Combining Piezo and Power Tools for a Better Outcome in Hybrid Structural-Preservation Rhinoplasty.

INTRODUCTION: Over the past decade, rhinoplasty has seen an unprecedented evolution in concepts, techniques and tools. New concepts have led to new techniques, prevalently but not exclusively related to preservation rhinoplasty, and the use of new tools has made such techniques easier, more precise and thus better reproducible. Power tools can presently be considered only relatively new, while Piezo has gained great popularity over the last years. MATERIALS AND METHOD: This article is focused on how power tools (diverse burrs with specific spherical, cylindrical, conical, discoid tips) can be integrated efficiently together with the use of Piezo and its different inserts in a logical and effective manner. DISCUSSION: This combination should be implemented in a progressive fashion into specific steps of surgery, although, in general, burrs should be used for reshaping and piezo for cutting bone. Specific and notable exceptions to this rule will be mentioned in the paper. Obviously, cost should be considered, but the benefits are evident: heightened control, reduced asymmetries, smoother bony and middle vault contour, and a more precise management of septum and turbinates. We have come to this conclusion following the combined experience of the two centers participating in the study, with over 350 patients over the last three years. CONCLUSIONS: The article focuses on the modified dorsal split preservation hybrid rhinoplasty favored by the senior author, but its principles will easily apply to any structural, preservation, or hybrid rhinoplasty. LEVEL OF EVIDENCE V: 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 .

U shaped costal cartilage resection to reduce donor site morbidity.

OBJECTIVE: The aim of our study is to reduce the complications of pain and chest wall deformity by modifying conventional costal cartilage graft harvesting. METHOD: In this method while the superior part of the costal cartilage is removed completely, medial, lateral, and inferior parts are excised incompletely and used as a graft. Hence, continuity of the costal cartilage is maintained inferiorly. RESULTS: Nineteen primary and 28 revision rhinoplasty patients were included in the study. There were no donor site complications in the early postoperative period or during one-year follow-up. CONCLUSION: The modified costal cartilage graft harvesting technique we described is a safe conservative surgical method.

A systematic review and meta-analysis of complications associated with crushed cartilage in rhinoplasty.

BACKGROUND: Crushed cartilage grafts improve augmentation and contour irregularities in rhinoplasty; however, they are associated with complications including resorption, asymmetries, palpability, and need for revision surgery. METHODS: A systematic review and meta-analysis following the preferred reporting items for systematic reviews and meta-analyses guidelines was performed on all recorded history up to November 2022 using the search query ("crush" or "crushed") AND cartilage AND rhinoplasty for PubMed, World of Science, Embase, and Cochrane online registries. Data were collected on study information, patient demographics, surgical details, and outcomes. Graft resorption and revision surgery were pooled in a random-effects model, and a subgroup analysis was performed for coverage/non-coverage of the cartilage and degree of crushing. RESULTS: The initial search yielded 163 results, with 11 studies included in the final full-text review. A total of 1132 patients were analyzed, with 456 (40.3%) women, mean age of 48.0 years, and an average follow-up period of 24.9 months. Cartilage resorption rates were statistically higher in graft preparation using severely crushed cartilage (3.4%) compared to non-severely crushed cartilage (0.9%, p = 0.049). There was no significant difference in resorption rate for patients with covered cartilage graft (1.3%) compared to those with non-covered grafts (1.8%, p = 0.7). There were significantly more revision surgeries for severely crushed (17.9%) compared to non-severely crushed (3.5%, p = 0.003) cartilage grafts. CONCLUSIONS: Severely crushed cartilage grafting provides smooth contour and less palpability compared to other degrees of crushing but demonstrates significantly higher rate of resorption.

Management of Nasal Valve Dysfunction.

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.

The Influence of Mallet Mass and Velocity on the Fracture Patterns in Osteotomies.

INTRODUCTION: Osteotomies are routinely incorporated in rhinoplasty, however, the influence of mass, velocity, kinetic energy (KE), and momentum (p) of the mallet on fracture patterns has not been studied. METHODS: An experimental sledge guillotine setup was designed simulating a mallet strike with adjustable height and mass and 2 mm-thick Sawbone blocks. KE and p were calculated using KE = ½ mass × velocity2 and p = mass × velocity formulas. Fracture lengths and angles were measured. RESULTS: Ten groups with varying mallet masses and drop heights were tested with 10 bones per group. Fracture length positively correlated with KE (R = 0.542, p < 0.001) and p (R = 0.508, p < 0.001). Fracture angle also positively correlated with KE (R = 0.367, p < 0.001) and p (R = 0.329, p < 0.001). In groups with similar KE, osteotomies with higher p (heavier mallet with slower velocity) had greater fracture lengths (29.31 ± 0.68 vs. 27.68 ± 2.12 mm, p = 0.013) but similar fracture angles (p = 0.189). In groups with similar p, osteotomies with higher KE (lighter hammer with faster velocity) had significantly greater fracture lengths (28.28 ± 1.28 vs. 20.45 ± 12.20 mm, p = 0.041) and greater divergent fracture angles (3.13 ± 1.97° vs. 1.40 ± 1.36°, p = 0.031). Regression modeling of the relationship between KE and fracture lengths and angles demonstrated that cubic followed by logarithmic regression models had the best fits. CONCLUSION: Osteotomy fracture patterns positively correlated with the mallet's KE more so than its p, suggesting that the mallet's velocity has an increased impact effect than its mass. Clinically, a heavier mallet with a lower velocity will likely generate a smaller fracture length and fracture angle, indicating a more controlled and ideal fracture. LEVEL OF EVIDENCE: NA Laryngoscope, 2024.

Psychometric evaluation of the perfectionism scale's characteristics regarding physical appearance in patients seeking rhinoplasty surgery.

Introduction: This study aimed to investigate the psychometric characteristics of the perfectionism scale regarding physical appearance in patients seeking rhinoplasty. Methods: This cross-sectional study involved 250 individuals seeking rhinoplasty in Kermanshah beauty clinics. Participants were purposively selected. Tools included perfectionism, social comparison, and body image acceptance scales. Divergence and convergence were assessed using various scales. Data analysis was performed using SPSS version 25 and LISREL. Results: The obtained value for the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy was 0.83, indicating that the sample adequacy was desirable, and the data in this study had the potential for factor analysis. The significance level for Bartlett's test of sphericity was also less than 0.0001, demonstrating the appropriateness of factor analysis for identifying the structure (factor model). Furthermore, the Cronbach's alpha-coefficient for the entire scale was 0.853, indicating acceptable questionnaire reliability. Internal consistency among the perfectionism subscales was confirmed. Additionally, the correlation between perfectionism subscales and measures of interindividual sensitivity and body appearance acceptance was confirmed (p < 0.001). Results supported the convergent validity of perfectionism with appearance acceptance and the divergent validity of perfectionism with interindividual sensitivity. Conclusion: This questionnaire, a self-report tool for measuring perfectionism traits in individuals seeking rhinoplasty, is recommended for use alongside interviews and observations for a thorough assessment. However, results may be influenced by individual biases. Despite this, the acceptable validity and reliability of this questionnaire make it suitable for research.

Versatile vertical alar resection technique for positioning of the nasal tip.

BACKGROUND: In rhinoplasty, it is very important to adjust the rotation and projection of the tip together harmoniously with the nasal dorsum and face to achieve pleasing results. OBJECTIVE: In this study, our aim is to describe a new modification of the vertical alar resection technique that can effectively regulate nasal tip projection and rotation. MATERIALS AND METHODS: Versatile vertical alar resection (V-VAR) technique was applied to 14 primary and 9 revision rhinoplasty cases with highly projected nasal tip. V-VAR technique consists of three steps. In the first step, the original dome point was marked. In patients with high tip projection and caudal rotation, resection was performed from the lateral crus of the original dome. In patients with high tip projection and cephalic rotation, resection was performed from the medial crus of the original dome. In patients with high nasal tip projection but adequate rotation, an equal amount of resections were performed from both the medial crus and lateral crus of the original dome. The patients were followed in average 18 months (between 12 and 24 months). RESULTS: The desired type of rotation and projection was achieved utilizing V-VAR technique in all patients. All patients had satisfactory esthetic results. CONCLUSIONS: In highly projected nasal tips, the height can be reduced using the proposed V-VAR technique. Rotation in the nasal tip region was maintained, increased or decreased in accordance with the esthetic aims.

Polish Translation and Validation of the SCHNOS (Standardized Cosmesis and Health Nasal Outcomes Survey) Questionnaire.

<b>Introduction:</b> Rhinoseptoplasty procedures are focused not only on the aesthetic but also on the functional aspects. Surgical outcomes have to be evaluated in each patient. To date, the Polish literature has lacked a tool facilitating simultaneous assessment of rhinoseptoplasty's impact on both the external appearance and functionality of the nose.<b>Aim:</b> The aim of this study was to translate, adapt, and validate the Polish version of the original SCHNOS (Standardized Cosmesis and Health Nasal Outcomes Survey) questionnaire as used for the assessment of the functional and aesthetic outcomes in patients after rhinoplasty.<b>Materials and methods:</b> A total of 31 subjects (N = 24 [77.4%] women and N = 7 men [22.6%]) aged 19 through 55 years (M = 31.32; SD = 8.50) participated in the study. The SCHNOS questionnaire was translated in accordance with international guidelines. The psychometric accuracy of translation was tested in native speakers of Polish. The authors measured the internal consistency, correlatability, and repeatability of the instrument to determine its validity. The data were subjected to statistical analysis.<b>Results:</b> The confirmatory factor analysis confirmed the two-factor structure of the scale. The satisfactory reliability amounted to 0.888 [95% CI: 0.804-0.940] for the SCHNOS-O and 0.883 [95% CI 0.795-0.937] for the SCHNOS-C scale. Differential accuracy was confirmed by AVE values of > 0.5 as well as by correlation of the results with the Rhinoplasty Outcome Evaluation (ROE) questionnaire scores.<b>Conclusions:</b> The SCHNOS questionnaire has been translated, adapted, and validated for use in the Polish-speaking population. The tool was found to be relevant and reliable.

Nonsurgical Rhinoplasty: Results from a Retrospective Study of Rino-4-Puntos Technique with Hyaluronic Acid.

BACKGROUND: Nonsurgical rhinoplasty (NSR) utilizing hyaluronic acid (HA) filler injections is increasingly used to address nose shape issues. While refinements have been proposed, the technique lacks standardization. OBJECTIVES: Our study aimed to evaluate the aesthetic outcome, longevity of results, safety, and patient satisfaction with the novel Rino-4-Puntos (R4P) NSR technique. METHODS: This is a retrospective study of consecutive individuals treated with R4P between January 2021 and July 2023. All participants had one of the four indications: rectification of the dorsum (21%), triangulation of the tip (32%), projection (25%), and strengthening of the columella (22%). Each patient received two hyaluronic acid (HA) fillers: one with intermediate G prime (G') at Points 1-3 and another with high G' at Point 4, which is further divided into Points 4.1, 4.2, 4.3, and 4.4. The injection points were as follows: P1 (radix, 0.05-0.15 mL, supraperiosteal), P2 (supratip, 0.025 mL, suprachondrial), P3 (tip, 0.15 mL, deep fat), P4 (columella, 0.30 mL, supraperiosteal [4.1], or deep fat [4.2, 4.3, and 4.4]). RESULTS: Four hundred individuals (n = 284 [71%] females) are included. The mean filler volume used was 0.65 ± 0.17 mL. Injecting small boluses (≤ 0.05 mL) in the midline at deep planes minimized the risk of adverse effects, as no vascular complications occurred. Ninety-three percent of participants considered the overall outcome at least satisfactory ("good," "very good," or "excellent"). The treatment effect was maintained for a median of 11 months. CONCLUSIONS: The R4P technique refines NSR by combining enhanced aesthetic outcome, longevity, and safety. 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 .

Complicated calcified alloplastic implants in the nasal dorsum: A clinical analysis.

BACKGROUND: In rhinoplasty, calcification around silicone implants is frequently observed in the tip dorsum (TD) area. Additionally, based on a review of various literature, it is presumed that calcification in silicone implants occurs due to both inflammatory chemical reactions and physical friction against the tissue. The calcification of nasal silicone implants not only results in the functional loss of the implants, but also leads to material deformation. However, there is a lack of research on calcification of nasal silicone implants in the current literature. AIM: To elucidate various clinical characteristics of calcification around nasal silicone implants, using histological and radiological analysis. METHODS: This study analyzed data from 16 patients of calcified nasal implants, who underwent revision rhinoplasty for various reasons after undergoing augmentation rhinoplasty with silicone implants. The collected data included information on implant duration, implant types, location of calcification, presence of inflammatory reactions, and computed tomography (CT) scans. RESULTS: The most common location of calcification, as visually analyzed, was in the TD area, accounting for 56%. Additionally, the analysis of CT scans revealed a trend of increasing Hounsfield Unit values for calcification with the duration of implantation, although this trend was not statistically significant (P = 0.139). CONCLUSION: Our study shows that reducing the frequency of calcification may be achievable by using softer silicone implants and by minimizing the damage to perioperative tissues.

Effect of Medical Ozone Therapy in Preventing Compromised Nasal Skin in Revision Rhinoplasty.

BACKGROUND: Ozone is often used as an additive therapy for skin conditions like infectious diseases, wound healing, diabetic foot, and pressure ulcers. The viability of the nasal skin has crucial importance in revision rhinoplasty cases. The study investigates the potential benefits of medical ozone therapy in healing the nasal skin in multiple-operated cases. METHODS: The study retrospectively examined 523 revision rhinoplasty patients operated by the first author from January 2017 to January 2024. Patients consenting to ozone therapy received 3 major autohemotherapy sessions post-surgery. Patients were divided into 2 groups: those with compromised nasal skin (infection, poor vascular supply) and those with normal healing. Age, gender, smoking, diabetes, previous surgeries, grafting materials, and techniques were considered. RESULTS: Of the 523 patients, 12 (2.3%) experienced major skin complications like infection and necrosis, while 511 (97.7%) had no or minor issues, such as discoloration. In total, 301 patients accepted and received ozone therapy. Of the patients without major complications, 299 (58.3%) received ozone therapy, while 212 (41.7%) did not. Among the 12 with major complications, two (16.7%) received ozone therapy, and the remaining 10 (83.3%) did not. Ozone therapy recipients showed statistically fewer skin problems (p<0.05). Costal cartilage as tip and septal extension graft was linked to skin issues (p<0.05). No major adverse effects from ozone therapy were noted. CONCLUSIONS: Our findings indicate that ozone therapy may be a safe and potentially effective option for patients undergoing revision rhinoplasty, especially those with compromised nasal skin. It appears to aid in skin healing and regeneration, possibly through enhancing oxygen delivery and modulation of the immune response. Ozone therapy is a promising adjunct treatment for managing skin complications in revision rhinoplasty patients. 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 .

Bridging the Gap: Understanding Appalachian Patient Satisfaction in Cosmetic Rhinoplasty.

Rhinoplasty is a surgical procedure aimed at correcting both functional and aesthetic nasal deformities, addressing issues such as trauma-induced disfigurements and patient dissatisfaction with nasal appearance. Patient satisfaction is a critical outcome measure in rhinoplasty, reflecting the success of the procedure and the quality of care provided. This study investigates factors influencing patient satisfaction among Appalachian patients undergoing rhinoplasty for aesthetic reasons, considering the unique healthcare challenges faced by rural populations. A modified Rhinoplasty Outcome Evaluation questionnaire was utilized to assess patient satisfaction. Descriptive statistics and regression analyses were performed to analyze demographic characteristics, complications, re-operations, and satisfaction scores among rural and urban participants. While no significant differences were found in demographic characteristics, trends in satisfaction scores suggest potential disparities between rural and urban populations. Rural patients exhibited marginally lower satisfaction scores and higher rates of complications and re-operations, highlighting the need for targeted interventions in rural healthcare settings. Addressing geographic barriers, enhancing preoperative education and postoperative support, and fostering interdisciplinary collaboration are essential strategies to improve patient satisfaction and outcomes in rhinoplasty procedures, particularly in rural communities. Further research with larger sample sizes and qualitative methods is warranted to explore the underlying factors contributing to patient satisfaction disparities and to inform evidence-based interventions aimed at narrowing healthcare disparities and advancing health equity in rhinoplasty care.

Invited Response on: The Use of Hyaluronic Acid in Non-surgical Rhinoplasty: A Systematic Review of Complications, Clinical, and Patient-Reported Outcomes.

NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. 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 New Alar Base Reduction Technique in Rhinoplasty.

BACKGROUND: Alar base reduction is one of the most challenging parts of rhinoplasty because the maneuvers that are performed during this procedure are nearly irreversible. Some of the important complications of alar base reduction are notching, scarring and unnatural results. In this study, we present a modified alar base reduction technique in order to prevent these complications. MATERIALS AND METHODS: Seventy-five female patients (46 bilateral and 29 unilateral alar base reductions) who needed alar base reduction were operated on consecutively between January 2016 and June 2022 with this new technique. They were compared retrospectively with 67 female patients (41 bilateral and 26 unilateral alar base reductions) who were operated on consecutively with the classical alar base reduction technique between 2010 and 2015. Scar quality was assessed with a modified Stony Brook Scar Evaluation Scale (MSBSES). Three people assessed the overall appearance (resulting in naturalness and symmetry) with a Visual Analog Scale (VAS). RESULTS: Statistically significant differences were found between classical alar base reduction and modified alar base reduction techniques (p<0.05) according to SBSES scores. Also, VAS scores about the result of naturalness were statistically different between the two groups (p<0.05) (Cronbach's alpha value 0.796). There was no significant difference between the VAS scores of the two groups in terms of symmetry (p>0.05) (Cronbach's alpha value 0.828). CONCLUSION: This new modified alar base reduction technique is found to be useful, easy to apply and has better results than the classical alar base reduction technique. LEVEL OF EVIDENCE III: 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 .

Tip Surgery in Dorsal Preservation Rhinoplasty: The Effect of Modified Low Septal Strip Septoplasty on Tip Plasty.

BACKGROUND: The aim in tip surgery is to provide rotation, derotation, projection and deprojection. In this study, we aimed to show the effects of modified low septal strip septoplasty, septal extension graft, TIG technique and additional maneuvers on tip shape in dorsal preservation rhinoplasty (DPR) and to discuss our clinical results. PATIENTS AND METHODS: One hundred eighty-nine patients who underwent DPR with modified low septal strip septoplasty between November 2021 and August 2023 were included in the study. Demographic data, complications, revision surgeries and follow-up periods of the patients were analyzed retrospectively. RESULTS: The mean age of the patients is 29.58±9.04 (17-65). The mean follow-up period was 14, 50±2,98 months. Complications were observed in 1.1% of the patients (n=2/189). Revision surgery was performed in all these patients. Residual hump in 2 were observed and dorsum rasping was performed under local anesthesia. No tip revision was performed on any patient. CONCLUSIONS: A strong tip fixation is achieved with the modified low septal septoplasty technique described in this publication, and when combined with septal extension graft, tongue in groove technique and other suture techniques, an effective and permanent tip plasty can be performed in DPR. 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 .

The Alar Extension Graft Technique for the Treatment of External Nasal Valve Collapse: Preliminary Results of a Single-Centre Prospective Analysis.

BACKGROUND: The aim of this study is to describe the efficacy of the alar extension graft for the correction of external nasal valve collapse and to evaluate the functional and aesthetic results. METHODS: The study included 51 patients who underwent alar extension grafting for external nasal valve collapse. Pre- and post-operative rhinomanometry was performed before and after surgery. NOSE and SNOT 20 questionnaires were completed before and 9 months after surgery. Patients were also asked about their post-operative satisfaction. RESULTS: 90% of patients were subjectively satisfied with the post-operative improvement in nasal breathing. There was a significant improvement in the values of the pre- and post-operative NOSE and SNOT 20 questionnaire scores. Rhinomanometry showed increased nasal flow with a statistically significant difference between pre- and post-operative results. CONCLUSIONS: The alar extension graft has been proved to be effective and reliable in the surgical treatment of external nasal valve collapse, improving the patients' objective and subjective breathing with good functional and aesthetic results. 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 .

Measurement of Nasal Contour Landmarks in Septorhinoplasties with Special Regard to the Course of Postoperative Swelling Using a Three-Dimensional Camera.

The integration of three-dimensional (3D) cameras into clinical practice for pre-operative planning and post-operative monitoring of rhinoplasties remains controversial. However, this technology offers the advantage of capturing the 3D surface without exposing patients to potentially harmful radiation. Continuous assessment allows the follow-up of swelling patterns, cartilage alignment, and bone remodeling. The primary objective of our study was to quantify changes in nasal structure before and after rhinoplasty by using 3D photography. Our study cohort consisted of 29 patients who underwent open structural rhinoplasty. We used the Artec Space Spider camera to acquire a total of 103 3D images. We collected pre-operative and at least two or three post-operative follow-up scans, which were taken one, three, and six months after surgery. We evaluated paired scans that included various time intervals to improve our understanding of swelling behavior and to ensure an objective analysis of changes. Eleven specific anatomical landmarks were identified for measurement. Two independent raters determined the distances between these landmarks over time. The calculation of intraclass correlation coefficients showed low inter-rater variability. Statistically significant changes over time (p < 0.05) were observed for various anatomical landmarks, including soft tissue nasion, soft tissue orbitale right, soft tissue maxillofrontale left, soft tissue maxillofrontale right, nasal bridge, and nasal break point. Conversely, no significant changes (p > 0.05) were observed in the measurements of soft tissue orbitale left, pronasale, subnasale, alare right, or alare left. A visual assessment was conducted using surface distance maps. The results indicate that the complete decrease in swelling takes at least 6 months or even longer. Additionally, 3D photography can provide an objectively comparable analysis of the face and external contours. Furthermore, it allows for a comparison of external contours and therefore pre- and post-operative differences.

Süreyya-Dani technique, a new technique to address notching of soft triangle and opening external nasal valve.

Introduction: While different methods are employed for fixing narrowed nasal valves and preventing the notching of soft triangles, this study aims to demonstrate the effectiveness of a new technique called Süreyya-Dani Technique. Methods: This prospective study composed 100 patients who underwent rhinoplasty using the Süreyya-Dani technique. All patients presented with either notching of the soft triangle and/or external nasal valve dysfunction. Patients with the absence of soft triangle notching and external nasal valve dysfunction were excluded from this study. Facial analysis was conducted for all patients to identify any asymmetry in the face, and all nasal defects were identified. Descriptive statistics were calculated for different variables. Analytical statistics, namely Chi-Square test, was conducted with a significance level set at P < 0.05. Results: In the current study, 100 patients were involved, out of which 63 (63%) were female and 37 (37%) were male. The participants' ages ranged from 18 to 46 years, with a mean age of 30 years. various chief complaints were found among patients, with the majority 37(37%) expressing cosmetic concerns. A statistically significant difference was found for the association of nasal tip defects with genders, intraoperative findings, and chef complaints, and the association between the degree of external valve insufficiency and crural weakness (P-value < 0.05). Conclusion: Despite many techniques that have been put forward to fix narrowed nasal valves and prevent notching of the soft triangle, the Süreyya-Dani Technique could work to prevent its occurrence successfully.

Outcomes of dorsal nasal augmentation using costochondral graft.

Objective: To assess functional and aesthetic outcomes in patients having undergone dorsal nasal augmentation with costochondral graft in a tertiary care setting. METHODS: The single-centre, retrospective, observational study was conducted at Shifa International Hospital, Islamabad, Pakistan, and comprised data of patients who underwent dorsal nasal augmentation using costochondral graft between January 1, 2018, and December 31, 2022. Aesthetic outcomes in terms of patient satisfaction were assessed using Facial Appearance, Health-related Quality of Life and Adverse Effects scores. Data was analysed using SPSS 26. RESULTS: Of the 46 patients, 28(61%) were males and 18(39%) were females. The overall mean age was 28.39±9.13 years. Dorsal nasal deficiency occurred secondary to congenital causes in 12(26.1%) patients, trauma 19(41.3%) and prior surgery 15(32.6%). Postoperative complication rate was 7(15%); 3(6.5%) had recipient site infection and 2(4.3%) had rib graft resorption. Besides, 1(2.2%) patient reported pain 2 months postoperatively and 1(2.2%) had hypertrophic scarring. Patient satisfaction with the outcome was noted in all the 10 parameters analysed. Most commonly reported problem was that the nose was 'looking thick/swollen' by 12(26.1%) patients, but the issue resolved during 1-year follow-up. Conclusion: Costochondral graft was found to be an ideal material for dorsal nasal augmentation, with high patient satisfaction rate.

Nasal filling guided by high frequency ultrasound: Reducing risks.

BACKGROUND: Given the significant increase in the quantity of cosmetic procedures utilizing hyaluronic acid fillers, including in the nasal region, the initial evaluation of patients using high frequency ultrasound becomes a crucial instrument in evaluating and handling nonsurgical rhinoplasty. AIMS: The aim of this article is to introduce an assessment methodology for nasal filling guided by high frequency ultrasound. PATIENTS/METHODS: A prospective and single-center study was conducted with 12 Latin American patients. The patients underwent nasal filling with hyaluronic acid following high power ultrasound mapping. RESULTS AND CONCLUSIONS: In the evaluation of the GAIS scale, all patients reported improvement with the treatment. No infections, nodules, ischemia, or other relevant adverse effects were noted. Real-time ultrasound-guided filler techniques have been developed to reduce the risk of vascular compromise, confirming the distribution pattern of blood vessels. It's also crucial to visualize the cannula at the same moment as the vessels, even if the previous vascular mapping was performed. Therefore, the utilization of high frequency ultrasound can act as a pivotal tool in augmenting procedure safety.