Facial Plastic Surgery最新文献

{"title":"Utility of J-Shaped Scar Tissue-Based Flap for Secondary Bilateral Cleft Lip Repair: A One-Stage Procedure with Successful Outcomes on Correction of Vermilion Border, Volume Deficiency of Lip, and Muscular Function.","authors":"Ayhan Okumus","doi":"10.1055/s-0043-1777866","DOIUrl":"10.1055/s-0043-1777866","url":null,"abstract":"<p><p>This study aimed to evaluate the utility of J: -shaped scar-tissue-based flap as a new technique in secondary bilateral cleft lip reconstruction in patients with challenging secondary deformities. A total of 52 patients, comprising 38 males and 14 females with a mean age of 21.0 years (range: 16-42 years), who underwent secondary bilateral cleft lip repair operation via the J: -shaped scar tissue flap technique in our clinic between 2014 and 2019 were included. Postoperatively, patients were followed up for an average of 2 years (range, 6 months to 5 years) to assess the outcomes regarding vermilion border, philtrum symmetry, function of the orbicularis muscle, and lip volumetric symmetry, based on the Global Aesthetic Improvement Scale (GAIS), patient-reported outcomes, and independent plastic surgeons' examinations. After an average follow-up of 2 years, outcomes regarding vermilion border, philtrum symmetry, function of the orbicularis muscle, and lip volumetric symmetry were successful, and none of the patients experienced new notch formation, muscular functional loss, lip volume loss, or asymmetry. Owing to good muscular function preventing the stretching, the postoperative scars become more acceptable to the patients. The technique has proven to be safe and successful through the GAIS objective assessment, as also confirmed by the examinations of the three independent surgeons, while the majority of patients reported an exceptional improvement in the appearance alongside a more than 95% satisfaction rate with the operation. In conclusion, our findings revealed successful functional and aesthetic outcome of using J: -shaped scar tissue flaps in secondary repair of cleft lips. The technique was associated not only with the correction of significant secondary deformities yielding an improved and symmetrical lip volume, correction of vermilion notch, and prevention of notch re-formation but also with the restoration of orbicularis oris muscle function and thus integrity of the lip with minimal scarring.</p>","PeriodicalId":12195,"journal":{"name":"Facial Plastic Surgery","volume":" ","pages":"632-639"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139416716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Rhinoplasty Health Care Monitor: An Update on the Practical and Clinical Benefits after 10 Years of Prospective Outcome Measurements.","authors":"Victor S van Dam, Floris V W J van Zijl, Bernd Kremer, Frank R Datema","doi":"10.1055/a-2218-7189","DOIUrl":"10.1055/a-2218-7189","url":null,"abstract":"<p><p>The era of value-based health care is characterized by an increasing interest in patient-reported health outcomes. For this purpose we developed the rhinoplasty health care monitor (RHM), a streamlined outcome measurement protocol, including all rhinoplasty patients since 2014. Statistical analyses of patient-reported outcome data are automated and visually presented on a custom web-based dashboard. We describe the clinical and practical benefits of the RHM and discuss how routine prospective outcome measurements have upgraded our care standards. For this prospective study, 979 consecutive patients referred for functional (revision) rhinoplasty from April 2014 to August 2023 were included. Preoperative and 3- and 12-month postoperative scores on the Nasal Obstruction Symptom Evaluation scale (NOSE), Utrecht Questionnaire (UQ), and visual analog scales (VAS) were obtained. Of 979 referred patients, 599 (61.2%) were eligible for rhinoplasty. One year postoperatively, mean NOSE scale sum score improved from 69.1 ± 22.8 to 23.1 ± 23.5 (<i>p</i> < 0.001). Functional VAS scores improved from 4.1 ± 2.8 (left) and 4.1 ± 2.8 (right) to 7.5 ± 1.9 (left) and 7.3 ± 2.0 (right; <i>p</i> < 0.001). Mean UQ sum score improved from 12.0 ± 6.4 to 6.8 ± 3.3 and aesthetic VAS score improved from 4.5 ± 2.5 to 7.4 ± 1.7 (<i>p</i> < 0.001) 1 year postoperatively. Benefits of the outcome routine were improved patient selection, data-driven expectation management and patient empowerment, and targeted critical appraisals of surgical performance. In conclusion, routine, automated, prospective outcome monitoring provides physicians with a response to the increasing demand for data-driven insights in health outcomes. The limited effort that is needed to gather and monitor outcome data is heavily repaid by valuable insights into aspects of care that can be improved.</p>","PeriodicalId":12195,"journal":{"name":"Facial Plastic Surgery","volume":" ","pages":"539-545"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138451316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Rhinoplasty in Mild Forms of Body Dysmorphic Disorder: Safety, Protocols, and Long-Term Outcomes.","authors":"Munish Shandilya, Stephanie Bourke, Avi Shandilya","doi":"10.1055/s-0044-1779627","DOIUrl":"10.1055/s-0044-1779627","url":null,"abstract":"<p><p>Body dysmorphic disorder (BDD) is an obsessive-compulsive disorder concerning body image which negatively distorts the patient's perception of their appearance. In rhinoplasty, surgery on patients with severe BDD is considered contraindicated as patients are often dissatisfied and their BDD symptoms rarely improve. For patients with borderline to mild BDD, however, there has been some preliminary evidence to show that they can benefit from surgical rhinoplasty. In our first article on this series of BDD in rhinoplasty, we presented our two-specialist protocol using mandatory psychiatric evaluation (MPE) to assess patient's suitability. In this present article, we used this protocol to identify a group of borderline to mild BDD patients, performed surgical rhinoplasty on this group, and evaluated the outcome using a visual analog scale (VAS) and a five-point Likert scale. From 2010 to 2023, 1,602 patients attended our practice seeking cosmetic rhinoplasty, out of which, 892 were sent for MPE to the same psychiatrist. The MPE identified 2.5% (22/892) patients as having mild BDD, out of which, 15 were considered suitable for surgical intervention and underwent successful rhinoplasty (follow-up 6-95 months, <i>M</i> = 54.13 months). Five of 15 patients scored 10/10 on the VAS and were very happy, 8 of 15 patients scored 7 to 9/10 on the VAS and were happy, and 2 of 15 patients scored 6/10 on the VAS but were still happy. Although all patients were happier, 3 of 15 patients requested revision rhinoplasty which was not offered as was planned and discussed before the initial intervention. This study shows that in the presence of safe protocols, including a two-specialist model, safe outcomes can be expected even in the long term. Further, the request for revision surgery appears to be common in borderline to mild BDD cases, and we like to warn the patients against it before surgery.</p>","PeriodicalId":12195,"journal":{"name":"Facial Plastic Surgery","volume":" ","pages":"565-570"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139711860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association of Same-Day CT Scan with Postoperative Outcomes in Isolated Orbital Fracture Repair.","authors":"Kwasi Enin, Cole Pavelchek, Yupeng Liu, Sebastian Sciegienka, Emily Spataro","doi":"10.1055/a-2216-5015","DOIUrl":"10.1055/a-2216-5015","url":null,"abstract":"<p><p>The potential benefits to surgical outcomes of intraoperative and/or same-day computed tomography (CT) during isolated orbital fracture reconstruction are debatable, and previous research on this topic is limited by small sample size. This retrospective IBM MarketScan Commercial and Medicare Supplemental research database study examined patients undergoing isolated orbital reconstruction from January 1, 2012 to December 31, 2018, to assess whether same-day CT affected postoperative outcomes. The average age of the 5,023 participants was 37 (standard deviation [SD]: 16) years and 63% were males. The data revealed that 16.2% (815 of 5,023) patients underwent a same-day CT. Those who underwent a same-day CT scan exhibited reduced odds of postoperative enophthalmos (adjusted odds ratio [aOR]: 0.269; 95% confidence interval [CI]: 0.167-0.433) and diplopia (aOR: 0.670; 95% CI: 0.495-906). Interestingly, these patients also displayed a higher rate of revision surgeries (aOR: 2.721; 95% CI: 1.893-3.912). In summary, while same-day CT scans diminish certain postoperative complications of orbital fracture repair, they are also associated with an increased likelihood of subsequent surgical revision.</p>","PeriodicalId":12195,"journal":{"name":"Facial Plastic Surgery","volume":" ","pages":"610-614"},"PeriodicalIF":16.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138295006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 20-Year Experience with Tissue Expansion for Large Cervical Fascial Defects: An Algorithm Based on Different Clinical Flap Designs.","authors":"Si-Si Luo, Zhe Yang, Ning Ma, Yang-Qun Li","doi":"10.1055/a-2173-8425","DOIUrl":"10.1055/a-2173-8425","url":null,"abstract":"<p><p>Over the past 20 years, we have designed various types of expanded cervical flaps for large facial defects and achieved excellent tissue matching. This study was performed to propose a treatment strategy for flap selection for the reconstruction of different facial units. The authors retrospectively reviewed the application of cervical expanded flaps for facial rehabilitation in our department between January 2003 and January 2023. The study included 122 patients with unilateral (62.3%) and bilateral (37.7%) facial deformities ranging from the zygomatic arch to the chin. The median area of the tissue defect was 15.2 × 8.5 cm² (ranging from 6 × 4 cm² to 27 × 12 cm²). The expansion period ranged from 61 to 175 days (mean: 86.5 days). Maximum and minimum sizes of pre-expanded cervical flaps were 30 × 13 cm² to 7 × 5 cm². All the flaps could be summarized into type 1, an advanced expanded cervical flap; type 2, a wing-shaped expanded cervical flap with overlapping tissue expansion; and type 3, an expanded single-lobed transposition flap rotated based on the anterior neck. Cervical flaps reliably meet the reconstructive requirements for different facial units, especially for large cutaneous defects in the clinic. The selection of these flaps can be planned preoperatively according to the location and size of the defect or lesion.</p>","PeriodicalId":12195,"journal":{"name":"Facial Plastic Surgery","volume":" ","pages":"598-604"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10224657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retraction Note: Way Forward in Improving Rhinoplasty Outcomes.","authors":"Rui Xavier","doi":"10.1055/a-2295-7562","DOIUrl":"10.1055/a-2295-7562","url":null,"abstract":"","PeriodicalId":12195,"journal":{"name":"Facial Plastic Surgery","volume":" ","pages":"e1"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140305360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Audit of Outcomes in Cosmetic Rhinoplasty with the Mandatory Psychiatric Evaluation Protocol.","authors":"Munish Shandilya, Stephanie Bourke, Avi Shandilya","doi":"10.1055/a-2369-7091","DOIUrl":"10.1055/a-2369-7091","url":null,"abstract":"<p><p>With the high demand of rhinoplasty surgery, careful selection and management of aspirants, as well as proper assessment of outcomes after surgery, are imperative for achieving successful outcomes and learning from it. The aim of this study was to answer two important questions: (1) What is the success rate in cosmetic rhinoplasty? (2) How can we best identify candidates who would achieve good outcomes in cosmetic rhinoplasty? In this study cohort, we excluded patients with any functional concerns and confounding factors that could in any way influence patient satisfaction with a cosmetic surgery. This study is a part of the trilogy of articles on \"psychology of rhinoplasty\" submitted to this volume of <i>Facial Plastic Surgery</i>, using mandatory psychiatric evaluation (MPE) to optimize candidacy. In total, 184 patients (144 females and 40 males) aged 16 to 63 years (<i>M</i> = 31.09) met the inclusion criteria and were included in this study (follow-up: 3-122 months; <i>M</i> = 70.18 months), and outcome satisfaction was assessed using the visual analog scale (VAS) score and a 5-point Likert scale. The mean improvement between preoperative (<i>M</i> = 4.26) and postoperative VAS scores (<i>M</i> = 8.47) was 4.23. Most patients were happy or very happy (95.1%) about the surgical outcome. Patients who were very happy generally scored between 8 and 10 on the VAS (77.2%) and those who were happy generally scored between 6 and 7.9 (21.2%). Some patients, however, were neutral (3.3%) or unhappy (1.6%) about their surgical outcome, and generally scored around ≤7 on the VAS. Although the successful outcome in 95.1% patients reflects a carefully designed protocol for rhinoplasty candidacy, 4.9% patients reported poor satisfaction despite these efforts. An ever-present proportion of unhappy outcomes is a reality of this popular surgery.</p>","PeriodicalId":12195,"journal":{"name":"Facial Plastic Surgery","volume":" ","pages":"591-597"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141727089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Body Dysmorphic Disorder: A Decade of Mandatory Psychiatric Evaluation in Cosmetic Rhinoplasty Aspirants.","authors":"Munish Shandilya, Stephanie Bourke, Avi Shandilya","doi":"10.1055/s-0044-1779045","DOIUrl":"10.1055/s-0044-1779045","url":null,"abstract":"<p><p>The aim of rhinoplasty is to make the patient happier with their nose. The patient's perception plays a substantial role in their outcome satisfaction. Body dysmorphic disorder (BDD) is an obsessive-compulsive disorder concerning body image, which negatively distorts the patient's perception, rendering them dissatisfied with the outcome even if the results are close to the defined objectives. In this paper, we present a protocol with a two-specialist approach (rhinoplasty surgeon and a psychiatrist) to standardize BDD diagnosis using the DSM-5 criteria. The patients deemed suitable for cosmetic rhinoplasty by the rhinoplasty surgeon's first consultation were sent for Mandatory Psychiatric Evaluation (MPE) for further consultation and second opinion. MPE was employed with a semi-structured clinical interview by a psychiatrist incorporating the Cosmetic Procedure Screening Questionnaire and Appearance Anxiety Inventory. From 2010 to 2023, 1,602 patients attended our practice seeking cosmetic rhinoplasty, out of which, 892 were sent for MPE to the same psychiatrist. The MPE identified 2.5% (22/892) patients as having mild BDD; out of which, 15 were considered suitable for surgical intervention and underwent successful rhinoplasty (follow up: 1-10 years, <i>M</i> = 4.33 years). Although BDD is considered a contraindication in rhinoplasty, our experience shows that borderline and mild BDD can be offered surgery with good insight and support system. Moderate to severe BDD in our practice was filtered out at the first stage and was not offered surgical intervention. BDD among rhinoplasty aspirants is not as prevalent as previously reported. Standardized diagnostic protocols and studying the severity of BDD when present has clarified management of BDD in rhinoplasty aspirants in our practice. MPE is not easy to incorporate in every rhinoplasty practice, but we aim to present guidelines arising from our ongoing experience to help management of BDD in rhinoplasty.</p>","PeriodicalId":12195,"journal":{"name":"Facial Plastic Surgery","volume":" ","pages":"551-559"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139706441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Cannula Drain in Reducing Edema and Ecchymosis after Rhinoplasty.","authors":"Saad Younus Sulaiman, Haitham Alnori, Islam Al-Talibi, Abdulkadir Goksel","doi":"10.1055/a-2253-5971","DOIUrl":"10.1055/a-2253-5971","url":null,"abstract":"<p><p>Rhinoplasty is one of the most common plastic surgeries and is commonly associated with postoperative edema, ecchymosis, and pain which play a role in patients' dissatisfaction. In this randomized comparative study, we discuss the effect of cannula drainage in the reduction of postoperative periorbital edema, ecchymosis, pain, and nasal obstruction after open structural septorhinoplasty. The study was conducted at a tertiary referral center from April to November 2022. We performed internal lateral osteotomy on all patients using the lateral saw and aided by lateral osteotome. At the end of the procedure, a cannula drain is prepared and inserted in the subperiosteal tunnel on the left side only. Patients were examined on the 1st, 3rd, 7th, 14th, and 21st days for periorbital edema, ecchymosis, pain, and nasal obstruction, and each side is scored separately. A total of 40 patients (80 sides in total) were recruited, 22 females (55%) and 18 males (45%), all of whom were adults (18-44 years old; mean age 29 years). The most frequent age group is those younger than 20 years representing 35% of the sample and the males forming 33.3%. The reduction in edema and pain was statistically significant in the drained sides (<i>p</i> = 0.000) during all the postoperative days. On the other hand, ecchymosis was lower on the drained side but statistically insignificant (<i>p</i> = > 0.29). Nasal obstruction was reduced significantly only on the seventh postoperative day (<i>p</i> = 0.000). The postoperative morbidities associated with rhinoplasty could have important functional and psychological effects on patients. This study demonstrates that inserting a cannula in the subperiosteal tunnel for drainage in rhinoplasty yields a significant clinical and statistical decrease in postoperative periorbital edema and pain with little effect on ecchymosis and nasal obstruction.</p>","PeriodicalId":12195,"journal":{"name":"Facial Plastic Surgery","volume":" ","pages":"664-669"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139546091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Body Dysmorphic Disorder Questionnaire-Aesthetic Surgery: Are We Screening the Troublesome Patients?","authors":"Frank Declau, Laura Pingnet, Yannick Smolders, Erik Fransen, Valérie Verkest","doi":"10.1055/a-2241-9934","DOIUrl":"10.1055/a-2241-9934","url":null,"abstract":"<p><p>This study aims to clarify the current concept of performing rhinoplasty in patients with possible body dysmorphic disorder (BDD). The primary objective was to investigate the validity and evolution over time of the Body Dysmorphic Disorder Questionnaire-Aesthetic Surgery (BDDQ-AS) before and after surgery. Together with the BDDQ-AS, also the Nasal Obstruction Symptom Evaluation scale, FACE-Q nose and nostrils, and Utrecht questionnaire (UQ) were used for convergent validation. In this prospective study, 187 patients completed these patient-reported outcome measures at four time points: at the preoperative consultation and postoperatively at 3, 6 and 12 months. The preoperative BDDQ-AS positivity rate was as high as 55.1%. Postoperatively, there was a highly significant decrease in the odds of scoring positive on the BDDQ-AS. At the preoperative consultation, positively screened patients were less satisfied with the esthetics of their noses with worse scores on UQ, FACE-Q nose, and visual analog scale. The preoperative differences in outcome measure ratings disappeared postoperatively, except for the FACE-Q nostrils, which surprisingly showed better values in BDDQ-AS positive patients. Younger age and absence of nasal trauma were statistically significant covariates associated with positive BDDQ-AS screening. Due to the overwhelming decrease in positive BDDQ-AS outcomes after surgery, a positive screening result on the BDDQ-AS should not be interpreted as a formal contraindication for surgery. Collaboration with psychologists or psychiatrists remains crucial to diagnose BDD conclusively.</p>","PeriodicalId":12195,"journal":{"name":"Facial Plastic Surgery","volume":" ","pages":"571-580"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139416715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}