Design  Retrospective photographic analysis of 35 consecutive patients seeking functional or aesthetic nasal surgery regardless of cause.

Results  Nasal axis had a significant correlation with the alar-facial angle on base view photographs (P < .001) irrespective of cause (traumatic vs congenital). However, there was no significant correlation between alar facial angle on anteroposterior view (frontal) with nasal axis and no correlation between frontal and basal angles.

Conclusion  Soft-tissue analysis demonstrates a relationship between nasal axis deviation and lower midfacial asymmetry or hypoplasia.

Methods  A retrospective cohort analysis of vehicle occupants with facial fractures following a motor vehicle crash was performed using the population-based 1993-2005 National Automotive Sampling System Crashworthiness Data System database. Injury trends were analyzed by calendar year and vehicle model year. A multivariate analysis was performed on biomechanical, demographic, and safety restraint data, with the calculation of odds ratios (ORs) and 95% confidence intervals (CIs).

Results  The incidence of facial fractures was found to be decreasing (P < .01), along with a declining probability of injury with newer car models (P < .01). Seat belts with frontal air bag use were associated with a significantly decreased probability of facial fracture (OR, 0.14; 95% CI, 0.09-0.22). Air bags alone were not associated with a reduced probability of injury (OR, 0.78; 95% CI, 0.58-1.06). Side impacts (OR, 1.81; 95% CI, 1.14-2.86) and mismatch in the sizes of the crash vehicles (OR, 1.99; 95% CI, 1.27-3.12) were associated with increased risk of facial fractures.

Conclusions  The probability of facial fractures from motor vehicle collisions is decreasing. This finding may be due to design improvements implicitly related to vehicle model year. Restraint use continues to be important for injury prevention, while factors such as changes in vehicle fleet composition may alter injury trends.

Methods  Retrospective, single-institution case series.

Results  We describe 8 patients treated for extensive lesions in various parts of the head and neck reconstructed with free flaps. These malformations have a tendency to recur, which was the case in 75% of our patients (6 of 8) during a mean follow-up period of 5 years. Revision procedures are expected at a mean rate of 6.75 per person in our series.

Conclusions  Arteriovenous malformations are uncommon and challenging lesions. Use of FTT can ameliorate the large defects resulting from excision of these lesions.

Methods  Thirty-three patients underwent a thread-lift procedure alone or in combination with other facial rejuvenation procedures to the brow, midface, jowl, and neck. Ten patients underwent thread-lifts only, and 23 had thread-lifts with other procedures. Ten additional patients having had non–thread-lift rejuvenation procedures, including lipotransfer, chemical peels, and rhytidectomies, were randomly designated as controls. The mean follow-up period was 21 months (range, 12-31 months). Photodocumentation was obtained at each visit. Long-term aesthetic results were evaluated by 4 independent, blinded, and board-certified facial plastic surgeons. Each result was graded on a scale of 0 to 3, with 0 indicating no change; 1, minimal improvement; 2, moderate improvement; and 3, considerable improvement. The population was divided into 3 groups for comparison. Two-tailed t test (P = .05) was used for statistical analysis of aesthetic outcomes.

Results  Although aesthetic improvement was noted in all groups at 1 month, measurable results persisted to the end of the study for all but the group that underwent the thread-lift procedure only. Aesthetic improvement scores of the non–thread-lift control group were better than the group that underwent thread-lift only. Similarly, when the thread-lift was combined with other procedures, scores were better than when thread-lift was used alone. Statistical significance was demonstrated in both of these comparisons (P < .01).

Conclusions  The thread-lift provides only limited short-term improvement that may be largely attributed to postprocedural edema and inflammation. Our results objectively demonstrate the poor long-term sustainability of the thread-lift procedure. Given these findings, as well as the measurable risk of adverse events and patient discomfort, we cannot justify further use of this procedure for facial rejuvenation.

Methods  During a 28-month period, we independently completed 272 concurrent procedures in 95 patients aged 42 to 80 years in whom nitrogen plasma skin regeneration was performed immediately on completion of various aesthetic procedures, including brow-lift, blepharoplasty, lateral canthoplasty, midface-lift, rhytidectomy, cheek augmentation, lip vermillion advancement, filler injections, and augmentation mentoplasty. The treatment variables evaluated included nitrogen plasma pulse energy, pass number, and pulse count, and outcomes monitored included complications and subjective aesthetic improvement.

Results  The various treatment combinations were well tolerated at all anatomical sites. Rhytidectomy flap treatment included escalation of single-pass low-energy to high-energy nitrogen plasma treatment. Although perioperative complications did not otherwise negatively affect results, they included erythema with acneiform eruption (in 2 patients) and presumed herpes simplex virus infection, brief healing delay, and postinflammatory hyperpigmentation (in 1 patient each). In general, the treatment combinations were synergistic.

Conclusions  Combining nitrogen plasma skin regeneration with aesthetic facial surgery enhances outcomes for procedures in the forehead and in the periorbital, midface, and perioral regions. It does not seem to increase the risk of dermatologic or surgical complications for the procedures described herein.

Methods  A single permanent or absorbable suture is placed via an open or cartilage delivery approach. The suture is placed along the cephalic borders of the domes at the medial third of the lateral crura bilaterally just posterior to the junction of the intermediate and lateral crura as a final step in tip rhinoplasty.

Results  The domal stabilization suture provided a means to help maintain dome symmetry in the setting of variable healing and scarring forces with no complications and no effect on tip rotation or projection.

Conclusion  Use of the domal stabilization suture enables correction of subtle changes in mild tip asymmetry and irregularities in domal height and provides subtle narrowing of the interdomal distance.

Design  Frontal view photographs were used to measure bilateral symmetry ratios of the medial and lateral canthi, tragus, ala, and oral commissure in 100 patients before and 6 months after rhinoplasty. Gestalt dichotomous impressions of facial symmetry were also obtained in all cases. Paired t tests and ² tests were used to compare facial proportions and the proportion of faces perceived as symmetrical, respectively, before and after surgery. The receiver operating characteristic and analysis of variance were used to assess whether perceptual shifts in symmetry could be correlated with objectively measurable changes in facial proportion.

Results  The number of faces perceived as symmetrical increased from 42 to 62 after rhinoplasty (P < .001, ² test). Objectively, midline-to-ala symmetry increased from an average of 91.1% (5.5%) (mean [SD]) to 93.8% (4.5%) after rhinoplasty (P < .001, paired t test). Other facial proportions did not change significantly (P > .10). The degree of change in midline-to-ala symmetry was the only objective measure that was significantly associated with the subjective perception of the face as symmetrical or asymmetrical (P < .01, 1-way analysis of variance). Most positive perceptual shifts were associated with an objective improvement in nasal symmetry that was greater than 2%. Conversely, most negative perceptual shifts were associated with minimal postoperative improvement or loss of nasal symmetry.

Conclusion  Rhinoplasty leads to objectively measurable changes in nasal symmetry that correspond with psychophysical modifications in the perception of a face as symmetrical or asymmetrical.