ABCS Facial Cosmetic Surgery 3 — Questions and Answers
Question 1: Which technique is most appropriate to address a patient with a bulbous nasal tip and poor tip projection?
- Hump reduction with osteotomy
- Cartilage-splitting approach with cephalic trim only
- Structural rhinoplasty with columellar strut and tip sutures (Correct answer)
- Closed approach with alar base reduction
Correct answer: Structural rhinoplasty with columellar strut and tip sutures
Structural rhinoplasty using a columellar strut graft and interdomal/transdomal sutures increases tip projection and refines tip shape.
Question 2: A patient presents with lower eyelid retraction and scleral show following lower blepharoplasty. What is the most likely cause?
- Excessive fat removal from medial compartment
- Anterior lamellar shortening from skin excision (Correct answer)
- Violation of the orbital septum
- Injury to the inferior oblique muscle
Correct answer: Anterior lamellar shortening from skin excision
Removing too much skin from the lower lid creates anterior lamellar shortage, pulling the lid margin downward and exposing the sclera.
Question 3: Which fascial layer is the primary target of the deep plane facelift to release the key facial retaining ligaments?
- Subcutaneous fat layer
- Deep temporal fascia
- SMAS and its deep extensions (Correct answer)
- Parotid fascia
Correct answer: SMAS and its deep extensions
The deep plane facelift releases the zygomatic and masseteric cutaneous ligaments by operating beneath the SMAS, allowing composite tissue mobilization.
Question 4: What is the most common complication of otoplasty using the Mustardé suture technique?
- Keloid formation
- Suture extrusion or abscess (Correct answer)
- Hematoma
- Permanent sensory loss
Correct answer: Suture extrusion or abscess
Permanent sutures used in Mustardé otoplasty can extrude through the skin or become infected, especially with permanent braided sutures.
Question 5: In the treatment of facial aging, which structure most directly contributes to nasolabial fold deepening with age?
- Platysma laxity
- Descent of the malar fat pad (Correct answer)
- Atrophy of the buccal fat pad
- Ptosis of the superficial temporal fat pad
Correct answer: Descent of the malar fat pad
Inferior descent of the malar fat pad off the zygoma accentuates the nasolabial fold by accumulating tissue at that crease.
Question 6: Which blood supply consideration is most critical when designing a forehead flap for nasal reconstruction?
- Supratrochlear artery must be included in the pedicle (Correct answer)
- The angular artery must be ligated to prevent bleeding
- The flap must be based on the temporal artery only
- Facial artery perforators must be included in the base
Correct answer: Supratrochlear artery must be included in the pedicle
The paramedian forehead flap relies on the supratrochlear artery as its axial blood supply, which must be included in the medially based pedicle.
Question 7: When performing osteotomies in rhinoplasty to close an open roof deformity, what is the correct sequence of cuts?
- Lateral osteotomy then medial osteotomy
- Medial osteotomy then lateral osteotomy (Correct answer)
- Transverse osteotomy only
- Intermediate osteotomy then lateral osteotomy
Correct answer: Medial osteotomy then lateral osteotomy
Medial osteotomies are performed first to create a mobile segment that then pivots after lateral osteotomies to close the open roof.
ABCS Facial Cosmetic Surgery 3
Which technique is most appropriate to address a patient with a bulbous nasal tip and poor tip projection?