Factors Involved in the Decision of Iranian Men to Undergo Rhinoplasty: A Grounded Theory Study.

Undergoing a rhinoplasty can affect an individual's mental health either positively or negatively, depending upon how he or she perceives the results. Because of the impact that rhinoplasty may have on an individual's mental health and the cost of this surgery, it is important to understand the reasons that men decide to undergo rhinoplasty and the challenges they face when making the decision to have a rhinoplasty. Using a grounded theory method, we collected data by conducting interviews with 20 participants. We analyzed the data and initially obtained 684 initial codes. After we removed duplicate codes and carefully analyzed participants' interviews, a total of 497 codes remained. We developed these codes into 10 main categories and 32 subcategories. We found that the causal factors affecting the decision of Iranian men to undergo rhinoplasty included the following 5 categories: a lack of confidence; a desire to improve their appearance; a desire for attention from others; a need to keep up with the Joneses (i.e., a desire to show that one is as good as other people by getting what others have and doing what others do); and persuasion by others. Intervening factors affecting the decision of Iranian men to undergo rhinoplasty included the following 4 categories: family challenge; social atmosphere; financial problems; and unwanted consequences. Iranian men make the decision to undergo rhinoplasty by overcoming and ignoring these intervening factors. The primary variable in participants' decision to undergo rhinoplasty was the desire to improve their appearance.

Comparison of Accuracy of Subjective Measurement of Tip-Supra Tip Difference During Rhinoplasty Between Plastic Surgeons.

INTRODUCTION: This study compared the subjective measurement of difference between the nasal tip and supra tip (TSD) (using eyes) versus objective measurement of TSD (by a ruler) during rhinoplastic surgery to determine the accuracy of subjective measurements among surgeons with varying degrees of experience. MATERIALS AND METHODS: In this analytical observational study, 40 cosmetic rhinoplasty candidates were involved. Those with the history of rhinoplastic surgery were excluded from the study. At the end of the operation, the surgeon was asked to estimate the TSD subjectively. The researcher, without the intervention of the surgeon, remeasured TSD by a presterile ruler. The researcher recorded both objective and subjective TSD measurements and the experience of the surgeon in rhinoplasty in the checklist. RESULT: Of 40 cosmetic rhinoplasty candidates, 17 were operated by a surgeon with >10 years' experience (group 1), and 23 by a surgeon with <5 years' experience (group 2). The results indicated that 5 surgeries (29.4%) in group 1 and 6 surgeries (26.1%) in group 2, had 0-mm difference in subjective and objective measurement. The difference of <1 mm between subjective and objective measurement was achieved in 13 surgeries (76.5%) in group 1 and 13 surgeries (56.5%) in group 2 (P = 0.191). CONCLUSION: According to the results, it can be concluded that the surgeon's experience is effective in reducing the differences in measurements of TSD in both measurement modes.

Principles of Nasal Reconstruction.

The rise in cutaneous malignancies over the past 20 years has led to significant advances in reconstructing the nose from an aesthetic and functional standpoint. The principles of nasal reconstruction center on application of the nasal subunit principle, three-layered reconstruction, nasal skin characteristics, and patient factors. Reconstructive planning starts with proper defect analysis, followed by application of the reconstructive ladder for soft-tissue repair, adequate structural support, and repair of nasal lining deficits. Optimal reconstructive methods depend on the location and size of the defect. Finally, refinement of the reconstruction is achieved through dermabrasion, scar revision, and flap thinning techniques.

The Quality of Rhinoplasty Health Information on the Internet.

BACKGROUND: Patients considering rhinoplasty often use internet health information resources before consultation with a surgeon. These can be beneficial and promote patient autonomy if high quality or be detrimental if misleading impressions about results and complications are reported as fact. This study aimed to objectively assess the quality of health information regarding rhinoplasty on the internet. METHODS: The 3 most popular search engines in the United Kingdom (Google, Bing, and Yahoo) were searched using 4 different terms relating to rhinoplasty. The first 30 links from each search were collated; 360 links in total were screened. Sixty-six suitable websites were examined using the LIDA and DISCERN instruments and had their Flesch Reading Ease Scores (FRES) calculated. RESULTS: The websites displayed low LIDA reliability scores (22%), moderate usability (61%) and high accessibility scores (87%). There was no correlation between a website's search result rank and its LIDA score (Spearman ρ = 0.033, P = 0.799). The DISCERN scores were generally low (mean 54%) and displayed no correlation with website rank (Spearman ρ = 0.070, P = 0.564). FRES values were less readable than that recommended for health information (mean FRES = 57.8; recommended ≥70) and significantly correlated with website rank (Spearman ρ = -0.3164; P = 0.009). CONCLUSIONS: Rhinoplasty internet health information is generally of low quality, unreliable and less readable than recommended. Improvements are needed to increase the quality of internet rhinoplasty resources for patients.

[The anthropometric parameters of the external nose in a Kazakh population with particular reference to the planning of ethnic-specific rhinoplasty]. / Antropometricheskie parametry naruzhnogo nosa v kazakhskoi populyatsii v aspekte planirovaniya etnicheskoi rinoplastiki.

The objective of the present study was to determine the anthropometric parameters of the external nose in a Kazakh population for the subsequent elaboration of the algorithms of and approaches to the planning of ethnic-specific rhinoplasty. The study included 500 ethnic Kazakhs (197 women and 303 men) at the age varying from 16 to 25 (mean 20.6±3.5) years. The following parameters were calculated; the height and the width of the nose, nasal index, lobular index, nasolabial angle, nasal projection index, projection and rotation of the tip of the nose. It was found that the nasal index in male and female Kazakhs was 80.8±0.53 and 79.4±3.17 respectively which corresponds to mesorhinia and is more characteristic of the Europeoid race. The nasofrontalindex in men andwomen was 138.94±5.71 ad 130.1±8.25 degrees respectively. Rotation of the tip of the nose in men was 78.45±2.24 degrees in men and 73.92±4.32 degrees in women. Goode's nasal projection index was 57.25±4.36%. The nasal tip projection was estimated at 67.9±5.21 and 76.72±4.17 in men and women respectively. It is concluded based on the results of the present study that noses in Kazakh men and women have certain specific masculine and feminine anthropometric features making them different from the typical «Asiatic¼ noses because some of their proportions are more characteristic of the Europeoid race. The height of the nose in the Kazakhs is lowest among the three races. It indicates that the main concern as regards rhinoplasty in the Kazakh population is the dorsal augmentation. The present study provided the reference information on the parameters of the external nose in the Kazakh population that may be of value not only in terms of reconstructive and aesthetic rhinosurgery but also for the purpose of forensic medical and other expertises.

Validation of the sino-nasal outcome test-23 in septorhinoplasty surgery.

BACKGROUND: There has been a great expansion in patient-based outcome measures to face the ever-increasing demand to demonstrate surgical efficacy. However, surgeons have not adopted until now any systematic outcome instrument. The 22-item Sino-Nasal Outcome Test (SNOT-22) is a validated sinonasal outcome score in sinonasal and septorhinoplasty surgery but does not measure aesthetic outcome. The aim of this paper is to validate a modification to the Sino-Nasal Outcomes Test-22 (SNOT-22) with a new question regarding the shape of the nose (SNOT-23). METHODOLOGY: We conducted a prospective cohort study on 69 consecutive patients undergoing septorhinoplasty and a control group of healthy volunteers. Reproducibility, responsiveness to treatment, known group differences and validity of the SNOT-23 were analysed. Scores were compared to visual analogue scales, nasal obstruction symptoms evaluation (NOSE) score and nasal inspiratory peak flow. RESULTS: SNOT-23 has good test-retest reliability and is a valid outcome measure for assessing response to surgery especially with regards to shape of the nose and nasal obstruction when compared to other patient reported measures. CONCLUSION: SNOT-23 is a valid and reliable tool that can be easily used in routine clinical practice to assess the functional and aesthetic outcomes from septorhinoplasty surgery. The SNOT-23 could be adopted as a universal, easy to use tool in rhinology clinics for the assessment of response to septorhinoplasty and sinus surgery.

Development and validation of the Functional Rhinoplasty Outcome Inventory 17 (FROI-17).

STATEMENT OF PROBLEM: Quality of life aspects become more and more important in all fields of medicine. There is a lack of such instruments for septorhinoplasty that cover sufficiently both functional and aesthetic aspects. METHODOLOGY: In Phase 1, a group of experts identified 22 questions that represent the symptoms of patients with nasal deformities, which undergo a functional and aesthetic nasal surgery. Forty-one patients filled out the questionnaires before septorhinoplasty. The item assessment and item reduction was performed by a sequential statistical analysis, which included a single item analysis, an assessment of internal consistency, construct validity, the divergence validity and a factor analysis. The resulting 17-item questionnaire was used in a prospective validation study (Phase 2) in which 103 patients were enrolled. Statistical analysis included testing of validity, reliability and responsiveness. RESULTS: In Phase 2 data analysis revealed a good internal consistency and significant test-retest reliability. A literature survey confirmed that the relevant items were included in the questionnaire. We found significant item-score-correlations. Furthermore, the existence of concurrent validity was confirmed. Standardized Response Mean (SRM) as a measure for sensitivity to change indicated moderate to large effects. CONCLUSION: FROI-17 is a valid quality of life instrument for use in septorhinoplasty patients. The instrument is now available for prospective data collection in future septorhinoplasty outcome studies.

[Standard rhinoplasty]. / Rhinoplastie standard de réduction.

Most patients who consult a surgeon for rhinoplasty do not want a radical change in their nose. They seek a reduction in the volume of the nasal pyramid and correction of a precise element that they judge to be ungainly--most often an osteocartilaginous hump. The procedure that we qualify as "standard" will eliminate the osteocartilaginous hump, decrease the dimensions of the septum and reduce the size of the alar crus of the alar cartilage. Although the required technical maneuvers are simple, their sequence must be coherent with a few basic rules that are simple but rarely explained in order to avoid defects linked to excessive, or on the contrary, insufficient corrections.

Reporting of Complications in Rhinoplasty Randomized Controlled Trials: An Analysis Using the CONSORT Extension for Harms Checklist.

OBJECTIVE: This study aimed to assess the completeness of adverse event (AE) reporting in randomized control trials (RCTs) focused on rhinoplasty, using the Consolidated Standards for Reporting (CONSORT) Extension for Harms checklist. STUDY DESIGN: A cross-sectional design was employed to review RCTs related to rhinoplasty published between January 1, 2005, and January 28, 2022. SETTING: The study analyzed clinical trials on rhinoplasty retrieved from PubMed. METHODS: We performed a comprehension search on PubMed, blind and duplicate screening, and data extraction. Adherence to the 18 recommendations of the CONSORT Extension for Harms was evaluated, with 1 point assigned for each adhered item. Percent adherence was calculated based on the 18 points, taking into account the multiple subcategories within some recommendations. Descriptive statistics were used to summarize adherence-including frequencies, percentages, and 95% confidence intervals. RESULTS: Our search returned 240 articles, of which 56 met inclusion criteria. No RCTs adhered to all 18 CONSORT Extension for Harms items. Twenty-six (26/56, 46.4%) adhered to ≥50% of the items, and 30 (30/56, 53.6%) adhered to ≥33.3% of the items. Seven (7/56, 12.5%) RCTs adhered to no items. Across all RCTs, the average number of CONSORT-Harms items adhered to was 7.2 (7.2/18, 40.0%). The most adhered to item was item 10. Discussion balanced with regard to efficacy and AEs (80.4%, [70.0-90.8]). CONCLUSION: This study highlights the inadequacy of AE reporting in rhinoplasty RCTs according to CONSORT-Harms guidelines. Urgent efforts are required to bridge this reporting gap and enhance transparency in surgical research, ultimately safeguarding patient well-being.

Correcting for Rater Effects in Operating Room Surgical Skills Assessment.

OBJECTIVE: To estimate and adjust for rater effects in operating room surgical skills assessment performed using a structured rating scale for nasal septoplasty. METHODS: We analyzed survey responses from attending surgeons (raters) who supervised residents and fellows (trainees) performing nasal septoplasty in a prospective cohort study. We fit a structural equation model with the rubric item scores regressed on a latent component of skill and then fit a second model including the rating surgeon as a random effect to model a rater-effects-adjusted latent surgical skill. We validated this model against conventional measures including the level of expertise and post-graduation year (PGY) commensurate with the trainee's performance, the actual PGY of the trainee, and whether the surgical goals were achieved. RESULTS: Our dataset included 188 assessments by 7 raters and 41 trainees. The model with one latent construct for surgical skill and the rater as a random effect was the best. Rubric scores depended on how severe or lenient the rater was, sometimes almost as much as they depended on trainee skill. Rater-adjusted latent skill scores increased with attending-estimated skill levels and PGY of trainees, increased with the actual PGY, and appeared constant over different levels of achievement of surgical goals. CONCLUSION: Our work provides a method to obtain rater effect adjusted surgical skill assessments in the operating room using structured rating scales. Our method allows for the creation of standardized (i.e., rater-effects-adjusted) quantitative surgical skill benchmarks using national-level databases on trainee assessments. LEVEL OF EVIDENCE: N/A Laryngoscope, 134:3548-3554, 2024.

Revision nasal surgery after septoplasty: trainees versus trainers.

Otolaryngology trainees are expected to be able to successfully perform septoplasty early in their career. An important parameter to assess the success of an operation is to look at the revision surgery rate. This study aimed to investigate the revision nasal surgery rate after septoplasty based on the grade of the primary surgeon. Retrospective review of hospital records of all patients who underwent septoplasty with or without inferior turbinate reduction over 12 years (1998-2010) in a tertiary referral centre in North-East Scotland. Patients were identified from theatre log books and were excluded if they underwent any other simultaneous nasal procedure. Data were collected on demographics, type of primary and revision surgery, grade of surgeon and duration of hospital stay. 2,168 eligible patients (70 % male, 30 % female) with a mean age of 39 years were investigated. Surgeons were divided into four categories: junior trainee (Group A), senior trainee (Group B), staff grade (Group C) and consultant (Group D). There were 753, 644, 298 and 473 patients in Groups A, B, C and D, respectively. The revision rate in Group A was 4.4 % compared to 3.2 % for Group D and this difference was not statistically significant. For their operation, patients in Group A stayed for 1.54 nights compared to 1.47 nights in Group D, the difference being insignificant. Grade of the surgeon does not appear to strongly affect the need for revision nasal surgery and our patients do not appear to be disadvantaged if operated on by trainees.

Nasal reconstruction by modified bilobed forehead flap.

Paramedian forehead flaps, which are supplied by supratrochlear artery and have structural compatibility with nasal skin, have been successfully used for nasal reconstruction for many years. However, removing this flap from midline as perpendicular to natural lines of forehead may lead to marked scar. A flap extending to lateral in parallel to natural lines of forehead results in ipsilateral elevation of eyebrow. In this article, we aimed to demonstrate a flap technique called as "modified bilobed forehead flap technique". In this technique, pedicle of the flap is supplied by supratrochlear artery at one side and the flap is removed at the contralateral side of the lesion using parallel incision to natural lines of forehead. Another flap with a half thickness of the original flap is removed from contralateral frontal region and interpolated to the site where the original flap is removed to prevent the asymmetrical elevation of eyebrow ipsilateral to flap removal. The aim of this technique is to utilize masking effect of natural lines of forehead, while the basic method is bilobed flap technique. Secondary benefits of this technique include forehead lifting and bilateral eyebrow lifting.

A guide to the assessment and analysis of the rhinoplasty patient.

The science and art of facial analysis have made giant strides in the past 50 years. In addition to excellent technical knowledge about the anatomy of the region and the numerous surgical options available, the rhinoplasty surgeon must demonstrate meticulous care in the planning and execution of this difficult and demanding operation to minimize the real risks posed to the patient and to maximize the likelihood of a successful procedure and of obtaining the ultimate goal: the happy patient. Although imaging and computer analysis have provided a new technological dimension to this process, the surgeon's clinical acumen, technical prowess, and communication skills remain paramount in their importance.

[Our experience in nasal reconstruction with local nasal and regional flaps]. / Nazal rekonstrüksiyonda lokal nazal ve bölgesel flep uygulamalarimiz.

OBJECTIVES: In this study, we evaluated the patients, who underwent nasal reconstruction with local nasal or regional flaps and compared our approach with the algorithms of nasal reconstruction in literature. PATIENTS AND METHODS: Twenty-seven patients (15 males, 12 females; mean age 68.7 years; range 42 to 86 years) who underwent nasal reconstruction with local nasal or regional flaps due to excision of skin cancers on the nose, between November 2007 and December 2009 were included in this study. The demographic data (age, sex and occupation), the location, histopathologic type, subtype and size of the tumor, the size and thickness of the defect area, the reconstruction technique and complications were recorded. All patients were photo-documented pre-, intra- and postoperatively, and were followed up at regular intervals. RESULTS: Basal cell carcinoma was detected in 23 patients and squamous cell carcinoma was detected in four patients. The tumors were most frequently located on the nasal dorsum (n=8, 29%) and the side walls (n=6, 22%). The tumor size was >15 mm in 14 (52%) patients. The size of the nasal defect was >20 mm in 18 (66%) patients. Reconstruction was performed with local nasal flaps in 10 patients and with regional flaps in 17 patients. CONCLUSION: The surgical flaps for nasal reconstruction should be selected individually. The ideal technique of nasal reconstruction should be determined based on the location, size, and thickness of the nasal defects, the preferences of the patients and the surgeon's experience.

Powered Rhinoplasty: A Simple Step-by-Step Approach.

SUMMARY: Reduction of a nasal hump and nasal base narrowing are very common steps during a primary rhinoplasty procedure. The greatest difficulty is to obtain stable fracture lines, a natural appearance, beautiful dorsal aesthetic lines, and the absence of palpable or visible irregularities, especially in the long term. The surgeon strives for a reproducible technique, which seems to be more feasible with mechanical osteotomies (powered or piezoelectric) than with traditional manual osteotomies. The aim of this article is to describe powered osteotomy in a step-by-step fashion to provide a clear guideline for rhinoplasty surgeons.

Natural History of the Standardized Cosmesis and Health Nasal Outcomes Survey After Rhinoplasty.

OBJECTIVES/HYPOTHESIS: To explore the natural history of nasal obstruction and cosmesis following rhinoplasty by utilizing the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS). STUDY DESIGN: Retrospective chart study. METHODS: This study was carried out at a tertiary referral center, preoperative and postoperative Nasal Obstruction Symptom Evaluation (NOSE), SCHNOS-Obstruction (SCHNOS-O), and SCHNOS-Cosmesis (SCHNOS-C) scores in patients who underwent rhinoplasty for functional, cosmetic, or both reasons from June 2017 to May 2019 were reviewed and analyzed. Postoperative intervals were defined as <2 months, 2 to 5 months, 5 to 8 months, 8 to 12 months, and >12 months. RESULTS: A total of 302 patients (67% women), with a mean age (standard deviation [SD]) of 35 (13) years, who underwent rhinoplasty for functional (90, 30%), cosmetic (124, 41%), and combined functional and cosmetic (88, 29%) reasons, met inclusion criteria. The mean follow-up period (SD, range) was 5 months (4.2 months, 13 days-1.8 years). Compared to the preoperative mean NOSE score, SCHNOS- O, and SCHNOS-C scores, postoperative mean scores for the functional and combined subgroup were significantly lower (P < .05) across all five postoperative intervals. In the cosmetic subgroup, postoperative mean SCHNOS-C scores were significantly lower (P < .05) across all postoperative intervals compared to the mean preoperative scores. CONCLUSIONS: The natural history of the SCHNOS-O and SCHNOS-C score in patients who underwent rhinoplasty demonstrates 1) after functional rhinoplasty, an improvement in nasal breathing symptoms is attained as early as <2 months postoperatively; and 2) after cosmetic rhinoplasty, an improvement in nasal cosmesis is seen as early as <2 months postoperatively. These improvements in nasal breathing and cosmesis are sustained through a follow-up interval >12 months. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E116-E123, 2021.

Evidence-Based Performance Measures for Rhinoplasty: A Multidisciplinary Performance Measure Set.

SUMMARY: The American Society of Plastic Surgeons, the American Academy of Otolaryngology-Head and Neck Surgery, and the American Academy of Facial Plastic and Reconstructive Surgery commissioned the multidisciplinary Rhinoplasty Performance Measure Development Work Group to identify and draft quality measures for the care of patients undergoing both functional and aesthetic rhinoplasty. One outcome measure and three process measures were identified. The outcome looked at patient satisfaction with rhinoplasty procedures. The process measures look at motivations and expectations of the procedure, airway assessment, and nonnarcotic shared decision-making strategies for pain management. All measures in this report were approved by the American Society of Plastic Surgeons Quality and Performance Measures Work Group and Executive Committee, and the American Academy of Otolaryngology-Head and Neck Surgery Foundation, the American Academy of Facial Plastic and Reconstructive Surgery, The Rhinoplasty Society, and the American Association of Oral and Maxillofacial Surgeons. The Work Group recommends the use of these measures for quality initiatives, Continuing Medical Education, Maintenance of Certification, Qualified Clinical Data Registry reporting, and national quality reporting programs.

Evaluation of local tranexamic acid on septoplastic surgery quality.

BACKGROUND: Even a small amount of bleeding during nose surgery can impair the surgeon's vision, prolong the duration of operation, and affect surgery quality; therefore, various techniques have been proposed to control the bleeding. The aim of this study was to compare the efficacy of the local use of tranexamic acid (TXA) in the dry field of surgery. METHOD: This randomized, double-blinded, controlled trial was conducted in the operation room of Imam Reza Hospital, Tehran, Iran, from January 10, 2016 to February 8, 2017. Sixty patients with age range from 20 to 60 years and the American Society of Anesthesiologists physical status classes I candidates who require septoplasty enrolled. Patients were randomized through white and black cards to receive either syringes. Thirty patients in the intervention group received lidocaine + adrenaline + TXA and 30 patients in the control group received lidocaine + adrenaline. Bleeding volume accumulated in the suction chamber, the nasopharyngeal pack, and hemodynamic variations were measured. Surgeon's satisfaction scores and suitability of operation field were obtained from the surgeon by using the Likert scale and Boezaart grading scale, respectively. RESULTS: The intervention group had a higher score of surgeon satisfaction [4.1 vs 3.16 in the control group (P = 0.001)] and fewer hemodynamic variations. The mean bleeding volume in the intervention was 187.23 ± 54.61 mL and in the control group was 341.22 ± 49.17 mL (P = 0.001). The mean Boezaart score (suitability of operation field) in the intervention group was 1.8 (score range: 1-3) and in the control group was 2.53 (score range: 2-4) and it was statistically significant (P = 0.001). CONCLUSION: The local use of TXA + lidocaine + adrenaline is associated with reduced bleeding, greater surgeon satisfaction, reduced need for Karpol injection, and better hemodynamic stability.

Rhinosurgery during and after the COVID-19 Pandemic: International Consensus Conference Statement on Preliminary Perioperative Safety Measures.

BACKGROUND: The coronavirus disease of 2019 (COVID-19) pandemic has widely affected rhinosurgery, given the high risk of contagion and the elective nature of the aesthetic procedure, generating many questions on how to ensure safety. The Science and Research Committee of the Rhinoplasty Society of Europe aimed at preparing consensus recommendations on safe rhinosurgery in general during the COVID-19 pandemic by appointing an international panel of experts also including delegates of The Rhinoplasty Society. METHODS: A Zoom meeting was performed with a panel of 14 international leading experts in rhinosurgery. During 3.5 hours, four categories of questions on preoperative safety measures in private practice and outpatient clinics, patient assessment before and during surgery, and legal issues were presented by four chairs and discussed by the expert group. Afterward, the panelists were requested to express an online, electronic vote on each category and question. The panel's recommendations were based on current evidence and expert opinions. The resulting report was circulated in an iterative open e-mail process until consensus was obtained. RESULTS: Consensus was obtained in several important points on how to safely restart performing rhinosurgery in general. Preliminary recommendations with different levels of agreement were prepared and condensed in a bundle of safety measures. CONCLUSION: The implementation of the panel's recommendations may improve safety of rhinoplasty by avoiding operating on nondetected COVID-19 patients and minimizing severe acute respiratory syndrome coronavirus 2 virus spread in outpatient clinics and operating rooms.