Aesthetic Rhinoplasty Research Articles

Consideration of Aesthetic Rhinoplasty in Children and Adolescents.

Consideration of Aesthetic Rhinoplasty in Children and Adolescents.

Discrepancy of the subjective perception of the nasal appearance between independent individuals and patients undergoing functional rhinoplasty (fRPL)

PurposeSatisfaction with the nasal appearance is a crucial outcome parameter in functional rhinoplasty (fRPL). The visual analogue scale is a suitable instrument not only for the preoperative patient assessment, but also as a patient-reported outcome measure in fRPL. In this study, we analyzed whether a high discrepancy in the preoperative subjective perception of the nasal appearance between patients and other individuals predicts a lower level of satisfaction with the postoperative result and hence a worse outcome of fRPL.MethodsStandardized facial pictures of patients (n = 80) who underwent fRPL were taken preoperatively, 3 and 12 months postoperatively. In addition, patients were asked to complete the German version of the Utrecht Outcome Assessment Questionnaire in Aesthetic Rhinoplasty (D-OAR). The standardized facial pictures of the patients were presented to surgeons as well as to examiners without a medical background, and they were asked to evaluate the patients’ nasal appearance using the visual analogue scale.ResultsThe external evaluation of patient’s nasal appearance was 1.7 points higher in median than the patient’s subjective perception (range −5.7–7.00). A large discrepancy between self- and external estimation significantly correlates with higher D-OAR values (r = 0.539, p < 0.001). Patients with high scores in the D-OAR trick questions, indicating a body dysmorphic disorder, show a significant larger discrepancy between the external- and the self-assessment (2.8 ± 0.5 vs. 1.4 ± 0.3, mean ± SEM, p = 0.017).ConclusionsLarge discrepancies between the self and external assessment of the nasal appearance are associated with a high-perceived influence of the appearance of the nose on the quality of life in patients undergoing functional rhinoplasty. That might be an indicator for unrealistic expectations concerning the postoperative outcome. Knowledge about this factor helps to identify the need for intensive discussion about possibilities and limitations of the planned procedure to avoid postoperative dissatisfaction.

Aesthetic Science of Rhinoplasty: Three Principles

Aesthetic science is a rapidly growing discipline that involves plastic surgery as much or more than other disciplines of science. Fortunately, how and why the human brain responds to the visual world is better understood now than ever before. Of necessity plastic surgery is a part of that aesthetic science movement because it deals directly with the application of aesthetic principles. Therefore, it behooves the surgeon to be familiar with the principles of aesthetic science so as to both delineate and attain the aesthetic goal at the same time any functional goal is part of the operation. There are three important principles for rhinoplasty: (1) symmetry, (2) continuity and (3) persistence. This study provides examples of how they apply in the preop, intraop and postop phase of performing aesthetic rhinoplasty. A firm understanding of these principles can then guide the surgeon through the difficult maze of decision making, operative planning and surgical execution that arguably makes aesthetic rhinoplasty the most difficult aesthetic operation in plastic surgery. LEVEL OF EVIDENCE V: 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 .

Simulation and Artificial Intelligence in Rhinoplasty: A Systematic Review.

Rhinoplasty is one of the most popular cosmetic procedures. The complexity of the nasal structure and the substantial aesthetic and functional impact of the operation make rhinoplasty very challenging. The past few years have witnessed an increasing implementation of artificial intelligence (AI) and simulation systems into plastic surgery practice. This review explores the potential uses of AI and simulation models in rhinoplasty. Five electronic databases were searched: PubMed, CINAHL, EMBASE, Scopus, and Web of Science. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis as our basis of organization. Several simulation models were described to predict the nasal shape that aesthetically matches the patient's face, indicate the implant size in augmentation rhinoplasty and construct three-dimensional (3D) facial images from two-dimensional images. Machine learning was used to learn surgeons' rhinoplasty styles and accurately simulate the outcomes. Deep learning was used to predict rhinoplasty status accurately and analyze the factors associated with increased facial attractiveness after rhinoplasty. Finally, a deep learning model was used to predict patients' age before and after rhinoplasty proving that the procedure made the patients look younger. 3D simulation models and AI models can revolutionalize the practice of functional and aesthetic rhinoplasty. Simulation systems can be beneficial in preoperative planning, intra-operative decision making, and postoperative evaluation. In addition, AI models can be trained to carry out tasks that are either challenging or time-consuming for surgeons. 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 .

Patient Reported Outcome Measures for Functional and Aesthetic Rhinoplasty

Patient Reported Outcome Measures for Functional and Aesthetic Rhinoplasty

The Spare Roof Technique as a New Approach to the Crooked Nose.

Background: The literature reporting outcomes in crooked nose patients submitted to surface dorsal preservation techniques is almost nonexistent. Objectives: To evaluate aesthetic and functional outcomes in crooked nose patients undergoing rhinoplasty with the Spare Roof Technique (SRT). Methods: Prospective, interventional, and longitudinal study performed on patients presenting a crooked nose undergoing primary rhinoplasty by SRT. The validated Portuguese version of the Utrecht Questionnaire for Outcome Assessment in Aesthetic Rhinoplasty and a visual analog scale were used to assess aesthetic and functional outcomes, respectively. Patients completed the questionnaire preoperatively and again 3 and 12 months postoperatively. Results: The study population included 54 Caucasian Mediterranean patients (34 female), mean aged 34.5 years. The SRT resulted in a highly significant improvement in all questions regarding subjective body image in relation to nasal appearance and subjective nasal function. The mean preoperative aesthetic Utrecht Questionnaire sum score was 13.4 (standard deviation [SD] 0.5), which improved to 9.2 (SD 0.15) at 12 months postsurgery (p < 0.001). Conclusions: The SRTa is a reliable technique that can help deliver consistently good results in reduction rhinoplasty in patients with a crooked nose.

Perceived Age and Attractiveness Using Facial Recognition Software in Rhinoplasty Patients: A Proof-of-Concept Study.

Artificial intelligence (Al)-based analyses may serve as a more objective tool for measuring cosmetic improvements following aesthetic plastic surgery. This preliminary proof-of-concept study utilized a novel commercial facial recognition software to assess perceived changes in age and attractiveness among patients receiving rhinoplasty.This study was a retrospective evaluation of three-dimensional photographs of patients who underwent rhinoplasty by the senior author (DS). Both pre- and post-operative (> 12-month follow-up) Vectra three-dimensional images (Canfield Scientific, Parsippany, NJ) were assessed using Haystack AI Software (Haystack AI, New York, NY). Facial attractiveness (score 1-10) and apparent age were predicted. A retrospective chart review of demographic variables was additionally performed. Paired t tests were used to compare age and attractiveness scores before and after surgery. Multivariate linear regression was performed to identify factors associated with age and attractiveness scores.One hundred twenty-four patients receiving rhinoplasty met the study criteria (average age: 35.58). Overall, rhinoplasty was associated with increases in Al-rated attractiveness (+0.28, P = 0.03) and decreases in perceived age relative to the patient's true age (-1.03 years, P = 0.03). Greater decreases in postoperative perceived age were achieved in patients who appeared older than their actual age preoperatively ( P < 0.001).Facial recognition software was successfully used to evaluate improvements in perceived age and attractiveness in patients undergoing aesthetic rhinoplasty. Patients were perceived by the software as younger and more attractive following rhinoplasty. Age reversal was greatest among patients who appeared much older than their actual age at the time of surgery.Level of Evidence: IV.

Next-generation Septal Contouring in Aesthetic Rhinoplasty: A Structural Viewpoint.

Aesthetic rhinoplasty is a challenge of both architecture and engineering. While aesthetic appeal is conspicuous, sound geometric design, even load distribution, and foundational stability are the concealed principles of durable results. Additional challenges faced by the rhinoplasty surgeon include complex material properties, variable boundary conditions, and irregular stresses.1 Septal cartilage remains the prime source of graft material in aesthetic rhinoplasty. Surgical pioneers including Ingals (1882), Kreig (1889), Freer (1902), and Killian (1905) advocated preservation of the dorsal and caudal extent of the septum—a configuration that has become known as the “L-strut.”2 Oral tradition advocates preservation of dorsal and caudal limbs of 10–15 mm width. However, borrowing from the foundations to adorn the façade is structurally dubious while cartilage yield correlates poorly with external nasal projection.3 Problematically, the L-strut comprises the thinnest portions of the septum yet supports the lower two-thirds of the nose. Structural failure causes nasal collapse, saddle deformity, tip deviation, and nasal valve dysfunction. Warping or fracture of the thin right angle is encountered in up to 40% of revision surgeries.4 Curiously, the structural competence of a right angled L-strut evaded scrutiny until recently. This probably reflects the sense of rigor and purpose with which the modern rhinoplasty community are reappraising their craft to meet heightened functional and aesthetic expectations.5 In 2007, human cadaveric septal L-struts were first investigated by finite element modeling to better understand surgical failure.6 Subsequent investigations added greater complexity and sophistication to the understanding of L-strut biomechanics and how failure might be mitigated through improved surgical design.7 Our assimilation of the collective computational evidence supports the replacement of the L-strut with a delta-shaped strut.1 It is interesting to speculate on the reasons for the enduring appeal of the L-strut. There is inevitably a learning curve when faced with a paradigm shift, and thus, a powerful motivator for change is necessary. Many of us who have embraced an approach based on structural preservation have done so only after stepping out of the comfort zone when faced with the evidence from our own clinical observations. Moreover, as aestheticians rather than bioengineers, we are averse to analyzing structural failure from a mathematical point of view. The philosophy of structural optimization has merged with the trends toward elevation of the soft tissue envelope in the subperichondrial/subperiosteal plane, preservation of the nasal dorsum, and advances in suture-based manipulation of the lower lateral cartilages into a new philosophical approach to primary aesthetic rhinoplasty.8 These founding principles are risk-averse in that they preserve the structural integrity of the nose, avoiding the need for complex reconstructive rhinoplasty for primary failures.5 Thus, although the tenacious popularity of the L-strut is acknowledged, it is hard to justify from a structural point of view. Rather, the computationally sound “delta strut,” with optimized axial load distribution and foundational stability, is better placed to support aesthetic remodeling and withstand the vicissitudes of time. As preservation techniques gain traction within the rhinoplasty community, the preeminence of the L-strut will become increasingly challenged until a new paradigm is established. ACKNOWLEDGMENTS This article does not contain any studies with human participants or animals performed by any of the authors. For this type of study, informed consent is not required. DISCLOSURE G.E. Glass is a member of the British Association of Aesthetic Plastic Surgeons. All the authors have no financial interest to declare in relation to the content of this article.

A Useful Tool for Various Problems in Nasal Tip: The Cephalic Transdomal Suture.

Surgical manipulation of the nasal tip is a critical point in functional and aesthetic rhinoplasty procedure. Cephalic strip excision from the lower lateral cartilages, elongation or shortening the caudal septum, structural grafting for supporting the medial and lateral crura are major structural moves in building a durable cartilaginous framework. However, it is suture techniques that make up the final touch in fine tuning of the shape, projection, definition, and angulation (rotation) of the nasal tip over this framework.Problems with fine-tuning of the nasal tip include inadequate or excessive definition, or projection resulting with bulbous or boxy appearance can be overcome reversibly with correctly placed sutures. One of the most decisive sutures in this context is transdomal sutures. Incorrect placement of which can result with too narrow or too wide nostril apices, as well as a cephalic malposition deformity of the lower lateral cartilages, botching an otherwise perfectly executed rhinoplasty procedure.In this article, cephalad placement of the transdomal sutures, and its relevance is disclosed in 223 consecutive cases of primary rhinoplasty.

Impact of aesthetic rhinoplasty on the respiratory function of the nose in patients with a straight nasal septum

Introduction/Objective. Aesthetically, the nose adds special signature to a person?s look. This results in many nasal pyramid surgeries, either functional or aesthetic. The problem arises in aesthetic surgeries. Patients often tend to present their dissatisfaction with the appearance of the nose as a breathing difficulty, as they often lack the support of the environment in the decision to undergo cosmetic surgery. The objective of the paper was to examine, using subjective assessment and objective measurements, the change in the nasal respiratory function in patients who undergo aesthetic nose surgeries, despite having a straight nasal septum before the surgery. Methods. The study was conducted as a prospective, cross-sectional one, and involved 32 patients of both genders. Before and at six months after surgery all patients underwent subjective nasal breathing assessment using visual analog scale (grade 0?10) as well as objective nasal respiratory function assessment using rhinomanometry and acoustic rhinometry after anemization. Results. There were seven male and 25 female patients, age ranging 18?27 years. Objective measurements after surgery showed that the nasal cavity volume, minimum cross-sectional area, as well as the airflow through the nose reduced, while resistance to the nasal airflow increased, but with no statistical significance. The subjective assessment of nasal breathing statistically significantly improved after the surgery. Conclusion. The subjective assessment of nasal breathing postoperatively is not a relevant indicator of the objective state of the nasal respiratory function in patients after aesthetic rhinoplasty.

Assessment of Functional and Esthetic Outcomes of External Approach Septorhinoplasty with Spreader Graft in North India

Introduction: Rhinoplasty is one of the most commonly performed facial plastic surgeries. Esthetic rhinoplasty can be exclusively esthetic or for both functional and esthetic concerns combined. The spreader graft can be used as a spacer where a patient with nasal obstruction who is also having external nasal deformity can be benefitted in both the areas. Objectives: The objective is to assess the functional and esthetic outcomes pre- and post-operatively in patients undergoing external approach rhinoplasty with spreader grafting. Methodology: Thirty patients were included in the study. Internal valve collapse was confirmed by modified Cottle's maneuver and diagnostic nasal endoscopy. All surgeries were done using an external approach under general anesthesia. Pre- and post-operative nasal obstruction symptom evaluation (NOSE) and rhinoplasty outcome evaluation (ROE) score were taken. Results: The preoperative NOSE score average was 64.5. After 3 months of postoperative follow-up, the NOSE score reduced to a mean value of 11.83. The preoperative ROE score average was 6.73. Postoperative ROE score improved to a mean value of 18.83. Conclusion: Rhinoplasty is a delicate, skill demanding surgical procedure which, when done along with a spreader graft will be beneficial both functionally and cosmetically in patients with external nasal deformity with obstruction symptoms. Comparison of esthetic and functional results could be done further in future studies which will provide further inputs in the field of rhinoplasty.

Open Rhinoplasty for Nasal Tip Correction by the Transverse Columellar Incision for Egyptian &amp; Mediterranean Noses

Rhinoplasty may be the most common, most challenging, most unforgiving in plastic surgery. It is an ultimate combination of an evolving art and science. Rhinoplasty is a precise surgery in which the margin of error is measured in millimeters. Excellent results can only be obtained by a thorough knowledge of nasal anatomy and the surgical relevance of the alteration of the anatomic structures. To a lot of the Junior Staff, Rhinoplasty is a blind procedure requiring much imagination. This procedure has always been a challenge to the plastic surgeons. Objectives: Since the early eighties I had all the worry a young plastic surgeon has: standardizing his results for Aesthetic Rhinoplasty. Results were not always what one expected, and definitely tip correction was a great challenge. It was then I embarked adopting the open Columellar Incision. I am sharing with you my journey over 40 years and the results of believing and mastering a technique, preaching it in different arenas, and the final results achieved d not only nationally or regionally but also internationally when this technique is now universally accepted as a precise tool for better refinement. The indications limitations and the ghost of the scar are shown and proved to be over stated. In the millennium different strategies (suturing and grafting) have been adopted to obtain better aesthetic outcome and less functional disturbances, all these seem to go hand in had with the open rhinoplasty incision. Different indications are briefly gone through in this review and the long-lasting results are shown. Conclusions: Excellent symmetry, Lack of supratip deformity, particularly in Secondary and Tertiary Rhinoplasty The scar was inconspicuous in the healing phase, then in a few months it tended to migrate lower down and becomes almost invisible. The use of either grafts or various tip sutures can help in the control of the tip dynamics. The aesthetic outcome following a combination of suturing and grafting was more satisfactory than the outcome that can be achieved following either one of them. All these techniques could not be achieved through a closed endonasal rhinoplasty

The Effect of Nasal Tip Defatting on Skin Thickness in Rhinoplasty: A Quasi-Experimental Study.

Background: A few studies have been published on the clinical efficacy and safety of nasal tip defatting plus rhinoplasty, particularly among people with bulbous noses. Therefore, the present study aimed to assess the consequences of nasal tip defatting for skin thickness reduction. Methods: This quasi-experimental study was performed on 72 consecutive patients, candidates for aesthetic rhinoplasty. Twenty-seven patients were scheduled for nasal tip defatting with routine open rhinoplasty concomitantly. Besides, 45 patients underwent rhinoplasty without nasal tip defatting method. Tip and supra-tip skin thickness were assessed before and 12 months after the operation using ultrasonography. The patients' and surgeon's satisfaction with aesthetic results after the operation were also evaluated based on visual analog scaling (VAS). SPSS version 16.0 (SPSS Inc., Chicago, IL., USA) was used for the analyses. P values below 0.05 were considered statistically significant. Results: Seventy-two patients (4 men, 68 women; mean age 26.40 ± 4.61 years) entered the study. Twenty-seven candidates underwent rhinoplasty plus nasal tip defatting (group A). Open rhinoplasty alone was performed for the other 45 patients (group B). The mean nasal tip thickness was 3.98±0.84 mm in group A and 3.69±0.64 mm in group B before the surgery (p=0.059). Preoperative nasal supra-tip thickness of the patients was also assessed using ultrasonography (3.54±0.72 mm in group A versus 3.73±0.54 mm in group B; p=0.065). Both preoperative tip and supra-tip thickness did not statistically differ between the two groups. No significant difference in postoperative tip skin thickness was obtained between two groups after 12 months (3.24±1 mm in group A versus 3.25±0.625 mm in group B; p=0.960), while postoperative supra-tip skin thickness differed significantly according to ultrasonography assessments (2.86±0.60 mm in group A versus 3.25±0.71 mm in group B; p=0.016). Postoperative satisfaction of the candidates was obtained using theVAS scoring system 12 months after the operation in both groups (8±1 in group A, 7.5±1 in group B; p=0.021). Surgeon’s satisfaction in terms of the aesthetic outcome was also assessed based on the VAS system which did not statistically differ between the two groups as well as the patients’ satisfaction (7.84±1.42 in group A, 7±1.61 in group B; p=0.014). Conclusion: Nasal tip skin defatting is the main component in aesthetic rhinoplasty, but its significant effect on the reduction of tip skin thickness is controversial. However, in patients with moderate or thick nasal tip skin, such a procedure can result in higher postoperative satisfaction with the aesthetic outcome compared to rhinoplasty alone.

Klebsiella Aerogenes Infection on the Costochondral Graft of the Nose.

Klebsiella aerogenes is a nosocomial and pathogenic bacterium that causes opportunistic infections including most types of infections. After rhinoplasty, the inserted costochondral graft could be a good material for bacterial growth due to less vascularization and difficult-to-reach antibiotics. The unusual bacterial infection should be considered for preventing poor aesthetic results including graft or implant loss when the surgical site infection is uncontrolled despite proper treatment and administration in aesthetic rhinoplasty surgery. The use of appropriate antibiotics for drug sensitivity may be necessary with bacterial culture tests. In this case, an unusual K. aerogenes infection on the costochondral graft of the nose and related treatment course was reported.

QS6: Improvements In Perceived Age And Attractiveness Following Aesthetic Rhinoplasty Using Facial Recognition And Artificial Intelligence

Purpose:Facial recognition software may serve as a more objective tool for measuring aesthetic improvements following facial plastic surgery. This study utilized a novel facial recognition and artificial intelligence software in order to assess perceived changes in age and attractiveness amongst patients receiving rhinoplasty.Methods:This study was a retrospective evaluation of 3D photographs of patients who underwent aesthetic rhinoplasty alone by the senior author (DS). Both pre- and post-operative (>12-month follow-up) Vectra 3D images (Canfield Scientific, Parsippany, NJ) were assessed using Haystack Artificial Intelligence Software (Haystack AI, New York, NY). Facial attractiveness (score 1-10) and apparent age were predicted. Paired t-tests were used to compare age and attractiveness scores before and after surgery. Multivariate linear regression was performed to identify factors associated with age and attractiveness scores.Results:Forty patients receiving rhinoplasty met the study criteria (average age 48.3). Overall, rhinoplasty was associated with increases in AI-rated attractiveness (+0.58, p = 0.004) and decreases in perceived age relative to the patient’s true age (-1.62 years, p = 0.021). Greater decreases in post-operative perceived age were achieved in patients who appeared older than their actual age pre-operatively (p = 0.04). AI age predictions were also closer to true patient age post-operatively (+1.71 years) than they were pre-operatively (+3.33 years).Conclusion:Facial recognition software was successfully implemented to evaluate improvements in perceived age and attractiveness in patients undergoing aesthetic rhinoplasty. Using this technology, patients were found to appear more attractive and younger after rhinoplasty. Additionally, age reversal was greatest among patients who appeared older than their actual age at the time of surgery.

A Comprehensive Strategy for Improving Nasal Outcomes After Large Maxillomandibular Advancement for Obstructive Sleep Apnea.

Background: Rate of corrective nasal surgery after maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA) has been reported to be 18.7% for functional and aesthetic indications. Objective: Describe a comprehensive strategy to optimize nasal outcomes with MMA for OSA. Methods: A retrospective review of patients undergoing MMA for OSA in a tertiary referral center was performed, with a comprehensive perioperative intervention to optimize nasal outcomes from January 2014 to February 2018. Outcomes included the Apnea-Hypopnea Index (AHI), oxygen saturation (SpO2) nadir, corrective nasal surgery needed after MMA, and Nasal Obstruction Symptom Evaluation (NOSE) scores. Results: AHI after MMA showed significant reduction (-34.65, p < 0.001), SpO2 nadir increased (+6.08, p < 0.001), and NOSE scores decreased (-5.96, p < 0.001). Corrective nasal surgery needed after MMA was reported in 6.5% (8 of 122) subjects at a mean of 8.5 months, ranging from 1 to 24.7 months. Six subjects underwent either septoplasty and/or valve stenosis repair, and two subjects underwent functional and aesthetic rhinoplasty. Conclusion: A perioperative strategy was applied since 2014 that showed effectiveness in reducing post-MMA corrective nasal surgery to 6.5%.

Self-Esteem in Rhinoplasty Patients: A Comparative Study.

Self-esteem is one of the most important psychological aspect of cosmetic surgery, in our case aesthetic rhinoplasty surgery. Self-esteem can be described as one's attitude towards ownself. Our aim isto assess the self-esteem pre-operatively in patients seeking aesthetic rhinoplasty with respect to those seeking functional rhinoplasty and also compare the post-operative improvement in the self-esteem in those patients. This is a Prospective comparative studyin a Tertiary care centre. A total of 48patients who were planned to undergo rhinoplasty over a period of 1year in a tertiary care centre, A total of 48patients (24 requiring aesthetic rhinoplasty and the rest functional rhinoplasty),grouped according to their primary objective, were asked to fill up Rosenberg's self-esteem scale pre-operatively and 6months post-operatively. Independent t test was used for data analysis. The mean value of self-esteem in aesthetic rhinoplasty group was significantly lower as compared to functional rhinoplasty and there was also significant improvement of self-esteem score post -operatively in the aesthetic rhinoplasty group. Age,gender, marital status, socio-economic status and educational backgrounds were analyzed and there was no significant differences in these factors on comparison between the two groups. Our study showed that self-esteem is an important parameter in cosmetic surgery as patients opting for aesthetic rhinoplasty had lower self-esteem score pre-operatively and there was significant improvement of these scores post-operatively.

Polycaprolactone Mesh for Asian Rhinoplasty: Outcomes and Complications of Composite Septal Extension Graft Compared to Mesh-Only Graft.

Despite the great demand of aesthetic rhinoplasty in Asian population, it is difficult to obtain the lasting ideal tip projection along with lengthening of the nose due to the small and weak nasal septum. The shortage of available septal cartilage to work with is another major obstacle. A retrospective study was conducted between January 2017 and December 2019 in Seoul, Korea. A total of 774 patients underwent septorhinoplasty using polycaprolactone (PCL) mesh for the cosmetic enhancement of the nasal tip and the projection. Comparisons of aesthetic outcomes, patients' satisfaction surveys, and complications were performed between PCL mesh-only group and composite PCL group. Of all the patients, 97.5% of the patients in composite PCL group were rated more than 3 scores in aesthetic outcomes, whereas 90.4% in mesh-only group (p-value = 0.0002). About 96.7% of the patients with composite PCL rated their satisfaction level as more than satisfied, whereas 94.3% in mesh-only group (p-value = 0.0365). Overall, there were 17 patients in composite PCL group who exhibited complications including decreased tip projection, deviated nasal tip, mesh infection, and mesh exposure. However, there were two patients who had mesh injection in mesh-only group. Septorhinoplasty with septal extension graft using composite PCL graft provides robust support to the aesthetically modified projection and the lengthened nose without obvious complications on the nasal tip. Such technique allows surgeons to overcome the nature of Asian nose that is weak and small, and also provides satisfaction to patients who desire ideal tip projections and dramatic changes.

Principles related to informed consent in functional and aesthetic rhinoplasty: A prospective study

IntroductionRhinoplasty is one of the most complex surgical procedures in plastic surgery. ContextPatient requirement is often mixed, aesthetic and functional, for resolution of functional respiratory problems is therefore as important as correction of nasal deformity. Informed consent in rhinoseptoplasty is a difficult process because of the complexity of the operative technique, which presents a wide range of potential complications. Patients and methodType of study: This is a prospective, descriptive study conducted in the department of oral and maxillofacial surgery. Fifty-two patients, who consulted for rhinoplasty, participated in the study. Patients were informed about the complications commonly discussed during the consent process in rhinoplasty surgery. Each patient was contacted one month after the initial consultation to assess recall of complications and acceptance of surgery. ConclusionThe aim of our study is to highlight the importance of informed consent in rhinoplasty surgery in terms of complications, and to identify gaps in the consent process.

An Artificial Intelligence Tool for Image Simulation in Rhinoplasty.

During rhinoplasty consultations, surgeons typically create a computer simulation of the expected result. An artificial intelligence model (AIM) can learn a surgeon's style and criteria and generate the simulation automatically. The objective of this study is to determine if an AIM is capable of imitating a surgeon's criteria to generate simulated images of an aesthetic rhinoplasty surgery. This is a cross-sectional survey study of resident and specialist doctors in otolaryngology conducted in the month of November 2019 during a rhinoplasty conference. Sequential images of rhinoplasty simulations created by a surgeon and by an AIM were shown at random. Participants used a seven-point Likert scale to evaluate their level of agreement with the simulation images they were shown, with 1 indicating total disagreement and 7 total agreement. Ninety-seven of 122 doctors agreed to participate in the survey. The median level of agreement between the participant and the surgeon was 6 (interquartile range or IQR 5-7); between the participant and the AIM it was 5 (IQR 4-6), p-value < 0.0001. The evaluators were in total or partial agreement with the results of the AIM's simulation 68.4% of the time (95% confidence interval or CI 64.9-71.7). They were in total or partial agreement with the surgeon's simulation 77.3% of the time (95% CI 74.2-80.3). An AIM can emulate a surgeon's aesthetic criteria to generate a computer-simulated image of rhinoplasty. This can allow patients to have a realistic approximation of the possible results of a rhinoplasty ahead of an in-person consultation. The level of evidence of the study is 4.