Structural preservation rhinoplasty (SPR) uses structural methods and dorsal preservation. SPR approaches include (1) dorsal preservation techniques coupled with structural approaches to the lower third/nasal tip complex; (2) use of structural methods to convert a nasal dorsum to a preservation candidate; (3) preservation ideology applied to structural tip pasty, emphasizing suture modification and limited resection; (4) minimization of the degree of soft tissue disruption at the middle vault and dorsum in preservation and structural cases; (5) modified dorsal preservation techniques in which some components of the nasal dorsum are treated with structural methodology while others are treated with preservation methods.

Background: The rise of social media parallels a mental health epidemic. The effect of social media usage on rates and severity of body dysmorphic disorder is not well-understood.Objective: To determine if an association exists between social media engagement, body dysmorphia symptoms, and/or interest in cosmetic surgery in a demographically diverse cross-section of the U.S. adult population.Methods: In a Qualtrics platform-based survey study of the general U.S. adult population, responses to demographic information, social media activity questionnaire and the body dysmorphic disorder screening questionnaire, and interest in cosmetic surgery were collected. Descriptive statistics and a multivariate logistic regression model were carried out.Results: A total of 1,013 respondents completed the survey. The average age was 40.9 (SD, 14.8) years, 72% were women. Median time spent on social media (IQR) was 4 (2-7) h/day. Respondents who screened positive for symptoms of body dysmorphia had higher daily mean social media usage time (odds ratio [OR] 1.49), tend to be female (OR 2.17), younger (OR 0.97), identify as Caucasian (OR 1.65), and are more likely considering a cosmetic procedure in the next year (OR 2.98).Conclusion: This study demonstrates a positive association between daily social media usage, self-reported symptoms of body dysmorphia, and interest in cosmetic procedures.

BACKGROUND:Attractive individuals receive higher ratings on independent social attributes including intelligence, success, and likability. The authors sought to determine whether knowledge that a person in a photograph had facial plastic surgery affects perceptions of attractiveness or social attributes. METHODS:US adults were recruited to complete an online survey (Qualtrics respondent distribution system). Demographic information, a cosmetic surgery questionnaire, and a body dysmorphic disorder screening questionnaire were collected. Participants viewed photographs of young, White, male- and female-presenting individuals with above-average attractiveness (selected by Delphi method). Half of the participants were told that the individuals had facial plastic surgery. All participants rated the people presented in photographs in terms of attractiveness and social attributes. Descriptive statistics were used to analyze the data. RESULTS:A total of 1000 participants (500 female; mean age, 49 years [SD 16.9]) were enrolled. There were no differences between participants in the primed ( n = 500; 250 female) or unprimed groups based on demographics, bias toward cosmetic procedures, or body dysmorphia screen. Ratings of the attractiveness and social attributes of people presented in photographs did not differ between the primed and unprimed groups (all P > 0.13). This held true even for those with negative bias toward cosmetic surgery. CONCLUSION:Knowledge that someone had facial plastic surgery does not affect ratings of attractiveness or social attributes.

In dorsal preservation rhinoplasty (DPR), approaching the septum with a subdorsal flap (or Cottle technique) classically requires two pillars. If either of these are compromised, despite release of all blocking points, the dorsal contour may not flatten adequately. The first is the caudal pillar, exemplified by the caudal fixation of the septal flap to a stable underlying structure. The subdorsal flap is sutured to the remnant caudal strut of septal cartilage, which remains attached to the maxillary spine, to secure the dorsum in its new extended and reduced position. However, in cases where the caudal septum must be replaced, tensioning the subdorsal flap on the anterior septal reconstruction (ASR) may introduce undesirable posterior and superior forces on the strut, and in turn lack the stability needed for adequate dorsal reduction. The second is the cephalic pillar, typically a stable PPE beneath the radix osteotomy. In some cases, the PPE may be unintentionally disrupted or the sub-radix PPE may be over-resected, resulting in loss of control at the radix. In this situation, the dorsum may not adequately flatten. The senior author (SPM) has successfully utilized a novel dorsal flattening suture (DFS) in situations where one of these pillars is compromised. The most common example would be the anterior septal reconstruction, a modified extracorporeal septoplasty technique.1 Using the DFS, a single suture technique tightens and flattens the dorsum independently, freeing an ASR graft from the posterior forces of the subdorsal flap. The senior author has used the DFS successfully to correct deviated noses and caudal septal deviations with DPR.Level of Evidence V 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.

The excessively short nose is a challenging dilemma in rhinoplasty. The variability in patient goals and nasal anatomy prevents a one-size-fits-all approach, yet a collection of commonly employed techniques may be considered when approaching an individual nose. This article discusses the common anatomical abnormalities associated with a short nose and reviews the existing literature on techniques to address these abnormalities and how they may be combined to create a unique surgical plan. Typically, correcting a short nose requires an increase in nasal length and projection, along with a decrease in rotation. Achieving this necessitates a complete release of the soft tissue and ligaments from all bony and cartilaginous attachments to allow for skin redraping, as the mucosa and/or soft tissue envelope often pose limitations. Commonly employed techniques include a septal extension graft, anterior septal reconstruction, lower lateral cartilage repositioning with grafting, tip grafts, and occasionally composite grafts.

The COVID-19 pandemic led to increased telehealth utilization in outpatient otolaryngology settings. While other studies on telehealth usage in otolaryngology settings have focused on demographic disparities during the pandemic, none have yet assessed how these demographic disparities have evolved from before versus after the pandemic. This study examines 4 recent consecutive years of demographic and clinical data from a large hospital system to investigate how the COVID-19 pandemic has changed demographic patterns in telehealth utilization. We demonstrate substantial increases in the number of otolaryngology patients participating in telehealth since the beginning of the COVID-19 pandemic but with no differences in patient distributions by race or ethnicity over time. We also found that telehealth patients, on average, were younger, more likely to be English-speaking, and more likely to be female. While these disparities widened slightly after the start of the pandemic, they were also present prior to the pandemic.

Facial Plastic Surgery & Aesthetic MedicineAhead of Print Evaluating the Effectiveness of Septoplasty for Nasal Valve Collapse: A Retrospective StudyAllen Green, Eric X. Wei, Cherian K. Kandathil, Gun Min Youn, Jay P. Shah, and Sam P. MostAllen GreenStanford University School of Medicine, Stanford, California, USA.Search for more papers by this author, Eric X. WeiDepartment of Otolaryngology—Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA.Search for more papers by this author, Cherian K. KandathilDivision of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology—Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA.Search for more papers by this author, Gun Min YounStanford University School of Medicine, Stanford, California, USA.Search for more papers by this author, Jay P. ShahStanford University School of Medicine, Stanford, California, USA.Search for more papers by this author, and Sam P. Most*Address correspondence to: Sam P. Most, MD, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology—Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94303, USA, E-mail Address: [email protected]Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology—Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA.Search for more papers by this authorPublished Online:20 Oct 2023https://doi.org/10.1089/fpsam.2023.0218AboutSectionsView articleView Full TextSupplemental MaterialPDF/EPUBView Supplemental Data Permissions & CitationsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail View article"Evaluating the Effectiveness of Septoplasty for Nasal Valve Collapse: A Retrospective Study." Facial Plastic Surgery & Aesthetic Medicine, , pp. FiguresReferencesRelatedDetails Volume 0Issue 0 InformationCopyright 2023, American Academy of Facial Plastic and Reconstructive Surgery, Inc.To cite this article:Allen Green, Eric X. Wei, Cherian K. Kandathil, Gun Min Youn, Jay P. Shah, and Sam P. Most.Evaluating the Effectiveness of Septoplasty for Nasal Valve Collapse: A Retrospective Study.Facial Plastic Surgery & Aesthetic Medicine.ahead of printhttp://doi.org/10.1089/fpsam.2023.0218Online Ahead of Print:October 20, 2023PDF download

Background: In revision rhinoplasty, lateral crural repositioning/reconstruction is considered a complex maneuver. The aim of this study is to measure patient outcomes after lateral crural repositioning/reconstruction in revision rhinoplasty. Methods: In this retrospective case series, patients who underwent revision rhinoplasty with lateral crural repositioning/reconstruction for functional, cosmetic, or combined purposes were reviewed. Preoperative Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) scores, functional and cosmetic visual analog scales (VAS-functional [F] and VAS-cosmetic [C]), and lateral wall insufficiency (LWI) grades were compared with their respective postoperative scores. Results: Forty-two patients were identified who underwent lateral crural repositioning. The mean postoperative follow-up for ≤6 months (PO1) and >6 months (PO2) was 3.1 (standard deviation [SD] 1.7) and 11.5 (SD 5.3) months, respectively. At both postoperative periods, significant improvement (p < 0.05) in patient-reported outcomes was observed in mean SCHNOS-Obstruction, SCHNOS-Cosmesis, VAS-F, and VAS-C scores. The postoperative changes in LWI scores (Δ) were significant on both sides at zone 1 at PO1 (p < 0.05) and PO2 (p < 0.05), and at PO2 on the left side (p < 0.05) only, for zone 2. Conclusion: Lateral crural repositioning with reconstruction is an effective maneuver in revision rhinoplasty in a subset of patients and specifically helps to improve nasal tip aesthetics while preserving function.

Successful treatment of nasal airway obstruction depends on accurate diagnosis of the underlying etiology. Lateral wall insufficiency (LWI) is a common cause of obstructed nasal breathing and should be recognized and treated accordingly by the rhinoplasty surgeon. LWI refers to dynamic collapse of the lateral nasal sidewalls at the internal (zone 1) and external (zone 2) nasal valves. This article serves as an overview of the important aspects in evaluation and management of LWI.

Background Preservation rhinoplasty is a novel and increasingly utilized method in nasal plastic surgery. Objectives The study aimed to compare the functional and aesthetic outcomes of dorsal preservation rhinoplasty, a new and interesting method, with conventional hump resection. Methods A total of 84 rhinoplasty applicants were randomly assigned to 2 groups. The first group underwent convention dorsal hump resection with spreader flap midvault reconstruction and the second group underwent dorsal preservation rhinoplasty with the modified subdorsal strip method. Aesthetic and functional outcomes, including residual hump, nasal width, projection, and rotation, were evaluated after 1 year with the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS), visual analog scale (VAS), and image analysis. Results Eighty-four patients with a mean age of 30.96 ± 6.75 years were recruited, of whom 15 (17.6%) were male. There were no significant differences in confounding variables between the 2 groups. There were no significant differences in residual hump (P = .11), nasal width (P = .37), projection (P = .70), rotation (P = .79), VAS (P = .81), or SCHNOS (P = .90) between the 2 groups. Conclusions Dorsal preservation rhinoplasty with the modified subdorsal strip method may have comparable aesthetic and functional outcomes to spreader flaps midvault reconstruction. Level of Evidence: 3

Dorsal preservation (DP) rhinoplasty techniques, including surface techniques (STs) and foundation techniques (FTs) have garnered significant attention internationally over the past few years. The practice patterns and opinions from 117 of these surgeons were surveyed from a cohort of these surgeons who participate in an online Evidence-Based Rhinoplasty Research Group. The findings of the survey are merely a snapshot of the international rhinoplasty community's practices, yet did capture data from surgeons from a diverse geographic, years of experience, and training background. STs were most used for the bone changes, and the high-strip technique was preferred for the cartilaginous septal surgery. STs are mostly performed by younger surgeons (<10 years of experience), whereas FTs were more common in older surgeons (10-30 years of experience). STs were considered more stable (p < 0.001), more predictable (p < 0.001), and associate with a shorter learning curve (p = 0.015). Revision surgery rates were not different. Regarding why many surgeons using DP still perform structural rhinoplasty, the most cited concern was hump persistence/recurrence. In summary, among surgeons using DP rhinoplasty techniques, the majority perform DP in over half of their primary rhinoplasty surgeries, highlighting the importance of updating educational programs in medical training, conferences, and courses.

Application of dorsal preservation rhinoplasty techniques requires an in-depth understanding of the underlying nasal anatomy. A key tenant of dorsal preservation rhinoplasty is maintaining the relationship between the upper lateral cartilages and nasal bones. In this study, the authors discuss the pertinent nasal anatomy, surgical approaches to the nasal septum and bony pyramid, management of blocking points, and fixation of the lowered dorsum. They also introduce a new dorsal fixation method termed the "dorsal osseocartilaginous horizontal mattress" suture developed by the senior author for application in cases of combined structural and open dorsal preservation rhinoplasty.

The asymmetric nose is challenging for even the most experienced rhinoplasty surgeons. It has often been referred to as the crooked, twisted, and deviated nose and describes any nose that has deviation of the nasal dorsum and pyramid from the facial midline. This article summarizes the senior author's (SPM) approach and application of structural and preservation concepts to correct the underlying causes of the crooked nose.

Key points Complications in combined surgery are equivalent to ESS but are higher than rhinoplasty alone. The most common complications are pneumonia, stroke, and epistaxis. Rhinoplasty surgeries with graft use have a higher risk of complications.