In the last few years, the Deep Plane Face Lift (DPFL) has gained great popularity among plastic surgeons, even if its origins are traced back to the 1970s. Certainly, it could have some advantages but based on our experience, it can reveal some unpleasant features in the long term. For this reason, the senior authors have adopted the high superficial musculoaponeurotic system (SMAS) Face Lift for many years in their surgical practice.The goal of our study is to analyze the DPFL critical aspects in the long term and show how the High SMAS Face Lift (HSFL) technique can help to improve them.

Frontal view morphing is needed for better preoperative consultation and simulation process in rhinoplasty. Restoration of the correct light-shadow interactions in rhinoplasty demands a firm appreciation of the underlying nasal structures. Chiaroscuro is a painting technique of dark and light contrasts that can be utilized in the morphing process, enabling the surgeon to explain possible results. Patients undergoing surgery in 2019. Encounters were divided into three. First visit: history taking, a list of desires and physical examination, photography. Second visit: photo analysis was presented as well as the hypothesis of correction expressed by morphing (morphing with Adobe Photoshop software). We termed the differences between light and shade of the lateral nasal walls, the dorsum and the brow dome line and nose cheek line as the "Chiaroscuro of the nose." This term is significant in the process of morphing of the frontal view. We used this method of morphing in the simulation process of 126 patients. The age range was 15 to 59 years old. A total of 67% (84) were females and 33% (42) were males. A total of 43% (54) of the cases were revision cases. At the postoperative visits, all patients were more satisfied with their operative result than with their "morphed" simulation. The chiaroscuro concept of the nose is an essential step in the analysis and morphing processes of the frontal view, and a logical tool in creating a realistic surgical game plan. The morphing of the frontal view enables the surgeon and patients to discuss the possible result with more details and refinements. Morphing may be a good option to educate young surgeons in both preoperative consultation and at the operating theater.

Optimal results in complex nasal reconstruction, particularly in the context of post-traumatic and revision septorhinoplasty, often require the use of cartilage grafts to provide additional structural support to the nose. While autologous costal cartilage (ACC) has been traditionally used, this can be limited by donor site morbidity, increased operative time, and in some cases, lack of suitable cartilage for grafting. There has been a trend towards using irradiated homologous costal cartilage (IHCC) as an alternative source of graft material. We review our departmental experience of using IHCC in functional septorhinoplasty surgery. We performed a retrospective review of electronic medical records of all patients who underwent septorhinoplasty using IHCC at a tertiary referral center between May 1, 2022, and April 30, 2024. Demographic data, surgical details, and postoperative outcomes, including rates of infection, resorption, warping, and revision were recorded and analyzed. Fifty-seven patients (34 males, 23 females) with a mean age of 41.0 years (range: 18-65 years) were included. Forty-one were revision septorhinoplasty operations, while 16 were primary cases. Almost all were performed via an open approach (98.2%). Three patients developed postoperative infection (5.3%) while one developed columellar dehiscence needing further revision surgery (1.8%). Functional and aesthetic results were otherwise satisfactory in all patients. We observed no cases of warping, resorption, or extrusion. The median length of follow-up was 279 days (interquartile range: 171-527 days). We present the largest United Kingdom series to date on the use of IHCC in septorhinoplasty surgery. Our findings support its use as a safe and effective graft material and a viable alternative to autologous sources, offering the benefits of a robust reconstructive material and shortened operative time, without the risk of donor site complications. A longer follow-up period is ideally required to evaluate its long-term structural stability.

Exosomes have emerged as a promising therapeutic frontier in facial plastic surgery. Preclinical studies have demonstrated their ability to modulate wound healing, skin rejuvenation, hair growth, and nerve regeneration. Early clinical evidence suggests potential benefits in enhancing recovery after laser resurfacing, treating acne scars, and promoting hair growth. Despite their potential, there are currently no exosome products that are FDA-approved for medical use, and they should be considered experimental until receiving regulatory approval and robust clinical validation. As research advances, exosomes may offer valuable tools for facial plastic surgeons to improve patient outcomes and expand regenerative medicine applications in facial aesthetics and reconstruction.

Cephalic trimming of the lower lateral cartilage (LLC) can result in the collapse of the internal and external nasal valves, pinched nose, and alar retraction. The cephalic lateral crural advancement flap (CLCAF) technique is introduced as a method to prevent these complications by avoiding grafts in the LLC. A retrospective study was conducted on 126 open-approach rhinoplasties (82 female and 44 male) employing the CLCAF technique between January 2021 and March 2022. Preoperatively, 20 patients exhibited collapse of the internal nasal valve. CLCAF was performed in all patients following cephalic incision, leaving 7 to 8 mm horizontally and caudally of LLC, and preserving the scroll ligament. The CLCAF was advanced onto the lateral crura to reinforce it and tension the scroll ligament. The Nasal Obstruction Symptom Evaluation (NOSE) scale was used to assess the technique. The average postoperative follow-up period was 14 months. Overall, 114 patients (90.5%) experienced improved nasal breathing on the NOSE scale, and the overall NOSE score significantly decreased from a mean of 30.4 to 14.0 ( < 0.001). A statistically significant reduction in NOSE scores was observed in groups with moderate, severe, and extreme obstruction ( < 0.001), with greater improvement seen in the patients with more severe preoperative nasal breathing obstruction. Postintervention, no patient exhibited collapse of the internal valve, and all patients with preoperative collapse of the internal nasal valve showed an increase of at least 40 points in the NOSE scale. Two patients required revision due to tip asymmetry related to CLCAF. Pinched nose or alar retraction was not observed postoperatively in any patient. The implementation of CLCAF, combined with other techniques, enhances nasal breathing function, prevents the collapse of the internal nasal valve, and leads to optimal nasal tip definition, resulting in a better-shaped and functioning nose.

Prominent ears, also known as prominauris, inflict psychological distress and suffering on both children and adults. Otoplasty has become one of the most common aesthetic operations due to its high prevalence and significant impact on patients. Various surgical techniques for otoplasty have been documented and developed over time. While complications are rare, open and cartilage-resection techniques may result in hemorrhage, hematomas, contour deformities, hypertrophic scarring, and keloid formation. Incisionless otoplasty has been demonstrated in the literature to be an effective method, when correctly indicated, to correct prominauris with a shorter recovery time and reduced morbidity. A thorough preoperative evaluation, awareness of the different techniques, and assessment of their appropriate application minimize potential risks and unpleasant results.

Prominent ear deformities often result from a combination of hypertrophic conchal cartilage and an underdeveloped antihelical fold. Traditional otoplasty techniques, such as antihelical folding sutures and conchal setback maneuvers, may introduce tension and risk of relapse, leading to suboptimal aesthetic outcomes. The PILLARS CONCEPT: represents an alternative surgical approach specifically designed to address hypertrophic concha, ensuring stable and natural results.This study aimed to present the Pillars Concept as an alternative method for correcting hypertrophic conchal cartilage, highlighting its advantages over traditional techniques, and evaluating its effectiveness in maintaining long-term stability of the ear's position without relapse.A retrospective analysis was conducted on 89 patients who underwent otoplasty utilizing the Pillars Concept. The technique involves selective transection of two supporting pillars located in the superior and inferior conchal regions after partial resection of the hypertrophic concha. This releases the conchal cartilage and enables tension-free repositioning of the auricular framework.Of the 89 cases, no hypertrophic concha recurrences were noted during follow-up periods. Complications were minimal, with only two patients (2.2%) experiencing a sensation of "glued ears" following complete conchal resection. Retroauricular fullness was observed in two cases (2.2%) after conchal setback, primarily due to inadequate management of the residual cartilage length. Patient satisfaction was high, and the natural aesthetic of the auricle was consistently preserved.The Pillars Concept provides a reliable, tension-free method for addressing hypertrophic conchal cartilage in otoplasty, preserving the natural ear anatomy and ensuring long-term stability without the risk of relapse. This technique should be considered a valuable addition to the armamentarium of otoplasty procedures.

The surgical management of the periocular region in facial palsy is a critical aspect of addressing the ocular morbidity associated with facial paralysis. The reconstruction around the eye in facial palsy should take into account the duration of the facial palsy and underlying ocular pathologies. Exposure keratopathy can develop secondary to lagophthalmos, ectropion, and brow ptosis. Clinicians should optimize the function of the eye with medical treatments in the first instance and where required adjunctive static or dynamic surgical therapy. The cosmesis of the periocular region should also be taken into consideration when surgical reconstruction is being planned. This manuscript aims to provide a review of surgical solutions for patients with chronic eye manifestations of facial palsy.

The quest to achieve younger and media-driven facial aesthetics has resulted in an exponential increase in the use of facial fillers. Inevitably, this has meant that it is now commonplace for facial plastic surgeons to have patients with fillers in the face. In the senior author's experience (A.R.D.), it was observed that patients with facial fillers experienced persistent edema post-rhinoplasty. It was, therefore, hypothesized that this prolonged edema may be related to fillers affecting the lymphatic drainage impacting postoperative edema following facial surgery.This article aims to gather evidence from wider literature to support the hypothesis that fillers do indeed compromise lymphatic drainage. A narrative literature review was performed using selective articles on fillers and post-rhinoplasty edema. A methodological analysis was then followed to develop a standard theory characterized through the discussion.It is theorized that due to their hydrophilic characteristics, hardness, volume, and backflow phenomena, hyaluronic acid fillers can lead to prolonged edema. In addition, they can either directly block or indirectly exert pressure on the lymphatic pathways and hinder drainage.The research findings support the hypothesis that facial fillers impact postoperative facial edema. Further research is required to objectively measure the effect of fillers on facial lymphatic drainage.The level of evidence is IV.

The correction of prominent ears is a rewarding operation. When choosing a surgical technique, we prefer a cartilage-sparing technique to a cartilage-splitting technique to achieve natural-looking long-term results. In this article, we present our preferred technique of an anterior scoring technique combined with concha-mastoid sutures step by step.

The aim of this study was to translate, validate, and culturally adapt the original English version of the Expectations of Aesthetic Rhinoplasty Scale (EARS) into Turkish for use in Turkish-speaking communities. Fifty-one patients who wanted to undergo primary rhinoplasty and were literate in Turkish were included in the study. The control group consisted of 81 healthy volunteers who did not require rhinoplasty. A Turkish version of the EARS (EARS-T) was created. The participants completed the EARS-T questionnaire twice, 4-week apart. The internal consistency of the scale (Cronbach's α), the test-retest reliability (intraclass correlation coefficient [ICC]), and differences between the patient and control groups (Pearson's chi-square test) were analyzed. A statistically significant difference was found between the age and gender of the patient and control groups ( = 0.001 and 0.001, respectively). Univariate analysis showed that this significant difference did not affect the study results (age:  = 0.2; gender:  = 0.12). In addition, a statistically significant difference was found between the scale scores of the control and rhinoplasty groups (all  < 0.05). The EARS-T had good internal consistency, with high Cronbach's α scores ranging between 0.74 and 0.87. Test-retest reliability was demonstrated by high ICC scores ranging from 0.71 to 0.87. Our study revealed that the EARS-T has good internal consistency, reliability, and validity. Therefore, it can be used to assess the expectations of aesthetic rhinoplasty patients in preoperative consultation practice and in clinical studies related to rhinoplasty.

Lop ear deformity is the most common head and neck congenital malformation with an estimated incidence of 5% among newborns. Otoplasty is the surgical procedure designed for its correction. More than 200 surgical techniques have been described so far to treat this condition, most of them including a cartilage weakening maneuver to avoid the relapse of the original auricle shape a few months after surgery. Classic techniques, such as like Mustarde's, describe this maneuver through scoring the posterior side of the cartilage and stabilizing the new shape with sutures. Cartilage biomechanical properties work against posterior scoring since cartilage folding occurs in the contralateral side of the scoring. This critical point may explain the high rates of relapse in the posterior scoring otoplasty techniques. In this paper, we present our surgical otoplasty technique with anterior scoring and we discuss specific tips and its nuances. We believe that the anterior scoring otoplasty technique achieves natural ears with both low complication rates and significant reduced long-term relapses.

Pterygium colli or webbed neck is a congenital deformity mainly found in Turner syndrome. It appears as a bilateral triangular fold extending from the mastoid to the acromion with hairy skin abnormality. Structural variation of the fold, as described by Mehri Turki's webbed neck classification, implies appropriate surgical repair. Despite the availability of a range of surgical techniques, it remains difficult to choose the most suitable one. Thus, this report aims to compare the lateral approach techniques by selecting those providing the best results. A literature search using PubMed and Google Scholar Database identified lateral approach techniques for pterygium colli. A critical reading led us to select criteria for comparison, linked to procedures and results. Moreover, according to aesthetic results, surgical techniques were classified into three categories. A total 16 articles were published from 1937 to 2020 and enrolling 48 patients were selected. The neck contour was obtained with all procedures. However, scars were hidden at the posterior neck in only 10 reports. Otherwise, the posterior hairline was corrected in only 6 reports. According to these outcomes, a classification of surgical technique was made allowing their pragmatic assessment. An objective assessment of lateral approach techniques was realized to help surgeons choose the most convenient one. From this study, a classification arises, based on aesthetic results, distinguishing three groups of surgical techniques and allowing their comparison. Techniques belonging to Group 2, using cervical advancement flap, were the most suitable, mainly both techniques described by Reichenberger and Mehri Turki.

Otoplasty has been described for nearly 200 years for children and adults. Although auricular deformity has been recognized in newborns, treatment options were lacking. With the development of ear molding techniques, newborn ear deformities can now be corrected nonsurgically. However, these techniques have distinct limitations with much dependent on the age of initiation of treatment and deformities present. Awareness of these early interventions is therefore crucial to initiate treatment in the early developmental period when the ear is still malleable. During the first few weeks of life, the ears are malleable, and the ears are rapidly growing, relatively. Therefore, the neonatal period provides a unique opportunity to contour the ears properly. Different techniques have been developed. However, the premise is that the ears are stabilized in a favorable contour continuously for several weeks to hold into proper position. This procedure carries minimal risk and can be quite efficacious, preventing a child from needing surgery later in life.

The purpose of this study is to investigate facial symmetry aesthetics (FSA) in the Saudi Arabian population using artificial intelligence (AI).Two hundred and ten people from a range of demographic backgrounds participated in an observational cross-sectional study that was done at a hospital. Standardized posed photos of the face and smile were taken using a Canon camera utilizing a stratified random sample approach. Webceph software (Korea) with AI was used to evaluate macro, micro, and tiny aesthetic factors. The data were analyzed using paired -tests, post hoc Bonferroni testing, analysis of variance (ANOVA), and descriptive statistics. The computation of intraclass correlation coefficients (ICCs) was utilized to assess the dependability of AI evaluations.All variables had ICCs of more than 0.97, indicating exceptional dependability for the AI-based evaluations. Between the Class I and Class III malocclusion groups, there were significant variations in right mandibular body length ( < 0.001), with Class III patients exhibiting greater values. While no significant changes were identified for other characteristics, paired -tests showed a significant divergence in mandibular body length between the right and left sides ( = 0.001). In Class III malocclusion, there was a significant preference for right deviation in the direction of mandibular deviation ( = 0.005). These results imply that AI is capable of accurately identifying some anatomical characteristics associated with face aesthetics, especially when it comes to differentiating between Class III malocclusions.In conclusion, the Saudi Arabian population's facial symmetry assessments via AI have demonstrated a high degree of reliability and consistency. Notably, the length of the mandible on the right side has emerged as a crucial feature in discriminating between malocclusion classes. The study emphasizes how AI might improve the accuracy of assessments of face aesthetics and our knowledge of facial features connected to malocclusion.

While Asian noses are generalized as having smaller bones and softer cartilages, thicker skin and soft tissue envelop (SSTE), there exists a diversity of morphology amongst Asian noses. The oversimplification of Asian noses diminishes the validity or generalizability of rhinoplasty research findings and makes comparison of outcomes challenging. A classification system is proposed that reflects the different structures and SSTEs of the nasal subtypes, the techniques required in the management of each of the subtypes, the challenges the surgeon will face intra- and postoperatively, allows for preoperative counselling of expected outcomes, and facilitate valid and fair comparison of study outcomes by comparing like for like. The classification system stratifies noses into four subtypes based on (1) the size and strength of the nasal bone and cartilages, and (2) the thickness of the SSTE. Type I noses have thinner SSTE and stronger structure. Type II noses have thinner SSTE and weaker structure. Type III noses have thicker SSTE and stronger structure. Type IV noses have thicker SSTE and weaker structure. Interrater variability in classifying noses among rhinoplasty surgeons was found to be very high with a kappa coefficient of 0.933 (95% confidence interval: 0.852-1.014; variance 0.013).

 The shape of the forehead is primarily determined by the frontal bone, which holds significance for health and aesthetics. This study evaluated the morphology of the frontal bone in different age groups and genders using computed tomography (CT).

 Prominent ears negatively impact the psychological and social health of individuals. Despite the availability of different surgical correction methods for this congenital condition, many of these techniques might result in significant risks of complications and the condition often reappears. Herein, we present log-term outcomes of our suture-free method that employs various strategies to reduce these risks and prevent recurrences.

Prominauris, often known as prominent ears, is one of the most frequent congenital deformities of the head and neck. Therefore, otoplasty has gained significant popularity and is now one of the most performed procedures in the field of facial plastic surgery.Reconstructing and correcting ear abnormalities remains a challenging procedure in facial plastic and reconstructive surgery. These deformities, whether congenital or acquired, have a substantial influence on patients' lives and inflict psychological harm. Addressing the deformity and tissue loss will improve the overall quality of life.Throughout history, various surgical techniques have been reported for treating external ear abnormalities. While most of these surgeries are considered safe, a comprehensive preoperative evaluation and understanding of the different techniques and risks can minimize potential complications.