Facial Dermatology Flashcards Preview

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Flashcards in Facial Dermatology Deck (190):
1

How many stages are required for completion of the Juri flap

4

2

Normally, how many hair follicles are contained within 1 cm3 of scalp

200

3

What is the incidence of hematoma after rhytidectomy

0.3 - 15°/o.

4

What is the incidence of facial nerve injury during rhytidectomy

0.4% - 2.6%.

5

How many hairs are contained in a micrograft

1 -2.

6

What are the primary theories on the etiology of infraorbital bags

1. Congenitally excess fat. 2. Weakening of the orbital septum and attenuation of the orbicularis oculi. 3. Weakening of global support resulting in enophthalmos and lower lid pseudohemiation 4. Weakening and descent of the Lockwood suspensory ligament.

7

What are 5 lower lid blepharoplasty techniques that help prevent postoperative retraction

1. Horizontal alignment of lower lid incisions. 2. Preservation of a strip of orbicularis attached to the tarsal plate. 3. Draping of the flap medially and superiorly. 4. Placement of a suspension suture between the deep surface of the orbicularis and the orbital periosteum. 5. Triamcinolone injection into plane of orbital septum.

8

How long does it take for hair to start growing after transplantation

10 - 16 weeks.

9

How long do side effects last after C02 and Er: Y AG laser

3 - 6 months after C02 laser; 2 - 4 weeks after Er: Y A G laser.

10

How long does injectable collagen remain in the tissue

3 - 6 months.

11

How many hairs are contained in a minigraft

3 - 8.

12

What is the incidence of positive responses to skin tests for injectable collagen

3%.

13

What is the incidence of temporary facial nerve paralysis after deep plane rhytidectomy

3.6%.

14

Approximately what % of hair follicles must be lost before hair loss is noticeable

30%.

15

What % of patients develop postinflammatory hyperpigmentation

33% (more for darker skin types).

16

How much time should be allotted between transplantation sessions

4 months.

17

When does hypopigmentation after laser skin resurfacing present

6 - 12 months after treatment.

18

What % of patients develop contact dermatitis after laser resurfacing

65%.

19

What is the average gain in soft-tissue projection after implant placement

70% of the size of the implant.

20

What skin preparations have been shown to significantly improve the overall severity of photodamaging but have not been shown to affect wrinkles

8 - 10% alpha hydroxy acids.

21

How is infection managed after chin implantation

A I 0-day course of antibiotics is given, and if the infection does not resolve, the implant should be removed. 1 f a micro porous implant is used, the implant is removed without delay.

22

What is ochronosis

A potential adverse reaction to hydroquinone characterized by a reticulated, sooty pigmentation of the cheeks, forehead, and periorbital regions.

23

What is cryptotia

Absence of the retroauricular helix.

24

What is the most common cause of lower lid retraction after blepharoplasty

Accumulation of small amounts of blood in the middle lamellar plane.

25

What is the pathophysiology of androgenetic alopecia

Affected scalp follicles inhibit androgen, causing terminal hairs to convert to veil us hairs.

26

When should micro and minigrafts be placed in relation to flap or reduction procedures

After the flap or reduction procedures have healed.

27

What is the ideal age for unilateral microtia correction

Age 6.

28

What is the safest plane of dissection in the malar region

Along the superficial surface of the elevators of the upper lip (zygomaticus major and minor).

29

What is the most common cause of hair loss in men and women

Androgenetic alopecia or male pattern baldness.

30

Where in the midface is the facial nerve most vulnerable during SMAS undermining

Anterior to the parotid gland.

31

What does the Converse technique attempt to reconstruct during surgery for the prominent ear

Antihelix of the auricle.

32

How much time should be allotted before removing an implant due to improper size

At least 3 months.

33

How much cartilage should be preserved during a complete strip procedure

At least a 4 - 5 mm strip or 75% of the original cartilage volume.

34

Which major tip support mechanism is violated by the inter- and transcartilaginous incisions

Attachment of the caudal edge of the upper lateral cartilages to the cephalic edge of the alar cartilages.

35

Which major tip support mechanism is violated by the complete transfixion incision

Attachment of the medial crura to the caudal septum.

36

Which bleaching agent is also an effective treatment for acne

Azelaic acid.

37

In what region is division of the frontalis muscle prohibited

Between the lateral brow and the temporal hair line.

38

Between which layers of the scalp are tissue expanders placed

Between the periosteum and the loose areolar tissue.

39

What is lobule colobomata

Bifid lobule.

40

How is it treated

Bland emollients (avoid topical antibiotics), topical class I corticosteroids, cool and wet compresses.

41

What is the mechanism of action of hydroquinone

Blocks the conversion of dopa to melanin.

42

Which laser causes the most intense and prolonged side effects

C02 laser.

43

Reduction of what structure accomplishes the majority of profile changes in patients requesting reduction rhinoplasty

Cartilaginous dorsum.

44

What is one way to improve the stability of a columellar strut

Carve the base into a V or fork or rest a large strut on a cartilage platform (plinth).

45

What are the major adjunctive procedures for tip rotation

Caudal septal shortening, upper lateral cartilage shortening, high septal transfixion with septal shortening, reduction of convex caudal medial crura.

46

What is the mechanism of action of retinoids

Cause a 70% inhibition of AP- 1 transcription factor binding to DNA, which decreases the activation of metalloproteases such as collagenase, gelatinase, and stromatolysis.

47

What is the most feared complication of otoplasty

Chondritis.

48

What are the complications of radical septal resections

Columellar retraction, dorsal saddling, airway collapse, increased nasal width, loss of tip support, and septal perforation.

49

What is a pixie or satyr earlobe

Common complication of rhytidectomy where the earlobe is elongated and directly attached to the facial cheek skin.

50

What are the minor adjunctive procedures for tip rotation

Complete transfixion incision, wide skin sleeve undermining, excision of excessive vestibular skin, proper tip taping, plumping grafts, columellar strut, division of the septi depressor muscle.

51

What are the different approaches used in septoplasty

Complete, partial, hemi- and high transfixion incisions.

52

How does release of the arcus marginalis affect eye contour

Creates a more convex, youthful eye contour.

53

What are the clinical effects of tretinoin

Decrease in fine wrinkling, roughness, and mottled hyperpigmentation after 6 months of use.

54

What effect does the complete transfixion incision have on tip projection and rotation

Decreases tip projection and increases tip rotation (resulting in nasal shortening).

55

Which approach to rhytidectomy improves the nasolabial folds

Deep plane rhytidectomy.

56

What is the proper plane of dissection during rhinoplasty

Deep to the subcutaneous tissue and SMAS layers.

57

What effect does SMAS suspension have on the nasolabial folds

Deepens them.

58

What are the two major approaches to tip surgery

Delivery and nondelivery.

59

What other factors increase the risk of scarring

Development of wound infection or contact dermatitis, recent use of isotretinoin, history of radiation therapy, history of keloids.

60

What is the most likely cause of dimpling of the skin following liposuction of the jowls

Directing the opening of the extractor towards the skin.

61

What can be done for the patient whose lateral crura are concave

Dissect lateral crura completely free and reverse them 180 degrees.

62

What is the most crucial factor limiting surgical correction of a congenitally short nose

Dorsal skin shortness.

63

How deep can a 20°/o TCA solution penetrate

Down to the papillary dermis.

64

What is the major complication of laser resurfacing of darker skinned individuals

Dyspigmentation (hyper- or hypo-).

65

Patients who have previously undergone blepharoplasty are at increased risk for which complication after laser skin resurfacing

Ectropion.

66

What are the normal side effects of laser skin resurfacing

Erythema, edema, serous discharge, and crusting.

67

What is the most common complication of submental liposuction

Excessive submental wrinkling.

68

T/F: Closed suction drains are associated with a significantly lower incidence of hematoma after rhytidectomy

False.

69

What medication used to treat androgenetic alopecia can reduce libido

Finasteride.

70

When do most major hematomas occur after rhytidectomy

First 12 hours postoperatively.

71

Alopecia in which area of the scalp is not improved by scalp reduction

Frontal.

72

What causes melasma

Genetic predisposition, exposure to UV radiation, pregnancy, oral contraceptives, thyroid dysfunction, cosmetics, phototoxic and antiseizure drugs.

73

What are the main indications for collagen injection

Glabellar frown lines, nasolabial lines, crow's feet, and saucer-shaped acne scars.

74

What happens to the position of the globe when 2.5 cc of fat is removed

Globe moves 1 mm inferiorly and 2 mm posteriorly.

75

What is the most commonly injured nerve during rhytidectomy

Greater auricular nerve.

76

What is the most common complication of rhytidectomy

Hematoma.

77

What is the major problem of using Mersilene mesh for genioplasty

High potential for resorption.

78

Which of these is preferred when the anatomy of the tip - infratip lobule and related structures is ideal

High septal transfixion with septal shortening.

79

What treatments can be used to help this problem

Hydroquinone or retinoic acid plus a topical class I corticosteroid, glycolic acid.

80

What are the initial manifestations of systemic phenol toxicity from a chemical facial peel

Hyperreflexia and hypertension.

81

What are the 5 stages in the repair of 3rd degree microtia

I - auricular reconstruction. II - lobule transposition. III - atresia repair. IV - tragal construction. V - auricular elevation.

82

What are the 3 basic categories of auricular defects as defined by Weerda

I 51 , 2"d, and 3'd degree dysplasia.

83

What is the significance of the labiomental fold in chin implantation

If the fold is high, implantation can enlarge the entire lower face.

84

What is the difference between SMAS imbrication and SMAS plication

Imbrication involves undermining and cutting the SMAS prior to suspension; plication involves folding the SMAS on itself.

85

Why is the gain reduced

Implant settling, bone resorption, and soft-tissue compression.

86

In which patients is sliding genioplasty indicated

In patients with excess or insufficient vertical mandibular height, extreme microgenia, hemifacial atrophy or mandibular asymmetry, and in those who fail alloplastic chin augmentation.

87

When can the transcartilaginous incision not be used

In patients with widely divergent intermediate crura where the domes need exposure for narrowing.

88

How does the facelift incision differ between men and women

In women, the incision runs along the posterior margin of the tragus (post-tragal); in men, the incision is placed in the preauricular crease (pre-tragal) so that facial hair does not grow on the tragus postoperatively. Also, a margin of non-hair-bearing skin is preserved around the inferior attachment of the earlobe in men.

89

What is the most common complication of otoplasty

Inadequate correction.

90

What effects do alpha hydroxy acids have on the dermis

Increase collagen and glycosaminoglycan production.

91

Identification of what structure is essential in safely exposing the medial and central fat pads during a transconjunctival lower eyelid blepharoplasty

Inferior oblique muscle.

92

Which anatomic areas are more prone to scarring after laser treatment

Infraorbital area, mandible, and anterior neck.

93

What is isolagen

Injectable autologous soft tissue material derived from cultured human fibroblasts.

94

Which incisions can be used for exposure and delivery of the alar cartilages

Intercartilaginous and marginal incisions.

95

What are the three primary incisions used in tip surgery

Intercartilaginous, transcartilaginous, and marginal incisions.

96

Which technique results in greater cephalic tip rotation: interrupted or complete strip

Interrupted strip.

97

What is the Goldman technique for increasing tip projection

Interrupted strip~ borrowed cartilage from the lateral crus is sutured into the medial crus, resulting in elongation of the medial crura.

98

Skin that rarely burns and tans more than average is which Fitzpatrick's class

IV.

99

What transposition flap restores the frontal hairline

Juri flap.

100

Which bleaching agent is produced by Aspergillus and Penicillium

Kojic acid.

101

What is melasma

Large, symmetric macules on the cheeks, forehead, upper lip, nose, and chin.

102

What are the various interrupted strip techniques

Lateral division, medial division, multiple vertical interrupting cuts, both medial and lateral division with a resection of a lateral segment, rotation of a segment of lateral crus into medial crus.

103

What are the 4 levels of TCA peels

Level 0 - no frost, skin appears slick and shiny representing removal of the stratum corneum. Level I - irregular light frost with some erythema; 2 - 4 days of light peeling. Level 2 - pink white frost, full thickness epidermal peel, 5 days of peeling. Level 3 - solid white frost, papillary dermis.

104

What procedure is normally performed prior to extensive scalp reductions

Ligation of the occipital vessels 2 - 6 weeks before the reduction.

105

What can be used to treat scarring after laser skin resurfacing

lntralesional or topical corticosteroids, 585 nm pulsed-dye laser (2 to 3 treatments at 6 - 8 week intervals).

106

What is the consequence of overly aggressive resection of upper lid skin

Loss of crease definition.

107

What are the relative contraindications to the coronal forehead lift

Male-pattern baldness in men and high hairlines in women.

108

What is Binder's syndrome

Maxillonasal dysplasia with inadequate projection, absent nasal spine, premaxillary hypoplasia, severe columellar-lobular disproportion.

109

Which technique is ideal for patients with an over-projected tip due to overdeveloped alar cartilages

Medial and lateral division with resection of lateral segment.

110

What techniques can be used to augment the effects of the complete strip, without sacrificing tip projection

Medial triangle excision, alternating incomplete incisions, crosshatching, gentle morselization, transdomal suture narrowing.

111

Which patients are good candidates for the midforehead lift

Men with deep rhytids in whom a coronal lift is contraindicated.

112

What are the 2 most common complications of dermabrasion

Milia and hypopigmentation. cos ETIC SURGERY

113

What is the definition of 1st degree dysplasia

Minor deformities that usually do not require additional skin or cartilage for reconstruction.

114

What medication used to treat androgenetic alopecia is also used to treat HTN

Minoxidil.

115

How do chin implants used in women differ from those used in men

More oval in women, squarer and larger in men.

116

What is the advantage of leaving a small amount of soft tissue on the auricular graft

More rapid host bed fixation.

117

What technique involves placing several horizontal mattress sutures along the scapha to create an antihelical sulcus

Mustarde technique.

118

What is the difference in outcome between these approaches

No significant difference in outcome.

119

When should lid malposition after blepharoplasty be corrected

No sooner than 6 months after the initial surgery.

120

What are the advantages and disadvantages of the intraoral approach to chin implantation

No visible scars; increased potential for contamination; suture line irritation; requires larger incision than the external approach; unable to stabilize the implant internally.

121

What is the definition of 3rd degree dysplasia

None of the structures of a normal auricle are recognizable and total reconstruction requires the use of additional skin and large amounts of cartilage.

122

What is the most commonly used system to classify alopecia

Norwood's system.

123

What should be done if bony resorption occurs under the implant

Nothing.

124

What factors affect the risk of complications after laser skin resurfacing

Number of laser passes, energy densities, degree of pulse or scan overlap, preoperative skin condition, anatomic areas.

125

What is the most common cause of alar margin elevation

Overaggressive resection of the lateral crus.

126

Which patients are better served by 15 - 20°/o alpha hydroxy acids

Patients with sebaceous, Fitzpatrick type III and IV skin.

127

Which area of the face is C02 laser most effective for treating rhytids

Periorbital.

128

Which alloplastic implant material has been reported to cause the least amount of bony resorption

Porous polyethylene.

129

In which plane is the neck dissected during deep plane rhytidectomy

Pre-platysma).

130

In what direction are the flaps pulled during SMAS suspension

Primarily superiorly and partially posterior.

131

What are the mild complications of laser skin resurfacing

Prolonged erythema, acne or milia, contact dermatitis, pruritus.

132

What factors predispose to lid malposition after lower lid blepharoplasty

Proptosis or unilateral high myopia; preexisting scleral show; malar hypoplasia; lower lid laxity from previous surgery; females >65 years and all males.

133

What effect does excessive surgical reduction of the nasal bridge have on the eyes

Pseudohypertelorism.

134

What are the advantages of lateral interruption techniques

Reduced likelihood of uneven tip-defining points becoming evident months after surgery; faster symmetrical healing; less loss of projection; avoidance of notching and pinching.

135

What are two major limitations of the transconjunctival approach to lower lid blepharoplasty

Redundant skin cannot be removed and orbicularis hypertrophy cannot be treated.

136

What factors increase the risk of prolonged erythema

Regular use of tretinoin or glycolic acid, rosacea, multiple passes, inadvertent pulse stacking, aggressive intraoperative rubbing.

137

How deep does Jessner's solution penetrate

Remains intraepidermal.

138

What are the advantages of using a nondelivery approach

Requires minimal dissection ensuring more symmetric and predictable healing; resists cephalic rotation; single incision; preserves existing tip projection; resists tip retrodisplacement and postoperative tip ptosis.

139

What are the components of Jessner's solution

Resorcinol, salicylic acid, lactic acid, and ethanol.

140

What are the two types of lower lid malposition after blepharoplasty

Retraction and ectropion.

141

What is the difference between retraction and ectropion

Retraction is vertical lid shortening due to fibrosis in the middle lamellar plane; ectropion is lid eversion caused by shortening of the anterior lamella, skin, and orbicularis oculi.

142

Which is more common

Retraction.

143

What is the most severe, yet rarest complication of blepharoplasty

Retrobulbar hemorrhage... incidence 0.04%.

144

What problem can occur with overzealous tightening of the superior and inferior third of the ear

Reverse telephone ear.

145

What is the most common cause of nasal valve collapse

Rhinoplasty.

146

Which of these techniques is best for thick-skinned patients with abundant soft tissue and a wide, under-projected tip

Rotation of a segment of lateral crus into the medial crus.

147

What techniques can be used to decrease tip projection

Sacrifice of major tip support mechanisms, reduction of a large nasal spine, resection of a small amount of cartilage from the lateral alar crus, softening the domes by serial crosshatching, reduction of overdeveloped cartilaginous dorsum.

148

What is the primary advantage of AlloDerm

Semi-permanent (20 - 50% persistence beyond I year).

149

In the delivery approach, what are the indications for using a complete, rather than hemi-, transfixion incision

Severely deviated caudal septum; when access to the nasal spine is necessary; when tip rotation and nasal shortening are desired.

150

When should a posterior incision be used to harvest auricular cartilage

Small grafts and when epithelial and soft tissues are to be incorporated with the graft.

151

Which alloplastic implant material forms a surrounding capsule

Solid silicone.

152

What is the definition of 2"d degree dysplasia

Some structures of a normal auricle are recognizable and partial reconstruction requires the use of additional skin or cartilage.

153

What is the typical prophylactic antiviral regimen

Starting 1 - 2 days preprocedure, 250 mg BID famciclovir for 7 - I 0 days (if no history of HSV)... 500 mg BID if history positive for HSV.

154

In which plane is the midface dissected during deep plane rhytidectomy

Subcutaneous for 2 - 3 em anterior to the tragus, then immediately superficial to the orbicularis and zygomaticus muscles.

155

What is the plane of dissection in the coronal forehead lift

Subgaleal.

156

In which plane is the lower face dissected during deep plane rhytidectomy

Sub-SMAS plane.

157

What should be used to prevent this problem

Sunscreen (pretreatment regimens have not been proven to help).

158

What is the blood supply to this flap

Superficial temporal artery.

159

How should an outbreak of HSV be treated

Switch to a different antiviral and administer the maximum dose.

160

What are the disadvantages of using a nondelivery approach

Technically more difficult if inexperienced.

161

What complication is caused by too much flexion of the midportion of the antihelix and inadequate flexion at the superior and inferior poles

Telephone ear.

162

In what region of the face can transection of the SMAS directly injure a branch of VII

Temporal region.

163

Where should the chin implant lie in relation to the lower incisors

The anterior surface should not lie beyond the labial surface of the lower incisors.

164

What is the basic method of the Converse technique

The antihelix is created using an island of cartilage.

165

What landmark is used to determine the correct position of the natural hairline

The apex of the frontotemporal triangle should fall on a vertical line intersecting the lateral canthus.

166

How much auricular cartilage can be harvested without affecting the structural integrity of the ear

The entire concha can be removed as long as the antihelix is kept intact.

167

What is the difference between the hemitransfixion incision and the Killian incision

The hemitransfixion incision is made unilaterally at the junction of the caudal septum and the columella, whereas the Killian incision is made unilaterally 2 - 3 mm cephalic to the mucocutaneous junction.

168

What are the histologic features of photoaged skin

Thickened stratum corneum, thinner atrophic epidermis with atypia, irregular dispersion of melanin, decreased glycosaminoglycans, abnormal elastic fibers in the dermis (solar elastosis).

169

What are the characteristics of photoaged skin

Thicker than normal with wrinkling, roughness, sallowness, telangiectasias, mottled hyperpigmentation, and loss of elasticity.

170

What are the risk factors for developing bossae or horns after rhinoplasty

Thin skin, strong cartilages, and bifidity.

171

What are the histologic effects of tretinoin

Thinner stratum corneum, thickened epidermis, increased collagen, angiogenesis, and more uniform dispersion of melanin granules.

172

Which hair follicles are most likely to be involved in androgenetic alopecia

Those in the frontotemporal and crown regions of the scalp.

173

Which patients are good candidates for direct brow lift

Those with brow asymmetries ( ie, from facial nerve paralysis) and marked ptosis of the lateral eyebrow.

174

Why should extra caution be taken during lateral dissection of the upper lid

To avoid prolapsing the lacrimal gland.

175

What is the purpose of application of topical vitamin C after skin resurfacing

To decrease the inflammation associated with prolonged erythema (must wait until reepithelization is complete before applying).

176

What are the two types of nondelivery approaches

Transcartilaginous and retrograde.

177

What are the disadvantages of the open approach

Transcolumellar external scar; risk of disturbing normal anatomy in the infratip lobule and caudal aspects of the alar cartilages; prolonged edema in thick-skinned patients; potential for excess trauma to the tip and dorsal skin flap~ increased operative time; increased difficulty in judging the exact tip-supratip relationship after skin flap replacement~ grafts must be suture-fixated.

178

What maneuver can be done to help prevent this complication

Transdomal suture to narrow the tip.

179

T /F: Complete avoidance of sunlight can reverse some of the histologic signs of photoaging.

True.

180

T/F: Hematoma after rhytidectomy is more common in males than females

True.

181

What is cockleshell ear

Type III cup ear where the ear is mal formed in all directions.

182

What are the advantages and disadvantages of medial interruption techniques

Useful in more extreme anatomic situations to normalize tip projection but almost always result in a moderate to major loss of tip projection and have the potential for notching and pinching.

183

Defects of the nasal valve involving what structures can be repaired with a composite graft from the auricle

Vestibular skin and alar cartilage.

184

What complication results from pulling too far posteriorly

Widening and flattening of the oral commissure.

185

What are the advantages to the open approach

Wider exposure, allowing the use of binocular vision, bimanual dissection, and microcautery for hemostasis; enables direct vision of the domes and the nasal profile; can secure tip grafts directly with suture and approach the septum from above-down as well as from below-up.

186

When are cardiac arrhythmias that develop during a phenol peel most likely to occur

Within 30 minutes of the start of the procedure.

187

What is the proper plane of dissection in the temporal region to avoid injury to VII

Within the subaponeurotic plane (deep to the temporoparietal fascia).

188

What is the safest plane of dissection in the temporal region when exposure of the zygomatic arch is necessary

Within the superficial temporal fat pad deep to the superficial layer of the deep temporal fascia.

189

Which patients are good candidates for the pretrichial forehead lift

Women with a high hairline and long vertical height to the forehead.

190

Which patients are not good candidates for endoscopic brow lift

Women with high hairlines, patients with male-pattern baldness or tight, thick skin with extensive bony attachments (more common in Asians and Native Americans).