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Aesthetic Surgery of the Face and Neck
Facial Surgery
Continuing Medical Education Examination
Aesthetic Surgery of the Face and Neck INSTRUCTIONS FOR CATEGORY 1 CME CREDIT The American Society for Aesthetic Plastic Surgery is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The American Society for Aesthetic Plastic Surgery designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit™ for correctly answering enough questions to earn a minimum score of 70%. Each physician should claim credit commensurate with the extent of his/her participation in the activity. This activity should take 60 minutes to complete.
PLEASE TAKE THIS EXAMINATION TWICE As a measure of the success of the education we hope you will receive from this article, we encourage you to log on to the Aesthetic Society website and take the pre-exam before reading this article. Once you have completed the article, you may take the examination again for CME credit. The Aesthetic Society will be able to compare your answers and use these data for future reference as we attempt to continually improve the CME articles we offer. Aesthetic Society members can complete this exam online by logging on to the Aesthetic Society members–only website (http://www.surgery.org/members). To take the online exam, please click on the “CME Triangle” on the right hand side of the page. Navigate to this activity, scroll down its launch page, and click “Take Pre-Exam.” You will be presented with a preexamination to establish a baseline of knowledge. After completing the pre-exam, read the article, navigate back to this activity on the website, and click “Online Exam.” You will then be presented with the post-exam. The Aesthetic Society, as an accredited provider of CME, is required to measure changes in the knowledge of its physician learners. If you elect to take the print version, please return the examination (photocopy or tear out) with your full name and address, your Aesthetic Society or ASPS identification number, and your e-mail address to: ASJ CME, c/o ASAPS Central Office, 11262 Monarch Street, Garden Grove, CA 92841-1441. Completed exams with evaluations can be faxed to ASJ CME at (562) 799-1098. Please include your name, address, and identification number. If you are not a member of either the Aesthetic Society or ASPS, please note this on your examination and include your e-mail address. Members will have thier credits reported to ASPS for inclusion in the combined plastic surgery database on a quarterly basis. Nonmember readers of the Journal who achieve a passing score will be provided with a confirmation e-mail. The deadline for receipt of examination for Category 1 CME Credit™ based on this activity is December 15, 2012.
MULTIPLE CHOICE 1.
The most common superficial mimetic muscle to be absent anatomically is the: A. Zygomaticus major B. Zygomaticus minor C. Levator alae nasi D. Levator labii superioris E. Orbicularis oris
2.
False statements regarding the SMAS include that it: A. Partitions the subcutaneous fat parallel to the skin B. Is adherent to the external surface of the parotid capsule C. Invests the platysmal muscle D. Partitions the deep facial fat into compartments E. Fuses with the temporoparietalis fascia above the zygomatic arch
464 • Volume 29 • Number 6 • November/December 2009
3.
Retaining ligaments of the face include all areas except the: A. Zygomaticus B. Orbicularis (orbitomalar) C. Zygomaticocutaneous (malar membrane) D. Mandibulocutaneous E. Nasolabial
Aesthetic Surgery Journal
4.
All of the following statements regarding the facial nerve (cranial nerve VII) are true except: A. It exits the skull through the stylomastoid foramen B. It divides into three major divisions C. It has frequent cross-communications in the buccal area D. The marginal mandibular branch usually runs above the mandibular border anterior to the facial artery E. The frontal branch passes lateral to the tail of the brow
5.
All of the following statements regarding facelift scars are true except: A. A posttragal scar is preferable in men with heavy beards B. A horizontal sideburn incision may avoid displacement of the sideburn C. A postauricular sulcus incision (short scar) may be all that is needed in patients with minimal neck skin excess D. A posterior hairline incision is useful in patients with great excess of cervical skin E. A preauricular skin incision is less noticeable below the temporal recess
6.
True statements regarding subcutaneous facelifts include all except that: A. Dissection can be varied in extent B. Direct defatting of the jowls can be performed C. The dermis has less subsequent stress relaxation than the SMAS D. The dissection plane is superficial to the facial nerve branches E. Skin redraping can be either vertical or horizontal
7.
One criticism of the subcutaneous facelift with suture plication has been that: A. Separate skin dissection allows differential movement of the skin and deep tissues B. Suspension sutures can directly reach the anterior cheek fat C. There is a lack of longevity because of suture “tear through” D. Different areas of suspension may be addressed separately E. Deep dissection near facial nerves is avoided
8.
A potential criticism of the SMAS imbrication technique is that: A. Release of the SMAS anteriorly provides greater mobility B. Sub-SMAS dissection puts the facial nerve branches at greater risk C. The “mobile SMAS” is advanced to the “fixed SMAS” D. Vertical elevation of the cheek fat can be achieved E. Imbrication may provide a stronger support than plication
Aesthetic Surgery of the Face and Neck
9.
The potential limitation of the temporal approach to facelift is that: A. A subperiosteal or supraperiosteal approach can be used B. Middle lamella complications in the lower lid are minimized C. The supraperiosteal approach avoids disruption of the origin of the zygomaticus major muscle D. A preauricular incision is avoided E. The lower face is not improved
10. All of the following are true regarding the long, thin neck except that: A. Medial advancement of the platysma does not affect upward mobility of the cheek SMAS B. The optimal cervicomental angle is between 90° and 110° C. Medial platysmal fibers may decussate in the submental area D. The cervical investing fascia holds the platysma within the contour of the neck E. There is a gliding plane deep to the platysma 11. All of the following are true regarding correction of the obtuse fatty neck except that: A. Preplatysmal fat can be removed by liposuction B. Medial subplatysmal fat can be removed though a submental incision C. Partial division of the platysma may be beneficial D. The hyoid lies opposite the third cervical vertebra E. A firm anterior “corset” platysmal closure improves submental contour 12. All the following are true of potential platelet inhibition except that: A. Omega-3 fatty acids (fish oils) inhibit platelet function B. Cyclooxygenase enzymes facilitate the production of thromboxane C. Aspirin is an irreversible cyclooxygenase (COX)1 and COX-2 inhibitor D. PFA-100 is a rapid screen for aspirin induced platelet defects E. Desmopressin may help minimize aspirininduced bleeding 13. True statements regarding the effects of smoking include all the following except: A. Smoking causes a chronic obliterative endarteritis B. A single cigarette can cause a transient 24% to 42% decrease in blood flow C. Skin flap necrosis is 12.5 times greater in smokers D. Nonsmoke nicotine does not affect flap circulation E. Cotinine levels can be rapidly assessed with a salivary test strip
Volume 29 • Number 6 • November/December 2009 • 465
14. True statements regarding the perioperative management of hypertension include all except that: A. A preoperative blood pressure of 140/90 mm Hg or less is desirable B. A transdermal clonidine patch may prevent rebound hypertension from adrenalin in the local anesthetic C. Injected adrenalin may be absorbed for four to 10 hours postoperatively D. Labetalol intravenous boluses may be useful for intraoperative hypertension E. Labetalol is the antihypertensive agent of choice in patients with relative bradycardia
15. All of the following facts are true regarding facelift complications except that: A. Postoperative hematomas occur in approximately 3% of patients B. Men have a higher incidence of hematoma than women C. An adrenalin dilution of 1:100,000 is necessary for wound hemostasis D. Nasal staphylococci can be eradicated with topical mupirocin E. The most common infective agent from the ear canal is Pseudomonas
EVALUATION 1. 2. 3. 4. 5. 6. 7. 8.
Overall, did the activity provide an adequate overview of the subject matter? Yes ____ No ____ The subject matter of the activity was: Too basic ____ Too advanced ____ Just right ____ The length of the activity was: Too short ____ Too long ____ Just right____ This activity increased my awareness and understanding of the issues discussed in the article. Strongly agree____ Agree____ Neutral____ Disagree____ Strongly disagree ____ Did any commercial bias negatively impact this educational activity? Yes ____ No ____ If yes, which product?______________________________________________________ I would again participate in an Aesthetic Surgery Journal CME activity. Yes ____ No ____ I would recommend an Aesthetic Surgery Journal CME activity to a colleague. Yes ____ No____ What other topics (including instructor names, if possible) would you like covered in future issues of Aesthetic Surgery Journal? __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________
Name:________________________________________________________________________________________________ Address:______________________________________________________________________________________________ City/State/Zip: ________________________________________________________________________________________ ASAPS/ASPS ID No.: ____________ Check if not a member of ASAPS or ASPS ____ Copyright © 2009 by The American Society for Aesthetic Plastic Surgery, Inc. 1090-820X/$36.00 doi:10.1016/j.asj.2009.08.021
466 • Volume 29 • Number 6 • November/December 2009
Aesthetic Surgery Journal
Continuing Medical Education Examination
Aesthetic Surgery of the Face and Neck INSTRUCTIONS FOR CATEGORY 1 CME CREDIT The American Society for Aesthetic Plastic Surgery is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The American Society for Aesthetic Plastic Surgery designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit™ for correctly answering enough questions to earn a minimum score of 70%. Each physician should claim credit commensurate with the extent of his/her participation in the activity. This activity should take 60 minutes to complete.
PLEASE TAKE THIS EXAMINATION TWICE As a measure of the success of the education we hope you will receive from this article, we encourage you to log on to the Aesthetic Society website and take the pre-exam before reading this article. Once you have completed the article, you may take the examination again for CME credit. The Aesthetic Society will be able to compare your answers and use these data for future reference as we attempt to continually improve the CME articles we offer. Aesthetic Society members can complete this exam online by logging on to the Aesthetic Society members–only website (http://www.surgery.org/members). To take the online exam, please click on the “CME Triangle” on the right hand side of the page. Navigate to this activity, scroll down its launch page, and click “Take Pre-Exam.” You will be presented with a preexamination to establish a baseline of knowledge. After completing the pre-exam, read the article, navigate back to this activity on the website, and click “Online Exam.” You will then be presented with the post-exam. The Aesthetic Society, as an accredited provider of CME, is required to measure changes in the knowledge of its physician learners. If you elect to take the print version, please return the examination (photocopy or tear out) with your full name and address, your Aesthetic Society or ASPS identification number, and your e-mail address to: ASJ CME, c/o ASAPS Central Office, 11262 Monarch Street, Garden Grove, CA 92841-1441. Completed exams with evaluations can be faxed to ASJ CME at (562) 799-1098. Please include your name, address, and identification number. If you are not a member of either the Aesthetic Society or ASPS, please note this on your examination and include your e-mail address. Members will have thier credits reported to ASPS for inclusion in the combined plastic surgery database on a quarterly basis. Nonmember readers of the Journal who achieve a passing score will be provided with a confirmation e-mail. The deadline for receipt of examination for Category 1 CME Credit™ based on this activity is December 15, 2012.
MULTIPLE CHOICE 1.
The most common superficial mimetic muscle to be absent anatomically is the: A. Zygomaticus major B. Zygomaticus minor C. Levator alae nasi D. Levator labii superioris E. Orbicularis oris
2.
False statements regarding the SMAS include that it: A. Partitions the subcutaneous fat parallel to the skin B. Is adherent to the external surface of the parotid capsule C. Invests the platysmal muscle D. Partitions the deep facial fat into compartments E. Fuses with the temporoparietalis fascia above the zygomatic arch
464 • Volume 29 • Number 6 • November/December 2009
3.
Retaining ligaments of the face include all areas except the: A. Zygomaticus B. Orbicularis (orbitomalar) C. Zygomaticocutaneous (malar membrane) D. Mandibulocutaneous E. Nasolabial
Aesthetic Surgery Journal
4.
All of the following statements regarding the facial nerve (cranial nerve VII) are true except: A. It exits the skull through the stylomastoid foramen B. It divides into three major divisions C. It has frequent cross-communications in the buccal area D. The marginal mandibular branch usually runs above the mandibular border anterior to the facial artery E. The frontal branch passes lateral to the tail of the brow
5.
All of the following statements regarding facelift scars are true except: A. A posttragal scar is preferable in men with heavy beards B. A horizontal sideburn incision may avoid displacement of the sideburn C. A postauricular sulcus incision (short scar) may be all that is needed in patients with minimal neck skin excess D. A posterior hairline incision is useful in patients with great excess of cervical skin E. A preauricular skin incision is less noticeable below the temporal recess
6.
True statements regarding subcutaneous facelifts include all except that: A. Dissection can be varied in extent B. Direct defatting of the jowls can be performed C. The dermis has less subsequent stress relaxation than the SMAS D. The dissection plane is superficial to the facial nerve branches E. Skin redraping can be either vertical or horizontal
7.
One criticism of the subcutaneous facelift with suture plication has been that: A. Separate skin dissection allows differential movement of the skin and deep tissues B. Suspension sutures can directly reach the anterior cheek fat C. There is a lack of longevity because of suture “tear through” D. Different areas of suspension may be addressed separately E. Deep dissection near facial nerves is avoided
8.
A potential criticism of the SMAS imbrication technique is that: A. Release of the SMAS anteriorly provides greater mobility B. Sub-SMAS dissection puts the facial nerve branches at greater risk C. The “mobile SMAS” is advanced to the “fixed SMAS” D. Vertical elevation of the cheek fat can be achieved E. Imbrication may provide a stronger support than plication
Aesthetic Surgery of the Face and Neck
9.
The potential limitation of the temporal approach to facelift is that: A. A subperiosteal or supraperiosteal approach can be used B. Middle lamella complications in the lower lid are minimized C. The supraperiosteal approach avoids disruption of the origin of the zygomaticus major muscle D. A preauricular incision is avoided E. The lower face is not improved
10. All of the following are true regarding the long, thin neck except that: A. Medial advancement of the platysma does not affect upward mobility of the cheek SMAS B. The optimal cervicomental angle is between 90° and 110° C. Medial platysmal fibers may decussate in the submental area D. The cervical investing fascia holds the platysma within the contour of the neck E. There is a gliding plane deep to the platysma 11. All of the following are true regarding correction of the obtuse fatty neck except that: A. Preplatysmal fat can be removed by liposuction B. Medial subplatysmal fat can be removed though a submental incision C. Partial division of the platysma may be beneficial D. The hyoid lies opposite the third cervical vertebra E. A firm anterior “corset” platysmal closure improves submental contour 12. All the following are true of potential platelet inhibition except that: A. Omega-3 fatty acids (fish oils) inhibit platelet function B. Cyclooxygenase enzymes facilitate the production of thromboxane C. Aspirin is an irreversible cyclooxygenase (COX)1 and COX-2 inhibitor D. PFA-100 is a rapid screen for aspirin induced platelet defects E. Desmopressin may help minimize aspirininduced bleeding 13. True statements regarding the effects of smoking include all the following except: A. Smoking causes a chronic obliterative endarteritis B. A single cigarette can cause a transient 24% to 42% decrease in blood flow C. Skin flap necrosis is 12.5 times greater in smokers D. Nonsmoke nicotine does not affect flap circulation E. Cotinine levels can be rapidly assessed with a salivary test strip
Volume 29 • Number 6 • November/December 2009 • 465
14. True statements regarding the perioperative management of hypertension include all except that: A. A preoperative blood pressure of 140/90 mm Hg or less is desirable B. A transdermal clonidine patch may prevent rebound hypertension from adrenalin in the local anesthetic C. Injected adrenalin may be absorbed for four to 10 hours postoperatively D. Labetalol intravenous boluses may be useful for intraoperative hypertension E. Labetalol is the antihypertensive agent of choice in patients with relative bradycardia
15. All of the following facts are true regarding facelift complications except that: A. Postoperative hematomas occur in approximately 3% of patients B. Men have a higher incidence of hematoma than women C. An adrenalin dilution of 1:100,000 is necessary for wound hemostasis D. Nasal staphylococci can be eradicated with topical mupirocin E. The most common infective agent from the ear canal is Pseudomonas
EVALUATION 1. 2. 3. 4. 5. 6. 7. 8.
Overall, did the activity provide an adequate overview of the subject matter? Yes ____ No ____ The subject matter of the activity was: Too basic ____ Too advanced ____ Just right ____ The length of the activity was: Too short ____ Too long ____ Just right____ This activity increased my awareness and understanding of the issues discussed in the article. Strongly agree____ Agree____ Neutral____ Disagree____ Strongly disagree ____ Did any commercial bias negatively impact this educational activity? Yes ____ No ____ If yes, which product?______________________________________________________ I would again participate in an Aesthetic Surgery Journal CME activity. Yes ____ No ____ I would recommend an Aesthetic Surgery Journal CME activity to a colleague. Yes ____ No____ What other topics (including instructor names, if possible) would you like covered in future issues of Aesthetic Surgery Journal? __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________
Name:________________________________________________________________________________________________ Address:______________________________________________________________________________________________ City/State/Zip: ________________________________________________________________________________________ ASAPS/ASPS ID No.: ____________ Check if not a member of ASAPS or ASPS ____ Copyright © 2009 by The American Society for Aesthetic Plastic Surgery, Inc. 1090-820X/$36.00 doi:10.1016/j.asj.2009.08.021
466 • Volume 29 • Number 6 • November/December 2009
Aesthetic Surgery Journal