Role of steroid injection for skin thickness and edema in rhinoplasty patients

Feasibility and Efficacy of Transdermal Skin Contour Sutures: A Retrospective Propensity Score Matched Study

Achieving optimal contour and projection of the nasal tip is one of the most challenging aspects of rhinoplasty. The skin-soft tissue envelope (STE) plays a pivotal role in determining the final outcome, as its thickness and elasticity significantly impact the predictability of postoperative results. Avoiding dead space in the lower third of the nose is essential to ensure consistent outcomes. Recently, transcutaneous skin contour sutures (TSCS) have been proposed to enhance the precision of tip definition and contouring, particularly in patients with thick STE. To mitigate risks such as skin necrosis or scarring associated with traditional TSCS techniques, we modified the approach by placing the knot of the transdermal contour suture on the internal nasal surface.A retrospective, propensity-score matched analysis was conducted on 159 patients who underwent rhinoplasty. After matching, two cohorts of 120 patients were retained: 60 patients underwent rhinoplasty with TSCS, while the control cohort of 60 patients underwent rhinoplasty without TSCS. Patient-reported outcome measures (PROMs) were utilized to evaluate functional and aesthetic outcomes.Using PROMs, we found significant improvements in mean preoperative scores for all PROMs in both cohorts. Postoperative assessments revealed that while the overall healing trajectories were not significantly different, TSCS offered notable early benefits in nasal contour and patient satisfaction, especially during the first 3 to 6 months postoperatively.The modified TSCS technique shows significant early postoperative benefits, particularly in the first 3 to 6 months. However, the overall healing trajectories over 12 months of follow-up were similar between both groups. This suggests that while TSCS has a short-term impact, the natural healing processes in both groups likely converge over time, leading to a diminishing of observable differences. Future research should focus on identifying patient subgroups that experience the greatest benefits from TSCS. The level of evidence is 3.

Dead Space, the Final Frontier in Rhinoplasty: Review and 10 Key Recommendations

SUMMARY

Mitigating dead space has been recognized as an essential step toward ensuring a more predictable and aesthetically pleasing outcome in rhinoplasty. The current body of literature leaves a discernible gap in offering a unified, systematic approach to dead-space management in rhinoplasty. The aim of this article is to bridge this gap by presenting an integrative approach to surgical and postsurgical techniques.

Treatment of the Induration of the Soft Tissue of the Lower Eyelids After Accidental Oil Injections

Injection cosmetic procedures have shown rapid continuing growth in the last 2 decades. Various substances are injected into the periorbital region for skin quality increase and correction of tear trough deformity, including hyaluronic acid, peptides, collagen, and others. Sometimes patients get accidentally injected with different substances that are not approved for cosmetic treatment in this anatomic area. The author presents a case of a 51-year-old woman, injected with unknown oil solution into the lower eyelid skin by the local dermatologist. Inflammation and induration of the skin of the lower periorbital region have occurred after these injections. The patient was treated conservatively until the acute process stopped, and then surgical correction was performed to correct skin and orbicularis oculi muscle induration changes. Surgical treatment included direct oil cyst excision and removal after injection changed tissues between skin and orbicularis oculi muscle. The patient was observed for scheduled appointments and conservative treatment to prevent unfavorable scar formation and lower eyelid deformity. Although different kinds of oil substances are not approved for skin injections for cosmetic purposes, accidental injections occur and may lead to terrible results. Methods to correct eyelid deformity after oil solution injections are not presented in the literature. In this article, the author presents a case report with the method of correction of induration of soft tissues of the lower eyelids occurring after oil injections. Although cases like this are rare, they require correct surgical solution to provide a good aesthetic result after the treatment.

Management of Thick Skin in Rhinoplasty

Rhinoplasty in thick skin patients is challenging because the skin soft tissue envelope (S-STE) is more inelastic, and has a tendency for prolonged postsurgical edema, increased dead space formation, and underlying scar tissue formation. Changes in the S-STE will have an impact on how the final rhinoplasty result will look. When performing surgery, approaches should be targeted to the underlying bony-cartilaginous framework and the S-STE to obtain consistent, improved long term results. In this article, 3 experts will be discussing up to date medical, topical, and surgical management key points, as well as diagnostic options and post-operative treatments.

Efficacy and Safety of Triamcinolone Acetonide Injections Following Rhinoplasty: A Systematic Review of Recommended Doses, Complications, and Outcomes

BACKGROUND

Triamcinolone acetonide injections (TAIs) have been suggested to decrease complications following rhinoplasty. This systematic review aimed to assess the efficacy and safety of TAIs following rhinoplasty.

METHODS

We performed a systematic literature search on Medline, Embase, Google Scholar, and Cochrane Central Register of Controlled Trials from inception to May 2023, without any timeframe limitations. The following terms were used: (Triamcinolone OR steroid injections OR triamcinolone acetonide) AND (Skin thickness OR supratip edema OR supratip deformity OR Pollybeak deformity) AND (rhinoplasty OR external rhinoplasty). We included randomized controlled trials and observational studies (prospective, retrospective, and case series).

RESULTS

In total, six of the 1604 articles met our inclusion criteria. A total of 1524 patients were included in this study. Our results included patient demographics, type of rhinoplasty, post-injection follow-up period, site of injection, type of syringe used, timing of the first dose, volume and concentration used, time interval between doses, response to the injection, and complications of injection.

CONCLUSION

To our knowledge, this is the first systematic review to address this issue. Our results demonstrate the ease and safety of TAIs as a first-line treatment, with positive outcomes and limited complications. TAIs can be used early postoperatively to minimize the need for revision surgery. Despite the limited number of studies on TAIs, this study provides the best available evidence that can help surgeons decide when to use the injection, the intervals between doses, and the duration of use. Further randomized controlled trials are required to confirm our findings.

LEVEL OF EVIDENCE II

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 .

Skin Contour Sutures in Rhinoplasty

BACKGROUND

The skin-soft tissue envelope (STE) is a critical component of rhinoplasty and can have a significant impact on the final result. Skin contour sutures (SCSs) can be used to prevent potential complications related to skin detachment and to improve rhinoplasty results.

OBJECTIVES

The aim of this study was to assess the efficiency of SCSs for nasal skin approximation.

METHODS

SCSs involve the use of external sutures to stabilize the STE flap based on the principle that the pressure of the sutures helps to approximate the STE to the underlying nasal skeleton. The first study group demonstrated the utilization of SCSs in 459 consecutive rhinoplasty cases between December 2016 and April 2022 which were retrospectively reviewed. The second study group consisted of 30 patients with thick skin who had insertion of SCSs with ultrasonic evaluation both preoperatively and postoperatively.

RESULTS

The average postoperative follow-up period in the first study group was 41 months (range, 12-64 months). Any suture site that was visible after removal of the suture disappeared completely after 6 weeks in most patients. No complications were reported. In the second group the ultrasound data indicated that STE healing was faster as its thickness returns to its preoperative state earlier in the healing process when SCSs were used.

CONCLUSIONS

SCSs appear to help to decrease severe nasal edema, hematomas, loss of tip definition, fibrosis, and pollybeak deformity, thereby improving the results and predictability of rhinoplasty surgery.

LEVEL OF EVIDENCE: 4

Prevention and non-surgical treatment of soft tissue polly beak deformity after rhinoplasty: a scoping review

The aim of this study is to map the available evidence of surgical preventive measures and postoperative methods for addressing supratip fibrosis (polly beak deformity) following rhinoplasty, to describe the postoperative results and to identify the most effective techniques. A scoping review was performed, selecting articles from the following medical electronic databases: PubMed, Cochrane Central, EMBASE, and Web of Science up to October 2022. The following keywords were used: supratip fullness, supratip deformity, polly beak deformity and supratip fibrosis. A total of 19 studies met the eligibility criteria. Of these 18 were included, and were divided into two categories: studies that solely used non-surgical management and studies that used operative techniques to prevent soft tissue polly beak deformity. Cartilaginous causes of polly beak deformity were excluded. Although a number of different methods are described in literature, the effectiveness and potential of each are still open to debate. Randomized controlled trials that use a standardized objective measurement method for soft tissue polly beak deformity are needed to objectively compare different methods.