Facial Plastic Surgery最新文献

Platysma bands are caused by excessive muscular activity and a novel threefold approach (denervation, platysmaplasty, and skin resection) was developed to minimize recurrence.To investigate the efficacy, tolerability, and satisfaction of this new technique in a larger cohort.A total of 80 patients were included in this prospective descriptive study and followed for 1 year.Surgical platysma transection with intentional denervation was performed simultaneously with a primary rhytidectomy and recurrence, complications, and satisfaction were assessed.Platysma band recurrence occurred in 10% of patients all of whom were >63 years old. There were no major postoperative complications, with a total of 35 minor complications (in 43.7% of patients). Satisfaction scores were high for both patients and the surgeon 1 year after treatment, with Global Aesthetic Improvement Scale scores of 4.64 and 4.54, respectively.This technique was effective and well tolerated, with low rates of recurrence and only minor complications.

Physician wellness is important for physician engagement and reduction of medical errors 1-6, impacting patient care. A recent survey showed that academic otorhinolaryngologists reported low levels of professional fulfillment and high levels of burnout 7,8. This study explores wellness factors in facial plastic and reconstructive surgery (FPRS).To examine factors associated with fulfillment, burnout, and intent to leave within FPRS.Cross-sectional survey.AAFPRS members completed an anonymous and standardized survey to assess professional fulfillment and burnout. Chi-square testing was used for data analysis.Among 75 respondents (5% response rate), 34% lacked professional fulfillment and 18% experienced burnout, lower than reported rates in academic otorhinolaryngology7. Lack of decision-making power in recruitment/purchasing decisions and uncompensated otolaryngology call were driving factors.Decreased autonomy and extra-subspecialty responsibilities drive burnout, lack of fulfillment, and intent to leave and should be considered in employment arrangements.

Achieving optimal contour and projection of the nasal tip is one of the most challenging aspects of rhinoplasty. The skin-soft tissue envelope (STE) plays a pivotal role in determining the final outcome, as its thickness and elasticity significantly impact the predictability of postoperative results. Avoiding dead space in the lower third of the nose is essential to ensure consistent outcomes. Recently, transcutaneous skin contour sutures (TSCS) have been proposed to enhance the precision of tip definition and contouring, particularly in patients with thick STE. To mitigate risks such as skin necrosis or scarring associated with traditional TSCS techniques, we modified the approach by placing the knot of the transdermal contour suture on the internal nasal surface.A retrospective, propensity-score matched analysis was conducted on 159 patients who underwent rhinoplasty. After matching, two cohorts of 120 patients were retained: 60 patients underwent rhinoplasty with TSCS, while the control cohort of 60 patients underwent rhinoplasty without TSCS. Patient-reported outcome measures (PROMs) were utilized to evaluate functional and aesthetic outcomes.Using PROMs, we found significant improvements in mean preoperative scores for all PROMs in both cohorts. Postoperative assessments revealed that while the overall healing trajectories were not significantly different, TSCS offered notable early benefits in nasal contour and patient satisfaction, especially during the first 3 to 6 months postoperatively.The modified TSCS technique shows significant early postoperative benefits, particularly in the first 3 to 6 months. However, the overall healing trajectories over 12 months of follow-up were similar between both groups. This suggests that while TSCS has a short-term impact, the natural healing processes in both groups likely converge over time, leading to a diminishing of observable differences. Future research should focus on identifying patient subgroups that experience the greatest benefits from TSCS. The level of evidence is 3.

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 (INV), are associated with the "classical" cephalic trim. To prevent complications in nasal tip surgery a horizontal reduction of the lateral crus (LC) using a cephalic hinged flap while preserving the scroll area is described. In 138 patients with bulbous tips, a modification of the hinged flap, the angulated cephalic strip flap (ACSF), 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 LC to prevent flap displacement and warping of lower lateral cartilage, particularly in thin-skin patients where the healing forces are significantly stronger. In all 138 patients, a satisfactory postoperative result was achieved, with improved aesthetic and functional outcomes for the nasal tip. The ACSF facilitated tip suturing in all patients after resection of the anterior-cephalic triangle. No revision related to this technique was required, and no narrowing of the INV was observed.

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.

Managing comminuted and complicated nasal fractures is challenging because it requires obtaining both functional and cosmetic satisfaction.This research examines patient satisfaction with the closed reduction strategy paired with the use of SJ tripod suspension and splintage technique for severe nasal fractures. Our hypothesis is that proper duration of internal and external splintage is the key to satisfying results.Case series.A total of 186 consenting individuals presenting over 10 years with severe nasal fractures underwent this technique. The average duration of splintage was 10 days. Patients assessed their satisfaction using a visual analog scale.Out of the total 186 cases, 183 cases were highly satisfied with both functional (98.91%) and cosmetic (91.39%) outcomes.The tripod suspension and splintage approach is an effective and comfortable technique for the closed reduction and splintage of comminuted and complicated nasal fractures.

Cephalic trimming of the lower lateral cartilage (LLC) can result in the collapse of the internal and external nasal valves, pinched nose, and alar retraction. The cephalic lateral crural advancement flap (CLCAF) technique is introduced as a method to prevent these complications by avoiding grafts in the LLC. A retrospective study was conducted on 126 open-approach rhinoplasties (82 female and 44 male) employing the CLCAF technique between January 2021 and March 2022. Preoperatively, 20 patients exhibited collapse of the internal nasal valve. CLCAF was performed in all patients following cephalic incision, leaving 7 to 8 mm horizontally and caudally of LLC, and preserving the scroll ligament. The CLCAF was advanced onto the lateral crura to reinforce it and tension the scroll ligament. The Nasal Obstruction Symptom Evaluation (NOSE) scale was used to assess the technique. The average postoperative follow-up period was 14 months. Overall, 114 patients (90.5%) experienced improved nasal breathing on the NOSE scale, and the overall NOSE score significantly decreased from a mean of 30.4 to 14.0 (p < 0.001). A statistically significant reduction in NOSE scores was observed in groups with moderate, severe, and extreme obstruction (p < 0.001), with greater improvement seen in the patients with more severe preoperative nasal breathing obstruction. Postintervention, no patient exhibited collapse of the internal valve, and all patients with preoperative collapse of the internal nasal valve showed an increase of at least 40 points in the NOSE scale. Two patients required revision due to tip asymmetry related to CLCAF. Pinched nose or alar retraction was not observed postoperatively in any patient. The implementation of CLCAF, combined with other techniques, enhances nasal breathing function, prevents the collapse of the internal nasal valve, and leads to optimal nasal tip definition, resulting in a better-shaped and functioning nose.

Septorhinoplasty is a complex facial surgery that involves osteotomy, a procedure that can lead to complications such as postoperative edema, ecchymosis, and potential changes in intraocular pressure (IOP). However, there is limited research on how different osteotomy techniques, such as conventional osteotomy versus ultrasonic bone cutting, affect IOP.This study aimed to compare the effects of conventional osteotomy and ultrasonic bone cutting on IOP in patients undergoing septorhinoplasty. We hypothesized that ultrasonic osteotomy would result in less change in IOP compared to conventional osteotomy.Prospective, double-blind, randomized, controlled study conducted at a tertiary referral hospital in Türkiye. The study adhered to the CONSORT guidelines for randomized trials.Sixty patients undergoing septorhinoplasty were randomly assigned to either the conventional osteotomy group or the ultrasonic osteotomy group. IOP was measured preoperatively, on postoperative day 1, and on postoperative day 7 using noncontact tonometry. Statistical analyses were performed using SPSS version 25.0 with repeated measures analysis.No significant difference in IOP was observed between groups on postoperative day 7. However, the conventional osteotomy group showed a significant increase in IOP on postoperative day 1 (p < 0.001), with a subsequent decrease by day 7. The ultrasonic osteotomy group showed no significant IOP change.Ultrasonic bone cutting for osteotomy in septorhinoplasty results in more stable IOP compared to conventional osteotomy, making it potentially safer for patients at risk of glaucoma. Further studies with longer follow-ups are required to confirm these findings.

Feminizing rhinoplasty, as part of facial feminization surgery (FFS), aims to align nasal appearance with gender identity. While nasal obstruction is a known complication of rhinoplasty, its impact on feminizing rhinoplasty is unclear.This study investigates if feminizing rhinoplasty causes nasal obstruction secondary to structural modifications.Prospective cohort study.IRB-approved study included males and females undergoing cosmetic rhinoplasty and transgender females undergoing feminizing rhinoplasty at Cedars-Sinai Medical Center. Nasal obstruction was assessed using the nasal obstruction and symptom evaluation (NOSE) survey preoperatively and 3-, 6-, and 12-months postoperatively, analyzed with a t-test.NOSE scores significantly decreased in all groups, with transgender females showing a 78, 84, and 77% reduction at 3-, 6-, and 12-months. No significant difference was found between cosmetic rhinoplasty and FFS groups postoperatively.Decreases in average NOSE scores across groups suggest that feminizing rhinoplasty does not worsen nasal obstruction and may improve functional outcomes.

The footplates of the medial crura are relevant structures that play an important role in the columella and nostril sill design. They also work as a connection between the nasal and oral muscles, as the insertion of the superficial orbicularis oris nasalis (SOON) is placed into the footplates and the continuation of the superficial muscular aponeurotic system (SMAS) is situated within the membranous septum. Moreover, the SOON is a powerful depressor of the nasal tip.Many techniques attempt to reconstruct the tip support with grafts, but footplates and their connections can play an important role.We describe a surgical technique that involves footplate release and repositioning for better sill design, improvement of tip support and stability, better balance of the columellar-labial junction (CLJ), upper lip lifting, and eversion of the vermilion.This retrospective study reviewed the medical records of 64 patients who underwent all steps described in the paper.The patients were followed up for 12 months and decreases in philtrum length were accompanied by an enhanced vermilion showing creating a more favorable balance.The footplate release and repositioning technique can be incorporated as an adjunct in rhinoplasty to provide additional tip support, facilitate nasolabial angle adjustment, and assist in upper lip repositioning.