Ethics and the facial plastic surgeon

AbstractThe revision rhinoplasty presents many unique challenges to the facial plastic surgeon. While many cases will require a full revision in the operating room, there are several isolated deformities which may be repaired in the office via an endonasal approach. This provides many benefits to the patient and surgeon including decreased cost, shorter recovery time, avoidance of general anesthesia, and less discomfort. It is critical to identify defects appropriate for endonasal repair, establish clear expectations with the patient, and work within one's skill set and level of experience. The surgeon who can comfortably navigate both open and endonasal techniques can offer their patients a comprehensive set of solutions for revision rhinoplasty. In this article we outline the defects amenable to this type of repair as well as technical considerations for each defect addressed. We hope it serves as a useful framework for the range of deformities the rhinoplasty surgeon may take on for in-office repair.

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The Potential for Telemedicine to Reduce Bias in Patients Seeking Facial Plastic Surgery

Otolaryngology ◽

10.1177/0194599820964731 ◽

2020 ◽

pp. 019459982096473

Author(s):

Parsa P. Salehi ◽

Brian J. F. Wong ◽

Babak Azizzadeh

Keyword(s):

Head And Neck ◽

Plastic Surgery ◽

Plastic Surgeon ◽

Patient Relationship ◽

Doctor Patient Relationship ◽

Facial Plastic Surgery ◽

Facial Plastic

Telemedicine use among otolaryngologists–head and neck surgeons and facial plastic and reconstructive surgeons has accelerated as a result of the COVID-19 pandemic. Yet, it is unclear what impact the increased adoption of telehealth will have on the doctor-patient relationship, patients’ perceptions of individual practices, and the likelihood of patients proceeding with the next steps toward surgery. While an understanding of these complex questions is imperative for all otolaryngologists, it is extremely important for facial plastic surgeons who focus on elective procedures, particularly cosmetic/aesthetic operations. The use of telemedicine has the potential to reduce bias among patients seeking facial plastic surgery, especially cosmetic procedures. As reports of this phenomenon are anecdotal thus far, we recommend further study into the specific criteria that patients consider when selecting a facial plastic surgeon.

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Influence of Specialist Title On Perceived Surgical Ability

Canadian Journal of Plastic Surgery ◽

10.1177/229255039400200405 ◽

1994 ◽

Vol 2 (4) ◽

pp. 149-154 ◽

Cited By ~ 1

Author(s):

Michael L Kreidstein ◽

Hugh G Thomson ◽

Peter C Neligan

Keyword(s):

Plastic Surgery ◽

Plastic Surgeon ◽

Reconstructive Procedures ◽

Operative Results ◽

Before And After ◽

Facial Plastic ◽

The Face ◽

Operative Result ◽

Surgery Resident ◽

Nose And Throat

ML Kreidstein, HG Thomson, PC Neligan. Influence of specialist title on perceived surgical ability. Can J Plast Surg 1994;2(4):149-154. This study was conducted to test the hypothesis that patients associate specialist titles with superior surgical ability, and that operative results are viewed more favorably if believed to be the handiwork of a specialist. Subjects (n=130) were randomly selected from among patients at a medical walk-in clinic. All subjects were presented with an identical set of ‘before and after’ photographs depicting six unrelated facial operations. However, each set of photographs was attributed at random to one of the following surgeons: plastic surgeon, plastic surgery resident, aesthetic plastic surgeon, facial plastic surgeon, ear nose and throat/ head and neck surgeon, cosmetic surgeon. Subjects completed a questionnaire evaluating the quality of the result from each operation, and then for each operation indicated which of the above surgeons was likely to achieve the best operative result. The attribution of identical operative results to the different surgeons resulted in evaluations that were not statistically different (P>0.05). Cosmetic surgeons were chosen most frequently as the type of surgeon likely to perform the best quality rhytidectomy or rhinoplasty, and facial plastic surgeons were chosen most frequently as best for repairs of facial lacerations or removal of skin tumours on the face (P<0.00l). Plastic surgeons and ear nose and throat surgeons received intermediate ratings, and aesthetic plastic surgeons and plastic surgery residents received low ratings. As hypothesized, specialist titles were associated with superior surgical ability, with cosmetic surgeons thought to provide the best cosmetic procedures, and facial plastic surgeons thought to provide the best reconstructive procedures. Despite this bias, evaluations of the operative results were not influenced by the type of surgeon credited with the operation, refuting the hypothesis of a placebo-type effect.

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Introduction to 3D Imaging Technologies for the Facial Plastic Surgeon

Facial Plastic Surgery Clinics of North America ◽

10.1016/j.fsc.2011.07.001 ◽

2011 ◽

Vol 19 (4) ◽

pp. xv-xvi ◽

Cited By ~ 3

Author(s):

John Pallanch

Keyword(s):

3D Imaging ◽

Plastic Surgeon ◽

Imaging Technologies ◽

Facial Plastic

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The Difficult Neck Patient—Practical Management: A Personal Approach

Facial Plastic Surgery ◽

10.1055/s-0041-1725109 ◽

2021 ◽

Vol 37 (02) ◽

pp. 168-175

Author(s):

Kristian Haynes Hutson ◽

Alwyn Ray D'Souza

Keyword(s):

Aesthetic Surgery ◽

Plastic Surgeon ◽

Related Factors ◽

Global Trends ◽

Practical Management ◽

Current Thinking ◽

Facial Plastic ◽

Personal Approach ◽

The Individual

AbstractWith increasing global trends in aesthetic surgery, the facial plastic surgeon will undoubtedly encounter a variety of patient types including those with more unfavorable underlying anatomy. The “difficult” neck represents a cohort of individuals that exhibit both anatomical and patient-related factors that may limit overall surgical improvement. Anatomical issues that contribute to the difficult neck include excessive fat (“heavy” neck), ptosis of deep structures, obtuse cervicomental angle, and abnormalities of the underlying skeletal framework, such as a low set hyoid and inadequate chin projection. It is important that these factors are recognized and highlighted preoperatively, and that surgery is tailored appropriately to the individual. Although satisfactory results can be achieved, these may be ultimately limited, and it is important that patients understand this. We will present a review of current thinking alongside our own practice in the identification and management of these “difficult neck” patients.

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Grafts in Endonasal Rhinoplasty

Facial Plastic Surgery ◽

10.1055/s-0041-1729633 ◽

2021 ◽

Author(s):

Daniel D. Lee ◽

Ziad Katrib ◽

Edwin F. Williams

Keyword(s):

Plastic Surgeon ◽

Endonasal Approach ◽

Facial Plastic ◽

Nasal Function

AbstractRhinoplasty is arguably one of the most challenging but rewarding procedures for the facial plastic surgeon. To adequately improve facial aesthetic parameters and preserve nasal function, the appropriate utilization of grafts is of utmost importance. While there is no best method, I found that in my hands, the endonasal approach allowed me to achieve greater control over my results by limiting dissection, utilizing less cartilage, and minimizing variables. In this manuscript, I outline the surgical pearls I have developed throughout my career that have helped me execute these grafts efficiently and effectively.

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The Nasal Hinge

Otolaryngology ◽

10.1177/01945998941113p110 ◽

1994 ◽

Vol 111 (3P1) ◽

pp. 219-231 ◽

Cited By ~ 8

Author(s):

Peter A. Adamson ◽

Todd A. Morrow

Keyword(s):

Clinical Results ◽

Plastic Surgeon ◽

Hinge Region ◽

Lateral Cartilage ◽

Lower Lateral Cartilage ◽

Lateral Aspect ◽

Nasal Tip ◽

Tip Projection ◽

Facial Plastic

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.

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