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Frequency of Migraine and Sinus Headaches in Patients Undergoing Primary Rhinoplasty.
[BACKGROUND] Nearly two thirds of patients who suffer from migraine headaches (MH) have a rhinogenic trigger site. A majority of rhinoplasty patients are female, and an estimated 18% of females suffer from MH. Rhinogenic MH and sinus headac…
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Aspects and Concepts of What I Preserve in Rhinoplasty: Proceedings of the 2025 American Society of Plastic Surgeons Spring Meeting.
Despite increasing national rhinoplasty rates, plastic surgeons' share of these procedures may be changing, and rhinoplasty remains one of the most difficult procedures to teach residents. In part, among many factors, any lower adoption tre…
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An Algorithm for Control of Excessive Perioperative Bleeding and Ecchymosis in Rhinoplasty Patients Based on 4 Decades of Experience.
[BACKGROUND] Persistent intraoperative bleeding, excessive postoperative ecchymosis, epistaxis, and blood collection in the supratip area increase the complexity of rhinoplasty, causing suboptimal outcomes. The authors present an intraopera…
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Evidence-Based Dynamics in Rhinoplasty.
Rhinoplasty is a delicate surgical procedure that requires a thorough understanding of the dynamic interplay between the various structures of the nose. Any changes made to one part of the nose can have downstream effects on the overall har…
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What Makes Rhinoplasty Challenging? Some Answers from 45+ Years of Clinical Experience.
Rhinoplasty is considered one of the most perplexing procedures to master in the field of plastic surgery. Given the varied and complex anatomy of the nose, along with the dynamic interplays between maneuvers, rhinoplasty demands precision,…
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Comprehensive Criteria for Differential Diagnosis and a Surgical Management Algorithm for Occipital Neuralgia and Migraine Headaches.
The differential diagnoses and nuances of the surgical management of occipital migraine and occipital neuralgia have not been clearly discussed in the available literature. This study aims to highlight additional diagnostic features and off…
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Chin Dysmorphology in the Primary Rhinoplasty Population: Prevalence, Objective Analysis, and Implications.
[BACKGROUND] Chin flaws are far more common than recognized. Denial of genioplasty by parents or adult patients can present a surgical planning enigma, especially in patients with microgenia and chin deviation. This study aims to investigat…
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Management of Thick Skin in Rhinoplasty.
Rhinoplasty in thick skin patients is challenging because the skin soft tissue envelope (S-STE) is more inelastic, and has a tendency for prolonged postsurgical edema, increased dead space formation, and underlying scar tissue formation. Ch…
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The Incidence of Nasal Tip and Upper Lip Malposition in Primary Rhinoplasty.
[BACKGROUND] For an optimal aesthetic plan for correction of nasal tip disharmony, it is crucial to note lip and tip disproportions. [OBJECTIVES] In this study we sought to investigate the incidence of preoperative upper lip malposition in…
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Incisor Show-based Selection of Tip Augmentation Rhinoplasty Technique.
Our recent studies show that the majority of patients seeking rhinoplasty have inadequate incisor show. Furthermore, some rhinoplasty maneuvers, such as a columella strut, can alter the lip position and consequently the incisor show. We rep…
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Nonpharmacologic Treatments for Chronic and Episodic Migraine: A Systematic Review and Meta-Analysis.
[BACKGROUND] Minimally invasive techniques for treatment-resistant migraine have been developed on recent insights into the peripheral pathogenesis of migraines. Although there is a growing body of evidence supporting these techniques, no s…
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The Versatile Role of Fat Injection During Various Genioplasties.
[BACKGROUND] Fat injection has become increasingly popular in aesthetic surgery, but there is a sparsity of literature regarding its role during genioplasty. In this study, we present the largest series of patients receiving fat injections …
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Frequency, Indications and Intraoperative Dynamics of Repositioning of the Lateral Crura of the Lower Lateral Cartilage: A 35-Year Experience.
[BACKGROUND] Lower lateral cartilage repositioning (LLCR) is an effective technique that places the lateral crus in a newly created caudal pocket, and is utilized for a variety of indications including cephalic malposition, alar asymmetries…
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Exploring the Resurgence of the Preservation Rhinoplasty: A Systematic Literature Review.
[INTRODUCTION] The underlying principles of preservation rhinoplasty (PR) center around maintaining the soft tissue envelope, dorsum, and alar cartilage through surgical manipulations and tip suture techniques. In particular, the let-down (…
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Common Dorsal Flaws Following Preservation Rhinoplasty: A Systemic Analysis.
[BACKGROUND] There has recently been a resurgence of interest in preservation rhinoplasty (PR) for dorsal hump elimination or dorsal projection reduction. However, no studies have scrutinized aesthetic outcomes to identify common pattern of…
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The Logical Sequence of Primary Open Rhinoplasty Founded on the Principles of Rhinoplasty Dynamics.
Rhinoplasty is a perplexing procedure due to the variety of complex interplays between anatomical structures of the nose and the maneuvers used to accomplish the intended objective. Although every rhinoplasty is individualized, having a sys…
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The External Rhinoplasty Approach.
The nose is a complex three-dimensional structure with critical structural and functional roles; its relationship to surrounding structures is, in part, responsible for a harmonious, pleasing visage as a whole. There are many variables and …
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Economizing the Septal Cartilage for Grafts During Rhinoplasty, 40 Years' Experience.
[BACKGROUND] During rhinoplasty, it is typically necessary to use cartilage to shape and support the final nasal construct to provide both form and function to the nose (Tanna et al. in Plast Reconstr Surg 141(1):137e-151e, 2018; Guyuron in…
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Delayed Septal Perforation as a Complication of COVID-19: A Case Report.
[BACKGROUND] There are increasing reports of the effects of SARS-CoV-2 on olfactory function, with a significant number of patients reporting anosmia as a symptom. However, our knowledge and understanding of the virus's complete impact on t…
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The Evolution of Migraine Surgery: Two Decades of Continual Research. My Current Thoughts.
A mere serendipitous finding has culminated in a life-changing development for patients and a colossally fulfilling field for many surgeons. The surgical treatment of migraine headaches has been embraced by many plastic surgeons after numer…
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Updated Dynamics of Rhinoplasty: A Review of the Literature and Comprehensive List of the Findings.
[BACKGROUND] The cardinal reason accounting for the complexity of rhinoplasty is that each maneuver during this operation has both intended and unintended effects. The purpose of this report is to review the literature and update the dynami…
- Discussion: Botulinum Toxin versus Placebo: A Meta-Analysis of Prophylactic Treatment for Migraine.
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Treatment of dopplerable nummular headache with minimally invasive arterectomy under local anesthesia.
[OBJECTIVE] The objective of the current study is to elucidate the potential role of surgery in the treatment of nummular headache (NH). [BACKGROUND] NH is a disorder in which pain is localized to a specific area. Treatment has traditional…
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Neck Contouring Without Rhytidectomy in the Presence of Excess Skin.
[BACKGROUND] Patients with severe neck skin laxity due to excess submental adipose tissue have required either standard rhytidectomy or direct excision of neck skin with Z-plasty and submental lipectomy. Our recent experiences with four pat…
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The Super-High SMAS Facelift Technique with Tailor Tack Plication.
[BACKGROUND] Super-high superficial musculoaponeurotic system (SMAS) suspension and tailor tack plication are powerful facelift tools used in cases of primary facial rhytidectomy. [TECHNIQUE] Thorough pre-operative patient screening and co…
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Evidence-Based Medicine: Current Practices in Rhinoplasty.
[LEARNING OBJECTIVES] After studying this article, the participant should be able to: 1. Perform aesthetic and functional nasal analysis to guide septorhinoplasty. 2. Recognize common complications associated with rhinoplasty. 3. Select app…
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The Cartilage Warp Prevention Suture.
[BACKGROUND] Costal cartilage graft warping can challenge rhinoplasty surgeons and compromise outcomes. We propose a technique, the "warp control suture," for eliminating cartilage warp and examine outcomes in a pilot group. [METHODS] The …
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Fat Injection: A Systematic Review of Injection Volumes by Facial Subunit.
[BACKGROUND] Fat grafting to the aging face has become an integral component of esthetic surgery. However, the amount of fat to inject to each area of the face is not standardized and has been based mainly on the surgeon's experience. The p…
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Contact Cooling of Random-Pattern Cutaneous Flaps: Does it Increase Necrosis?
[BACKGROUND] Cooling after surgery reduces pain, swelling and ecchymosis. However, the fear of adverse effects of vasoconstriction caused by cooling may prevent its use when the skin is undermined extensively, for example, after rhytidectom…
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Effects of the Rhinoplasty Maneuvers on Upper Lip Position and Incisor Show.
[BACKGROUND] Smiling involves dynamic movements that include nasal tip descent and upper lip ascent. The effect of rhinoplasty on upper lip position is poorly described. [METHODS] One hundred charts were reviewed in reverse chronologic ord…