FPRS facelift and facial implants Flashcards
With what layer in the neck is the SMAS layer contiguous?
The platysma
What leads to jowl formation?
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).
What structures are responsible for creating the
nasolabial fold?
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.
What is the process of aging that leads to the
nasojugal/tear trough deformity?
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
What surgical approach is most common for malar
implant placement?
Intraoral (canine fossa)
Anterior to the parotid gland, what layer separates
the branches of the facial nerve from the SMAS?
The parotidomasseteric fascia
What is the vector of pull for the soft tissues of the
face during rhytidectomy?
Posterior and superior
During rhytidectomy, what determines whether the preauricular incision curves into the hairline or
stays below the inferior edge of the preauricular
tuft?
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.
Review some risk factors associated with skin
necrosis following rhytidectomy.
Tobacco use, superficial dissection, excessive wound tension, untreated hematoma, systemic conditions associated with microvascular disease
Smoking increases the risk of flap necrosis following rhytidectomy by what factor?
Thirteen times
Which facelift technique is most prone to hyper-
trophic scarring?
Skin-only facelift
What is the most commonly injured nerve during
rhytidectomy?
Greater auricular nerve (1 to 7%)
When elevating the cervical skin flap during rhytidectomy, the great auricular nerve is inadvertently transected. How should this complication be managed?
Direct suture anastomosis
During rhytidectomy, an uninterrupted bridge of tissue should be maintained between the temporal and preauricular elevations to protect what structure?
Frontal branch of the facial nerve
The temporal branch of the facial nerve lies within or immediately deep to what structure?
Superficial temporal fascia, also known as the temporoparietal fascia
What is the cause of Satyr (devil’s) ear after
rhytidectomy?
Downward tension on the earlobe leading to inferior
displacement of the lobule
What causes a cobra deformity after rhytidectomy?
Overaggressive submental lipectomy and/or inadequate
platysmal plication
What is the cause of the “turkey gobbler”
deformity?
Diastasis and ptosis of the platysma muscle with accumulation of submental and cervical fat
How is the mentocervical angle determined?
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
What percentage of women undergoing rhytidectomy will experience depression after surgery?
50%
How does liposuction lead to a decrease in
subcutaneous fat?
By direct removal of adipocytes and induction of apoptosis
For what type of fat deposits, congenital or acquired, is liposuction most effective?
Congenital fat accumulations that do not shrink with
weight loss
Describe the ideal chin position.
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.
What method is used to determine ideal chin projection?
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.
What is the difference between microgenia,
micrognathia, and retrognathia?
● 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.
What is a useful landmark for identifying the
mental foramina?
The mental foramina is variable but is usually found below
the second premolar tooth.
Where should the pocket for a chin implant be
created?
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.
What are some of the indications for distraction
osteogenesis of the mandible?
Hemifacial microsomia, syndrome-related micrognathia, severe obstructive sleep apnea, deformity of the mandibular angle, and mandibular hypoplasia causing malocclusion
