"Subzone-Counting" Method in Asian Facial Liposuction: A Retrospective Study.

BACKGROUND: Facial liposuction is a popular and reliable procedure for patients with subcutaneous fat accumulation pursuing the ideal face shape. However, complications like irregularities and asymmetry are still problems for plastic surgeons. To lower the incidence of the above complications, we developed the "subzone-counting" method. In this study, this technique was introduced and evaluated. METHODS: By several lines all parallel to the earlobe-mouth corner line, the liposuction area was subdivided into several subzones. With consistent negative pressure, the paths of the cannula trip in all subzones were also parallel to the earlobe-mouth corner line. An objective index could be obtained by counting the number of aspiration in every subzone. Based on this index, the real-time adjustment was made to achieve smoothness and symmetry. RESULTS: This study identified 32 Chinese patients who accepted this method between January 2019 and January 2021. The follow-up ranged from 6 to 44 months. Twenty-nine and 3 patients were satisfied and somewhat satisfied with the postoperative outcome, respectively. No patient was unsatisfied with the outcome. And no major complication was reported. CONCLUSIONS: The "subzone-counting" method is safe and effective for facial liposuction. The approach helps intraoperative judgment and adjustment. According to the real-time counting results, contour smoothness and bilateral symmetry can be easily achieved and less dependent on the surgeon's experience.

Short Nose Lengthening in Primary and Revision Rhinoplasty in Asians.

BACKGROUND: Surgical techniques and graft materials are important factors for short nose lengthening in both primary and revision rhinoplasty in Asian patients. Other subunit of the nose need to be improved as well to achieve aesthetic perfection. MATERIALS AND METHODS: A cohort of 98 patients who underwent primary and revision rhinoplasty for moderate to severe short nose deformity from January 1, 2019, to December 31, 2020, were enrolled. Nasal elongation was achieved via an open rhinoplasty approach using autologous costal cartilage exclusively for grafting. Aesthetic outcomes were evaluated by anthropometric measurement and satisfaction assessment from patients and physicians. RESULTS: The mean duration of follow-up was 10.6 months. In both primary and revision cases, nasal length relative to preoperative measurements increased significantly, while nasal tip projection did not differ significantly. Columellar-facial angle and nasofrontal angle decreased significantly in both groups. Both physicians and patients reported improvement in aesthetic outcomes. CONCLUSIONS: Aesthetic satisfaction was reported from both patients and physicians. Autologous costal cartilage is an ideal graft material that offers strong structural support. Caudal septal extension graft using autologous costal cartilage sandwiched by extended spreader grafts achieve satisfactory lengthening of the central compartment and also increase nasal tip projection and rotation.

A Combination Method of Costal Cartilage Injection Techniques for Augmentation Rhinoplasty.

BACKGROUND: The multiple toothpick-shaped costal cartilage (MTCC) injection technique was introduced as an improvement based on the free diced costal cartilage (FDCC) injection technique for augmentation rhinoplasty. However, radix irregularities may occur when using the MTCC technique. Considering that the FDCC grafts are easier to shape at the nasal radix, we adopted a combination method of the 2 techniques to achieve natural and smooth contour. METHODS: Four patients accepted this method for augmentation rhinoplasty. Through a unilateral marginal incision, the costal cartilage grafts were injected for nasal augmentation at the subperiosteal plane. The FDCC grafts and the MTCC grafts were used for nasal radix and dorsum augmentation, respectively. Nasal contour was adjusted by external shaping. The follow-up ranged from 24 to 43 months. RESULTS: All patients were satisfied with the surgical outcome. There were no major complications occurred during the follow-up. One patient underwent rasping revision due to her own beauty-appreciation changes. CONCLUSIONS: The combination method can take advantages of the FDCC and MTCC injection techniques. It can effectively lower the incidence of contour irregularities and graft displacement. Meanwhile, it is easy to perform without special procedure, and is time-saving and cartilage-saving.

The Ideal Nasal Tip Projection and Rotation Angles in Chinese: A Preference Analysis of the General Population.

ABSTRACT: Rhinoplasty to reshape the nasal tip is increasingly popular among Chinese women. Aesthetic standards vary across different ethnic groups and it is key to identify preferences for the ideal nasal tip in China to set surgical goals. Therefore, we administered an online survey to plastic surgeons and the public through social media to rank nasal tip images by aesthetic preference. Images were created from a single photograph to show various dimensions of nasal tip projection to nasal dorsum length ratio (NTP/NDL) and nasal labial angle (NLA). Preferences were compared by age, sex, living area, ethnic background, occupation, and history of plastic procedures on respondents' preferences. Overall, there were 703 respondents, including 441 (63%) women and 50 plastic surgeons. Nasal tip projection to nasal dorsum length ratio of 0.63 was ranked highest by all demographic groups, including women (47%), men (50%), and plastic surgeons (66%). Nasal labial angle of 106° was first choice overall and preferred by 34%, 34%, and 52%, respectively. Preferences followed a bell curve for NTP/NDL and NLA, with lower rates of preference as parameters diverged further from the first choice. The preference for NTP/NDL of 0.63 and NLA of 106° was conserved across surgeons, lay people, and all demographic groups. The authors suggest that these proportions could be used as reference for preoperative design in rhinoplasty.

Comparison of Free Diced and Multiple Toothpick-Shaped Costal Cartilage Injection Techniques for Augmentation Rhinoplasty.

BACKGROUND: The free diced costal cartilage (FDCC) injection technique has been used in the augmentation rhinoplasty for a long time. In order to lower the incidence of nasal contour irregularities and graft displacement, we developed the multiple toothpick-shaped costal cartilage (MTCC) injection technique. This comparative study was conducted to introduce and assess this new technique. METHODS: This retrospective analysis included 51 patients who underwent augmentation rhinoplasty with either the FDCC or MTCC injection technique at the 17th Department of Plastic Surgery in the Plastic Surgery Hospital between July 2014 and May 2020. The patients were divided into the FDCC (n = 30, 58.82%) and MTCC (n = 21, 41.18%) groups. General data, postoperative patient satisfaction, complications and revision rate were compared between the groups. RESULTS: Except for the follow-up period, there were no significant differences in general data (age, sex, preoperative dorsum deformity, preoperative rhinoplasty history) between the groups. Postoperative patient satisfaction, complications and revision rate were similar between the two groups. CONCLUSIONS: The MTCC injection is a safe and effective technique for augmentation rhinoplasty. Like the FDCC injection technique, the new technique is relatively easy to perform and time-saving with concealed scarring and minimal postoperative edema. Most of its revision surgeries are also easy to perform by simple rasping and reinjection. According to our experience, the new technique may have wider indication as well as lower incidence of nasal contour irregularities and graft displacement. Therefore, we suggest that the MTCC injection technique is reliable and worthy of recommendation. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A systematic review and meta-analysis of comparison between autologous costal cartilage and alloplastic materials in rhinoplasty.

BACKGROUND: Both autologous costal cartilage (ACC) and alloplastic materials are widely used in rhinoplasty. However, there is controversy regarding which material can offer the ideal outcome and fewer complications. OBJECTIVE: The authors review current literature to evaluate complication and satisfaction rates with different materials used in rhinoplasty. METHODS: A comprehensive literature search of articles was conducted in Embase and PubMed published through April 14, 2017. We included only articles that used ACC, silicone, Medpor, Gore-Tex, or a combination of autologous and alloplastic materials in rhinoplasty. The primary outcomes analyzed were complications and postoperative satisfaction. After data extraction, meta-analysis using the random effect model was performed to summarize outcome parameters among different implant types. RESULTS: Fifty-three articles met inclusion criteria and were included in the meta-analysis. The overall complication rate of ACC was 14%, which was higher than that of other implants. However, ACC was more commonly used in revision rhinoplasty. Medpor was associated with low overall complication rates (6%) and good aesthetic and functional outcomes. CONCLUSIONS: Our analysis of available evidence suggests that ACC is preferred in revision rhinoplasty, which may explain its association with higher complication rates. In primary rhinoplasty, Medpor offered versatility in addition to low complication rates and good aesthetic and function outcomes. But its potential dramatic damage to the nasal tissue made secondary surgery extremely difficult. Our findings were limited by lack of high-quality evidence. Future studies with rigorous study design for head-to-head comparisons and longer follow-up are needed to establish clear guidelines for choosing the appropriate rhinoplasty graft material.