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478 Part IX&Body Contouring
CRYOLIPOLYSIS
6. What is the incidence of localized erythema and edema following cryolipolysis?
A. <1%.
B. 5%.
C. 15%.
D. 50%.
E. 100%.
CRYOLIPOLYSIS
7. What is the incidence of paradoxical adipose hyperplasia following cryolipolysis?
A. <1%.
B. 5%.
C. 15%.
D. 50%.
E. 100%.
HIGH-INTENSITY FOCUSED ULTRASOUND (HIFU)
8. What is the mechanism of action of high-intensity focused ultrasound (HIFU)?
A. Thermal ablation of subcutaneous tissue with induction of neocollagenesis.
B. Increased peripheral blood flow leading to greater metabolic demand.
C. Decreased volume by limiting edema and improving the egress of lymphatic fluid.
D. Tightening the skin and subcutaneous tissue through myofibroblast activation.
E. Tightening the skin and subcutaneous tissue through heating via low frequency electromagnetic waves.
HIGH-INTENSITY FOCUSED ULTRASOUND (HIFU)
9. Generally, what is the focal depth of high-intensity focused ultrasound (HIFU)?
A. <5 mm.
B. 5–10 mm.
C. 11–16 mm.
D. 20–30 mm.
E. >30 mm.
HIGH-INTENSITY FOCUSED ULTRASOUND (HIFU)
10. What is the incidence of minor complications following high-intensity focused ultrasound (HIFU)?
A. <1%.
B. 5%.
C. 15%.
D. 50%.
E. 100%.
HIGH-INTENSITY FOCUSED ULTRASOUND (HIFU)
11. At what time point will results be typically seen following treatment with high-intensity focused ultrasound
(HIFU)?
A. Immediate.
B. 1 week.
C. 2–4 weeks.
D. 8–12 weeks.
E. 6 months.
LOW-LEVEL LASER THERAPY (LLLT)
12. What is the mechanism of action of low-level laser therapy (LLLT)?
A. Thermal ablation of subcutaneous tissue with induction of neocollagenesis.
B. Increased peripheral blood flow leading to greater metabolic demand.
C. Induction of a transitory pore into an adipocyte resulting in the release of lipids and adipocyte deflation.
D. Tightening the skin and subcutaneous tissue through myofibroblast activation.
E. Tightening the skin and subcutaneous tissue through heating via low frequency electromagnetic waves.
Chapter 64&Noninvasive Body Contouring 479
LOW-LEVEL LASER THERAPY (LLLT)
13. At what distance should the diode be from the skin for low-level laser therapy (LLLT)?
A. Directly on the skin.
B. Several millimeters above the skin with ultrasound jelly on the skin.
C. 2 cm above the skin.
D. 10 cm above the skin.
E. 15 cm above the skin.
LOW-LEVEL LASER THERAPY (LLLT)
14. Which of the following is a very rare and unexpected risk following low-level laser therapy (LLLT)?
A. Mild warming during the procedure.
B. Erythema.
C. Intermittent paresthesias after first treatment.
D. Potential skin ulceration.
E. Paroxysmal hypertrophy of subcutaneous tissue.
LOW-LEVEL LASER THERAPY (LLLT)
15. What is the incidence of skin ulceration from low-level laser therapy (LLLT)?
A. <1%.
B. 3%.
C. 12%.
D. 20%.
E. 33%.
NONINVASIVE BODY CONTOURING
16. Which of the following is accurate regarding the use of noninvasive body contouring procedures?
A. The number of noninvasive body contouring procedures performed in the United States each year is growing
quickly.
B. Noninvasive body contouring typically has a prolonged patient downtime.
C. Noninvasive body contouring often requires only 1 to 2 treatments to achieve excellent results.
D. Noninvasive body contouring modalities can be considered as replacement for liposuction, healthy lifestyle,
or a treatment to lose weight.
E. Noninvasive body contouring results are usually seen within 1 to 2 weeks after treatment.
480 Part IX&Body Contouring
Answers
PREOPERATIVE EVALUATION
1. Which of the following patients would be an appropriate candidate for noninvasive body contouring?
B. A 32-year-old female with a BMI of 23 with small areas of stubborn flank lipodystrophy but who oth-
erwise was unwilling to undergo a surgical procedure.
Of the candidates described, the best candidate for noninvasive body contouring would be choice B. In general, this is a thin woman with localized areas of concern. Noninvasive body contouring would not be good for
the massive weight loss patient with excess skin, those who are actively losing weight, or for the correction
of a rectus diastasis. In addition, noninvasive body contouring modalities are not a replacement for liposuction, healthy lifestyle, or a treatment to lose weight. In addition, noninvasive modalities often require multiple treatments to achieve modest results.
REFERENCES
1. Manstein D, Laubach H, Watanabe K, et al. Selective cryolysis: a novel method of non-invasivefat removal. Lasers
Surg Med 2008;40:595
2. Zelickson B, Egbert BM, Preciado J, et al. Cryolipolysis for noninvasivefat cell destruction: initial results from a pig
model. Dermatol Surg 2009;35:1462
3. Ingargiola MJ, Motakef S, Chung MT, et al. Cryolipolysis for fat reduction and body contouring: safety and efficacy
of current treatment paradigms. Plast Reconstr Surg 2015;135:1581
1,2,3
INFORMED CONSENT
2. Which of the following should be counseled to the patient when describing noninvasive body contouring
procedures?
D. No guarantee of final aesthetic outcome.
Although generally well tolerated, almost all modalities will have some component of discomfort during the
procedure. This is generally followed by a few days to a week of erythema/edema. With some modalities,
there is a risk of peripheral nerve paresthesias or hyperesthesias. Most importantly, there is no guarantee
of aesthetic outcome and results are largely dependent on an individual's response to these energy
devices.
1,2,3,4,5
REFERENCES
1. Ingargiola MJ, Motakef S, Chung MT, et al. Cryolipolysis for fat reduction and body contouring: safety and efficacy
of current treatment paradigms. Plast Reconstr Surg 2015;135:1581
2. Coleman SR, Sachdeva K, Egbert B, et al. Clinical efficacy of noninvasive cryolipolysis and its effects on peripheral
nerves. Aesthetic Plast Surg 2009;33:482
3. Jewell ML, Baxter RA, Cox SE, et al. Randomized sham-controlled trial to evaluatethe safety and effectiveness of a
high-intensity focused ultrasound device for noninvasive body sculpting. Plast Reconstr Surg 2011;128:253
4. Robinson DM, KaminerMS, Baumann L, et al. High-intensity focused ultrasound for the reduction of subcutaneous
adipose tissue using multiple treatment techniques. Dermatol Surg 2014;40:641
5. Neira R, Arroyave J, Ramirez H, et al. Fat liquefaction: effect of low-level laser energy on adipose tissue. Plast
Reconstr Surg 2002;110:912; discussion 923
METHODS
3. Which of the following would be considered to be invasive body contouring?
E. Power-assisted liposuction.
Power-assisted liposuction requires incisions and is not considered a noninvasive body contouring method.
The other options are all technologies currently used for noninvasive body contouring.
1,2,3,4
Chapter 64&Noninvasive Body Contouring 481
REFERENCES
1. Ingargiola MJ, MotakefS, Chung MT, et al. Cryolipolysis for fat reduction and body contouring: safety and efficacy
of current treatment paradigms. Plast Reconstr Surg 2015;135:1581
2. Robinson DM, KaminerMS, Baumann L, et al. High-intensity focused ultrasound for the reduction of subcutaneous
adipose tissue using multiple treatment techniques. Dermatol Surg 2014;40:641
3. Friedmann DP. A review of the aesthetic treatment of abdominal subcutaneous adipose tissue: background,
implications, and therapeutic options. Dermatol Surg 2015;41:18
4. Jackson RF, Stern FA, Neira R, et al. Application of low-level laser therapy for noninvasive body contouring. Lasers
Surg Med 2012;44:211
CRYOLIPOLYSIS
4. What is the mechanism of action of cryolipolysis that occurs by placing cooling panels to a localized area?
B. Cause apoptosis-mediated cell death and subsequent inflammatory response.
The proposed mechanism of cryolipolysis is through an apoptosis-mediated cell death and subsequent
inflammatory response to the subcutaneous fat. The panels act to cool the tissue in a controlled manner.
The subcutaneous tissue is more susceptible to damage than the skin, thus causing a hypotrophy of the subcutaneous tissue. The other mechanisms are not supported by the current body of literature.
1,2,3
REFERENCES
1. Manstein D, Laubach H, Watanabe K, et al. Selective cryolysis: a novel method of non-invasivefat removal. Lasers
Surg Med 2008;40:595
2. Zelickson B, Egbert BM, Preciado J, et al. Cryolipolysis for noninvasivefat cell destruction: initial results from a pig
model. Dermatol Surg 2009;35:1462
3. Ingargiola MJ, MotakefS, Chung MT, et al. Cryolipolysis for fat reduction and body contouring: safety and efficacy
of current treatment paradigms. Plast Reconstr Surg 2015;135:1581
CRYOLIPOLYSIS
5. Which of the following medical problems is a contraindication to cryolipolysis?
C. Cold-induced dermatologic syndromes.
Patients are contraindicated for cryolipolysis if they pregnant or have a history of cold-induced dermatologic
syndromes (e.g., cryoglobulinemia, paroxysmal cold hemoglobinuria, or cold urticaria). Clotting deficiencies
and other hematology disorders are not generally thought of as contraindications to cryolipolysis. Other relative contraindications are those with excessive skin laxity and large-volume weight loss in obese
patients.
1,2,3
REFERENCES
1. Manstein D, Laubach H, Watanabe K, et al. Selective cryolysis: a novel method of non-invasivefat removal. Lasers
Surg Med 2008;40:595
2. Zelickson B, Egbert BM, Preciado J, et al. Cryolipolysis for noninvasivefat cell destruction: initial results from a pig
model. Dermatol Surg 2009;35:1462
3. Ingargiola MJ, MotakefS, Chung MT, et al. Cryolipolysis for fat reduction and body contouring: safety and efficacy
of current treatment paradigms. Plast Reconstr Surg 2015;135:1581
CRYOLIPOLYSIS
6. What is the incidence of localized erythema and edema following cryolipolysis?
E. 100%.
All patients should expect localized erythema immediately following the treatment. The patient should
understand that this could last up to 7 days. In addition, patients should know that there is a 67% incidence
of developing postprocedural sensory deficits in the treated area. These deficits generally self-resolve by 2
months.
1,2
482 Part IX&Body Contouring
REFERENCES
1. Ingargiola MJ, Motakef S, Chung MT, et al. Cryolipolysis for fat reduction and body contouring: safety and efficacy
of current treatment paradigms. Plast Reconstr Surg 2015;135:1581
2. Coleman SR, Sachdeva K, Egbert B, et al. Clinical efficacy of noninvasive cryolipolysis and its effects on peripheral
nerves. Aesthetic Plast Surg 2009;33:482
CRYOLIPOLYSIS
7. What is the incidence of paradoxical adipose hyperplasia following cryolipolysis?
A. <1%.
Paradoxical adipose hyperplasia is a rare but potential side effect of cryolipolysis. Specifically, rates have
been quoted at approximately 0.52%. There have been no reports of spontaneous resolution. Liposuction
is the preferred method of treatment but some cases require surgical excision.
1,2
REFERENCES
1. Ingargiola MJ, Motakef S, Chung MT, et al. Cryolipolysis for fat reduction and body contouring: safety and efficacy
of current treatment paradigms. Plast Reconstr Surg 2015;135:1581
2. Karcher C, Katz B, Sadick N. Paradoxical hyperplasia post cryolipolysis and management. Dermatol Surg
2017;43:467
HIGH-INTENSITY FOCUSED ULTRASOUND (HIFU)
8. What is the mechanism of action of high-intensity focused ultrasound (HIFU)?
A. Thermal ablation of subcutaneous tissue with induction of neocollagenesis.
The mechanism of action of HIFU is thought to be thermal ablation of subcutaneous tissue with induction of
new collagen formation. HIFU increases the local temperature in the midlamellar fat layer leading to a
coagulative necrosis of adipocytes and a reduction of the fat layer. The other mechanisms have not been proposed or defended based on the current body of literature.
1,2,3,4
REFERENCES
1. Fatemi A. High-intensity focused ultrasound effectively reduces adipose tissue. Semin Cutan Med Surg
2009;28:257
2. Fatemi A, Kane MA. High-intensity focusedultrasoundeffectivelyreduceswaistcircumference by ablating adipose
tissue from the abdomen and flanks: a retrospective case series. Aesthetic Plast Surg 2010;34:577
3. Jewell ML, Baxter RA, Cox SE, et al. Randomized sham-controlled trial to evaluatethe safety and effectiveness of a
high-intensity focused ultrasound device for noninvasive body sculpting. Plast Reconstr Surg 2011;128:253
4. Robinson DM, KaminerMS, Baumann L, et al. High-intensity focused ultrasound for the reduction of subcutaneous
adipose tissue using multiple treatment techniques. Dermatol Surg 2014;40:641
HIGH-INTENSITY FOCUSED ULTRASOUND (HIFU)
9. Generally, what is the focal depth of high-intensity focused ultrasound (HIFU)?
C. 11–16 mm.
The focal depth of HIFU is generally considered to be between 1.1 and 1.6 cm. The focal depth is determined
by the thickness of adipose tissues being treated (Fig. 64.1). The total energy dose is 100 to 150 J/cm
Multiple passes are made with the HIFU transducer to deliver the appropriate amount of energy with
treatment durations typically lasting <1 hour.
1,2,3,4
3
.
High-intensity
focused ultrasound
device (HIFU)
Chapter 64&Noninvasive Body Contouring 483
Ultrasound
imaging transducer
Focused ultrasound
therapeutic transducer
Skin
Fat
Low energy everywhere
except in the focal area
Fig. 64.1 The HIFU transducer focally delivers the beam to the treatment nodes to thermally ablate fat. The lowenergy beams pass through skin over a wider area (with minimal damage) to converge at a focal depth within
the fat. (Source: Technique. In: Janis J, ed. Essentials of Aesthetic Surgery. 1st Edition. New York: Thieme; 2018.)
REFERENCES
1. Fatemi A. High-intensity focused ultrasound effectively reduces adipose tissue. Semin Cutan Med Surg
2009;28:257
2. Fatemi A, Kane MA. High-intensity focusedultrasoundeffectivelyreduceswaistcircumference by ablating adipose
tissue from the abdomen and flanks: a retrospective case series. Aesthetic Plast Surg 2010;34:577
3. Jewell ML, Baxter RA, Cox SE, et al. Randomized sham-controlledtrial to evaluatethe safety and effectiveness of a
high-intensity focused ultrasound device for noninvasive body sculpting. Plast Reconstr Surg 2011;128:253
4. Robinson DM, KaminerMS, Baumann L, et al. High-intensity focused ultrasound for the reduction of subcutaneous
adipose tissue using multiple treatment techniques. Dermatol Surg 2014;40:641
HIGH-INTENSITY FOCUSED ULTRASOUND (HIFU)
10. What is the incidence of minor complications following high-intensity focused ultrasound (HIFU)?
C. 15%.
The incidence of minor complications from HIFU is 10 to 15%, which have been shown to resolve on their
own over 1 to 2 weeks. These included tenderness, edema, ecchymosis, and hard lumps in the treated areas.
Pain is adequately controlled with topical or oral analgesics. All complications are self-limited.
1
REFERENCE
1. Jewell ML, Baxter RA, Cox SE, et al. Randomized sham-controlledtrial to evaluatethe safety and effectiveness of a
high-intensity focused ultrasound device for noninvasive body sculpting. Plast Reconstr Surg 2011;128:253
HIGH-INTENSITY FOCUSED ULTRASOUND (HIFU)
11. At what time point will results be typically seen following treatment with high-intensity focused ultrasound
(HIFU)?
D. 8–12 weeks.
The results of HIFU are not immediate. Instead, results are typically seen 8 to 12 weeks after treatment. This
is important when counseling potential patients and when seeing early postprocedural patients.
1,2,3,4
484 Part IX&Body Contouring
REFERENCES
1. Fatemi A. High-intensity focused ultrasound effectively reduces adipose tissue. Semin Cutan Med Surg
2009;28:257
2. Fatemi A, Kane MA. High-intensity focusedultrasoundeffectivelyreduceswaistcircumference by ablating adipose
tissue from the abdomen and flanks: a retrospective case series. Aesthetic Plast Surg 2010;34:577
3. Jewell ML, Baxter RA, Cox SE, et al. Randomized sham-controlled trial to evaluatethe safety and effectiveness of a
high-intensity focused ultrasound device for noninvasive body sculpting. Plast Reconstr Surg 2011;128:253
4. Robinson DM, KaminerMS, Baumann L, et al. High-intensity focused ultrasound for the reduction of subcutaneous
adipose tissue using multiple treatment techniques. Dermatol Surg 2014;40:641
LOW-LEVEL LASER THERAPY (LLLT)
12. What is the mechanism of action of low-level laser therapy (LLLT)?
C. Induction of a transitory pore into an adipocyte resulting in the release of lipids and adipocyte
deflation.
Low-level laser therapy is believed to place transient pores into adipocytes leading to deflation. There is
controversy over efficacy of this technique. In addition, there is no consistent observations of adipocyte
disruption on histology or electron-scanning microscopy in human cells or animal models. That being said,
there were several studies that report decrease in circumference measurements following LLLT. It should be
noted that these studies have low sample size, no postprocedural body mass index (BMI) control, and
encouraged patients to undergo diet and exercise regiments after treatments.
1,2,3
REFERENCES
1. Neira R, Arroyave J, Ramirez H, et al. Fat liquefaction: effect of low-level laser energy on adipose tissue. Plast
Reconstr Surg 2002;110:912; discussion 923
2. Friedmann DP. A review of the aesthetic treatment of abdominal subcutaneous adipose tissue: background,
implications, and therapeutic options. Dermatol Surg 2015;41:18
3. Brown SA, Rohrich RJ, Kenkel J, et al. Effect of low-level laser therapy on abdominal adipocytes before lipoplasty
procedures. Plast Reconstr Surg 2004;113:1796
LOW-LEVEL LASER THERAPY (LLLT)
13. At what distance should the diode be from the skin for low-level laser therapy (LLLT)?
E. 15 cm above the skin.
For LLLT, the diode modules are suspended approximately 15 cm above the anterior and then the posterior
aspect of the treatment area. A 635 nm laser is used for transdermal delivery of energy. That being said,
specific distances, wattage, wavelength, and delivery duration vary depending on the device used.
1,2,3
REFERENCES
1. Neira R, Arroyave J, Ramirez H, et al. Fat liquefaction: effect of low-level laser energy on adipose tissue. Plast
Reconstr Surg 2002;110:912; discussion 923
2. Friedmann DP. A review of the aesthetic treatment of abdominal subcutaneous adipose tissue: background,
implications, and therapeutic options. Dermatol Surg 2015;41:18
3. Brown SA, Rohrich RJ, Kenkel J, et al. Effect of low-level laser therapy on abdominal adipocytes before lipoplasty
procedures. Plast Reconstr Surg 2004;113:1796
LOW-LEVEL LASER THERAPY (LLLT)
14. Which of the following is a very rare and unexpected risk following low-level laser therapy (LLLT)?
E. Paroxysmal hypertrophy of subcutaneous tissue.
Following low-level laser therapy (LLLT), mild warming of the skin during the procedure is likely followed
by the potential for prolonged erythema (>24 hours). Skin ulceration is a potential complication. Although
most complications are self-limited, prolonged erythema and skin ulceration have been shown in 12% of
cases. Patients should be counseled on these risks before electing to undergo these procedures.
Paroxysmal hypertrophy is a rare risk related to cryolipolysis.
1,2,3,4,5
Chapter 64&Noninvasive Body Contouring 485
REFERENCES
1. Jackson RF, Dedo DD, Roche GC, et al. Low-level laser therapy as a non-invasive approach for body contouring: a
randomized, controlled study. Lasers Surg Med 2009;41:799
2. Jackson RF, Stern FA, Neira R, et al. Application of low-level laser therapy for noninvasive body contouring. Lasers
Surg Med 2012;44:211
3. Nestor MS, Zarraga MB, Park H. Effect of 635nm low-level laser therapy on upper arm circumference reduction. J
Clin Aesthet Dermatol 2012;5:42
4. Thornfeldt CR, Thaxton PM, Hornfeldt CS. A six-week low-level laser therapy protocol is effective for reducing
waist, hip, thigh, and upper abdomen circumference. J Clin Aesthet Dermatol 2016;9:31
5. Jankowski M, Gawrych M, Adamska U, et al. Low-level laser therapy (LLLT) does not reduce subcutaneous adipose
tissue by local adipocyte injury but rather by modulation of systemic lipid metabolism. Lasers Med Sci
2017;32:475
LOW-LEVEL LASER THERAPY (LLLT)
15. What is the incidence of skin ulceration from low-level laser therapy (LLLT)?
C. 12%.
The rate of skin ulceration from low-level laser therapy (LLLT) has been shown to be as high as 12%. This is
also true of prolonged erythema. Patients must understand this risk prior to electing to undergo LLLT.
1,2,3,4,5
REFERENCES
1. Jackson RF, Dedo DD, Roche GC, et al. Low-level laser therapy as a non-invasive approach for body contouring: a
randomized, controlled study. Lasers Surg Med 2009;41:799
2. Jackson RF, Stern FA, Neira R, et al. Application of low-level laser therapy for noninvasive body contouring. Lasers
Surg Med 2012;44:211
3. Nestor MS, Zarraga MB, Park H. Effect of 635nm low-level laser therapy on upper arm circumference reduction. J
Clin Aesthet Dermatol 2012;5:42
4. Thornfeldt CR, Thaxton PM, Hornfeldt CS. A six-week low-level laser therapy protocol is effective for reducing
waist, hip, thigh, and upper abdomen circumference. J Clin Aesthet Dermatol 2016;9:31
5. Jankowski M, Gawrych M, Adamska U, et al. Low-level laser therapy (LLLT) does not reduce subcutaneous adipose
tissue by local adipocyte injury but rather by modulation of systemic lipid metabolism. Lasers Med Sci
2017;32:475
NONINVASIVE BODY CONTOURING
16. Which of the following is accurate regarding the use of noninvasive body contouring procedures?
A. The number of noninvasive body contouring procedures performed in the United States each year is
growing quickly.
The number of noninvasive body contouring procedures performed in the United States each year is growing quickly. Noninvasive body contouring typically has a limited patient downtime. Additionally, it often
requires multiple treatments to achieve even modest results. Noninvasive body contouring modalities are
not considered a replacement for liposuction, healthy lifestyle, or a treatment to lose weight. Noninvasive
body contouring results are usually seen 2 months after treatment. This is a growing field and should not be
overlookedas potential adjunct or precursor to surgery for selected patients. That being said, patients must
understand the risk and limitations of these modalities.
1,2,3,4,5,6,7,8,9
REFERENCES
1. Ingargiola MJ, MotakefS, Chung MT, et al. Cryolipolysis for fat reduction and body contouring: safety and efficacy
of current treatment paradigms. Plast Reconstr Surg 2015;135:1581
2. Fatemi A. High-intensity focused ultrasound effectively reduces adipose tissue. Semin Cutan Med Surg
2009;28:257
3. Fatemi A, Kane MA. High-intensity focusedultrasoundeffectivelyreduceswaistcircumference by ablating adipose
tissue from the abdomen and flanks: a retrospective case series. Aesthetic Plast Surg 2010;34:577
4. Robinson DM, KaminerMS, Baumann L, et al. High-intensity focused ultrasound for the reduction of subcutaneous
adipose tissue using multiple treatment techniques. Dermatol Surg 2014;40:641
486 Part IX&Body Contouring
5. Friedmann DP. A review of the aesthetic treatment of abdominal subcutaneous adipose tissue: background,
implications, and therapeutic options. Dermatol Surg 2015;41:18
6. Brown SA, Rohrich RJ, Kenkel J, et al. Effect of low-level laser therapy on abdominal adipocytes before lipoplasty
procedures. Plast Reconstr Surg 2004;113:1796
7. Jackson RF, Stern FA, Neira R, et al. Application of low-level laser therapy for noninvasive body contouring. Lasers
Surg Med 2012;44:211
8. Nestor MS, Zarraga MB, Park H. Effect of 635 nm low-level laser therapy on upper arm circumference reduction. J
Clin Aesthet Dermatol 2012;5:42
9. AmericanSocietyof Plastic Surgeons. National Clearinghouseof Plastic Surgery Statistics:2010 Report of the 2009
Statistics. Arlington Heights, IL: American Society of Plastic Surgeons, 2010
65. Aesthetics of Gender Affirmation Surgery
Juan L. Rendon
See Essentials of Aesthetic Surgery, pp. 934–956
ANATOMIC CONSIDERATIONS
1. Which of the following statements is an accurate description regarding the female face relative to male face?
A. The upper female craniofacial skeleton is characterized by greater bone volume relative to males.
B. The female nose tends to be larger because of increased volume of bone and cartilage.
C. In females, the mandibular angle tends to be squared with well-defined corners.
D. Females have a greater concentration of fat in the middle third of the face while males tend to have greater
malar bone volume.
E. Males have a greater concentration of fat in the middle third of the face while females tend to have greater
malar bone volume.
ANATOMIC CONSIDERATIONS
2. Which of the following is an accurate description and consideration when evaluating the hairline?
A. Females tend to have an M-shaped hairline while males have a rounded hairline.
B. Both females and males tend to have M-shaped hairlines.
C. Both females and males tend to have rounded hairlines.
D. Females tend to have a rounded hairline while males have an M-shaped hairline.
E. Females tend to have a rounded hairline that extends slightly lower in the center than in men.
ANATOMIC CONSIDERATIONS
3. A transgender female patient wishes to undergo facial feminization surgery. CT scan demonstrates that the
anterior table of her frontal sinus is 2 mm in thickness. Which of the following approaches is appropriate?
A. A combination of frontal bone set back and burring of the anterior table of the frontal sinus is necessary for
optimal results.
B. Frontal bone set back with osteotomy and repositioning of the anterior wall of the frontal sinus alone.
C. Burring of the anterior table of the frontal sinus is necessary for optimal results.
D. Placement of an alloplastic implant will achieve similar results.
E. The patient is a not a candidate for feminizing forehead surgery.
ANATOMIC CONSIDERATIONS
4. During facial feminization surgery, hair transplantation should ______________.
A. Be performed before androgenic alopecia stabilizes.
B. Be performed after androgenic alopecia stabilizes.
C. Be performed to create an M-shaped hairline.
D. Be performed to create a rounded hairline.
E. Not be performed, as there is no difference between male and female hairlines.
ANATOMIC CONSIDERATIONS
5. Which is the following is a potential reason to be cautious if performing an upper lip lift in conjunction with
an open rhinoplasty in the same stage?
A. Unpredictable aesthetic result.
B. Higher rates of infection.
C. Concern for skin necrosis between the intervening segment of skin between the two incisions.
D. Higher incidence of abnormal scarring and narrowing of the alar base.
E. Higher rates of hematomas.