Facial Plastic Surgery最新文献

Functional rhinoseptoplasty (FRS) is a surgical procedure with both functional and aesthetic impacts, significantly affecting patients' quality of life. The influence of nonsurgical factors on FRS outcomes remains a debated topic in the literature. For instance, some authors deny the long-term impact of gender, age, inferior turbinectomy, or active smoking on the results. The rhinoplasty outcome evaluation (ROE) questionnaire is a useful tool for assessing patients' satisfaction once submitted to this surgery.To evaluate the subjective impact of nonsurgical factors on the long-term outcomes of FRS.The authors conducted a retrospective study of all patients who underwent FRS at a tertiary hospital between 2019 and 2023. Patients with less than 1 year of postoperative follow-up were excluded. The ROE questionnaire was used to quantify subjective surgical satisfaction. Various variables were analyzed, including previous nasal pyramid trauma, age, known hematologic pathology, psychiatric history, allergic rhinitis, smoking habits, and inferior turbinectomy. Statistical calculations were performed using the Kruskal-Wallis formula.The sample included 75 patients with an average age of 33.4 years, mostly female (51%; n = 38). The average ROE score in the sample was 79.6%. Thirty-eight point seven percent (n = 29) of the procedures were performed after nasal pyramid trauma, with these patients reporting higher ROE scores than others (85.78% in the trauma group; 75.6% in the nontrauma group; p-value = 0.01394). Even though no statistical correlation was demonstrated, ROE scores were also higher in patients with allergic rhinitis (82.1% vs. 78.1% on the healthy group), psychiatric disorders (85.8% vs. 75.6% on the healthy group), hematological disorders (91.7% vs. 78.9% on the healthy group), nonsmokers (81.7% vs. 74.0% on smokers), younger patients (81.7% vs. 76.8% on patients older than 33.4 years) and patients that underwent inferior turbinectomy (81.0% vs. 75.9%).This study established a correlation between the subjective degree of surgical satisfaction and previous nasal trauma in patients undergoing FRS.

Nonsurgical 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 (HA), to enhance nasal profiles and correct defects. However, limited data exist on the effects of HA-containing dermal fillers on nasal cartilage. This study aimed to evaluate these effects histopathologically. 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. 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. This study demonstrated the 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.

Irregularities on the nasal dorsum post rhinoplasty remain a prevalent concern for both surgeons and patients. Various techniques using cartilage are used to hide the nasal dorsum, such as crushed cartilage, free diced cartilage, surgical-wrapped diced cartilage, or diced cartilage mixed with blood glue. Diced cartilage can address issues that arise with solid materials. However, it may lead to undesirable outcomes such as graft deformation and migration. It is challenging to uniformly implant the loosely linked cartilage pieces. To prevent issues, cartilage is mixed with other materials to serve as a stabilizing scaffold.This descriptive study will examine fibrin glue, platelet-rich plasma (PRP), and warm blood as stabilizing scaffolds for correcting saddle nose deformity.To compare functional and aesthetic results of the fibrin glue, PRP, and warm blood usage with diced cartilage for correction of saddle nose deformity in rhinoplasty as a descriptive study.This prospective interventional study was conducted on 30 patients with saddle nose undergoing rhinoplasty with dorsal nasal augmentation using three materials to collide the diced cartilage. All patients were divided into three groups: Study group 1 includes 10 patients who used fibrin glue. Study group 2 includes 10 patients who used PRP. Study group 3 includes 10 patients who used warm blood in Otorhinolaryngology Department, Faculty of Medicine, Ain Shams University hospitals from August 2021 till July 2023. The study was approved by an ethical committee before the start of the recruitment (FMASU M D 44/2021).Our study included 19 primary and 11 revision cases. The mean age of the patients was 31.10 years. Mean postoperative follow-up period was 12 months. There was a statistically significant improvement in rhinoplasty outcome evaluation score (ROE) and dorsal height postoperatively among the studied patients with p-value <0.001, with no statistical difference between the three different groups regarding postoperative resorption.One can augment the nasal dorsum significantly with diced cartilage combined with any of the three different materials, fibrin glue, PRP (PRP), or warm blood, guided by the availability of prerequisites of each material. As the warm blood can fit any patient with no required complex tools, it seems to be the best material to correct saddle nose and maintain the nasal dorsal height.

The septocolumellar suture technique has shown consistent efficacy in achieving precise nasal tip aesthetics for over 20 years. This study aims to evaluate the long-term outcomes of primary endonasal rhinoplasty.Retrospectively analyze 1,096 consecutive patients who underwent primary endonasal rhinoplasty using the septocolumellar suture technique between March 2005 and March 2025. The procedure anchors the medial crura to the caudal septum at variable distances from the anterior nasal spine, allowing control of tip projection and rotation. Objective and photographic analyses assessed the nasal tip parameters, including projection, rotation, shape, deviation, alar width, and flare. Statistical significance was set at p < 0.001.Long-term stability of nasal tip projection and rotation was maintained in 96% of the patients at a minimum 12-month follow-up. All the evaluated parameters demonstrated statistically significant improvement (p < 0.001). The revision and complication rates were 3.2 and <1%, respectively.The septocolumellar suture technique is a reliable and minimally invasive method for nasal tip refinement in rhinoplasty. It ensures stable aesthetic outcomes while preserving nasal support and functional integrity. This technique effectively enhances tip projection in mestizo patients using intrinsic anatomy and can be applied in both open and closed approaches.

Septoplasty and septorhinoplasty are key procedures in functional and aesthetic nasal surgery. Over the past decade, evidence on diagnostics, techniques, and outcomes has expanded significantly.To provide a structured summary of current evidence from systematic reviews and meta-analyses, focusing on diagnostics, surgical techniques, perioperative treatment, and patient-reported outcomes.Narrative review of 86 articles, reviews, and meta-analyses published within the past 10 years.Studies were screened for relevance to functional and aesthetic rhinoplasty. Extracted data covered diagnostic methods, surgical techniques, medications, PROMs, and functional outcomes.Four-phase rhinomanometry offers promise but lacks validation. Body dysmorphic disorder (BDD) screening is gaining relevance. Evidence supports perioperative corticosteroids and tranexamic acid; routine antibiotics appear unnecessary. PROMs (NOSE, ROE, SNOT-22) are widely used.Evidence for rhinoplasty is growing but heterogeneous. Standardized diagnostics, PROM-linked objective measures, and long-term data are needed to guide future patient-centered care.

Rhinoplasty outcomes are determined by the complex interplay of modifications to both the osseocartilaginous framework and the behavior of the overlying skin-soft tissue envelope (SSTE). Successful surgery demands attention to several soft tissue characteristics including skin thickness, elasticity, sebaceous content, and fibrous ligamentous attachments, which together influence tip definition, support, and long-term aesthetic outcomes.This review summarizes evidence-based principles and practical strategies for soft tissue management in primary rhinoplasty. By integrating anatomical knowledge, meticulous surgical technique, and attentive postoperative management, surgeons can enhance tip definition, minimize complications, and achieve durable, aesthetically satisfying results. Emphasizing both structural and soft tissue considerations provides a comprehensive framework for optimizing rhinoplasty outcomes through thoughtful SSTE management.This article thoroughly reviews the body of literature on skin and soft tissue management in primary rhinoplasty, providing a historical and contemporary account on this complex topic.The surgeon's understanding of nasal anatomy continues to evolve since the advent of facial plastic surgery. This review provides a detailed description of all the layers of the nose and how they relate to surgical considerations in rhinoplasty.This review provides both current and future insight into the management of skin and soft tissue management in rhinoplasty largely centered around strong understanding of nasal anatomy, soft tissue analysis and preservation, and refined grafting techniques.Contemporary rhinoplasty has shifted away from a "one-size-fits-all" approach and more toward a deliberate and methodical approach based on the biochemical, structural, and nuanced subtleties of the nasal SSTE that makes every nose a unique challenge. This review hopes to inform readers on the many complexities that must be taken into account in rhinoplasty with the goal of supplementing the modern surgeon's intellectual toolbox when approaching this challenging surgery.

Internal nasal valve insufficiency is a major cause of nasal obstruction. Alar batten grafts (ABGs) are commonly used, but data on lateral crural tensioning (LCT) remain limited.To compare the efficacy of ABG and LCT techniques in improving nasal airflow. Primary outcomes were nasal obstruction symptom evaluation (NOSE) score and revision surgery rate; secondary outcome was complication rate.Retrospective cohort study (PICOS).The study included 22 patients undergoing rhinoplasty for nasal valve insufficiency (2017-2023): ABG (n = 8) and LCT (n = 14). NOSE scores were obtained via telephone survey. Data were collected from clinical records.Mean NOSE scores improved from 55 to 30.6 overall. ABG improved from 51.7 to 31.7, LCT from 56.7 to 30. One ABG patient required revision (12.5%), none in LCT group. Differences were not statistically significant between groups.LCT showed greater symptom improvement and no revisions. Further randomized trials are needed to confirm efficacy.

Thick skin-soft tissue envelope (SSTE) and weak cartilage make nasal tip definition challenging in many Asian rhinoplasty patients.We aimed to assess whether the Princess and the Pea (PP) graft-a solid, conical costal cartilage tip graft-can improve tip projection and definition in thick-SSTE patients. We hypothesized that it would yield reliable aesthetic and functional results with minimal complications.Prospective clinical study with 12-month postoperative follow-up.Sixty patients of East, South, and Southeast Asian descent received a PP graft anchored to the lower lateral cartilages. Outcomes were measured using SCHNOS and a 5-point Likert satisfaction scale.Mean satisfaction was 4.5/5, average SCHNOS score 0.54, and no graft-related complications occurred.The PP graft is a safe and effective method for enhancing nasal tip projection and definition in thick-SSTE patients.

Revision or secondary rhinoplasty involving the nasal tip is challenging due to distorted anatomy, scarring, and compromised tip support. This article presents a framework for surgical approach and decision-making in secondary rhinoplasty.Contemporary principles emphasize stability, conservative cartilage handling, and restoring native architecture.The nasal tip depends on the soft-tissue envelope and lower lateral crura, whose relationship with the septum determines projection, rotation, and contour.High-resolution photography, endoscopy, and improved grafting materials enhance the diagnosis and correction of nasal tip deformities.Optimal patients should undergo in-depth assessment with special attention to skin thickness, previous complications, and unrealistic expectations.Structure and support of the tip cartilages are the foundation and critical for the appearance and longevity of your results. As part of building the structure and support, the lower lateral cartilages can be repositioned and reshaped to the ideal appearance. Further refining of the definition and contour then occurs, with management of the soft tissue envelope being part of the decision process throughout.Scar modulation and protection of graft constructs are critical for long-term stability.Regenerative therapies, advanced biomaterials, and minimally invasive contour solutions continue to evolve.A regimented, anatomy-driven approach provides consistent and durable outcomes in revision tip rhinoplasty.

This article aims to provide a comprehensive overview of nasal tip support, tensioning mechanics, and suture-based techniques that refine projection, rotation, and stability in rhinoplasty. Modern approaches emphasize predictable, structurally sound methods that balance form and function while accommodating individual anatomic variability. Understanding tension vectors and ligamentous relationships is essential for optimizing both aesthetics and long-term outcomes.The evolution of nasal tip surgery reflects a shift from primarily reductive maneuvers to graft- and suture-based strategies that reinforce and shape the tip framework. Early innovators recognized the limitations of aggressive cartilage excision, leading to the development of both structural cartilage grafts and suture-based techniques to provide tip stability.Tip anatomy is governed by the relationship between the lower lateral cartilages (LLCs), medial crural base, the caudal septum, and the soft-tissue envelope. Cartilage grafts bolster weak or asymmetric native structures, reinforcing the medial crural pillar or lateral crural support, while sutures fine-tune shape, redistribute tension, and harmonize graft-induced forces. Optimal outcomes depend on understanding how grafts and sutures interact biomechanically within the intrinsic support system.Integrating cartilage grafting with targeted suture techniques enables surgeons to control projection, rotation, and definition with greater precision. A combined structural and tension-modulating strategy enhances long-term stability, counteracts postoperative contracture, and provides durable, natural tip aesthetics across primary and secondary rhinoplasty.