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Nasal valve dysfunction can substantially impact nasal airflow and overall quality of life. This review provides a comprehensive examination of nasal valve dysfunction, including its mechanisms, classification, and surgical management. The nasal valves include internal and external valves, each of which plays a crucial role in regulating nasal airflow. Subclassification of the external nasal valve into alar and rim valves helps specify the site of obstruction when present and informs the choice of surgical intervention. Dynamic nasal valve obstruction, often characterized by inspiratory collapse of the nasal valve, must be distinguished from static obstruction, which refers to nasal valve stenosis. Accurate identification of the location and mechanism of nasal valve dysfunction is essential for effective management. Various surgical procedures target specific components of the nasal valve and can produce favorable functional outcomes. The selection of surgical procedures, whether individually or in combination, should be tailored to the characteristics of nasal valve dysfunction and the external nasal characteristics of the patient. Strict adherence to proper surgical techniques is imperative for achieving optimal treatment outcomes.

INTRODUCTION: It has been reported in the literature that cigarette smoking is associated with otorhinolaryngological diseases. However, literature about the connection of smoking with septorhinoplasty satisfaction is limited. Considering its negative effects on health, I hypothesized that smoking may also negatively affect septorhinoplasty satisfaction. This study aimed to investigate if smoking is associated with septorhinoplasty satisfaction. METHODS: In the present study, 53 cases with septorhinoplasty were divided into two groups: smokers and non-smokers. The groups were compared for individual and clinical features and septorhinoplasty satisfaction scores. A linear correlation between septorhinoplasty satisfaction and smoking was evaluated. In the assessment of septorhinoplasty satisfaction, the Turkish version of the Rhinoplasty Outcomes Evaluation Questionnaire (ROE-T) was used. RESULTS: The findings showed that two groups in the present study were similar in age (p=0.886), weight (p=0.099), height (p=0.433), BMI (p=0.257), working status (p=0.511), education levels (p=0.064), single/married (p=1.0), urban/rural (p=1.0), postoperative duration (p=0.985), and also septorhinoplasty satisfaction (p=0.432). The satisfaction scores had no significant correlations with age (p=0.832), weight (p=0.337), height (p=0.652), BMI (p=0.696), smoking intensity (p=0.435), and smoking duration (p=0.551) scores considering all cases with septorhinoplasty. Only, a significant positive correlation was found between septorhinoplasty satisfaction and postoperative duration (r: 0.361; p=0.008). DISCUSSION AND CONCLUSION: There was no significant relationship between smoking on septorhinoplasty satisfaction. However, related literature is limited and inconsistent. Therefore, the association of smoking with septorhinoplasty results is worth further investigating.

For correction of dentofacial deformities, orthosurgical treatment is recommended and often involves bi-maxillary orthognathic surgery. The chin area is an important key for a harmonious facial profile and plays an important role. The present case (of a 38-year-old female) describes one successful surgical-orthodontic treatment. The treatment consisted of the use of an Edgewise fixed appliance (0.022”×0.028”), mini Wing osteotomy (mWo), correction of the deviated nasal septum, and rhinoplasty. The treatment resulted in a better facial harmony and aesthetic with greater definition and lengthening of the submental region, adipose tissue elimination, and an upturned nose due to the correction of the deviated nasal septum associated with rhinoplasty. The Class I canine and molar relationship, the upper and lower midlines coincident with the facial midline, and the compensatory projection of the lower incisors were maintained. A satisfactory overbite and overjet, and leveled curve of Spee were obtained. In conclusion, the orthodontic treatment associated with mWo, correction of the deviated nasal septum, and rhinoplasty surgery provided satisfactory functional and aesthetic results.

Background and purpose: Bleeding during rhinoplasty is a complication that causes the surgeon to lose vision and will cause other complications. So far, various methods have been proposed to reduce bleeding during nose surgery. The present study aims to compare the effect of oral clonidine and tranexamic acid on intraoperative bleeding in patients undergoing rhinoplasty. Materials and methods: In this randomized, double-blind clinical trial, 120 patients who were candidates for elective rhinoplasty surgery were included. In the first group, three µg/kg of clonidine was administered orally 90 minutes before surgery. In the second group, 250 µg/kg bw tranexamic acid capsules were administered orally two hours before surgery. There was no intervention in the control group. Bleeding levels, hemodynamic parameters, and surgeons' visual satisfaction were evaluated. Results: The mean age of patients (28.67±5.35) years and 96 (80.0%) were women. Regarding the effect of drug and surgeon’s visual satisfaction, there is a significant difference between the clonidine and tranexamic acid groups (P=0.055); the mean bleeding volume in the clonidine group was 112.0±0.47 and in the tranexamic acid group was 132.0±0.36. In addition, the clonidine group (P=0.008) and tranexamic acid (P

The aim. Increasing the effectiveness of treatment of patients with primary deformity of the nasal skeleton with a pronounced violation of the function of nasal breathing, by improving existing and developing new methods of reconstructive surgery of the nose. Materials and methods. 38 patients participated in the study. They were divided into two groups of 19 patients each. The gender and age distribution in both groups was approximately the same. The control group had rhinoplasty performed using a traditional osteotomy. Endonasal continuous osteotomy was performed using a 4 mm chisel. The research group underwent a combination of piezoelectric surgery and combined transcutaneous access, during rhinoplasty. At the same time, a 3 mm chisel was used for lateral and transverse lateral osteotomies, and a piezotome was used to remove the hump, medial and transverse dorsal osteotomies. All patients of both groups underwent only primary rhinoplasty in a closed manner. Results. Postoperative symptoms and complications were studied in both groups: perforation of the mucous membrane, narrowing of the nasal airways, bony irregularities, eyelid swelling, periorbital ecchymoses, as well as overall patient satisfaction. Symptoms were evaluated on the first day after surgery, 3 days after surgery, and 1 week after treatment. When comparing the obtained data, a statistically significant decrease in intra- and post-operative complications was found when performing rhinoplasty using piezoelectric surgery in combination with transcutaneous access. Also, piezotome osteotomy in combination with transcutaneous access has a number of advantages over classic osteotomy, which consist in reducing traumatic complications, obtaining more stable bone structures during surgery, which gives a better predicted result of rhinoplasty, and therefore, greater patient satisfaction. Conclusions. Performing a combination of piezotome osteotomy with a transcutaneous approach improves the postoperative period for patients and contributes to a better rhinoplasty result due to fewer complications.

Abstract Background and Aims The individual's perceived beauty, sense of identity, and general well‐being are all influenced by the social implications of the esthetics of their facial appearance. One of the major indicators of one's facial beauty is anthropometric proportions. This study was conducted to measure and evaluate the anthropometric proportions in a Syrian population, and to determine their desired nasal shape. Methods A cross‐sectional study was conducted on Syrian university students. Lateral and frontal pictures of the participants were taken using Canon EOS 250D from a standard distance of 100 cm. These pictures were analyzed, then nasal measurements were adjusted according to the participants' desire using Adobe Photoshop 2020. All anthropometric measurements were conducted on AutoCAD® 2019 software before and after the adjustments. Data was analyzed using the SPSS‐25 using paired samples T test to compare the means. Results The study included 53 females and 47 males. The mean age was 22.25. The mean unadjusted nasofrontal angle, nasolabial angle, nasomental angle, nasofacial angle, nasal index, Byrd and Hobar ratio, and Powell‐modified Baum ratio were 141.80, 102.18, 129.21, 34.60, 71.71, 0.62, and 3.08 in the rhinoplasty‐negative participants, and 145.89, 102.03, 130.20, 32.44, 67.96, 0.64, and 3.06 in the rhinoplasty‐positive participants, respectively. While the mean of the adjusted previously mentioned angles were 144.59, 106.32, 131.19, 31.15, 62.91, 0.60, and 3.19 in the rhinoplasty‐negative participants, and 146.31, 102, 130.20, 31, 62.55, 0.62, and 3.08 in the rhinoplasty‐positive participants, respectively. Conclusion In contrast to other populations, our study concluded that Syrians had unique anthropometric measurements and facial esthetics preferences. Moreover, the local plastic surgeons were able to identify most of the preferred nasal measurements for rhinoplasty in this ethnic group. It is advisable to use photogrammetry before rhinoplasty to identify the preferred nasal measurements of each individual to ensure the patient's satisfaction with the outcome of the surgery. Level of Evidence Level IV, cross‐sectional study.

Key Clinical Message Through this case report, we review a rare radiographic finding within the nasal cavity and its histopathological findings in order to emphasize the importance of familiarizing oneself with all radiographic findings, regardless of their rarity.

Our study aims to investigate the seasonal effects on the breath and quality of life (QoL) of patients who underwent septorhinoplasty (SRP). A total of 52 patients who underwent SRP between 2018-2023 were included in the study. Two groups those who operated in the winter (winter group, n=26) and those who performed in the summer (summer group, n=26) were evaluated with the NOSE (Nasal Obstruction Symptom Evaluation) scale to reveal the QoL after surgery. Compared with the summer group, NOSE scores in the winter group showed a statistically significant difference (p [Med-Science 2023; 12(4.000): 1210-2]

Introduction Correction of caudal septal deviations has always been a challenging subject in septorhinoplasty. The septum batten extension graft (SBEG) is a new graft that has potential properties in rhinoplasty. However, few reports have evaluated the surgical outcomes of this technique.

Objectives. A crooked nose is frequently caused by nasal bony vault deviation, and proper management of the bony vault is an integral part of rhinoplasty. Conventional osteotomy to correct a deviated nose favors simultaneous medial and lateral osteotomies, which allows the free independent movement of each nasal bone. However, patient satisfaction with deviated nose surgery is sometimes low. In the present study, we introduce a one-unit osteotomy procedure that combines bilateral and root osteotomies with unilateral triangular bony wedge resection to allow symmetry of both nasal bones. Methods. Twenty consecutive patients who presented with bony vault deviation and underwent one-unit osteotomy were enrolled in this retrospective single-center study. The Nasal Obstruction Symptom Evaluation (NOSE) questionnaire was used to evaluate each patient’s functional outcome. The angle of bony vault deviation before and after one-unit osteotomy was measured using a protractor and compared with the results of 14 patients who had undergone conventional osteotomy. The improvement in dorsal deviation was evaluated using facial photography preoperatively and 3 months postoperatively. Results. NOSE values improved from 8.4±6.4 to 4.1±4.2 (P=0.021). The angle of bony vault deviation improved from 6.9°±2.2° to 2.1°±1.2° (P

Cleft lip and palate (CLP) is one of the craniofacial defects. The objective of this study was to identify the differences in appearance between the tissue factors in cartilage of CLP patients after primary and secondary rhinoplasty. Immunohistochemistry was performed with MMP-2, MMP-8, MMP-9, TIMP-2, IL-1α, IL-10, bFGF, and TGFβ1. The quantification of the structures was performed using a semi-quantitative census method. MMP-2, -9, IL-1a, and bFGF demonstrated higher number of positive cells in patients, while the number of MMP-8, IL-1a, -10 and TGFβ1 cells was higher or equal in the control subjects. The only statistically significant difference between CLP-operated patients was found in the TIMP-2 group, where the primary CLP patient group had a higher number of TIMP-2 positive chondrocytes than the secondary CLP patient group (U = 53.5; p = 0.021). The median value of the primary CLP group was ++ number of TIMP-2 positive chondrocytes compared to +++ in the secondary CLP group. No statistically significant difference was found between primary and secondary rhinoplasty patients for other tissue factors. Commonly, the rich expression of different tissue factors suggests a stimulation of higher elasticity in cleft affected cartilage. The statistically significant TIMP-2 elevation in primary operated cartilage indicates an impact of the selective tissue remodeling for hard tissue.

Introduction: Mental health problems and personality disorders may influence individuals’ motivation to request cosmetic surgeries. The aim of this study was to assess mental health status and personality disorders among the candidates for rhinoplasty. Materials and Methods: This case-control study was conducted in 2019–2020. Participants were 45 candidates for rhinoplasty and 45 individuals with no request for rhinoplasty purposefully selected from the ear nose throat clinics of Ruhani hospital, Babol, Iran. Data collection instruments were the Symptom Checklist-90 Revised (SCL-90-R) and the Millon Clinical Multiaxial Inventory (MCMI). The SPSS software (v. 16.0) was employed for data analysis through the independent-sample t and the Chi-square tests at a significance level of less than 0.05. Results: In the case group, 28.9% of participants had at least one psychiatric symptom and 7.26% had at least one personality disorder. The prevalence of psychiatric symptoms and personality disorders in the case group was significantly more than in the control group (P < 0.05). Conclusion: Compared with individuals with no request for rhinoplasty, the prevalence of psychiatric symptoms and personality disorders is high among the candidates for rhinoplasty. Therefore, a preoperative mental health assessment is essential to improve post-rhinoplasty outcomes.

Background and Objective: Hump reduction is performed by different instruments with inherent drawbacks. The present study was conducted to compare the frequency of complications in the nasal bridge area after hump reduction with piezosurgery and a conventional instrument (Rasp). Materials and Methods: This clinical trial was carried out on 20 primary rhinoplasty patients. The patients were randomly assigned to two groups. In one group, nasal dorsum height reduction was performed with a rasp, and in the other group, hump reduction was fulfilled with piezosurgery. The patients in both groups were examined after 10, 30, and 90 days of surgery to detect palpebral ecchymosis, asymmetry, bony form, and cartilaginous irregularities of the dorsum. Results: In the rasp group, two patients with ecchymosis were observed on the 10th day after surgery. Moreover, one patient with dorsal asymmetry, two patients with bony form, and one patient with cartilaginous irregularity in the dorsum were observed in the 3rd month after surgery. In the piezosurgery group, no patient had any complications. However, these differences between the two groups were not statistically significant (P>0.05). Conclusion: As evidenced by the obtained results, piezosurgery can be used safely for hump reduction.

Abstract Background Body dysmorphic disorder (BDD) is a prevalent mental disorder, particularly in those seeking plastic surgery, leading to unnecessary surgeries and postsurgical dissatisfaction. Among the plastic surgeries, rhinoplasty is the most commonly sought, yet the data on prevalence of BDD among the candidates of rhinoplasty is limited. Therefore, this systematic review and meta‐analysis aimed to estimate the prevalence of BDD in rhinoplasty candidates. Methods The online libraries of Web of Science, PubMed, Cochrane Library, ProQuest, Research Square, Scopus, and Google Scholar were searched up to August 2022. Statistical analyses were performed using STATA software (v. 16). The heterogeneity was determined using the I2 statistic, and an overall estimated analysis was conducted. Subgroup analyses were performed on study year, age, gender, World Health Organization regional classification, sociodemographic index, country, sample size, and employed diagnostic tool. A meta‐regression analysis was performed to identify potential sources of heterogeneity. Results Out of 12,999 studies assessed, 18, with a combined sample size of 2132 individuals, met our criteria and were included in the study. The pooled prevalence of BDD was 32.7% (95% CI: 23.6−41.7; I2 = 96.45%). Subgroup analyses revealed the studies that were conducted in the European region (42.8%), with a sample size of ≥100 (40.2%), utilized the BDD modification of the Y‐BOCS (BDD‐YBOCS) diagnostic method (47.3%), and with a quality score of ≥6 (34.2%) demonstrated higher prevalence of BDD. The meta‐regression analysis identified a higher prevalence in the BDD‐YBOCS diagnostic method than in the BDD questionnaire (β: 0.23; 95% CI: 0.04−0.43; p = 0.022). Conclusions The prevalence of BDD is high in those seeking rhinoplasty. Clinicians should be aware of BDD symptoms to prevent unnecessary surgery and dissatisfaction. Public awareness through the media and access to affordable medical services should also be provided.

Objectives Nonsurgical rhinoplasty using threads has gained popularity in recent years. While the benefits of this procedure have been emphasized, possible complications and their management are not well-known. This study aimed to present the surgical management and results of the complications of thread rhinoplasty. Methods We retrospectively reviewed the medical records of seven patients who underwent revision rhinoplasty due to the complications of thread rhinoplasty from January 2018 to May 2021. The presentation of complications, detailed surgical procedures, and outcomes of revision rhinoplasty were reviewed. Results Visible or extruded threads at the tip were the most common complication, followed by dorsum irregularity. All the threads were unabsorbed and intact in shape, even several years after insertion. Thread removal necessitated careful tissue dissection, resulting in the loss of tip support and dorsal irregularity. To restore the tip support and camouflage the dorsum shape, an autologous tissue graft was needed. Conclusion Removal of threads at the tip and dorsum was accompanied by structural weakening and partial tissue loss, which required tip support restoration and dorsum camouflage.

Herpes zoster ophthalmicus (HZO) occurs due to reactivation of dormant varicella zoster virus infection in the ophthalmic division of the trigeminal nerve. Hutchinson’s sign, a herpetic skin lesion in the nasal tip, is a predictor of ocular complications, as the nasal tip area and ocular structure are innervated by the same nasociliary nerve. Patients who present with Hutchinson’s sign should be referred to an ophthalmologist due to possibility of ocular complications. Here, we present a case of a 44-year-old man with HZO that was confused with delayed rhinoplasty complication. The patient presented with nasal tip skin lesions 17 years after undergoing augmentation rhinoplasty. A graft-related infection was suspected due to operation history and skin lesions. However, surgical exploration disclosed no infection or inflammation, and serological tests revealed positive varicella zoster virus immunoglobulin M, and immunoglobulin G, antibodies. Based on these findings, the patient was diagnosed with HZO. Further, the patient received antiviral treatment with famciclovir. The lesions gradually improved with conservative treatment and became almost unrecognizable. Therefore, HZO should be considered when there is an unexplained skin lesion at the nasal tip in patients with history of rhinoplasty.

Aim:Platelet-rich fibrin (PRF) effectively improves the surgical effect in augmentation rhinoplasty; while there are a limited number of studies regarding its impact on postoperative morbidity in primary open rhinoplasty with conventional osteotomy (COS). This study was designed to investigate the utility of PRF in reducing the short-term postoperative morbidity in primary open rhinoplasty with conventional osteotomy.Methods:A total of 61 adult patients who underwent primary open rhinoplasty with conventional osteotomy, either alone (COS group; n=31) or combined with the application of PRF over the osteotomy line (COS-PRF group; n=30) were included in this prospective study conducted between March 1, 2020 and March 1, 2021. Data on postoperative morbidity, including edema and periorbital ecchymosis (on postoperative day 2 and day 7), pain [via visual analogue scale (VAS) and verbal rating scale (VRS)] and the analgesic use (on postoperative days 1, 2, 3 and 7) were recorded.Results:COS and COS-PRF groups were similar in terms of the likelihood of eyelid edema and periorbital ecchymosis on any postoperative day. The study groups were also similar in terms of average VAS (median 2.5 vs. 2.4, p=0.680) and VRS (median 1.5 vs. 1.4, p=0.521) scores and the number of analgesics used (median 1.5 vs. 1.3, p=0.196) during the 7-day postoperative period and daily VAS, VRS and analgesic usage records.Conclusion:Our findings indicate no significant impact of using local PRF application over osteotomy line in reducing postoperative eyelid edema, periorbital ecchymosis, or pain within the first postoperative week of open rhinoplasty.

Open rhinoseptoplasty has been widely performed in the field of otorhinolaryngology. However, from the perspective of beginners, rhinoseptoplasty is a hard-to-learn surgery that involves a relatively steep learning curve. Therefore, practical guidance is essential to enhance the skills needed for excellent surgical outcomes. Here, we provide a step-wise dissection manual using a commercialized silicone nose model designed for rhinoseptoplasty. The contents include general approaches with regard to transcolumellar inverted V incision, flap elevation, osteotomy, septoplasty, modification of the lower lateral cartilage for tip surgery, and dorsal augmentation using silicone implants. In addition, we introduce novel techniques such as dorsal augmentation using a ready-made mold with tissue glue applied to diced cartilage and polycaprolactone mesh for rhinoseptoplasty. The present study also provides photos of individual surgical procedures using a silicone nose model for actual guidance. The authors expect that this manual will help beginning rhinoseptoplasty surgeons improve their confidence.

Background: According to statistics, the number of rhinoplasty applicants is increasing. Rhinoplasty is performed to improve the nose shape fit into the face. Objective: The main objective of this study was to determine the effect of rhinoplasty on changing body images in rhinoplasty candidates. Methods: The statistical population of the present prospective study, including those referring to the Otorhinolaryngology Clinic of Rafsanjan University of Medical Sciences (Iran) with complaints of dissatisfaction with the appearance of the nose and demand for rhinoplasty, completed Body Image Concern (BIC) Inventory and Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) before and 6 months after surgery at the clinic. Data were analysed using SPSS software version 16 using Mann–Whitney U and Wilcoxon tests at a significance level of 0.05. Results: In total, 95 subjects were examined, of which 85 (89.5%) were women and 57 (60%) were single. There was no difference in the mean scores of BIC and Y-BOCS between women and men as well as between single and married subjects (p < 0.05). The Wilcoxon test results showed that the mean score of post-operative Y-BOCS was significantly increased in the rhinoplasty subjects (p < 0.001). Moreover, the mean score of post-operative BIC was significantly decreased in the rhinoplasty subjects (p < 0.001). Conclusions: The results of this study demonstrated that the rhinoplasty could improve the body image status and increase the obsessive thoughts and actions in an individual. Therefore, psychological primary care for avoiding pointless surgical plan and pre-operative psychological counselling, is suggested to examine the individual's psychological status and to assess the individual's expectations of surgery along with the necessary explanations.

Relapsing polychondritis (RP) is an uncommon autoimmune disease characterized by repeated and progressive inflammation in cartilage tissue. The auricular cartilage is the location of the most common clinical findings and the most common site of initial involvement. Nasal chondritis is a manifestation present in 15% of patients. Progressive destruction of nasal cartilage leads to the characteristic flattening of the nasal bridge, resulting in saddle nose deformity. The case is, here, presented of a 38-year-old patient who developed nasal chondritis which resulted in saddle nose deformity, and was diagnosed with RP following rhinoplasty.

Dexmedetomidine can be used to achieve controlled hypotension during surgery. A 26-year-old female with no medical history underwent rhinoplasty. The maintenance of the anesthesia was achieved with propofol and dexmedetomidine (1 mcg kg-1 as a loading dose for 10 minutes, followed by 0.5 mcg kg-1 hr-1 as maintenance) infusion as total intravenous anesthesia. Propofol and dexmedetomidine infusion doses were adjusted to maintain a bispectral index of 40-60 and a mean arterial pressure of 55-65 mmHg. During surgery, rhinorrhea developed, which disrupted the view of the surgical field. An intravenous antihistamine and a topical decongestant were administered. However, rhinorrhea persisted, suggesting that it developed as a drug-related adverse effect. Dexmedetomidine was halted. Subsequently, the rhinorrhea decreased, and the quality of the surgical field improved. That was a temporary and reversible side effect, which resulted in no long-term sequela. To the best of our knowledge, this is the first patient who developed rhinorrhea as a side effect of dexmedetomidine infusion during rhinoplasty.

Introduction:We aimed at comparing nasal tip projection and nasolabial angle changes following primary open rhinoplasty with short-floating columellar strut graft and suture techniques.Methods:Participants were divided into two groups depending on the type of technique employed. In the first group, short-floating columellar strut grafts were employed. The second group involved those who underwent suture techniques only.Results:We included 119 patients who underwent primary rhinoplasty in the study. The mean value of preoperative nasolabial angle measurement was 92.77±8.5 degrees and 92.14±6.7 degrees in groups 1 and 2, respectively. Postoperative nasolabial angle measurement in group 1 was 107.2, 104.3 and 101.3 degrees in the 1st, 3rd, and 5th postoperative year, respectively. Postoperative nasolabial angle measurement in group 2 was 107.4, 104, and 102.2 degrees in the 1st, 3rd, and 5th postoperative year respectively. The mean value of preoperative nasal tip projection was 0.605±0.07 and 0.653±0.08 in groups 1 and 2, respectively. Postoperative nasal tip projection measurement in group 1 was 0.636, 0.632 and 0.627 in the 1st, 3rd, and 5th postoperative year, respectively. Postoperative nasal tip projection measurement in group 2 was 0.656, 0.634 and 0.632 in the 1st, 3rd, and 5th postoperative year, respectively.Conclusion:Suture techniques were efficient than columellar strut grafts in maintaining the nasolabial angle but not the nasal tip projection when.

In treating a nasal bone, an incomplete nasal bone reduction can result in nasal deformity, both aesthetic and functional, requiring a secondary operation. A 60-year-old female with a traumatic comminuted nasal bone fracture with septal fracture was initially treated with closed reduction, which later resulted in a saddle nose and a completely occluded nasal cavity. Later, the patient underwent a revision operation of extracorporeal septorhinoplasty with rib cartilage graft, and the postoperative course was uneventful. Herein, we present a case of complications occurring after inadequate treatment of septal fracture. Physicians should thoroughly evaluate the extent of the nasal bone fracture, including the integrity of the nasal septum, and manage accordingly.

Background and Objectives The alar-columellar relationship plays an important role in the esthetic balance of the nose. We analyzed alar rim deformities and aesthetic concerns and expectations among patients by deformity type in Korean primary rhinoplasty patients. Materials and Methods Retrospective photographic analysis was done on 336 patients planning to undergo primary rhinoplasty at Kyung Hee University Hospital at Gangdong. We categorized their alar rim deformities as normal, hanging columella, retracted columella, hanging ala, retracted ala, convex ala, concave ala, thick ala, and a combination of the above. Patients’ aesthetic concerns and expectations about their nose were analyzed by preoperative questionnaire. Results Of the enrolled patients, 38 (11.3%) had no alar rim deformities, and the other 298 patients (88.7%) had one or more deformities. The most prevalent alar rim deformity was hanging ala (59.2%), followed by convex ala (53.3%) and thick ala (32.1%). Male patients were more likely to have convex ala and retracted columella than female patients. More than one-half of the patients (64.1%) had two or more deformities and tended to be young (p=0.028). Patients with thick ala had several reasons for being dissatisfied with their nose and various demands for correction. Conclusion Distinctive characteristics of alar rim deformities should be considered in surgical planning in order to obtain satisfactory results in Korean primary rhinoplasty patients.

Objective: Rhinoplasty is a stressful and challenging procedure for plastic surgeries. Researchers are looking for appropriate methods of traditional and complementary medicine to control anxiety before rhinoplasty. This study aims to compare the effects of Benson Relaxation Technique (BRT) and Rose essential oil on preoperative anxiety and hemodynamics and postoperative complications in rhinoplasty candidates. Methods: In this randomized intervention study, participants were 68 candidates for rhinoplasty referred to Zare Hospital in Sari, Iran who were randomly divided into BRT (n=34) and aromatherapy (n=34) groups. Anxiety was assessed before and after the intervention by Spielberger’s State-Trait Anxiety Inventory. Hemodynamic status, intraoperative bleeding, nausea and vomiting were assessed 24 hours after surgery. Results: The two groups were homogenous in terms of demographic characteristics. The level of overt anxiety decreased by 27.5% in the aromatherapy group and by 20.4% in the BRT group. The level of covert anxiety decreased by 27.2% in the aromatherapy group and by 20.8% in the BRT group. Systolic and diastolic blood pressure levels decreased more in the aromatherapy group than in the BRT group. There was a significant difference in the number of pulses between the two groups after the intervention (P= 0.038). The mean amount of intraoperative bleeding was 18.6±2.4 mL in the BRT group and 18.2±3.8 mL in the aromatherapy group (P= 0.626). Nausea, vomiting and surgeon satisfaction levels during the surgery were similar in the two groups Conclusion: Rose essential oil and BRT are recommended for patients before rhinoplasty due to reducing their preoperative anxiety and stabilizing their hemodynamic status.

Objective: To answer whether life satisfaction, self-esteem and body image rate differ significantly in patients before and after aesthetic rhinoplasty. Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital, Sialkot and Combined Military Hospital, Rawalpindi Pakistan,from Aug 2019 to Aug 2021. Methodology: The study was conducted on 60 male and female participants between the age of 20-50 years. The demographic questionnaire, questionnaires of life satisfaction, body image and Rosenberg self-esteem scale were used to investigate the significant difference between males and females for life satisfaction, body image, and self-esteem before and after rhinoplasty. Patients filled out the questionnaires before surgery and six months after surgery. Result: The results of the study showed a significant difference in the mean scores before and after rhinoplasty. For life satisfaction the scores were, 23.550±1.032, 28.80±13.31, for body image, 8.91±3.34, 28.51±4.27 and self-esteem 4.68±4.74,30.56±5.27 in both genders. Results revealed that 49 (56.80%) females, with the highest number (31, 51.7%) of undergraduate participants and the majority of them (40, 66.7%), were from the middle class. Conclusion: The results of our study confirmed a significant change in the participants' experience of their life satisfaction,body image and self-esteem after rhinoplasty.

Objectives When performing cosmetic rhinoplasty with alloplastic materials, complications such as implant visualization, inflammation, dislocation, and extrusion should be thoroughly evaluated. Although computed tomography (CT) can provide useful information about the implant status and its interaction with the skin soft tissue envelope (SSTE), the radiologic findings of these interactions have rarely been reported. Methods We retrospectively reviewed the data of 80 patients who underwent facial bone CT or ostiomeatal unit CT at Asan Medical Center between July 2008 and January 2020 for the evaluation of dorsal implants with complications. We reviewed the implantation period, implant dislocation, implant curling or deformation, radiodensity (in Hounsfield units), and nasal bone changes including bone erosion or hyperostosis. Results Of the 80 patients, 67 (83.8%) had silicone implants and 13 (16.2%) had Gore-Tex implants. The radiologic findings of the silicone implants were as follows: maintenance of the implant shape (80.6%), radiolucency (similar density to that of fat tissue) halo (83.6%), and homogeneous attenuation (82.1%). Peri-implant calcification was often found in silicone implants with >20-year implantation periods. The findings of Gore-Tex were as follows: curling or deformation (84.6%), heterogeneous attenuation (84.6%), and consistent peri-implant calcification over time. Conclusion Silicone and Gore-Tex implants have distinctive radiologic features. These findings of alloplastic materials help us to understand how implants behave in the nasal dorsum and how they affect the SSTE.

When planning rhinoplasty, there are several options of grafts for augmentation, especially in relatively short and small Asian noses. Among such grafts, conchal cartilage is one of the most commonly used materials due to its histological similarity to nasal alar cartilage. Keloids and hypertrophic scars are fibroproliferative disorders that can occur after deep cutaneous injury. Since patients who wish to undergo rhinoplasty tend to have a lot of interest in cosmetic appearance, keloid formation can be serious complication to them. This case report presents an 18-year-old man who experienced keloid formation following conchal cartilage graft at 6 months after rhinoplasty. The authors introduce the case and review the considerations in prevention and treatment strategies for keloid scars after conchal cartilage harvest in Asian rhinoplasty.

Introduction:The objective of rhinoplasty is to provide predictable changes in the nasal contours and improve nasal functions. Nasal osteotomy is a frequently used correction technique in rhinoplasty. However, the optimal osteotomy technique and approach remain a matter of dispute.Methods:In this study, 24 patients who underwent primary septorhinoplasty and 24 patients who underwent paranasal sinus computed tomography (CT) due to various causes were retrospectively assessed. Operated patients completing a minimum postoperative follow-up duration of 1 year were invited to the study center. Informed consent form was signed, and a CT of the nasal bone in the axial plane was performed. These recorded values were compared with their preoperative results and with non-surgical patients.Results:Comparison of data between postoperative and nonsurgical cases showed that there was a significant reduction in the ventral width of operated patients (p=0.022), whereas no significant difference was observed in the dorsal width despite bilateral spreader grafts (p=0.108).Conclusion:Our results suggest that the dorsal width in patients undergoing bilateral osteotomy and bilateral spreader grafts was not significantly different from those in non-operated subjects. Also, contrary to what one may expect, spreader grafts are not associated with an increased dorsal width.

Rhinology is the study of nose, paranasal sinus, and nasopharynx. The nose is the most prominent structure on the human face and has been a subject of study since ancient human civilization. The history of rhinology has reflected the sociocultural aspects of the times, and rhinology has achieved remarkable growth with innovative discoveries by numerous pioneers. The focus of surgical procedures of the paranasal sinus shifted from mucosal stripping to functional endoscopic surgery with advancement of technology. Furthermore, the field of rhinology is gradually expanding due to cutting-edge technologies such as image-guided surgery, three-dimensional endoscopy, and robotic surgery. Additional clinical experiences and technological developments are expected to further advance rhinology.

Objectives In extracorporeal septoplasty (ECS), the entire septal cartilage is harvested, and a neo-L strut is built extracorporeally. Thus, ECS can simultaneously achieve septum straightening and tip projection. This study evaluated the functional and esthetic outcomes of the ECS technique for rhinoplasty in Asian patients. Methods We conducted a retrospective review of 64 patients who underwent rhinoplasty using ECS between January 2016 and March 2018. Subjective patient satisfaction was assessed and objective surgical outcomes were evaluated. Improvement in nasal obstruction was rated using a visual analog scale (VAS). Anthropometric changes were compared between preoperative and postoperative facial photographs. Complications and revisions were also analyzed. Results The participants comprised 64 patients (48 males and 16 females, with a mean age of 29.3 years). The mean operative time was 89.3 minutes. In total, 61 patients were satisfied with the esthetic outcome, and the overall objective rhinoplasty outcome score was 3.45. Preoperative nasal obstruction symptoms (7.9±1.2 on VAS) improved postoperatively (3.1±1.3, P

In the article, the authors analyzed the results of a survey of individuals who referred to a plastic surgeon for cosmetic rhinoplasty, as well as the authors evaluated the satisfaction of the operation. All patients, depending on the presence or absence of cosmetic defects of the nose, were divided into two groups: the first (I) – 69 individuals (men – 30, women – 39, aged 19 to 50 years), with visible defects and deformations of the external nose, which deviated from the established aesthetic norms accepted in cosmetology, but did not distort the appearance of the face and did not violate the physiological functions of the nose; the second group (II) – 30 individuals (men – 14, women – 16, aged 19 to 30 years) who do not have cosmetic defects of the nose, however these individuals fixed unreasonably great attention on their nose, were categorically dissatisfied with it, as well as persistently demanded to change its shape. In accordance with the results of the study, the authors showed that the vast majority of the examined individuals, who referred to a plastic surgeon for rhinoplasty, have mental disorders of the nonpsychotic register, which differed depending on the presence or absence of defects and deformities of the nose. Based on the results of the study, the authors determined the predictors of the negative psychological consequences of rhinoplasty and dissatisfaction with its results (dysmorphophobia, limitation of social functioning, repeated rhinoplasty with an unrealistic expectation of results, high levels of depression and anxiety) and suggested a screening questionnaire for the timely identification of patients who would not be satisfied with a successful surgical intervention.

Objectives: An increase in the level of cortisol hormone caused by preoperative stress may have undesirable effects on the surgery. Thus, it is necessary to manage the level of this hormone. Therefore, this study aimed to investigate the effect of ear acupressure on stress and serum cortisol hormone levels before rhinoplasty surgery. Materials and Methods: The present randomized clinical trial study was carried out in six months and finished on August 21, 2019. In general, 66 participants were selected based on quadratic-block randomization at Imam Reza hospital, Tabriz. Ear acupressure group received the intervention in each ear twice a day for 10 minutes (the duration of each intervention) three days before the surgery. The data were recorded in the demographic form of Spielberger’s implicit and explicit stress just before and three hours after each intervention. The data were analyzed by SPSS 21 using Kolmogorov-Smirnov, independent samples t test, and chi-square statistical tests and P0.05) regarding the amount of implicit and explicit stress and serum cortisol levels (P0.05). In contrast, the intervention group faced significant changes considering the level of stress and serum cortisol in the posttest. Conclusions: Overall, performing ear acupressure before rhinoplasty can reduce stress (implicit and explicit) and serum cortisol levels.

The surgical reconstruction of nose also termed 'Rhinoplasty' is as old as human civilisation. While major contribution of total nasal reconstruction originated in India by Sushrutha in around 600 B.C and later paved its way to the modern facial plastic surgery in North America and Europe in 18th century and popularised the Indian methods of nasal reconstruction to develop cosmetic and corrective rhinoplasty. This article aims to take you through the journey of evolution of rhinoplasty.

Background: The upper limit of rhinoplasty age increases as the concept of old age shifts forward. Rhinoplasty operations of this era have their own characteristics. The aim of this study is to point out these characteristic features and propose solutions to the problems observed in our series. Materials and Methods: Between 2014 and 2018, 32 primary rhinoplasties were performed on patients over 55 years of age. A comprehensive preoperative evaluation was done in all cases. Wider skin undermining was a prerequisite to overcome skin redundancy. Proper elevation of the droopy nose was the primary goal. Placement of a wide and homogeneously crushed cartilage graft over the lower and upper lateral cartilages was applied in all patients for structural support in addition to standard measures. In patients with extreme droopiness, a deep temporal or rectus fascial sling was applied between the columella and the nasal dorsum to support tip elevation. Results: The follow-up period was 6 months–4 years. All of the patients were satisfied with the postoperative results except for one case having dorsal irregularities and one case with postoperative relapse of the droopiness. Revisional operations of these patients were performed with the utilization of deep temporal fascia. A pulmonary embolus was encountered in one patient in 56 years of age at the 39th-postoperative day. She was hospitalized, and an anticoagulant treatment was applied. Conclusion: The most important problem in this age group is the droopiness of the tip. The use of a wide and homogeneously crushed septal cartilage graft over both the upper and lower lateral cartilages and autologous fascial sling rising and stabilizing the tip may help to prevent its relapse.

Introduction Inferior turbinate surgery is often performed concomitantly with rhinoseptoplasty. As inferior turbinates play a major role in allergic rhinitis, it seems reasonable to suggest that inferior turbinate surgery reduces allergy. Objective To assess the impact of nasal turbinate surgery on non-obstructive allergic symptoms (nasal discharge, sneezing, pruritus, and allergic conjunctivitis) and on the use of allergic medication in patients with allergic rhinitis undergoing rhinoseptoplasty. Methods Secondary analysis of aggregated data from two randomized controlled trials. Participants with allergic rhinitis aged ≥ 16 years were recruited. Data from two groups were analyzed: patients with rhinoseptoplasty and concomitant turbinate reduction (intervention group) and patients with rhinoseptoplasty only (control group). The 90-day postoperative frequency of non-obstructive allergic symptoms and of nasal steroid and oral antihistamine use were analyzed. Results A total of 100 patients were studied. The groups were similar in terms of allergic symptom intensity and mean age. The frequency of non-obstructive allergic symptoms decreased 90 days postoperative in both groups (p

The aim of this study was to present the advantages and disadvantages of open approach in rhinoplasty. In it, we also present the development of this technique in Croatia and examine its application in the last five years at the Department of Otorhinolaryngology and Head and Neck Surgery of the Clinical Hospital Centre Osijek. Retrospectively, from January 2008 to August 2012, 400 patients with septal deviation and/or deformities of the nasal pyramid who underwent open rhinoplasty at the Department of Otorhinolaryngology, Head and Neck Surgery of the Clinical Hospital Centre of Osijek, Croatia were identified. The clinical diagnosis was based on a detailed medical history of the patient and nasal endoscopy. The patients were photographed in six projections before and after the surgery, and followed up on two occasions.

Rhinoplasty is the most demanding aesthetic procedure that is currently shifted from ablative to conservative surgical procedures, one of these procedures is using cartilage grafts for correction and augmentation of congenital and acquired nasal deformities. The Autologous costal cartilage graft (ACCG) is a good choice for reconstruction of these deformities because its ample amount and good strength. The aim of this study is to assess the outcome of using autologous costal cartilage graft in augmentation rhinoplasty in severe congenital and acquired nasal deformities. This is a prospective study of 10 patients aged between 16-45 years (7 females and 3 males) in form of 4 cases of saddle nose, 3 cases of cleft lip nasal deformity, two cases of post-traumatic severely deviated nose, and one case of African nose. Patients underwent augmentation rhinoplasty by ACCG, from July 2018-June 2019. The follow-up period was 6-12 months concentrating on preoperative and postoperative structural and functional evaluation. The outcome of augmentation rhinoplasty by ACCG was evaluated by 2 independent surgeons and the results were accepted by both surgeons and patients in 9 out of 10 cases (apart from one case that she had infection of the graft) with donor site complication rates near to the related studies. In conclusion, ACCG is one of the best choices for severe nasal deformities that need ample amount of cartilage for structural and functional support and good aesthetic outcome with low complication rate. Keywords: Autologus graft, Costal cartilage, Surgery, Rhinoplasty, Augmentation.

Introduction: Medical malpractice and violations and following that litigation by patients and finally recycling by them, is faced doctors and medical community with the growing crisis. Medical malpractice, ie, abuse of the specific requirements of the medical profession has the responsibility of doctor In fact, Including diagnosis and treatment and disease management mistakes Materials and Methods: This study is a retrospective cross-sectional study to determine Seven years old complaints about facial cosmetic surgery that referred to forensic medicine of Fars province that in 1385 to 92 years was conducted. Results: In terms of gender between men (34/5%) and women (65/5%) relatively large differences can be seen in the complaint. In our study in according to marital status a huge difference between married (36/4%) and single (54/6%) was seen in the complaint. Most physician were specialist with 57.4% (n = 31), and then Subspecialty with 27.8% (n = 15) and general practitioners were (13%) of cases. According to the results, 60% (n = 33) of physician were acquitted and 40% were sentences (n=22). The results of most frequent type of expertise (n=28) is related to ENT specialists (50.9%), followed by plastic surgery with 29.1% (n = 16) and GP (12.7%). The area of operation, the rhinoplasty is the most frequent complaint among the plaintiffs in 32 cases (58.2%). The type of malpractice, most malpractice was using inappropriate techniques with 27/3% of cases. In this regard, lack of skill, complications of treatment and compound, any 22/7% allocated to own.

Septal extension graft is a unique technique for controlling nasal lengthening and tip projection, rotation, and shape by which a graft is fixed to the septum, leading to a strong and stable supporting structure. Nasal tip three-dimensional positioning is a vital and difficult component in the overall appearance of the tip. A total of 12 Middle Eastern patients with thick nasal envelope skin were subjected to rhinoplasty using the septal extension graft (SEG) method. Eleven out of the 12 patients, had pleasing results after primary rhinoplasty with SEG, while only one patient had SEG as a secondary procedure. In conclusion, septal extension graft in rhinoplasty is an effective technique for achieving a strong supporting force of the nasal tip for adequate projection. Keywords: Nasal tip, surgery, septal extension, graft, rhinoplasty

Abstract Lagophthalmos is an inability to close the eyelids which can result from many causes. Septorhinoplasty surgery is an uncommon reason for that. This paper reports the lagophthalmos complication, after a septorhinoplasty surgery.

Introduction The predictability of nasal tip projection and rotation after aesthetic surgery is a challenge. Tongue-in-groove (TIG) is an effective technique to control tip projection and rotation, but there may be a small loss of projection and rotation of the tip lobe due to lack of support between the anterior septal angle and the domus, since this region is sustained by medial crusts suture-linked and interdomus sutures. Objective To describe a new surgery technique in an attempt to correct the lack of support for the nasal tip after lowering the nasal dorsum. Methods The horn technique consists in preserving a square of cartilage during the removal of the nasal dorsum and septum excess in patients with long and projected nose. This piece will give greater support to the TIG technique and greater predictability of the rotation and projection of the nasal tip. Results Between 2016 and 2018, 50 patients with long and projected noses were submitted to the “horn technique” surgery. They were submitted to the TIG technique associated to the horn technique. A retrospective review of the preoperative and postoperative photographs (3 months to 1 year) of these patients treated with the horn technique were analyzed and showed better support of the nasal tip. Conclusion The horn technique provides greater support to the projection and rotation of rhinoplasties in patients with long and projected nose.

Introduction Reconstruction of external nasal defects poses a challenge for the plastic surgeons. The scalping forehead flap, first described by Converse in 1942 is a versatile technique for subtotal and total external nasal reconstruction. The flap is extremely reliable with robust vascularity and provides excellent colour and texture match for the external nose with minimal donor-site morbidity. Materials and Methods In this series, eleven patients with external nasal soft-tissue defects (post traumatic and post excisional) were reconstructed with scalping forehead flap; among them four presented with congenital naevus, three with post-traumatic external nasal defect, two presented with basal cell carcinoma, and two with arterio-venous malformation. The age of the patients ranged between 24 and 67 years; eight male and three female patients were included in this study. Among them three had comorbidities like diabetes mellitus and/ hypertension. Results All the flaps survived nicely. I didn’t face any complication in any of my patients. The external nasal defects were reconstructed with scalping forehead flap in two stages with an interval of three weeks in between. Conclusion The Converse scalping forehead flap is an excellent option in the armamentarium of plastic surgeons for subtotal and total nasal reconstruction because of its reliability, vascularity, and simplicity even in the era of microvascular free tissue transfer.

Abstract Even in the most difficult clinical scenario of reconstructive rhinoplasty, a solid fixation of the nasal L‐strut is possible. Fixation by using titanium microplates screwed to the facial skull has proved to be stable two years after surgery, providing a good outcome.

Introduction Human bites are notorious due to chance of infection by direct inoculation of pathogens from saliva and must be managed properly. Human bite injuries cause dilemma to the treating doctor regarding its way of management. The options of management are primary closure, delayed closure with skin/tissue grafting and conservative. Case Report A 43 year old male patient with a human bite injury with tissue loss on the tip of nose was admitted in hemodynamically stable condition. He was given tetanus toxoid and anti-rabies vaccination as per current guidelines. Delayed wound closure was done in 2 steps with forehead flap, in 3 weeks interval. Patient was discharged after suture removal. There was good color matching and no complications. Discussion Human bite injuries are mostly due to inter personal violence, alcohol intoxication and psychiatric illnesses. Multiple instances of such bite injuries have been reported. Delayed closure of bite injuries with forehead flap provides good colour and texture match as well as good flap survival due to rich vascularity.

Abstract Strut graft is an important, commonly used method to increase nasal tip projection and rotation. This study discuss its benefit by prospective analysis of a group of patients in which strut graft was used and compare it with a control group using digitalized photographs. The aim of this study is to evaluate the benefit of columellar strut graft and its effect on nasal projection and rotation using digital images. Thirty two patients were treated with external rhinoplasty. Using their photographs, we analyzed the projection and rotation of the nose before and after operation. The patients were classified into two groups: group A included 18 patients who have strut and group B included 14 patients without strut. The analysis of the photos of the two groups was done with a computer program. By using Goode method, nasal tip projection decreases from 0.63 to 0.62 for patients using the strut, while in patients without strut nasal tip projection decreases from 0.64 to 0.61. Nasal tip rotation slightly increased in patients with strut graft from 99 to 99.5 degrees, while in those without the graft, nasal tip rotation markedly increased from 95 to 103 degrees. In conclusion, external rhinoplasty decreases nasal tip projection and the use of strut graft is unnecessary in increasing nasal tip projection but it helps in preserving the projection and slightly increasing nasal tip rotation. Keywords: Rhinoplasty, Graft, Strut, Columella, Nasal, Projection, Rotation