Twelve Steps to Optimize Scar Outcomes in External Rhinoplasty.

A well-healed scar extends beyond a mere superficial concern, reflecting the precision and care underlying the surgery. This study addresses the lack of recent literature on the complete closure technique for external rhinoplasty scars, emphasizing its potential impact on patient satisfaction and overall aesthetic quality. The main purpose of this article was to introduce and assess the efficacy of a novel closing suture technique for external rhinoplasty and emphasize on 12 specific steps for wound closure. A cohort of 104 patients who underwent external rhinoplasty utilizing the proposed closing suture technique were evaluated. Standardized photographic documentation and scar assessment were performed using the Vancouver-Manchester scale, considering notching, skin level differences, pigmentation, and overall appearance. The surgical approach involved a combination of vertical mattress and interrupted simple sutures, creating an effective closure framework. Analysis revealed an absence of poor scars, with 83.6% classified as good. Note that 65.5% of the good scars achieved a perfect 6-point score. While one moderate scar scored 3 points, the majority demonstrated optimal outcomes. Clinical photographs further illustrated the technique's success, showcasing imperceptible scars and reinforcing the efficacy of the complete closure approach. Our study introduces and assesses the efficacy of the complete closure technique for external rhinoplasty scars. The approach consistently yields positive outcomes, with an emphasis on almost imperceptible scars. While not achieving a 100% imperceptible scar rate, this study underscores the need for ongoing research to refine techniques and enhance patient satisfaction in external rhinoplasty. The proposed technique contributes significantly to scar management practices and encourages further exploration within the evolving landscape of rhinoplasty.

Apaydin Classification of Spreader Flaps Updated.

The use of spreader flaps (SFs) is very helpful in middle vault reconstruction. The aim of the study was to evaluate the versatility of Apaydin classification of SFs on a patient population. This was a retrospective analysis which included 120 rhinoplasty cases. Thorough preoperative planning adhering to precision profileplasty principles was conducted for all patients. The study employed six primary variants of SFs. SFs' types were utilized as follows: type 1 in 41 patients (34.2%), type 2 in 2 patients (1.7%), type 3A in 38 patients (31.7%), types 3B and 3D in 10 cases each (8.3%), type 3C in 2 cases (1.7%), type 4 in 5 cases (4.2%), type 5 in 7 cases (5.8%), and type 6 in 5 cases (4.2%). This study highlights that different SF techniques should be tailored according to the need of the patient when dealing with middle vault reconstruction during reduction rhinoplasty.

Standardizing Septocolumellar Sutures: A New Practical Classification.

The septocolumellar sutures are very helpful to obtain planned rotation and projection. The goal of this study is to revitalize the septocolumellar techniques described before and present an easy new classification for these sutures, and to present their multiple uses on the same patient as a new option for surgeons. Eighty patients were involved in this retrospective study. All the patients were females except one. A detailed preoperative preparation was performed on all patients by following the principles of precision profileplasty. In this study, five main types of septocolumellar sutures were used. Type 4 septocolumellar suture was used in 39 cases, type 3 in 33, type 2 in 22, type 1 in 5, and type 5 in 2 cases. In 21 cases, more than one suture was used. In conclusion, the new practical classification presented in this study gives the surgeon powerful tools to reshape the tip during surgery.

Lamb Head as a Training Model for Septoplasty and Rhinoplasty.

Septoplasty and rhinoplasty are difficult operations to learn and teach. Many modalities have been proposed to make the teaching process of these operations easier. In this study, it was investigated if lamb heads were good training models to teach septoplasty and rhinoplasty to trainees or experienced surgeons. In the first part of the study, 21 lamb heads were dissected according to a dissection protocol and several anatomical distances were measured to compare them with human cadavers. In the second part, eight lamb heads were dissected and different preservation rhinoplasty techniques were practiced. The study on 21 lamb heads used showed that the lateral crura were 17.8 × 11.6, the average interdomal distance was 8.1 mm, and the average domal width was 3.7 mm. The average length of the upper lateral cartilages was 31.1 mm laterally and 21.2 medially. The average length of the nasal bones was 63.9 mm, and the width was 16 mm. In the second part of the study, 8 lamb heads were used to experience where high-strip techniques were used in 5 and the Cottle technique in 3. This study revealed that lamb heads should be considered as an excellent training model for septoplasty and rhinoplasty. Its very low cost, ease of availability, and close similarity to the human cadavers can be counted as the main advantages. This study also proved that it was not only a tool for beginners, but also a very helpful tool for experienced surgeons to try new methods.

Which Lighting Option Is the Best for Photography in Rhinoplasty?

Photography for preoperative analysis and follow-up is indispensable for the facial plastic surgeon. The use of strobe flash units, light-emitting diode (LED) lamps, and their position related to axis of the patient can affect the nasal contours and nasal measurements. The aim of this study was to compare the rhinoplasty pictures taken under three different lighting settings and two different positioning at 30- and 45-degree angles, and with direct measurements taken by caliper from the subjects. Standardized rhinoplasty pictures from 10 patients were taken in frontal view in a studio. These pictures were taken under three different lighting settings: built-in flash of the camera, two strobe flashes, and two LED continuous lights placed at 30 to 45 degree angles to the patient. All the pictures were uploaded to Rhinobase 2.0. In five subjects, direct measurements were done by using a Vernier caliper and compared with the computer measurements. In this study, when comparing the light sources and the angles without taking single flash into account, no relation was found between strobe lights at 30 and 45 degrees and between LED lights at 30 and 45 degrees regarding tip width, base bony width, dorsum width, interalar width, and nasal length. However, a statistically significant difference was found when the angle was changed from 30 to 45 degrees for tip width, interalar width and nasal length. The use of two LED continuous lights or two strobe lights in a studio setting has given similar results. Changing the angles of the light sources from 30 to 45 degrees affected only the tip width and the interalar width; otherwise the rest of the nasal measurements did not show any significant changes. The pictures taken at 45-degree angles to the subject showed the closest values to the direct measurements done on the patient.