Awareness of Facial Asymmetry and Its Impact on Postoperative Satisfaction of Rhinoplasty Patient

The Isosceles Nasal Tip-Laser-Assisted Midline Assessment in Rhinoplasty

The accurate determination of the nasal tip's spatial location is crucial for achieving symmetry in rhinoplasty. Even minor deviations can result in asymmetrical lengths and configurations of the nostrils. Our approach centers on defining the nasal tip position by establishing the midline of the nasal base and projecting an isosceles triangle. This triangle, with the tip as the vertex and alar creases as angles, ensures symmetric sidewalls. The symmetry axis, derived from the isosceles triangle, guides the placement of the tip sidewalls and columella. To implement this, we use anatomical benchmarks such as the implantation of the nasal base and position of the alar creases, considering inherent facial asymmetries. We introduce a laser gadget as an auxiliary tool, projecting perpendicular lines to guide precise midline alignment. Marking specific points, including interbrow midpoint and alar creases, ensures accuracy. In the past 12 months, we applied this methodology in 247 rhinoplasty cases, observing improved outcomes and patient satisfaction. Our proposal of utilizing isosceles triangles provides a streamlined approach to achieving symmetry. The laser device, while beneficial, should be viewed as supportive rather than an absolute guiding measure.

Facial Asymmetry in Children With Unilateral Congenital Ptosis

PURPOSE

To analyze facial asymmetry in children with unilateral congenital ptosis.

METHODS

This is a retrospective review of pediatric patients undergoing ptosis repair between January 1, 2017, and December 31, 2020. Charts were reviewed to ensure a diagnosis of idiopathic unilateral congenital ptosis. Sex, age, laterality, margin to reflex distance 1, levator function, and surgical intervention were collected.Clear preoperative photos without head turn were included. Using the ImageJ software ( nih.gov ), landmarks of the periorbital region, midface, and lower face were marked, and measurements between these landmarks were taken.Two-tailed Student t tests were used to compare measurements between the ptotic and non-ptotic sides. Relationships between different measurements on the same side of the face were analyzed using paired-variable regressions.

RESULTS

Forty-four patients with unilateral congenital ptosis were included. The surgical management consisted of Mullerectomy in 9 of 44 (20%), levator resection in 15 of 44 (34%), and frontalis suspension in 20 of 44 (46%) patients. The side of the face with blepharoptosis was found to more often have smaller margin to reflex distance 1 ( p < 0.001), smaller margin to reflex distance 2 ( p < 0.005), smaller horizontal palpebral fissure ( p < 0.05), shorter midface height ( p < 0.001), and a more inferiorly displaced lateral canthus (canthal angle, p < 0.001) relative to the non-ptotic side of the face. The mean head tilt of patients with right sided ptosis (1.37° right tilt) was statistically significantly different from those with left sided ptosis (0.85° left tilt; p = 0.04).

CONCLUSIONS

In children with unilateral congenital ptosis, the ptotic side of the face was found to be the nondominant side of the face. Patients were also found to have ipsilateral head tilt.

Paranasal Augmentation Using Diced Costal Cartilage for Midface Concavity: A Retrospective Study of 68 Patients

BACKGROUND

Paranasal augmentation was effective management for midface concavity. Both alloplastic graft (e.g. silicone, porous polyethylene, or expanded polytetrafluorethylene) and autologous tissue (e.g. costal cartilage) were used for paranasal augmentation. The study aims to evaluate the safety and efficacy of paranasal augmentation using diced costal cartilage for midface concavity.

METHODS

A retrospective review of demographic data and complications was conducted for consecutive patients who underwent paranasal augmentation using diced costal cartilage. A questionnaire was used for investigating the patient's satisfaction (i.e. overall satisfaction, bilateral alar bases symmetry, improvement of concavity, and foreign body sensation). Patients' photographs were used to evaluate aesthetic outcomes (i.e. overall satisfaction, bilateral alar bases symmetry, and improvement of concavity) by third-party doctors.

RESULTS

Sixty-eight patients (60 females; mean age, 27.1 ± 8.2 years) were included. During a median follow-up of 6.5 months, costal cartilage migration occurred in 13 (19.1%) patients and partial resorption occurred in 2 (2.9%) patients. Seventy-five per cent of the patients and 98.5% of the doctors reported overall satisfaction. Bilateral alar bases asymmetry by 20 (29.4%) patients, no improvement of concavity by 13 (19.1%) patients, and foreign body sensation by 13 (19.1%) patients were reported. While bilateral alar bases asymmetry was not reported, improvement of concavity was reported in 67 (98.5%) patients by third-party doctors. On both univariate and multivariate analyses, improvement of concavity was significantly associated with patients' overall satisfaction (p = 0.008 and 0.045, respectively), while bilateral alar bases symmetry and foreign body sensation were not (all p > 0.05).

CONCLUSIONS

Paranasal augmentation using diced costal cartilage seems a safe and effective method for midface concavity. Improvement of concavity may be significantly associated with patients' overall satisfaction.

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 .

Forehead Contouring as an Adjunct to Rhinoplasty: Evaluation of the Effect on Facial Appearance, Personal Traits and Patient Satisfaction

BACKGROUND

The nose has a great impact on facial beauty and appearance. Therefore rhinoplasty is one of the most performed procedures worldwide. However, considering the varying degrees of cosmetic operations holistic approach to face is essential to achieve more successful results. In order to this, the forehead is noteworthy with its gender-related features and important relation to the nose. The purpose of this study is to assess the effect of forehead contouring with fat grafting adjunct to rhinoplasty on personal traits, facial appearance and patient satisfaction.

METHODS

A total of 15 patients who underwent rhinoplasty and forehead contouring with fat grafting were enrolled in this retrospective study. Facial appearance and personal traits were evaluated via subject Global Aesthetic Improvement Scale (S-GAIS), and patient satisfaction was assessed with custom design Forehead Rhinoplasty Outcome Evaluation Questionnaire (F/ROE-Q). Forehead inclination was calculated as an objective indicator of fat graft survival and contour improvement. Pre- and postoperative photographs were taken and used for evaluation.

RESULTS

According to the F/ROE-Q score, mean total preoperative score was 9,13 and the mean total postoperative score was 24,86 (p < 0,01). High postoperative satisfaction scores were observed in all patients. Statistically significant improvement was observed in attractiveness, femininity, youthfulness, facial harmony, forehead contour, facial profile view parameters based on S-GAIS assessment. The mean forehead inclination angle was 19,04^o preoperatively and 16,74° postoperatively.

CONCLUSION

With the important benefits such as higher patient satisfaction and improvement on facial appearance and personal traits, forehead contouring with fat grafting was an efficient and applicable procedure adjunct to rhinoplasty.

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 .

Invited Discussion on "Awareness of Facial Asymmetry and Its Impact on Postoperative Satisfaction of Rhinoplasty Patient"

In this invited discussion, we applaud the authors of "Awareness of Facial Asymmetry and Its Impact on Postoperative Satisfaction of Rhinoplasty Patient" for their efforts to reinforce the importance of recognizing facial asymmetry preoperatively in the rhinoplasty patient. They can be applauded for translating this known key factor into data in the form of validated patient-reported outcomes tools. The study could be improved by better defining the asymmetry that the study patients had and investigating the symmetry of the surgical result. Furthermore, we provide suggestions for how to better counsel patients on facial asymmetry and its effects on their rhinoplasty result. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.