The Tripod Concept of the Upper Nasal Third

Key Points

Question  Can we describe a concept related to the well-known tripod theory with extrapolation to the upper nasal third as it pertains to cosmetic rhinoplasty?

Findings  In this study of 10 lay individuals and 10 rhinoplasty-trained individuals who evaluated manipulated photographs of 3 women who had not had surgery, lay individuals were more likely to choose an ideal nasal profile based on surrounding facial architecture, while individuals with rhinoplasty training tended to separate the ideal nose from the surrounding face (statistically significant). Projection was recognized as being altered by both rhinoplasty-trained and lay individuals (although not statistically significant), whereas subjective changes in rotation were significantly more elusive to the lay individual (statistically significant).

Meaning  Simple alteration of the upper nasal third can result in an improved nasal profile without specific alteration of tip architecture.

Importance  The tripod theory of the upper nasal third parallels the concept of the well-known nasal tip tripod. We are evaluating the idea that one can simply alter the upper nasal angles reliably without the complex physics associated with the nasal tip to achieve a pleasing cosmetic result.

Objective  To describe a concept related to the well-known tripod theory with extrapolation to the upper nasal third as it pertains to cosmetic rhinoplasty.

Design, Setting, and Participants  This is a prospective study in which lateral photographs of 3 women who had not undergone surgery (age range, 20-50 years) were selected for digital manipulation of the nasal radix with subsequent alteration of the nasofrontal and nasofacial angles via imaging software. The altered images were analyzed by 20 blinded individuals between July 2009 and June 2017 to assess how changes in the height of the nasal dorsum and radix alone affect nasal appearance and the perception of ideal nasal angles. The study took place at a tertiary center, and the patients chosen for evaluation had nasal architecture that only required subtle changes rather than structure that demonstrated glaringly obvious overprojection or underprojection and rotation or a large dorsal bony hump. Analysis began June 2018.

Main Outcomes and Measures  Overall trend in recognition of objective and subjective alterations in projection and rotation for the rhinoplasty- and non–rhinoplasty-trained evaluators.

Results  Ten medically trained and 10 lay individuals (13 women [65%]; mean [SD] age, 38 [8.6] years) analyzed digitally manipulated photographs of 3 women (age range, 20-50 years) who had not undergone surgery. Lay individuals were more likely to choose an ideal nasal profile based on surrounding facial architecture (28 of 30 [93%]), while individuals with rhinoplasty training tended to separate the ideal nose from the surrounding face (18 of 30 [60%]) (P < .001). Projection was consistently and accurately recognized as being altered by both rhinoplasty-trained and lay individuals (95% CI, −0.18 to 0.38; P = .60 and 95% CI, −0.26 to 0.33; P > .99 for most and least projected), whereas subjective changes in rotation were significantly more elusive to the lay individual (95% CI, −0.04 to 0.52; P = .12 and 95% CI, 0.11 to 0.65; P = .01 for most and least rotated).

Conclusions and Relevance  Predictable and consistent aesthetic results are the primary aim in rhinoplasty. Alterations in the upper nasal tripod are more reliable with extrapolated healing than with the tripod of the nasal tip. Ultimately, simple alteration of the upper nasal third can result in an improved nasal profile without specific alteration of tip architecture.

Level of Evidence  NA.

Original Article

Source

ScanMed Allows for Quick Medical Information Retrieval

Wolters Kluwer Health

JavaScript Error
JavaScript has been disabled on your browser. You must enable it to continue. Here’s how to enable JavaScript in the following browsers:

Internet Explorer

  1. From the Tools menu, select Options
  2. Click the Content tab
  3. Select Enable JavaScript

Firefox

  1. From the Tools menu, choose Internet Options
  2. Click the Security tab
  3. Click Custom Level
  4. Set Active Scripting to Enable

Safari

  1. From the Edit menu, choose Preferences
  2. Click the Security tab
  3. Select Enable JavaScript

Original Article

Source

Answers to common tummy tuck questions

answers to common tummy tuck quesitons

A tummy tuck is a surgical procedure that removes the extra skin and fat of the abdomen and repairs the paired six-pack muscles that may have separated after childbirth, weight gain, or aging. After a tummy tuck, patients enjoy a flat abdominal contour and a stronger core.

If you are considering tummy tuck surgery, you undoubtedly have questions. Below are the answers to the most common questions people have about tummy tuck surgery.

What should you expect during your tummy tuck consultation?

Your board-certified plastic surgeon will provide a comprehensive and personalized consultation which includes a detailed patient history, physical examination, treatment options and before and after photos. During your consultation, your plastic surgeon will work to tailor your procedure according to your desires and goals for the tummy tuck.

What happens during tummy tuck surgery?

During tummy tuck surgery, your plastic surgeon will work diligently to remove the extra skin and fat of the abdomen and repair the separation of your abdominal muscles. Liposuction may be added to contour the abdomen and flanks if needed.

What should you expect after tummy tuck surgery?

After surgery, you will be placed in a compression garment, which will be worn for 4-6 weeks after surgery to help with reducing swelling. You may feel some pain or discomfort, but most patients are able to manage post-procedure pain or discomfort with just a few days of pain medications.

You will be bent at the waist while standing or lying down for 7-10 days after surgery to protect the incision and to allow for your skin to adapt. After this time, you will be able to stand up straight. If a drain is placed, then it will be removed as soon as the output is low enough (usually in 1-2 weeks).

What is the recovery after tummy tuck surgery?

You can walk the day of surgery. In fact, most plastic surgeons encourage patients to walk three times the day of surgery to improve blood circulation to keep the risk of blood clots in the legs to a minimum. However, running or lifting should be avoided for six weeks after the procedure.

Patients typically return to work in approximately two weeks. The bruising will subside in a couple of weeks, and the swelling will continue to diminish until approximately three months post-procedure. The scars will continue to heal and will become thinner and lighter in color at around 12-18 months.

What are the risks of tummy tuck surgery?

As with any surgery, there is a small risk of bleeding and infection. Great care is taken to ensure that these risks are kept to the absolute minimum with meticulous surgical technique. In addition, there is a small risk of blood clots in the legs or lungs.

Due to this risk, compression boots on your calves during surgery are placed to help circulation, and a low dose of blood thinner may be used. Adequate hydration and ambulation are also important to lower the risk of blood clots after surgery.

What are some long-term considerations after a tummy tuck?

With stable weight, tummy tuck results are stable over time. If you experience any weight fluctuations or become pregnant, this may change your tummy tuck result.

Starting your tummy tuck journey

If you think that tummy tuck surgery might be right for you and your aesthetic goals, be sure to meet with a board-certified plastic surgeon for a consultation. You can use the ASPS Plastic Surgeon Match referral service to find ASPS member surgeons in your area.

The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.

Original Article

Source

Measuring Tape for Children

Wolters Kluwer Health

JavaScript Error
JavaScript has been disabled on your browser. You must enable it to continue. Here’s how to enable JavaScript in the following browsers:

Internet Explorer

  1. From the Tools menu, select Options
  2. Click the Content tab
  3. Select Enable JavaScript

Firefox

  1. From the Tools menu, choose Internet Options
  2. Click the Security tab
  3. Click Custom Level
  4. Set Active Scripting to Enable

Safari

  1. From the Edit menu, choose Preferences
  2. Click the Security tab
  3. Select Enable JavaScript

Original Article

Source

Postoperative Antibiotic Use Among Patients Undergoing Functional Facial Plastic and Reconstructive Surgery

Key Points

Question  How frequently are antibiotics prescribed after nasal and oculoplastic procedures, and is antibiotic use associated with reduced postoperative infection rates?

Findings  Of 294 039 adult patients in this population-based cohort study, 45.2% of patients filled antibiotic prescriptions after nasal and oculoplastic procedures; these patients were at significantly decreased risk of postoperative infections compared with those who did not fill antibiotic prescriptions. Increased duration of postoperative antibiotics was not associated with reduced infection rates.

Meaning  Antibiotic use after facial plastic and reconstructive procedures is associated with decreased rates of postoperative infections.

Importance  Best practices for antibiotic use after facial plastic and reconstructive procedures have been the subject of much debate, and there is a need for large-scale data to guide further development of evidence-based guidelines for antibiotic use in this setting.

Objective  To assess patterns of postoperative antibiotic prescriptions and infection rates after nasal and oculoplastic procedures.

Design, Setting, and Participants  A retrospective population-based cohort study was conducted using IBM MarketScan Commercial and Medicare Supplemental research databases of 294 039 patients who underwent facial plastic surgery procedures between January 1, 2007, and December 31, 2015. Patients were excluded if they were younger than 18 years, lacked continuous insurance coverage for 1 year before and after the procedure, or underwent additional procedures on the surgery date of interest. Statistical analysis was performed from January 1, 2007, to December 31, 2016.

Main Outcomes and Measures  Primary outcomes were antibiotic prescription patterns in the immediate postoperative period and rates of postoperative infectious complications. Explanatory variables included patient demographics, procedure type, and relevant comorbidities, which were used in multivariable logistic regression analysis.

Results  Of the 294 039 patients who met inclusion criteria (55.9% women and 44.1% men; mean [SD] age, 54.0 [18.6 years]), 45.2% filled prescriptions for postoperative antibiotics, including 55.3% of patients undergoing nasal procedures and 14.7% of patients undergoing oculoplastic procedures. Superficial surgical site infections occurred in 1.6% of patients, while deep surgical site infections occurred in 0.3% of patients. On multivariable logistic regression, patients receiving postoperative antibiotics were at significantly decreased risk of postoperative infections (nasal procedures: adjusted odds ratio [aOR], 0.144 [95% CI, 0.102-0.203]; oculoplastic procedures: aOR, 0.254 [95% CI, 0.104-0.622]) compared with those who did not receive postoperative antibiotics. Increased duration of postoperative antibiotics was not associated with reduced rates of infectious complications (nasal procedures: aOR, 1.000 [95% CI, 0.978-1.022]; oculoplastic procedures: aOR, 1.024 [95% CI, 0.959-01.092]). Despite being more likely to experience postoperative infections, patients with a history of tobacco use (aOR, 0.806 [95% CI, 0.747-0.870]), immunodeficiency (aOR, 0.774 [95% CI, 0.737-0.813]), or type 1 or 2 diabetes (aOR, 0.810 [95% CI, 0.772-0.850]) were less likely to be prescribed antibiotics than those without these conditions.

Conclusions and Relevance  Postoperative antibiotic prescriptions were associated with reduced rates of infections after facial plastic surgery. This study highlights the role of population-level data in the development of best practices for postoperative antibiotic use and identifies the need for additional examination of antibiotic use patterns and recommendations for populations at increased risk for postoperative wound infection.

Original Article

Source

Clarification of a Suspension Technique for Unstable Nasal Bones

To the Editor We read the article “Suspension Technique for Unstable Nasal Bones” (and related video) by Hunter and Tasman.1 We congratulate the authors on their work; however, some aspects may be underlined in their article.1

First, the suspension technique proposed by the authors seems very similar to the one reported by Maliniac in 1946 (Figure).2 In Maliniac’s technique, the internal support (pressure pads rather than silicon sheeting) is combined with an external device by means of transcutaneous suspension. As in the procedure described by Hunter and Tasman,1 Maliniac introduced the pads through transcutaneous bridle sutures, which were used to fix them in place. Certainly an outdated device was used, even though the concept seems identical to that reported by Hunter and Tasman.

Original Article

Source

Patient Education Program

Wolters Kluwer Health

JavaScript Error
JavaScript has been disabled on your browser. You must enable it to continue. Here’s how to enable JavaScript in the following browsers:

Internet Explorer

  1. From the Tools menu, select Options
  2. Click the Content tab
  3. Select Enable JavaScript

Firefox

  1. From the Tools menu, choose Internet Options
  2. Click the Security tab
  3. Click Custom Level
  4. Set Active Scripting to Enable

Safari

  1. From the Edit menu, choose Preferences
  2. Click the Security tab
  3. Select Enable JavaScript

Original Article

Source

Clarification of a Suspension Technique for Unstable Nasal Bones—Reply

In Reply Many thanks for the letter and comments relating to the recently published Surgical Pearl.1 We are very grateful to you for drawing our attention to the work of Maliniac,2 of which the authors were unaware. I remember during my higher surgical training once being told that if I thought I had had an original idea, I should check the German literature. Although that is not completely accurate in this case, the point is well made.

Original Article

Source

Is a rhinoplasty right for you?

Ongoing dissatisfaction with one or more physical features of your nose, as well as functional or aesthetic problems due to injury or trauma, are just some of the common reasons why patients decide to undergo rhinoplasty surgery.

Commonly known as a “nose job,” rhinoplasty consistently ranks among the top ten most sought-after plastic surgery procedures. While it may seem like a straightforward surgery, rhinoplasty requires a high level of experience and training to produce superior quality results. If you do decide that a rhinoplasty is right for you, it is important to seek a qualified plastic surgeon that has an eye for aesthetics and detail.

What is rhinoplasty?

Your nose is composed of cartilage, soft tissue and small bones, all of which work together to create the shape and appearance of your nose. Any changes made to any one of these components can significantly alter the appearance of your nose, which is why rhinoplasty can be an intricate, complicated procedure.

During rhinoplasty surgery, your plastic surgeon works on, and with, these individual parts, utilizing a range of techniques to alter the nose both aesthetically and functionally. The techniques used for your rhinoplasty will depend on both your personal goals as well as on the natural anatomical makeup of your nose and any previous trauma or surgery that might have occurred there.

What are the reasons to consider a rhinoplasty?

To change the way your nose looks

Many people considering rhinoplasty want to change the shape and appearance of their nose, which is known as cosmetic rhinoplasty. Depending on the anatomical makeup of your nose and the look one is looking for, cosmetic rhinoplasty may only involve minor changes in structure that are reflected in visibly noticeable improvements.

However, in some cases, altering multiple components of the internal structure of the nose will be necessary to achieve the look you want. Cosmetic rhinoplasty is typically done to change the overall shape of the nose, making it wider, larger, narrower or smaller – with the goal being to improve the overall proportion and balance of the face. To that end, the tip of your nose can be altered as well.

To improve your breathing

Injuries, genetic abnormalities and growths inside the nose can impede the flow of air into the nose and make breathing difficult. Under these conditions, rhinoplasty can include work on the passageways that the air takes and the changes in shape or structure of the nose are designed so air can flow through normally.

This type of procedure will likely involve altering the septum. The septum is the long, large piece of cartilage tissue that runs along the very center of the nose. Changing the position or size of the septum typically is considered a medically necessary surgery because the goal entails a marked improvement in function, and may be covered by health insurance. Sometimes, work on the soft tissue inside the nostril can improve the airflow by widening the space between the septum and the sidewalls and soft tissue of the nose, commonly referred to the nasal valve area.

To complement your ethnicity

Ethnic rhinoplasty is an approach that changes the appearance of the nose, but in doing so, remains true to the patient’s ethnicity – enhancing one’s nose and balancing your features without sacrificing the various nasal features that characterize different ethnicities. The objective is to give an individual a beautiful, natural-looking nose that remains in harmony with the rest of the face and unique features.

Are you a good candidate for rhinoplasty?

The decision to undergo rhinoplasty is a personal one, based on dissatisfaction with certain features of one’s nose and the desire for a different look. The presence of one or more undesired nasal features may well make you a good candidate for rhinoplasty, some common reasons include:

  • A crooked septum that makes the nose appear off-center
  • A bump on the bridge of the nose
  • A wide nose
  • A thick nasal tip, asymmetric, or an overly projecting, or even drooping, tip
  • Cosmetic irregularities due to injury or trauma

Who should you see for a rhinoplasty?

While there are many surgeons who might be technically qualified to perform rhinoplasty procedures, you want to entrust the alterations of the focal point of your face to someone with extensive experience and training in the procedure. You want to make certain that the plastic surgeon you choose possesses the level of expertise necessary to deliver the superior results you expect.

Considering how precise this procedure can be, it’s especially important to choose a plastic with extensive training and experience in aesthetic surgery of the face – being a member of the American Society of Plastic Surgeons and board certified by the American Board of Plastic Surgery helps assure one that the surgeon is qualified and undertakes continual education of the procedure.

The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.

Original Article

Source

New Safety Eyewear

Wolters Kluwer Health

JavaScript Error
JavaScript has been disabled on your browser. You must enable it to continue. Here’s how to enable JavaScript in the following browsers:

Internet Explorer

  1. From the Tools menu, select Options
  2. Click the Content tab
  3. Select Enable JavaScript

Firefox

  1. From the Tools menu, choose Internet Options
  2. Click the Security tab
  3. Click Custom Level
  4. Set Active Scripting to Enable

Safari

  1. From the Edit menu, choose Preferences
  2. Click the Security tab
  3. Select Enable JavaScript

Original Article

Source