Primary and Revision Rhinoplasty: A Single Surgeon Experience and Patient Satisfaction

Trends in rhinoplasty: Insights from an international survey of facial plastic surgeons

PURPOSE

Advancements in rhinoplasty techniques are continuously evolving, leading to reportedly better outcomes, though clinical practice does not necessarily reflect the adoption of these tools and methods. This survey study aims to compare current literature with reported clinical practices.

MATERIALS AND METHODS

A cross-sectional survey collected responses from facial plastic surgeons regarding demographics, practice settings, and experiences with costal cartilage grafts, as well as their use of newer instruments and techniques. Our study aggregated survey responses from facial plastic surgeons from diverse practice settings, including private practice, academic hospitals, and combined academic-private practices.

RESULTS

134 surgeons responded; most have been in practice for over 20 years and work in private practice, and perform a median of 8 rhinoplasties monthly, with approximately a quarter being revision cases. Cosmetic rhinoplasties accounted for nearly half of the procedures. Autologous CCG was preferred for revisions despite the reported increased risk of warping.

CONCLUSIONS

Most surgeons continue to choose autologous costal cartilage but have not adopted regular use of piezo or the dorsal preservation technique. To improve patient outcomes and reduce costs in the long term, further research is needed to understand surgeons' preferences and identify barriers to adopting new techniques and instruments.

Repositioning the Posterior Septal Angle in Rhinoplasty: Methods and Outcomes

OBJECTIVE

Repositioning and fixation of the posterior septal angle (PSA) relative to the anterior nasal spine (ANS) is a well-known maneuver performed during rhinoplasty. Suture techniques through the periosteum along with transosseous drilling through the spine are the two most common fixation methods. We report on how nasal airway patency varies as a function of technique and patient demographic factors.

METHODS

A retrospective analysis was performed on patients who underwent PSA repositioning and stabilization during rhinoplasty due to caudal septal deformities. Nasal Obstruction Symptom Evaluation (NOSE) scales were measured pre- and post-operation to evaluate functional outcomes.

RESULTS

207 patients with either mobile or immobile PSA underwent ANS fixation secured with either a suture passed through the periosteum of the ANS or with the creation of a drill hole through the ANS. In all patients regardless of clinical or demographic groupings, postoperative NOSE scores were significantly decreased when compared to preoperative scores (p < 0.05). Preoperative NOSE score, fixation method, sex, functional versus cosmetic, age, follow-up period, and graft site did not independently affect the postoperative NOSE score. Though the differences between primary and revision outcomes were statistically significant, patients in both groups reported significant improvements in postoperative NOSE scores that deescalated their symptoms from "severe" to "mild."

CONCLUSION

Repositioning and fixation of the PSA improve patient outcomes. However, there is no significant difference between fixation methods on final NOSE scores. Septal fixation with consideration for patient anatomy allows for effective treatment.

LEVEL OF EVIDENCE

4 Laryngoscope, 135:1975-1982, 2025.

Long-Term Safety and Reliability of Using Tutoplast-Processed Fascia Lata to Refine the Nasal Dorsum in Primary and Revision Rhinoplasty

BACKGROUND

Tutoplast-processed fascia lata (TPFL) is an allograft substance employed alongside cartilaginous materials to achieve optimal augmentation in rhinoplasty. Alternatively, it can be utilized to conceal and smooth irregularities of the nasal dorsum during the procedure. Despite its application, there is limited available data on the extended safety of TPFL. Consequently, our objective was to assess the enduring long-term safety and reliability of TPFL in both primary and revision rhinoplasty.

METHODS

A retrospective cohort study was conducted on 300 patients who underwent primary and revision rhinoplasty with TPFL grafts. Baseline characteristics, types of surgical techniques, and surgical outcomes were evaluated. The surgical success and satisfaction rates were assessed as primary outcomes. The Statistical Package for Social Sciences (SPSS), version 27 for Windows, was used to conduct the statistical analysis.

RESULTS

TPFL was used in both primary and revision rhinoplasty, with septal cartilage being the most common conjunction graft material. The overall surgical success rate was 97.3%, with only 2.7% of patients experiencing complications. The satisfaction rate was 92.7%, with no significant difference between primary and revision cases. The highest satisfaction rate was found in patients who underwent the crushed cartilage in fascia technique (96.3%).

CONCLUSIONS

TPFL in conjunction with cartilaginous materials; is a safe and reliable option for dorsal augmentation and camouflage material in primary and revision rhinoplasty, with low complication and high patient satisfaction rates.

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 .

Reporting of Complications in Rhinoplasty Randomized Controlled Trials: An Analysis Using the CONSORT Extension for Harms Checklist

OBJECTIVE

This study aimed to assess the completeness of adverse event (AE) reporting in randomized control trials (RCTs) focused on rhinoplasty, using the Consolidated Standards for Reporting (CONSORT) Extension for Harms checklist.

STUDY DESIGN

A cross-sectional design was employed to review RCTs related to rhinoplasty published between January 1, 2005, and January 28, 2022.

SETTING

The study analyzed clinical trials on rhinoplasty retrieved from PubMed.

METHODS

We performed a comprehension search on PubMed, blind and duplicate screening, and data extraction. Adherence to the 18 recommendations of the CONSORT Extension for Harms was evaluated, with 1 point assigned for each adhered item. Percent adherence was calculated based on the 18 points, taking into account the multiple subcategories within some recommendations. Descriptive statistics were used to summarize adherence-including frequencies, percentages, and 95% confidence intervals.

RESULTS

Our search returned 240 articles, of which 56 met inclusion criteria. No RCTs adhered to all 18 CONSORT Extension for Harms items. Twenty-six (26/56, 46.4%) adhered to ≥50% of the items, and 30 (30/56, 53.6%) adhered to ≥33.3% of the items. Seven (7/56, 12.5%) RCTs adhered to no items. Across all RCTs, the average number of CONSORT-Harms items adhered to was 7.2 (7.2/18, 40.0%). The most adhered to item was item 10. Discussion balanced with regard to efficacy and AEs (80.4%, [70.0-90.8]).

CONCLUSION

This study highlights the inadequacy of AE reporting in rhinoplasty RCTs according to CONSORT-Harms guidelines. Urgent efforts are required to bridge this reporting gap and enhance transparency in surgical research, ultimately safeguarding patient well-being.