Dallas Plastic Surgery Institute

Patient-reported outcome measures (PROMs) are crucial for evaluating rhinoplasty outcomes, yet no standardized, validated PROM tailored to rhinoplasty exists. This systematic review examines existing PROMs, identifying gaps in their ability to capture both aesthetic and functional outcomes. A PRISMA-compliant systematic review was conducted using MEDLINE, Embase, Google Scholar, CENTRAL, Science Citation Index, and PubMed. The protocol was registered a priori (CRD42024513514). Risk of bias was assessed using Cochrane's Risk of Bias Tool, with study quality evaluated via the validated GRADE tool. Twelve randomized controlled trials involving 743 patients were analyzed. The mean follow-up was 9.1 months, with a mean patient age of 35.35 years (±5.95) and a male-to-female ratio of 1:1.91. Ten distinct PROMs were identified, with FACE-Q emerging as the most robust, meeting 19 of 21 development standards. However, FACE-Q lacked the ability to assess functional outcomes critical to rhinoplasty, such as nasal airway function and breathing. This review highlights the heterogeneity of PROMs in rhinoplasty research and the limitations of current tools in addressing both aesthetic and functional outcomes. While FACE-Q is the most robust for aesthetic evaluation, its functional limitations underscore the need for refinement or a dedicated PROM tailored to the comprehensive demands of rhinoplasty.

Dorsal preservation rhinoplasty (DPR) is increasingly popular, with some suggesting superior outcomes over open structural rhinoplasty (OSR). To date, there has been little investigation into comparative outcomes between the techniques. This study aims to ascertain whether experts in the field can differentiate between the techniques in aesthetic outcomes. A survey was created that consisted of OSR and DPR cases with an average 2.5 month and 1 year follow-up. The survey was distributed to the Rhinoplasty Society and Dallas Rhinoplasty instructors. Results were correlated to expertise in rhinoplasty. Univariate analysis was performed using Chi-square or Fischer's exact test for categorical variables and Student's t-test for continuous variables. Pearson's correlation coefficient was used to assess the relationship between study variables. Statistical significance was defined as p < 0.05. Fifty-one plastic surgeons responded (24.2 % response rate). Participants averaged almost 10 years of experience, with an average 58 rhinoplasties performed annually. 59% used open techniques and 39% used both open and closed. 54.5% utilized preservation techniques. The average correct survey score was 58% at 2.5 months and 61% at 1 year. There was no positive correlation between survey score and rhinoplasties performed, experience in years, comfort level or utilization of preservation rhinoplasty techniques. The study demonstrates no discernable differences in aesthetic results when using OSR and DPR techniques at 1 year after surgery. Ultimately, OSR and DPR techniques should both be considered and potentially combined, when performing rhinoplasty. 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 .

Background: This study compared the impact of spreader grafts (SG) and spreader flaps (SF) on the transport of intranasal drug delivery to target the posterolateral nasal wall. Method: SG and SF were each performed in sequence on two cadaveric specimens after soft tissue elevation technique. Computed tomography scans were acquired following each procedure to generate anatomic models for computational fluid dynamics simulation of intranasal sprays under the following conditions: inhalation rate (15 and 30 L/min), spray velocity (1, 5, and 10 m/s), spray released location (center, lateral, medial, top, and bottom), head position (upright, tilted-forward, tilted-backward, and supine), and particle diameter (1-100 µm). Percentage of particles deposited on the posterolateral nasal wall were calculated. Results: For Specimen 1, highest posterolateral wall depositions were Pre-Op: left = 74%, right = 74%; SF: left = 53%, right = 22%; SG: left = 60%, right = 61%. For Specimen 2, highest posterolateral wall depositions were Pre-Op: left = 25%, right = 83%; SF: left = 29%, right = 76%; SG: left = 14%, right = 72%. In general, posterolateral wall deposition was higher at 30 L/min inhalation rate and at 1 m/s spray velocity. Conclusions: Drug delivery targeting the posterolateral nasal wall appears to be dependent on many factors. However, midvault nasal reconstruction does not increase drug delivery to the posterolateral nasal wall.

Tibial plateau fractures (TPFs) are orthopedic challenges with multiple injury modalities and clinical presentations. TPFs are often classified using the Schatzker classification system, which can dictate management. In our case, a 37-year-old male presented at an orthopedic specialty hospital with right knee pain after a fall from a truck ramp. X-rays and CT imaging demonstrated a comminuted bicondylar TPF in the emergency room with metaphyseal dissociation. The patient was placed in a knee immobilizer, made non-weight bearing, and scheduled for outpatient follow-up with a local orthopedic surgeon. The patient was lost to follow-up and referred to our clinic six months after the fall with the chief complaint of inability to ambulate with severe pain and instability in the knee. X-rays demonstrated a malunion of the bicondylar tibial plateau with fracture deformities of the medial femoral condyle and lateral tibial plateau. The patient's deformity was corrected with a medial opening wedge proximal tibial osteotomy with a fibula strut allograft and filled with beta-tricalcium bone filler. At the first month follow-up, the patient's pain was well controlled, fragments and the knee were appropriately aligned, and no significant soft tissue or joint effusion was appreciated on imaging.After failing nonoperative treatment, this patient with comminuted bicondylar TPF has received definitive treatment with open reduction and internal fixation. Higher rates of unacceptable results from nonoperative treatment are in line with the Schatzker series, in which operative treatment resulted in more acceptable outcomes. Because the fracture in this patient is consistent with a Schatzker VI classificationwith intra-articular depression, the patient should have initially been treated with an external fixator and not been sent home in a knee immobilizer. This led to a malunion that necessitated corrective surgery. Therefore, correctly classifying fracture severityis important for selecting the best treatment course and minimizingcomplications.

Background:Allograft adipose matrix (AAM) offers a novel, off-the-shelf, and readily available natural option in the treatment of facial soft tissue volume and reconstructive deficits. AAM is a natural soft tissue supplement or replacement that can support cushioning and volume correction. A prospective multicenter pilot study evaluated AAM in facial volume restoration.Methods:Eleven women (mean age of 55.8 ± 10.9 y) with midface volume deficit were followed up for 24 weeks after AAM treatment in this institutional review board–approved multicenter pilot study. The clinical safety and efficacy of the AAM treatment were evaluated using clinical scales and three-dimensional quantitative facial photography.Results:AAM was safe to address facial volume deficits, with minor site-related adverse events and discomfort that resolved within 2–4 weeks. Observations also revealed facial volume improvements throughout the study with 91% positive responders. At week 24, the subject facial satisfaction scores revealed an 86% increase compared to baseline, along with a statistically significantly improved midface fullness compared to baseline.Conclusion:AAM offers a natural and safe option for midface volume restoration and supports overall satisfaction and volume improvements.

Hemangiomas of the nasal tip are a relatively uncommon presentation of a common tumor. While optimal medical and surgical management of nasal tip infantile hemangiomas has been described and debated extensively in the literature, to our knowledge, there is no report of secondary aesthetic and functional rhinoplasty in these patients at skeletal maturity, until now. This special topic article provides an excellent example of the 5 key technical elements to revision rhinoplasty in the skeletally mature patient with a history of nasal tip infantile hemangioma.

A particularly prominent mandibular angle or a hypertrophied masseter muscle can result in an excessively wide facial appearance, which some individuals may find less aesthetically pleasing. Although normally a benign condition and strictly an aesthetic concern, a hypertrophied masseter can also cause pain, bruxism, and headaches. Neuromodulator for masseter reduction and treatment of bruxism has become first-line treatment. In this article, the authors present the senior author's (R.J.R.) anatomic approach to neuromodulator injection of the masseter, with a corresponding video of the injection technique.

The deviated nose derives from underlying skeletal and soft-tissue deformities in the upper, middle, and/or lower third of the nose. Although deviation may stem from several intrinsic and extrinsic elements, the septum is most often the primary contributor. Attempts to straighten the nose without properly addressing the septum invariably result in a persistently deviated nose. The goal of this article is to review the 10 key steps for a reliable, methodical approach to correcting the deviated septum in primary rhinoplasty.

Proper facial analysis is the first step toward delivering an excellent result in any face lifting or facial rejuvenating operation or procedure. Every case should be approached in a systematic and comprehensive manner, ensuring proper assessment of specific anatomic regions contributing to facial aging as well as the global facial aesthetic. Failure to do so may result in an unnatural or partially rejuvenated face. The senior author's (R.J.R.) approach entails 10 key anatomic regions on the frontal view and 7 on the lateral view. The 10-7 facial analysis method allows the surgeon to reliably assess every patient in a detailed, top-down, structural approach when considering face lifting or facial rejuvenation.