Association of Dorsal Reduction and Tip Rotation With Social Perception

High and Low Septal Strip Excision on Dorsal Preservation Rhinoplasty to Fix Septal Deviation

ABSTRACT

Rhinoplasty is one of the leading procedures among aesthetic and plastic surgery interventions. Dorsal hump and nasal deviation deformities are prevalent among the general population. Patients who have both dorsal hump and nasal deviation deformities can be considered challenging for rhinosurgeons. Dorsal preservation techniques are of great interest for obtaining better and more satisfactory aesthetic and functional results. Dorsal strip excision plays a considerable part in dorsal preservation techniques. In this study, the author defines a new method that includes excisions of low and high septal strips in the subdorsal area to straighten deviation in the lower part of the distal septum and fix it on the middle line. The present study was designed as retrospective. Sixty-nine patients met the inclusion and exclusion criteria, and their records were assessed (49 females and 20 males). The patients who were included in the study have undergone surgery with high and low septal strip excision through either push-down or let-down techniques. Patients were evaluated using the "Rhinoplasty Outcome Evaluation" (ROE) questionnaire before and 12 months after surgery. The follow-up period ranged between 12 and 20 months (median, 16.3 months). All procedures were performed by the same surgeon between October 1, 2018, and April 1, 2020. The ROE scores ranged between 82 and 100 points after 1 year. The initial median ROE score was 56.5, and it increased to 93.00 points 12 months after surgery (P < 0.001). Patient satisfaction was excellent in 88.76% of the included patients. The combination of let- and push-down methods with low to high septal strip excision resulted in favorable outcomes in patients who had concomitant hump and septal deviation deformities. This new approach presents a suitable and easy method to the surgeons who are interested in dorsal preservation rhinoplasty.

The Impact of Component Dorsal Hump Reduction on Patient-Perceived Nasal Aesthetics and Obstruction in Rhinoplasty

OBJECTIVE

This study aimed to evaluate functional and aesthetic patient-reported outcomes using validated metrics after component dorsal hump reduction (DHR) with spreader graft placement, which have not been previously reported.

STUDY DESIGN

Prospective cohort study.

METHODS

This prospective cohort study was conducted in a tertiary care medical center. Participants underwent septorhinoplasty (SRP) with spreader graft placement with cosmetic, component DHR (cosmetic DHR), or SRP with spreader graft placement without dorsal hump reduction (noncosmetic, non-DHR). The Nasal Obstruction Symptom Evaluation (NOSE) scale and the FACE-Q Satisfaction with Nose, Nostrils, and Social Functioning scales were administered to patients preoperatively and postoperatively (at 2, 4, 6, and/or 12 months). Pre- and postoperative NOSE and FACE-Q scores were compared.

RESULTS

A total of 226 patients underwent SRP with spreader graft placement; 113 (50.0%) with cosmetic DHR and 113 (50.0%) noncosmetic, non-DHR (control). Patients who completed the NOSE and FACE-Q surveys preoperatively and at least at one postoperative time point were included. Both cohorts had a statistically and clinically significant improvement in NOSE and FACE-Q scores. There were similar improvements in NOSE scores in both cohorts. Postoperative FACE-Q scores were higher in the cosmetic DHR cohort despite lower preoperative FACE-Q scores when compared to the control cohort.

CONCLUSIONS

Although there are multiple techniques for DHR, component DHR with spreader graft placement has long been considered the standard. Therefore, it is important to note the significant postoperative cosmetic and functional improvements reported by patients who have undergone this procedure to compare to newer techniques as they evolve.

LEVEL OF EVIDENCE

3 Laryngoscope, 2022.

Partial Let-Down and Push-Down Techniques With Complete Cartilage Preservation

ABSTRACT

Dorsal hump reduction is one of most commonly performed operations among Caucasian patients because of their nose anatomy. Dorsal preservation techniques in hump reduction are highly favorable, and recent studies have focused on dorsal preservation techniques. In the present research, the authors describe novel approaches for the push-down and let-down techniques in which the cartilage is totally preserved. According to the inclusion and exclusion criteria, the records of 48 patients were assessed (40 females and 8 males). Twenty-seven partial modificated push-down and 21 partial let-down techniques were performed. Participants completed the ROE questionnaire before surgery and at their 1-year follow-up control. The ROE scores before and 1 year after surgery were compared. The median ROE score was 60.0 points before surgery and 93.6 points 1 year after surgery. The ROE score was increased significantly (P < 0.001). A total of 92% of the included patients reported excellent satisfaction with the surgical outcome (ROE score > 85). The present study is the first to show total cartilage preservation with let-down and push-down techniques. These approaches are easy to perform and will lead to better cosmetic results in clinical settings.

Dorsal Preservation Rhinoplasty: Method and Outcomes of the Modified Subdorsal Strip Method

There has been particular recent interest in dorsal preservation rhinoplasty techniques because of claims of superior functional and aesthetic results relative to conventional hump reductions. The septum in dorsal preservation rhinoplasty is managed in a variety of ways with differences largely based on the location of septal excision (subdorsal resection, midseptal resection, and inferior septal resection). The technical considerations of a modified subdorsal strip method using a structural preservation technique are described. This technique maintains a subdorsal and caudal strut of cartilage. Patient-reported measures demonstrate significantly improved functional and aesthetic outcomes postoperatively with this procedure.

Social Perceptions of Pediatric Hearing Aids

OBJECTIVES

To determine whether hearing aid (HA) use affects social perceptions of general public adults and age-matched peers and if so, determine if effects are modulated by lack of societal representation of pediatric HAs.

METHODS

A 10-year-old boy was presented in six photographic conditions with and without HAs and eyeglasses (a worn sensory aid with wider societal representation). HAs were presented in neutral skin tone and bright blue colors. Photographic conditions were embedded into web-based surveys with visual analog scales to capture social perceptions data and sourced to 206 adults (age 18-65) and 202 peers (age 10) with demographic characteristics representative of the general US population. Mean differences in scores for each condition compared to control images were computed using two-tailed t-tests.

RESULTS

In both adult and child respondents, HAs were associated with decreased athleticism, confidence, health, leadership, and popularity. Glasses were associated with decreased athleticism and popularity but increased intelligence, overall success, and in the child respondents, friendliness. When worn in combination, the beneficial effects of glasses were mitigated by brightly colored but not neutrally colored HAs.

CONCLUSION

Negative effects of pediatric HAs on social perceptions may be influenced by poor societal representation of HAs. These results suggest that greater representation of pediatric HAs is necessary to make society more inclusive for children with hearing loss.

LEVEL OF EVIDENCE

4 Laryngoscope, 131:E2387-E2392, 2021.

Nasal Analysis of Classic Animated Movie Villains versus Hero Counterparts

Opposing facial features between animated villains and heroes have historically been used to demonstrate contrasting morality between characters, and this could have an impact on how humans view someone as good or evil in everyday life. Studies have been done investigating classic dermatologic features of villainous characters. This principle can be applied to nasal features as well. A search for "top animated characters" was performed. Characters were chosen from American Film Institute's "The Top Tens," Rolling Stone's "25 Best Pixar Movie Characters," and Screenrant's "The 30 Best Animated Movie Characters of All Time." Twenty villains and twenty hero counterparts from respective films were chosen. Classic nasal features were analyzed. Twenty villains (14 male, 6 female) and 20 heroes (12 male, 8 female) were analyzed. Sixteen villains (80%) had greater than normal nasal frontal angle versus 18 heroes (90%). Thirteen villains (65%) had an acute nasolabial angle versus two heroes (10%). Two villains (10%) had excess columellar show versus seven heroes (35%). Seven villains (35%) and one hero (5%) had a dorsal hump. Twelve villains (60%) had an overprojected chin versus three heroes (15%). Villains in pre-2000s films more frequently had a dorsal hump, overprojected chin, ptotic tip, pollybeak deformity, and bulbous tip. Heroes in pre-2000s films more frequently had an overrotated tip. Villains and heroes commonly have a greater than normal nasofrontal angle. Villains more commonly have an acute nasolabial angle, underrotated tip, overprojected chin, dorsal hump, and pollybeak deformity. Heroes more commonly have a large nasolabial angle and overrotated tip. Further research in conjunction with psychologists is required to obtain concrete data on how this affects whether an individual in real life is seen as good or evil, and the impact this has on interactions in society, including in the medical field.

A Review and Modification of Dorsal Preservation Rhinoplasty Techniques

Importance: Although conventional hump resections are a hallmark of rhinoplasty, there has been a rekindled interest in dorsal preservation (DP) techniques as a means for addressing the dorsal hump, with claims of superior functional and aesthetic results. As such, an understanding of DP, including technical considerations and outcomes, is imperative.

Observations: DP allows for mobilization of the osseocartilaginous nasal vault as a single unit and thereby prevents disruption of the natural keystone area. The osseous nasal vault is managed with a transverse osteotomy and either a bilateral single lateral osteotomy (pushdown procedure) or bilateral bony wedge resections (letdown procedure) to allow for descent of the nasal dorsum. A variety of approaches to the septum exist, each differentiated by the location of cartilage resection: subdorsal, high-septal, midseptal, or inferior septum. These techniques result in pleasing dorsal aesthetic lines but may be limited by a higher rate of dorsal hump recurrence. Patency of the internal nasal valve (INV) is theoretically improved with DP. Robust series with patient-reported outcomes are lacking, although several reports and early experience at our center with a newly described high-septal resection technique do suggest positive functional and cosmetic outcomes with DP.

Conclusions and Relevance: With the recent revitalized interest in DP, an understanding of the potential benefits, techniques, and challenges associated with this surgery is helpful. Maintenance of the dorsum as a single unit has implications for maintaining structural integrity at the nasal keystone, pleasing dorsal aesthetic lines, and the patency of the INV. As surgeons continue to develop and employ these techniques, critical assessment of patient-reported outcomes and objective nasal measurements, with an emphasis on comparison with standard hump takedown techniques, will be valuable.

Differences in Social Perceptions Between Digital Single Lens Reflex Camera and Cell Phone Selfie Images

Background: In light of the current selfie craze, driven primarily by social media platforms, there is an absolute need among facial plastic surgeons to consider the role of these social platforms in patient counseling regarding their cosmetic requirements. Objectives: Is there a difference in how people are perceived when their image is viewed as a selfie as opposed to a digital single lens reflex (DSLR) camera image? This objective was studied by utilizing a web-based survey to explore differences in third-party perceptions, if any, between portrait photograph using a DSLR camera and a selfie. Design, Setting, Participants:: This research was performed via a survey study. Five types of portrait images of a female participant were taken for the survey: (1) image taken with the DSLR camera [a Nikon® D7200 DSLR camera fitted with a Sigma® DG Macro (70 mm 1:2.8) lens] at a distance of 3'from the subject, (2) selfie taken with an iPhoneX® at 12″ from the subject with a Snapchat® filter, (3) selfie at 12″ without a Snapchat filter, (4) selfie at 24″ with a Snapchat filter, and (5) selfie at 24″ without a Snapchat filter. Utilizing the Qualtrics survey platform (Qualtrics LLC), questions were based on the five images, where the respondent choose an image each for the youngest, oldest, and "most" or "least" for approachability, attractiveness, confidence, health, feminine, intelligent, and successful. Results: The survey was distributed to 223 respondents aged at least 18 years. Pearson χ2 test found significant differences (p < 0.05) in the distribution of the proportion of responses in 14 out of 16 questions in the survey. The proportion of responses to questions for "youngest" and "most approachable" was highest for selfie at distance 24″ with filter; questions for "most attractive," "most healthy," and "most feminine" were highest for selfie at distance 12″ with filter; those for "oldest," "most confident," "most intelligent," "most successful" and "least approachable," "least attractive," "least healthy," "least feminine," and "least successful" were highest for images taken with a DSLR camera. The only insignificant differences were seen in responses to questions for "least confident" (p = 0.5) and "least intelligent" (p = 0.55). Conclusions: Selfie images with filters are exclusively associated with aesthetic qualities, whereas DSLR images are associated with inherent characteristics of an individual.

The Social Perception of Microtia and Auricular Reconstruction

OBJECTIVES

To examine the social perception of microtia and quantify the effect of reconstruction on socially perceived attributes.

METHODS

Parental consent was obtained for peri-reconstruction photographs in a patient with unilateral grade 3 microtia without an underlying craniofacial syndrome. With computer simulation, the normal, preoperative microtia, and postoperative reconstruction ear were isolated and blended into the oblique and lateral views of that volunteer's face to isolate ear morphology as a variable against a constant facial baseline. These photographs were embedded into Web-based surveys with visual analogue scales to capture social perception data and then were sourced to general population adults.

RESULTS

Survey respondents totaled 631. On average, the face with the microtia ear was perceived to be less friendly (P = .015), less healthy (P = .022), and less successful (P = .005) than the same face with the "normal" ear. There were no statistically significant differences in socially perceived attributes between the face with the normal ear and the face with the reconstructed ear.

CONCLUSION

This is the first study to examine the social perception consequences of microtia and microtia reconstruction in children. These findings may explain the significant psychosocial distress experienced by these patients by exploring the social perception of specific attributes perceived. Lastly, this study may better inform microtia patients and their physicians on the impact of auricular reconstruction on third party's perception of social attributes.

LEVEL OF EVIDENCE

N/A Laryngoscope, 131:195-200, 2021.

Social Perception of the Nasal Dorsal Contour in Male Rhinoplasty

Importance

The social perception of nasal dorsal modification for male rhinoplasty is poorly understood.

Objective

To investigate the association of modifying the male nasal dorsum with the perception of such social attributes as youth, approachability, healthiness, masculinity/femininity, intelligence, successfulness, and leadership.

Design, Setting, and Participants

Using computer simulation software, 12 images with varied combinations of the nasal dorsal shape, nasofrontal angle (NFA), and nasolabial angle (NLA) were generated from a photograph of a male volunteer's face in profile. These photographs were then sent to participants at a university clinic who were English-speaking adult internet users who were masked to the purpose of the study, which asked them to value different social attributes regarding the face in the photograph in a 16-question survey. The study was conducted in September 2018 and the data were analyzed thereafter until March 2019.

Exposures

Twelve photographs embedded in a 16-question survey.

Main Outcomes and Measures

Population proportions of responses and χ2 test and graphical analysis based on 95% confidence intervals.

Results

Of 503 respondents (survey provision rate, 100%), 412 (81.9%) were women, 386 (76.7%) were white, 32 (6.4%) were Hispanic or Latinx, 63 (12.5%) were black/African American, 10 (2.0%) were Asian/Pacific Islander, and the median age was 46 years (interquartile range, 32-61 years). The man with ski slope-shaped nose with an NFA of 130° and NLA of 97° was often associated with frequently perceived positive characteristics; specifically, he was judged to be the most attractive (95% CI, 18%-26%; P < .001). Participants also often associated superlative youth (95% CI, 15%-24%; P < .001), approachability (95% CI, 13%-20%; P = .002), and femininity (95% CI, 14%-22%; P < .001) with dorsal contours that did not feature a dorsal hump. The man with a dorsal hump-shaped nose with an NFA of 140° and NLA of 105° was associated by the highest proportion of participants with being the oldest (95% CI, 35%-44%; P < .001), least approachable (95% CI, 27%-35%; P < .001), least attractive (95% CI, 37%-42%; P < .001), and least healthy (95% CI, 26%-34%; P < .001). Subset analyses also revealed statistically significant dorsal contour preferences by observers' age, gender, and race/ethnicity.

Conclusions and Relevance

A reduced dorsal slope combined with more acute NFAs and NLAs was associated with positively perceived social attributes. The results may be of interest to rhinoplasty surgeons and their male patients when planning changes to the nasal dorsal contour.

Level of Evidence

NA.

The miniature lateral crural strut graft: Efficacy of a novel technique in tip plasty

OBJECTIVES/HYPOTHESIS

To describe a novel technique for tip plasty and determine its efficacy using validated patient-reported outcome measures and objective measures.

STUDY DESIGN

Retrospective cohort study.

METHODS

This study was carried out at a tertiary center. Patients undergoing tip plasty using the miniature lateral crural strut grafts (mini-LCSG) in cosmetic/combined rhinoplasty between January 2016 and August 2019 with available outcome measures were included. We used the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS), Nasal Obstruction Symptom Evaluation (NOSE) scores, visual analog scale: functional and cosmetic, and lateral wall insufficiency (LWI) grades.

RESULTS

Among 52 patients, 33 were included; 26 had cosmetic whereas seven had combined functional and cosmetic rhinoplasty, with a follow-up up to 3 years. Both cosmetic and combined subjects showed significant improvement in SCHNOS-Cosmesis (C) scores (-57.31 ± 1.79, P < .001 and - 53.57 ± 8.39, P < .001, respectively) and zone 1 LWI (P < .05, both sides). SCHNOS-Obstruction (O) and NOSE scores showed significant decrease among subjects undergoing combined rhinoplasty only (-55.36 ± 18.58, P < .004, and - 53.93 ± 15.99, P < .003, respectively). With specific regard to tip cosmesis, the mean SCHNOS-6 (item 6 of the SCHNOS questionnaire for tip cosmesis) showed significant improvement (-2.61, P < .001).

CONCLUSIONS

The mini-LCSG is a novel modification for tip plasty that improves tip cosmesis and symmetry, both subjectively and objectively without compromising nasal function.

LEVEL OF EVIDENCE

4 Laryngoscope, 130:2581-2588, 2020.