ABCS Facial Cosmetic Surgery 2 — Questions and Answers
Question 1: Which nerve is most at risk during a standard rhytidectomy when dissecting in the preauricular region?
- Greater auricular nerve (Correct answer)
- Facial nerve marginal mandibular branch
- Auriculotemporal nerve
- Transverse cervical nerve
Correct answer: Greater auricular nerve
The greater auricular nerve is the most commonly injured nerve in rhytidectomy, causing earlobe and lower ear numbness.
Question 2: What is the primary goal of the SMAS plication technique in facelift surgery?
- Remove excess skin tension
- Reposition the superficial musculoaponeurotic system without incising it (Correct answer)
- Excise fatty deposits from the jowl
- Release retaining ligaments of the face
Correct answer: Reposition the superficial musculoaponeurotic system without incising it
SMAS plication folds and sutures the SMAS to itself, elevating it without making an incision through it.
Question 3: In upper blepharoplasty, which anatomic layer must be preserved to prevent lagophthalmos?
- Orbicularis oculi muscle (Correct answer)
- Orbital septum
- Levator aponeurosis
- Müller's muscle
Correct answer: Orbicularis oculi muscle
Excessive removal of orbicularis oculi muscle impairs eyelid closure, leading to lagophthalmos and corneal exposure.
Question 4: A patient develops an asymmetric smile with inability to show the lower teeth on one side following a facelift. Which structure was likely injured?
- Zygomatic branch of the facial nerve
- Marginal mandibular branch of the facial nerve (Correct answer)
- Buccal branch of the facial nerve
- Cervical branch of the facial nerve
Correct answer: Marginal mandibular branch of the facial nerve
The marginal mandibular branch innervates the depressor anguli oris and depressor labii inferioris, and its injury causes inability to depress the lower lip.
Question 5: Which grafting material is considered the gold standard for dorsal augmentation rhinoplasty to minimize resorption and infection risk?
- Silicone implant
- Autologous rib cartilage (Correct answer)
- Alloderm
- Expanded polytetrafluoroethylene (ePTFE)
Correct answer: Autologous rib cartilage
Autologous rib cartilage provides durable augmentation with the lowest rates of infection and extrusion compared to alloplastic materials.
Question 6: Which anatomic landmark defines the ideal position of the lateral canthus relative to the medial canthus in aesthetic facial analysis?
- At the same horizontal level as the medial canthus
- 1–2 mm superior to the medial canthus (Correct answer)
- At the level of the pupil
- 2–3 mm inferior to the medial canthus
Correct answer: 1–2 mm superior to the medial canthus
In an aesthetically pleasing eye, the lateral canthus sits approximately 1–2 mm higher than the medial canthus, creating a slight upward tilt.
Question 7: In genioplasty, which muscle attachment is critical to preserve bilaterally to prevent postoperative chin ptosis?
- Masseter muscle
- Digastric muscle
- Mentalis muscle (Correct answer)
- Platysma muscle
Correct answer: Mentalis muscle
Bilateral detachment of the mentalis muscle without proper re-approximation leads to chin ptosis and a 'witch's chin' deformity.
ABCS Facial Cosmetic Surgery 2
Which nerve is most at risk during a standard rhytidectomy when dissecting in the preauricular region?