Aesthetic

Front 1

Zones of Adherence

Back 1

1. lateral gluteal depression

2. gluteal crease

3. distal posterior thigh

4. mid medial thigh

5. inferolateral illitibial tract

Front 2

Huger Zones of vascularity to abdomen

Back 2

I- superior and inferior epigastrics (xiphoid to ASIS, between recti muscles)

II- superficial and deep circumflex iliacs, SIEA (below ASIS to inguinal creases)

III- intercostal and lumbar perforators

Front 3

What is the arcuate line?

Back 3

transition point found halfway between umbilicus and symphysis pubis

- above: distinct anterior and posterior sheaths

- below: no posterior rectus sheath

Front 4

Where is the umbilicus found?

Back 4

1. midline at level of iliac crest

Front 5

Blood supply to umbilicus

Back 5

subdermal plexus, DIEA, ligamentum teres, median umbilical ligament

Front 6

What are the fascial systems in the arms?

Back 6

1. SFS (superficial fascial system/ aka clavipectoral/ axillary fascia)

- encases fat of upper arm circumferentially from axilla to elbow

2. longitudinal fascial system

- extends to axillary fascia and connects to the SFS

3. deep fascia

- envelopes muscles, where major NV bundles lie, must not be violated during brachioplasty

- with age, SFS and axillary fascia loosen creating a loose hammocklife effect

- only nerves superficial to deep fascia are: medial brachial cutaneous and antebrachial cutaneous nerves

- MABC runs with basilic vein

Front 7

Medial thigh structures to watch for during lift

Back 7

- superficial fat

- colles fascia

- deep fat

- great saphenous vein

Front 8

Extension of Scarpa's fascia in groin

Back 8

- Colles fascia in thigh

- Dartos fascia in perineum

Front 9

What is the femoral triangle?

Back 9

Front 10

Complications of medial thigh lift

Back 10

- inferior scar migration

- lateral traction deformity of the vulva

-*anchoring to Colle's fascia produces more favorable results

Front 11

Seven distinct circumferential aesthetic units of female abdomen

Back 11

1. dorsal rolls

2. upper abdomen

3. flanks

4. umbilicus

5. lower abdomen

6. mons

7. sacral

Front 12

Indications for bariatric surgery

Back 12

1. BMI >/= 40, or 35 with comorbidity

2. Failed medical management

3. Multidisciplinary evaluation

4. Motivated, well-informed patient with realistic expectations

5. Commitment to long-term follow up

Front 13

What is dual plane breast augmentation?

Back 13

Dual plane I: most routine breasts, nipple-to-IMG between 4-6cm

Dual plane II: breasts with mobile perenchyma muscle interface, nipple-to-IMG between 5.5-6.5 cm

Dual plane III: glandular ptotic and constricted lower pole breasts, nipple-to-IMG between 7-8 cm, or 2-5cm

Front 14

Types of wetting solutions

Back 14

Front 15

Tumescent formula

Back 15

- 1 L of saline or RL

- 1 ml of 1:100 epinephrine

- 50 ml of 1% lidocaine

Front 16

Classification of upper arm lipodystrophy

Back 16

Type 1- fatty arms; best for liposuction

Type 2- saggy arms; best for brachioplasty (limited, traditional, extended)

Type 3: fatty and saggy; lipo and brachioplasty

Front 17

Matarasso abdominal laxity classification

Back 17

Front 18

Medial thigh laxity classification

Back 18

I- lipodystrophy with no skin laxity

- SAL

II- lipodystrophy + skin laxity upper third

- SAL + horizontal skin excision

III- lipodystrophy + moderate skin laxity beyond upper 1/3

- SAL + horizontal and vertical skin excision

IV- skin laxity extending length of thigh

- longer vertical resection than type III

V- severe medial thigh laxity with lipodystrophy

- two stage: 1- aggressive SAL, 2- excisional medial thigh lift

Front 19

Define Radix, nasion, rhinion, and lobule

Back 19

Radix- soft tissue landmark: region on nose between lash line and supratarsal crease with eyes in horizontal gaze

Nasion- Ceph landmark: junction of frontonasal suture. This is also the deepest point of radix

Rhinion- ceph landmark: point at lowest point of nasal bone aka keystone region

Lobule- entire area overlying alar cartilages

Front 20

Define pogonion, menton, and gnathion

Back 20

Pogonion- most anterior portion of chin

Menton- inferiormost portion of chin

Gnathion- point between pogonion and menton

Front 21

Define Frankfort Horizontal plane

Back 21

Line joining Porion (superior point of external auditory meatus) and orbitale (inferior edge of orbital rim)

Front 22

Blood supply to nose

Back 22

Branches from:

- External carotid:

- Facial artery

- superior labial

- angular (dorsum and sidewall)

- lateral nasal (sidewall and tip)

- collumellar (tip)

- Maxillary artery

- infraorbital artery

- sphenopalatine (posterior septum)

- greater palatine

- Internal carotid:

- ophthalmic artery

- dorsal nasal

- anterior and posterior ethmoidal (upper septum) branches

-little's area (Kiesselbach's plexus)

Front 23

Nerve supply to nose

Back 23

Nasal tip:

- external branch of anterior ethmoidal nerve (V1)

lower lateral half of nose and collumella:

- infraorbital nerve (V2)

Cephalic portion of nasal sidewalls and radix:

- infratrochlear (V1)

Radix:

- supraorbital (V1)

Forehead Skin:

- supratrochlear (V1)

Inferior septum:

- nasopalatine nerve of ptergygopalatine ganglion (V2)

Front 24

Name all easthetic subunits of nose

Back 24

9 units:

1. nasal sidewall (2)

2. dorsum

3. ala (2)

4. soft triangle (2)

5. columella

6. nasal tip

Front 25

Muscles of nose

Back 25

1. Nasalis

2. Depressor septi nasi

3. Levator labii superioris alaque nasi

4. dilator naris

Front 26

Septal compostiion

Back 26

1. septal cartilage (quadrangular cartilage)

2. vomer

3. perpendicular plate of ethmoid bone

4. nasal crest of maxillary bone

5. nasal crest of palatine bone

Front 27

Drainage of the three meatuses

Back 27

1. superior meatus - posterior ethmoid air cells

2. middle meatus- frontal sinus, maxillary sinus, anterior ethmoid air cells

3. inferior meatus- nasolacrimal duct

Front 28

What is the internal nasal valve?

Back 28

- narrowest part of nasal airway

- junction of caudal edge of ULC and quadrilateral cartilaginous septum

- normal angulation is 10-15 degrees

Front 29

What is the external nasal valve?

Back 29

- formed by the alar cartilage lateral crura, and associated investing soft tissue cover

Front 30

Ideal nasofrontal angle

Back 30

115-125 in females, 120-130 in males

Front 31

ideal radix projection

Back 31

9-14 mm

Front 32

Ideal nasal tip projection

Back 32

0.67 x RT (radix to tip length aka length of nose)

* also, distance between ala = distance between tip and ala laterally

* upper lip also lies at 50% of nose

Front 33

Ideal nasolabial angle

Back 33

90-95 degrees in men; 95-105 degrees in women

also, columellar-lobule angle = 30-45 degrees

Front 34

What is the cottle sign?

Back 34

Lateral cheek traction to open nasal valve. This helps lift the ULCs and the open the internal valve

Front 35

Most common incision for rhinoplasty

Back 35

- transcolumellar

- bilateral infracartilaginous (aka marginal) incisions

Front 36

Indications for nasal osteotomies

Back 36

- narrow/ wide bony vault

- to close an open roof

- to correct bony asymmetry

* can be done externally or internally

* low-to-high OR low-to-low

*medial osteotomies are also possible and involve passing vertically between septum and nasal bones

Front 37

What is the angle of divergence?

Back 37

angle between the two middle crura while looking from worm's eye view

* ideal is 30-60 degrees; >60 = boxy tip; <30 narrow tip

Front 38

How much septum should remain when harvesting graft?

Back 38

1 cm of caudal and dorsal septum for L-Strut to avoid collapse and saddle nose deformity

Front 39

What are transdomal sutures?

Back 39

horizontal mattress sutures placed at dome/ or lateral crus of LLC

*narrows domes and/or convexity of lateral crura in order to decrease bulbosity and narrow tip; may slightly increase tip projection

Front 40

What are interdomal sutures?

Back 40

sutures between BOTH LLC domes

*increases columellar and tip projection, narrows tip

Front 41

What are medial crural sutures?

Back 41

sutures between paired medial crura of LLCs

*corrects medial crura asmmetry, reduces flaring, narrows columella, stabilizes columellar strut graft

Front 42

What is a columella-septal suture?

Back 42

suture between caudal septum and medial crura

*rotates tip upward and strengthens tip, prevents post-op tip droop, elevate hanging columella, increase tip projection

Front 43

What is cephalic trim?

Back 43

- cephalic portion of LLCs trimmed

* de-rotates tip, reduces tip width, decreases tip fullness, increases definition of tip-defining points

* should leave at least 4-6 mm width for support

Front 44

List possible post-op nasal deformities

Back 44

1. saddle nose deformity

- from excessive resection of nasal dorsum/ septum leading to loss of dorsal support, fracture of perpendicular plate of ethmoid, comminution of nasal bones during infracture, septal hematoma

2. open roof deformity

- aggressive dorsal hump reduction leading to separation between nasal sidewalls and septum

3. pollybeak deformity

- inadequate resection of lower dorsal septum or excess scar formation in supratip region

4. rocker deformity

- medial osteotomy that goes beyond thick radix bone resulting in rocking of fragment during manipulation

5. inverted V deformity

- avulsion of ULCs or excessive removal of transverse portion of ULC during dorsal septal resection

Front 45

Differences in asian and black noses

Back 45

Asian:

- alar flare, slanted external nares bulbous tip, short retracted columella, thick subcutaneous tissue, wide and flat dorsum

black:

- low radix, otherwise same as asian