Aesthetic Surgery of the Face and Neck
Core concepts
Aesthetic facial surgery requires understanding facial aging in layers (skin, fat compartments, SMAS, bone) and the deep plane vs sub-SMAS vs skin-only rhytidectomy approaches. Know facial nerve danger zones and the SMAS/platysma continuity; neck rejuvenation often needs platysmaplasty. For the nose, understand nasal analysis (dorsal height, tip projection/rotation, alar base) and maneuvers (spreader grafts, columellar strut, tip sutures). For eyelids, know blepharoplasty anatomy, fat compartments, and dry eye/eyelid tone assessment. For brow and forehead, know nerve blocks and frontalis/glabellar dynamics. Understand fillers and neuromodulators, their vascular occlusion risks, and the glabellar and nasal danger zones.
Traps
Questions test patient selection and safety: unrecognized dry eye before blepharoplasty, or a patient with unrealistic expectations. Another trap is vascular occlusion from filler-know danger zones and management (hyaluronidase for HA). Distinguish skin-only vs SMAS lifting for durability and nerve risk. Know that over-resection of nasal dorsum causes saddle nose and that tip support loss causes Polly beak.
Worked example / rule of thumb
A patient requesting upper blepharoplasty with dry-eye symptoms and lax lower lid: assess Schirmer and eyelid tone; avoid aggressive skin excision. Rule of thumb: lift the deeper plane for durability; respect danger zones for filler and nerve; never operate on an unrecognized dry eye.