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Discovering the True Resolution of Postoperative Swelling After Rhinoplasty Using 3-dimensional Photographic Assessment

Schreiber, Jillian E. MD; Marcus, Ellen BS; Tepper, Oren MD; Layke, John DO

Plastic and Reconstructive Surgery - Global Open: August 2019 - Volume 7 - Issue 8S-1 - p 11-12
doi: 10.1097/01.GOX.0000584252.84509.e7
Aesthetic Abstracts
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Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

PURPOSE: Although prolonged nasal edema is a well-known sequela after rhinoplasty, the anticipated time to resolution and anatomical distribution of edema remain largely anecdotal. Nasal swelling obscures the delicate contours and definition of the nose, and it is particularly noticeable in the nasal tip. Edema and lack of definition in the nasal tip may affect patient satisfaction and prolong the assessment of the final esthetic result. The following study set out to quantify the dynamics and anatomic distribution of postoperative edema after rhinoplasty.

METHODS: Consecutive patients undergoing primary open rhinoplasty in 2018 were included in this study. Retrospective analysis of postoperative 3-dimensional photographs was performed using Canfield Vectra VAM software. Three-dimensional changes to the nose were analyzed only for patients who had 3-dimensional pictures at either 7 or 14 days postoperatively and ≥2 additional pictures at the following time points 45, 90, 180, and >250 days postoperatively (N = 18). Three-dimensional metrics including volume, anterior–posterior projection, horizontal width and were calculated at each interval for the upper nasal two thirds and lower third, defined as nasal tip. Edema was defined as the change in nasal volume at postoperative intervals relative to the baseline image. The distribution of edema was calculated as the percent of total nasal volume in the upper two thirds versus the lower third (nasal tip). Topographic color maps and mesh overlays were created for each interval to visualize changes to the nasal contour at postoperative intervals.

RESULTS: Maximum nasal volume occurs at 7–14 days postoperatively. The mean volume loss from 7 days postoperatively to >250 days postoperatively was 2.8 ± 0.7 ml. The distribution of edema changed over time, however, and was consistently greater in upper two thirds than the nasal tip. The anterior projection of the nasal tip was greatest at 1 week, whereas the width was minimum at 1 week. The projection decreased and width increased progressively from 7 to 90 days, with near resolution at >250 days.

CONCLUSIONS: Three-dimensional analysis reveals that nasal tip edema greater in the upper two thirds of the nose compared to the tip after rhinoplasty. Interestingly, the relative distribution of edema in the nasal tip increases over time. In this region where definition and delicate contours are obscured by minimal edema, nasal tip edema is more noticeable but less in overall volume than the upper two thirds. The behavior of overall nasal edema was comparable to prior published data. This study objectively quantifies the amount and duration of edema in the nasal tip after rhinoplasty that can guide patient and surgeon expectations. Evidence of persistent nasal tip edema serves as a therapeutic target for improving the patient postoperative course with new technology, including specialized splinting that includes support to the nasal tip as a modification to the traditional nasal splint. Further investigation into methods for improving postoperative nasal tip edema is ongoing.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.