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45 Cards in this Set
- Front
- Back
Zones of Adherence |
1. lateral gluteal depression 2. gluteal crease 3. distal posterior thigh 4. mid medial thigh 5. inferolateral illitibial tract |
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Huger Zones of vascularity to abdomen |
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 |
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What is the arcuate line? |
transition point found halfway between umbilicus and symphysis pubis - above: distinct anterior and posterior sheaths - below: no posterior rectus sheath |
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Where is the umbilicus found? |
1. midline at level of iliac crest |
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Blood supply to umbilicus |
subdermal plexus, DIEA, ligamentum teres, median umbilical ligament |
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What are the fascial systems in the arms? |
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 |
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Medial thigh structures to watch for during lift |
- superficial fat - colles fascia - deep fat - great saphenous vein |
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Extension of Scarpa's fascia in groin |
- Colles fascia in thigh - Dartos fascia in perineum |
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What is the femoral triangle? |
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Complications of medial thigh lift |
- inferior scar migration - lateral traction deformity of the vulva -*anchoring to Colle's fascia produces more favorable results |
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Seven distinct circumferential aesthetic units of female abdomen |
1. dorsal rolls 2. upper abdomen 3. flanks 4. umbilicus 5. lower abdomen 6. mons 7. sacral |
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Indications for bariatric surgery |
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 |
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What is dual plane breast augmentation? |
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 |
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Types of wetting solutions |
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Tumescent formula |
- 1 L of saline or RL - 1 ml of 1:100 epinephrine - 50 ml of 1% lidocaine |
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Classification of upper arm lipodystrophy |
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 |
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Matarasso abdominal laxity classification |
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Medial thigh laxity classification |
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 |
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Define Radix, nasion, rhinion, and lobule |
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 |
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Define pogonion, menton, and gnathion |
Pogonion- most anterior portion of chin
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Define Frankfort Horizontal plane |
Line joining Porion (superior point of external auditory meatus) and orbitale (inferior edge of orbital rim) |
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Blood supply to nose |
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) |
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Nerve supply to nose |
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) |
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Name all easthetic subunits of nose |
9 units: 1. nasal sidewall (2) 2. dorsum 3. ala (2) 4. soft triangle (2) 5. columella 6. nasal tip |
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Muscles of nose |
1. Nasalis 2. Depressor septi nasi 3. Levator labii superioris alaque nasi 4. dilator naris |
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Septal compostiion |
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 |
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Drainage of the three meatuses |
1. superior meatus - posterior ethmoid air cells 2. middle meatus- frontal sinus, maxillary sinus, anterior ethmoid air cells 3. inferior meatus- nasolacrimal duct |
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What is the internal nasal valve? |
- narrowest part of nasal airway - junction of caudal edge of ULC and quadrilateral cartilaginous septum - normal angulation is 10-15 degrees |
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What is the external nasal valve? |
- formed by the alar cartilage lateral crura, and associated investing soft tissue cover |
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Ideal nasofrontal angle |
115-125 in females, 120-130 in males |
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ideal radix projection |
9-14 mm |
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Ideal nasal tip projection |
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 |
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Ideal nasolabial angle |
90-95 degrees in men; 95-105 degrees in women also, columellar-lobule angle = 30-45 degrees |
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What is the cottle sign? |
Lateral cheek traction to open nasal valve. This helps lift the ULCs and the open the internal valve |
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Most common incision for rhinoplasty |
- transcolumellar - bilateral infracartilaginous (aka marginal) incisions |
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Indications for nasal osteotomies |
- 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 |
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What is the angle of divergence? |
angle between the two middle crura while looking from worm's eye view * ideal is 30-60 degrees; >60 = boxy tip; <30 narrow tip |
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How much septum should remain when harvesting graft? |
1 cm of caudal and dorsal septum for L-Strut to avoid collapse and saddle nose deformity |
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What are transdomal sutures? |
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 |
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What are interdomal sutures? |
sutures between BOTH LLC domes *increases columellar and tip projection, narrows tip |
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What are medial crural sutures? |
sutures between paired medial crura of LLCs *corrects medial crura asmmetry, reduces flaring, narrows columella, stabilizes columellar strut graft |
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What is a columella-septal suture? |
suture between caudal septum and medial crura *rotates tip upward and strengthens tip, prevents post-op tip droop, elevate hanging columella, increase tip projection |
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What is cephalic trim? |
- 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 |
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List possible post-op nasal deformities |
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 |
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Differences in asian and black noses |
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 |