Postoperative care in rhinoplasty is a critical determinant of surgical success, complication prevention, and patient satisfaction. Despite advances in operative technique, variability in postoperative management remains a significant contributor to suboptimal outcomes and revision surgery. This chapter aims to define the essential components of effective postoperative care and emphasize the role of structured systems in protecting surgical results and guiding patient recovery. Key elements of postoperative management are reviewed, including standardized follow-up schedules, pain control with opioid-sparing strategies, antibiotic stewardship, corticosteroid use, saline irrigations, nasal support techniques, activity modification, and patient education. Emerging evidence regarding non-steroidal anti-inflammatory drugs, isotretinoin use, topical antibiotics, and adjunctive therapies is discussed. Special considerations for revision rhinoplasty, complex grafting, and patients with comorbid conditions such as obstructive sleep apnea are highlighted. The importance of consistent documentation, photography, and communication is emphasized to support both clinical decision-making and patient reassurance. There is no universal postoperative pathway in rhinoplasty; however, comprehensive preoperative preparation and structured postoperative systems consistently improve outcomes. Surgeons who prioritize postoperative care as an extension of the operation itself are better positioned to minimize complications, manage expectations, and achieve durable, high-quality results.

A patient's ethnicity and culture need to be considered prior to male facial rejuvenation. Here, we describe the most important factors across ethnicities that affect the analysis, treatment, and postoperative considerations of commonly performed procedures.There are some traits commonly associated with certain ethnicities that differ from each other. These span skeletal structure, skin characteristics, predisposition to poor scarring, periorbital and nasal anatomy, and hair qualities.As they pertain to the described differences in traits, certain variations exist within procedures to accommodate non-Caucasian patients. This is to make results more natural, fitting to a patient's ethnicity and goals, and to account for differences in postoperative healing.An integral part of every patient encounter is to listen to the patient's perspective and goals prior to developing a treatment plan. Their facial analysis should subsequently be performed in the context of their ethnicity. The management of non-Caucasian facial rejuvenation patients should not be taught as a variation of the norm but rather as unique considerations to modify known surgical techniques for each individual ethnicity and culture. Training needs to emphasize and popularize these differences.

The nasal septum is a key structure influencing both nasal airflow and aesthetic balance. Detailed anatomical understanding is essential for optimal septorhinoplasty planning. This study aims to provide precise morphometric data on key septal structures and to explore correlations between anatomical landmarks relevant to surgery. Retrospective observational study (STROBE-compliant) of adult patients undergoing primary septorhinoplasty. Preoperative CT scans of 50 Turkish patients were analyzed. Volume, length, and height of the septal cartilage, vomer, and perpendicular plate of the ethmoid were measured, along with caudal septum length. IRB approval was obtained. No AI was used during analysis. Sex-based differences in septal cartilage volume were identified. Caudal septum length positively correlated with cartilage-PPE junction length. These anatomical measurements may guide graft design and preoperative strategy, contributing to individualized surgical planning.

Revision or secondary rhinoplasty involving the nasal tip is challenging due to distorted anatomy, scarring, and compromised tip support. This article presents a framework for surgical approach and decision-making in secondary rhinoplasty. Contemporary principles emphasize stability, conservative cartilage handling, and restoring native architecture. The nasal tip depends on the soft-tissue envelope and lower lateral crura, whose relationship with the septum determines projection, rotation, and contour. High-resolution photography, endoscopy, and improved grafting materials enhance the diagnosis and correction of nasal tip deformities. Optimal patients should undergo in-depth assessment with special attention to skin thickness, previous complications, and unrealistic expectations. Structure and support of the tip cartilages are the foundation and critical for the appearance and longevity of your results. As part of building the structure and support, the lower lateral cartilages can be repositioned and reshaped to the ideal appearance. Further refining of the definition and contour then occurs, with management of the soft tissue envelope being part of the decision process throughout. Scar modulation and protection of graft constructs are critical for long-term stability. Regenerative therapies, advanced biomaterials, and minimally invasive contour solutions continue to evolve. A regimented, anatomy-driven approach provides consistent and durable outcomes in revision tip rhinoplasty.

This study aims to review contemporary principles of structural nasal tip grafting and provide a practical framework for selecting techniques that achieve durable aesthetic and functional outcomes. We summarize the evolution from reduction rhinoplasty toward preservation and structural approaches that prioritize long-term tip support. Key osteocartilaginous and soft tissue support mechanisms of the nasal tip are outlined with emphasis on major and minor tip support structures. Open and endonasal approaches, autologous cartilage sources, and ancillary materials such as fascia are described as tools to modify tip contour and support. Clinical assessment focuses on skin-soft tissue envelope, cartilage strength, airway function, and dynamic deformities. Stepwise algorithms for columellar strut and septal extension grafts, plumping grafts, alar rim and batten grafts, lateral crural struts, shield and cap grafts, and articulated alar rim grafts are presented. Postoperative management to protect graft position and control edema is reviewed. Emerging trends toward individualized, data-informed rhinoplasty and objective outcomes assessment are discussed. Thoughtful selection and execution of structural tip grafts allow surgeons to achieve stable, reproducible tip shape while optimizing nasal airway function.

Spreader grafts (SG) are used in rhinoplasty to correct cartilaginous deviations. There are no studies that compare aesthetic and functional outcomes of unilateral (USG) and bilateral SG (BSG). Compare whether USG or BSG is better to correct cartilaginous deviations, if there are differences in dorsal width ratio (DWR) and in patient-perceived aesthetic and functional outcomes. Retrospective study of 35 patients who underwent septorhinoplasty with USG or BSG. Deviation angle and DWR were calculated in frontal images before and 6 months postsurgery. Aesthetic and functional results were measured using nasal obstruction symptom evaluation (NOSE) and visual analog scales (VAS). BSG significantly improved postoperative nasal deviation compared to USG (179.6 degrees vs. 172.9 degrees; p < 0.05). In minor preoperative deviations, there were no significant differences between BSG and USG (179.57 degrees vs. 177 degrees, respectively; p > 0.05). In major preoperative deviations, BSG provided better correction (179.62 degrees vs. 170.5 degrees; p < 0.05). DWR increased more with BSG compared to USG (0.12 vs. 0.04; p < 0.05). VAS and NOSE scores were similar in both groups. BSG is more effective in correcting major cartilaginous deviations, while both USG and BSG effectively correct minor deviations. Though BSG increases DWR, this does not negatively impact patient-perceived aesthetic or functional outcomes.

Burnout and declining fulfillment are prevalent among facial plastic surgeons (FPS), yet the organizational drivers of these challenges remain underexplored. Ownership structure, workplace autonomy, and collective representation may influence surgeon well-being and workforce sustainability.To assess how autonomy, ownership, and unionization relate to satisfaction and stress among FPS. We hypothesized that private practitioners would report greater autonomy and satisfaction, that academic and hospital-employed surgeons would experience more stress and diminished control, and that prior union exposure would correspond with more favorable views of collective representation.Cross-sectional observational survey (STROBE).A 26-item anonymous survey was distributed to all 1,041 members of the American Academy of Facial Plastic and Reconstructive Surgery; 104 responded (10%). Variables included practice type, ownership, union history, autonomy, compensation satisfaction, stressors, and openness to unionization. Analyses employed chi-square tests and qualitative content analysis.Surgeons in private practice reported the highest autonomy and compensation satisfaction and the lowest rates of feeling rushed. Hospital-employed and academic surgeons were more likely to report diminished autonomy, administrative stress, and lack of influence over workplace decisions. Only 11% of respondents expressed interest in unionizing, though prior union members generally described positive experiences. Surgeons' beliefs about whether unionization affects patient care did not vary significantly by practice setting.Structural factors, particularly the autonomy and ownership model, are strongly linked to satisfaction and stress among FPS. Organizational reforms that enhance autonomy and support collective voice may reduce burnout and improve workforce sustainability.

This study aimed to explore the clinical application value of a new porous high-density polyethylene (PHDPE, Supor) exogenous scaffold in nasal tip shaping for East Asians.We conducted a retrospective analysis of patients who underwent rhinoplasty involving the new nasal framework implantation at our institution from July 2020 to June 2024. Photographic measurement was used to obtain nasal-facial parameters, including nasal bridge length index, nasolabial angle, nasal tip projection, and the ratio of nasal tip width to nasal width, which served as objective indicators for nasal aesthetic evaluation. A rhinoplasty questionnaire was designed for patients to subjectively rate their nasal appearance, providing subjective indicators. The Nasal Obstruction Symptom Evaluation (NOSE) scale was utilized to assess nasal ventilation status, with the NOSE score as an indicator for nasal functional evaluation. Pre- and postoperative differences in nasal-facial parameters, self-rated nasal appearance, and NOSE scores were analyzed. The incidence of complications and patient satisfaction with surgical outcomes were also recorded. A total of 36 female Han Chinese patients with a mean age of 29 ± 4 years were included, with an average follow-up of 13 ± 4 months. Results showed that Nasal-facial parameters significantly improved postoperatively. The preoperative nasolabial angle was 102.9 ± 4.8 degrees, and the postoperative angle was 96.1 ± 2.8 degrees, with a significant decrease of 6.9 ± 2.2 degrees (p < 0.01). Only one patient developed a postoperative infection, while no other complications such as rejection, deformation, or implant extrusion were observed.In nasal tip plastic surgery for East Asians, the application of new PHDPE exogenous scaffolds yielded favorable surgical outcomes with low complication rates.

Submental fat can be addressed using both surgical and nonsurgical techniques. Cryolipolysis is a noninvasive treatment that uses cold temperatures to trigger apoptosis in adipose tissue.This study aims to evaluate the efficacy and safety of cryolipolysis for submental fat reduction, specifically analyzing changes in submental fat thickness and volume. It is hypothesized that cryolipolysis leads to measurable improvements in submental fat among patients.This is a systematic review and meta-analysis conducted in accordance with the PRISMA reporting guidelines.A literature search was performed across PubMed, Scopus, and Web of Science from 1973 to 2025. A total of 951 articles were screened, and eight pre-post studies involving 206 patients met inclusion criteria.Pooled analysis showed a mean reduction in submental fat thickness of -2.78 mm and volume of -19.57 cm3.Cryolipolysis significantly reduces submental fat with minimal, transient side effects.

The footplates of the medial crura are relevant structures that play an important role in the columella and nostril sill design. They also work as a connection between the nasal and oral muscles, as the insertion of the superficial orbicularis oris nasalis (SOON) is placed into the footplates and the continuation of the superficial muscular aponeurotic system (SMAS) is situated within the membranous septum. Moreover, the SOON is a powerful depressor of the nasal tip.Many techniques attempt to reconstruct the tip support with grafts, but footplates and their connections can play an important role.We describe a surgical technique that involves footplate release and repositioning for better sill design, improvement of tip support and stability, better balance of the columellar-labial junction (CLJ), upper lip lifting, and eversion of the vermilion.This retrospective study reviewed the medical records of 64 patients who underwent all steps described in the paper.The patients were followed up for 12 months and decreases in philtrum length were accompanied by an enhanced vermilion showing creating a more favorable balance.The footplate release and repositioning technique can be incorporated as an adjunct in rhinoplasty to provide additional tip support, facilitate nasolabial angle adjustment, and assist in upper lip repositioning.