Facial Plastic and Reconstructive

Surgery
 Soal 1
Which of the following will increase photographic
depth of field?
A. Changing from a 60-mm lens at f/ 8 to a 300-mm
lens at f/ 8
B. Moving farther from the subject
C. Changing shutter speed from 1/60 to 1/125 of a
second
D. Changing aperture from f/ 16 to f/ 8
Answer B.
Depth of field is increased the farther the
camera is placed from the subject. Changing
from a 60-mm to a 300-mm lens will lessen or
compress depth of field. Changes in shutter
speed will affect exposure but will not change
depth of field. Since aperture is inversely related
to f- stop, changing from f/ 16 to f/ 8 would
decreasedepth of field.
 Soal 2
Which of the following modifications creates
the illusion of decreased nasal-tip rotation?
A. A dorsal augmentation graft
B. An increase in nasolabial angle
C. A reduction of a hanging columella
D. A lateral crural overlay
Answer: A.
An increase in the nasolabial angle by definition reflects
increase nasal-tip rotation. By shortening the lateral limbs
of the tip tripod, a lateral crural overlay will also increase
tip rotation. A dorsal-hump reduction also creates the
illusion of increasing tip rotation. A hanging columella
creates the illusion of a more acute nasolabial angle, and
therefore, reduction makes the nasolabial angle appear
more obtuse, increasing apparent tip rotation.
Augmenting the nasal dorsum, on the other hand, is one
of many techniques that applies to visually lengthen the
nose and visually derotate the tip (i.e., decrease tip
rotation).
 Soal 3
Which of the following statements is true about
chin augmentation with an implant?
A. Implants commonly cause anterior bony
resorption of the mandible.
B. Implants are preferably placed through an
intraoral approach.
C. The reported incidence of mentalis muscle
dyskinesis is 25%.
D. A small button-style implant aesthetically causes
less complications than wider implants
Answer: A.
Chin implants often cause a small amount of
resorption of the anterior mandible. This
condition is exacerbated by implant mobility.
The mandibular resorption is usually not
clinically significant.
 Soal 4
Which of the following factors provide strong justification
for declining revision rhinoplasty?
A. A well-defined and exacting cosmetic goal on behalf
of the patient
B. The demonstration of anger or frustration by the
patient during the initial consultation
C. Patient familiarity with fundamental rhinoplasty
terminology and common treatment strategies
D. Surgical skills of the surgeon that are insufficient to
achieve the approximate cosmetic goal
E. All of the above
Answer: D.
Pinpointing he specific desires of the patient can
be a critical aspect of surgical planning and can
facilitate communication between the surgeon
and prospective patient. The surgeon must
however be confident that his/her skills are
commensurate with the challenges of revision
surgery before agreeing to proceed surgically.
 Soal 5
Studies examining length of time required for
adhesion between cranium and overlying
periosteum or periosteum with overlying galea
have demonstrated that biomechanical
strength of the dissected flap matches controls at
which time period?
A. 1 to 2 weeks
B. 2 to 4 weeks
C. 4 to 6 weeks
D. 6 to 8 weeks
Answer: D.
Various studies have shown that 6 to 8 weeks
are required for adhesion between the cranium
and overlying periosteum.
 Soal 6
What are the anatomic elements of the internal nasal valve?
A. The caudal margin of the upper lateral cartilage (ULC), the
anterior head of the inferior turbinate, and the adjacent
septum.
B. The cephalic margin of the ULC, the anterior head of the
inferior turbinate, and the adjacent septum.
C. The cephalic margin of the ULC, the medial crus of the lower
lateral cartilages, and the posterior septum.
D. The caudal margin of the ULC, the anterior head of the
inferior turbinate, and the alar rim.
Answer: A.
Anatomically the internal nasal valve is
delimited by the space bounded by the caudal
aspect of the ULC, the head of the inferior
turbinate, and the dorsal septum.
 Soal 7
Which of the following statements are true regarding body
dysmorphic disorder (BDD)?
A. BDD sufferers are at significantly increased risk for suicide.
B. Many BDD patients are delusional and lack awareness
regarding their preoccupation with trivial cosmetic
imperfections.
C. Cosmetic surgery is generally contraindicated in patients
with BDD.
D. A and C.
E. All of the above.
Answer: E.
All of the above are fe atures of BDD. BDD is
much more common among patients seeking
cosmetic surgery than in the general population.
Surgical success rates are extremely poor in
those suffering fr om BDD regardless of the
cosmetic outcome. Patients with suspected BDD
should be referred for psychiatric evaluation and
treatment.
 Soal 8
What is the plane of dissection for the preseptal
transconjunctival approach in blepharoplasty?
A. Between the conjunctiva and the lower eyelid
retractors
B. Between the lower eyelid retractors and the orbital
fat
C. Between the skin and the orbicularis oculi muscle
D. Between the orbicularis oculi muscle and the orbital
septum
E. Directly through the conjunctiva and the lower eyelid
retractors near the conjunctival fornix.
Answer: D.
The preseptal approach involves dissecting
inferiorly along the avascular plane between the
orbital septum and the orbicularis oculi muscle.
The postseptal approach is a more direct
approach to the orbital fat through the
conjunctiva and the lower lid retractors closer
to the conjunctival fornix.
 Soal 9
What is the minimal amount of cartilage width that
should remain for adequate support of the L-strut?
A. 15 mm
B. 20 mm
C. 10 mm
D. 30 mm
E. 25 mm
Answer: C.
The accepted "minimum" width of the dorsal
and caudal septal struts that should remain for
adequate support of the L-strut is 10 mm.
 Soal 10
Examples of pivotal flaps include:
A. Rotation, transposition, and interpolation
flaps
B. Rotation, advancement, and island flaps
C. Bilobe, V-Y, and interpolation flaps
D. Advancement, hinge, and rhomboid flaps
Answer: A.
Pivotal flaps move around a fixed axis toward
the center of the wound. This can include
rotation flaps, transposition flaps, and
interpolation flaps. Island flaps and V-Y flaps are
examples of advancement flaps. Both bilobe and
rhomboid flaps are types of transposition flaps.
 Soal 11
Full-thickness grafts survive initially by diffusion
of nutrition from fluid in the recipient site, a
process known as:
A. Plasma imbibition
B. Vascular inosculation
C. Neovascularization
D. None of the above
Answer: A.
Plasma imbibition, a process whereby nutrients
diffuse into the skin graft from fluids in the
recipient site, is the first process that is active in
the survival of full-thickness skin grafts. This is
followed by vascular inosculation and then
capillary ingrowth.
 Soal 12
Which of the following is the most appropriate
method of stabilizing the nasal base in a patient
with retracted columella?
A. Caudal septal extension graft
B. Columellar strut
C. Set back medial crura on caudal septum
(tongue-in-groove technique)
D. Extended columellar strut fixed to nasal spine
Answer: A.
A columellar strut will stabilize the nasal base when the
medial crura are long and the alar-columellar relationship
is appropriate. An extended columellar strut may be an
option in the patient with poor tip support and a deficient
premaxilla. Setting the medial crura back on the caudal
septum (tongue-in-groove) is effective when the caudal
septum is overly long-the hanging columella. If the
columella is short or retracted, a caudal septal extension
graft will address the alar-columellar disharmony and
restore appropriate length to the septum to allow for
stabilization of the medial crura to the extension graft.
 Soal 13
An overprojected (shallow) radix on nasal
apperance will:
A. Exaggerate nasal dorsal height, creating the
illusion of a "pseudohump"
B. Make the nose look visually longer
C. Make the nasal tip look more rotated
D. Make the nasal tip look more projected
Answer: B.
A shallow (overprojected radix) or a high radix
(cephalically malpositioned) will both have the
effect of making the nose look visually longer by
increasing distance from to tip-defining point.
 Soal 14
How are contour irregularities that are seen 1
week following cervical liposuction and anterior
platysmaplasty best managed?
A. Reexploration
B. Steroid injections
C. Massage
D. Reassurance
Answer: D.
Early contour irregularities following cervical
liposuction are the rule rather than the
exception. Most resolve as healing progresses
and edema lessens.
 Soal 15
What complication from face-lifting is thought to be
significantly more frequent in men than in women?
A. Hematoma
B. Nerve injury
C. Skin necrosis
D. Hypoesthesia
E. Pixie ear deformit
Answer: A.
Due to the rich subdermal vascular plexus
supplying their hair follicles, hematoma rates
are higher in male patients
 Soal 16
True or False: The greater the pivot of the flap,
the shorter the effective length of the flap?
A. True
B. False
Answer: A.
In general, the greater the degree of rotation or
pivot, the shorter the effective length of the
flap. This needs to be taken into account with
flap design-with increasing degrees of pivot a
longer flap must be designed to allow for the
loss of effective length.
 Soal 17
You are asked to evaluate a newborn with bilateral
microtia and atresia. What is your most important
recommendation?
A. High-resolution CT scan
B. Auditory brainstem response testing
C. Placement of bone conduction hearing aid
D. Plan to perform surgical correction at 10 weeks
E. Molding splints to the microtic vestige
Answer: C.
Patients with bilateral microtia/atresia should
get a bone conduction hearing aid before their
first birthday to maximize their ability to verbally
communicate and develop.
 Soal 18
Which of the following best characterizes a prominent
ear?
A. Absent antihelical fold
B. Absent antihelical fold and large conchal bowl
C. Absent antihelical fold and defect of upper one-
thirds of the helix
D. Absent antihelical fold and purse-string appearance
at helix
Answer: B.
The prominent ear is a type of deformational
auricular anomaly characterized by an absent
antihelical fold and a deep conchal bowl.
 Soal 19
Blepharochalasis refers to:
A. Excess skin of the lower eyelid
B. Drooping of the lower eyelid
C. A rare recurrent inflammatory disorder of the
eyelids
D. Orbital fat pseudo herniation
E. Scleral show
Answer: C.
Dermatochalasis refers to excess skin of the
eyelids. Dermatochalasis should not be confused
with blepharochalasis, which is a rare
inflammatory disorder of the eyelids
characterized by recurrent edema.
 Soal 20
During endoscopic browlift surgery, the temporal branch of the
facial nerve can be safely preserved:
A. With endoscopic assisted dissection lateral to the orbital rim
and zygomatic arch
B. By dissecting along the undersurface of the temporoparietal
fascia
C. By identifying the “sentinel vein” and staying deep in a plane
deep to the temporoparietal fascia
D. By dissecting medially within a radius of 3 cm from the
lateral orbital rim
Answer: C.
The temporal branch of the facial nerve can be
reliably found running just superficial to the
sentinel vein. The nerve runs in the deep
portion of the temporoparietal fascia.
 Soal 21
Which of the following statements best describes the
Tyndall effect?
A. It can be treated with a-adrenergic ophthalmic
drops to stimulate Mueller's muscle.
B. It is seen with overly superficial injection of
polymethyl methacrylate.
C. It may require treatment with hyaluronidase.
D. It results from intra-arterial injection of a dermal
filler.
Answer: C.
The Tyndall effect is a bluish discoloration of the
overlying skin seen when hyaluronic acid (HA) fillers
are placed too superficially. This can be treated with
extrusion of the product through a nick in the
overlying skin if seen early. If not noted early,
untoward side effects with HA fillers can be treated
by dissolving the product with the injection of
hyaluronidase.
 Soal 22
Which of the following statements regarding the
overresected nose is not correct?
A. Noncompliant skin does not affect successful revision
of the overresected nasal tip.
B. Reducing dorsal septal height exacerbates the sequela
of the overresected tip.
C. The inverted-V deformity can arise without
overresection of the dorsum.
D. Preserving 6 mm of lateral crural width does not
always prevent crural collapse.
E. All of the above.
Answer: A.
Skeletal reexpansion of the overresected nose in
the patient with inelastic skin and a
noncompliant skin envelope can jeopardize
tissue perfusion and lead to ischemic
compromise. Skin stretching exercise may be
helpful to improve tissue elasticity.
 Soal 23
Which type of lighting best replicated natural
sunlight to see deviations in nose shape?
A. Anterior flash
B. Overhead flash
C. Side flash
D. Inferior flash
E. Posterior flash
Answer: B.
An overhead flash most closely replicates
natural overhead sunlight which accentuates
deviations in the crooked nose.
 Soal 24
What type of total pharyngeal reconstruction provides
the best speech and swallowing results?
A. Gastroomental
B. Anterolateral thigh
C. Jejunum
D. Latissumus dorsi from a patient with a high body
mass index
Answer: B.
The anterolateral thigh is a source which is thin,
pliable, and affords the surgeon a large skin
paddle. Cutaneous donor sites can provide
better voice, less dysphagia, and less donor site
morbidity. Peristalsis of the jejunal flap can
produce functional problems with swallowing
and voice issues as well.
 Soal 25
In general, composite grafts should be limited in
size to:
A. 2cm
B. 5 mm
C. 1 cm or less from each wound edge
D. The entire aesthetic unit should be replaced
Answer: C.
Survival of composite grafts ultimately depends on
ingrowth of capillaries from the wound edges. The
farther the center of the graft is from the edge of the
defect (i.e., larger grafts), the more likely it becomes
that the graft will fail before sufficient capillary
ingrowth occurs. Current recommendations are that no
portion of the graft should be more than 1 cm from a
wound edge.
 Soal 26
A 27-year-old pregnant woman presents to an urgent care clinic
with a 3-week history of a rapidly growing red friable papule that
easily bleeds on the lateral commisure of the mouth. As the
consulting physician you astutely clinically diagnose:
A. Fibrous papule
B. Basal cell carcinoma
C. Angioma
D. Pyogenic granuloma
E. Sebaceous hyperplasia
Answer: D.
Pyogenic granulomas are the most common
acquired hemangiomas. They are often
precipitated by minor trauma or pregnancy.
 Soal 27
A patient is left with a 10-cm2 defect of the scalp after
resection of a basal cell carcinoma. A reconstructive
surgeon plans on using a tissue expander to reconstruct
the defect. What is the ideal surface area of the expander
base that should be used?
A. 5 cm2
B. 10 cm2
C. 20 cm2
D. 30 cm2
E. 40 cm2
Answer: D.
The surface area of the expander base should be
2.5 to 3 times as large as the defect size.
 Soal 28
Which of the following is not a consequence of
cephalically positioned lateral crura?
A. Lateral wall collapse
B. Parenthesis deformity
C. Increased middle vault width
D. Ptotic nasal tip
Answer: D.
Cephalically positioned lateral crura offer poor
support to the lateral nasal wall/external nasal
valve increasing the risk of dynamic collapse. In
addition, the cephalic malposition creates a
bulbous nasal tip with a "parenthesis" deformity
and apparent increase in middle vault width.
 Soal 29
Which of the following muscles is a brow
depressor?
A. The corrugator procerus
B. The depressor supercilii
C. The depressor oculi
D. The oculi supercilii
Answer: B.
The depressor supercilii (the fibers of the
orbicularis oculi deep to the medial brow) is the
only muscle listed that is a brow depressor. The
other brow depressors are the corrugator
supercilii, the orbicularis oculi, and the procerus
 Soal 30
The injectable filler most likely to be seen on CT
scan is:
A. Hyaluronic acid (Juvederm)
B. Calcium hydroxylapatite (CaHA) (Radiesse)
C. Poly-L-lactic acid (Sculptra)
D. Silicone
Answer: B.
Radiesse is made up of 30% CaHA microspheres
suspended in a 70% carrier gel made up of water,
glycerin, and carboxymethylcellulose. The CaHA is
apparent within the soft tissue on CT imaging.
Juvederm is made up of hyaluronic acid and Sculptra is
an injectable poly-L-lactic acid