Example FRCS Plast questions

Aesthetics: FRCS(Plast) example questions

Our aesthetic coverage spans the whole JCST curriculum, from facelift and blepharoplasty planning through rhinoplasty, otoplasty and body contouring to non-surgical rejuvenation, with illustrated questions and referenced explanations throughout.

Facial rejuvenation

Blepharoplasty

Rhinoplasty

Otoplasty

Body contouring

Fat grafting

Non-surgical rejuvenation

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Question 1

Aesthetics

A 62-year-old woman is seen in clinic for periorbital rejuvenation. She is bothered by horizontal skin creasing of the lower eyelids that is present at rest and worsens on smiling. On examination, the lower lid skin is redundant and pinches readily between forceps. On upgaze, there is no convexity or pseudoherniation of the medial, central, or lateral fat compartments. The lid-cheek junction is smooth, the tear trough is not prominent, and there is no festoon. Snap-back is brisk at under one second, distraction is less than 6 mm, the lateral canthus sits 2 mm above the medial canthus, and the globe has a positive vector. She has no history of dry eye and Schirmer's testing is normal.

Which is the most appropriate surgical management?

AI-generated image

CORRECT ANSWER

The pathology is isolated to the skin envelope: dermatochalasis without steatoblepharon, lid laxity, tear trough deformity, or midface descent. The component-based approach to lower blepharoplasty dictates intervention only on the abnormal layer - here, a subciliary skin-pinch excision that preserves the orbicularis oculi, the orbital septum, and the lower-lid retractors.

This minimises the principal causes of postoperative lid malposition:

Orbicularis denervation
Middle-lamellar scarring, and
Septal violation.

Other answers:

Option A removes fat she does not have and leaves the skin untouched.
Option B is overtreatment that introduces denervation risk and is unnecessary in the absence of fat or muscle pathology.
Option D adds canthal support in a lid with a normal snap-back and good tarsoligamentous tone - overtreatment again.
Option E is reserved for significant midface descent with tear trough deformity, neither of which is present.

REFERENCES

Codner MA, Kikkawa DO, Korn BS, Pacella SJ. Blepharoplasty and brow lift. Plastic and reconstructive surgery. 2010;126(1):1e-17e.Alghoul M. Blepharoplasty: Anatomy, Planning, Techniques, and Safety. Aesthetic surgery journal. 2019;39(1):10-28.Bellinvia P, Klinger F, Bellinvia G. Lower blepharoplasty with direct excision of skin excess: a five-year experience. Aesthetic surgery journal. 2010;30(5):665-70.

Question 2

Aesthetics

A 76-year-old man is referred with epiphora, ocular irritation and lower lid descent, and is keen on surgical correction. Both lower lids distract 8 mm from the globe and fail to return to apposition without a blink. During distraction, both canthal angles remain sharp and undisplaced, and firm lateral traction on the lids fail to eliminate horizontal redundancy of the lid margins. The punctum are well positioned.

Which procedure most appropriately addresses his lid laxity?

AI-generated image

CORRECT ANSWER

Two questions decide the operation:

How lax is the lid?

Distraction of 8 mm (normal <6 mm) and a lid that will not snap back without a blink mean marked laxity - a simple support stitch will not be enough.

Where is the laxity?

Pulling the lid laterally tightens the canthal tendon. If the laxity were in the tendon, this would take up the slack. Here, redundancy persists and the canthal angles stay sharp; the excess is in the lid itself, so tissue must be excised: full-thickness horizontal shortening (modified Kuhnt-Szymanowski), with lateral canthal support.

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Aesthetics: FRCS(Plast) example questions

Better questions. Better preparation.

Better questions.
Better preparation.