COSMETIC SURGERY SYLLABUS OVERVIEW

•    HISTORY OF COSMETIC SURGERY
•    HISTORY OF ACADEMIES, ASSOCIATIONS, SOCIETIES, COLLEGES
•    MISSION STATEMENTS, GOALS OF TRAINING BODIES
•    CODES OF PRACTICE - see GMC publication "Duties of a Doctor - Good Medical Practice"
•    ETHICS
•    MEDICOLEGAL esp. protecting the patient & yourself
•    TRAINING PRE-REQUISITES
•    SOURCES & RESOURCES
•    ACADEMIC Responsibilities & REQUIREMENTS
•    CLINICAL REQUIREMENTS
•    ASSESSMENT-regular, ongoing final
•    ETHENIC SCIENCE as part of Cosmetic Surgery.
•    PROFILE imaging, photography.
•    SCULPTING.

• THEORETICAL, CLINICAL, TECHNICAL, SURGICAL, MEDICAL
• REGIONS - break down into smaller regions which relate to particular procedures:
  

  Face /

  Body /

  Skin

• ANATOMY
• PHYSIOLOGY
• PATHOLOGY - RELEVANT MICROBIOLOGY, IMMUNOLOGY, HISTOLOGY, DERMATOLOGY etc
• PHARMACOLOGY
• PHYSICS / PSYCHOLOGY
• MEDICAL EMERGENCIES
• SURGERY - PROCEDURE, TECHNIQUE, PRE/INTRA / POSTOP
• PHOTOGRAPHY
• STANDARDISE PHOTOGRAPHY, PRE, INTRA, POST-OP NOTES,
• ETHENIC SCIENCE as part of Cosmetic Surgery.
• PROFILE imaging, photography.
• SCULPTING

REGIONS:

FACE - HEAD & NECK:  (Click for Procedure)

•    DISPROPORTION & DEFORMITIES & HOW TO ASSESS
•    CONCEPT OF PROPORTIONS IE CANONS/THIRDS
•    CONCEPT OF REGIONS IE UPPERA41D/LOWER FACE
•    DISTANCES & ANGLES EG NOSE, EARS, EYES, MOUTH, HAIRLINE, ETC
•    NORMAL VARIANTS EG SHAPE OF BROW AS INFLUENCING BOTOX INJECTION
•    EYES
•    NECK
•    FOREHEAD/BROW
•    MALAR/ZYGOMATIC REGION IE CHEEKS/MIDFACE
•    MANDIBULAR REGION IE JAW INCLUDING CHIN
•    MOUTH
•    EARS
•    HAIR
•    NOSE

BODY:  (Click for Procedure)

•    PROPORTIONS, NORMAL, ABNORMAL, DISPROPORTION & DEFORMITIES
     & HOW TO ASSESS
•    THORAX/CHEST - BREASTS, PECTORAL REGION
•    ABDOMEN
•    PELVIS
•    GLUTEAL
•    BACK
•    UPPER LIMBS
•    LOWER LIMBS

SKIN:

•    NORMAL SKIN, LAYERS, STRUCTURES, ETC.
•    HISTOLOGY
•    SKIN & SKIN TYPES - VARIOUS CLASSIFICATIONS, ALL USEFUL TO A DEGREE
     BUT NO IDEAL
•    TENSION LINES, LANGER'S LINES
•    DERMATOMES

PROCEDURES RE REGION:

FACE:

•    Facelift
•    Blepharoplasty
•    Brow lift
•    Neck/platysmal surgery
•    Botulinium Toxoid
•    Dermal fillers including fat grafting
•    Liposculpture
•    Facial implants
•    LASER resurfacing
•    Other LASER applications (pigmented lesions, telangiectasia, neoplasms etc)
•    Chemical peels
•    Dermabrassion / Microdermabrasion
•    Scar treatment e.g. acne, & revision post surgery or post traumatic
•    Otoplasty
•    Hair transplant - scalp & other areas e.g. eyebrows, scars
•    Rhinoplasty

BODY:

•    Liposculpture
•    Other techniques of body contour surgery ie lipectomy
•    Augmentation mammoplasty
•    Reduction mammoplasty
•    Mastopexy
•    Male gynaecomastia - treatment options
•    Abdominoplasty
•    Body implants
•    Sclerotherapy
•    U/S guided sclerotherapy
•    LASER treatments e.g. LHR, neoplasms, fine capillaries
•    Phalloplasty

ADJUNCTIVE THERAPY:

FACE & BODY

both pre & postop eg endermologie, massage, skin care, role of beauty therapy, etc

•    Relevant embryology
•    Surface anatomy & surface markings
•    Dermatomes
•    Skin & skin types -various classifications, all useful lo a degree but no ideal
•    Tension lines, Langer's lines
•    Muscles & their innervation
•    Nerve supply - sensory & motor
•    Blood supply
•    Course & distribution of nerves & vessels
•    Normal/Frequent variations & aberrant structures
•    Association of structures esp. within operative region & those at risk
•    Lymphatics
•    Salivary glands
•    Breasts
•    Organs: eyes, nose, ears
•    Relevant cranial nerve function
•    Examination of nervous system, both cranial & peripheral

•    Nerve blocks

PHYSIOLOGY:

•    Basic review of relevant physiol:
•    Cell membrane & bio transport mechanisms
•    Nerve & muscle function
•    Special senses
•    Autonomic nervous system
•    Fluid dynamics, fluid & electrolyte balance
•    Physiol relevant to administration of anaesthetics & fluid shifts
•    Knowledge required to understand & avoid potential complications, and to treat them
  

PATHOLOGY:

•    INFLAMMATORY RESPONSE
•    WOUND HEALING
•    INFECTION
•    SKIN:
  

Genetics & Biochemistry of the ageing cell
Macro & Micro response to Laser, peels, etc
Histology of normal & ageing skin
Sun damage
Neoplasms
Dermatological lesions & conditions eg acne, acne rosacea, port wine stains etc

PHARMACOLOGY:

ANAESTHETICS - LA, GA

ANTIBIOTICS

STEROIDS & OTHER ANTIINFLAMMATORIES

BOTOX

SEDATION

ANALGESICS

ANTIEMETICS

DERMAL FILLERS

TOPICAL PREPARATIONS

•    MECHANISM OF ACTION
•    SAFETY MARGINS
•    DESIRED EFFECTS
•    UNWANTED/SIDE EFFECTS
•    INTERACTIONS
•    OVERDOSE
•    ALLERGY
•    HOW TO DETECT & TREAT COMPLICATIONS eg cardiac arrhythmias, naphylaxis,
     cardiac arrest etc

PHYSICS:

Must understand relevant physics in order to practice safely

•    DIATHERMY - MONO/BIPOLAR
•    LASER
•    LIPOSUCTION INCLUDING U/S & MECHANICAL
  

PSYCHOLOGY:

•    PATIENT SELECTION

MEDICAL EMERGENCIES:

•    CARDIAC ARREST
•    ANAPHYLAXIS

FOR EACH PROCEDURE:

•    MOST IMPORTANT: Discuss how to assess the pt from a physical viewpoint & decide
     which procedure is appropriate, which method/approach is appropriate & WHY.
•    Indications for procedure
•    Contraindications - absolute/relative
•    Pre-op consultation & assessment
•    Assessment must be both general & specific
•    Thorough relevant medical assessment most important:
         Thorough medical & surgical Hx
  
         Relevant examination & investigations
  
         Medications
  
         Allergies
  
         Response to previous anaesthetics
  
         Psychological assessment
  
         Brief social/personal history may be relevant

•    Thorough assessment from cosmetic surgery viewpoint

               Determine what the pt. wants, feels, and thinks - balance expectations against what is
               cosmetically achievable

               Discuss appropriate procedure of choice - agreement b/w pt & surgeon

               Must be doing this for themselves

               Decide whether pt is appropriate for surgery i. e. pt selection - probably the single most
               important part of the whole process, esp. from psyche viewpoint

               3 categories:
                                Suitable
                                Suitable with reservations
                                Unsuitable

Specific physical assessment relevant to procedure eg note breast asymmetry etc

If suitable, explain details of procedure and what is realistically achievable

Show photos

Discuss expected post-op course, time off work, bruising, swelling, discomfort, usual follow-up, 24 hour availability, etc

Include risks & possible complications

Know when to refer to specialist pre-op e.g. cardiol, ophthalm etc

Make sure that the patient understands & encourage time to make informed decision

Also encourage them to ask questions both at consultation & pre-op

BEWARE CERTAIN PATIENTS (see later)

Arrange further pre-op appointment if necessary e.g. BAM - sizing etc

PREOP

•    PHOTOS
•    MARKINGS
•    CONSENT

SURGICAL TECHNIQUE:

GENERAL / BASIC:

       MOST OF THIS KNOWLEDGE IS ASSUMED SO INCLUDED FOR PURPOSES OF REVIEW

•    GA / LA / twilight
•    Positioning
•    Prepping & draping
•    Sterile technique
•    Sutures, clips, etc & methods of wound closure
•    Instruments.
•    Drainage
•    Dressings
•    Tissue handling - GENTLE
•    Flaps

SPECIFIC: PER PROCEDURE

INTRAOPERATIVE

•    Discuss various approaches & how to select the correct approach for the individual pt
•    Discuss techniques commonly used & internationally accepted
•    Anaesthetic, infiltration
•    Incision/s
•    Dissection
•    Operative technique
•    Haemostasis
•    Identification & preservation of important structures
•    Visual aid ie fibreoptic
•    Closure
•    Dressings

POSTOPERATIVE

•    Immediate ie 1st 4 hours
•    1st 24 hours
•    1st week
•    Thereafter

COMPLICATIONS

•    Intra-op
•    Post-op
•    How to avoid
•    How to predict
•    How to treat

SOURCES / RESOURCES:

•    Text
•    Journals - recent/relevant studies / articles
•    Relevant articles only - summarise contents
•    Internet
•    Product/pharmaceutical/instrument companies
•    Conferences/workshops
•    Colleagues
•    Techniques/practices which are internationally accepted
•    Complications
•    Exam questions

SOME BASICS (can be removed or altered!)

(KNOWLEDGE ASSUMED BUT REITERATED)

Experience NB - with pts, staff, juniors, seniors, colleagues, emergencies, Cx, etc, THEN the operation

Medical assessment: thorough Hx, relevant examination, lx, medications, and allergies

Documentation esp. drugs, pre & post-op notes, op notes, any assessment or problem to be documented clearly

Think pt welfare 1st, closely followed by medico legal considerations

Protect the patient AND yourself

Use logic & rationale - common sense

Continuity, on call, follow-up, minor/major problems, and phone call can reassure - 24-hour responsibility Professionalism

Respect for patients & colleagues

Seek help when necessary, NOT when it's too late