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218 Part VII&Facial Surgery
REGION-SPECIFIC ANALYSIS
PERIORBITAL
7. With the lid closed, the brow should be how many centimeters above the upper lid margin?
C. 2 cm.
With the lid closed, the brow should be 2 to 2.5 cm above the upper lid margin.
1
REFERENCE
1. Barton FE Jr, ed. Facial Rejuvenation. New York: Thieme Publishers; 2008
REGION-SPECIFIC ANALYSIS
PERIORBITAL
8. In Caucasian females, what is considered to be the most attractive intercanthal distance?
C. 30–35 mm.
The ideal intercanthal distance is 31 to 33 mm; however, 33 to 36 mm can be considered attractive.
REFERENCE
1. Barton FE Jr, ed. Facial Rejuvenation. New York: Thieme Publishers; 2008
REGION-SPECIFIC ANALYSIS
PERIORBITAL
9. What is the minimum distance the upper eyelid should extend below the upper limbus?
C. 1.5 mm.
The upper lid extends down at least 1.5 mm below the upper limbus but no more than 3 mm.
1
1
REFERENCE
1. Barton FE Jr, ed. Facial Rejuvenation. New York: Thieme Publishers; 2008
REGION-SPECIFIC ANALYSIS
PERIORBITAL
10. Which of the following is an indicator of levator dehiscence?
A. High supratarsal fold, thinning of the lid above the tarsal plate.
Indicators of levator dehiscence include elevation of supratarsal fold and an accentuated supratarsal hollow
(Fig. 31.3).
This woman in the photo shows classic signs of left levator dehiscence with ptosis, a high lid crease, and
thinning of the lid above the tarsal plate.
Fig. 31.3 This woman shows classic signs of left levator dehiscence with ptosis, a high lid crease, and thinning
of the lid above the tarsal plate. (Source: Is Levator Dehiscence Present?. In: Codner M, McCord C, ed. Eyelid &
Periorbital Surgery. 2nd Edition. New York: Thieme; 2016.)
1
Chapter 31&Facial Analysis 219
REFERENCE
1. McCord CD Jr, Codner MA, eds. Eyelid & Periorbital Surgery. New York: Thieme Publishers; 2008
REGION-SPECIFIC ANALYSIS
NOSE
11. The width of the body of the nose at the nasal–cheek junction should equal what percentage of the alar base
width?
D. 80%.
The width of the body of the nose at the nasal–cheek junction should equal 80% of the alar base width
(Fig. 31.4).
1,2
Fig. 31.4 The body of the nose at the nasal-cheek junction should equal 80% of the alar base width. (Source:
Proportions of the Face. In: Rohrich R, Adams W, Ahmad J, Gunter J, ed. Dallas Rhinoplasty: Nasal Surgery by the
Masters. 3rd Edition. New York: Thieme; 2014.)
REFERENCES
1. Gunter JP, Rohrich RJ, Adams WP Jr, eds. Dallas Rhinoplasty: Nasal Surgery by the Masters. New York: Thieme
Publishers; 2002
2. Byrd HS, Hobar PC. Rhinoplasty: a practical guide for surgical planning. Plast Reconstr Surg 1993;91:642; discussion 655
220 Part VII&Facial Surgery
REGION-SPECIFIC ANALYSIS
NOSE
12. How many millimeters is considered normal alar flaring in white females?
C. 2 mm.
Normal alar flaring in white females is 2 mm wider than alar base; if it is greater than this, alar base resection should be considered.
1,2
REFERENCES
1. Gunter JP, Rohrich RJ, Adams WP Jr, eds. Dallas Rhinoplasty: Nasal Surgery by the Masters. New York: Thieme
Publishers; 2002
2. Byrd HS, Hobar PC. Rhinoplasty: a practical guide for surgical planning. Plast Reconstr Surg 1993;91:642; discussion 655
REGION-SPECIFIC ANALYSIS
NOSE
13. When evaluating the nose from the basal view, what is the ideal ratio of columella to lobular portion?
C. 2:1.
On basal view, an equilateral triangle is visualized with a 2:1 ratio of columella to lobular portion; the
nostrils should be teardrop shaped (Fig. 31.5).
1,2
Fig. 31.5 Basal view. (Source: Proportions of the Face. In: Rohrich R, Adams W, Ahmad J, Gunter J, ed. Dallas Rhinoplasty:
Nasal Surgery by the Masters. 3rd Edition. New York: Thieme; 2014.)
REFERENCES
1. Gunter JP, Rohrich RJ, Adams WP Jr, eds. Dallas Rhinoplasty: Nasal Surgery by the Masters. New York: Thieme
Publishers; 2002
2. Byrd HS, Hobar PC. Rhinoplasty: a practical guide for surgical planning. Plast Reconstr Surg 1993;91:642; discussion 655
Chapter 31&Facial Analysis 221
REGION-SPECIFIC ANALYSIS
NOSE
14. When evaluating the nasal dorsum in women, how many millimeters should the nasal dorsum lie behind
and parallel to a line connecting the nasofrontal angle with the desired tip projection?
C. 2 mm.
In women it lies 2 mm behind and parallel to a line connecting the nasofrontal angle with the desired tip
projection; a slight supratip break is preferred (Fig. 31.6). In men it lies slightly more anteriorly. If it is
too far posterior to this line, augmentation will be required. If it is too far anterior to this line, reduction
is indicated.
1,2
Fig. 31.6 Nasal dorsum evaluation. (Source: Proportions of the Face. In: Rohrich R, Adams W, Ahmad J, Gunter J, ed.
Dallas Rhinoplasty: Nasal Surgery by the Masters. 3rd Edition. New York: Thieme; 2014.)
REFERENCES
1. Gunter JP, Rohrich RJ, Adams WP Jr, eds. Dallas Rhinoplasty: Nasal Surgery by the Masters. New York: Thieme
Publishers; 2002
2. Byrd HS, Hobar PC. Rhinoplasty: a practical guide for surgical planning. Plast Reconstr Surg 1993;91:642; discussion 655
REGION-SPECIFIC ANALYSIS
NOSE
15. What is the preferred nasolabial angle in women?
C. 95–100 degrees.
Tip rotation is determined by the degree of the nasolabial angle. Draw a straight line through the most anterior and posterior points of the nostrils on lateral view. The angle formed when this line bisects a perpendicular line to the natural horizontal facial plane is the nasolabial angle. In women 95- to 100-degree angle
is preferred. In men 90- to 95-degree angle is preferred (Fig. 31.7).
1,2
222 Part VII&Facial Surgery
Fig. 31.7 Nasolabial angle. (Source: Proportions of the Face. In: Rohrich R, Adams W, Ahmad J, Gunter J, ed. Dallas
Rhinoplasty: Nasal Surgery by the Masters. 3rd Edition. New York: Thieme; 2014.)
REFERENCES
1. Gunter JP, Rohrich RJ, Adams WP Jr, eds. Dallas Rhinoplasty: Nasal Surgery by the Masters. New York: Thieme
Publishers; 2002
2. Byrd HS, Hobar PC. Rhinoplasty: a practical guide for surgical planning. Plast Reconstr Surg 1993;91:642; discussion 655
REGION-SPECIFIC ANALYSIS
NOSE
16. What is the preferred nasolabial angle in men?
B. 90–95 degrees.
Tip rotation is determined by the degree of the nasolabial angle. Draw a straight line through the most anterior and posterior points of the nostrils on lateral view. The angle formed when this line bisects a perpendicular line to the natural horizontal facial plane is the nasolabial angle. In women 95- to 100-degree angle
is preferred. In men 90- to 95-degree angle is preferred (Fig. 31.8).
1,2
Chapter 31&Facial Analysis 223
Fig. 31.8 Nasolabial angle. (Source: Proportions of the Face. In: Rohrich R, Adams W, Ahmad J, Gunter J, ed. Dallas
Rhinoplasty: Nasal Surgery by the Masters. 3rd Edition. New York: Thieme; 2014.)
REFERENCES
1. Gunter JP, Rohrich RJ, Adams WP Jr, eds. Dallas Rhinoplasty: Nasal Surgery by the Masters. New York: Thieme
Publishers; 2002
2. Byrd HS, Hobar PC. Rhinoplasty: a practical guide for surgical planning. Plast Reconstr Surg 1993;91:642; discussion 655
REGION-SPECIFIC ANALYSIS
NOSE
17. What is the preferred columellar– lobular angle?
B. 30–45 degrees.
The columellar–lobular angle is formed by the junction of the columella with the infratip lobule. It is usually
30 to 45 degrees. Increased fullness in this area (usually caused by prominent caudal septum) will give the
appearance of increased tip rotation even though the angle of rotation (nasolabial angle) is within normal
limits (Fig. 31.9).
1,2
224 Part VII&Facial Surgery
Fig. 31.9 Columellar-lobular angle. (Source: Proportions of the Face. In: Rohrich R, Adams W, Ahmad J, Gunter J, ed.
Dallas Rhinoplasty: Nasal Surgery by the Masters. 3rd Edition. New York: Thieme; 2014.)
REFERENCES
1. Gunter JP, Rohrich RJ, Adams WP Jr, eds. Dallas Rhinoplasty: Nasal Surgery by the Masters. New York: Thieme
Publishers; 2002
2. Byrd HS, Hobar PC. Rhinoplasty: a practical guide for surgical planning. Plast Reconstr Surg 1993;91:642; discussion 655
REGION-SPECIFIC ANALYSIS
NOSE
18. Compared with nasal ideals for white patients, the noses of black patients have which of the following
characteristics?
D. Alar flaring.
Compared with nasal ideals for whites, the nose of black patients has the following characteristics: wide,
low nasal dorsum, decreased nasal length and tip projection, poor nasal tip definition, acute columellar–
labial angle, and alar flaring (Fig. 31.10).
1,2
Fig. 31.10 (a,b) Typical characteristics of the noses of black patients. (Source: Proportions of the Face. In: Rohrich R,
Adams W, Ahmad J, Gunter J, ed. Dallas Rhinoplasty: Nasal Surgery by the Masters. 3rd Edition. New York: Thieme; 2014.)
Chapter 31&Facial Analysis 225
REFERENCES
1. Gunter JP, Rohrich RJ, Adams WP Jr, eds. Dallas Rhinoplasty: Nasal Surgery by the Masters. New York: Thieme
Publishers; 2002
2. Byrd HS, Hobar PC. Rhinoplasty: a practical guide for surgical planning. Plast Reconstr Surg 1993;91:642; discussion 655
REGION-SPECIFIC ANALYSIS
EAR
19. When considering ideal ear aesthetics, approximately how many degrees should the long vertical axis incline
posteriorly from the scalp?
B. 20.
In normal ear aesthetics, the ear is positioned approximately one ear length posterior to the lateral orbital
rim and centered in the middle third horizontal plane. The long axis inclines posteriorly approximately 20
degrees from the vertical plane. The ideal width is approximately 55 to 60% of the height. The anterolateral
aspect of the helix protrudes 21 to 30 degrees (1.5–2 cm) from the scalp. The helix should project 2 to 5 mm
more laterally than the antihelix in frontal view (Fig. 31.11).
1,2
Fig. 31.11 (a–c) Normal ear aesthetics. (Source: Ears. In: Janis J, ed. Essentials of Aesthetic Surgery. 1st Edition. New
York: Thieme; 2018.)
REFERENCES
1. Janis JE, Rohrich RJ, Gutowski K A. Otoplasty. Plast Reconstr Surg 2005;115:60e
2. Ha RY, Trovato MJ. Plastic surgery of the ear. Sel Read Plast Surg 2011;11:1
REGION-SPECIFIC ANALYSIS
NECK
20. What is the ideal cervicomental angle?
C. 105–120 degrees.
The qualities of a youthful neck are: a distinct inferior mandibular border, subhyoid depression, a visible
thyroid cartilage bulge, a visible anterior border of the sternocleidomastoid, and a cervicomental angle of
105 to 120 degrees.
1
REFERENCE
1. Ellenbogen R, Karlin JV. Visual criteria for success in restoring the youthful neck. Plast Reconstr Surg 1980;66:826
32. Hair Transplantation
Sammy Sinno, Jeremie Oliver Piña
See Essentials of Aesthetic Surger y, pp. 402–410
DEFINITION OF PROBLEM
1. Which phase of hair growth is prolonged during the thinning and balding process?
A. Anagen.
B. Catagen.
C. Telogen.
D. Club phase.
E. Papillary.
CONTRAINDICATIONS
2. Which of the following is a contraindication to pursuing hair transplantation treatment?
A. Congenital hair loss.
B. Chronic systemic lupus erythematosus (SLE).
C. Scarring-induced alopecia.
D. Androgenic alopecia in a female.
E. Radiation therapy–induced alopecia.
PREOPERATIVE EVALUATION
3. A patient presents to your office seeking hair transplantation. On examination, you observe that the patient
has symmetrical triangular frontotemporal recessions extending more than 2 cm posteriorly. According to the
Norwood classification system, which type of male alopecia would most accurately describe this patient's
condition?
A. Type II.
B. Type III.
C. Type V.
D. Type VI.
E. Type VII.
PREOPERATIVE EVALUATION
4. What is the minimum range of hair follicles per square centimeter that is classified as appearing normal?
A. 0–30.
B. 30–70.
C. 70–110.
D. 140–220.
E. 240–400.
PREOPERATIVE EVALUATION
5. Which of the following are the two most ideal donor sites for hair transplantation harvest?
A. Occipital and frontal.
B. Temporal and frontal.
C. Postauricular and temporal.
D. Temporal and occipital.
E. None of the above.
Chapter 32&Hair Transplantation 227
TECHNIQUE
6. In a mature patient, which of the following landmarks would be most appropriate for donor site selection?
A. Two-thirds of the way down from the posterior fringe to the lower hairline.
B. One-third of the way down from upper border of baldness to the lower hairline.
C. One-half the distance down from the upper border of baldness to the lower hairline.
D. 2 inches above the lower hairline.
E. 2 inches below the posterior fringe.
TECHNIQUE
7. What is the maximum number of hairs acceptable in a mini-graft?
A. 1.
B. 2.
C. 3.
D. 4.
E. 5.
TECHNIQUE
8. Which graft placement technique in relation to the scalp epidermis will best prevent cyst and ingrown hair
formation?
A. Graft placed just above scalp epidermis.
B. Graft placed evenly with scalp epidermis.
C. Graft placed just below scalp epidermis.
D. Cysts and ingrown hairs are inevitable.
E. By grasping the bulb of the follicle prior to graft placement, you can reduce potential cyst formation.
TECHNIQUE
9. In a patient under the age of 23 requesting hair transplantation, what is the appropriate route of initial
therapy?
A. Follicular unit extraction.
B. Strip technique.
C. Combined follicular unit extraction and transplantation.
D. Trial of medical treatment (e.g., minoxidil [Rogaine] or finasteride [Propecia]).
E. Deny treatment until the patient is at least 25 years of age.