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This study is a randomized controlled interventional study aimed to determine the effect of preoperative brochure-assisted education on surgical fear and anxiety in patients scheduled for septorhinoplasty surgery. The study was conducted between May 2022 and February 2023 in the Otorhinolaryngology services and clinics of a training and research hospital in the southern region of Turkey. The study included 61 patients, with 29 in the education group and 32 in the control group. All patients received routine nursing care before surgery, with the education group receiving additional education through an informative brochure. The data were collected using the "Personal Information Form", "Surgical Fear Questionnaire", and "Surgical Anxiety Questionnaire". There was no significant difference in the mean scores of surgical fear between the groups on the morning of the surgery (p > 0.05). However, a significant difference was found in the mean scores of surgical anxiety between the groups (p < 0.05). In conclusion, patients in the education group who received preoperative brochure-assisted education had lower anxiety compared with the control group.

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BACKGROUND: Hump reduction with traditional ostectomy is an invasive procedure performed in aesthetic rhinoplasty. Natural and flawless nasal dorsum can be obtained with wedge ostectomy (WO) technique. OBJECTIVE: The objective of this study is to describe the nasal dorsum WO technique and examine its effectiveness in correcting nasal dorsum with absent and minor humps in patients undergoing aesthetic rhinoplasty. MATERIALS AND METHODS: Senior author performed 488 rhinoplasty and septorhinoplasty operations from April 2009 to April 2021. After exclusion of major hump patients, the remaining 312 patients had a secondary evaluation for suitability for wedge ostectomy. After secondary examination, 87 patients, including 19 with absent humps (0 mm) and 68 with small humps (1-3 mm) were operated. RESULTS: Nasal bone hump reduction with WO has proven satisfactory results in majority of patients, minimal revision in done in five patients but no complications were occurred related to this method. CONCLUSIONS: Nasal dorsum WO provides lesser invasive approach to bony hump reduction in selected patients, ensuring bone cortex continuity in nasal dorsum. It decreases possible dorsal nasal irregularities associated with conventional coronal plane ostectomies. At the same time, it provides a natural and anatomically accurate nasal dorsum.

Résumé Contexte:La réduction de la bosse avec l'ostectomie traditionnelle est une procédure invasive effectuée dans la rhinoplastie esthétique. Le dos nasal naturel et sans faille.Objectif:L'objectif de cette étude est de décrire la technique du dorsum nasal et d'examiner son efficacité dans la correction du dos nasal avec des bosses absentes et mineures chez les patients subissant une rhinoplastie esthétique.Matériaux et méthodes:l'auteur principal a effectué 488 opérations de rhinoplastie et de septorhinoplastie d'avril 2009 à avril 2021. Après exclusion des patients principaux Hump, les 312 patients restants ont eu une évaluation secondaire pour l'adéquation pour l'ostectomie en coin. Après un examen secondaire, 87 patients, dont 19 avec des bosses absents (0 mM) et 68 avec de petites bosses (1­3 mm) ont été opérés.Résultats:La réduction de la bosse osseuse nasale avec le WO a prouvé des résultats satisfaisants dans la majorité des patients, une révision minimale dans cinq patients, mais aucune complication n'a été produite à cette méthode.Conclusions:Le dorsum nasal WO fournit une approche invasive moins invasive de la réduction de la bosse osseuse chez les patients sélectionnés, assurant la continuité du cortex osseux dans le dos nasal. Il diminue les éventuelles irrégularités nasales dorsales associées aux ostectomies du plan coronal conventionnel. Dans le même temps, il fournit un dos nasal naturel et anatomiquement précis.

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BACKGROUND: Diced cartilage (DC) plays an integral role in rhinoplasty, and its application is well established in nasal dorsal augmentation rhinoplasty as a diced cartilage framework (DCF). METHODS: Fifteen patients requiring nasal dorsal augmentation were included. Two different types of DCF were applied: DC wrapped in fascia lata or Lyomesh® and DC embedded in platelet-rich fibrin (PRF). Postoperative ultrasound follow-ups were performed at intervals of one month, three months, and one year after surgery using a high-frequency linear ultrasound transducer. The aim was to depict the viability of the DCF in vivo. RESULTS: DCF was successfully depicted using ultrasound imaging in all 15 patients. Ultrasound rendered DC as hypoechoic and inhomogeneous areas. Perifocal hypoechoic edema was detected, which significantly decreased by the one-year follow-up. During the one-year postoperative period, very little DC had decreased in diameter and the framework was fully intact, with no signs of migration. On high-frequency ultrasound, DC wrapped in fascia lata or Lyomesh® appeared as a hypoechoic and inhomogeneous area clearly limited by a thin hyperechoic envelope material, whereas DC embedded in PRF presented as a hypoechogenic area that spread laterally along the bone and nasal cartilage on both sides. Using color Doppler imaging, neovascularization of the DCF was identified in 7 of 15 patients at the postoperative examination. CONCLUSION: High-resolution ultrasound is an accurate, non-invasive imaging method appropriate for visualizing DCF in augmentation rhinoplasty. Additionally, it is possible to detect nascent neovascularization within grafts by using color Doppler imaging.

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BACKGROUND: Crushed cartilage grafts improve augmentation and contour irregularities in rhinoplasty; however, they are associated with complications including resorption, asymmetries, palpability, and need for revision surgery. METHODS: A systematic review and meta-analysis following the preferred reporting items for systematic reviews and meta-analyses guidelines was performed on all recorded history up to November 2022 using the search query ("crush" or "crushed") AND cartilage AND rhinoplasty for PubMed, World of Science, Embase, and Cochrane online registries. Data were collected on study information, patient demographics, surgical details, and outcomes. Graft resorption and revision surgery were pooled in a random-effects model, and a subgroup analysis was performed for coverage/non-coverage of the cartilage and degree of crushing. RESULTS: The initial search yielded 163 results, with 11 studies included in the final full-text review. A total of 1132 patients were analyzed, with 456 (40.3%) women, mean age of 48.0 years, and an average follow-up period of 24.9 months. Cartilage resorption rates were statistically higher in graft preparation using severely crushed cartilage (3.4%) compared to non-severely crushed cartilage (0.9%, p = 0.049). There was no significant difference in resorption rate for patients with covered cartilage graft (1.3%) compared to those with non-covered grafts (1.8%, p = 0.7). There were significantly more revision surgeries for severely crushed (17.9%) compared to non-severely crushed (3.5%, p = 0.003) cartilage grafts. CONCLUSIONS: Severely crushed cartilage grafting provides smooth contour and less palpability compared to other degrees of crushing but demonstrates significantly higher rate of resorption.

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OBJECTIVE: In this article, we present our academic experience with the reconstruction of the dorsum and nasal tip by folded paramedian forehead flap described by F.J. Ménick (LFPP). We take a closer look at the technical aspects of this surgical technique and the aesthetic results at the donor sites. We compare our surgical technique with those reported in the literature. MATERIAL AND METHOD: A monocentric retrospective study was carried out on patients operated on by LFPP for surgical reconstructions of the nasal dorsum and nasal tip between January 2017 and December 2022. In each case, we analysed the typology of the type of substance loss for reconstruction, the type of reconstruction and the aesthetic result of reconstruction. A satisfaction survey on the aesthetic and functional results was sent to patients who had undergone LFPP reconstruction at 6 months post-op. RESULTS: There was no necrosis, even partial in any of the 17 cases of LFPP reconstruction. The average size of the substance loss was 3.5±0.6cm [2.5-5]. The number of aesthetic subunit (SUE) to be reconstructed was 2.6±0.9 [1-4]. The etiologies of substance loss were mainly related to skin tumors, including 58% basal cell carcinoma basal cell carcinoma (n=10), 24% squamous cell carcinoma (n=4), 6% adenoid cystic carcinoma adenoid cystic carcinoma (n=1) and 12% melanoma (n=2). The patients were very satisfied overall, both from a functional point of view with a questionnaire result of 89% (8.94±1.98 [2-10]), aesthetic, with a result of 87% (8.76±1.75 [3-10]). CONCLUSION: Among the various techniques for reconstructing the nasal pyramid, including paramedian 2-stage paramedian forehead flaps combined with a local flap of the internal lining, the technique of reconstruction described by J.F. Menick using a 3-stage paramedian folded flap is the most reliable option for complex nasal reconstructions with low donor-site morbidity.

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This technical note addresses the complexities of reconstructive surgery for malignant skin lesions in the lower nasal aperture and pericolumellar region. Traditional solutions, such as free skin grafts, face challenges in maintaining attachment to the surgical site without adequate support. Nasal packing, a common approach, obstructs the nasal opening and compromises air passage, hindering ventilation. The use of a nasal trumpet has proven beneficial in maintaining nasal patency in various cases, but it falls short of addressing the specific challenges posed by reconstructive surgery. The proposed solution involves a novel device comprising a nasal cannula, surgical sponge, and fine mesh gauze with 3% bismuth tribromophenate. This combination serves a triple purpose: the nasal cannula facilitates air passage, the surgical sponge applies controlled pressure around the nasal opening to aid graft adhesion, and the gauze with bismuth tribromophenate promotes wound healing and prevents infection. The assembled device is inserted into the nostril, anchored to the patient's skin with silk stitches. This innovative approach offers a practical solution for maintaining nasal patency, promoting graft adherence, and supporting wound healing in reconstructive surgery.

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BACKGROUND: In rhinoplasty, it is very important to adjust the rotation and projection of the tip together harmoniously with the nasal dorsum and face to achieve pleasing results. OBJECTIVE: In this study, our aim is to describe a new modification of the vertical alar resection technique that can effectively regulate nasal tip projection and rotation. MATERIALS AND METHODS: Versatile vertical alar resection (V-VAR) technique was applied to 14 primary and 9 revision rhinoplasty cases with highly projected nasal tip. V-VAR technique consists of three steps. In the first step, the original dome point was marked. In patients with high tip projection and caudal rotation, resection was performed from the lateral crus of the original dome. In patients with high tip projection and cephalic rotation, resection was performed from the medial crus of the original dome. In patients with high nasal tip projection but adequate rotation, an equal amount of resections were performed from both the medial crus and lateral crus of the original dome. The patients were followed in average 18 months (between 12 and 24 months). RESULTS: The desired type of rotation and projection was achieved utilizing V-VAR technique in all patients. All patients had satisfactory esthetic results. CONCLUSIONS: In highly projected nasal tips, the height can be reduced using the proposed V-VAR technique. Rotation in the nasal tip region was maintained, increased or decreased in accordance with the esthetic aims.

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Objective: To assess functional and aesthetic outcomes in patients having undergone dorsal nasal augmentation with costochondral graft in a tertiary care setting. METHODS: The single-centre, retrospective, observational study was conducted at Shifa International Hospital, Islamabad, Pakistan, and comprised data of patients who underwent dorsal nasal augmentation using costochondral graft between January 1, 2018, and December 31, 2022. Aesthetic outcomes in terms of patient satisfaction were assessed using Facial Appearance, Health-related Quality of Life and Adverse Effects scores. Data was analysed using SPSS 26. RESULTS: Of the 46 patients, 28(61%) were males and 18(39%) were females. The overall mean age was 28.39±9.13 years. Dorsal nasal deficiency occurred secondary to congenital causes in 12(26.1%) patients, trauma 19(41.3%) and prior surgery 15(32.6%). Postoperative complication rate was 7(15%); 3(6.5%) had recipient site infection and 2(4.3%) had rib graft resorption. Besides, 1(2.2%) patient reported pain 2 months postoperatively and 1(2.2%) had hypertrophic scarring. Patient satisfaction with the outcome was noted in all the 10 parameters analysed. Most commonly reported problem was that the nose was 'looking thick/swollen' by 12(26.1%) patients, but the issue resolved during 1-year follow-up. Conclusion: Costochondral graft was found to be an ideal material for dorsal nasal augmentation, with high patient satisfaction rate.

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Background/aim: Herein, we describe a new technique to obtain both the appropriate degree of rotation angle and the ideal nasal bridge length. The aim of this study is to investigate the long-term results of this new technique with regard to these two variables. Materials and methods: A total of 76 (27 males, 49 females) patients were operated in accordance with the presented technique. Internal caudal mucosal excision and lower lateral cartilage (LLC) suspension were applied to all the patients included in this prospective study. Preoperative, immediate postoperative, and postoperative 1st-year photographs were taken. NOSE scores were obtained in the postoperative 1st year. Results: The mean nasolabial angle values of the patients preoperatively, at the end of the surgery (immediate postoperative), and at the end of the first year were 94.13° ± 5.1, 113.1° ± 5.3, and 109.6° ± 5.2, respectively. The patients had an average gain of 19° at the nasolabial angle at the end of the surgery and experienced a 3.5° (3.1%) loss at the end of the first year. For the nasal bridge length (n-prn) values; the preoperative, immediate postoperative, and first year mean values were 5.1 ± 0.55 cm, 3.98 ± 0.41 cm, and 4.29 ± 0.39 cm, respectively. The noses of the patients were shortened by 1.11 cm on average at the end of the surgery. Conclusion: Internal caudal mucosal resection with a suspension of the LLC to the caudal edge of the upper lateral cartilages (ULC) offers a reliable method to control the nasal tip rotation and shorten the long noses. This technique's effect is more obvious in long noses compared to the short ones.

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BACKGROUND: Although rhinoplastic surgery has progressed considerably in recent years, nasal dorsal irregularities still cause postoperative distress for both surgeons and patients. PURPOSE: The aim of this study was to measure the association between two biologic graft adjuncts, platelet-rich plasma (PRP) and concentrated growth factor (CGF), and ultra-diced cartilage viability in an animal model. STUDY DESIGN, SETTING, AND SAMPLE: This study was designed as a randomized in-vivo study using a rabbit model. Fourteen rabbits were utilized in this investigation. The ultra-diced cartilage was obtained from auricular cartilage. PREDICTOR VARIABLE: The graft biologic adjunct is the predictor variable. There were three treatment groups: graft mixed with PRP or CGF or untreated (control). The grafts were placed in three separate pockets opened on the same rabbit. Grafts were harvested 3 months after insertion for analysis. MAIN OUTCOME VARIABLE(S): The primary outcome variable was histopathological and regenerative scores obtained from multiple histopathological parameters indicating the viability of the cartilage. Histopathological score parameters were chondrocyte loss, inflammation, fibrosis, cartilage fragmentation, and calcified area formations in the lacunae. Regenerative score parameters were peripheral cell proliferation in the cartilage tissue, vascularization in the connective tissue, proteoglycan increase in the matrix, and the amount of connective tissue. COVARIATES: The variables were age, sex, and weight. ANALYSES: Statistical analysis employed the analysis of variance test, with a significance level of P < .05. RESULTS: The sample was composed of 14 rabbits and 42 samples. The histopathologic scores were 11.93 (±2.49), 8.78 (±2.19), and 6.85 (±1.46) for the control, PRP, and CGF groups, respectively. A statistically significant difference was found in the PRP (P < .0275) and CGF (P < .0001) groups compared to the control group. The regenerative scores were 6.21 (±0.97), 8.85 (±1.70), and 12.07 (±1.26) for the control, PRP and CGF groups, respectively. A statistically significant difference was found in the PRP (P < .0159) and CGF (P < .0001) groups compared to the control group. CONCLUSION AND RELEVANCE: This is the first study investigating the ultra-diced cartilage graft in an experimental animal model. Histopathological examination has shown that mixing ultra-diced cartilage with CGF or PRP increases viability by reducing the histopathological score and increasing the regenerative score.

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OBJECTIVE: A deviated nose is traditionally classified as bony, cartilaginous, or combined deviation. Osteotomy is commonly used to correct bony deviation, and accurate surgical techniques and postoperative patient management are important for favorable outcomes. The authors investigated the change in the external nasal deviation angle over time using sequential clinical photographs to identify the optimal postoperative follow-up duration. METHODS: Medical records and sequential standardized clinical photographs of 22 patients who underwent bilateral medial and lateral osteotomies without dorsal augmentation from January 1, 2014 to May 31, 2021, were retrospectively reviewed. Clinical photographs were classified into 4 periods: "a" preoperative, "b" postoperative day (POD) ≤3 weeks, "c" POD ≤9 weeks, and "d" POD >9 weeks. The angle of deviation (AoD) was measured in both frontal and chin-on-chest views for each period. Differences in AoD between temporally adjacent periods were analyzed. RESULTS: Nineteen men and 3 women (mean age: 28.8 y) were included. Thirteen patients showed rightward deviation, whereas 9 showed leftward deviation. Eleven patients underwent surgery through an endonasal approach, whereas the other 11 underwent surgery through an external approach. In the frontal view, AoD differences (mean ± SD) between periods "a" and "b," "b" and "c," and "c" and "d" were 5.79 ± 3.36 degrees (P < 0.001), 1.44 ± 1.14 degrees (P < 0.001), and 1.07 ± 1.24 degrees (P < 0.05), respectively. In the chin-on-chest view, the values were 5.17 ± 2.69 degrees (P < 0.001), 2.06 ± 2.63 degrees (P < 0.001), and 1.46 ± 1.31 degrees (P < 0.001), respectively. No statistically significant difference in AoD differences was observed between the two approaches. CONCLUSIONS: Angle of deviation can change even 9 weeks after bilateral osteotomy. Thus, long-term follow-up using sequential clinical photographs is mandatory. If needed, close follow-up with early postoperative interventions may be required. The chin-on-chest view showed better sensitivity for assessing AoD than the frontal view.

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The aim of this narrative-style review was to evaluate non-surgical rhinoplasty in terms of indications, outcomes, and limitations. Both 'PubMed' and 'Science Direct' were reviewed by all authors, in order to reach consensus with regard to the chosen studies. Studies published from 1980 to 2023 were searched using the key terms "non-surgical rhinoplasty", "dermal filler", "thread lifting", and "botulinum toxin", and relevant papers were selected. Non-surgical rhinoplasty refers to the use of injectable temporary fillers to augment selected areas of the nose, in order to achieve improved appearance or function in select patients. It includes the use of dermal fillers, thread lifting, and botulinum toxin injections. The perfect dermal filler would be inexpensive, safe, painless to inject, hypoallergenic, and long lasting. In addition, it should produce consistent and predictable results, feel natural under the skin, take little time to inject, be ready to use, exert no downtime on the patient, and have a low risk of complications. Regions of the nose treated with filler injections include the frontonasal angle, dorsum, nasolabial angle, and columella. Thread lifting and botulinum toxin injection are the other methods of non-surgical rhinoplasty. Dermal fillers, thread lifting, and botulinum toxin injections can be used as non-surgical rhinoplasty. Dermal fillers and botulinum neurotoxin can be used alongside each other to allow minimally invasive resculpting of the nasal region and midface, compensating for a reduction in tissue volume and the formation of rhytides.

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PURPOSE OF REVIEW: The use of piezoelectric instrumentation is increasingly recognized as an alternative to traditional bone-cutting techniques across a wide array of surgeries. Here, we provide an overview of the technique, including device principles, benefits, and drawbacks. We also review its use in craniofacial surgery. RECENT FINDINGS: Piezoelectric surgery is a minimally invasive bone-cutting system with lower risk of damage to surrounding soft tissue structures. Indications for its use are rapidly expanding across multiple fields, including craniofacial surgery. To date, piezosurgical techniques have been most widely adopted and studied in the contexts of rhinoplasty, orthognathic surgery, and cranioplasty in craniosynostosis. Piezosurgery can facilitate more precise and consistent osteotomies while decreasing morbidities associated with traditional osteotomy techniques. Primary limitations include cost and concerns regarding increased operative times secondary to operator learning curves and decreased cutting efficiency. SUMMARY: Piezoelectric surgery represents an alternative to traditional bone-cutting modalities to improve precision, consistency, and safety of osteotomies. Further research is needed to better understand the efficacy of the technique as well as potential for additional applications.

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ABSTRACT: Rhinophyma leads to severe facial deformities and significant social pressure for patients. Patients often seek medical intervention due to cosmetic defects and functional impairments, such as nasal congestion and airway collapse. Currently, there are numerous treatment modalities for rhinophyma, each with distinct advantages and disadvantages, leading to a lack of consensus in nasal vegetation management. Severe thickening in the nasal area can obstruct breathing through external nasal valve blockage, necessitating appropriate management for relief. This article presents a case study involving severe rhinophyma with respiratory obstruction that was successfully treated using incomplete resection followed by reconstruction to restore normal nasal contour. This not only achieved an upright position for nasal columella but also improved nasal contour to achieve normal appearance levels while completely relieving respiratory tract obstruction and enhancing patients' ventilation function. This method is easily performed without requiring additional expensive equipment, making it economically feasible even in ordinary medical centers while enabling patients to achieve a high quality of life.

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The authors present the contemporary landscape for males seeking Asian blepharoplasty and Asian rhinoplasty, with special emphasis on the unique anatomical and aesthetic considerations for this patient population. The authors highlight the latest techniques used to achieve superlative results.

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In general, fewer male patients seek rhinoplasty surgery than females. The surgical principles are similar in both populations with some special anatomic considerations that will need attention. There is a higher rate of body dysmorphic syndrome in males seeking rhinoplasty as well as greater challenges with patient satisfaction, and the consultation process needs to be thorough and deliberate when undertaking aesthetic surgery in this population to maximize positive outcomes.

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BACKGROUND: Rhinoplasty is a common surgical procedure used in nose esthetics and pathologies. Shaping the nasal bones is a crucial step in achieving successful rhinoplasty surgery. However, complications such as excessive bleeding, edema, mucosal damage, and periosteal damage may occur during osteotomy for nose shaping. AIM: To investigate the damage to soft tissue and the effects on oxidative stress and proinflammatory cytokines in the blood caused by osteotomy performed on rabbits, using different osteotomy methods. Methods: Thirty-two albino New Zealand rabbits were divided into four groups. Group A was the sham group (n = 8), Group B the piezoelectric device group (n = 8), Group C the manual saw group (n = 8), and Group D the classical osteotomy group (n = 8). About 3 ml of blood was drawn to compare preoperative and postoperative interleukin-1ß (IL-1ß), thiobarbituric acid-reactive substances (TBARS), tumor necrosis factor-alpha (TNF-alpha), nitric oxide (NO), interleukin-10 (IL-10), and glutathione (GSH) levels. A 1 mm3 piece of soft tissue from the nasal bone of each animal in the study groups was sent for histopathological examination. The Chi-square test was used to analyze the incidence of postoperative necrosis, inflammation, and edema in the groups. RESULTS: Histopathologically, edema was significantly higher in Group C and Group D compared to Group B. Inflammation was increased in all groups. The necrosis was significantly higher in Group B compared to Group C and Group D. Except for two parameters, no significant changes were found in the biochemical markers for all groups. CONCLUSIONS: The piezoelectric device was found to be a better option for reducing edema and inflammation, while manual saws and classical osteotomy may lead to more tissue damage.

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