Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
502 Cards in this Set
- Front
- Back
|
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
|
|
|
T3 invasive breast ca in large breast
reduction mammplasty? |
yes, if tumor can be cleared as with lumpectomy standards
|
|
|
how long after alloplastic chin implant to wait if mental nerve paresthesia persists
|
2-3 weeks
(seems to short time to me) |
|
|
reduction mammoplasty - nac sensation preservation most dependent upon
|
position of pedicle
(inferior is most protective) |
|
|
what to do if infiltrating for liposuction and tachycardia occurs
|
stop infiltrating
|
|
|
cartilage ear reconstruction in the elderly
problem? |
costochondral cartilage is ossified
|
|
|
nerve adjacent to external jugular vein
|
great auricular
|
|
|
grade 2 breast ptosis
Rx |
mastopexy
implant is not enough (probably some controversy) |
|
|
most common complication of "lower body lift"
|
seroma
|
|
|
gynecomastia
medical Rx |
Danazol, tamoxifen, testosterone
|
|
|
pubertal gynecomastia greater than 5 cm
regression % |
none
|
|
|
gynecomastia
endocrine disorders causing |
hrpogonadism
hyperthyroidism adrenal disorders |
|
|
serum prolactin level in patients with gynecomastia
|
normal
|
|
|
nac innervation
|
lateral branches of 4th intercostal
|
|
|
dominent blood supply to the breast
|
internal mammary perforators (60%)
|
|
|
indications for free nipple graft
|
>1500 gm reduction (?)
>25 cm nac transposition (?) smoker (?) diabetes (?) (i use >19 cm vertical pedicle length) |
|
|
how is breast cup size measured
|
breast girth exceeds chest girth by
1 inches = A 2 inches = B 3 inches = C 4 inches = D |
|
|
reduction of 1 cup size
volume reduction |
chest circumference - volume resection (to dec 1 cup size)
32-34 - 100 gm 36-38 - 200 gm 42-44 - 300 gm 44-46 - 400 gm |
|
|
Rx of immediate post op cyanotic nac
|
remove nac sutures
re-explore if no improvement |
|
|
what % of women can breast feed after pedicle reduction mammoplasty
|
60 - 70%
|
|
|
vertical scar reduction mammoplasty
maximum volume according to Lejour |
1000 gms
(most suggest over 500 gms compromises the appearance) |
|
|
most common planning error in reduction mammoplasties
|
placing th nac too high
|
|
|
contraindications to "doughnut" mastopexy
|
Grade 2 ptosis or greater
when implants are being downsized or removed at the same operation |
|
|
definition
amazia amastia athelia |
amazia - lack of glandular tissue
amastia - lack of breast athelia - lack of nipple |
|
|
what detemines the timing of polund syndrome breast reconstruction
|
development of contralateral breast
|
|
|
Tuberous breast
|
constricted height
hypoplasia nac hypertrophy |
|
|
definition
overweight obese |
overweight = BMI >25 <30
obese BMI >30 |
|
|
contraindications to autologous tissue breast reconstruction
|
morbid obesity
smoking hypercoag disorder general wellbeing (long surg) unrealistic expectations |
|
|
avg external diameter of DIEA
|
deep inferior epigastric artery average = 3.5 mm
|
|
|
what is PUP flap
|
diep flap based on a single peri-umbilical perforator
|
|
|
incidence of total flap loss in microvascular breast reconstruction
|
<5%
|
|
|
most common complication of tram flap at recipient site
|
fat necrosis
|
|
|
preferred method for lateral patial mastectomies
|
latissimus dorsi (?)
i agree but othes may not |
|
|
blood supply to the umbilicus
|
diea, vessels from lig. teres and medial umbilical ligament
|
|
|
frequency of hernia post tram flap
|
2%
|
|
|
can abdomenal weakness occur after DIEP harvest
|
yes (?) may be controvesial
|
|
|
what is a Ruben's flap
|
dcia (deep circumfles iliac artery) flap
|
|
|
latissimus dorsi flap
type art supply |
type V
subscapular/thoracodorsal |
|
|
how wide can the latissimus flap skin paddle be to allow primary closure of donor site
|
9 cm
|
|
|
will the serratus branch of the subscapular artery supply the latissimus flap with retrograde flow, if the thoracodorsal art. is divided
|
yes
|
|
|
are laproscopic scars a contraindication to abdomenal donor free flaps
|
no
|
|
|
ideal donor for the Ruben's flap
|
"gynecoid" (pear shaped) female of normal weight
|
|
|
TFL flap
art supply innervation |
lateral circumflex femoral (lateral branch)
motor = sup. gluteal sensory = lateral fem. cutaneous/ branch T12 |
|
|
nerve at risk with dissection of IGAP flap
|
sciatic
|
|
|
anteriorlateral thigh flap
artery location |
lateral circumflex femoral
midpoint of a line between ASIS and patella |
|
|
TAP flap
|
thoracodorsal perforator flap
perforatprs of the lateral branch of throacodorsal art. |
|
|
TUG
|
transverse upper gracilis
used for breast reconstruction |
|
|
what effect does smoking have on autologous ftt breast reconstruction
|
mastectomy flap and donor site healing
(no evidence that smoking effect microvascular patentcy) |
|
|
how much should the breast pocket be overexpanded before implant reconstruction
|
20 - 30%
|
|
|
complications of nipple "sharing" in nipple reconstruction
|
scar deformity
loss of pigment loss of donor nipple height loss of donor sensation |
|
|
when do mammary ridges develop in embryo
|
5 - 6 weeks gestation
|
|
|
what is the result of incomplete involution of the mammary ridge
|
accessory breast tissur and supernumery nipples
|
|
|
most common site of accessory breast tissue
|
axilla
|
|
|
where is the most common site of supernumery nopple
|
inframammary area
|
|
|
breast overlies which ribs
|
2nd - 6th
|
|
|
most common bacteria cultures from breast tissue
|
staph epidermidis
|
|
|
which internal mammary perforator is usually the largest
|
2nd
|
|
|
intercostal brachial nerve
supplies branch |
axilla and medial arm
2nd intercostal |
|
|
course of the lateral branch of 4th intercostal
|
pierces the deep fascia in midaxillary line and courses deep to the pectoralis major fascia to midclavicular line the turns 90 degrees to the nac
|
|
|
normal diameter of nac
|
35 - 50mm
|
|
|
what ar montgomery glands
|
sebaceous glands in nac
|
|
|
breast parenchyma borders
lateral superior medial |
lateral border of l.d.
clavicle lateral stermum |
|
|
what is major component of the anterior axillary fold
|
pectoralis major
|
|
|
where does the serratus anterior insert
|
deep surface of scapula
|
|
|
long thoracic nerve located in anterior or mid axillary line
|
midaxillary line
|
|
|
which nerves supply the medial breast skin
|
2nd - 6th medial intercostal branches
|
|
|
what is the blood supply to the abdomenoplasty flap
|
lateral intercostal vessels
|
|
|
nerves at risk for entrapment or injury in abdomenoplasty
|
iliohypograstic
ilioinguinal intercostal |
|
|
most tenuous blood supply in abdomenoplasty flap
|
infraumbilical midline
|
|
|
placement of incision for brachioplasty
|
medial from medial epicondyle to axilla
|
|
|
most common complication of brachioplasty
|
widened scar
|
|
|
composition of tumescent solution
|
1 L saline
50 cc 1% lidocaine 1 cc 1:1000 epinephrine 2.5cc 8.4% NaHCO3 |
|
|
blood loss in "superwet" technique
|
1%
|
|
|
most common complication of liposuction
|
contour irregularities
|
|
|
most important determinants for success of liposuction
|
skin/muscle tone and fat distribution
|
|
|
does ultrasound liposuction disrupt fibrous connective tissue
|
no
|
|
|
most common complication of abdomenoplasty
|
seroma
|
|
|
what is said to improve the long term results of body lift procedures
|
repair of superficial fascial system
|
|
|
belt lipectomy
long term complication (problem) |
scar widening
flattening of buttocks |
|
|
most common cause of death with liposuction
|
thromboembolism
rate = 1:5000 |
|
|
do fat cells removed by liposuction regenerate
|
no
|
|
|
levels of testosterone and estrogen in male pattern alopecia
|
normal
|
|
|
best donor site for hair transplantation
|
occipital
|
|
|
androgenic alopecia
what area |
frontal
crown |
|
|
what is the action of 5alpha reductase
|
convert testosterone to dihydryxytestosterone
|
|
|
is the hair bulb necessary to hair growth
|
no if the upper 2/3 of the follicle are intact a significant numble will grow hair
|
|
|
normal hair growth after transplant
|
1 cm/month
|
|
|
indication for scalp reduction
|
stable alopecia in
crown or vertex |
|
|
main advantage of tissue expansion for Rx alopecia
|
hair follicle orientation is correct
50% of scalp can be covered |
|
|
define thremal relaxation time
|
time for tissue to absorb and difuse heat through the tissue
|
|
|
define "pulse energy"
|
energy of one pulse
|
|
|
define power density
|
power/unit area
measured in watts/cm2 |
|
|
define fluence
|
total laser energy/unit area
joules/cm2 |
|
|
laser targets are called what
|
chromophobes
|
|
|
three chromophobes in the skin
|
hemoglobin
water melanin |
|
|
hair removal laser
ideal patient |
dark hair/light skin
|
|
|
contraindication to hair removal laser
|
grey hair
accutane,retin A, tetracycline dark skin (tan) hx of herpes |
|
|
how long to collagen fillers last
|
3 months
|
|
|
what is restylane
|
hyaluronic acid
(made from fermentation of sugar by eqine streptococcus) |
|
|
how long do hyaluronic fillers last
|
6 months
|
|
|
what is Cymetra
|
injectable form of alloderm
|
|
|
Sculptra
|
poly-l-lactic acid
used for hiv assoc. facial lipodystrophy |
|
|
botox
onset of action |
6-36 hours
may take 7-14 days for max. effect |
|
|
is pregnancy or lactation a contraindication for botox
|
yes
|
|
|
what is the difference between pulsed-dye, tunable-dye, and flash lamp-pumped pulsed dye lasers
|
no major difference, all used to Rx vascular anomalies
|
|
|
advantage of Q-switched laser
|
short pulse high energy laser targeting tatoo
|
|
|
Baker formula
|
phenol (3 ml)
croton oil (3 gtts) liquid soap (8 gtts) water (2 ml) |
|
|
what is phenol
|
carbolic acid
derived from coal oil |
|
|
Jessner's solution
|
resorciono 14g
salicylic acid 14g laactic acid14ml ethanol 100cc |
|
|
how is depth controlled
baker (pheonol) jessner TCA |
strength of sl'n (croton oil)
or contact time (taping) numble of coats strength of solution |
|
|
first sign of phenol toxicity
|
cardiac arrythmias
|
|
|
normal dermal collagen ratio
|
I:III = 6:1
|
|
|
three primary components of dermis
|
glycoaminoglycns
collagen elastin |
|
|
most predominant tissue component of dermis
|
collagen 70 - 80%
|
|
|
which is the most "predictable" peeling agent
|
phenol (test answer- prob. controversial)
|
|
|
most common side effect of Retina A
|
erythema
|
|
|
classic agent for "medium depth" peel
|
35% TCA
|
|
|
what happens with lower concentrations of phenol
|
more penetration therefore more hazardess
|
|
|
can phenol be used anywhere else other than the ace
|
no
|
|
|
advantage of dermabrassion
|
less expensive
|
|
|
what structures comprise the nasal septum
|
cartilaginous plate, vomer, ethmoid, maxillary crest, palatine bone
|
|
|
nasalabial angle in men
" ' " " women |
90degrees
100 degrees |
|
|
what is consequence of lowering ot the nasal tip
what is the treatment |
alar flarring
alar base resection |
|
|
how much lower lateral cartilage should be left
|
5mm rim
|
|
|
what is Cottel sign
|
improved airway with lateral traction on the cheek
|
|
|
what is the cause of post rhynoplasty supra tip fullness
|
inadequate septal resection
|
|
|
botox
what is one unit |
corresponds to the calculated median intraaperitoneal lethal dose (LD50) in mice
|
|
|
do men require higher dose of botox
|
yes, muscles are larger
|
|
|
how to avoid brow ptosis with botox injection
|
keep injection 1-2 cm above the brow
|
|
|
when to reasses patient post botox
|
2 weeks (is no effect or assymetry inject)
|
|
|
complications of platysmal band injection with botox
|
dysphagia, dysphonia, neck weakness
|
|
|
duration of action of botox
|
3 - 4 months
|
|
|
most common reported side effect
|
headache
|
|
|
FDA approved use
|
Rx of lines between the eyebrows of patients betwee 18 and 65 yeears
|
|
|
length of response of axillary hyperhidrosis
|
mean = 200 days
|
|
|
contraindicaitons to botox
|
sensativity to agent
infection at site pregency neuropathic disorders (amls,myasthenia etc) |
|
|
analog of levator palpebrae in lower lid
|
capsulopalpebral fascia
|
|
|
most appropriate Rx of congenital ptosis upper lid
|
frontalis sling
|
|
|
most common injured muscle in blow out fracture
|
inf oblique
|
|
|
what will be the result of unilateral eyelid ptosis correction on the contalateral lid
|
it will become worse
|
|
|
how many fat compartments in
upper lid lower lid |
2
3 |
|
|
def: lagophthalmos
|
inability to close the eyelids
|
|
|
def: chemosis
|
edema of conjunctiva
|
|
|
flap used for total lower eyelid reconstruction
|
cheek rotation (mustarde)
|
|
|
most common cancer of eyelid
|
BCC
|
|
|
second most common eyelid cancer
|
SCC
|
|
|
third most common eyelid cancer
|
sebacwous cancer
|
|
|
def: arcus marginalis
|
periosteal thickening of the orbital rim where the orbital septum inserts
|
|
|
oil secreting glands of eyelid
|
meibomian and Zeiss
|
|
|
def; SOOF
ROOF |
sub - orbicularis fat fat
retro- " " " |
|
|
distance from orbital rim to apex
|
40-45mm
|
|
|
most appropriate temperature for operating room for extensive body contour surgery
|
70 degrees
|
|
|
best laser for capillaries
|
near 585 nm
(i.e.KTP) |
|
|
factors that contribute to a communication between rt and lft augmentation cavities where the implant can be moved each way
|
multiple procedures
previous chest wall deformity large base diameter subpectoral positioning |
|
|
factor that does not contribute to single rt and lft breast augmentation cavity
|
type of implant
|
|
|
what type of calcifications are most worrisome on mammography
|
branching or pleomorphic
|
|
|
what anatomic structure lies immediately deep to the levator palpebrae
|
muller's muscle
|
|
|
effect on pectoralis strength with submuscular implants
|
decrease
|
|
|
cardiac monitoring is necessary with which type of chemical peal
|
phenol
|
|
|
current recomended monitoring for reconstructed breast prosthesis
|
baselilne mri at 3 years and q 2 years after that
|
|
|
what is incised in a transconjunctival blepharoplasty
|
conjunctiva and capsulopalpebral fascia
|
|
|
presence of extra nipples on children should raise concern for ?
|
renal disease
|
|
|
what percentage of patients adenocarcinoma have polythelia
|
19%
|
|
|
ploythelia
def: |
presence of supernumerary nipples
|
|
|
primary choice for pre op abiotic for rhynoplasty
|
cefazolin (ancef)
allergic = clindamycin |
|
|
Rx of post operative "inverted v deformity" of nose
|
def: collapse of nasal sidewalls
Rx = spreader graft (? whether this is real- it is the book answer) |
|
|
neg hx, no medication adolescent with gynecomastia
first step in evaluation |
testicle exam and ultrasound
|
|
|
aging abdomen male vs female
diastasis skin laxity fat accumulation |
diastasis men = upper women = lower
laxity = men less skin thicker fat = men - central women - lateral and below iliac crest |
|
|
Rx of Posative Cottle test
(nasal septum) |
spreader graft
|
|
|
laboratory test suggesting increased risk for kleinfelter syndrome and risk of breast cancer
|
high number of progesterone receptors in mesenchymal breast tissue
|
|
|
vesicular rash post co2 laser
Dx Rx |
Herpes simplix
antiviral |
|
|
the most likely cause of immediate blindness following fat injection into the tear trough
|
fat emolism
|
|
|
what is the route of fat embolism to the eye post fat injection in face
|
retrograde flow of fat into carotid system
|
|
|
what is the most effective ysstem to promote adherence of tissue to ear reconstruction cartilage schphold
|
closed suction
one author reported 33% incidence of necrosis with pressure dressing |
|
|
what is the level of silicone in breast milk post augmentation
|
similar to women without implants
|
|
|
what is the most effective mechanism to prevent litigation with cosmetic patients
|
effective communication
|
|
|
what is the long term nasal deformity with untreated septal hematoma
|
saddle nose
|
|
|
`what is the normal growth pattern of micrografting of hair follivles
|
growth 1 month
hair loss (telogen phase) hair growth begins 2 - 3 months |
|
|
what is the most common unfavorable outcome of brachioplasty
|
unattractive scar
|
|
|
what is the biomechanical characteristic that is designed to minimize silicone "gel leak"
|
implant internal barrier coating
|
|
|
with dcis (ductal ca in situ)what is the risk of recurrent ipsilateral breast cancer post subcutaneous mastectomy (skin sparing)
|
2%
|
|
|
inervation of frontoparietal scalp
(risk of injury in brow lift) |
supraorbital
|
|
|
innervation of supratrochlear nerve
|
nasal radix and central forehead
|
|
|
numbness in nac (nipple areolar complex) is injury to which nerve
|
4th intercostal
|
|
|
where should hyalouronic acid be injected to repair tear trough deformity
|
level of theperiostal
|
|
|
maximum recomended total volume of lipoaspirate
|
5000cc
|
|
|
ectopic polymastia
what is the most likely site |
chest region including axilla
(90%) |
|
|
what are the primary factors that should be considered in contralateral mastectomy in patient with dcis
|
in absence of BRACHA gene, previous biopsy concern, family hx, difficult mammogram interpretation,
most imp = patient choice |
|
|
numbness in forearm post brachioplaty
injury = |
medial antebrachial cutaneous nerve
|
|
|
what is the reported complication of a complete transfixation incision vs hemi transfixation incision for nasal septal Rx
|
decreased tip projection
(test answer - have done it all my life withour the problem) |
|
|
what is the most sig. contributing factor to post op hematoma in face lilft
|
elevated blood pressure
|
|
|
ptosis upper lid post botox
cause |
most common = levator paresis
second = paresis of frontalis in unrecognized senile ptosis |
|
|
dry eye syndrome and upper blepharoplasty with lateral fullness
|
avoid injury/removal lacrimal gland
|
|
|
artery = predominant supply to the breast
|
internal thoracic (tnernal mammary)
|
|
|
contribution of arterial supply to the breast by thoracodorsal
|
none
|
|
|
superior and inferior gluteal arteries
branch of? |
internal iliac
|
|
|
what anatomic structure neutralizes trichloracetic acid (TCA)
|
dermis
|
|
|
numbness of nasal tip = injury to which nerve
|
anterior ethmoid
|
|
|
anterior ethmoid nerve is anesthetized by topical anestiesia in what location
|
apex of the nasal bones at the caudal border.
|
|
|
relationship of metformin and gynecomastia
|
none
|
|
|
is a verbal agreement satisfactory for use of photographs in advertising
|
no
|
|
|
colles fascia is continuous with which structure
|
scarpa's
|
|
|
1.5 mm breslow melanoma Rx = resection and ?
|
sentinel ln bx
|
|
|
amazia - definition
|
absence of glandualr tissue only
NAC and chest muscle intact |
|
|
athelia = def.
|
absence of nipple alone
|
|
|
poland syndrome
|
hypoplasia of absence of breast and pectoralis muscle
|
|
|
most likely cause of dissatisfaction post co2 lasar resurfacing
|
depigmentation
(occurs 100% of the itme 40% noticable) |
|
|
breast pedicle least likely to preserve blood supply with mastopexy augmentation
|
inferior ( test answer ?fact or opinion?
|
|
|
with excess eyelid skin, what is the major disadvantage of the fasanella-servat procedure
|
no skin removal, performed theough conjunctival surace
|
|
|
medial inframmary flap
lateral inframmary flap artery |
medial internal mammary
lateral - intercostal perforators |
|
|
excessive eyelid fat resection results in what lng term deformity
|
cadavaric apperance to eyes
|
|
|
open rhynoplasty and columella necrosis
cause |
injury to branch of angular artery
(?) almost impossible |
|
|
UAL needs
|
wet (to prevent nec to skin at entry site)
|
|
|
grade ii ptosis - mastopexy
grade iii ptosis - mastopexy |
vertical
wise pattern |
|
|
Rx cryptocia in which the superior part of the ear is buried
|
release helix and skin graft at age 5 or 6
|
|
|
best placement of skin paddle in autol breast recon
|
inferior/lateral
|
|
|
temporal branch facial nerve
plane of dissection to periosteum |
most superficial
on undersurface of superficial temp fascia no interconnecting branches deep to superficial layer of deep temp fascia |
|
|
amastia - def
|
absent breast and nipple
|
|
|
how far above the vulvar commisure is incision for mons elevation
|
5 cm
|
|
|
art supply to nasal tip
|
lateral nasal, branch of angular
|
|
|
poland syndrome
|
must have absence or hypoplasia of sternal head of pectoralis major muscle
|
|
|
wrestler's ear
|
hematoma within cartilage
Rx = drain + bolster dressing |
|
|
thin subcutaneous cover and subglandualr saline implant
|
wrinkling
|
|
|
Rx of "nearly" amputated ear
|
suture
|
|
|
posative Cottle test
Rx |
spreader graft
|
|
|
accessory mammary structures found
|
along milk line axilla to groin
|
|
|
ectopic mammary structures found
|
outside the mammary line
|
|
|
sharp deformity to anthelical fold post otoplasty
|
incising cartilage
|
|
|
infected implant post augmentaiton
Rx |
remove implant
reinsert 6 mnths |
|
|
buttock aumentation post massive wgt loss
|
autologous gluteal flaps
|
|
|
cosmetic forehead procedure for improvemet in bell's palsy
|
botox contralateral side
|
|
|
senile ectropion resulting in dry eyes is caused by
|
excess horizontal laxity of lower lid
|
|
|
best rx of burn ear
|
mafenimide (sulfamylon)
best escar penetration |
|
|
Rx of adolesent with breast assmetry
|
adjustable implant (tissue expander)
chang size with normal side development |
|
|
local anesthetic absorption rate above and below the clavicle
|
above is 2-3 X faster
therefore do the face first when injecting above and below the clavicle |
|
|
hertel ophthalmometer
norm measurement |
15 - 17 mm
> = exophthalmos |
|
|
wide intracrural distance called
|
"boxy" tip
|
|
|
disadvantage of liposuction rx of macromastia
|
does not corredt ptosis
|
|
|
thromboembolism prophylaxis
|
enoxaparin and squential compressing devises
|
|
|
most common complication of latissimus dorsi flap
|
seroma
|
|
|
inferior oblique
action on eye |
moves up and inward
|
|
|
superiod oblique
action on eye |
down and inward
|
|
|
superior rectus
action on eye |
up and out
|
|
|
inferior rectus
action on eye |
down and out
|
|
|
tubular breast Rx
|
radial scoring of breast
nipple reduction augmentation |
|
|
ear reconstruction
|
temporal parietal flap (when available) covered autologous cartilage framework
|
|
|
entropion vs extropion
test to differentiate |
activate orbiclaris muscle
(sometimes hard to tell in repose) |
|
|
support of external nasal valve
|
alar rim ( lower lateral cartilage)
|
|
|
MRI recommendation to follow silicone implants
|
3 years post op & q 2 years thereafter
|
|
|
bet mech to decrease lymphedema in medial thigh lift
|
superficial dissection at femoral triangle
|
|
|
vessel to use for ear replantation
|
posterior auricular artery
|
|
|
Rx of unilateral recurrent severe capsule contracture
|
capsulectomy and autologous tissue reconstruction
(autolog tissue best for inhibiting scar, but ? choice for unilateral problem - other side will do the same thing) |
|
|
advantage of microneural muscle transfer for facial palsy
(using cross facial n. gft) |
spontaneous animation
|
