Assessment of rhinoplasty techniques by overlay of before-and-after 3D images

Unveiling the Impact of Three-Dimensional Technology on Rhinoplasty: A Systematic Review and Meta-analysis

This study aimed to investigate the impact of three-dimensional (3D) technology on preoperative evaluation for rhinoplasty.A systematic search was conducted on Embase, MEDLINE, and Web of Science. Studies that utilized 3D technology in preoperative assessment for rhinoplasty were included. The primary outcome was surgeon and patient satisfaction. The secondary outcomes included nasal function, cost-efficiency, reoperation rate, precision, and surgical time.Twelve studies (595 patients) were included. Surgeons reported higher satisfaction with 3D approaches based on precision and postoperative results. Patients expressed satisfaction with the 3D approaches due to a better understanding of the procedure and the ability to discuss with the surgeons planning the procedure and participating in postoperative design. The 3D approaches demonstrated higher surgeon satisfaction (mean difference -0.13, 95% confidence interval [CI] -0.20 to -0.06, p = 0.0002), particularly in revision cases, and provided higher precision compared with the two-dimensional (2D) approaches. However, 3D technology was more expensive and not cost-efficient. There were no significant differences in reoperation rate (odds ratio 0.16, 95% CI 0.02-1.36, p = 0.09) and surgical time. Postoperative nasal function showed inconsistent results.3D technology offered higher surgeon satisfaction and increased precision compared with 2D imaging. However, 3D imaging was expensive and not cost-efficient. Reoperation rate and surgical time were comparable, while postoperative nasal function outcomes showed inconsistent results.

Open-Source 3D Morphing Software for Facial Plastic Surgery and Facial Landmark Detection Research and Open Access Face Data Set Based on Deep Learning (Artificial Intelligence) Generated Synthetic 3D Models

Background: The scarcity of 3D facial models presents a significant hurdle for researchers and educators. Gathering such data demands substantial resources. Objective: To introduce an open-source 3D morphing software to generate 3D facial data sets for research and to provide a large sample data set that is based on synthetically generated 3D models. Methods: Software is developed to morph 3D facial models in bulk by altering landmark locations. Twenty synthetic 3D facial models are generated utilizing deep learning tools and 28 landmarks located on each. The measurements of synthetic models are confirmed to be realistic by comparing them with facial statistics. Several facial deformities and types are simulated at various magnitudes on 3D models to generate a large data set. Results: An open-source software and an open-access data set of 980 3D facial models, each with 28 landmark locations, are provided. Since the data set is based on synthetically generated 3D models, no institutional review board approval is required. Conclusion: The 3D morphing software and the large 3D data set are expected to benefit researchers and educators in the field of facial surgery and facial landmark detection.

Long-Term Control of Nasal Tip Position: Quantitative Assessment of Caudal Septal Extension Graft

BACKGROUND

Control of nasal tip position is critical to final rhinoplasty outcomes. Two frequent methods of exerting tip control are columellar strut and caudal septal extension graft (SEG). Past work has demonstrated that SEG are better able to preserve tip position. However, there is no quantitative data describing long-term projection and rotation. The purpose of this study was to analyze long-term maintenance of tip projection and rotation following SEG.

METHODS

A retrospective study of adult patients undergoing open rhinoplasty was conducted. Three-dimensional photogrammetric evaluation of nasal tip position was performed. Anthropometric points were analyzed preoperatively and postoperatively. Outcome variables were tip projection, tip rotation, and nasal length.

RESULTS

Twenty patients were included with an average follow-up time of 3.3 years (2.0 - 6.6 years). From postoperative week 1 to 6, there was a statistically significant decrease in rotation (-4.3%, p<0.01). There were no statistically significant decreases in projection, rotation, or nasal length from 6 weeks postoperative to 2 years postoperative, or from 6 weeks postoperative to final follow-up (2.0 - 6.6 years).

CONCLUSIONS

Nasal tip projection and rotation appear to decrease from the immediate postoperative position, likely due to resolving edema. In this study, patients that underwent open rhinoplasty with SEG experienced modest loss of projection and rotation until 6 weeks postoperative, but projection and rotation were maintained from 6 weeks postoperative to 2 years and beyond. This study provides evidence that SEG maintains long-term changes in tip projection and rotation.

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 Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Measuring Outcomes in Aesthetic Surgery by Board-Certified Plastic Surgeons

SUMMARY

Aesthetic surgery is a visual specialty in which plastic surgeons and patients work together to enhance or restore facial and body harmony. The field of aesthetic surgery is advanced through descriptive technical procedures and outcomes research. With increasing competition in cosmetic medicine, aesthetic surgery stands to benefit from an evidence-based approach to document the high standards of care from board-certified plastic surgeons. In this article, the authors highlight challenges, current objective and subjective outcomes, and a path forward.

Application of Auricular Cartilage-Skin Graft in the Reconstruction of Unilateral Cleft Lip Nasal Deformity

BACKGROUND

Autologous cartilage grafts are increasingly used in the treatment of cleft lip nasal deformity, but nasal alar retraction caused by lining defects often occurs after surgery. We designed a new graft to treat unilateral cleft lip nasal deformity while avoiding nasal alar retraction.

METHODS

Nineteen patients in our hospital underwent unilateral cleft lip nasal deformity repair surgery with an auricular cartilage-skin graft. The effect of surgery was evaluated in four aspects: satisfaction with postoperative appearance, nasal aesthetic subunit indices, position of the nasal alar rim and three-dimensional spatial difference.

RESULTS

Overall satisfaction with each index was above 90%. The nasal tip angle and nasolabial angle of patients were significantly smaller after surgery than before surgery (P < 0.01). The height of the nostril on the affected side and the length of the nasal columella were greater after surgery than before surgery (P < 0.01). The spatial differences in soft tissue between the unaffected side and the affected side after surgery were significantly smaller than before surgery (P < 0.01). According to the follow-up results of 1-2 years, there were no significant retraction of the nasal alar rim (P > 0.05) and no obvious auricular deformity. All patients had a noticeable improvement in their nasal appearance.

CONCLUSION

The auricular cartilage-skin graft, which can not only improve the appearance of the nose but also avoid nasal alar retraction, is an ideal graft to cure unilateral cleft lip nasal deformity.

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 .

Quantitative Analysis of Morphometric Changes in Feminization Rhinoplasty Utilizing a Standardized Forehead-Rhinoplasty Technique

Background

Rhinoplasty is one of the most commonly performed facial gender-affirming surgeries (FGASs) for transgender females, but well-established morphometric parameters describing feminizing nasal changes do not exist.

Objectives

Describe the author's technique for feminization rhinoplasty, analyze the changes in 3-dimensional nasal anthropomorphic parameters, and describe patient-reported outcomes.

Methods

Three-dimensional photogrammetric evaluation was performed both preoperatively and postoperatively in transgender female patients who underwent FGAS. Measurements assessed included the nasofrontal angle, nasolabial angle, dorsal height, mid-dorsal width, alar width, nasal tip width, and tip projection. Patients were surveyed preoperatively and postoperatively using the FACE-Q Nose module. Paired t-tests were utilized to assess changes in postoperative measurements and FACE-Q Nose satisfaction scores.

Results

Twenty patients underwent FGAS during the study period. The average time between surgery and postoperative 3-dimensional images was 13.6 ± 6.8 months. The nasofrontal angle increased by 8.2° (148.0 ± 7.4° to 156.1 ± 6.7°, P < .001) and tip projection increased by 0.017 (0.58 ± 0.03 to 0.60 ± 0.04, P < .01). Dorsal height, mid-dorsal width, and tip width all decreased significantly (P < .05). There were significant improvements in patients' "Satisfaction with Nose," "Satisfaction with Facial Appearance Overall," "Psychological Function," and "Social Function" on FACE-Q. One revision rhinoplasty was performed, and no documented surgical complications were reported.

Conclusions

There were statistically significant changes in the nasofrontal angle, tip projection, dorsal height, mid-dorsal width, and tip width in patients receiving feminization rhinoplasty. These data may help surgeons with preoperative planning and intraoperative decision making.

Level of Evidence 4

Three-dimensional (3D) area and volume measurements for rhinoplasty

BACKGROUND

Morphometric changes achieved in rhinoplasty are mostly analyzed on two-dimensional (2D) images. However, most of these alterations are amenable to three-dimensional (3D) analysis.

OBJECTIVES

Objective measurements for rhinoplasty are currently done on 2D photographic analyses. We believe that newer techniques will develop. This is a study to help define new parameters.

METHODS

Landmarks that are widely used in the literature were used to define the boundaries of these measurements. They comprised certain parts of the nose (tip, dorsum, radix, etc.). Measurements were done on a generic face (GF) 3D model. The model's nose was then morphed using the free, open-source 3D modeling software (Blender) to generate seven different deformed noses and to perform the area and volume measurements.

RESULTS

Each nose with a different type of deformity demonstrated significant area and volume differences. For example, comparing area measurements to GF-Pleasant nose, GF-Snub nose showed a significant difference at the tip (43.3% reduction). Volume measurements were found to be mostly parallel to the area measurements; however, some incongruences were noted.

CONCLUSIONS

We show that new area and volume measurements can be reliably developed for 3D-scanned images. These measurements can be utilized and will enrich the facial analysis and evaluation of the outcomes of rhinoplasty.

A Modified Technique in Rhinoplasty: A Septal Extension Graft Complex Using Septal Cartilage, Ethmoid Bone, and Auricular Cartilage

BACKGROUND

Due to the small and weak septal cartilage of Asians, it is a challenge to obtain ideal tip projection and nose lengthening in this population by performing septal extension grafts with only septal cartilage.

OBJECTIVES

The aim of this study was to introduce a septal extension graft complex incorporating nasal septal cartilage, the perpendicular plate of the ethmoid bone, and bilateral auricular cartilage, and to examine its effectiveness in terms of morphological and mechanical support.

METHODS

Septal cartilage was harvested under an endoscope according to standard techniques. Two pieces of the perpendicular plate of the ethmoid bone, placed on either side of the "L" strut, served as 2 spreader grafts. A double layer of auricular cartilage was fixed as columellar strut grafts. Three-dimensional facial scanning was used to examine the change of 3 parameters. Nasal tip resistance was evaluated by a digital Newton meter.

RESULTS

In total, 25 patients were followed up postoperatively for a mean of 25.9 months. The analysis showed significant differences in both contour parameters and nasal resistance: nasal length (mean [standard deviation], 41.4 [4.0] vs 46.2 [3.4] mm, P < 0.05) and nasal tip projection (21.3 [3.2] vs 24.4 [2.7] mm, P < 0.05) appeared to increase postoperatively, whereas nasolabial angle (117.6° [5.9°] vs 109.5° [5.3°], P < 0.05) showed a significant decrease after surgery. The resistance of the nasal tip also increased significantly (P < 0.05) at displacements of 1, 2, and 3 mm. All patients were satisfied with the aesthetic results, and no serious complications occurred.

CONCLUSIONS

This kind of modified septal extension graft technique can effectively adjust nasal morphology for short-nose East Asians.

LEVEL OF EVIDENCE: 4

The Need for Innovation in Rhinoplasty

Rhinoplasty is a challenging surgery and results are not always perfect. There are many obstacles to achieving optimal results. Among these are inadequate instrumentation, the unpredictability of healing, imprecise planning, and many more. Furthermore, selecting patients who can most benefit from surgery is equally important. In this article, some of the more pressing areas of rhinoplasty that need innovation are discussed. From proper patient selection, to advances in education, to the standardization of training programs, to the development of sophisticated implants, the future of rhinoplasty surgery lies in continued creativity and innovation.

3D Virtual Planning for Rhinoplasty Using a Free Add-On for Open-Source Software

BACKGROUND

Rhinoplasty is one of the most frequent aesthetic surgeries; the procedure can be challenging for inexperienced surgeons, and positive outcomes depend on good communication with the patient, proper planning, and precise execution. Three-dimensional (3D) technology has emerged to address these issues, but specific software for 3D planning tends to be expensive.

OBJECTIVES

This study presents a simple, low-cost method for 3D simulation to plan rhinoplasty.

METHODS

This preliminary report describes 3D rhinoplasty planning in a series of 3 cases employing free software and an add-on especially developed for rhinoplasty (Blender and RhinOnBlender, respectively). The photogrammetry protocol, which can be performed easily with a smartphone, is described in detail along with all the steps in 3D planning.

RESULTS

The software and add-on automated the process, making the tool environment accessible to surgeons who are not familiar with graphic design software. The surgeries were uneventful in all cases, and the patients were satisfied with the outcomes.

CONCLUSIONS

3D graphic technology has provided significant advances in health research, improvement, and teaching for surgeons and communication between surgeons and patients. Free open-source software and add-ons are excellent options that offer proven utility, affordability, and ease of utilization to healthcare providers.

Evaluating the agreement and reliability of a web-based facial analysis tool for rhinoplasty

PURPOSE

Rhinoplasty is one of the most common and challenging plastic surgery procedures. Facial analysis is a crucial step in planning. Utilizing three-dimensional (3D) model of a patient's face is an emerging way of performing facial analysis. This paper evaluates the agreement and reliability of facial measurements taken using a web app, located at digitized-rhinoplasty.com, that utilizes 3D models of the patient's face.

METHODS

Eleven measurements were calculated on 16 human subjects. Three methods of measurements were performed: direct measurements on human subjects' faces, measurements on 2D photographs, and measurements on 3D models of face scans. The Bland-Altman plot is used for testing the agreement between the web app and the well-known Blender 3D modeling software. Intra-rater and inter-rater reliability was calculated and compared for 2D and 3D methods using the intraclass correlation coefficient (ICC) method. The statistical analysis methods were checked for the normality and homoscedasticity assumptions.

RESULTS

The results indicate that the web app and Blender software show agreement within 95% confidence limits. The web app performs well in intra-rater and inter-rater reliability statistical analysis. The web app's reliability scores are consistently better than facial analysis software which was found highly reliable in a previous study. We also compare the methods of measurements in terms of time, ease of use, and cost.

CONCLUSION

The utilization of 3D computer modeling for facial analysis has its advantages and started to become more common due to recent advances in technology. The web app utilizes 3D face scans for pre-operative planning and post-operative evaluation of facial surgeries. The web app performs well in agreement and inter-/intra-reliability analysis and performs consistently better than software that works utilizing 2D photographs. The web app provides accurate, repeatable, affordable, and fast facial measurements for facial analysis when compared to direct and 2D methods.

Cone-Beam Computed Tomography: A User-Friendly, Practical Roadmap to the Planning and Execution of Every Rhinoplasty-A 5-Year Review

BACKGROUND

Cone-beam computed tomography has recently rapidly developed worldwide as a versatile and convenient alternative to traditional computed tomography for imaging of the maxillofacial region. However, most surgeons performing rhinoplasty are surprisingly unfamiliar with it, in both the plastic surgery and ear, nose, and throat communities.

METHODS

The broad clinical experience of a single center over the past 5 years is reviewed. The many applications of cone-beam computed tomography to primary and secondary rhinoplasty are analyzed regarding septum, turbinates, nasal bones, skin thickness, and other issues. The importance of a paradigm shift from a two-dimensional to a three-dimensional approach in image reconstruction is demonstrated, together with the value of surface contour enhancement.

RESULTS

Cone-beam computed tomography has a multitude of practical applications highly relevant to rhinoplasty. The surface image will strengthen aesthetic analysis, and the detailed preview of bony and functional anatomy will facilitate surgical planning. Cone-beam computed tomography serves as a roadmap to plan and execute rhinoplasties more predictably and efficiently. The availability of spatial views and accurate detail, together with the possibility of easy, accurate measuring, offers a plenitude of potential applications.

CONCLUSIONS

Cone-beam computed tomography is a user-friendly, quick technique with abundant advantages in planning any rhinoplasty. It causes the patient no inconvenience and has very few, if any, drawbacks, with these being limited to radiation exposure and limited cost.

A Comparative Study of Three-Dimensional Simulation in Nonsurgical Rhinoplasty With Hyaluronic Acid Fillers

BACKGROUND

The use of 3-dimensional computer imaging has grown steadily over the past decade, especially with cosmetic facial surgery. The technological advance has influenced how we counsel patients, perform procedures, and assess outcomes. The purpose of this study was to analyze the feasibility of quantifying simulated versus actual outcomes for nonsurgical rhinoplasty with hyaluronic acid.

METHODS

A retrospective review of 3-dimensional images (LifeViz Inc, France) for rhinoplasty patients was performed. Randomized preoperative, simulated, and actual images were rated by a blinded panel of physicians (1 = poor, 5 = excellent). In addition, a quantitative assessment of nasofrontal angle and nasolabial angle was conducted where paired and 2-sample t tests were performed (P < 0.05 as significant).

RESULTS

Twenty-five patients were included in this comparison study. Fifty-six percent of preoperative images were rated as poor (mean, 1.7). The simulation received a mean score of 3.4 (good in 60% of cases), and 80% of actual cases were rated good to excellent (mean, 3.7). Mean nasofrontal angle decreased from 147.1 ± 1.2° preinjection to 143.3 ± 1.6° posttreatment, a mean change of 3.8 ± 2.0°. The mean nasolabial angle decreased from 125.5 ± 1.6° pretreatment to 117.5 ± 1.5° posttreatment. Average volume of actual dosage was 1.74 ± 0.18 mL.

CONCLUSION

Three-dimensional simulation for patients undergoing nonsurgical rhinoplasty is helpful for surgical planning and patient communications. It provides a mechanism for critical self-evaluation and helps set patients with realistic expectations about rhinoplasty.

Digitizing rhinoplasty: a web application with three-dimensional preoperative evaluation to assist rhinoplasty surgeons with surgical planning

PURPOSE

Rhinoplasty is one of the most common and challenging plastic surgery procedures. The results of the operation have a significant impact on the facial appearance. The planning is critical for successful rhinoplasty surgery. In this paper, we present a web application designed for preoperative rhinoplasty surgery planning.

METHODS

The application uses the three-dimensional (3D) model of a patient's face and facilitates marking of an extensive number of facial features and auto-calculation of facial measurements to develop a numerical plan of the surgery. The web application includes definitions, illustrations, and formulas to describe the features and measurements. In addition to the existing measurements, the user can calculate the distance between any two points, the angle between any three points, and the ratio of any two distances. We conducted a survey among experienced rhinoplasty surgeons to get feedback about the web application and to understand their attitude toward utilizing 3D models for preoperative planning.

RESULTS

The web application can be accessed and used through any web browser at digitized-rhinoplasty.com. The web application was utilized in our tests and also by the survey participants. The users successfully marked the facial features on the 3D models and reviewed the auto-calculated measurements. The survey results show that the experienced surgeons who tried the web application found it useful for preoperative planning and they also think that utilizing 3D models is beneficial.

CONCLUSIONS

The web application introduced in this paper helps analyzing the patient's face in details utilizing 3D models and provides numeric outputs to be used in the rhinoplasty operation planning. The experienced rhinoplasty surgeons that participated to our survey agree that the web app would be a beneficial tool for rhinoplasty surgeons. We aim to further improve the web application with more functionality to help surgeons for preoperative planning of rhinoplasty.

In-House Manufacture of Sterilizable, Scaled, Patient-Specific 3D-Printed Models for Rhinoplasty

BACKGROUND

Rhinoplasty relies on clear patient communication and precise execution of a three-dimensional (3D) plan to achieve optimal results. As 3D imaging and printing continue to grow in popularity within the medical field, rhinoplasty surgeons have begun to leverage these resources as an aid to preoperative planning, patient communication, and the technical performance of this challenging operation.

OBJECTIVES

Utilizing departmentally available resources and open-access 3D imaging platforms, we have developed an affordable, reproducible protocol for rapid in-house virtual surgical planning (VSP) and subsequent manufacture of 3D-printed rhinoplasty models.

METHODS

Preoperative 3D photographic images underwent virtual rhinoplasty using a freely available 3D imaging and sculpting program (BlenderTM [Version 2.78, Amsterdam, The Netherlands]). Once the ideal postoperative result was digitally achieved, scaled, sterilizable, and patient-specific 3D models of the preoperative and ideal postoperative result were manufactured in-house using a departmentally owned 3D printer.

RESULTS

3D-printed models have successfully been manufactured and employed for 12 patients undergoing rhinoplasty. The average time to prepare a set of pre- and postoperative models was 3 hours, while the printing process required 18 to 24 hours per model. Each set of surgical models can be manufactured at a total materials cost of approximately $5.00.

CONCLUSIONS

We describe an affordable means to construct sterilizable, scaled, patient-specific 3D-printed models for rhinoplasty. This technique may become of increasing interest to academic and cosmetic centers as hardware costs of 3D printers continue to fall.

LEVEL OF EVIDENCE: 4

Three-dimensional Morphing and Its Added Value in the Rhinoplasty Consult

Background:

The evolving literature on 3D surface imaging demonstrates that this technology is becoming the preferred simulation technique in hospitals and research centers. However, no study has demonstrated before the superiority of this facility over standard 2D simulation during preoperative evaluation in rhinoplasty.

Methods:

One hundred seventy-two consecutive patients requesting rhinoplasty were included. Patients answered a questionnaire following a 2D simulation and subsequently experienced 3D morphing. A single question was answered regarding the added value of the latter by patients and surgeons, respectively.

Results:

In our survey, satisfaction with 2D morphing reached 61%. Ninety-five percentage of the same group considered 3D simulation an added value over 2D. Additionally, 84% of patients requesting revision rhinoplasty admitted that 3D computer simulation has helped them understand the aims of surgery, in contrast to 61% of patients from the primary group. Furthermore, patients unsatisfied with their 2D simulation got reassured following 3D simulation to undergo surgery at a higher percentage (67%), compared with the group initially satisfied with 2D (48%). Women appeared reassured by 3D imaging in higher percentage (63%) compared with men (42%). The 2 surgeons, however, found 3D simulations to be an added value in 66% and 74% of all patients.

Conclusions:

The overwhelming majority of our patients considered 3D simulation an added value over 2D. Patients initially unsatisfied with 2D morphing, revision rhinoplasty patients, and women seemed to be the groups that appreciated more 3D than 2D computer simulation. In contrast, surgeons considered the facility of 3D an added value in two-thirds of the patients.

Three-Dimensional Imaging in Rhinoplasty: A Comparison of the Simulated versus Actual Result

PURPOSE

Computer imaging has become increasingly popular for rhinoplasty. Three-dimensional (3D) analysis permits a more comprehensive view from multiple vantage points. However, the predictability and concordance between the simulated and actual result have not been morphometrically studied. The purpose of this study was to aesthetically and quantitatively compare the simulated to actual rhinoplasty result.

METHODS

A retrospective review of 3D images (VECTRA, Canfield) for rhinoplasty patients was performed. Images (preop, simulated, and actual) were randomized. A blinded panel of physicians rated the images (1 = poor, 5 = excellent). The image series considered "best" was also recorded. A quantitative assessment of nasolabial angle and tip projection was compared. Paired and two-sample t tests were performed for statistical analysis (P < 0.05 as significant).

RESULTS

Forty patients were included. 67.5% of preoperative images were rated as poor (mean = 1.7). The simulation received a mean score of 2.9 (good in 60% of cases). 82.5% of actual cases were rated good to excellent (mean 3.4) (P < 0.001). Overall, the panel significantly preferred the actual postoperative result in 77.5% of cases compared to the simulation in 22.5% of cases (P < 0.001). The actual nasal tip was more projected compared to the simulations for both males and females. There was no significant difference in nasal tip rotation between simulated and postoperative groups.

CONCLUSION

3D simulation is a powerful communication and planning tool in rhinoplasty. In this study, the actual result was deemed more aesthetic than the simulated image. Surgeon experience is important to translate the plan and achieve favorable postoperative results.

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 .

Long-term Outcomes of Subtotal Septal Reconstruction in Rhinoplasty

IMPORTANCE

Significant nasal septal deviation may require complex reconstruction to achieve complete correction. Subtotal septal reconstruction is a method for addressing deviations in the L-strut.

OBJECTIVES

To review the long-term outcomes of subtotal septal reconstruction and provide objective evidence of functional and aesthetic improvement.

DESIGN, SETTING, AND PARTICIPANTS

This medical record review obtained data on 144 patients who underwent subtotal septal reconstruction from September 1, 2008, to September 1, 2013. Data analysis was performed from September 1, 2013, to September 1, 2014.

MAIN OUTCOMES AND MEASURES

Functional outcomes were measured using the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire, and objective aesthetic outcomes were measured using 3-dimensional (3-D) stereophotogrammetry. Follow-up times were classified as time point 1 (TP1; preoperative), time point 2 (TP2; early postoperative), and time point 3 (TP3; final postoperative).

RESULTS

Of the 144 patients who underwent subtotal septal reconstruction, 104 (72.2%) were female; the mean (SD) age was 37.3 (13.7) years; 57 underwent primary septorhinoplasty; and 87 (60.5%) underwent revision septorhinoplasty. The NOSE scores improved in all 5 categories of nasal obstruction, with mean (SD) survey completion at 270 (260.1) days. Aesthetic results were measured with 3-D imaging after a mean (SD) follow-up of 613.5 (434.4) days postoperatively. No statistically significant loss was found in mean (SD) nasal length over time (TP2 to TP 3, -0.16 [1.36] mm; 95% CI, -0.54 to 0.22 mm; P = .41) or between mean (SD) postoperative loss of projection (TP2 and TP3, -0.19 [0.92] mm, 95% CI, -0.45 to 0.07 mm; P = .17). An increase in mean (SD) rotation (nasolabial angle) generated with septorhinoplasty (4.24° [11.08°]; 95% CI, 1.14°-7.34°; P = .01) and a mean (SD) decrease in rotation detected during postoperative healing (-2.63° [6.96°]; 95% CI, -4.63° to -0.63°; P = .01) were found. Although measurement of symmetry was improved in the early postoperative period (TP1 to TP2, -0.16 [1.26] mm; 95% CI, -0.52 to 0.20 mm; P = .40), this finding did not become statistically significant until the final measurement (TP1 to TP3, -0.43 [1.07] mm; 95% CI, -0.73 to -0.13 mm; P = .007; TP2 to TP3, -0.28 [0.87] mm; 95% CI, -0.53 to -0.03 mm; P = .03). A mean (SD) decrease in columellar show was achieved with surgery (-0.66 [1.37] mm; 95% CI, -1.05 to -0.27 mm; P = .001). No statistically significant change was found in the alar-columellar association from TP2 to TP3 in this patient population, confirming no unwanted alar or columellar retraction over time (0.10 [0.61] mm; 95% CI, -0.07 to 0.27 mm; P = .25). A total of 114 patients (79.2%) required costal cartilage harvest for adequate reconstruction.

CONCLUSIONS AND RELEVANCE

Subtotal septal reconstruction yields improved functional and aesthetic outcomes and has the potential to be a useful tool for the rhinoplasty surgeon in the treatment of severe septal deviation.

LEVEL OF EVIDENCE

4.

Use of Computer Imaging in Rhinoplasty: A Survey of the Practices of Facial Plastic Surgeons

OBJECTIVE

The objective of this study was to quantify the use of computer imaging by facial plastic surgeons.

METHODS

AAFPRS Facial plastic surgeons were surveyed about their use of computer imaging during rhinoplasty consultations. The survey collected information about surgeon demographics, practice settings, practice patterns, and rates of computer imaging (CI) for primary and revision rhinoplasty. For those surgeons who used CI, additional information was also collected, which included who performed the imaging and whether the patient was given the morphed images after the consultation.

RESULTS

A total of 238 out of 1200 (19.8%) facial plastic surgeons responded to the survey. Out of those who responded, 195 surgeons (83%) were board certified by the American Board of Facial Plastic and Reconstructive Surgeons (ABFPRS). The majority of respondents (150 surgeons, 63%) used CI during rhinoplasty consultation. Of the surgeons who use CI, 92% performed the image morphing themselves. Approximately two-thirds of surgeons who use CI gave their patient a printout of the morphed images after the consultation.

CONCLUSIONS

Computer imaging (CI) is a frequently utilized tool for facial plastic surgeons during cosmetic consultations with patients. Based on these results of this study, it can be suggested that the majority of facial plastic surgeons who use CI do so for both primary and revision rhinoplasty. As more sophisticated systems become available, it is possible that utilization of CI modalities will increase. This provides the surgeon with further tools to use at his or her disposal during discussion of aesthetic surgery.

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 .

Postoperative Edema Resolution following Rhinoplasty: A Three-Dimensional Morphometric Assessment

BACKGROUND

The final result of rhinoplasty may be masked for several months after surgery because of postoperative edema; however, no objective evidence supports this time estimate. The purpose of this study was to three-dimensionally quantify the decrease in postsurgical nasal edema following rhinoplasty over the first postoperative year.

METHODS

This was a retrospective, three-dimensional, morphometric study of primary, open rhinoplasty patients. Subjects with at least three postoperative three-dimensional images up to 1 year were included. Patients were excluded for closed or secondary procedures or cleft deformities. Images were assessed using three-dimensional stereophotogrammetry (Vectra) and volumetric analysis (Geomagic). Baseline nasal volume (time 0) occurred at the first postoperative visit at 1 to 2 weeks. All subsequent nasal volume measurements were calculated as a percentage of baseline values. Data points from all patients were pooled, and a six-point moving average was used to create an inverse function line of best fit.

RESULTS

Forty patients were included, with 146 three-dimensional photographs quantified. The equation for the inverse function line of best fit of the six-point moving average was y = 1.484 (1/x) + 0.844 (R = 0.85, p < 0.01). According to this equation, approximately two-thirds of edema resolves within the first month, 95 percent after 6 months, and 97.5 percent after 1 year. A plateau is reached at 84.4 percent of the original postoperative volume.

CONCLUSIONS

This study provides quantitative evidence to predict decrement of rhinoplasty edema with time. Three-dimensional morphometric assessment demonstrated a two-thirds decrease in edema at 1 month, a 95 percent decrease at 6 months, and a 97.5 percent decrease at 1 year.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Early Changes in Facial Profile Following Structured Filler Rhinoplasty: An Anthropometric Analysis Using a 3-Dimensional Imaging System

BACKGROUND

Quantitative measurements are important for objective evaluation of postprocedural outcomes. Three-dimensional (3D) imaging is known as an objective, accurate, and reliable system for quantifying the soft tissue dimensions of the face.

OBJECTIVE

To compare the preprocedural and acute postprocedural nasofrontal, nasofacial, nasolabial, and nasomental angles, early changes in the height and length of the nose, and nasal volume using a 3D surface imaging with a light-emitting diode.

METHODS

The 3D imaging analysis of 40 Korean women who underwent structured nonsurgical rhinoplasty was conducted. The 3D assessment was performed before, immediately after, 1 day, and 2 weeks after filler rhinoplasty with a Morpheus 3D scanner (Morpheus Co., Seoul, Korea).

RESULTS

There were significant early changes in facial profile following nonsurgical rhinoplasty with a hyaluronic acid filler. An average increase of 6.03° in the nasofrontal angle, an increase of 3.79° in the nasolabial angle, increase of 0.88° in the nasomental angle, and a reduction of 0.83° in the nasofacial angle was observed at 2 weeks of follow-up. Increment in nasal volume and nose height was also found after 2 weeks. Side effects, such as hematoma, nodules, and skin necrosis, were not observed.

CONCLUSION

The 3D surface imaging quantitatively demonstrated the early changes in facial profile after structured filler rhinoplasty. The study results describe significant acute spatial changes in nose shape following treatment.

Overview of Facial Plastic Surgery and Current Developments

Facial plastic surgery is a multidisciplinary specialty largely driven by otolaryngology but includes oral maxillary surgery, dermatology, ophthalmology, and plastic surgery. It encompasses both reconstructive and cosmetic components. The scope of practice for facial plastic surgeons in the United States may include rhinoplasty, browlifts, blepharoplasty, facelifts, microvascular reconstruction of the head and neck, craniomaxillofacial trauma reconstruction, and correction of defects in the face after skin cancer resection. Facial plastic surgery also encompasses the use of injectable fillers, neural modulators (e.g., BOTOX Cosmetic, Allergan Pharmaceuticals, Westport, Ireland), lasers, and other devices aimed at rejuvenating skin. Facial plastic surgery is a constantly evolving field with continuing innovative advances in surgical techniques and cosmetic adjunctive technologies. This article aims to give an overview of the various procedures that encompass the field of facial plastic surgery and to highlight the recent advances and trends in procedures and surgical techniques.

Lateral crural repositioning for treatment of cephalic malposition

After completion of this article, the reader should be able to describe the indications for lateral crural repositioning, understand the key steps to performing the procedure, and be able to manage the complications associated with this treatment strategy.

Lower lateral cartilage repositioning: objective analysis using 3-dimensional imaging

IMPORTANCE

In recent years, with the advent of 3-dimensional (3D) imaging techniques, it has become possible to objectively measure rhinoplasty results. However, few studies have used 3D imaging software to assess postoperative rhinoplasty results of the nasal tip.

OBJECTIVE

To analyze nasal tip volumes of patients with bulbous tips and measure postoperative nasal tip volume changes in patients who have undergone lower lateral cartilage (LLC) repositioning.

DESIGN, SETTING, AND PARTICIPANTS

A prospective study of patients with a preoperative diagnosis of bulbous nasal tip and cephalically oriented LLC as measured intraoperatively (with angles less than 30 degrees from the midline) who underwent rhinoplasty by a single surgeon and preoperative and postoperative 3dMD imaging at a university hospital.

INTERVENTIONS

Rhinoplasty with LLC repositioning and preoperative and postoperative 3dMD system imaging. We also used 3dMD Vultus software for the analysis of nasal tip volume changes.

MAIN OUTCOMES AND MEASURES

Changes in nasal tip volume and LLC angle.

RESULTS

Thirty-one patients met the inclusion criteria (25 women and 6 men; mean age, 33 years). Among these, there were 16 primary and 15 revision cases with a follow-up range of 1 to 19 months. Statistical tests included a paired t test on volume and angle changes as well as correlative and exploratory analyses to gain further insight into the analysis population over time. The change in the LLC angle after repositioning was found to be statistically significant. The mean decrease in volume on the right was 0.0254 mL, and the mean decrease on the left was 0.0249 mL. The mean total volume change was a decrease of 0.0503 mL. An exploratory analysis suggested that subjects with longer follow-up displayed a greater reduction in volume. Using 5 months as a cutoff, we found that the subgroup with longer follow-up displayed a mean total bilateral volume change of -0.07 mL compared with -0.03 mL in the subgroup with shorter follow-up.

CONCLUSIONS AND RELEVANCE

We found that LLC repositioning when used to address bulbous nasal tips and cephalically oriented LLCs leads to significant increase (preoperative to postoperative) in the angle of the LLC (to a more caudal orientation). We also found an overall trend of decreasing nasal tip volume throughout follow-up. Although not statistically significant, the overall decrease in volume is clinically meaningful when paired with favorable positioning of the LLC. Exploratory analyses suggest that treatment effect is consistent across sexes and that greater decrease in total volume might be found with longer follow-up.

LEVEL OF EVIDENCE

4.

Simple techniques for three-dimensional photography of the nose in nasal deformity

AIM

To investigate the use of anaglyphs and stereograms for three-dimensional imaging of the external nose.

METHOD

Red-cyan anaglyphs and colour stereograms created from stereo photographs of patients with nasal deformity were compared to standard photographs. Assessors rated images on 'life-likeness' of imaging, contour definition and utility for surgical planning.

RESULTS

9 patients were recruited. Stereograms provided significantly improved life-like features and definition of nasal structure, with some benefit for pre-operative planning. Less benefit was found for anaglyph images. Oblique views proved most effective.

CONCLUSIONS

Stereograms provide simple, inexpensive three-dimensional images of the nose, with potential uses in operative analysis, medicolegal documentation, teaching and research.