ABPS Aesthetic Procedures & Patient Safety 3 — Questions and Answers
Question 1: A patient requests hyaluronic acid filler for nasal tip augmentation. The most serious potential complication specific to this anatomic location is:
- Vascular occlusion leading to skin necrosis or blindness via retrograde embolism (Correct answer)
- Prolonged bruising lasting more than 2 weeks
- Infection requiring oral antibiotics
- Asymmetry requiring touch-up injection
Correct answer: Vascular occlusion leading to skin necrosis or blindness via retrograde embolism
The nasal tip and dorsum are high-risk zones due to anastomoses with the ophthalmic artery; retrograde embolism can cause blindness or skin necrosis.
Question 2: Which factor is most predictive of poor psychological outcome following aesthetic surgery?
- Body dysmorphic disorder (BDD) diagnosed preoperatively (Correct answer)
- BMI greater than 30
- History of prior aesthetic procedures
- Age older than 60 years
Correct answer: Body dysmorphic disorder (BDD) diagnosed preoperatively
BDD is the strongest predictor of postoperative dissatisfaction and psychological harm; screening and referral to psychiatry before surgery is essential.
Question 3: The maximum recommended single-session volume of fat removed during liposuction for an outpatient procedure, per most safety guidelines, is:
- 5 liters of total aspirate (Correct answer)
- 10 liters of total aspirate
- 2 liters of pure fat
- No established limit exists
Correct answer: 5 liters of total aspirate
Most safety guidelines and ASPS recommendations cap outpatient liposuction at 5 liters total aspirate to reduce fluid shift risks and systemic complications.
Question 4: A patient undergoing blepharoplasty develops sudden vision loss immediately postoperatively. The most urgent intervention is:
- Immediate wound exploration and hematoma evacuation to relieve orbital compartment pressure (Correct answer)
- IV corticosteroids and ophthalmology consult in 24 hours
- Warm compresses and observation for 1 hour
- Topical lubricating eye drops and patch the eye
Correct answer: Immediate wound exploration and hematoma evacuation to relieve orbital compartment pressure
Retrobulbar hematoma causing vision loss is a surgical emergency; immediate orbital decompression via wound exploration can prevent permanent blindness.
Question 5: Which patient characteristic is an absolute contraindication to outpatient aesthetic surgery under general anesthesia?
- Uncontrolled obstructive sleep apnea without CPAP compliance (Correct answer)
- BMI of 28 with no comorbidities
- Age 65 with well-controlled hypertension
- Prior allergic reaction to penicillin
Correct answer: Uncontrolled obstructive sleep apnea without CPAP compliance
Uncontrolled OSA without CPAP compliance poses an unacceptable risk of postoperative airway obstruction in an outpatient setting lacking overnight monitoring.
Question 6: When performing breast augmentation, which implant pocket plane is associated with the lowest rate of capsular contracture in primary augmentation?
- Dual-plane (partial submuscular) (Correct answer)
- Subglandular
- Subfascial
- Complete submuscular
Correct answer: Dual-plane (partial submuscular)
The dual-plane technique provides partial muscle coverage over the upper implant while allowing the lower pole to be subglandular, balancing contracture risk with aesthetic result.
Question 7: What is the primary mechanism by which epinephrine added to tumescent solution improves safety during liposuction?
- Vasoconstriction reducing systemic lidocaine absorption and blood loss (Correct answer)
- Direct fat cell lysis accelerating aspirate removal
- Reducing postoperative edema by blocking histamine release
- Providing additional analgesic effect synergistic with lidocaine
Correct answer: Vasoconstriction reducing systemic lidocaine absorption and blood loss
Epinephrine causes local vasoconstriction, which slows lidocaine absorption into the systemic circulation and significantly reduces intraoperative blood loss.
ABPS Aesthetic Procedures & Patient Safety 3
A patient requests hyaluronic acid filler for nasal tip augmentation.
The most serious potential complication specific to this anatomic location is: