History of rhinoplasty

Bridging the Gap: Understanding Appalachian Patient Satisfaction in Cosmetic Rhinoplasty

Rhinoplasty is a surgical procedure aimed at correcting both functional and aesthetic nasal deformities, addressing issues such as trauma-induced disfigurements and patient dissatisfaction with nasal appearance. Patient satisfaction is a critical outcome measure in rhinoplasty, reflecting the success of the procedure and the quality of care provided. This study investigates factors influencing patient satisfaction among Appalachian patients undergoing rhinoplasty for aesthetic reasons, considering the unique healthcare challenges faced by rural populations. A modified Rhinoplasty Outcome Evaluation questionnaire was utilized to assess patient satisfaction. Descriptive statistics and regression analyses were performed to analyze demographic characteristics, complications, re-operations, and satisfaction scores among rural and urban participants. While no significant differences were found in demographic characteristics, trends in satisfaction scores suggest potential disparities between rural and urban populations. Rural patients exhibited marginally lower satisfaction scores and higher rates of complications and re-operations, highlighting the need for targeted interventions in rural healthcare settings. Addressing geographic barriers, enhancing preoperative education and postoperative support, and fostering interdisciplinary collaboration are essential strategies to improve patient satisfaction and outcomes in rhinoplasty procedures, particularly in rural communities. Further research with larger sample sizes and qualitative methods is warranted to explore the underlying factors contributing to patient satisfaction disparities and to inform evidence-based interventions aimed at narrowing healthcare disparities and advancing health equity in rhinoplasty care.

Limited Incision Rhinoplasty: An Approach for All Primary and Revision Cases

INTRODUCTION

Rhinoplasty was one of the most frequently performed aesthetic surgeries in the USA in 2022. Traditionally, the open approach has been preferred by the majority of surgeons often due to familiarity and ease of visualization. However, patient interest in closed and preservation rhinoplasty is driving a resurgence in the popularity of endonasal techniques. We present a series of 100 consecutive endonasal primary and revision rhinoplasty cases using bilateral isolated modified rim incisions.

METHODS

One-hundred consecutive patients underwent closed rhinoplasty via isolated modified rim incisions at a single-surgeon private practice. The senior author performs 100% endonasal rhinoplasty. A retrospective chart review was performed from 06/25/20 to 09/21/22. Information on demographics, complications, and need for revision was collected.

RESULTS

Eighty-four patients underwent primary rhinoplasty, 11 underwent secondary rhinoplasty, 4 underwent tertiary rhinoplasty, and 1 underwent quaternary rhinoplasty. Isolated modified rim incisions were used in all cases except in cases of septoplasty when a unilateral Killian incision was added, or in cases of lateral osteotomy when vestibular stab incisions were added. Post-operatively, six (6.0%) patients required revision, all of which were performed under local anesthesia.

CONCLUSION

Limited incision rhinoplasty is a reliable surgical approach that produces predictable results with a low revision rate. This technique is highly effective in minimizing soft tissue disruption to ensure safe, reliable, and effective outcomes in primary and revision rhinoplasty. It is an easier technique to learn compared to traditional endonasal and even arguably open rhinoplasty, thus lending itself to widespread adoption especially among novice rhinoplasty surgeons. 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 .

Cosmetic Rhinoplasty

LEARNING OBJECTIVES

After studying this article, the participant should be able to: 1. Perform a systematic nasofacial analysis. 2. Identify the underlying anatomical cause of specific external nasal findings. 3. Recognize the interrelated effects of operative maneuvers. 4. Develop an appropriate operative plan to address patient concerns.

SUMMARY

The rhinoplasty operation is one of the most challenging procedures in plastic surgery, and requires a combination of surgical judgment, knowledge of anatomy, technical skill, and lifelong study. A foundation must be built on clearly defined patient goals and an accurate diagnosis, based on known ideals and their anatomical correlation. It is important to recognize the definitive impact of each operative maneuver to achieve predictable outcomes. This article provides a problem-based approach to common cosmetic nasal deformities.

A Narrative Review of the History of Skin Grafting in Burn Care

Thermal injuries have been a phenomenon intertwined with the human condition since the dawn of our species. Autologous skin translocation, also known as skin grafting, has played an important role in burn wound management and has a rich history of its own. In fact, some of the oldest known medical texts describe ancient methods of skin translocation. In this article, we examine how skin grafting has evolved from its origins of necessity in the ancient world to the well-calibrated tool utilized in modern medicine. The popularity of skin grafting has ebbed and flowed multiple times throughout history, often suppressed for cultural, religious, pseudo-scientific, or anecdotal reasons. It was not until the 1800s, that skin grafting was widely accepted as a safe and effective treatment for wound management, and shortly thereafter for burn injuries. In the nineteenth and twentieth centuries skin grafting advanced considerably, accelerated by exponential medical progress and the occurrence of man-made disasters and global warfare. The introduction of surgical instruments specifically designed for skin grafting gave surgeons more control over the depth and consistency of harvested tissues, vastly improving outcomes. The invention of powered surgical instruments, such as the electric dermatome, reduced technical barriers for many surgeons, allowing the practice of skin grafting to be extended ubiquitously from a small group of technically gifted reconstructive surgeons to nearly all interested sub-specialists. The subsequent development of biologic and synthetic skin substitutes have been spurred onward by the clinical challenges unique to burn care: recurrent graft failure, microbial wound colonization, and limited donor site availability. These improvements have laid the framework for more advanced forms of tissue engineering including micrografts, cultured skin grafts, aerosolized skin cell application, and stem-cell impregnated dermal matrices. In this article, we will explore the convoluted journey that modern skin grafting has taken and potential future directions the procedure may yet go.