Clinical Application of Botulinum Toxin A on Nasal Reconstruction with Expanded Forehead Flap for Asian Patients.

BACKGROUND: Because of its unique advantages, frontal expansion has become a common tool for Asian nasal reconstruction, but it has the limitations of prolonging the duration and pain in the expansion area. Based on the fact that the denervation effect of botulinum toxin type A (BTX-A) has been widely used in the reconstruction of superficial organs, we hypothesized that BTX-A would shorten the length of nasal reconstruction sequence and alleviate the discomfort of patients. METHODS: A comparative retrospective study was conducted of consecutive patients underwent sequential treatment of nasal reconstruction between June 2010 and July 2012. Data on demographics, BTX-A injection plan and expansion duration were collected and analyzed. Phased pain intensity outcomes were evaluated by visual analogue scale (VAS). Photographs were collected during the follow-up period. RESULTS: Thirty patients were enrolled in the study; 15 (50%) with and 15 (50%) without BTX-A pre-injection. Demographic data were homogeneous. The duration of the observation group (BTX-A pretreated) (133.87 ± 13.64 days) was significantly shortened versus the control group (164.27 ± 14.08 days, P<0.001). At the initial stage, no significant difference was found in the VAS scores (P=0.64). At the medium stage, the VAS score of the observation group (2.07 ± 0.80) was significantly lower than the control group (3.00 ± 0.53, P<0.01). At the terminal stage, the VAS score of the observation group (1.93 ± 0.59) was significantly lower than the control group (2.73 ± 0.70) but with a narrower disparity. CONCLUSION: Pre-injection of BTX-A is effective in shortening the duration of the expansion phase, as well as relieving the pain associated with expansion. LEVEL OF EVIDENCE IV: The journal asks authors to assign a level of evidence to each article. For a complete description of Evidence-Based Medicine ratings, see the Table of Contents or the online Instructions for Authors at www.springer.com/00266 .

Tunneled Paranasal Augmentation Using Diced Autologous Costal Cartilage in Asian Rhinoplasty: A Comparative Study.

Due to the prevalence of anterior maxilla dysplasia in Asian population, paranasal concavity is a common accompaniment to low nose, but its impact on facial harmonization is often underestimated. A retrospective comparative study was conducted on patients diagnosed as low nose with paranasal concavity between June 2017 and June 2021, with a total of 56 patients followed up successfully. The control and observation groups were established according to whether the paranasal augmentation was performed. Demographic data were collected. Cosmetic enhancement was quantitatively evaluated by sagittal planimetry, establishing related anatomical landmarks and measuring columella base prominence (CBP) and alar base prominence (ABP). Subjective evaluation concluded the patient-reported satisfaction (FACE-Q-Rhinoplasty Module and Facial Appearance Module) and the third-party physician assessment (Global Aesthetic Improvement Scale, GAIS).Significant improvements in CBP and ABP were reported both in the control and the observation group (p < 0.01). In postoperative intergroup comparisons, the observation group was superior to the control group regarding ABP values (2.5 ± 0.75 degrees, p < 0.01), FACE-Q-Facial scores (7.49 ± 3.70, p < 0.05), and GAIS scores (p < 0.05). However, no statistical difference was found in CBP values and FACE-Q-Rhinoplasty scores. Paranasal augmentation-related complications included asymmetry of alar bases (6.9%) and facial or intraoral foreign body sensation (34.5%). This study affirmed that paranasal augmentation using diced costal cartilage in rhinoplasty is a safe procedure effective in remedying paranasal concavity and improving facial satisfaction. LEVEL OF EVIDENCE:: IV.

The Dynamic Changes in Skin Thickness of Forehead during Tissue Expansion.

In addition to providing extra flap size, the tissue expansion process also brings changes in flap thickness. This study aims to identify the changes in the forehead flap thickness during the tissue expansion period. Patients undergoing forehead expander embedment from September 2021 to September 2022 were included. The thickness of the forehead skin and subcutaneous tissue were measured with ultrasound before and 1, 2, 3, and 4 months after expansion. Twelve patients were included. The average expansion period was 4.6 months, and the mean expansion volume was 657.1 mL. The thickness of skin and subcutaneous tissue in the central forehead changed from 1.09 ± 0.06 to 0.63 ± 0.05 mm and from 2.53 ± 0.25 to 0.71 ± 0.09 mm, respectively. In the left frontotemporal region, skin and subcutaneous tissue thickness changed from 1.03 ± 0.05 to 0.52 ± 0.05 mm and 2.02 ± 0.21 to 0.62 ± 0.08 mm. On the right side, skin and subcutaneous tissue thickness changed from 1.01 ± 0.05 to 0.50 ± 0.04 mm and 2.06 ± 0.21 to 0.50 ± 0.05 mm. This study measured the dynamic changes in the thickness of the forehead flap during expansion. The thickness of the forehead flap decreased the fastest in the first 2 months of expansion, and the changes in skin and subcutaneous thickness slowed down in the third and fourth months and tended to a minimum value. Additionally, the thickness of subcutaneous tissue decreased greater in magnitude than the dermal tissue.

The Dynamic Changes in Hemodynamics of the Forehead Flap During Tissue Expansion.

Background: The tissue expansion process brings changes in hemodynamics. Objective: To measure the change in vessel diameter, blood flow, and resistance in the blood vessels using ultrasound before, during, and after tissue expansion. Methods: Patients undergoing the embedment of a forehead expander from September 2021 to October 2022 were included. Hemodynamics parameters, including vessel diameter, blood flow velocity, and resistance index (RI) of the supraorbital artery (SOA), supratrochlear artery (STrA), and frontal branch of the superficial temporal artery (FBSTA), were measured with ultrasound before and 1, 2, 3, and 4 months after expansion. Results: Nine males and six females with ages ranging from 15 to 26 years (mean, 20 years) were included. After 4 months of expansion, the diameter of the STrA, SOA, and FBSTA increased significantly, the RI decreased significantly, and except the right SOA, peak systolic flow velocity increased significantly. Conclusion: The parameters of flap perfusion were significantly improved in the first 2 months of expansion and tended to stable values.

Handheld Doppler Detection and Light Illumination for Vascular Mapping in Nasal Reconstruction.

BACKGROUND: The application of the expanded forehead flap in nasal reconstruction has the advantage of being able to provide a sufficient amount of flap and can provide good aesthetic results. For an expanded forehead flap to survive, there must be adequate arterial supply and venous return. Despite this, limited studies have been conducted on preoperative vascular mapping and the design of the expanded forehead flap for nasal reconstruction. In this article, the authors present a technique of hand-held Doppler detection with light illumination for vascular mapping. PATIENTS AND METHODS: The study included patients who underwent total nasal reconstruction with expanded forehead flaps between May 2016 and April 2021. The design of the flap was based on the result of preoperative vascular detection by hand-held Doppler detection assisted by light illumination. RESULTS: A total of 32 patients underwent total nasal reconstruction with an expanded forehead flap. The distal part of the flap became necrotic 1 week after the surgery in 2 patients. Following dressing changes and the administration of antibiotics, the distal flap in these patients survived well. No complications were reported in the long term. CONCLUSIONS: Hand-held Doppler detection combined with light illumination is a convenient and effective preoperative design method for nasal reconstruction with an expanded forehead flap. All flaps survived well in the long term. LEVEL OF EVIDENCE: Level IV.

Comparing the Effectiveness of Betamethasone and Triamcinolone Acetonide in Multimodal Cocktail Intercostal Injection for Chest Pain After Harvesting Costal Cartilage: A Prospective, Double-Blind, Randomized Controlled Study.

BACKGROUND: There has been no previous study on the availability of different glucocorticoid varieties used in the multimodal cocktail for harvesting autologous costal cartilage. This randomized controlled trial (RCT) was to compare the significance and complications of betamethasone and triamcinolone acetonide as a component of the cocktail for harvesting costal cartilage in patients. MATERIALS AND METHODS: The patients were randomized to two groups. The group A used multimodal cocktail: ropivacaine, parecoxib sodium, epinephrine, and triamcinolone acetonide; group B used multimodal cocktail: ropivacaine, parecoxib sodium, epinephrine, and betamethasone. The primary outcomes were chest pain after surgery evaluated with a visual analog scale (VAS). The secondary outcomes evaluated the quality of recovery. The tertiary outcomes included rescue analgesic consumption, the first feeding time and the time to the first ambulation, and duration of hospital stay. RESULTS: The VAS scores between the two groups was not considered clinically significant, but the groups achieved a VAS score of 3 or less. However, the time until the first rescue analgesia and the number were significantly longer and smaller for group A. Additionally, there were no significant differences between the two groups in the duration of hospital stay, first feeding time, the quality of recovery, and the first ambulation time. CONCLUSION: Adding corticosteroids into the multimodal cocktails could improve pain relief after costal cartilage harvest. And the efficacy of Triamcinolone acetonide was better than betamethasone. LEVEL OF EVIDENCE II: 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 .

Regulation of Sulfur Atoms in MoSx by Magneto-Electrodeposition for Hydrogen Evolution Reaction.

Compared with crystalline molybdenum sulfide (MoS2 ) employed as an efficient hydrogen evolution reaction (HER) catalyst, amorphous MoSx exhibits better activity. To synthesize amorphous MoSx , electrodeposition serving as a convenient and time-saving method is successfully applied. However, the loading mass is hindered by limited mass transfer efficiency and the available active sites require further improvement. Herein, magneto-electrodeposition is developed to synthesize MoSx with magnetic fields up to 9 T to investigate the effects of a magnetic field in the electrodeposition processing, as well as the induced electrochemical performance. Owing to the magneto-hydrodynamic effect, the loading mass of MoSx is obviously increased, and the terminal S2- serving as the active site is enhanced. The optimized MoSx catalyst delivers outstanding HER performance, achieving an overpotential of 50 mV at a current density of 10 mA cm-2 and the corresponding Tafel slope of 59 mV dec-1 . The introduction of a magnetic field during the electrodeposition process will provide a novel route to prepare amorphous MoSx with improved electrochemical performance.

Rhinoplasty with Mortise-Tenon Cartilaginous Framework for Caudal Septal Cartilage Defects.

INTRODUCTION: Rhinoplasty for caudal septal cartilage defects is a challenge due to the difficulty of fixation of the grafts. OBJECTIVES: This study presents an approach for correcting defects in caudal septal cartilage with the costal cartilaginous framework using a mortise-tenon technique. METHODS: From May 2019 through May 2022, a retrospective analysis of patients with caudal septal cartilage defects underwent rhinoplasty using a mortise-tenon cartilaginous framework by a senior surgeon was performed. The surgical outcomes were evaluated both preoperatively and postoperatively. RESULTS: This study involved 17 patients, ranging in age from 27 to 58 years. There were 22.4 months of follow-up on average. There was no long-term or short-term complication observed. The aesthetic outcome of all cases was satisfactory. The mean score for the patients of the perceptions of improvement in their noses was 8.11. CONCLUSION: Correction of caudal septal cartilage defects with this costal cartilaginous framework using the mortise-tenon technique is feasible and effective. 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 .

Application of Modified V-Y Advancement Flap in Alar Base Reduction.

BACKGROUND: A variety of techniques for alar base modification have been described in the literature. Limitations of these techniques include scars, recurrence, asymmetry, etc. An incorrect excision of the lateral alar wall can result in a tear-drop or Q-shaped deformity. OBJECTIVES: In this study, a modified V-Y advancement flap will be introduced that will avoid the complications discussed above as well as adjust the positional relationship between the nasal alar and the columella using this technique. In addition, this method is reversible; once the nostril is narrow due to excessive advancement of the flap, the reverse V-Y advancement method can be used to enlarge the nostril. METHODS: In this study, a retrospective review of wide nasal bases in the past 3 years was conducted. A blind analysis of anthropometric points was conducted. There were 3 outcome variables: the width of the alar base, the width of the flare, and the distance between the alar base and columellar base. RESULTS: The alar base was reduced with a modified V-Y advancement flap on 65 female patients ranging from 18 to 45 years of age. In 10 cases, an "Inclined Y-arm flap" was used to narrow alar bases and adjust columella-alar positions. In the remaining cases, a "Horizontal Y-arm flap" was performed to narrow the simple nasal alar width. In all cases, the nasal base was reduced without distortion. In the postoperative period, all the effects were seen to persist for a long time, and patients were generally satisfied with the results of the procedure. CONCLUSION: By using this modified V-Y advancement flap technique, the incision can be concealed as thoroughly as possible, thereby avoiding "tear-drop" or "Q" deformities as well as narrowing the nasal alar effectively. Furthermore, this method, in combination with rhinoplasty surgery, will greatly enhance the nasal appearance.

Phase Engineering of W-Doped MoS2 by Magneto-Hydrothermal Synthesis for Hydrogen Evolution Reaction.

Molybdenum disulfide (MoS2 ) has been proved as an excellent potential hydrogen evolution reaction (HER) catalyst. Compared with thermodynamically stable 2H-MoS2 , 1T-MoS2 exhibits higher conductivity and catalytic activity, whereas it is usually difficult to prepare since of thermodynamically metastable. Herein, a feasible method is reported to fabricate ambient-stable MoS2 with high concentration 1T phase through magnetic free energy synergistic microstrain induced by W doping under low magnetic field. The 1T phase proportion in MoS2 can be as high as 80% and is ambient-stable for more than one year. The catalyst prepared under a magnetic field of 3 T delivers an overpotential of 195 mV at a current density of 10 mA cm-2 and has a long-term stability over 50 h. This work provides a novel strategy for preparation of MoS2 with high 1T concentration and high stability.

The Immediate Contraction of the Expanded Forehead Flap.

INTRODUCTION: Flaps contract immediately after harvest, which added difficulty to flap design. This study aims to investigate the immediate contraction rate of the expanded forehead flap used in nasal reconstruction. METHODS: Patients undergoing nasal reconstruction with expanded forehead flaps from September 2021 to January 2023 were included. Objective measurements of the pedicle width, maximum width, maximum length, and flap size of the expanded forehead flap before and after harvest were conducted. RESULTS: Fourteen patients, including 9 males and 5 females, were included. The average expansion period was 4.6 months, and the mean injection volume was 658.6 ml. The average retraction rate of pedicle width, maximum width, maximum length, and size of the flap after harvest were 16.15%, 30.26%, 26.86%, and 50.89%, respectively. CONCLUSION: This study presents the contraction rate of the expanded forehead flap used for nasal reconstruction. The data from the measurement will help surgeons to design the expanded forehead flap. LEVEL OF EVIDENCE: Level-Level IV.

Correction of Cleft Lip Nose Deformity With Circular Shape Alar Graft and Block Costal Cartilage.

BACKGROUND: Secondary deformities of the cleft lip and nose are mainly caused by the long period of craniofacial development and the secondary scarring. Correction of the secondary cleft lip-nose deformity is a complex process that requires both the correction of the soft tissue and skeletal support. The purpose of this study was to present our experience in correcting the secondary unilateral cleft lip-nose deformities with autologous costal cartilage. METHODS: A retrospective analysis of patients who underwent correction of unilateral cleft nasal deformity with simultaneous rhinoplasty by a senior surgeon from January 2015 to January 2022 was conducted. Preoperative and postoperative measurements of the columellar-labial angle and the inclination of nasal base were conducted to evaluate the surgical outcomes. RESULTS: A total of 54 patients were included in this study according to the inclusion criteria. The mean follow-up period was 4 years (range, 1-7 years). The mean values of the columellar-labial angle were 91.1 ± 9.2 degrees preoperatively and 101.0 ± 5.9 degrees postoperatively. The mean values of the inclination of nasal base were 4.5 ± 1.2 degrees preoperatively and 0.9 ± 0.4 degrees postoperatively. There was a considerable increase in the columellar-labial angle after the surgery (9.9 ± 6.0 degrees; P < 0.01). The inclination of nasal base decreased significantly (3.6 ± 1.1 degrees; P < 0.01). CONCLUSIONS: Our approach on correction the secondary clef lip nose through repositioning the muscles by Z-plasty and application of the block cartilage graft and circular shape alar graft has achieved long-term satisfactory results.

Nasal reconstruction with the expanded forehead flap: Long-term follow-up of esthetic outcome and 12-year experience.

BACKGROUND: The expanded forehead flap has its unique advantage in nasal reconstruction. The authors present their 12-year experience with nasal reconstruction with an expanded forehead flap. The esthetic and functional outcomes were assessed with long-term subjective and objective evaluations. METHODS: A retrospective analysis was conducted of consecutive patients who underwent nasal reconstruction with the expanded forehead flap from 2009 to 2021 performed by the senior author (F.F.). Data were collected and analyzed regarding defect characteristics, processes of treatment, and complications. Subjective esthetic and functional outcomes were assessed through questionnaires FACE-Q (Face Questionnaire) and NOSE (Nasal Obstruction Symptom Evaluation). The objective esthetic outcome was assessed by a senior resident through the viewing of clinical photographs. RESULTS: One hundred and fifty-five patients underwent nasal reconstruction with an expanded forehead flap. The average expansion period was 174 days, and the injection volume was 685.7 ml. There were 15 complications. One hundred and eight patients (69.6%) were satisfied, and 19 patients (12.2%) were very satisfied with the outcome. The differences between postoperative and preoperative scores of FACE-Q were statistically significant (p < 0.01). Sixty-nine percent of patients complained of bilateral eyebrow asymmetry, 27.1% of patients reported partial recovery of frontal deformity with dissatisfaction, and 2.6% of patients considered not recovered at all. The results of 78 patients (50.3%) were considered "satisfied," and 41 patients (26.5%) were considered "very satisfied" by objective evaluation. CONCLUSION: Nasal reconstruction with an expanded forehead flap was a safe technique with good esthetic outcomes. Although problems with the asymmetry of the eyebrows and frontal deformation were presented, the influence was minimal and well-accepted by most patients.

Learning Curve Analysis of Full-Length Costal Cartilage Harvesting by Plastic Surgery Residents: A Retrospective Study.

ABSTRACT: Costal cartilage harvesting (CCH) is a fundamental skill for plastic surgery residents to master. Understanding the learning process is essential for optimizing training programs and ensuring patient safety. Previous research on learning curves has been limited. A retrospective study was conducted on patients who underwent CCH between January 2018 and December 2022. The learning process of 14 inexperienced residents was analyzed using the curve-fitting method, with operative time (OT) and complication rates as outcome measured. Data were compared with 4 attending surgeons who also performed CCH. Resident OTs decreased as experience grew, with the bi-exponential model fitting best. After 10 to 20 cases, the average OT decreased to around 40 minutes. By extrapolation, novice residents require ~50 cases to achieve a plateau of OT similar to the attending surgeons, around 27 minutes. Most complications of the resident group occurred within the first 10 to 20 cases, and the complication rate of attending surgeons was <1%. Harvesting on the left side and a higher body mass index resulted in longer OTs for residents. Harvesting the seventh rib required significantly more time for both residents and attending surgeons. The learning curve for CCH shows that 10 to 20 cases are necessary for residents to perform safely and efficiently. Training should progress gradually, starting with longer incisions and leaner patients, then moving to smaller incisions and more challenging cases. LEVEL OF EVIDENCE: Level IV.

Modified Drilled Extended Spreader Grafts in Asian Rhinoplasty: Clinical Application and Histopathological Analysis.

BACKGROUND: Extended Spreader Grafts (ESGs) are widely used for both esthetic and functional purpose in rhinoplasty. This study aims to examine the effects of drilling on ESGs in rhinoplasty and their clinical benefits, as well as to analyze their histologic characteristics. METHODS: We conducted a retrospective review of patients undergoing esthetic rhinoplasty using drilled ESGs with autologous costal cartilage by a senior surgeon from January 2018 to April 2022. RESULTS: A total of 80 patients were included, with a mean follow-up period of 26 months. Revision operations were performed on 4 patients. The phenomenon of tissue ingrowth from the septum mucoperichondrium to the septal cartilage through the holes of the drilled ESGs was observed in all 4 patients. Specimens of the ingrown tissue were taken from 3 patients during their revision surgeries. Vascular structures and connective tissue were observed in the specimens after fixation, paraffin embedding, and staining with hematoxylin-eosin. No other complications were observed except for 2 cases presenting cartilage warping after surgery. CONCLUSION: Application of the drilled ESGs is a simple but effective approach, which has 3 significant advantages in rhinoplasty: enhancing the stability of the cartilaginous framework through connective tissue ingrowth, preserving the septal cartilage, and providing septum vitality by allowing the formation of vascular structures between the perichondrium and the septal cartilage; reducing the probability of warping in early stages through release the tension force of the cartilage itself. LEVEL OF EVIDENCE: Level IV.

Mechanical properties of extensive calcified costal cartilage: An experimental study.

Background: Autologous costal cartilage is widely used as nasal augmentation or nasal reconstruction material. However, no study has focused on the mechanical difference between no calcified costal cartilage and extensive calcified costal cartilage at present. Our study aims to study the loading behavior of calcified costal cartilage under tensile and compressive stress. Method: Human costal cartilage specimen was obtained from five extensive calcified costal cartilage patients and classified into four groups (group A: no calcified costal cartilage; group B: calcified costal cartilage; group C: no calcified costal cartilage after transplantation in BALB/c nude mice for half a year; group D: calcified costal cartilage after transplantation in BALB/c nude mice for half a year). Young's modulus, stress relaxation slope, and relaxation amount were analyzed through tensile and compressive tests using a material testing machine. Results: We included five female patients with extensive calcified costal cartilage. Group B exhibited significantly higher Young's modulus in both the tensile and compressive tests (p < 0.05 in tensile test, p < 0.01 in compressive test), higher relaxation slope (P < 0.01) and higher relaxation amount (p < 0.05 in compression test). After transplantation, the Young's modulus of calcified and non-calcified costal cartilage decreased, except that the calcified costal cartilage increased slightly in the tensile test. The final relaxation slope and relaxation amount had increased at different degrees, but the changes did not change significantly before and after transplantation (P > 0.05). Conclusion: Our results showed that the stiffness of calcified cartilage would increase 30.06% under tension and 126.31% under compression. This study may provide new insights to researchers focusing on extensive calcified costal cartilage can be used for autologous graft material.

Application of a Modified Costal Cartilaginous Framework in Correction of Severe Saddle Nose Deformity.

BACKGROUND: Insufficient support of the nasal septum due to congenital or secondary deficiency leads to severe saddle nose deformity, which presents an unpleasant appearance. OBJECTIVES: The purpose of this study is to present our approach to constructing a costal cartilaginous framework with autologous costal cartilage for correction of severe saddle nose deformities. METHODS: A retrospective analysis was conducted of patients who underwent correction of severe saddle nose deformity (type 2 to type 4) by a senior surgeon from January 2018 to January 2022. Preoperative and postoperative measurements were conducted to evaluate the surgical outcomes. RESULTS: A total of 41 patients ages 15 to 50 years completed the study. The average follow-up time was 20.6 months. No short-term complications were observed. Revisional operations were performed on 3 patients. All patients were satisfied with the aesthetic results. Analysis of objective measurements showed that the nasofrontal angle, columellar-labial angle, and tip projection improved significantly in type 2 cases, the nasofrontal angle and tip projection improved significantly in type 3 cases, and tip projection improved significantly in type 4 cases. CONCLUSIONS: Application of this modified costal cartilaginous framework, which consists of a fairly stable foundation layer and an aesthetic contour layer of block costal cartilage, has achieved satisfactory results over the long term.

Analysis of the Cause of Cartilage Warping in the Rhinoplasty of Costal Cartilage and Application of Embed-In Graft in Revisional Surgery.

BACKGROUND: It is undeniable that costal cartilage is an excellent source of grafts, however it has some potential disadvantages, including a tendency to warp. There are very few studies that have examined how to resolve preexisting cartilage warping during secondary revisional surgery. OBJECTIVES: The aim of this study was to explore causes of cartilage warping other than the cartilage itself and ways to correct cartilage warping during revisional surgery. METHODS: In the present study, cases of cartilage warping in the past 5 years were retrospectively reviewed, and external factors of cartilage warping were evaluated to help design new cartilage grafts that could be employed to repair cartilage deformities. RESULTS: A total of 29 females and 3 males between the ages of 18 and 60 years participated in the study (average age, 32.5 years). In all cases, embed-in grafts were utilized to correct warping. All patients were satisfied with the results. As a result of our research, we found that another external cause of cartilage warping was the hump that was not removed completely during the initial surgery. CONCLUSIONS: Incomplete removal of the hump is a major contributing external factor to cartilage warping, particularly in the sagittal plane. This embed-in graft is not intended as a routine graft in normal circumstances, but rather as an immediate means of solving an unexpected situation. The graft is primarily for management of severely warped cartilage.

Costal Cartilage Harvest Through a Small Incision in Asian Rhinoplasty After Breast Augmentation.

BACKGROUND: The costal cartilage is widely used in rhinoplasty. Although different surgical methods of costal cartilage harvest have been developed, few studies have reported the method of costal cartilage harvest for patients after breast augmentation. This study aims to provide our experience of costal cartilage harvest through a small incision approach. METHODS: A retrospective review was performed for patients undergoing esthetic rhinoplasty with costal cartilage after breast augmentation between May 2019 and May 2021. Postoperative pain was evaluated with the Visual Analog Scale, and the scars at the donor site were assessed 1 year postoperatively with the Modified Vancouver Scar Scale. RESULTS: A total of 23 female patients were included. The average follow-up time was 21.4 months. No complications of massive bleeding, pleural injury, or breast implant injury during the surgery, wound dehiscence, or wound infection in the harvested site were observed. No patients complained of changes in breast morphology or breast asymmetry after costal cartilage harvest. Results of Visual Analog Scale for donor-site pain indicated pain in donor-site peaked at 12 hours after surgery and gradually decreased. All patients were satisfied with the scarring of the donor sites after surgery. CONCLUSION: The better scar performance, low complication rates, and high satisfaction among patients suggest that this is a safe technique to harvest costal cartilage with a small incision in rhinoplasty for patients after breast augmentation.

A ten-year surgical experience in patients of Tessier No.0 cleft with a bifid nose.

BACKGROUND: Tessier No.0 cleft with a bifid nose is a rare malformation. Reconstruction of the nose is essential for children/adults to correct facial cosmetic defects and contribute to developing patients' mental health. The aim of the study was to present the 10-year clinical results using local flaps or expanded forehead flaps in bifid nose patients. METHODS: A retrospective review was performed between January of 2010 and August of 2021 in our department. Sex, age at surgery, associated anomalies, and type of operation were reviewed. RESULTS: A total of 33 patients were retained. The median duration of follow-up was 5.5 years. Fourteen patients underwent multi-stage nasal reconstruction using expanded forehead flap with costal cartilage as a framework, and 16 patients were operated with local skin flap with silicone while the other three were operated with local skin flap with costal cartilage. There were six cases (18.18%) of complications in our study. During follow-up, 28 patients (84.85%) had satisfactory outcomes, four patients (12.12%) had partially satisfactory results, and one patient (3.03%) had an unsatisfactory outcome. CONCLUSION: Using local skin flap with silicone or costal cartilage rhinoplasty and nasal reconstruction using expanded forehead flap with costal cartilage for patients with a bifid nose of Tessier No.0 cleft showed that it was safe and effective, and had satisfying results in the long-term follow-up.