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Objectives: To describe and assess the vertical sectioning technique for mid vault dissection in patients undergoing primary and secondary rhinoplasty., Methods: A retrospective review of 208 patients undergoing primary or revision rhinoplasty utilizing the vertical sectioning technique. The Nasal Obstruction Symptom Evaluation (NOSE) scale was administered to patients pre- and post-operatively. A detailed description of the technique is presented., Results: Mean follow up was 8.59 ± 7.30 months. Spreader grafts were used in 185 patients (89%), upper lateral cartilage autospreader flaps were utilized in 16 patients (7.7%), and both spreader grafts and autospreader flaps were used in 7 patients (3.4%). Ten primary rhinoplasty patients (4.8%) and 3 revision rhinoplasty patients (4.5%) complained of functional nasal obstruction post-operatively. At time of last follow-up, there was a significant improvement in mean NOSE scores for patients receiving spreader grafts (71.2 ± 21.4-21.5 ± 2.8, P  < .001), autospreader flaps (69.2 ± 25.9-17.2 ± 21.5, P  < .001), and both (57.9 ± 35.0-26.1 ± 20.2, P  = .03)., Conclusion: The vertical sectioning technique respects the anatomic, functional, and esthetic relationship of the middle vault, while maximizing cartilage preservation., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Summary: The intermediate cleft tip rhinoplasty is frequently performed during childhood to address nasal tip anomalies in cleft patients before the most critical period of psychosocial development. The authors previously described the component restoration intermediate cleft tip rhinoplasty technique for the unilateral cleft nose, which was developed to systematically address the lining deficiency, cleft lower lateral cartilage malpositioning, and cleft lateral cartilage weakness using a combination of lower lateral cartilage release, lateral cartilage repositioning, and placement of an auricular composite chondrocutaneous graft. In this work, the authors evaluate the utility of this technique to the bilateral cleft nose. Preoperative and postoperative (mean ± SD, 18.6 ± 10.8 months) photographs of bilateral cleft patients treated with the component restoration intermediate cleft tip rhinoplasty (n = 7) were evaluated using photogrammetric measurements and aesthetic assessments. From preoperatively to postoperatively, the columella length-to-alar width ratio on basal photographs increased (0.19 ± 0.05 versus 0.28 ± 0.05; p = 0.001). On lateral view, the columella-labial angle decreased from preoperatively to postoperatively [138 degrees (interquartile range, 132 to 144 degrees) versus 123 degrees (interquartile range, 122 to 139 degrees); p = 0.04]. Aesthetic ratings performed by four blinded observers also improved from preoperatively to postoperatively (1.6 ± 0.8 versus 2.4 ± 0.7; p = 0.004). As a comparison, bilateral cleft nose patients who did not undergo intermediate cleft tip rhinoplasty (n = 3) of similar ages were subjected to the same photogrammetric and aesthetic analyses, which showed no differences from preoperatively to postoperatively. In combination, the current work suggests that the component restoration technique in the bilateral intermediate cleft tip rhinoplasty improves nasal tip support and aesthetic outcomes., (Copyright © 2021 by the American Society of Plastic Surgeons.)

Objectives/hypothesis: Intraoperative recording devices are being increasingly used to provide video for contemporary surgical training. The objective of this study was to evaluate the use of a smartphone as a low-cost alternative to obtain high-resolution video from the surgeon's perspective., Study Design: A study evaluating the feasibility of using a head-mounted smartphone with a telephoto lens for point-of-view surgical videography., Methods: Video recordings of a rhinoplasty procedure were taken using a head-mounted smartphone and two handheld cameras, a Canon Powershot SD1400 IS and a Sony HandyCam HDR-CX160. Video clips were shown to 16 blinded otolaryngology residents (n = 10) and attending physicians (n = 6) for individual video evaluation using a Likert scale (1 being poor quality, 5 being excellent quality). In addition, the study participants were asked to select which video clip they preferred when presented to them side by side., Results: The iPhone 7 was given the highest overall mean video quality rating of 3.9 ± 0.57 and was preferred over the two handheld cameras by nearly all surveyed surgeons. The Canon Powershot SD1400 IS was given a mean rating of 3.3 ± 1.0 and preferred over the SonyHandyCam HDR-CX160 by all surgeons. The Sony HandyCam HDR-CX160 was given a mean rating of 1.5 ± 0.13., Conclusions: A head-mounted smartphone equipped with a telephoto lens provides a novel method to intraoperative surgical recording. The design is simple, low cost, and allows the surgeon to capture fine anatomical detail from the desirable point-of-view perspective., Level of Evidence: NA Laryngoscope, 129:578-581, 2019., (© 2018 The American Laryngological, Rhinological and Otological Society, Inc.)

Facial feminization surgery (FFS) incorporates aesthetic and craniofacial surgical principles and techniques to feminize masculine facial features and facilitate gender transitioning. A detailed understanding of the defining male and female facial characteristics is essential for success. In this first part of a two-part series, we discuss key aspects of the general preoperative consultation that should be considered when evaluating the prospective facial feminization patient. Assessment of the forehead, orbits, hairline, eyebrows, eyes, and nose and the associated procedures, including scalp advancement, supraorbital rim reduction, setback of the anterior table of the frontal sinus, rhinoplasty, and soft tissue modifications of the upper and midface are discussed. In the second part of this series, bony manipulation of the midface, mandible, and chin, as well as soft tissue modification of the nasolabial complex and chondrolaryngoplasty are discussed. Finally, a review of the literature on patient-reported outcomes in this population following FFS is provided. [ABSTRACT FROM AUTHOR]