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Pegalajar-García MD, Ayén-Rodriguez A, Almazán-Fernández FM, Ruiz-Villaverde R. Five-Case Report Series of Dermofat Graft in Nasal Alar Surgical Defect Reconstruction. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00255-2. [PMID: 38552784 DOI: 10.1016/j.ad.2023.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/12/2023] [Accepted: 05/14/2023] [Indexed: 05/23/2024] Open
Affiliation(s)
| | - A Ayén-Rodriguez
- Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, España
| | | | - R Ruiz-Villaverde
- Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, España
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Hattori Y, Tu JCY, Chou PY, Lo LJ. Two-flap technique with interpositional dermofat graft for anterior oronasal fistula closure in patients with cleft: A case series. J Plast Reconstr Aesthet Surg 2024; 90:51-59. [PMID: 38359499 DOI: 10.1016/j.bjps.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 11/28/2023] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Oronasal fistula at the anterior hard palate is one of the common sequelae after cleft surgery, and the leakage negatively affects the patient's quality of life. Although several surgical techniques have been proposed for reconstruction, it remains challenging because of the scarred regional tissue with a high rate of fistula recurrence. In this study, we present the anterior oronasal fistula repair using a two-flap technique with an interpositional dermofat graft (DFG). METHODS A retrospective review of anterior oronasal fistula repair performed by the senior author between April 2018 and August 2022 at the Craniofacial Center was conducted. Patients who underwent a fistula repair using the technique were further identified and investigated. RESULTS Thirty-four operations were performed using the technique, and 31 fistulas were completely closed, with a success rate of 91.2%. The fistula symptom improved but persisted postoperatively in 3 patients, of whom 2 patients underwent a second fistula repair using the same procedure, resulting in successful closure. Fistula recurrence was significantly correlated with fistula size (p = 0.04). The DFG was simultaneously utilized for nasal dorsum and/or vermillion reconstruction in 28 cases. CONCLUSION The two-flap technique enabled tension-free approximation, and the interpositional DFG facilitated watertight closure of the fistula, resulting in a high success rate of anterior oronasal fistula repair. The fistula closure could be combined with other revisional procedures for cleft-related deformities, where the DFG was simultaneously utilized.
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Affiliation(s)
- Yoshitsugu Hattori
- Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Junior Chun-Yu Tu
- Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Pang-Yun Chou
- Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lun-Jou Lo
- Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan, Taiwan.
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Rafizadeh SM, Mirghorbani M, Tavakoli M, Haydar AA. Surgical Correction of Cicatricial Lower Eyelid Retraction: A Systematic Review. Semin Ophthalmol 2024; 39:40-59. [PMID: 37904540 DOI: 10.1080/08820538.2023.2273850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 10/09/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND Cicatricial lower eyelid retraction is a challenging condition. It involves scarring of the lower eyelid, which causes it to retract and expose the sclera. This can lead to complications such as dry eye syndrome and corneal melting. It can be caused by trauma, burns, or previous eyelid surgery. Detailed assessment and understanding of eyelid anatomy and retraction are critical for successful surgical planning. Dynamic and static examinations of the eyelid including measurements of the lower eyelid margin reflex distance (MRD2) and scleral show are also essential to determine the appropriate treatment approach. METHODS A systematic review was conducted using Medline, Scopus, and Cochrane databases with keywords related to cicatricial lower eyelid retraction. The publication language was limited to English after 2000. A total of 29 articles were included for data extraction and analysis. RESULTS The main surgical techniques include tarsoconjunctival grafts, spacers, midface lift, and lateral canthal tendon suspension, although no single procedure has been universally recognized as the gold standard. New innovations such as synthetic grafts and xenografts are being explored for their potential in eyelid reconstruction. Severe cases, defined as those with inferior scleral show greater than 2 mm, may require a combination of reconstruction methods. CONCLUSIONS Correcting cicatricial lower eyelid retraction is a major challenge in oculoplastic reconstruction. The surgical approach should be individualized, considering the pathologies and etiologies of lid retraction. In-depth knowledge and careful surgical planning are essential for best outcomes. There is no gold standard technique, and postoperative outcomes, complications, and management vary depending on the surgical approach used.
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Affiliation(s)
- Seyed Mohsen Rafizadeh
- Farabi Eye Research Center, Department of Oculofacial Plastic and Reconstructive Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Mirghorbani
- Farabi Eye Research Center, Department of Oculofacial Plastic and Reconstructive Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Tavakoli
- Department of Ophthalmology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Ali A Haydar
- Farabi Eye Research Center, Department of Oculofacial Plastic and Reconstructive Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Ince B, Zuhour M, Kadiyoran C, Avunduk MC, Dadaci M. A Comparison Between Hyaluronic Acid Filler and Dermofat Grafts With or Without Tie-Over Dressing for Lip Augmentation. Dermatol Surg 2024; 50:52-58. [PMID: 37994437 DOI: 10.1097/dss.0000000000003995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND There are many different autologous grafts used for lip augmentation, such as fat, fascia, or dermofat grafts (DFG). However, filling with synthetic materials such as hyaluronic acid (HA) fillers is the most preferred method. OBJECTIVE The authors aimed to compare DFG with HA fillers regarding cost, permanence, complication rate, gained volume, and satisfaction rate. The authors investigated the effect of tie-over dressings on the viability of DFG. PATIENTS AND METHODS Patients who received hyaluronic acid fillers were referred to as Group H. Patients who received grafts without tie-over and with tie-over dressings formed Groups D1 and D2, respectively. The lip index (LI) was used for volume comparisons. The viable area of the grafts was measured using ultrasound imaging. RESULTS At postoperative month 6, the only significant difference was found between Group D1 and Group D2 ( p < .05). At the postoperative first year, Groups D1 and D2 had a statistically higher LI value compared with Group H. Group D2 had a higher viable area than Group D2 ( p < .05). Group H and Group D2 showed higher satisfaction scores than Group D1 ( p < .05). CONCLUSION Dermofat grafts with or without tie-over dressings can be considered a reliable and inexpensive choice for patients who seek a more permanent procedure. Tie-over dressings increase the predictability of DFG and reduce the need for overcorrection.
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Affiliation(s)
- Bilsev Ince
- Department of Plastic Reconstructive and Aesthetic Surgery, Private Clinic, ¡zmir, Turkey
| | - Moath Zuhour
- Department of Plastic Reconstructive and Aesthetic Surgery, Private Hospital of Büyükşehir, Konya, Turkey
| | - Cengiz Kadiyoran
- Department of Radiology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Mustafa Cihat Avunduk
- Department of Medical Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Mehmet Dadaci
- Department of Plastic Reconstructive and Aesthetic Surgery, Private Clinic, ¡zmir, Turkey
- Department of Plastic, Reconstructive and Aesthetic Surgery, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
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Fung CY, Kim JH, Liao PH, Jang YJ. Revision Rhinoplasty Using Glued Diced Costal Cartilage Shaped With Mold for Management of Complicated Silicone Rhinoplasty. Aesthet Surg J 2023; 43:1237-1247. [PMID: 37289986 DOI: 10.1093/asj/sjad180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/28/2023] [Accepted: 05/31/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Complicated silicone nose is a common clinical problem. Selection of replacement material for revision dorsal augmentation is a challenging task. OBJECTIVES The authors presented their experience in the use of molded glued diced cartilage graft (GDCG) for revision rhinoplasty in patients who had complicated silicone augmentation. METHODS The authors performed a retrospective review of the medical records of 28 patients who underwent silicone implant removal and revision dorsal augmentation with costal cartilage at a tertiary center between February 1, 2018, and February 28, 2022. Patient demographics, surgical technique, anthropometric measurements, and complication data were retrieved and analyzed. Aesthetic outcome scoring and anthropometric measurements were performed. RESULTS Twenty-eight patients (9 males and 19 females) who underwent revision rhinoplasty with augmentation were reviewed. The principal indication for revision was cosmetic dissatisfaction. Mean postoperative follow-up duration was 18.3 months. All patients had revision dorsal augmentation with molded GDCG. Other key surgical techniques include the use of caudal septal extension and extended spreader and tip grafts. The majority of the patients were judged to have good or excellent outcomes (91.1%). There were significant percentage increases in dorsal height, radix height, nasal length, and nasal tip projection (2.78%, 2.26%, 7.53%, and 2.40%, respectively; P < .05) and reduction of nasal axis deviation of 1.15° (P < .05) postoperatively. Two patients had postoperative complications, including infection and cosmetic dissatisfaction. CONCLUSIONS Revision rhinoplasty following unsuccessful silicone augmentation is commonly encountered in the Asian population. Molded GDCG for revision dorsal augmentation is a reliable option that delivers good to excellent aesthetic outcomes with acceptable complication rates. LEVEL OF EVIDENCE: 4
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Kim YH, Lee WS, Kim JW, Chung KJ. Cosmetic Open Rhinoplasty in Acute Nasal Bone Fracture With Pre-Existing Deformity. J Craniofac Surg 2023; 34:e358-e363. [PMID: 36959116 DOI: 10.1097/scs.0000000000009232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 10/26/2022] [Indexed: 03/25/2023] Open
Abstract
The simultaneous reduction of nasal bone fracture and cosmetic rhinoplasty is a challenging procedure, because of fracture severity and skeletal instability. Our aim was to investigate the surgical strategy and outcomes of cosmetic rhinoplasty according to the pre-existing nasal deformity when performing simultaneous reduction of nasal bone fracture and cosmetic rhinoplasty. In total, 71 patients who underwent cosmetic rhinoplasty were included. All patients were categorized according to pre-existing deformity, dorsal hump and irregularities, and deviation of the nose, wide nose, and flat nasal dorsum. The authors performed individual maneuvers to correct each deformity. Autologous tissue was used in all maneuvers for graft. Photoanalysis was performed to measure the deviation, nasal length, radix height, dorsal height, tip projection, nasofrontal angle, and nasolabial angle. Subjective evaluation of the functional and esthetic problems was confirmed through rhinoplasty outcome evaluation. In the analysis of the photographs, most patients presented improved scores ( P <0.05). The scores of satisfaction were significantly higher in the postoperative state ( P <0.05). As a postoperative complication, 2 cases of deviated tip occurred due to septal instability and were successfully revised with septoplasty and columellar strut graft. The authors created a harmonious face by evaluating, categorizing, and treating each deformity of the nose in patients with nasal fractures according to our algorithm.
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Affiliation(s)
- Yong-Ha Kim
- Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Daegu, Republic of Korea
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Jeong HY, Cho KS, Bae YC, Seo HJ. Simple method of saddle nose correction: A double-layer dermofat graft: case report. Medicine (Baltimore) 2022; 101:e30300. [PMID: 36107523 PMCID: PMC9439822 DOI: 10.1097/md.0000000000030300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Saddle nose deformities are typically reconstructed with cartilage grafts; however, conchal cartilage grafts are and associated with a risk of damage to the posterior auricular ligament and insufficient amounts, and costal cartilage grafts require invasive surgery under general anesthesia. We proposed a double-layer dermofat graft as an alternative to these methods. PATIENT CONCERNS Two patients with type IV saddle nose deformity underwent reconstruction with nasal augmentation with a double-layer dermofat graft harvested from the gluteal sulcus. DIAGNOSIS After operation, photogrammetric analysis demonstrated an improvement in the dorsal depression area, which corresponded to the angle between the sellion, most depressed point, and pronasale. Rhinoplasty Outcome Evaluation questionnaire was assessed. INTERVENTIONS The graft was divided into 2 sections; the first section was implanted transversely into the depressed nasal framework, and the second section was inserted vertically from the nasion to the supratip break for augmentation. OUTCOMES Both patients reported high satisfaction with the Rhinoplasty Outcome Evaluation questionnaire. The mean preoperative angle between the sellion, most depressed point, and pronasale was 157.8°, and the mean postoperative angle at 6 months was 176.9°. CONCLUSION The simple method double-layer dermofat graft technique demonstrated excellent outcomes in saddle nose deformity correction, did not require cartilage, and was easily performed under local anesthesia.
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Affiliation(s)
- Ho Yoon Jeong
- Department of Plastic and Reconstructive Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan City, Korea
| | - Kyu-Sup Cho
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan City, Korea
| | - Yong Chan Bae
- Department of Plastic and Reconstructive Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan City, Korea
| | - Hyung Joon Seo
- Department of Plastic and Reconstructive Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan City, Korea
- *Correspondence: Hyung Joon Seo, Department of Plastic and Reconstructive Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan City 49241, Korea (e-mail: )
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A novel soft tissue graft alternative in rhinoplasty: the buccal fat graft. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-022-01968-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Chen HC, Teng LH, Yen CI, Yang SY, Hsiao YC, Yang JY, Chang SY, Chuang SS, Huang PJ. Selection of Site for Harvesting Dermal Grafts as a Spacer in the Correction of Eyelid Retraction. Aesthetic Plast Surg 2021; 46:1261-1269. [PMID: 34782914 DOI: 10.1007/s00266-021-02652-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/24/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Several materials can serve as spacer grafts in the repair of retracted lower eyelids. However, previous studies did not reveal any of these to be superior to the others. From our perspective, autologous dermal grafts are ideal because they are biologically compatible and abundantly available. However, the absorption of these grafts is an issue, and the thickness of the dermal grafts is crucial. We evaluated the dermal thickness at five potential donor sites using ultrasonography and the efficacy and safety of the posterior neck dermis as a spacer graft in the correction of retracted lower eyelids. METHODS In 20 healthy volunteers, the dermal thickness was assessed using ultrasonography and compared between the posterior neck, upper arm, inguinal area, intergluteal cleft, and gluteal sulcus. Between January 2018 and June 2021, eight retracted lower eyelids in eight patients were repaired using a posterior neck dermal graft. The surgical results of these grafts were also evaluated. RESULTS The mean age of the volunteers was 37.8 years, and the mean body mass index was 24.45 kg/m2. The intergluteal cleft provided the thickest dermis followed by the posterior neck and gluteal sulcus, which were not significantly different. The upper arm and inguinal area had the thinnest dermis without significant differences between them. The mean marginal reflex distance 2/iris ratio decreased by 0.15 (p=0.008). The mean cosmetic score (0-10) for evaluation of lower eyelid reconstruction increased by 3.38 (p=0.011). The mean Vancouver Scar Scale score for evaluation of donor site scarring was 3.21. CONCLUSIONS Although the posterior neck dermis is the second thickest, it is an ideal spacer graft in the reconstruction of retracted lower eyelids. Adequate thickness, uncomplicated methods, and a closer surgical field are its advantages. Additionally, donor site morbidity is minimal, with acceptable scarring. LEVEL OF EVIDENCE IV 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 .
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Affiliation(s)
- Hung-Chang Chen
- Department of Plastic and Reconstructive Surgery, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Linkuo, 5, Fu-Hsin Street, Kwei-Shan, Taoyuan, 333, Taiwan, ROC
| | - Lan-Hsuan Teng
- Department of Plastic and Reconstructive Surgery, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Linkuo, 5, Fu-Hsin Street, Kwei-Shan, Taoyuan, 333, Taiwan, ROC
| | - Cheng-I Yen
- Department of Plastic and Reconstructive Surgery, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Linkuo, 5, Fu-Hsin Street, Kwei-Shan, Taoyuan, 333, Taiwan, ROC
| | - Shih-Yi Yang
- Department of Plastic and Reconstructive Surgery, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Linkuo, 5, Fu-Hsin Street, Kwei-Shan, Taoyuan, 333, Taiwan, ROC
| | - Yen-Chang Hsiao
- Department of Plastic and Reconstructive Surgery, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Linkuo, 5, Fu-Hsin Street, Kwei-Shan, Taoyuan, 333, Taiwan, ROC
| | - Jui-Yung Yang
- Department of Plastic and Reconstructive Surgery, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Linkuo, 5, Fu-Hsin Street, Kwei-Shan, Taoyuan, 333, Taiwan, ROC
| | - Shu-Yin Chang
- Department of Plastic and Reconstructive Surgery, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Linkuo, 5, Fu-Hsin Street, Kwei-Shan, Taoyuan, 333, Taiwan, ROC
| | - Shiow-Shuh Chuang
- Department of Plastic and Reconstructive Surgery, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Linkuo, 5, Fu-Hsin Street, Kwei-Shan, Taoyuan, 333, Taiwan, ROC
| | - Po-Jen Huang
- Department of Plastic and Reconstructive Surgery, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Linkuo, 5, Fu-Hsin Street, Kwei-Shan, Taoyuan, 333, Taiwan, ROC.
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Percutaneous Thread Lift Facial Rejuvenation: Literature Review and Evidence-Based Analysis. Aesthetic Plast Surg 2021; 45:1540-1550. [PMID: 33471152 DOI: 10.1007/s00266-020-02095-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Interest in noninvasive facial rejuvenation procedures continues to grow. With the advent of the so-called lunch-time face-lift, suture suspension facial rejuvenation has gained prominence and much popularity largely patient driven rather than data driven. We have published a decade ago a review about this rejuvenation technique. Despite its popularity at that time, serious long-term studies and peer-reviewed data about longevity and patient satisfaction were lacking to our surprise. As 10 years have passed, we have conducted a new systematic PubMed database search limited to the last 10 years interval. METHODS The search identified 192 publications. After screening the titles and abstracts, 20 clinical and 2 experimental studies met the inclusion criteria and were selected for this review. RESULTS Though thread lift facial rejuvenation is considered to be a promising modality, no new evidence has been added to the literature to support its use. CONCLUSION Until evidence-based efficacy and robust data are objectively documented, patients requesting percutaneous facial rejuvenation must be well informed about adverse events, longevity of effect, and limited available data on efficacy. LEVEL OF EVIDENCE III 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 .
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Invited Discussion on: Using Dermofat Grafting in Revision Rhinoplasty. Aesthetic Plast Surg 2021; 45:626-627. [PMID: 33403421 DOI: 10.1007/s00266-020-02073-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
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