Facial Plastics Flashcards
(90 cards)
1
Q
What is the Frankfort horizontal line?
A
Imaginary line drawn from the top of the tragus to the infraorbital rim
2
Q
What is the trichion?
A
Hairline in the midsagittal plane
3
Q
What is the glabella?
A
The most prominent portion of the forehead in the midsagittal plane
4
Q
What is the nasion?
A
The deepest point in the nasofrontal angle and the beginning of the nasal dorsum
5
Q
What is the radix?
A
The root of the nose; the uppermost segment of the nasal pyramid
6
Q
What is the rhinion?
A
The junction of the bony and cartilaginous dorsum
7
Q
Where is the nasal skin the thinnest?
A
The rhinion
8
Q
What is the nasal tip?
A
The anterior most point of the nose
9
Q
What is the pogonion?
A
The anterior most point of the chin
10
Q
What is the menton?
A
The inferior most point of the chin
11
Q
What is the nasofacial angle?
A
The angle between the plane of the face and the nasal dorsum; usually 36 degrees
12
Q
What is the nasolabial angle?
A
The angle between the upper lip and the nasal tip
13
Q
What is the ideal nasolabial angle in men?
A
90 to 95 degrees
14
Q
What is the ideal nasolabial angle in women?
A
95 to 105 degrees
15
Q
What is nasal projection?
A
The degree to which the nasal tip extends out from the plane of the face
16
Q
What is nasal rotation?
A
The plane of the nostril openings with respect to the plane of the face
17
Q
How far should ears ideally project from the mastoid?
A
20 degrees
18
Q
Collagen synthesis in the dermis declines by what percentage per year in adult life?
A
3 percent
19
Q
Where is the incision placed for a coronal forehead lift?
A
4 to 6 cm behind the anterior hairline, through the galea
20
Q
What are the advantages of the coronal forehead lift?
A
- No visible scar
- Excellent exposure
- Ability to address different muscles for rhytid control
21
Q
What are the disadvantages of the coronal forehead lift?
A
- Most extensive of the forehead lifts
- Elevates the hairline
- Cannot use in males with alopecia
- Scalp hypoesthesia
22
Q
Where is the incision placed for a high forehead lift?
A
Just inferior to the hairline for a pretrichial lift or 2 mm posterior to the hairline for a trichophytic lift
23
Q
What are the advantages of the high forehead lift?
A
- Excellent exposure
- Height of the hairline is not altered
24
Q
What are the disadvantages of the high forehead lift?
A
- Potentially visible scar
- Scalp hypoesthesia
25
What is the ideal position of the male brow?
The supraorbital rim
26
What is the ideal position of the female brow?
On the supraorbital rim with a lateral arch above the rim
27
Where should the highest point of the brow be located?
Vertically up from the lateral limbus
28
What are the advantages of the midforehead lift?
1. Less extensive
2. Does not alter the hairline
3. Allows precise brow elevation
4. Avoids scalp hypoesthesia
29
What are the disadvantages of the midforehead lift?
1. Visible scar
2. Difficult to achieve lateral brow elevation
30
What are the advantages to the direct brow lift?
1. Simple procedure
2. Able to tightly control brow position and shape
31
What are the disadvantages to the direct brow lift?
1. Visible scar
2. Unable to address crow's feet
3. Unable to address other musculature
32
What nerves are most at risk from a coronal or high forehead lift?
1. Frontal branch of CN VII
2. Supraobital nerves
3. Supratrochlear nerves
33
What is the term for excessive upper eyelid skin laxity?
Dermatochalasis
34
What are the primary indications for upper lid blepharoplasty?
1. Dermatochalasis with impairment of visual fields
2. Fat pseudoherniation into the central and medial fat compartments
35
When performing blepharoplasty, where is the inferior aspect of the incision placed?
The superior border of the tarsal plate in the naturally formed skin crease, 7 to 10 mm from the lash line
36
When creating the superior incision for upper lid blepharoplasty, how many mm superior is the line placed?
1. 8 to 10 mm at the midpupillary line
2. 5 mm at the lateral canthus
37
What is the most concerning complication of blepharoplasty?
Orbital hematoma
38
What occurs if too much skin is resected during upper lid blepharoplasty?
Lagophthalmos
39
When evaluating for lower lid blepharoplasty, what history is critical?
1. Presence of xerophthalmia (primary or secondary to LASIK)
2. Medical conditions leading to eyelid problems (Grave's disease)
3. Lid distraction test to allow for less than 10 mm of play
4. Snap test to assure the tissue snaps firmly back onto the globe (avoids post-operative ectropion)
40
How does one distinguish between fat pseudoherniation and fluid retention in the lower lid?
Pseudoherniation occurs above the infraorbital rim, fluid retention occurs along and beneath the rim
41
When is the skin-muscle flap lower lid blepharoplasty indicated?
To address skin excess and fat pseudoherniation
42
When is the skin flap lower lid blepharoplasty indicated?
For patients with excess skin only
43
When is the transconjunctival lower lid blepharoplasty indicated?
To adderss excess fat; no skin excess
44
Where is the skin-muscle flap incision placed when peforming lower lid blepharoplasty?
2 to 3 mm below the lash line (subciliary)
45
What is an advantage to the transconjunctival approach to lower lid blepharoplasty?
1. Avoids a visible scar
2. Avoids potential postoperative ectropion
46
Describe the classes of mid/lower face aging.
1. Class I-minimal laxity; not good surgical candidate
2. Class II-Skin laxity alone
3. Class III-Skin laxity with submental jowling and excess fat
4. Class IV-anterior platysmal banding
5. Class V-congenital or acquired micrognathia which may need augmentation
6. Class VI-low-lying hyoid bone
47
Why is a low-lying hyoid bone problematic in patients undergoing rhytidectomy?
Inability of the surgeon to address the cervicomental contour
48
When performing a SMAS plication, at what level is the flap raised?
Just deep to the hair follicles in the hair-bearing portions and more superficially just deep to the subdermal plexus in the other portions
49
What is the incidence of hematoma after rhytidectomy?
3 to 15 percent
50
What nerves are at risk when performing rhytidectomy?
1. Great auricular nerve
2. CN VII-particularly frontal, buccal, and marginal mandibular
51
What is a Class I Fitzpatrick?
very white, always burns, never tans
52
What is a Class II Fitzpatrick?
white, usually burns, tans minimally
53
What is a Class III Fitzpatrick?
white to olive, sometimes burns, tans
54
What is a Class IV Fitzpatrick?
brown, rarely burns, always tans
55
What is a Class V Fitzpatrick?
dark brown, very rarely burns, tans profusely
56
What is a Class VI Fitzpatrick?
black, never burns, tans profusely
57
What must be done to prevent scarring from dermabrasion?
Do not damage the reticular dermis
58
What are the major indications for dermabrasion?
* Surgical scars
* Acne scarring
* Tattoo removal
* Telangiectasias
* Melasma
* Wrinkles
* Milia
59
Who are ideal candidates for chemical peels?
Fitzpatrick Class I-III non-oily skin
60
What is the depth of a superficial peel?
Papillary dermis, partial epidermolysis
61
What are the effects of a superifical peel?
Rejuvenate skin, address very fine rhytids, treat pigment changes, actinic damage
62
What solutions are used for a superficial peel?
* Glycolic acid
* Tretinoin
* TCA 10-25%
* Jessner solution
63
What is the penetration level of a medium depth peel?
Supeficial reticular dermis
64
What are the effects of a medium depth peel?
Remove actinic keratoses, pigment changes, and flattens depressed scars
65
What solutions are used in a medium depth peel?
* TCA 35 to 50%
* Full strength phenol (88%)
66
What are the advantages to using TCA for a peel?
* Less bleaching effects (can be used on darker-skinned)
* Not systemically toxic
67
What is the penetration level of a deep peel?
Midreticula dermis
68
What are the effects of a deep peel?
Corrects most severe actinic damage, rhytids, acne scarring
69
What solution is used for a deep peel?
* Baker's phenol
* Phenol 88%
* 2 mL tap water
* 3 drops croton oil
* 8 drops soap solution
70
Why should one avoid the neck when doing a deep peel?
There are no adnexal structures to promote re-epithelialization
71
Does more phenol lead to a deeper peel?
No, because the concentration is inversely propotional to the depth
72
What is "frosting" in a peel?
Protein coagulation, which inhibits further penetration of the peeling compound
73
What is the ideal nasofrontal angle?
120 degrees
74
What are the advantages to closed septorhinoplasty?
* Minimize tip edema
* No external incision
* Short operative time
75
What are the disadvantages to closed septorhinoplasty?
* Limited tip modification possible
* Distortion of normal anatomy can lead to surgical error
76
What are the advantages to open septorhinoplasty?
* Excellent exposure
* Ability to make manipulations of the nasal tip
77
What are the disadvantages to open septorhinoplasty?
* Visible scar
* Prolonged tip edema
* Longer operative time
78
What are the major sources of nasal tip support?
* Medial crura
* Lateral crura
* Medial crural attachments to the septal cartilage
* The scroll area
79
What are the minor sources of nasal tip support?
* Interdomal ligament
* Cartilaginous septal dorsum
* Sesamoid complex
* Attachments of the alar cartilage to the overlying skin
* Nasal spine
80
How much alar width must be preserved when doing a cephalic trim to avoid nasal valve collapse?
5 mm
81
How can one deproject the nose?
Shortening all three limbs of the nasal tip at once
82
How do you decrease columellar show?
Trim the caudal border of the septum and/or medial crura
83
How can one narrow a wide nasal base?
Weir excisions
84
What is a Norwood Type I?
Minimal or no recession of the hair line
85
What is a Norwood Type II?
Areas of recession at the frontotemporal hair line
86
What is a Norwood Type III?
Deep symmetrical recession at the temples that are bare or only sparsely covered
87
What is a Norwood Type IV?
Hair loss is primarily from the vertex, limited recession of the frontotemporal hair line
88
What is a Norwood Type V?
Vertex hair loss region is separated from the frontotemporal region but is less distinct; the band of hair across the Crown is narrow
89
What is a Norwood Type VI?
Frontotemporal and vertex regions are joined together
90
What is a Norwood Type VII?
Most severe form A narrow band of hair remains in horseshoe shape
