plastic surgery 2
Terms
undefined, object
copy deck
-
complication rate abdomenoplasty
smoker
non-smoker -
smoker = 50%
non smoker = 25% -
% rhytidectomy requiring
drain hematoma - 3-5%
- most common acquired ptosis
- degeneration levator apponeurosis
-
buccal fat pad hernia (pseudo-hernia)
what fascia - buccopharyngeal fascia
- NAC sensability
-
3rd, 4th, 5th intercostals
90% lateral branch crosses throug the pect. major
lateral branch T4 -
infiltrate/aspirate/blood loss
superwet
tumescent
wet -
superwet 1:1 1-4% ebl
tumescent 2-3:1 1% ebl
wet 25% ebl -
malar fat pad
arterial supply - angular artery
-
botox complication
blepharoptosis Rx? - alpha adrenergic gtts.
- traumatic tatoo Rx?
- Q switched laser
- Retenoids
-
decrease activation of metalloproteases
by inhibit AP1 transcription - laser wave length with the greatest affinity for water
-
2940 nm
Erb:Yag -
upper lid ptosis Rx
reposition lev appon >3mm
advance mueller muscle <3mm
Fasenella Servat
Levator resection
Frontal resection -
good levtr func. = reposition
advan muell musc=<3 mm ptosis
eyebrow suspen.= poor lev func
Fas.Serv = lev >10mm,ptos <2mm
shortens lower components of the lid (tarsus,conjunctiva,mueller's)
lev resect = ptos >3mm,
lev func 4 - 10 mm
frontal suspn = poor lev func. - exception to complication secondary to smoking
- no fat necrosis
- Propecia inhibits ?
- 5 alpha reductase
-
cartilage graft
survival most related to ? - protoglyco matrix
- endermologie
-
Rx cellulite
increases transverse collagen in the deep sq tissue -
fat grafting
most common complication
retension
greatest resorption -
mst com complx = under correction
retensoion = 40 - 78%
greates resorption = NLF - Jessener's solution
-
ETOH
Lactic acid
Resorcinal
Hyaluronic acid -
Abdomenoplasty
nerves at risk
nerves not at risk -
risk = iliohypograstic
ilioinguinal
intercostal
not at risk = genitofemoral - fat retension
-
50% 6 month
30% 9 month - cause of arm skin ptosis
- clavopectoral fascia
-
most common complication of
tip graft for poor tip projection - visability of graft
-
dermal peel after rhytidectomy
delay? - 3 months
- width of nasal alar defect for composite graft
- 1.5 cm
-
cosmetic subsets of the nose
# - 9
- zyderm test
- 1 month
- restylene
- hyaluronic acid
- decrease depth of phenol peel
- liquid soap
-
primary blood supply to the facial skin after
rhytidectomy - transverse facial artery
- delay secondary rhynoplasty
- 12 months
-
SMAS plication
not safe......... -
distal to lateral border of
zygomatic major muscle - innervation of the upper ear
- lesser occipital nerve
-
absence of auriculocephalic sulcus = ?
timing of surgery -
cryptocia
delay surgery -
otoplasty
revision rate - 8 - 24%
-
prominent ear
apex protrusion - 24mm
-
thigh lift
suture to ......... - cole's fascia
- purple/violet tatoo
- Q switched Ruby laser
- medpor
-
polyethelene
do not resterilize -
cosmetic surgery
cutus laxa
erlers danlos
elastoderma
progeria
werner's syndrome -
cutus laxa
(premature loss of elastic fibers) - burn scar hypertrophy if not healed by
- 3 weeks
- kelod and hypertroghic scars are higher in .
-
ATP (adenosine triphosphatase)
fibroblasts - results of a chemical peel
-
dec. non lamellar collagen
inc. dermal thicness
inc fibroblast density
inc elatic tissue -
alpha hydroxy acids
&
trentinoin -
inc papillary collagen
inc blood vessels
inc glucosamine and glycans
exfoliates
thickens epidermis -
lasers
co2
Erb:yag
alexendrite
pulse dye - copper vapor
Nd:Yag -
co2- 10,600
erbyag - lymphatic - 3910
Nd-Yag - tatoo - 1064
alexendrite hair/blue green
tatoo 810
copper vap - small vessel 585 -
recurrence rate
excision hypertrophic scar - 50 - 100%
-
Dapsone
most com. adverse effect - hemolysis
-
prominent NLF
results from loosening of ? - zygomatic ligaments
- cosmetic dye pigments contain
- iron (black pigment)
- laser resurfacing and acutane
- delay 2 years
-
fat retension at
9 months - 30%
- comlication of retrogenioplasty
- anesthesia chin
-
most common nerve injury in
facelift - greater auricular
- hair transplant
-
false growth 1 month
telogen phase 3 months - % breast = fat
- 50%
- acutane =
- isotrentoin
- pathe of inspiratory air flow
- through middle meatus
-
most ocmmon sequelae of
TCA peel -
pigment change
usually hyper pignment which is transient - most important consideration in chin augmentation
- occlusion
-
nerve injury risk in facelift
subsmas : non subsmas - 4:1
- TCA neutralized by
- dermis
-
breast augmentation
%revision
%breast not seen on mammogram
%capsule contracture
%deflation -
25% rev in 10 years
5% brst tiss. not seen on mam.
20-25% capsule contracture
1%?year deflation -
BRAC-1
BRAC-2
risk of Ca - 50-85%
- implant rupture incidence
-
inc incidence 8-15 years
weak shell = most com cause -
with severe atypia on biopsy
what is the incidence of DCIS in subcutaneous mastectomy - 17%
- implant rupture frequency
- 50% 7-10 years
- presence of galactorrhea
-
measure prolactin
r/o pituitary tumor - capsule contracture is related to
-
fibrinogen
(surface bound protein) -
ear amputation
artery -
found on posterior surface
branches carotid, temporal, occipital - morpheaform BCC
- Moh's
-
dusky 15 mm cartilage/skin composite graft to ear
RX - hyperbaric O2
-
transaxillary breast augmentation
risk - malposition
- common canaliculus enters lacrimal sac
- posterior to medial canthal tendon
-
face lift
most common facial nerve injures - buccal
- saddle nose deformity
- speader grafts support the septum
-
blepharoplasty
most common muscle injury - suprtion oblique
- effect of corticocsteroids on post op edema and ecchymosis
- none
- jones test
-
I = dye flourescein reaches the beneath the inf turbisnate
II = dye in lacrimal sac - negative jones I, positive jnoes II
- dacrocystorhynostomy
- factor decreasing longevity of saline filled implants
- underfilling
- adverse effect of infracture of nasal bones
- narrowing internal nasal valve
- advantage of "extended" latissimus dorsi flap for breast reconstruction
- added volume
- mammograms >6 months post reduction mammoplast
- calcifications
- internal nasal valve
-
septum
nasal floor
caudal edge of upper lateral
cartilage - scleral show and lower lid blepharoplasty
- lateral cnthopexy
- breast reconstruction and post op radiotherapy
- dealayed reconstruction with autologous tissue
- planned botox injection of which muscle results in inadvertant ptosis
-
corregator (the target)
they want you to realize the risk of corregtor injection -
ectropion post blepharoplasty
scar between -
tarsal plate
and
capsulopapebral fascia -
secondary rhytidectomy
risk vs. primary - destort hair line
- evaluation of gynecomastia patient
- examine genetalia
- protect sensation to NAC
- blunt dissection lateral to pectorlis muscle border
- osseous genioplaste
-
corrects anterior-posterior
&
vertical deficiency - nasal tip projection
-
suture medial crura
tip grafting -
NAC
nerves -
3,4,5 interscostal nerves
(antereolateral branches) - lidocaine dose in tumescent liposection
- as high as 55mg/kg
-
suction lipectomy ok in all except
axillary hyperhidrosis
hiv-assoc lipodystropohy
lymphedema
madelung's disease
liposarcoma - liposarcoma
-
inner ear abnormalities in
microtia -
none
have middle ear abnormalities proportiate to the severity of the microtia - breast ca with post op radiation
- delayed autologous tissue reconstruction
- liposuction fluid management
- infiltrate and iv fluids should = 2 x aspirate
- most sensative area of breast
-
superior quadrants
(NOT nac) - 15 y.o. with large breast mass
- fibroadenoma
- layer of scalp analagous to smas
- galea
- stahl's ear
- 3rd crus
- ear reconstruction
- remember prosthesis in absence of skin and temp fascia
- implant breast reconstruction with necrotic skin
-
implant not exposed = resect skin and close
implant exposed = removal - numbness nasal tip
- ext. branch anterion ethmoid
- explanation for lack of tumnescent lidocaine toxicity
- rate of absorption
- complication abdomenoplasty and suction lipec.
- avoid central area
- rx facial nerve palsy 1 mo. post op facelift
- observation
- rx ectropion 6 months post blepharoplaty
- lateral tarsal strip + skin graft
-
ear lobe
nerve - great auricular
- levator palpebrae tendon
- lies immediately superficial to Mueller's muscle
- poland syndrome
- requires absence of pectoralis muscles
- asian vs occidental upper eyelid
-
preaponeurotic fat more caudal
levator muscle inserts closer to caudal border of tarsal plate -
saline implant rupture
more likely with -
under filling
(fold flaws) -
transconjunctival blepharoplasty
structures incised -
conjunctiva
capsulopapebral fascia -
3 cm of skin slough post sub-smas rhytidectomy
Rx -
observe
local wound care -
sal
max dose of lidocaine - 35 mg/kg
-
belt lipectomy
most com. smplx - seroma
-
stenstrom otobrasion
which surface - anterior anthelical fold
- dorsal hump rasping with swelling and erythema 10 days post op
- oral antbiotic
- epiblepharon
- a fold of skin that crosses the free margin of either the upper or lower eyelid so that the eyelashes are pressed against the globe
-
epiblepharon
Rx -
resect redundant skin and orbicularis muscle
more common in asians -
nasal septal fracture
physical finding - tear of mucosa
-
poland syndrome
assoc. anomalies -
ipsilateral syndactyly or extremity hypoplasia
rib abnormalities -
breast augmentaiton
reoperation rate in 10 yrs - 25%
-
deep transverse glabellar lines
muscle - procerus
-
medial thigh lift
superficial dessection to avoid - lymphatic plexus
- facial muscles innervated on superficial surface
-
buccal
mentalis
levator anguli oris -
otoplasty
furnas - conchomastoid suture
-
otoplasty
mustarde - antihelical fold suture
-
otoplasty
stenstrom -
carticlage scoring
(on surface opposite to direction of desired bending) -
otoplasty
webster - suture tail helix to conchal bowl
-
otoplasty
lucket -
skin resection
(also cartilage incision) -
rhynoplasty
resection cephalad lower lat cartilage and resection caudal septum = - rotation tip (shortening nose)
-
neonatal molding of prominent ears
hormone responsible -
estrogen
approx 6 weeks (longer in breast feeding babies) -
raising eyebrow with botox
which muscle to target - orbicuolaris oculi
- most important factor determining need for mastopexy after implant removal
- preoperative ptosis
-
amputated ear cartilage banking
disadvantage - warping
- percent of inferior pedicle breast reduction that are able to breast feed
-
approximately 60%
(brazillian study) -
free margin ear resection 12 mm
best flap - antia buch
-
dusky composite graft to ear at two days
Rx - hyperbaric O2
- advantage of endoscopic transaxillary augmentation vs. standard transaxillary
-
better implant position
(visualize medial pect, major and divide it) - lancinating pain in eye post blepharoplasty
-
retrobulbar hematoma
rexploration + steriod + acetazolamide - most commonly injured facial nerve in rhytidectomy
- buccal
- conjunctivorhynostomy
- in patient with obliterated lacrimal sac
- smoker risk with abdomenoplasty
- 50%
- nasal infracture narrows what structure
- internal nasal valve
- advantage of "extended" lat. dorsi flap over standard lat dorsi flap
- decrease need for implant
- scleral show before bleparoplasy add what
- lateral tarsorraphy
- best landmark for positioning of nac in red. mamm markings
- inframammary crease
- methods for nasal tip projection
-
tip graft
suture medial crura -
microtia
inner ear abnormalities? - none
- location of hair follicles
- subcutaneous
- pierre robin mand deformity is ?
-
retrognathia
(not micrognatia bec in pierre robin the manible grows normally) - most likely effect of intralesional steriod for rx of keloid
- relief of itching and burning
- blepharophimosis syndrome
-
a form of congenital ptosis
epicanthal folds, horizontal shortening, severe ptosis -
Blepharophimosis
Rx -
correct epicanthal folds
correct ptosis - skin laxity arms post wgt loss= laxity of
- clavopectoral fascia
-
blue-green tatoo
Rx -
multiple treatments with
Q switched Nd:YAG
or alexendrite -
red, brown, orange tatoo
Rx - Nd:YAG
-
violet-purplw tatoo
Rx - Q swithed ruby laser
-
upper cranial surface of the ear
nerve - lesser occipital
-
anterio surface upper ear
nerve - auriculotemoporal
-
dorasl nasal flap
size ?
position -
2 cm
nasal tip -
ptosis upper lid with > 10mm levator function
rx - levator advancement
-
"juvenile melanoma"
Rx - excision with clear margins only
-
excessive lower lateral cartilage resection with resultant airway obstruction
Rx -
they want cartilage graft to increase tip projection
(prob won't work) -
immediate post op ptosis
cause
Rx -
swelling and hemorrhage into mueller muscle
Rx = observation -
midline ant to occiput alopecia
Rx - saggital scalp reduction
- nevoid basal syndrome (Gorlin's)
-
bcc + odontgenic cysts
(also palmar pits rib and spine abnormalities, intracranial calcifications) - Rs of suspected silicone implant rupture
- surgery
-
symptomatic patient
incidence of breast implant rupture -
31%
(goes up t0 80% with + ultrasound and 97% with + mri) -
burn ear reconstruction
with skin scarring - cart framework with temp parietal flap and skin graft
- retinoic acid (trentinoin) increases ?
- typr III (embryonic) collagen
-
recurrent prom. ears
cause = - failure of Mustarde sutures(sutures to create the antehelical fold)
-
upper lid fat pads
location -
superficial to levator palpabrae
posterior to orb. septum - actinic keratosis
-
5 f.u. cream (5% fluorocil)
effudex - highest position of brow in brow lift
-
they want from lateral limbus to lateral brow
(not on my patients) - nasal alar defect
- nasolabial flap up to 1.75cm
- nasal tip defect <1.2cm
- banner flap
- nasal dorsum defect >1.2 cm
- bilobe flap
- management of patient with massive wgt loss who will undergo additional20 lbs of wgt loss
-
they want surgery because "additional wgt loss will only make it worse"
duh - my answer is wait till the wgt loss is stable
another e.g. "can't argue with a piece of paper" - lateral traction on cheek relieving airway obstruction =
- int nasal valve problem
-
vetrical nasal forehead lines
muscle - corregator
-
foreign body pigment
Rx -
Q-switched ruby laser
2 - 3 treatments -
epiphora
def. - excess tearing
-
medial thigh lift
suture to which layer -
colle's fascia
(inelastic layer of the superficial perineal fascia) -
microtia
usually requires excision of vestigial ear cartilage
True or False - True
- breast implant most assoc. with visable wrinkling
- textured saline
- most common complication post otoplasty
- recurrrence
-
numbness in medial arm post mastectomy
nerve? - intercostobrachial
-
prominent ear measurements
protrusion
scaphoconchal angle
cephaloauricular -
protrusion = 24mm
scaphoconchal angle >90deg
cephaloauricular angle >25 deg - absent nac =
- athelia
- rapid growing umbilicated lesion =
-
keratoacanthoma
(key = rapid growth) - ear anesthetic include peripheral nerve block and
-
nerve of Arnold
(vagus in posterior wall of ext aud canal) -
great auricular nerve
branch of - cervical plexus
- most common complication of alloplastic malar implant
- malposition
- nerve at risk during resection of corregator muscle
- supratrochlear
- most important variable in the peak level of lidocaine in tumescent infiltration
-
absorption rate
related to epinephrine, tissure infused (vascularity), and rate of infiltration - long term effect of chemical peel in dermis
- decrease of nonlamellar collagen
- camera focal length for accuarate body images
-
55mm
face = 90 105mm -
nonreplantible traumatic ear amputation
flap cover - post auricular
-
ectopic polymastia
most common site -
chest
also, axilla, groin, vulva, medial thigh - otoplasty recreation of antelelical fold
-
permanent mattress sutures on posterior surface
(Mustarde) - male pattern baldness is triggered by
-
sex linked dominant gene
results in increase on 5alpha-reductase - TCA peel neutralized where
- dermis
- malar implants are placed on which muscle
- masseter
- male patient requesting aesthetic rhynoplasty
-
simon
single immature male overexpectant narcissistic
careful, do not operate -
when exposing the zygomatic arch through a coronal incision, what layer should be incised
where -
superficial layer of deep temporal fascia
level of lateral orbital rim - ratio of facial n. injury in subsmas facelift compared to subcutaneous facelift
- 4:1
-
nasal tip
nerve -
external branch of
anterior ethmoid -
trentinoin Rx
maximize effect with addition of - alpha hydroxy acids
-
"miniabdomenoplasty
indications -
fullness and strtech marks limited to the infraumbilical area
test answer - subsmas dissection not safe
- medial to the lateral border of zygomaticus major
-
facelift
men have more post op hematomas than woemen
true or false - true
-
bilateral florid adenosis with epithelial hyperplasia
indication for mastectomy -
none
no additional risk for breast cancer - 1% xylocaine = ? mg/ml
-
10mg/ml
10 g/l - most effective monitor of adequate fluid resuscitation
- urine output
-
isograft
def. - a graft taken from the same individual or from a genetically identical genotype (identical twin)
- bilobe flap is characterized as
- transposition (interpolated) flap
- most common cause of late silicone implant failure
- weakening of silicone shell
- kassabach-merritt syndrome
- platelet consumptive coagulopathy with hemangiomas
- what holds skin grafts in place within the first few days
- fibrin bonding
-
rattle snake bite
venom suction value? -
yes if done within 15 minutes
incisions no deeper than the skin -
brachioplasty
fascia to anchor - axillary
-
breast shrinkage occurs with implants
T/F -
true
larger implant more shrinkage - inferior oblique muscle function
- extorsion,elevation, abuction
- angle of divergence
- between medial (middle) crura of lower lateral cartilage
-
wreatler's ear
Rx -
evacuation of hematoma
tie through bolster dressing - vertical reduction mammoplasty advantage over inverted T
- shorter scar
-
witch's chin deformity post genioplasty (increased lower tooth show)
cause - inadequate repair of mentalis muscle
-
wedge resection of lower lid for ectropion
contraindication -
prominent globe
would "clothesline" the lid below the limbus - artery at risk in lateral osteotomy nose
- angular
- suspensory system for the globe
- Lockwood's ligament
-
Poland syndrome
muscle most often missing - sternal head of pectoralis major
-
burn contracture inhibiting breast expansion
Rx - Integra (dermal regeneration template) said to allow secondary expansion
-
"washboard" irregularity post liposuction
most likely cause - superficial liposuction through a single port
- incidence of occult breast cancer in reduction mammoplasty
- 0.2%
- "side wall" nasal wrinkles caused by which muscle
- nasalis
-
chondrodermatitis helicus
Rx - excision and primary closure
- most common cause of death post liposuction
- pulmonary embolus (fat or thrombus)
- ratio of lobular portion of caucasion nose to columalla
-
1:2
(don't know what this means) - Rx of stahl's ear
- resection of third crus and helical advancement
-
post mastectomy radiation
reconstruction technique - autologous tissue
-
orbital ligament
def;
clinical relavence -
band of connective tissue fixing the superfial fascia to the bone of lateral orbital rim
must release during browlift - osteointegrated implants in burn ear reconstruction
-
high rate of complication
choose local flap reconstruction -
vertical reduction mammoplasty
limitations -
pedicle length (? 9 cm)
better with small (800gm) reductions - massive weight loss incision thigh
- medial longitudinal
- peak position of brow for brow lift
-
"between limbus and lateral canthus"
MOT ON MY PATIENTS -
early infected ear cartilage reconstruction with fluctuance
Rx - i&d, irrigate, and place irrigation catheters