Injection Suture Suspension Face Lifting: Introduction and Basic Science Exam

What is an Injection Suture Suspension Face lift?

A Non-excisional lift
Elevation of the thermally undermined flap
RFAL and Morpheus thermally treated flap
Fixation of the elevated, thermally undermined flap to the craniofacial skeleton
Fixation is with a barbed, resorbable suture
The Suture holds the elevated flap in place until collagen deposition provides the biological fixation and stability
All of the above

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

Patients with some degree of Deflation, Descent and Deterioration
Patients who want a noticeable lift effect
Patients who want the best results without a scar or open lift
Patients who will accept a lift result that may only last 3 years
Patients who want the best lift result and are accepting of a scar and surgery
Patients on a limited budget and recovery time

4 Economic downturns that affect general consumer spending include?

The 1999, Dot com bust and Y2K Banking scare
September 11th, 2001
The 2008 Financial Crisis
The COVID-19 Pandemic
All of the above

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

Desire to look good
Desire to look young
Desire to look better
A Vanity culture
An Ageistic culture
The “Zoom” streaming culture
Influencers and Dating apps
The emergence of GAP procedures by InMode
Affordable pricing for non-invasive and minimally invasive options
Improved General Anesthetic drugs

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

Some Luxury good purchases remain strong
The Lip Stick index improved
Patients are still looking but may want a deal
More interest in GAP procedures than bigger, riskier procedures
It can be a good time to capture market share for your practice
All of the above

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

Brow lift
Lateral Facelift: Temporal Tuft Loop Lift
Jawline and Jowl Lift
Suture suspension upper lip lift
Mid-Face lift
Neck lift: Mastoid Hyoid Suspension Loop lift

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

Typical aging of the Brow is predictable
Strong central depressors, (DCS and Procerus) pull down the central brow
Strong lateral depressors (orbicularis oculi lateral fibers) pull down the lateral brow
The Tail of brow descent aging pattern is most common
Hooding of the upper lid occurs as the brow descends
Periosteal resorption of the supraorbital rim is the most important driver of aging of the brow
Deflation of the supraorbital buttress and the temporal brow hallow occurs
Attenuation and elongation of the soft issue ligaments of support occurs

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

Elevation of the entire brow (medial, central and lateral third)
Elevation of the lateral third or “tail of the brow” so it is slightly higher than the head of the brow
Create a youthful look to the upper third of the face
Elevation of the lateral 2/3’s of the Brow (Tail and central 1/3)
Create a vital, rested look to the upper third of the face
Elevation of the Head of the brow higher than the lateral 2/3’s of the brow
Create an “exotic”, elegant tail of the brow elevation where the outer 1/3 is higher than the rest of the Brow
Elevate some of the upper lid hooding up off the Supra-tarsal fold and increase the upper lid show

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

Classify by the Brow Segment to the lifted
Lateral Brow Lift or lateral 1/3 “Tail of Brow lift”
Central body 1/3 lift
Medial 1/3 Brow lift or Head of the Brow lift
Total Brow lift: Tail, Body and Head
Combination 2/3 lift
Depth of Lift: Subcutaneous
Upper Lid Lateral Canthal and Brow lift
Depth of Lift; Subperiosteal

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
The Brow includes the Supra-orbital volume into the Temporal Fossa
The Brow extends from the inferior aspect of the eyebrow hair line to the frontal Scalp hair line
The Brow include the prime elevator the Frontalis
The Brow includes the prime central depressors the Corrugator Depressor Supracilii (DCS) and the Procerus
The Brow includes the Prime Lateral Depressors the vertical fibers Orbicularis oculi (OOc)
The Brow includes the front bone
The Brow includes the Galea aponeurotica
The Frontalis is innervated by the V1 Supraorbital nerve
The Frontalis inserts into the dermis the upper eyebrow

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

Mid-Face deflation and loss of mid-facial fat and volume
Attenuation and elongation of the supportive ligaments
Descent of the malar fat pad and soft tissue
Elongation of the lower id-cheek junction
Descent and encroachment of soft tissue over the nasolabial fold (NLF), labio-mental (LMF), pre-jowl and jowl
Loss of the mid-face ogee
Loss of the Bi-zygomatic dominance
Re-establishment of an oval face
Development of Bi-para-symphyseal, Bi-jowl dominance

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
Elevation and tightening of the jowls
Elevation and tightening of the jawline
All of the above

The following best describes a Barbed Loop lift except?

A 2-0 PDO
The Loop is also barbed and used as tension bearing
Each barb is the suture arm is 2.1 mm
Each barbed limb is passed down a different soft tissue path
The needles are cut off each limb
The Sutures are each passed up the #18-gauge needle
The Soft tissue flap to be elevated is thermally undermined
The loop lift is placed under assertive tensile load
The Loop lift is sutured under tensile load

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
The lateral facelift zone includes the lateral facial soft tissue
The lateral facelift zone includes the jawline
The lateral facelift zone includes the malar fat pad

Which of the following best describes the Tuft Test?

Lifting the mastoid tissue to simulate the desired lift effect
Lifting the mid-cheek skin to simulate the desired lift effect
Lifting the temporal side burn skin to simulate the desired lift effect
Lifting the mandibular skin to simulate the desired lift effect

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

Loss of malar fat pad volume
Attenuation and loss of soft tissue mid-face support structures
Descent of the mid-face fat pad and soft tissue
Elongation of the Lower lid to cheek junction
Loss of the malar eminence projection
Encroachment of descendant fat over the Nasolabial folds, labio-mental folds
Increased fullness to the pre-jowl and jowl
Loss of Bi-zygomatic transverse width dominance
Increased Bi-jowl width dominance
Improvement in the upside-down pyramid, oval shape of the face

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
The Cheek Fat Pad Lift and the Commissure Injection Suture Suspension Lifts
The Cheek Fat Pad Lift the Labio-mental fold Injection Suture Suspension Lifts
The Nasolabial fold and the labio-mental fold Injection Suture Suspension Lifts

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

Malar Fat Pad Descent but with little skin laxity
Cheek Skin laxity and Descent but with little Malar fat pad volume
Nasolabial fold and labio-mental fold descent
Combined Hybrid Malar fat pad descent with Skin laxity

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
Shortening the lower lid-cheek junction
Covering the exposed orbital rim
Covering the exposed lower lid fat pads
Restoring the Bi-Zygomatic width dominance
Improving and lifting the overhanging soft tissue over the Nasolabial folds, the Labio-mental folds
Lifting the jowls
Restoring a more Pyramidal shape to the face
Horizontalizing a down going commissure and mouth pout
Lifting loose and descent cheek skin

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

The Malar fat pad and eminence
The Malar Zygomatic Buttress
The Zygomaticus Major and Minor
The Nasolabial fold
The Labio-mental Folds
The Orbicularis Oculi
The Jowl and Pre-Jowl

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
Overpowering Mid-face depressors
Attenuation and compromise of supportive tissues
Periosteal resorption
Descent and encroachment of the mid-face soft tissue on the perioral structures (NLF, commissure and LMF)
Enlargement of the jowl
Compromise of the smooth jawline contour
Enlargement of the submandibular glands
Loss of convexity definition over the mandibular border

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

A smooth, prolene Loop Lift
A Barbed Bidirectional, barbed Loop Lift
A smooth PGA (Polyglycolic acid suture)
A Barbed Bidirectional, barbed power loop lift PGA/PCL suture
A vicryl mesh

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

Toradol
Nitrous oxide
Craniofacial blocks
Mesotherapy delivered dilute lidocaine
Tumescent infiltration
All of the above

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
A Subdermal layer on skin type 1-3 and a SMAS on Skin type 4-6
A SMAS layer is never performed unless it is an open procedure
Always combine the two techniques for the best result

When would you consider Aspiration of the jowl and jawline?

In all patients
Only skin type 4 and 5 patients
Patients with a full jowl and significant adipose tissue and good skin tone
Patients who are very elderly

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

Acute cervico-mental angle
Defined jawline
Concave submandibular contour
Smooth, bright, even tone skin
No horizontal or vertical lines/rhytids
No platysma bands/cords
No visible submandibular glands
Visible, youthful thyroid gland
No Masseteric hypertrophy
Smooth, modest fat distribution

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

Intrinsic and extrinsic factors contribute to neck aging
An obtuse cervico-mental angle
Poorly defined jawline
Submental fat
Jowls
Dyschromia
Vertical rhytids
Horizontal necklace lines
Solar elastotic skin
Smooth skin, even color and tone

The Anatomy of the Neck includes which of the following?

Framed by the Jawline above
From the pogonion to the gonial angle
The Clavicle below
The posterior border of the trapezius laterally
A cylinder that meet a cervico-mental angle
A horizontal plan to the anterior mandible
All of the above

The Cervical Skin undergoes the following aging changes?

Intrinsic aging with fat atrophy and diminished dermal structure
Extrinsic UV and environment damage
Dyschromia
Telangiectasia
Elastosis and hyperkeratotic epidermis
Vertical rhytids
Horizontal animation lines
Platysma atrophy and cords
All of the above

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

Less fibrous than truncal skin
Less subcutaneous fat than the body and one layer
More FSN structure than the body
Pre and post muscular (platysma) fat
Thinner dermis than most truncal regions

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
Avoid movements that counter act or exceed the tensile strength of the PDO and/or PGA-PCL sutures holding up the undermined flaps
Inject Botox in the brow and mid-face depressors BEFORE the Injection Suture Suspension lifting
Wrap (neck, jawline, brow) support for one week or more
Steri strips to support the end of the Suture lift in advance of re-contouring
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
Soft Cervical collar to help prevent sudden “head turning movements” and Sleeping on ones back (supine) at night
No solid foods for 6 weeks
No rubbing (gentle padding)
No sleeping on ones back

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
Overall soft tissue contraction between 40-60% can occur
During the post 12 months period, adding non-invasive energy-based devices to the post Injection suspension can improve collagen formation and outcome
Start treatment after the ISSF (Injection Suture Suspension Face lifting) at 12 weeks, as long as there is no more sensitivity
Intense Pulsed Light (IPL), or Lumecca photo rejuvention to the face and neck every 3 months
FORMA, or bulked heating non-ablative RF every 3 months
Morpheus, very gentle Fractional RF treatments with the M24, multiple pass and settings less than 25 mj/pin
A new Injection Suspension lift every 6 months
Injectable Botox 3 times per year in the relevant depressors
Injectable Soft Tissue fillers every 9-12 months

The Holy Trinity of Facial Rejuvenation maintenance refers to?

Named so for the “rule of 3’s”
3 applicators used in the same session
IPL, Forma, Morpheus
performed every 3 weeks
3 sessions in total
3 times per year maintenance
Look 3 years younger
$3,000 dollars for the 3 pack
All of the above

Injection Suture Suspension Complications can be classified as?

Minor vs Major
Early vs Late
Reversible vs non-reversible
All of the above

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

Infection
Ecchymosis
Swelling and Edema
Venous Hematoma
Cerebral Vascular Accident or Stroke
Sensory Anesthesia over undermined flaps
Facial nerve branch neuropraxia

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
Botox to the central and lateral Depressors
Supraorbital Buttress Injectable filler
AccuTite and Morpheus 8 to the Brow and upper lid
Injection Suture Suspension, Subcutaneous Powerlift to the Brow, with Injectable RF to the Brow and Upper lid
Injection Suture Suspension, Composite dual plane Powerlift to the Brow, with Injectable RF to the Brow and Upper lid

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
Botox to the mid-face depressors
Injectable soft Tissue fillers to the Infraorbital, Malar-Zygomatic, perioral and Mandibular Buttresses
Injectable RF, AccuTite and Morpheus 8 Skin tightening of the mid-face and jawline
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
Injection Suture Suspension Malar Fat pad lift

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
Botox to the mid-face depressors
Injectable soft Tissue fillers to the Infraorbital, Malar-Zygomatic, Perioral and Mandibular Buttresses
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
Injectable RF, AccuTite and Morpheus 8 Skin tightening of the mid-face and Jawline

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
Injectable Botox to the mid-face depressors and platysma
Injectable soft tissue fillers to the Perioral and Mandibular Buttresses, including the pogonial and gonial angles
An Injection Suture Suspension Neck lift with a Barbed Hyoid Loop Lift, combined with Lateral Subcutaneous Powerlift, and subcutaneous Powerlift to the Jowls
FaceT1ite to the Jowls and submentum, lipo-aspiration and Morpheus 8 to the face and neck

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
Complete a formal executive MBA (Master of Business Administration) program at a university
Hire a second manager
Buy the Boomerang Book, read it carefully, pass the certification course, watch “tips of the week” AND IMPLEMENT

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
$500 COGS and I would charge $1500
$1,500-$2,000 COGS and I would charge $3000
$1,500-$2,000 COGS and I would charge 50% of the average Highest priced facelifts in your market

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
$1.500 COGS and I would charge $4,000
$1,500-$2,000 and I would charge $5,000
$1,500 COGS and I would charge 50% of the average highest priced open Mid-Face Lift In your market

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
$3.500 COGS and I would charge $6,000
$3.000 COGS and I would charge $7,000
$3,500 COGS and I would charge 50% of the average highest priced open Mid-Face Lift In your market

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
Decrease the “number” of each disposable unit used and raise the price
Keep the same number of reach disposable, negotiate the best transfer pricand raise your procedure fees to near or top of the market
Get rid of your assistant
Stop spending on lead generation
Buy your leads cheaper or squeeze them out of your funnel

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

Your SRVP
Charge by the # or years youth delivered as your ‘unit”
Charge the same, just work faster
Take the average to high market price for an open procedure and charge 50%
Take your COGS and then apply the Average net hourly rate you want to make per hour

Best way to Grow your Injectable Facial Shaping revenue is?

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

The Conversion Cascades refers to?

the percentage of leads who convert to consults
the percentage of consults who convert to treatments
the percentage of treatments who come back
the conversion rate of each of the 6 stage in your practice funnel

Middle and Bottom of funnel management means?

Spend more on Injectable SEO
Optimize organic social injectable leads
Increase the Number of unclosed Injectable consults, delinquent injectable re-treatment and rewards program clients in your practice
Improving your CPL (Cost per lead)

The least expensive new injectable leads business often come from?

SEO to new patients
Organic Social drivers
Paid Search
Database marketing
B2B and community marketing

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

SEO
Organic Instagram
Tik Tok
Modern Paid search with specific landing page strategies
Facebook
Linked in
Reality TV
Kim Kardashian
80 million Boomers
80 million Millennials

Injection Suture Suspension Face Lifting: Introduction and Basic Science Exam

Injection Suture Suspension Face Lifting: Introduction and Basic Science Exam

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