Facial Plastic Surgery最新文献

Long-Term COVID-19-related olfactory dysfunction (C19OD) remains a significant challenge with no established treatment providing meaningful improvement. This study aimed to assess the efficacy of functional septorhinoplasty (fSRP) in improving olfactory dysfunction in patients with persistent C19OD compared to a control group undergoing olfactory training (OT). In this prospective study patients with persistent C19OD undergoing fSRP were enrolled while those declining surgery continued with OT as the control group. Patients were followed for six months with olfactory function assessed using Sniffin' Sticks (S'S) and nasal airflow evaluated through peak nasal inspiratory flow (PNIF) and acoustic rhinometry (AR). Among the participants 12 underwent fSRP while 13 were in the control group. Significant improvements (p < 0.05) in all S'S scores were observed in the fSRP group but not in the control group. TDI scores improved above the minimal clinically important difference only in the fSRP group. Strong correlations were found between olfactory scores and nasal measurements. Comparison of olfactory threshold gains between groups revealed a statistically significant benefit in the fSRP group. These findings suggest that fSRP can significantly improve persistent C19OD providing a notable olfactory threshold gain compared to OT.

This study aims to provide an overview of how rhinoplasty surgeons manage patients with previous nonsurgical rhinoplasty and facial fillers. A multicenter international cross-sectional study was conducted in accordance with strengthening the reporting of observational studies in epidemiology (STROBE) guidelines. A survey was distributed to members of the European Academy of Facial Plastic Surgery and associated colleagues, with responses analyzed from surgeons performing over 10 rhinoplasties annually. A total of 171 surgeons from 45 countries participated, with 165 meeting the inclusion criteria. The respondents included ear, nose, and throat (41%), plastic (7%), maxillo-facial (10%), and facial plastic surgeons (23%), averaging 116 rhinoplasties annually and 13 years of experience. Among the surgeons, 74% perform rhinoplasty on patients with prior nasal fillers, typically waiting 21 weeks after filler rhinoplasty before surgery. Additionally, 44% of surgeons remove nasal fillers preoperatively, primarily using hyaluronidase. During surgery, 76% of surgeons remove nasal fillers, and 25% modify their surgical steps for patients with a history of fillers. This study shows that there is no clear consensus in the management of patients with nasal fillers. Surgeons are often unaware of the preoperative existence of nasal and facial fillers, their potential complications, and their management. To address this, guidelines should be established to facilitate the management of the growing number of patients with facial fillers.

Introduction: In nasal tip surgery, achieving both functional and aesthetic results is crucial. Several complications, such as alar retraction or weakening of the internal nasal valve, are associated with the "classical" cephalic trim. Objective & Hypotheses: To prevent complications in nasal tip surgery a horizontal reduction of the lateral crus using a cephalic hinged flap while preserving the scroll area is described.

Study design: Retrospective cohort study Methods: In 138 patients with bulbous tips, a modification of the hinged flap, the angulated cephalic strip flap, was performed during open septorhinoplasty. The cephalic portion of the lower lateral cartilage was superficially incised without separation, preserving the scroll area. The anterior-cephalic triangle of the cephalic portion was resected to facilitate tip sutures and avoid cartilage duplication in the new dome area and hereby creation of additional, undesired volume. The cephalic part was folded inferiorly and anchored with a single fixation suture. Additionally, a fixation with a suture in the scroll area should be performed to strengthen the cranial border of the lateral crus to prevent flap displacement and warping of lower lateral cartilage, particularly in thin skin patients where the healing forces are significantly stronger.

Results: In all 138 patients, a satisfactory postoperative result was achieved, with improved aesthetic and functional outcomes for the nasal tip. The angulated cephalic strip flap facilitated tip suturing in all cases after resection of the anterior-cephalic triangle. No revision related to this technique was required, and no narrowing of the internal nasal valve was observed.

Conclusion: The angulated cephalic strip flap resulted in improved aesthetic and functional outcomes for the nasal tip. By re-creating the scroll area, complications such as alar retraction or narrowing of the internal nasal valve were avoided. The resected cephalic triangle facilitated tip suturing.

To compare postoperative edema, ecchymosis, and pain after rhinoplasty using conventional (classical) osteotomy versus powered (electric) micro-saw osteotomy techniques. Between December 2021 and May 2023, 90 patients aged 18 to 45 underwent rhinoplasty at our clinic. Of these, 45 patients underwent lateral and transverse osteotomy with powered saw instruments, whereas 45 underwent conventional osteotomy. A resident examined edema, ecchymosis, and pain on the first, third, and seventh postoperative days. The specialist was blinded to the osteotomy method (single-blind). Edema and ecchymosis were categorized using the Yücel modification of the Kara and Gokalan classification, and the pain was evaluated using the visual analog scale. The patients who underwent osteotomy with an electric micro-saw (group 1) had less edema on the first and third days than with conventional osteotomy (group 2). However, on the seventh day, although group 1 had slightly less edema than group 2, there were no significant differences. On the other hand, group 2 had significantly more ecchymosis on the first and third postoperative days compared with group 1, but there were no significant differences on the seventh day. On the first postoperative days, patients in group 2 reported significantly more pain on average compared with group 1. There were no significant differences in pain levels between the two groups on the third and seventh days following the surgery. After rhinoplasty, patients commonly suffer from edema, ecchymosis, and pain. Our research suggests that using a powered micro-saw effectively reduces early-stage ecchymosis and pain compared with the conventional low-to-low osteotomy technique. However, there were no notable differences between the two methods regarding edema, ecchymosis, and pain on the seventh day after surgery. The electric micro-saw appears to be a feasible alternative in the osteotomy step, showing effectiveness comparable to that of the conventional method.

Introduction 5-Fluorouracil (5-FU) is an adjunct therapeutic agent in facial plastic surgery, treating hypertrophic scars, keloids, granulomas, contractures, and thickened nasal skin. It reduces scars, enhances aesthetics, and improves function with a favorable safety profile. This systematic review evaluates the evidence for 5-FU use in facial aesthetics. Methods Comprehensive searches in MEDLINE, Cochrane, SCOPUS, EMBASE, PubMed, and Web of Science identified studies on 5-FU in facial aesthetics. Results From 4,772 articles, 32 studies (1,456 patients) met criteria. Indications included keloids, hypertrophic scars, and contractures (18 studies); periocular scars (6); granulomas (4); nasal skin thickening (1); infections (1); resistant warts (1); and hypochromic lesions (1). Most studies reported improvements in scar dimensions and erythema. Combination therapies and innovative delivery methods enhanced outcomes with minimal side effects. Conclusion Findings support 5-FU as a safe, minimally invasive therapy, achieving aesthetic and functional goals. However, standardized protocols and long-term studies are needed.

Purpose Non-surgical rhinoplasty has emerged as a preferred nasal aesthetic treatment due to its safety, predictability, and high patient satisfaction. It utilizes dermal fillers, primarily hyaluronic acid, to enhance nasal profiles and correct defects. However, limited data exist on the effects of hyaluronic acid-containing dermal fillers on nasal cartilages. This study aimed to evaluate these effects histopathologically. Methods Sixteen New Zealand white rabbits were divided into two groups (A and B). Group A's right lateral cartilages (AR) received 0.1 ml of VYC-20L filler, while the left (AL) received isotonic saline. Group B's right lateral cartilages (BR) received 0.1 ml of VYC-25L filler, with the left (BL) serving as the control. After 90 days, the rabbits were sacrificed, and cartilage samples were analyzed histopathologically for cartilage thickness, chondrocyte nucleus loss, inflammation, fibrosis, giant cells, granulation tissue, abscess, and necrosis. Statistical significance was set at p<0.05. Results Significant differences were found between groups for chondrocyte nucleus loss, fibrosis, and giant cells (p=0.005, 0.018, <0.001, respectively). No difference was observed in cartilage thickness between AR and BR (p=0.918). Chondrocyte nucleus loss was present in AR and BR but absent in AL and BL. Giant cells were detected in all VYC-20L and VYC-25L samples. Chronic inflammation and fibrosis varied but were not statistically significant. No abscess or necrosis was observed. Conclusion This study demonstrated histopathological effects of VYC-20L and VYC-25L on nasal cartilage using a rabbit model. Further studies with larger samples and diverse fillers are recommended.

Rhinoseptoplasty addresses both nasal deformities and functional issues. Effective postoperative care is essential for optimal recovery, as complications such as swelling, bruising, and pain can adversely affect healing and patient satisfaction. Proper postoperative care emphasizes the significance of comprehensive management strategies.A systematic literature review was performed utilizing the PubMed and Cochrane databases to identify articles published between 2014 and 2024 that specifically addressed postoperative care following rhinoplasty. Of 191 articles, 22 met the preestablished inclusion criteria. We assessed the quality of evidence according to the Oxford Centre for Evidence-Based Medicine's Levels of Evidence.Seven key studies were analyzed, exploring a range of postoperative care interventions, including administering corticosteroids, elevating the head during and after the procedure, using alternative therapeutic approaches, and applying cooling techniques.Postsurgical recovery after rhinoplasty involves managing pain, swelling, and bruising, among other complications. Educating patients about expected outcomes and the healing process helps alleviate their anxiety and uncertainty. Corticosteroids have proven effective in controlling swelling and bruising. Antibiotics are generally not recommended. Silicone septal splints provide support, particularly when stabilization of an injured mucous membrane or septal cartilage is required; however, nasal packing is not recommended. Adhesive strips can help reduce edema in the dorsal and supratip areas. Positioning patients in a 20° reverse Trendelenburg position during surgery, followed by maintaining the head elevated at a 90° angle postoperatively, has significantly reduced edema and ecchymosis. Using a cannula for drainage and cooling techniques has been shown to reduce postoperative morbidity effectively.Rhinoplasty is a common facial plastic surgery, yet there is no consensus on optimal postoperative care. Key strategies include silicone splints, subperiosteal drainage, nasal taping, cooling, corticosteroids, and intra- and postoperative head elevation. However, further systematic trials are necessary to refine these strategies and improve patient outcomes.

Microtia encompasses a spectrum of congenital pinna malformation. Autologous rib reconstruction is a widely utilized surgical reconstruction technique for microtia. The surgery presents various challenges that can impact surgical outcomes and patient satisfaction. Sculpting and shaping the cartilage into a detailed auricular framework poses is a technically difficult surgery due to the complexity of the ear's anatomy. Postoperative complications such as scar formation, infection, and framework resorption may lead to poor aesthetic outcomes like asymmetry of the reconstructed ear and inadequate projection. Patient-related factors, such as age, rib cartilage quality and quantity, and psychological expectations, also play critical roles in determining success. Additionally, the surgeon's experience and expertise heavily influence the reconstruction's quality.This paper explores the challenges microtia surgeons face during the reconstruction process, emphasizing technical, patient-specific, and postoperative challenges. It underscores the importance of comprehensive preoperative planning, advanced surgical training, and ongoing research to mitigate these challenges and optimize outcomes in autologous rib microtia reconstruction.

The extended deep plane facelift is a powerful technique to correct aging of the midface and neck. After many years of superficial muscular aponeurotic system lift techniques, the senior author transitioned to an extended deep plane facelift for all patients. The primary catalyst for this shift in practice was the pursuit of superior rejuvenation of the midface. Consistent uniform elevation of the deep plane with complete ligament release and management of the soft tissue flap were the most significant challenges in the early adoption period. Navigating the transition was facilitated by consultation with experienced colleagues and frequent cadaver dissections. This manuscript details the authors' current technique. Complications and recovery from this technique are similar to those reported with historical techniques and are minimized with proper preparation, precision, and perioperative management. In our experience the results from this procedure are extremely reproducible, durable, and natural, and patients are overwhelmingly extremely satisfied.

This is a comprehensive review of facial fillers including landmark studies and expert commentary spanning the years from 2003 (when the first hyaluronic acid [HA] dermal filler underwent Food and Drug Administration approval in United States) to present.