Dr. Most graduated with High Honors from the University of Michigan in Ann Arbor. Subsequently he attended Stanford University School of Medicine, where he received a prestigious Howard Hughes Medical Institute Grant and was honored with the Dean's Award upon graduation. He completed an internship in General Surgery at Yale University School of Medicine before returning to the West Coast. Upon his return, he trained at the University of Washington in Department of Otolaryngology-Head and Neck Surgery, where he received the Lampkin Temporal Bone Dissection Award in 1998, and the awards from the Association for Research in Otolaryngology (ARO) in 1997, 1998, and 1999. In 2000 he joined the Physicians Research Training Committee of the ARO, the first resident to do so. After residency, he was selected for what was, at that time, one of the most competitive fellowships in Facial Plastic and Reconstructive Surgery, also at the University of Washington. He has authored over 100 articles, textbook chapters and reviews on the science and practice of Facial Plastic and Reconstructive Surgery. He was appointed Division Chief in Facial Plastic & Reconstructive Surgery at the University of Washington in 2002, a position he also has held at Stanford since his arrival here in 2006.

Clinical Focus

  • Facial Plastic Surgery
  • Facial reconstructive surgery
  • Facial aesthetic surgery
  • Rhinoplasty
  • Facelift
  • Blepharoplasty
  • Reconstruction after mohs surgery
  • Facial nerve paralysis
  • Functional rhinoplasty
  • Eyelid surgery
  • Mohs Surgery
  • Otolaryngology - Head & Neck Surgery (Ear, Nose and Throat)
  • Otolaryngology
  • botox
  • restylane
  • Dysport
  • Juvederm

Academic Appointments

  • Professor - Med Center Line, Otolaryngology - Head & Neck Surgery Divisions

Administrative Appointments

  • Vice President, Research and Development, American Academy of Facial Plastic & Reconstructive Surgery (2015 - 2018)
  • Board of Directors, The Rhinoplasty Society (2014 - Present)
  • Chair, Research Center, American Academy of Facial Plastic & Reconstructive Surgery (2013 - 2016)
  • Faculty senate, Stanford University School of Medicine (2011 - 2013)
  • Western Region Director, Board of Directors, American Academy of Facial Plastic & Reconstructive Surgery (2010 - 2014)
  • Division Chief, Facial Plastic & Reconstructive Surgery, Stanford University School of Medicine (2006 - Present)
  • Fellowship Director, Facial Plastic & Reconstructive Surgery, American Academy of Facial Plastic & Reconstructive Surgery (2006 - Present)
  • Director, Facial Nerve Center, Stanford University School of Medicine (2006 - 2017)
  • Medical Director, Multidisciplinary Cosmetic Surgery Center, University of Washington Medical Center (2004 - 2006)
  • Director, Facial Nerve Center, University of Washington School of Medicine (2002 - 2006)
  • Division Chief, Facial Plastic & Reconstructive Surgery, University of Washington School of Medicine (2002 - 2006)

Honors & Awards

  • Ben Shuster Award, American Academy of Facial Plastic & Reconstructive Surgery (2003)
  • Clinician Teacher of the Year, Department of Otolaryngology-HNS, University of Washington, Seattle, WA (2003)
  • Mark Rafaty Award, American Academy of Facial Plastic & Reconstructive Surgery (2014)

Boards, Advisory Committees, Professional Organizations

  • Editorial Board, JAMA-Facial Plastic Surgery (2007 - Present)
  • Fellow Member, American Academy of Facial Plastic & Reconstructive Surgery (2006 - Present)
  • Fellowship Director, American Academy of Facial Plastic & Reconstructive Surgery (2006 - Present)
  • Board Member, American Academy of Facial Plastic & Reconstructive Surgery (2009 - Present)

Professional Education

  • Residency:University of Washington Otolaryngology Residency (2001) WA
  • Internship:Yale New Haven Hospital (1996) CT
  • Medical Education:Stanford University School of Medicine Registrar (1995) CA
  • Fellowship:University of Washington Medical Center (2002) WA
  • Board Certification: Otolaryngology, American Board of Otolaryngology (2002)
  • M.D., Stanford University, Medicine (1995)
  • B.S., University of Michigan-Ann Arbor Honors College, Biology (Neuroscience) (1990)

Community and International Work

  • Facial Reconstructive Mission Trip, Cambodia


    Pro Bono Reconstructive Surgery

    Partnering Organization(s)

    Face to Face/Operation Smile

    Populations Served




    Ongoing Project


    Opportunities for Student Involvement


Current Research and Scholarly Interests

Division of Facial Plastic and Reconstructive Surgery-Research Program Summary

Evidence-based medicine in Facial Plastic Surgery
The primary goal of this research program is to develop a higher standard of care for facial plastic surgery patients. The approach to this goal is two-fold. The first involves development of prospective studies that examine the efficacy of new or existing surgical techniques in facial plastic surgery. One clinical problem we have already begun to examine is nasal obstruction. Functional rhinoplasty techniques have been a mainstay of otolaryngology, and facial plastic surgery in particular, for decades. While many have attempted, with mixed success, to examine nasal function using quantitative measures, few prospective studies of quality of life have been performed. To this end, we have begun to examine prospectively various functional rhinoplasty techniques.

The second approach to development of a higher standard of care for our patients is the testing of various over-the-counter ‘cosmeceutical’ products. Generally, products that are touted as effective by industry have little or no clinical evidence to back up said claims. Two of these studies have been completed and have resulted in remarkable response from industry as well as the media. More importantly, these types of studies provide valuable information about product efficacy to physicians and patients alike.

Facial Nerve Recovery after Injury
Facial nerve injury after trauma or extirpative surgery can be devastating to patients. The Division seeks to develop a clinical and basic research program studying facial nerve recovery after such injuries. The basic research program within the Division will use a previously developed animal (mouse) model for facial nerve injury to examine the age-dependence of motor neuron survival in the facial nucleus and its correlation to facial nerve recovery. Furthermore, the role of apoptotic cell death in the facial nerve nucleus will be studied, with the hope that anti-apoptotic processes may aid in facial nerve recovery. The clinical research program will study quality of life issues in facial nerve injury patients.

2018-19 Courses

All Publications

  • Assessment of Persistent and Prolonged Postoperative Opioid Use Among Patients Undergoing Plastic and Reconstructive Surgery. JAMA facial plastic surgery Olds, C., Spataro, E., Li, K., Kandathil, C., Most, S. P. 2019


    Importance: Although the development of persistent opioid use after surgical procedures has garnered much attention in recent years, large-scale studies characterizing patterns of persistent opioid use among patients undergoing plastic and reconstructive surgery procedures are lacking.Objective: To assess the prevalence of immediate and long-term postoperative opioid use after plastic and reconstructive surgery procedures.Design, Setting, and Participants: In this population-based cohort study, patients who underwent 5 classes of plastic and reconstructive procedures (nasal, eye, breast, abdomen, and soft tissue reconstruction) between January 1, 2007, and December 31, 2015, were identified using IBM MarketScan Commercial and Medicare Supplemental research databases. Patients were excluded if they were younger than 18 years, lacked continuous insurance coverage for 1 year preoperatively and postoperatively, had a second anesthesia event within 1 year postoperatively, and filled an opioid prescription within the year prior to surgery.Main Outcomes and Measures: Analgesic prescription patterns in the immediate postoperative period. The primary outcome was rates of persistent opioid use (opioid prescriptions filled 90-180 days postoperatively). The secondary outcome was rates of prolonged opioid use (opioid prescriptions filled 90-180 days postoperatively and again 181-365 days postoperatively). Explanatory variables included patient demographics, procedure type, and relevant comorbidities.Results: Of the 466 677 patients who met inclusion criteria, 96 397 (45.3%) were men, and the mean (SD) age was 46.8 (17.7) years. Furthermore, 212 387 (54.6%) of the patients filled prescriptions for postoperative analgesics, with 212 387 (91.5%) of analgesic prescriptions filled being for opioids. Persistent opioid use occurred in 30 865 (6.6%) patients (5.1%-13.5% across procedure classes), while prolonged opioid use occurred in 10 487 (2.3%) patients (1.7%-5.6% across procedure classes). Patients who filled prescriptions for opioids in the perioperative period were significantly more likely to exhibit persistent (odds ratio [OR], 2.87; 95% CI, 2.80-2.94) and prolonged (OR, 2.90; 95% CI, 2.77-3.02) opioid use than those who did not fill perioperative opioid prescriptions, with the greatest odds for persistent use found in patients who underwent breast (OR, 4.36; 95% CI, 4.10-4.63) and nasal (OR, 3.51; 95% CI, 3.30-3.73) procedures. On multivariable logistic regression analysis, independent risk factors for persistent and prolonged opioid use included perioperative opioid use, procedure type, and prior-year mental health (depression and anxiety) and substance abuse diagnoses.Conclusions and Relevance: Given the significant risk of persistent opioid use after plastic and reconstructive procedures, it is imperative to develop best practices guidelines for postoperative opioid prescription practices in this population.Level of Evidence: NA.

    View details for DOI 10.1001/jamafacial.2018.2035

    View details for PubMedID 30844024

  • Psychometric Properties of the Standardized Cosmesis and Health Nasal Outcomes Survey: Item Response Theory Analysis JAMA FACIAL PLASTIC SURGERY Saltychev, M., Kandathil, C. K., Abdelwahab, M., Spataro, E. A., Moubayed, S. P., Most, S. P. 2018; 20 (6): 519–21

    View details for PubMedID 30027293

  • Association of Dorsal Reduction and Tip Rotation With Social Perception. JAMA facial plastic surgery Kandathil, C. K., Saltychev, M., Moubayed, S. P., Most, S. P. 2018


    Importance: Social perception by laypersons of people who have undergone rhinoplasty primarily for cosmetic purposes has not been fully described.Objective: To evaluate the social perception of patients who have undergone cosmetic rhinoplasty.Design, Setting, and Participants: Preoperative images of 4 patients with dorsal hump and tip ptosis were selected using the Delphi method. Computer simulations of dorsal hump reduction and tip rotation, alone or in combination, were performed. Using the Qualtrics internet-based survey platform, laypersons blinded to the purpose of the study viewed randomized original and simulated images and estimated the age, approachability, perceived success, overall health, intelligence, and rated their attractiveness on a visual analog scale from 0 to 100.Main Outcomes and Measures: Comparison of responses (mean [SD] score) for each of the 3 types of simulated image against the original image employing a pairwise comparison of means (Dunnett test).Results: After excluding 27 (4%) invalid responses, a total of 813 respondents (593 women and 220 men) were included in the study. The mean (SD) age was 44.6 (16.2) years. A total of 628 (77%) respondents were white and the observed highest level of education was a bachelor's degree (193 [24%]) or having attended college but without a diploma (194 [24%]). A significant age reduction (31 [10] years; 95% CI, -2.5 to 0; P=.04) and an increase in approachability (64 [22]; 95% CI, 0.7-5.8; P=.009), attractiveness (60 [22]; 95% CI, 4.0-9.4; P<.001), and health (70 [19]; 95% CI, 0.7-5.2; P=.006) for the simulation involving hump reduction was observed. When combined simulation of dorsum and tip rotation were tested, only significant increases in attractiveness (60 [23]; 95% CI, 3.6-9.0; P<.001) and health (69 [19]; 95% CI, 0.1-4.6; P=.03) were seen. No significant association was found for any of the responses when the tip alone was rotated. The Wilks lambda varied slightly below 1.0 showing significant P values (P<.05) for all variance and covariance (respondent particulars).Conclusions and Relevance: Though rhinoplasty procedures for nasal cosmesis involving both the nasal dorsum and tip were perceived to make a person more attractive and healthier, these results suggest that manipulation of the dorsum is more strongly associated with perception of the nose.Level of Evidence: NA.

    View details for PubMedID 29879285

  • Risk of Venous Thromboembolism in Patients With Keratinocyte Carcinoma. JAMA facial plastic surgery Rudy, S. F., Li, K., Moubayed, S. P., Most, S. P. 2018


    Importance: Although malignancy is an established risk factor for venous thromboembolism (VTE), the risk of VTE specifically in patients with keratinocyte carcinoma (KC) has not been previously studied.Objective: To determine the risk of VTE in patients with KC compared with patients not diagnosed with cancer and with patients diagnosed with common malignant neoplasms associated with VTE.Design, Setting, and Participants: Population-based retrospective analysis of patient insurance claims made between January 1, 2007, and December 31, 2014, from the Truven MarketScan Commercial and Medicare Supplemental Databases. Patients treated across the United States were divided into 3 cohorts: patients with KC, patients with pancreatic cancer or acute myelogenous leukemia who are thus at high risk for VTE, and patients without a history of common malignant neoplasms. Patients were excluded from the KC cohort if they had a history of another type of cancer. Data were analyzed between April 1, 2017, and January 15, 2018.Main Outcomes and Measures: Diagnosis of VTE within 1 year following the index date (for the KC and high-risk cohorts, the date of the initial diagnosis of cancer; for the control cohort, the date following 365 days of continuous insurance enrollment). Logistic regression was used to assess the risk of VTE in the KC cohort compared with the high-risk and control cohorts before and after matching across patient characteristics and known risk factors for VTE.Results: Of 5 753 613 potentially eligible patients, the final sample consisted of 740 246 patients (12.8%) across 3 cohorts. Of the 740 246 study participants, 417 839 were in the KC cohort (223 986 [53.6%] men, mean [SD] age, 64.2 [13.6] years); 314 736 were in the control cohort (135 203 [43.0%] men, 42.9 [15.2] years); and 7671 were in the high-risk cohort (3502 [45.7%] men, 59.4 [14.4] years) The risk of VTE in the KC cohort was lower compared with the high-risk cohort in univariable analysis (odds ratio [OR], 0.22; 95% CI, 0.20-0.23; P<.001), multivariable analysis (OR, 0.29; 95% CI, 0.26-0.32; P<.001), and after matching across patient characteristics and known risk factors (OR, 0.52; 95% CI, 0.35-0.78; P=.001). The risk of VTE in the KC cohort was higher in the univariable analysis (OR, 2.31; 95% CI, 2.23-2.41; P<.001), lower in the multivariable analysis (OR, 0.85; 95% CI, 0.80-0.90; P<.001), and not different after matching of patient characteristics and risk factors (OR, 0.95; 95% CI, 0.89-1.01; P=.08) than that of the control cohort.Conclusions and Relevance: The results of this study provided no evidence supporting the increased risk of VTE in the KC cohort compared with the control cohort. Given the inherent risks of chemoprophylaxis, the need for prophylactic anticoagulation in patients with KC who are scheduled for surgery should be carefully considered.Level of Evidence: NA.

    View details for PubMedID 29800029

  • Repair of the Lateral Nasal Wall in Nasal Airway Obstruction: A Systematic Review and Meta-analysis. JAMA facial plastic surgery Kandathil, C. K., Spataro, E. A., Laimi, K., Moubayed, S. P., Most, S. P., Saltychev, M. 2018


    Importance: While functional rhinoplasty has been broadly studied, to our knowledge no systematic review and meta-analysis of lateral wall repair has been done previously.Objective: To evaluate the effectiveness of repair of the lateral nasal wall in adult patients with nasal airway obstruction.Data Sources: Medline, Embase, Cinahl, Central, Scopus, and Web of Science databases and reference lists were searched for clinical and observational studies.Study Selection: The selection criteria were defined according to the PICO (population, intervention, comparison, and outcome) framework. The relevant studies were selected by 2 independent reviewers based on the studies' abstracts and full texts.Data Extraction and Synthesis: Data were extracted using standardized lists chosen by the authors according to Cochrane Collaboration guidelines. The effect sizes were first calculated for each study and then pooled together using random effects synthesis. Heterogeneity was assessed using the I2 statistic, and publication bias was evaluated by the Egger test.Main Outcomes and Measures: The results were reported as pooled row mean differences in changes from preoperative to postoperative Nasal Obstruction Symptom Evaluation scores at different times of follow-up (≤3 months, >3 to 6 months, and >6 months).Results: Of 1522 initial records, 10 studies were considered relevant-all of them observational. The pooled study sample included 324 participants. When combining all the repeated measures together, the pooled effect size for functional rhinoplasty was -47.7 (95% CI, -53.4 to 42.1) points on the Nasal Obstruction Symptom Evaluation scale with high heterogeneity of 72%. The pooled effect size outcomes were similar in short- (-45.0 points [95% CI, -47.8 to -42.2 points]), mid- (-48.4 points [95% CI, -52.5 to -44.4 points]), and long-term (-49.0 points [95% CI, -62.1 to -35.8 points]) follow-ups.Conclusions and Relevance: The pooled effect size of 10 observational studies supported the effectiveness of functional rhinoplasty for the treatment of nasal airway obstruction caused by lateral nasal wall insufficiency. To improve the level of evidence, randomized clinical trials are needed.Level of Evidence: NA.

    View details for PubMedID 29543934

  • Repair of Lateral Wall Insufficiency JAMA FACIAL PLASTIC SURGERY Vaezeafshar, R., Moubayed, S. P., Most, S. P. 2018; 20 (2): 111–15


    Lateral wall insufficiency (LWI) is classified by the zone in which it occurs. Multiple techniques for treating LWI are described in the literature and are used, but no treatment approach has been widely adopted.To establish an algorithm for treatment of LWI by evaluating subjective and objective outcomes of patients who underwent LWI repair and comparing these results with those of a control group who received no specific LWI repair.This case-control study was conducted in a tertiary referral center. In group 1, there were 44 patients who underwent septorhinoplasty to repair LWI between February 1, 2014, and May 31, 2016. In group 2, there were 44 age- and sex-matched patients who underwent cosmetic septorhinoplasty without LWI repair. Data analysis was conducted from February 1, 2014, to May 31, 2016.Open septorhinoplasty.Nasal Obstruction Symptom Evaluation (NOSE) scores and LWI grades.Forty-four patients (8 men and 36 women, with a mean [SD] age of 46 [16] years) who underwent open septorhinoplasty to repair LWI and 44 age- and sex-matched patients (composed of 8 men and 36 women, with a mean [SD] age of 41 [12] years) were included in the study. The mean (SD) preoperative NOSE scores were 69.4 (22) in group 1 and 20.5 (20.8) in group 2 (P < .001). The NOSE scores in both groups significantly improved after surgery (44.7 [95% CI, -28.9 to -49.9; P < .001] and -14.5 [95% CI, -2.7 to -18.5; P = .02]), although the improvement in group 2 was not clinically significant. The mean preoperative LWI grades were higher in group 1 than in group 2 for each zone (P < .001 and P = .001) but were similar between groups for each zone after surgery. Postoperative LWI scores significantly decreased in group 1 to levels similar to that of group 2. A positive linear correlation was noted between NOSE scores and LWI grades, with the strongest correlation between preoperative zone 1 LWI grades and NOSE scores (R = 0.68). Lateral crural strut grafts were used for zone 1 LWI and alar rim grafts were used for zone 2 LWI.The LWI grading system enables surgeons to localize LWI, tailor the surgical treatment to the patient, and monitor improvements in the postoperative period.3.

    View details for DOI 10.1001/jamafacial.2017.0718

    View details for Web of Science ID 000427514100004

    View details for PubMedID 28837711

    View details for PubMedCentralID PMC5885964

  • Risk Factors for Corrective Septorhinoplasty Associated With Initial Treatment of Isolated Nasal Fracture. JAMA facial plastic surgery Li, K., Moubayed, S. P., Spataro, E., Most, S. P. 2018


    Initial treatment of nasal fractures can result in long-standing cosmetic or functional defects, but the risk factors for subsequent septorhinoplasty have not been explored.To assess the risk factors for septorhinoplasty after the initial treatment of isolated nasal fracture.This retrospective population-based analysis of US patients diagnosed with nasal fracture between January 1, 2007, and December 31, 2015, used insurance claims data from the Commercial and Medicare Supplemental categories of the Truven Health MarketScan database. Of the 340 715 patients diagnosed with nasal fracture, 78 474 were included in the final study cohort, excluding those who did not meet enrollment criteria or were diagnosed with concomitant facial fracture. Patients were classified into 1 of 4 groups according to the type and timing of treatment.Septorhinoplasty between 6 and 24 months after nasal fracture diagnosis. Explanatory variables included initial fracture treatment, demographics, comorbidities, and diagnoses associated with a preexisting nasal obstruction or defect.Most of the 78 474 patients were under 65 years of age (66 770 [85.1%]) and male (41 997 [53.5%]) and lived in an urban area (67 938 [86.6%]). Among patients with no preexisting diagnosis of nasal obstruction or defect, open treatment within 3 weeks (adjusted odds ratio [aOR], 1.76; 95% CI, 1.33-2.32) of nasal fracture and between 3 weeks and 6 months (aOR, 1.52; 95% CI, 1.14-2.04) after fracture were associated with increased risk of subsequent septorhinoplasty. In patients with a diagnosis of preexisting nasal obstruction or defect, observation (aOR, 3.56; 95% CI, 2.80-4.53), closed reduction treatment (aOR, 3.10; 95% CI, 1.93-4.96), and open treatment within 3 weeks (aOR, 2.02; 95% CI, 1.48-2.77) of fracture were all associated with increased risk of subsequent septorhinoplasty, with observation having the highest risk. Patients were also more likely to undergo subsequent septorhinoplasty if they were younger than 65 years, with the greatest risk seen in patients 18 to 34 years of age (aOR, 6.02; 95% CI, 4.26-8.50), lived in an urban area (aOR, 1.21; 95% CI, 1.01-1.44), or had a history of anxiety (aOR, 1.45; 95% CI, 1.18-1.78), but less likely if they were male (aOR, 0.82; 95% CI, 0.73-0.91).This study suggests that a preexisting diagnosis of nasal obstruction or defect and other aspects of a patient's history are factors to consider when assessing the likelihood of surgical revision of initial treatment of nasal fracture.NA.

    View details for PubMedID 29902309

  • Evaluation of Antibiotic Prophylaxis in Rhinoplasty: A Systematic Review and Meta-analysis. JAMA facial plastic surgery Nuyen, B., Kandathil, C. K., Laimi, K., Rudy, S. F., Most, S. P., Saltychev, M. 2018


    Although antibiotic prophylaxis following rhinoplasty is widespread, the evidence on antibiotic prophylaxis effectiveness and the superiority of particular administration regimens is controversial. To date, a meta-analysis on the topic has not been performed.To systematically review the association between use of preventive antibiotics and postoperative complications in patients undergoing rhinoplasty and quantify the review through meta-analysis.MEDLINE, Embase, CINAHL, Central (Cochrane Controlled Register of Trials), Scopus, and Web of Science were searched with prospectively designed search phrases on February 16, 2018. All databases were searched from database inception. Key search terms included rhinoplasty, nasal valve repair, and antibacterial agent.Randomized clinical trials (RCTs) with adults (≥18 years) undergoing rhinoplasty and including systemic antibiotic medications administered in the absence of other reasons for use of an antibiotic (eg, localized or systemic infection), without restrictions on language or the time of publication, were included in the study. Interventions of interest were classified into 3 types: (1) single-dose systemic antibiotic administered within 24 hours before the first incision, (2) multidose systemic antibiotic treatment started within 24 hours before the first incision and continuing after the operation, and (3) systemic antibiotic therapy (single dose or multidose) started within 24 hours after the first incision. The following comparisons were made: for the interventions of type 1, no antibiotic; for the interventions of types 2 or 3, no antibiotic or an intervention of type 1.Data extraction was compliant with PRISMA guidelines and Cochrane Handbook for Systematic Reviews of Interventions. Two independent reviewers assessed the relevance of the remaining records at abstract and full-text stages. Meta-analysis pooled with random-effects model.Difference in infectious complication rate between groups.A total of 262 records were identified; of these, only 5 RCTs fulfilled predetermined population, intervention, comparison, and outcome criteria. The pooled study sample consisted of 589 participants. No significant differences in outcome of preventive antibiotic therapy given either preoperatively or postoperatively were found, with a pooled risk ratio of 0.92 (95% CI, 0.35-2.43; P = .86).This study appears to be the first Cochrane-protocol systematic review and meta-analysis investigating preventive antibiotics in rhinoplasty. This study's results suggest that pooled evidence from the 5 RCTs does not support the use of preventive antibiotic therapy in rhinoplasty.1.

    View details for PubMedID 30489601

  • The 10-Item Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) for Functional and Cosmetic Rhinoplasty JAMA FACIAL PLASTIC SURGERY Moubayed, S. P., Ioannidis, J. A., Saltychev, M., Most, S. P. 2018; 20 (1): 37–42


    Rhinoplasty is a common operation in which shape and function are intimately related, whether the procedure is cosmetic, functional, or combined in nature. There is currently no properly developed and validated patient-reported outcome measure (PROM) to evaluate both functional and cosmetic components of rhinoplasty.To develop, validate, and field test the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) to evaluate both functional and cosmetic outcomes of rhinoplasty.Survey development study between October 2016 and April 2017 in a tertiary referral facial plastic and reconstructive surgery clinic. Preoperative and postoperative adult patients undergoing rhinoplasty, whether cosmetic or reconstructive, were included. A fifth group of adult nonrhinoplasty patients (facial cosmetic or reconstructive) were also included for the field test.Generated and reduced items, psychometric validation measures of the SCHNOS, and differences on scales between groups.For survey development, a total of 18 patients and 5 experts were interviewed. Of these patients, 5 were male, and 13 were female. Their mean (SD) age was 38 (14.8) years (range, 20-64 years). Field testing included 191 patients (67% were women and the mean [SD] age was 41.5 [15.8] years). A total of 10 items were included after generation, cognitive interviews, and item reduction. The 10 items represent 2 domains: nasal obstruction (first 4 items) and nasal cosmesis (last 6 items). For both domains, Cronbach α was excellent: 0.94 (95% CI, 0.92-0.95) for obstruction and 0.94 (95% CI, 0.93-0.95) for cosmesis. Exploratory factor analysis using scree plots for each domain showed that the domains are unidimensional in nature with each domain evaluating what it is intended to assess (nasal obstruction and cosmesis). The factor loading estimates were high for all the items, varying from 0.74 to 0.92. Kruskal-Wallis testing showed a significance level of P < .001 when evaluating the difference between groups (preoperative cosmetic, postoperative cosmetic, preoperative functional, postoperative functional, and nonrhinoplasty) for all individual questions, composite scores, and Nasal Obstruction Symptom Evaluation (NOSE) score. Correlations between the obstruction composite score and the NOSE scores were r = 0.943 (P < .001), which is very strong. The obstruction and cosmesis composite scores were only weakly correlated (r = 0.388; P < .001).We have developed and validated a new PROM to evaluate both functional and cosmetic rhinoplasty patients. The domains of obstruction and cosmesis were found to be internally consistent and unidimensional. The SCHNOS provides a short, validated questionnaire that we recommend for use in all functional or cosmetic rhinoplasty patients.N/A.

    View details for PubMedID 28880988

  • Comparison of the aesthetic results of two common incisions in external rhinoplasty: A randomized trial AMERICAN JOURNAL OF RHINOLOGY & ALLERGY Saedi, B., Amali, A., Taibnama, N., Most, S. P. 2016; 30 (4): 310-312


    To compare the scar outcomes of two common incisions (inverted V and stair step) by using a validated scar-outcome instrument via a randomized clinical trial.Fifty-eight consecutive cases of external rhinoplasty were randomly divided into two groups according to the type of incision. These patients were followed-up for 1 year, and the columellar scar was analyzed by using the Stony Brook Scar Evaluation Scale (SBSES) and visual analog scale (VAS) scores by an independent reviewer.Of 58 patients, 28 received the inverted V and the rest received the stair-step incision. Thirty-four participants (58.6%) were women. The mean (standard deviation) age of the participants was 26.2 ± 6.6 years. After 1 month, the scar outcome was significantly better in patients with the stair-step incision (p = 0.001) by using the SBSES, but the same was not true after 1 year (p = 0.425). However, when the VAS instead of the SBSES was used to evaluate the scar, the inverted V received a better score after 12 months in this series (p = 0.005).Despite the better aesthetic outcome of the stair-step incision in the first month after the surgery, there was no significant difference between the two incisions after 1 year. However, in this series, when the VAS instead of the SBSES was used to evaluate the scar, the inverted V received a better score after 12 months.

    View details for DOI 10.2500/ajra.2016.30.4333

    View details for Web of Science ID 000382104100022

    View details for PubMedID 27456602

  • Cost-effectiveness of Corticosteroid Nasal Spray vs Surgical Therapy in Patients With Severe to Extreme Anatomical Nasal Obstruction JAMA FACIAL PLASTIC SURGERY Teti, V. P., Akdagli, S., Most, S. P. 2016; 18 (3): 165-170


    Health insurance companies commonly require a trial of corticosteroid nasal spray prior to authorizing nasal surgery, even in patients with severe to extreme anatomical nasal obstruction, despite lack of data supporting such medical therapy.To provide a model for the comparative analysis of medical vs surgical treatment for nasal obstruction to help maximize health care benefit per dollar spent and to explore the cost-effectiveness of corticosteroid nasal spray in patients with severe to extreme nasal airway obstruction on Nasal Obstruction Symptom Evaluation (NOSE) scores.A cost-efficiency frontier economic evaluation was performed. The economic perspective was that of the health care third-party payer. Effectiveness data were obtained from NOSE score questionnaires in 179 patients. An incremental cost-effectiveness ratio was determined from the cost and efficacy data. Comparative treatment groups were medical therapy with corticosteroid nasal spray vs surgical therapy for nasal airway obstruction. The study was conducted between January 1, 2011, and December 30, 2013. The time horizon included 1, 2, and 5 years. Data analysis was completed June 1, 2015.The primary outcome was cost per quality-adjusted life-year (QALY). A modified Markov decision tree model was used. Costs were obtained from the Medicare 2015 physician fee schedule, and the mean was determined (owing to geographic disparity) along with wholesale and generic pharmaceutical pricing.Among 100 men and 79 women evaluated (mean [SD] age, 37.9 [12.9] years), surgical repair of severe nasal airway obstruction cost $6537 and produced a total of 1.15 QALYs at 1 year. Medical treatment involved a trial of corticosteroid nasal sprays, which cost $520 and produced a total of 1.03 QALYs. The surgical approach was markedly more effective but at greater short-term cost. In cases of extreme nasal obstruction, medical treatment cost $520.73 with 1.004 QALYs, demonstrating an incremental cost-effectiveness ratio (ICER) of $354 693 per QALY compared with no treatment. Conversely, surgical treatment cost $6536.64 and produced 1.136 QALYs, with an ICER of $45 633 compared with medical therapy. At 5 years, the ICER decreased from $45 634 to $8110 per QALY for surgical treatment of extreme nasal obstruction. The medical treatment ICER decreased from $354 693 per QALY at 1 year to $273 704 per QALY at 5 years. An ICER was performed and demonstrated a cost threshold of $50 554 per QALY for surgical treatment compared with $67 518 per QALY for medical treatment at 1 year for severe nasal obstruction. If the evaluation is extended to 5 years, surgical treatment cost $8984 per QALY compared with $52 571 per QALY for medical treatment. Owing to the improved effectiveness outcomes, greater cost savings per ICER was demonstrated in patients with extreme nasal obstruction.Surgical treatment for patients with severe to extreme anatomical nasal obstruction demonstrates increased short-term expense but is cost-effective in the long term. These data suggest that treatment with corticosteroid nasal spray in patients with documented severe to extreme anatomical nasal obstruction is unnecessary and results in a delay in treatment.NA.

    View details for DOI 10.1001/jamafacial.2015.2039

    View details for PubMedID 26747790

  • A Comprehensive Quality-of-Life Instrument for Aesthetic and Functional Rhinoplasty: The RHINO Scale. Plastic and reconstructive surgery. Global open Lee, M. K., Most, S. P. 2016; 4 (2)


    Currently, there is no validated quality-of-life instrument that evaluates both functional and aesthetic outcomes after rhinoplasty. The goal of this study was to develop and validate a comprehensive quality-of-life instrument to assess patient satisfaction with both functional and aesthetic outcomes after rhinoplasty.The study was designed as a prospective instrument validation study at a university-affiliated academic medical center. Inclusion criteria included patients with nasal obstructive symptoms, nasal aesthetic deformity, or both, who underwent functional and/or aesthetic rhinoplasty by a single surgeon between December 2014 and June 2015. A novel 10-item instrument (the Rhinoplasty Health Inventory and Nasal Outcomes [RHINO] scale) was developed to assess physical, mental, and social well-being after functional and/or aesthetic rhinoplasty. Instrument validation was performed by assessment of test-retest reliability, internal consistency reliability, construct validity, and concurrent validity.Twenty-two patients (10 males and 12 females) were enrolled. Mean age was 34.9 years (range: 18-67 years). All patients were followed for a minimum of 12 weeks (range: 12-23 weeks; mean: 16.5 weeks). Mean RHINO score was 51.4 ± 13.8 on the first preoperative evaluation and 51.7 ± 12.5 when repeated preoperatively on the day of surgery (r = 0.94; P < 0.001). Internal consistency demonstrated Cronbach's α value of 0.74. Mean postoperative RHINO score was 84.7 ± 14.1 (mean difference from preoperative RHINO = 33.2 ± 18.9; P < 0.001).The RHINO instrument demonstrates robust reliability and validity in assessing patient-reported satisfaction with rhinoplasty outcomes.

    View details for DOI 10.1097/GOX.0000000000000592

    View details for PubMedID 27014540

  • The Autospreader Flap for Midvault Reconstruction following Dorsal Hump Resection FACIAL PLASTIC SURGERY Moubayed, S. P., Most, S. P. 2016; 32 (1): 36-41


    Dorsal hump reduction without adequate reconstitution of the midvault can often result in cosmetic or functional problems. One of the simplest techniques to avoid these problems is the use of the excess upper lateral cartilage to reconstruct the midvault (the spreader flap or autospreader). Herein we outline the history of the technique and present the specific indications and contraindications, as well as describe our method for achieving it successfully. Case studies are presented with the specific indications. Grafting alternatives to the spreader flap are also outlined. The spreader flap technique offers multiple advantages, including maximal use of local tissues, simplicity, and airway preservation. Disadvantages are the use of an external approach and the inability to use it alone in the presence of severe asymmetries.

    View details for DOI 10.1055/s-0035-1570324

    View details for PubMedID 26862962

  • Evidence-Based Medicine: Rhinoplasty. Facial plastic surgery clinics of North America Lee, M. K., Most, S. P. 2015; 23 (3): 303-312


    Evidence-based medicine has become increasingly prominent in the climate of modern day healthcare. The practice of evidence-based medicine involves the integration of the best available evidence with clinical experience and expertise to help guide clinical decision-making. The essential tenets of evidence-based medicine can be applied to both functional and aesthetic rhinoplasty. Current outcome measures in functional and aesthetic rhinoplasty, including objective, subjective, and clinician-reported measures, is summarized and the current data is reviewed.

    View details for DOI 10.1016/j.fsc.2015.04.004

    View details for PubMedID 26208769

  • Anterior Septal Reconstruction for Treatment of Severe Caudal Septal Deviation: Clinical Severity and Outcomes OTOLARYNGOLOGY-HEAD AND NECK SURGERY Surowitz, J., Lee, M. K., Most, S. P. 2015; 153 (1): 27-33


    To report the long-term efficacy of a modified extracorporeal septoplasty technique in the treatment of anterocaudal septal deviations.Case series with chart review.Academic tertiary care medical center.Data were obtained by a retrospective review of patients treated by a single surgeon (S.P.M.) from December 2010 to April 2014. A total of 77 patients (52 male, 25 female) met inclusion criteria. The Nasal Obstruction Septoplasty Effectiveness (NOSE) scale and a visual analog scale (VAS) were administered to all patients preoperatively and at each postoperative visit. Statistical analysis was performed using a matched-pair t test comparing preoperative and postoperative NOSE and VAS scores. A recently described severity scale for nasal obstruction was applied to NOSE scores to demonstrate postoperative results.Average follow-up was 4.7 months. Average preoperative NOSE and VAS scores were 68.2 ± 17.4 and 7.2 ± 1.8, respectively, placing these patients in the "severe" symptoms classification. Average NOSE and VAS scores in the early postoperative period (1-3 months after surgery) were 21.1 ± 19.8 (P < .0001) and 2.1 ± 2.6 (P < .0001), respectively. Average NOSE and VAS scores in the late postoperative period (>3 months after surgery) were 15.8 ± 19.0 (P < .0001) and 1.4 ± 1.8 (P < .0001), respectively. Both early and late postoperative NOSE scores represented "mild" symptomatology.Anterior septal reconstruction represents a powerful method for correction of nasal valve stenosis resulting from severe anterocaudal septal deviations.

    View details for DOI 10.1177/0194599815582176

    View details for PubMedID 25883105

  • Use of Laser-Assisted Indocyanine Green Angiography for Early Division of the Forehead Flap Pedicle JAMA FACIAL PLASTIC SURGERY Surowitz, J. B., Most, S. P. 2015; 17 (3): 209-214


    The paramedian forehead flap is used to reconstruct medium to large nasal defects. The staged nature, with its vascular pedicle bridging the medial eyebrow to the nose, results in significant facial deformity. Earlier division lessens this morbidity.To quantify flap neovascularization 2 weeks after the initial flap transfer and to describe an algorithm for earlier division of the flap pedicle in select patient populations.We performed a prospective and retrospective study at the Ambulatory Surgery Center, Stanford University, Palo Alto, California, from October 14, 2014, through January 21, 2015. Patients with defects appropriate for paramedian forehead flap reconstruction had partial-thickness defects, vascularized tissue in more than 50% of the recipient bed, and no nicotine use. The patients underwent reconstructive surgery by a single surgeon from August 24, 2012, through September 12, 2014. Laser-assisted indocyanine green angiography was used for imaging before and immediately after the initial flap transfer, before pedicle division with the pedicle atraumatically clamped, and immediately after pedicle division and flap inset. Analysis of data and calculation of relative perfusion were performed using a postprocessing analysis toolkit.Perfusion was calculated using the analysis toolkit as the percentage of the area of interest relative to a predetermined reference point in normal peripheral tissue.We enrolled a total of 10 patients. The mean (SD) relative perfusion of the forehead donor site before flap transfer was 61.2% (3.4%); at initial flap transfer, 81.4% (50.2% [range, 31%-214%]) (P = .70 compared with measurement before flap transfer). The mean (SD) relative perfusion of the forehead donor site was 57.5% (21.2% [range, 32%-89%]) at the time of atraumatic pedicle clamping and 58.6% (32.4% [range, 16%-127%]) after pedicle division and flap inset (P = .85 compared with measurement before flap transfer). No flap failures or other complications were observed.In select patients (those meeting the inclusion criteria), division of the pedicle at 2 weeks after the initial flap transfer is safe. Earlier pedicle division and flap transfer reduces the duration of facial deformity for the patient.3.

    View details for DOI 10.1001/jamafacial.2015.0171

    View details for PubMedID 25880793

  • Bilobe flap with auricular cartilage graft for nasal alar reconstruction AMERICAN JOURNAL OF OTOLARYNGOLOGY Akdagli, S., Lee, M. K., Most, S. P. 2015; 36 (3): 479-483


    To report outcomes for reconstruction of the nasal ala using a bilobe flap in combination with an auricular cartilage graft.Case series with chart review.Academic tertiary care medical center.Data were obtained by a retrospective review of patients treated by a single surgeon (SPM) from January 2013 to December 2014. Patients were included who underwent reconstruction of the nasal ala using a bilobe flap in combination with an auricular cartilage graft. Clinical notes and postoperative photographs were reviewed to evaluate post-operative outcomes including flap viability, presence of iatrogenic lateral nasal wall insufficiency, alar retraction, and patient and surgeon reported satisfaction with aesthetic outcome.A total of 7 patients (3 male, 4 female) met inclusion criteria. Patient age ranged from 34 to 71 years (mean: 55 years). Follow-up time ranged from 1 to 12 months (mean: 6.3 months). All defects were located within 5 mm of the alar margin. Defect size ranged from 6 to 15 mm in largest diameter (average 11 mm). There were no incidences of flap loss, alar retraction, or iatrogenic lateral wall insufficiency, and all patients had results deemed aesthetically satisfactory by both the patient and surgeon.Defects of the nasal ala can be successfully reconstructed using a bilobe flap in combination with an auricular cartilage graft with excellent aesthetic and functional outcomes.

    View details for DOI 10.1016/j.amjoto.2015.01.022

    View details for PubMedID 25702571

  • Consistent ipsilateral development of the posterior extension of the quadrangular cartilage and bony spur formation in nasal septal deviation. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Saedi, B., Rashan, A. R., Lipan, M., Nayak, J. V., Most, S. P. 2015; 152 (3): 444-448


    Septal spurs are exceedingly common structural deformities that contribute to nasal obstruction and often require surgical correction. The posterior extension of the quadrangular cartilage (PEQC) and its relationship with septal spurs have not been previously examined. We seek to examine the anatomic and histologic relationship of the PEQC and concurrent septal spurs in patients undergoing septoplasty.Prospective cohort study.Facial plastic and rhinology center in tertiary hospital setting.Thirty patients with septal deviation are described in this series. The quadrangular cartilage and associated septal spur were removed en bloc from patients undergoing septoplasty. The length of the PEQC, the side of spur deviation, and the relationship of the PEQC to the spur (ipsilateral vs contralateral) were recorded.The mean length of the PEQC, beyond the bony-cartilaginous junction, was 30.06 ± 6.06 mm. The PEQC was present on the ipsilateral side of the spur deviation in all 30 patients (100%).At sites of septal spur formation, the quadrangular cartilage possesses an average 3-cm extension beyond its junction with the bony components of the septum. This cartilaginous extension is exclusively found on the same side of spur deviation. These findings have implications on our understanding of the ontogeny of commonly found septal spurs and deviations, as well as treatment strategies and cartilage graft harvesting.

    View details for DOI 10.1177/0194599814564549

    View details for PubMedID 25573678

  • Radiofrequency Thermotherapy vs Bone-Anchored Suspension for Treatment of Lateral Nasal Wall Insufficiency A Randomized Clinical Trial JAMA FACIAL PLASTIC SURGERY Weissman, J. D., Most, S. P. 2015; 17 (2): 84-89


    Lateral nasal wall insufficiency is a common problem with little consensus on optimal treatment.To assess the efficacy of radiofrequency (RF) thermotherapy for the treatment of lateral nasal wall collapse.A prospective randomized trial comparing RF thermotherapy with bone-anchored suspension technique (BAST) for lateral nasal wall collapse in 13 patients was conducted, with recruitment occurring between March 1, 2010, and February 28, 2012, and follow-up of 1 year. The setting was a tertiary care facial plastic and reconstructive surgery clinic at an academic hospital. Eligible patients had lateral nasal wall insufficiency and met study inclusion criteria.Participants were randomized to receive either BAST of the lateral nasal wall or RF thermotherapy to the lateral nasal wall.Outcomes were assessed 1, 3, 6, and 12 months after surgery using 2 subjective patient outcomes surveys (the Nasal Obstructive Symptom Evaluation and a visual analog scale) and a physician-derived assessment of lateral wall collapse.Significant improvements in symptom scores were seen postoperatively for both treatment arms, though more consistently in the radiofrequency group. One month postoperatively, the mean (SD) drop in NOSE scores was 52.5 ± 22.2 and 51.7 ± 26 (P = .96) for the BAST and RF groups, respectively. Similar results were noted at 6 and 12 months postoperatively (56.7 ± 38.2 vs 50 ± 14.7 [P = .76] and 53.3 ± 20.2 vs 56.7 ± 18.9 [P = .84] at 6 and 12 months, respectively). No statistical difference in change in NOSE scores occurred between the 2 groups at 1, 6, or 12 months postoperatively. Likewise, the drop in VAS scores between the 2 treatment groups was similar at each time point. One month postoperatively, the mean (SD) drop in VAS scores was 5.1 ± 2.8 and 4.8 ± 2.6 (P = .90). Similar results were noted at 6 and 12 months postoperatively (5.8 ± 3.4 vs 4.9 ± 3.1 [P = .72] and 5.5 ± 3.1 vs 5.4 ± 1.3 [P = .96] at 6 and 12 months, respectively). Using a physician-derived score, significant improvement was seen in patients in the RF group at 1 month (P = .005), 6 months (P = .002), and 12 months (P = .03). For the BAST group, significant improvement was noted only at the 1-month postoperative visit (P = .007). Comparison of RF vs BAST revealed significant improvement in the RF group over the BAST group at 12 months (P = .04). The other periods revealed no significant differences between the two.Radiofrequency thermotherapy is a viable alternative option for lateral nasal wall collapse, both in terms of improvements in symptoms and physical examination, with suggested evidence for efficacy at least as good as that for bone-anchored Identifier: ISRCTN14219489.

    View details for DOI 10.1001/jamafacial.2014.1384

    View details for PubMedID 25633257

  • Spreader flaps do not change early functional outcomes in reduction rhinoplasty: A randomized control trial AMERICAN JOURNAL OF RHINOLOGY & ALLERGY Saedi, B., Amaly, A., Gharavis, V., Yekta, B. G., Most, S. P. 2014; 28 (1): 70-74


    Internal nasal valve collapse is a preventable complication of rhinoplasty, for which the spreader graft is the gold standard. More recently, the spreader flap technique has been espoused as an alternative to spreader grafting. Here, we evaluated the efficacy of this technique in a randomized trial setting.The autospreader was used in 32 patients who were candidates for primary rhinoplasty; 34 who did not undergo a spreader flap procedure were recruited as a control group. Acoustic rhinometry was used in every patient preoperatively and 1 year postoperatively. Average volume and minimal cross-sectional area (MCA) of the nose and findings were collected. Also, the pre- and postoperative patients' subjective assessment about their satisfaction from their appearance and nasal obstruction were evaluated according to visual analog scale (VAS).Among the study group patients, 46 (69.7%) were female and 20 (30.3%) were male subjects. Their mean age was 50/5 ± 6/24 years. The difference in MCA in the control group was -0.1 and +0.6 (on right and left sides, respectively), and in the spreader flap group it was -0.03 and +0.05, which showed an increase in MCA in the left side and a decrease in the opposite side of both groups. However, their difference was not statistically significant (p = 0.50). Also, the differences between preoperative and postoperative VAS were not significant in either nasal obstruction (p = 0.68) and cosmetic satisfaction (p = 0.38).Spreader flap is an attractive technique in preserving the middle vault in nasal plastic surgery. However, its effect needs more evaluation.

    View details for DOI 10.2500/ajra.2014.28.3991

    View details for Web of Science ID 000330953900027

    View details for PubMedID 24717890

  • Complications of Rhinoplasty FACIAL PLASTIC SURGERY CLINICS OF NORTH AMERICA Surowitz, J. B., Most, S. P. 2013; 21 (4): 639-?


    This article provides a concise description of common complications of rhinoplasty, recommendations for avoidance, and corrective techniques. The surgeon must have a comprehensive understanding of nasal anatomy and effects of surgical maneuvers to help avoid complications. Meticulous history, physical examination, and standardized photographic documentation are central to preoperative evaluation and surgical planning for rhinoplasty. Photographic documentation is useful to illustrate preexisting preoperative asymmetries. Appropriate preoperative counseling regarding appropriate postoperative expectations as well as all risks, benefits, and alternatives is critical. Any complications should be openly discussed with the patient.

    View details for DOI 10.1016/j.fsc.2013.07.003

    View details for Web of Science ID 000327572000010

    View details for PubMedID 24200382

  • Development of a Severity Classification System for Subjective Nasal Obstruction JAMA FACIAL PLASTIC SURGERY Lipan, M. J., Most, S. P. 2013; 15 (5): 358-361


    IMPORTANCE Nasal airway obstruction is a common presenting symptom in otolaryngology and facial plastic surgery practices, and the potential for multiple contributing causes requires extensive evaluation. OBJECTIVE To develop a classification system for nasal obstruction using a subjective, validated quality-of-life instrument. DESIGN, SETTING, AND PARTICIPANTS Retrospective study of patients' responses on the Nasal Obstruction Symptom Evaluation (NOSE) instrument performed from July 2011 through May 2012. All patients were seen at a university-based tertiary medical center. MAIN OUTCOMES AND MEASURES Scores from patients with or without nasal obstruction were used to develop a classification system after receiver operating characteristic curve analysis. The classification subdivides nasal obstruction scores into a range of defined classes. RESULTS Data analysis was performed using results from 345 patients. A score of 30 on the NOSE survey best differentiated patients with and without nasal obstruction. This threshold also provided intervals used to define the other class ranges. Patients were categorized as having mild (range, 5-25), moderate (range, 30-50), severe (range, 55-75), or extreme (range, 80-100) nasal obstruction, depending on responses on the NOSE survey. CONCLUSIONS AND RELEVANCE The NOSE scale is an important tool for gauging symptoms in patients with nasal obstruction. The proposed classification system will improve patient care by providing a framework for the severity of their symptoms and helping them understand potential treatment effects. If the classification is used in future outcomes research, it will allow physicians to better understand the study patient population and the effect of treatment on each severity class. LEVEL OF EVIDENCE NA.

    View details for DOI 10.1001/jamafacial.2013.344

    View details for PubMedID 23846399

  • Transient, afferent input-dependent, postnatal niche for neural progenitor cells in the cochlear nucleus. Proceedings of the National Academy of Sciences of the United States of America Volkenstein, S., Oshima, K., Sinkkonen, S. T., Corrales, C. E., Most, S. P., Chai, R., Jan, T. A., Cheng, A. G., Heller, S. 2013; 110 (35): 14456-14461


    In the cochlear nucleus (CN), the first central relay of the auditory pathway, the survival of neurons during the first weeks after birth depends on afferent innervation from the cochlea. Although input-dependent neuron survival has been extensively studied in the CN, neurogenesis has not been evaluated as a possible mechanism of postnatal plasticity. Here we show that new neurons are born in the CN during the critical period of postnatal plasticity. Coincidently, we found a population of neural progenitor cells that are controlled by a complex interplay of Wnt, Notch, and TGFβ/BMP signaling, in which low levels of TGFβ/BMP signaling are permissive for progenitor proliferation that is promoted by Wnt and Notch activation. We further show that cells with activated Wnt signaling reside in the CN and that these cells have high propensity for neurosphere formation. Cochlear ablation resulted in diminishment of progenitors and Wnt/β-catenin-active cells, suggesting that the neonatal CN maintains an afferent innervation-dependent population of progenitor cells that display active canonical Wnt signaling.

    View details for DOI 10.1073/pnas.1307376110

    View details for PubMedID 23940359

  • Validation of a grading system for lateral nasal wall insufficiency. Allergy & rhinology (Providence, R.I.) Tsao, G. J., Fijalkowski, N., Most, S. P. 2013; 4 (2): e66-8


    This study was designed to validate a grading scheme for lateral nasal wall insufficiency with interrater and intrarater reliability measures. Representative endoscopic videos depicting varied degrees of lateral nasal wall insufficiency were collated into a 30-clip video (15 clips in duplicate). This was rated by five reviewers for a total of 150 observations. Interrater and intrarater reliability were determined using Fleiss kappa and intraclass correlation coefficient (ICC) statistics, respectively. Good agreement was established between reviewers (interrater reliability), with a Fleiss kappa of 0.7733 (p < 0.01). Analysis of intrarater variability with the ICC revealed a very strong agreement (ICC = 0.88; p < 0.01). The proposed grading system is shown to have good interrater and intrarater reliability. It provides a reliable instrument for assessing lateral wall insufficiency.

    View details for DOI 10.2500/ar.2013.4.0054

    View details for PubMedID 24124639

  • The Double-Half Bilobe Flap: An Alternative for Midline Defects of the Tip and Supratip Region OTOLARYNGOLOGY-HEAD AND NECK SURGERY Woodard, C. R., Most, S. P. 2012; 147 (4): 668-670

    View details for DOI 10.1177/0194599812455313

    View details for Web of Science ID 000314283700012

    View details for PubMedID 23015636

  • Intraoperative Angiography Using Laser-Assisted Indocyanine Green Imaging to Map Perfusion of Forehead Flaps ARCHIVES OF FACIAL PLASTIC SURGERY Woodard, C. R., Most, S. P. 2012; 14 (4): 263-269


    To quantify the perfusion of forehead flaps and compare blood flow from the supratrochlear artery with vascular in-growth at the recipient bed.Patients with nasal defects necessitating forehead flap closure were prospectively enrolled to study flap perfusion dynamics. Laser-assisted indocyanine green angiography was used to obtain the measurements. When possible, patients returned for weekly recording of flap perfusion from the recipient bed with the pedicle clamped. Analysis of the data was performed using SPY-Q software.Six patients were prospectively enrolled. All patients had intraoperative angiography at flap transfer, pedicle division, and at least 1 postoperative visit between these surgical procedures. Flow was measured as a percentage of perfusion of normal surrounding tissue. A higher percentage of perfusion was seen at the distal end of the flap when compared with the pedicle when the pedicle was clamped. This phenomenon was seen as early as the 1-week postoperative visit.This is the first study attempting to quantify forehead flap perfusion from the supratrochlear artery and recipient bed. Data obtained suggest evidence of vascular in-growth 1 week following flap transfer.

    View details for DOI 10.1001/archfacial.2011.1540

    View details for Web of Science ID 000306380400007

    View details for PubMedID 22351848

  • Preservation of the Nasal Valve Area With a Lateral Crural Hinged Flap: A Cadaveric Study AESTHETIC PLASTIC SURGERY Sazgar, A. A., Woodard, C., Most, S. P. 2012; 36 (2): 244-247


    Overresection of the lateral crura of the lower lateral cartilages is referred to as the most common cause of nasal valve collapse after rhinoplasty. The modern approach to functional rhinoplasty recognizes the importance of the tip framework's structural integrity and preserves tip support.Traditional cephalic resections of lateral crura were performed on one side of five adult cadaver noses. On the opposite sides, hinged flaps of lateral crura were created. The noses were cross-sectioned at or near the internal nasal valve level, and the difference between the two sides was described.The study findings demonstrated improvement in the postoperation nasal valve area of the hinged flap side compared with the cephalic trim side.This preliminary study showed that the hinged flap is an option in nasal tip reduction surgery that may provide improved long-term aesthetic and functional outcomes through preservation of the nasal valve area.

    View details for DOI 10.1007/s00266-011-9797-6

    View details for Web of Science ID 000302411700004

    View details for PubMedID 21853403

  • Stabilization of nasal tip support in nasal tip reduction surgery. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Sazgar, A. A., Most, S. P. 2011; 145 (6): 932-934

    View details for DOI 10.1177/0194599811417227

    View details for PubMedID 21817158

  • Nasal Airway Preservation Using the Autospreader Technique Analysis of Outcomes Using a Disease-Specific Quality-of-Life Instrument ARCHIVES OF FACIAL PLASTIC SURGERY Yoo, S., Most, S. P. 2011; 13 (4): 231-233


    To measure the efficacy of a specific midvault reconstruction technique (the autospreader flap) in dorsal reductive rhinoplasty with a validated quality-of-life instrument.A prospective observational outcomes study of patients desiring reduction of the nasal dorsum who either (1) had no breathing obstruction, who underwent purely aesthetic rhinoplasty, or (2) had concomitant severe nasal obstruction due to septal deviation, internal valve narrowing, and/or turbinate hypertrophy, who subsequently underwent combined functional and aesthetic rhinoplasty. Preoperative and postoperative evaluation was performed using the Nasal Obstruction Symptoms Evaluation (NOSE) scale.Thirty-eight patients completed preoperative and postoperative evaluation. No complications occurred. Patients in the purely aesthetic group were noted to have low preoperative NOSE scores, with no change postoperatively. There was a significant improvement in mean NOSE score postoperatively for the combined functional and aesthetic group (P < .001).Midvault reconstruction using the autospreader graft may help prevent postoperative nasal obstruction due to midvault collapse. Combining this procedure with dorsal reduction in functional rhinoplasty patients with traditional airway reconstruction techniques is effective in improving nasal airway function as measured by a patient-based, disease-specific quality-of-life instrument.

    View details for DOI 10.1001/archfacial.2011.7

    View details for PubMedID 21339471

  • Correlation of Asymmetric Facial Growth with Deviated Nasal Septum LARYNGOSCOPE Kim, Y. M., Rha, K., Weissman, J. D., Hwang, P. H., Most, S. P. 2011; 121 (6): 1144-1148


    To evaluate the correlation between growth differences of the face and nasal septal deviation, and to evaluate whether developmental differences of the face have an effect on nontraumatic nasal septal deviation (DNS).Retrospective study.Twenty-five patients with DNS who underwent facial aesthetic surgery and had an ostiomeatal unit-computed tomography (OMU-CT) scan and photos for facial analysis were included in the study. Coronal views of the OMU-CT scan where the nasal septum was most severely deviated were selected and from which five parameters (angle of septal deviation [ASD], angle of nasal floor [ANF], angle of lateral nasal wall [ALW], angle of inferior turbinate [AIT], and width of IT [WIT]) were measured. Preoperative frontal views of the patients were analyzed by comparing the distances between the following points on both sides of the faces: midsagittal plane to Zygion (MSP-Zy), Glabella to Exocanthion (G-Ex), Exocanthion to Cheilion (Ex-Ch), and Zygion to Cheilion (Zy-Ch).The differences between the right and left MSP-Zy, G-Ex, and Ch-Zy distance were significantly associated with the direction of septal deviation. The difference between the right and left AIT and WIT were also significantly associated with the direction of septal deviation. Using bivariate correlation, it was found that the absolute difference between the right and left MSP-Zy, G-Ex, and WIT showed significant correlation with the amount of septal deviation.We demonstrate that there is a strong relationship between deviated nasal septum and facial growth asymmetry.

    View details for DOI 10.1002/lary.21785

    View details for Web of Science ID 000291259900004

    View details for PubMedID 21495046

  • Effects of Corticosteroids on Functional Recovery and Neuron Survival After Facial Nerve Injury in Mice ARCHIVES OF FACIAL PLASTIC SURGERY Lieberman, D. M., Jan, T. A., Ahmad, S. O., Most, S. P. 2011; 13 (2): 117-124


    To assess the effects of corticosteroid administration on functional recovery and cell survival in the facial motor nucleus (FMN) following crush injury in adult and juvenile mice and to evaluate the relationship between functional recovery and facial motoneuron survival.A prospective blinded analysis of functional recovery and cell survival in the FMN after crush injury in juvenile and adult mice was carried out. All mice underwent a unilateral facial nerve crush injury and received 7 doses of daily injections. Adults received normal saline or low-dose or high-dose corticosteroid treatment. Juveniles received either normal saline or low-dose corticosteroid treatment. Whisker function was monitored to assess functional recovery. Stereologic analysis was performed to determine neuron and glial survival in the FMN following recovery.Following facial nerve injury, all adult mice recovered fully, while juvenile mice recovered slower and incompletely. This corresponded to a significantly greater neuron loss in the FMN of juveniles compared with adults. Corticosteroid treatment slowed functional recovery in adult mice. This corresponded with significantly greater neuron loss in the FMN in corticosteroid-treated mice. In juvenile mice, corticosteroid treatment showed a trend, which was significant at several time points, toward a more robust functional recovery compared with controls.Corticosteroid treatment slows functional recovery and impairs neuron survival following facial nerve crush injury in adult mice. The degree of motor neuron survival corresponds with functional status. In juvenile mice, crush injury results in overall poor functional recovery and profound cell loss in the FMN. With low-dose corticosteroid treatment, there is a significantly enhanced functional recovery after injury in these mice (P < .05).

    View details for DOI 10.1001/archfacial.2010.98

    View details for PubMedID 21079107

  • Comparative Computation of Orbital Volume From Axial and Coronal CT Using Three-Dimensional Image Analysis OPHTHALMIC PLASTIC AND RECONSTRUCTIVE SURGERY Kwon, J., Barrera, J. E., Most, S. P. 2010; 26 (1): 26-29


    Volume measurements calculated from axial and coronal CT scans were compared to determine which method more accurately determines orbital volume.Thirty facial CT scans were used to measure 30 normal orbits using an image analysis program (Dextroscope, Singapore). The 3-dimensional volumes determined from axial scans and coronal scans were analyzed. The coronal scan volume measurements were further subdivided based on anterior limit criteria (termed C1 and C2). Three novel cephalometric angular measurements of the anterior orbital aperture were calculated and used to analyze the volumetric methodologies described above.The calculated orbital volume was greatest on axial scan, 25.6 +/- 2.4 ml, followed by volume based on coronal calculations with C1 delimitation (23.8 +/- 2.9 ml) and C2 delimitation (16.6 +/- 2.2 ml). We measured 3 novel orbital aperture angles on sagittal 3-dimensional reconstruction images, anterovertical, posterovertical, and horizontal orbital aperture angles that are related to the volume measurement underestimation.The orbital volume from coronal scans is underestimated compared with that from the axial scans, and the criterion for anterior limit of measurement can affect volume determination. Three novel cephalometric angle measurements may account for inaccuracies in orbital volume measurements.

    View details for DOI 10.1097/IOP.0b013e3181b80c6a

    View details for PubMedID 20090480

  • Decompression of the Orbital Apex An Alternate Approach to Surgical Excision for Radiographically Benign Orbital Apex Tumors ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Almond, M. C., Cheng, A. G., Schiedler, V., Sires, B. S., Most, S. P., Jian-Amadi, A. 2009; 135 (10): 1015-1018


    To study the outcome of patients with orbital apex lesions treated with endoscopic decompression alone.Retrospective medical chart review with a mean follow-up of 25.6 months.Departments of Ophthalmology and Otolaryngology, University of Washington, Seattle.Five individuals seen at the University of Washington Medical Center from November 2003 through December 2005 with visual disturbance caused by orbital apex lesions as documented by preoperative magnetic resonance imaging or computed tomographic scan.All patients underwent endoscopic decompression of the medial wall of the orbital apex with incision of the periorbita.Postoperative visual acuity, presence or absence of a relative afferent pupillary defect, color vision, and visual field were recorded.All 5 patients presented with visual field deficits, 4 of whom improved postoperatively. Three patients had dyschromatopsia preoperatively, 2 of whom improved postoperatively. Visual acuity improved or stabilized in 4 of 5 patients postoperatively. One patient had progressive visual loss during the course of her follow-up, which, after obtaining postoperative imaging, was attributed to inadequate decompression of the apex at its most posterior aspect. This same patient also developed postoperative sinusitis that resolved with antibiotic treatment. Two patients developed diplopia, 1 in primary gaze requiring treatment with prismatic lenses. All patients presented with and maintained normal intraocular pressures.Orbital apex lesions can often be effectively and relatively safely treated by endoscopic decompression alone.

    View details for Web of Science ID 000270777800010

    View details for PubMedID 19841341

  • Trends in Functional Rhinoplasty ARCHIVES OF FACIAL PLASTIC SURGERY Most, S. P. 2008; 10 (6): 410-413

    View details for PubMedID 19018063

  • Volumetric imaging of the malar fat pad and implications for facial plastic surgery ARCHIVES OF FACIAL PLASTIC SURGERY Barrera, J. E., Most, S. P. 2008; 10 (2): 140-142

    View details for Web of Science ID 000254057400011

    View details for PubMedID 18347243

  • Prospective examination of the efficacy of 2 topical over-the-counter cosmeceutical creams for rapid treatment of facial rhytids ARCHIVES OF FACIAL PLASTIC SURGERY Most, S. P. 2007; 9 (5): 340-343


    To examine the efficacy of 2 over-the-counter cosmeceutical creams in reducing facial rhytids-Freeze 24/7 Anti-Wrinkle Cream (Freeze 24/7 International LLC, New York, New York) and LiftFusion Micro-Injected M-Tox Transdermal Face Lift (Fusionbeauty, Inc, Boca Raton, Florida)-against placebo (Nutraderm Therapeutic Lotion; Healthpoint, Inc, San Antonio, Texas).A prospective, blinded clinical trial was performed on 42 subjects, comparing 2 cosmeceutical creams that each represent a class of purported rapid rhytid reduction formulas with placebo. Independent analysis by 2 facial plastic surgeons was performed as well as completion of self-assessment questionnaires by the participants.No complications occurred. Self-evaluation of cream effectiveness was no different for test creams compared with placebo. Neither cream produced substantial reduction of rhytids when examined critically by 2 independent facial plastic surgeons. Stratification by Glogau (photoaging) class did not reveal increased effectiveness based on rhytid severity.Two typical over-the-counter rhytid reduction products are ineffective at substantially reducing facial rhytids.

    View details for Web of Science ID 000249515600006

    View details for PubMedID 17875827

  • Analysis of outcomes after functional rhinoplasty using a disease-specific quality-of-life instrument ARCHIVES OF FACIAL PLASTIC SURGERY Most, S. P. 2006; 8 (5): 306-309


    To measure the efficacy of functional rhinoplasty techniques with a validated quality-of-life instrument.Prospective observational outcomes study of patients with severe nasal obstruction owing to septal deviation, internal or external valve collapse, and turbinate hypertrophy who subsequently underwent functional rhinoplasty. Preoperative and postoperative evaluations were performed using the Nasal Obstruction Symptoms Evaluation scale.Forty-one patients completed preoperative and postoperative evaluations. No complications occurred. There was a significant improvement in mean Nasal Obstruction Symptoms Evaluation score postoperatively for the entire cohort (P<.01). Nasal Obstruction Symptoms Evaluation scores were also examined based on the procedure performed, such as spreader grafting, septoplasty, external valve suspension, and turbinectomy. Each subgroup also demonstrated airway improvement.Functional rhinoplasty techniques are effective in improving nasal airway function as measured by a patient-based, disease-specific, quality-of-life instrument. The specific techniques considered to treat nasal obstruction can be tailored to address the areas of concern, including septal deviation, internal or external valve collapse, and turbinate hypertrophy.

    View details for Web of Science ID 000240593300003

    View details for PubMedID 16982985

  • The Upper Airway Nasal Complex: Structural Contribution to Persistent Nasal Obstruction. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Williams, R., Patel, V., Chen, Y., Tangbumrungtham, N., Thamboo, A., Most, S. P., Nayak, J. V., Liu, S. Y. 2019: 194599819838262


    OBJECTIVE: To determine the contribution of the nasal floor and hard palate morphology to nasal obstruction for nonresponders to prior intranasal surgery.STUDY DESIGN: Retrospective case-control study.SETTING: Tertiary academic center.METHODS: Institutional review board-approved, retrospective institutional database analysis was obtained of a cohort of 575 patients who presented with nasal obstruction over a 21-year period. Of the patients, 89 met inclusion criteria: 52 were placed into the experimental group, defined as having persistent nasal obstruction following endoscopic sinus surgery (ESS), septoplasty, nasal valve repair, and/or turbinoplasty using validated subjective questionnaires, and 37 were placed into the control group, defined as having resolution of subjective nasal obstruction. Computed tomography imaging was presented to 3 blinded experts, who measured numerous nasal airway and hard palate morphology parameters, including anterior nasal floor width, anterior maxillary angle, maxilla width, anterior nasal floor width, and palatal vault height. Standard demographic information, comorbidities, perioperative 22-item Sinonasal Outcome Test (SNOT-22), and follow-up time were also assessed. Wilcox rank sum analysis or t test was performed where appropriate.RESULTS: Follow-up ranged from 2 to 36 months following surgical intervention. Several skeletal characteristics within the upper airway were significantly associated with persistent nasal obstruction, including acute maxillary angle ( P = .035), narrow maxillary width ( P = .006), and high arched palate ( P = .004).CONCLUSION: Persistent nasal obstruction may be seen in patients with narrow, high arched hard palate despite prior nasal surgical intervention and may benefit from additional skeletal remodeling procedures such as maxillary expansion.

    View details for PubMedID 30909809

  • Translation, cultural adaptation and validation of the SCHNOS in French. Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale Atallah, M., Milad, D., Benamer, Y., Saltychev, M., Most, S. P., Moubayed, S. P. 2019; 48 (1): 17


    BACKGROUND: The Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) is a validated questionnaire that assesses functional and aesthetic outcomes of rhinoplasty patients. There are 274 million French speakers worldwide, and this questionnaire is currently not available in French. The purpose of this study was to translate, adapt, and validate a French version of the SCHNOS questionnaire.METHODS: The SCHNOS questionnaire was translated from English to French according to international guidelines. Ten French-speaking rhinoplasty patients were interviewed in order to evaluate the understandability and acceptability of the translation and produce a final version. The final version was administered prospectively to 25 rhinoplasty patients and 25 controls at two-week intervals. It was then administered to 165 consecutive patients. Psychometric properties were evaluated using the Item Reponse Theory (IRT) and confirmatory factor analysis (CFA).RESULTS: Three items from the original SCHNOS were modified to produce the French-SCHNOS (F-SCHNOS). Discrimination abilities of F-SCHNOS-O and F-SCHNOS-C were perfect, with values of 2.18(p<0.001, 95% CI 1.74 to 2.62) for SCHNOS-O and 2.62(p<0.001, 95% CI 2.03 to 3.21). Internal consistency was high, with Cronbach's alpha of 0.93 for F-SCHNOS-O and 0.95 for F-SCHNOS-C. IRT showed good psychometric properties with almost each step up or down across the scale associating with meaningful differences in outcome severity. All four SCHNOS-O items were equally "important" in defining the total score. The F-SCHNOS-C total score was defined by mostly four out of six items.CONCLUSIONS: The SCHNOS was translated, adapted, and psychometrically validated for use in a French-speaking population.

    View details for PubMedID 30894227

  • Postoperative Complications of Paramedian Forehead Flap Reconstruction. JAMA facial plastic surgery Chen, C. L., Most, S. P., Branham, G. H., Spataro, E. A. 2019


    Importance: Paramedian forehead flaps are commonly used to reconstruct facial defects caused by skin cancers. Data are lacking on the complications from this procedure, postoperative outcomes, and association of cancer diagnosis with rate of deep venous thrombosis (DVT).Objectives: The primary objective was to determine complication rates after paramedian forehead flap reconstruction for defects resulting from resection of facial cancers; and the secondary objective was to determine patient factors and complications that are associated with readmission.Design, Setting, and Participants: Retrospective cohort study of patients who underwent paramedian forehead flap reconstruction for skin cancer reconstruction from January 1, 2007, through December 31, 2013. Data analysis took place between October 1, 2017, and June 1, 2018.Main Outcomes and Measures: Complication rates including DVT, emergency department visits, and hospital readmissions.Results: A total of 2175 patient were included in this study; mean (SD) age, 70.3 (13.4) years; 1153 (53.5%) were men. Postoperative DVT occurred in 10 or fewer patients (≤0.5%); postoperative bleeding in 30 (1.4%), and postoperative infection in 63 (2.9%). Most patients went home on the day of surgery (89.6%; n=1949), while 10.4% stayed one or more days in the hospital (n=226). Overnight admission was associated with tobacco use (odds ratio [OR], 1.65; 95% CI, 1.11-2.44), hypothyroidism (OR, 1.93; 95% CI, 1.10-3.39), hypertension (OR, 1.82; 95% CI, 1.29-2.57), ear cartilage graft (OR, 2.20; 95% CI, 1.51-3.21), and adjacent tissue transfer (OR, 1.88; 95% CI, 1.33-2.67). Risk factors strongly associated with immediate return to the emergency department or readmission within 48 hours of surgery included postoperative bleeding (OR, 13.05; 95% CI, 4.24-40.16), neurologic disorder (OR, 4.11; 95% CI, 1.12-15.09), and alcohol use (OR, 7.70; 95% CI, 1.55-38.21).Conclusions and Relevance: In this study, the most common complication of paramedian forehead flap reconstruction was infection. Risk factors for readmission included development of postoperative bleeding, having a neurologic disorder, and alcohol use. Deep venous thrombosis was a rare complication. Because bleeding is a more common complication in this patient population, discretion should be used when deciding to administer anticoagulation medication to low- to medium-risk patients prior to surgery.Level of Evidence: NA.

    View details for PubMedID 30869737

  • Minimal Clinically Important Difference of the Standardized Cosmesis and Health Nasal Outcomes Survey. Aesthetic surgery journal Kandathil, C. K., Saltychev, M., Abdelwahab, M., Spataro, E. A., Moubayed, S. P., Most, S. P. 2019


    BACKGROUND: The minimal clinically important difference (MCID) for the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) has not been determined.OBJECTIVE: To define the MCID for both domains of the SCHNOS questionnaire.METHODS: This prospective cohort study included patients who underwent functional, cosmetic, or combined rhinoplasty operation from June 2017-June 2018 at a tertiary referral center. The average preoperative, postoperative, and change in scores were calculated for NOSE and SCHNOS. Anchor-based MCIDs were estimated for both SCHNOS subscales to define change in obstruction and cosmesis perceived after the rhinoplasty.RESULTS: Eighty-seven patients (69% women, 31% males) with mean age (SD) of 38 years (14.7) at the time of surgery. The mean postoperative follow up period (SD) was 145 days (117). The mean preoperative score (SD) for NOSE was 52 (32), SCHNOS-O score 55 (33), and SCHNOS-C score was 50 (26) points. Postoperatively, the NOSE score was 23 (22), SCHNOS-O score 24 (23), and SCHNOS-C score was 13 (18) points. The mean change in scores (SD) for NOSE, SCHNOS-O and SCHNOS-C were -29 (37), -31 (38), and -37 (28), respectively. The calculated MCID for SCHNOS-O was 26 (16) and for SCHNOS-C was 22 (15) points. The MCID for NOSE was 24 (13) points. A sensitivity test for the patients with follow-up ≥3 months showed only slightly different MCID estimates: 28 (17) for SCHNOS-O, 18 (13) for SCHNOS-C, and 24 (15) points for NOSE.CONCLUSION: For the obstruction domain SCHNOS-O, the MCID was 28 points. For the cosmetic domain SCHNOS-C, the MCID was 18 points.

    View details for PubMedID 30873533

  • Association of Periosteal Sweeping vs Periosteal Preservation With Early Periorbital Sequelae Among Patients Undergoing External Perforating Osteotomy During Rhinoplasty. JAMA facial plastic surgery El-Sisi, H., Abdelwahab, M., Most, S. P. 2019


    Importance: Periorbital sequelae are a significant source of early postoperative morbidity after rhinoplasty, particularly after an osteotomy is performed.Objective: To compare postoperative periorbital sequelae after external perforating lateral osteotomy in rhinoplasty using a periosteal sweeping vs a periosteal preserving approach.Design, Setting, and Participants: This prospective cohort study conducted at a tertiary referral center located in Mansoura, Egypt, included 28 patients who underwent external perforating lateral osteotomy in open rhinoplasty between January and May 2017.Exposures: Periosteal sweeping was performed on one side of the nose and periosteal preservation was performed on the other side during external perforating lateral osteotomy.Main Outcomes and Measures: Periorbital sequelae, including eyelid edema, periorbital ecchymosis, and subconjunctival hemorrhage, were assessed on both sides of the face on postoperative days 1, 7, and 21 by 2 independent surgeons using the scale first proposed by Kara and Gokalan in 1999. The scales for eyelid edema ranged from 0 to 4, for ecchymosis from 0 to 4, and for subconjunctival hemorrhage from 0 to 2, with higher values indicating greater edema, ecchymosis, and hemorrhage, respectively. Differences in the 3 time points and differences between the 2 osteotomy methods were analyzed.Results: In total, 19 men and 9 women with a mean (SD) age of 23.7 (3.9) years were enrolled. All patients showed significant decreases in eyelid edema on postoperative days 7 and 21 compared with day 1 (1.71 and 1.39 vs 2.89 for the swept side, and 1.86 and 1.46 vs 2.68 for the preserved side; both P<.05) and in periorbital ecchymosis (2.02 and 1.13 vs 2.86 for swept side, and 2.05 and 1.13 vs 2.82 for the preserved side; both P<.05). A significant decrease in subconjunctival hemorrhage was observed on day 21 compared with days 1 and 7 (1.79 vs 2.11 and 2.11 for the swept side, and 1.71 vs 2.14 and 2.14 for the preserved side; both P<.05). The mean rank score for eyelid edema on day 1 for the swept side was significantly higher than that for the preserved side (33.18 vs 23.82, P=.02), and the mean rank score for periorbital ecchymosis on the swept side was significantly higher than that for the preserved side (33.59 vs 23.41, P=.01). Although both eyelid edema and periorbital ecchymosis appeared to remain greater on the swept side on postoperative days 7 and 21, the differences no longer reached statistical significance. Periosteal preservation was not associated with minimizing subconjunctival hemorrhage postoperatively.Conclusions and Relevance: This study suggests that lateral nasal osteotomy is associated with varying degrees of eyelid edema, periorbital ecchymosis, and subconjunctival hemorrhage. Compared with sweeping the periosteum, preserving the periosteum in an external perforating lateral osteotomy was associated with less eyelid edema and periorbital ecchymosis in the early postoperative period.Level of Evidence: 2.

    View details for PubMedID 30789649

  • Neovascularization Perfusion of Melolabial Flaps Using Intraoperative Indocyanine Green Angiography. JAMA facial plastic surgery Abdelwahab, M., Spataro, E. A., Kandathil, C. K., Most, S. P. 2019


    Importance: Assessment of melolabial flap perfusion using indocyanine green (ICG) angiography for nasal reconstruction has not been previously described.Objective: To assess melolabial flap relative perfusion using ICG angiography in nasal reconstruction and highlight its clinical relevance.Design, Setting, and Participants: In this retrospective case series at a tertiary referral center, 10 patients undergoing melolabial flap reconstruction of nasal defects between January 2015 to April 2018 with flap perfusion were assessed by ICG angiography.Exposures: Indocyanine green angiography was performed to assess melolabial flap perfusion at second stage surgery after temporary clamping of the pedicle and after pedicle division and flap inset.Main Outcomes and Measures: Flap perfusion in relation to a reference point on the cheek was calculated after both pedicle clamping and division by 2 methods: (1) ingress (arterial inflow) and egress (venous outflow) flap-to-cheek ratio; (2) flap-to-cheek perfusion (fluorescence) ratio at 3 time points (midpoint of ICG flap inflow, maximum [peak] fluorescence, and midpoint of ICG outflow), and their calculated mean. Correlations of perfusion with time between stages, and patient factors were performed; perfusion parameters after temporary pedicle clamping and after division and flap inset were compared.Results: Ten patients (mean [SD] age, 66 [7.5] years) were enrolled with a mean (SD) interval of 23 (4) days between first and second surgery. No correlation existed between perfusion parameters and time interval between first and second stage, or any other patient factors. Of the different perfusion parameters, a statistically significant difference was observed when comparing temporary clamping and postdivision mean (SD) flap-to-cheek perfusion ratio (0.89 [0.22] and 0.80 [0.19]; 95% CI, 4.1-12.6; P=.001), as well as mean (SD) peak perfusion ratio (0.81 [0.2] and 0.77 [0.2]; 95% CI, 0.005-0.080; P=.02) only. No partial or complete flap necrosis was reported after pedicle division.Conclusions and Relevance: Indocyanine green angiography is an effective method to determine neovascularization perfusion of melolabial flaps, with a mean perfusion of 89% after pedicle clamping. Future applications of this technology include use in patients at high risk for flap necrosis, or those who may benefit from early flap division to ensure adequate perfusion and minimize the time interval between staged procedures.Level of Evidence: NA.

    View details for PubMedID 30730539

  • Severe deviated nose treatment: importance of preserving the dorsal septal remnant. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Sazgar, A. A., Teimouri, Y., Arjang, S., Amali, A., Most, S. P. 2019


    PURPOSE: To compare the surgical outcomes of modified extracorporeal septoplasty and anterior septal reconstruction for the management of the severe deviated nose.METHODS: In a prospective cohort study, we selected 86 patients referred for septorhinoplasty to a tertiary center in May 2015-April 2017 with a primary complaint of nasal obstruction and deformity. They had moderate-to-severe septal deviation and severely deviated noses, particularly in the dorsum. Forty-three patients underwent each procedure. The cohorts were age- and sex-matched, and were operated at a similar time point. Surgical outcome was assessed and compared using anthropometric measurement of photographs, acoustic rhinometry, and The Nasal Obstruction Septoplasty Effectiveness questionnaire (including a visual analog scale).RESULTS: In all patients, MCA1 (initial minimum cross-sectional area) and MCA2 (minimum cross-sectional area after topical decongestion of the nasal mucosa), anthropometric angles (nasolabial, nasofacial and tip projection), and The Nasal Obstruction Septoplasty Effectiveness questionnaire significantly improved after surgery in both groups (p=0001), with no significant difference in improvement between two groups. However, anthropometric angles and minimal cross-sectional area were better in anterior septal reconstruction group.CONCLUSION: Both methods are effective in patients with a severely deviated nose for correction of deviation and obstruction. Anterior septal reconstruction is the preferable method in patients with more deviation.

    View details for PubMedID 30712092

  • Confirmatory Factor Analysis of the Standardized Cosmesis and Health Nasal Outcomes Survey. Plastic and reconstructive surgery Saltychev, M., Kandathil, C. K., Abdelwahab, M., Spataro, E. A., Moubayed, S. P., Most, S. P. 2019; 143 (2): 454e–456e

    View details for PubMedID 30689612

  • Utility of Indocyanine Green Angiography to Identify Clinical Factors Associated With Perfusion of Paramedian Forehead Flaps During Nasal Reconstruction Surgery. JAMA facial plastic surgery Abdelwahab, M., Kandathil, C. K., Most, S. P., Spataro, E. A. 2019


    Importance: Identifying factors affecting forehead flap neovascularization during nasal reconstruction surgical procedures using quantitative dynamics of fluorescence from indocyanine green angiography may be associated with reduced vascular complications.Objectives: To identify quantifiable forehead flap perfusion measures using indocyanine green angiography during nasal reconstruction procedures and to evaluate clinical factors associated with neovascularization.Design, Setting, and Participants: Retrospective cohort study of 71 patients at a tertiary referral center of Stanford University, Stanford, California, between January 1, 2010, and March 31, 2018, undergoing forehead flap nasal reconstruction surgery with flap perfusion assessed by indocyanine green angiography.Exposures: Indocyanine green angiography was performed intraoperatively to record forehead flap neovascularization during the second stage of nasal reconstruction surgery after temporary clamping of the pedicle.Main Outcomes and Measures: With use of quantifiable data of fluorescence dynamics, flap perfusion in association with a reference point in the cheek after pedicle clamping was assessed by 2 methods: (1) ingress (arterial inflow) and egress (venous outflow) flap-to-cheek ratio and (2) flap-to-cheek perfusion (fluorescence) ratio at 3 time points (midpoint of indocyanine green flap inflow, maximum fluorescence [peak], and midpoint of indocyanine green flap outflow) and their calculated mean. Association of the perfusion measures with patient and procedural factors was performed using linear regression models.Results: Of the 71 patients included in the study, 43 (61%) were men; the mean (SD) age was 71.1 (11.0) years. The mean (SD) flap-to-cheek inflow ratio was 0.48 (0.40), peak fluorescence ratio was 0.59 (0.34), and outflow ratio was 0.88 (0.42). The calculated mean (SD) flap-to-cheek perfusion ratio of these measures was 0.65 (0.35). The mean (SD) flap-to-cheek ingress ratio was 0.54 (0.36) and egress ratio was 0.65 (0.98). With use of a multivariable regression model, the time between stages was positively associated with flap-to-cheek ingress ratio (beta, 0.015; 95% CI, 0.001 to 0.030), and cartilage grafting was negatively associated with flap-to-cheek outflow ratio (beta, -0.240; 95% CI, -0.472 to -0.008).Conclusions and Relevance: The findings suggest that indocyanine green angiography is an effective method to quantify relative neovascularization perfusion of forehead flaps. Future applications may include the use of this technology to aid in early flap division and ensure adequate perfusion among high-risk patients.Level of Evidence: NA.

    View details for PubMedID 30703191

  • Relationship of Sociodemographic Factors and Outcomes in Functional Rhinoplasty. Facial plastic surgery : FPS Nuyen, B., Spataro, E. A., Olds, C., Kandathil, C. K., Most, S. P. 2019


    The objective of this article was to compare the effect of such sociodemographic factors as gender, age, marital status, employment status, race, and income on short- and long-term rhinoplasty outcomes using a validated disease-specific instrument-Nasal Obstruction Symptom Evaluation (NOSE) scale, as well as complication and revision rates. Patients who underwent a functional (+/- cosmetic) rhinoplasty with the senior author between January, 1 2012, and September 9, 2017, and had both a preoperative and at least one postoperative NOSE score, were included in the study. Sociodemographic variables of binary gender, age, marital status, employment status, race, and income based on zip code were collected. The primary outcomes were the differences between the preoperative and postoperative NOSE scores with short-term (less than 3 months) and longer-term (greater than 3 months) follow-up. Secondary outcomes were general complications and specifically revision surgery. Standard descriptive statistics, as well as univariable linear and logistic regressions, were conducted with each outcome measure. A total of 341 patients were included in this study. No individual patient-level variables were found to significantly affect the short- or longer-term average change in NOSE scores, although older age trended toward significance in longer-term average change in NOSE scores (p=0.07). No factors significantly affected the rate of complications or revision surgery in this cohort. The authors found improvement in NOSE scores after rhinoplasty was not related to factors of age, gender, race, employment status, income, and marital status. This cohort also did not demonstrate differential rates in complications or revision surgery based on sociodemographic variables.

    View details for PubMedID 30654390

  • Arabic Validation of the Standardized Cosmesis and Health Nasal Outcome Survey (SCHNOS) for Arabic-speaking Rhinoplasty Patients. Plastic and reconstructive surgery Abdelwahab, M., Saltychev, M., Elkholy, N. A., Elsisi, H., Moubayed, S. P., Most, S. P. 2018

    View details for PubMedID 30601313

  • A prospective study for treatment of nasal valve collapse due to lateral wall insufficiency: Outcomes using a bioabsorbable implant LARYNGOSCOPE Stolovitzky, P., Sidle, D. M., Ow, R. A., Nachlas, N. E., Most, S. P. 2018; 128 (11): 2483–89


    To examine 6-month outcomes for treatment of lateral nasal wall insufficiency with a bioabsorbable implant.Prospective, multicenter, nonrandomized, single-blinded study.One hundred and one patients with severe-to-extreme class of Nasal Obstruction Symptom Evaluation (NOSE) scores were enrolled at 14 U.S. clinics (September 2016-March 2017). Patients were treated with a bioabsorbable implant designed to support lateral wall, with or without concurrent septoplasty and/or turbinate reduction procedure(s). NOSE scores and visual analog scale (VAS) were measured at baseline and month 1, 3, and 6 postoperatively. The Lateral Wall Insufficiency (LWI) score was determined by independent physicians observing the lateral wall motion video.Forty-three patients were treated with implant alone, whereas 58 had adjunctive procedures. Seventeen patients reported 19 adverse events, all of which resolved with no clinical sequelae. Patients showed significant reduction in NOSE scores at 1, 3, and 6 months postoperatively (79.5 ± 13.5 preoperatively, 34.6 ± 25.0 at 1 month, 32.0 ± 28.4 at 3 months, and 30.6 ± 25.8 at 6 months postoperatively; P < 0.01 for all). They also showed significant reduction in VAS scores postoperatively (71.9 ± 18.8 preoperatively, 32.7 ± 27.1 at 1 month, 30.1 ± 28.3 at 3 months, and 30.7 ± 29.6 at 6 months postoperatively; P < 0.01 for all). These results were similar in patients treated with the implant alone compared to those treated with the implant and adjunctive procedures. Consistent with patient-reported outcomes, postoperative LWI scores were demonstrably lower (1.83 ± 0.10 and 1.30 ± 0.11 pre- and postoperatively; P < 0.01).Stabilization of the lateral nasal wall with a bioabsorbable implant improves patients' nasal obstructive symptoms over 6 months.2b. Laryngoscope, 2483-2489, 2018.

    View details for PubMedID 29756407

  • Validation of the Persian Language Version of the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS). JAMA facial plastic surgery Rahavi-Ezabadi, S., Most, S. P., Saltychev, M., Sazgar, A. A., Moubayed, S. P., Saedi, B. 2018

    View details for DOI 10.1001/jamafacial.2018.1163

    View details for PubMedID 30286213

  • Tongue-in-Groove Technique for Rhinoplasty: Technical Refinements and Considerations. Facial plastic surgery : FPS Spataro, E. A., Most, S. P. 2018


    A key concept in successful rhinoplasty surgery is maintaining or increasing tip support, and addressing tip projection and rotation. The tongue-in-groove (TIG) technique is a method to achieve this goal using sutures to create a strong connection between the septum and medial crura to change tip rotation and projection. Criticisms of this method include that it may cause stiffness of the nasal tip and columellar retraction. TIG is routinely used by the authors during anterior septal reconstructions (a modified extracorporeal septoplasty technique), as well as in primary and revision aesthetic and functional rhinoplasties. Through this review, technical aspects of the TIG technique are discussed, as well as how pitfalls of the technique can be avoided, as illustrated by several rhinoplasty patient examples.

    View details for PubMedID 30216946

  • Measuring Nasal Obstruction Outcomes. Otolaryngologic clinics of North America Spataro, E., Most, S. P. 2018


    Methods of measuring nasal obstruction outcomes include both objective anatomic and physiologic measurements, as well as subjective patient-reported measures. Anatomic measurements include acoustic rhinometry, imaging studies, and clinician-derived examination findings. Physiologic measures include rhinomanometry, nasal peak inspiratory flow, and computational fluid dynamics. Patient-reported outcome measures (PROMs) are self-reported assessments of disease-specific quality-of-life outcomes. Several studies attempted correlation of these outcome measures; however, few show strong correlation. Expert opinion favors determining successful surgical outcomes using PROMs. This review provides a summary of current nasal obstruction outcome measures.

    View details for PubMedID 29937066

  • Lateral Wall Insufficiency Severity and Patient-Reported Nasal Obstruction Measures. JAMA facial plastic surgery Kandathil, C. K., Rudy, S. F., Moubayed, S. P., Most, S. P. 2018

    View details for PubMedID 29710296

  • Reply to Letter to the Editor regarding "Systematic review and meta-analysis of venous thromboembolism in otolaryngology-head and neck surgery" HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK Moubayed, S. P., Eskander, A., Mourad, M. W., Most, S. P. 2018; 40 (2): 449

    View details for PubMedID 29144563

  • Rhytidectomy (Face-Lift Surgery). JAMA Sanan, A., Most, S. P. 2018; 320 (22): 2387

    View details for DOI 10.1001/jama.2018.17292

    View details for PubMedID 30535220

  • Efficacy and Safety of Titanium Miniplates for Patients Undergoing Septorhinoplasty JAMA FACIAL PLASTIC SURGERY Mittermiller, P. A., Sheckter, C. C., Most, S. P. 2018; 20 (1): 82–84

    View details for PubMedID 29167868

  • Nuances of the Tongue-in-Groove Technique for Controlling Tip Projection and Rotation. JAMA facial plastic surgery Spataro, E. A., Most, S. P. 2018

    View details for PubMedID 30326023

  • Natural History of Nasal Obstruction Symptom Evaluation Scale following Functional Rhinoplasty FACIAL PLASTIC SURGERY Kandathil, C. K., Moubayed, S. P., Chanasriyotin, C., Most, S. P. 2017; 33 (5): 551–52

    View details for PubMedID 28962063

  • Lateral Wall Insufficiency after Septal Reconstruction FACIAL PLASTIC SURGERY Rudy, S., Moubayed, S. P., Most, S. P. 2017; 33 (4): 451–52

    View details for PubMedID 28753722

  • Cost-effectiveness of Early Division of the Forehead Flap Pedicle. JAMA facial plastic surgery Calloway, H. E., Moubayed, S. P., Most, S. P. 2017


    The paramedian forehead flap is considered the gold standard procedure to optimally reconstruct major defects of the nose, but this procedure generally requires 2 stages, where the flap pedicle is divided 3 weeks following the initial surgery to ensure adequate revascularization of the flap from the surrounding recipient tissue bed, which can cost a patient time out of work or away from normal social habits. It has previously been shown that the pedicle may be safely divided after 2 weeks in select patients where revascularization from the recipient bed was confirmed using intraoperative laser fluorescence angiography to potentially save the patient time and money.To demonstrate the cost-effectiveness of takedown of the paramedian forehead flap pedicle after 2 weeks using angiography with indocyanine green (ICG).Retrospective cohort study of all patients who underwent 2-week division of the forehead flap after nasal reconstruction. Patient, tumor, defect, and outcomes data were collected. Cost-minimization analysis was performed by comparing the overall costs of 2-week takedown with angiography to a hypothetical patient undergoing 3-week takedown without angiography.Two-week division of the forehead flap after nasal reconstruction.Cost-minimization analysis performed by calculating the total variable costs for a patient in our cohort vs costs to a theoretical patient for whom angiography was not performed and the pedicle was divided at the 3-week mark.A total of 22 patients were included (mean [SD] age, 70.3 [10.0] years; 8 women [36.4%] and 14 men [63.6%]). The selection criteria for 2-week division of the pedicle are a wound bed with at least 50% vascularized tissue present, partial-thickness defects, and absence of nicotine use. All were divided at the 2-week mark with no instances of flap necrosis. One patient had a squamous eccrine carcinoma histology before reconstruction, all other patients had basal cell carcinoma, squamous cell carcinoma, and melanoma. Cost-minimization analysis showed that the use of angiography with ICG results in cost savings of $177 per patient on average.Two-week takedown of select paramedian forehead flap patients can be performed safely with verification using angiography with ICG. Although this technology inherently adds cost, it is cost-effective, saving a total of $177 per patient.NA.

    View details for DOI 10.1001/jamafacial.2017.0310

    View details for PubMedID 28570726

  • Systematic review and meta-analysis of venous thromboembolism in otolaryngology-head and neck surgery HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK Moubayed, S. P., Eskander, A., Mourad, M. W., Most, S. P. 2017; 39 (6): 1249-1258


    The purpose of this study was to present our systematic review and meta-analysis of the data on venous thromboembolism (VTE; deep venous thrombosis [DVT] and/or pulmonary embolism [PE]) in otolaryngology-head and neck surgery (OHNS).PubMed and Scopus databases were searched for studies reporting VTE in OHNS. Incidence of VTE and bleeding is reported and meta-analyzed overall and for chemoprophylaxis and squamous cell carcinoma (SCC)/free flap subgroups.A total of 23 studies were included with a total of 618,264 patients. Incidence of VTE was 0.4%. The incidence of bleeding complications was 0.9%. The addition of chemoprophylaxis did not result in a decreased VTE incidence (odds ratio [OR], 0.86), but produced an increased risk of bleeding (OR, 3.78). The overall OR for VTE in SCC/free flap cases was 6.28.Chemoprophylaxis may not be necessary in the OHNS non-SCC or free flap patient population and must be balanced against an increased risk of bleeding. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1249-1258, 2017.

    View details for DOI 10.1002/hed.24758

    View details for PubMedID 28370756

  • Septoplasty: Basic and Advanced Techniques FACIAL PLASTIC SURGERY CLINICS OF NORTH AMERICA Most, S. P., Rudy, S. F. 2017; 25 (2): 161-?


    Nasal septal deviation is a prevalent problem that can have significant quality of life ramifications. Septoplasty is commonly performed to provide qualitative and quantitative benefit to those with nasal obstruction owing to septal deviation. Although a standard, basic technique is often adequate for individuals with mild to moderate mid to posterior septal deviation, unique challenges arise with caudal septal deviation. Herein, multiple strategies that attempt to address anterior septal deviation are discussed. Anterior septal reconstruction has been shown to be a safe and effective means by which to address severe caudal septal deviation and long-term reduction in preoperative symptoms.

    View details for DOI 10.1016/j.fsc.2016.12.002

    View details for PubMedID 28340647

  • Correcting Deviations of the Lower Third of the Nose FACIAL PLASTIC SURGERY Moubayed, S. R., Most, S. P. 2017; 33 (2): 157-161


    By convention, a "deviated nose" is one in which the lower third is asymmetric with regard to the midline. The lower third of the nose is composed of the lower cartilages, as well as the dorsal and caudal nasal septum. Not only does the deviated nose cause a cosmetic deformity that is often disconcerting for patients, but it may also be associated with functional problems. Airway obstruction may result from a narrowed internal nasal valve in the middle third or from a deviated caudal septum in the lower third. The most common deviation involves both the middle and lower thirds and often requires addressing the underlying dorsal and caudal septum. The most effective technique to correct this type of deviation is the principle of extracorporeal septoplasty, either the traditional or modified, such as the anterior septal reconstruction (ASR) technique combined with the clocking suture. An isolated middle third deviation may be treated with a camouflage graft or a unilateral spreader graft. An isolated lower third deviation involving the septum should be treated with ASR. When an isolated lower third deviation only involves the lower cartilages, it may be corrected using suture techniques, cartilage division techniques, or grafting.

    View details for DOI 10.1055/s-0036-1598018

    View details for PubMedID 28388794

  • Revision of the Nasal Dorsum FACIAL PLASTIC SURGERY Moubayed, S. P., Most, S. R. 2017; 33 (2): 202-206


    Revision of the dorsum in secondary rhinoplasty is challenging, regardless of the cause. Dorsal deformities should be evaluated for both aesthetic and functional. The authors briefly outline the presentation, etiology, pathogenesis, and treatment choices backed by evidence-based data, when applicable, for the following dorsal revision indications in secondary rhinoplasty: inverted-V and midvault narrowing, overresected dorsum, irregular dorsum, saddle nose, and pollybeak.

    View details for DOI 10.1055/s-0036-1598017

    View details for PubMedID 28388798

  • Managing the Dorsum in Rhinoplasty FACIAL PLASTIC SURGERY Most, S. P. 2017; 33 (2): 119

    View details for PubMedID 28388789

  • Facial Augmentation using Expanded Polytetrafluoroethylene Covered Silicone FACIAL PLASTIC SURGERY Moubayed, S. P., Chanasriyotin, C., Most, S. P. 2017; 33 (2): 241–43

    View details for PubMedID 28388805

  • Midvault Reconstruction in Primary Rhinoplasty FACIAL PLASTIC SURGERY Rudy, S., Moubayed, S. P., Most, S. P. 2017; 33 (2): 133-138


    The nasal midvault is an important consideration in rhinoplasty. This region is defined by the attachment of the upper lateral cartilages (ULCs) to the nasal bones superiorly and the cartilaginous septum medially. Inadequate management of the nasal midvault can have negative functional and aesthetic ramifications. Indications for midvault reconstruction in primary rhinoplasty include a narrow midvault, dorsal hump resection, a deviated midvault, and an asymmetric midvault, with an additional relative indication of zone 1 lateral wall insufficiency (LWI), defined as dynamic collapse of a weakened lateral nasal wall at the level of the ULC. Numerous techniques for midvault reconstruction have been described, dating back to Sheen's description of the spreader graft in the 1980s, which remains the gold standard for repair. Herein, the various indications for midvault reconstruction are described, along with a discussion of the most commonly used techniques for successful reconstruction.

    View details for DOI 10.1055/s-0036-1598016

    View details for PubMedID 28388792

  • The Rhinoplasty Clinical Practice Guideline Neither a Cookbook for, Recipe of, nor Reduction Sauce of the Complex Art of Rhinoplasty JAMA FACIAL PLASTIC SURGERY Most, S. P. 2017; 19 (2): 85–86

    View details for PubMedID 28196211

  • Incidence of Venous Thromboembolism in Rhinoplasty. Aesthetic surgery journal Moubayed, S. P., Akdagli, S., Most, S. P. 2017

    View details for DOI 10.1093/asj/sjw252

    View details for PubMedID 28158446

  • Straightening the Crooked Middle Vault With the Clocking Stitch: An Anatomic Study. JAMA facial plastic surgery Keeler, J. A., Moubayed, S. P., Most, S. P. 2016

    View details for DOI 10.1001/jamafacial.2016.1647

    View details for PubMedID 28033438

  • Facial Nerve Recovery in KbDb and C1q Knockout Mice: A Role for Histocompatibility Complex 1. Plastic and reconstructive surgery. Global open Akdagli, S., Williams, R. A., Kim, H. J., Yan, Y., Mustapha, M., Most, S. P. 2016; 4 (12)


    Understanding the mechanisms in nerve damage can lead to better outcomes for neuronal rehabilitation. The purpose of our study was to assess the effect of major histocompatibility complex I deficiency and inhibition of the classical complement pathway (C1q) on functional recovery and cell survival in the facial motor nucleus (FMN) after crush injury in adult and juvenile mice.A prospective blinded analysis of functional recovery and cell survival in the FMN after a unilateral facial nerve crush injury in juvenile and adult mice was undertaken between wild-type, C1q knockout (C1q-/-), and KbDb knockout (KbDb-/-) groups. Whisker function was quantified to assess functional recovery. Neuron counts were performed to determine neuron survival in the FMN after recovery.After facial nerve injury, all adult wild-type mice fully recovered. Juvenile mice recovered incompletely corresponding to a greater neuron loss in the FMN of juveniles compared with adults. The C1q-/- juvenile and adult groups did not differ from wild type. The KbDb-/- adults demonstrated 50% recovery of whisker movement and decreased cell survival in FMN. The KbDb-/- juvenile group did not demonstrate any difference from control group.Histocompatibility complex I plays a role for neuroprotection and enhanced facial nerve recovery in adult mice. Inhibition of the classical complement pathway alone does not affect functional recovery or neuronal survival. The alternative and mannose binding pathways pose alternative means for activating the final components of the pathway that may lead to acute nerve damage.

    View details for DOI 10.1097/GOX.0000000000001186

    View details for PubMedID 28293529

  • Patient-Reported Outcome Measures for Facial Plastic Surgery: A Specialty Finally Gets to Go to the PROM. JAMA facial plastic surgery Most, S. P., Moubayed, S. P. 2016

    View details for DOI 10.1001/jamafacial.2016.1429

    View details for PubMedID 27893023

  • Measuring Nasal Obstruction. Facial plastic surgery clinics of North America Keeler, J., Most, S. P. 2016; 24 (3): 315-322


    The nose and the nasal airway is highly complex with intricate 3-dimensional anatomy, with multiple functions in respiration and filtration of the respired air. Nasal airway obstruction (NAO) is a complex problem with no clearly defined "gold-standard" in measurement. There are 3 tools for the measurement of NAO: patient-derived measurements, physician-observed measurements, and objective measurements. We continue to work towards finding a link between subjective and objective nasal obstruction. The field of evaluation and surgical treatment for NAO has grown tremendously in the past 4-5 decades and will continue to grow as we learn more about the pathophysiology and treatment of nasal obstruction.

    View details for DOI 10.1016/j.fsc.2016.03.008

    View details for PubMedID 27400845

  • Large Septal Perforation Repair with Pericranial Flap and Intraoperative Fluorescence Angiography. Craniomaxillofacial trauma & reconstruction Williams, R., Lee, M. K., Most, S. P. 2016; 9 (2): 181-184


    Septal perforations present a challenging dilemma for surgical intervention when medical therapy fails. Multiple techniques have been described in the literature to address perforations using numerous techniques; however, there have been varying rates of success and reproducibility reported. The use of a large, pericranial flap was previously described to repair large septal perforation. The objective of this case report is to describe the use of a pedicled pericranial flap in combination with intraoperative fluorescence angiography to quantify vascular perfusion. This article presents a 31-year-old man with an idiopathic, septal perforation measuring 1.7 × 1.7 cm who previously failed medical therapy and surgical repair. He underwent a combined, coronal incision and external rhinoplasty approach with a tunneled pericranial flap resulting in a successful repair. This case report illustrates robust reconstructive capability of pericranial flaps for repair of septal perforations, as well as the potential value of intraoperative fluorescence angiography in determining the likelihood of a successful outcome.

    View details for DOI 10.1055/s-0035-1570073

    View details for PubMedID 27162579

  • Intracranial Dislocation of the Mandibular Condyle: A Case Report and Literature Review WORLD NEUROSURGERY Zhang, M., Alexander, A. L., Most, S. P., Li, G., Harris, O. A. 2016; 86

    View details for DOI 10.1016/j.wneu.2015.09.007

    View details for PubMedID 26365884

  • ComparingMethods for Repair of the External Valve One More Step Toward a Unified View of Lateral Wall Insufficiency JAMA FACIAL PLASTIC SURGERY Most, S. P. 2015; 17 (5): 345–46

    View details for PubMedID 26247486

  • Commentary on: Assessing Demographic Differences in Patient-Perceived Improvement in Facial Appearance and Quality of Life Following Rhinoplasty AESTHETIC SURGERY JOURNAL Most, S. P. 2015; 35 (7): 794–95

    View details for PubMedID 26063832

  • Complications in Facial Plastic Surgery Preface FACIAL PLASTIC SURGERY CLINICS OF NORTH AMERICA Goode, R. L., Most, S. P. 2013; 21 (4): XIII
  • Upper lid blepharoplasty. Facial plastic surgery Weissman, J. D., Most, S. P. 2013; 29 (1): 16-21


    Blepharoplasty is one of the most commonly performed aesthetic procedures in the realm of aging face surgery. Although not prohibitively challenging from a technical perspective, upper blepharoplasty remains a surgical procedure that requires comprehensive knowledge of intricate eyelid anatomy. In addition, the surgeon must pay attention to adjacent areas, notably the brow, which may also need to be addressed to achieve optimal results. These features, along with changes associated with aging and important aspects of the clinical evaluation are reviewed herein. A thorough history and physical exam are required, along with a frank discussion of the patient's expectation and the surgeon's ability to address them. The authors' approach to preoperative marking and surgical procedure are included, along with discussion of variations in technique. Complications that may be seen after upper blepharoplasty are also discussed.

    View details for DOI 10.1055/s-0033-1333833

    View details for PubMedID 23426747

  • An Analysis of Malar Fat Volume in Two Age Groups: Implications for Craniofacial Surgery CRANIOMAXILLOFACIAL TRAUMA & RECONSTRUCTION Corey, C. L., Popelka, G. R., Barrera, J. E., Most, S. P. 2012; 5 (4): 231–34


    Objective To evaluate how malar fat pad (MFP) volumes vary with age, after controlling for gender and body mass index (BMI). Study Design A prospective case-control study evaluating volume of the MFP in women of two age groups. Methods Soft tissue dimensions were measured in eight subjects using magnetic resonance imaging. A multiplanar localizing sequence, followed in sagittal and coronal orientations using a turbo spin echo sequence, was performed to define the MFP. Volumetric calculations were then performed using a 3D image analysis application (Dextroscope, Volume Interactions, Republic of Singapore) to circumscribe areas, orient dimensions, and calculate volumes of the MFP. Results These data reveal no significant difference in the mean (standard deviation) right MFP (p = 0.50), left MFP (p = 0.41), or total MFP (p = 0.45) volumes when comparing the two age groups. In addition, these data indicate that there was no correlation between age and total MFP volume (Pearson correlation coefficient 0.27). Moreover, there was no correlation between age and the ratio of total volume/BMI (Pearson correlation coefficient -0.18). Conclusions Although the sample size of this study was small, these data indicate that ptosis of midfacial fat is more important than volume loss in midfacial aging. These data would suggest repositioning as the primary modality for craniofacial reconstruction.

    View details for DOI 10.1055/s-0032-1329545

    View details for Web of Science ID 000219669300006

    View details for PubMedID 24294406

    View details for PubMedCentralID PMC3577599

  • Cadaveric analysis of nasal valve suspension. Allergy & rhinology (Providence, R.I.) Bae, J. H., Most, S. P. 2012; 3 (2): e91-3


    This study was designed to measure the efficacy of a nasal valve suspension technique and determine the adequate traction length without creation of nasofacial fullness in a cadaveric model. Seven fresh frozen cadaveric heads were evaluated. Minimal cross-sectional (MCA) areas were measured with a transient-signal acoustic rhinometer (Ecco Vision; Hood Instruments, Pembroke, MA) before and after suspension. The adequate traction length, which did not cause obvious changes, was determined. Five millimeters of lateral nasal valve traction was determined to be the maximal traction achievable without creating facial fullness. After lateral nasal suspension, average MCA increased by 13.7%. Average distance to the MCA from the nostril changed from 1.57 to 1.76 cm. Postsuspension values were significantly higher than the presuspension values (p < 0.05). Nasal valve suspension with 5 mm of lateral traction has a significant impact on nasal valve area without obvious nasofacial changes.

    View details for DOI 10.2500/ar.2012.3.0037

    View details for PubMedID 23342294

  • An Introduction to Stem Cell Biology FACIAL PLASTIC SURGERY Hemmat, S., Lieberman, D. M., Most, S. P. 2010; 26 (5): 343-349


    The field of stem cell biology has undergone tremendous expansion over the past two decades. Scientific investigation has continued to expand our understanding of these complex cells at a rapidly increasing rate. This understanding has produced a vast array of potential clinical applications. This article will serve as an overview of the current state of stem cell research as it applies to scientific and medical applications. Included in the discussion is a review of the many different types of stem cells, including but not limited to adult, embryonic, and perinatal stem cells. Also, this article describes somatic cell nuclear transfer, an exciting technology that allows the production of totipotent stem cells from fully differentiated cells, thereby eliminating the use of embryonic sources. This discussion should serve as a review of the field of stem cell biology and provide a foundation for the reader to better understand the interface of stem cell technology and facial plastic and reconstructive surgery.

    View details for DOI 10.1055/s-0030-1265015

    View details for PubMedID 20853224

  • Fat Grafting and Stem Cell Technology PREFACE FACIAL PLASTIC SURGERY Most, S. P. 2010; 26 (5): 339
  • Three-dimensional analysis of zygomatic-maxillary complex fracture patterns. Craniomaxillofacial trauma & reconstruction Pau, C. Y., Barrera, J. E., Kwon, J., Most, S. P. 2010; 3 (3): 167-176


    Zygomatic-maxillary (ZMC) complex fractures are a common consequence of facial trauma. In this retrospective study, we present a novel method of ZMC fracture pattern analysis, utilizing three-dimensional visualization of computed tomography (CT) images to record displacement of the malar eminence in a three-dimensional coordinate plane. The pattern of fracture was then correlated with treatment outcome. Facial CT scans were obtained from 29 patients with unilateral ZMC fractures and 30 subjects without fractures and analyzed. Briefly, displacement of the malar eminence (ME) on the fractured side was measured in medial-lateral (x), superior-inferior (y), and anterior-posterior (z) dimensions, as well as Euclidean distance, by comparison to ME location on the unfractured side. Baseline natural variance in asymmetry was accounted for by comparing ME location on the left and right sides in subjects without fractures. Patients who required open reduction and internal fixation (ORIF) to repair the ZMC fracture alone had significantly greater cumulative ME displacements than patients who did not require ORIF (p = 0.02). Additionally, patients with a high fracture score of 3, 4, or 5 (assigned based on severity displacement in each dimension) had significantly higher rates of ORIF than patients with a low fracture score of 0, 1, or 2 (p = 0.05). Severe displacement in one or more dimensions was associated with higher rates of ORIF than seen in patients with only neutral or mild displacements in all dimensions (p = 0.05). Severe x displacement was most strongly correlated with surgical intervention (p = 0.02). Overall, orbital floor repair was less strongly associated with most displacement measures than ZMC repair alone; however, patients requiring orbital floor repair had greater Euclidean ME displacements than patients who did not require orbital floor repair (p = 0.02). Fracture severity, as determined by multiple parameters in this novel evaluation system, is associated with higher rates of ORIF in patients with unilateral ZMC fractures. Determination of ZMC fracture pattern may thus be informative when considering treatment options.

    View details for DOI 10.1055/s-0030-1263082

    View details for PubMedID 22110833

  • An Alternative Method for Reconstruction of Large Intranasal Lining Defects The Farina Method Revisited ARCHIVES OF FACIAL PLASTIC SURGERY Parikh, S., Futran, N. D., Most, S. P. 2010; 12 (5): 311-314


    To examine use of the paramedian forehead flap for intranasal lining.The medical records and photographs were reviewed for patients who underwent a nasal reconstruction involving a paramedian forehead flap used for internal lining.Three patients underwent this procedure. In all patients, the flap provided excellent intranasal lining. External incisions were acceptable in all the patients.The paramedian forehead flap may be used for internal lining of large intranasal defects. An external rhinoplasty approach facilitates reconstruction.

    View details for PubMedID 20855772

  • Rejuvenation of the upper eyelid. Facial plastic surgery clinics of North America Parikh, S., Most, S. P. 2010; 18 (3): 427-433


    The eyes are the most captivating feature of the face. Many of the early signs of aging occur in the periocular region. This article focuses on surgical rejuvenation of the upper eyelid with an emphasis on the eyelid anatomy, aging of the eyes, clinical evaluation, surgical technique, and postoperative complications. The paradigm has shifted to a more conservative resection of skin, muscle, and fat to preserve fullness to the upper eyelid that portrays youthfulness.

    View details for DOI 10.1016/j.fsc.2010.04.005

    View details for PubMedID 20659675

  • Adult Xanthogranuloma Causing Nasal Obstruction ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Worden, B. F., Barrera, J. E., Most, S. P. 2010; 136 (5): 509-512

    View details for PubMedID 20479384

  • Pre- and postoperative portrait photography: standardized photos for various procedures. Facial plastic surgery clinics of North America Swamy, R. S., Most, S. P. 2010; 18 (2): 245-?


    Photodocumentation in facial plastic surgery is essential in the perioperative setting, and with meticulous uniformity and standardization it serves as the primary tool for surgical planning and critical analysis of results. Accurate photodocumentation is dependent on strict and consistent use of equipment, lighting, and patient positioning. The purpose of this article is to review the principles of standardization in perioperative patient photography for common facial plastic procedures and to provide the facial plastic surgeon with the tools necessary to develop consistent and accurate patient photographs.

    View details for DOI 10.1016/j.fsc.2010.01.004

    View details for PubMedID 20511074

  • Principles of Photography in Rhinoplasty for the Digital Photographer CLINICS IN PLASTIC SURGERY Swamy, R. S., Sykes, J. M., Most, S. P. 2010; 37 (2): 213-?


    The art and technology of photography can be overwhelming to the facial plastic surgeon. Photographic documentation of patients undergoing rhinoplasty is essential for patient consultation, perioperative planning, and postsurgical evaluation. Possession of a basic understanding of photographic principles, technique, equipment, as well as consideration regarding consistency of patient positioning is essential for producing the best photographic results. This article reviews the basic principles of photography and discusses their application to facial plastic surgery practice, and rhinoplasty in particular.

    View details for DOI 10.1016/j.cps.2009.12.003

    View details for PubMedID 20206739

  • Lateral nasal wall suspension using a bone-anchored suture technique. Archives of facial plastic surgery Lieberman, D. M., Most, S. P. 2010; 12 (2): 113-?

    View details for DOI 10.1001/archfacial.2010.9

    View details for PubMedID 20231592

  • Autologous Fat Grafts for Skull Base Repair After Craniotomies AUTOLOGOUS FAT TRANSFER: ART, SCIENCE, AND CLINICAL PRACTICE Barrera, J. E., Most, S. P., Harsh, G. R., Shiffman, M. A. 2010: 383–87
  • Measurements of Orbital Volume Change Using Computed Tomography in Isolated Orbital Blowout Fractures ARCHIVES OF FACIAL PLASTIC SURGERY Kwon, J., Barrera, J. E., Jung, T., Most, S. P. 2009; 11 (6): 395-398


    To measure the orbital volume of unilateral pure blowout fractures with computed tomography before and after surgery and to compare 3-dimensional (3-D) imaging systems.Twenty-four patients were evaluated with facial computed tomographic scans before and after surgery. Both the orbital volume and the displaced soft tissue volume were measured by 2 operators using 2 different 3-D software programs (Vitrea; Vital Images Inc, Minnetonka, Minnesota; and Dextroscope; Bracco AMT Inc, Princeton, NJ).The mean (SD) normal orbital volumes calculated by Vitrea and Dextroscope were 25.5 (2.4) mL and 24.8 (3.0) mL, respectively. The average preoperative orbital volumes were 28.3 (2.3) mL and 27.6 (3.1) mL, while the postoperative volumes were 25.8 (2.5) mL and 24.9 (3.0) mL. Vitrea showed that the average volume of displaced orbital soft tissue was 2.8 (1.9) mL before surgery and that it was reduced to 0.3 (1.3) mL after surgery, while Dextroscope showed that the average displaced orbital soft tissue was 2.9 (1.4) mL before surgery and that it was reduced to 0.1 (1.2) mL after surgery. There was no statistical difference between the 3-D analysis programs.Consistent volume measurements can be obtained using different 3-D image analysis programs. Measuring preoperative and postoperative volume changes and postoperative reduction can ensure a good surgical result and thereby decrease the incidence of enophthalmos.

    View details for PubMedID 19917900

  • Functional Valvular Indrawing In reply ARCHIVES OF FACIAL PLASTIC SURGERY Most, S. P. 2009; 11 (6): 427
  • A Prospective Evaluation of the Efficacy of Topical Adhesive Pads for the Reduction of Facial Rhytids ARCHIVES OF FACIAL PLASTIC SURGERY Ryan, W. R., Most, S. P. 2009; 11 (4): 252-256


    To determine the efficacy of an over-the-counter topical skin adhesive pad for reducing central forehead and glabellar rhytids over a 4-week period.Prospective series involving 30 healthy volunteers with central forehead and glabellar rhytids at a tertiary care academic medical center. The participants used topical skin adhesive pads over the central forehead area and the glabella for 4 weeks in an effort to reduce rhytids. Before and after treatment, the participants had facial photographs taken and completed a questionnaire assessing the severity of their rhytids. Blinded to the timing of the photographs, 2 independent facial plastic surgeons scored the pretreatment and posttreatment rhytid severity using the Glogau scale (1-4) and a wrinkle severity scale (1-10) to evaluate treatment effect.Twenty-six participants (87%) completed follow-up with an average of 7.4 hours of use of the topical adhesive pads per night. The independent evaluators found minimal improvements in the Glogau scores (mean [SD], 0.12 [0.33] [P = .08] and 0.06 [0.22] [P = .18] for the central forehead area and the glabella, respectively). The same evaluators also found minimal change in the wrinkle severity scores (mean [SD], 0.21 [1.28] [P = .41] and 0.25 [0.75] [P = .10] out of 10 for central forehead rhytids and glabellar rhytids, respectively). None of these measures were statistically significant. The study participants' self-evaluations demonstrated changes in the wrinkle severity scores of 0.35 (2.10) (P = .41) in the central forehead area and 0.73 (1.7) (P = .04) in the glabella.Subjective self-evaluation of topical adhesive pads demonstrates improvement in glabellar rhytids but may be affected by bias. Independent, blinded evaluation by facial plastic surgeons showed no statistical benefit in the reduction of rhytids in the central forehead area or the glabella.

    View details for Web of Science ID 000268137300006

    View details for PubMedID 19620531

  • Treatment of Nasal Obstruction in the Posttraumatic Nose OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA Corey, C. L., Most, S. P. 2009; 42 (3): 567-?


    The sequelae of trauma to the nose include nasal deformity and nasal obstruction that can have a long-term negative impact on patient quality of life. Successful management of posttraumatic nasal obstruction relies on a detailed history, careful analysis, and accurate diagnosis. Dividing the nose into horizontal thirds assists in preoperative analysis as well as surgical treatment. Adequate treatment of posttraumatic nasal obstruction must address deflection of the bony nasal pyramid, septal deformities (especially caudal or dorsal), turbinate hypertrophy, and incompetence of internal and external nasal valves. Treatment must balance the seemingly disparate goals of re-establishing structure, improving contour and esthetics, as well as restoring the nasal airway.

    View details for DOI 10.1016/j.otc.2009.03.002

    View details for PubMedID 19486751

  • Long-term outcomes of a rhinolift procedure for obstructive symptoms in the aging nose in 2 patients. Ear, nose, & throat journal Roofe, S. B., Most, S. P. 2009; 88 (4): E29-32


    Age-related changes in the structure of the nose can obstruct the nasal airway and adversely affect quality of life. Several procedures are available to restore the patency of the airway, but not all are appropriate for all patients. Also, long-term outcomes data on such procedures are lacking. We describe our use of a rhinolift procedure with local anesthesia to correct nasal obstruction caused by nasal tip ptosis in 2 elderly men. In both cases, the procedure resulted in a complete or near-complete resolution of obstructive symptoms. We also conducted long-term follow-up of these 2 patients. Both experienced a recurrence of symptoms 1 to 2 years postoperatively. We conclude that the rhinolift procedure we describe is safe and effective for the short-term relief of age-related nasal obstruction in selected patients.

    View details for PubMedID 19358117

  • Preserving Structural Integrity of the Alar Cartilage in Aesthetic Rhinoplasty Using a Cephalic Turn-in Flap ARCHIVES OF FACIAL PLASTIC SURGERY Murakami, C. S., Barrera, J. E., Most, S. P. 2009; 11 (2): 126-128


    Resection of the alar cartilage has long been a mainstay of aesthetic rhinoplasty. One drawback of this technique is the destabilization of the ala/lateral nasal wall complex. Herein we describe the cephalic turn-in flap, a technique for reinforcement of the alar cartilage after removal of its cephalic portion.

    View details for Web of Science ID 000264218500009

    View details for PubMedID 19289686

  • Preoperative, anesthetic, and postoperative care for rhinoplasty patients. Facial plastic surgery clinics of North America Swamy, R. S., Most, S. P. 2009; 17 (1): 7-?


    The perioperative period can be anxiety provoking for rhinoplasty patients. Patients rely on the skill and confidence of the surgeon to attain optimal results. Having an established strategy for the preoperative, anesthetic, and postoperative care of this patient population is critical to achieving a successful outcome and to ensuring a positive experience for the patient. Establishing a sincere rapport in the preoperative period and being able to properly address patient concerns regarding anesthesia helps patients develop a positive frame of mind and aids in their recovery. This presentation reviews important elements of the preoperative, anesthetic, and postoperative care of rhinoplasty patients and provides insight to making the experience a positive one for the patient and the surgeon.

    View details for DOI 10.1016/j.fsc.2008.09.006

    View details for PubMedID 19181277

  • External Rhinoplasty Columellar Scar Analysis: The Stanford Experience LARYNGOSCOPE Erickson, V. R., Kriet, J., Most, S. P. 2009; 119: S173

    View details for DOI 10.1002/lary.20453

    View details for Web of Science ID 000207862500173

  • Repair of the Philtrum: An Illustrative Case Series JOURNAL OF CUTANEOUS MEDICINE AND SURGERY Housman, T. S., Berg, D., Most, S. P., Odland, P. B., Stoddard, E. 2008; 12 (6): 288-294


    Distortion of the philtrum, which lends considerable symmetry to the midface, leads to a poor esthetic outcome.This case series describes reconstructive approaches to six philtral defects after Mohs micrographic surgery. Reconstructive approaches including advancement flaps, full-thickness skin grafts, and second-intention healing are illustrated. Postoperative complications included graft hypertrophy, irregularity of the graft surface, graft color mismatch, tenderness, and slight eclabium, which improved with dermabrasion or intralesional triamcinolone.The reasonable success of full-thickness skin grafts demonstrated here provides an additional approach to philtral repairs, especially when combined with traditional advancement flaps.

    View details for DOI 10.2310/7750.2008.07043

    View details for Web of Science ID 000268108600005

    View details for PubMedID 19317951

  • Management of the lower lid in male blepharoplasty. Facial plastic surgery clinics of North America Barrera, J. E., Most, S. P. 2008; 16 (3): 313-?


    Rejuvenation of the lower eyelid blepharoplasty in men requires consideration of different esthetic norms than those considered in women. Although both require a thorough understanding of anatomy, and the process of aging in each includes descent of the globe, pseudoherniation of the orbital fat, and skeletonization of the inferior bony rim, the goals for male blepharoplasty differ. The authors review the primary surgical approaches in lower lid blepharoplasty (transconjunctival skin-muscle flap) and the currently described techniques used to address displaced orbital fat, with special consideration of the male patient.

    View details for DOI 10.1016/j.fsc.2008.05.001

    View details for PubMedID 18620982

  • Placement of a lateral nasal suspension suture via an external rhinoplasty approach ARCHIVES OF FACIAL PLASTIC SURGERY Roofe, S. B., Most, S. P. 2007; 9 (3): 214-216

    View details for Web of Science ID 000246581300011

    View details for PubMedID 17515499

  • Anterior septal reconstruction - Outcomes after a modified extracorporeal septoplasty technique ARCHIVES OF FACIAL PLASTIC SURGERY Most, S. P. 2006; 8 (3): 202-207


    To describe a modified extracorporeal septoplasty technique and measure its efficacy with a validated quality-of-life instrument.A prospective observational outcomes study of patients with severe septal deviation who subsequently underwent anterior septal reconstruction. Preoperative and postoperative evaluation was performed using photographs and the Nasal Obstruction Symptoms Evaluation scale.Twelve consecutive patients were enrolled. No complications occurred. All patients noted improved airway function postoperatively. There was a significant improvement in mean Nasal Obstruction Symptoms Evaluation score postoperatively (76.6 vs 12.9; P<.01). Examination of postoperative photographs revealed improved midvault and tip anatomy.The anterior septal reconstruction technique is effective in improving both nasal airway function and aesthetics in patients with severe septonasal deviation. The technique avoids the most common complication of standard extracorporeal septoplasty by preserving the dorsal strut of septal cartilage and its attachment to the nasal bones at the keystone area.

    View details for Web of Science ID 000237543300007

    View details for PubMedID 16702533

  • A prospective examination of the efficacy of 2 noninvasive devices for treatment of the aging face ARCHIVES OF FACIAL PLASTIC SURGERY Lee, S., Most, S. P. 2006; 8 (1): 66-68

    View details for Web of Science ID 000234658000010

    View details for PubMedID 16415451

  • Anatomy of the eyelids. Facial plastic surgery clinics of North America Most, S. P., Mobley, S. R., Larrabee, W. F. 2005; 13 (4): 487-?


    The variety and complexity of periorbital surgical procedures continue to increase. Successful completion of reconstructive and esthetic ocular procedures requires an exacting knowledge of the relevant anatomy. Interestingly, the definition of ocular and periorbital anatomy continues to evolve, including more recent descriptions of the orbitomalar ligament and a new understanding of eyelid lymphatics. This article presents the most recent descriptions of periorbital anatomy.

    View details for PubMedID 16253835

  • Porous high-density polyethylene for orbital reconstruction AO ASIF Advanced Craniomaxillofacial Trauma Course Lee, S., Maronian, N., Most, S. P., Whipple, M. E., McCulloch, T. M., Stanley, R. B., Farwell, G. AMER MEDICAL ASSOC. 2005: 446–50


    To determine the safety and efficacy of using porous high-density polyethylene (PHDPE) in the repair of orbital defects.Retrospective case series.Academic tertiary care trauma center. Patients One hundred seventy patients with orbital defects requiring surgical repair. Intervention Orbital defect repair with PHDPE. Main Outcome Measure Our review documents surgical results and complications associated with the use of PHDPE.There was a 6.4% complication rate associated with the use of PHDPE. The infection rate was 1.8%. The persistent orbital malposition rate was 3.5%. The extrusion rate was 0%.This report represents the largest case series in the literature using PHDPE for orbital reconstructions. The use of PHDPE resulted in a low complication rate and excellent functional and cosmetic reconstructive results. Because of our success with the use of PHDPE, we have changed our clinical practice to minimize the use of autologous graft material, thereby eliminating donor site morbidity in cases involving orbital reconstruction.

    View details for Web of Science ID 000229001800013

    View details for PubMedID 15897425

  • Efficacy of an over-the-counter lip enhancer in lip augmentation ARCHIVES OF FACIAL PLASTIC SURGERY Lee, S., Most, S. P. 2005; 7 (3): 203-205

    View details for Web of Science ID 000233221500010

    View details for PubMedID 15897412

  • A modern approach to nasal osteotomies. Facial plastic surgery clinics of North America Most, S. P., Murakami, C. S. 2005; 13 (1): 85-92


    A thorough understanding of the anatomy of the nose is paramount in rhinoplasty. Correction of deformities of the nasal vault presents a challenge to the facial plastic surgeon. Suboptimal aesthetic results may occur when either inadequate or excessive mobilization of the nasal bony-cartilaginous framework is performed. Furthermore, postoperative complications such as collapse of the nasal airway may occur. A number of techniques are available to appropriately mobilize and reposition the bony nasal vault. In this article, we will review pertinent anatomy, technical considerations and clinical perspectives on mobilization of the nasal bones.

    View details for PubMedID 15519930

  • Facial nerve recovery in bcl2 overexpression mice after crush injury. Archives of facial plastic surgery Most, S. P. 2004; 6 (2): 82-87


    To develop a mouse model for measuring facial nerve injury and recovery and to test the hypothesis that overexpression of the antiapoptotic gene, bcl2, enhances recovery of facial nerve function after peripheral crush injury.Prospective analysis of recovery of function after facial nerve crush injury in mice at juvenile (postnatal day 7) and adult (postnatal day 30) ages with blind comparison of wild-type and transgenic bcl2 overexpression littermates at both ages and immunohistologic confirmation of overexpression of bcl2 in facial motoneurons in transgenic animals.Adult wild-type mice demonstrated full recovery of facial nerve function (measured as eye blink and whisker movement) within 3 weeks of injury. Juvenile wild-type mice demonstrated diminished recovery of function. Juvenile transgenic bcl2 overexpression mice demonstrated more rapid and complete recovery of eye blink but not whisker movement in comparison with wild-type littermates.Measurement of facial nerve function in mice after injury is feasible. Enhanced recovery of facial nerve function in adult mice and mice overexpressing bcl2 indicates that preservation of central motoneurons after injury may improve function after peripheral nerve injury.

    View details for PubMedID 15023794

  • Nasal osteotomies: anatomy, planning, and technique. Facial plastic surgery clinics of North America Most, S. P., Murakami, C. S. 2002; 10 (3): 279-285

    View details for PubMedID 15062309

  • The Abbe flap in secondary cleft lip repair. Archives of facial plastic surgery Bagatin, M., Most, S. P. 2002; 4 (3): 194-197


    The Abble flap is a full-thickness composite flap, involving the transfer of the skin, muscle, and mucosa of the central part of the lover lip to the upper lip. This vermilionpedicled flap, based on the inferior labial vessels, has been used for secondary corrections in cleft deformities, more often in bilateral cases. Indications for its use include deficiency of scarring of the central part of the upper lip. thinness of the vermilion with a nonexistent lip tuberculum, or the absence of a Cupid's bow. The procedure may be combined with other reconstructive procedures.

    View details for PubMedID 12167080

  • Outcomes of facial cosmetic procedures. Facial plastic surgery Most, S. P., Alsarraf, R., Larrabee, W. F. 2002; 18 (2): 119-124


    Facial cosmetic procedures lend themselves to outcomes studies in ways that traditional reconstructive procedures may not. The most important measures of outcome in facial cosmetic surgery are quality of life and patient satisfaction, in contrast to other, more objective measures such as complications or mortality rates. For this reason, outcomes research in facial cosmetic surgery deserves a special focus of attention. In this article, we review outcomes studies for the more common facial cosmetic procedures, discuss in depth what aspects of patient-related satisfaction have been quantified by these existing studies, and highlight the direction that future outcomes research projects may wish to follow. There exists an abundance of potential interesting areas of study in facial cosmetic surgery, and the application of outcomes research methodology to these realms may allow the facial plastic surgeon to better define the success or failure of each individual facial cosmetic surgery procedure.

    View details for PubMedID 12063659