Aesthetic Surgery (Face, Breast, Body Contouring)
What this domain tests
Patient selection, safe planes, complication recognition and the decision points that distinguish a good from a dangerous outcome. Stems often hinge on a risk factor or an emergency.
Face
- Ageing involves bone resorption, fat compartment descent and atrophy, SMAS laxity and skin quality.
- Rhytidectomy planes: subcutaneous with SMAS plication, or deep-plane/composite. The frontal branch of the facial nerve runs within the temporoparietal fascia over the zygomatic arch - dissection deep to it in the temporal region risks palsy. The marginal mandibular nerve is at risk below the mandibular angle; the great auricular nerve over the mid-belly of sternocleidomastoid.
- Blepharoplasty: assess levator function, tear film and lid laxity first. Retrobulbar haematoma is an emergency - loss of vision, proptosis, pain - requiring immediate lateral canthotomy and cantholysis. Excess upper lid skin excision causes lagophthalmos.
- Rhinoplasty: tip support from the lower lateral cartilages and septum; spreader grafts for internal valve collapse, alar batten grafts for external valve; over-resection of the dorsum causes an inverted-V deformity.
Breast
- Augmentation: plane (subglandular, subfascial, dual plane), implant selected by base-width measurement; incisions inframammary, periareolar, transaxillary.
- BIA-ALCL: mostly textured implants, late seroma more than one year after implantation, CD30-positive T-cell lymphoma; treatment is capsulectomy with implant removal.
- Capsular contracture graded by Baker I–IV; reduction by Wise pattern with superomedial pedicle, or free nipple graft in very large reductions.
Body contouring
- Abdominoplasty addresses rectus diastasis and skin laxity that liposuction cannot; progressive tension sutures reduce seroma. Highest venous thromboembolism risk in aesthetic surgery - stratify and give prophylaxis.
- Liposuction: tumescent or superwet technique; complications include fluid overload, lidocaine toxicity, visceral perforation and fat embolism.
- Gluteal fat grafting carries the highest reported mortality in aesthetic surgery from fat embolised into gluteal veins; inject subcutaneously only, never intramuscularly.
Worked example
A 42-year-old, BMI 27, two pregnancies, 4 cm rectus diastasis and a suprapubic scar requests liposuction alone. Reasoning: liposuction removes fat but cannot tighten fascia or skin. Standard abdominoplasty with plication, umbilical preservation on its stalk and scar revision addresses the actual pathology; combining full abdominoplasty with large-volume liposuction in one stage in a higher-risk patient should be reconsidered or staged.
Traps
- Operating on a smoker without four weeks of cessation.
- Failing to examine the breast and image appropriately before augmentation.
- Ignoring a late seroma around a textured implant.
- Treating a retrobulbar haematoma with observation.
- Injecting gluteal fat into muscle.