Search Results (72)

Cannabis use has increased substantially in the United States, driven by broader legalization, decriminalization, and expanding medical and recreational availability. For facial plastic surgeons, the clinical implications remain difficult to define because “cannabis use” encompasses heterogeneous products and routes, including smoked flower, vaping, concentrates, edibles, pharmaceutical cannabinoids, topical cannabidiol (CBD), and frequent co-use with tobacco or nicotine. Current evidence suggests that systemic cannabis use, particularly inhaled or heavy perioperative use, may be associated with increased surgical complications in selected populations; however, existing studies are limited by retrospective design, inconsistent exposure definitions, inadequate dose and route characterization, and confounding by tobacco use and comorbidities. Cannabinoids exert biologic effects through the endocannabinoid system, particularly CB1 and CB2 receptors, which are expressed in the central nervous system, immune cells, vasculature, and skin. These pathways influence inflammation, keratinocyte proliferation, fibroblast activity, angiogenesis, immune surveillance, pain signaling, and tissue remodeling. The net effect of cannabinoid exposure on wound healing is likely context dependent, varying based on receptor expression, wound-healing phase, route of administration, cannabinoid composition, local tissue environment, and patient-specific risk factors. Preclinical and early dermatologic literature suggests potential therapeutic roles for topical cannabinoids, especially CBD, in modulating inflammation and epithelial repair. In contrast, systemic perioperative cannabis use has been associated in several surgical cohorts with infection, delayed healing, hematoma, nonunion, and reoperation. Evidence specific to facial plastic surgery remains sparse. The most directly relevant study evaluated cannabis and tobacco use in patients undergoing operative mandibular fracture repair. Cannabis-only use was not associated with increased complications, although the cohort was small; concurrent cannabis and tobacco use was associated with higher rates of surgical site infection, facial nonunion, abscess, debridement, and malocclusion. To date, no published studies address cannabis-associated outcomes in rhinoplasty, rhytidectomy, blepharoplasty, browlift, or facial rejuvenation. This review summarizes the biologic rationale, available surgical evidence, and clinical considerations for incorporating cannabis use into individualized perioperative risk assessment in facial plastic surgery. Full article

Portable handheld three-dimensional (3D) scanners have improved facial surface measurement workflows in plastic and reconstructive surgery and have potential applications in preoperative planning, postoperative assessment, and customized implant design. However, the relative agreement of low-cost passive stereophotogrammetry for nasal surface reconstruction remains insufficiently characterized when compared with handheld structured-light scanning. This study evaluated the feasibility and relative surface-deviation performance of two passive stereophotogrammetry-based systems for nasal 3D surface reconstruction in healthy participants. Twenty-five healthy participants were enrolled, and nasal 3D models were reconstructed using Artec Eva, COLMAP, and Agisoft Metashape. COLMAP- and Agisoft Metashape-derived models were aligned to the corresponding Artec Eva models in MeshLab. Geometric deviations were quantified using root mean square (RMS) surface deviation, mean surface distance (MSD), and Hausdorff distance (HD), and regional discrepancies were visualized using surface-distance heat maps. Both passive pipelines produced deviations generally within previously reported ranges for facial or nasal 3D imaging, with median RMS and MSD values below 0.5 mm. Hausdorff distance showed larger local deviations, particularly in the alar and perinasal regions, and was significantly lower for Agisoft Metashape than for COLMAP. These findings suggest that low-cost passive stereophotogrammetry may support standardized nasal surface measurement under controlled acquisition conditions. Full article

Background: Columellar strut grafting is a widely adopted technique for nasal tip support in rhinoplasty; however, autologous cartilage grafts are associated with well-recognized limitations, including resorption, warping, and donor-site morbidity. Absorbable plates composed of poly-L-lactic acid (PLA) or poly-lactic-co-glycolic acid (PLGA), which have an established role in craniofacial fracture fixation, were investigated as a structural adjunct to auricular cartilage columellar strut grafts. The present study evaluates the safety and clinical outcomes of this technique in a large patient cohort. Methods: A retrospective review was conducted of 1710 consecutive patients who underwent primary rhinoplasty with absorbable plate-assisted columellar strut grafting between November 2012 and June 2022. A PLA plate (n = 792) or PLGA plate (n = 918) was used in combination with auricular conchal cartilage. Nasal tip projection was assessed using standardized clinical photographs and Ricketts’ E-line analysis at a minimum follow-up of 1 month (range, 1 month to 6 years). Results: Satisfactory nasal tip projection was achieved and sustained throughout the follow-up period in the majority of patients. Transient mild overprojection, attributable to intentional overcorrection, resolved consistently by 6 months postoperatively. Among patients with recorded follow-up, the overall complication rate was 0.35% (6 of 1710 patients): 1 case of minor skin exposure and 1 case requiring revision for the aesthetic desire of further tip elevation (rather than structural projection loss) in the PLA group and 4 cases of mucosal penetration in the PLGA group, all of which occurred during the initial learning phase and resolved without sequelae. No delayed infections were recorded. Conclusions: Absorbable plate-assisted columellar strut grafting using auricular conchal cartilage is a safe, reproducible, and effective technique for achieving stable nasal tip projection. By providing temporary structural support during the critical early healing phase and subsequently undergoing biologic resorption, this approach mitigates the long-term risks associated with permanent implants while avoiding the morbidity of costal cartilage harvest. Despite the limitations of a retrospective design lacking a cartilage-only control group and objective three-dimensional volumetric assessments, it represents a viable and practical alternative for nasal tip support, particularly in East Asian patients with thick skin envelopes and weak cartilaginous frameworks. Full article

Background and Objectives: Nostril aperture symmetry is an important component of nasal base aesthetics after rhinoplasty. However, nostril retainers are commonly used in reconstructive nasal surgery; their role after primary aesthetic rhinoplasty remains insufficiently defined. This study aimed to evaluate the effect of early postoperative nostril retainer use on nostril aperture symmetry after primary rhinoplasty using ImageJ-based morphometric measurements. Materials and Methods: This prospective, non-randomized comparative observational study included 52 patients who underwent primary open structural rhinoplasty. A total of 26 patients used a nostril retainer postoperatively, whereas 26 patients did not. Standardized basal-view photographs were obtained at postoperative week 1 and postoperative month 3. Right and left nostril aperture area, height, and width were measured using ImageJ software version 1.54 g after individual calibration with a millimetric ruler. Changes in symmetry indices from week 1 to month 3 were compared between groups. Results: Baseline week-1 symmetry indices were comparable between groups. The increase in area symmetry index from postoperative week 1 to month 3 was significantly greater in the nostril retainer group than in the control group (3.08 ± 4.99 vs. −1.00 ± 4.86; mean difference: 4.08; 95% CI: 1.34–6.82; p = 0.004). Changes in height symmetry index and width symmetry index did not differ significantly between groups. Conclusions: Early postoperative nostril retainer use was associated with improved nostril area symmetry after primary rhinoplasty. This benefit may be better reflected in global area-based symmetry than in isolated height or width measurements. Nostril retainers may represent a simple, noninvasive adjunct for selected patients at risk of early postoperative nostril asymmetry. Full article

Background/Objectives: Total nasal reconstruction has long represented a formidable surgical challenge. To date, no universally accepted, evidence-based protocol for nasal reconstruction exists to guide clinical practice. This study introduces a novel technique for comprehensive, three-layer nasal reconstruction. Specifically, the approach entails (1) reconstruction of the nasal mucosal lining using a free radial forearm flap; (2) provision of robust structural support via an exogenous extended framework; and (3) restoration of the external nasal skin using an expanded forehead flap. Methods: Ten patients underwent reconstruction for full-thickness nasal defects, all achieving successful structural and functional restoration. All surgical procedures were completed successfully, with operative durations ranging from 6.5 to 10.5 h. One patient developed an infection involving the rib cartilage graft. Following thorough debridement, the radial forearm free flap healed uneventfully. A second patient experienced postoperative vascular compromise of the flap. Intraoperative exploration revealed inadequate perfusion; immediate microsurgical revision—including adjustment of recipient vessels and/or re-anastomosis—successfully restored flap viability. Results: Primary wound healing was achieved in all patients within 10–22 days. All patients completed a follow-up of 12–36 months (mean: 21.5 months). Both patients and the surgical team rated postoperative nasal aesthetics as satisfactory. Objective functional assessments—including anterior rhinomanometry and peak nasal inspiratory flow—demonstrated no clinically significant impairment in nasal airflow. Conclusions: This surgical strategy for reconstructing the three-layer nasal architecture in patients with total nasal defects represents a rational and clinically viable approach—offering a valuable reference for rhinoplasty surgeons performing such complex reconstructions. Full article

Background: Costal cartilage is the preferred structural material for augmentation rhinoplasty when robust and durable tip support is required. However, conventional full-thickness harvest is associated with significant donor-site morbidity, and commonly employed rigid fixation strategies—such as the septal extension graft—substantially restrict postoperative nasal tip compliance. The present study introduces a novel two-component technique combining a half-harvest costal cartilage procurement method with a pyramidal-shaped columellar strut graft anchored on the floating-tip principle, with the objective of maintaining postoperative nasal tip flexibility while providing structural support following augmentation rhinoplasty. Methods: A retrospective review was performed of consecutive patients who underwent primary or revision augmentation rhinoplasty using the pyramidal costal cartilage columellar strut graft technique by a single surgeon between June 2018 and February 2026. The medial half of the conjoined costal cartilage at the seventh, eighth, or ninth rib was procured via a half-harvest approach, preserving the lateral cortex and perichondrium to minimize donor-site morbidity and potential cartilage regeneration was considered a theoretical benefit. The harvested cartilage was carved into a pyramidal columellar strut and secured to the anterior nasal spine using a floating fixation construct; the inferior base of the strut was rigidly fixed to the nasal septum and anterior nasal spine with a minimum of three PDS 5-0 sutures, while the superior portion remained free to preserve physiologic nasal tip mobility. Adjunctive cap and shield grafts, perichondrial wrapping, and dermal fat grafts were employed as indicated. Primary outcomes included nasal tip projection, postoperative tip mobility, donor-site morbidity, and surgical complication rates. Results: Favorable clinical observations of maintained tip projection were noted throughout follow-up. Manual postoperative examination suggested preservation of tip flexibility in most patients; however, no validated objective mobility assessment tool was available. The revision rate for clinically significant tip deviation was low. No major donor-site adverse events—including pneumothorax or rib fracture—were encountered. Postoperative chest wall pain was minimal and transient, with most patients resuming daily activities within one week of surgery. Conclusions: The pyramidal-shaped costal cartilage columellar strut graft with half-harvest technique is a novel, biomechanically informed, and technically reproducible approach to augmentation rhinoplasty that was developed to address donor-site morbidity and postoperative tip rigidity, two commonly recognized limitations of conventional costal cartilage rhinoplasty: donor-site morbidity and postoperative nasal tip rigidity. Preservation of the lateral cortex and perichondrium during procurement may contribute to reduced postoperative donor-site discomfort, accelerates functional recovery, and may promote endogenous cartilage regeneration over time. The anatomically derived pyramidal strut geometry, combined with floating fixation to the anterior nasal spine, was designed to approximate the native columellar architecture, enabling consistent preservation of physiologic nasal tip mobility. The present series demonstrated a favorable safety profile with a low overall complication rate and an absence of major donor-site adverse events. Prospective studies with validated objective outcome measures are required to confirm these findings, to delineate the optimal patient selection criteria, and to establish evidence-based long-term outcome benchmarks for this technique. Full article

Background: Correct performance of rhinoseptoplasty often requires osteotomy, the effectiveness and safety of which depend on precise knowledge of nasal anatomy, particularly the shape, length, and thickness of the nasal bones. Aim: The aim of this study was to assess the morphometry of the nasal bone and nasal pyramid in adult patients based on three-dimensional computed tomography (CT) using Slicer 3D software. Materials and Methods: A retrospective analysis was performed on data from 87 patients (44 women and 43 men; mean age 50.64 SD ±16.7 years) who underwent head CT between 1 January 2024 and 31 December 2025 because of trauma (to exclude intracranial hemorrhage) or dizziness (to diagnose central causes). Results: The comparative analysis demonstrated statistically significant differences in the dimensions of the nasal bony structures between women and men, with women showing lower values for all assessed parameters. For point 1L, the mean value was 6.29 in women compared with 8.07 in men (p = 0.0056). For point 4L, the values were 2.07 vs. 2.55, respectively (p = 0.009), whereas for point 5L they were 1.52 vs. 1.66 (p = 0.01). A similar relationship was also noted on the right side: for point 1R, the values were 5.95 vs. 8.02 (p = 0.03), and for point 5R they were 1.54 vs. 1.89 (p = 0.03), confirming consistently smaller dimensions of the bony structures in women in the analyzed study group. Conclusions: The obtained results may have important practical significance in planning osteotomy during rhinoseptoplasty procedures, enabling a more precise and safer surgical procedure. Full article

Background: Cleft lip with or without cleft palate (CL ± P) is a common congenital anomaly requiring a multidisciplinary team approach from birth into adulthood. Many patients undergo multiple secondary procedures on the lip, nose, and alveolus, representing a substantial long-term “burden of care” for families and health systems. The relationship between preoperative cleft severity and the cumulative number of surgical interventions into late adolescence remains insufficiently characterized. Methods: A retrospective cohort study was conducted on 166 patients with cleft lip ± cleft palate treated at a single tertiary cleft center. All patients underwent primary cheiloplasty, with or without concomitant gingivoperiosteoplasty (GPP), and had follow-up extending to a mean age of 18 years. Preoperative nasolabial deformity was graded into four categories (mild, moderate, severe, and very severe) using standardized photographic assessment. The primary outcome was the total number of cleft-related surgical interventions on the lip, nose, and alveolus, including the primary operation and all subsequent corrective procedures. Associations between preoperative severity and surgery counts were analyzed using the Kruskal–Wallis test and Bonferroni-adjusted pairwise comparisons. Results: All 166 patients underwent a primary procedure, either cheiloplasty alone (n = 86; 51.8%) or cheiloplasty combined with GPP (n = 80; 48.2%). A second surgical intervention was performed in 111 patients (66.8%), yielding 138 procedures, most commonly GPP with bone grafting (n = 54), corrective cheiloplasty (n = 48), GPP without graft (n = 23), and rhinoplasty (n = 12). A third intervention was performed in 48 patients (28.9%; 70 procedures), predominantly rhinoplasty and additional cheiloplasties, and a fourth intervention in 13 patients (7.8%; 17 procedures), mostly staged rhinoplasty and lip revisions. Overall, 56 patients (33.7%) had only one (primary) operation, 50 (30.1%) had two, 27 (16.3%) had three, 18 (10.8%) had four, 13 (7.8%) had five, and one patient (0.6%) had six surgical interventions. The total number of operations differed significantly across severity grades (Kruskal–Wallis p < 0.001). Patients with mild and moderate severity had significantly fewer surgeries than those with severe or very severe deformities (all p ≤ 0.023), whereas differences between mild vs. moderate and severe vs. very severe were not significant. Conclusions: In this cohort of patients with cleft lip followed to a mean age of 18 years, two-thirds required at least one secondary procedure, and nearly one-fifth underwent four or more surgeries. Higher preoperative severity was strongly associated with greater surgical burden, particularly when comparing mild or moderate deformities to severe and very severe clefts. These findings underline the importance of preoperative severity assessment for family counseling, expectation management, and the design of treatment protocols aimed at minimizing the long-term burden of care while preserving functional and esthetic outcomes. Full article

The annual congress of the Italian Association of Plastic Aesthetic Surgery (AICPE) is one of the most relevant conference meetings in Europe concerning aesthetic plastic surgery as there are a number of participants, over 400, and an international team of invited speakers chosen for their renowned scientific value. The 12th meeting was held in Rimini (Italy) from 6 to 8 June 2025. The scientific issues concerned new advancements in aesthetic surgery. This book of abstracts contains research related to facial surgery, body contouring, breast surgery, and rhinoplasty, also including aesthetic medicine, AI’s impact on the medical profession, and forensic medicine. For the first time, the AICPE established an award in memory of Flavio Saccomanno for the best paper presented by a young surgeon with the endorsement of Surgical Techniques Development by MDPI. Full article

Background: Rhinoseptoplasty is regarded by many surgeons as one of the most demanding procedures in aesthetic surgery. The introduction of new surgical techniques and instruments aims to improve treatment outcomes, increase procedural safety and reproducibility, reduce soft-tissue trauma and shorten operative time. The development of powered instrumentation has contributed substantially to progress in nasal surgery by supporting these goals. The aim of this study was to compare the aesthetic and functional outcomes of rhinoseptoplasty performed with powered instrumentation (PI) and with conventional methods (CR). Methods: The study included 106 patients (78 women, 28 men) aged 18–65 years (mean 34 ± 9.8) who were qualified for surgery. CR were used in 62 (58.5%), while PI were used in 44 (41.5%). Patients completed the Rhinoplasty Outcome Evaluation (ROE) and the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) questionnaires before surgery and 6 months postoperatively. The data were statistically analyzed. Results: Both groups demonstrated statistically significant postoperative improvement in all assessed questionnaire outcomes (p < 0.0001). ROE scores increased, whereas total SCHNOS, SCHNOS-O, and SCHNOS-C scores decreased. Effect-size analysis indicated a stronger therapeutic effect in the PI group than in the CR group: ROE Cohen’s d, 3.48 vs. 3.07; total SCHNOS r, 0.99 vs. 0.80; SCHNOS-O r, 0.85 vs. 0.62; and SCHNOS-C r, 0.97 vs. 0.93. No major intraoperative complications were observed. Conclusions: Meaningful gains in patient-reported outcomes were observed following rhinoseptoplasty in this cohort. The findings provide a rationale for future studies examining whether powered instrumentation offers measurable advantages in selected patients and surgical contexts. Full article

Background and Objectives: Achieving long-term stability of nasal tip rotation and projection remains a challenge in rhinoplasty because of postoperative remodeling processes such as edema resolution, soft tissue redraping, and scar maturation. This study evaluated the temporal changes in nasal tip rotation and projection following rhinoplasty using the Pentagonal Tip Support Technique (PTST). Materials and Methods: A retrospective analysis was conducted on patients undergoing primary rhinoplasty using PTST, with standardized photographic assessments performed intraoperatively and at 6 and 12 months postoperatively. Nasal tip rotation and projection were quantified using the nasolabial angle and Goode ratio, respectively, and temporal changes were analyzed across postoperative intervals. Results: Both parameters demonstrated statistically significant reductions over time. However, the majority of changes occurred within the first 6 months, whereas later follow-up intervals demonstrated smaller changes and a reduced rate of change. Similar temporal patterns were observed across different skin types, and skin type was not significantly associated with late postoperative changes in rotation or projection. Conclusions: The findings of the present study suggest that PTST is associated with a temporal pattern characterized by greater early postoperative changes followed by smaller interval changes during later follow-up. These findings may reflect postoperative healing dynamics and structural support behavior following rhinoplasty. However, further prospective comparative studies are needed to better define the clinical behavior of PTST over extended follow-up periods relative to established structural rhinoplasty techniques. Full article

Background: Nasal valve dysfunction (NVD) is a common yet underrecognized cause of nasal airway obstruction, with a significant impact on quality of life. Despite its clinical relevance, no universally accepted diagnostic standard exists, and optimal management remains debated. Multiple diagnostic tools and surgical or minimally invasive treatments have been proposed. This systematic review and meta-analysis aimed to evaluate current evidence regarding diagnostic approaches and treatment outcomes in NVD. Methods: A systematic search of PubMed/MEDLINE, Embase, and Cochrane Library was performed for studies published between January 1990 and January 2026, in accordance with PRISMA 2020 guidelines. Randomized controlled trials, non-randomized comparative studies, cohort studies, and case series (≥10 patients) assessing diagnostic methods or therapeutic interventions for NVD were included. Diagnostic data were synthesized narratively. The primary surgical outcome was change in the Nasal Obstruction Symptom Evaluation (NOSE) score. Risk of bias was assessed using RoB 2, ROBINS-I, and QUADAS-2 tools. Results: Seventy-two primary clinical studies were included (15 diagnostic, 57 treatment-focused). Objective airflow measurements, particularly rhinomanometry and peak nasal inspiratory flow, showed greater reliability than isolated clinical maneuvers. Imaging modalities provided anatomical detail but correlated inconsistently with symptoms. Meta-analysis of 12 studies (n = 1210 patients) suggests that both traditional surgical and minimally invasive interventions can substantially improve nasal breathing, with mean NOSE score reductions of 40–55 points, though heterogeneity precludes direct comparison of their relative effectiveness. Conclusions: Diagnosis of NVD requires a multimodal approach combining clinical assessment, validated symptom scores, and selective objective testing. Surgical and minimally invasive treatments provide substantial symptom improvement when appropriately indicated. Evidence is constrained by the predominance of observational data, emphasizing the need for standardized diagnostics and robust comparative trials. Full article

Objective: To explore the efficacy and outcomes of the ‘Inverted V graft’ technique, which synergistically combines a columellar strut and an extension graft. This innovative approach aims to provide enhanced structural support and improved aesthetic results in rhinoplasty procedures. Methods: Patients were observed postoperatively over a period of one year, with evaluations at designated intervals using the Rhinoplasty Outcome Evaluation (ROE) questionnaire to assess satisfaction. The closed preservation rhinoplasty method was employed under general anesthesia with all patients. The Inverted V graft was meticulously sutured in place, augmenting nasal structure and stability. Results: In a group of 19 participants, the study observed significant enhancements in patient satisfaction post-rhinoplasty, as indicated by ROE scores, with no age-related variation in outcomes. Surgical times averaged around 209.5 min, with an 18-month follow-up showing similar satisfaction improvements across both genders. Conclusions: The study demonstrates that the dual-purpose Inverted V graft technique significantly enhances structural support and aesthetic outcomes in rhinoplasty procedures. The use of this technique resulted in substantial improvements in patient satisfaction, as measured by the Rhinoplasty Outcome Evaluation (ROE) scores, indicating its effectiveness in achieving desired surgical results. Full article

Objectives: To evaluate the relationship between anterior maxillary sinus wall position and nasal bone asymmetry, and to assess their association with patient-reported aesthetic and functional outcomes following septorhinoplasty. Methods: Preoperative and postoperative evaluations were performed using the Rhinoplasty Outcome Evaluation (ROE) and Nasal Obstruction Symptom Evaluation (NOSE) questionnaires. Nasal bone dimensions were measured preoperatively using computed tomography (CT) scans. Results: A positive correlation was observed between anterior maxillary sinus wall position and nasal bone asymmetry, with significant nasal bone discrepancies contributing to nasal deviation. Conclusions: Anterior maxillary sinus wall position and nasal bone asymmetry are significantly associated with patient-reported outcomes following septorhinoplasty. Consideration of these anatomical parameters during surgical planning may improve aesthetic and functional results. Full article

Background: Despite advances in cleft rhinoplasty, the nasal sill remains an underappreciated subunit, yet it plays a crucial role in nostril symmetry and aesthetic balance. Hypoplasia or absence of the nasal sill on the cleft side often persists after primary repair and may complicate secondary nasal base correction. Current methods for sill reconstruction are limited by donor site morbidity, variability in tissue match, or non-anatomic tissue substitution. Methods: This technical note describes a surgical protocol utilizing the Tela Cutis Nasi flap, a pedicled fibro-adipose flap harvested from the adjacent nasal base, to reconstruct the deficient sill in patients with previously repaired unilateral cleft lip. The flap concept, anatomical rationale, stepwise operative steps, and patient selection considerations are outlined. Results: This technical note details the surgical steps, anatomical rationale, and flap design. No formal morphometric or patient-reported outcome analysis is included in this report; these data are being collected within an ongoing prospective outcome study designed to evaluate efficacy and long-term stability. Conclusions: The Tela Cutis Nasi flap is intended as an anatomically based local option for nasal sill reconstruction that can be integrated into secondary cleft nasal base surgery. This article contributes a standardized operative description, indications, technical constraints, and anticipated pitfalls, without assessment of clinical outcomes or long-term stability. Full article