Peter A. Adamson

Otoplasty : critical review of clinical results

Although it is generally believed that otoplasty provides uniformly gratifying results, thorough patient follow‐up reviews are quite rare. Otoplasty surgery performed on 119 ears was retrospectively reviewed to assess the results of our cartilage‐sparing technique. This method of otoplasty relies on a conchal set‐back and suture transfixion technique to improve the antihelical contour.

Open Rhinoplasty: An Assessment

The senior author (J.R.A.), having taught endonasal rhinoplasty for more than 25 years, felt obligated to evaluate so-called open rhinoplasty. His experience, and that of his coauthors, indicates that, on balance, this technique offers more advantages than disadvantages; in fact, there is no reason why it should not be used routinely if the surgeon desires. However, while open rhinoplasty permits the surgeon to approach the correction with more confidence, visualization of the structures of the nose does not, of itself, guarantee a good result.

Perceived Age Change After Aesthetic Facial Surgical Procedures: Quantifying Outcomes of Aging Face Surgery

OBJECTIVE To quantify the degree of perceived age change after aesthetic facial surgical procedures to provide an objective measure of surgical success. METHODS Sixty patients undergoing various aging face surgical procedures were randomly chosen for analysis. Preoperative and postoperative photographs were evaluated. Raters were presented with photographs in a random assortment and were asked to estimate the age of the patient. Perceived age difference was defined as the difference between the chronological age and the estimated age, and the change in this value after surgery was the chief outcome of interest. Statistical models were designed to account for any effects of interrater differences, preoperative chronological age, rater group, photograph order, or surgical procedure performed. RESULTS Our patient population was divided into the following 3 groups based on the surgical procedure performed: group 1 (face- and neck-lift [22 patients]), group 2 (face- and neck-lift and upper and lower blepharoplasty [17 patients]), and group 3 (face- and neck-lift, upper and lower blepharoplasty, and forehead-lift [21 patients]). Adjusted means demonstrated that patient ages were estimated to be 1.7 years younger than their chronological age before surgery and 8.9 years younger than their chronological age after surgery. The effect was less substantial for group 1 patients and was most dramatic for group 3 patients, who had undergone all 3 aging face surgical procedures. CONCLUSIONS Our study is novel in that it quantifies the degree of perceived age change after aging face surgical procedures and demonstrates a significant and consistent reduction in perceived age after aesthetic facial surgery. This effect is more substantial when the number of surgical procedures is increased, an effect unrelated to the preoperative age of a patient and unaffected by other variables that we investigated. The ability to perceive age correctly is accurate and consistent.

Augmentation, Enhancement, and Implantation Procedures for the Lips

Individual features of the face combine to capture the idealized image of youth and sensuality. In Western cultures, well-contoured lips contribute to this standard and are considered desirable attributes. In contrast, thin or drawn lips project a picture of aging and a severe countenance. In recent years, an increasing number of interventions have been introduced that seek to enhance lip fullness and shape. This article reviews the options available for lip augmentation with a focus on injectable and implantable materials.

Cephalic Positioning of the Lateral Crura: Implications for Nasal Tip-plasty

OBJECTIVE To apply a mathematical model to determine the relative effectiveness of various tip-plasty maneuvers while the lateral crura are in cephalic position compared with orthotopic position. METHODS A Matlab (MathWorks, Natick, Massachusetts) computer program, called the Tip-Plasty Simulator, was developed to model the medial and lateral crura of the tripod concept in order to estimate the change in projection, rotation, and nasal length yielded by changes in crural length. The following rhinoplasty techniques were modeled in the software program: columellar strut graft/tongue-in-groove, lateral crural steal, lateral crural overlay, medial/intermediate crural overlay, hinge release with alar strut graft, and lateral crural repositioning. RESULTS Using the Tip-Plasty Simulator, the directionality of the change in projection, rotation, and nasal length produced by the various tip-plasty maneuvers, as shown by our mathematical model, is largely the same as that expected and observed clinically. Notably, cephalically positioned lateral crura affected the results of the rhinoplasty maneuvers studied. CONCLUSIONS By demonstrating a difference in the magnitude of change resulting from various rhinoplasty maneuvers, the results of this study enhance the ability of the rhinoplasty surgeon to predict the effects of various tip-plasty maneuvers, given the variable range in alar cartilage orientation that he or she is likely to encounter.

The Nasal Hinge

It is generally agreed that rhinoplasty is the most challenging procedure performed by the facial plastic surgeon. Mastery of nasal tip maneuvers to alter tip projection, rotation, and lobule refinement is intrinsic to successful rhinoplasty technique. The nasal hinge region comprises the most lateral aspect of the lower lateral cartilage. Its importance is often overlooked. As the foundation of the nasal base, It plays a key role in tip dynamics and can be sculpted to significantly modify projection, rotation, and lobule refinement. One hundred randomly selected rhinoplasty patients were studied with respect to the indications for hinge maneuvers, techniques applied, and resulting affect on tip aesthetics. Clinical results are shown. The applicability of these hinge techniques is compared with other lateral crural techniques. The importance of the hinge region in rhinoplasty dynamics and the necessity of knowledgeably applying surgical maneuvers in this region are discussed.

Analysis of Alar Base Narrowing

* This paper was presented at the Canadian Society of Otolaryngology-Head and Neck Surgery meeting, June 1987, Ottawa, Ontario. t Department of Otolaryngology, University of Toronto, Toronto, Ontario, Canada A lar base narrowing is a useful ancillary technique in rhinoplasty. Although often deferred, it provides an additional element of refinement, which is particularly significant in patients with a wide alar base and in patients on whom significant retrodisplacement of the nasal tip has been accomplished. The aesthetic concepts to be considered and techniques of alar base narrowing, particularly as it pertains to location, shape and amount of excision, are discussed. We usually prefer excision of a segment of the nasal sill, complemented or not by a wedge excision of the lateral alar insertion. The benefit to be derived from the judicious use of this technique cannot be overlooked by the modem-day rhinoplasty surgeon.

Arguing the Ethics of Facial Transplantation

While 7 face transplants have been performed around the world, to date, there remains debate regarding the validity of this procedure. We submit that performing a facial transplant-in the appropriately selected patient-is technically defensible and ethically sound. By outlining the technical and ethical boundaries of the debate, responding to the key arguments against the procedure, and describing its motivations and potential benefits, we state our justification of facial transplantation.

Modern Concepts of Beauty

Since the beginning of humanity, man has sought to define beauty. Whether by philosophy, mathematical constructs, social studies, or biology, the fascination with and the study of beauty has consumed our emotions and intellect. Many myths about this powerful force in our daily lives have been created, and some continue to be believed. Recent studies are shaping a new reality of beauty, one founded on evolutionary and biologic findings that link our fascination with beauty to our reproductive success. Cosmetic surgery, itself, may be an ongoing part of our biologic adaptation. Curr Opin Otolaryngol Head Neck Surg 2003, 11:295–300

Alar Soft-Tissue Techniques in Rhinoplasty Algorithmic Approach, Quantifiable Guidelines, and Scar Outcomes From a Single Surgeon Experience

OBJECTIVES To describe various techniques, including alar base reduction, alar flaring reduction, and alar hooding reduction and present a decision-making treatment algorithm and quantifiable guidelines for soft-tissue excision, along with scar outcomes from a single-surgeon practice. The soft tissue of the nasal tip, ala, and nostrils is important in overall nasal tip dynamics. Excisional alar contouring is an essential part of many successful cosmetic rhinoplasty outcomes. METHODS The various soft-tissue excision techniques are described in detail and an algorithm is provided. Quantitative analysis of excision parameters was performed using statistical analysis. Finally, qualitative scar analysis was performed and scar outcomes were statistically derived. RESULTS Seventy-four patients were female and 26 were male. Of the procedures reviewed, 47% involved alar soft-tissue excision. Alar base reduction was performed in 46 patients (46%). Alar flare reduction was performed in 16 patients (16%). Alar hooding reduction was performed in 2 patients (2%). Mean scar outcome scores ranged from 0.55 to 0.69. CONCLUSIONS Alar soft-tissue techniques are often necessary to achieve a balanced outcome and superior results when performing rhinoplasty surgery. Therefore, they should be an integral part of every rhinoplasty evaluation and surgical plan as indicated.