Facial Plastic and Reconstructive Surgery
Core concepts
Master facial aesthetic subunits and the principle that scars should lie within relaxed skin tension lines. Know nasal anatomy (upper/lower lateral cartilages, septum, tip support) and the goals of rhinoplasty: airway and aesthetics. Understand skin cancer reconstruction - Mohs or excision with margins, then local flap vs graft based on subunit and laxity. Recognise facial nerve danger zones (temporal branch over zygomatic arch, marginal mandibular near mandibular border) and the vascular supply of local flaps (random vs axial). Know cleft lip/palate timing (lip ~3 months, palate ~9–12 months) and the multidisciplinary team. Understand microtia, prominent ear (Mustarde sutures), and facial reanimation options.
Traps
Do not place elective scars across relaxed skin tension lines. Respect the temporal branch - injury causes brow ptosis. Flap necrosis risk increases with tension, smoking, and distal random flaps. Beware confusing cleft lip and palate repair timing.
Rule of thumb
Plan reconstruction by subunit: replace "like with like," keep scars in relaxed skin tension lines, and never compromise the airway for aesthetics.