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Otoplasty has undergone a number of important developments over the course of the past 150 years. While cartilage-incision techniques were favored earlier in the century, suture-only techniques are now favored. Prominauris, a condition that affects 5% of the Caucasian population, is inherited as an autosomal dominant trait. Protruding ears commonly are due to a combination of two defects: under-development of antihelical folding, and overdevelopment of the conchal wall. Utilizing a graduated approach, consistently superior results can be obtained. Our approach includes: fusiform skin excision; concha-mastoid sutures; scapha-conchal sutures; and refinement of the scapha, helix, and lobe. The aesthetic results are well retained and significant complications are rare.

To assess perioperative quality-of-life (QOL) changes in a facial plastic surgery patient population and to ascertain factors determinative of QOL changes. A notable paucity of objective scientific measurements of QOL exists within the facial plastic surgery literature.Methods: A 3-year prospective cohort study. The patient population, which comprised a consecutive series of patients 16 years or older, undergoing cosmetic nasal or facial surgery, was obtained from the senior author's (P.A.A.) private surgical practice. All patients presenting for surgery were offered participation. The main outcome measure was the 59-item Derriford Appearance Scale (DAS59), a valid and reliable instrument assessing psychological distress associated with self-consciousness of facial appearance. Three patient score subgroupings were established: group 1, the DAS59 scores for all patients; group 2, the DAS59 score according to sex; and group 3, the DAS59 score according to the main surgical procedure. Surveys were administered to eligible patients at the final preoperative clinic visit and at 3 months after surgery. Data from the casecontrol groups were analyzed by a blinded statistician with appropriate t tests.Results: A total of 93 patients were enrolled with a 100% response rate (82 females [88%] and 11 males [12%]). The most common procedures were rhinoplasty (49%) and surgery for the aging face (51%). Marked differences in perioperative QOL were noted across all DAS59 domains for group 1 and for all females in group 2. Male patients in group 2 analysis experienced QOL improvement only from DAS59 domain 2 (General Self-consciousness of Facial Appearance). Rhinoplasty and surgery for the aging face improved patients' QOL but differed with respect to which DAS59 domains were affected.Conclusions: Quality of life was enhanced by facial plastic surgery in this patient population. Male and female patients seem to have different needs to be met from facial cosmetic surgery and correspondingly different areas of improvement in QOL. Rhinoplasty and surgery for the aging face act on different domains of QOL.

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.

Revision rhinoplasty requires sound judgment by both patient and surgeon. Detailed preoperative assessment facilitates proper patient selection. If the patient is deemed a favorable revision rhinoplasty candidate, both patient and surgeon must agree on the goals for and risks inherent in revision rhinoplasty. Thoughtfulness regarding the degree of aesthetic and functional correction desired by the patient and the corresponding intraoperative techniques required to achieve this correction must be contemplated prior to committing to revision rhinoplasty. Furthermore, the surgeon must feel confident that the surgical demands requested by the patient may be met and satisfaction achieved. A precise preoperative surgical plan minimizes intraoperative misadventures. Options for grafting materials should be discussed and agreed upon by both patient and surgeon preoperatively. Both patient and surgeon commit to long-term postoperative follow-up and the patience necessary for the eventual outcome to be realized.

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Open (external) rhinoplasty is becoming increasingly popular. Two of its disadvantages most frequently espoused are the difficulty in making the external incision atraumatically and the resulting scar. To diminish these concerns, different incision lines and methods of exposure have been proposed by various authors. These are reviewed along with our preferred technique. We reviewed 100 consecutive cases of open rhinoplasty, yielding 81 patients who underwent subjective and objective scar analysis. There was 1 subjective failure (1.2%), and 2 minor objective failures (2.5%). Recommendations are made to minimize difficulties in performing the open approach and to maximize scar cosmesis.

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