Plastics Flashcards
What are the major nasal tip support mechanisms
- Size and shape of lower lateral cartilages 2. Attachment of the lower lateral cartilages to the septum 3. Attachment of upper to lower lateral cartilage
What kinds of defects is the bilobed flap best used for in reconstruction?
Defects of nasal tip, dorsum, and side wall 1.5 to 2 cm or less
What is the best location to harvest a split Calabrian bone graft from?
2 cm inferior to the saggital suture on the parietal bone
How much negative pressure is required to perform cervicofacial liposuction
1 atm
How many weeks after injury does type III collagen start being replaced by type I
3 weeks
Most common draw back of open approach to rhino
Tip and Supra tip edema
What is the blood supply to the temporalis flap
Deep temporal artery
Which peel requires neutralization with water or 5% sodium bicarbonate?
Glycolic acid peel
How long does it take to establish new blood supply in a full thickness skin graft?
3-5 days
What is the syndrome depicted and how could you increase nasal tip projection in this patient
Binder syndrome (maxillo-nasal dysplasia), anterior caudal septal strut graft
Which local anesthetics associated with more allergic reactions (amides or esthers)
Amides
In what layer does the facial nerve lie in the temporal region?
deep to the temporoparietal fascia
What is a normal amount of collumellar show
2-3 mm
What is the sunderland classification of nerve injury
- neuropraxia
- axonotmesis: axon transected, endoneurium preserved
- neural tube transected: axon, myelin sheath, endoneurium
- Violation of perineurium
- Complete transection of nerve, pt at risk of forming neuroma
Where does the frontal branch of the facial nerve course deep to the SMAS (important to know in face lift)
0.5 cm anterior to the tragus to 1.5 cm lateral to the supraorbital rim
What condition will still be ok to have a rhytidectomy
Cutis laxa. Less elastin but normal collagen
What is Crumley’s method for calculating nasal tip projection
3-4-5 triangle and establishes a nasal angle of 36 degrees to be ideal
where should you inject botox for forehead rhytids?
should mnot extend past midpupillary line and should not come within 1 cm of orbital rim
Which approach to repair of orbital Floor fracture most likely to cause ectropion?
Subciliary
what are the minor nasal tip support mechanisms
Dorsal cartilagenous septum, interdomal ligament, membranous septum, nasal spine, surrounding skin and soft tissue, alar side walls
What do u use for pretreatment in chemical peel
Hydroqionone Retinoin Valtrex
Dedo class IV neck
Ptotic platysma
What causes the rocker deformity
Extending the lateral osteotomies too high close to the frontal bone
What is the ideal upper eyelid height in men?
6-9 mm
Which extraocular muscle is most commonly injured during blepharoplasty?
Inferior oblique, due to indiscriminate cautery of the fat pads
What is part of the SMAS
Galea aponeurotica Platysma Temporiparietal fascia Parotidomasseteric fascia is NOT part of the smas
People with short nasal bones are at risk for _______ after osteotomies
Internal valve collapse Inverted V deformity Consider spreader grafts in your preop planning
what muscles of facial expression are innervated on their superficial surface by facial nerve
Buccinator, mentalis, and levator anguli oris
Green tattoos targeted by
Ruby and alexandrite laser
What is the Q stitch nidium yag laser used for?
Tattoo removal
How common is a common lingual-facial artery trunk?
10-15% of cases
What are concave regions of the face that are most likely to heal well with secondary intention?
NEET: nose, eye, ear, and temple
Which muscle in mid face is most affected by aging
Orbicularis oculi
Lugols solution
Potassium Iodide and Elemental Iodide in Water
What is Goode’s method for determining nasal projection
Uses Frankfurt horizontal plane to calculate the distance from the nasal tip to the alar-facial crease and distance of nasal tip to the nasion
Major tip support mechanisms of nasal tip
Size shape and resilience of lower lateral cartilages Attachment of medial crural footplate to caudal septum Scroll/where upper and lower lateral cartilages interlock
Describe the lengths achieved by different angle z - plasties
What are the 4 types of pivotal flaps
Rotational, transposition, interpolated, and island
Jessner Solution
resorcinol, salicylic acid, lactic acid, ethanol, trichloracetic acid (35%), medium depth chemical peel
What is a dedo class III neck
Subcutaneous or subplatysmal adiposis
How long does it take to establish new blood supply into a full thickness skin graft
3-5 days
How to increase projection without increasing rotation?
Lateral crural steal Vertical dome division Columellar strut Suture suspension of the tip
By what age does the auricle reach 95% of its adult size
6
What is a Dedo class I neck
Smooth and contoured neck
Baker Gordon Solution
Deep chemical peel, 88% phenol, water, liquid soap, croton oil
What’s the most common complication of tip deprojection
Alar flaring
What order do u do Botox and laser to improve the appearance of facial rhytids
Botox then laser two weeks later
Dedo class II neck
Excess skin
Minor tip
Interdomal ligaments Cartilaginous dorsal septum Skin soft tissue envelope Nasal spine Alar cartilages Septum
What is the tongue in groove technique for decreasing tip projection
Moving medial crus back onto caudal septum
What is the ideal upper eyelid height in women
8-11
Red and orange colors in tattoos targeted by
Ruby laser
What location does the superficial temporal artery pierce the parotidomasseterix fascia?
1 cm anterior and 1.75 cm superior to the EAC
How long does it take for hair to regrow after a hair transplant
3 months
what is the ideal upper eye lid crease height in women and men
8 - 11 mm for women, and 6 - 9 mm in men
What can help eye ptosis after botox
Apraclonidine eye drops: sympathomimetic, affects mullers muscle Vysine otc
what is a good landmark vein that reliable marks where the frontal branch of facial nerve is in the temporal region in endocopic brow liftt?
sentinel vein, branch of the zygomaticotemporal vein
How much tip do you need to leave to still safely have tip support
7 mm
Which antibiotics should you not use when getting Botox
Aminoglycosides
What should be the vertical height of the ear
From the lateral brow to the subnasale
What is mustarde sutures
To recreate antihelical fold, from concha to scaphoid
What are Furnas
sutures from conchal bowl to mastoid, conchal set back
What is Gibson’s principle
When you score cartilage it weakens it and it is able to bend away from the side you have scored
What nerves innervate the auricle
great auricular nerve, the auriculotemporal nerve (V3), the lesser occipital nerve, and the greater branch of the vagus nerve (Arnold’s nerve)
What is the frankfurt horizontal plane?
line drawn from the EAC to the inferior orbital rim
What makes up the anterior lamella of the eye
Skin and orbicularis oculi
What makes up the posterior lamella of the eye
levator, conjunctiva
What is a risk of lower lid blepharoplasty
lower lid retraction if you violate the orbital septum
Which layer of orbicularis oculi do you not want to violate during bleph
pretarsal
What is normal schirmer’s test?
>15 mms
What is the MRD 1?
Distance from the pupillary light reflex to the ciliary line, should be 2.5 mm at least
What is MRD 2
Distance from mid pupillary line to lower lid mucosa, 5 mm or less
What should the length of the distance from lid to supratarsal fold?
9-11 mm
How medial do you go for bleph
At level of punctum
Most common mistake of upper bleph
underesection of medial orbital fat
What is the most commonly injured muscle during blepharoplasty
inferior oblique
What is the arcus marginalis, what is its relevance?
The extension of the orbital septum onto the orbital rim. It is what you want to release during brow lift
What class of drug is apraclonidine
alpha 2 agonist
What kind of graft for nasal reconstruction is leak likely ot resorb?
Split calvarial bone graft, bone that is derived from intramembranous ossification rather then endochondral (rib)
What is the tensile strength of a wound at 1 week post op, 3 weeks post op, 5 weeks post op, and 12 months?
3%, 30%, 60%, 80% (max)
How does hydroquinone work to prevent pigmentation in post skin resurfacing?
It is a tyrosine kinase inhibitor, works by preventing conversion of tyrosine to dopa in melanocytes
wavelength of Er:YAG and Nd:Yag respectively
Nd:YAG (1,320 nm), Er:YAG (2,940 nm)
