Facial Plastic and Reconstructive Surgery
Core concepts
Understand the aesthetic subunits of the face and the principles of scar revision, local flaps, and skin grafts. Know the blood supply of the face and the vascular territories relevant to flap design, including the axial pattern of the paramedian forehead flap. Be familiar with the management of facial fractures (nasal, zygomatic, orbital, mandibular) and the indications for open reduction. Understand the principles of rhinoplasty, including the distinction between reduction and augmentation, and the role of grafting.
Traps
A frequent trap is underestimating nasal bone fractures; a seemingly minor injury may cause septal hematoma, which must be drained to prevent saddle deformity. Another is confusing the flap choice for nasal alar defects: the paramedian forehead flap is the workhorse for large defects. Questions on facial nerve injury often test that the marginal mandibular branch is at risk in submandibular surgery. Do not forget that skin cancer excision in the face prioritizes oncologic clearance while respecting aesthetic subunits.
Worked rule
For any nasal trauma, examine the septum for hematoma; if present, incise and drain and place a stent, because an untreated septal hematoma can cause cartilage necrosis and saddle nose.