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2.
Clin Plast Surg ; 49(1): 149-160, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782133

RESUMO

Today non-Caucasian patients comprise an important group of patients seeking rhinoplasty. The term non-Caucasian is used interchangeably to speak about patients of ethnic origin. It becomes important to understand the interplay of culture, race, and ethnicity when evaluating patients and defining what their aesthetic ideals are and what will be needed for surgery. An integrated approach and management of the non-Caucasian patient is presented in which medical and surgical options are explored. The final goal when treating non-Caucasian patients should be trying to help patients achieve their aesthetic ideal in the best possible fashion.


Assuntos
Rinoplastia , Estética , Humanos , Nariz/cirurgia
3.
Artigo em Inglês | MEDLINE | ID: mdl-33970690

RESUMO

Background: Dorsal preservation rhinoplasty (DPR) has recently received significant academic attention in part due to theoretical benefits over excisional surgical methods. The purpose of this study was to assess the global practice patterns regarding this technique. Materials and Methods: An 11-item questionnaire was electronically distributed to regional academies/societies representing rhinoplasty surgeons worldwide. Respondent exposure to and use of DPR were assessed based on geographic location. Results: Eight hundred thirty-six responses were received. Despite early publications on DPR originating largely from Western Europe and the United States, Turkey and Mexico have the greatest use of DPR techniques currently. The familiarity across many regions with preservation techniques appear to be secondary to courses and conferences rather than incorporation into training. Mexico demonstrates the greatest exposure to DPR during training. One hundred twenty-five respondents had previously used but abandoned dorsal preservation techniques. Poor results, less predictability, and complications (largely hump recurrence) are cited as common reasons for this. Conclusion: There is variability in the global practice of DPR across regions and this will likely continue to evolve.

4.
Facial Plast Surg Clin North Am ; 28(4): 531-541, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33010872

RESUMO

This article is intended to engage international facial plastic and reconstructive surgeons so they can maximally benefit from the increased connectivity fostered by the Internet. Facial plastic surgeons are encouraged to participate in the educational programs being developed by the International Federation of Facial Plastic Surgery Societies. Many international surgeons grapple with the issues surrounding the development or expansion of their own facial plastic and reconstructive surgery practices. The Strategy Circle and suggestions on how to acquire knowledge and surgical skills are discussed. Practical recommendations to assist in transitioning a practice to facial plastic and reconstructive surgery are provided.


Assuntos
Certificação , Prática Profissional/organização & administração , Sociedades Médicas , Cirurgia Plástica , Competência Clínica , Face/cirurgia , Bolsas de Estudo , Humanos , Internacionalidade , Marketing de Serviços de Saúde , Procedimentos Cirúrgicos Reconstrutivos , Mídias Sociais , Cirurgia Plástica/educação
5.
Facial Plast Surg ; 36(4): 447-452, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32866981

RESUMO

Minimally invasive cosmetic procedures are in increasing demand worldwide. Patients are constantly searching for office-based techniques that can help improve the signs of aging but without the morbidity of a surgical procedure. Thread lifting with polydioxanone (PDO) sutures is a cosmetic procedure where lax tissue is lifted and repositioned trying to create a more youthful looking facial contour. The threads are absorbable and come in different shapes and lengths. The rate of complications and the downtime of the procedure are low, which are something patients are looking for. Ideally, these procedures should be performed by trained specialists who have complete knowledge of the facial anatomy, thus enhancing and improving results. Thread lifting with PDO absorbable threads has become an excellent option for minimally invasive facial rejuvenation procedures with a high satisfaction among patients and very few complications. It is a new tool that can be introduced in the armamentarium of specialists who work in the field of facial plastic surgery and who can offer this option to their patients with improved outcomes.


Assuntos
Ritidoplastia , Envelhecimento da Pele , Face , Humanos , Polidioxanona , Rejuvenescimento
6.
Facial Plast Surg Aesthet Med ; 22(3): 219-224, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32101478

RESUMO

Importance: Intraoperative videography is widely used to record rhinoplasty procedures, yet little is known about the optimal surgical vantage points at critical procedural steps. Objective: To assess commonly used camera angles in public and proprietary intraoperative rhinoplasty videos and discuss approaches to obtaining these viewing angles. Design: Public and propriety rhinoplasty videos were reviewed and categorized based on procedure type, specific area(s) of focus, and camera angles utilized at a series of critical operative steps. The most commonly used camera angles were recorded and assessed based on surgical field visualization and the authors' personal recording experiences. Results: Of the 114 videos that met inclusion criteria, 49 were full-length open rhinoplasty procedures, 20 full-length endonasal rhinoplasty procedures, 17 tip techniques, 8 opening techniques, 7 fashioning grafts, 7 osteotomies, and 6 cartilage harvests. With respective to footage acquisition, the upward camera angle was most frequently used for recording, and endoscopic view was least frequently used. Conclusions and Relevance: These findings demonstrate that there is extensive variability in camera angles between surgical films. Moreover, many of these camera angles are insufficient due to obstruction by surgical staff, inability to visualize deep structures, and difficulty capturing the three-dimensional nasal framework. A guide indicating the best viewing angles for different aspects of the procedure would be useful to optimize educational videos.


Assuntos
Rinoplastia/educação , Gravação em Vídeo/normas , Guias como Assunto , Humanos , Período Intraoperatório
7.
Otolaryngol Clin North Am ; 53(2): 267-282, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32037080

RESUMO

Mestizo noses have mesorrhine nasal characteristics. They have a modest osteocartilaginous framework, nasal tips that tend to be bulbous with poor projection and rotation, and skins that tend to be thick and acne prone. A structural rhinoplasty approach is performed, focusing on anatomic findings. Conservative tissue excision with preservation or reinforcement of support structures of the nose is done. Structural grafting and suturing techniques are used to remodel cartilage and create better definition and support. The skin and soft tissue envelope is managed medically and surgically. The objective is to create balanced-looking noses that bring patients closer to their own aesthetic ideal.


Assuntos
Estética , Nariz/anatomia & histologia , Rinoplastia/métodos , Cartilagem/transplante , Assistência à Saúde Culturalmente Competente , Humanos , Septo Nasal/anatomia & histologia , Septo Nasal/cirurgia , Técnicas de Sutura
8.
Acta otorrinolaringol. cir. cabeza cuello ; 48(e-Boletín): 97-101, 2020. ilus, tab
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1095918

RESUMO

Una de las especialidades más afectadas con la pandemia del coronavirus SARSCov- 2/ COVID-19 es la otorrinolaringología y la cirugía plástica facial. El contacto estrecho que tienen los cirujanos plásticos faciales con la mucosa nasal, cavidad oral y nasofaringe durante el examen médico, los procedimientos de consultorio y las cirugías funcionales, estéticas y reconstructivas, ha elevado las posibilidades de contagio de esta especialidad por la alta carga viral encontrada en estos sitios anatómicos. Actualmente se están definiendo los parámetros nacionales e internacionales para definir los criterios de bioseguridad y de elementos de protección personal (EPP) para poder reiniciar la consulta externa, los procedimientos mínimamente invasivos y los procedimientos quirúrgicos del área de cirugía plástica facial. Se presentará un esquema para la realización de actividades de consulta externa, procedimientos mínimamente invasivos y procedimientos quirúrgicos electivos, estableciendo normas de seguridad para el paciente y los trabajadores de la salud. Cuando se inicien estas actividades va a depender en gran parte de la evolución de la pandemia y de la disponibilidad de servicios médicos y quirúrgicos en los diferentes ámbitos profesionales. Sin embargo, es importante hacer las adecuaciones necesarias para poder prestar los servicios de salud de la mejor manera posible y con los más altos estándares de calidad y seguridad para los pacientes y todo el personal administrativo y de salud.


Otolaryngology and facial plastic surgery are specialties have been affected directly by the pandemia of the coronavirus SARS Covid 2/Covid 19. Facial plastic surgeons have close contact with nasal mucosa, oral cavity and nasopharynx during the physical examination, the performance of office procedures and during functional and cosmetic surgery, elevating the risk of exposure and infection due to the high concentrations of Covid 19 virus found in these anatomic sites. Currently, national and international parameters are being established to try and define which are the best biosafety parameters and protective personal equipment (PPE) to be able to reopen outpatient clinics, perform minimally invasive procedures and eventually elective surgical procedures in the area of facial plastic surgery. A plan will be presented implementing guidelines trying to guarantee the highest security standards for the patient and the health workers. The timing to re-open facilities will depend mainly on the evolution of the pandemic and the availability of medical and surgical facilities in the different areas of the country. Despite this, it becomes important to start establishing the necessary changes to be able to offer health services with the highest standards of quality and security for patients, administrative and health personnel.


Assuntos
Humanos , Otolaringologia , Cirurgia Plástica , Infecções por Coronavirus , Procedimentos Cirúrgicos Reconstrutivos , Equipamento de Proteção Individual , Betacoronavirus
9.
Facial Plast Surg ; 35(4): 313-321, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31470460

RESUMO

Ethnic rhinoplasty traditionally has been used to define this surgical procedure performed on non-Caucasian patients. Because of globalization, massive migrations, and interracial mixing, ethnic patients today are considered mixed race patients. Surgical techniques should be based not on what ethnic group they belong to but on anatomical findings and patients' needs and wishes. Preservation techniques are presented and structural approaches are discussed using sutures and grafts. The final objectives of rhinoplasty are better definition, more refined appearance, and compliance with patients' aesthetic ideals while preserving function.


Assuntos
Rinoplastia , Cartilagem , Estética , Humanos , Nariz
10.
Plast Reconstr Surg Glob Open ; 7(3): e2153, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31044120

RESUMO

Background: The Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) questionnaire is a new instrument that was developed to evaluate both functional and cosmetic components of rhinoplasty. It is a reliable, consistent, and validated patient-reported outcome measure that is not available in Spanish. Methods: The SCHNOS questionnaire was forward translated, back translated, and culturally adapted following international guidelines. Its psychometric validity was tested with native Spanish speakers in 2 centers in Colombia. The authors measured internal consistency, correlation, and reproducibility to determine validity of the instrument. Results: The final Spanish version of the SCHNOS was administered to 76 native Spanish speakers. Both the SCHNOS-O (obstructive domain) and SCHNOS-C (cosmetic domain) showed a high internal consistency with Cronbach's alpha of 0.84 and 0.94, respectively. The Spearman correlations between the items of SCHNOS-O (0.38-0.82) and SCHNOS-C (0.49-0.88) were positive and significant. Spearman's rank correlation in the test-retest analysis for SCHNOS-O (r = 0.87) and SCHNOS-C (r = 90) was positive and statistically significant. There was statistical significance in responses obtained for SCHNOS-O (P < 0.001) but not for SCHNOS-C (P = 0.222). Conclusions: In this study, the SCHNOS was successfully translated and culturally adapted into Spanish. The Spanish version of the SCHNOS was shown to be a reliable and valid instrument that we recommend it should be used in Spanish-speaking patients who are having functional or cosmetic rhinoplasty.

11.
JAMA Facial Plast Surg ; 21(2): 96-102, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30629094

RESUMO

Importance: The "other-race effect" describes the phenomenon in which individuals demonstrate greatest recognition ability among faces of their own race. Thus, in our multicultural world, it follows that race influences social interactions. However, the association of race with perception of plastic surgery outcomes has not been studied. Objective: To objectively measure how the other-race effect influences perception of white and Latin American patients undergoing rhinoplasty by using eye-tracking technology and survey methodology. Design, Setting, and Participants: In the first part of the study, 134 participants viewed 32 paired facial images of white and Latin American patients, either prerhinoplasty or postrhinoplasty, on an eye-tracking system that recorded observer scan paths. In the second part of this study, the same patient images were individually graded by a separate group of 134 participants for degree of racial identification and perceived attractiveness. Main Outcomes and Measures: The primary outcome was to measure the influence of patient and observer race on perception of rhinoplasty outcomes. For the eye-tracking part, planned hypothesis testing was conducted using an analysis of variance to compare patient race, rhinoplasty status, and attractiveness with respect to visual fixation time. Results: Of the 134 eye-tracking participants, 68 (51%) were women and the mean (SD) age was 26.4 (7.7) years; of the 134 graders, 64 (48%) were women and the mean (SD) age was 25.0 (6.9) years. Rhinoplasty did not affect racial identity scores among either same-race or other-race evaluators. Visual fixation times for white faces were significantly increased compared with Latin American faces among all casual observer groups (white observers mean change, -20.14 milliseconds; 95% CI, -29.65 to -10.62 milliseconds; P < .001; Asian observers mean change, -39.04 milliseconds; 95% CI, -48.95 to -29.15 milliseconds; P < .001; and African American observers mean change, -20.73 milliseconds; 95% CI, -37.78 to -3.69 milliseconds; P < .02), with the exception of Latin American observers (mean change, -7.8 milliseconds; 95% CI, -29.15 to 14.39 milliseconds; P < .51). With respect to attractiveness, white graders reported a significant postrhinoplasty increase across both races (white patients mean change, 8.07 points; 95% CI, 5.01-11.12 points; P < .001; and Latin American patients mean change, 3.69 points; 95% CI, 0.87-6.49 points; P = .01), whereas Latin American graders only observed a significant attractiveness increase in their own race (Latin American patients mean change, 10.50 points; 95% CI, 1.70-19.32 points; P = .02). Neither perceived attractiveness nor rhinoplasty status influenced fixation times. Conclusions and Relevance: Both patient and observer race influence visual attention and perception of attractiveness before and after rhinoplasty. These findings underscore the importance of counseling patients that the influence of rhinoplasty, as perceived by the casual observer, may vary by race or ethnicity of the observer group. Level of Evidence: NA.


Assuntos
Beleza , Rinoplastia/psicologia , Percepção Social , /psicologia , Adulto , Atenção , Movimentos Oculares , Feminino , Humanos , Masculino , Inquéritos e Questionários
14.
Facial Plast Surg ; 34(1): 3-8, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29409097

RESUMO

Patients with thick skin are a challenge in facial plastic surgery. Rhinoplasty is still the most frequently performed facial plastic procedure worldwide and it becomes very difficult to obtain optimal consistent results in these patients. A systematic presurgical skin evaluation is performed dividing skin into type I-III depending on the elasticity, oiliness, presence of skin alterations, size of skin pores, and laxity. Depending on the skin type, presurgical, surgical, and postsurgical management of the epidermis and dermis is defined. Preconditioning and treating thick skin can improve postsurgical results and reduce postsurgical unwanted results.


Assuntos
Cicatriz/prevenção & controle , Fármacos Dermatológicos/administração & dosagem , Rinoplastia/métodos , Pele/fisiopatologia , Cicatrização/fisiologia , Estética , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Rinoplastia/efeitos adversos , Pele/efeitos dos fármacos , Fenômenos Fisiológicos da Pele
15.
Artigo em Inglês | MEDLINE | ID: mdl-27846021

RESUMO

PURPOSE OF REVIEW: The caudal septum has important functional and aesthetic implications. Deviations in this area can result in important nasal obstruction due not only to blockage of the nasal passage but also to compromise of the internal nasal valve. Cosmetically, alterations in the caudal septum can result in a twisted nasal tip, loss of projection, rotation, and imbalance in the ala-columellar relationship. Contemporary surgical options will be discussed showing how to preserve, reshape, and reinforce the caudal septum to obtain a final looking nose that is not only functional but also aesthetically pleasing. RECENT FINDINGS: Recent publications have shown that cartilage preservation and remodeling techniques can be efficient in the treatment of the caudal septum. Adequate preoperative diagnosis must be made to be able to create a step-wise approach evolving from simple suturing techniques to more complex ones that require the use of grafts to reposition and keep the caudal septum in the midline with an adequate functional and cosmetic outcome. SUMMARY: Adequate management of the caudal portion of the nasal septum is a challenge because of its importance in nasal function and cosmetic final results. There are many surgical options that can be used to correct and align this structure and there is no one single surgical technique that can be used in all cases. A step-wise approach is presented covering the different techniques used today evolving from simple to more complicated ones. The final surgical objective should be cosmetically pleasing noses that function appropriately.


Assuntos
Cartilagem/transplante , Septo Nasal/cirurgia , Rinoplastia/métodos , Técnicas de Sutura , Colômbia , Estética , Humanos , Masculino , Obstrução Nasal/fisiopatologia , Obstrução Nasal/cirurgia , Septo Nasal/anormalidades
16.
Facial Plast Surg ; 32(6): 656-661, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28033642

RESUMO

One of the characteristics of mestizo patients can be the thick sebaceous skin associated with a poor osteocartilaginous underlying nasal structure. In spite of using a proper structural approach where grafts and sutures are used to define the nasal tip, frequently the results are suboptimal. Surgical techniques have been described to reduce the thickness of the skin-soft tissue envelope, but these frequently give unreliable results. The monitored use of isotretinoin given orally as a complement after performing a rhinoplasty can adequately control the production of the sebaceous glands and thin the skin-subcutaneous tissue envelope in a uniform fashion without compromising the underlying bony and cartilaginous structures of the nose. Patients ideally should be treated jointly with a dermatologist and be followed closely to monitor hepatic function. Follow-up after 2 years with pre- and postoperative pictures shows improved definition of the nasal tip and dramatic improvement on sebaceous gland production.


Assuntos
Fármacos Dermatológicos/farmacologia , Isotretinoína/farmacologia , Rinoplastia/métodos , Pele/anatomia & histologia , Administração Oral , Feminino , Humanos , Masculino , Estudos Retrospectivos , Pele/efeitos dos fármacos , Resultado do Tratamento
17.
Clin Plast Surg ; 43(1): 237-54, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26616711

RESUMO

Rhinoplasty is the main facial plastic procedure performed in Latin America. Mestizo or Latino patients tend to have noses with thick skin, bulbous tips with poor projection, and flimsy osteocartilaginous underlying frameworks. A technique is presented in which structural grafts are used to strengthen support structures of the nose. A gradual approach is used to obtain tip definition, rotation, and projection using sutures and grafts. Simple techniques are used initially, progressing to more aggressive and less predictable ones in patients who require greater changes. The result should be noses that look more refined, with greater definition, but without looking bigger.


Assuntos
Rinoplastia/métodos , Cartilagem/transplante , Humanos , Próteses e Implantes
18.
Facial Plast Surg Clin North Am ; 22(3): 395-415, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25049124

RESUMO

Mestizo patients are the largest ethnic minority in the United States; the main facial plastic procedure they request is rhinoplasty. Mestizo noses are a challenge. It is common to find bulbous, undefined nasal tips sitting on a poorly structured osteocartilaginous framework. A structural approach is presented whereby support structures of the nose are strengthened and reinforced with structural grafts. A gradual approach to the nasal tip is presented whereby sutures and grafts are used to improve rotation and projection and create more definition. Cases showing long-term results are presented with discussion of the different surgical techniques used.


Assuntos
Nariz/anatomia & histologia , Rinoplastia/métodos , Assistência à Saúde Culturalmente Competente , Humanos , Septo Nasal/anatomia & histologia , Septo Nasal/cirurgia , Osteotomia , Técnicas de Sutura
20.
Facial Plast Surg ; 29(3): 149-53, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23761117

RESUMO

In an effort to try to define the tendencies in the practice of facial plastic surgery in the different countries of Latin America, a survey was conducted from June 2012 to August 2012. Questionnaires were sent to specialists in otolaryngology and facial plastic surgery in the countries of Colombia, Brazil, Venezuela, Ecuador, Chile, Peru, and Mexico. Results are shown and discussed. Comparisons are made with existing surveys performed by the American Academy of Facial Plastic and Reconstructive Surgery.


Assuntos
Face/cirurgia , Cirurgia Plástica/estatística & dados numéricos , Cirurgia Plástica/tendências , Adulto , Idoso , Blefaroplastia/estatística & dados numéricos , Toxinas Botulínicas Tipo A/administração & dosagem , Feminino , Humanos , Ácido Hialurônico/administração & dosagem , América Latina , Masculino , Pessoa de Meia-Idade , Otolaringologia/estatística & dados numéricos , Rinoplastia/estatística & dados numéricos , Sociedades Médicas , Inquéritos e Questionários , Viscossuplementos/administração & dosagem , Adulto Jovem
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