ABPS Aesthetic Procedures & Patient Safety 4 — Questions and Answers
Question 1: A patient presents with induration, erythema, and papules 3 weeks after calcium hydroxylapatite filler injection. The most appropriate treatment is:
- Intralesional corticosteroids and possibly 5-fluorouracil for biofilm-associated granuloma (Correct answer)
- Hyaluronidase injection to dissolve the filler
- Immediate surgical excision of the affected area
- Topical tretinoin applied twice daily
Correct answer: Intralesional corticosteroids and possibly 5-fluorouracil for biofilm-associated granuloma
Late inflammatory nodules after CaHA filler are often biofilm-mediated granulomas best treated with intralesional corticosteroids ± 5-FU; hyaluronidase has no effect on CaHA.
Question 2: Which nerve is most at risk of injury during suction-assisted lipectomy of the medial thigh?
- Saphenous nerve (Correct answer)
- Sciatic nerve
- Common peroneal nerve
- Femoral nerve
Correct answer: Saphenous nerve
The saphenous nerve runs superficially along the medial thigh and knee, making it vulnerable to cannula trauma during medial thigh liposuction.
Question 3: In the setting of accidental intra-arterial injection of hyaluronic acid filler causing skin blanching, the immediate first-line treatment is:
- High-dose hyaluronidase injection into and around the affected area without delay (Correct answer)
- Warm compress and massage for 10 minutes before deciding on intervention
- Aspirin 325 mg orally and referral to emergency department
- Nitropaste applied topically and recheck in 30 minutes
Correct answer: High-dose hyaluronidase injection into and around the affected area without delay
Immediate high-dose hyaluronidase injection is the first-line emergency treatment to dissolve the occluding filler and restore vascular perfusion.
Question 4: Which classification system is most widely used to grade the severity of capsular contracture following breast augmentation?
- Baker classification (Grades I–IV) (Correct answer)
- Rosen classification
- TNM staging system
- Fitzpatrick skin type scale
Correct answer: Baker classification (Grades I–IV)
The Baker classification grades capsular contracture from I (soft, natural) to IV (hard, painful, distorted) and is the universal standard for clinical communication.
Question 5: A surgeon notices excessive bleeding during a facelift despite normal preoperative coagulation studies. The most important history item to clarify is:
- Use of herbal supplements such as fish oil, ginkgo, or vitamin E within 2 weeks of surgery (Correct answer)
- Family history of heart disease
- Alcohol use in the past month
- History of kidney stones
Correct answer: Use of herbal supplements such as fish oil, ginkgo, or vitamin E within 2 weeks of surgery
Many herbal supplements have platelet-inhibiting or anticoagulant properties and are frequently omitted from standard medication histories unless specifically asked.
Question 6: When selecting patients for awake liposuction under local anesthesia only, which factor most strongly favors this approach over general anesthesia?
- Small volume treatment of a single zone in a low-anesthetic-risk patient (Correct answer)
- Patient preference for avoiding needles
- Surgeon preference for faster turnover
- Presence of multiple medical comorbidities requiring complex anesthetic management
Correct answer: Small volume treatment of a single zone in a low-anesthetic-risk patient
Awake local-only liposuction is safest and most appropriate for small-volume, single-zone treatments in healthy patients with low anesthetic risk.
Question 7: The 'no-fly' recommendation of 2–4 weeks after certain aesthetic procedures is primarily intended to reduce risk of:
- Deep vein thrombosis and pulmonary embolism exacerbated by prolonged immobility at altitude (Correct answer)
- Surgical site infection from recirculated cabin air
- Implant displacement from pressure changes during ascent
- Postoperative nausea worsened by turbulence
Correct answer: Deep vein thrombosis and pulmonary embolism exacerbated by prolonged immobility at altitude
Prolonged immobility during flights combined with postoperative hypercoagulability significantly increases DVT/PE risk, justifying a waiting period before air travel.
ABPS Aesthetic Procedures & Patient Safety 4
A patient presents with induration, erythema, and papules 3 weeks after calcium hydroxylapatite filler injection.
The most appropriate treatment is: