Facial Plastic Surgery最新文献

To explain a very clear and concise, systematic approach to revision rhinoplasty from the preoperative visit, to the operation, and finally to the postoperative course.All pertinent anatomy is discussed both in the preoperative examination, and in the technical details describe in the operation. Images accompany all key maneuvers for further clarification.We discuss the key physical examination findings, functional analysis, and standardized photography of the patient prior to the operation.We describe the key foundational techniques utilized from start to finish to design and construct the most stable, functional, and aesthetic nose possible in a revision rhinoplasty. We discuss anesthesia, as well as intraoperative splints and dressings.We review all postoperative care given to our patients, as well as the reasoning behind these instructions.We provide an easy-to-follow, step-by-step logical approach to revision rhinoplasty. Despite the nearly endless combination of possible findings once in the operation, by following these guiding principles the operation can be completed in a consistent, efficient, and thorough manner.

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.

Candidacy for dorsal preservation rhinoplasty (DPR) techniques is determined by a combination of preoperative nasal analysis and intraoperative assessment of the bony vault and septum. Classic ideal candidates have a pleasing frontal aesthetic, shorter nasal bones, bony cap at or cephalic to the rhinion, straight and appropriately narrow dorsal aesthetic lines (DALs), and a small to medium-sized hump.Alongside the growing popularity of DPR in recent years there have been numerous new methods described for approaching the bony vault and septum that expand both the definition of dorsal preservation and its potential indications. These techniques expand DPR candidacy to the crooked nose, S-shaped hump, wide or irregular DALs, and deviated caudal septum.The decision toward choosing a dorsal preservation approach is nuanced, surgeon-dependent, and may be less obvious with these new modifications. Classical or modified DPR, when executed well in appropriate candidates, is an excellent method to achieve a natural reduction of the dorsal profile.

Spreader grafts (SG) are used in rhinoplasty to correct cartilaginous deviations. There are no studies that compare aesthetic and functional outcomes of unilateral (USG) and bilateral SG (BSG).Compare whether USG or BSG is better to correct cartilaginous deviations, if there are differences in dorsal width ratio (DWR) and in patient-perceived aesthetic and functional outcomes.Retrospective study of 35 patients who underwent septorhinoplasty with USG or BSG. Deviation angle and DWR were calculated in frontal images before and 6 months postsurgery. Aesthetic and functional results were measured using nasal obstruction symptom evaluation (NOSE) and visual analog scales (VAS).BSG significantly improved postoperative nasal deviation compared to USG (179.6 degrees vs. 172.9 degrees; p < 0.05). In minor preoperative deviations, there were no significant differences between BSG and USG (179.57 degrees vs. 177 degrees, respectively; p > 0.05). In major preoperative deviations, BSG provided better correction (179.62 degrees vs. 170.5 degrees; p < 0.05). DWR increased more with BSG compared to USG (0.12 vs. 0.04; p < 0.05). VAS and NOSE scores were similar in both groups.BSG is more effective in correcting major cartilaginous deviations, while both USG and BSG effectively correct minor deviations. Though BSG increases DWR, this does not negatively impact patient-perceived aesthetic or functional outcomes.

Selective myectomy has gained popularity for treating facial synkinesis.We examined the combined effectiveness of depressor anguli oris (DAO), partial buccinator, and platysma myectomies.Retrospective case series.Pre- and postoperative botulinum toxin-A (BTX-A) treatments of selective myectomy patients were collected. Facial photographs were analyzed using Emotrics + . Facial Asymmetry Index (FAI) and electronic facial paralysis assessment (eFACE) scores were calculated.Twenty patients underwent myectomies. Improvements (mean ± standard error) were seen in several smile metrics, including FAI by 2.80 ± 0.68 mm, nasolabial fold angle by 4.78 ± 1.83 degrees, and smile angle by 4.43 ± 1.18 degrees (all p < 0.05). Postoperative FAI was 2.79 mm. Total BTX-A decreased by 10.85 ± 4.48 units (p = 0.03). eFACE revealed improved oral commissure movement and platysmal synkinesis (p < 0.05 for both).Combined myectomies of the DAO, partial buccinator, and platysma clinically and statistically improve smile in facial synkinesis.

Rhinoplasty is one of the most frequently requested aesthetic procedures. However, a subset of patients presents with complex psychological profiles that can adversely impact surgical outcomes. Early psychological assessment is crucial to optimizing patient safety and satisfaction.This narrative review aims to explore the role of integrated psychological assessment within multidisciplinary facial plastic surgery services. It hypothesizes that early psychological input improves patient selection, manages expectations, and reduces revision rates.Narrative review.We conducted a structured narrative review of PubMed/MEDLINE, PsycINFO, Embase, and Scopus (from inception to June 2025), supplemented by clinical experience from a high-volume United Kingdom rhinoplasty center. Search terms included rhinoplasty, psychology, BDD, screening, and multidisciplinary care. Eligible sources comprised peer-reviewed studies, reviews, and guidelines on psychological assessment or outcomes in aesthetic rhinoplasty.Integrated psychological assessment can identify patients at risk of dissatisfaction, enhance patient selection, reduce revision surgeries, and improve overall outcomes.Multidisciplinary collaboration between surgeons and psychologists improves rhinoplasty outcomes, enhances patient safety, and supports the ethical principle of nonmaleficence.

Training in facial soft tissue and flap surgery is limited by access to cadaver models and realistic simulation tools.This study aimed to evaluate the lamb head as a practical and cost-effective model for facial flap planning and soft tissue closure techniques in surgical education.Prospective observational study involving two dissection courses with surgical residents. Reporting complies with STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) guidelines.Two lamb heads were used for initial testing. Subsequently, two training sessions were conducted with 49 ENT and dermatology residents. Participants practiced standard flap designs using predrawn templates. Postsession feedback was collected.All participants reported increased understanding and confidence. The model was rated highly for its realism and teaching value.The lamb head provides a realistic, accessible, and low-cost model for facial soft tissue training. It may be valuable for residency programs lacking access to cadaveric simulation.

Facelift surgery is among the most commonly performed aesthetic procedures. Achieving optimal outcomes requires careful preoperative planning, particularly in managing airway positioning and maintaining a clean surgical field from the forehead to the neck.This study aims to outline standardized perioperative protocols for facelift surgery, hypothesizing that such measures improve surgical access and reduce intraoperative complications.Retrospective case series (N > 5) conducted by senior authors. The study adheres to STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for observational studies.Patients undergoing facelift under general anesthesia with endotracheal intubation were reviewed. Focus was placed on tube positioning, scalp access, and hair management. No institutional review board approval was required.Standardized protocols enhanced tube stability, optimized exposure, and minimized operative delays.Precise airway management and field preparation are essential for efficient, safe facelift surgery and should be standardized in clinical practice.