The aim of this study is to compare piezoelectric osteotomy with conventional osteotomy in rhinoplasty using ultrasonographic techniques in terms of ICP and the measurement of the optic nerve sheath diameter (ONDM). A total of 40 patients who underwent rhinoplasty surgery were included in the study. The patients were randomly divided into two groups of 20. Conventional osteotomy was performed in the first group during surgery. Piezoelectric osteotomy was performed in the second group. ONDMs were measured. Prior to anesthesia induction, baseline ONDM was determined as ONDM-1. A total of five measurements were taken: after intubation (ONDM-2), immediately before hump resection and osteotomy (ONDM-3), immediately after osteotomy (ONDM-4), and immediately before extubation (ONDM-5). ONDM-2 was significantly larger than ONDM-1 in both groups. In group 1, significant differences were found between ONDM-2 and ONDM-4 (p < 0.001) and between ONDM-3 and ONDM-4 (p < 0.001). In the second group, significant differences were observed between ONDM-2 and ONDM-4 (p < 0.001). No significant difference was observed between ONDM-3 and ONDM-4 (p= 0.694). Additionally, significant differences were found between the two groups in terms of ONDM-4 and ONDM-5 values (p < 0.001, p = 0.011). Both intubation and conventional osteotomy can increase ONDM, suggesting a possible increase in ICP in the conventional osteotomy group. In patients who underwent piezoelectric osteotomy, an increase in ONDM was observed only after intubation. This suggests that piezoelectric osteotomy is safer in terms of ICP. 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 .

Home care after rhinoplasty is a critical stage in the recovery process. The effectiveness of home care is influenced by many factors such as the nature of the surgical procedure, the timing of discharge, the patient’s general condition, ongoing needs, and social support network. In the postoperative period, patients receiving adequate education play an important role both in reducing complications (for example, hospital-acquired infection) and in supporting recovery physiologically and psychologically. In this way, patients experience a more comfortable recovery process at home, and increasing their quality of life. In the home care process after rhinoplasty, nurses play a crucial role. Nurses provide patients with the necessary education before discharge, explain the points that need attention during care, and give information about possible complications. Thus, nursing care facilitates the recovery process by increasing patient safety and minimizes the risk of complications. The aim of this review is to highlight the significance of the home care process for patients who have undergone rhinoplasty and to provide a contribution to the improvement of patient care.

Background: Periorbital edema and ecchymosis are frequent complications after rhinoplasty, impacting early recovery and patient satisfaction. Objective: To evaluate the effect of subperiosteal drain placement in patients undergoing ultrasonic piezo-assisted rhinoplasty, as measured by periorbital edema and ecchymosis on postoperative days (POD) 3, 7, and 14. Methods: In this prospective comparative study, 110 adults undergoing open rhinoplasty with piezo-assisted osteotomies were divided into drain (n = 55) and non-drain (n = 55) groups. The drain group received bilateral subperiosteal cannula drains along the osteotomy lines, removed on POD3. Edema and ecchymosis were graded by blinded observers on days 3, 7, and 14 using a 0-4 scale. Results: Patients were 28.2 ± 8.5 years; 76/110 (69.1%) were female; groups were balanced in age (p = 0.224) with a higher female proportion in the drain group (81.8% vs. 56.4%). At POD3 and POD7, total ecchymosis scores were lower with drains (POD3: 2.82 vs. 4.29, p = 0.002; POD7: 0.76 vs. 1.58, p = 0.001), while edema scores were similar between groups at all timepoints. By POD14, edema had resolved and ecchymosis was minimal in both groups. Conclusions: In this study, the use of subperiosteal drains in patients undergoing piezo-assisted osteotomies was found to be associated with a reduction in early postop ecchymosis, but not periorbital edema.

Tranexamic acid (TXA) is widely used to reduce postoperative edema and ecchymosis; however, evidence comparing topically applied and locally injected routes following rhinoplasty remains limited and inconsistent. To compare the efficacy of topically applied versus locally injected TXA in reducing periorbital edema and ecchymosis after primary rhinoplasty and to explore whether route of administration influences clinical outcomes. In this triple-blind, randomized, controlled clinical trial, 75 patients undergoing primary open rhinoplasty were allocated into three groups: topical TXA (2.5 mL of 100 mg/mL applied via soaked pad for 5 minutes after osteotomy), locally injected TXA (2.5 mL of 100 mg/mL injected just before surgery), and saline control. A single surgeon performed all procedures using standardized piezo-assisted osteotomies. Postoperative edema and ecchymosis were evaluated on postoperative days 1, 3, and 7 by a blinded assessor using validated photographic grading scales. Statistical analyses were performed using the Kruskal-Wallis and Mann-Whitney U tests with Bonferroni correction. Both TXA groups demonstrated significantly reduced edema and ecchymosis compared with the control at all time points (P < 0.05). The topical TXA group exhibited greater reductions than the injection group on days 1 and 3, though differences were not statistically significant by day 7. No adverse events were observed. Compared with locally injected TXA, topically applied TXA administered immediately after osteotomy achieved greater early reduction in postoperative periorbital edema and ecchymosis. These findings underscore the importance of the administration route in optimizing aesthetic recovery after rhinoplasty.

Objective: Retrospective analysis of the reasons for patients undergoing rhinoplasty and the results of their attitude change towards undergoing rhinoplasty. Materials and Methods: A retrospective analysis was conducted on the clinical data of 108 patients who underwent rhinoplasty from December 2021 to January 2025. Among them, 98 patients chose to completely remove nasal implants. Analyze the preoperative nasal photos and invite patients to voluntarily complete an online survey questionnaire for self-evaluation. Results: According to the physician’s evaluation of preoperative photos of patients, the main reason for post-rhinoplasty repair is the deviation of the nasal tip and dorsal. Through patient self-evaluation surveys, it can be concluded that the most concerning nasal issue for patients is the appearance of nasal tip and nasal dorsal grafts. Thirty-eight of them believe that they will not undergo rhinoplasty again. Conclusions: From a physician’s perspective, the reason for reoperation after rhinoplasty repair surgery is the deviation of the nasal tip or back, whereas the most concerning reason for patients is the appearance of the nasal transplant. Because of the excessive pursuit of a straight nose shape, both patients and physicians face a high rate of post-rhinoplasty repair. Physicians should pay attention to controlling skin tension.

Postoperative care in primary and revision rhinoplasty-A survey-based study.

Schwannomas are rare benign tumors arising from Schwann cells, with infrequent occurrence in the nasal cavity and paranasal sinuses. Even more uncommon is their presence in the nasal columella, where only a few cases have been reported. We report the case of a 64-year-old female presenting with a slow- growing, firm, non-tender mass in the left nasal vestibule, arising from the membranous septum. The lesion measured 1.5×1.2 cm, causing partial nasal obstruction. The patient had a complex oncological history, including treated breast cancer and suspected CNS metastases. Computed tomography (CT) imaging revealed a well-defined hypodense mass at area I of Cottle. Complete surgical excision was performed via open rhinoplasty, allowing optimal access and aesthetic preservation. Histopathology revealed Verocay bodies in Antoni A pattern. Immunohistochemical staining was positive for S-100 and vimentin, confirming the diagnosis of schwannoma. Postoperative recovery was uneventful. This case highlights a rare location of sinonasal schwannoma and supports open rhinoplasty as an effective approach for diagnosis and treatment, providing both functional and cosmetic benefits.

Abstract Introduction Rhinoplasty is the most common cosmetic surgery performed by otorhinolaryngologist and plastic surgeons. It can be done for both aesthetic and functional purposes. Quality of life of the patient becomes important, so in this study we will assess the quality of life of patients using outcome evaluation scores. Materials and methods This prospective longitudinal clinical study was performed on patients who visited to Department of Otorhinolaryngology from March 2023 to April 2024 and underwent open rhinoplasty. Rhinoplasty Outcomes Evaluation(ROE) and Rhinoplasty health inventory and nasal outcomes(RHINO) was applied to all patients and evaluated pre and post operatively. Results obtained and statistically assessed. Results A total of 16 patients were studied, which shows improvement of ROE and RHINO scores from preoperative to postoperative and followed by 3 months. Conclusion The statistical significance of the improvements seen at the 3-month and postoperative follow-up points to the fact that rhinoplasty produces notable and long-lasting gains in both functional and cosmetic results.

Emergence agitation in open rhinoplasty operations neutrophil/ lymphocyte and platelet/lymphocyte ratio as a predictive marker

Objectives: We reviewed graft and suture options in rhinoplasty operations. We aimed to focus on choosing the right graft and suture for each patient based on the specific needs of their nose. Another key factor is selecting procedures according to the surgeon's skill and experience. It is well known that while some procedures are straightforward and produce perfect results for certain surgeons, others can achieve similar outcomes using different techniques. Methods: The literature was searched from 1932 to 2025 using PubMed, Medline, and Google search engines. A list of search terms related to "rhinoplasty," “endonasal,” “open,” “closed,” “grafts,” and “sutures” was compiled and used to find current and relevant publications. The search results encompass a range of research types, including review articles, meta-analyses, randomized controlled trials, prospective studies, retrospective studies, and online sources. Results: Controlling the shape of the nose mainly involves managing the shape of the cartilages. Most of this control is achieved through excisional and grafting techniques. Graft options in rhinoplasty include Floating graft (Goldman), Shield graft (Sheen), Onlay graft (Peck), Prespinal graft, Dorsal graft, Columellar strut, Lateral crural strut graft, alar rim graft, and Spreader graft. The following sutures and techniques are also used in rhinoplasty: the Hemi-Transdomal Suture, the Lateral Crural Mattress Suture, the Columellar-Septal Suture, and the universal horizontal mattress suture. These sutures aid in septal straightening, correcting the collapsed lateral crus (external valve), and the collapsed upper lateral cartilages (internal valve). Suture and grafting techniques are essential for supporting the internal nasal valve, correcting lateral deviation and contour asymmetry, enhancing tip projection and support, facilitating tip rotation, and refining the tip. Conclusion: Achieving good outcomes relies on skilled hands and, more importantly, sound decision-making throughout the entire process, from preoperative evaluation and counseling to recovery. The importance of identifying suitable surgical candidates, understanding their goals, setting realistic expectations, and supporting them at every stage cannot be overstated.

BackgroundThe aim of this study is to evaluate whether the use of Oxygen Reserve Index (ORi) can prevent hyperoxia in patients undergoing rhinoplasty surgery and whether it can reduce oxidative stress caused by hyperoxia.MethodsA total of 60 patients, who were scheduled for rhinoplasty surgery and had an American Society of Anesthesiologists (ASA) score of I and II, were included in the study. The patients were randomly divided into two groups: the ORi group (Group R) and the control group (Group C). In Group R, oxygen support was titrated to keep the ORi values close to zero. In the control group, oxygen support was provided conventionally. Arterial blood gas samples were taken after intubation, at the 120th minute of the surgery and at the end of the surgery to record partial arterial oxygen pressure (PaO₂) values. During this process, patients’ peripheral oxygen saturation (SpO₂) and ORi values were continuously recorded along with hemodynamic data. Preoperative and postoperative blood samples were collected from both groups, and oxidative stress was assessed by evaluating thiol-disulfide homeostasis and ischemia-modified albumin (IMA), which are current indicators of oxidative stress.ResultsThe demographic characteristics and the surgical durations were similar between the groups. PaO₂ values were lower in Group R compared to Group C. ORi values were correlated with PaO₂ values. Preoperative native thiol, total thiol, and disulfide values were similar in both groups. In both groups, postoperative native thiol, total thiol, and disulfide values decreased compared to the preoperative period, while IMA values increased. In Group R, the decrease in native thiol and total thiol values and the increase in IMA values were less than in Group C.ConclusionWe concluded that ORi guided oxygen titration may reduce the severity of hyperoxia and may decrease oxidative stress in rhinoplasty surgery.Trial registrationClinicalTrials.gov Identifier NCT07158073. Registered on 21 August 2025.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12871-025-03424-0.

ABSTRACTBackground and AimsThe present study aimed to investigate patients' satisfaction after rhinoplasty using the ROE questionnaire and to examine some influencing variables.MethodsThis is an analytical cross‐sectional study. The study population included all patients seeking rhinoplasty referred to the plastic surgery department of Velayat Hospital in Rasht in 2023. Initially, the demographic characteristics of the patients were recorded. The Rhinoplasty Outcome Evaluation questionnaire was used to assess patient satisfaction. All patients were operated on by a single experienced plastic and reconstructive surgeon using the open rhinoplasty technique. The ROE questionnaire was completed by all patients before surgery and then 3 months after surgery during a follow‐up visit. Descriptive and analytic statistics were used for data analysis, with a significance level of p < 0.05. Statistical analyses were performed using the IBM SPSS Statistics software, version 28.ResultsOne hundred and thirty patients were examined. Eighty‐five of the participants (65.4%) were female. The mean age of the patients undergoing rhinoplasty was 26.5 ± 6.24 years. The obtained score before rhinoplasty in patients was 32.76 ± 12.63, and 3 months after surgery, it was 92.05 ± 5.83, which was statistically significant (p < 0.001). Significant differences were found in patient satisfaction scores before and 3 months after surgery in each group for the variables under study (gender, age, marital status, and education). Additionally, in the between‐group comparison in male and female patients, the mean percentage increase in patient satisfaction was 68.14 ± 9.73 in males and 54.6 ± 6.15 in females, which was statistically significant (p < 0.001).ConclusionThis study showed that despite the complexity and intricacies of rhinoplasty, it leads to high satisfaction levels for most patients, and some demographic factors significantly affect patient satisfaction with rhinoplasty outcomes. However, generally, rhinoplasty has a positive effect on patient satisfaction regardless of age, gender, and education level.

Background and objective: This study investigates self-esteem among university students who underwent rhinoplasty surgery to assess its impact on their perceived self-worth and explore associations with personal and demographic factors. Methods: A qualitative descriptive cross-sectional design was employed. A purposive sample of 100 undergraduate students from the old campus of the University of Sulaimani participated. Data was collected using a self-reported questionnaire consisting of sociodemographic questions and the Rosenberg Self-Esteem Scale (RSES). Data analysis was performed using SPSS version 23, applying descriptive and inferential statistics. Results: The findings indicated that 83% of participants had normal self-esteem, 13% reported high self-esteem, and 4% experienced low self-esteem. No significant associations were found between self-esteem and demographic factors such as gender, age, marital status, or economic status (P &gt;0.05). However, the participants' academic year showed a statistically significant relationship with self-esteem (P = 0.034). Conclusion: Rhinoplasty may improve self-esteem for some individuals, but its influence varies across demographic profiles. These results underscore the importance of psychological assessments before and after cosmetic surgeries and highlight the need for interventions to foster positive body image beyond physical alterations.

Abstract Background Rhinoplasty is a highly individualized procedure, and the choice of approach—closed (endonasal) or open (external)—has significant implications for nasal structure, function, healing, and aesthetic outcomes. This article presents an academic comparison between the two techniques based on anatomical, physiological, and surgical principles. Results The closed technique preserves the columella and maintains the three-dimensional integrity of the lower third of the nose. It utilizes internal incisions to access and modify nasal structures while preserving their natural support and function. The open approach, on the other hand, requires external incisions, detachment of key anatomical supports, and often depends on structural grafts for reconstruction. It is associated with longer healing, graft-related complications, and visible scarring. Conclusions Closed and open rhinoplasty are not merely alternative access routes but are two fundamentally different procedures with different goals. Closed rhinoplasty emphasizes preservation of native anatomy and function, while the open approach is better suited for revision or reconstructive cases requiring extensive modification.

Nasal septal perforation (NSP) repair has evolved with the development of advanced techniques like the anterior ethmoidal artery (AEA) and greater palatine artery (GPA) flaps, achieving high success rates. Traditional challenges in combining NSP repair with rhinoplasty stem from the reliance on mucoperichondrial blood supply for graft survival and the risks of cartilage absorption or infection during exposure of the L-strut framework. This article presents modified "racket-on-donut" and "boot-on-donut" techniques for simultaneous NSP repair and rhinoplasty, incorporating innovations to bilaterally cover grafts with mucosal flaps and reconstruct the dorsal L-strut under a preserved dorsum. Case 1 involved a 62-year-old patient with an anterior NSP and structural deformities. The modified "racket-on-donut" flap was used to cover the perforation and the septal replacement graft bilaterally, ensuring functional and aesthetic correction. Case 2 featured a 65-year-old patient with a larger NSP and thin skin. Using the modified "boot-on-donut" flap, the NSP was repaired, and dorsal preservation maintained keystone area integrity. Both cases utilized open rhinoplasty to optimize access, facilitate flap mobilization, and enhance mucosal recruitment. The combined approach offers superior outcomes by addressing functional and aesthetic issues in a single procedure, reducing complications like graft necrosis and septal reperforation. Preservation rhinoplasty, traditionally contraindicated in NSP repair, proved effective with careful reconstruction of the L-strut and keystone area preservation. These techniques provide a versatile solution for complex NSP cases, integrating pedicled flaps with reconstructive rhinoplasty to achieve durable, aesthetic and functional results.

Nasal septal perforation (NSP) is characterized by defects in the mucosal, cartilaginous, and bony structures of the septum, most commonly resulting from septoplasty. Spontaneous healing of NSPs is rare, necessitating surgical intervention once the condition stabilizes. Numerous techniques have been developed for NSP repair. This study presents a novel technique combining fascia lata grafts, platelet-rich plasma (PRP), and diced septal cartilage harvested from the patient's remaining deviated nasal septum for the repair of medium-sized NSPs. A retrospective analysis was conducted on 32 patients who underwent NSP repair between July 2022 and July 2023. The repair utilized fascia lata, PRP derived from venous blood, and diced cartilage from residual septal cartilage. The procedure involved an open rhinoplasty approach for graft placement, followed by stabilization using endoscopic techniques. The mean horizontal and vertical diameters of the septal perforations were 12.06 ± 2.87 mm and 13.12 ± 2.44 mm, respectively. All patients had medium-sized perforations (0.5-2 cm). The mean follow-up period was 12.03 ± 1.11 months. Complete closure was achieved in 28 of 32 cases (87.5%). The cohort included 18 males (56.3%) and 14 females (43.8%), with a mean age of 35.47 ± 5.31 years (range: 25-45). Ten patients (31.3%) were smokers, among whom 4 experienced incomplete closure. Smoking was not significantly associated with repair failure (P = .06). This novel technique combining fascia lata, PRP, and diced septal cartilage offers a reliable and effective approach for the repair of medium-sized NSPs.

East Asian women often present with mild nasal contour imperfections for which they are unwilling to undergo open rhinoplasty because the potential risks outweigh the modest severity. Autologous fat grafting is a mature technique for soft tissue augmentation and has been applied in rhinoplasty; however, when solely used, its efficacy in this demographic remains obscure. To evaluate the clinical effectiveness of autologous fat grafting for mild nasal contour imperfections in East Asian women. Cadaveric head dissection was performed to verify the anatomical accuracy of fat placement using the described techniques. A retrospective examination was conducted on 130 East Asian female patients (median age, 31 years; median follow-up, 18 months) that underwent rhinoplasty with autologous fat grafting between May 2013 and April 2024. Pre- and postoperative profile photos were measured for objective results. Patient satisfaction was assessed using FACE-Q questionnaires, and the results were also evaluated by three-party ratings. Cadaveric dissections confirmed precise and predictable fat placement within targeted anatomical planes. Clinically, significant postoperative changes were observed in nasofrontal angle (mean change, +0.99°), nasolabial angle (+1.41°), nasal base convexity (+0.73%), and dorsal inclination angle (-0.38°; all p < 0.05); subgroup analyses identified nasal spine augmentation driving nasolabial angle increases. Both FACE-Q scores and three-party ratings reflected high postoperative satisfaction. No severe complications were reported; minor complications included nodule formation and fat migration. Autologous fat grafting is effective for correcting mild nasal contour imperfections in East Asian women. As corroborated by clinical results and dissection, the described techniques ensure precise fat placement in different nasal esthetic units.

Background: Nasal tip position is critical for optimal rhinoplasty outcomes, yet managing rotation and projection is challenging in patients with short caudal septa or ptotic tips. The Teo Strut Graft (TSG) enhances tip support. Objective: To present an extended TSG technique using Tongue-In-Groove (TIG) fixation to improve tip position in primary open rhinoplasty. Patients and Methods: This prospective case series enrolled 38 primary rhinoplasty patients presenting with ptotic tips and/or short septal anatomy from March 2021 to June 2023. Patients underwent open rhinoplasty by a single surgeon, involving placement of an extended TSG (septal cartilage), fixed via the TIG method. Standardized lateral photographs were assessed preoperatively and immediately postoperatively and the nasolabial angle (NLA) and Goode's ratio tip projection were quantified at one year. Results: The mean preoperative NLA significantly increased from 83.62±8.01° to 103.45±7.37° at one year postoperatively (p&lt;0.001). Mean Goode's ratio increased considerably from 0.634±0.055 preoperatively to 0.714±0.061 at one year (p&lt;0.001). One-year NLA was stable (p = 0.18 vs immediate postoperation). At the same time, projection showed a minor, significant decrease from immediate postoperation (p = 0.013) and remained significantly improved than baseline (p&lt;0.001). Conclusions: The extended TSG effectively increased NLA and nasal tip projection in patients with ptotic tips and short septum, yielding largely stable one-year results.

Abstract Background Osteotomy is a critical component of rhinoplasty but is associated with postoperative morbidity, including pain, edema, ecchymosis, and subconjunctival hemorrhage. Aim This study compares the outcomes of three osteotomy techniques—conventional, magic saw, and piezoelectric—in terms of operative performance and postoperative morbidity. Methods In this single-blinded, randomized trial, sixty individuals of Caucasian Mediterranean ethnicity underwent primary septorhinoplasty at Mansoura University Hospital (2022–2024). Patients were randomized into three groups (n = 20 each): Group 1 (conventional osteotomy), Group 2 (magic saw), and Group 3 (piezoelectric). All surgeries followed a standardized open rhinoplasty approach. Postoperative outcomes, including pain (VAS score), periorbital edema, ecchymosis, and subconjunctival hemorrhage, were assessed on days 1, 7, and 21. Functional and aesthetic results were evaluated using NOSE and SCHNOS scores at baseline, 1 month, and 6 months postoperatively. Results Piezoelectric osteotomy resulted in significantly lower pain, edema, ecchymosis, and subconjunctival hemorrhage on day 1 compared to conventional and magic saw techniques (p &lt; 0.05). By day 7, no significant differences remained among groups. All patients showed complete resolution of early complications by day 21. SCHNOS and NOSE scores improved significantly in all groups over time, with no intergroup differences at 6 months. Conclusion Piezoelectric osteotomy demonstrates superior short-term outcomes in reducing postoperative morbidity but requires longer operative time. Magic saws also reduce early complications relative to conventional techniques, though less consistently. Despite differences in early recovery profiles, all three techniques yield comparable long-term functional and aesthetic outcomes.

Nasal tip position is a crucial aspect of rhinoplasty. To stabilize and define the nasal tip, various cartilaginous grafts have been widely utilized. The purpose of this systematic review is to critically evaluate and compare 2 prevalent grafting techniques: columellar strut grafts (CSGs) and septal extension grafts (SEGs). This study aims to 1) review rhinoplasty studies directly comparing CSGs with SEGs, 2) examine variations in graft technique, and 3) compare their impact on nasal tip projection, rotation, and patient-reported outcomes. A systematic review adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines was conducted. Screening and full-text review were performed by 2 independent evaluators. Data collection included patient demographics, operative techniques, patient-reported outcomes, and anthropometric measures of projection, and rotation. Ninety-three articles were identified and screened based on predetermined criteria, with 24 undergoing full-text review. Eight studies, involving 571 patients, were included in the final analysis. Of these, 54% (n = 310) underwent SEGs, while 46% (n = 261) underwent CSGs. Patient-reported outcomes were only available in 2 studies. Most studies reported short- and long-term measurements of tip projection and rotation; 1 study provided additional data on nasal tip stiffness. This systematic review provides a comprehensive examination of SEGs and CSGs in open rhinoplasty. While SEGs have been shown to provide superior long-term tip stability, some authors contend that CSGs hold value for specific patients. We propose a patient-specific approach for selecting between CSGs versus SEGs based on existing comparative data.