure?

Answer 15

Superficial temporal fascia, also known as the temporoparietal fascia

Question 16

What is the cause of Satyr (devil’s) ear after

rhytidectomy?

Answer 16

Downward tension on the earlobe leading to inferior

displacement of the lobule

Question 17

What causes a cobra deformity after rhytidectomy?

Answer 17

Overaggressive submental lipectomy and/or inadequate

platysmal plication

Question 18

What is the cause of the “turkey gobbler”

deformity?

Answer 18

Diastasis and ptosis of the platysma muscle with accumulation of submental and cervical fat

Question 19

How is the mentocervical angle determined?

Answer 19

In lateral view, the angle created by a line drawn from the
glabella to the pogonion and an intersecting line drawn from
the menton to the junction of the neck and submental region

Question 20

What percentage of women undergoing rhytidectomy will experience depression after surgery?

Answer 20

50%

Question 21

How does liposuction lead to a decrease in

subcutaneous fat?

Answer 21

By direct removal of adipocytes and induction of apoptosis

Question 22

For what type of fat deposits, congenital or acquired, is liposuction most effective?

Answer 22

Congenital fat accumulations that do not shrink with

weight loss

Question 23

Describe the ideal chin position.

Answer 23

Draw a vertical line through the vermilion border of the lower lip. In men, the pogonion should touch this line and may lie up to 2 mm anterior. In women, the pogonion should touch this line and should not rest more than 2 mm posterior.

Question 24

What method is used to determine ideal chin projection?

Answer 24

Gonzalez-Ulloa method: A line is made from the nasion perpendicular to the Frankfort horizontal. The ideal chin projection should be at this line. When the chin is posterior, and the patient has normal occlusion, a hypoplastic mentum is present.

Question 25

What is the difference between microgenia,

micrognathia, and retrognathia?

Answer 25

● Microgenia is caused by an underdeveloped mentum with
an otherwise normal mandible and normal occlusion.
● Micrognathia implies a hypoplastic retruded mandible
with class 2 occlusion.
● Retrognathia implies a normal sized mandible with class 2
occlusion.

Question 26

What is a useful landmark for identifying the

mental foramina?

Answer 26

The mental foramina is variable but is usually found below

the second premolar tooth.

Question 27

Where should the pocket for a chin implant be

created?

Answer 27

Inferior to the mental foramen but above the muscle insertions of the inferior mandibular border (generally 8 to 10 mm of space). It may be placed transorally or transcutaneously through a submental crease incision.

Question 28

What are some of the indications for distraction

osteogenesis of the mandible?

Answer 28

Hemifacial microsomia, syndrome-related micrognathia, severe obstructive sleep apnea, deformity of the mandibular angle, and mandibular hypoplasia causing malocclusion