Impact of cosmetic facial surgery on satisfaction with appearance and quality of life.

OBJECTIVES: To assess perioperative quality-of-life (QOL) changes in a facial plastic surgery patient population and to ascertain factors determinative of QOL changes. A notable paucity of objective scientific measurements of QOL exists within the facial plastic surgery literature. METHODS: A 3-year prospective cohort study. The patient population, which comprised a consecutive series of patients 16 years or older, undergoing cosmetic nasal or facial surgery, was obtained from the senior author's (P.A.A.) private surgical practice. All patients presenting for surgery were offered participation. The main outcome measure was the 59-item Derriford Appearance Scale (DAS59), a valid and reliable instrument assessing psychological distress associated with self-consciousness of facial appearance. Three patient score subgroupings were established: group 1, the DAS59 scores for all patients; group 2, the DAS59 score according to sex; and group 3, the DAS59 score according to the main surgical procedure. Surveys were administered to eligible patients at the final preoperative clinic visit and at 3 months after surgery. Data from the case-control groups were analyzed by a blinded statistician with appropriate t tests. RESULTS: A total of 93 patients were enrolled with a 100% response rate (82 females [88%] and 11 males [12%]). The most common procedures were rhinoplasty (49%) and surgery for the aging face (51%). Marked differences in perioperative QOL were noted across all DAS59 domains for group 1 and for all females in group 2. Male patients in group 2 analysis experienced QOL improvement only from DAS59 domain 2 (General Self-consciousness of Facial Appearance). Rhinoplasty and surgery for the aging face improved patients' QOL but differed with respect to which DAS59 domains were affected. CONCLUSIONS: Quality of life was enhanced by facial plastic surgery in this patient population. Male and female patients seem to have different needs to be met from facial cosmetic surgery and correspondingly different areas of improvement in QOL. Rhinoplasty and surgery for the aging face act on different domains of QOL.

Otoplasty technique.

Otoplasty remains a challenging but rewarding operation for surgeons who approach it in a rigorous and exacting manner. This article outlines a particular systematic approach to cartilage-sparing otoplasty and related adjuvant procedures. Whichever methods are chosen, precise adherence to the goals and principles summarized herein will help ensure optimal surgical outcomes and associated patient satisfaction.

Psychologic aspects of revision rhinoplasty.

This article is designed to provide some utility in identifying favorable prospective patients for revision rhinoplasty having balanced yet slightly divergent views, expectations, and more importantly, unfavorable candidates who are best left unrevised. The management after-the-fact of the few patients who meet with and unsatisfactory outcome is also discussed.

The Korean American woman's nose: an in-depth nasal photogrammatic analysis.

OBJECTIVES: To assess the differences in nasal anthropometric measurements between Korean American women and North American white women and to perform an in-depth nasal index calculation. METHODS: This anthropometric survey included a volunteer sample of Korean American women (n = 72) aged 18 to 35 years with Korean parents and no previous nasal surgery or trauma to the nose. Standardized and referenced frontal, lateral, and basal photographs of the nose were taken of the subjects and 22 standard anthropometric measurements of the nose were determined. Results were compared with published standards for North American white women. In addition, 18 nasal indices were calculated and compared with the published standards for North American white women. RESULTS: The Korean American woman's nose did not fit the neoclassic facial canons. Compared with North American white women, 20 of 22 nasal measurements in Korean American women were found to be significantly different. Nasal indices also revealed significant differences in 16 of the 18 that were calculated. The Korean American woman's nose exhibits less rotation, has a flatter dorsum, and is more flared at the alae, with less definition of the nasal tip. CONCLUSIONS: The average Korean American and North American white female nasal anthropometric measurements are very different. As cosmetic surgery becomes more popular among Asian Americans, our findings bolster the need for a broader view of facial analysis and transcultural aesthetics.

Otoplasty technique.

Otoplasty remains a challenging but rewarding operation for surgeons who approach it in a rigorous and exacting manner. This article outlines a particular systematic approach to cartilage-sparing otoplasty and related adjuvant procedures. Whichever methods are chosen, precise adherence to the goals and principles summarized herein will help ensure optimal surgical outcomes and associated patient satisfaction.

Limited vs extended face-lift techniques: objective analysis of intraoperative results.

OBJECTIVE: To compare the intraoperative outcomes of superficial musculoaponeurotic system plication, imbrication, and deep-plane rhytidectomy techniques. METHODS: Thirty-two patients undergoing primary deep-plane rhytidectomy participated. Each hemiface in all patients was submitted sequentially to 3 progressively more extensive lifts, while other variables were standardized. Four major outcome measures were studied, including the extent of skin redundancy and the repositioning of soft tissues along the malar, mandibular, and cervical vectors of lift. The amount of skin excess was measured without tension from the free edge to a point over the intertragal incisure, along a plane overlying the jawline. Using a soft tissue caliper, repositioning was examined by measurement of preintervention and immediate postintervention distances from dependent points to fixed anthropometric reference points. RESULTS: The mean skin excesses were 10.4, 12.8, and 19.4 mm for the plication, imbrication, and deep-plane lifts, respectively. The greatest absolute soft tissue repositioning was noted along the jawline, with the least in the midface. Analysis revealed significant differences from baseline and between lift types for each of the studied techniques in each of the variables tested. CONCLUSION: These data support the use of the deep-plane rhytidectomy technique to achieve a superior intraoperative lift relative to comparator techniques.

Applications of the M-arch model in nasal tip refinement.

The M-arch model of nasal tip dynamics provides an elaboration and modernization of the tripod concept to better permit understanding of the effects of various tip-altering maneuvers on the overall form and function of the tip complex. It defines the tip complex as paired arches whose overall length determines the major nasal parameters. This length may be adjusted at numerous points within the arch to effect specific desirable changes. This article provides a practical account of the M-arch model with case-based examples to better demonstrate its applicability.

The M-Arch model: a new concept of nasal tip dynamics.

The M-Arch Model introduced herein expands on the utility and simplicity of the tripod concept to consider the overall length of the cartilaginous tripod arch as the major determinant of nasal tip parameters. Surgeons may exploit this powerful tool using modern grafting, suture, and cartilage-cutting techniques to predictably achieve desired tip alterations and, by extension, more consistently satisfactory aesthetic outcomes.

Evolution of rhytidectomy techniques.

Rhytidectomy techniques have advanced greatly since their inception a century ago. Today, a rich array of procedures is available, ranging from limited and minimally invasive approaches to extensive dissections. The evolution of rhytidectomy is outlined herein, along with a review of the relative indications and advantages of commonly practiced procedures.

Surgical management of the aging neck.

Blunting of the cervicomental angle with age is caused by progressive laxity of the skin and subcutaneous tissues, along with proliferation of fatty deposits and platysma muscle banding. This contributes to a loss of the slender neckline associated with youth, often a primary point of concern for patients. Surgeons may avail themselves of several surgical techniques in common use to restore definition to this region. A thorough evaluation of bone and soft tissue anatomy informs the appropriate surgical approach and allows successful rejuvenation of the aging neck. The lead author's tactics for enhancement of the neck are outlined.

The Korean American woman's face: anthropometric measurements and quantitative analysis of facial aesthetics.

OBJECTIVES: To assess the differences in facial proportions between Korean American (KA) women and North American white (NAW) women and to quantitatively describe aesthetic facial features in the KA women. DESIGN: Anthropometric survey and facial aesthetic evaluation. PARTICIPANTS: Volunteer sample of KA women (n = 72) who served as models for part 1 of the study and a different sample of KA women (n = 5) and men (n = 5) who served as judges for part 2 of the study. All subjects were between ages 18 and 35 years and had Korean parents and no previous facial surgery or trauma. Intervention For part 1 of the study, standardized and referenced frontal and lateral photographs were taken of the models, and 26 standard anthropometric measurements were determined. Results were compared with published NAW standards. For part 2 of the study, 10 judges evaluated frontal views of the models for facial aesthetics using a visual analog scale. Quantitative analysis was done of the faces of attractive KA women (>90th percentile in aesthetic scores) and comparisons were made with the faces of NAW women and average KA women. RESULTS: The KA woman's face did not fit the neoclassical facial canons. Compared with NAW women, 24 of the 26 facial measurements in KA women were significantly different. Only 9 of the 26 facial measurements were significantly different when the attractive KA women were compared with the NAW women. Nine of the 17 nonsignificant facial measurements were very similar to those of the NAW women; many of these facial features centered around the midface. CONCLUSIONS: Although the average KA woman's facial anthropometric measurements were very different from those of the NAW woman, attractive KA women reflected many of the facial features of NAW women. These findings support the need for ethnically sensitive facial canons and further research into transcultural aesthetics.

Rhinoplasty in the aging nose.

The aging nose presents a difficult challenge for the rhinoplastic surgeon. To best address the patient's wishes, the surgeon must possess a sound understanding of the atrophic changes associated with the aging nose, including tip ptosis, increased nasal bulbosity, a lengthened nasal appearance, and altered nasal airflow patterns. Surgical emphasis is placed on conservative structured reduction to address functional concerns. Overresection risks destabilizing the nasal tip and altering the patient's concrete self-image. This article outlines our approach to rhinoplasty in the aging nose with a special emphasis on the use of porous polyethylene alloimplants to provide added structural support.

Management of the severe bulbous nasal tip using porous polyethylene alloimplants.

Reliable outcomes in correction of the severely bulbous nasal tip remain elusive. Reduction and binding of the tip cartilages result in a partial external nasal valve collapse. If a concurrent dorsal hump reduction is accomplished and osteotomies are completed to close the open roof deformity, then a severe constriction of the external valve may result. This is best avoided by resection of the residual lower lateral cartilages and substitution with external valve batten implants. The tripod of nasal tip supports is then rigidly reconstituted. When autogenous graft materials are considered inadequate or undesirable, the surgeon may safely use porous polyethylene alloimplants to support the external nasal valve. A dependable surgical technique based on extensive experience with these materials is outlined.