As demand for aesthetic procedures continues to grow in the UK, alongside presentations of aesthetic-related complications, understanding current training provision and clinician preparedness is essential to inform educational curriculum development and regulatory policy. A cross-sectional online survey was conducted across UK medical schools and postgraduate medical education regions to evaluate UK medical students' and resident doctors' exposure to, knowledge of, and perceptions of aesthetic practice. A total of 2369 participants completed the survey (1757 students; 612 residents). Formal aesthetic teaching was uncommon: 10.9% of students (n = 191) and 10.5% of resident doctors (n = 64) received undergraduate teaching, and 11.9% of residents (n = 73) had postgraduate exposure. Self-reported knowledge scores ranged from 1.72 to 2.65/5 for surgical procedures and 2.32-2.99/5 for non-surgical procedures. However, 40.7% of residents (n = 249) had already managed at least one aesthetic complication, with 78.3% (n = 195) arising from procedures performed abroad. Career interest was substantial (38.2% overall), with participants identifying consent principles (4.08 ± 1.02) and procedure overview (4.00 ± 1.00) as priority curriculum additions. Social media was the most influential source shaping perceptions (residents 3.64 ± 1.17; students 3.51 ± 1.30), while formal education had minimal impact. Strong consensus emerged on regulatory needs: 86.4% of residents and 78.6% of students identified lack of regulation in the non-surgical sector as a significant concern, with 88.2% and 86.0% respectively supporting restriction of invasive non-surgical procedures to medically trained professionals. These findings provide an evidence base for developing structured aesthetic curricula and strengthening regulatory frameworks to better prepare clinicians for this expanding area of practice.
Cosmetic surgery refers to procedures aimed at changing and enhancing external body appearance. This study aims to investigate the correlation between the dark triad personality traits and the acceptance of cosmetic surgery among university students in the Kurdistan region of Iraq. This quantitative cross-sectional study was conducted between October and November 2024 using random sampling and self-report questionnaires. The dark triad and acceptance of cosmetic surgery were assessed by using the Dark Triad Dirty Dozen and the Acceptance of Cosmetic Surgery Scale, respectively. Data were analyzed using t tests, Pearson correlations, and multiple regressions in SPSS software. A sample of 1321 participants-984 females and 337 males-participated in the study. Descriptive statistics of gender differences revealed that narcissism, psychopathy, and Machiavellianism were significantly higher in males than females, whereas consider the sub-scale of acceptance of cosmetic surgery, which was higher in females. The correlational analysis illustrates that all variables are correlated regarding dark traits and acceptance of cosmetic surgery sub-scales. Narcissism was found to be the most predictable dark triad among applicants who seek cosmetic surgery. Individuals with high levels of narcissism are more likely to consider cosmetic surgery. Health professionals should be aware of the effects of the dark triad on cosmetic surgery decisions, and the study recommends further research. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 www.springer.com/00266 .
Reconstructive options for nasal dorsum defects are limited by poor skin laxity and high aesthetic demands. Few new techniques have been described in recent decades. To introduce and evaluate a novel reconstructive method-the bipedicled bridge flap|(BBF)-that combines the reliability of dual-pedicle vascularity with scar concealment along cosmetic subunit boundaries. Prospective single-center study of consecutive patients undergoing BBF reconstruction of nasal dorsum defects after Mohs micrographic surgery between June 2021 and June 2025. Defect characteristics, flap variants (unilateral, bilateral, horizontal, or with M-plasty), complications, and aesthetic outcomes using the Manchester Scar Scale (MSS) were recorded. High-quality digital photographs of all defects, repairs, and follow-up to at least 6 months were recorded. Forty-five patients underwent BBF reconstruction (4 bilateral, 4 horizontal). Mean defect size was 1.7 cm2 (range 0.3-4.3). No infections, necrosis, dehiscence, hematoma, or hypertrophic scarring occurred. Median MSS = 4, indicating excellent cosmetic results. The BBF is a novel, reliable, and versatile single-stage option for small-to-medium nasal dorsum defects, expanding current reconstructive algorithms by combining favorable vascularity with superior aesthetic concealment.Cutaneous malignancies of the nose are common and frequently require Mohs micrographic surgery to achieve complete excision. Reconstruction of the nasal dorsum after tumor removal remains one of the most technically and aesthetically demanding challenges in dermatologic surgery. The skin of the nasal dorsum is thin, tightly adherent, and deficient in redundancy, making primary closure difficult without distortion. Positioned at the center of a highly visible cosmetic subunit, even subtle discrepancies in contour, color, or texture can be conspicuous. Successful aesthetic repair, therefore, depends on restoring natural nasal contour, with matching skin texture and symmetry while confining scars within the boundaries of cosmetic subunits.
Tranexamic acid (TXA) has gained increasing popularity in plastic and reconstructive surgery for minimizing perioperative bleeding and improving postoperative outcomes. However, standardized guidelines on its use remain lacking. Methods: An anonymous international survey was distributed to over 400 plastic surgeons worldwide to evaluate current TXA usage patterns, including dosage, timing, route of administration as well as perceived efficacy and safety. Sixty-nine fully completed responses from 17 countries were analyzed. Overall, 86.9% of respondents reported TXA use, primarily to reduce blood loss and postoperative bruising. Intravenous administration was preferred by 55.9%, topical by 15.3%, and 28.8% used both. The most common intravenous dose was 10-14 mg/kg BW, usually given intraoperatively or within 30 min before incision. Topical TXA was typically applied during hemostasis or wound closure, most frequently undiluted (100 mg/mL) or in diluted solutions (10-50 mg/mL). Use was highest in aesthetic bodycontouring and breast procedures but remained low in microvascular and burn surgery. Almost all respondents (98%) reported no TXA-related complications. No thromboembolic or neurological adverse events occurred. TXA is widely and safely implemented in plastic surgery, particularly in aesthetic procedures, but substantial heterogeneity exists regarding dosage, timing, and route of application. These findings underscore the need for procedure-specific, evidence-based protocols and prospective multicenter trials to standardize TXA use in plastic and reconstructive surgery.
Nasal septal deviation is a common cause of nasal obstruction, and septorhinoplasty addresses both functional and aesthetic concerns. The role of endoscopic assistance in closed septorhinoplasty remains incompletely characterized. To compare conventional closed and endoscopic-assisted septorhinoplasty regarding functional and aesthetic outcomes, postoperative morbidity, and operative time. This prospective, randomized, single-blinded clinical trial included 50 patients randomized to conventional closed (group A) or endoscopic-assisted septorhinoplasty (group B). Outcomes included Nasal Obstruction Symptom Evaluation (NOSE) scores, FACE-Q Rhinoplasty Module, operative time, and postoperative morbidity (edema, ecchymosis, pain). Operative time was longer in group B (116.68 ± 7.02 vs. 90.96 ± 7.07 min; p < 0.001). Group B showed significantly greater NOSE score improvement at 1 and 6 months (p < 0.001). Aesthetic satisfaction was higher in group B at 1 month (p < 0.001) but comparable at 6 months. Postoperative edema, ecchymosis, and day-7 pain scores were significantly lower in group B (p < 0.05). Endoscopic-assisted septorhinoplasty offers superior early functional outcomes and reduced postoperative morbidity despite longer operative time, with comparable long-term aesthetic results. These findings support endoscopic assistance as a valuable adjunct for enhancing surgical precision and early recovery in septorhinoplasty.
Telemedicine revolutionized healthcare post-COVID-19 by expanding virtual care across consultations, post-operative care, and inter-physician collaboration. However, its impact on adoption and effectiveness in plastic surgery remains underexplored. This study systematically compares pre- and post-pandemic telemedicine in plastic surgery, focusing on outcomes, accessibility, and patient satisfaction to inform best practices. A systematic review was conducted using PubMed, Medline, and Web of Science, following PRISMA guidelines, for articles published through November 2024. Extracted data included author, year, country, subspecialty, pandemic classification, sample size, demographics, utilization, barriers, travel time/distance, satisfaction, complications, and appointment duration. Meta-analyses calculated pooled estimates with 95% confidence intervals. Meta-regression and Welch's t-test assessed pre- versus post-pandemic differences. Analyses were performed in R 4.4.1. Of 450 identified publications, 72 met inclusion criteria, encompassing 9435 subjects (mean age: 47.99). 89.3% (95% CI 59.3-96.2%) of patients reported willingness to reuse telemedicine, and the pooled satisfaction rate was 83.9% (95% CI 79.4-88.5; p < 0.05). Meta-analysis showed significant reductions in travel time (120 min; p < 0.05) and distance (187.1 km; p < 0.05). Five studies reported a mean appointment duration of 16.07 min. Complications were rare (7.7%; 95% CI 2.9-18.6%; p < 0.05). Post-pandemic satisfaction score was lower (81.1 vs. 91.2; p = 0.0315), likely reflecting increased utilization and technological barriers. Other outcomes, including complication rates and willingness to reuse telemedicine, showed no significant difference (p > 0.05). Telemedicine plays an evolving role in plastic surgery, reducing travel burden and maintaining safety. However, lower post-pandemic satisfaction highlights the need to improve accessibility and technology to optimize outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Facelift surgery is increasingly performed in older adults, yet data on age-stratified risk remain limited. This study updates a prior 2011 single-surgeon series and evaluates whether advancing age, including age greater than 75 years, is associated with complications after facelift surgery. We retrospectively reviewed 10 years of consecutive primary or secondary facelifts by a single surgeon using extended SMAS or SMAS plication. Demographics, comorbidities, and operative details were recorded. Complications were classified as major (unplanned admission, reoperation, persistent motor nerve injury) or minor (outpatient-managed). Age was analyzed in five strata (less than 60, 60-65, 66-70, 71-75, and 76 or older) and at dichotomous cutoffs (66 years or greater, 71 years or greater, 76 years or greater). Multivariable logistic regression evaluated age-complication associations. 541 patients underwent facelift: less than 60 years (28%), 60-65 (24%), 66-70 (24%), 71-75 (17%), and 76 or older (7%). Major complications were rare (0.4%) and did not differ by age (p=0.08). Minor complications occurred in 7.6% of patients and were not associated with age on univariate (p=0.4) or multivariable analysis. On subanalysis, age was not associated with any complication (major or minor) after adjustment, including among patients older than 75 (OR 1.82 [0.51-5.19], p=0.3). In this single-surgeon cohort with strict preoperative screening and standardized management, facelift surgery remained safe across all age groups, including age greater than 75 years. Chronological age alone is therefore not an independent predictor of adverse events after rhytidectomy.
Dorsal preservation rhinoplasty aims to maintain the native dorsal roof while achieving aesthetic and functional goals comparable to structural dorsal hump reduction. This systematic review evaluates comparative outcomes, patient-reported measures, and complication patterns across techniques. A systematic search of PubMed, Embase, Scopus, Web of Science, and Cochrane CENTRAL was performed from inception to November 1, 2025. Eligible studies included randomized trials, comparative cohorts, and case series with ≥ 10 patients and ≥ 6 months of follow-up. Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2 and ROBINS-I. Outcomes included validated PROs, objective airway metrics, aesthetic assessments, and complications. From 487 records identified, 20 studies met inclusion criteria. Across randomized and nonrandomized comparative studies, dorsal preservation demonstrated aesthetic and functional results equivalent to structural dorsal hump reduction at 6-12 months. Patient-reported improvement (ROE, NOSE, SCHNOS) was consistently favorable in both groups. The only comparative objective airway study showed no significant differences in cross-sectional area or nasal volume. Complication and revision rates were low overall, with pooled recurrence and revision typically between 2-4%. Current evidence indicates that dorsal preservation rhinoplasty provides outcomes comparable to structural reduction in appropriately selected patients. Standardized reporting and more objective physiologic evaluations are needed.
The femme fatale has traditionally been examined as a visual archetype characterized by beauty intertwined with danger. Previous craniofacial analyses of Western portraiture demonstrated that depictions of femme fatales emphasize gaze intensity, orbital shadow, and structural contour rather than soft symmetry or luminosity. However, Western culture encodes archetypes not only visually but also acoustically. In 19th-century opera, central seductive and destructive female figures-such as Carmen, Dalila, and Amneris-are frequently written for mezzo-soprano rather than soprano. The mezzo-soprano voice is characterized by lower tessitura, greater chest resonance, and reduced overtone brilliance, producing a timbre perceived as mature, grounded, and authoritative. This editorial proposes that the femme fatale is consistently encoded across visual and acoustic domains through sensory depth rather than brightness. Chiaroscuro modeling in portraiture and timbral density in opera represent parallel strategies of archetypal construction. Recognizing such cross-modal structural patterns may broaden the scope of aesthetic medicine beyond brightness-centered youthfulness toward a more nuanced understanding of contour, maturity, and cultural symbolism. Beauty may be associated with luminosity, but power often resides in depth.
The optimal timing for surgical intervention in single-suture craniosynostosis (SSC) remains debated, despite advances in minimally invasive and open reconstructive approaches. This work integrates Children's National Medical Center (CNMC) institutional data with current literature to clarify age-related outcomes and guide timing recommendations. Published series from CMNC were analyzed and outcomes included perioperative morbidity, morphometric correction, intracranial pressure, and revision rates. Findings were contextualized with recent systematic reviews and multicenter data. Early endoscopic repair (≤ 4 months) yielded superior morphometric gains, lower blood loss, and shorter hospital stays. O'Brien et al. demonstrated a 2-4-month "sweet spot" for sagittal synostosis1, while Lajthia et al. confirmed excellent outcomes for metopic deformities in the same age range2. Open reconstruction at 9-12 months achieved durable aesthetic correction with low complication rates3. Delayed presentations were associated with elevated intracranial pressure but benefited from surgical decompression4. Meta-analyses corroborate these trends. CNMC's experience and global evidence converge on an early-infancy window (2-4 months) as optimal for endoscopic repair. Open cranial vault reconstruction remains effective for older infants or complex anatomy. Surgical timing should balance biological potential, institutional resources, and neurodevelopmental opportunity.
Crown lengthening serves as a key procedure for addressing aesthetic concerns such as gummy smile, short clinical crowns, and uneven gingival contours. Advances in digital technology, particularly computer-aided design and computer-aided manufacturing (CAD/CAM), now allow precise translation of preoperative plans into surgical execution, enabling accurate control over gingival margin and alveolar ridge positioning. To standardize the clinical application of this technology, the Chinese Society of Digital Dental Industry (CSDDI) convened a panel of experts to develop this guideline document. It aims to define steps for digital data acquisition, integration, and design in guided crown lengthening within the aesthetic zone; standardize the digital workflow for designing surgical guides for aesthetic crown lengthening; assist clinicians in formulating appropriate digital surgical plans through thorough digital analysis and diagnosis; and offer practical guidance on performing crown lengthening surgery using digital guides in aesthetic areas. Ultimately, this guideline seeks to standardize the surgical protocol for digital guide assisted crown lengthening, thereby improving procedural accuracy and predictability of treatment outcomes. 牙冠延长术常用于改善露龈笑、临床牙冠短等口腔美学缺陷及相关功能问题，其美学效果取决于对软硬组织切除位置、形态和量的精确控制。随着数字化技术的发展，计算机辅助设计与辅助制作技术可通过导板将术前规划准确转移至手术中，从而精确引导龈缘与牙槽嵴位置。为规范该技术的临床应用，全国卫生产业企业管理协会数字化口腔产业分会（CSDDI）组织专家制订本指南，旨在建立明确的导板引导下前牙美学区牙冠延长术的数字化资料采集、整合与设计步骤，规范前牙美学区牙冠延长手术导板的数字化设计流程；指导临床医师在临床工作中通过全面的数字化分析和诊断，为前牙美学区制订适宜的牙冠延长术数字化手术方案；对临床医师应用数字化手术导板进行前牙美学区牙冠延长术操作给予指导，规范数字化手术导板的操作流程，提升治疗精准性和结果的可预期性。.
Pulmonary fat embolism (PFE) is a serious complication of liposuction surgery, characterized by atypical clinical presentation and considerable diagnostic difficulty. Morphological examination of Bronchoalveolar Lavage Fluid (BALF) can provide critical evidence for diagnosis. This article reports a rare delayed-onset case, highlighting the diagnostic value of this examination and the importance of risk prevention and management in plastic surgery. A 25-year-old female was admitted with a 4-day history of chest tightness, which worsened after eating and at night. The patient had undergone liposuction surgery half a month prior. Laboratory findings revealed elevated D-dimer levels and decreased total protein and albumin. Chest Computed Tomography (CT) suggested chronic inflammation with fibroproliferative changes in the left lower lobe. Bronchiectasis was initially diagnosed; however, anti-infective therapy was ineffective. Microscopic examination of BALF revealed fat droplets and macrophages phagocytosing fat particles, with positive Sudan III staining. In conjunction with contrast-enhanced pulmonary CTA, the patient was ultimately diagnosed with pulmonary fat embolism secondary to liposuction. After receiving symptomatic and supportive treatment, the patient's symptoms resolved, and she was discharged. This case indicates that pulmonary fat embolism following liposuction is prone to being misdiagnosed. BALF morphological examination can effectively assist in early diagnosis and gain valuable time for treatment. Meanwhile, this case also reminds us of the significance of risk assessment in aesthetic and plastic surgery. Clinicians should remain vigilant regarding atypical postoperative symptoms to prevent missed diagnoses and misdiagnoses.
Free nipple-areola grafting (FNAG) is the most common approach for nipple-areola complex (NAC) reconstruction in transgender patients and is often performed in conjunction with double incision mastectomy for chest masculinization. Unwanted consequences of FNAG include graft failure, hypopigmentation as well as circular scarring around the areola. We developed a novel technique for NAC reconstruction using nipple punch grafts in conjunction with 3D areola tattooing (NPAT). Patient demographics and postoperative complications were reviewed. To compare aesthetic outcomes of NPAT with FNAG, postoperative images of both groups were distributed among public raters using the crowdsourcing platform Amazon MTurk. Raters were asked to rank the aesthetic appearance of each NAC on a 1-7 Likert scale. Eighteen patients (mean age 30 ± 10.74, mean BMI 27 ± 7.36) underwent double incision mastectomy together with NPAT for NAC reconstruction. Mean follow-up was 100 days after surgery. Postoperative complications such as graft loss, partial graft necrosis, hypertrophic/distended scarring were not observed. One patient demonstrated a loss of graft projection, and one patient developed partial graft depigmentation. Across the full sample of 895 public raters, NPAT received significantly higher aesthetic ratings than FNAG (NPAT 5.0 ± 1.5 vs FNAG 4.5 ± 1.8, p < 0.001), a pattern that persisted across different genders and age groups. The NPAT technique is a simple and effective approach to NAC reconstruction in transgender patients, combining the advantages of traditional FNAG and 3D tattooing. Our findings suggest that NPAT may provide an aesthetically superior NAC and potentially reduce complications associated with traditional FNAG.
Patients who undergo auricular reconstruction have a high risk of developing keloids. The traditional incision designs for keloid excision may appear inadequate to accommodate the biomechanical characteristics of different subunits of reconstructed ears. A retrospective cohort of 86 patients (90 ears) with auricular keloids post-reconstruction from January 2020 to January 2024 underwent the keloid core removal surgery. We designed different incisions based on specific sites: earlobe, helix, crus of helix, and others. 24-48 h after surgery, all participants underwent superficial low-dose radiotherapy (3 Gy/session × 4). At the average 18.6 follow-up, the treatment protocol achieved a reduced recurrence rate of 6.7% compared to tradition treatments, with patient satisfaction as 92.2%. The Vancouver Scar Scale (VSS) score demonstrated marked improvement compared with that of pre-operation (p < 0.05). Site-specific incision designs combined with immediate postoperative radiotherapy effectively reduced the reconstructed ear keloids' recurrence rate. This approach achieved optimal functional and aesthetic outcomes in keloids on congenital microtia reconstructed auricles. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Cleft lip and palate are frequently associated with disturbances in maxillary growth, and many patients require orthognathic surgery at skeletal maturity. This study aimed to characterize baseline craniofacial morphology and determine factors influencing the magnitude of planned orthognathic surgical movements in a Singaporean cleft cohort managed using virtual surgical planning (VSP). A retrospective cohort study was conducted, including non-syndromic cleft patients who underwent orthognathic surgery between 2020 and 2025 at a tertiary cleft center in Singapore. All procedures were planned using VSP and performed with customized cutting guides and fixation plates. Demographic variables, preoperative cephalometric parameters (SNA, SNB), and planned skeletal and dental movements were extracted from surgical planning records. Forty-four patients were included (20 males, 24 females). The median age at surgery was 20.24 years (IQR 19.67-22.46). Male patients underwent surgery at a significantly older age than females (22.21 versus 19.87 y, P < 0.001) and demonstrated greater baseline maxillary retrusion (median SNA 73.05 degrees versus 77.50 degrees, P = 0.007). Planned maxillary advancement was significantly greater in males for both A-point (8.18 ± 2.19 mm versus 5.88 ± 2.05 mm; P < 0.001) and maxillary incisor tip movement (7.55 ± 1.94 mm versus 5.25 ± 2.24 mm, P < 0.001). SNB differed significantly across cleft subtypes (P = 0.005), although the magnitude of planned surgical movements did not differ significantly between cleft phenotypes. These findings suggest that while sex and cleft phenotype influence baseline craniofacial morphology, planned orthognathic surgical movements remain broadly comparable across cleft subtypes within contemporary VSP workflows.
Midline diastema is an unpleasant condition that affects a patient's smile and causes significant aesthetic concerns. Treating diastema and achieving the desired aesthetics, function, and harmony can be challenging without invasive treatment. This case report demonstrates a minimally invasive approach to closing a lower midline diastema. A 38-year-old female patient presented to the dental clinic at King Khalid University with the primary complaint of a "large space in the lower front tooth region." Her medical history indicated no significant health concerns. The patient was diagnosed with localized periodontitis, stage III, grade B. She presented with a Miller class III gingival recession at the lower central incisors, an aberrant frenum, a decreased width of keratinized gingiva, and a midline diastema of 6 mm. A free gingival graft is used to increase the width of the keratinized gingiva, followed by the placement of a zirconia resin-bonded bridge to close the space. The treatment yielded a satisfactory outcome, as evidenced by an increase in the width of keratinized gingiva from 1 mm at baseline to 5 mm at 4 months and a gain of 1 to 2 mm in clinical attachment level. Two months following surgery, complete closure of a 6-mm lower midline diastema was successfully achieved using a zirconia resin-bonded bridge. The use of a free gingival graft effectively increases the width of the keratinized gingiva. A resin-bonded bridge offers satisfactory aesthetics and functionality, providing a conservative treatment that makes it a favorable option for closing lower midline diastema compared with more invasive and time-consuming procedures, such as bone grafting or orthodontic treatment.
To compare early and long-term patient-reported outcomes following dorsal preservation rhinoplasty (DPR) versus conventional hump reduction (CHR) in patients undergoing primary nasal dorsal reduction. We conducted a retrospective cohort study of 377 patients who underwent DPR (n = 178) or CHR (n = 199) between 2017-2024. Outcomes were assessed using the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) and visual analog scale (VAS) scores at baseline and at 3, 6, 12, and 24 months postoperatively. Multivariate linear regression adjusted for age, sex, and baseline symptom severity. In unadjusted analyses, DPR was associated with lower SCHNOS-C scores and higher VAS-C scores at 3 and 6 months postoperatively compared with CHR, although the absolute differences were modest. After multivariable adjustment, DPR was independently associated with improved SCHNOS-C scores at 6 months, but not at 3 months. No significant differences in aesthetic outcomes were observed at 12 or 24 months. Functional outcomes were similar between groups across all time points. Patients who underwent CHR more frequently underwent midvault reconstruction with spreader grafts or autospreaders, anterior septal reconstruction (ASR), and clocking sutures, whereas DPR patients frequently underwent supratip, radix, and underlay articulated rim grafting. DPR was associated with modest, early improvements in patient-reported aesthetic outcomes that reached statistical significance at 6 months after adjustment, with convergence of aesthetic and functional outcomes thereafter. These findings are associative rather than causal and emphasize the importance of patient selection and underlying nasal anatomy in guiding surgical technique.Level of Evidence: 3.
The thin labial alveolar wall (LAW) of anterior maxillary teeth is prone to resorption after flap surgery, jeopardizing aesthetic outcomes. This study evaluated whether extended guided bone regeneration (GBR) to cover the LAW of adjacent teeth mitigates this bone loss. In this retrospective cohort study, we categorized adjacent teeth into three groups according to the intraoperative extension of the graft relative to the LAW: Non-Extended GBR (NE-GBR; graft confined to edentulous site), Partially Extended GBR (PE-GBR; graft on partial BBW), and Fully Extended GBR (FE-GBR; graft covering BBW to the crest). Horizontal LAW thickness and vertical distance from cementoenamel junction to the alveolar crest were measured on superimposed pre-operative and 6-month post-operative CBCT scans. Analysis included 135 adjacent teeth (80 patients). Significant horizontal resorption occurred in the NE-GBR (- 0.40 ± 0.32 mm) and PE-GBR (- 0.43 ± 0.44 mm) groups (p < 0.001), while the FE-GBR group maintained stable dimensions (0.15 ± 0.75 mm, p = 0.523). Vertically, the FE-GBR group showed a significant dimensional gain (0.43 ± 1.10 mm, p < 0.001), unlike the resorption seen in other groups. Mixed-effects models confirmed FE-GBR as a significant positive predictor for both horizontal (β = 0.48, p < 0.001) and vertical (β = 0.48, p = 0.001) dimensional preservation. Fully extended GBR to cover the LAW up to the crest appears to counteract post-surgical reduction, better preserving radiographic alveolar ridge dimensions in the aesthetic zone over a 6-month period. This study protocol was approved by the Institutional Review Board (LCYJ20250303005) and was registered in the Chinese Clinical Trial Registry (ChiCTR2500099603).
The nasal tip plays a central role in facial aesthetics, and achieving long-term tip stability is a key objective in rhinoplasty. This study compared postoperative tip stability between structural rhinoplasty using a strut graft (SG) and preservation rhinoplasty with an underlay Pitanguy ligament graft (PLG). Eighty-six primary rhinoplasty candidates were enrolled and divided into two groups of 43. One group received structural rhinoplasty with strut graft, while the other underwent preservation rhinoplasty with an underlay PLG. Nasal tip rotation and projection were measured using 3D soft tissue scans before surgery and at 3, 6, and 9 months postoperatively. Time significantly affected tip projection (P = 0.001) with both groups showing a downward trend, but no significant differences were observed between techniques at 3, 6, or 9 months (P > 0.05). Tip rotation showed a similar pattern; no significant differences between techniques at any time point. Repeated measures ANOVA confirmed a significant effect of time on rotation (P = 0.001) without a significant time-by-group interaction (P = 0.285). Both structural rhinoplasty with SG and preservation rhinoplasty with underlay PLG yield similar outcomes in maintaining tip projection and rotation over 9 months. Time-dependent reductions were observed, but no statistically significant differences existed between techniques. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .