Facial Plastic Surgery & Aesthetic Medicine最新文献

Background: Autologous costal cartilage (ACC) and irradiated homologous costal cartilage (IHCC) are commonly used in septorhinoplasty when there is insufficient septal cartilage for grafting. Objective: To assess the surgical outcomes of patients who underwent septorhinoplasty with either ACC or IHCC as measured by rates of infection, resorption, warping, and revision rate. Methods: A retrospective analysis of patients who underwent rhinoplasty with ACC or IHCC at a single academic institution was performed. Demographic data, surgical details, antibiotic use, and outcomes, including surgical duration, infection, resorption, warping, and revision rate, were analyzed using Fisher's exact test, chi-squared test, and logistic regression. Results: One hundred forty-three patients were identified. The median age was 48 years (interquartile range: 35-57.5) and 62.2% (n = 89) were female, 61 patients (42.7%) underwent ACC, and 82 (57.3%) IHCC. Revision rate in both groups was similar (ACC = 14.8%, IHCC = 14.6%; p = 0.98). There was no difference in infection rate (ACC = 4.9%, IHCC = 3.7%; p = 0.71). Postoperative deformity and nasal obstruction were the most common indications for revision surgery. Surgical time was shorter with IHCC (p < 0.01). Mean follow-up time was 26.5 months (±25) for ACC, and 16 months (±12) for IHCC. Conclusions: ACC and IHCC are similar in terms of effectiveness and safety in septorhinoplasty.

Background: A novel single-unit septal extension-columellar strut graft was designed to overcome limitations of traditional techniques in rhinoplasty. Objective: To evaluate the outcomes of rhinoplasty utilizing the novel graft, focusing on nasal support, obstruction, and cosmetic results. Methods: A retrospective analysis included patients who underwent rhinoplasty with this graft between 2020 and 2022, with a minimum 1-year follow-up. Pre- and postoperative nasal obstruction symptom evaluation (NOSE) surveys and standardized photographic assessments were employed. Results: A total of 32 patients (mean age 32.8 ± 11.9 years; 96.9% female, 87.5% Caucasian) underwent primary rhinoplasties (68.8% cosmetic, 31.3% functional). Mean follow-up was 13.4 ± 4.9 months (range 12 to 29). Postoperatively, NOSE scores significantly decreased from 34.4 to 4.84 (p < 0.001). Independent reviewers observed improved nasal aesthetics (preop mean 11.96 ± 3.53, postop 1.83 ± 1.6, p < 0.001) without a loss of nasal tip support. No revisions were required. Conclusions: Rhinoplasty using the septal extension-columellar strut graft, in combination with other techniques, provides durable support to nasal tip structures and contributes to improved nasal tip aesthetics.

Background: Some patients report persistent nasal obstruction after surgical treatment despite objective improvement. Objective: To compare patients' perceptions of nasal obstruction after surgery with objective nasal airflow as determined by computational fluid dynamics (CFD) modeling: (1) Is perception driven by a more symptomatic side? (2) Can symptom improvement be predicted with CFD modeling? Methods: Pre/postoperative Nasal Obstruction Symptom Evaluation (NOSE) and visual analog scale (VAS) score were collected for patients undergoing nasal obstruction surgery. Pre/postoperative computed tomography was used to generate patient-specific airway models for CFD simulation at 15 L/min resting inspiration. Results: Ten patients (22-53 years, seven men and three women) underwent septoplasty, turbinate reduction, and/or rhinoplasty. Postoperative NOSE was most correlated with postoperative VAS score from the "affected" side (R² = 0.59, p < 0.01), and postoperative NOSE was strongly predicted by a two-parameter model using parameters only from the "affected" side (R² = 0.84, adjusted R² = 0.80, p < 0.01). Conclusion: The postoperative state of the initially "affected" side drives outcomes after nasal obstruction surgery. Surgeries should prioritize improving the "affected" side. A two-parameter model using the VAS and nasal airflow from only the "affected" side strongly predicts NOSE and is promising for the future using virtual planning to individualize procedures to optimize outcome.

"Ethnic rhinoplasty" is a term that historically has been employed to categorize patterns in nasal anatomy, possible procedures to change appearance, and patient and surgeon expectations for expected outcomes for the multitude of patients with features that belong to non-White groups. Categorizing anatomical structures based on broad definitions of race or ethnicity may not be an accurate representation, nor give an accurate depiction of nasal anatomical features. A shift is needed regarding how race and ethnicity are employed in describing nasal anatomy and rhinoplasty. We present a categorization system based on nasal anatomical patterns that may have more meaningful surgical implications without generalization into ethnic groups. Common anatomical nasal features such as projection, rotation, skin thickness, and anthropometric measurements were grouped into types, which may also help in patient education and remove any ethnic or racial terms.

Background: The distribution of lip shapes in young females and how morphological variation relates to attractiveness are poorly defined. Objectives: We hypothesized that among young female lip images generated by a statistical atlas model, those with more full lips compared with those with less full lips would be perceived as more attractive as measured by anonymous survey participants. Method: A statistical atlas of lip morphology was created using photographs of 700 women aged 18-35 years. The average lip shape was determined by coregistering and averaging images. Morphological variation was analyzed using principal component analysis. The relationship between attractiveness and observed lip morphologies was assessed using publicly distributed surveys. Results: In total, 428 survey responses were obtained. We developed a statistical model of variation of lip shape in the population and its relationship to attractiveness. The most attractive lips were significantly fuller than the average shape in the population, with greater vertical height and surface area. Conclusion: A statistical atlas can provide a visual guide to variation in lip shape in the population. The most attractive lip shapes vary significantly from the population average, lending support to procedures that increase lip height and surface area.

Background: With the rising popularity of online search tools, patients seeking information on facial palsy are increasingly turning to the Internet for medical knowledge. Objective: To categorize the most common online questions about Bell's palsy or facial paralysis and the sources that provide answers to those queries. Methods: Query volumes for terms pertaining to facial palsy were obtained using Google Search trends. The top 40 keywords associated with the terms "Bell's palsy" and "facial paralysis" were extracted. People Also Ask (PAA) Questions-a Google search engine response page feature-were used to identify the top questions associated with each keyword. Results: A total of 151 PAA Questions pertaining to the top 40 keywords associated with "Bell's palsy" and "facial paralysis" were identified. Etiology questions were most frequent (n = 50, 33.1%), meanwhile those pertaining to treatment were most accessible (119.5 average search engine response pages/question, 35.5%). Most sources were academic (n = 81, 53.6%). Medical practice group sites were most accessible (211.9 average search engine response pages/website, 44.8%). Conclusion: Most PAA questions pertained to etiology and were sourced by academic sites. Questions regarding treatment and medical practice sites appeared on more search engine response pages when compared with all other categories.

Dorsal preservation rhinoplasty techniques can be surface or foundation techniques and respect the philosophy of preserving the osteocartilaginous nasal vault. A spare roof technique (SRT) aims to preserve the upper lateral cartilages through surface techniques. In tension noses with considerable caudal septum deviations, the septal can be repositioned after a low strip of septal cartilage is removed, and the SRT-B is used to reduce the osteocartilaginous hump. This inclusion of the low septal cartilage strip in the SRT-B rhinoplasty is termed as SRT-B3 and builds upon the previously reported philosophy advocated in SRT-A and SRT-B. Correction of moderate deviations of the nasal axis and/or the caudal septum can be addressed with this modification.