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?
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What are some medical treatments for IOP?
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What are the signs of a retrobulbar hematoma?
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Which muscles of facial expression are innervated from the anterior surface?
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What structures lie in close proximity to the SCM?
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What is a batten graft related to in rhinoplasty?
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What is the location of the supratrochlear and supraorbital nerves?
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Where does an aesthetic lateral brow lie relative to the orbital rim?
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What is blepharochalasis?
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What is the grey line?
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What is blepharoptosis?
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What is apraclonidine used for?
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What is the orbital fat pad?
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What is the sentinel vein related to?
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What are the post-operative instructions for blepharoplasty?
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What are potential complications for a blepharoplasty and how are they treated?
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What is the difference between modified Cottle maneuver and Cottle maneuver?
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What can decrease the bulbousness of the lower lateral cartilage?
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What are the major tip supports for the nose?
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What can be done to increase tip rotation?
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What can be done to decrease tip rotation?
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What can increase tip projection?
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What can decrease tip projection?
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What are the approaches to the septum?
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What can be done about inferior turbinate hypertrophy and nasal obstruction?
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What is the normal projection of the radix?
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What is the rhinion?
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What does the Glogau classification describe?
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What does the Fitzpatrick classification assess?
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What does the Dedo classification label?
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What is an inverted V deformity?
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What is the term for excessive eyelid skin?
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What is an epiblepharon?
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What are the glands of Zeis?
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What are the glands of Moll?
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What are Krause's glands?
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What are Ciaccio's glands?
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What term describes the inability to close one's eyelids?
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What is the Marginal Reflex Distance (MRD)?
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How do you measure lower lid laxity?
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What is Schirmer's test?
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What is Lockwood's ligament?
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What is the valve of Hasner?
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What is the Aschner reflex?
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What is a coloboma?
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What is a scroll incision?
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What are the retaining ligaments of the face?
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What muscles contribute to the nasolabial fold?
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What is rhinophyma?
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At what age does growth of the ear terminate?
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What are the three most common causes of prominent ears?
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What is Stahl's ear deformity?
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What is cryptotia?
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What is a question mark ear?
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What is the Mustarde technique?
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What is the Stenstrom technique?
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By what principle does scored cartilage tend to bend away from the site of abrasion?
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Name the two procedures for creating an antihelical fold.
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What is the Furnas suture?
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What is the most effective technique for lobule repositioning?
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What type of suture is associated with granulomas?
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What are the rules of Firmin regarding cartilage grafting for ears?
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How large of a defect of the helix can be closed with a helical advancement flap?
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What is injected into a keloid for treatment/prevention?
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What is the location and function of Müller's muscle?
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What is Whitnall's ligament?
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What is Whitnall's tubercle?
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What is the position of the upper eyelid crease in Caucasian and Asian individuals?
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What separates the medial and central fat pads of the upper eyelid?
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What does the term hooding refer to?
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What is a steatoblepharon?
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What is a xanthelasma?
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What is the pull test?
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What is Bell's phenomenon?
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How much intact eyelid skin is required for normal eyelid function?
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What determines the shape of incision on an upper blepharoplasty?
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Where is the incision made for a lower blepharoplasty?
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At what intraocular pressure is surgical intervention required?
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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!