Injection Suture Suspension Face Lifting: Introduction and Basic Science Exam

What is an Injection Suture Suspension Face lift?

A Non-excisional lift

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Elevation of the thermally undermined flap

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RFAL and Morpheus thermally treated flap

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Fixation of the elevated, thermally undermined flap to the craniofacial skeleton

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Fixation is with a barbed, resorbable suture

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The Suture holds the elevated flap in place until collagen deposition provides the biological fixation and stability

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All of the above

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An Injection Suture Suspension Facelift appeal to all of the following except?

Patients with some degree of Deflation, Descent and Deterioration

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Patients who want a noticeable lift effect

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Patients who want the best results without a scar or open lift

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Patients who will accept a lift result that may only last 3 years

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Patients who want the best lift result and are accepting of a scar and surgery

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Patients on a limited budget and recovery time

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4 Economic downturns that affect general consumer spending include?

The 1999, Dot com bust and Y2K Banking scare

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September 11th, 2001

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The 2008 Financial Crisis

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The COVID-19 Pandemic

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All of the above

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The following factors likely drive boomers and millennials to have cosmetic procedures in a downturn except?

Desire to look good

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Desire to look young

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Desire to look better

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A Vanity culture

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An Ageistic culture

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The “Zoom” streaming culture

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Influencers and Dating apps

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The emergence of GAP procedures by InMode

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Affordable pricing for non-invasive and minimally invasive options

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Improved General Anesthetic drugs

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What can be said of consumer spending in a downturn economy?

Some Luxury good purchases remain strong

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The Lip Stick index improved

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Patients are still looking but may want a deal

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More interest in GAP procedures than bigger, riskier procedures

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It can be a good time to capture market share for your practice

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All of the above

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All of the following are described Injection Suture Suspension Facial Shaping Lifts except?

Brow lift

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Lateral Facelift: Temporal Tuft Loop Lift

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Jawline and Jowl Lift

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Suture suspension upper lip lift

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Mid-Face lift

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Neck lift: Mastoid Hyoid Suspension Loop lift

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The following are all consider pathophysiology of the Aging Brow except?

Typical aging of the Brow is predictable

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Strong central depressors, (DCS and Procerus) pull down the central brow

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Strong lateral depressors (orbicularis oculi lateral fibers) pull down the lateral brow

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The Tail of brow descent aging pattern is most common

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Hooding of the upper lid occurs as the brow descends

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Periosteal resorption of the supraorbital rim is the most important driver of aging of the brow

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Deflation of the supraorbital buttress and the temporal brow hallow occurs

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Attenuation and elongation of the soft issue ligaments of support occurs

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The Aesthetic Brow Lift Contour Goals can commonly include all of the following except?

Elevation of the entire brow (medial, central and lateral third)

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Elevation of the lateral third or “tail of the brow” so it is slightly higher than the head of the brow

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Create a youthful look to the upper third of the face

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Elevation of the lateral 2/3’s of the Brow (Tail and central 1/3)

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Create a vital, rested look to the upper third of the face

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Elevation of the Head of the brow higher than the lateral 2/3’s of the brow

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Create an “exotic”, elegant tail of the brow elevation where the outer 1/3 is higher than the rest of the Brow

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Elevate some of the upper lid hooding up off the Supra-tarsal fold and increase the upper lid show

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Classification of the Injection Suture Suspension Browlift can include all of the following except?

Classify by the Brow Segment to the lifted

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Lateral Brow Lift or lateral 1/3 “Tail of Brow lift”

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Central body 1/3 lift

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Medial 1/3 Brow lift or Head of the Brow lift

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Total Brow lift: Tail, Body and Head

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Combination 2/3 lift

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Depth of Lift: Subcutaneous

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Upper Lid Lateral Canthal and Brow lift

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Depth of Lift; Subperiosteal

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Injection Suture Suspension Brow lift Anatomy includes all of the following except?

The Brow Extends from the Medial Head of the Brow to the tail of the brow

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The Brow includes the Supra-orbital volume into the Temporal Fossa

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The Brow extends from the inferior aspect of the eyebrow hair line to the frontal Scalp hair line

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The Brow include the prime elevator the Frontalis

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The Brow includes the prime central depressors the Corrugator Depressor Supracilii (DCS) and the Procerus

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The Brow includes the Prime Lateral Depressors the vertical fibers Orbicularis oculi (OOc)

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The Brow includes the front bone

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The Brow includes the Galea aponeurotica

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The Frontalis is innervated by the V1 Supraorbital nerve

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The Frontalis inserts into the dermis the upper eyebrow

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The pathophysiology of the aging face includes all of the following except?

Mid-Face deflation and loss of mid-facial fat and volume

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Attenuation and elongation of the supportive ligaments

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Descent of the malar fat pad and soft tissue

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Elongation of the lower id-cheek junction

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Descent and encroachment of soft tissue over the nasolabial fold (NLF), labio-mental (LMF), pre-jowl and jowl

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Loss of the mid-face ogee

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Loss of the Bi-zygomatic dominance

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Re-establishment of an oval face

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Development of Bi-para-symphyseal, Bi-jowl dominance

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The Aesthetic Goals of the Injection Suture Suspension Temporal Tuft Lateral Face lift include all but one of the following?

Elevation of the Lateral Face Soft tissue

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Elevation and tightening of the jowls

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Elevation and tightening of the jawline

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All of the above

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The following best describes a Barbed Loop lift except?

A 2-0 PDO

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The Loop is also barbed and used as tension bearing

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Each barb is the suture arm is 2.1 mm

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Each barbed limb is passed down a different soft tissue path

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The needles are cut off each limb

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The Sutures are each passed up the #18-gauge needle

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The Soft tissue flap to be elevated is thermally undermined

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The loop lift is placed under assertive tensile load

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The Loop lift is sutured under tensile load

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The Anatomy of the lateral face that gets lifted and optimally impacted by a Lateral Temporal Tuft lift includes all of the following except?

The lateral facelift zone includes the Jowl

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The lateral facelift zone includes the lateral facial soft tissue

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The lateral facelift zone includes the jawline

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The lateral facelift zone includes the malar fat pad

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Which of the following best describes the Tuft Test?

Lifting the mastoid tissue to simulate the desired lift effect

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Lifting the mid-cheek skin to simulate the desired lift effect

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Lifting the temporal side burn skin to simulate the desired lift effect

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Lifting the mandibular skin to simulate the desired lift effect

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All of the following describe the pathophysiology of mid-face aging except?

Loss of malar fat pad volume

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Attenuation and loss of soft tissue mid-face support structures

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Descent of the mid-face fat pad and soft tissue

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Elongation of the Lower lid to cheek junction

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Loss of the malar eminence projection

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Encroachment of descendant fat over the Nasolabial folds, labio-mental folds

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Increased fullness to the pre-jowl and jowl

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Loss of Bi-zygomatic transverse width dominance

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Increased Bi-jowl width dominance

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Improvement in the upside-down pyramid, oval shape of the face

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Which of the following accurately represent the two different types of Injection Suture Suspension Cheek Lifts ?

The Malar Fat Pad and the Cheek Skin Flap Injection Suture Suspension Lifts

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The Cheek Fat Pad Lift and the Commissure Injection Suture Suspension Lifts

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The Cheek Fat Pad Lift the Labio-mental fold Injection Suture Suspension Lifts

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The Nasolabial fold and the labio-mental fold Injection Suture Suspension Lifts

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The following are the 3 phenotypes of Mid-Face aging except?

Malar Fat Pad Descent but with little skin laxity

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Cheek Skin laxity and Descent but with little Malar fat pad volume

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Nasolabial fold and labio-mental fold descent

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Combined Hybrid Malar fat pad descent with Skin laxity

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The Aesthetic Goals of the Injection Suture Suspension Mid-face include all of the following except?

Elevation and re-establishment of the Malar fat pad and projection

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Shortening the lower lid-cheek junction

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Covering the exposed orbital rim

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Covering the exposed lower lid fat pads

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Restoring the Bi-Zygomatic width dominance

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Improving and lifting the overhanging soft tissue over the Nasolabial folds, the Labio-mental folds

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Lifting the jowls

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Restoring a more Pyramidal shape to the face

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Horizontalizing a down going commissure and mouth pout

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Lifting loose and descent cheek skin

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The Lifting anatomy of the Injection Suture suspension mid-face lift includes all of the following except?

The Malar fat pad and eminence

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The Malar Zygomatic Buttress

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The Zygomaticus Major and Minor

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The Nasolabial fold

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The Labio-mental Folds

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The Orbicularis Oculi

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The Jowl and Pre-Jowl

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All of the following reasonably describe the pathophysiology of the aging neck except?

Deflation and loss of volume of the Malar fat pad and mid-face soft tissue

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Overpowering Mid-face depressors

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Attenuation and compromise of supportive tissues

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Periosteal resorption

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Descent and encroachment of the mid-face soft tissue on the perioral structures (NLF, commissure and LMF)

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Enlargement of the jowl

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Compromise of the smooth jawline contour

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Enlargement of the submandibular glands

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Loss of convexity definition over the mandibular border

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What kind of Suspension Suture is used in jawline and jowl lifting?

A smooth, prolene Loop Lift

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A Barbed Bidirectional, barbed Loop Lift

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A smooth PGA (Polyglycolic acid suture)

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A Barbed Bidirectional, barbed power loop lift PGA/PCL suture

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A vicryl mesh

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What kind of Anesthesia is commonly used for Jawline and Jowl lifting?

Toradol

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Nitrous oxide

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Craniofacial blocks

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Mesotherapy delivered dilute lidocaine

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Tumescent infiltration

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All of the above

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When might you deploy a subdermal layer Jawline lift versus a SMAS layer lift?

Subdermal layer with the skin is thin and there is moderate jawline laxity and SMAS layer when the jawline is heavy and lax

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A Subdermal layer on skin type 1-3 and a SMAS on Skin type 4-6

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A SMAS layer is never performed unless it is an open procedure

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Always combine the two techniques for the best result

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When would you consider Aspiration of the jowl and jawline?

In all patients

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Only skin type 4 and 5 patients

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Patients with a full jowl and significant adipose tissue and good skin tone

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Patients who are very elderly

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All of the following describe the features of a youthful neck except?

Acute cervico-mental angle

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Defined jawline

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Concave submandibular contour

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Smooth, bright, even tone skin

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No horizontal or vertical lines/rhytids

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No platysma bands/cords

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No visible submandibular glands

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Visible, youthful thyroid gland

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No Masseteric hypertrophy

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Smooth, modest fat distribution

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All of the following describe the features of an Aging neck except?

Intrinsic and extrinsic factors contribute to neck aging

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An obtuse cervico-mental angle

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Poorly defined jawline

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Submental fat

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Jowls

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Dyschromia

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Vertical rhytids

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Horizontal necklace lines

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Solar elastotic skin

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Smooth skin, even color and tone

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The Anatomy of the Neck includes which of the following?

Framed by the Jawline above

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From the pogonion to the gonial angle

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The Clavicle below

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The posterior border of the trapezius laterally

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A cylinder that meet a cervico-mental angle

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A horizontal plan to the anterior mandible

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All of the above

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The Cervical Skin undergoes the following aging changes?

Intrinsic aging with fat atrophy and diminished dermal structure

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Extrinsic UV and environment damage

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Dyschromia

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Telangiectasia

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Elastosis and hyperkeratotic epidermis

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Vertical rhytids

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Horizontal animation lines

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Platysma atrophy and cords

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All of the above

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The Subcutaneous layer of the neck is best described by all of the following except?

Less fibrous than truncal skin

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Less subcutaneous fat than the body and one layer

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More FSN structure than the body

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Pre and post muscular (platysma) fat

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Thinner dermis than most truncal regions

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All of the following are common post procedures instructions following an Injection Suture Suspension except?

Minimize any activity that exerts a downward for on the lift effect while the endogenous healing of the undermined flaps

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Avoid movements that counter act or exceed the tensile strength of the PDO and/or PGA-PCL sutures holding up the undermined flaps

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Inject Botox in the brow and mid-face depressors BEFORE the Injection Suture Suspension lifting

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Wrap (neck, jawline, brow) support for one week or more

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Steri strips to support the end of the Suture lift in advance of re-contouring

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Re-contouring: at 4 and again 7 days, hold on the distal end of the suture left long from their exit sites and MOLD, LIFT and PUSH the elevated flaps up and over the barbed sutures, as one last opportunity for elevation as there may have been some mechanical dislodgement in the first few days

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Soft Cervical collar to help prevent sudden “head turning movements” and Sleeping on ones back (supine) at night

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No solid foods for 6 weeks

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No rubbing (gentle padding)

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No sleeping on ones back

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The following are the recommended post Injection Suture Suspension maintenance program treatments and help with the tightening and contraction except?

Post Injectable RF Skin Tightening, FSN contraction and Dermal remodeling takes 12 months to optimize

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Overall soft tissue contraction between 40-60% can occur

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During the post 12 months period, adding non-invasive energy-based devices to the post Injection suspension can improve collagen formation and outcome

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Start treatment after the ISSF (Injection Suture Suspension Face lifting) at 12 weeks, as long as there is no more sensitivity

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Intense Pulsed Light (IPL), or Lumecca photo rejuvention to the face and neck every 3 months

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FORMA, or bulked heating non-ablative RF every 3 months

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Morpheus, very gentle Fractional RF treatments with the M24, multiple pass and settings less than 25 mj/pin

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A new Injection Suspension lift every 6 months

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Injectable Botox 3 times per year in the relevant depressors

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Injectable Soft Tissue fillers every 9-12 months

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The Holy Trinity of Facial Rejuvenation maintenance refers to?

Named so for the “rule of 3’s”

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3 applicators used in the same session

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IPL, Forma, Morpheus

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performed every 3 weeks

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3 sessions in total

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3 times per year maintenance

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Look 3 years younger

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$3,000 dollars for the 3 pack

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All of the above

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Injection Suture Suspension Complications can be classified as?

Minor vs Major

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Early vs Late

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Reversible vs non-reversible

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All of the above

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The minor and early Injectable Suture Suspension Facial Lifting complications include all of the following except?

Infection

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Ecchymosis

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Swelling and Edema

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Venous Hematoma

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Cerebral Vascular Accident or Stroke

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Sensory Anesthesia over undermined flaps

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Facial nerve branch neuropraxia

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If a patient presents with Upper lid hooding and heavy brow tissue and wants a non-excisional Lift of the Upper 1/3 of the face, which of the following might be the best single lift and shaping option?

Browlift and upper lid blepharoplasty

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Botox to the central and lateral Depressors

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Supraorbital Buttress Injectable filler

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AccuTite and Morpheus 8 to the Brow and upper lid

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Injection Suture Suspension, Subcutaneous Powerlift to the Brow, with Injectable RF to the Brow and Upper lid

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Injection Suture Suspension, Composite dual plane Powerlift to the Brow, with Injectable RF to the Brow and Upper lid

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If a patient presents with Lateral Facial laxity and a moderate jowl, with an intact malar eminence, exhibits positive “tuft test”, and wants a non-excisional lift, which of the following might be the best lift and shaping option?

A composite deep plane open Facelift

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Botox to the mid-face depressors

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Injectable soft Tissue fillers to the Infraorbital, Malar-Zygomatic, perioral and Mandibular Buttresses

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Injectable RF, AccuTite and Morpheus 8 Skin tightening of the mid-face and jawline

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Injectable Suture Suspension Lateral Face Lift with a Barbed Loop Lift and Subcutaneous Injection Suspension Power lift to the jawline with Injectable RF, AccuTite and Morpheus to the mid-face and jawline

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Injection Suture Suspension Malar Fat pad lift

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If a patient presents with Mid-face malar fat pad deflation and descent, facial skin laxity, deep perioral folds and a jowl and wants the best non-excisional lift, which of the following might be the best lift and shaping option?

Composite deep plane open Facelift and open Mid-facelift

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Botox to the mid-face depressors

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Injectable soft Tissue fillers to the Infraorbital, Malar-Zygomatic, Perioral and Mandibular Buttresses

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Injectable Suture Suspension Composite, Dual plan Power Mid-Face Lift with a Subcutaneous Power lift to the Jawline and Injectable RF, AccuTite and Morpheus to the mid-face and jawline

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Injectable RF, AccuTite and Morpheus 8 Skin tightening of the mid-face and Jawline

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If a patient presents with an obtuse cervico-mental angle, submental fat, skin laxity and Anterior compartment cervical fat, elastosis, vertical rhytids skin laxity, Jowls and skin laxity of the Jawline and wants the best non-excisional lift, which of the following might be the best lift and shaping option?

An open deep plane lower face and Neck lift with an anterior platysmaplasty and hyoid suspension, open submental lipectomy and Morpheus 8

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Injectable Botox to the mid-face depressors and platysma

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Injectable soft tissue fillers to the Perioral and Mandibular Buttresses, including the pogonial and gonial angles

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An Injection Suture Suspension Neck lift with a Barbed Hyoid Loop Lift, combined with Lateral Subcutaneous Powerlift, and subcutaneous Powerlift to the Jowls

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FaceT1ite to the Jowls and submentum, lipo-aspiration and Morpheus 8 to the face and neck

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The BEST WAY to optimize my profitability from my Injectable Facial Shaping Practice is to?

Read and memorize Section 5 of this Injectable Facial Shaping Book

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Complete a formal executive MBA (Master of Business Administration) program at a university

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Hire a second manager

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Buy the Boomerang Book, read it carefully, pass the certification course, watch “tips of the week” AND IMPLEMENT

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An average injectable shaping Browlift will require (i) 75 units of Botox to uncouple the Brow elevators from the central and lateral depressors and soften the central frontalis (ii) 3 ml (3 syringes of HA Gel filler to the Supraorbital Buttress and Temporal Hallow (iii) 1 X Morpheus 8 M24 Tip and 1 X AccuTite tip and (iv) 4 X Power Lift sutures. You will require one medical assistant to help in your side office and you perform this in one hours. To determine your profitability, you need to know your COGS, what is your COGS and how much might you charge and which of the following is likely the best answer?

$1,500 COGS and I would charge $2500

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$500 COGS and I would charge $1500

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$1,500-$2,000 COGS and I would charge $3000

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$1,500-$2,000 COGS and I would charge 50% of the average Highest priced facelifts in your market

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An injectable Facial Shaping Mid-face lift uses 15 units of Botox to uncouple the midface depressors, 6 ml (or 6 syringes) of HA gel filler to the infraorbital, malar zygomatic, perioral and mandibular buttress, AccuTite and Morpheus 8 to the perioral folds, mid-face and jawline with an Injection Suspension Malar Fat pad lift. You will require one medical assistant to help in your side office and you perform this in one hours. To determine your profitability, you need to know your COGS, what is your COGS and how much might you charge and which of the following is likely the best answer?

$1,000 COGS and I would charge $2500

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$1.500 COGS and I would charge $4,000

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$1,500-$2,000 and I would charge $5,000

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$1,500 COGS and I would charge 50% of the average highest priced open Mid-Face Lift In your market

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An injectable Facial Shaping Lateral Tuft Facelift, Power Lift jawline lift and Suture Suspension Hyoid neck lift and uses 200 units of Botox to uncouple the brow, midface and neck depressors, 10 ml or 10 syringes of HA gel filler to the supraorbital, infraorbital, malar zygomatic, perioral and mandibular buttress, AccuTite and Morpheus 8 to the perioral folds, mid-face and jawline with an Injection Suspension Malar Fat pad lift, Power Suture jawline lift, Injection suspension Malar fat pad lift and Injection Suture Hyoid Suspension neck lif with spiroatom You will require one medical assistant to help in your side office and you perform this in one hours. To determine your profitability, you need to know your COGS, what is your COGS and how much might you charge and which of the following is likely the best answer?

$3,000 COGS and I would charge $5,000

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$3.500 COGS and I would charge $6,000

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$3.000 COGS and I would charge $7,000

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$3,500 COGS and I would charge 50% of the average highest priced open Mid-Face Lift In your market

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All of the following are accepted ways to potentially increase your injectable shaping revenue except?

Go to your vendor and negotiate a lower COGS for each disposable

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Decrease the “number” of each disposable unit used and raise the price

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Keep the same number of reach disposable, negotiate the best transfer pricand raise your procedure fees to near or top of the market

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Get rid of your assistant

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Stop spending on lead generation

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Buy your leads cheaper or squeeze them out of your funnel

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All of the following help guide How much should you be charging for your procedures except?

Your SRVP

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Charge by the # or years youth delivered as your ‘unit”

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Charge the same, just work faster

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Take the average to high market price for an open procedure and charge 50%

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Take your COGS and then apply the Average net hourly rate you want to make per hour

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Best way to Grow your Injectable Facial Shaping revenue is?

Buy more leads

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Increase re-treatments of those you inject

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Increase the re-treatment rate and cross merchandising spend of those you already injected

Correct Incorrect Correct answer

Increase the re-treatment rate and cross merchandising and Ambassador Rewards program sign ups and spend of those you already injected

Correct Incorrect Correct answer

The Conversion Cascades refers to?

the percentage of leads who convert to consults

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the percentage of consults who convert to treatments

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the percentage of treatments who come back

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the conversion rate of each of the 6 stage in your practice funnel

Correct Incorrect Correct answer

Middle and Bottom of funnel management means?

Spend more on Injectable SEO

Correct Incorrect Correct answer

Optimize organic social injectable leads

Correct Incorrect Correct answer

Increase the Number of unclosed Injectable consults, delinquent injectable re-treatment and rewards program clients in your practice

Correct Incorrect Correct answer

Improving your CPL (Cost per lead)

Correct Incorrect Correct answer

The least expensive new injectable leads business often come from?

SEO to new patients

Correct Incorrect Correct answer

Organic Social drivers

Correct Incorrect Correct answer

Paid Search

Correct Incorrect Correct answer

Database marketing

Correct Incorrect Correct answer

B2B and community marketing

Correct Incorrect Correct answer

It has never been less expensive to acquire an well qualified, low CPL, High ASP Injectable Facial Shaping patient because of the following?

SEO

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Organic Instagram

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Tik Tok

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Modern Paid search with specific landing page strategies

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Facebook

Correct Incorrect Correct answer

Linked in

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Reality TV

Correct Incorrect Correct answer

Kim Kardashian

Correct Incorrect Correct answer

80 million Boomers

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80 million Millennials

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Injection Suture Suspension Face Lifting: Introduction and Basic Science Exam

Injection Suture Suspension Face Lifting: Introduction and Basic Science Exam

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