The goal of rhinoplasty surgery is to create a natural and pleasing looking nose that fits the face. Plastic surgery of the nose, or rhinoplasty, is a frequently requested and routine cosmetic procedure. The key to a successful outcome is to create a natural and well-proportioned nose without sacrificing breathing function.
Nose Surgery Updates
From the Departments of Otorhinolaryngology, Head and Neck Surgery, University Hospitals, Leuven, Belgium and Academic Medical Center, Amsterdam, The Netherlands.
Peter W. Hellings MD, PhD; Gilbert J. Nolst Trenité MD, PhD; The Laryngoscope, Volume 117, Issue 6, pages 985–989, June 2007
In cases of dissatisfaction after rhinoplasty for aesthetic or functional reasons, or both, revision rhinoplasty may be advocated to improve the patients’ nasal performance. In contrast to studies on primary rhinoplasty, no objective outcome evaluation parameter has been validated in revision rhinoplasty, nor has there been a study specifically looking at long-term satisfaction after revision rhinoplasty.
We aim at studying patient satisfaction after a long-term follow-up of revision rhinoplasty performed at an academic referral center.
At a mean period of 2.5 years after revision rhinoplasty, 90 patients who underwent a revision rhinoplasty at the Academic Medical Center in Amsterdam, The Netherlands, were sent a questionnaire on general satisfaction together with the validated rhinoplasty outcome evaluation (ROE) questionnaire.
Of the 46 patients who responded to the questionnaire, 88% experienced a significant improvement in nasal performance by revision rhinoplasty, and 79% would choose to undergo the revision procedure again. Subgroup analysis of the ROE scores demonstrated that good satisfaction was mainly obtained in the young adult and middle-aged groups, without major differences between males and females.
Satisfaction was unrelated to the open or closed technique used for revision, or to the graft material used. Interestingly, an inverse correlation was found between satisfaction and the number of previous rhinoplasties.
This retrospective study demonstrates that revision rhinoplasty in an academic practice provides most patients with long-standing satisfaction.
From the Departments of Otolaryngology, The New York Eye & Ear Infirmary, New York, New York and New York Medical College, Valhalla, New York, U.S.A.
Anthony P. Sclafani MD, FACS; Steven D. Schaefer MD, FACS; The Laryngoscope, Volume 119, Issue 4, pages 778–791, April 2009
Study objectives and hypothesis
To examine the effect of concurrent endoscopic sinus surgery (ESS) on the postoperative course of cosmetic rhinoplasty (CR), identify any specific contraindications, and to develop more useful treatment regimen in patients undergoing concurrent ESS and CR
Consecutive patients undergoing CR (performed by the principal investigator (PI) in a tertiary care academic practice) at the same operative setting as ESS from June 2004–June 2007 were identified.
Additionally, patients undergoing CR (also by the PI) without ESS over the same time period (matched for gender, age, and rhinoplasty approach and techniques) were identified and used as control subjects.
The office and hospital charts of these patients were reviewed for details of pre-, intra-, peri-, and postoperative care, preoperative CT scans as well as for patient and physician observations. Specifically noted were details regarding the type of cosmetic changes sought, course of symptoms of chronic sinusitis, prior treatment, surgical techniques used for both ESS and CR, and postoperative treatment with antibiotics and corticosteroids Additionally, a literature review of articles describing concurrent CR and ESS was performed.
Thirteen patients were identified who underwent ESS at the same time as CR. There were no cases of cerebrospinal fluid leak, epistaxis, orbital complications, septal perforation, cellulitis or saddle nose deformity.
No correlation was found between sinus surgery performed and need for revision surgery (CR or ESS) or postoperative infections. However, the time to patient reported resolution of postoperative nasal swelling was significantly higher in patients undergoing concurrent ESS/CR compared to CR onl. Among patients who underwent concurrent ESS and CR, this time was highly correlated with the severity of sinus disease on preoperative
- While our data supports concurrent ESS and CR as safe, our findings suggest that the presence and treatment of concurrent sinonasal disease prolongs the patients’ recovery from CR
- This may be due to the effects of sinus pathology and manipulation of sinonasal venous and lymphatic drainage patterns or could be due to subclinical infectious soiling of rhinoplasty tissue planes
- We recommend a two-team approach to promote excellent surgical technique, avoid surgeon fatigue, and enhance patient care
- We recommend adequate medical management of chronic sinusitis prior to surgery, pre, intra and postoperative antibiotic coverage, appropriate postoperative sinus toilet beginning 1 week after surgery and careful and close patient follow-up to optimize results
- Most importantly, we advocate close coordination of sinonasal and rhinoplastic care in a two-team approach to maximize care
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