COSMETIC SURGERY SYLLABUS OVERVIEW
AIM: TO OUTLINE GENERAL & SPECIFIC REQUIREMENTS FOR TRAINING
GENERAL:

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
SPECIFIC:

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, ETC.
REGIONS:
FACE – HEAD & NECK:

DISPROPORTION & DEFORMITIES & HOW TO ASSESS

CONCEPT OF PROPORTIONS IE CANONS/THIRDS

CONCEPT OF REGIONS IE UPPER/MID/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
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
BODY:

PROPORTIONS, NORMAL, ABNORMAL, DISPROPORTION &
DEFORMITIES & HOW TO ASSESS

THORAX/CHEST – BREASTS, PECTORAL REGION

ABDOMEN

PELVIS

GLUTEAL

BACK

UPPER LIMBS

LOWER LIMBS
PROCEDURES RE REGION:
FACE:

Facelift

Blepharoplasty

Brow lift

Neck/platysmal surgery

Botox

Dermal fillers including fat grafting

Liposculpture

Facial implants

LASER resurfacing

Other LASER applications (pigmented lesions, telangiectasia, neoplasms etc)

Chemical peels

Dermabrasion/microdermabrasion

Scar treatment eg acne, & revision post surgery or post traumatic

Otoplasty

Hair transplant – scalp & other areas eg 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 eg LHR, neoplasms, fine capillaries

Phalloplasty
ADJUNCTIVE THERAPY:
FACE & BODY
both pre & postop eg endermologie, massage, skin care, role of beauty therapy, etc
ANATOMY:
General & that which is specifically relevant to cosmetic surgery
Include:

Relevant embryology

Surface anatomy & surface markings

Dermatomes

Skin & skin types – various classifications, all useful to a degree but no ideal

Tension lines, Langer’s lines

Muscles & their innervations

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 physiology:

Cell membrane & bio transport mechanisms

Nerve & muscle function

Special senses

Autonomic nervous system

Fluid dynamics, fluid & electrolyte balance

Physiologic 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,
anaphylaxis, 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
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
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

Preop 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, 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 ie 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 e.g. note breast asymmetry
etc
If suitable, explain details of procedure and what is realistically achievable
Show photos
Discuss expected postoperative course, time off work, bruising, swelling,
discomfort, usual follow up, 24 hour availability, etc
Include risks & possible complications
Know when to refer to specialist preop 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 & preop
BEWARE CERTAIN PATIENTS (see later)
Arrange further preop 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/twig light

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 i.e. fibreoptic

Closure

Dressings
POSTOPERATIVE

Immediate i.e. 1st 4 hours

1ST 24 hours

1st week

thereafter
COMPLICATIONS

Intraop

Postop

How to avoid

How to predict

How to treat
SOME BASICS
(KNOWLEDGE ASSUMED BUT REITERATED)
Experience NB – with pts, staff, juniors, seniors, colleagues, emergencies, Cx, etc,
THEN the operation
Medical assessment: thorough Hx, relevant examination, Ix, medications, allergies
Documentation esp. drugs, pre & postop 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, phone call can reassure – 24
hour responsibility
Professionalism
Respect for patients & colleagues
Seek help when necessary, NOT when it’s too late