Rhinoplasty Complication Requiring Multiple Revisions.

Cosmetic rhinoplasties are complex surgical procedures that can present with serious complications requiring revision surgeries. Septal graft difficulties are common complications in rhinoplasties, requiring surgeon awareness of the potential future need for corrective surgery. Here, we report a case of multiple revision cosmetic rhinoplasties due to recurrent complications. Additionally, a review of the literature regarding cosmetic rhinoplasty complications and risk factors was performed.

The Impact of Component Dorsal Hump Reduction on Patient-Perceived Nasal Aesthetics and Obstruction in Rhinoplasty.

OBJECTIVE: This study aimed to evaluate functional and aesthetic patient-reported outcomes using validated metrics after component dorsal hump reduction (DHR) with spreader graft placement, which have not been previously reported. STUDY DESIGN: Prospective cohort study. METHODS: This prospective cohort study was conducted in a tertiary care medical center. Participants underwent septorhinoplasty (SRP) with spreader graft placement with cosmetic, component DHR (cosmetic DHR), or SRP with spreader graft placement without dorsal hump reduction (noncosmetic, non-DHR). The Nasal Obstruction Symptom Evaluation (NOSE) scale and the FACE-Q Satisfaction with Nose, Nostrils, and Social Functioning scales were administered to patients preoperatively and postoperatively (at 2, 4, 6, and/or 12 months). Pre- and postoperative NOSE and FACE-Q scores were compared. RESULTS: A total of 226 patients underwent SRP with spreader graft placement; 113 (50.0%) with cosmetic DHR and 113 (50.0%) noncosmetic, non-DHR (control). Patients who completed the NOSE and FACE-Q surveys preoperatively and at least at one postoperative time point were included. Both cohorts had a statistically and clinically significant improvement in NOSE and FACE-Q scores. There were similar improvements in NOSE scores in both cohorts. Postoperative FACE-Q scores were higher in the cosmetic DHR cohort despite lower preoperative FACE-Q scores when compared to the control cohort. CONCLUSIONS: Although there are multiple techniques for DHR, component DHR with spreader graft placement has long been considered the standard. Therefore, it is important to note the significant postoperative cosmetic and functional improvements reported by patients who have undergone this procedure to compare to newer techniques as they evolve. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:2157-2161, 2022.

Reduction Rhinoplasty Re-Endorsed: When Conservative and Measured.

Reduction rhinoplasty has been widely criticised and dismissed due to the current preference for structural rhinoplasty. The criticism is related to airway compromise and secondary structural deformities, both early and late, due to overzealous resection. This two-year study attempted to prospectively assess the risk of airway and structural problems following reduction rhinoplasty in 30 consecutive patients. The findings showed no statistically significant difference either in the NOSE score (subjective sense of breathing) or in nasal valving (objective observations), at the 3-month follow-up. Subsequent 12-month telephone reviews revealed no change in the patients' functional or aesthetic outcomes. There was a 3% structural complication rate (requiring secondary surgery) and a 20% rate for further refining reduction surgery. The findings confirmed the author's impression that conservative, measured reduction rhinoplasty, performed with due consideration to preserving the nasal supportive framework, is a technique well worth endorsing with confidence to reduce the disproportionately large nose. Contemporary surgeons need not feel obliged to only use the more complex later-developed structural rhinoplasty techniques.

Surgical Considerations in Patients of Middle Eastern Descent.

Rhinoplasty in patients of Middle Eastern descent presents a unique challenge. There are a large number of variations of skin tone, skin thickness, and structural deformities, which require a high degree of thoughtfulness and planning. A thorough history and physical examination is the cornerstone to achieving a good result. An open and honest discussion is necessary to fully understand the patient's goals. The surgeon should clearly define which goals are achievable and which are not. Conservative techniques will help achieve a natural, balanced outcome and will allow for preservation of nasal function.

Analysis of Nasal Obstruction Patterns Following Reductive Rhinoplasty.

BACKGROUND: Cosmetic rhinoplasty has been linked to iatrogenic breathing disturbances using clinical tools. However, few studies have evaluated outcomes using validated, patient-centered instruments. OBJECTIVE: We aim to determine the incidence and severity of nasal obstruction following cosmetic rhinoplasty as measured by patient-centered, disease-specific instruments. DESIGN: This is a retrospective review of adult patients who underwent cosmetic rhinoplasty at Stanford Hospital between January 2017 and January 2019. General demographic as well as Nasal Obstruction and Symptom Evaluation (NOSE) and the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) questionnaire data were included. Scores were tracked across postoperative visits and compared to the preoperative state. Patients were subdivided into dorsal hump takedown, correction of the nasal tip, and both. RESULTS: Of the 68 included patients, 56 were women, and the mean age was 30.6 years. Although mean SCHNOS and NOSE scores increased at the first postoperative interval, mean scores decreased on each subsequent visit. There were no significant increases in SCHNOS or NOSE scores for either dorsal hump takedown, tip correction, or both. There were only two patients who recorded NOSE scores higher than baseline at most recent postoperative visit. CONCLUSION: Our results indicate reductive rhinoplasty is not associated with a greater risk of breathing obstruction when performed with modern airway preservation techniques. The initial increases in obstructive symptoms we observed on the first postoperative visit likely represent perioperative swelling given the improvement on follow-up visits. Both the NOSE and SCHNOS are patient-centered questionnaires capable of evaluating nasal obstruction following cosmetic rhinoplasty. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Nasal Obstruction Considerations in Cosmetic Rhinoplasty.

Cosmetic rhinoplasty is an increasingly popular procedure in the United States. There are critical aspects of preoperative planning and intraoperative execution that facilitate successful rhinoplasty. Thorough preoperative assessment of the structures comprising the internal and external nasal valves and identification of potential at-risk areas for static or dynamic compromise must be done before surgery. Thoughtful maneuvers and meticulous surgical technique must be used. Postoperative counseling ranges from simple reassurance to medical therapy to procedural efforts to alleviate a patient's concerns. It is important to establish rapport with the patient and dutifully address all cosmetic and functional concerns.

International consensus (ICON) on functional and aesthetic rhinoplasty.

During the 2017 IFOS international congress in Paris, a roundtable discussion on the topic of functional and aesthetic rhinoplasty was organised. Five experts, from the five continents and renown in the field of rhinoplasty, were brought together to discuss the issue from an international perspective and to put forward a consensus or on the contrary practical differences. Five questions were put to the experts beforehand to guarantee independent answers, which were then discussed during the roundtable. The questions were the following: - What are the age limits for achieving a rhinoplasty? - Do you use objective measurements before, during and after surgery? (facial landmarks, airflow, peroperative measurements) - How do you manage the preoperative general information and computer imaging of the patient? - What are the indications in your practice to perform a CT-scan or endoscopic examination before doing a rhinoplasty? - What kind of graft or prosthesis do you use for an augmentation rhinoplasty? This paper offers a synthesis of the roundtable based on the experts' answers to the different questions.

Anatomical Study and Comprehensive Review of the Incisivus Labii Superioris Muscle: Application to Lip and Cosmetic Surgery.

Objectives The incisivus labii superioris muscle, which originates from the floor of the incisive fossa of the maxilla, has previously been described, it is not well understood. The purpose of this study was to investigate the incisivus labii superioris muscle with detailed dissection. Methods Twenty-six halves from thirteen fresh frozen cadaveric Caucasian heads were used in this study. First, the incisivus labii superioris muscle was dissected to reveal its origin and insertion, and its relationship to other mimetic muscles. Secondly, the distance from the midline to the innermost part of the bony attachment of the muscle was measured. The literature describing the incisivus labii superioris muscle was reviewed. Results The incisivus labii superioris muscle consisted of two parts, inferior and superior. The former merged into the orbicularis oris and the latter into the nasalis. The mean distance from the midline to the innermost part of the bony attachment of the incisivus labii superioris muscle was 4.8 ± 1.7 mm on the right side and 4.9 ±1.7 mm on the left. Conclusions The results of the present study suggest that the inferior part of the incisivus labii superioris should be considered as an accessory muscle of the orbicularis oris complex, and the superior part is the nasalis muscle.

Evidence-Based Medicine: Rhinoplasty.

Evidence-based medicine has become increasingly prominent in the climate of modern day healthcare. The practice of evidence-based medicine involves the integration of the best available evidence with clinical experience and expertise to help guide clinical decision-making. The essential tenets of evidence-based medicine can be applied to both functional and aesthetic rhinoplasty. Current outcome measures in functional and aesthetic rhinoplasty, including objective, subjective, and clinician-reported measures, is summarized and the current data is reviewed.

The role of septal surgery in cosmetic rhinoplasty.

Septoplasty is performed to resolve breathing problems, but it often becomes pivotal to correct external nasal deviation, representing a central step in rhinoplasty surgery. Even in patients with no functional problems, septal surgery may represent the best solution for obtaining a proper realignment of the external nasal pyramid. One-stage septorhinoplasty has become the standard of treatment for a deviated nose, hence septoplasty cannot be considered as a separate procedure to perform before or after rhinoplasty or as a partial operation subject to later revision. The aim of this article is to discuss the close relationship between the nasal septum and the aesthetics of the nose, and how a graduated surgical approach for the correction of septal deviations could affect the external deviated nose.

Psychopathology and psychiatric co-morbidities in patients seeking rhinoplasty for cosmetic reasons / Psicopatología y comorbilidad psiquiátrica en pacientes que buscan rinoplastia por razones cosméticas

AIM: The purpose of the study was to examine psychopathological traits and psychiatric co-morbidities in seekers of cosmetic rhinoplasty. SUBJECTS AND METHOD: Fifty persons seeking cosmetic rhinoplasty and 50 control subjects were admitted to the study. Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Symptom Checklist - 90 [Revised] (SCL-90-R) were administered to people who requested cosmetic rhinoplasty and control subjects. All participants were also screened by the Structured Clinical Interview for DSM-IV-(SCIDI/ CV, SCID-II). RESULTS: Thirteen cosmetic rhinoplasty seekers [CRS] (26%) and three control subjects (6%) had at least one psychiatric diagnosis. There was a significant difference between the two groups (p = 0.006). Beck depression inventory (p = 0.002) and BAI (p = 0.046) levels above the cut-off point were significantly higher in the CRS group than in the normal control. Somatoform disorders were statistically higher in the CRS than control group (p = 0.007). Nine CRS (18%) and two control subjects (4%) had at least one personality disorder. There were differences between the two groups (p = 0.025). The average of SCL-90-R was significantly higher in the CRS than in the control subjects (p < 0.001). The most prevalent somatoform disorders of the CRS were six with body dysmorphic disorder [BDD] (12%). The most prevalent personality disorders of the CRS were three with avoidant (6%) and three with narcissistic (6%) personality. CONCLUSION: Assessment of detailed psychopathological aspects and psychiatric co-morbidities could help to define the clinical profile of people requesting cosmetic rhinoplasty in cosmetic surgery settings. Research into these factors may be important as it is essential to detect crucial problems such as personality disorders and BDD before surgery.

OBJETIVO: El propósito del estudio fue examinar los rasgos psicopatológicos y las comorbilidades psiquiátricas en los solicitantes de rinoplastia cosmética. SUJETOS Y MÉTODO: Cincuenta personas que buscaban rinoplastia cosmética, y 50 sujetos de control fueron registrados en el estudio. El Inventario de Depresión de Beck (BDI), el Inventario de Ansiedad de Beck (BAI), y el Listado de Síntomas 90 (Revisado) (SCL 90), fueron aplicados a las personas que solicitaron rinoplastia cosmética y a los sujetos del control. Todos los participantes fueron también sometidos a tamizaje mediante la Entrevista Clínica Estructurada para DSM - IV-(SCID-/ CV, SCIDII). RESULTADOS: Trece solicitantes de rinoplastia cosmética solicitantes (SRC) (26%) y tres sujetos de control (6%) tuvieron al menos un diagnóstico psiquiátrico. Hubo una diferencia significativa entre los dos grupos (p = 0.006). Los niveles de BDI (p = 0,002) y BAI (p = 0.046) por encima del valor límite, fueron significativamente más altos en el grupo de SRC que en el grupo control normal. Los trastornos somatoformes fueron estadísticamente más altos en el grupo SRC que en el grupo control (p = 0.007). Nueve SRC (18%) y dos sujetos de control (4%) tenían al menos un trastorno de personalidad. Hubo diferencias entre los dos grupos (p = 0. 025). El promedio de SCL-90-R fue significativamente más alto en el grupo de SRC que en los sujetos del grupo control (p < 0.001). Los trastornos somatoformes más prevalentes de SRC fueron seis con trastorno dismórfico corporal (TDC) (12%). Los trastornos de personalidad más prevalentes de SRC fueron: tres con trastorno de la personalidad por evitación (6%) y tres con personalidad narcisista (6%). CONCLUSIÓN: La evaluación de los aspectos psicopatológicos detallados y las comorbilidades psiquiátricas podrían ayudar a definir el perfil clínico de las personas que solicitan rinoplastia cosmética en los escenarios de cirugía cosmética. La investigación en estos factores puede ser importante, ya que es esencial para detectar problemas cruciales tales como los trastornos de personalidad y TDC antes de la cirugía.

Psychopathological evaluation of patients requesting cosmetic rhinoplasty a review / Evaluación psicopatológica de pacientes que requieren rinoplastia cosmética una revisión

OBJECTIVE: The goal of this review is to discuss possible underlying psychopathological situations in patients requesting surgical cosmetic rhinoplasty operation and to examine potential problems that might arise. SUBJECTS AND METHODS: An extensive search was conducted through PubMed, Ambase and PsychInfo by using related keywords in English, like "rhinoplasty and psychiatric comorbidities ", "rhinoplasty and psychopathology". RESULTS: Patients who demand cosmetic rhinoplasty operation appealed to the surgeon since they wanted to feel better about themselves after the surgery. Indeed, some long-term studies determined that such a situation can take place at high rates. However, some studies reported the possibility of serious psychological disorders after such surgical operations. Studies relating to the analysis of psychopathologic symptoms are quite limited. Research has shown that psychopathologic evaluation conducted preoperatively is especially important to identify serious psychopathologies such as personality disorders and body dysmorphic disorder (BDD). CONCLUSIONS: Exclusion of patients possessing serious psychopathologies from operations provides better results in the long term. The lack of sufficient research in this area necessitates new and comprehensive studies.

OBJETIVO: El propósito de esta revisión es discutir las posibles situaciones psicopatológicas detrás de pacientes que solicitan la operación de rinoplastia quirúrgica cosmética, y examinar problemas potenciales que podrían suscitarse. SUJETOS Y MÉTODOS: Se llevó a cabo una búsqueda extensa a través de PubMed, Ambase y PsychInfo usando palabras claves en inglés, como "rinoplastia y comorbidades psiquiátricas " "rinoplastia y psicopatología ". RESULTADOS: Pacientes que solicitaban una operación de rinoplastia cosmética, apelaron al cirujano expresando que deseaban sentirse mejor luego de la cirugía. En realidad, algunos estudios a largo plazo determinaron que una situación semejantepuede tener una alta tasa de ocurrencia. Sin embargo, otros estudios reportan la posibilidad de trastornos psicológicos serios Los estudios que se refieren al análisis de síntomas psicopatológicos, son muy limitados. Las investigaciones han demostrado que realizar una evaluación psicopatológica antes de la operación, es en extremo importante [ara identificar serias psicopatologías tales como trastornos de la personalidad y Trastorno Dismórfico Corporal (TDC). CONCLUSIONES: El excluir a los pacientes con serias psicopatologías de las operaciones arroja mejores resultados a largo plazo. La insuficiente investigación en esta área apunta a la necesidad de que se realicen estudios nuevos y abarcadores.