An Evidence-Based and Case-Based Comparison of Modern Face Lift Techniques.

Background: Facial aging is a multifactorial process that affects each component of facial anatomy. The two general groups of face lift techniques are superficial musculoaponeurotic system (SMAS) elevation and SMAS manipulation. The purpose of this article is to describe and compare the advantages, disadvantages, and limitations of face lift techniques.

Gender Considerations in Rhinoplasty.

Precise nasofacial analysis ahead of rhinoplasty is imperative. Features common to the White masculine nose are reviewed in a stepwise fashion and contrasted with those of the White feminine nose. A solid understanding of the cisgender male, masculine nose enables the plastic surgeon to determine the changes required for a successful facial feminizing rhinoplasty as a part of facial gender confirmation surgery.

Functional Nasal Surgery.

Learning Objectives: After studying this article, the participant should be able to: (1) understand the functional significance of nasal anatomy as it relates to rhinoplasty and perform a comprehensive functional nasal assessment. (2) Identify the anatomical level of obstruction based on the authors' algorithmic approach and understand the current evidence supporting operative techniques for correcting nasal airway obstruction from septal deformity, inferior turbinate hypertrophy, internal nasal valve collapse, external nasal valve collapse. (3) Understand the current evidence supporting operative techniques for correcting nasal airway obstruction from septal deformity, inferior turbinate hypertrophy, internal nasal valve collapse, and external nasal valve collapse.

The Alar Equalization Suture for Nasal Tip Refinement.

Anatomic subtleties of the nasal tip have a dramatic impact on the overall appearance of the nose. Creation of the ideal nasal tip in rhinoplasty requires straight lower lateral cartilages, everted lateral crura, a higher caudal edge of the lower lateral cartilages relative to the cephalic margin, and a diamond-shaped tip. In this article, the authors describe the alar equalization suture, a suture technique that further refines nasal tip shaping after traditional maneuvers have been performed.

A Novel Algorithm for Defining the Mandibular Border.

Techniques for defining the mandibular angle are a particular focus for patients around the world. Developing the desirable sharp contours is a combination of reducing bulkiness around the mandible while augmenting the border. Invasive techniques (e.

The Five-Step Rhinoplasty Dead Space Closure Technique.

The creation of dead space in rhinoplasty creates a welcoming environment for erratic soft -tissue contraction. If rhinoplasty surgeons can control and reliably predict skin contraction and wound healing, rhinoplasty results will undoubtedly improve. Obliteration of dead space is a key component in rhinoplasty as it minimizes soft-tissue contraction, resulting in a more predictable outcome.

An Update on the Surgical Management of the Bulbous and Boxy Tip.

The bulbous and box tips are two common morphologies encountered in rhinoplasty. Nasal tip reshaping is a challenging aspect of rhinoplasty. Understanding the classifications of nasal tip morphologies aids when performing a nasal-facial analysis.

Two or Three? Approaches to Staging of the Paramedian Forehead Flap for Nasal Reconstruction.

The paramedian forehead flap is a historic cornerstone of plastic surgery and a mainstay of complex nasal reconstruction. Although initially described as a 2-stage procedure, several procedural advancements and modifications have been proposed, with the most notable being the addition of a third, intermediate stage. Proponents of this 3-stage approach argue that the addition of an intermediate stage improves flap perfusion, expands lining and structural support options, and provides superior aesthetic outcomes.

Nasal Tip Shaping Finesse in Rhinoplasty.

Anatomic subtleties of the nasal tip have a dramatic impact on the overall appearance of the nose. Mastery of normal nasal aesthetics and anatomy is a critical prerequisite to adeptly performing nasal tip refinement during open rhinoplasty. This article and series of videos aim to provide a focused review of nasal tip analysis, anatomy, and surgical technique, with particular emphasis on pertinent tip sutures and cartilage grafts.

Why Primary Rhinoplasty Fails.

Rhinoplasty remains one of the most challenging operations performed by plastic surgeons. The complexity lies in the ability to have a consistent and predictable aesthetic result. The unpredictability is mainly attributable to the interplay of manipulated internal structures and wound healing dynamics.

Evidence-Based Medicine in Plastic Surgery: From Then to Now.

Evidence-based medicine, as described by Dr. Sackett, is defined as the "conscientious, explicit, and judicious use of current best evidence, combined with individual clinical expertise and patient preferences and values, in making decisions about the care of individual patients." In the late 2000s, seminal articles in Clinics in Plastic Surgery and Plastic and Reconstructive Surgery introduced evidence-based medicine's role in plastic surgery and redefined varying levels of evidence.

Social Media Guidelines for Young Plastic Surgeons and Plastic Surgery Training Programs.

Social media are a powerful tool that creates a unique opportunity for the young plastic surgeon and trainee to share content, brand oneself, educate the public, and develop one's own professional voice early. The majority of all plastic surgery programs and particularly those that are highly ranked have social media opportunities for their residents, yet clear rules to guide implementation of social media programming in residency have remained unspecified. These guidelines and pitfalls can be used to inform a productive and professional entry into plastic surgery social media use for the resident and young plastic surgeon.

The Role of the Buccal Fat Pad in Facial Aesthetic Surgery.

Social media have triggered a buccal fat pad excision frenzy. Not surprisingly, there is tremendous appeal of having a slimmer lower face and more defined jawline after undergoing a small intraoral procedure under local anesthesia. Although this procedure is great for social media and seemingly beneficial for jawline aesthetics, the evidence remains limited as to whether or not this is an effective long-term solution.

Revisiting Primary Otoplasty: Surgical Approach to the Prominent Ear.

Prominent ears and other ear deformities are some of the most common congenital deformities of the head, affecting over 10 percent of the general population. In 2018, more than 10,000 otoplasties were performed in the United States, with over one-third performed on men. The goal of primary otoplasty is creation of a normal-appearing ear without evidence of surgical intervention.

Secondary Rhinoplasty for Unilateral Cleft Nasal Deformity.

Background: Secondary cleft rhinoplasty presents some of the most challenging cases of both cosmetic and functional nasal deformities. Understanding the anatomy and growth abnormality seen with the cleft nasal deformity helps to tailor surgical management. This article seeks to expand on the application of current concepts in secondary rhinoplasty for unilateral cleft lip nasal deformity.

Perioperative Approach to Reducing Hematoma during Rhytidectomy: What Does the Evidence Show?

Background: Postoperative hematoma remains the most common complication in rhytidectomy, prompting surgeons to use a multitude of adjunctive measures to prevent its occurrence. The goal of this systematic review was to determine which of these measures are supported by strong evidence, and to highlight those that remain unsubstantiated and require further investigation.

Methods: A systematic search was performed of the PubMed and Embase databases for English literature from 1975 to March of 2020 containing designated keywords, and focusing specifically on adjunctive measures aimed at preventing hematoma in rhytidectomy.

Management of Patients with Textured Surface Breast Implants.

The purpose of this special topic article is to present an evidence-based approach and provide recommendations for the management of both asymptomatic and symptomatic patients with textured surface breast implants. There are currently no scientific data to support complete removal of a benign capsule. When unnecessary capsulectomies are performed, the patient is at higher risk for developing postoperative complications.

Prediction of Facial Aging Using the Facial Fat Compartments.

Facial aging is a multifactorial process governed by both intrinsic and extrinsic factors that impart a change to each component of the facial anatomy. Our understanding of the science of aging has evolved over the years. A recent and valuable addition to our understanding is the knowledge of both the superficial and deep facial fat compartments.

Systematic Surgical Approach to Alar Base Surgery in Rhinoplasty.

In an era with smartphone photography and social media (specifically, "selfies"), basal view aesthetics is becoming increasingly important. Achieving balance between the nasal base and the remainder of the nose and face while preserving or restoring external valve function are essential to a successful rhinoplasty. Without a systematic approach to the nasal base, it is more difficult to achieve an ideal outcome from both aesthetic and functional standpoints.

Surgical Management of the Explant Patient: An Update on Options for Breast Contouring and Volume Restoration.

Background: Breast implant removal is becoming a common procedure in light of the current events and controversies with silicone breast implants. The authors believe strongly in informing patients about the indications and options regarding both explantation and the management of the secondary breast deformity.

Methods: Relevant literature regarding the management of the explant patient was reviewed and organized to provide an update on prior publications addressing the explant patient population.