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• W4290930487 abstract "Postoperative edema after rhinoplasty obscures the aesthetic result, causing distress for both the patient and surgeon.1 This study characterized the postoperative anatomic distribution of edema and change to the nasal contour using three-dimensional technology. A retrospective review identified patients who underwent primary open rhinoplasty from February of 2017 through 2020 performed by the senior authors (J.C.L. and O.M.T.). Photographs were taken by Vectra M3 (Canfield Scientific, Inc., Parsippany–Troy Hills, N.J.) at intervals of 1 week, 2 weeks, 6 weeks, 3 months, and 6 months postoperatively. Changes in volume (cc) and surface area (cm2) were measured for total nose, nasal tip, and dorsum relative to baseline maximum edema 1 week postoperatively. [See Figure, Supplemental Digital Content 1, which shows mesh overlays and a color map for edema resolution. Profile views of the nose are shown at (left) 7 days postoperatively and (center, left) 42 days postoperatively. (Center, right) Overlay of the nose shown at 42 days postoperatively (solid) and 7 days (mesh). (Right) An image of the nose 42 days after surgery was registered onto the 7-day postoperative image. Along the color spectrum, 1.5-mm reductions in volume are shown in green and 3.0-mm reductions are shown in red, https://links.lww.com/PRS/F391.] Analysis was performed with Vectra analysis module software (3D Imaging System; Canfield Scientific) using a two-tailed paired t test (significance represented by p < 0.05). This study was approved by the Albert Einstein College of Medicine’s institutional review board (no. 2015-5156). A total of 25 patients (average age, 32 years; range, 17 to 65 years) met inclusion criteria. The total nose volume and surface area were documented at time points of 14, 42, 90, and 180 days, as detailed in Table 1. For the total nose, volume was reduced at a faster rate than surface area (Fig. 1, above). At baseline (7 days postoperatively), the dorsum represented a smaller percentage of total nasal volume and surface area. [See Figure, Supplemental Digital Content 2, which shows the percentage of total nose volume (left) and surface area (right) for the nasal dorsum and tip, https://links.lww.com/PRS/F392.] Table 1. - Results Volume or Surface Area 14 Days Postoperatively 42 Days Postoperatively 90 Days Postoperatively 180 Days Postoperatively Mean ± SD p Mean ± SD p Mean ± SD p Mean ± SD p Volume Total nose 92.2 ± 3.9 <0.001 86.3 ± 3.6 <0.001 84.9 ± 4.6 0.03 81.7 ± 5.9 0.04 Dorsum 93.1 ± 6.5 <0.001 86.2 ± 7.0 <0.001 81.2 ± 5.4 0.08 79.8 ± 8.5 0.11 Tip 93.2 ± 5.6 <0.001 87.2 ± 5.4 <0.001 85.8 ± 6.7 0.01 84.9 ± 4.5 0.73 Surface area Total nose 95.5 ± 2.8 <0.001 92.0 ± 2.8 <0.001 90.4 ± 2.7 0.02 90.2 ± 3.6 0.46 Dorsum 95.7 ± 3.2 <0.001 92.8 ± 3.3 <0.001 89.0 ± 3.3 0.01 89.6 ± 5.0 0.14 Tip 95.2 ± 4.1 0.13 91.5 ± 5.2 <0.001 92.1 ± 4.2 0.18 90.8 ± 2.4 0.48 Fig. 1.: Relationship between edema resolution and days after surgery for total nose volume and surface area. (Above) Scatterplot and linear regressions for percentage of original total nose volume (n = 53, r = 0.60, p < 0.001) and (continues) surface area (n = 53, r = 0.51, p < 0.001) for increasing days postoperatively. (Center) Scatterplot and linear regressions for percentage of original volume for the dorsum (n = 53, r = 0.55, p < 0.001) and nasal tip (n = 53, r = 0.40, p = 0.003) for increasing days postoperatively. (Below) Scatterplot and linear regressions of original surface area for the dorsum (n = 53, r = 0.56, p < 0.001) and nasal tip (n = 53, r = 0.26, p = 0.07) for increasing days postoperatively.The dorsum and nasal tip volume were also studied in isolation and detailed in Table 1. Compared with the nasal tip, the dorsum demonstrated a greater reduction in volume and surface area for interval time points (Fig. 1, center and below). This study confirmed and expanded upon previous data that characterized total nose edema after rhinoplasty by including analysis of the dorsum and nasal tip.2 We found the dorsum exhibited larger reductions in volume, indicating that the total amount of postoperative edema is relatively greater in the dorsum than the nasal tip. This contradicts previous reports and traditional teaching in plastic surgery suggesting the majority of swelling is located at the nasal tip.3–5 The decrease in volume in the dorsum is associated with a corresponding decrease in surface area. The nasal tip surface area remained relatively constant with decreasing volume. Although edema is volumetrically greater in the dorsum, the appearance of edema may be greater in the nasal tip because of the complexity of surface anatomy that reveals itself when edema is resolving, which subsequently adds to the surface area of the nasal tip. Analysis demonstrated the apparent derotation of the nasal tip as edema resolves. This may be attributed to columellar edema, which makes the angle made by the columella and upper lip seem more obtuse. Three-dimensional analysis revealed the dorsum has greater volume change and faster resolution of edema, suggesting that the nasal tip experiences less total edema but takes longer to resolve. Edema in the nasal tip is more distorting than in the dorsum because of fine detail in this region. Future studies should further define regional changes to the nasal tip complex and delineate whether these changes are structural or sequelae of edema. DISCLOSURE Dr. Tepper is a shareholder of MirrorMe3D. The remaining authors have no financial interests to report." @default.
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• W4290930487 date "2022-08-12" @default.
• W4290930487 modified "2023-10-17" @default.
• W4290930487 title "Defining Spatial and Temporal Resolution of Edema following Rhinoplasty: A Three-Dimensional Topographical Analysis" @default.
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• W4290930487 doi "https://doi.org/10.1097/prs.0000000000009528" @default.
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