Publications by authors named "Tom D Wang"

41 Publications

Complications in Rhinoplasty.

Clin Plast Surg 2022 Jan 2;49(1):179-189. Epub 2021 Sep 2.

Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, SJH01, Portland, OR 97239, USA.

Rhinoplasty is widely regarded as one of the more technically challenging surgeries, owing in part to the many possible short- and long-term complications that can arise. Although severe complications are uncommon, unforeseen complications can lead to esthetic and functional compromise, patient dissatisfaction, and need for revision surgery. The rhinoplasty surgeon must be prepared to counsel patients and identify and manage the range of complications that may result from this procedure. This article reviews some of the most frequently encountered complications related to rhinoplasty and their management approaches.
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http://dx.doi.org/10.1016/j.cps.2021.07.009DOI Listing
January 2022

Management of Dorsal Graft and Implant Infections.

Facial Plast Surg 2020 Feb 19;36(1):24-27. Epub 2020 Mar 19.

Division of Facial Plastic and Reconstructive Surgery, Oregon Health & Science University, Portland, Oregon.

Deficiency of the nasal dorsum can result from several etiologies, most commonly congenital, traumatic, or iatrogenic. The use of dorsal grafts or implants for augmentation of the dorsum is a mainstay of both functional and cosmetic rhinoplasty. Due to the cosmetically sensitive nature of the dorsum, and the relatively large amount of graft or implant material that is typically used, infections in this area can be particularly difficulty to manage. Here, we review the current literature on dorsal graft and implant infections, along with options for management.
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http://dx.doi.org/10.1055/s-0040-1701489DOI Listing
February 2020

Nasal obstruction symptom evaluation (NOSE) score outcomes after septorhinoplasty.

Laryngoscope 2019 04 21;129(4):841-846. Epub 2018 Dec 21.

Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A.

Objectives/hypothesis: The time interval at which Nasal Obstruction Symptom Evaluation (NOSE) scores stabilize after functional septorhinoplasty has not been determined. Our goal was to characterize longitudinal trends of patient-reported outcomes of nasal obstruction using the NOSE survey instrument following functional septorhinoplasty.

Study Design: Prospective longitudinal cohort study.

Methods: Adult patients (≥18 years) with nasal obstruction who underwent functional septorhinoplasty by three different surgeons at a single academic, tertiary referral center were identified. NOSE scores were obtained preoperatively and prospectively during three postoperative intervals defined as early (1-3 months), middle (4-6 months), and late (≥10 months.) Longitudinal analysis included repeated measures analysis of variance and adjustments for multiple comparisons.

Results: A total of 49 patients met inclusion criteria. For the total cohort, mean NOSE scores significantly improved between preoperative and early postoperative evaluations (71.4, standard deviation [SD] ± 17.0 vs. 24.2, SD ± 19.5; P < .001) but did not significantly change between early and middle (20.6, SD ± 19.1; P = .543) or middle and late (23.1, SD ± 24.9; P > .999) time intervals.

Conclusions: Patients with nasal obstruction who undergo functional septorhinoplasty can be expected to have significant improvement in self -reported nasal obstruction as early as 1 to 3 months postoperatively with a continued, durable, long-standing benefit lasting at least 10 months after surgery. Future studies can consider the 3-month time frame as a proxy for 1 year outcomes to help reduce survey burden.

Level Of Evidence: 2c Laryngoscope, 129:841-846, 2019.
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http://dx.doi.org/10.1002/lary.27578DOI Listing
April 2019

Modification of the Butterfly Graft.

JAMA Facial Plast Surg 2018 Dec;20(6):509-510

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland.

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http://dx.doi.org/10.1001/jamafacial.2018.0686DOI Listing
December 2018

Hybrid Cartilage-Modifying Otoplasty Technique and Outcomes.

JAMA Facial Plast Surg 2018 Jan;20(1):57-62

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland.

Importance: Otoplasty is performed to correct prominauris, one of the most common head and neck congenital deformities. Advances in combination hybrid approaches enable surgeons to achieve greater precision and accuracy.

Objective: To describe a hybrid cartilage-modifying approach and evaluate the procedure's effectiveness and safety.

Design, Setting, And Participants: Medical record review including patients undergoing otoplasty by the present technique from January 2006 to December 2016 as performed by the senior author at a tertiary academic referral center. Twenty-three patients underwent 24 total procedures including both bilateral (n = 17) and unilateral (n = 7) procedures. Two procedures were revisions.

Interventions: Hybrid cartilage-modifying otoplasty procedure.

Main Outcomes And Measures: Preoperative and postoperative measurements were recorded. Paired sample t testing was performed to assess changes between preoperative superior, middle, and inferior helical measurements and corresponding postoperative measurements for all operated ears. Two-tailed, independent sample t testing was performed to compare postoperative differences between right and left ears within separate superior, middle, and inferior measurements in patients undergoing bilateral otoplasty.

Results: Twenty-four surgeries were performed on 23 patients. The mean (SD) age at surgery was 16.3 (13.6) years with 13 patients (58%) between the ages of 4 and 10 years. Preoperatively, the mean (SD) superior, middle, and inferior helical rim-to-mastoid distance of the 41 discrete ears measured 16.5 (3.1) mm, 24.1 (3.8) mm, and 19.3 (4.4) mm, respectively. Mean (SD) postoperative measurements were 12.1 (2.4) mm, 14.7 (2.5) mm, and 14.0 (2.8) mm, respectively, for mean (SD) decreases of 4.4 (2.7) mm, 9.4 (3.4) mm, and 5.3 (3.6) mm. For the 17 bilateral procedures, the mean (standard error) postoperative scores between ears measured 0.7 (0.9) mm for the superior, 0.5 (0.9) mm for the middle, and 0.2 (1.0) mm for the inferior. The unaffected ear was measured in 4 of 7 (57%) of patients undergoing unilateral otoplasty, and the mean (SD) postoperative differences between left and right ears were 1.3 (0.8) mm, 3.0 (1.2) mm, and 1.0 (0.7) mm for the superior, middle, and inferior, respectively. Preoperative-to-postoperative differences for all ears (n = 41) were significant (P < .001 for all) for superior, middle, and inferior measurements. There were no significant absolute differences identified for superior (P = .41), middle (P = .58), and inferior (P = .88) measurements regarding left vs right postoperative comparisons for bilateral otoplasties. One patient undergoing bilateral repair required subsequent revision surgery of 1 ear. Two patients developed chronic suture site irritation, and 1 patient developed a hematoma.

Conclusions And Relevance: The present technique allows multiple opportunities to adjust the auricular parameters. The results indicate a low revision rate and high degree of symmetry.

Level Of Evidence: 4.
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http://dx.doi.org/10.1001/jamafacial.2017.1139DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5833664PMC
January 2018

Technical Refinements and Outcomes of the Modified Anterior Septal Transplant.

JAMA Facial Plast Surg 2018 Jan;20(1):31-36

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland.

Importance: Severe anterior septal deviation and resultant nasal obstruction represent a difficult surgical task to correct. The goal of surgery is to straighten the anterior dorsal and caudal struts, while maintaining nasal tip and midvault support. This study presents a novel extracorporeal septoplasty technique to straighten the crooked anterior septum.

Objective: To describe the novel anterior septal transplant technique, which consists of complete resection of the caudal septum and reconstruction with extended spreader grafts and a columellar strut, without a separate caudal septal replacement graft.

Design, Setting, And Participants: This study was a retrospective case series at a tertiary academic referral center. Participants were sequential adult patients undergoing anterior septal transplant from January 1, 2008, to December 31, 2015.

Main Outcomes And Measures: Patient-reported nasal obstruction using Nasal Obstruction Symptom Evaluation (NOSE) scores and objective photographic analysis. Nasal tip deviation, projection, and rotation were measured. Preoperative and postoperative outcomes were compared. Complications are reported.

Results: Seventy-one patients (mean age, 46 years [age range, 16-72 years]; 48 [67.6%] female and 23 [32.4%] male) were included in the case series. Postoperative NOSE scores (mean [SD], 24.00 [24.58]) were significantly better than preoperative NOSE scores (mean [SD], 72.25 [14.55]) (P < .001). A separate cohort of 32 patients (mean age, 42 years [age range, 13-72 years]; 23 [71.9%] female and 9 [28.1%] male) had photographs available for analysis. In the frontal view, nasal deviation improved from a mean (SD) of 2.9 (2.0) degrees before surgery to a mean (SD) of 1.4 (1.7) degrees after surgery (P = .004). In the base view, the deviation was corrected from a mean (SD) of 4.9 (2.8) degrees to a mean (SD) of 1.7 (1.2) degrees (P < .001). Tip rotation and projection were unchanged after surgery. Four patients had mild dorsal irregularities after surgery.

Conclusions And Relevance: Anterior septal transplant by the described technique is a safe and effective treatment option for severe anterior septal deviation.

Level Of Evidence: 4.
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http://dx.doi.org/10.1001/jamafacial.2017.1040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5833671PMC
January 2018

Facelift Controversies.

Facial Plast Surg Clin North Am 2016 Aug 10;24(3):357-66. Epub 2016 Jun 10.

Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, SJH01, Portland, OR 97239, USA. Electronic address:

The primary purpose of the facelift is to restore the shape, volume, and contours of the youthful face. Facelift surgery has evolved over the years into multiple techniques to accomplish the same results. This article discusses the common controversies in facelift surgery and evaluates the best available evidence to guide surgical decision-making. In regard to the salient question of whether there is a "best" technique, the literature suggests that the options are generally equal in efficacy. This highlights the need for high-quality research with standardized preoperative assessment and evaluation of postoperative results to better assess outcomes.
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http://dx.doi.org/10.1016/j.fsc.2016.03.012DOI Listing
August 2016

Modifications to the Butterfly Graft Used to Treat Nasal Obstruction and Assessment of Visibility.

JAMA Facial Plast Surg 2016 Dec;18(6):436-440

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland.

Importance: Graft visibility in the supratip region has been the main criticism of the butterfly graft. Because of the graft location, slightly unfavorable supratip fullness can occur, resulting in patient dissatisfaction with the cosmetic result.

Objective: To describe the clinical outcomes and visibility of the butterfly graft after technique modifications.

Design, Setting, And Participants: In this retrospective review of adults who had undergone primary or secondary rhinoplasty with butterfly grafting from July 1, 2013, through July 31, 2014, at a tertiary care center at an academic institution, an operative log and photographs were reviewed in an effort to analyze outcomes of butterfly graft use in rhinoplasty.

Main Outcomes And Measures: Nasal obstruction and visibility of the butterfly graft.

Results: Thirty-four patients were included in the case series (mean [SD] age, 46 [19.4] years; 23 women and 11 men). The mean (SD) length of the graft was 3.4 (0.5) cm, and the mean (SD) width was 0.9 (0.2) cm. A significant decrease was found in the Nasal Obstruction Symptoms Evaluation score after surgery (mean [SD] preoperative score, 69 [17]; mean [SD] postoperative score, 23 [24]; P < .001). In regard to appearance, 25 patients (74%) rated their appearance as improved or no changes, 6 (18%) as minimally worse, and 1 (3%) as much worse. Fifty-nine observers participated in the masked survey for the study. When the graft was present, observers detected it 59.7% (282 of 472 answers) of the time. When the graft was not present, its presence was suspected 36.5% (237 of 649 answers) of the time.

Conclusions And Relevance: The modified butterfly graft is a longer and thinner graft than the originally described butterfly graft. It is still an effective tool in the treatment of nasal obstruction with acceptable visibility. In most cases, it is difficult for health care professionals to identify the presence of the graft.

Level Of Evidence: 4.
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http://dx.doi.org/10.1001/jamafacial.2016.0681DOI Listing
December 2016

Dorsal Augmentation-Choosing the Right Material for the Right Patient.

JAMA Facial Plast Surg 2016 Sep;18(5):333-4

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland.

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http://dx.doi.org/10.1001/jamafacial.2016.0326DOI Listing
September 2016

Evolution of the rhytidectomy.

World J Otorhinolaryngol Head Neck Surg 2016 Mar 4;2(1):38-44. Epub 2016 Feb 4.

Department of Otolaryngology - Head and Neck Surgery, Division of Facial Plastic & Reconstructive Surgery, Oregon Health and Science University, Portland, OR, USA.

Since the advent of facelift surgery, there has been a progressive evolution in technique. Methods of dissection trended towards progressively aggressive surgery with deeper dissection for repositioning of ptotic facial tissues. In recent decades, the pendulum has swung towards more minimally invasive options. Likewise, there has been a shift in focus from repositioning alone to the addition of volumization for facial rejuvenation. The techniques in this article are reviewed in a chronologic fashion with a focus on historical development as well as brief discussion on efficacy in relation to the other existing options. There is currently no gold standard technique with a plethora of options with comparable efficacy. There is controversy over which approach is optimal and future research is needed to better delineate optimal treatment options, which may vary based on the patient.
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http://dx.doi.org/10.1016/j.wjorl.2015.12.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5698509PMC
March 2016

Definitive Cleft Rhinoplasty for Unilateral Cleft Nasal Deformity.

JAMA Facial Plast Surg 2016 Mar-Apr;18(2):144-5

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland.

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http://dx.doi.org/10.1001/jamafacial.2015.2031DOI Listing
July 2016

Revision Rhinoplasty.

Clin Plast Surg 2016 Jan 21;43(1):177-85. Epub 2015 Oct 21.

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR, USA. Electronic address:

Revision rhinoplasty is one of the most challenging operations the facial plastic surgeon performs given the complex 3-dimensional anatomy of the nose and the psychological impact it has on patients. The intricate interplay of cartilages, bone, and soft tissue in the nose gives it its aesthetic and function. Facial harmony and attractiveness depends greatly on the nose given its central position in the face. In the following article, the authors review common motivations and anatomic findings for patients seeking revision rhinoplasty based on the senior author's 30-year experience with rhinoplasty and a review of the literature.
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http://dx.doi.org/10.1016/j.cps.2015.09.009DOI Listing
January 2016

Management of the Deviated Nasal Dorsum.

Facial Plast Surg 2015 Jun 30;31(3):216-27. Epub 2015 Jun 30.

Department of Facial Plastic Surgery, OHSU, Portland, Oregon.

The deviated nasal dorsum veers off the ideal straight vertical orientation at midline. Deviations in the dorsum lead to functional and aesthetic consequences that frequently prompt the patient to seek consultation with a rhinoplasty surgeon. Inability to breathe through the nose and self-image perception significantly detracts from the patient's quality of life. Correction of the deviated nasal dorsum represents a challenge for the rhinoplasty surgeon. Anatomic correction of deviations is the goal. Straightening a deviated nasal dorsum will require maneuvers to realign the nose distinct from traditional aesthetic rhinoplasty techniques. The nasal dorsum is formed by the three-dimensional structures of the septum, the bony nasal pyramid, and the cartilaginous nasal midvault. Restoring the position of the septum at midline is the first step in providing adequate support to the nasal architecture. Extracorporeal septoplasty and anterior septal transplant are often necessary techniques to correct the septum and achieve dorsal correction. Subsequently, asymmetric maneuvers to bony dorsum and midvault are performed to restore symmetry. Asymmetric hump reduction and nasal osteotomies are often necessary. Supporting the midvault to avoid nasal collapse often requires asymmetric maneuvers to the upper lateral cartilages and asymmetric spreader grafts. Finally, camouflaging grafts to the nasal dorsum may be necessary. Significant rigidity and memory of the native tissues must be overcome to successfully straighten a nose. The surgeon who can master the deviated dorsum will significantly improve the appearance and quality of life of the patients he or she treats.
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http://dx.doi.org/10.1055/s-0035-1555617DOI Listing
June 2015

Secondary cleft rhinoplasty.

JAMA Facial Plast Surg 2014 Jan-Feb;16(1):58-63

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland.

The cleft nasal deformity seen in patients with unilateral and bilateral cleft lip presents a formidable challenge for the facial plastic surgeon. The underlying anatomic deformities combined with scarring from previous procedures make secondary cleft rhinoplasty a difficult procedure for even the most experienced surgeons. Numerous techniques for secondary cleft rhinoplasty have been described in the literature over the past several decades, yet the lack of wide adoption of any given technique highlights the great variability seen with this problem. Regardless, the fundamental goals of achieving nasal symmetry with definition of the nasal base and tip, correction of nasal airway obstruction, and repair of nasal scarring or webbing have driven the progressive evolution of techniques developed to correct various aspects of the cleft nasal deformity. Despite the number of techniques that have been published, very few studies have looked specifically at outcomes in secondary cleft rhinoplasty, and further work is needed in this area. In this article, we will review anatomy of the cleft nasal deformity, repair strategies and timing, surgical techniques for both unilateral and bilateral cleft nasal deformity, and outcomes for secondary cleft rhinoplasty.
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http://dx.doi.org/10.1001/jamafacial.2013.1562DOI Listing
January 2015

Complications of forehead lift.

Facial Plast Surg Clin North Am 2013 Nov;21(4):619-24

Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Science University, Mailcode: SJH-01, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA. Electronic address:

Complications and prevention of complications in brow lift are presented. A discussion of anatomic features of the brow introduces the article in keeping with the focus that a thorough understanding of the anatomy, patient variations, and potential complications is requisite for surgeons performing forehead rejuvenation. The varying approaches to brow lift are discussed. Complications reviewed are bleeding, nerve injury, scarring, alopecia, brow asymmetry, and brow elevation overcorrection or undercorrection.
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http://dx.doi.org/10.1016/j.fsc.2013.07.006DOI Listing
November 2013

Complications in periorbital surgery.

Facial Plast Surg 2013 Feb 20;29(1):64-70. Epub 2013 Feb 20.

Department of Otolaryngology, Head and Neck Surgery, University of Colorado, Denver, Aurora, Colorado, USA.

Comprehensive rejuvenation of the periorbital region commonly involves management of the brow, as well as the upper and lower eyelids. Browlifting, upper and lower blepharoplasty, fat transfer, and neuromodulators are frequently utilized with excellent results. However, surgery in this region can be fraught with potential complications ranging from a poor cosmetic outcome to orbital hematoma and vision loss. Although avoidance of complications is preferred, it is incumbent on the surgeon to have a detailed understanding of the pathophysiology, prevention, and management of these complications. The authors examine the more common complications of periorbital surgery.
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http://dx.doi.org/10.1055/s-0033-1333838DOI Listing
February 2013

Aesthetic treatment of the eyelids and midface.

Facial Plast Surg 2013 Feb 20;29(1):1-2. Epub 2013 Feb 20.

Department of Otolaryngology, Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA.

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http://dx.doi.org/10.1055/s-0033-1333837DOI Listing
February 2013

Technical considerations in endoscopic brow lift.

Clin Plast Surg 2013 Jan 27;40(1):105-15. Epub 2012 Aug 27.

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR 97239, USA.

The authors discuss how, in performing an endoscopic brow lift, meticulous surgical technique, adherence to anatomic dissection planes, and direct visualization used at key points in the procedure enable a safer, more-complete dissection and a better outcome. Anatomy as it relates to the procedure is discussed. Patient evaluation and patient expectations are reviewed with a discussion of the points to present to patients about outcomes of this surgery. Detailed steps of the endoscopic brow-lift technique are presented. Complications are discussed and the authors conclude with a summarization of what the ideal brow-lift procedure would accomplish.
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http://dx.doi.org/10.1016/j.cps.2012.06.004DOI Listing
January 2013

Complications associated with alloplastic implants in rhinoplasty.

Arch Facial Plast Surg 2012 Nov;14(6):437-41

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, University of Colorado-Denver, Aurora, CO 80045, USA.

Objective: To evaluate the incidence of infection and extrusion of porous high-density polyethylene (pHDPE) and expanded polytetrafluoroethylene (ePTFE) implants used in rhinoplasty at a high-volume, academic facial plastic surgery practice.

Methods: A total of 662 rhinoplasty procedures performed by 3 faculty surgeons from 1999 to 2008 were retrospectively reviewed. Patient demographics, medical comorbidities, operative details, and postoperative course findings were collected from patient records.

Results: The incidence of postoperative infection was 2.8% (19 of 662 patients). In each case of infection, alloplastic material had been used. Infections occurred in 1 in 5 rhinoplasty procedures in which pHDPE implants were used. In patients in whom ePTFE was used alone, the infection rate was 5.3%. Exposure developed in 12% of patients in whom an alloplast was used during surgery. Factors notably not associated with infection on bivariate analysis included sex, surgeon, purpose of procedure (functional vs cosmetic), current tobacco use, or history of cocaine use (P > .05 for all).

Conclusions: To our knowledge, this study represents the largest evaluation of the use of pHDPE implants in rhinoplasty to date. Our findings are in contrast to those of previous studies regarding the use of pHDPE in rhinoplasty and parallel to those regarding the use of ePTFE. Caution is strongly recommended when considering the use of pHDPE in rhinoplasty.
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http://dx.doi.org/10.1001/archfacial.2012.583DOI Listing
November 2012

Asymmetric nasal tip.

Facial Plast Surg 2012 Apr 6;28(2):177-86. Epub 2012 May 6.

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.

Asymmetry of the nasal tip is a common finding in the setting of primary and revision rhinoplasty. Careful preoperative analysis is imperative to identify the anatomic etiology of the asymmetry to develop an appropriate surgical plan to correct it. This article describes the anatomic structures that affect the overall appearance of the nasal tip, explains how intrinsic asymmetries can alter nasal tip appearance, and offers a menu of surgical techniques that can be used to correct these asymmetries.
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http://dx.doi.org/10.1055/s-0032-1309297DOI Listing
April 2012

Botulinum toxin: clinical techniques, applications, and complications.

Facial Plast Surg 2011 Dec 28;27(6):529-39. Epub 2011 Dec 28.

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA.

This article outlines practice routines, clinical techniques, applications, and complications of botulinum toxin type A treatment of mimetic facial and neck muscles. Detailed descriptions are provided for each clinical indication that maximize the treatment of the intended muscle groups while minimizing potential complications.
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http://dx.doi.org/10.1055/s-0031-1298786DOI Listing
December 2011

Gore-Tex nasal augmentation: a 26-year perspective.

Authors:
Tom D Wang

Arch Facial Plast Surg 2011 Mar-Apr;13(2):129-30

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, 3303 Bond Avenue SW, Portland, OR 97239-4501, USA.

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http://dx.doi.org/10.1001/archfacial.2011.10DOI Listing
July 2011

Forehead lifting: state of the art.

Facial Plast Surg 2011 Feb 18;27(1):50-7. Epub 2011 Jan 18.

Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon 29239, USA.

Forehead lifting serves to restore a more youthful appearance as well as a more functional and aesthetically pleasing brow position. The purpose of this review is to describe the pertinent anatomy and forehead aesthetics, then to discuss the patient evaluation, surgical approaches, complications, and nonsurgical adjuncts. Anatomic features reviewed include the layers of the forehead and scalp, blood supply, innervation, musculature, and the temporal branch of the facial nerve anatomy. Forehead aesthetics described include the aging process, with its contributing factors and consequences, and the ideal brow position in women and men. Key aspects of the patient evaluation include assessment of skin type; ptosis; hairline, brow, and lid position; symmetry; and bony contours. Pertinent past medical/surgical history as well as family history are reviewed, and the need for ophthalmology evaluation is discussed. Surgical indications and approaches, including direct, coronal, mid-forehead, endoscopic, and trans-blepharoplasty, are reviewed. The advantages and disadvantages of each approach are discussed and techniques briefly described. Complications are mentioned, and the article concludes with a review of nonsurgical adjuncts.
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http://dx.doi.org/10.1055/s-0030-1270419DOI Listing
February 2011

Options for internal lining in nasal reconstruction.

Facial Plast Surg Clin North Am 2011 Feb;19(1):163-73

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology and Head & Neck Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.

Nasal reconstruction has been refined to the point that its goals should include full restoration of form and function in addition to providing an aesthetically-pleasing result. Contemporary facial plastic surgeons have all the tools available in their armamentarium to repair the complex composite structure of nasal lining, structure, and skin cover. Nasal defects most often result from oncologic surgery or, less commonly, nasal trauma. While defects of nasal cover are more prominent, the impact of unrepaired nasal lining defects should not be underestimated. Meticulous repair of lining, structure and cover are all required for functional, stable and aesthetic nasal reconstruction.
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http://dx.doi.org/10.1016/j.fsc.2010.10.005DOI Listing
February 2011

Fat grafting of the midface.

Facial Plast Surg 2010 Oct 17;26(5):369-75. Epub 2010 Sep 17.

Department of Facial Plastics and Reconstructive Surgery, Oregon Health and Science University, Portland, Oregon 97239-3098, USA.

Autogenous fat injection of the midface is a viable and lasting remedy for midface soft tissue loss and has become a mainstay in facial rejuvenation. This serves as either a stand-alone technique or as an adjunct to other restorative lifting and repositioning techniques depending on patient needs. Although the use of fat grafting carries the inherent concern for resorption and a need for additional augmentation in the future, several tenets of fat transfer have emerged over the past century. Founded in these principles, the regimen set forth here has proved reliable and reproducible with little to no evidence of resorption over time.
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http://dx.doi.org/10.1055/s-0030-1265020DOI Listing
October 2010

Methicillin-resistant Staphylococcus aureus infection in septorhinoplasty.

Laryngoscope 2010 Jul;120(7):1309-11

Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon 29239, USA.

Objectives: Review the literature on methicillin-resistant Staphylococcus aureus (MRSA) infection following septorhinoplasty, identify patient groups at risk for MRSA complications following septorhinoplasty, and evaluate the need for antibiotic prophylaxis in these patients.

Discussion: Patients who are susceptible to MRSA infections may also be at higher risk for nasal colonization, and this includes elderly patients, patients recently hospitalized or treated in a rehabilitation center, and healthcare workers. Few cases of MRSA infection following septorhinoplasty have been reported in the literature. Prevention of nosocomial and postsurgical MRSA infections has been well studied, and it seems that elimination of nasal colonization is a major step in preventing these infections.

Conclusions: Patients at increased risk for MRSA colonization should be screened prior to septorhinoplasty and if positive treated with antibiotic prophylaxis consisting of elimination of nasal carriage prior to surgery. Perioperative systemic antibiotic use should be considered, especially in revision cases.
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http://dx.doi.org/10.1002/lary.20966DOI Listing
July 2010

Secondary rhinoplasty in unilateral cleft nasal deformity.

Authors:
Tom D Wang

Clin Plast Surg 2010 Apr;37(2):383-7

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, 3303 SW Bond Avenue, Mail Code: CH 5E, Portland, OR 97239-450, USA.

The cleft-lip nasal deformity presents a formidable challenge in rhinoplasty surgery. A wide variety of techniques have been proposed for the correction of this problem, which is proof of the difficulty of this reconstructive problem. The approach outlined in this article amalgamates many cleft-lip rhinoplasty concepts into a single unified technique. This technique is designed to address the deficiencies present on the cleft side of the nose.
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http://dx.doi.org/10.1016/j.cps.2009.12.013DOI Listing
April 2010

Facial resurfacing with coblation technology.

Medscape J Med 2008 Jul 2;10(7):155. Epub 2008 Jul 2.

Department of Otolaryngology and Head & Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Oregon Health & Science University, Portland, Oregon, USA.

Objective: To describe our experience with coblation technology for facial resurfacing

Methods: Retrospective chart review of all patients treated with coblation at our institution

Results: Twenty-four patients (22 female) underwent a total of 29 coblation procedures for aging face (n = 21) or acne scarring (n = 3). The perioral region was the most frequently treated aesthetic subunit (n = 14), followed by the lower eyelid (n = 7). Five patients underwent full-face coblation. Three patients underwent a second coblation procedure for aging face while a single patient with severe acne scarring underwent 3 procedures. Repeat coblation was delayed at least 5 months (mean, 9 months). Seventeen coblation procedures (59%) were performed concurrently with procedures including, but not limited to, injection treatment, rhinoplasty, blepharoplasty, or combined face/necklift; no adverse events occurred. Seven procedures, including a full-face coblation, were performed in the office under local anesthesia and oral sedation without any adverse events. Mean follow-up was 6 months (range, 1 week to 24 months). No complications were observed. All patients were satisfied with the results after their final coblation treatment.

Conclusions: Facial coblation is a safe and effective treatment modality for facial resurfacing.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2525463PMC
July 2008

Current concepts in midfacial rejuvenation.

Curr Opin Otolaryngol Head Neck Surg 2008 Aug;16(4):335-8

Department of Otolaryngology/Head and Neck Surgery, Facial Plastic and Reconstructive Surgery, Oregon Health and Science University, Portland, Oregon, USA.

Purpose Of Review: Treatment of the aging midface is an underappreciated element of overall facial rejuvenation. The anatomy of the midface and the pathophysiology of midface aging both remain somewhat controversial. The quest for ideal long-lasting midfacial rejuvenation continues. The purpose of this paper is to outline the latest progress in the field of midface rejuvenation.

Recent Findings: The complexity of midface anatomy has sparked many new investigations. Minimally invasive techniques such as threadlifts have shown promise but require further study. Volume augmentation with autologous fat and fillers is an important aspect of midface rejuvenation. Nonablative therapies offer an attractive concept, but the ideal modality still does not exist. Enthusiasm for cheek implants seems to be decreasing in favor of soft-tissue-based treatments. Open surgical treatment via suspension techniques continues to be an important option for surgeons when rejuvenating the aging midface.

Summary: Cadaver dissection and clinical observation have recently been used to further define the complex anatomy of the aging midface. New developments in both minimally invasive and open surgical procedures continue to both advance and redefine the field.
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http://dx.doi.org/10.1097/MOO.0b013e3283079c9bDOI Listing
August 2008

Midcheek and lower face/neck rejuvenation in the male patient.

Facial Plast Surg Clin North Am 2008 Aug;16(3):317-327

Division of Facial Plastic Surgery, Department of Otorhinolaryngology, Oregon Health & Science University, Portland, OR, USA.

Rejuvenation of the mid- and lower face in the male patient can be challenging. Historically, most of these procedures were performed on female patients. However, an increasing number of men are seeking rejuvenative procedures and because of this trend, it is imperative that facial plastic surgeons become facile with the nuances of male mid- and lower facial rejuvenation. Failing to understand the important differences between male and female patients can lead to pitfalls during the perioperative period. The conscientious surgeon should be mindful of these differences, beginning with the male cosmetic consultation and proceeding through to the postoperative period. The goal of this article is to review the principles of male mid- and lower facial rejuvenation.
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http://dx.doi.org/10.1016/j.fsc.2008.03.006DOI Listing
August 2008
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