Oren M. Tepper’s research while affiliated with Albert Einstein Medical Center and other places

Background The iPhone (Apple Inc, Cupertino, California) contains a high-fidelity 3D-scanner and is widely distributed in the United States. Presently, 3D analysis of the breast necessitates ownership of cost-prohibitive cameras and software packages such as the Vectra system. Objectives We compared the accuracy of 3D photos of the breast obtained with the iPhone X 3D scanner against the Canfield Vectra H2 (Canfield Scientific Inc. Parsippany, NJ) in an effort to expand access to 3D technology in plastic surgery. Methods Twenty breasts (n=20) were 3D-photographed with iPhone X and the Vectra H2 and compared with color map analysis and by measuring distances across the model between key anatomical landmarks. These distances included sternal notch to nipple (SN-N), mid-chest to nipple (M-N), nipple to mid-inframammary fold (N-IMF), and inframammary fold width (IMF). Statistical tests included the Bland-Altman Plot analysis. Results When comparing absolute differences in distances between key anatomical landmarks, the average discrepancy in measurements between iPhone and Vectra image pairs were the following: SN-N: 0.94mm, M-N: 0.70mm, N-IMF 0.81mm, and IMF 0.96mm. Colormap analysis demonstrated an average error of 1.53mm, mean of 0.53mm, and standard deviation of ±1.81mm. Bland-Altman Plot revealed a mean difference of 0.13mm and an agreement interval between -1.90 and 2.17mm. Conclusions The iPhone is capable of capturing 3D-photographs with a high level of fidelity when compared to Vectra. 3D-scans obtained with the iPhone may be useful for planning nipple position, measuring the breast footprint, choosing implants, and performing other functions using 3D technology that are typically performed using the more expensive systems.

Background Significant swelling after rhinoplasty can temporarily obscure results and lead to distress for patients and surgeons. We recently developed three dimensional (3D)-printed nasal splints that aim to protect the nose and limit edema by applying gentle compression. This prospective, randomized study compares postoperative nasal edema in patients being treated with traditional taping versus 3D-printed splints. Methods Patients undergoing primary rhinoplasty (2019–2020) were randomized into two groups: taping versus 3D-printed splinting. For 12 weeks, patients either applied steri-strips to the dorsum and tip, or used 3D-printed splints, which were based on nasal simulations. The percentage change in volume (cm ³ ) was calculated for the total nose, dorsum, and nasal tip at various time points. Results Nasal taping (n = 34) demonstrated a volume reduction of 4.8%, 9.9%, 10.0%, 10.3%, and 10.6% (compared with baseline) at 2 weeks, 6 weeks, 3 months, 6 months, and 1 year, respectively. In contrast, the resolution of swelling with 3D splints (n = 36) was 5.0%, 8.6%, 11.0%, 14.9%, and 15.1% at the same time points. Inter-group comparison showed that 3D splints led to significantly less edema of the total nose at 6 months and 1 year ( P ≤ 0.05), as well as consistent reductions in the tip and dorsum, specifically (1 year, P ≤ 0.1, 0.01, respectively). Conclusions 3D-printed splints after rhinoplasty leads to a significant reduction of edema, most noticeable at 6 months and 1 year. This study suggests that customized 3D-printed splints offer an effective clinical alternative to traditional taping to reduce postoperative edema after rhinoplasty.

Background Aesthetic norms fluctuate over time and often result in generational differences in preferred ideal nasal aesthetics. While some traditional concepts in ideal nasal aesthetic have been suggested in our literature, there is no study to date which has identified contemporary preference across different age groups. Objectives To understand the general population’s current perception of ideal nasal profiles. Methods Two dimensional (2D) images of female noses (n=10) of varying ethnicities were simulated to alter either the radix height or nasolabial angle (NLA) independently. Radix height was manipulated by increasing or decreasing the height by 5 mm relative to baseline. For NLA, 3 images were created with the following measurements: (1) 90, (2) 100, and (3) 110 degrees. Groups were categorized by generation and age at the time of completing the study: Generation Z (age 18-23), Millennial 20s (age 24-30), Millennial 30s (age 31-39), and Generation X (age 40-55). Each figure consisted of either 3 variations in radix height (n=10) or 3 variations in NLA (n=10). Within each figure, volunteers were asked to choose their preferred nose. Results The younger generations, Generation Z (Gen Z) and Millennial 20s and 30s, preferred a more augmented radix compared to Generation X (Gen X) which preferred baseline radix height. Gen Z, Millennial 20s, and Gen X preferred a 90-degree NLA while Millennial 30s preferred a NLA of 100-degrees. Conclusions The authors found that younger populations (Gen Z, Millennial 20s, and Millennial 30s) preferred a more augmented appearance to the nasal radix and, on average, a more acute NLA than published data suggests.

Background: Breast reduction mammoplasty (BRM) is among the most common procedures in plastic surgery, with a 1-7% postoperative hematoma incidence reported. Tranexamic acid (TXA) has been shown to reduce perioperative bleeding and need for transfusion when administered intravenously or topically, but remains underutilized in plastic surgery. This study aims to investigate whether topical administration of topical TXA reduces postoperative hematoma following BRM. Methods: A double-blinded, randomized controlled trial of 98 patients (196 breasts) undergoing bilateral primary reduction mammoplasty at a single academic institution was performed. Patients were used as internal matched controls, with one breast randomized to receive 1000mg of topical TXA before closure, and the other receiving saline. All members of the surgical team and patient were blinded as to which breast received the study drug. Postoperative complications, including hematoma, within 30 days of surgery, drain outputs, and duration of drain use, were compared between treatment and placebo breasts. Results: The overall hematoma rate was 1.5%. There was no significant association between application of TXA and development of a hematoma (p=0.56) or other complications. The hematoma rate of patients enrolled in the trial was similar to the overall rate of hematoma during the study time period (1.5% versus 2.4%, p=0.511). In a multivariate model, TXA was not significantly associated with differences in drain output after controlling for resection weight, age, and duration of drain use (p=0.799). No adverse effects or thromboembolic events from TXA were observed. Conclusion: Topical application of TXA does not decrease the incidence of hematoma following reduction mammoplasty.

See the Original Article here. We very much enjoyed reading the manuscript entitled “The Management of Lumps, Bumps, and Contour Irregularities (LBC) of the Lower Eyelid and Cheek After Poor Outcome Fat Transfer.” This manuscript serves as a valuable addition to our literature, and sheds light on a very important yet challenging area in facial aesthetic surgery. The eyelid-cheek junction has long been an area of both great interest and frustration for aesthetic surgeons. Various approaches to create a more youthful appearance have been described, ranging from excision of fat, redistribution of fat, addition of volume (ie, filler, fat), or some combination of these. In recent years, fat grafting has gained favor among patients and surgeons alike due to the relative ease of fat harvest, minimal downtime, and long-lasting results. Despite fat grafting being considered a relatively minimally invasive procedure, it is a highly nuanced technique that is not without risk, with the most common complications being visibility and palpability.

Introduction: Alar flare reduction (AFR) is a widely utilized technique in rhinoplasty. While the impact of AFR on the alar base has been well studied, its effect on the surrounding tissues is largely unknown. This study aims to elucidate the potential effect of AFR on the overall nasal and peri-nasal anatomy. Methods: AFR was performed on cadavers (n=7) with sequential crescent shaped alar excisions of 2, 4 and 6mm. 2D and 3D-photographs were obtained at baseline and subsequent intervals. Analysis was performed with Adobe Photoshop and Vectra. Standardized landmarks were placed at the nasal tip point (NTP) and alar base point (ABP) to quantify NTP vector distances, NTP surface distances, and alar crease angle. Results: The surface and vector distances between the NTP and ABP decreased for increasing AFR intervals. AFR created a surface decrease of 1.90±1.60, 3.54±1.85, and 4.91±1.89mm respectively. AFR created a vector decrease of 1.50±1.14, 2.83±1.37, and 3.97±1.38mm respectively. NTP projection decreased by 0.54±0.31mm for 6mm excision. AFR led to cheek elevation of 0.87±0.70, 1.25±0.60, and 1.96±0.48mm respectively. This alar crease elevation blunted the transition between the cheek and upper lip skin at the level of the alar rim with the angle of this transition increasing 26.62±12.78 degrees from baseline to 6mm. Conclusions: 3D-analysis demonstrates the influence of AFR on the alar base and surrounding peri-nasal contour. AFR results in nasal tip de-projection, alar crease elevation, and alar flare width narrowing. Further investigation into the impact of modifying the alar base on surrounding structures is warranted.

Recent developments in three-dimensional (3D) imaging technology offer a more comprehensive means of assessing facial features. 3D printing allows for the transition of planning from simply a preoperative tool to an intraoperative device with the use of tools such as 3D-printed cutting guides, marking guides, or positioning guides. With the advent of 3D printing technology, 3D surface images can now be used to generate new medical models, devices, or tools to assist with rhinoplasty during preoperative, intraoperative, and postoperative phases. In the field of rhinoplasty, 3D printing can be applied in three main areas: (1) reference models, (2) surgical guides, and (3) nasal splints. The value of 3D imaging extends far beyond the benefits of “conversion” during a preoperative consultation and has the potential to greatly enhance the overall treatment of rhinoplasty patients with enhanced communication and personalized devices that can be used during surgery and in the postoperative phase.

Background The sub-nasal lip lift is a surgical technique that elevates the “lip line” (interface between vertical maxillary incisor height and upper lip) to achieve a more youthful aesthetic. Objectives This study offers the first ever definition of 3D changes to the upper lip due to sub-nasal lip lift. Methods A lip lift procedure was performed (on cadaveric samples) in a sequential manner from 2.5mm to 5.0mm intervals (n=13). 3D photographs were taken using the VECTRA H1 system (Canfield Scientific, Fairfield, NJ), and 3D analysis was performed including vermillion height and width, philtral height, sagittal lip projection, vermillion surface area, and incisor show. A subset of samples (n=9) underwent a modification of the technique by undermining of the upper lip subcutaneous tissue off of the underlying muscular fascia. Results Vermillion surface area (baseline ranged from 1.45 - 5.52 cm 2) increased by an average of 20.5% and 43.1% with 2.5 mm and 5.0 mm lip lift, respectively. Anterior projection of the vermillion increased in all cases by an average of 2.13mm and 4.07 mm at 2.5 and 5.0 mm respectively. Philtral height decreased in all cases by an average of 3.37 and 7.23 mm at 2.5 and 5.0 mm, whereas incisal show increased on average of 1.9 and 4.09 mm, respectively. Conclusions This study is the first to define the 3D morphometric changes to the upper lip following sub-nasal lip lift. Quantifying these changes aids the surgeon in both preoperative planning and guiding patient expectations.