The following filler products are matched with various information. When quoted, the estimated number of patients upon which each has been used is correct in all cases. Which one answer is incorrect?
Product: hyaluronic acid, brand name Restylane®, persistence 12 months, patients 2 million, granuloma rates (manufacturers) 1:50,000. This statement is incorrect; Restylane has a persistence of 6 months not 12, and the quoted manufacturer granuloma rate is 1:2500 not 1:50,000, although published figures from independent authors show granuloma rates of approximately 1:250. A discussion of granulomas should be part of the consent process for any filler injection. The other independent granuloma published rates available for other products are: Zyderm® 1:300, Sculptra® 1:400, Bioalcamid® 1:300. Interestingly, the granuloma rates for permanent silicone gel injections is around 1:1000 (independent and manufacturer’s rates).
Reference:
1. Cohen SR, Born TM. Facial rejuvenation with fillers. In: Techniques in aesthetic surgery. Codner MA, series editor. Edinburgh: Saunders, 2009.
The following is false about aesthetic breast surgery:
A peri-areolar approach is a poor option through which to adjust the inframammary fold (IMF). D is false. The peri-areolar approach allows good access to the IMF. The subfascial position for implants has been reported by both Goes and Graf and may reduce capsular contracture rates. Other positions include the subglandular plane, the subpectoral plane deep to pectoralis major but superficial to minor, a plane beneath both pectoralis and serratus anterior, and the dual plane approach of Tebbetts. Suction as advocated by Khouri and colleagues using the BRAVA® device has purported some success especially with adjunctive fat injection, although the latter technique remains controversial. The circumference of a circle follows the equation 2 x pi x radius (or pi x diameter).
Suggested ‘ideal’ breast measurements in the context of inferior pedicle breast reduction surgery do not include:
The nipple to inframammary fold distance of 3.4cm. C is false. Jack Penn published on the aesthetics of the female breast in 1954 in what was then the British Journal of Plastic Surgery. The ideal nipple to IMF distance was quoted as 6.9cm but some think 5-6cm, and it is dependent on technique employed. He stated in the abstract: “it should be within the capacity of plastic surgery to produce a final modelling which should satisfy the strictest artistic criteria”. The ideal areolar diameter is approximately 3.8- 4.5cm.
The following Q-switched laser is least appropriately matched with the pigment colours for which its ablative efficacies are optimal:
Nd:YAG [KTP] (532) - black, blue and green. All the Q-switched lasers are effective at removing black pigment, although the frequency doubled Nd:YAG laser (KTP laser) is slightly less efficacious than the others listed. Those lasers in the red or infrared spectrum are more effective at ablating complimentary colours such as green. Hence Alexandrite, Ruby and Nd:YAG lasers are effective at ablating green and blue pigments. Nd:YAG has less affinity for green and blue pigments compared with KTP and Alexandrite as it is further into the infrared spectrum. However, it is the deepest penetrating laser, and as such can be more efficacious against pigments in deeper layers of the skin. KTP is a green laser and therefore has affinity for red and yellow pigment, with little affinity for blue and green.
References: 1. Dibernardo BE, Pozner JN. Lasers and non-surgical rejuvenation. In: Techniques in aesthetic surgery. Codner MA, series editor. Edinburgh: Saunders, 2009.
Which of the following is not a useful nerve block for peri-orbital surgery?
Anterior ethmoidal nerve block. This is not a useful nerve block for periorbital surgery. The four major nerve blocks for peri-orbital surgery include the infra-orbital nerve, the zygomaticofacial nerve, the frontal nerve (which anaesthetises the supra-orbital and supratrochlear branches) and the nasociliary block for lacrimal and medial canthal surgery. An isolated anterior ethmoidal block is not undertaken and is included in a nasociliary block.
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