Chin Augmentation Using Silastic Implants.

An aesthetically pleasing face is centered on strength, symmetry, and balance. A defined, well-projected chin and jawline are crucial to this harmony and recontouring the lower third of the face plays a significant role in plastic surgery. Chin augmentation can be performed with injectables, implantation, or osseous genioplasty. The selection of the best procedure is based on the type and extent of deformity. This article reviews chin augmentation with emphasis on alloplast implantation. The relevant anatomy, patient evaluation, implant indications and limitations, alloplast selection, and surgical techniques in implantation are presented.

Correction of the Crooked Nose.

Successful management of the crooked nose can be a formidable task and requires a systematic approach that begins with an understanding of the patients' aesthetic desires, expectations, and functional symptoms. Dividing the nose into thirds and organizing a plan to correct each region individually can simplify the preoperative planning. There are two broad philosophical strategies of surgical management: engineering (reconstructive) and artistic (camouflaging). While the camouflaging technique is helpful for minor asymmetries, protrusions, and depressions, the engineering approach is best for more extreme corrections. The surgeon must be skilled in both approaches as either one or a combination of the two may yield the best results. Once corrected, postoperative care is essential to obtain optimal outcomes.

Extracorporeal Septoplasty: Assessing Functional Outcomes Using the Validated Nasal Obstruction Symptom Evaluation Score over a 3-Year Period.

BACKGROUND: It is well recognized that the standard septoplasty approach, in patients with severe septal deformities, may be less than adequate to address all portions of the deviated septum. The extracorporeal septoplasty technique is an alternative to the other common approaches in these more severe cases. In this study, the authors investigate functional outcomes of the standard approach. The authors use the validated Nasal Obstruction Symptom Evaluation score, before and after surgery, to quantify symptom improvement and confirm the validity and usefulness of this method in treating severe septal deviation. METHODS: A retrospective collection of clinical data was performed on all patients undergoing extracorporeal septoplasty in a 28-month period from January of 2010 through May of 2013. Fifty-five patients were identified. Demographic information, previous surgical history, and complication status were collected. The main outcome measured was functional outcome identified from preoperative and postoperative Nasal Obstruction Symptom Evaluation scores. Collaboration occurred with the study design and biostatistics center for statistical analysis. RESULTS: The median preoperative and postoperative Nasal Obstruction Symptom Evaluation scores were 14.5 (interquartile range, 11.0 to 16.0) and 3.0 (interquartile range, 1.0 to 5.0), respectively. The median change between preoperative and postoperative scores was a decrease of 9.0 (interquartile range, 25.0 to 47.5). It was a statistically significant difference with (p < 0.0001 (Wilcoxon signed rank test). CONCLUSIONS: Extracorporeal septoplasty is an important surgical option for repair of the severely deviated nasal septum. This study shows significant improvements in functional outcomes following this procedure, as shown by notable improvements in the validated Nasal Obstruction Symptom Evaluation score after extracorporeal septoplasty surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Soft tissue trauma and scar revision.

Numerous techniques and treatments have been described for scar revision, with most studies focusing on the adult population. A comprehensive review of the literature reveals a paucity of references related specifically to scar revision in children. This review describes the available modalities in pediatric facial scar revision. The authors have integrated current practices in soft tissue trauma and scar revision, including closure techniques and materials, topical therapy, steroid injection, cutaneous laser therapy, and tissue expanders.

Reconstructing the extended nasal tip defect.

Reconstruction of large facial defects requires surgical skill, an understanding of engineering principles, an artistic eye, and patience to design the most elegant solution for each patient. Extended nasal tip defects, which may involve additional facial subunits, require even more thoughtful analysis and planning. Reconstructive surgeons need to be aware of the pros and cons of various options for flaps, the use of a delay stage, and sequencing and scheduling of staged operations to achieve an optimal outcome.

Elegant solutions for complex paramedian forehead flap reconstruction.

Nasal reconstruction is one of the most challenging aspects of facial plastic surgery. The authors present reconstructive techniques to maximize the final aesthetic result and minimize scarring. They discuss techniques used in nasal reconstruction with a paramedian forehead flap (PMFF) that help to achieve these goals and minimize the chance of complications, including performing a surgical delay, using generous, supportive cartilage grafts, adding extra length and bulk to the flap at the alar rim and using topical nitroglycerin and triamcinolone injections when indicated. The steps outlined can help to create a more elegant and consistent result in PMFF nasal reconstruction.

Treatment options in trigeminal trophic syndrome: a multi-institutional case series.

Trigeminal trophic syndrome (TTS) is an uncommon medical condition that may be encountered by otolaryngologists and facial plastic surgeons. TTS begins with damage to the trigeminal nerve or its central sensory connections, causing anesthesia in a dermatomal distribution. With repeated scratching and manipulation, an ulceration occurs, often in the alar region. In this multi-institutional report, we summarize a small series of patients with TTS. Treatment options are discussed along with a review of the relevant literature. Although rare, it is important that practicing otolaryngologists be familiar with the classic signs and symptoms of this condition in order to avoid delays in diagnosis and treatment.

Extracorporeal septoplasty: complications and new techniques.

OBJECTIVES: To report our complication rates during extracorporeal septoplasty (ECS) and to describe a new fixation and splinting technique we developed to simplify stable midline fixation of the neocaudal septum. Correction of the caudally deviated septum remains one of the more difficult surgical goals in functional nasal surgery. METHODS: A retrospective medical record review of patients undergoing ECS at our institution. We report our complications and describe a new technique for ECS. RESULTS: Forty-six patients underwent ECS from June 1, 2007, through April 30, 2010. Twenty-six of these patients underwent primary surgical repair, whereas 20 presented for revision surgery from outside facilities. Ten revision cases required an ear cartilage graft, and 5 required a rib graft. The overall complication rate was 9% (4 patients), with 4% (2 patients) each for minor and major complications. CONCLUSIONS: Complication rates of ECS are similar to those of endonasal septoplasty. Stable midline fixation of a reconstructed neocaudal septum is possible with a new technique that relies on novel splinting instead of suture fixation to the midline of the nasal spine.

A graded approach to repairing the stenotic nasal vestibule.

OBJECTIVE: To describe a graded approach to repairing vestibular stenosis that involves restoring structural support to the ala. METHODS: Retrospective review of 5 nostrils in 4 patients who presented to the senior author with vestibular stenosis. The cause was burn injury in 3 patients and congenital in 1 patient. The cornerstone is a batten graft to restore strength to the ala. A short-term thermoplastic stent helps the nostril assume its natural shape. When an obstructing cicatrix is present, it is excised in a second stage followed by full-thickness skin grafting. The patients were evaluated up to 16 months postoperatively. Vestibular patency was documented using high-resolution photographs, and medical records were reviewed for complications. RESULTS: Two patients had their nostrils repaired in a single stage and the others required 2 stages. In all patients, significant improvement in nostril diameter was maintained. The patients were satisfied with the functional and aesthetic results. Stenting averaged 13 days after surgery and was well tolerated. No wound complications occurred. CONCLUSIONS: In patients with vestibular stenosis, we use a graded approach that addresses the inherent weakness of the nasal ala to achieve long-term vestibular patency. This technique restores form and function to the stenotic vestibule while avoiding long-term stenting.

Considerations in male aging face consultation: psychologic aspects.

Historically, the male cosmetic surgery patient has been viewed as being highly psychopathologic. Recent studies have refuted this longheld belief. However, when conducting a male aging face consultation, it is important for cosmetic surgeons to perform a focused psychiatric assessment to screen for mentally-ill patients, who may not be good surgical candidates. Included in the spectrum of psychiatric diseases that should be recognized is body dysmorphic disorder, an illness characterized by distortions in body perception, which has a higher prevalence in the cosmetic surgery population. By taking a focused psychiatric history, the cosmetic surgeon can identify patients who have untreated psychiatric pathology and are not psychologically appropriate for surgery. These patients would instead benefit from consultation with a mental health professional.

Prone positioning for head and neck reconstructive surgery.

Certain head and neck surgical cases require the patient to be positioned prone. Such positioning carries with it an attendant subset of risks and complications not otherwise encountered in more traditional supine positioning. Gaining awareness of these risks and complications, and developing proactive positioning strategies, will enable the surgical team to position the patient optimally for the procedure and provide for every consideration of patient safety. This article consists of a specific literature review of those issues directly related to the anatomical and physiological concerns arising from prone positioning. Particular attention is paid to the cardiopulmonary, renal, ophthalmologic, and neurological vulnerabilities unique to this position. Proper planning by the surgical team and utilization of the correct equipment are a necessity. A tailored approach to the needs of the individual patient and an intimate awareness of the potential pitfalls will contribute to better outcomes when using the prone position.

Nasal valve suspension revisited.

OBJECTIVES: Nasal valve suspension (NVS) is a simple technique to correct nasal valve obstruction or collapse by providing a lateral vector of pull on the nasal sidewall. The purpose of this research was to review our experience with NVS in a cohort of patients with nasal valve collapse, including a subset of patients with facial paralysis. The objectives were to determine patient satisfaction and complication rates after NVS. STUDY DESIGN: A retrospective review of patients 18 years and older who had NVS from 2003 to 2006 with a follow-up of at least 1 month was performed. METHODS: Data were collected on diagnosis, surgical outcomes, complications, and treatments required. Complications included adverse outcomes, infections, and the need for repeat surgery or treatments. RESULTS: In 17 charts reviewed, 9 patients (53%) had nasal valve collapse as a result of facial paralysis, and 8 (47%) had previous nasal surgery. Follow-up ranged from 1 to 30 months, with a mean of 16.5. Moderate to complete resolution of obstruction was reported by 82% of patients, or for 88% of procedures. Sustained relief was observed in two of eight patients who had previous nasal surgery and six of nine who had no previous nasal surgery (P = .1). Infection occurred in four (24%) patients and five (21%) total suspensions and ranged from 1.5 to 7 months. Six (35%) patients experienced a loss of suspension at 6 to 22 months. CONCLUSIONS: NVS is a technically straightforward, relatively reversible procedure particularly useful in the patient with facial paralysis. The efficacy is excellent in the short term yet appears to diminish with time.