Rhinoplasty Outcome Evaluation Research Articles

Push-Down Technique Without Osteotomy: A New Approach.

Dorsal hump reduction is one of the most frequently performed rhinoplasty operations among white populations. The best method for preserving a natural nasal dorsum and avoiding revision surgery is to perform the push-down technique. The concept of the push-down technique is not new and has been improved over time. In the present study, the author introduces a new approach for the push-down technique in which there is no need for osteotomy. According to the inclusion and exclusion criteria, sixty-two patients were included in the present study. All patients who were included in the study were assessed with the Rhinoplasty Outcome Evaluation (ROE) questionnaire at their 1-year follow-up appointment. In the present technique, the superior dorsal cartilage was pushed down to the reverse side of the septal deviation, and the nasal dorsum was rasped with a micromotor rasping machine instead of undergoing osteotomy. The initial median ROE score was 68.5 points, and the postoperative median score was 90.5 points. A final score greater than 85 was considered excellent and an indication of high patient satisfaction. Among the sixty-two patients, 56 had a score greater than 85 points (90.32%) (p = 0.001). There were no complications, and there was no need for revision surgery. This push-down technique can be considered an easy and suitable approach for selected patient populations. Additionally, the recovery time is shortened with the push-down technique without osteotomy. 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.

Improvement of Alar Concavity With Scroll Ligament Preservation: Sandwich Technique.

Excessive concavity of the lower lateral crura can cause significant aesthetic problems for the nasal tip and can be associated with significant functional problems, such as insufficiencies in the external nasal valve. The aim of this study was to develop a novel technique for the improvement of several alar concavities that preserve the scroll area. In this retrospective study, 51 primary rhinoplasty patients with unoperated alar concavity deformities were assessed. Alar concavities were repaired with alar strut grafts and a superior transposition flap or superior-based sliding flap, which were designed with the "sandwich" technique. Additionally, the scroll ligament was completely preserved in the 2 variants of the technique. All patients who were included in the study were assessed with the Rhinoplasty Outcome Evaluation (ROE) questionnaire before surgery and at their 1-year follow-up appointment. The median age of patients was 29.2 years (range, 19-49 years). The ROE scores ranged between 90 and 100 points after 1 year. The median score was 91.2 points, and this was significantly increased at the 1-year follow-up appointment (P = 0.002). Patient satisfaction was found to be excellent in 92% of the included patients. Patients were also evaluated in terms of functionality. The patients' patency scores increased to 9.4 from 6.1 (out of 10) after a 12-month follow-up (P = 0.003). This "sandwich" technique involves a combination of superior transposition flaps, superior-based sliding flaps, and alar strut grafts. Thus, patients who receive this treatment may also benefit from new flap techniques and vertical and longitudinal scroll ligament preservation. This new technique presents a novel and easy method for the reconstruction of severe alar concavities.

Rhinoplasty in secondary nasal deformities: Subjective and objective outcome evaluation

Introduction:Secondary nasal deformities are associated with trauma and secondary cleft nose (after primary cleft nose surgery). Nasal deformities affect esthetic, function, and psychological status of the patient. The goal of the secondary rhinoplasty is to correct both form and function, so that this positively impacts on their facial appearance.Aims:The study aimed to evaluate the patient satisfaction (subjective outcome) by rhinoplasty outcome evaluation questionnaire (ROEQ) preoperatively and postoperatively and esthetic outcome (objective outcome) by surgical team in patients with secondary nasal deformities.Materials and Methods:Secondary rhinoplasty was done in 13 patients of traumatic and unilateral secondary cleft nose through the external approach. Objective outcome was assessed by surgical team with clinical measurement, radiograph (lateral cephalometric), and photographic documentation pre- and postoperatively. Clinical measurements include nasolabial and nasofrontal angle. The patients completed the ROEQ for the subjective outcome evaluation.Results:There was significant improvement of subjective outcome (83.30%) based on the ROEQ and objective outcome based on the clinical measurement.Conclusion:Our study suggests that secondary rhinoplasty in trauma and cleft patients leads to both subjective and objective improvement of the facial appearance.

Analysis of revision rhinoplasty; what is the problem and the management?

Background: Revision rhinoplasty is reported to occur in 8% to 15%. Reoperation should be performed to correct deformities that were not diagnosed or addressed in previous surgeries, such as those from poor planning, performance and poor surgical healing. The aim of the study was to evaluate the problem of each case seeking revision rhinoplasty and different modalities for management to reach satisfactory results.Methods: This is a prospective study which was done in plastic surgery department, Menoufia University Hospitals over the period from December 2017 to December 2019. The study included 31 patients underwent previous rhinoplasty.Results: Patients were selected from the outpatient clinic, 31 patients who had varieties of nasal deformities. Mean age of the patients was 31.7 years. Female represent the majority of patients by 80.60% and males were 19.40% with significant difference in satisfaction (p=0.05). Patient satisfaction after surgery and it was excellent for 14 cases (45.20%), good for 9 cases (29 %) and it was fair in 8 cases (25.8%). Rhinoplasty outcome evaluation (ROE) score was correlated with patient satisfaction grades as mean of ROE score in excellent group was 67.5; in good group was 58.3; while in fair group was 38.8 with significant p value (0.001).Conclusions: Excellent patient satisfaction is related good planning, close follow up time, and less complication. Cartilage grafts especially rib cartilage is considered a lifeboat for revision rhinoplasty. We can link grades of patient satisfaction to ROE score.

Psychological Analysis of Non-surgical Rhinoplasty.

The aim of this study is to analyze the psychological outcomes for patients undergoing non-surgical correction of nasal defects using injections of cross-linked hyaluronic acid. We assessed changes in the subjective perception of nasal appearance after non-surgical rhinoplasty using the Rhinoplasty Outcomes Evaluation (ROE) questionnaire, which is validated and widely used in the literature. One hundred adult subjects without prior history of surgical or non-surgical rhinoplasty underwent non-surgical recontouring using the hyaluronic acid filler from December 2016 to December 2018. The points of inoculation have been standardized by the authors and are divided according to the aesthetic subunits of the nose. A final 74 patients (65 females and 9 males) completed a one-year follow-up and were included in the present study. The ROE questionnaire consists of six questions and assesses the way patients perceive the appearance of their nose and the way they think the people around them view the appearance of their nose. The results of each question were analyzed for each patient, comparing the preoperative results over a 12-month time-frame. Candidates for rhinoplasty, either medical or surgical, are among the most difficult to treat and, interestingly, there is substantial literature showing that among these patients, there is a higher rate of psychiatric disorders. Many of these patients seek aesthetic surgery and are often dissatisfied with the outcome of their surgery. The authors suggest that the use of ROE is not only a valid method of assessing patient satisfaction, but it could also be used as a tool to highlight some of the psychological characteristics of patients long before performing any treatment and could help identify potentially problematic patients.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Cosmetic and Functional Outcomes of Septorhinoplasty.

prospective cohort study. patients with complaints of nasal obstruction and external deformity who are undergoing Septorhinoplasty after evaluation. patients undergoing Septorhinoplasty at Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla during a period of 1½ years, starting from 01/01/2017. non-random, consecutive sampling. The mean age in this study is 26.10years. The most common age group of patients who were included in the study was 11-20years. We had 11 females and 8 males. Female to male ratio was 1.375. The mean duration of symptom was 6.33years. Most of the patients in our study were students. The mean pre-op ROE score was 29.79 ± 15.28 and post-op score was 87.32 ± 8.75. There was significant improvement in ROE scores following Septorhinoplasty (p < 0.0001). The mean pre-op PNIF score was 76.58 ± 41.37 and post-op score was 125 ± 50.22. There was significant improvement in PNIF scores following surgery (p < 0.0001). There is significant improvement in cosmetic and functional aspects in patients undergoing Septorhinoplasty. There is significant improvement in external appearance and nasal obstruction following Septorhinoplasty. The patient satisfaction following Septorhinoplasty can be measured with ease with the help of Rhinoplasty outcome evaluation questionnaire and Peak nasal inspiratory flow meter.

Rainbow graft for tip reconstruction in revision rhinoplasty

Patients undergoing revision rhinoplasty can show complex tip deformities such as asymmetry, dome angulation with cartilage interruption, alar pinch and retraction, and underprojection. When these defects are present at the same time, often multiple cartilage grafts are needed to restore a pleasing tip and functional external nasal valve. This study reports our experience with the rainbow graft, a previously described technique that can repair with a single cartilage graft the above-mentioned defects. We performed a retrospective review of 21 patients who had undergone revision rhinoplasty between 2006 and 2017 employing the rainbow graft technique to correct complex tip deformities. The presence of tip deformities such as asymmetry, dome angulation with cartilage interruption, alar pinch, alar retraction, and under/overprojection was recorded preoperatively and postoperatively. Complete photographic documentation was done, and Rhinoplasty Outcome Evaluation (ROE) questionnaire was administered to the patients. Five patients were male and 16 were females. Mean age of patients was 40±7.6 years. Follow-up ranged from 1 to 12 years, mean 5 ± 3 years. Eight patients had undergone one rhinoplasty, 10 patients had undergone two, and three patients had undergone three. Before surgery, all patients showed asymmetry, 20 dome angulation, 19 alar pinch, and 18 retraction. Eight showed tip overprojection, six underprojection, and seven no alteration of tip projection. The mean ROE score was 20.23±7.37. After surgery, two patients showed persistent asymmetry, none had dome angulation, one alar pinch, and two alar retraction. Projection was corrected in every patient. We observed no case of graft infection, malposition, or resorption, and corrections achieved remained stable during follow-up. Mean postoperative ROE score was 80.75±6.24. Its improvement was statistically significant (p<0.001). The rainbow graft is a safe and effective technique in revision rhinoplasty indicated for the total restoration of nasal tip appearance in the presence of complex secondary deformities.

Tumor Control and Quality of Life in Skin Cancer Patients With Extensive Multilayered Nasal Defects.

Objectives.The reconstruction after nasal skin cancer (NSC) resection is often practiced differently. The objective of this study is to evaluate the influence of patient-, tumor- and management-related factors on the role of surgery and choice of reconstruction.Methods.This was a monocentric retrospective study of patients who were diagnosed with a NSC (squamous cell or basal cell carcinoma) and suffered from an extended defect after ablative surgery between 2003 and 2013. Twenty-five patients were included. Tumors were staged using the Union for International Cancer Control (eighth edition) TNM classification for primary cutaneous skin cancer of the head and neck. Preferred treatment was surgery in all patients. Health-related quality of life (HRQoL) measurement was evaluated by one generic (36-Item Short Form Health Survey [SF-36]) and two organ-specific questionnaires (Rhinoplasty Outcome Evaluation [ROE] and Functional Rhinoplasty Outcome Inventory 17 [FROI-17]) after therapy. Survival data were estimated by the Kaplan-Meier method and statistical analysis was performed by log-rank, analysis of variance, Levene’s and t-tests. The median follow-up time was 2.1 years.Results.According to the Union for International Cancer Control classification, 13 of 25 tumors were staged as pT1 (52%), four as pT2 (16%), seven as pT3 (28%) and one as pT4a (4%). Seventy-two percent of patients (n=18) chose plastic reconstruction, and for the remaining 28% (n=7) of the patients opted for an implant-retained prosthesis. The overall survival was 69.5% after 5 years, the 5-year recurrence-free survival was 90.9% and the 5-year disease-specific survival was 100%. There was no significant difference in the HRQoL outcome between both rehabilitation methods.Conclusion.Surgery in NSC gives an excellent oncologic prognosis. Nasal reconstruction and prostheses are both very viable options depending on tumor stage and biology, the patient’s wishes as well as the experience of the surgeon.

Satisfaction in Patients After Rhinoplasty Using the Rhinoplasty Outcome Evaluation Questionnaire.

IntroductionRhinoplasty is a challenging procedure. The goal of the surgery is not only to restore the function and youthful appearance of the nose but also to improve quality of life. With the passage of time, the trend has been changing rapidly from more invasive to less invasive procedures. Although the technical aspects of rhinoplasty are important, patient satisfaction is the factor that dictates the success of the procedure.Materials and methodsA total of 118 rhinoplasties were performed in our department between 2016 and 2018. The Rhinoplasty Outcome Evaluation (ROE) questionnaire was used to study the patients' satisfaction level. Ninety out of 118 patients took part in this study. Rhinoplasty was done using an open technique in all cases. The ROE questionnaire was filled preoperation and six months postoperation. Data analysis was done using SSPS statistic version 20 (IBM Corp., Armonk, NY, US).ResultsThe main reasons for rhinoplasty in our patients were: aesthetic 23.3% (n=21), functional 25.5% (n=23), and a combination of both in 51% (n=46) patients. The mean ROE score of all patients preoperation was 30.5 (males: 31.3, females 29.8) and the mean score postoperation was 79.5 (males 78.2, females 80.9) at six months with no statistical differences (CI 17.11 - 12.59, P=0.762). However, both genders showed a statistically significant improvement between the preoperative and postoperative scores (mean difference = 49.3, CI 63.25 - 35.34, P<0.01), indicating an overall good satisfaction level after surgery. The satisfaction level of patients was inversely proportional to their level of understanding and knowledge of the surgical procedure. This difference was statistically significant ( CI 7.36-10.42, P<0.01). Minor corrections or modifications were done in eight patients under local anesthesia, with no significant difference in ROE scores as compared to those who had single surgery (CI 0.7 - 1.6, P=0.92). There was no statistically significant difference in the before and after surgery ROE scores among patients operated by different surgeons as well (P=0.82).ConclusionOur study shows that rhinoplasty, despite being a complex procedure, has proven benefits in terms of functional as well as aesthetic outcomes. The ROE questionnaire proves to be a valid tool for estimating patient satisfaction in our population. There is a need for further training and education of surgeons in Pakistan to improve the functional and aesthetic disabilities of nasal deformities.

Vertical Alar Folding (VAF): A Useful Technique for Correction of Long and Concave Lateral Crura in Rhinoplasty.

The tripod theory explains the dynamics of the nasal tip, where surgery is difficult because of anatomic variations and pathologies and the various surgical possibilities. Abnormalities or weaknesses of the lateral crura can result in concavity in ala or alar collapse and cause aesthetic and functional impairments of the nose. Several tip plasty techniques and lateral crura modifications are used in rhinoplasty. To describe the vertical alar folding (VAF) technique for making modifications in the lateral crura (LC) and rotation of the tip. Included in the study were 83 patients (59 women, 24 men) undergoing rhinoplasty using VAF with the senior author as surgeon between 2013 and 2018. The mean age was 26.3years (range 18-47). Mean postoperative follow-up period was 26.7months (range 12-64). Patients who completed the 1-year postoperative period completed the rhinoplasty outcome evaluation (ROE) questionnaire. Outcome measures were performed at examinations, and preoperative and postoperative photographs of the patients were analyzed. In the span of 5years, no revision surgery was required for technique-specific reasons. In patients who had a droopy or asymmetric tip or long and concave lateral crura, we saw remarkable functional and aesthetic improvements with VAF. According to the ROE questionnaire, 90.3% (75 out of 83) of the patients were content with the aesthetic and functional results. VAF is a useful and effective method for modifying the LC and tip of the nose. VAF allowed for controlling the rotation and projection of the tip, changing the length of the lateral crus and nose with durability and smooth, symmetric contours, and correcting concavity of a lateral crus for better functioning and aesthetics. 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 .

Scroll Ligament Preservation and Improvement in Nasal Tip with the Room Concept.

In rhinoplasty operations, concavity and convexity have a particular place in terms of aesthetic and functional problems. To fix the problems associated with concavity and convexity, several techniques were reported for straightening of the lower lateral cartilage (LLC). The scroll ligament and its associated tissues can be preserved, and a better nasal tip can be obtained after the surgery. The purpose of this research is to present a new, more comfortable and more practical technique to overcome the problems associated with LLC. The records of 190 patients who were operated on with this novel technique were assessed retrospectively. In the present "superior-based sliding flap" technique, the LLC remained thick and stable; therefore, a particular functional improvement was achieved. Additionally, the scroll ligament was preserved, so this technique prevented the accumulation of skin at the nose tip. Patients were evaluated using the "Rhinoplasty Outcome Evaluation" (ROE) 12months after the surgery. The median patient age was 24.3years. Among 190 patients, 23 were male (12.1%) and 167 were female (87.9%). All patients included in the study completed the ROE questionnaire. Patient satisfaction was excellent, registering at 95% of the included cases. In the assessment of nasal obstruction, it was found that the patients' patency score increased to 8.8 from 6.2 (out of 10) after the 12-month follow-up (p < 0.001). Revision surgery was not needed in any patient. The ability to have control over the LLC for all shapes via suturing two different points together is a noteworthy benefit of this technique. This is a safe, controlled and easily applicable technique that can be applied to generally every patient without the need for additional grafts. 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.

Outcome of rhinoplasty in patients undergoing autospreader flaps without notable dorsal hump reduction: A clinical trial

Reconstruction of the nasal midvault is an important component of successful rhinoplasty outcomes. Use of the autospreader flap is a beneficial technique for preserving the middle vault. In the present study, we evaluated the esthetic and functional outcomes of this technique in patients without notable dorsal hump reduction. A nonrandomized clinical trial was performed from December 2017 to April 2018 with a minimum follow-up time of 6 months. From among patients seeking rhinoplasty, 38 were eligible for inclusion in the study. The autospreader flap was used to recreate the middle vault in patients undergoing open rhinoplasty, with up to 2 mm bony and cartilaginous dorsal hump removal. Preoperative and postoperative standard photographs were obtained. Assessment of patients was based on Rhinoplasty Outcome Evaluation (ROE) and Nasal Obstruction Symptom Evaluation Scale (NOSE) scores. Objective assessment included quantitative analysis of anthropometric angles, mean dorsal width, nasal length, and projection which was performed on standard pre- and postoperative photos. Overall, the patients had statistically significant improvement in their postoperative NOSE scores (9 vs. 6.92, p = 0.0001). The majority of patients were satisfied with the postoperative appearance of their noses. The mean nasal dorsal width (NDW) decreased postoperatively (43% vs. 36%). No difference was found between the mean height of the nose and projection pre- and postoperatively. There was a significant postoperative increase in the nasolabial angle and reduction in nasal length. The autospreader flap is an effective technique for preservation and restoration of the middle vault and dorsal esthetic line in cases of less than 2 mm dorsal hump reduction. Nasal function can be improved while achieving good cosmetic outcomes.

Three Dimensional Rhinoplasty and Nasal Airway Improvement in Cleft-Nose Deformity.

Septorhinoplasty is particularly challenging among revision surgeries for cleft sequelae. The challenge of cleft septorhinoplasty is mainly due to the complex anatomy of nose, deformity of each of its components and the difficulty and lack of clarity in surgical management. From 2014 to 2017, 26 patients with cleft lip nose deformity were operated by the same cleft team. The study was conducted to assess the improvement in nasal airway and appearance following secondary rhinoplasty with extracorporeal septoplasty. Post operatively each patient was evaluated using the standard modified rhinoplasty outcome evaluation questionnaire, a validated instrument that aids in stratifying patients according to their subjective response. All patients reported great relief of nasal obstruction and improved breathing. More than 80% of our patients were satisfied with improved aesthetics and reported better self-confidence. Secondary cleft rhinoplasty with extracorporeal septoplasty surgery significantly improves the cosmesis and nasal airway opening, subsequently giving them improved self-confidence.

The Importance of Multiple, Different Rhinoplasty Consultations in Patient Selection.

We aimed to investigate the relationship between the number of visits to different physicians and postoperative satisfaction in patients undergoing primary septorhinoplasty by using the ROE survey. Patients for whom we performed septorhinoplasty in the last 3years were examined. Patients who visited 3 different physicians (including us) before the surgery were allocated to group 1. Patients who visited ≥ 4 physicians comprised group 2. We randomized 50 patients in each group. Rhinoplasty outcome evaluation (ROE) was performed twice for the preoperative evaluation and to determine the satisfaction in postoperative 6th month. Preoperative and postoperative ROE values were significantly lower in group 2 (p < 0.001). ROE values after surgery were 82% in group 1 and 68.92% in group 2. We think that it is more appropriate for patients who visit many surgeons to be evaluated more carefully and to be psychologically examined. 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.

Reporting Outcomes and Outcome Measures in Open Rhinoplasty: A Systematic Review.

Comparative studies have shown little statistical difference in outcomes following rhinoplasty, demonstrating near equivalent results across all surgical techniques. Cross-study comparisons of these trials are difficult because variation in outcome reporting prevents statistical pooling and analysis. The authors sought to identify all outcomes and outcome measures used to evaluate postoperative results in rhinoplasty. An extensive computerized database search of MEDLINE and EMBASE was performed; all trials involving n ≥ 20 patients, aged 18 years and older undergoing a primary, open rhinoplasty procedure, were included for review. Of the 3235 citations initially screened, 72 studies met the stated inclusion criteria. A total of 53 unique outcomes and 55 postoperative outcome measures were identified. Outcomes were divided into 6 unique domains: objective signs, subjective symptom severity, physical function related to activities of daily living, patient satisfaction, surgeon satisfaction, and quality of life. The identified outcome measures consisted of 5 nasal-specific, author-reported instruments; 5 nasal specific, patient-reported instruments; 5 patient-reported, generic instruments; and 40 author-generated instruments. Of the outcome measures identified, the Rhinoplasty Outcomes Evaluation, Sino-Nasal Outcome Test-22, and FACE-Q were the only instruments to demonstrate adequate validity, reliability, and responsiveness to change in patients who underwent a rhinoplasty procedure. There is heterogeneity in the outcomes and outcome measures employed to assess postsurgical outcomes following rhinoplasty. A standardized core outcome set is urgently needed to make it possible for future investigators to compare results of various techniques in rhinoplasty surgery.

Optimising Results of Nasal Tip Rotation Applying Combination of Nasolabial Angle and Lip-Columellar Angle in Tandem in Patients Operated by "Cock-up" Alar Cartilage Flaps Technique.

Background Setting the angle of tip rotation is of utmost importance in achieving satisfactory results in rhinoplasty. Conventionally the upward rotation of the tip requires shortening of the septum by caudal resection and shortening of the lateral walls by cephalic trim of the alar cartilages. The results are usually assessed subjectively. We describe the use of objective parameters to ensure accuracy of nasal tip rotation in patients operated with “cock-up” alar cartilage flaps, a modification of the cephalic trim. Methods Fifteen patients with a long nose having adequate width of lateral crura, desiring a shorter nose with upward tip rotation, were included in the study. Values of preoperative and desired nasolabial angle (from morphed images), and the derived columellar–labial angle were documented. Nasal tip rotation was set to the derived angle and maintained using cock-up alar cartilage flaps. The outcome was evaluated by digital measurements of the nasolabial angle and patients’ feedback by Rhinoplasty Outcome Evaluation (ROE) score. Results Satisfactory tip rotation and an aesthetic supratip area could be achieved. The difference in preoperative and postoperative nasolabial angles was statistically significant (p value < 0.0001). The difference in desired and the obtained nasolabial angle was not significant (p value 0.085). The results were maintained on subsequent follow-up. Conclusion Application of angles in practice and use of K-wire template helps us achieve accurate and consistent results. Cock-up flap is an effective technique—to obtain an open nasolabial angle and a desirable supratip region by making use of tissues otherwise discarded.

Evaluation of the effects of open and closed rhinoplasty on the psychosocial stress level and quality of life of rhinoplasty patients

To investigate patient-reported functional and aesthetic outcomes and psycho-social distress levels in patients undergoing rhinoplasty with regard to technique, type, and indications of surgery. A total of 90 patients (mean(SD) age: 27.4(6.5) years, 64.4% females) undergoing rhinoplasty were included prospectively. Data of Nasal Symptom Obstruction Evaluation (NOSE) scale for the functional outcome, the rhinoplasty outcome evaluation (ROE) scale for the esthetic outcome, and the Derriford Appearance Scale (DAS-24) for psychosocial outcomes were recorded preoperatively and in the postoperative 1st, 3rd, and 6th month. No significant difference was noted in ROE or NOSE scores with regard to technique (open vs. closed), type (primary vs. secondary), and indication (functional vs. cosmetic) of rhinoplasty during study visits. Open vs. closed surgery, secondary vs. primary rhinoplasty, and cosmetic vs. functional indication for rhinoplasty were associated with significantly higher DAS-24 scores at the preoperative visit (p<0.001 for each) and postoperative 1st (p<0.001 for each) and 3rd month (p<0.001, p<0.001, and p<0.01, respectively) visits. NOSE, ROE, and DAS-24 scores significantly decreased from the preoperative to the postoperative period and from 1st month to 3rd and 6th months of postoperative follow-up in all patients, regardless of the rhinoplasty subgroup (p<0.001 for each). In conclusion, our findings revealed favorable postoperative functional and esthetic outcome and improved psycho-social distress in patients undergoing rhinoplasty, with significantly improved NOSE, ROE, and DAS-24 scores after rhinoplasty during the entire 6-month follow-up, regardless of the technique (open vs. closed), type (primary vs. revision), and indication (cosmetic vs. functional) of rhinoplasty. Closed rhinoplasty may be a more preferable method because of less psycho-social distress.

Effectiveness of chondrofascial ‘cigar’ graft in contouring the nasal dorsum

Irregularities of the nasal dorsum after rhinoplasty are frustrating for the patient and the surgeon. Different grafts and implants have been adopted to camouflage this nasal imperfection. This study was performed to assess the outcome of a composite chondrofascial ‘cigar’ graft for contouring an irregular nasal dorsum. Thirty-six patients who underwent rhinoplasty between May 2014 and October 2016 were studied prospectively. The cartilaginous core of the graft was obtained from the septal or conchal cartilage, while the graft outer sleeve was harvested from the right lateral thigh fascia lata. The graft was secured over the nasal dorsum through an external rhinoplasty approach. The patients were followed up for at least 18 months postoperative. All participants were evaluated objectively by two independent rhinoplasty surgeons and subjectively by Rhinoplasty Outcome Evaluation (ROE) score. Donor site morbidity was also assessed. All patients had satisfactory aesthetic results with no apparent irregularities detected over the nasal dorsum. The ROE score improved, from a mean of 20.94±8.67 (range 8–58) preoperatively to a mean of 79.56±10.65 (range 50–96) postoperatively. Insignificant donor site morbidity was encountered, with inconsequential effects. The chondrofascial cigar graft is a reliable method for contouring dorsal irregularities, particularly in patients with thin nasal skin.

The Association Between Facial Proportions and Patient Satisfaction After Rhinoplasty: A Prospective Study.

Rhinoplasty is one of the most common aesthetic surgeries. The aim of the study was to evaluate facial proportions and patient satisfaction with the appearance of their nose after rhinoplasty compared to preoperatively. This cross-sectional study was conducted at Islamic Azad University, Mashhad Branch. Eighty-two candidates with indications for primary cosmetic rhinoplasty were selected. Facial proportions and patient satisfaction with their nasal appearance were evaluated before and 6 months after rhinoplasty. Patient satisfaction was assessed using the Rhinoplasty Outcome Evaluation questionnaire. Eighty-two patients referred for cosmetic rhinoplasty (13.4% men and 86.6% women) with a mean age of 28.5 (6.4) years underwent open rhinoplasty and were evaluated. Facial proportions, including nasofrontal, nasolabial, and nasomental ratios increased significantly, while the nasofacial ratio, nasal tip projection, columellar show, alar base, and nasal length reduced significantly after rhinoplasty (P < .05). Furthermore, patient satisfaction with the appearance of their nose increased significantly after surgery (P < .001). All of the facial proportions changed significantly following rhinoplasty. Although patient satisfaction with nose appearance increases significantly after the operation, there is no significant association between patient satisfaction and facial proportions. As beauty is a subjective, relative and qualitative issue, facial proportions may not be a proper tool to determine facial beauty and predict the satisfaction rate following rhinoplasty.

Dorsal Roof Technique for Dorsum Preservation in Rhinoplasty.

Management of the nasal dorsum is an important part of rhinoplasty. Hump removal results in the destruction of the internal valve and keystone area, which are reconstructed with either spreader flaps or grafts for aesthetic and functional reasons. The goal of this work was to present the dorsal roof technique for both dorsum reduction and narrowing during rhinoplasty. Fifty-two patients (35 females, 17 males) underwent septorhinoplasty surgery with the dorsal roof technique. During the follow-up period, all patients were photographed in the standard views. Photos were examined by two independent plastic surgeons. The pyramidal angles of the patients were measured with a protractor preoperatively and 1 year postoperatively. A rhinoplasty outcomes evaluation questionnaire was administered to all patients at the 1-year follow-up visit. Functional improvement was assessed utilizing self-evaluated nasal patency. The chi-square test was employed for statistical analyses. Data were evaluated retrospectively. Of the 52 patients, 44 completed the 1-year follow-up period and rhinoplasty outcomes evaluation questionnaire. During the follow-up period, no irregularity or residual hump was detected. Significant narrowing was achieved (P < 0.001). High patient satisfaction was achieved, and no functional or aesthetic complications were encountered. Whenever possible, the dorsal roof technique is preferred to resection or camouflage the dorsum. This technique allows treatment of the wide dorsum, wide nasal base, and dorsal hump without resection, thus maintaining the integrity of the dorsal bone-cartilage complex.