Facial attractiveness and abnormality of nasal reconstruction patients and controls assessed by laypersons

Autologous versus prosthetic nasal and auricular reconstruction - patient, professional and layperson perceptions

The aim of this study was to retrospectively evaluate the perceptions of aesthetic outcome following the autologous and prosthetic reconstruction of nasal and auricular defects among patients, professionals (oral and maxillofacial surgeons and ear, nose and throat surgeons) and people unfamiliar with reconstructive surgery. The influence of anatomical subunits on the overall perception of nasal and auricular reconstructions was also determined. A total of 119 patients treated for nasal and auricular defects between 1997 and 2016, with a minimum follow-up period of 6 months, were selected, and photographs of 77 of these patients (65%) were presented in a digital survey and reviewed using a standardized questionnaire. No clinically relevant correlations were found between the age or gender of patients (as well as those of the respondents) and their scores. Prosthetic reconstructions of nasal and auricular defects were considered advantageous over autologous reconstructions in terms of the subjective aesthetic outcome in the view of the professionals, in particular oral and maxillofacial surgeons; however, the patients judged both techniques to be equally effective in terms of aesthetics. No anatomical subunits were found to have a significant impact on the overall match of a nasal or auricular reconstruction with the patient's face.

The pedicled levator labii superioris alaeque nasi flap: A durable single-stage option for reconstruction of full-thickness nasal defects

IMPORTANCE

Repair of full-thickness nasal defects can often be associated with multi-stage operations that can result in significant physical and psychological morbidity for patients. We present a single-stage option for reconstruction of these defects.

OBJECTIVE

Demonstrate the utility of the pedicled levator labii superioris alaeque nasi flap and consistency of its vascular pedicle.

DESIGN

Anatomical study using fresh cadavers.

SETTING

Academic medical center.

MAIN OUTCOME AND MEASURES

Evaluation of vascular anatomy of pedicled flap and measurements of distances with relationship to facial anatomic landmarks.

RESULTS

With few noted anatomic variations, the vascular pedicle of the pedicled levator labii superioris alaeque nasi flap arises from the superior labial artery and is reliably located within 1 cm lateral and inferior of the nasal sill.

CONCLUSIONS AND RELEVANCE

As a robust single-stage option, the pedicled levator labii superioris alaeque nasi flap can serve as a powerful option in the arsenal of the reconstructive surgeon. The technique for harvest is simple with attention to a few anatomic variations as described herein, and excellent results can be obtained with proper application.

Association of Rhinoplasty With Perceived Attractiveness, Success, and Overall Health

IMPORTANCE

To date, the impact of rhinoplasty surgery on social perceptions has not been quantified.

OBJECTIVE

To measure the association of rhinoplasty with observer-graded perceived attractiveness, success, and overall health.

DESIGN, SETTING, AND PARTICIPANTS

In a web-based survey, blinded casual observers viewed independent images of 13 unique patient faces before or after rhinoplasty. Delphi method was used to select standardized patient images, confirming appropriate patient candidacy and overall surgical effect. Observers rated the attractiveness, perceived success, and perceived overall health for each patient image. Facial perception questions were answered on a visual analog scale from 0 to 100, where higher scores corresponded to more positive responses. A multivariate mixed-effects regression model was used to determine the effect of rhinoplasty while accounting for observer biases. To further characterize the effect of rhinoplasty, estimated ordinal rank change was calculated for each domain.

MAIN OUTCOMES AND MEASURES

The primary objective was to measure the effect of rhinoplasty on observer-graded perceived attractiveness, success, and overall health.

RESULTS

A total of 473 observers (mean age, 29 years [range, 18-73 years]; 305 [70.8%] were female) successfully completed the survey. On multivariate regression, patients after rhinoplasty were rated as significantly more attractive (rhinoplasty effect, 6.26; 95% CI, 5.10-7.41), more successful (rhinoplasty effect, 3.24; 95% CI, 2.32-4.17), and overall healthier (rhinoplasty effect, 3.78; 95% CI, 2.79-4.81). The ordinal rank change for an average individual's perceived attractiveness, success, and overall health was a positive shift of 14, 9, and 10 out of 100 rank positions, respectively.

CONCLUSIONS AND RELEVANCE

As perceived by casual observers, rhinoplasty surgery was associatedwith perceptions that in patients appeared significantly more attractive, more successful, and healthier. These results suggest patients undergoing rhinoplasty may derive a multifaceted benefit when partaking in social interactions. Furthermore, these results facilitate improved patient discussions aiming to provide more precise surgical expectations with an understanding that these results represent optimal outcomes.

LEVEL OF EVIDENCE

NA.

Secondary cleft rhinoplasty rejuvenates the nose: a suggestion from a panel survey

BACKGROUND

Cleft-lip nasal deformity (CLND) affects the overall facial appearance and attractiveness. The CLND nose shares some features in part with the aging nose.

OBJECTIVES

This questionnaire survey examined: 1) the panel perceptions of the role of secondary cleft rhinoplasty in nasal rejuvenation; and 2) the influence of a medical background in cleft care, age and gender of the panel members on the estimated age of the CLND nose.

STUDY DESIGN

Using a cross-sectional study design, we enrolled a random sample of adult laypersons and health care providers. The predictor variables were secondary cleft rhinoplasty (before/after) and a medical background in cleft care (yes/no). The outcome variable was the estimated age of nose in photographs derived from 8 German nonsyndromic CLND patients. Other study variables included age, gender, and career of the assessors. Appropriate descriptive and univariate statistics were computed, and a P value of <.05 was considered to be statistically significant.

RESULTS

The sample consisted of 507 lay volunteers and 51 medical experts (407 [72.9%] were female; mean age ± SD = 24.9 ± 8.2 y). The estimated age of the CLND noses was higher than their real age. The rhinoplasty decreased the estimated age to a statistically significant degree (P < .0001). A medical background, age, and gender of the participants were not individually associated with their votes (P > .05).

CONCLUSIONS

The results of this study suggest that CLND noses lack youthful appearance. Secondary cleft rhinoplasty rejuvenates the nose and makes it come close to the actual age of the patients.

Panel and patient perceptions of nasal aesthetics after secondary cleft rhinoplasty with versus without columellar grafting

BACKGROUND

Cleft-lip nasal deformity alters patient's self-image, as well as posing unique challenges for the rhinoplastic surgeon.

OBJECTIVES

The main purpose of this study was to compare the panel perceptions of nasal aesthetics following secondary cleft rhinoplasty with versus without caudal septal extension grafting (columella grafting). We also investigated whether patient's self-assessment and satisfaction correlated with 4 other variables: (1) rhinoplasty techniques; (2) patients' age; (3) patients' gender; and (4) panel perceptions.

METHODS

Using a cross-sectional study design, we enrolled a sample of adult laypersons and medical experts. The predictor variable was the rhinoplasty techniques (with/without columellar grafting). The outcome variable was the panel rankings of nasal aesthetics based on the photographs of 50 nonsyndromic cleft patients before and after the rhinoplasty. Other variables included the patient's subjective assessment and satisfaction, demographic and anatomic variables. Appropriate descriptive, uni- and bivariate statistics were calculated. The significance level was set at P≤0.05 and <0.05 for single- and two-tailed tests of hypothesis, respectively.

RESULTS

The sample consisted of 507 laypersons and 51 professionals who gave comparative ratings (P>0.05). Columellar grafting was associated with higher rankings of postoperative nasal aesthetics (P =0.04). Most of the patients (90%) rated positive outcomes. Surgical techniques, patients' age and gender, and panel perceptions were not individually significantly associated with subjective measures and satisfaction.

CONCLUSIONS

Our results suggest that caudal septal extension grafting improves the nasal aesthetics of the cleft patients, as judged by the panel. Patient's self-assessment seems unreliable to be used as an outcome measure.