Changing practices in septorhinoplasty: the Irish experience.

PURPOSE: Septorhinoplasty (SR) is one of the most complex surgical procedures of the head and neck. As an elective procedure aiming to enhance patient quality of life, it can be difficult to perform in single-payer healthcare systems due to capacity pressures from acute and oncological surgical demand. We aimed to review national trends in the practice of SR to inform future healthcare planning. METHODS: This was a cross-sectional, population-based, longitudinal study of SR cases in Ireland's single-payer (public) healthcare system from 2005 to 2021. Time-series analysis using a linear regression model was performed to analyse trends by operation type, revision rates and length of stay. The impact of the COVID-19 pandemic and introduction of national surgical guidelines was analysed. RESULTS: 1952 SR were performed. Annual mean cases declined in both real (r = - 0.76, p < 0.01) and relative (r = - 0.87, p < 0.01) terms by 31% and 43%, respectively. Ambulatory SR, while initially rarely performed, increased to account for 55% of cases performed. The mean hospital length of stay declined significantly (r = - 0.84, p < 0.01) by 44%. CONCLUSIONS: SR increasingly struggles to find its place in Ireland's public healthcare system. New changes in SR practices including the rapid growth of ambulatory surgery and shorter lengths of hospital stay indicate positive responses to the mounting pressures faced by healthcare systems.

A Google Trends Analysis of Facial Plastic Surgery Interest During the COVID-19 Pandemic.

The COVID-19 pandemic has had a multitude of effects on daily life. Aesthetic and cosmetic surgery practices have been significantly reduced in their working capacity or closed during this time. We used Google Trends to gauge the public's interest in facial plastic surgery during this pandemic, and how it has changed over the preceding months. As local shelter-in-place orders are being lifted, interest in facial plastic surgery is increasing even in the context of an ongoing national pandemic. LEVEL OF EVIDENCE V: Letter to the Editor.

Oculoplastic surgery practice during the COVID-19 novel coronavirus pandemic: experience sharing from Hong Kong.

At present, all parts of the world are hit hard by COVID-19. The first confirmed case of COVID-19 in the territory of Hong Kong was announced on January 23, 2020. Since then, oculoplastic surgeons in Hong Kong have been taking every measure to protect all healthcare workers and patients from contracting the disease. This paper aims to share the experiences of and measures taken by local oculoplastic surgeons in combating COVID-19. Three main aspects are discussed, namely clinical, administrative, and training and educational. We hope our experiences would provide reference to fellow oculoplastic colleagues in other parts of the world in fighting this COVID-19 pandemic.

Google Trends as a Resource for Informing Plastic Surgery Marketing Decisions.

BACKGROUND: Celebrities have long influenced the medical decisions of the general population. By analyzing Google search data using Google Trends, we measured the impact of highly publicized plastic surgery-related events on the interest level of the general population in specific search terms. Additionally, we investigated seasonal and geographic trends around interest in rhinoplasties, which is information that physicians and small surgical centers can use to optimize marketing decisions. METHODS: Google Trends was used to access search data histories for three separate areas of interest: Kylie Jenner and lip fillers, Joan Rivers and plastic surgery, and rhinoplasty, which were then analyzed using two-tailed, two-sample equal variance t-tests. RESULTS: The average interest level in fillers increased by 30.31 points after Kylie Jenner announced that she received Juvéderm lip injections. The interest level in plastic surgery was decreased by 21.3% the month after Joan Rivers' death. Between January 2004 and May 2017, the average interest level for rhinoplasty was significantly different in January/December (67.91 ± 20.68) and June/July (70.12 ± 18.89) from the remaining calendar months (63.58 ± 19.67). Los Angeles, New York City, and Miami showed consistently high interest levels throughout the time period, while Tulsa, OK, showed a major interest increase between 2015 to 2016 of 65 points. CONCLUSIONS: A noticeable impact was observed in both celebrity cases on search term volume, and a seasonal effect is apparent for rhinoplasty searches. As many surgeons already employ aggressive Internet marketing strategies, understanding and utilizing these trends could help optimize their investments, increase social engagement, and increase practice awareness by potential patients. 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 .

Trends in Nasal Subunit Reconstruction by Facial Plastic and Reconstructive Surgeons.

To determine if facial plastic and reconstructive surgeons still adhere to the classic nasal subunit principle as described by Burget and Menick. Observational survey. A Weill Cornell Medicine institutional review board approved electronic survey that was sent via e-mail to active members of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). The survey consisted of 32 multiple-choice questions pertaining to the operative management of small (22-30%), medium (50-58%), and large (75-81%) defects of each subunit of the nose, as well as demographic, provider, and practice characteristics. There were 111 responses to the survey (10.1% response rate). Ninety-eight percent of respondents reported familiarity with the subunit principle, and 59.6% considered the subunit principle in greater than 90% of cases. Almost three-quarters (70.4%) of respondents felt the subunit principle should be applied but could be modified based on the particular nasal defect, whereas 28.7% felt it was only sometimes helpful and was not mandatory for successful nasal reconstruction. Large defects of the tip and ala are generally treated by excision of the remaining subunit (79.4 and 80.6%, respectively). Fewer surgeons would excise the remaining subunit for large defects of the dorsum (39.8%), sidewall (38.8%), and soft tissue facet (18.4%). Simple repair without additional excision was the treatment of choice for small defects of the tip (58.2%), ala (59.2%), sidewall (65%), dorsum (68%), and soft tissue facet (71.8%). However, in many small- (up to 32%) and medium- (up to 51%) sized defects of the tip, ala, sidewall, and dorsum, respondents reported partial subunit excision. The majority of AAFPRS members abide to the classical subunit principle by completely excising the remaining subunit for large defects of the tip and ala. Many surgeons modify the subunit principle in small and medium defects.

Use of Computer Imaging in Rhinoplasty: A Survey of the Practices of Facial Plastic Surgeons.

OBJECTIVE: The objective of this study was to quantify the use of computer imaging by facial plastic surgeons. METHODS: AAFPRS Facial plastic surgeons were surveyed about their use of computer imaging during rhinoplasty consultations. The survey collected information about surgeon demographics, practice settings, practice patterns, and rates of computer imaging (CI) for primary and revision rhinoplasty. For those surgeons who used CI, additional information was also collected, which included who performed the imaging and whether the patient was given the morphed images after the consultation. RESULTS: A total of 238 out of 1200 (19.8%) facial plastic surgeons responded to the survey. Out of those who responded, 195 surgeons (83%) were board certified by the American Board of Facial Plastic and Reconstructive Surgeons (ABFPRS). The majority of respondents (150 surgeons, 63%) used CI during rhinoplasty consultation. Of the surgeons who use CI, 92% performed the image morphing themselves. Approximately two-thirds of surgeons who use CI gave their patient a printout of the morphed images after the consultation. CONCLUSIONS: Computer imaging (CI) is a frequently utilized tool for facial plastic surgeons during cosmetic consultations with patients. Based on these results of this study, it can be suggested that the majority of facial plastic surgeons who use CI do so for both primary and revision rhinoplasty. As more sophisticated systems become available, it is possible that utilization of CI modalities will increase. This provides the surgeon with further tools to use at his or her disposal during discussion of aesthetic surgery. 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 .

[New aspects in reconstructive nasal surgery]. / Neue Aspekte bei der rekonstruktiven Nasenchirurgie.

Developments in surgical procedures have led to improved results in the field of reconstructive nasal surgery. In this article, the authors focus on the forehead flap technique in one of its smallest forms to cover three-layered alar defects. The example of a complete nasal reconstruction shows how, despite the use of a proven surgical concept, serious complications could occur. In the case shown, a satisfactory outcome was achieved by starting anew with the forehead flap in one of the largest forms-the expanded lateral forehead flap. The authors ascribe particular importance to preoperative analysis with standardized series of photographs. Such series should be made before each surgical step. These are indispensable for structured planning and, thus, are prerequisite for an excellent outcome.

Inferior turbinoplasty during cosmetic rhinoplasty: techniques and trends.

BACKGROUND: The sheer number of accepted inferior turbinoplasty techniques emphasizes the fact that there is no general agreement on which approach yields optimal results, nor are there data available that describes prevalent techniques in turbinate surgery among plastic surgeons. OBJECTIVE: The aim of this study was to identify practice patterns among plastic surgeons who perform inferior turbinoplasty during rhinoplasty. METHODS: Members of the American Society of Plastic Surgeons were invited to participate in an anonymous, Internet-based survey containing questions related to personal preferences and outcomes in inferior turbinate surgery. RESULTS: A total of 534 members of the American Society of Plastic Surgeons participated in the survey. Most (71.7%) trained in an independent plastic surgery program with prerequisite training in general surgery. More than half (50.6%) had more than 20 years of operative experience; only 15.2% reported performing greater than 40 rhinoplasties per year. The 5 most preferred inferior turbinate reduction techniques were outfracture of the turbinates (49.1%), partial turbinectomy (33.3%), submucous reduction via electrocautery (25.3%), submucous resection (23.6%), and electrocautery (22.5%). Fewer than 10% of the respondents reported the use of newer techniques such as radiofrequency thermal ablation (5.6%), use of the microdebrider (2.2%), laser cautery (1.1%), or cryosurgery (0.6%). Mucosal crusting and desiccation were the most frequently reported complications. CONCLUSIONS: The results of this survey provide insights into the current preferences in inferior turbinate reduction surgery. Plastic surgeons are performing more conventional methods of turbinate reduction rather than taking advantage of the many of the more novel technology-driven methods.

New trends in rhinoplasty.

Rhinoplasty is one of the most interesting and complex aesthetic surgeries. It's main aesthetic and artistic goal is to enhance beauty by creating a harmonious natural looking face. There isn't one and only standard rhinoplasty procedure, but as many rhinoplasties as there are individual patients. Everyone seeks for more wellbeing and self-confidence in the quest of beauty. Along with facial aesthetic, rhinoplasty aims to improve the nasal breathing function, another important factor for patients. Rhinoplasties have evolved in much the same way as other plastic surgeries: more radical; more preserving of the function; and more simple both in concept and in procedure. Rhinoplasty procedures are simplified with the objective of reducing surgical trauma and optimising down time. It remains a surgical act, but newer fields of aesthetic medicine modify its philosophic and technical approach. Furthermore, approaches which propose an external approach and large dissection are now becoming less common. The developpement of aesthetic medicine is also one of the most recent and important "evolution corner" in the indication strategy. We can now modifiy and "sculpt" the nose by using fillers, with or without the use of botulinum toxin. In this article, the author describes his personal surgical strategies and the position of non-surgical solutions in the modification of the nose appearance.

A Practical Classification System for Dorsal Preservation Rhinoplasty Techniques.

Preservation rhinoplasty in general and dorsal preservation in particular are for sure one of the most attractive topics in modern rhinoplasty and probably the most puzzling concept in this field. Recent major meetings and many other publications have led to an increased interest in these old/new techniques. New strategies for preservation have been developed in recent years, with a broader range of indications than the older push/let down. A simple classification urges to clarify this puzzled semantic concept of "preservation". Is it possible to systematize all new preservation variations in a simple classification? Yes, in this viewpoint, we propose a simple classification that systematizes all kinds of preservation techniques-the old and the new techniques. Classifying preservation will clarify the relative position of all techniques. It will allow comparing procedures from similar families there so to compare outcomes and indications from each technique.

The changing face of rhinology in the NHS: a study of septoplasty, septorhinoplasty and rhinoplasty hospital episode statistics.

INTRODUCTION: In 2011, septorhinoplasty and rhinoplasty were reclassified as procedures of limited clinical value in the NHS. The criteria for funding these operations varies across England. We used hospital episode statistics and freedom of information requests to review the total number of rhinology procedures performed across the previous decade, looking at trends in practice related to time, demographics and commissioning policy. MATERIALS AND METHODS: Hospital episode statistics for 2012-2019 were used to calculate the number of septoplasty, septorhinoplasty, rhinoplasty and reduction rhinoplasty procedures performed in children and adults. Freedom of information requests were also made to all clinical commissioning groups in England asking for number of procedures performed and number of individual funding requests made. RESULTS: A total of 158,031 procedures were performed over this period; the majority were in adult (99.0%) men (65.7%). Septoplasty was the most frequently performed operation; however, the total numbers declined by 5.4% over this period. There was a yearly reduction in the overall number of septorhinoplasty, rhinoplasty and reduction rhinoplasty operations. Four clinical commissioning groups provided a detailed breakdown of data by year and procedure. Those that required individual funding requests for all cases saw septorhinoplasty numbers fall by 81% and 75% over the period. Those that did not, saw numbers increase or remain the same. CONCLUSIONS: We found an overall year-on-year reduction in the number of rhinology operations being performed in the NHS, but variation in trends between different clinical commissioning groups. A reduction in operative activity likely represents the effect of underlying restrictions on commissioning rather than reduced clinical need.

[Reconstructive nasal surgery--the problem of the internal lining]. / Rekonstruktive Nasenchirurgie--das Problem der Innenauskleidung.

Careful internal defect coverage is important for a well vascularised internal base for the transplant in reconstructive nasal surgery. Secondary healing of intranasal wounds often results in nostril contracture and scar stenosis. The choice of methods for surgical coverage depends on the location of the defect and the condition of surrounding elements. For example, the double-stemmed "pot handle" flap is suitable for small defects of the internal lining of the nasal lobule. The septal mucosa flap can be used for larger and more complex defects of the internal nasal lining. Using composite skin and cartilage grafts from the ear, three-layered nasal defects can be treated in a variety of ways. The turn-in flap is a tilt flap and is very versatile for the treatment of inner defects of the lower nasal half.

[Predictable tip suture techniques in rhinoplasty]. / Berechenbare Nahttechniken für die Nasenspitze bei Rhinoplastik.

Recontouring the nasal tip in rhinoplastic procedures has generated a wide range of surgical techniques. These range from aggressive cartilage resection, division, grafting, or suture methods. Each of these categories contains many variations described in hundreds of publications. The goal of this communication is to describe a predictable, reproducible technique that can be used in a wide variety of rhinoplasty operations. Based on pre-existing anatomy variations of this technique can be adopted. The author described the basic technique in 2004 [1].The cornerstone of the technique is a predictable method of narrowing the interdomal space utilizing a suture technique. This procedure employs a pair of permanent sutures designed to minimize distortion, valve impingement and overcorrection. It can be performed through intranasal or external approaches. This paper will define the wide interdomal space, describe the technique, and demonstrate the efficacy of the technique in 250 rhinoplasty procedures. In addition, variations of the technique for specific goals will be shown.

[Rhinoplasty: open or closed technique?]. / Rhinoplastik: Offene oder geschlossene Technik?

The present article gives a short historical overview of rhinoplasty. Frequency as well as advantages and disadvantages of the open and closed techniques are discussed. The choice of the surgical access depends on the current flow and the surgeon's experience. Regional differences do exist. It is essential to have sufficient knowledge of both techniques, in order that the surgeon can choose the appropriate technique according to the wishes of the patient. Primarily, an endonasal approach should be aimed for.

[The crooked nose: correction of dorsal and caudal septal deviations]. / Die Schiefnase: Korrektur dorsaler und kaudaler Septumdeviationen.

The deviated nose represents a complex cosmetic and functional problem. Septal surgery plays a central role in the successful management of the externally deviated nose. This study included 800 patients seeking rhinoplasty to correct external nasal deviations; 71% of these suffered from variable degrees of nasal obstruction. Septal surgery was necessary in 736 (92%) patients, not only to improve breathing, but also to achieve a straight, symmetric external nose. A graduated surgical approach was adopted to allow correction of the dorsal and caudal deviations of the nasal septum without weakening its structural support to the nasal dorsum or nasal tip. The approach depended on full mobilization of deviated cartilage, followed by straightening of the cartilage and its fixation in the corrected position by using bony splinting grafts through an external rhinoplasty approach.

[Nasal dorsal augmentation]. / Augmentation des Nasenrückens.

The present article describes the anatomy, surgical technique and outcomes for nasal dorsal augmentation. The various materials available for augmentation are outlined, including polytetrafluoroethylene (PTFE), autogenous costal cartilage graft and irradiated costal cartilage. In addition, appropriate surgical guidelines for successful augmentation are given. The correct height of the nasal dorsum is determined according to the position of the nasion and the nasal tip, whereby the desired height may also be influenced by the sex of the patient as well as his/her notion of an aesthetic ideal. Access is chosen according to the extent of the planned correction; external access is advisable in the case of extensive correction. Osteotomies should only be undertaken where unavoidable, e. g. in the case of concomitant nasal misalignment. Patient results, complications and future directions are presented.

[Suture tip plasty using an endonasal approach]. / Korrektur der Nasenspitze durch endonasale Zugänge und Nähte.

BACKGROUND: Over the last two decades, the use of the external approach for primary and secondary rhinoplasties has become increasingly popular. This article illustrates the versatility of endonasal techniques for the correction of nasal tip deformities on the basis of four cases. PATIENTS AND METHODS: The approach to the nasal tip and the chosen technique as used in 100 consecutive rhinoplasties were reviewed. RESULTS: For primary and revision tip plasty, endonasal approaches were used in 81% of cases. Preferred incisions were the infracartilaginous approach and the transfixion incision. Using these approaches, correction of the tip was achieved by using sutures to reposition and reshape the alar cartilages and the columella without grafts to the nasal tip in most cases. CONCLUSION: Nasal tip plasty via endonasal approaches using sutures is technically more challenging compared to the external approach with its superior exposure. This drawback is outweighed by less operating time and faster patient recovery. Contrary to the general trend, the authors believe that endonasal tip plasty techniques using sutures can obviate the external approach and grafts in many cases and should form an integral part of the rhino-surgeon's repertoire.