Immediate secondary rhinoplasty using a folded dermofat graft for resolving complications related to silicone implants: A case report

BACKGROUND Various surgical techniques have been developed to enhance the nose shapes of Asian patients.Silicone implant augmentation rhinoplasty is widely used because it is relatively easy to perform and often yields satisfactory outcomes.However,this technique may lead to complications,including ischemia,necrosis,and over-augmentation.The most appropriate management of these complications,including infection,is immediate implant removal and revision surgery once the accompanying inflammation has healed.Occasionally,the patient may experience distress from nasal deformities during the intervention period.CASE SUMMARY Herein,we describe the case of a patient who underwent a secondary dorsal augmentation,with a folded dermofat graft harvested from the inguinal area and simultaneous implant removal,successfully preventing dimpling of the nasal deformity.CONCLUSION This surgical method can effectively manage implant-related complications following augmentation rhinoplasty using a silicone implant and provide satis-factory patient outcomes.

Ear keloid and epidermal cyst following auricular cartilage harvest for rhinoplasty:A case report

BACKGROUND This case report highlights a rare instance of concurrent keloid and epidermal cyst development at an ear cartilage harvest site following rhinoplasty in a 25-year-old woman.Both conditions,which typically stem from skin trauma,seldom occur together,demonstrating the exceptional characteristics of this case.CASE SUMMARY The patient underwent successful surgical removal of both the keloid and the epidermal cyst.Postoperative treatment included the use of silicone sheets,gel,and oral tranilast to reduce scarring.No recurrence was observed over a 6-mo follow-up period,indicating effective management of the condition.CONCLUSION The effective management of complex skin trauma cases underscores the need for individualized treatment strategies in plastic surgery.

Current practice in autologous rib and costal-cartilage harvest for rhinoplasty:A systematic review

Background:Autologous costal grafts are used universally in clinical practice for rhinoplasty and reconstruction.However,surgeons worldwide have not agreed on the details of graft harvesting,including rib selection,side preference,operation mode,cutting methods,and handling of the periosteum and perichondrium.This study aimed to provide an overview of the novel techniques used for auto-rib harvesting in rhinoplasty within the past 5 years and identify potential avenues for future research.Methods:We searched for related articles in PubMed,Embase,and Web of Science from 2019 to 2023,summa-rized crucial but controversial steps in recent practice,and analyzed their theoretical basis and clinical feasibility.Results:Auto-rib and cartilage open harvest is still mainstream in rhinoplasty and reconstruction,with the 5th to 8th ribs and cartilage being the most used.The laparoscopic harvest is gaining attention,being second only to the open harvest,with the 9th/10th ribs and cartilages being particularly convenient.The clinical applications of full-cut and split-cut methods differ in their advantages.Except for some special reasons,almost all studies tended to preserve the periosteum and perichondrium in situ,and few surgeons chose to harvest the grafts on the left side.Conclusion:Multiple techniques have emerged,requiring surgeons to balance the benefits and risks of various strategies at each step.New theories and techniques should be fully tested promptly and in clinical practice before wide application.Overall,a professional consensus is needed for better directivity,precision,and stability in clinical practice.

3D image system improves the learning curve and contributes to medical education of rhinoplasty

Background: Rhinoplasty is a complex surgical procedure that requires critical analysis and precise design before surgery, making it a challenging operation for both the surgical team and medical educators. This study aimed to evaluate the impact of 3D design involvement on learning curves and to establish a more effective method for rhinoplasty education.Methods: Surgeons who participated in an educational program were divided into two groups. The experimental group was involved in the 3D design before the operation, and the control group was asked to review the rhinoplasty atlas. A self-assessment questionnaire was used to evaluate the learning curve of the eight rhinoplasty procedures for each surgeon, and the overall satisfaction rate data were also collected.Results: The self-assessment scores in both groups showed an increasing trend from the first to the eighth operation. The mean scores of the experimental group were significantly higher than those of the control group at the fifth operation(P=0.01). The satisfaction rate of the experimental group(91.7%) was higher than that of the control group(54.5%).Conclusion: The 3D imaging system can improve the learning curve and satisfaction rate of rhinoplasty education,proving that it is an easy and effective tool for medical education.

Principles and Techniques of Post-Traumatic Rhinoplasty: A Review of the Literature

Post-traumatic rhinoplasty is the surgical treatment of the complex functional and aesthetic sequelae of nasal trauma. Correcting a post-traumatic nose is a challenging task, requiring the surgeon to employ a range of techniques and grafts to adequately address the deformities observed. The results of our research show that restoring pre-traumatic form and function remains complex, although many guidelines have been established to refine and optimize the management of the after-effects of nasal trauma. But it is achievable with the right techniques. The objective of our review is to highlight the various post-traumatic nasal sequelae, describe the fundamental principles in the field of post-traumatic rhinoplasty and provide the surgeon with the various existing surgical techniques and strategies so that he or she can make an appropriate choice for the patient.

Aesthetic and Functional Outcomes of Open versus Closed Septorhinoplasty in Deviated Nose Deformity

Background: Over the years, an optimal surgical method for septorhinoplasty in deviated nose as a challenging problem was the one of common interest of plastic surgeon;the purpose of this study is to compare outcomes of open and closed methods of septorhinoplasty in patients with deviated noses. Methods: Through a prospective study, we selected seventy patients with deviated nose. Based on their deviation severity, they underwent open or closed septorhinoplasty. Patients were evaluated for deviation angles of nasal bony and cartilage components, nasal projection, nasolabial angle, nasofacial angle, and nasofrontal angle;for which three standard photos were captured pre and postoperatively. Finally the outcomes were analyzed according to their surgical methods. Results: Closed septorhinoplasty could grant a mean 11 degrees correction to nasal bony component and a mean 8.6 degrees correction to cartilage component. That’s while open septorhinoplasty could bring a mean 19.5 degrees deviation correction to the bony component and a mean 12.5 degrees deviation correction to the cartilage component. Cosmetic angles were not improved significantly after the surgery, maybe because of complicated deformities our series of patients had. Conclusion: Open septorhinoplasty resulted in better cosmetic and functional outcomes than the closed method.

Use of Autologous Costal Cartilage Combined with Expanded Polytetrafluoroethylene in Asian Rhinoplasty

Background The corresponding author's experience and recent methods employed in autologous costal cartilage grafts combined with expanded polytetrafluoroethylene(ePTFE)in Asian rhinoplasty were presented in this study.Objectives The purpose of this study was to assess the outcomes of rhinoplasty performed on patients using autogenous costal cartilage grafts combined with an ePTFE implant.Methods Seventy-five rhinoplasty cases with autologous costal cartilage grafts and an ePTFE implant were retrospectively reviewed.Graft types,complications associated with the graft itself or graft harvesting,surgical outcomes,and patient satisfaction were assessed.Results The mean follow-up time post-operation was 13.5 months.A total of 42/75 patients underwent revision surgeries.Graft-related complications were found in 8%of cases,including two warped graft and four infection cases.Three individuals with infections had mild graft resorption.One patient with an infection removed the implant.Graft exposure,mobility,and substantial resorption were not recorded.A total of two cases underwent revision procedures for infection and perforation,respectively.Chest incision lengths for graft harvesting averaged 2.1 cm.No pneumothorax or significant donor-site pain was found.Donor-site scars were negligible,although two cases had hypertrophic chest scars.In general,functional and esthetic outcomes were mostly satisfactory among the assessed patients.Conclusions Rhinoplasty using autologous rib cartilage provides adequate support and sufficient cartilage amounts for correcting nasal contouring.Meanwhile,ePTFE alone for nasal dorsum augmentation safely achieves satisfactory outcomes.Rib cartilage rhinoplasty performed by an experienced surgeon yields excellent,long-lasting results with minimal risk;however,the potential for infection should be considered following revision surgery.

Clinical features and literature review related to the material differences in thread rhinoplasty:Two case reports

BACKGROUND Thread rhinoplasty can trigger a reaction to thread material,which is a foreign body.We compared clinical features induced by absorbable and non-absorbable threads following thread rhinoplasty.CASE SUMMARY Two patients who underwent different thread materials showed different clinical courses and different Hounsfield unit(HU)values in computed tomography.Patients with absorbable thread showed high HU values similar to a metallic material,and the HU value of inflammation was similar to vascular tissues with a lot of water(250).In the intraoperative field,absorbable thread materials and micro-abscesses were observed.In contrast,in the case of a non-absorbable thread,an object presumed to be thread was seen on the computed tomography(CT),and the HU value of inflammatory tissues was less than 100.In both patients,post-operative HU decreased to less than 100 and the clinical course improved.In both cases,histopathologic findings revealed foreign body granuloma associated with inflammation.CONCLUSION Absorbable threads were more aggressive and are more easily detected on CT.

Revision rhinoplasty for contracted nose:A systematic review and meta-analysis

Background:This study aimed to review treatments and evaluate the aesthetic outcomes,complications,and reoperation rates regarding surgical correction for a postoperative contracted nose.Methods:PubMed,MEDLINE,and Embase databases were searched for studies detailing aesthetic outcomes and complications of surgical correction of a contracted nose.Surgical procedures,adjuvant treatment,outcomes,and complications were synthesized and analyzed.Results:Nine articles encompassing 376 patients were included in the systematic review,and six articles(198 participants)were included in the meta-analysis.The most frequently used graft material was the autologous rib cartilage(61.1%).Surgical procedures were heterogeneous in these studies.The nasolabial angle reduced by 9.52°(95%confidence interval(CI):(-11.95,-7.09),P<0.0001),and the nasal length increased significantly(standardized mean difference(SMD)=2.25,95%CI:(1.26,2.23),P<0.00001).However,the evidence was insufficient to determine a significant change in the columellar-labial angle(SMD=-0.95,95%CI:(-2.19,0.29),P=0.13)and columellar-lobular angle(SMD=2.39,95%CI:(-1.20,5.97),P=0.19).Aesthetic dissatisfaction(12.5%)and infection(4.5%)were the most commonly reported complications.Reoperation was performed in 5.3%of patients.Conclusion:Surgical correction can increase the nasal length,reduce the nasolabial angle,and have a low reoperation rate.No significant improvement in the columellar-labial or columellar-lobular angle was observed.

Integrated Product Development in Rhinoplasty:A Case Study

The 3D simulation in preoperative design for nasal plastic surgery was studied to help patients see the postoperative effects and reduce medical disputes.The study developed and clinically tested an innovative design for surgical guides for nasal plastic surgery,which showed positive results in patient satisfaction and accuracy in achieving the preoperative simulated effect.The study also investigated the process of designing and producing nasal prostheses and how patient feedback could be obtained using third-party social media voting.Patient satisfaction information was collected and evaluated using the Likert scale,and the data statistical analysis was carried out with the SPSS19.0 software.More than 94.1% of the patients were satisfied with the postoperative results.The study provides a good reference case for the integration of knowledge and skills from the medicine,design,and engineering fields in the development of medical devices.

Dysmorphophobic Patient Seeking Primary Cosmetic Rhinoplasty

This article is aimed to elaborate the significance of detecting clinical features (subjectivity, objectivity and assessment) of the Dysmorphophobic (DMP) psychiatric patients seeking primary cosmetic rhinoplsty (PCR). DMP clients present as a fixation of their thoughts toward the trivial flaws on their body’s anatomy. They consider such minor defects as major and show a great amount of anxiety for such negligible issues. Such dread affects their social, occupational and family’s life and trigger them to seek means of correcting such small blemishes through medical and or surgical approaches. Considering to their nose, they crave to eliminate their minor defects through PCR operation. PCR is viewed as one of the most prevalent aesthetic operations in the field of cosmetic surgery. Author’s method of approach in PCR is to select candidates after obtaining a meticulous health history, physical exam and appropriate para clinical tests. In some uncertained cases, based on their subjectivity and objectivity presentations, are referred for consultation with a psychiatrist for final assessment. Most selected patients undergo PCR via standby anesthesia through an incision on the nasal columella (open rhinoplasty), or in others which their nasal tip alternation is not needed, PCR is approached with no incision on the nasal columella (closed rhinoplasty). Due to the high demand of PCR in the world, among many clients who are seeking for such surgery, might be some cases with DMP disorder who are overlooked in spite of an accurate surgeon’s screening.

Rhinoplasty in China: A review of the most important events in its history of development

A review of the literature in commonly used retrieval systems generally yields minimal or no pertinent information on the early works of Chinese doctors.Herein,the early works in rhinoplasty by pioneers Dr.Maolian Hu(胡懋廉)and Dr.PC Nyi(倪葆春)were retrieved from the database of Chinese Medical Journal published before1949 that overseas doctors could not gain access to online possibly due to the language barrier in collecting and processing those old professional data by main retrieval systyems.They published original articles on costal cartilage applications for correction of saddle noses in as early as 1939 and 1949,respectively,which represent the earliest attempts of treating nasal deformities with costal cartilages in China as well as in Asia.The private cosmetic surgical practices in rhinoplasty from the 1930s to the 1940s were recovered and briefly reviewed,and some of the most important clinical cases were presented.Other important events related to rhinoplasty,such as the establishment of the first national society of rhinoplasty in Chengdu,China in 2011 and the successful performance of the first national congress on rhinoplasty in Shanghai,China in 2012,were included.

Gender Differences in Aesthetic Rhinoplasty Patients: A Study on Psychopathological Symptoms

The aim of the current study was to investigate the gender differences in aesthetic rhinoplasty candidates in dimensions of psychopathology. Considering the existing body of literature, it was hypothesized that women would score higher in different dimensions of psychopathology. SCL-90-R was used to evaluate the differences. This instrument consists of 10 subscales which measure depression, anxiety, phobia, hostility, obsessive-compulsive symptoms, interpersonal sensitivity, somatization, paranoid ideation, psychoticism, and added items of psychopathology. Independent t-test between male patients (n = 19) and female patients (n = 32) was performed. Findings indicated that women had higher scores in four subscales. Women had higher scores in anxiety (P < 0.01), obsessive-compulsive symptoms (P < 0.05), depression (P < 0.05), and added items (P < 0.05). Effect size measures were calculated in order for better interpretation of statistical significance tests. Findings supported the notion that women who applied for aesthetic rhinoplasty showed higher scores of anxiety, depression, obsessive-compulsive symptoms, and general psychopathological symptoms. Surgeons can utilize validated psychometric instruments in order to screen psychologically disturbed patients as these patients are more likely to show dissatisfaction after the surgery.

Photogrammetry of Chin as a Requisite Preoperative Evaluation of Cosmetic Rhinoplasty

Introduction: The aim of this study is evaluation of chin deformities and their role in rhinoplasty cosmetic surgery outcomes via photogrammetry of chin. Materials and Methods: The study is a cross sectional one. All photos of rhinoplasty surgery candidates of three hospitals (Amir Aalam, Imam Khomeini and Razi of Tehran) which were taken in standard lateral position via SLR cameras were assessed through Adobe Photoshop CS, in order to determine four different aesthetic measurements. Except for excluded photos due to our excluding criteria or technical problems, all photographs were evaluated carefully. Results: 144 photos of patients were enrolled. The oldness of patients ranges between below 20 up to above;65.99 patients were female (68.8%) and 45 were male. 73 patients (50.7%) had an abnormal silver condition. Moreover 9 patients (6.3%) with abnormal nasomental, 124 patients with abnormal status of Gonzalez-Ulloa (93.8%), 63 patients (43.8%) with unusual status of Ricketts’ E line/upper and 49 patients (34%) with abnormal Ricketts’ E line/lower status can be demonstrated. Discussion: Performing a photogrammetric study for candidates of cosmetic rhinoplasty also a chin examination as a mandatory preoperative assessment seems to be essential. Due to the lack of studies in this field, more studies are necessary.

The latest trends in Asian rhinoplasty

Rhinoplasty in Asia is becoming increasingly widespread.When taking into consideration the anatomical differences between the features of Caucasian and Asian patients,it is unsurprising that knowledge gained from research on Caucasian rhinoplasty is not always applicable to Asian rhinoplasty.Furthermore,reviews aimed at describing the recent developments in Asian rhinoplasty are rare.This review aims to provide a comprehensive summary of the latest trends in rhinoplasty for Asians by classifying it into three parts:methods,materials,and three-dimensional techniques,hopefully providing surgeons with references to aid in conducting rhinoplasty on Asians.

Modern Composite Materials and Technical Strategies in Posttraumatic Augmentation Rhinoplasty

The selection of ideal posttraumatic augmentation rhinoplasty materials and technical strategies has always been a pressing challenge.Owing to the complexity of the traumatic nasal anatomical structure,such procedures are more complicated than ordinary cosmetic rhinoplasty.The choice of reconstruction material should emphasize its inherent characteristics,such as biocompatibility,anti-infective ability,strength,and plasticity.With the development of rhinoplasty,the choice of material is less limited and composite materials have become mainstream.This review outlines current composite materials and techniques in posttraumatic augmentation rhinoplasty.

Perioperative Dexamethasone and Post-Rhinoplasty Edema: A Prospective Observational Study

Purpose: The timing, schedule, and doses of dexamethasone administration to control edema are a topic of debate. This prospective observational study was performed to evaluate the effects of perioperative and intraoperative administration of dexamethasone on the occurrence of edema in patients who underwent rhinoplasty. Methods: This study was conducted at Najran University Hospital, Najran University, Saudi Arabia, from June 2019 to August 2020. Seventy-five patients who underwent open rhinoplasty were assigned using a consecutive non-random sampling method into three groups, with 25 patients in each group. Group A patients received three doses of intravenous 8 mg dexamethasone perioperatively, and group B patients received a single dose of intravenous 8 mg dexamethasone intraoperatively. Group C patients received intravenous 2 mL of 0.9% normal saline solution intraoperatively and were considered as a control group. Digital photographs of patients were obtained and assessed on the 1st, 7th, and 14th days post-operatively. Results: The mean duration of operation was comparable between the studied groups (p = 0.368). On comparing the studied groups, significant differences in the edema scores were observed on the 1st and 7th day post-operatively (p < 0.001 for both), but not on the 14th day (p = 0.079). When comparing each group against the postoperative day of evaluation, statistically significant differences were detected between the 1st vs. 7th day and 1st vs. 14th day in Group A, whereas, in the other groups, no significant difference was detected (all p > 0.05). No Dexamethasone-related complications were observed. Conclusion: Dexamethasone significantly reduced periorbital swelling and edema after rhinoplasty compared to the control group. A short course of triple dose perioperative administration of dexamethasone is more potent in reducing edema from 1st to 7th day postoperative than a single dose intraoperatively.

Bioinspired 4D Printing Shape-Memory Polyurethane Rhinoplasty Prosthesis for Dynamic Aesthetic Adjustment

The disparity between the postoperative outcomes of rhinoplasty and the expected results frequently necessitates secondary or multiple surgeries as a compensatory measure,greatly diminishing patient satisfaction.However,there is renewed optimism for addressing these challenges through the innovative realm of Four-Dimensional(4D)printing.This groundbreaking technology enables three-dimensional objects with shape-memory properties to undergo predictable transformations under specific external stimuli.Consequently,implants crafted using 4D printing offer significant potential for dynamic adjustments.Inspired by worms in our research,we harnessed 4D printing to fabricate a Shape-Memory Polyurethane(SMPU)for use as a nasal augmentation prosthesis.The choice of SMPU was guided by its Glass Transition Temperature(Tg),which falls within the acceptable temperature range for the human body.This attribute allowed for temperature-responsive intraoperative self-deformation and postoperative remodeling.Our chosen animal model for experimentation was rabbits.Taking into account the anatomical structure of the rabbit nose,we designed and produced nasal augmentation prostheses with superior biocompatibility.These prostheses were then surgically implanted in a minimally invasive manner into the rabbit noses.Remarkably,they exhibited successful temperature-controlled in-surgery self-deformation according to the predetermined shape and non-invasive remodeling within a mere 9 days post-surgery.Subsequent histological evaluations confirmed the practical viability of these prostheses in a living organism.Our research findings posit that worm-inspired 4D-printed SMPU nasal prostheses hold significant promise for achieving dynamic aesthetic adjustments.

Nonsurgical rhinoplasty

Interest in liquid,or nonsurgical rhinoplasty,has increased in demand as patients pursue less invasive techniques to achieve their aesthetic goals.Improved filler technology and refinement in injection techniques have made liquid rhinoplasty a reasonable choice for well-selected patients in both primary and revision rhinoplasty cases.This article reviews nasal anatomy,injection techniques,selected applications,and safety measures pertinent to performing nonsurgical rhinoplasty.

An updated diced cartilage fascia technique for dorsal augmentation in rhinoplasty

The aim of this paper is to discuss an updated technique for dorsal augmentation during rhinoplasty using diced cartilage wrapped in fascia. The usage of diced cartilage has been variously described in the literature with consistently satisfactory results. Herein, we present our experience with patients undergoing dorsal augmentation during rhinoplasty using an updated method of diced cartilage wrapped in fascia. Diced cartilage fascia techniques have become the technique of choice for dorsal augmentation for an ever-increasing number of rhinoplasty surgeons. The term is broadly descriptive and there remains a wide-range of ways to execute. Updating and enhancing the technique with greater attention to precision, and creating an aesthetically optimal and predictable result, may result in even improved outcomes for future patients.