ABCS Surgical Anatomy for Cosmetic Procedures 2 — Questions and Answers
Question 1: In rhinoplasty, the 'keystone area' refers to the junction between which two structures?
- Upper and lower lateral cartilages
- Nasal bones and upper lateral cartilages (Correct answer)
- Septum and columella
- Alar base and nasal floor
Correct answer: Nasal bones and upper lateral cartilages
The keystone area is the junction of the nasal bones and upper lateral cartilages; disruption here can cause collapse of the middle vault.
Question 2: Which layer of the scalp contains the major blood vessels and is the preferred plane for tissue elevation in scalp flap procedures?
- Skin
- Dense connective tissue (subcutaneous) (Correct answer)
- Galea aponeurotica
- Loose areolar tissue
Correct answer: Dense connective tissue (subcutaneous)
The dense connective tissue layer contains the main scalp blood vessels, making it the vascular pedicle plane used in scalp flap elevation.
Question 3: When performing a neck lift, the marginal mandibular nerve is most vulnerable at which anatomical location?
- At the angle of the mandible posteriorly
- As it crosses the facial artery and vein near the mandibular border (Correct answer)
- At the level of the earlobe
- Near the midline of the neck
Correct answer: As it crosses the facial artery and vein near the mandibular border
The marginal mandibular branch crosses over the facial vessels near the inferior border of the mandible, where it is most susceptible to injury during neck dissection.
Question 4: The blood supply to the nipple-areola complex in breast reduction is primarily preserved by which pedicle in the inferior pedicle technique?
- Superior pedicle
- Lateral pedicle
- Inferior pedicle (Correct answer)
- Central pedicle
Correct answer: Inferior pedicle
In the inferior pedicle technique, the nipple-areola complex remains attached to an inferiorly based dermoglandular pedicle that carries perforators from the internal mammary and intercostal vessels.
Question 5: Which named ligament, when released during lower blepharoplasty, helps to correct the tear trough deformity?
- Whitnall's ligament
- Lockwood's ligament
- Orbitomalar ligament (Correct answer)
- Canthal tendon
Correct answer: Orbitomalar ligament
The orbitomalar (or orbicularis) ligament creates the tear trough groove, and releasing it allows fat repositioning to correct the hollowness.
Question 6: In gluteal fat grafting (Brazilian Butt Lift), injection into which layer is associated with the highest risk of fatal fat embolism?
- Subcutaneous plane
- Intramuscular plane
- Subfascial plane
- Deep intramuscular/submuscular plane (Correct answer)
Correct answer: Deep intramuscular/submuscular plane
Fat injected into the deep intramuscular or submuscular compartment can enter large gluteal veins, causing potentially fatal pulmonary fat embolism.
Question 7: The cephalic trim of the lower lateral cartilage in rhinoplasty should generally preserve a minimum cartilage width of how many millimeters to prevent alar collapse?
- 2 mm
- 4 mm (Correct answer)
- 6 mm
- 8 mm
Correct answer: 4 mm
At least 4 mm of the caudal strip of the lower lateral cartilage should be preserved after cephalic trim to maintain structural support and prevent alar rim collapse.
ABCS Surgical Anatomy for Cosmetic Procedures 2
In rhinoplasty, the 'keystone area' refers to the junction between which two structures?