Facial Plastic Surgery Clinic Research Articles

Unilateral Nasal Obstruction Causes Symptom Severity Scores Similar to Bilateral Nasal Obstruction.

The objective of this paper is to investigate the differences between unilateral and bilateral nasal obstruction with subjective symptomatology in nasal obstruction. This is a retrospective chart review of prospectively collected data of patients with nasal obstruction presenting to a facial plastic and reconstructive surgery clinic for evaluation and treatment. Patient demographics including age and gender were recorded along with nasal physical exam findings. These included internal valve narrowing (IVN), external valve narrowing, internal valve collapse, external valve collapse, and septal deviations (inferior and superior). Findings were reported for the left, the right, and both sides. Nasal valve and septal findings were recorded on 3- and 4-point Likert scales, respectively, for each side of the nose. A total of 1,646 patients were included in the study. On univariate analysis, a significant correlation was seen between Nasal Obstruction Symptom Evaluation (NOSE) scores and all individual exam findings (p < 0.001). On multiple linear regression, total, left, and right septal deviation (p < 0.001, p = 0.001, p = 0.007, respectively) and total, left, and right IVN (p < 0.001, p = 0.003, p < 0.001) were all predictive of an increased NOSE score. Patients with unilateral septal deviation or internal nasal valve narrowing have symptoms of nasal obstruction similar to those with bilateral nasal obstruction. Unilateral and bilateral septal deviation and internal nasal valve narrowing are predictive of having an increased NOSE score. Unilateral nasal obstruction should be recognized and treated as a cause for severe symptomatic nasal obstruction despite a normal contralateral nasal exam.

The Bilobe Flap for Nasal Reconstruction.

Repair of nasal defects is technically challenging due to inelastic nasal skin and unforgiving nasal geometry. The bilobe flap is a double transposition flap that can transpose skin from cephalad to caudad to repair defects of the lower third of the nose. However, pincushioning may complicate this flap, yielding untoward aesthetic outcomes. We review our single surgeon series of patients who underwent bilobe flap reconstruction of nasal defects, and describe our surgical technique to minimize pincushioning and poor aesthetic outcomes. This was a retrospective chart review of patients who underwent bilobe flap reconstruction of nasal defects at a tertiary referral facial plastic and reconstructive surgery clinic between January 1, 2010 and February 12, 2019. All postoperative clinic notes were analyzed for complications, reports of unfavorable cosmetic outcome, and rates of revision procedures. Surgical technique is described. In the analysis, 125 patients were included, of whom 84 (67%) patients were women, and the mean (standard deviation) age was 60.7 (12.5) years. Complications were reported in 20 (16%) patients, including scars, pincushioning, and nasal obstruction. Five patients underwent revision surgery (4%), including scar revision and z-plasty. Pincushioning was reported in four patients (3.2%), of whom three underwent scar revision procedures. One patient had alar notching requiring correction. There was no statistically significant association between ear cartilage graft and complications (p = 0.84) or requirement of intervention (p = 1.0). Univariate and multivariate logistic regression did not show statistically significant association between size of the defect and the presence of complications (p > 0.05). The bilobe flap is an excellent transposition flap for the repair of small nasal tip defects. By adequately thinning the transposition flap of excess subcutaneous tissue prior to inset, rates of poor aesthetic outcomes, revision procedures, and pincushioning are minimized.

Evaluation of Selfies and Filtered Selfies and Effects on First Impressions

Selfies and filtered selfies are becoming more prevalent throughout society and in the facial plastic surgery clinic. The term "Snapchat dysmorphia" has been used to describe patients seeking procedures to look like their selfie or filtered selfie. This is particularly frequent in the Millennial population, aged 22 to 37 years. The authors sought to determine the effects on first impression from different photograph types: selfies, filtered selfies, a rear-facing smartphone camera, and a digital camera (DC). We hypothesize that the DC photographs will have the highest rated first impressions among evaluators despite the popularity of selfies and filtered selfies. This study included 240 evaluators and 4 patients each completing the 4 different photograph types. The evaluators completed a survey rating first impression on various measures of success for each photograph type. A total of 960 first impressions were recorded for each of the 8 subscales, yielding 7680 individual assessments of first impression. The DC photograph was found to have the highest first impression scores among the 4 photograph types. There was no statistical difference between selfies and filtered selfies. The rear-facing smartphone camera received the lowest first impression scores. Our findings indicate that the standard DC photograph taken during a preoperative consultation has higher first impressions than selfies or filtered selfies. Although "Snapchat dysmorphia" may continue to be a growing trend in the near future, our findings provide important information to discuss with patients in the preoperative visit to set realistic expectations.

Facial Plastic Surgery Clinics of North America: Facial Gender Affirmation Surgery

Facial Plastic Surgery Clinics of North America: Facial Gender Affirmation Surgery

Assessment of Ideal Dimensions of the Ears, Nose, and Lip in the Circles of Prominence Theory on Facial Beauty.

A theory on facial beauty might allow clinicians to achieve better results. To find the ideal vertical position of the ears, total lip length, lip pucker length, distance between the irises, and starting point for the nasal radix. In this subjective survey, 11 sets of 43 total digitally adjusted pictures (DAPs) and line drawings of actual faces were ranked based on attractiveness by 419 clients at a facial plastic surgery clinic. The data were collected from July 13 to August 29, 2015, and were analyzed from September 17, 2015, to March 21, 2016. Six groups of line drawings and 5 groups of DAPs of an actual person were used to test the ideal position of the ears to determine whether the face is organized into oblique and parallel relationships and whether the total lip length and the lip pucker length are associated with multiples of an iris width (IW), and to determine the start of the nasal radix and its association with the superior margin of the iris and distance between the irises. Of the 419 survey respondents, the ear aligned with the second oblique was considered the most ideal by the participants. The preferred total lip length was 4.0 IWs in the DAPs and 5.0 IWs in the line drawings. For the lip pucker length, 2.0 and 3.0 IWs were considered the best. The ideal start of the nasal radix was tangential with the superior margin of the iris. The distance of 5.5 IWs from iris to iris and 3.0 IWs from the horizontal level of the iris to the nasal tip was preferred. The face may be ideally organized into 3 parallel obliques. The IW, horizontal aperture of the eye, and then iris to iris distance may best determine the size and shape of progressively larger objects in the face. The absolute position of the eye was considered important by the participants in the ideal positioning of other objects in the face. NA.

Facial Plastic Surgery Clinics of North America: Controversies in Facial Plastic Surgery

Facial Plastic Surgery Clinics of North America: Controversies in Facial Plastic Surgery

Facial Plastic Surgery Clinics of North America: Functional Rhinoplasty

Facial Plastic Surgery Clinics of North America: Functional Rhinoplasty

Measuring Patient-Reported Outcomes in Rhinoplasty Using the FACE-Q: A Single Site Study.

AbstractRhinoplasty is one of the most popular surgical cosmetic treatments. Measuring the appearance of the nose has typically involved the use of observer- or surgeon-reported outcome measures (e.g., photographs). While objective outcomes are important, facial appearance is subjective, and therefore outcome assessment should incorporate the patient perspective through the use of patient-reported outcome measures. This study aims to explore relationships between FACE-Q scales scores and measuring adverse effects and change 4 months after surgery in a United Kingdom sample. A questionnaire booklet was completed by patients seeking rhinoplasty between March 2014 and March 2015. The study was conducted at a facial plastic surgery clinic office in London, United Kingdom. Pre- and postoperative rhinoplasty patients aged 19 years and older participated in the study. FACE-Q scales/checklist was utilized for the study. A total of 54 preoperative patients completed seven FACE-Q scales. Before surgery, characteristics of the nose that our sample at least satisfied (i.e., at the harder end of the clinical hierarchy) included the tip of the nose, and how the nose looked in photos and from different angles. In preoperative participants, lower scores for satisfaction with nose and/or nostrils correlated with lower satisfaction with facial appearance and appearance-related psychosocial distress. Participants (N = 13) who had surgery reported significant improvement in satisfaction with the nose, nostrils, and facial appearance overall, and improved psychological and social function. Standardized response means ranged from 0.65 (social function) to 1.55 (facial appearance). The FACE-Q rhinoplasty module can be used in clinical practice, research, and quality improvement to incorporate the patient perspective of appearance in outcome assessments. The level of evidence is defined as level III (diagnostic).

The 10-Item Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) for Functional and Cosmetic Rhinoplasty.

Rhinoplasty is a common operation in which shape and function are intimately related, whether the procedure is cosmetic, functional, or combined in nature. There is currently no properly developed and validated patient-reported outcome measure (PROM) to evaluate both functional and cosmetic components of rhinoplasty. To develop, validate, and field test the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) to evaluate both functional and cosmetic outcomes of rhinoplasty. Survey development study between October 2016 and April 2017 in a tertiary referral facial plastic and reconstructive surgery clinic. Preoperative and postoperative adult patients undergoing rhinoplasty, whether cosmetic or reconstructive, were included. A fifth group of adult nonrhinoplasty patients (facial cosmetic or reconstructive) were also included for the field test. Generated and reduced items, psychometric validation measures of the SCHNOS, and differences on scales between groups. For survey development, a total of 18 patients and 5 experts were interviewed. Of these patients, 5 were male, and 13 were female. Their mean (SD) age was 38 (14.8) years (range, 20-64 years). Field testing included 191 patients (67% were women and the mean [SD] age was 41.5 [15.8] years). A total of 10 items were included after generation, cognitive interviews, and item reduction. The 10 items represent 2 domains: nasal obstruction (first 4 items) and nasal cosmesis (last 6 items). For both domains, Cronbach α was excellent: 0.94 (95% CI, 0.92-0.95) for obstruction and 0.94 (95% CI, 0.93-0.95) for cosmesis. Exploratory factor analysis using scree plots for each domain showed that the domains are unidimensional in nature with each domain evaluating what it is intended to assess (nasal obstruction and cosmesis). The factor loading estimates were high for all the items, varying from 0.74 to 0.92. Kruskal-Wallis testing showed a significance level of P < .001 when evaluating the difference between groups (preoperative cosmetic, postoperative cosmetic, preoperative functional, postoperative functional, and nonrhinoplasty) for all individual questions, composite scores, and Nasal Obstruction Symptom Evaluation (NOSE) score. Correlations between the obstruction composite score and the NOSE scores were r = 0.943 (P < .001), which is very strong. The obstruction and cosmesis composite scores were only weakly correlated (r = 0.388; P < .001). We have developed and validated a new PROM to evaluate both functional and cosmetic rhinoplasty patients. The domains of obstruction and cosmesis were found to be internally consistent and unidimensional. The SCHNOS provides a short, validated questionnaire that we recommend for use in all functional or cosmetic rhinoplasty patients. N/A.

Prevalence of Body Dysmorphic Disorder and Surgeon Diagnostic Accuracy in Facial Plastic and Oculoplastic Surgery Clinics.

Body dysmorphic disorder (BDD) is a relative contraindication for facial plastic surgery, but formal screening is not common in practice. The prevalence of BDD in patients seeking facial plastic surgery is not well documented. To establish the prevalence of BDD across facial plastic and oculoplastic surgery practice settings, and estimate the ability of surgeons to screen for BDD. This multicenter prospective study recruited a cohort of 597 patients who presented to academic and private facial plastic and oculoplastic surgery practices from March 2015 to February 2016. All patients were screened for BDD using the Body Dysmorphic Disorder Questionnaire (BDDQ). After each clinical encounter, surgeons independently evaluated the likelihood that a participating patient had BDD. Validated instruments were used to assess satisfaction with facial appearance including the FACE-Q, Blepharoplasty Outcomes Evaluation (BOE), Facelift Outcomes Evaluation (FOE), Rhinoplasty Outcomes Evaluation (ROE), and Skin Rejuvenation Outcomes Evaluation (SROE). Across participating practices (9 surgeons, 3 sites), a total of 597 patients were screened for BDD: 342 patients from site 1 (mean [SD] age, 44.2 [16.5] years); 158 patients, site 2 (mean [SD] age, 46.0 [16.2] years), site 3, 97 patients (mean [SD] age, 56.3 [15.5] years). Overall, 58 patients [9.7%] screened positive for BDD by the BDDQ instrument, while only 16 of 402 patients [4.0%] were clinically suspected of BDD by surgeons. A higher percentage of patients presenting for cosmetic surgery (37 of 283 patients [13.1%]) compared with those presenting for reconstructive surgery (21 of 314 patients [6.7%]) screened positive on the BDDQ (odds ratio, 2.10; 95% CI, 1.20-3.68; P = .01). Surgeons were only able to correctly identify 2 of 43 patients (4.7%) who screened positive for BDD on the BDDQ, and the positive likelihood ratio was only 1.19 (95% CI, 0.28-5.07). Patients screening positive for BDD by the BDDQ had lower satisfaction with their appearance as measured by the FACE-Q, ROE, BOE, SROE, and FOE. Body dysmorphic disorder is a relatively common condition across facial plastic and oculoplastic surgery practice settings. Patients who screen positive on the BDDQ have lower satisfaction with their facial appearance at baseline. Surgeons have a poor ability to screen for patients with BDD when compared with validated screening instruments such as the BDDQ. Routine implementation of validated BDD screening instruments may improve patient care. NA.

Association Among Facial Paralysis, Depression, and Quality of Life in Facial Plastic Surgery Patients

Though anecdotally linked, few studies have investigated the impact of facial paralysis on depression and quality of life (QOL). To measure the association between depression, QOL, and facial paralysis in patients seeking treatment at a facial plastic surgery clinic. Data were prospectively collected for patients with all-cause facial paralysis and control patients initially presenting to a facial plastic surgery clinic from 2013 to 2015. The control group included a heterogeneous patient population presenting to facial plastic surgery clinic for evaluation. Patients who had prior facial reanimation surgery or missing demographic and psychometric data were excluded from analysis. Demographics, facial paralysis etiology, facial paralysis severity (graded on the House-Brackmann scale), Beck depression inventory, and QOL scores in both groups were examined. Potential confounders, including self-reported attractiveness and mood, were collected and analyzed. Self-reported scores were measured using a 0 to 100 visual analog scale. There was a total of 263 patients (mean age, 48.8 years; 66.9% were female) were analyzed. There were 175 control patients and 88 patients with facial paralysis. Sex distributions were not significantly different between the facial paralysis and control groups. Patients with facial paralysis had significantly higher depression, lower self-reported attractiveness, lower mood, and lower QOL scores. Overall, 37 patients with facial paralysis (42.1%) screened positive for depression, with the greatest likelihood in patients with House-Brackmann grade 3 or greater (odds ratio, 10.8; 95% CI, 5.13-22.75) compared with 13 control patients (8.1%) (P < .001). In multivariate regression, facial paralysis and female sex were significantly associated with higher depression scores (constant, 2.08 [95% CI, 0.77-3.39]; facial paralysis effect, 5.98 [95% CI, 4.38-7.58]; female effect, 1.95 [95% CI, 0.65-3.25]). Facial paralysis was associated with lower QOL scores (constant, 81.62 [95% CI, 78.98-84.25]; facial paralysis effect, -16.06 [95% CI, -20.50 to -11.62]). For treatment-seeking patients, facial paralysis was significantly associated with increased depression and worse QOL scores. In addition, female sex was significantly associated with increased depression scores. Moreover, patients with a greater severity of facial paralysis were more likely to screen positive for depression. Clinicians initially evaluating patients should consider the psychological impact of facial paralysis to optimize care. 2.

Facial Plastic Surgery Clinics of North America: Evidence-Based Procedures in Facial Plastic Surgery

Lisa E. Ishii, Travis T. Tollefson, and J. Regan Thomas, eds. Facial Plastic Surgery Clinics of North America: Evidence-Based Procedures in Facial Plastic Surgery . New York, NY: Elsevier, 2015. ISBN-10: 0323393322, ISBN-13: 978-0323393324. $99.00. ![Graphic][1] In our new era of evidence-based medicine, the editors and authors attempt to lay down the current state of best evidence for a number of subjects in facial plastic surgery, including; skin care, lasers, rhinoplasty, facial fractures, facial reanimation, microvascular surgery, cleft lip and palate, and infantile hemangiomas. They also include a primer on systematic reviews, meta-analysis, and evidence-based medicine itself. Drs Ishii, Tollefson, and Thomas are clearly leaders in the field of facial plastic surgery. They are well equipped to bring together this distinguished group of contributors to create an important first step at documenting the levels of evidence on which others can build to bring higher levels of evidence into this field of research. The chapters are clearly written and … Corresponding Author: Dr Donald Lalonde, Dalhousie University, Suite C204, 600 Main Street, Saint John, NB E2K 1J5, Canada E-mail: drdonlalonde{at}nb.aibn.com [1]: /embed/inline-graphic-1.gif

Facial Plastic Surgery Clinics of North America: Multicultural Aesthetics in Facial Plastic Surgery

J. Regan Thomas, ed. Facial Plastic Surgery Clinics of North America: Multicultural Aesthetics in Facial Plastic Surgery . Hardcover, Publisher: Elsevier; 1 edition (August 7, 2014). Language: English; ISBN-10: 0323320112; ISBN-13: 978-0323320115; Pages: 149, Price: $99.00. ![Graphic][1] As with many things in life, context is very important. In reviewing this issue of Facial Plastic Surgery Clinics it would be unfair not to point out that these 12 chapters form part of an ongoing compendium in a series that has been compiled over the last 15 years. In its entirety it provides a comprehensive resource of literature for facial reconstruction and aesthetics. The theme of this issue is the special considerations of ethnicity in relation to facial plastic surgery and the areas focus as one might expect on rhinoplasty and Asian blepharoplasty. There are thoughtful introductory chapters, particularly one written by Julian Rowe-Jones, in which he discusses the importance of managing expectations not just from an aesthetic and psychological viewpoint but minding the context of cultural background. The issue also includes two general introductory chapters, some chapters on hair restoration and skin … Corresponding Author: Dr Norman Waterhouse, 150 Harley Street, London W1G 7LQ, United Kingdom. E-mail: info{at}nwal.co.uk [1]: /embed/inline-graphic-1.gif

Body dysmorphic disorder in a facial plastic and reconstructive surgery clinic: measuring prevalence, assessing comorbidities, and validating a feasible screening instrument.

Body dysmorphic disorder (BDD) is underrecognized and underdetected among patients undergoing facial plastic and reconstructive surgery. Patients with BDD require psychiatric care, not cosmetic surgery. To measure the prevalence of BDD in a facial plastic and reconstructive surgery clinic, to validate the Body Dysmorphic Disorder Questionnaire (BDDQ) in that setting, to assess the feasibility of implementing a standardized process for identifying patients with BDD accurately in a busy clinical practice, and to assess the comorbidity of BDD, depression, and anxiety in our patient population. We performed a prospective prevalence and instrument validation study in an academic facial plastic and reconstructive surgery clinic. We included 234 consecutive patients 18 years or older presenting to the clinic from March 3 to June 30, 2014. Prevalence of BDD as determined by the BDDQ and the criterion-standard BDD Structured Clinical Interview for DSM-IV (BDD SCID). The BDD SCID and a defect severity scale were used to confirm the BDD diagnosis and to validate the BDDQ finding. We also assessed demographic characteristics, depression, and anxiety in all patients. As confirmed by the BDD SCID, 13.1% of patients undergoing cosmetic surgery and 1.8% of those undergoing reconstructive surgery had BDD. We found the BDDQ to be an accurate (91.7%), sensitive (100%), and specific (90.3%) screening instrument for BDD. Patients with a positive BDD finding were most commonly concerned with their nose (10 of 18 [56%]), skin (5 of 18 [28%]), hair (1 of 18 [6%]), chin (1 of 18 [6%]), and ears (1 of 18 [6%]), that is, areas commonly addressed by facial plastic surgeons. Furthermore, compared with patients who did not have BDD, patients with BDD had elevated depression scores (mean [SD], 12.6 [10.8] vs 3.2 [4.2]). In the non-BDD population, mean (SD) state and trait anxiety scores resembled the norm (30.0 [7.7] and 30.3 [7.7], respectively, for men; 31.7 [10.0] and 32.1 [8.7], respectively, for women); in the BDD population, these scores were elevated (53.8 [23.4] and 50.4 [19.5], respectively, for men; 47.8 [12.7] and 49.0 [11.6], respectively, for women). Depression and anxiety scores were highly correlated in patients with BDD (r = 0.84 for patients with a BDDQ-positive screen result; r = 0.94 for patients with a positive BDD SCID finding) compared with those who did not have BDD (r = 0.51). Patients with BDD often seek cosmetic treatment. Given the documented risks and harms of surgery for patients with BDD, a systematic process for identifying such patients who seek cosmetic surgery is imperative. We found a BDD screening instrument (BDDQ) followed by the BDD SCID for patients with a BDDQ-positive screen result to be a feasible and effective way to identify patients with BDD. NA.

Book Review: Facial Plastic Surgery Clinics of North America: Techniques in Facial Plastic Surgery: Discussion and Debate, Part 2

Fred Fedok, Robert Kellman, eds. Facial Plastic Surgery Clinics of North America: Techniques in Facial Plastic Surgery: Discussion and Debate, Part 2. New York: Elsevier, 2013. ISBN-10: 1455738603 Facial Plastic Surgery Clinics of North America , like most of the Clinics series, is typically a collection of reviews created by experts in the field, as selected by the series editors. The current issue, however, piqued my interest as its title suggested something a bit different: Techniques in Facial Plastic Surgery: Discussion and Debate, Part 2 . Looking through the text, I immediately noted that the format was atypical. Only 6 chapters are listed, but each includes contributions from several of my colleagues who are well published in the area to be discussed. As the preface states, the goal of this issue is not simply to provide a single-author review of a given subject area. Rather, the goal is to simulate “the most sought after and popular aspect of a live meeting—the panel discussion.” My impression is that the editors have succeeded in this regard. The main strength of this book is the concept of creating a “panel discussion” in text form. The chapter topics are chemical peels, rhinoplasty, revision rhinoplasty, lower blepharoplasty, midface lift, and distraction osteogenesis. As this is noted to be Part 2, presumably some of the other hot …

Book Review: Facial Plastic Surgery Clinics of North America: Complications in Facial Plastic Surgery

Richard L. Goode, Samuel P. Most Facial Plastic Surgery Clinics of North America: Complications in Facial Plastic Surgery. New York: Elsevier, 2013. ISBN-10: 0323242219 The November issue of Facial Plastic Surgery Clinics of North America consists of several review articles dedicated to surgical complications. The editors, Drs Goode and Most, have assembled a team of authors from both academic and private circles, drawing heavily from their home institution of Stanford. Most senior authors have extensive publications. The book contains 12 chapters dedicated to discussing complications of both cosmetic and reconstructive procedures, including surgical and nonsurgical modalities. Articles provide concise updates on the root cause, prevention, and treatment of complications in facial plastic surgery. As such, the volume is well suited to residents, fellows, and surgeons desiring up-to-date reviews of procedure-specific problem solving. Standard cosmetic procedures, such as facelifts, blepharoplasty, hair restoration, and rhinoplasty, each receive chapter-length discussion. There are 2 chapters on facial fillers and neurotoxins, as well as others on …

Book Review: Facial Plastic Surgery Clinics of North America: Hair Restoration

Raymond J. Konior, Steven P. Gabel Facial Plastic Surgery Clinics of North America: Hair Restoration. New York: Elsevier, 2013. ISBN-10: 0323186033 The clinical review on hair restoration by Konior and Gabel in the August 2013 Facial Plastic Surgical Clinics of North America is an excellent compendium of all updated, state-of-the-art techniques in hair restoration surgery by some of the clinical leaders in the world. In addition to covering all the planning and technical aspects of this procedure, this volume also encompasses a comprehensive review of all aspects of medical treatment of hair loss in both men and women, as well as gives the reader a good perspective of futuristic trends in the field of hair cloning and germanative hair fragment formation. The quality of the writing and editing of the book is excellent, and the schematic artwork is also of high quality, although one …

Nasal bone length in Saudi rhinoplasty: a clinical-radiological study

BACKGROUND AND OBJECTIVESHump reduction in the presence of short nasal bones can result in significant esthetic and/or functional problems in patients seeking rhinoplasty in the Middle East. The aims of this study were to determine the mean length of nasal bones, amount of nasal dorsum it forms in relation to the whole nose, and incidence of short nasal bones in the Middle Eastern population.DESIGN AND SETTINGSA prospective study that has been carried out in a tertiary care hospital.PATIENTS AND METHODSA total of 154 patients (80 females and 74 males) who were scheduled for computed tomography scan for the paranasal sinuses were included in the study. The inclusion criteria were adults with no history of facial/nasal trauma, sinus space occupying lesions, or surgery.RESULTSIn males, the mean clinical nasal bone length was 19.59 mm and the mean radiological nasal bone length was 24.96 mm. In females, the mean clinical nasal bone length was 18.17 mm and the mean radiological bone length was 22.82 mm.CONCLUSIONThe bony vault represents 44.2% of the female nose and 44.3% of the male nose. In the present study, no patients displayed a short nasal bone that was less than one-third of the whole nasal length.

Modeling Nasal Physiology Changes Due to Septal Perforations

To use computational fluid dynamics (CFD) technology to help providers understand (1) how septal perforations may alter nasal physiology and (2) how these alterations are influenced by perforation size and location. Computer simulation study. Facial plastic and reconstructive surgery clinic. With the aid of medical imaging and modeling software, septal perforations of 1 and 2 cm in anterior, posterior, and superior locations were virtually created in a nasal cavity digital model. The CFD techniques were used to analyze airflow, nasal resistance, air conditioning, and wall shear stress. Bilateral nasal resistance was not significantly altered by a septal perforation. Airflow allocation changed, with more air flowing through the lower-resistance nasal cavity. This effect was greater for anterior and posterior perforations than for the superior location. At the perforation sites, there was less localized heat and moisture flux and wall shear stress in superior perforations compared with those in anterior or posterior locations. For anterior perforations, a larger size produced higher wall shear and velocity, whereas in posterior perforations, a smaller size produced higher wall shear and velocity. Septal perforations may alter nasal physiology. In the subject studied, airflow allocation to each side was changed as air was shunted through the perforation to the lower-resistance nasal cavity. Anterior and posterior perforations caused larger effects than those in a superior location. Increasing the size of anterior perforations and decreasing the size of posterior perforations enhanced alterations in wall shear and velocity at the perforation.

Dermatitis Artefacta: Facts for a Facial Plastic Surgeon

Objective: 1) To report a large scalp lesion secondary to dermatitis artefacta, requiring reconstruction. 2) To emphasize the need for a multidisciplinary approach involving dermatologist, psychiatrist, and facial plastic surgeon for optimizing outcome. 3) To highlight specific issues in the patient’s care in the perioperative period. Method: Case report of a 44-year-old white female patient who presented to our combined dermatology–facial plastic surgery clinic with a large lesion on her scalp and a known diagnosis of dermatitis artefacta. Results: The scalp lesion had gradually increased in size over 4 years. Prior to this she was being followed up by the dermatologists for this and other multiple, bizarre ulcerating areas on her face; the patient had associated depression. A diagnosis of dermatitis artefacta was made by the dermatologists and supported by the psychiatrists. She was treated with antibiotics for the excoriating lesions and local dressing for the scalp wound initially. Regional reconstruction of scalp was subsequently carried out to achieve closure of the scalp defect, with the active involvement of the dermatology and psychiatry teams. Conclusion: 1) Close monitoring is required postoperatively, as these patients can be passively noncompliant with treatment, inducing self-harm repeatedly because of lack of insight in causing skin damage. 2) Prompt discussion in a multidisciplinary setting with earlier input from facial plastic surgeons will potentially minimize the extent of reconstructive surgery required.