Cosmetic Surgery Classifications

Questions and Answers

What is the normal intraocular pressure (IOP)?

less than 22 mmHg

When is surgical intervention required for IOP?

When IOP is greater than 40 mmHg

How much does solitary canthotomy decrease IOP?

5 mmHg

How much does canthotomy with inferior cantholysis lower IOP?

20 mmHg Signup and view all the answers

What are some medical treatments for IOP?

IV Mannitol, Carbonic anhydrase inhibitors, Beta-blocker eye drops Signup and view all the answers

What are the signs of a retrobulbar hematoma?

Proptosis, blurry or double vision, afferent pupillary deficit (Marcus Gunn pupil), ophthalmoplegia Signup and view all the answers

Which muscles of facial expression are innervated from the anterior surface?

Levator anguli oris, Buccinator, Mentalis Signup and view all the answers

What structures lie in close proximity to the SCM?

External jugular vein, Greater auricular nerve Signup and view all the answers

What is a batten graft related to in rhinoplasty?

An only cartilage graft that can strengthen integrity of the native cartilage and alter contour Signup and view all the answers

What is the location of the supratrochlear and supraorbital nerves?

Supratrochlear: 17 mm lateral to glabellar midline; Supraorbital: 27 mm lateral to glabellar midline Signup and view all the answers

Where does an aesthetic lateral brow lie relative to the orbital rim?

Female: 2 mm medially, 10 mm laterally; Male: at or 1-2 mm above all across Signup and view all the answers

What is blepharochalasis?

Rare recurrent episodic idiopathic eyelid edema, typically found in younger women Signup and view all the answers

What is the grey line?

Gap formed between the pretarsal tissue and the tarsal plate at the lid margin Signup and view all the answers

What is blepharoptosis?

Drooping of the upper eyelid Signup and view all the answers

What is apraclonidine used for?

Pharmacologic correction when lid ptosis results from inappropriate Botox injections Signup and view all the answers

What is the orbital fat pad?

Pink - lacrimal gland Signup and view all the answers

What is the sentinel vein related to?

Has a relationship with the temporal branch of the facial nerve Signup and view all the answers

What are the post-operative instructions for blepharoplasty?

Cold compresses immediately, head above heart at all times, no lifting over 10 pounds for 10 days Signup and view all the answers

What are potential complications for a blepharoplasty and how are they treated?

Hematoma (release sutures to drain), Lower lid retraction (massage and stretch), Lagophthalmos (artificial tears) Signup and view all the answers

What is the difference between modified Cottle maneuver and Cottle maneuver?

Modified: uses an instrument to displace upper/lower cartilages; Cottle: lateral distraction of the cheek Signup and view all the answers

What can decrease the bulbousness of the lower lateral cartilage?

Cephalic trim, preserving 6 mm to prevent post-operative collapse Signup and view all the answers

What are the major tip supports for the nose?

Direction, strength, and resiliency of lower lateral cartilage; attachment of medial crura to inferior septal angle Signup and view all the answers

What can be done to increase tip rotation?

Remove hump, cephalic trim, augment medial crura, or use a premaxillary shield graft Signup and view all the answers

What can be done to decrease tip rotation?

Caudal septum rotation, shorten medial crura, augment dorsum Signup and view all the answers

What can increase tip projection?

Transdomal or interdomal sutures, shield graft, columellar strut graft, change chin position Signup and view all the answers

What can decrease tip projection?

Complete transfixion incision, shorten crura, lower septal angle, change chin position Signup and view all the answers

What are the approaches to the septum?

Closed: Killian, Transfixion; Open: External rhino, Lefort Signup and view all the answers

What can be done about inferior turbinate hypertrophy and nasal obstruction?

Antihistamines, decongestants, topical steroids, or turbinoplasty (submucosal resection or radiofrequency ablation) Signup and view all the answers

What is the normal projection of the radix?

4-9 mm anterior to the cornea; nasofrontal angle usually 120 degrees Signup and view all the answers

What is the rhinion?

Junction of bony and cartilaginous dorsum Signup and view all the answers

What does the Glogau classification describe?

The glow of your skin is blunted by wrinkles. Signup and view all the answers

What does the Fitzpatrick classification assess?

The Fitzpatrick classification assesses skin type based on response to UV light and propensity for sunburn. Signup and view all the answers

What does the Dedo classification label?

It labels by the depth of layers. Signup and view all the answers

What is an inverted V deformity?

It is caused by the separation of upper lateral cartilages from nasal bones. Signup and view all the answers

What is the term for excessive eyelid skin?

Dermatochalasis. Signup and view all the answers

What is an epiblepharon?

A congenital horizontal fold of skin near the margin of the upper or lower eyelid. Signup and view all the answers

What are the glands of Zeis?

Unilobar sebaceous glands located on the margin of the eyelid. Signup and view all the answers

What are the glands of Moll?

Modified apocrine sweat glands found on the margin of the eyelid. Signup and view all the answers

What are Krause's glands?

Small, mucous accessory lacrimal glands found underneath the eyelid. Signup and view all the answers

What are Ciaccio's glands?

Small tubular accessory lacrimal glands in the lacrimal caruncle of the eyelid. Signup and view all the answers

What term describes the inability to close one's eyelids?

Lagophthalmos. Signup and view all the answers

What is the Marginal Reflex Distance (MRD)?

The vertical distance between the pupillary light reflex and the eyelid margin. Signup and view all the answers

How do you measure lower lid laxity?

Using the snap-back test. Signup and view all the answers

What is Schirmer's test?

A test that determines whether the eye produces enough tears. Signup and view all the answers

What is Lockwood's ligament?

A suspensory ligament of the eyeball forming a hammock beneath it. Signup and view all the answers

What is the valve of Hasner?

A mucosal fold covering the opening of the nasolacrimal duct. Signup and view all the answers

What is the Aschner reflex?

A decrease in pulse rate associated with traction applied to extraocular muscles. Signup and view all the answers

What is a coloboma?

A hole in one of the structures of the eye, present from birth. Signup and view all the answers

What is a scroll incision?

An intranasal incision made between lower and middle lateral cartilages. Signup and view all the answers

What are the retaining ligaments of the face?

Aponeurotic condensations that anchor the skin and soft tissues. Signup and view all the answers

What muscles contribute to the nasolabial fold?

Levator labii superioris, zygomatic major/minor, and risorius. Signup and view all the answers

What is rhinophyma?

A thickening of the nose associated with rosacea. Signup and view all the answers

At what age does growth of the ear terminate?

The ear is fully grown by 7 to 8 years. Signup and view all the answers

What are the three most common causes of prominent ears?

Underdeveloped antihelical fold, prominent concha, and protruding earlobe. Signup and view all the answers

What is Stahl's ear deformity?

An additional crus posterior to the two crura that forms a Spock-like ear. Signup and view all the answers

What is cryptotia?

The superior portion of the helix buried in the temporal skin. Signup and view all the answers

What is a question mark ear?

A deformity of the supralobular region. Signup and view all the answers

What is the Mustarde technique?

A technique involving horizontal mattress sutures through ear cartilage. Signup and view all the answers

What is the Stenstrom technique?

A method of anterior abrasion of antihelical fold cartilage. Signup and view all the answers

By what principle does scored cartilage tend to bend away from the site of abrasion?

Gibson's principle. Signup and view all the answers

Name the two procedures for creating an antihelical fold.

Luckett procedure (single incision) and Converse-Wood-Smith technique (dual incision). Signup and view all the answers

What is the Furnas suture?

A technique that places sutures between the concha and the mastoid fascia. Signup and view all the answers

What is the most effective technique for lobule repositioning?

Gosain technique. Signup and view all the answers

What type of suture is associated with granulomas?

Braided suture. Signup and view all the answers

What are the rules of Firmin regarding cartilage grafting for ears?

Defects of 25% or more of the helical rim require rib cartilage for support. Signup and view all the answers

How large of a defect of the helix can be closed with a helical advancement flap?

2 cm. Signup and view all the answers

What is injected into a keloid for treatment/prevention?

Kenalog: Triamcinolone 40mg/ml. Signup and view all the answers

What is the location and function of Müller's muscle?

It aids in lifting the upper eyelid. Signup and view all the answers

What is Whitnall's ligament?

A sheath surrounding the levator palpebrae superioris. Signup and view all the answers

What is Whitnall's tubercle?

An insertion point for the check ligament for the lateral rectus. Signup and view all the answers

What is the position of the upper eyelid crease in Caucasian and Asian individuals?

Caucasian: Female - 10-12mm, Male - 8-10mm; Asian: 4-6mm above lashes. Signup and view all the answers

What separates the medial and central fat pads of the upper eyelid?

Superior oblique muscle separates them; medial fat is whiter, central is yellow. Signup and view all the answers

What does the term hooding refer to?

Redundant and ptotic tissue in the lateral orbital region of the upper eyelids. Signup and view all the answers

What is a steatoblepharon?

A pseudoherniation or prolapse of post-septal periorbital fat. Signup and view all the answers

What is a xanthelasma?

An accumulation of yellowish plaques in the upper eyelid skin. Signup and view all the answers

What is the pull test?

Pulling on the lower eyelid to assess lower lid laxity. Signup and view all the answers

What is Bell's phenomenon?

The mechanism by which the globe rotates superiorly to cover the cornea. Signup and view all the answers

How much intact eyelid skin is required for normal eyelid function?

20 mm. Signup and view all the answers

What determines the shape of incision on an upper blepharoplasty?

The presence of lateral hooding influences whether a 'bird beak' or 'napoleon's hat' incision is made. Signup and view all the answers

Where is the incision made for a lower blepharoplasty?

The incision typically follows a design based on cosmetic and functional needs. Signup and view all the answers

At what intraocular pressure is surgical intervention required?

Surgical intervention is usually required when IOP exceeds 21 mmHg. Signup and view all the answers

Study Notes

Cosmetic Surgery Classifications

Glogau Classification: Evaluates skin aging based on wrinkles and surface texture.
Fitzpatrick Classification: Assesses skin tone and its reaction to UV exposure, important for determining skin types.
Dedo Classification: Categorizes based on the depth of skin layers affected.

Nasal Deformities and Conditions

Inverted V Deformity: Results from separation of upper lateral nasal cartilages; can arise from over-aggressive hump reduction or trauma.
Rhinophyma: Characterized by thickened, fibrous nose with prominent pores; linked to rosacea, not solely due to alcohol.
Coloboma: A congenital defect where there is a hole in eye structures; can affect vision based on severity.

Eyelid Conditions and Anatomy

Dermatochalasis: Excess skin on the eyelids, commonly seen in aging.
Epiblepharon: A congenital eyelid condition causing misdirected lashes; prevalent in Asian children.
Lagophthalmos: Inability to close eyelids; can result from surgical complications, nerve palsy, or skin disorders.
Marginal Reflex Distance (MRD): Distance measurement related to eyelid positioning; used in diagnosing ptosis and retraction.

Eyelid Glands

Glands of Zeis: Sebaceous glands at eyelash margins, secreting oils for lubrication.
Glands of Moll: Modified sweat glands at eyelash bases, contributing to tear film stability.
Krause’s Glands: Accessory lacrimal glands aiding in tear production, located in conjunctiva.
Ciaccio’s Glands: Lacrimal glands in the caruncle, also involved in tear secretion.

Surgical Techniques and Procedures

Mustarde Technique: A mattress suture technique for creating the antihelical fold during ear surgery.
Stenstrom Technique: Abrades cartilage to alter ear shape; considered unreliable.
Luckett Procedure: Single incision approach for creating an antihelical fold.
Furnas Suture: Involves suturing between concha and mastoid fascia for ear repositioning.

Ear Deformities

Stahl's Ear Deformity: Blepharoplasty deformity resembling Spock's ear, correctable by surgery.
Cryptotia: Condition where the helix of the ear is buried beneath the skin.
Question Mark Ear: Deformity in the supralobular area of the ear.

Tear Duct and Lacrimal System

Valve of Hasner: Membrane covering the nasolacrimal duct's nasal opening.
Aschner Reflex: Oculocardiac reflex affecting pulse rate; stimulated by traction on ocular muscles.

Facial Anatomy and Fat Pads

Retaining Ligaments of the Face: Support soft tissue; true ligaments anchor to bone, while false ligaments attach superficial fascia to deep fascia.
Fat Pads: Palpable fat tissues in eyelids, which can change with aging; separated by eye muscles.

Eyelid Surgery Preparation

Normal Eyelid Function: Requires a minimum of 20mm of intact skin; critical for blepharoplasty outcomes.
Incision Types: Different incisions (bird beak or Napoleon's hat) affect upper blepharoplasty based on planned procedures.

Additional Surgical Considerations

Innovative Techniques: Various techniques maintain or enhance ear and eyelid structure.
Granulomas and Suture Types: Braided sutures are more associated with granuloma formation post-surgery.

Common Conditions and Tests in Oculoplastic Surgery

Schirmer's Test: Evaluates tear production; negative result indicates normal tear function.
Pull Test: Assesses lower lid laxity; significant gap indicates the need for correction.

Normal Eye and Eyelid Functions

Bell's Phenomenon: Protective reflex of the eye during eyelid closure; can be compromised in certain conditions.
Afferent Pupillary Deficit: Symptoms of retrobulbar hematoma indicating serious complications.

Unique Facial Muscles

Facial Expression Muscles: Buccinator and Mentalis muscles have anterior innervation, distinct from other facial muscles.### Eyelid Edema and Blepharoplasty
Rare, recurrent episodic idiopathic eyelid edema primarily occurs in younger women.
Blepharoplasty may be considered once the condition resolves.

Grey Line

The grey line refers to a gap between the pretarsal tissue and the tarsal plate at the lid margin, marking the junction of skin and conjunctiva.

Blepharoptosis

Blepharoptosis is characterized by the drooping of the upper eyelid.

Apraclonidine

Apraclonidine is utilized for pharmacologic correction of lid ptosis that may arise from incorrect Botox injections, targeting sympathetically innervated smooth muscle.

Orbital Fat Pad

The pink lacrimal gland is identified as the orbital fat pad.

Sentinel Vein

The sentinel vein is associated with the temporal branch of the facial nerve; it represents a caution zone during surgical procedures.

Post-Operative Instructions for Blepharoplasty

Apply cold compresses immediately following surgery.
Maintain head elevation above the heart at all times.
Avoid lifting items over 10 pounds for a duration of 10 days.

Complications of Blepharoplasty

Hematoma: May result from breaching the septum leading to retroseptal hematoma. Treatment includes releasing blepharoplasty sutures for drainage and possible lateral canthotomy with cantholysis.
Lower Lid Retraction: Caused by excessive removal of anterior lamella (skin and/or muscle) or scar formation of the septum. Treatment involves massage, stretching, tarsal strip procedures, and potential grafts.
Lagophthalmos: Characterized by lid incompetence (2-3 mm) which isn't a primary concern immediately post-op. Management includes artificial tears and lubricating ointment, alongside correcting any underlying deficiency.

Modified Cottle Maneuver vs Cottle Maneuver

Modified Cottle Maneuver: Uses a nasal instrument to laterally displace cartilages to assess obstruction.
Cottle Maneuver: Involves lateral distraction of the cheek without instruments.

Bulbousness of Lower Lateral Cartilage

Cephalic trim can reduce bulbousness but requires preserving a minimum of 6 mm to prevent post-operative collapse.

Major Tip Supports for the Nose

The strength and direction of lower lateral cartilage.
The connection of medial crura to the inferior septal angle.
The attachment between lower and upper lateral cartilage.

Increasing Tip Rotation

Techniques include removing any dorsal hump, performing cephalic trim or shortening lateral crura, augmenting medial crura, and using premaxillary shield grafts.

Decreasing Tip Rotation

Options include rotating the caudal septum, shortening medial crura, or augmenting the dorsum.

Increasing Tip Projection

Achieved through transdomal or interdomal sutures, shield grafts, columellar strut grafts, or adjusting chin position.

Decreasing Tip Projection

Accomplished via complete transfixion incision, shortening the crura, lowering the septal angle, or modifying chin position.

Approaches to the Septum

Closed Approaches: Killian and Transfixion.
Open Approaches: External rhinoplasty and Lefort procedures.

Inferior Turbinate Hypertrophy and Nasal Obstruction

Management options include antihistamines, decongestants, topical steroids, or surgical solutions like turbinoplasty, submucosal resection, or radiofrequency ablation.

Radix Projection

Normal projection of the radix is 4-9 mm anterior to the cornea, with the nasofrontal angle typically at 120 degrees and vertical positioning aligned at the supratarsal crease.

Rhinion

The rhinion is the junction where the bony and cartilaginous sections of the dorsum meet; improper osteotomies may lead to nasal obstruction in this area.

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Description

This quiz covers essential classifications in cosmetic surgery, including Glogau, Fitzpatrick, and Dedo classifications. Test your knowledge on how these classifications help assess skin type and conditions related to cosmetic procedures. Enhance your understanding of common terms associated with cosmetic surgery!