Rhinoplasty is one of the most frequently requested aesthetic procedures. However, a subset of patients presents with complex psychological profiles that can adversely impact surgical outcomes. Early psychological assess...Rhinoplasty is one of the most frequently requested aesthetic procedures. However, a subset of patients presents with complex psychological profiles that can adversely impact surgical outcomes. Early psychological assessment is crucial to optimizing patient safety and satisfaction.This narrative review aims to explore the role of integrated psychological assessment within multidisciplinary facial plastic surgery services. It hypothesizes that early psychological input improves patient selection, manages expectations, and reduces revision rates.Narrative review.We conducted a structured narrative review of PubMed/MEDLINE, PsycINFO, Embase, and Scopus (from inception to June 2025), supplemented by clinical experience from a high-volume United Kingdom rhinoplasty center. Search terms included rhinoplasty, psychology, BDD, screening, and multidisciplinary care. Eligible sources comprised peer-reviewed studies, reviews, and guidelines on psychological assessment or outcomes in aesthetic rhinoplasty.Integrated psychological assessment can identify patients at risk of dissatisfaction, enhance patient selection, reduce revision surgeries, and improve overall outcomes.Multidisciplinary collaboration between surgeons and psychologists improves rhinoplasty outcomes, enhances patient safety, and supports the ethical principle of nonmaleficence.
To discuss good and poor outcomes in Structure and Preservation rhinoplasty.Dorsal preservation and structure rhinoplasty are time tested techniques.Pertinent anatomy will be discussed.Use of the piezotome is mentioned.P...To discuss good and poor outcomes in Structure and Preservation rhinoplasty.Dorsal preservation and structure rhinoplasty are time tested techniques.Pertinent anatomy will be discussed.Use of the piezotome is mentioned.Proper indications will be covered.Structure and preservation techniques are discussed.Postoperative care is discussed.Structure and preservation rhinoplasty are effective techniques in rhinoplasty.
INTRODUCTION: Selective myectomy has gained popularity for treating facial synkinesis. OBJECTIVES AND HYPOTHESES: We examined the combined effectiveness of depressor anguli oris (DAO), partial buccinator, and platysma my...INTRODUCTION: Selective myectomy has gained popularity for treating facial synkinesis. OBJECTIVES AND HYPOTHESES: We examined the combined effectiveness of depressor anguli oris (DAO), partial buccinator, and platysma myectomies. STUDY DESIGN: Retrospective case series. METHODS: Pre- and postoperative botulinum toxin-A (BTX-A) treatments of selective myectomy patients were collected. Facial photographs were analyzed using Emotrics + . Facial Asymmetry Index (FAI) and electronic facial paralysis assessment (eFACE) scores were calculated. RESULTS: Twenty patients underwent myectomies. Improvements (mean ± standard error) were seen in several smile metrics, including FAI by 2.80 ± 0.68 mm, nasolabial fold angle by 4.78 ± 1.83 degrees, and smile angle by 4.43 ± 1.18 degrees (all < 0.05). Postoperative FAI was 2.79 mm. Total BTX-A decreased by 10.85 ± 4.48 units ( = 0.03). eFACE revealed improved oral commissure movement and platysmal synkinesis ( < 0.05 for both). CONCLUSION: Combined myectomies of the DAO, partial buccinator, and platysma clinically and statistically improve smile in facial synkinesis.
Facelift surgery is among the most commonly performed aesthetic procedures. Achieving optimal outcomes requires careful preoperative planning, particularly in managing airway positioning and maintaining a clean surgical...Facelift surgery is among the most commonly performed aesthetic procedures. Achieving optimal outcomes requires careful preoperative planning, particularly in managing airway positioning and maintaining a clean surgical field from the forehead to the neck.This study aims to outline standardized perioperative protocols for facelift surgery, hypothesizing that such measures improve surgical access and reduce intraoperative complications.Retrospective case series ( > 5) conducted by senior authors. The study adheres to STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for observational studies.Patients undergoing facelift under general anesthesia with endotracheal intubation were reviewed. Focus was placed on tube positioning, scalp access, and hair management. No institutional review board approval was required.Standardized protocols enhanced tube stability, optimized exposure, and minimized operative delays.Precise airway management and field preparation are essential for efficient, safe facelift surgery and should be standardized in clinical practice.
INTRODUCTION: Training in facial soft tissue and flap surgery is limited by access to cadaver models and realistic simulation tools. OBJECTIVES AND HYPOTHESES: This study aimed to evaluate the lamb head as a practical an...INTRODUCTION: Training in facial soft tissue and flap surgery is limited by access to cadaver models and realistic simulation tools. OBJECTIVES AND HYPOTHESES: This study aimed to evaluate the lamb head as a practical and cost-effective model for facial flap planning and soft tissue closure techniques in surgical education. STUDY DESIGN: Prospective observational study involving two dissection courses with surgical residents. Reporting complies with STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) guidelines. METHODS: Two lamb heads were used for initial testing. Subsequently, two training sessions were conducted with 49 ENT and dermatology residents. Participants practiced standard flap designs using predrawn templates. Postsession feedback was collected. RESULTS: All participants reported increased understanding and confidence. The model was rated highly for its realism and teaching value. CONCLUSION: The lamb head provides a realistic, accessible, and low-cost model for facial soft tissue training. It may be valuable for residency programs lacking access to cadaveric simulation.
Autologous costal cartilage calcification (CCC) can impact the course and long-term results of rhinoplasty. Preoperative information about the presence, severity, and pattern of CCC helps to assess donor site suitability...Autologous costal cartilage calcification (CCC) can impact the course and long-term results of rhinoplasty. Preoperative information about the presence, severity, and pattern of CCC helps to assess donor site suitability and rhinoplasty planning.To use machine learning to identify a sex-specific age threshold beyond which a preoperative chest CT is likely to reveal CCC relevant for rhinoplasty planning.Cross-sectional retrospective study of 662 Caucasian adults.Prevalence, severity, and patterns of CCC in ribs five to eight were assessed by three independent reviewers. A machine learning algorithm was used to predict the age threshold beyond which a chest CT scan is beneficial to rhinoplasty planning.The prevalence of CCC in Caucasian adults was 89.6%. Nearly all individuals over the age of 50 exhibited some form of CCC. In young females CCC was more severe and prevalent in the central core of ribs five to eight compared with age-matched males.A chest CT is recommended in females over 23 years and males over 40 years. No data-driven recommendations regarding an upper age limit for costal cartilage use could be determined from the data.
Perceived age is an objective surrogate for facial rejuvenation, but comparative evidence across facelift techniques using human and AI raters is limited.This trial assessed whether facelift techniques differ in rejuvena...Perceived age is an objective surrogate for facial rejuvenation, but comparative evidence across facelift techniques using human and AI raters is limited.This trial assessed whether facelift techniques differ in rejuvenation effect and whether AI estimates align with human evaluations.Randomized clinical trial.A total of 30 women (45-65 years) underwent rhytidectomy by deep plane, high SMAS, or plication ( = 10 each). Standardized photographs were rated by 200 laypersons (9,000 evaluations) and three AI models (180 evaluations). Primary outcome was change in perceived age (Δ age); secondary analyses included technique comparison, AI accuracy, rater bias, and human-AI correlation.All techniques significantly reduced perceived age, with no statistical difference between groups. Amazon Rekognition and HowOldDoYouLook were more accurate. Human-AI correlation was moderate (r = 0.41, = 0.020). Raters under 30 underestimated age ( < 0.001).Human and AI evaluations showed no technique differences, with AI estimates resembling human assessments.
Standardized photography is foundational in facial plastic surgery (FPS) for accurate documentation of outcomes. The increased use of smartphones and social media introduces challenges such as variable lighting, filters,...Standardized photography is foundational in facial plastic surgery (FPS) for accurate documentation of outcomes. The increased use of smartphones and social media introduces challenges such as variable lighting, filters, and digital manipulation that can distort results.To examine current FPS photography standards and propose updated guidelines that address the influence of digital platforms. We hypothesize that modern adaptations are required to ensure accuracy and patient trust.Perspective on FPS photography standards in the age of social media.We reviewed published recommendations, historical practices, and recent studies on perioperative FPS photography, including the impact of smartphone technology and social media on standardization.Findings highlight that smartphone photography and social media images often introduce bias through inconsistent angles, lighting, and digital enhancements.Revised photographic guidelines that integrate digital-era considerations are necessary to maintain accuracy, transparency, and ethical standards in FPS.
A patient's ethnicity and culture need to be considered prior to male facial rejuvenation. Here, we describe the most important factors across ethnicities that affect the analysis, treatment, and postoperative considerat...A patient's ethnicity and culture need to be considered prior to male facial rejuvenation. Here, we describe the most important factors across ethnicities that affect the analysis, treatment, and postoperative considerations of commonly performed procedures.There are some traits commonly associated with certain ethnicities that differ from each other. These span skeletal structure, skin characteristics, predisposition to poor scarring, periorbital and nasal anatomy, and hair qualities.As they pertain to the described differences in traits, certain variations exist within procedures to accommodate non-Caucasian patients. This is to make results more natural, fitting to a patient's ethnicity and goals, and to account for differences in postoperative healing.An integral part of every patient encounter is to listen to the patient's perspective and goals prior to developing a treatment plan. Their facial analysis should subsequently be performed in the context of their ethnicity. The management of non-Caucasian facial rejuvenation patients should not be taught as a variation of the norm but rather as unique considerations to modify known surgical techniques for each individual ethnicity and culture. Training needs to emphasize and popularize these differences.
INTRODUCTION: The superficial musculoaponeurotic system (SMAS), a complex network of fibromuscular tissue, is a fundamental component of facial anatomy, playing a key role in both dynamic function and aesthetic appearanc...INTRODUCTION: The superficial musculoaponeurotic system (SMAS), a complex network of fibromuscular tissue, is a fundamental component of facial anatomy, playing a key role in both dynamic function and aesthetic appearance. Although the anatomy of the SMAS has been widely studied, several aspects remain unclear-particularly the presence of its fascial component, the variability in its attachment to deeper tissues, the possibility of distinct SMAS layers, and the association of facial nerve branches with first arch structures. In this study, we propose a hypothesis to explain the anatomical variations in SMAS observed during deep-plane facelift procedures. METHODS: A comprehensive review of the literature on the phylogeny and ontogeny of the facial SMAS was conducted. While numerous studies address the development of the face and SMAS, many report conflicting findings. For the purpose of this hypothesis, we have relied on the most widely accepted interpretations. RESULTS: Current understanding suggests that the facial SMAS originates from the primordial panniculus carnosus, a primitive muscular layer present in many lower vertebrates. Our analysis indicates contributions from the platysma myoides, platysma cervicalis, and sphincter colli profundus. The latter two structures undergo regression and are represented in the adult form as fascia. The relationship of the SMAS to deeper tissues appears to depend on whether it lies deep to the platysma cervicalis or the platysma myoides. Additionally, existing literature on the embryology of the facial nerve explains the presence of its branches among first arch structures, as well as their maintained connections with the SMAS. CONCLUSION: The phylogeny and ontogeny of the facial SMAS represent a complex developmental process that likely accounts for the observed anatomical variations and inconsistencies in its relationship with surrounding fascial planes and facial nerve branches.
In recent years, the advancements of minimally invasive, energy-based facial treatments have been followed by an increase in male patient's demand. This article presents a review of current energy-based devices for male...In recent years, the advancements of minimally invasive, energy-based facial treatments have been followed by an increase in male patient's demand. This article presents a review of current energy-based devices for male facial rejuvenation, aiming to inform clinicians on evidence-based treatment options.A search of the scientific literature in the PubMed database from inception to June 2025 was conducted. Articles were included if they discussed energy-based options for male facial rejuvenation. Out of 70 articles screened, 23 met the inclusion criteria. In included articles, 18 energy-based options used for male facial rejuvenation were reported.This review provides an overview of the wide array of energy-based devices available for male facial rejuvenation. The literature suggests that these technologies can be effectively and safely used to tighten skin, improve contouring while reducing adiposity, enhance skin quality and tone, and manage cosmetic vascular lesions.
Burnout and declining fulfillment are prevalent among facial plastic surgeons (FPS), yet the organizational drivers of these challenges remain underexplored. Ownership structure, workplace autonomy, and collective repres...Burnout and declining fulfillment are prevalent among facial plastic surgeons (FPS), yet the organizational drivers of these challenges remain underexplored. Ownership structure, workplace autonomy, and collective representation may influence surgeon well-being and workforce sustainability.To assess how autonomy, ownership, and unionization relate to satisfaction and stress among FPS. We hypothesized that private practitioners would report greater autonomy and satisfaction, that academic and hospital-employed surgeons would experience more stress and diminished control, and that prior union exposure would correspond with more favorable views of collective representation.Cross-sectional observational survey (STROBE).A 26-item anonymous survey was distributed to all 1,041 members of the American Academy of Facial Plastic and Reconstructive Surgery; 104 responded (10%). Variables included practice type, ownership, union history, autonomy, compensation satisfaction, stressors, and openness to unionization. Analyses employed chi-square tests and qualitative content analysis.Surgeons in private practice reported the highest autonomy and compensation satisfaction and the lowest rates of feeling rushed. Hospital-employed and academic surgeons were more likely to report diminished autonomy, administrative stress, and lack of influence over workplace decisions. Only 11% of respondents expressed interest in unionizing, though prior union members generally described positive experiences. Surgeons' beliefs about whether unionization affects patient care did not vary significantly by practice setting.Structural factors, particularly the autonomy and ownership model, are strongly linked to satisfaction and stress among FPS. Organizational reforms that enhance autonomy and support collective voice may reduce burnout and improve workforce sustainability.
This article reviews surgical techniques and considerations in the male browlift. Proper understanding of the subtle, gender specific details of browlifting procedures allows for optimal correction in men.Throughout the...This article reviews surgical techniques and considerations in the male browlift. Proper understanding of the subtle, gender specific details of browlifting procedures allows for optimal correction in men.Throughout the evolution of various browlifting techniques, certain ones have stood out for their ability to correct brow ptosis in various patients. Browlift techniques, including temporal, endoscopic, pretrichial, direct, and midforehead, are reviewed. Discussion of these techniques begins with a review of our brow rating scale, common considerations, and bilaminar browlift concepts. Additionally, adjunct procedures are discussed for optimization of browlift results.Mastery of male browlifting begins with an objective assessment of the brow, allowing proper technique selection for natural and masculine results.
Direct submentoplasty remains a valuable alternative to rhytidectomy in male patients, addressing cervical laxity and fullness while avoiding feminization, periauricular scars, and prolonged recovery associated with trad...Direct submentoplasty remains a valuable alternative to rhytidectomy in male patients, addressing cervical laxity and fullness while avoiding feminization, periauricular scars, and prolonged recovery associated with traditional rhytidectomy.Since the early 20th century, submental skin excision has undergone refinement, progressing from horizontal ellipses to advanced configurations such as the Grecian urn pattern. These modifications aim to optimize scar camouflage while correcting horizontal and vertical redundancy.Key anatomic contributors to cervical aging include skin and platysmal laxity, supra- and subplatysmal fat, anterior belly of the digastric hypertrophy, ptotic submandibular glands, and a low-lying hyoid. Comprehensive preoperative analysis is required to address these factors.For patients presenting with submental fullness accompanied by good skin elasticity and minimal skin laxity, an isolated deep structural neck lift without skin excision may be sufficient. Optimal candidates for direct cervicoplasty (skin excision) demonstrate submental laxity limited to above the thyroid cartilage, minimal jowling, and acceptance of an anterior cervical scar.The isolated deep structural neck lift addresses the platysma and its underlying structures without the need for skin excision. A direct cervicoplasty with skin excision affords wide exposure for addressing the skin, platysma, and the subplatysmal anatomy. Skin excision patterns are varied and tailored to the patient's needs.Scar modulation strategies, drain management, lymphatic assistance with positioning/massage, and salivary flow management are key to a hastened recovery.Direct submentoplasty remains an essential tool in the aging male patient, offering reproducible results in appropriately selected patients who are willing to accept its limitations.
Men have distinct facial anatomy and facial patterns. Autologous fat grafting techniques can be tailored to maintain masculine features.Interest in male facial rejuvenation has grown in recent decades. Autologous fat gra...Men have distinct facial anatomy and facial patterns. Autologous fat grafting techniques can be tailored to maintain masculine features.Interest in male facial rejuvenation has grown in recent decades. Autologous fat grafting is favored for its natural, durable results and regenerative benefits.Men have angular facial structures with prominent brows, wider jaws, and thinner fat layers. Aging leads to forehead rhytids, midface hollowing, nasal lengthening, jawline blunting, and a more rectangular profile due to bone loss and skin laxity.Thorough preoperative evaluation and facial analysis are important for successful planning and outcomes.There are various commercially available tools for fat harvesting and processing. The Tulip cannula and PureGraft systems are described in this article. Microfat (1,000-1,500 microns) is preferred in facial grafting for its balance of volume restoration and low nodularity risk. The brow, infraorbital region, midface, jawline, and chin can be targeted to restore a youthful, masculine contour.Research on male-specific outcomes, including hormonal and weight effects on graft longevity and patient-reported outcomes, is limited and is an area ripe for future investigation.As interest in male aesthetics increases, tailoring facial rejuvenation techniques to their anatomy and aging is essential for successful outcomes.
Resident-run facial aesthetic surgery clinics improve surgical proficiency but are absent in Canadian Otolaryngology-Head and Neck Surgery (OtoHNS) training.To evaluate resident and program director (PDs) perspectives on...Resident-run facial aesthetic surgery clinics improve surgical proficiency but are absent in Canadian Otolaryngology-Head and Neck Surgery (OtoHNS) training.To evaluate resident and program director (PDs) perspectives on facial aesthetic training and the feasibility of resident-run clinics. We hypothesized residents would report inadequate training and support for clinics, while directors would express caution due to logistical barriers.National, cross-sectional survey.Anonymous, bilingual electronic surveys were distributed to Canadian OtoHNS residents and PDs. Quantitative data were analyzed descriptively; qualitative responses underwent thematic analysis.Fifty residents and 11 PDs responded. Most residents (91%) reported performing ≤ 5 core procedures; 82% desired more exposure. Resident-run clinics were supported by 83% of residents but only 30% of PDs. PDs cited supervision, funding, and legal concerns.Significant training gaps exist. Resident-run clinics may enhance education but require structured supervision and institutional support.
While facelift literature has largely focused on female patients, recent research highlights unique anatomical and psychosocial considerations in male facial rejuvenation. The short scar neck lift is explored to present...While facelift literature has largely focused on female patients, recent research highlights unique anatomical and psychosocial considerations in male facial rejuvenation. The short scar neck lift is explored to present the indications, technique, and outcomes as an alternative to the deep plane facelift in selected male patients.The short scar neck lift employs limited periauricular incisions to address submental fullness, platysmal banding, and mild-to-moderate cervical skin laxity. Ideal candidates demonstrate localized cervical and mandibular aging without significant midface descent. The procedure may be combined with submental liposuction, platysmaplasty, and energy-based devices to enhance skin contraction.In appropriately selected patients, the short scar neck lift achieves meaningful improvement in cervicomental angle definition with reduced operative time, morbidity, and recovery compared with deep plane facelifts. The short scar neck lift is a versatile, lower-morbidity alternative for male patients with localized cervical aging. Its targeted approach, adaptability, and favorable recovery profile make it a valuable addition to the male facial rejuvenation surgical algorithm.
Thick skin poses a challenge in rhinoplasty, often resulting in an undefined tip and supratip deformities.This study evaluates oral isotretinoin as an adjuvant treatment for thick-skinned rhinoplasty patients.This is a s...Thick skin poses a challenge in rhinoplasty, often resulting in an undefined tip and supratip deformities.This study evaluates oral isotretinoin as an adjuvant treatment for thick-skinned rhinoplasty patients.This is a systematic review conducted in accordance with PRISMA guidelines.Two independent investigators performed a comprehensive literature search to identify studies that assessed perioperative oral isotretinoin treatment in thick skin rhinoplasty patients. Key outcome measures include skin thickness reduction, cosmetic surgical outcomes, and postoperative patient satisfaction.Five studies met the study inclusion criteria. Their findings demonstrated that oral isotretinoin effectively reduces skin thickness and improves cosmetic outcomes and satisfaction up to 6 months postoperatively, with no major complications reported.Although evidence is limited, oral isotretinoin shows promise in enhancing short-term rhinoplasty outcomes for thick-skinned patients. Further, high-quality trials are needed to confirm these results and develop standardized treatment protocols.
Postoperative edema and fibrosis are key concerns following rhinoplasty, affecting outcomes and patient satisfaction. Triamcinolone acetonide (TA) is used for its proven anti-inflammatory and antifibrotic effects.This st...Postoperative edema and fibrosis are key concerns following rhinoplasty, affecting outcomes and patient satisfaction. Triamcinolone acetonide (TA) is used for its proven anti-inflammatory and antifibrotic effects.This study aims to evaluate the efficacy, usage profile, and safety of TA injections after rhinoplasty, focusing on postoperative edema and supratip fullness.A systematic review was conducted via PubMed and the Cochrane Database to identify studies on corticosteroid injections after rhinoplasty, following PRISMA guidelines and predefined selection criteria.Nine studies were included in the analysis. These studies focused on the postoperative use of TA after rhinoplasty and assessed their impact on key outcomes, such as edema reduction, fibrosis control, and the improvement of supratip fullness following rhinoplasty.TA injections were consistently associated with a significant reduction in postoperative edema and the incidence of pollybeak deformities. Current evidence supports the subcutaneous administration of TA at a 10 mg/mL concentration, initiated no earlier than 4 weeks following rhinoplasty. Injections are typically delivered at 4 to 6 week intervals, with a maximum volume of 0.3 mL per session, for a total of two to four administrations, depending on clinical response. TA showed a consistent safety profile with mild and infrequent side effects. Effects appeared within 7 to 14 days and lasted approximately 4 to 6 weeks.TA is an effective adjunct in the postoperative management of rhinoplasty, particularly in patients with thick or reactive soft tissue envelopes. Standardized, personalized protocols are needed, along with better studies and objective outcome tools.