ABPS Aesthetic Procedures & Patient Safety 2 — Questions and Answers
Question 1: A patient on warfarin requests a facelift. What is the most appropriate perioperative management strategy?
- Discontinue warfarin 5 days preoperatively and bridge with heparin as indicated (Correct answer)
- Continue warfarin at full dose throughout the perioperative period
- Switch permanently to aspirin before scheduling surgery
- Perform the procedure without any anticoagulation modification
Correct answer: Discontinue warfarin 5 days preoperatively and bridge with heparin as indicated
Warfarin should be stopped 5 days before elective surgery, with heparin bridging for high-thromboembolism-risk patients per established guidelines.
Question 2: Which informed consent element is most critical to document before performing liposuction under tumescent local anesthesia?
- Discussion of lidocaine toxicity risk including maximum safe dosing limits (Correct answer)
- Agreement that no revision surgery will be needed
- Patient's confirmation that they have researched the procedure online
- Disclosure of the surgeon's complication rate compared to national average
Correct answer: Discussion of lidocaine toxicity risk including maximum safe dosing limits
Lidocaine toxicity is a unique and potentially fatal risk of tumescent anesthesia that must be explicitly discussed, including the maximum safe dose (~35–55 mg/kg with epinephrine).
Question 3: A patient develops sudden dyspnea and pleuritic chest pain 48 hours after abdominoplasty. The first diagnostic step should be:
- CT pulmonary angiography (Correct answer)
- Chest X-ray only
- D-dimer lab test and discharge if negative
- Empiric anticoagulation without imaging
Correct answer: CT pulmonary angiography
CT pulmonary angiography is the gold standard for diagnosing pulmonary embolism and should be ordered promptly given the high clinical suspicion in this post-operative context.
Question 4: When injecting botulinum toxin for glabellar lines, inadvertent diffusion into which muscle most commonly causes upper eyelid ptosis?
- Levator palpebrae superioris (Correct answer)
- Orbicularis oculi
- Frontalis
- Zygomaticus major
Correct answer: Levator palpebrae superioris
Botulinum toxin diffusion through the orbital septum can weaken the levator palpebrae superioris, causing upper eyelid ptosis.
Question 5: Which of the following is the safest patient position for reducing the risk of venous thromboembolism during a prolonged cosmetic surgery?
- Sequential compression devices applied before induction and maintained throughout (Correct answer)
- Anti-embolism stockings applied at procedure end
- Reverse Trendelenburg positioning throughout the case
- Keeping the patient NPO the night before to reduce blood viscosity
Correct answer: Sequential compression devices applied before induction and maintained throughout
Sequential compression devices started before induction of anesthesia and continued throughout surgery are the most evidence-based mechanical prophylaxis for VTE prevention.
Question 6: A patient presents 6 weeks after rhinoplasty with progressive tip swelling and erythema. The most likely diagnosis is:
- Infected implant or suture abscess requiring drainage and possible implant removal (Correct answer)
- Normal postoperative edema resolving on schedule
- Hematoma requiring immediate surgical evacuation
- Allergic reaction to the surgical drape adhesive
Correct answer: Infected implant or suture abscess requiring drainage and possible implant removal
Progressive erythema and swelling weeks after rhinoplasty suggests infection, often around sutures or implants, requiring drainage and potentially implant removal.
Question 7: The Caprini Risk Assessment Model is used in aesthetic surgery primarily to:
- Stratify individual patient VTE risk and guide prophylaxis intensity (Correct answer)
- Predict likelihood of aesthetic dissatisfaction postoperatively
- Calculate the maximum safe dose of tumescent anesthesia
- Determine candidacy for general versus local anesthesia
Correct answer: Stratify individual patient VTE risk and guide prophylaxis intensity
The Caprini score assigns weighted points to VTE risk factors and guides the choice between no prophylaxis, mechanical-only, or pharmacologic prophylaxis.
ABPS Aesthetic Procedures & Patient Safety 2
A patient on warfarin requests a facelift.
What is the most appropriate perioperative management strategy?