Lower eyelid ectropion is a challenging postoperative complication that can affect both function and aesthetics. Preventative strategies are critical, particularly in high-risk periocular and midface surgeries.This revie...Lower eyelid ectropion is a challenging postoperative complication that can affect both function and aesthetics. Preventative strategies are critical, particularly in high-risk periocular and midface surgeries.This review aims to evaluate the efficacy and variety of prophylactic suspension techniques used to prevent lower eyelid ectropion. Primary outcome: Incidence of ectropion; secondary outcomes: Technique tolerability and reported complications.Systematic review conducted in accordance with PRISMA guidelines.A systematic search was performed through June 2025 using keywords: "Frost suture," "suspension," "ectropion," "tape," and "prevention." Sixteen studies were included (9 clinical, 8 technical). Data on patient indications, techniques, outcomes, and follow-up were extracted.Techniques included Frost sutures, periosteal anchoring, barbed sutures, external splinting, and forehead hitch. Ectropion prevention was generally successful, though one clinical study reported no significant benefit with Frost suture use.Multiple prophylactic strategies appear effective, but evidence quality is low. Higher-level comparative studies are needed.
Managing nasal tip support and lateral crura malposition remains a challenge in rhinoplasty.This study aimed to evaluate the effectiveness of a novel suture technique-the Pulley-Stitch-in correcting lateral crura malposi...Managing nasal tip support and lateral crura malposition remains a challenge in rhinoplasty.This study aimed to evaluate the effectiveness of a novel suture technique-the Pulley-Stitch-in correcting lateral crura malposition. Primary outcome: Change in lateral crura angle; secondary outcome: Long-term stability.Prospective cohort study ( = 42), reported in-line with STROBE guidelines.Forty-two patients underwent open rhinoplasty. The angle between the caudal margin of the medial crus and the anterior third of the lateral crus was measured from intraoperative images at T0 (prestitch) and T1 (poststitch). Standardized postoperative images were analyzed at 1 month (T2) and 12 months (T3).The angle increased from a mean of 18.2 to 26.9 degrees ( < 0.05), reflecting improved anatomical alignment and external nasal valve patency. Stability was confirmed at 12-month follow-up.The Pulley-Stitch is a safe, effective technique to improve nasal tip structure, cephalic rotation, and ala contour.
INTRODUCTION: Body dysmorphic disorder (BDD) is a condition to be assessed preoperatively prior to cosmetic rhinoplasty, as it may influence patient outcomes and satisfaction. The prevalence of BDD in Asians is not well-...INTRODUCTION: Body dysmorphic disorder (BDD) is a condition to be assessed preoperatively prior to cosmetic rhinoplasty, as it may influence patient outcomes and satisfaction. The prevalence of BDD in Asians is not well-studied, and the literature consists predominantly of smaller case series. OBJECTIVES: This systematic review and meta-analysis estimated BDD prevalence in Asian rhinoplasty candidates and examined the impact of diagnostic methods and regional factors. METHODS: Following Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, five databases were searched up to March 2025. Two reviewers independently screened studies. Meta-analysis using a random-effects model was conducted; study quality and publication bias were assessed. RESULTS: Fifteen studies ( = 1,977) were included. The pooled BDD prevalence was 30.0% (95% CI: 26.8-35.7), with higher rates using the Body Dysmorphic Disorder Questionnaire (36%) versus DSM-V criteria (18%). Substantial heterogeneity was observed and addressed. CONCLUSION: BDD may affect nearly one in three Asian rhinoplasty candidates, underscoring the need for standardized diagnostic protocols and culturally sensitive preoperative assessment to improve patient outcomes and safety.
Secondary rhinoplasty presents complex challenges due to anatomical distortions, scar tissue, and multiple iatrogenic deformities.Although a traditional structural approach is the time-honored benchmark against which any...Secondary rhinoplasty presents complex challenges due to anatomical distortions, scar tissue, and multiple iatrogenic deformities.Although a traditional structural approach is the time-honored benchmark against which any other technique should be measured, preservation concepts can be integrated together with structural techniques.This study is based on a retrospective review of cases.Preservation concepts applicable to secondary rhinoplasty are outlined in detail. A paradigm case highlighting the strategic application of preservation techniques is included.Preservation concepts pose an evident advantage in avoiding unnecessary dissection, further destabilization, and overgrafting while maintaining native structures that can be preserved and limiting dead space. Scar tissue can be used advantageously rather than discarded. However, introducing a "preservationist mindset" in revision rhinoplasty needs a refined approach, mastery of diverse techniques, and a flexible operative strategy.Preservation concepts can lead to improved outcomes even in secondary rhinoplasty.
Nasal valve dysfunction (NVD) is a prevalent cause of nasal obstruction, significantly impacting quality of life. In recent years, the emergence of office-based interventions has transformed the therapeutic landscape for...Nasal valve dysfunction (NVD) is a prevalent cause of nasal obstruction, significantly impacting quality of life. In recent years, the emergence of office-based interventions has transformed the therapeutic landscape for this condition, offering patients a wider choice and less invasive options compared to traditional surgical methods, yet their comparative safety and efficacy remain to be fully established.A systematic review and meta-analysis were conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Four databases (PubMed, Scopus, Cochrane Library, and Ovid) were searched for original studies (2005-2025) assessing minimally invasive treatments for NVD with patient-reported outcomes. Random-effects meta-analyses evaluated changes in Nasal Obstruction Symptom Evaluation (NOSE) and Visual Analog Scale (VAS) scores.Fifteen studies comprising 546 patients were included, evaluating temperature-controlled radiofrequency (TCRF), bioabsorbable implants, intranasal suturing techniques, and nasal valve stenting. TCRF yielded a weighted mean difference (WMD) in NOSE scores of -44.68 (95% confidence interval [CI]: -51.23 to -38.13; < 0.001), while bioabsorbable implants achieved a WMD of -39.91 (95% CI: -48.53 to -31.29; < 0.001). Intranasal suturing demonstrated a VAS WMD of -4.36 (95% CI: -4.88 to -3.84; < 0.001). All interventions surpassed minimal clinically important differences, with adverse events being relatively mild and transient. Improvements were sustained across all modalities over a follow-up period of 3 to 48 months ( = 63.9-89.7%).Minimally invasive techniques for NVD demonstrate statistically and clinically significant and durable symptom relief with favorable safety profiles. These interventions may offer viable alternatives to traditional surgical approaches, particularly in select patients seeking reduced morbidity and procedural complexity. Future research should prioritize randomized comparisons and standardized outcome metrics.
This article presents a comprehensive, anatomically precise approach to deep plane facelift surgery in male patients, a demographic with increasing interest in facial rejuvenation but historically underserved by techniqu...This article presents a comprehensive, anatomically precise approach to deep plane facelift surgery in male patients, a demographic with increasing interest in facial rejuvenation but historically underserved by techniques optimized for female anatomy. While foundational facelift principles are shared between genders, the male patient presents unique structural, vascular, and aesthetic demands that necessitate specific modifications to technique, planning, and execution.Key anatomical distinctions in the male face, including denser subcutaneous tissue, increased vascularity, prominent subplatysmal structures, and horizontally oriented submuscular aponeurotic system (SMAS)-platysma continuity, require surgical planning that respects and preserves masculine facial definition. The submental region is often complicated by hypertrophic digastric musculature and submandibular gland visibility, necessitating targeted management to optimize the cervicomental angle.This article outlines a male-specific technique emphasizing extended deep plane dissection, ligamentous release, SMAS repositioning with minimal subcutaneous dissection, and submental access. Deep plane neck procedures, including conservative subplatysmal fat reduction, digastric contouring, partial submandibular gland reduction, and corset platysmaplasty, supplement the facial portion of the procedure.When performed with anatomical precision and gender-specific adaptation, preservation-based techniques with extended deep plane facelift surgery yield consistent, natural, and structurally restorative outcomes in male patients.
Despite growing awareness of skin health, male patients remain less likely to engage in daily skincare or pursue cosmetic dermatologic care. This review provides an evidence-based framework for understanding male-specifi...Despite growing awareness of skin health, male patients remain less likely to engage in daily skincare or pursue cosmetic dermatologic care. This review provides an evidence-based framework for understanding male-specific skin biology, behavior, and treatment strategies to improve outcomes and adoption.Male skin is thicker, oilier, more acidic, and contains denser terminal hairs and collagen than female skin. It has increased transepidermal water loss, a more robust vascular supply, and higher androgen-driven glandular activity, all of which influence barrier integrity, aging, and treatment response.Successful engagement of male patients requires understanding their goals, lifestyle, and psychological drivers. Men prefer performance-focused language, streamlined routines, and clear functional benefits.Tailored regimens emphasizing minimal steps, multifunctional products, and tolerable formulations are key. Interventions must account for unique features such as thicker dermis and distinct patterns of aging and facial musculature.Emerging therapies such as exosome-based products, male-focused marketing, and gender-specific formulation advances support increased adoption and efficacy.Dermatologists must consider the biologic and behavioral distinctions of male skin to enhance prevention, adherence, and treatment outcomes. Sex-specific strategies can improve long-term skin health and aesthetics.
Patients frequently ask questions after Mohs facial reconstruction. AI tools, particularly large language models (LLMs), may optimize this communication.We evaluated four LLMs-Claude AI, ChatGPT, Microsoft Copilot, and G...Patients frequently ask questions after Mohs facial reconstruction. AI tools, particularly large language models (LLMs), may optimize this communication.We evaluated four LLMs-Claude AI, ChatGPT, Microsoft Copilot, and Google Gemini-on responses to postoperative questions, hypothesizing variation in quality, accuracy, comprehensiveness, and readability.Prospective observational study following STROBE guidelines.A total of 31 common postoperative questions were created. Each was submitted to all four LLMs using a standardized prompt. Responses were evaluated by blinded facial plastic surgeons using validated scoring tools (EQIP, Likert scales, readability formulas). IRB exemption was granted.Claude AI outperformed others in quality (EQIP: 90.3), accuracy (4.55/5), and comprehensiveness (4.60/5). All LLMs exceeded the recommended 6th-grade reading level.LLMs show potential for supporting postoperative communication, but variation in readability and content depth highlights the continued need for physician oversight.
INTRODUCTION: Columellar strut graft (CSG) and septal extension graft (SEG) are commonly used in septorhinoplasty for nasal tip support. OBJECTIVE AND HYPOTHESES: We aimed to systematically review and compare CSG and SEG...INTRODUCTION: Columellar strut graft (CSG) and septal extension graft (SEG) are commonly used in septorhinoplasty for nasal tip support. OBJECTIVE AND HYPOTHESES: We aimed to systematically review and compare CSG and SEG in achieving a desired nasolabial angle (NLA) and Goode's ratio (GR). STUDY DESIGN: Several databases were systematically searched from inception to August 2024. A two-arm meta-analysis of the pooled means was conducted with a random-effects model. This review was registered in PROSPERO (CRD42024574909). METHODS: Eligible studies included primary septorhinoplasty patients (≥17 years) receiving CSG or SEG. RESULTS: Eight studies met eligibility criteria including 256 CSG and 371 SEG patients. Intergroup comparison of long-term postoperative NLA favored SEG ( < 0.05) while GR showed no differences. However, SEG patients had significant improvement in GR postoperatively ( < 0.05), unlike CSG patients. CONCLUSION: SEG may provide superior long-term nasal tip rotation and projection stability.
Radix control remains a key concern in preservation rhinoplasty. Consistent techniques for managing this area are essential for optimal outcomes.This article presents the step-up maneuver, a novel technique for precise m...Radix control remains a key concern in preservation rhinoplasty. Consistent techniques for managing this area are essential for optimal outcomes.This article presents the step-up maneuver, a novel technique for precise modulation of radix height while preserving structural integrity.Retrospective case series.A retrospective analysis of 245 consecutive primary preservation rhinoplasties using the step-up maneuver between 2022 and 2023 was conducted.The subdorsal Tetris flap was employed in 86.1% of cases, whereas the low strip approach was used in 13.9%. Intraoperative outcomes included: Radix maintained-91.0%; Radix projected-2.9%; Radix deprojected-6.1%.The step-up maneuver represents a significant advancement in preservation rhinoplasty, broadening its indications and reducing the risk of radix-related complications. These findings suggest that preservation rhinoplasty can be safely and effectively extended to a wider range of nasal anatomies, further refining surgical strategies and reducing revision rates.
AIMS AND BACKGROUND: Auricular keloids, particularly in the upper third of the ear, often recur after treatment and can cause aesthetic and functional deformities. This study assesses the effectiveness of stellate excisi...AIMS AND BACKGROUND: Auricular keloids, particularly in the upper third of the ear, often recur after treatment and can cause aesthetic and functional deformities. This study assesses the effectiveness of stellate excision in reducing recurrence and improving cosmetic outcomes. HISTORICAL ASPECTS: Stellate excisions evolved from 19th-century wedge excisions, refined by 1960s otoplasty techniques to preserve ear shape and prevent deformities. Traditional skin flap techniques frequently show high recurrence rates and can compromise auricular contour, leading to unsatisfactory results. ANATOMY: The ear, and specifically the upper third, is a challenging site for keloids due to its characteristic anatomy and susceptibility to mechanical stress during healing. TECHNOLOGY: Stellate excision allows for precise resection of keloids with back cuts and wedge extension to preserve ear shape and reduce tension. PATIENT SELECTION: Forty adult patients with upper third keloids were retrospectively studied. All underwent stellate excision and standardized steroid injection follow-up. TECHNIQUES: Complete excision with cartilage wedge resection, local flap closure, and layered suturing was performed under local anesthesia. POSTOPERATIVE CARE: Triamcinolone injections were administered at 2, 4, and 8 weeks postoperatively; follow-up continued for 24 months. CURRENT AND FUTURE DEVELOPMENT: Stellate excision showed a 95% success rate; future studies should assess broader anatomical applicability. CONCLUSION AND CLINICAL RELEVANCE: Stellate excision is a reliable and cosmetically favorable method for managing upper third ear keloids, with a low recurrence rate.
Blepharoplasty is among the fastest-growing aesthetic procedures in male patients, reflecting shifting cultural norms and increasing demand for facial rejuvenation that preserves masculine features. This review outlines...Blepharoplasty is among the fastest-growing aesthetic procedures in male patients, reflecting shifting cultural norms and increasing demand for facial rejuvenation that preserves masculine features. This review outlines the anatomical and aging patterns specific to the male periorbital region and discusses contemporary surgical techniques tailored to this population.The gender-specific anatomical differences in the periorbital region influence both surgical planning and outcomes are highlighted.Aging in men involves distinct patterns that must be addressed to preserve masculine facial identity.Surgical strategies emphasize conservative tissue excision, preservation of eyelid fullness, and avoidance of feminizing features.Men are predisposed to complications like lower lid malposition, visible scarring, and wound dehiscence due to anatomical factors and skin characteristics. Overcorrection may lead to feminization, necessitating a conservative surgical philosophy and meticulous technique.A deep understanding of sex-specific anatomy and aging, coupled with meticulous surgical technique, is essential for achieving natural, harmonious outcomes that align with the male aesthetic ideal.
Men comprise up to 16% of aesthetic patients; however, the unique motivations and experiences of male patients remain understudied. We aimed to synthesize evidence on social, emotional, and psychopathological drivers of...Men comprise up to 16% of aesthetic patients; however, the unique motivations and experiences of male patients remain understudied. We aimed to synthesize evidence on social, emotional, and psychopathological drivers of male interest in aesthetic procedures and outline clinical implications for aesthetic practitioners.Changing expressions of masculinity, media, and technology, as well as social, romantic, and professional influences, were explored. Research regarding psychopathology and body dysmorphic disorder (BDD) in male aesthetic patients was reviewed.Modern, fluid notions of masculinity have normalized aesthetic interventions among male patients. However, men experience ongoing stigma as a barrier to accessing treatment. Men display similar motivations to women, but report professional drivers more frequently. Mental health concerns and BDD prevalence rates are inconsistently reported among male aesthetic patients, but are likely to predispose males to more challenging treatment experiences. Clinical implications and recommendations for working with male patients are discussed.As men continue to undertake cosmetic procedures more frequently, practitioners should take care to adapt their approaches to the unique preferences of male patients. This includes shifts in language, advertising, consultation, and treatment planning to overcome stigma and barriers to access, while prioritizing safe, ethical care.
Pediatric nasal surgery has been controversial due to concerns about facial growth during adolescence. There is limited data on patient outcomes and no clear guidelines on the optimal age for surgery.To evaluate the safe...Pediatric nasal surgery has been controversial due to concerns about facial growth during adolescence. There is limited data on patient outcomes and no clear guidelines on the optimal age for surgery.To evaluate the safety, complication, and revision rates of nasal surgery in children.Systematic review and meta-analysis of septoplasty, rhinoplasty, and septorhinoplasty studies from 1994 to 2024, following Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines.Studies on primary nasal septal surgery in children (ages: 0-18) were included. Data was analyzed using ANOVA and chi-squared testing.Twenty-three studies with 27,840 patients were included. Septoplasty had the highest age at surgery and low complication and revision rates. Septorhinoplasty had the youngest age at surgery, and high complication and revision rates. Rhinoplasty had high complications but low revision rates.Pediatric septoplasty has low complication and revision rates. Further studies are needed to determine the optimal age for each procedure.
OBJECTIVES & HYPOTHESES: The infraorbital region is challenging to treat due to complex anatomy and issues like skin laxity, malar edema, and malar mounds. This study evaluates micro focused ultrasound with visualization...OBJECTIVES & HYPOTHESES: The infraorbital region is challenging to treat due to complex anatomy and issues like skin laxity, malar edema, and malar mounds. This study evaluates micro focused ultrasound with visualization (MFU-V) as a non-invasive treatment for infraorbital rejuvenation, hypothesizing improved skin tightening and contouring. STUDY DESIGN: A case series with anatomical analysis and literature review. METHODS: Five female patients (aged 42-54) with mild-to-moderate skin laxity underwent MFU-V treatment using 1.5, 3.0, and 4.5 mm transducers. Standardized photos and assessment scales (Merz Infraorbital Hollow Scale, GAIS) were used at baseline and 6 months. RESULTS: MFU-V led to visible improvements in periorbital skin tightening and reduction of malar mounds, especially in more pronounced cases. No adverse effects occurred. CONCLUSION: MFU-V is a safe, effective, and non-invasive option for periorbital rejuvenation. It may serve as an alternative to surgical treatment for infraorbital skin laxity and malar deformities. Larger studies are needed to confirm efficacy.
This study aimed to explore the clinical application value of a new porous high-density polyethylene (PHDPE, Supor) exogenous scaffold in nasal tip shaping for East Asians.We conducted a retrospective analysis of patient...This study aimed to explore the clinical application value of a new porous high-density polyethylene (PHDPE, Supor) exogenous scaffold in nasal tip shaping for East Asians.We conducted a retrospective analysis of patients who underwent rhinoplasty involving the new nasal framework implantation at our institution from July 2020 to June 2024. Photographic measurement was used to obtain nasal-facial parameters, including nasal bridge length index, nasolabial angle, nasal tip projection, and the ratio of nasal tip width to nasal width, which served as objective indicators for nasal aesthetic evaluation. A rhinoplasty questionnaire was designed for patients to subjectively rate their nasal appearance, providing subjective indicators. The Nasal Obstruction Symptom Evaluation (NOSE) scale was utilized to assess nasal ventilation status, with the NOSE score as an indicator for nasal functional evaluation. Pre- and postoperative differences in nasal-facial parameters, self-rated nasal appearance, and NOSE scores were analyzed. The incidence of complications and patient satisfaction with surgical outcomes were also recorded. A total of 36 female Han Chinese patients with a mean age of 29 ± 4 years were included, with an average follow-up of 13 ± 4 months. Results showed that Nasal-facial parameters significantly improved postoperatively. The preoperative nasolabial angle was 102.9 ± 4.8 degrees, and the postoperative angle was 96.1 ± 2.8 degrees, with a significant decrease of 6.9 ± 2.2 degrees ( < 0.01). Only one patient developed a postoperative infection, while no other complications such as rejection, deformation, or implant extrusion were observed.In nasal tip plastic surgery for East Asians, the application of new PHDPE exogenous scaffolds yielded favorable surgical outcomes with low complication rates.
Tip support in rhinoplasty is one of the main concerns during surgery. The reconstruction of the natural mechanisms of the tip for stabilization has become an increasingly fascinating and critical area of study.This arti...Tip support in rhinoplasty is one of the main concerns during surgery. The reconstruction of the natural mechanisms of the tip for stabilization has become an increasingly fascinating and critical area of study.This article evaluates the fusion sling hook suspension technique for tip support in rhinoplasties.Prospective observational case series.A prospective analysis of 643 consecutive primary rhinoplasties performed between January 2020 and December 2024 was conducted, during which a careful dissection of the fusion sling anatomy was performed. Of these, 557 cases utilized the fusion sling hook suspension technique. Data were reported in accordance with the STROBE guidelines.The stability provided by the fusion sling hook maneuver proved to be highly effective and durable throughout the observation period. Seven patients (1.3%) who underwent the fusion sling hook suspension demonstrated some degree of loss of tip projection or rotation, among whom four (0.7%) required revision surgery.The fusion sling flap offers stability, biomechanical logic, and anatomical continuity to the tip. Its strategic use can reduce the need for grafting or decrease the mechanical load placed on grafts, prevent late failures, and ultimately offer surgeons a more precise and versatile tool for long-lasting, natural tip projection.
Navaratnam A, Phoommanee N, Acharya V
… +3 more, Pendolino AL, Leung TS, Andrews PJ
Facial Plast Surg
· 2026 Apr · PMID 40669854
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Nasal obstruction has multiple causes requiring specialist endoscopy for diagnosis. A rule-based expert system (RB-ES), which applies five "if-then" rules based on nasal features, may help replicate ENT decision-making i...Nasal obstruction has multiple causes requiring specialist endoscopy for diagnosis. A rule-based expert system (RB-ES), which applies five "if-then" rules based on nasal features, may help replicate ENT decision-making in settings with limited access.This study evaluated RB-ES in diagnosing allergic rhinitis, chronic rhinosinusitis with (CRSwNP) and without (CRSsNP) nasal polyps, and deviated nasal septum. Primary outcomes were sensitivity and specificity; the secondary outcome was agreement with ENT specialists.Prospective cohort study.Seventy-one participants (65 patients, 6 controls) underwent pre- and postdecongestion endoscopy. Four ENT specialists provided diagnoses. RB-ES performance was compared against confirmed clinical diagnoses.RB-ES showed no detectable significant sensitivity differences from ENT specialists (all > 0.05). Sensitivity was highest for CRSwNP; specificity remained high overall.RB-ES matched specialist performance in CRSwNP diagnosis. Dataset expansion and artificial intelligence integration are recommended for further validation.II.
The goal of the article is to help surgeons understand the anatomy and surgical technique of alloplastic and osseous genioplasty.The article provides a brief history of cosmetic osseous genioplasty and the rise of allopl...The goal of the article is to help surgeons understand the anatomy and surgical technique of alloplastic and osseous genioplasty.The article provides a brief history of cosmetic osseous genioplasty and the rise of alloplastic genioplasty after the 1950s.This study describes the vertical thirds of the face with anatomic landmarks and the zero meridian assessment for chin deficiencies.Use of virtual surgical planning for custom genioplasty advancements and hardware and the ultrasonic bone saw for bony cuts.This article also describes how to evaluate patients for genioplasty and determine if alloplastic or osseous genioplasty will result in the best patient desired outcome, including the degree of advancement desired, any change in vertical height, correction in horizontal asymmetry, or reduction of the chin.The surgical technique is described for both osseous and alloplastic genioplasty. An intraoral approach is described for osseous genioplasty, while external and intraoral is described for alloplastic.Brief discussion of postoperative care, including compressive dressings, postoperative edema, and duration of liquid diet.Improvement of custom planning with virtual surgical plans as well as development of implants with low risk of infection and extrusion.This study summarizes the anatomic importance of genioplasty with the advantages and disadvantages of osseous and alloplastic genioplasty.